Parental factors, mass media influences, and the onset of eating disorders in a prospective population-based cohort

The Impact of Following Instagram Influencers on Women's Body Dissatisfaction and Eating Disorder Symptoms

According to the Tripartite Influence Model, social media is one of the primary sources influencing women's body dissatisfaction. However, the role of social media influencers as a potential driver for impacting users' body image evaluation when disseminating content on social networks has been little investigated. The present research aims to explore the relationship between following three Instagram influencers (i.e., nutrition, fitness, and entertainment) and eating disorder (ED) symptoms and body dissatisfaction among a group of female users. A sample of 5060 women (mean age = 35.33 ± 9.33) were recruited with the collaboration of three Italian influencers, and self-reported questionnaires were administered. Women who followed the nutritional influencer account reported significantly higher scores on ED symptoms and body dissatisfaction than women who followed the fitness and entertainment influencer accounts (η2 = 0.05 and η2 = 0.02, respectively). Overall, following nutrition and fitness accounts (compared to entertainment accounts) and spending more time daily on social networks positively predicts ED symptoms (β = 0.28, p < 0.001, β = 0.10, p < 0.001, β = 0.11, p < 0.001, respectively) and body dissatisfaction (β = 0.07, p < 0.001, β = 0.04, p < 0.001, β = 0.07, p < 0.001, respectively). Moreover, following nutritional influencers compared to fitness influencers positively predicts ED symptoms (β = 0.17, p < 0.001) but not body dissatisfaction. The current results suggest that being exposed to dieting and weight loss topics on social media might be particularly harmful for individuals with specific vulnerabilities. Practical implications will be discussed.

A Scoping Review of the Prevalence of Eating Disorders in Spain

INTRODUCTION

Eating disorders (EDs) are mental health illnesses with a multifactorial origin. At present, no review of indexed publications studying their prevalence in Spain is available.

MATERIAL AND METHODS

A scoping review (PROSPERO -CRD42019140884-) was carried out through systematic searches (MEDLINE, EMBASE and PsycINFO) until January 2022. Papers published in Spanish/English analysing the prevalence of EDs in Spain (population < 65 years) were selected.

RESULTS

A total of 766 articles were identified (186 eliminated as duplicates). A total of 580 articles were analysed on the basis of title and abstract, and 67 articles were selected for full-text analysis. A total of 37 studies analysed the prevalence of EDs in Spain.

CONCLUSIONS

This is the first scoping review to analyse the prevalence of EDs in Spain. Puberty and adolescence are the most extensively studied stages. There is a high heterogeneity in the use of ED screening tools and a paucity of information on diagnostic tools.

The Impact of the COVID-19 Pandemic on Binge Eating Disorder: A Systematic Review

The aim of this systematic review was to synthesise the impact of the COVID-19 pandemic on binge eating disorder (BED) the new onset and course. Inclusion criteria: original articles and BED diagnosis; and the main outcomes: relationships between the COVID-19 pandemic and the new onset/clinical changes in BED, and specific results for BED. Exclusion criteria: mixed/inaccurate diagnoses and articles not written in English. We searched four databases and one registry until 5 May 2023. The quality appraisal was conducted using the Effective Public Health Practice Project (EPHPP) tool. Twelve studies with 4326 participants were included. All studies were observational with nine cross-sectional and three longitudinal. Four of the included studies investigated new-onset BED, while eight examined the BED clinical course of patients with a previous diagnosis. With the exception of one study, the available literature indicates both an increase in BED diagnoses and a clinical worsening during COVID-19. Major limitations include study quality (weak-to-moderate) and high heterogeneity in terms of pandemic phase, population, geographical areas, and psychometric tools. Our findings indicate that BED patients are particularly vulnerable to events characterised by social distancing and over-worry, and should be, therefore, carefully monitored. Further studies are needed to corroborate our findings, implement preventive strategies, and promote personalised treatments. PROSPERO registration number: CRD42023434106.

Interoceptive deficits moderate the relationship between bulimia symptoms and suicide risk

Objective: Interoceptive deficits have been linked to suicidality and eating disorders. The relationship between disordered eating symptoms and suicidality may depend on the level of interoceptive deficits. It was expected that interoceptive deficits would moderate the relationship between disordered eating symptoms (oral control, dieting, and bulimia) and suicidality (suicide attempts, ideation, and communication) when interoceptive deficits were high. Methods: University students (N = 417, Mage = 19.75, 78.2% white, 72.4% female) completed self-report measures that assessed disordered eating, interoceptive deficits, and suicide history. Results: Interoceptive deficits emerged as a significant moderator only in the association between bulimia symptoms and suicidality, when interoceptive deficits were high. Conclusions: The results of this study indicate that bulimia symptoms may have a unique interaction with interoceptive deficits and suicidality. Future research should focus on targeting interoceptive deficits in treatment to help reduce disordered eating symptoms and suicide risk, particularly for students with bulimia symptoms.

Association between social support for mothers of patients with eating disorders and mothers' active listening attitude: a cohort study

BACKGROUND

Family members of patients with eating disorders, especially their mothers, experience heavy caregiving burdens associated with supporting the patient. We predict that increasing caregivers' support will have a positive effect on their active listening attitudes, mental health, loneliness, and self-efficacy. This study aimed to investigate differences in mothers' active listening attitudes, mental health, loneliness, and self-efficacy improvements between mothers who did and did not experience increased perceived social support.

MAIN BODY

Participants were mothers of patients with eating disorders. Questionnaires for this cohort study were sent to the participants' homes at three time points (baseline, 9 months, and 18 months). The Japanese version of the Social Provision Scale (SPS-10) was used to evaluate social support, the Active Listening Attitude Scale (ALAS) for listening attitude, the UCLA Loneliness Scale (ULS) for loneliness, the General Self-Efficacy Scale (GSES) for self-efficacy, the Beck Depression Inventory (BDI-II) for depression symptoms, and the K6 for psychological distress. An unpaired t-test was used to determine whether participants' status differed between the groups that did and did not experience increased perceived social support. The mean age of the participants was 55.1 ± 6.7 (mean ± SD) years. The duration of their children's eating disorders was 7.6 ± 5.5 years. The degree of improvement for each variable (active listening attitude, loneliness, self-efficacy, depressive symptoms, and mental health) was the difference in each score (ALAS, ULS, GSES, BDI-II, and K6) from T1 to T3. The degree of improvement in active listening attitude and loneliness was significantly greater in the improved social support group than in the non-improved social support group (p < 0.002 and p < 0.012, respectively).

CONCLUSIONS

Our findings indicate that increasing mothers' perceptions of social support will be associated with improving their active listening attitudes and loneliness.

Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg’s self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables ‘number of meals’ (p < 0.01), ‘dieting’ (p < 0.01), and ‘drug consumption to lose weight’ (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.

There Are Predictors of Eating Disorders among Internet Use Characteristics-A Cross-Sectional Study on the Relationship between Problematic Internet Use and Eating Disorders

The aims of this cross-sectional study were: (i) to establish the prevalence of problematic Internet use (PIU) and eating disorders (EDs) among Polish students; (ii) to investigate potential correlations between the two phenomena; and (iii) to identify predictors of eating disorders among socio-demographic and Internet use characteristics in this population. To this end, a total of 1008 Polish students aged 18-40, completed the Problematic Internet Use Test (TPIU22), the Eating Attitudes Test (EAT-26) and a self-designed Socio-demographic and Internet Use Survey. Men received more PIU scores (p < 0.001), while women received more EAT-26 scores (p < 0.05) with a significant correlation observed between those variables (rho = 0.212; p < 0.001). The strongest predictors of EDs were as follows: preoccupation with the Internet, neglect of sleep in favor of Internet use, alleviation of negative feelings while online, higher mean number of hours spent online on weekends for academic and work-related purposes, extracurricular activity, lower height and higher BMI. An association has been demonstrated between problematic internet use and eating disorders. Somewhat surprisingly, our results suggest that people at risk of EDs use the Internet primarily to fulfill their routine duties. Nevertheless, further research is needed to establish the causality of EDs and PIU.

Problematic usage of the internet and eating disorder and related psychopathology: A multifaceted, systematic review and meta-analysis

Eating disorders are widespread illnesses with significant impact. There is growing concern about how those at risk of eating disorders overuse online resources to their detriment. We conducted a pre-registered systematic review and meta-analysis of studies examining Problematic Usage of the Internet (PUI) and eating disorder and related psychopathology. The meta-analysis comprised n = 32,295 participants, in which PUI was correlated with significant eating disorder general psychopathology Pearson r = 0.22 (s.e. = 0.04, p < 0.001), body dissatisfaction r = 0.16 (s.e. = 0.02, p < 0.001), drive-for-thinness r = 0.16 (s.e. = 0.04, p < 0.001) and dietary restraint r = 0.18 (s.e. = 0.03). Effects were not moderated by gender, PUI facet or study quality. Results are in support of PUI impacting on eating disorder symptoms; males may be equally vulnerable to these potential effects. Prospective and experimental studies in the field suggest that small but significant effects exist and may have accumulative influence over time and across all age groups. Those findings are important to expand our understanding of PUI as a multifaceted concept and its impact on multiple levels of ascertainment of eating disorder and related psychopathology.

Socio-Cultural Standards Promoted by the Mass Media as Predictors of Restrictive and Bulimic Behavior

Research lacks in verifying the nature of the relationship between mass media pressure, body image, and the risk of unhealthy eating behaviors. This study aimed to investigate whether the internalization of sociocultural norms, perceived pressure or searching for information about body image promoted by the mass media directly affect restrictive and bulimic behavior toward eating, through the mediating role of body image and physical appearance variables. The research hypotheses were that (1, 2) body image, the pressure and the internalization of sociocultural norms are significant predictors of unhealthy eating behavior among women and men; and (3) the variables related to body image play the role of the mediating variable between the impact of socio-cultural standards of body image promoted by the mass media and unhealthy eating behavior. The sample comprised 514 Polish men and women, aged 16 to 63 old (men M=24.35; SD=13.53; women M=24.77; SD=7.61), with average Body Mass Index (BMI). Assessment comprised the Sociocultural Attitudes Toward Appearance Scale (SATAQ-3), Eating Disorders Inventory (EDI 3), The Multidimensional Body-Self Relations Questionnaire (MBSRQ-AS), and the author's survey questionnaire. The descriptive and comparative statistics, and a path analysis (structural equations modeling) were applied. The statistical analysis showed that the variables related to body image do not play the role of intermediary variables. The pressure of sociocultural standards of body image and physical appearance had the strongest and most direct effect on the development of restrictive eating behavior and appeared to negatively affect body image in women. The search of information on body image in the mass media had the strongest and most direct impact on the development of bulimic eating behavior among women. However, only the global internalization of sociocultural standards of body image and physical appearance had a significant and direct effect on the development of bulimic eating behavior in men. Moreover, the internalization of athletic body shape standards had the strongest and most positive impact on some aspects of body image in this group. No sociocultural variables showed a direct impact on restrictive behavior among studied men. BMI had a positive and direct impact on individual body part satisfaction. These results may help improve prevention of eating disorders and dysfunctional eating behavior.

Body dissatisfaction and symptoms of bulimia nervosa prospectively predict suicide ideation in adolescents

OBJECTIVE

Symptoms of eating disorders have been established as significant concurrent correlates with suicide ideation and behaviors in adolescent samples, but very few studies have examined eating disorder symptoms as prospective risk factors for suicide. The current study examined eating disorder symptoms as prospective risk factors for suicide ideation in an unselected community sample of adolescents.

METHOD

Data were collected from 436 adolescents in middle and high school at baseline and 6- and 12-month follow-ups. Adolescents completed self-report measures assessing eating disorder symptoms and suicide ideation and behaviors at each time point during school hours.

RESULTS

Regression analyses found that body dissatisfaction was a significant prospective predictor of suicide ideation severity at the 6- and 12-month follow-ups, symptoms of bulimia nervosa (binge-eating disorder and purging) predicted suicide ideation severity at the 12-month follow-up only, and symptoms of anorexia nervosa (drive for thinness and restricting) were not significant predictors of suicide ideation at either follow-up. Exploratory analyses found the same pattern of results for the sample of girls only, while no significant predictors were found for boys only.

DISCUSSION

This is the first longitudinal study of disordered eating and suicide ideation in American adolescents. Symptoms of bulimia nervosa and body dissatisfaction seem to be true risk factors for suicidal ideation. The current study demonstrates the importance of disordered eating behaviors in the development of suicidal ideation in adolescents, particularly for adolescent girls.

Eating Disorder Prevention

Thirteen percent of girls and women experience an eating disorder, yet most do not receive treatment. Thus, broad implementation of eating disorder prevention programs that reduce eating disorder symptoms and future eating disorder onset is a critical priority. This article (1) reviews risk factors that have been shown to predict future onset of eating disorders, because this should guide the content of prevention programs and high-risk subgroups to target with selective prevention programs; (2) reviews the evidence base for eating disorder prevention programs that have reduced eating disorder symptoms or future onset of eating disorders; and (3) discusses directions for future research.

Prevalence of eating disorders over the 2000-2018 period: a systematic literature review

BACKGROUND

Eating disorders (EDs) lead to multiple psychiatric and somatic complications and thus constitute a major public health concern.

OBJECTIVES

The aim of this study was to give an exhaustive view of the studies reporting the prevalence of the different EDs or total EDs and to study their evolution.

METHODS

A literature search following PRISMA Guidelines and limited to studies in English or French published between 2000 and 2018 was performed and relevant studies were included in this systematic review on the prevalence of EDs. The literature search revealed 94 studies with accurate ED diagnosis and 27 with broad ED diagnosis.

RESULTS

In 94 studies with accurate ED diagnosis, the weighted means (ranges) of lifetime ED were 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. The weighted means (ranges) of 12-month ED prevalence were 2.2% (0.8-13.1%) for women and 0.7% (0.3-0.9%) for men. The weighted means (ranges) of point prevalence were 5.7% (0.9-13.5%) for women and 2.2% (0.2-7.3%) for men. According to continents, the weighted means (ranges) of point prevalence were 4.6% (2.0-13.5%) in America, 2.2% (0.2-13.1%) in Europe, and 3.5% (0.6-7.8%) in Asia.In addition to the former, 27 other studies reported the prevalence of EDs as broad categories resulting in weighted means (ranges) of total point prevalence of any EDs of 19.4% (6.5-36.0%) for women and 13.8% (3.6-27.1%) for men.

CONCLUSIONS

Despite the complexity of integrating all ED prevalence data, the most recent studies confirm that EDs are highly prevalent worldwide, especially in women. Moreover, the weighted means of point ED prevalence increased over the study period from 3.5% for the 2000-2006 period to 7.8% for the 2013-2018 period. This highlights a real challenge for public health and healthcare providers.

A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3-month follow-up

Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (η²  = 0.04) and in disordered eating attitudes/behaviours (η²  = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs.

Disordered eating behaviors among Christian and Muslim adolescents in Ceuta, a multicultural town

Studies on disordered eating behaviors (DEB) in multicultural populations with multiple religious/cultural affiliations are needed in order to clarify the relationship between cultural background and DEB. Therefore, we compared the presence of DEB among Christian and Muslim adolescents who share their school environment, controlling for the effect of body mass index, demographic variables and lifestyle habits. A sample of 493 girls and boys (339 Christian, 138 Muslim) whose mean (±SD) age was 14.8 (±1.7) years completed self-reporting questionnaires and underwent measurements of anthropometric data. Religious/cultural affiliation was defined by self-identification. The dependent variable, DEB was assessed by means of the Eating Disorders Inventory (EDI-2). Muslim girls and boys score higher than Christians on EDI-2 total scores, especially on the perfectionism subscale. Bivariate and multivariate analyses were used to determine the characteristics associated with DEB, which were detected in 24% of participants (19% of Christians and in 35% of Muslims). Among girls, DEB were directly associated with overweight or obesity, the presence of frequent quarrels with parents, academic failure and spending more than 3 h a day watching screen images. Among boys, DEB were directly associated with overweight or obesity and Muslim background; and inversely associated with age and socioeconomic status.

Eating disorders and associated risk factors among Imam Abdulrahman bin Faisal university preparatory year female students in Kingdom of Saudi Arabia

Objectives:

To estimate the prevalence of eating disorders among Imam Abdulrahman bin Faisal University (IAU) in Dammam, Kingdom of Saudi Arabia, female students and to investigate the associated factors.

Methods:

A cross-sectional study was conducted at IAU, Dammam, Kingdom of Saudi Arabia, in 2016 with 670 participants. Data was collected by self-administered questionnaires, including the Eating attitude test 26 (EAT-26) and the sociocultural attitudes toward appearance questionnaire (SATAQ-4). Eating behavior questions were asked to determine whether the respondents should seek evaluation for an eating disorder (ED) from a professional.

Results:

Eating attitude test 26 results showed that 29.4% of participants were categorized at a high level of concern for an ED, and 45.5% were categorized as at risk of having problematic feeding behaviors. Of the participants who scored above 20 on the EAT-26, 60.7% demonstrated high-risk feeding behavior attitudes, and approximately 11.5% who scored a body mass index (BMI) classified as underweight or very underweight required referral to a psychologist. A significant relationship was found between family stress to lose weight and EAT-26 scores above 20. The media was also found to represent external influence to lose weight.

Conclusion:

This study concluded that early detection of EDs or problematic feeding behaviors and attitude is vital to minimize the risks to physical health and well-being of the sufferers’ experiences.

Eating disorders: Insights from imaging and behavioral approaches to treatment

Understanding factors that contribute to eating disorders, which affect 13% of females, is critical to developing effective prevention and treatment programs. In this paper, we summarize results from prospective studies that identified factors predicting onset and persistence of eating disorders and core symptom dimensions. Next, implications for intervention targets for prevention, and treatment interventions from the risk- and maintenance-factor findings are discussed. Third, given that evidence suggests eating disorders are highly heritable, implying biological risk and maintenance factors for eating disorders, we offer working hypotheses about biological factors that might contribute to eating disorders, based on extant risk factor findings, theory, and cross-sectional studies. Finally, potentially fruitful directions for future research are presented. We suggest that it would be useful for experimental therapeutics trials to evaluate the effects of reducing the risk factors on future onset of eating pathology and on reducing maintenance factors on the risk for persistence of eating pathology, and encourage researchers to utilize prospective high-risk studies so that knowledge regarding potential intervention targets for prevention and treatment interventions for eating disorders can be advanced. Using the most rigorous research designs should help improve the efficacy of prevention and treatment interventions for eating disorders.

Association Among Internet Usage, Body Image and Eating Behaviors of Secondary School Students

Background

Presently, the internet plays a big role in daily life, especially for adolescents. In this age group, they are more concerned about their face and body shape. Despite the numerous studies on the effect traditional media has on body image, very few have focused on the effect of newer forms of media (e.g. online media). And almost none have looked at the relationship between time spent online and body image.

Aim

To study the associations between time spent on the internet, body image satisfaction and eating behaviors of students grades 7 to 12 in the Thai educational system.

Methods

The sample group included 620 students, who were selected using simple random sampling from 6 secondary schools in Bangkok. Data were collected using the Media and Internet use behavior questionnaires, The Body-Esteem Scale for Adolescents and Adults: Thai version (BESAA), Drive for Muscularity Scale (DMS: males only), The Rosenberg Self-Esteem Scale: Thai version, Eating Attitude Test-26: Thai version (EAT-26) and the eating behaviors at risk of obesity questionnaire.

Results

Mean (sd) age of the sample was 15.7 (1.9) years, 246 participants (39.7%) were male and 374 (60.3%) were female. Using the internet and social networks for content related to body image and eating behaviors, was negatively associated with body image satisfaction but positively associated with inappropriate eating attitudes/behaviors, binging, purging, use of laxatives/diuretics and drive for muscularity with respect to behaviors and attitudes, and was associated with eating behaviors that carried a risk for obesity.

Conclusions

Time spent on internet, especially engaged in activities related to self-image, and eating attitudes and behaviors, were associated with a decrease in body image satisfaction and problematic eating behaviors.

Disordered eating attitude and associated factors among high school adolescents aged 12-19 years in Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND

Eating disorders are very complex, frequently developed and have a public health impact on adolescents. Different studies revealed that eating disorders is a pressing public health problem among adolescents. Eating disorders may also lead to mortality due to their physiological sequelae. There is no previous study regarding disordered of eating attitude in Ethiopian adolescents. Therefore, this study aimed to assess prevalence of disordered eating attitude and its associated factors among adolescents in Addis Ababa high schools.

METHODS

A school-based cross sectional study was conducted. Data were collected among 836 high school adolescents aged 12-19 years from May to June, 2015 in Addis Ababa city. The data were collected by self-administered questionnaire containing eating attitudes test-26 items (EAT-26) and socio-demographic factors. Binary logistic regression analysis was carried out to identify factors associated with disordered eating attitude. Both crude odds ratio and adjusted odds ratio were calculated to show the strength of association. In multivariable analysis, variables with a P value of <0.05 were considered statistically significant.

RESULTS

The prevalence of disordered eating attitude among adolescents was 8.6% [95% CI 4.9, 12.3]. Being female [AOR = 1.75, 95% CI 1.03, 3.00], Mother's educational status (Primary [AOR = 0.28, 95% CI 0.11, 0.78], Certificate/diploma [AOR = 0.22, 95% CI 0.07, 0.58] and first degree and above [AOR = 0.16, 95% CI 0.07, 0.40]) were found to be significantly associated with disordered eating attitude.

CONCLUSION

The finding of this study revealed that a significant number of adolescents were susceptible to developing disordered eating attitude. Being female and Mothers' education status were significantly associated with disordered eating attitude among adolescents. Provision of screening test for eating disorders focusing on female adolescents is highly recommended.

Parenting Styles and Adolescents' Self-Esteem in Brazil

This study explored the relationship between parenting styles and self-esteem among 1,239 11- to 15-yr.-old Brazilian adolescents (54% girls; M age = 13.4 yr., SD=1.4). Teenagers' families were classified into 1 of 4 groups (Authoritative, Authoritarian, Indulgent, or Neglectful) based on adolescents' answers to the ESPA29 Parental Socialization Scale. Participants completed the AF5 Multidimensional Self-Esteem Scale which appraises five dimensions: Academic, Social, Emotional, Family, and Physical. Analyses showed that Brazilian adolescents from Indulgent families scored equal (Academic and Social) or higher (Family) in Self-esteem than adolescents from Authoritative families. Adolescents from Indulgent families scored higher than adolescents from Authoritarian and Neglectful families in four Self-esteem dimensions, Academic, Social, Family, and Physical. Adolescents from Authoritative families scored higher than adolescents from Authoritarian and Neglectful families in three Self-esteem dimensions, Academic, Social, and Family. These results suggest that Authoritative parenting is not associated with optimum self-esteem in Brazil.

Testing for interactive and non-linear effects of risk factors for binge eating and purging eating disorders

Almost no research has tested whether risk factors interact in the prediction of future eating disorder onset, which might suggest qualitatively distinct etiologic pathways. Accordingly, this prospective study tested for possible interactions between risk factors in the prediction of binge eating and purging eating disorders in adolescents. It also examined sex differences in pathways to risk. Two analytical approaches were used: (1) classification tree analysis (CTA), which is ideally suited to identifying non-linear interactions and the optimal cut-points for defining risk, with follow-up random forest analyses; and (2) two-way interaction terms in a series of logistic regression models. Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based study that followed participants from pre-birth to young adulthood. This study involved 1297 adolescents (49% male), 146 (11%) of whom developed bulimia nervosa, binge eating disorder or purging disorder in late adolescence. In CTA, sex was the first and most potent predictor of eating disorder risk with females showing a 5-fold increase in risk relative to males. For males and females, weight and eating concerns were the next most potent predictor of risk and three risk groups emerged, reflecting non-linear risk. For females with intermediate weight and eating concerns, externalizing problems emerged as an additional predictor. Interaction terms in logistic regression models did not produce significant results after correcting for multiple testing. Findings advance knowledge on risk pathways to eating disorder onset, highlight non-linear risk processes, and provide cut-points for prospectively identifying high-risk youth for prevention programs.

The effects of media, self-esteem, and BMI on youth's unhealthy weight control behaviors

PURPOSE

Youth engage in a variety of methods to manage their weight, including unhealthy weight control behaviors (UWCBs). The purpose of this study was to examine factors associated with youth's engagement in UWCBs, including media influence, youth's BMI z-score and self-esteem.

METHODS

Participants were 179 youth, aged 10-17, attending a primary care clinic appointment. Youth completed questionnaires assessing frequency of UWCBs, global self-worth, and perception of media influence to lose weight. BMI z-score was calculated based on height and weight measurements obtained from medical charts. The SPSS macro, PROCESS, was used to conduct moderation analyses.

RESULTS

Over 40% of youth endorsed using at least one UWCB in the past year. Girls reported using more UWCBs and engaging in UWCBs more frequently than boys. For boys, media influence to lose weight was only related to UWCB frequency for those with a BMI z-score of 1.23 and above. For girls, media influence was only related to UWCB frequency for those with low to average levels of global self-worth.

CONCLUSIONS

Girls' and boys' use of UWCBs is impacted by different factors. Prevention efforts should consider targeting factors, such as weight status and self-esteem, which are uniquely associated with gender.

Does parental divorce moderate the heritability of body dissatisfaction? An extension of previous gene-environment interaction effects

OBJECTIVE

Previous research suggests that parental divorce moderates genetic influences on body dissatisfaction. Specifically, the heritability of body dissatisfaction is higher in children of divorced versus intact families, suggesting possible gene-environment interaction effects. However, prior research is limited to a single, self-reported measure of body dissatisfaction. The primary aim of this study was to examine whether these findings extend to a different dimension of body dissatisfaction: body image perceptions.

METHOD

Participants were 1,534 female twins from the Minnesota Twin Family Study, aged 16-20 years. The Body Rating Scale (BRS) was used to assess body image perceptions.

RESULTS

Although BRS scores were heritable in twins from divorced and intact families, the heritability estimates in the divorced group were not significantly greater than estimates in the intact group. However, there were differences in nonshared environmental effects, where the magnitude of these environmental influences was larger in the divorced as compared with the intact families.

DISCUSSION

Different dimensions of body dissatisfaction (i.e., negative self-evaluation versus body image perceptions) may interact with environmental risk, such as parental divorce, in discrete ways. Future research should examine this possibility and explore differential gene-environment interactions using diverse measures.

Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research

BACKGROUND

Eating disorders are severe psychiatric disorders with a complex etiology involving transactions among sociocultural, psychological, and biological influences. Most research and reviews, however, focus on only one level of analysis. To address this gap, we provide a qualitative review and summary using an integrative biopsychosocial approach.

METHODS

We selected variables for which there were available data using integrative methodologies (e.g., twin studies, gene-environment interactions) and/or data at the biological and behavioral level (e.g., neuroimaging). Factors that met these inclusion criteria were idealization of thinness, negative emotionality, perfectionism, negative urgency, inhibitory control, cognitive inflexibility, serotonin, dopamine, ovarian hormones. Literature searches were conducted using PubMed. Variables were classified as risk factors or correlates of eating disorder diagnoses and disordered eating symptoms using Kraemer et al.'s (1997) criteria.

FINDINGS

Sociocultural idealization of thinness variables (media exposure, pressures for thinness, thin-ideal internalization, thinness expectancies) and personality traits (negative emotionality, perfectionism, negative urgency) attained 'risk status' for eating disorders and/or disordered eating symptoms. Other factors were identified as correlates of eating pathology or were not classified given limited data. Effect sizes for risk factors and correlates were generally small-to-moderate in magnitude.

CONCLUSIONS

Multiple biopsychosocial influences are implicated in eating disorders and/or disordered eating symptoms and several can now be considered established risk factors. Data suggest that psychological and environmental factors interact with and influence the expression of genetic risk to cause eating pathology. Additional studies that examine risk variables across multiple levels of analysis and that consider specific transactional processes amongst variables are needed to further elucidate the intersection of sociocultural, psychological, and biological influences on eating disorders.

Television viewing time and risk of eating disorders in Spanish adolescents: AVENA and AFINOS studies

BACKGROUND

Effective preventive interventions for both eating disorders and obesity in adolescence should be focused on shared risk factors. We analyzed the association between television (TV) viewing time and the risk of eating disorders, as well as the potential role of obesity in this association.

METHODS

The sample consisted of a total of 3458 Spanish adolescents, aged 13-18.5 years, from the Food and Assessment of the Nutritional Status of Adolescents (AVENA) and Physical Activity as a Preventive Measure of the Development of Overweight, Obesity, Allergies, Infections, and Cardiovascular Risk Factors in Adolescents (AFINOS) studies. Adolescents' TV time was assessed by self-report. Body mass index was calculated and the adolescents were classified into non-overweight and overweight-obesity. The risk of eating disorders was evaluated using the SCOFF questionnaire.

RESULTS

Adolescents who watched TV >1 h/day had a higher risk for eating disorders, compared with those adolescents who watch TV <1 h/day. Also, overweight-obese adolescents had a higher risk for eating disorders than those who were non-overweight. Analyses across groups of TV viewing time and weight status showed similar trends, so that the higher the time spent in TV viewing, the higher the risk of eating disorders, regardless of weight status.

CONCLUSIONS

TV viewing time might be a focal point for prevention of both eating disorders and obesity in adolescence.

Prevalência de transtornos mentais entre crianças e adolescentes e fatores associados: uma revisão sistemática

Objetivo O objetivo deste estudo foi realizar uma revisão sistemática para identificar os transtornos mais prevalentes na infância e adolescência e possíveis fatores associados. Métodos Várias bases eletrônicas de dados foram pesquisadas. Foram considerados critérios de inclusão: estudos epidemiológicos de base populacional; observacionais; com instrumentos validados; publicados em inglês, espanhol ou português; e que obtiveram pontuação acima de 12 pontos conforme critérios metodológicos do Checklist for Measuring Quality. Resultados Os transtornos mais frequentes encontrados pelos estudos, respectivamente, foram: depressão, transtornos de ansiedade, transtorno de déficit de atenção e hiperatividade (TDAH), transtorno por uso de substâncias e transtorno de conduta. Fatores que mais se mostraram associados aos diferentes transtornos foram: fatores biológicos, fatores genéticos e fatores ambientais. Conclusão O conhecimento desses transtornos e seus potenciais fatores de risco trazem a possibilidade de desenvolvimento de programas de intervenção focados em prevenir ou atenuar os efeitos destes.

Nobody's perfect: a qualitative examination of African American maternal caregivers' and their adolescent girls' perceptions of body image

Using semi-structured interviews, we explored African American maternal caregivers' and their adolescent girls' (N=25 dyads) perceptions about the adolescent's body using Grounded Theory. Caregivers and adolescent girls (Mage=13.42) were asked what the adolescent girls liked most/least about their bodies and how peers and media may affect adolescent girls' perceptions. While some adolescent girls reported overall body satisfaction, others described features they would like to change. Belief in God, body acceptance, and appreciation for average/moderate features helped the adolescent girls maintain their positive body image. The body-related messages that adolescent girls received from caregivers and peers included compliments, pressure to lose weight, teasing, and advice. Adolescent girls also reported being either influenced by or skeptical of the images presented in the media. Programs that promote caregiver-adolescent communication about body perceptions and that build on the adolescent girls' media skepticism may prove useful for their health-related attitudes and behaviors.

Impact of Parenting Styles on Adolescents' Self-Esteem and Internalization of Values in Spain

The relationship of parenting styles with adolescents' outcomes was analyzed within a sample of Spanish adolescents. A sample of 1456 teenagers from 13 to 16 years of age, of whom 54.3% were females, reported on their parents' child-rearing practices. The teenagers' parents were classified into one of four groups (authoritative, authoritarian, indulgent, or neglectful). The adolescents were then contrasted on two different outcomes: (1) priority given to Schwartz's self-transcendence (universalism and benevolence) and conservation (security, conformity, and tradition) values and (2) level of self-esteem (appraised in five domains: academic, social, emotional, family and physical). The results show that Spanish adolescents from indulgent households have the same or better outcomes than adolescents from authoritative homes. Parenting is related with two self-esteem dimensions—academic and family—and with all the self-transcendence and conservation values. Adolescents of indulgent parents show highest scores in self-esteem whereas adolescents from authoritarian parents obtain the worst results. In contrast, there were no differences between the priority given by adolescents of authoritative and indulgent parents to any of the self-transcendence and conservation values, whereas adolescents of authoritarian and neglectful parents, in general, assign the lowest priority to all of these values.

Prospective associations of parental smoking, alcohol use, marital status, maternal satisfaction, and parental and childhood body mass index at 6.5 years with later problematic eating attitudes

BACKGROUND

Few studies have prospectively investigated whether early-life exposures are associated with pre-adolescent eating attitudes.

OBJECTIVE

The objective of this study is to prospectively investigate associations of parental smoking, alcohol use, marital status, measures of maternal satisfaction, self-reported parental body mass index (BMI) and clinically measured childhood BMI, assessed between birth and 6.5 years, with problematic eating attitudes at 11.5 years.

METHODS

Observational cohort analysis nested within the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial conducted in 31 maternity hospitals and affiliated polyclinics in Belarus. Our primary outcome was a Children's Eating Attitudes Test (ChEAT) score 22.5 (85th percentile), an indicator of problematic eating attitudes. We employed multivariable mixed logistic regression models, which allow inference at the individual level. We also performed instrumental variable (IV) analysis using parents' BMIs as instruments for the child's BMI, to assess whether associations could be explained by residual confounding or reverse causation.

SUBJECTS

Of the 17 046 infants enrolled between 1996 and 1997 across Belarus, 13 751 (80.7%) completed the ChEAT test at 11.5 years.

RESULTS

In fully adjusted models, overweight children at age 6.5 years had a 2.14-fold (95% confidence interval (CI): 1.82, 2.52) increased odds of having ChEAT scores 85th percentile at age 11.5 years, and those who were obese had a 3.89-fold (95% CI: 2.95, 5.14) increased odds compared with normal-weight children. Children of mothers or fathers who were themselves overweight or obese were more likely to score 85th percentile (P for trend 0.001). IV analysis was consistent with a child's BMI causally affecting future eating attitudes. There was little evidence that parental smoking, alcohol use, or marital status or maternal satisfaction were associated with eating attitudes.

CONCLUSION

In our large, prospective cohort in Belarus, both parental and childhood overweight and obesity at 6.5 years were associated with pre-adolescent problematic eating attitudes 5 years later.

Impact of a School-Based Disordered Eating Prevention Program in Adolescent Girls: General and Specific Effects Depending on Adherence to the Interactive Activities

This study assessed the impact of a school-based program aimed at preventing disordered eating. The program was based on the media-literacy approach and has interactive format. The program was assessed under strong methodological conditions. Seven schools with 263 Spanish adolescent girls in the area of Barcelona, were randomly assigned to either the complete prevention program condition, the partial program condition or the non-treatment control condition, and assessed at pre, post and 6-month follow-up. The program was effective in generating positive changes at follow-up. The effects sizes (ESd= 0.29 to ESd= 0.38) were greater, on average, than that obtained up to now in selective-universal programs, and similar or greater than that achieved by targeted prevention programs. The results indicate a greater and relevant effect size of the intervention in those participants who completed the inter-session interactive activities (ESd= 0.29 to ESd= 0.45) although the differences were not significant. These results suggest the importance of monitoring adherence to the activities in all programs defined as “interactive”. The implications and limitations of this study are discussed.

A Confirmatory Factor Analysis of the “Autoconcepto Forma 5” Questionnaire in Young Adults from Spain and Chile

The aim of this work is to examine the pentafactorial validity of the AF5 Self-Concept Questionnaire in Spanish and Chilean young adults. From the responses of a total of 4,383 young adults aged 17 to 22 years (1,918 Spanish, 44%, and 2,465 Chilean, 56%) it was analyzed the reliability of the instrument, the compared validity of the 5 oblique factor model proposed by the authors versus the unifactorial and the orthogonal alternative models, and was studied the invariance of one Chilean sample. The results of confirmatory factor analyses supported the authors' pentafactorial model. The multi-group factorial invariance showed that Chilean sample of the AF5 does not change neither the Spanish factor weights, nor the variances and covariances of the factors, or the error variances of items. Finally, the internal consistency of the five scales was good in the samples of both countries.

Genetic and environmental influences on thin-ideal internalization

OBJECTIVE

Current research on the etiology of thin-ideal internalization focuses on psychosocial influences (e.g., media exposure). The possibility that genetic influences also account for variance in thin-ideal internalization has never been directly examined. This study used a twin design to estimate genetic effects on thin-ideal internalization and examine if environmental influences are primarily shared or nonshared in origin.

METHOD

Participants were 343 postpubertal female twins (ages: 12-22 years; M = 17.61) from the Michigan State University Twin Registry. Thin-ideal internalization was assessed using the Sociocultural Attitudes toward Appearance Questionnaire-3.

RESULTS

Twin modeling suggested significant additive genetic and nonshared environmental influences on thin-ideal internalization. Shared environmental influences were small and non-significant.

DISCUSSION

Although prior research focused on psychosocial factors, genetic influences on thin-ideal internalization were significant and moderate in magnitude. Research is needed to investigate possible interplay between genetic and nonshared environmental factors in the development of thin-ideal internalization.

Body image, eating disorders, and the relationship to adolescent media use

Historically and currently, media messages around body shape and size emphasize the importance of being below-average weight for women and hypermuscular for men. The media messages around physical appearance are not realistic for most and lead to body dissatisfaction for most adolescents. Interventions designed to mitigate the influence of negative media messages on adolescents' body image are presented; however, most have shown limited success.

Children, adolescents, and the media: health effects

The media can be a powerful teacher of children and adolescents and have a profound impact on their health. The media are not the leading cause of any major health problem in the United States, but they do contribute to a variety of pediatric and adolescent health problems. Given that children and teens spend >7 hours a day with media, one would think that adult society would recognize its impact on young people's attitudes and behaviors. Too little has been done to protect children and adolescents from harmful media effects and to maximize the powerfully prosocial aspects of modern media.

Association of socioeconomic status, problem behaviors, and disordered eating in Mexican adolescents: results of the Mexican National Health and Nutrition Survey 2006

PURPOSE

To explore the association of socioeconomic status (SES) with disordered eating behaviors (DEB) in Mexican adolescents, and the coexistence of DEB and other problem behaviors.

METHODS

Information about adolescents (10-19 years) was retrieved from the Mexican National Health and Nutrition Survey 2006 database. Associations were evaluated through ordinal regression.

RESULTS

Higher SES was associated with DEB (odds ratio [OR]: 2.05, 95% confidence interval [CI]: 1.52-2.75). Use of tobacco (OR: 2.10, 95% CI: 1.58-2.81), alcohol (OR: 2.03, 95% CI: 1.51-2.56), and suicide intent (OR: 5.13, 95% CI: 3.46-7.60) were associated with DEB.

CONCLUSION

DEB were more frequent among adolescents from higher SES households. The lack of association between SES and DEB reported by other studies might be because of the lack of variability in samples. The association of DEB and other problem behaviors highlights the importance of an integral approach to teenagers' mental health.

Assessment of body image: Psychometric properties of the Body Image Questionnaire

This study investigated the psychometric properties of the Body Image Questionnaire (QÜIC) in Spanish adolescents. The sample comprised 254 girls and 189 boys, aged 12–15. Principal component analyses showed that the 18 satisfaction items could be summarized using two moderately interrelated dimensions, torso and head/limbs, with satisfaction with chest/breast and genitals loading on a different factor for boys (torso) and girls (head/limbs). The QÜIC measures of body satisfaction, body problems, general physical appearance and conformity with weight and height presented satisfactory test-retest reliability, internal consistency and convergent validity. Our findings support the use of the QÜIC when assessing body image.

Parental divorce and disordered eating: an investigation of a gene-environment interaction

OBJECTIVE

We investigated gene-environment interactions (GxE) for associations between parental divorce and disordered eating (DE).

METHOD

Participants were 1,810 female twins from the Michigan State University Twin Registry and the Minnesota Twin Family Study. The Minnesota Eating Behaviors Survey was used to assess DE. We tested for GxE by comparing the heritability of DE in twins from divorced versus intact families. It was hypothesized that divorce would moderate the heritability of DE, in that heritability would be higher in twins from divorced than twins from intact families.

RESULTS

As expected, the heritability of body dissatisfaction was significantly higher in twins from divorced than intact families. However, genetic influences were equal in twins from divorced and intact families for all other forms of DE.

DISCUSSION

Although divorce did not moderate heritability of most DE symptoms, future research should replicate GxEs for body dissatisfaction and identify factors underlying this unique relationship.

Associations between sociocultural pressures to be thin, body distress, and eating disorder symptomatology among Chilean adolescent girls

This study explored the relationships between perceived sociocultural pressure to fulfill the thin beauty ideal, body distress, and the presence of eating disorder symptoms. Participants were 437 Chilean adolescent girls from Arica, northern Chile, aged 13-18. Results showed significant associations between perceived pressure from social agents to be thin and the presence of disrupted eating attitudes and behavior. The perceived influence of advertising, verbal messages and social situations related to eating and dieting emerged as the strongest predictors of eating disorders symptoms. Influence of advertising was also the strongest predictor of body image distress. Age differences emerged in perceived sociocultural pressure to be thin, with older participants reporting higher sociocultural pressure to fulfill the slender beauty ideal. This paper provides information about body distress and associated disturbances, a phenomenon which has seldom been studied in non-Western countries, but which has important health implications.

Traditional and new strategies in the primary prevention of eating disorders: a comparative study in Spanish adolescents

BACKGROUND

Research conducted to date into the primary prevention of eating disorders (ED) has mainly considered the provision of information regarding risk factors. Consequently, there is a need to develop new methods that go a step further, promoting a change in attitudes and behavior in the target population.

OBJECTIVE

This study describes an adaptation of the Girls' Group model to the Spanish context, the main objective being to compare two types of intervention, ie, one based on this model and the other following the traditional approach of providing information. The ultimate aim was to implement a prevention program that reduces the risk factors and boosts the protection factors that have been empirically shown to be related to ED.

METHODS

on the basis of previous research on the primary prevention of ed, and taking into account recognized risk and protective factors, the following topics were addressed: nutritional aspects; self-esteem; coping strategies; the ideal image of what is attractive and role of the media; and body image. The total sample (174 girls and 197 boys) was divided into 12 work groups, six for the intervention group (one school) and six for the control group (two schools). School-based input (intervention group) was provided by a pharmacist, a psychologist, a qualified nutritionist/dietician, and specialist support staff (psychologists and/or educators) and teachers of the three schools.

RESULTS

Participation in the intervention group reduced body dissatisfaction (F = 13.41; P < 0.01), the drive to thinness (F = 10.79; P < 0.01), and the influence of the media with respect to the esthetic body shape model (F = 13.90; P < 0.01), while self-esteem (F = 7.34; P < 0.01) and the use of coping strategies (F = 13.74; P < 0.01) both improved. There was also an improvement in the eating habits of participants, with better outcomes being achieved when intervening with females.

CONCLUSIONS

The present study shows that in the primary prevention of eating disorders, better outcomes are achieved by new models which target the attitudes and behavior of adolescents rather than focusing solely on the provision of risk information to raise awareness.

Influência da mídia em universitárias brasileiras de diferentes regiões

A mídia tem impacto na satisfação com a imagem corporal e risco para o desenvolvimento de transtornos alimentares. OBJETIVO: Avaliar a influência da mídia em universitárias e possíveis associações com idade, estado nutricional, renda e escolaridade do chefe da família. MÉTODOS: 2.489 estudantes do sexo feminino das cinco regiões do Brasil responderam à Sociocultural Attitudes Towards Appearance Scale (SATAQ-3). O escore na SATAQ foi comparado entre as regiões por meio de uma análise de variância. Uma análise de covariância foi utilizada para verificar a influência das variáveis estudadas no escore da SATAQ. Uma regressão logística foi realizada para verificar a interferência conjunta das variáveis em relação à influência da mídia. RESULTADOS: Não foram encontradas diferenças regionais na SATAQ total (p = 0,164) e subescalas Internalização atlética (p = 0,293) e Pressão (p = 0,150); houve diferença para as subescalas Internalização geral (p = 0,010) e Informação (p = 0,002). Idade, estado nutricional e renda influenciaram o resultado. CONCLUSÕES: O escore total na SATAQ foi similar entre as regiões, mas o Sul e o Nordeste apresentaram maiores pontuações para subescalas Internalização geral e Informação respectivamente. Estudantes com menos de 25 anos, com excesso de peso e maior renda foram em média mais influenciadas pela mídia.

Exposure to sexually explicit Web sites and adolescent sexual attitudes and behaviors

PURPOSE

Mass media play an important role in the socialization of youth. Given its expanding nature and accessibility, the Internet may be at the forefront of this education. However, the extent of the Internet's impact on adolescent sexual attitudes and behaviors is not yet known.

METHODS

A total of 433 adolescents completed an anonymous survey at a health center in New York City. The cross-sectional survey assessed Internet accessibility, exposure to sexually explicit Web sites (SEWs), sexual behaviors, and sexually permissive attitudes.

RESULTS

Of the participants, 96% had Internet access, and 55.4% reported ever visiting a SEW. Logistic regression analyses revealed that adolescents exposed to SEWs were more likely to have multiple lifetime sexual partners (OR=1.8, CI=1.2, 2.9), to have had more than one sexual partner in the last 3 months (OR=1.8, CI=1.1, 3.1), to have used alcohol or other substances at last sexual encounter (OR=2.8, CI=1.5, 5.2), and to have engaged in anal sex (OR=2.0, CI=1.2, 3.4). Adolescents who visit SEWs display higher sexual permissiveness scores compared with those who have never been exposed (2.3 vs. 1.9, p <or= .001), indicating a more permissive attitude.

CONCLUSIONS

Exposure to Internet pornography has potential implications for adolescent sexual relationships, such as number of partners and substance use. SEWs can serve an educational purpose and create an opportunity for adults to engage adolescents in discussions about sexual health and consumption of Internet material. Longitudinal research is needed to evaluate how exposure to SEWs influences youth attitudes and sexual behaviors.

An examination of the relation of gender, mass media influence, and loneliness to disordered eating among college students

Previous research has found that mass media influence and loneliness relate to disordered eating behaviors in women, but little is known about this relation in men. The present study examined the relations among disordered eating patterns, gender, mass media influence, and loneliness in male and female college students. Results of a stepwise regression revealed that disordered eating attitudes and behaviors (as measured by the Eating Attitudes Test-26) were predicted by mass media influence, gender, and loneliness, respectively. In the present study both male and female college students appear susceptible to developing disordered eating patterns. Clinicians may wish to address unrealistic comparisons to media and client interpersonal skills when designing treatment plans.

Digital facial image modification, body image, and parental support for dietary and physical activity behaviors

OBJECTIVE

To explore the effects of digital facial image modification on children's body image and on parental support for children's healthy dietary and physical activity behaviors.

STUDY DESIGN

Children and their parents were exposed to a novel image modification program that altered children's facial photographs to reflect weight loss and weight gain. The influences of facial image modification on children's body image and on parental support of children's healthy dietary and physical activity behaviors were measured with before and after surveys.

RESULTS

Eighty-one children and their parents were surveyed. Forty percent of children were at risk for overweight or overweight, and 59% of parents surveyed were overweight or obese. Parents' support for children's healthy dietary and physical activity behaviors significantly increased after parents viewed altered facial images of their child. In contrast, no change in children's body image measures was demonstrated after children viewed weight-altered photographs of themselves.

CONCLUSIONS

Facial image modification programs do not appear to have a detrimental effect on children's body image in the immediate post-exposure period. Image alteration may serve as an effective motivating tool to encourage parents to facilitate healthy dietary and physical activity behaviors in their children.

[Validation of the Eating Attitudes Test (EAT) as a screening tool in the general population]

BACKGROUND AND OBJECTIVE

To validate the best alternative cut-off point of a Spanish version of the Eating Attitudes Test (EAT-40) for the screening of eating disorders cases in the general population.

SUBJECTS AND METHOD

The translated questionnaire was administered to a representative sample of 2,734 female students who ranged in age from 13 to 22 years. Participants who scored above 21 points were interviewed, as were a random sample of participants who scored 21 or below. Internal and external validity parameters were estimated for different alternative cut-off scores below the usual EAT score of 30.

RESULTS

The best diagnostic prediction was obtained with a cut-off score of 21 points (sensitivity: 73.3%; specificity: 85.1%). A positive predictive value of 20% and a negative predictive value of 98.4% were obtained.

CONCLUSIONS

The best diagnostic prediction in a non-clinical setting is obtained with a cut-off score of 21, below that recommended by the authors of the questionnaire.

Family, peer, and media predictors of becoming eating disordered

OBJECTIVE

To identify predictors of becoming eating disordered among adolescents.

DESIGN

Prospective cohort study.

SETTING

Self-report questionnaires.

SUBJECTS

Girls (n = 6916) and boys (n = 5618), aged 9 to 15 years at baseline, in the ongoing Growing Up Today Study (GUTS). Main Exposures Parent, peer, and media influences.

MAIN OUTCOME MEASURES

Onset of starting to binge eat or purge (ie, vomiting or using laxatives) at least weekly.

RESULTS

During 7 years of follow-up, 4.3% of female subjects and 2.3% of male subjects (hereafter referred to as "females" and "males") started to binge eat and 5.3% of females and 0.8% of males started to purge to control their weight. Few participants started to both binge eat and purge. Rates and risk factors varied by sex and age group (<14 vs > or =14 years). Females younger than 14 years whose mothers had a history of an eating disorder were nearly 3 times more likely than their peers to start purging at least weekly (odds ratio, 2.8; 95% confidence interval, 1.3-5.9); however, maternal history of an eating disorder was unrelated to risk of starting to binge eat or purge in older adolescent females. Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly.

CONCLUSIONS

Risk factors for the development of binge eating and purging differ by sex and by age group in females. Maternal history of an eating disorder is a risk factor only in younger adolescent females.

Disordered eating attitudes and behaviours among adolescents in Hong Kong: prevalence and correlates

AIMS

To study the prevalence of disordered eating attitudes and behaviours among adolescents in Hong Kong and to examine the socio-demographic and behavioural correlates.

METHODS

Three secondary schools with different academic performance were selected from the Eastern District of Hong Kong. A total of 2382 students enrolled in Forms 1-7 at the three schools completed a specially designed questionnaire. The questionnaire contained questions on socio-demographic information, body weight satisfaction, exposure to mass media, health behaviours as well as the Eating Attitudes Test - 26 (EAT-26). Data were analysed using Student's t-test, chi2 analysis and multivariate logistic regression models.

RESULTS

Disordered eating (EAT score > or =20) was present in 52 (3.9%) adolescent boys and 68 (6.5%) adolescent girls. The youngest case was only 11 years old. A high degree of body weight dissatisfaction was shared by our adolescents. Teenage girls, overweight youths and those with poor academic performance were at increased risk of having disordered eating. Strong associations were found between disordered eating and other health-compromising behaviours including smoking, alcohol and soft drug use, delinquent behaviours, suicidal ideation and self-harm behaviours. Exposure to entertainment, beauty and youth magazines was positively related to disordered eating.

CONCLUSIONS

Disordered eating is prevalent among adolescents in Hong Kong. It remains a significant public health challenge to our community. Prevention programmes targeting youths at the greatest risk should be considered.