Teasing and weight-control behaviors in adolescent girls

A systematic review of weight stigma and disordered eating cognitions and behaviors

Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.

Associations of regular consumption of breakfast, lunch and dinner with Body Mass Index during adolescence: longitudinal findings by weight status among the Eating and Activity over Time 2010-2018 cohort

OBJECTIVE

To examine how the associations between meal consumption and BMI over 8 years differ by weight status in a sample of adolescents.

DESIGN

Longitudinal, population-based study. Breakfast, lunch and dinner consumption and BMI were self-reported. Linear regressions were used to examine how the associations between meal consumption and BMI differed by weight status.

SETTING

Adolescents in the Minneapolis/St. Paul metropolitan area.

PARTICIPANTS

Adolescents (n 1,471) were surveyed as part of the EAT 2010-2018 in 2009-2010 (Mage = 14·3 years) and 2017-2018 (Mage = 22·0 years).

RESULTS

The prevalence of regular breakfast, lunch and dinner consumption (≥ 5 times/week) ranged from 45 to 65 %, 75 to 89 % and 76 to 94 %, respectively, depending on weight status category. Among adolescents with a sex- and age-specific BMI < 15th percentile, regular consumptions of breakfast, lunch and dinner during adolescence were positively associated with BMI in emerging adulthood compared with irregular consumption of breakfast, lunch and dinner (<5 times/week) after adjustment for socio-demographic characteristics (β = 5·43, β = 5·39 and β = 6·46, respectively; all P-values <0·01). Among adolescents in the BMI 15-85th and 85-95th percentiles, regular consumptions of breakfast, lunch and dinner were positively associated with BMI but to a lesser extent (P-values <0·01). For participants with a BMI ≥ 95th percentile, regular consumptions of breakfast, lunch and dinner were positively associated with BMI, but the associations were not statistically significant (P-values > 0·05).

CONCLUSIONS

The relationship between meal consumption during adolescence and BMI in emerging adulthood differs by adolescent weight status. Future studies should investigate underlying factors related to meal consumption routines and BMI.

Bullying as a Risk Factor for Eating Disorder Behaviors Among Students: Secondary Analysis for a Cluster Randomized Controlled Trial

This study aimed to examine whether being a victim of bullying predicted body dissatisfaction and eating disorder behavior (EDB). In this study, we performed secondary analysis from a cluster randomized controlled trial among 5208 eight grade students from 73 public schools in three Brazilian cities. Data were collected in 2019 through an anonymous self-report questionnaire on bullying, body dissatisfaction, and EDB. We used factor analysis, multivariate linear regression, and multinomial logistic regression to verify whether being a victim of bullying during the baseline results in body dissatisfaction and EDB at the nine months follow-up for the control and intervention groups. Our results showed that being female (OR 1.41, 95% CI 1.22-1.63) is a risk factor for dissatisfaction by overweight. Bullying was not a predictor of body dissatisfaction; however, being a victim of bullying (β 0.40, 95% CI 0.35-0.46) is a predictor of having more EDB, independent of the exposure to the program. Therefore, bullying deserves attention in the school environment.

Weight stigma and disordered eating behaviors during the COVID-19 pandemic: the mediating role of weight gain concern and psychological distress

OBJECTIVES

The purpose of this study is to investigate whether the relationship between weight stigma experiences and disordered eating behaviors during the COVID-19 pandemic is mediated by weight gain concern and psychological distress among university students with and without overweight.

METHODS

A cross-sectional study was conducted with university students from five regions of Brazil who participated in the baseline assessment of the Online Cohort on Eating Behavior and Health (July/August 2020). Information on the frequency of binge eating episodes, food restriction, and purging, as well as experienced weight stigma, weight gain concern, and psychological distress, were recorded in an online questionnaire. Stratified structural equation modeling (SEM) analyses were performed to address the research questions of interest.

RESULTS

Out of the total sample (n = 2511), 33.5% of participants reported experiencing weight stigma. The prevalence of binge eating episodes, food restriction, and purging was 43.7%, 24.1%, and 5.4%, respectively. These behaviors were more prevalent in individuals with overweight than in those without this condition. Furthermore, it was observed that weight gain concern and psychological distress mediated the relationship between weight stigma and disordered eating behaviors regardless of body weight status.

CONCLUSIONS

Experiences of weight stigma and disordered eating behaviors were prevalent among Brazilian university students, especially among those with overweight. Weight gain concern and psychological distress appear to be important factors underlying the relationship between these constructs during the pandemic, and they can contribute to the development of targeted strategies for the prevention and management of disordered eating.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Prevalence of body weight dissatisfaction among adolescents: a systematic review

Objective:

To identify the prevalence of weight dissatisfaction among adolescents aged 10-19 years and stratify the analysis by sex.

Data source:

A literature review of cross-sectional studies among healthy adolescents was performed. The U.S. National Library of Medicine/National Institutes of Health (PubMed), Ovid^® (Wolters Kluwer), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), and American Psychological Association (PsycINFO^®) databases were searched between May 2019 and January 2020.

Data synthesis:

Initially, 3,700 records were identified, and 10 papers were obtained through other sources. After the removal of duplicates, 1,732 records were screened based on the titles and abstracts, and 126 were preselected for full-text analysis. After the application of the eligibility criteria, 34 papers were included in the present review. The studies were published between 1997 and 2020. The sample size ranged from <150 to >103,000 adolescents. The prevalence of weight dissatisfaction ranged from 18.0 to 56.6% in both sexes (10.8-82.5% among boys and 19.2-83.8% among girls).

Conclusions:

Based on the findings of the present systematic review, the prevalence of weight dissatisfaction is high among adolescents, especially girls. Such information can contribute to the planning of health and education programs addressing the issue of weight in adolescents.

Parental practices, body dissatisfaction and weight control practices in female adolescents from public schools in southern Brazil

The objective was to verify the association between body dissatisfaction (BD) - constituted by the desire to lose weight - with family and personal aspects related to the shape of the body and weight control practices in female adolescents. A cross-sectional, observational epidemiological study with adolescents aged 12-19 years, enrolled in classes of the 8th and 9th years of public schools belonging to the urban area of the city of Caxias do Sul/Rio Grande do Sul, Brazil, was conducted. A self-applicable questionnaire was used. BD was assessed using a silhouette scale. Multivariate regression was performed using Poisson regression with robust variation, hierarchically using a pre-established conceptual model, using the prevalence ratio (PR) adjusted with 95 % CI as a measure of effect. A significance level of 5 % (P ≤ 0·05) was considered. Among the 685 female students, 77·2 % had BD. The father's incentive to diet sometimes (PR 1·19; 95 % CI 1·07, 1·32; P ≤ 0·001) and always (PR 1·15; 95 % CI 1·03, 1·28; P ≤ 0·001), trying to lose weight (PR 1·63; 95 % CI 1·33, 1·99; P ≤ 0·001), dieting five times or more (PR 1·22; 95 % CI 1·09, 1·36; P ≤ 0·001) and skipping meals less than once a week (PR 1·16; 95 % CI 1·04, 1·29; P = 0·026) increased the chances of having BD. In conclusion, among the investigated parents' behaviours, only the father's incentive to go on a diet was associated with BD. Adolescent weight control practices increased the chances of having BD. Thus, it facilitates the identification of this condition at an early stage, enabling adequate treatment and prevention of health complications.

Weight stigma and disordered eating behaviors in Pakistani overweight adolescents: the mediating role of body esteem

PURPOSE

Weight stigma has been described as social devaluation of people on the basis of their weight and it is associated with negative consequences. The present study was designed to investigate weight stigma and its relationship with disordered eating behaviors in overweight adolescents. One of the main objectives of this study is to investigate the mediating role of body esteem between weight stigma and disordered eating behaviors in overweight adolescent girls.

METHODS

Through cross-sectional research design and purposive sampling technique, a sample of 200 overweight adolescent girls was recruited from Lahore, Pakistan. Participants were asked to fill self-report measures related to weight stigma, body esteem, and disordered eating behaviors.

RESULTS

SPSS and AMOS were used to analyze the data. Pearson product moment correlation showed that experiences of weight stigma were negatively related to body esteem and positively related to disordered eating behaviors in overweight adolescent girls. Furthermore, structural equation modeling (SEM) showed that body esteem was significantly mediating the relationship between weight stigma and disordered eating behaviors in adolescent girls.

CONCLUSION

It is concluded that weight stigma and body esteem play a significant role in the development and maintenance of disordered eating behaviors in overweight adolescents. Awareness/educational programs could be designed to empower adolescent girls in combating negative consequences of weight stigma. Furthermore, specific programs could be designed at college or university level to boost one's body esteem and reduce disordered eating behaviors.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The longitudinal relationship between family and peer teasing in young adulthood and later unhealthy weight control behaviors: The mediating role of body image

OBJECTIVE

Sociocultural theories hold that family and peer weight-related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross-sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and family teasing (occurrence and perceived impact) in early adolescence, body satisfaction in late adolescence, and UWCBs in young adulthood among a racially/ethnically and socioeconomically diverse population.

METHOD

Data were drawn from three waves of Project EAT over a 15-year period (Eating and Activity in Teens and Young Adults), and included responses from 1,902 young adults (57% female).

RESULTS

Among female participants, a mediated indirect pathway emerged with family weight-related teasing predicting increased engagement in UWCBs in early adulthood via poorer body image in late adolescence. In contrast, peer teasing did not predict body image or UWCBs. Among boys, the mediated indirect pathways were not significant. However, poor body image in late adolescent males predicted higher likelihood of engaging in UCWBs in early adulthood.

DISCUSSION

These findings support the long-term impact of family weight-related teasing on greater risk for UWCBs among girls and young women, and poor body image as a mechanism accounting for this relationship. Moreover, the results highlight the poor body image among adolescent boys as a factor for increased risk of engaging in UWCBs in early adulthood. Pending replication in current cohorts, health promotion and prevention involving family members of early adolescents that address family weight teasing and body image are needed.

"Healthy Habits, Healthy Girls-Brazil": an obesity prevention program with added focus on eating disorders

PURPOSE

To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating.

METHODS

Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01.

RESULTS

Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected.

CONCLUSION

H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil.

TRIAL REGISTRATION

Level I: cluster randomized controlled trial.

Weight-teasing: does body dissatisfaction mediate weight-control behaviors of Brazilian adolescent girls from low-income communities?

The objective was to examine the mediation hypothesis of body dissatisfaction and analyze their association with weight-teasing and body satisfaction. A total of 253 girls who attended 10 schools from São Paulo, Brazil, participated in this study. Data collection was carried out through a validated and self-reported questionnaire. Study variables were weight-teasing (independent), body satisfaction (mediation), and weight control behavior (outcome). Effect mediation analyses showed a significance level of 5% (p < 0.05). Prevalence of family and peers weight-teasing were 38.5% and 40.6%, respectively. Body dissatisfaction was associated with unhealthy weight control behaviors when controlled by family and peer weight-teasing. Data indicate that family and peers teasing are important aspects that interfere in body satisfaction and weight control behaviors.

Adolescents’ perceptions of their parents’ and peers’ opinions about their body weight

Purpose

The purpose of this study is to evaluate the associations between adolescents’ perceptions of their parents’ and peers’ opinions about body weight and their actual weight status.

Design/methodology/approach

A total of 795 Jordanian adolescents, 15-18 years of age, were recruited in this study. Adolescents completed a questionnaire to evaluate their perceptions: about how their parents’ and peers’ viewed their weight, regarding any criticism of their parents and peers about their weight and if their parents compared their weight against their siblings.

Findings

The study found that the majority of non-overweight adolescents thought their parents and peers considered them to have a normal weight (94.9 and 94.6 per cent for boys, 76.6 and 85.5 per cent for girls, respectively). For obese girls, 83.4 per cent thought their parents and 91.7 per cent thought their peers perceived them as overweight. The risk of being obese was significantly related to the amount of parental criticism perceived by adolescent girls with OR = 3.9 (95 per cent CI: 1.6-9.4; P = 0.01), while perception of peer criticism showed an increased trend of risk for obesity in boys. Adolescents’ perceptions regarding parental comparisons between their body weights against their siblings’ body weight was found to increase the risk for obesity significantly among girls.

Originality/value

The current study highlights that most of the obese adolescents perceived that their parents and peers underestimated their actual weight status. While obese boys were more likely to report being criticized about their body shape by their peers, obese girls indicated that they received more criticism about their weight from their parents.

ASSOCIATION BETWEEN WEIGHT-TEASING AND PHYSICAL ACTIVITY IN ADOLESCENTS

OBJECTIVE

The aim of the study was to determine the association between weight-teasing and physical activity in students from public schools of Curitiba, Paraná (Southern Brazil).

METHODS

The sample consisted of 95 students (48 boys and 47 girls) aged 12 to 14 years old. The Perception of Weight Teasing (POTS) and The Perception of Weight Teasing during Physical Activity Scale assessed the frequency of weight-teasing experienced by the participants. Accelerometers measured physical activity. BMI assessed the weight status of the participants. Pearson correlations analyzed the association between the teasing and physical activity variables at a significance level of 0.05.

RESULTS

The relationship between teasing variables and physical activity was not significant. A large proportion of participants failed to meet the recommended levels of physical activity regardless of sex (72%), and girls were significantly less physically active than boys (56.3% of boys and 89.4% of girls; p<0.01).

CONCLUSIONS

Some participants were targets of weight-teasing, but teasing was not related to physical activity. Interventions are necessary to educate middle school students about the harmful consequences of weight teasing.

Validity and Reliability of the Brazilian Version of the Weight Control Behaviors Scale

OBJECTIVE

To develop and validate the weight-control behaviors (WCBs) scale and to evaluate its psychometric properties.

STUDY DESIGN

We made use of data from a cluster-randomized trial assessing the effectiveness of the Brazilian New Moves Program. The Brazilian New Moves Program was a multicomponent intervention aimed at preventing weight-related problems among adolescent girls in public schools in São Paulo, Brazil.

RESULTS

Healthy and unhealthy WCBs were strongly associated. A 2-factor solution was the best model to explain the correlation across items, including following constructs: (1) healthy WCB: exercising, eating more fruits and vegetables, drinking less regular soda or sweetened drinks, eating fewer sweets, and paying attention to portion sizes; and (2) unhealthy WCB: skipping meals and the presence of any other, combined unhealthy weight-control behaviors, including fasting, eating little, going on a diet, vomiting, taking diet pills, using diuretics (water pills), using laxatives, using food substitutes (powder/special drinks), and smoking more cigarettes. The WCB scale was determined to be reliable (internally consistent) and valid, with high scores positively associated with body dissatisfaction and high body mass index values. Individual reliability values were high for factors representing healthy and unhealthy WCBs.

CONCLUSIONS

Our findings support the use of the WCB scale as a screening tool for overall weight control behaviors among female adolescents. This assessment tool should be considered in future observational and experimental prospective studies.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials: RBR-6ddpb3.

Peer Victimization and Unhealthy Weight Control Behaviors-the Role of Intersecting Identities among New York City Youth

We investigated the intersection of sexual minority, gender, and Hispanic identities, and their interaction with peer victimization in predicting unhealthy weight control behaviors (UWCB) among New York City (NYC) youths. Using logistic regression with data from the 2011 NYC Youth Risk Behavior Survey, we examined the association of sexual identity, gender, ethnicity, and peer victimization (dating violence, bullying at school, electronic bullying) in predicting UWCB. Sexual minority youths, dating violence victims, and youths bullied at school had 1.97, 3.32, and 1.74 times higher odds of UWCB than their counterparts, respectively (P < 0.001). The three-way interaction terms between (i) dating violence, gender, and sexual identity and (ii) electronic bullying, gender, and sexual identity were statistically significant. The effect of dating violence on unhealthy weight control practices was strongest among sexual minority males (OR = 4.9), and the effect of electronic bullying on unhealthy weight control practices was strongest among non-sexual minority males (OR = 2.9). Sexual minority and gender identities interact with peer victimization in predicting unhealthy weight control practices among NYC youths. To limit the prevalence and effect of dating violence and electronic bullying among youths, interventions should consider that an individual's experiences are based on multiple identities that can be linked to more than one ground of discrimination.

Weight Control Behavior as an Indicator of Adolescent Psychological Well-Being

BACKGROUND

Adolescence is a critical time for the development of psychological well-being. Weight gain and the emergence of body image concerns during this period can lead to the development of negative psychological states. To explore this issue, we examined the relationship between weight control behavior (WCB; ie, trying to lose, gain, stay the same, or do nothing about weight) and levels of depression and self-esteem.

METHODS

Adolescents (508 boys, 502 girls; Mage  = 12.32 ± .88 years) completed a survey that assessed WCB, depression, and self-esteem. Descriptive discriminant analysis was used to analyze WCB group differences on psychological well-being. Multivariate post hoc analysis further examined group differences. Structure coefficients indicated the relative importance of each dependent variable in boys and girls.

RESULTS

Results indicated that, among both sexes, WCB was significantly related to depression and self-esteem. Individuals trying to lose weight had lower levels of psychological well-being than the other groups.

CONCLUSIONS

Adolescents trying to lose weight reported the lowest psychological well-being scores whereas those not doing anything to control weight reported the highest levels of psychological well-being. These findings have important implications for screening and education programs designed to monitor and support adolescent psychological well-being.

[Children's eating behaviour: comparison between normal and overweight children from a school in Pelotas, Rio Grande do Sul, Brazil]

OBJECTIVE:

To evaluate differences in children's eating behavior in relation to their nutritional status, gender and age.

METHODS:

Male and female children aged six to ten years were included. They were recruited from a private school in the city of Pelotas, Rio Grande do Sul, southern Brazil, in 2012. Children´s Eating Behaviour Questionnaire (CEBQ) subscales were used to assess eating behaviors: Food Responsiveness (FR), Enjoyment of Food (EF), Desire to Drink (DD), Emotional Overeating (EOE), Emotional Undereating (EUE), Satiety Responsiveness (SR), Food Fussiness (FF) and Slowness in Eating (SE). Age-adjusted body mass index (BMI) z-scores were calculated according to the WHO recommendations to assess nutritional status.

RESULTS:

The study sample comprised 335 children aged 87.9±10.4 months and 49.3% had normal weight (n=163), 26% were overweight (n=86), 15% were obese (n=50) and 9.7% were severely obese (n=32). Children with excess weight showed higher scores at the CEBQ subscales associated with "food approach" (FR, EF, DD, EOE, p<0.001) and lower scores on two "food avoidance" subscales (SR and SE, p<0.001 and p=0.003, respectively) compared to normal weight children. Differences in the eating behavior related to gender and age were not found.

CONCLUSIONS:

"Food approach" subscales were positively associated to excess weight in children, but no associations with gender and age were found.