The association between disturbed eating behavior and socioeconomic status: the Online Korean Adolescent Panel Survey (OnKAPS)

BACKGROUND

A limited amount of research, primarily conducted in Western countries, has suggested that higher socioeconomic status (SES) is associated with higher risk of eating disorders (EDs). However, little is known about this association in Asian countries. We examined the association of SES with disturbed eating behavior (DEB) and related factors in Korean adolescents.

SUBJECTS

A nationwide online panel survey was conducted in a sample of adolescents (n = 6,943, 49.9% girls). DEB was measured with the 26-item Eating Attitudes Test (EAT-26). Participants who scored ≥20 on the EAT-26 were considered to have DEB. Participants' SES was determined based on self-reported household economic status.

RESULTS

The prevalence of DEB was 12.7%: 10.5% among boys and 14.8% among girls. Both boys and girls with DEB were more likely to perceive themselves as obese, experience higher levels of stress, and have lower academic achievement. The risk for DEB was significantly higher in boys of higher SES than in those of middle SES (OR = 1.45, 95%CI = 1.05-1.99 for high SES; OR = 5.16, 95%CI: 3.50-7.61 for highest SES). Among girls, higher risk of DEB was associated with the highest and lowest SES (OR = 1.52, 95%CI: 1.13-2.06 for lowest SES; OR = 2.22, 95%CI: 1.34-3.68 for highest SES).

CONCLUSIONS

Despite the lower prevalence of obesity in Korea compared with Western countries, the prevalence of DEB in Korean adolescents was high, especially among girls. Moreover, the association between SES and DEB followed a U-shaped curve for girls and a J-shaped curve for boys.

Identification and management of eating disorders in children and adolescents

The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.

The influence of puberty onset, body mass index, and pressure to be thin on disordered eating behaviors in children and adolescents

The main objective of this study is to verify the hypothesis that pubertal development, obesity, body satisfaction, as well as family and peer influences predict unhealthy eating habits in children and adolescents. A randomized stratified sample of young Quebecers aged 9, 13, and 16 years on March 31, 1999 [608 children aged of 9 years (325 girls and 283 boys) and 662 adolescents aged of 13 and 16 years (349 girls and 313 boys)] were used. Children's weight, height, and Body Mass Index (BMI) were recorded. Questionnaires were administered to children and a parent (usually the mother). Among 9-year-old children, this study found that weight loss or weight control behaviors were predicted mainly by the onset of puberty, lower maternal abusive control, and the level of peer pressure. Among adolescents, mother's BMI, income, peer pressure, and negative comments about the child's weight most strongly predicted behaviors to control weight, strategies to lose weight and the frequency of such behaviors. The findings suggest that both parents and children need to understand the impact of comments on a child's behavior.

The Italian version of the Body Cathexis Scale

AIMS

Various questionnaire measures have been developed to study body attitude and affect. The Body Cathexis Scale (BCS) was the first psychometric instrument devised to measure body dissatisfaction. In this study we report the validation of the Italian version of the BCS. Reliability and validity studies were conducted on 86 female subjects with eating disorders and 404 general population subjects.

RESULTS

Factor analysis yielded three factors called "Bust", "Weight-related Body Shape and Functions" and "Physical Functionality". Internal consistency was 0.90 (Cronbach's alpha). Test-retest reliability was 0.81. Criterion and concurrent validity are considered and norms as percentiles are reported for age classes.

The interaction role of obesity and pubertal timing on the psychosocial adjustment of adolescent girls: longitudinal data

OBJECTIVE

The objective of the study was to verify the hypothesis that obesity is associated with pubertal timing, as both factors interact to predict psychosocial adjustment problems in girls.

SUBJECTS

We selected 811 girls who had participated in a longitudinal study on a representative sample of French Canadian children from 1986 to 1997.

METHOD

Only data collected between 1993 and 1996 were analyzed. We classified the participants into three weight categories (normal, overweight, and obese) and pubertal timing (early, on-time, or late-maturing) and compared their internalized and externalized problem behavior and conflict as well as their socioeconomic status.

RESULT

We found that (1) early and late-maturing girls are more at risk of being overweight during the whole period of pubertal development as demonstrated by the increasing rate of obesity in these two groups between 11 and 13 y old, and (2) there was an interaction effect between pubertal timing and obesity in predicting problem behavior and conflict. Overweight and obese girls who developed faster or slower than their peers displayed more adjustment problems at 11 and 12 y old. At 13 y old, obesity predicted adjustment problems separately without regard to pubertal timing. Our results suggest that puberty timing is a risk factor for obesity and that both pubertal timing and being overweight predict adjustment problems during all the courses of pubertal development, supporting partially our hypothesis.

CONCLUSION

Programs and interventions must take into account these two factors and adolescents should be monitored throughout all the periods of pubertal development.

Prevalence of eating disorders in Argentine boys and girls, aged 10 to 19, who are in primary care. A two-stage community-based survey

The objective of this paper is to describe the prevalence of eating disorders (ED) in Argentina, in a randomly assigned national community-based sample of 1,231 girls and 740 boys in primary care, aged 10 to 19.9. A two-stage design was followed; subjects were screened with a self-report measure (EDE-Q4), and diagnosed with an expert-based interview (EDE-120D). Height, weight and BMI were measured and five subscales of the SCL90-R were completed. More than one quarter (a 26.4%) of the sample had a BMI greater than the 90th percentile, and these accounted for 48% of the suspected cases of ED. Only 42% returned for the EDE-12 interview; diagnosis was confirmed for 137 cases (6.9% of the total sample): 6.6% BED; 0.05% BN, and 0.3% EDNOS other than BED. Binge eating and restraint of food intake related directly to BMI and purging behaviors were very rare. More subjects than expected were found to be overweight and this related directly to the diagnosed ED. Psychological distress was directly related the presence of eating disturbances.

[Validation of the SCOFF questionnaire for screening the eating behaviour disorders of adolescents in school]

OBJECTIVE

To determine the internal consistency and criteria validity of the SCOFF questionnaire for screening adolescent eating behaviour disorders.

DESIGN

Validation study with stochastic sampling.

SETTING

Three schools at Bucaramanga, Colombia.

PARTICIPANTS

241 students selected at random from 1595 possible ones.

MAIN INTERVENTIONS

SCOFF questionnaire and semi-structured CIDI interview, administered independently.

MAIN MEASUREMENTS

Social and personal details, Cronbach's alpha, sensitivity analysis, specificity, forecast values, Cohen mean kappa test, and ROC curve.

RESULTS

Sensitivity found was 81.9% (95% CI, 70.7-89.7) and specificity, 78.7% (95% CI, 71.7-84.6). The area under the ROC curve was 0.8596 (95% CI, 0.8108-0.9084); the Cronbach's alpha test, 0.436, and the Cohen mean kappa, 0.554 (95% CI, 0.425-0.683).

CONCLUSIONS

The SCOFF questionnaire is an acceptable alternative for screening groups of adolescents because of its simplicity and speed of administration.

Eating disorders

Anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified remain a significant cause of morbidity and mortality in girls and young women. Management of eating disorders typically requires a multidisciplinary team approach, often spear-headed by the clinician initially detecting the illness. This article addresses the definitions and prevalence of eating disorders, tips on recognition and management of medical complications, and reproductive health concerns for these young women. Issues surrounding care of the patient with the female athlete triad, or amenorrhea, osteopenia, and eating disorders, are also discussed.

Identifying and treating eating disorders

Pediatricians are called on to become involved in the identification and management of eating disorders in several settings and at several critical points in the illness. In the primary care pediatrician's practice, early detection, initial evaluation, and ongoing management can play a significant role in preventing the illness from progressing to a more severe or chronic state. In the subspecialty setting, management of medical complications, provision of nutritional rehabilitation, and coordination with the psychosocial and psychiatric aspects of care are often handled by pediatricians, especially those who have experience or expertise in the care of adolescents with eating disorders. In hospital and day program settings, pediatricians are involved in program development, determining appropriate admission and discharge criteria, and provision and coordination of care. Lastly, primary care pediatricians need to be involved at local, state, and national levels in preventive efforts and in providing advocacy for patients and families. The roles of pediatricians in the management of eating disorders in the pediatric practice, subspecialty, hospital, day program, and community settings are reviewed in this statement.