Dieting, body weight, body image and self-esteem in young women: doctors' dilemmas

Adapting the Dietary Fat and Free Sugar Short Questionnaire: A Comprehensive Polish Modification for Enhanced Precision in Nutritional Assessments

BACKGROUND

This study aimed to investigate whether The Dietary Fat and Free Sugar-Short Questionnaire (DFS) is a reliable and valid measure that can be used in Polish conditions. It involved 291 participants, aged 14 to 70 (M = 25.9, SD = 10.1), the majority of whom were women (75%).

METHODS

The questionnaire consisted of, among others, Polish DFS version, FFQ-6, TFEQ, and SCOFF. Test-retest reliability was established on the group of 26 students with a 2-week interval. Participants' percentage of energy intake from both free sugars and saturated fats based on FFQ was correlated with DFS total and subscales scores. To investigate convergent and divergent validity, DFS scores with TFEQ correlations were performed. Diagnostic validity was established based on difference analysis between groups with the risk of eating disorders and those without the risk of those based on SCOFF.

RESULTS

Test-retest reliability (rtr = 0.856) and internal consistency (α = 0.797) indicated excellent reliability. DFS correlated significantly with FFQ for both total scores (r = 0.82) and each subscale: sugar (0.79), fat (0.75), and fat-sugar (0.59). The correlations of DFS and TFEQ were statistically significant for cognitive restraint (r = 0.32) and uncontrolled eating (r = 0.19). There also have been found significant differences based on SCOFF regarding DFS.

CONCLUSIONS

The results suggest good reliability and validity of the Polish version of DFS.

Factors associated with body dissatisfaction among the Lebanese population

OBJECTIVE

To evaluate the factors associated with body dissatisfaction among the Lebanese population, including sociodemographic characteristics, self-esteem, stress, anxiety, depression, emotional regulation, emotional eating and the adult attachment style.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The body dissatisfaction subscale of the eating disorder inventory version 2 (EDI-2) was used to measure body disturbance.

RESULTS

The mean age of the participants was 27.59 ± 11.76 years, with 66.5% females. The final model of the regression analysis showed that a higher binge eating score (Beta = 0.202), being married (Beta = 1.233), having a family history of eating disorders (Beta = 1.933), higher BMI (Beta = 0.076), dieting to lose weight (past 30 days) (Beta = 2.345), receiving comments from the family (Beta = 2.234) and pressure from TV/magazines to lose weight (Beta = 1.320), vomiting or taking laxatives to lose weight (past 30 days) (Beta = 1.861), higher depression (Beta = 0.103) and higher perceived stress (Beta = 0.107) were associated with a higher body dissatisfaction score. However, higher self-esteem (Beta = - 0.246), increased physical activity (Beta = - 0.022) and being divorced (Beta = - 4.226) were significantly associated with a lower body dissatisfaction score.

CONCLUSION

A significant association was found in this current study between the main variables: depression, self-esteem, social anxiety, eating disorders, family and television pressure and body image dissatisfaction.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The Effect of Media on Body Image in Pregnant and Postpartum Women

Much research has found that exposure to certain types of media portrayals of women can be related to body image concerns among women. The current paper focuses on the impact of certain messages on pregnant and postpartum women. These women are rarely examined in a media research context but are particularly vulnerable to body image concerns. This experimental study involved 192 pregnant or postpartum women who read a magazine containing glamorized media portrayals of pregnant/postpartum women or a control magazine. Pregnant women reported lower body image after only five minutes of exposure to the magazine with pregnant/postpartum women compared to the control group. There was no immediate effect on postpartum women. Implications for the media industry, health professionals, and women are discussed.

Emotional Freedom Techniques in the Treatment of Unhealthy Eating Behaviors and Related Psychological Constructs in Adolescents: A Randomized Controlled Pilot Trial

CONTEXT

In Australia and throughout much of the world, rates of obesity continue to climb as do the prevalence of eating disorders, particularly in adolescents. Psychological consequences of childhood obesity include low self-esteem, depression, body dissatisfaction, and social maladjustment (Young-Hyman et al., 2012).

OBJECTIVE AND INTERVENTION

This feasibility study sought to examine the impact of a six-week Emotional Freedom Techniques (EFT) group treatment program upon eating behaviours, self-esteem, compassion, and psychological symptoms.

DESIGN

Forty-four students were randomly allocated to either the EFT group or the waitlist control group.

RESULTS

Results revealed a delayed effect for both groups at post-intervention, with improved eating habits, self-esteem, and compassion at follow-up. Findings provide preliminary support for EFT as an effective treatment strategy for increasing healthy eating behaviours and improving associated weight-related psychopathology.

Adolescent development and eating disorder related quality of life in Indian females

OBJECTIVE

To study the relationship of adolescent development and eating disorder related quality of life in Indian females.

METHOD

461 female school students (aged 12-17 yrs) were recruited from middle to high socio-economic status (SES), English speaking schools in Delhi, India. Adolescent development was measured by Tanner stage and months since menarche. Subjects completed the Quality of Life for Eating Disorders questionnaire (QOL ED), which included six subscores. Correlation and partial correlation coefficient analysis to control for Body Mass Index (BMI) were performed.

RESULTS

After controlling for BMI, all adolescent development measures were correlated with the psychological feelings (PSY) subscore. This subscore contained items relating to confusion, social unease, sadness, difficulty coping, desiring perfection and loss of control. Tanner breast stage was correlated with the eating behaviour (EB) subscore.

DISCUSSION

During adolescent development, Indian girls became more aware of their psychological feelings and emotions. Only those reporting breast development were using behaviours to control their body, weight and shape. These behaviours are not associated with the presence of disordered eating thoughts, such as preoccupation with food, eating, body weight or shape.

Psychological distress and risk for eating disorders in subgroups of dieters

OBJECTIVE

The aim of the present study was to predict the risk of developing an eating disorder in subgroups of dieters, based on the adolescents own accounts of the reason for starting to diet.

METHOD

Eighty-one dieters from a cohort of 595 adolescents (318 boys and 288 girls) aged 15 participated in the present prospective study. Personal interviews at both base-line and follow-up were combined with questionnaire data on depression, social phobia and self-esteem.

RESULTS

Four mutually exclusive groups of dieters were identified: vanity dieters, overweight dieters, depressed dieters and feeling fat dieters. Depressed and feeling-fat dieters had a 15-fold risk of having a lifetime eating disorder at age 18 compared to vanity and overweight dieters.

CONCLUSION

Typical teenage vanity dieting and dieting among overweight adolescents appears to be a benign practice, but adolescents dieting because of psychological distress have high-risk of developing an eating disorder.

Why women of lower educational attainment struggle to make healthier food choices: the importance of psychological and social factors

Women of lower educational attainment are more likely to eat unhealthy diets than women of higher educational attainment. To identify influences on the food choices of women with lower educational attainment, 11 focus groups (eight with women of lower, and three with women of higher educational attainment) were held. Using a semi-structured discussion guide, environmental, social, historical and psychological factors known to be associated with food choice were explored. Audio recordings were transcribed verbatim and thematically analysed. Compared to women of higher educational attainment, women of lower educational attainment had less control over their families' food choices, less support for attempts to eat healthily, fewer opportunities to observe and learn good food-related practices, more negative affect, more perceived environmental constraints and more ambiguous beliefs about the consequences of eating a nutritious diet. These findings provide a starting point for taking forward the design of an intervention to improve the diets of young women.

Time since menarche, weight gain and body image awareness among adolescent girls: onset of eating disorders?

BACKGROUND

Eating, body weight and shape feelings and behaviours of female adolescents in relation to the time since their first menstrual period were studied.

METHOD

Three hundred sixty three female school students, aged 12-17 years participated in a cross-sectional computer survey.

RESULTS

There was a significant increase in body weight following menarche including a rapid rise from 7-12 months after menarche (47.4 kg, 95% CI 45.2-49.7, 56.9 kg 95% CI 54.0-59.8). Students did not immediately adjust their perception of body weight to incorporate this rapid rise. The discrepancy between actual and desired weight was greatest 7-12 and 13-24 months after menarche. Weight losing behaviours and associated feelings around body image increased significantly following menarche in adolescents of all body weights. Increases were related to body weight and time since menarche, but not to age. Binge eating commenced more than 6 months after menarche and purging behaviour after 12 months.

CONCLUSION

Both time since menarche and increase in body weight following menarche are associated with increasing concerns about eating, body image and weight losing behaviour. Some young women develop eating disorders. Menarche and subsequent weight gain appear as a risk factor for the onset of eating disorders.

Disordered eating attitudes in relation to body image and emotional intelligence in young women

BACKGROUND

A number of different psychological factors have been implicated in the multifactorial aetiology of disordered eating (DE) attitudes and behaviours; however, the possible role of emotional intelligence in DE symptomatology has not been thoroughly investigated in the past. The present study aimed to explore the possible differences in emotional intelligence, body image and anxiety levels in young females with DE attitudes and healthy controls.

METHODS

A total of 92 Greek female university students, 18-30 years old, were recruited. Subjects completed the following questionnaires: the Eating Attitudes Test (EAT-26), the Multidimensional Body-Self Questionnaire (MBRSQ), the State-Trait Anxiety Inventory (STAI) and the BarOn Emotional Intelligence Questionnaire (BarOn EQ-I).

RESULTS

The EAT-26 revealed that 23% of the subjects presented DE attitudes. Women in the DE attitudes group had lower levels of Emotional Intelligence (EI) in comparison to the control group, particularly in factors such as emotional self-awareness (P < 0.05), empathy (P < 0.05), interpersonal relationships (P < 0.001), stress management (P < 0.05) and happiness (P < 0.05). The MBRSQ has revealed significant differences between the two groups in terms of overweight preoccupation (P < 0.001) and illness orientation (P < 0.01). The DE attitudes group had higher anxiety scores (STAI), although the differences were not significant. Finally, anxiety levels (STAI) were significantly correlated with levels of EI (BarOn EQ-I) (P < 0.001).

CONCLUSIONS

The young women enrolled in the present study with DE attitudes, a potential precursor to eating disorders, appear to have significant differences in many psychometrical parameters of emotional intelligence, such as emotional self-awareness and interpersonal relationships, which is an important finding in terms of the prevention and management of DE, and warrants further investigation.

Feelings: what questions best discriminate women with and without eating disorders?

This study explored feelings that discriminate between eating disorder and community groups of women. Responses to 25 questions about body image (9), eating (8) self-esteem (3) general psychology (5) were collected in 2002-2003 (N=268) and 2005-2006 (N=472). Wilk's lambda was used to test discrimination. The most discriminating psychological questions were: 'feeling unhappy and unable to cope as well as usual', 'unease attending social functions', 'fearing loss of control over emotions'; and for eating questions were: 'feeling uneasy if other people saw you eating', 'feeling preoccupied with food/eating', 'fearing loss of control over eating'. For body image only 'feeling preoccupied with body weight/shape' and 'fearing loss of control over your body' discriminated. Questions relating to weight and shape for self-esteem ('feeling fat', 'fearing weight gain' and 'wanting to lose weight') discriminated poorly. Results for both cohorts were consistent. Preoccupation with thoughts of eating or body image and fear of loss of control of these would be useful additions to eating disorders criteria. Psychological impairment should also be present.

"Ice" use and eating disorders: a report of three cases

OBJECTIVE

To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss.

METHOD

We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit.

RESULTS

Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors. Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment.

DISCUSSION

"Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.

Coronary heart disease risk reduction intervention among overweight smokers with a psychotic disorder: pilot trial

OBJECTIVE

The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing (i) coronary heart disease (CHD) risk; (ii) smoking; and (iii) weight among smokers with psychosis. Secondary dependent variables included physical activity, unhealthy eating, substance use, psychiatric symptomatology, treatment retention, general functioning, and quality of life.

METHOD

This was a feasibility study utilizing a pre-post-treatment design with no control group (n=43). All participants provided written informed consent and were assessed before treatment and again a mean of 19.6 weeks later. The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy, in addition to treatment as usual. Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessments.

RESULTS

The intervention was associated with significant reductions in CHD risk scores, smoking and weight. A significant improvement was also reported in level of moderate physical activity, and a small change in the unhealthy eating index was reported. No improvement in biological measures (cholesterol and blood pressure) was evident.

CONCLUSIONS

A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term. A randomized controlled trial replicating and extending these findings is warranted.

Determinants of disordered eating behaviors among Israeli adolescent girls

Eating behaviors were assessed by a modified SCOFF questionnaire in a National representative cross-sectional study among 2978 Israeli schoolgirls. The mean age was 14.7. Thirty percent met the criteria for disordered eating. Being Jewish or underweight reduced the odds for disordered eating. The following increased the risk: dieting, early onset of menarche, being overweight or obese, and suffering from constipation. School socio-economic status, physical activity, and smoking status were not contributory. These results help identify possible interventions to prevent the development of disordered eating behaviors.

Intragastric balloon: ethics, medical need and cosmetics

The development of the intragastic balloon as a safe, noninvasive, alternative method to weight reduction raises all the ethical questions routinely faced by practitioners of other forms of cosmetic surgery. In the case of the morbidly, severely or merely obese, the surgeon is faced with a medical decision in a situation defined by medical parameters. The case of the overweight or normal may, however, create an ethical dilemma in which the doctor is forced to make decisions of a nonmedical nature, for which his training has not prepared him, and relating essentially to his personal attitudes and moral beliefs, culture and the recognition that 'if I don't, somebody else--possibly less competent--will'.

Exercise behaviours and feelings in eating disorder and non-eating disorder groups

OBJECTIVES

To compare exercise feelings and behaviours between female eating disorder (ED) (n = 287) and non-ED (n = 613) groups. To determine if exercise feelings and behaviours predict the presence of an ED.

METHODS

Nine hundred females completed questions about their exercise behaviours and feelings.

RESULTS

Both groups did similar amounts and days of exercise; the ED group scored higher on all other exercise behaviours and feelings except feeling that exercise was important for mood, and for weight loss. Best predictors of an ED diagnosis (VE 15.2%) were; 'being annoyed if exercise interrupted' (OR: 1.49; 95% CI 1.04-2.15), 'others feeling you exercise a lot' (OR: 1.61; 95% CI 1.06-2.44), 'feeling bad if unable to exercise a certain amount' (OR: 1.53; 95% CI 1.34-1.74), 'feeling that you have/have had problems with exercise' (OR: 2.12; 95% CI 1.33-3.39).

DISCUSSION

Clinicians assessing eating disordered individuals should address specific exercise feelings, rather than exercise amount or frequency.

When energy in does not equal energy out: disordered energy control

OBJECTIVE

To explore women's fear of loss of control and excessive inappropriate control of eating, exercise or their body in relation to patient/nonpatient status. To examine the utility of a concept of Disordered Energy Control (DEC).

METHODS

Comparison of the features of DEC of 169 female eating disorder, first admission inpatients, 61 previous inpatients ('recovering') and 225 female students who completed computer questions including the Quality of Life Eating Disorder (QOL ED).

RESULTS

Fear of loss of control was reported by 89% of inpatients, 36% of 'recovering' patients and 34% of students. Fear of loss of control or excessive controlling behaviour (defined as BMI <15.5, vomiting >7 days/month) was reported by 96% of inpatients (97% anorexia nervosa, 100% bulimia nervosa, 89% EDNOS), 51% of 'recovering' patients and 35% of students. There was significantly more impact on QOL ED psychological aspects, daily living, and acute medical health for student and patient groups reporting control issues compared to those who did not. DEC was present in 13% of students, 94% of inpatients and 28% of recovering patients.

DISCUSSION

The concept of disordered energy control warrants further investigation particularly in overweight and obese groups. A biological measure of inappropriate energy control associated with medical and psychological problems would be useful.

Quality of life: eating disorders

OBJECTIVE

There is a lack of measurements with predictive validity that are specific for quality of life (QOL) in patients with eating disorders.

METHOD

A total of 306 eating disorder patients treated as inpatients completed the Quality of Life for Eating Disorders (QOL ED): 109 at both admission and discharge from hospital, 65 at both admission and after 12 months. Patients also completed well-validated measures of eating disorders, psychological dysfunction and general physical and mental QOL. QOL ED consists of 20 self-report questions that provide scores for the domains of behaviour, eating disorder feelings, psychological feelings, effects on daily life, effects on acute medical status and body weight, and a global score.

RESULTS

QOL ED domain scores correlated appropriately with previously validated well-known measures of eating disorders, psychological dysfunction, general QOL and behaviour and body weight (p < 0.001). The QOL ED shows high reliability (Cronbach's alpha = 0.93). All scores changed significantly and appropriately during inpatient hospital treatment and between admission and 12 months after discharge from hospital (p < 0.001). The scores differed for anorexia nervosa, bulimia, eating disorder not specified (EDNOS) and no diagnosis. All no diagnosis (recovered) domain and global scores were significantly different from all diagnoses scores (p < 0.001).

CONCLUSION

This quick, simple instrument fulfils all potential uses for QOL assessments in the clinical and research settings associated with eating disorders, including outcome.

Predictors of functional and exercise amenorrhoea among eating and exercise disordered patients

BACKGROUND

The aim of this study was to investigate the predictors of amenorrhoea self-reported by patients who are suffering or recovering from eating or exercise disorders.

METHODS

Menstrual status, eating and exercise behaviours and feelings, and weight history of 268 female patients, 16-40 years old and not taking oral contraception or hormone replacement, were assessed on admission to hospital or 12 months later.

RESULTS

Most (134) had secondary amenorrhoea, 39 had oligomenorrhoea and 95 regular spontaneous menses. Amenorrhoea occurs in women with all types of eating disorder diagnoses including EDNOS (eating disorder not otherwise classified). The predictors of secondary amenorrhoea were: lower current BMI [odds ratio (OR) 0.59, confidence interval (CI) 0.50-0.68); a greater amount of body weight lost (OR 1.19, CI 1.06-1.33); exercising for mood, to burn up energy or for body image reasons (OR 1.50, CI 1.14-1.97); and younger age (OR 0.93, CI 0.87-1.00). Eating disorder patients with an exercise disorder were significantly more likely to report trying to reduce their food intake, to feel compelled to exercise and to have amenorrhoea/ oligomenorrhoea than eating disorder patients without an exercise disorder.

CONCLUSION

The greater the self-report behaviours and feelings associated with energy debt, the more likely menstruation is to be disturbed. Energy balance needs to be assessed in all amenorrhoeic patients.

Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders

OBJECTIVE

Gastrointestinal symptoms that occur without evidence of structural gastrointestinal disease are a well-recognized feature of patients with eating disorders (EDs). Despite this, the spectrum and predictors of specific functional gastrointestinal disorders (FGIDs), documented using standardized and validated questionnaires, have received little attention. The aims of the study were to describe the prevalence and type of FGIDs in patients suffering from anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS), and to determine the relationships between psychological features, eating-disordered attitudes and behaviours, demographic characteristics and the type and number of FGIDs present.

MATERIAL AND METHODS

A total of 101 consecutive female patients admitted to an eating disorder unit (AN 44%, BN 22%, EDNOS 34%, mean age 21 years) completed the Rome II modular questionnaire and a range of other validated self-reported questionnaires detailing illness history, psychological features and eating and exercise behaviour.

RESULTS

The criteria for at least one FGID were fulfilled by 98% of the sample. The most prevalent FGIDs were irritable bowel syndrome (IBS: 52%), functional heartburn (FH: 51%), functional abdominal bloating (31%), functional constipation (FC: 24%), functional dysphagia (23%) and functional anorectal pain disorder (FAno: 22%); 52% of the sample satisfied the criteria for at least three coexistent FGIDs. Psychological variables (somatization, neuroticism, state and trait anxiety), age and binge eating were significant predictors of specific, and > or =3 coexistent FGIDs. Other disordered eating characteristics, including body mass index, were not predictors.

CONCLUSIONS

In patients with EDs, specific psychological traits predict FGID type and the presence of multiple coexistent FGIDs. These findings support the role of specific psychological features as important contributors to certain FGIDs.

Influences of ethnicity and socioeconomic status on the body dissatisfaction and eating behaviour of Australian children and adolescents

The present study examined the association between socioeconomic status (SES), ethnicity, body dissatisfaction, and eating behaviours of 10- to 18-year-old children and adolescents. The study participants (N = 768) were categorised as Caucasian (74.7%), Chinese or Vietnamese (18.2%), and Italian or Greek (7.0%), and high (82%), middle (8.6%), and low SES (9.4%) according to parents' occupations. The chi(2), Mann-Whitney U test and Kruskal-Wallis test and logistic regression model were used to determine the interaction between variables. Females and older participants were more likely to desire a body figure that was thinner than their perceived current figure. Furthermore, the same groups were also more likely to be preoccupied with eating problems (females 7.1% vs. males 1.4%; for participants aged 15-18 years, 7.8% vs. participants aged 10-14 years, 3.9%). The body dissatisfaction gender difference was females 42.8% vs. males 11.8%, and participants aged 15-18 years 41.7% vs. those aged 10-14 years, 28.3%. Participants whose parents were managers/professionals were more likely to desire a body figure that was thinner than their perceived current figure than those from white-collar and blue-collar families. This was also the case for Caucasian Australians compared to those from Chinese or Vietnamese backgrounds. In conclusion, age and gender differences in body image and problems in eating behaviour were evident among children and adolescents. However, there was no significant SES and ethnic difference in the proportion of participants with eating problems and body dissatisfaction.