Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?

OBJECTIVE: To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. DESIGN: Population-based 5-year longitudinal study. PARTICIPANTS: Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). MAIN OUTCOME MEASURES: Weight status, binge eating, extreme weight control, and self-reported eating disorder. STATISTICAL ANALYSIS: Multiple linear and logistic regressions. RESULTS: Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. CONCLUSIONS: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.     

Adolescent binge/purge and weight loss behaviors: associations with developmental assets.

PURPOSE: To study associations between binge/purge and weight loss behaviors and "developmental assets" among adolescent girls and boys. METHODS: The Search Institute's Profile of Student Life: Attitudes and Behaviors self-report questionnaire was administered to 48,264 girls and 47,131 boys in grades 6 through 12 at schools in 213 cities or towns across the United States. The 156-item questionnaire measured 40 "developmental assets," or protective factors associated with successful adolescent development. Developmental assets were examined using multiple logistic regression among students who reported binge/purge behaviors, weight loss behavior, both, or neither. RESULTS: Developmental assets related to positive identity were the strongest discriminators of binge/purge and weight loss behaviors in both girls and boys. Girls who reported binge/purge and weight loss behaviors were about half as likely to report feeling a sense of purpose [odds ratio (OR) = 0.45, 95% confidence interval (CI) = 0.40, 0.50] and high self-esteem (OR = 0.55, 95% CI = 0.49, 0.61), compared with girls not reporting either of these behaviors. Among boys the ORs were: sense of purpose OR = 0.53 (95% CI = 0.46, 0.61) and self-esteem OR = 0.76 (95% CI = 0.65, 0.88). Assets related to values about abstinence from alcohol, drugs, or sex ("restraint") were also significant correlates. Girls and boys who reported these values were less likely to report binge/purge and weight loss behaviors, compared with those who did not report these values (girls: OR = 0.56, 95% CI = 0.50, 0.63; boys: OR = 0.83, 95% CI = 0.70, 0.97). CONCLUSIONS: Internal assets such as self-esteem, sense of purpose, and values related to abstinence from alcohol and sex appear to be protective against unhealthy eating behaviors and may reflect a general resilience that buffers against a broad range of health risk behaviors.     

Prevalence and correlates of binge eating in white and African American adolescents

OBJECTIVE: This study examined the prevalence and correlates of binge eating in a biracial sample of adolescent males and females. METHOD: White and African American students in Grades 6-12 (N=822) completed measures of social economic status (SES), body mass index (BMI), depression, current-ideal body image discrepancy, eating attitudes, dieting frequency, dietary intake, and activity level. RESULTS: Binge eating prevalence was highest among African American boys relative to the other demographic groups: 26% African American boys, 17% African American girls, 19% white boys, 18% white girls. Binge eating rates increased with age for white participants and decreased with age for African American participants. Depressive symptoms and consumption of high-fat foods predicted binge status among adolescents, whereas SES, BMI, eating attitudes, body image discrepancy, dieting, and low activity level failed to add predictive value. DISCUSSION: The observation of developmental differences in binging between whites and African Americans corresponds to their physical maturational divergence. These findings underscore the need for population-based surveys that sample binge eating across age, gender, and ethnicity.     

Eating behavior, depression, and self-esteem in high school students.

OBJECTIVE: In a representative sample of 4700 Slovene high school students, we examined their eating behavior and its correlations with some psychosocial and psychological characteristics with the aim of identifying the main risk factors for disordered eating. METHOD: Using a questionnaire which also included Zung's Self-rating Depression Scale and Rosenberg's Self-Esteem Scale, we compared girls (n = 2507) and boys (n = 2193) with regard to their satisfaction with their body weight, weight-reducing activities, and frequency of binge eating. We assessed their family relationships, abuse of alcohol and other psychoactive drugs, suicidal ideation, and suicidal tendences, as well as their level of depression and self-esteem. RESULTS: The results showed significant differences between girls and boys, between groups of those who were satisfied and those who were dissatisfied with their body weight, and also between groups which indulged in frequent binge eating and those which did not. CONCLUSION: Within a general population of adolescents, there is a substantial number of subjects with disordered eating behavior, some part of whom are at high risk for eating disorders.     

Psychosocial predictors of weight loss behaviors and binge eating in adolescent girls and boys

This study examined the predictors of dieting, extreme weight loss behaviors, and binge eating in adolescents (606 females and 315 males). High school classes were administered measures of weight loss behaviors, binge eating, perceived current and ideal body size, body dissatisfaction, advantages of being thinner and physically fitter, satisfaction with fitness, depression, self-esteem, parental overprotection, parental caring, and family adaptability and cohesion. Principal component analyses grouped predictor (body image, psychosocial) and criterion (weight loss behaviors, binge eating) variables. The primary predictor of weight loss behaviors in both sexes and binge eating in girls was the desire to be thinner which included a larger current body size. Psychological and family variables played lesser roles but were significantly predictive in a number of cases. Sex differences in factor structures and important predictors emerged. © 1992 John Wiley & Sons, Inc.     

Eating and body image concerns among average-weight and obese African American and Hispanic girls

Concern has been expressed that African American and Hispanic girls, because of their greater prevalence and degree of overweight, may be at greater risk than Caucasian girls for the development of bulimia nervosa and binge eating disorder. A cross-sectional study was undertaken to document the prevalence of overweight and obesity and to compare overweight and obese girls to average-weight girls with regard to early warning signs of eating disorder development. Participants included 139 predominantly African American and Hispanic girls who were classified as average weight, overweight, or obese in Grades 4 and 5. Overall, 18% of the girls were overweight and an additional 30.9% were obese. Overweight and obese girls had lower body esteem and greater concerns about peer influence than did their average-weight peers. They did not have greater fears of negative evaluation or more disturbed eating attitudes and behaviors. Future research should incorporate instruments more sensitive to disorders of overeating and investigate how eating disorder development differs among girls from various racial and ethnic backgrounds.     

Dieting and Binge Eating among Adolescents: What Do They Really Mean?

The study objectives were to gain insight into how the terms “dieting” and “binge eating” are understood and used by adolescents and to assess whether interpretations of these terms are consistent across age and gender. Twenty-five focus groups were conducted with 203 adolescents (138 girls and 65 boys) in urban public junior and senior high schools. Respondents were asked questions about dieting and binge eating behaviors. In the majority of groups (n=19), healthful eating behaviors, such as eating less fat or more fruits and vegetables, were mentioned in reference to dieting. However, in many of the groups (n=13) unhealthful eating behaviors, such as skipping meals or “starvation,” were also described. Dieting was frequently described as an umbrella term for different behaviors aimed at weight control (ie, physical activity) or in nonbehavioral terms (ie, as a desire or plan for weight loss). Although binge eating was described as overeating by many participants, often it was not clear if youth were referring to uncontrolled overeating. In nearly half of the groups, participants indicated unfamiliarity with the term “binge eating.” There was some confusion between binge eating and other forms of disordered eating. The findings suggest that prevalence rates of self-reported dieting and binge eating behaviors should be interpreted with caution and it should not be assumed that the majority of adolescents who self-report dieting are engaging in unhealthful behaviors. In providing nutrition counseling to youth, and in assessing dieting and binge eating behaviors in clinical settings and in research studies, specific behaviors should be defined. J Am Diet Assoc. 1998;98:446-450.     

Comparison of self-report to interview assessment of bulimic behaviors among preadolescent and adolescent girls and boys

OBJECTIVE: To compare self-report to interview assessment of bulimic behaviors among adolescents. METHOD: A sample of children in an ongoing study were recruited to complete in-depth telephone interviews in 1998 on bulimic behaviors (i.e., binge eating and purging). The sample comprised 449 girls and 50 boys. RESULTS: There was some over-reporting of bulimic behaviors on the 1998 questionnaire (asking about 1997-1998) compared with the interview that may have been due to the shorter and nonoverlapping time frame in the interview compared with the questionnaire. Despite the overestimation, the questionnaire did an excellent job at classifying girls who did not purge (negative predictive values [NPV]: 0.99) or binge eat (NPV = 0.98). When purging on the interview was compared with purging on either the 1998 or 1999 questionnaires, the sensitivity increased substantially from 0.73 to 0.93. DISCUSSION: These findings suggest that a short self-report assessment can be used to screen children engaging in, or at risk of beginning to engage in, binge eating and purging.     

Body Weight,Weight Self-Perception,Weight Teasing and Their Association with Health Behaviors among Chinese Adolescents—The Shanghai Youth Health Behavior Survey

Weight-related status has been associated with the physical and psychological health of adolescents. This cross-sectional study evaluated three different kinds of weight-related statuses (Body Mass Index (BMI), weight self-perception and weight teasing from others) among Chinese adolescents and identified their associations with health risk behaviors (lack of healthy dietary behavior, unhealthy dietary behavior, binge eating behavior, lack of physical activity (PA), sedentary behaviors (SB) and sleep disturbance). A stratified random cluster sampling method was used to select 10,070 students aged 11–18 years old from schools in Shanghai. Self-reported questionnaires were collected, weight-related statuses were divided into three categories and six specific health risk behaviors were classified into two groups: positive or negative. Overall, 27.82% of the adolescents were classified as being overweight and obese (35.61% of boys and 18.21% of girls), 43.45% perceived themselves as too heavy and 30.46% experienced weight teasing in the past. Among overweight or obese participants, 50.55% have been teased about their weight, and 77.48% perceived themselves as too heavy. Weight perception and weight teasing were significantly associated with health risk behaviors rather than the actual body weight status based on BMI, especially regarding binge eating behavior (body weight status (BMI): p > 0.05, underweight perception: OR = 1.18, 95%CI 1.03–1.34; weight teasing for more than once a year: OR = 2.00, 95%CI 1.76–2.27). In addition, weight perception and weight teasing were significantly associated with health risk behaviors, mainly in normal and overweight/obese groups but not in underweight groups. Weight teasing and weight self-perception play an independent and stronger role than actual body weight in the health behaviors of adolescents. This calls for more attention and intervention to reduce peer bullying and stigmas on weight among adolescents.     

Peer Reviewed: Screening High School Students for Eating Disorders: Results of a National Initiative

Introduction

Early identification and treatment of disordered eating and weight control behaviors may prevent progression and reduce the risk of chronic health consequences.

Methods

The National Eating Disorders Screening Program coordinated the first-ever nationwide eating disorders screening initiative for high schools in the United States in 2000. Students completed a self-report screening questionnaire that included the Eating Attitudes Test (EAT-26) and items on vomiting or exercising to control weight, binge eating, and history of treatment for eating disorders. Multivariate regression analyses examined sex and racial/ethnic differences.

Results

Almost 15% of girls and 4% of boys scored at or above the threshold of 20 on the EAT-26, which indicated a possible eating disorder. Among girls, we observed few significant differences between ethnic groups in eating disorder symptoms, whereas among boys, more African American, American Indian, Asian/Pacific Islander, and Latino boys reported symptoms than did white boys. Overall, 25% of girls and 11% of boys reported disordered eating and weight control symptoms severe enough to warrant clinical evaluation. Of these symptomatic students, few reported that they had ever received treatment.

Conclusion

Population screening for eating disorders in high schools may identify at-risk students who would benefit from early intervention, which could prevent acute and long-term complications of disordered eating and weight control behaviors.     

Binge eating and substance use among male and female adolescents.

OBJECTIVE: This study examines the relationship between binge eating and substance use behaviors and attitudes in adolescents and explores gender differences and mental health correlates. METHOD: The data are derived from the 1997 Ontario Student Drug Use Survey of public and Catholic school students. A weighted sample of 1,031 girls and 888 boys was categorized as nonbingers, past bingers, and noncompensating or compensating binge eaters. RESULTS: Binge eaters, particularly those who compensated, were more likely to use all types of substances, particularly cannabis and drugs other than tobacco and alcohol. Binge eating was associated with more problematic and heavier substance use and with lowered self-esteem and more depression. Female bingers were more likely to report compensatory behaviors than male students but gender differences in the relationship between binge eating and substance use were few. DISCUSSION: Adolescent binge eaters who engage in compensatory behaviors may be an appropriate target group for preventive programs in high schools.     

Shared risk and protective factors for overweight and disordered eating in adolescents

BACKGROUND: Weight-related problems, including obesity, eating disorders, and disordered eating, are major public health problems in adolescents. The identification of shared risk and protective factors for these problems can guide the development of relevant interventions to a broad spectrum of weight-related problems. This paper examines the prevalence and co-occurrence of overweight, binge eating, and extreme weight-control behaviors (vomiting, diet pills, laxatives, and diuretics) in adolescents and identifies shared risk and protective factors from within the socioenvironmental, personal, and behavioral domains for these three adverse weight-related outcomes. METHODS: Data were collected at Time 1 (1998-1999) and Time 2 (2003-2004) on 2516 adolescents participating in Project EAT (Eating Among Teens). Data were analyzed in 2006-2007. RESULTS: Weight-related problems were identified in 44% of the female subjects and 29% of the male subjects. About 40% of overweight girls and 20% of overweight boys engaged in at least one of the disordered eating behaviors (binge eating and/or extreme weight control). Weight-teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors strongly and consistently predicted overweight status, binge eating, and extreme weight-control behaviors after 5 years. Family meals, regular meal patterns, and media exposure to messages about weight loss were also associated with weight-related outcomes, although the strength and consistency of associations differed across outcomes and gender. CONCLUSIONS: Weight-specific socioenvironmental, personal, and behavioral variables are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence. These findings support the need for research to determine if decreasing weight-related social pressures, personal weight concerns, and unhealthy weight-control behaviors can contribute to reductions in obesity in children and adolescents.     

西安市初中生进食行为问题和家庭因素的关系研究

【目的】 调查西安市区初中生进食行为的现状,研究进食行为问题与家庭因素的关系,减少与进食障碍相关的进食行为问题对初中学生的危害。 【方法】 采用分层整群抽样方法,抽取西安市区631名初中学生作为调查对象,应用进食态度测试26项(EAT-26)、家庭亲密度和适应性量表Ⅲ(FACESⅢ)进行现场调查。 【结果】 西安市区13.47%的初中学生存在进食行为问题,其中女生占9.19%,多于男生;女生EAT-26总分明显高于男生,主要表现在节食维度;初三年级进食行为问题较严重,EAT-26总分显著高于初二年级,主要表现在口腔控制维度;初中男生家庭适应性与口腔控制维度呈正相关,而初中女生家庭亲密度与暴食维度呈正相关。 【结论】 家庭因素影响初中生的进食行为,对于存在进食行为问题的个体,应适当改变其家庭模式。     

Recurrent binge eating in black American women

CONTEXT: Recurrent binge eating is a core diagnostic feature of bulimia nervosa and binge eating disorder, and in samples of white women has been associated with obesity and psychiatric symptoms. Eating disorders have been believed to occur primarily among white women; in fact, the limited preliminary data available suggest that black women may be as likely as white women to report binge eating. OBJECTIVE: To examine race differences in prevalence of behavioral symptoms of eating disorders and clinically significant recurrent binge eating. DESIGN: Community survey. SETTING: General community in Connecticut and Boston, Mass. PARTICIPANTS: A community sample of 1628 black women and 5741 white women (mean age, 29.7 years) participated in a telephone survey designed to ascertain the presence, during the preceding 3 months, of binge eating and extreme weight control behaviors (vomiting, laxative or diuretic abuse, or fasting). MAIN OUTCOME MEASURE: Interviewer-based phone assessment of recurrent binge eating and behavioral symptoms of eating disorders. RESULTS: Black women were as likely as white women to report binge eating or vomiting during the preceding 3 months, and were more likely to report fasting and the abuse of laxatives or diuretics. Recurrent binge eating was more common among black women than among white women. In both race groups, recurrent binge eating was associated with elevated body weight and increased psychiatric symptoms. CONCLUSION: Results suggest that recurrent binge eating is a significant problem among black and white women. Health professionals need to be ready to respond to this health risk behavior.     

Gender differences regarding psychopathological, family and social characteristics in adolescents with abnormal eating behavior

OBJECTIVE: (1) To identify gender differences regarding psychopathological, family and social characteristics in adolescents with abnormal eating behavior; (2) to study risk factors for this abnormal eating in boys and girls. METHOD: Adolescents participating in this community-based longitudinal study completed, at the age of 13 (t(1)) and 15 years (t(2)), a semi-structured interview and the validated Spanish versions of several self-reported questionnaires measuring eating and general psychopathology. A control group of 150 pupils and 159 adolescents with abnormal eating behavior were selected. RESULTS: Girls with abnormal eating showed significantly more psychiatric morbidity and boys more social difficulties. Body dissatisfaction and psychiatric morbidity predicted abnormal eating at t(2) only in girls. DISCUSSION: The findings contribute to the debate on gender differences in abnormal eating behavior etiology.     

Binge eating and weight-related quality of life in obese adolescents

Limited data exist regarding the association between binge eating and quality of life (QOL) in obese adolescent girls and boys. We, therefore, studied binge eating and QOL in 158 obese (BMI ≥ 95th percentile) adolescents (14.5 ± 1.4 years, 68.0% female, 59% African-American) prior to weight-loss treatment. Youth completed an interview to assess binge eating and a questionnaire measure of QOL. Controlling for body composition, binge eating youth (n = 35), overall, reported poorer QOL in domains of health, mobility, and self-esteem compared to those without binge eating (ps < 0.05). Also, girls, overall, reported poorer QOL than boys in activities of daily-living, mobility, self-esteem, and social/interpersonal functioning (ps < 0.05). Girls with binge eating reported the greatest impairments in activities of daily living, mobility, self-esteem, social/interpersonal functioning, and work/school QOL (ps < 0.05). Among treatment-seeking obese adolescents, binge eating appears to be a marker of QOL impairment, especially among girls. Prospective and treatment designs are needed to explore the directional relationship between binge eating and QOL and their impact on weight outcomes.     

Early puberty and early sexual activity are associated with bulimic-type eating pathology in middle adolescence.

PURPOSE: To examine the associations between early pubertal timing and early advanced sexual development with bulimic-type eating pathology in middle adolescents. METHODS: A total of 19,321 boys and 19,196 girls aged 14-16 years (mean age 15.3 years, standard deviation 0.59) responded to the School Health Promotion Study, a class-room survey among Finnish adolescents about health, health behavior, and school experiences. Bulimic-type eating pathology was assessed with a questionnaire formulated according to the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) criteria. Pubertal timing was assessed by self-reported age at menarche or oigarche. Statistical methods were used chi-square and logistic regression. RESULTS: Bulimic-type eating pathology among girls was associated with early menarche, early sexual experiences, and increasing age. Among boys, onset of ejaculations at the normative age was protective for bulimic-type eating pathology, and the risk was elevated among very early and late maturers. Early sexual experience was associated with bulimic-type eating pathology. CONCLUSION: To prevent bulimia nervosa and to create opportunities for early intervention, attention should be paid to early maturing girls and off-time maturing boys, as well as those with early onset of sexual activity.     

Self-weighing among adolescents: associations with body mass index, body satisfaction, weight control behaviors, and binge eating

Among adolescent girls, the health effects of frequent self-weighing are unclear. This study examines cross-sectional and longitudinal associations between frequency of self-weighing and body mass index (BMI), body satisfaction, weight control behaviors, and binge eating among a diverse population of adolescent girls. The study was conducted in the Minneapolis/St Paul, MN, metropolitan area between 2007 and 2009. The study population included 356 adolescent girls (mean age 15.7 years); 46.2% of the girls were overweight or obese and >75% were from a racial/ethnic minority group. Anthropometric and survey data were collected at baseline and at follow-up 9 months later. Hierarchical linear regression models were developed to test associations. Cross-sectionally, frequent self-weighing was associated with lower body satisfaction (P=0.034) and higher rates of healthy (P=0.002), unhealthy (P=0.016), and extreme (P=0.038) weight control behaviors. A quadratic association was found between frequency of self-weighing and binge eating, with girls who weighed themselves least and most frequently reporting the highest prevalences of binge eating (P=0.014). No association was observed between frequency of self-weighing and girls' BMI (P=0.111). Short-term longitudinal associations between baseline frequency of self-weighing and changes in body satisfaction, weight control behaviors, binge eating, or BMI were not observed. Findings suggest that among adolescent girls, frequent self-weighing is cross-sectionally associated with both healthy and potentially harmful unhealthy weight control behaviors, and does not contribute to weight loss over time. Adolescents should not be encouraged to engage in frequent self-weighing.     

Evaluating the Impact of a School-based Prevention Program on Self-esteem,Body Image,and Risky Dieting Attitudes and Behaviors Among Kaua‘i Youth

Eating disorders and obesity (EDO) are increasing among youth, having serious long-term physical and psychological consequences. The purpose of this study was to determine if significant differences exist in EDO risk factors following participation of 4–6th grade students in a school-based EDO prevention curriculum. This community-based research project assessed students at baseline and one week following EDO intervention. Primary outcome variables measured self-esteem, body dissatisfaction, and high risk eating attitudes and behaviors. Pre and post-test differences were calculated using mixed models, correcting for clustering within schools and teachers. This study found mean changes in all scores in healthy directions, as well as movement of students into lower risk groups post-intervention. This program demonstrated that a classroom curriculum is associated with decreased risks of EDO in boys and girls, supporting prevention programs at an early age for both sexes. Studies to determine long term benefit and guide booster interventions are warranted.     

Comparison of the child and parent forms of the Questionnaire on Eating and Weight Patterns in the assessment of children's eating-disordered behaviors

OBJECTIVE: The assessment of eating-disordered behaviors in middle childhood is challenging. Frequently, both child and parents are queried about the child's eating behavior. However, no direct comparisons between parent and child reports of child eating disturbance have been published. We compared results from the adolescent and parent versions of the Questionnaire on Eating and Weight Patterns (QEWP-A and QEWP-P, respectively) in a nontreatment sample of overweight and normal weight children. METHOD: The QEWP-A and QEWP-P were administered to 142 overweight (body mass index [BMI] > or = 85th percentile) and 121 normal weight (BMI 15th-84th percentile) children, age 9.7 +/- 1.9 years, recruited from the community. RESULTS: The QEWP-A and QEWP-P showed good agreement for the absence of eating-disordered behavior but were not concordant in terms of the number or type of binge eating, overeating episodes, or compensatory weight control behaviors in the past 6 months. Children categorized by their own reports (QEWP-A) as engaging in no overeating, simple overeating, or binge eating behaviors did not differ significantly in body composition or in eating and general psychopathology. Children categorized according to their parents' reports (QEWP-P) as engaging in binge eating had significantly greater body adiposity, eating-disordered cognitions, body dissatisfaction, and parent-reported problems (all ps <.001) than children engaging in no overeating or simple overeating according to the QEWP-P. DISCUSSION: Child and parent reports of eating behaviors are not concordant regarding the presence of binge eating or compensatory behaviors. Further investigation of the utility of these questionnaires is needed before either can serve as a surrogate for a clinical interview.