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.     

Weight-control practices of adults in a rural community

Abstract: Obesity is recognised as a significant public health problem, and health authorities are concerned with promoting a healthy weight for all adults. However, there is a paucity of data about community weight-control practices. We surveyed weight-control behaviour, strategies and goals in a population-based sample of 1342 adults living in rural Victoria. In addition to the 20 per cent of adults who were attempting to lose weight, 22 per cent were actively trying to maintain their present weight or to avoid weight gain. Those taking action for their weight most often did so for health-related reasons, and most of the strategies used were those recommended by health authorities. However, some adults, particularly women, adopted potentially unhealthy weight-control practices. One in four women whose weight was acceptable was trying to lose weight, and 14 per cent of women had a weight goal that was below the acceptable range. Conversely, 50 per cent of men had a weight goal higher than that currently considered acceptable. Additional research is required to assess more accurately the specific nature of community weight-control practices     

Prevalence of Adolescents' Self-Weighing Behaviors and Associations With Weight-Related Behaviors and Psychological Well-Being

PurposeTo examine the relationships between self-weighing frequency, and weight-related behaviors and psychological well-being in a population-based sample of adolescents.MethodsThis study compared weight-related behaviors between infrequent and frequent self-weighers, stratified by weight status and gender. Data were from Project EAT 2010 (Eating and Activity in Teens), a population-based study of 2,778 adolescents.ResultsApproximately 14% of girls and boys weighed themselves frequently (weekly or more). In comparison to girls who were infrequent self-weighers, girls who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and have lower self-esteem and greater body dissatisfaction. In comparison to boys who were infrequent self-weighers, boys who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and report greater depressive symptoms. Among overweight adolescents, in addition to being associated with these harmful outcomes, frequent self-weighing was associated with the use of healthy weight control behaviors and with higher levels of moderate-to-vigorous activity.ConclusionsFindings indicate that adolescents who frequently self-weigh themselves are at increased risk for a number of problematic health behaviors and poorer psychological outcomes. For overweight adolescents, frequent self-weighing was additionally associated with a number of positive outcomes. Based upon these findings, any recommendations for weight monitoring should be made cautiously; all adolescents, including overweight adolescents, should be advised not to engage in frequent self-weighing behaviors. Furthermore, any adolescents engaging in frequent self-weighing behaviors should be monitored for problematic outcomes.     

Associations of Trying to Lose Weight, Weight Control Behaviors, and Current Cigarette Use Among US High School Students

BACKGROUND: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th–12th grade students in the United States.
METHODS: Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2).
RESULTS: In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15–1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not.
CONCLUSION: Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.     

Weight-control behaviors among adults and adolescents: associations with dietary intake

BACKGROUND: This study aimed to assess the prevalence of weight-control behaviors and their associations with overall dietary intake among adults and adolescents. METHODS: Participants included 3,832 adults and 459 adolescents from four regions of the United States. Cross-sectional data were collected on energy and nutrient intake, weight-control behaviors, body mass index (BMI), and sociodemographics. RESULTS: Current weight-control behaviors were reported by 52.7% of the study population (adult women, 56.7%; adult men, 50.3%; adolescent girls, 44.0%; adolescent boys, 36.8%). Weight-control behaviors were consistently and positively associated with socioeconomic status among adults, but not among adolescents. Among "dieters," unhealthy practices were reported by 22.7% of adult women, 21.3% of adult men, 30.4% of adolescent girls, and 18.5% of adolescent boys. Adults trying to control their weight reported healthier nutrient intakes than those not trying to control their weight, in particular when moderate weight-control methods were employed. Among adolescents, there were fewer differences across dieting status and these were not suggestive of healthier intakes among dieters than nondieters. CONCLUSIONS: Weight-control behaviors are reported by a large percentage of the population. Weight-control behaviors tend to be healthier among adults than among adolescents, in terms of the types of behaviors used and their impact on nutrient intakes. Obesity prevention interventions should emphasize the importance of using healthy weight-control practices.     

The relationship of weight-related perceptions, goals, and behaviors with fruit and vegetable consumption in young adolescents

BACKGROUND: The effect of dieting and weight-control perceptions, goals, and behaviors on food intake, including fruit and vegetable (F&V) consumption, is not completely understood. We examined these associations in 1,755 young adolescents. METHODS: Data from the Teens Eating for Energy and Nutrition at School (TEENS) study were analyzed separately by gender using mixed linear modeling. Surveys completed at the beginning and end of 7th grade asked students to self-report fruit and vegetable consumption, weight-related perceptions, goals, and behaviors, and demographic variables. RESULTS: Underweight boys reported 0.8 fewer F&V servings per day than boys who reported their weight to be 'about right' (P = 0.002), while overweight girls reported 0.7 fewer F&V than girls who reported their weight to be 'about right' (P = 0.005). Boys with weight-related goals consumed significantly more F&V than did boys not wanting to do anything about their weight (P < 0.05). Girls engaging in weight-related behaviors reported 0.7 more F&V than girls who did not engage in weight-related behaviors (P = 0.006). CONCLUSIONS: Because F&V intake is low among all adolescents, population interventions should take place to increase F&V intake. These data support the inclusion of gender-specific intervention components related to weight-related perceptions, goals, and behaviors.     

Relationship Between Current Substance Use and Unhealthy Weight Loss Practices Among Adolescents

Objectives To determine the relationship between current substance use and unhealthy weight loss practices (UWLP) among 12-to-18 year olds. Methods Participants were 12-to-18 year olds who completed the 2013 Youth Risk Behavior Survey in Florida (N = 5620). Current alcohol, tobacco, and marijuana use was self-reported based on last 30-day use. UWLP was defined based on self-report of at least one of three methods to lose weight in last 30-days: (1) ≥24 h of fasting, (2) diet pill use, and (3) laxative use/purging. The reference group included those with no reported UWLP. Logistic regression models adjusted for age, gender, race/ethnicity, academic performance, age-sex-specific body mass index percentiles, and perceived weight status were fitted to assess relationships between UWLP and current substance use. Results About 15 and 41 % of adolescents reported ≥1 UWLP and use of ≥1 substance in the last 30-days, respectively. Over half (60.1 %) of adolescents who reported substance use engaged in UWLP (p < 0.0001). The prevalence of current alcohol use (50.6 %) was the highest among those who reported UWLP, followed by marijuana (31.9 %), tobacco (19.7 %), and cocaine (10.5 %) use. Adolescents who reported current tobacco [adjusted odds ratio (AOR) 2.7, 95 % confidence interval (CI) 2.1–3.6], alcohol (AOR 2.2, 95 % CI 1.9–2.6), or marijuana (AOR 2.1, 95 % CI 1.7–2.5) use had significantly higher odds of UWLP compared to their non-user counterparts. Conclusions This cross-sectional study shows that substance use and UWLP behaviors are likely to co-exist in adolescents. Further studies are necessary to determine the temporal relationship between substance use and UWLP. It is recommended that intervention programs for youth consider targeting these multiple health risk behaviors.     

Dieting Habits of Men

There is little research involving the US male population regarding weight control and behavior that may affect weight status. Gender-specific weight-control programs for men aren’t the standard. Our study objectives were to survey dieting and health habits of an adult male employee population and to determine if the population would be interested in gender-specific programming. Demographics, weight-control practices and interest in gender-specific weight-control programs were examined cross sectionally. A 50-question web-based survey was posted via email from October 2–30, 2014 to male employees at a Mid-Atlantic university. Statistical analyses included frequencies, means and percentages. Chi square and t tests were conducted. The 254 participants were ages 18–65+ years, predominantly white, college educated with annual incomes above $50,000. Sources of nutrition knowledge ranged from a high of web sites (65 %) to a low of registered dietitians (9 %). Macronutrient restrictions reported for dieting were carbohydrates 77 %, fats 40 % and protein 19 %. The >30 age group was more likely to have: decreased amount of food intake P = .001), reducing overall calories (P = .047), skipping meals (P = .006) or trying commercial programs (P = .011). There was nothing of significance for those <30. Among all respondents, interest in gender-specific programs was compared with these variables: current weight satisfaction (P = .032), education (P = .008), income (P = . 006) and BMI (P = .004). Men who were dissatisfied with their weight were most likely to be interested in a gender-specific weight control program, especially those over age 30 years. Further research should address whether offering male-specific diet programs would offer incentive and motivation for males to lose and maintain weight loss.     

Self-perception of body weight, weight management practices and goals, and other weight-related factors in central and eastern European adolescents

Self-perception of body weight, management practices and goals, and other weight-related factors were assessed among a sample of 2,566 adolescents from 30 high schools in Hungary, Slovakia, Czech Republic, Romania, Ukraine, and Poland. Students who perceived themselves as much too fat were more likely than those with other weight perceptions to engage in weight management practices to lose weight, have higher body mass index, rate themselves lower on physical attractiveness, and estimate higher percentages of their same-sex friends as trying to lose weight. Similar to other research, boys and girls differed on self-perception of weight and other weight-related factors. Cross-cultural comparisons between central and eastern European adolescents and U.S. adolescents, as well as east and southeast Asian youth are made. Implications for health education practice are discussed.     

The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls

Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends' dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends' involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends' dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR = 1.47, CI = 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR = 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI = .97-1.50), even after controlling for friends' dieting behaviors. The social influences examined here were not associated with UWCBs among underweight ( < 15th percentile) or overweight ( > 95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.     

Weight-related attitudes and behaviors in fourth grade American Indian children

OBJECTIVE: American Indian children have a high prevalence of obesity, yet little is known about weight-related attitudes and the prevalence of dieting in this population. This study assessed weight concerns, body size perceptions, weight reduction attempts, and weight loss methods in fourth grade American Indian children. RESEARCH METHODS AND PROCEDURES: Participants (n = 304) attended one of eight schools in the Pathways Feasibility Study. Question and answer choices were read to children by trained staff, and children marked their own answers. RESULTS: Thirty-eight percent of the children reported that they had tried to lose weight. The most common strategy for weight reduction was exercising more. Girls were more likely than boys to be dissatisfied with their body size (48% of girls vs. 34% of boys desired a slimmer body size; 22% of girls vs. 15% of boys desired a larger body size; p<0.001). Children who had tried to lose weight were more likely to indicate that the size they most desired and the most healthy size were smaller than their perceived size (p<0.001). Children who reported trying to lose weight were also more likely to want to be skinnier and to be unhappy about their weight than were children who did not report trying to lose weight (p<0.001 for both). DISCUSSION: We conclude that weight loss attempts and weight-related concerns are prevalent in American Indian children at a young age.     

Self-perception of body weight among high school students in Taipei, Taiwan

Self-perception of body weight and other weight-related factors were assessed among 2665 Taipei, Taiwan high school students. A high percent of the girls (70.7%) and boys (42.2%) reported that they were too fat and these percentages were much higher than those reported by U.S. students in a recent Youth Risk Behavior Survey. In addition, only 13.2% of girls and 22.0% of boys reported being completely satisfied with their weight and the level of dissatisfaction with weight appeared to be greater than among U.S. students. Yet, in comparison to U.S. students, the Taiwanese students were considerably less likely than their U.S. counterparts to engage in weight management practices (e.g., dieting, eating less food, using diet pills). Taiwanese students with a self-perception of being too fat were more likely than those with perceptions of being just right or too thin to engage in weight management practices, to be dissatisfied with their weight, feel that they were unattractive, estimate that their same-sex peers were trying to lose weight, and have a higher body mass index. The findings from this study showed a relationship between self-perception of body size and engaging in weight control behaviors was consistent with other research. It suggested that self-perception of body weight, more so than objective weight status, was predictive of weight loss behavior and also negative psychological outcomes associated with poor body weight image. As a result, self-perception of weight may be an important point of focus for the design and implementation of clinical and public health initiatives targeted at this adolescent population as well as others.     

Alcohol-related consequences among women who want to lose weight

Previous research has identified a positive relationship between disordered eating behaviors and heavy alcohol use, demonstrating that alcohol use is heavier among individuals with eating disorders or who demonstrate significant symptoms of disordered eating. The purpose of this study was to examine whether this relationship also exists among women displaying milder disordered eating attitudes, defined by a stated desire to lose weight despite maintaining a healthy body weight. Participants in this study were 255 female college students at a large public university in the northeast region of the United States who were either under- or of normal body weight. Results indicated that women who reported a desire to lose weight were significantly more likely to experience several negative alcohol-related consequences, including doing something later regretted and having forced intercourse than those without a desire to lose weight. Results also indicated that the use of protective behavioral strategies was associated with fewer alcohol-related problems among this group. Implications for interventions and future research studies are discussed.     

Weight Management Efforts,But Not Weight Perceptions,Are Associated with Dietary Quality among Youth and Young Adults in Canada

BackgroundEfforts to lose, gain, or maintain weight are prevalent among youth and young adults, but little is known about the relationship between weight management efforts and dietary quality. Attempts to manage weight are typically driven by weight perceptions, which may also uniquely affect overall diet.ObjectiveThe objective was to explore sex-stratified associations between weight management efforts and perceptions with dietary quality among youth and young adults.DesignCross-sectional online survey data were drawn from Wave 1 (2016) of the Canada Food Study.Participants/settingYouth and young adults (n = 3,000), aged 16 to 30 years, were recruited from community settings in five Canadian cities and completed the online survey. The analytic sample consisted of 2,040 participants.Main outcome measuresThe Healthy Eating Index-2015 (HEI-2015) was used to characterize dietary quality among participants who completed a 24-hour recall. Respondents reported their weight change efforts over the past year and their weight perception.Statistical analyses performedSex-stratified multiple linear regression analyses were conducted to investigate relationships between each of weight management efforts and perceptions, separately, and dietary quality, controlling for known covariates.ResultsThe HEI-2015 mean score was 52 of 100 possible points. Nearly one quarter of male and female respondents reported not trying to do anything about their weight, whereas 16% reported trying to maintain, 28% and 5% trying to gain, and 33% and 55% trying to lose weight, respectively. Most respondents (63% of males and 66% of females) perceived their weight as just about right. Among males, trying to gain or maintain weight were each significantly associated with higher HEI-2015 mean scores compared with not trying to manage weight (P < .01 and <.001, respectively), whereas this relationship existed only for weight maintenance among female respondents (P < .01). Weight perceptions and HEI-2015 mean scores were not significantly related.ConclusionsEfforts to manage weight, which are commonplace among youth and young adults, are associated with dietary quality. Future behavioral research may provide insights into strategies used by youth to manage weight, guiding interventions that recognize links among weight-related behaviors, dietary quality, and other determinants of health.     

Prevalence of pathogenic weight-control behaviors among native American women and girls

Results of a survey administered to 85 Native American girls and women, aged 12–55, revealed that 74% were trying to lose weight and that 75% of those who were dieting to lose weight were employing potentially hazardous techniques. The results also showed that 24% of the dieters used one or more purging behaviors. The mean age of those using pathogenic weight-control methods was 28.8 years. Subjects with higher body mass indexes were more likely to use dangerous weightcontrol methods. These findings suggest that Native American women should be included among the groups at risk for eating disorders and that older and heavier women in this population also should receive attention.     

Weight-related behaviors among non-overweight adolescents: results from the Korean national survey from 2005 to 2007

This study aimed to assess the prevalence of overweight misperception, unhealthy diet practices, and factors associated with these weight-related behaviors among Korean adolescents. The subjects were a nationally representative sample of non-overweight students (52,515 in 2005, 64,084 in 2006, and 67,113 in 2007) in middle and high schools who completed the Korea Youth Risk Behavior Web-Based Survey. The prevalence of weight-related behaviors and factors associated with these behaviors were assessed using a complex sampling design. Of non-overweight students, 14.9% of boys and 22.2% of girls reported their weight as overweight/obese. Dieting within the last year was reported by 19.8% of boys and 41.8% of girls. Of those who attempted dieting, 17.1% of boys and 24.6% of girls indicated practicing at least one unhealthy diet behavior within the last month. Overweight misperceptions were independently associated with diet attempts and unhealthy diets after adjustment for weight status, and demographic, social, and psychological factors. Additionally, these weight-related behaviors were also associated with psychosocial factors such as low school achievement, sadness, suicidal ideation, increased stress perception, and cigarette or alcohol use. In conclusion, the high prevalence of inappropriate weight-related behaviors suggests a need for comprehensive approaches to improve weight-related behaviors in non-overweight Korean adolescents.     

Weight status, quality of life, and cigarette smoking among adolescents in Washington State

Purpose

We examine age- and sex-specific associations between weight status and intensity of cigarette smoking in a large sample of adolescents. Additionally, we test whether quality of life (QOL) and weight control behaviors (i.e., trying to lose, gain, or stay the same weight) mediate the association.

Methods

We used cross-sectional data from the 2010 Washington State Healthy Youth Survey collected in grades 8, 10, and 12 (n = 11,222). Multinomial logistic regression was used to model cigarette smoking (none, light, frequent) as a function of weight status, weight control behaviors, and QOL by sex and age. Indirect effects of presumed mediators were assessed using the product of coefficients approach.

Results

Weight status was not associated with smoking. Trying to stay the same weight was associated with lower odds of light smoking for younger girls (OR = 0.25; 95 % CI = 0.08, 0.84), whereas trying to lose weight was associated with higher odds of light smoking for older girls (OR = 1.73; 95 % CI = 1.11, 2.70). Low QOL was associated with higher odds of light and frequent smoking for both girls and boys (P < 0.001). The mediation effects of weight control behavior and QOL combined were significant in the associations between body mass index percentile and smoking among older girls.

Conclusion

Targeted interventions designed to promote QOL and healthy weight control behaviors among youth may help to decrease the prevalence of smoking.     

Weight-loss practices and asthma: findings from the behavioral risk factor surveillance system

OBJECTIVE: To describe weight-control practices and receipt of weight-loss advice among obese people with asthma. RESEARCH METHODS AND PROCEDURES: We analyzed data from the 2000 Behavioral Risk Factor Surveillance System. RESULTS: Among 13953 participants with current asthma, 27.3% had a body mass index of >or=30 kg/m2. Overall, 48.1% of participants with asthma reported trying to lose weight (64.1% among overweight or obese participants and 72.9% among obese participants). Among participants with asthma who were trying to lose or maintain weight, 74.7% reported trying to reduce their energy and/or fat intake, and 57.8% reported using physical activity. Approximately 29.7% were using the recommended combination of energy and/or fat intake reduction and physical activity of >or=150 min/wk. During the 12 months before the interview, 16.2% of overweight and 44.9% of obese participants with asthma reported receiving advice to lose weight. Among obese participants receiving weight-loss advice, 82.9% reported trying to lose weight compared to 63.8% of participants who did not receive such advice. DISCUSSION: Health professionals can play an important role in educating their patients with asthma about the importance of weight control and assisting their overweight and obese patients in setting appropriate weight goals and helping them achieve those goals.