Disordered Weight Control Behaviors Research Articles

A mixed-methods longitudinal examination of weight-related self-monitoring and disordered eating among a population-based sample of emerging adults

BackgroundWeight-related self-monitoring (WRSM) apps are used by millions, but the effects of their use remain unclear. This study examined longitudinal relationships between WRSM and disordered eating among a population-based sample of emerging adults.MethodsParticipants (n = 138) were recruited from EAT 2010–2018 (Eating and Activity over Time study) to participate in a mixed-methods (quantitative and qualitative) longitudinal study to understand the impacts of WRSM. In 2018, participants (Mage=21.7 ± 1.9 years) reported motivations for use and types of WRSM apps used. Dependent variables collected in 2022 (Mage=25.7 ± 1.9 years) included past year total number of disordered weight control behaviors, disordered muscle building behaviors, compulsive exercise, and binge eating. Linear and logistic regressions were used adjusting for sociodemographics, body mass index, and baseline disordered eating. Semi-structured interviews (n = 25) were analyzed using inductive thematic analysis.ResultsParticipants using WRSM apps for weight management demonstrated an increase in disordered weight control behaviors over time (β = 0.894, p = .012). Using WRSM apps for “healthy” eating was marginally associated with an increase in disordered weight control behaviors. (β = 0.673, p = .052). Qualitatively, participants reported varied temporality between WRSM and disordered eating, but believed that app use encouraged restriction/binge cycles and normalized disordered eating.ConclusionsFindings suggest there may be individual variation in the relationships between WRSM and disordered eating, but that using WRSM apps with the motivation of managing eating or weight may increase disordered eating in some. Additionally, WRSM apps may normalize or encourage disordered eating. Therefore, safeguards, including screening and monitoring, are needed to ensure WRSM does not cause or escalate harm among WRSM users.

The unintended consequences of school-based health and nutrition policies: a systematic review.

Significant funding and attention are directed toward school-based health and nutrition interventions. Less attention is given to the potential unintended consequences of these policies, especially those that target children and adolescents. This systematic review aimed to elucidate the unintended consequences of school-based health and nutrition policies in the United States. We conducted a systematic review, adhering to PRISMA guidelines, to analyze quantitative, qualitative, and mixed methods research conducted between January 2013 and September 2023. The search strategy encompassed three databases, identifying 11 articles that met the inclusion criteria. Unintended consequences were organized into four themes: disordered weight control behaviors, parental discomfort or encouragement of disordered weight control behaviors, eating disorder triggers, and financial losses. The analysis of disordered weight control behaviors indicates limited impact on youth, and we noted limited consensus in the assessment of these behaviors. We observed parent concerns about BMI screening and reporting as well as apprehensions about privacy and efficacy. There were fewer articles addressing eating disorder antecedents, although there was evidence that some youths with eating disorders considered school health class a trigger of their disorder. One study was identified that found an increase in food waste following replacement of sugar-sweetened beverages. Findings underscore the importance of comprehensive evaluation and consideration of unintended consequences in the development and implementation of school-based health policies. Recommendations include further longitudinal research, integrating obesity prevention with eating disorder prevention, and de-implementation when unintended consequences potentially outweigh benefits, such as in BMI screening and surveillance.Systematic Review Registration: Identifier CRD42023467355. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=467355.

Population-level policy recommendations for the prevention of disordered weight control behaviors: A scoping review.

The aim of this scoping review was to identify recommendations and gaps in knowledge surrounding the prevention of disordered weight control behaviors (DWCBs) through policy. A search was conducted in several databases to identify English language articles that described an active policy, recommendation, guideline, or educational curriculum that could be implemented by governments or regulatory bodies to prevent DWCBs or related constructs (e.g., weight stigma, body dissatisfaction). Two researchers independently screened articles with oversight from a third researcher. Data were extracted from the final sample (n = 65) and analyzed qualitatively across all articles and within the domains of education, public policy, public health, industry regulation, and media. Only a single empirical evaluation of an implemented policy to reduce DWCBs was identified. Over one-third of articles proposed recommendations relating to industry regulation and media (n = 24, 36.9%), followed by education (n = 21, 32.3%), public policy (n = 19, 29.2%), and public health (n = 10, 15.4%). Recommendations included school-based changes to curricula, staff training, and anti-bullying policies; legislation to ban weight discrimination; policies informed by strategic science; collaboration with researchers from other fields; de-emphasizing weight in health communications; diversifying body sizes and limiting modified images in media; and restricting the sale of weight-loss supplements. The findings of this review highlight gaps in empirically evaluated policies to reduce DWCBs but also promising policy recommendations across several domains. Although some policy recommendations were supported by empirical evidence, others were primarily based on experts' knowledge, highlighting the need for greater research on population-level DWCBs prevention through policy. Our scoping review of the evidence on policies for the prevention of disordered weight control behaviors identified several recommendations across the domains of education, public policy, public health, and industry regulation and media. Although few empirical investigations of implemented policies have been conducted, expert recommendations for policies to prevent disordered weight control behaviors among populations are plentiful and warrant future consideration by researchers and policymakers alike.

Social media, traditional media, and other body image influences and disordered eating and cosmetic procedures in Malaysia, Singapore, Thailand, and Hong Kong

In this study, we investigated the association between perceived sociocultural influences and the 3-month prevalence of disordered weight-control behaviors and lifetime prevalence of cosmetic procedures in four Asian countries, and if these associations were modified by gender. We conducted a cross-sectional online survey in September 2020 among adults ages 18–91 years (N = 5294) in Malaysia, Singapore, Thailand and Hong Kong. The 3-month prevalence of disordered weight control behaviors ranged from 25.2 % (Singapore) to 42.3 % (Malaysia), while the lifetime prevalence of cosmetic procedures ranged from 8.7 % (Singapore) to 21.3 % (Thailand). Participants who perceived their body image to be influenced by sociocultural factors were more likely to engage in disordered weight control behaviors (RRs ranged from 2.05 to 2.12) and have cosmetic procedures (RRs ranged from 2.91 to 3.89) compared to participants who perceived no sociocultural influence. Men who were influenced by traditional or social media were more likely to engage in disordered weight control behaviors and have cosmetic procedures than similarly influenced women. The high 3-month prevalence of disordered weight control behaviors and lifetime prevalence of cosmetic procedures in Asia is concerning. More research is needed to develop effective preventive interventions in Asia for men and women to promote a healthy body image.

Self-Reported Total Screen Time and Viewing Modes Are Associated with Body Dissatisfaction, Disordered Eating, and Cosmetic Surgery Intentions among Young Adults.

While numerous studies have shown that media exposure is linked to body dissatisfaction and disordered eating behavior, limited research has examined these associations by screen-viewing mode. This study examined associations of total screen-time and screen-viewing modes with body dissatisfaction, disordered eating, and cosmetic surgery intention among young adults. Men (n = 3466) and women (n = 7300), aged 19 to 34 years, self-reported their screen-time on various TV viewing modes, and their body dissatisfaction, overeating, disordered weight control behaviors, and cosmetic surgery intentions. We fit linear, logistic, and multivariate models to examine cross-sectional associations between total screen-time and screen-viewing modes and body dissatisfaction, disordered eating, and cosmetic surgery intention. Handheld viewing was associated with body dissatisfaction for women only, and online viewing was associated with greater body dissatisfaction among both men (βˆ = 0.40; 95% CI, 0.15 to 0.65) and women (βˆ = 0.25; 95% CI, 0.10 to 0.40). Downloaded viewing was associated with higher odds of overeating behaviors among both men (OR = 1.24; 95% CI, 1.10 to 1.40) and women (OR = 1.21; 95% CI, 1.12 to 1.32), respectively. Although total screen time was associated with greater cosmetic surgery intention for both men (βˆ = 0.24; 95% CI, 0.09 to 0.39) and women (βˆ = 0.43; 95% CI, 0.28 to 0.58), sex differences were found for the viewing modes. Our results suggest that different viewing modes may be differently associated with men and women’s body image, disordered eating behavior, and cosmetic surgery intention. Future research should consider all modes of screen-viewing in our media environment.

Using apps to self-monitor diet and physical activity is linked to greater use of disordered eating behaviors among emerging adults

Use of weight-related self-monitoring (WRSM) apps is common among emerging adults, as are weight and shape concerns. The present study aimed to examine (1) whether emerging adult use of dietary-focused (e.g., MyFitnessPal) and physical activity-focused (e.g., Fitbit) WRSM apps was associated with weight-control and muscle-building behaviors, including commonly recommended/conventional behaviors and disordered behaviors and (2) whether prior use of weight-control and muscle-building behaviors in adolescence might explain such relationships. Data were collected as part of the EAT (Eating and Activity over Time) 2010–2018 study (n = 1446) and analyzed using gender-stratified logistic regression models adjusted for demographic characteristics and body mass index. Among women and men, physical activity- and dietary-focused app use were associated with greater adjusted prevalence of disordered weight-control behaviors (e.g., fasting, purging), and disordered muscle-building behaviors (e.g., using steroids). Physical activity- and dietary-focused app use were also associated with a higher adjusted prevalence of commonly recommended weight-control and conventional muscle-building behaviors (e.g., exercising, changing eating habits), but only among those who were also engaging in disordered behaviors. The observed associations remained statistically significant in models that further adjusted for adolescent use of the respective behaviors. Findings suggest that emerging adults who use physical activity- and dietary-focused WRSM apps are more likely to engage in disordered weight-control and muscle-building behaviors and that associations are not explained by engagement in these behaviors during adolescence. Future research is needed to examine if there are aspects of WRSM apps that could be modified to reduce potential harm.

Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students

PurposeThe purpose of this study is to examine the association between gender expression, peer victimization, and disordered weight-control behaviors (DWCBs) in four population-based samples of U.S. high school students. MethodsAnalyses include data from 5,488 U.S. high school students from the 2013 Youth Risk Behavior Surveys in four jurisdictions (Broward County, FL; Chicago, IL; Los Angeles, CA; San Diego, CA). Participants were 56% Hispanic/Latino, 21% black/African American, and 14% white. Two items asked about perceived gender expression; responses were classified into three groups: highly gender conforming (e.g., very masculine boys), moderately gender conforming, gender nonconforming (e.g., feminine boys). Sex-stratified multivariable logistic regression models were used to examine the association between gender expression, peer victimization, and DWCBs in previous month (fasting, using diet pills/liquids/powders, and purging [vomiting or using laxatives]), controlling for potential confounders. ResultsOverall, 12% of respondents reported fasting, 6% reported diet pill use, and 5% reported purging, with significantly higher prevalence among gender nonconforming than among gender conforming male students (p < .001). In adjusted models, gender nonconforming male students had greater odds of fasting (odds ratio [95% confidence interval]: 3.0 [2.0–4.7]), diet pill use (6.1 [3.7–9.9]), and purging (7.2 [3.6–14.8]), relative to moderately conforming males. No significant associations were found among female students. Adding peer victimization to models modestly attenuated the association between gender nonconformity and DWCBs for male students. ConclusionsIn probability samples of U.S. high school students, we observed marked differences by gender expression in DWCBs among male students but not among female students. Gender expression-related stigma should be addressed within clinical and school-based interventions to prevent DWCBs.

The Prospective Association of Internalized Sexual Prejudice during Adolescence with Binge Drinking, Smoking, and Disordered Weight Control Behaviors in Adulthood

Prior research shows the importance of internalized sexual prejudice and participation in health indicators for sexual minority people, yet no research has used prospective measures or differentiated sexual minority groups. Data come from the longitudinal cohort study Growing Up Today Study 1 (N = 6,606), limited to participants who provided information on internalized sexual prejudice in adolescence and health indicators in adulthood. Completely heterosexual women with same-sex partners and mostly heterosexual women who reported high internalized sexual prejudice during their adolescence were more likely to binge drink during adulthood than completely heterosexual women with no same-sex partners. Similar patterns existed for mostly heterosexual and lesbian women when predicting smoking. Sexual orientation-related disparities in binge drinking smoking were largest for women with high internalized sexual prejudice who identify as completely heterosexual women with same-sex partners and mostly heterosexual women–groups that may have lower levels of connectedness to the buffering effects of sexual minority communities.

Maternal Comfort with Lesbian, Gay, and Bisexual People and Their Children's Drinking, Smoking, and Disordered Weight Control Behaviors as Adults.

Purpose: We investigated associations between maternal comfort with lesbian, gay, and bisexual (LGB) people during the participant's adolescence and their health indicators in adulthood. Methods: Data came from a prospective cohort, Growing Up Today Study (N = 7476), limited to men and women who provided information during their adulthood about recent binge drinking, cigarette smoking, or disordered weight control behaviors (DWCB) and whose mothers provided information during the participant's adolescence about her comfort with LGB people. Results: Increased maternal comfort with LGB people was associated with increased engagement in health indicators for heterosexual but not sexual minority adults (binge drinking, cigarette smoking, and DWCB for women; binge drinking for men). No association existed between maternal comfort with LGB people and binge drinking or cigarette smoking for sexual minority women, and binge drinking for sexual minority men. This resulted in statistically smaller differences across sexual orientation in cigarette smoking for women when their mothers were highly comfortable with LGB people compared with those whose mothers were uncomfortable with LGB people. There were no differences in binge drinking (women and men) and DWCB (women only) across sexual orientation when mothers were highly comfortable with LGB people. Conclusion: Maternal comfort with LGB people is associated with certain sexual orientation-related disparities in health indicators through adulthood, due to increased engagement in health indicators by heterosexual adults. Exposure to sexual orientation stigma in adolescence, measured as maternal comfort with LGB people, possibly drives well-known differences in drinking, smoking, and DWCB during adulthood between heterosexual and sexual minority adults.

158. Maternal Comfort with Sexual Minorities and Children’s Alcohol Use, Smoking, And Disordered Weight Control Behaviors During Adulthood: A Comparison Of Sexual Minority And Heterosexual Adults

Sexual minority adults often have worse health indicators (e.g., alcohol use, cigarette smoking, disordered weight control behaviors [DWCB]) than heterosexuals, with the exact pattern varying by sexual orientation and gender. Emerging research suggests maternal comfort with sexual minorities during adolescence is associated with better health indicators, but it is unclear if this association lasts into adulthood.

Body weight perception, disordered weight control behaviors, and depressive symptoms among Korean adults: The Korea National Health and Nutrition Examination Survey 2014.

Background/ PurposeDespite emerging evidence suggesting harmful influences of accurate weight perception on psychological health among individuals with obesity, little is known about the association in Asian populations. The aim of this study was investigate the association between body weight perception and depressive symptoms among Korean adults, and potential differential associations across gender.MethodsWe used data from the sixth Korea National Health and Nutrition Examination Survey in 2014, comprising 3,318 female (n = 1,876) and male (n = 1,442) participants, aged 19–65 years, with no history of depression and a body-mass index (BMI)> = 18.5kg/m2. Depressive symptoms were measured by the Patient Health Questionnaire-9 Korean version. Weight perception patterns were categorized by comparing self-perceived and objectively measured weight status. Gender-stratified four-level multilevel linear models adjusted for age, BMI, menopause, education, income, marital status, urbanicity, chronic conditions, exercise, smoking, and alcohol use. Subgroup analyses were performed across BMI category.ResultsAmong women with obesity, those who underperceived their weight status reported fewer depressive symptoms compared to those who accurately perceived their weight status (β = -1.25, p<0.05). Among women with normal weight, those who overperceived their weight status reported more depressive symptoms compared to those who accurately perceived their weight status (β = 1.00, p<0.05). The same associations were not found in men.ConclusionAwareness-oriented strategies for obesity prevention and weight management focused on providing information on weight status may need to consider unintended consequences of accurate weight perception on mental health among individuals with obesity, particularly among women.

Lessons Learned From Tennis Coaches’ Limited Disordered Weight Control Behaviors And Disordered Eating Knowledge

Irrational fears of food and weight gain are the foundation for Disordered Weight Control Behaviors, (DWCB), methods of weight control deemed unhealthy (e.g. severe Caloric restriction). Those extreme behaviors serve as clinical diagnostic criteria for Eating Disorders (ED). Adolescence is the time when DWCB and ED are likely to originate, especially in athletes. DWCB is linked to nutrition misinformation. The most frequently athlete cited source of nutrition information is equally misinformed coaches. PURPOSE: To assess high school tennis coaches’ knowledge in 5 domains: (1) Macronutrients/Energy, (2), ED Etiology (3) Symptoms (4) Scope of Practice, and (5) ED Treatment. METHODS: The Nutrition & Eating Disorders in Tennis Survey (NETS) was created through modification of Turk et al.’s survey as no survey specific to all of the domains existed. An expert panel confirmed the Face and Construct Validity of the NETS before it was piloted. A link to Qualtrics survey and informed consent form was emailed to Indiana High School coaches. The criterion for “Adequate Knowledge” (AK) was set at 80%. Mean knowledge scores were calculated for each question and the 5 domains. A three - way ANOVA tested for any significant differences (p < 0.05) between means of total knowledge scores and demographic variables. RESULTS: Seventy-nine coaches (male = 61, female = 18) ages 24 to 71 (43.97, ± 11.97) completed every question, which corresponds to a 23% rate of return, 90% statistical power according to Insel, G.D. The most cited source of nutrition knowledge was “experience as an athlete” (48.1% or 38 of 79) and the least was a Registered Dietitian (1.3% or 1 of 79). Data analysis revealed that the coaches lacked knowledge: the mean total score was 17.65 correct out of 25 or 70.6% (±10.9%), falling below the established AK criterion. The lowest mean scores were 57.0% (±22.4%), 60.0% (±21.7%), 63.6% (±22.9%), for domains 1, 3, and 5, respectively. There was no significant differences between knowledge scores and education. CONCLUSION: The low knowledge scores suggest that the coached athletes are at a higher risk of DWCB. Likewise, they are likely to be misinformed about the importance of correct energy intake. The common notion that experience as an athlete or taking a nutrition course makes one a qualified nutrition educator, must be questioned.

Sex of sexual partners and disordered weight control behaviors in a nationally representative sample of South Korean adolescents

Eating disorders are a serious and life-threatening health issue associated with physical and mental health problems. Stigma associated with sexual orientation is thought to be one contributor to eating disorders symptoms in U.S. adolescents. Additional research on disordered weight control behaviors in diverse populations is needed to better understand their etiology. To examine the association of sex of sexual partners with disordered weight control behaviors among South Korean adolescents, we analyzed survey data from 67,266 adolescents, ages 12–18 years, from the 2015 Korea Youth Risk Behavior Web-based Survey. Adolescents were grouped based on self-reported sex of sexual partners. Disordered weight control behaviors included fasting, vomiting, or use of unprescribed diet pills for weight control in the past month. Among both girls and boys, those reporting partners of both sexes had higher odds and those with no sexual partners had lower odds of disordered weight control behaviors. Those with same-sex partners only were not significantly different in disordered weight control behaviors from those with other-sex partners only for girls or boys. Our findings demonstrate the need for further research identifying ways to mitigate risk for this vulnerable group.

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey.

To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area. We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,687 girls, 33,842 boys) aged 12-18 years. DWCB was defined as engaging in any of the following behaviors for weight control over the past month: fasting, one-food diet (eating only one food over an extended period of time for weight control), vomiting, and taking laxatives/diuretics/unprescribed diet pills. Sex-stratified four-level multilevel logistic models examined potential predictors of DWCB, including age, body-mass index, puberty, perceived household economic status, parental education, living structure, school type and sex-composition, percentage of students participating in school nutrition programs, and urbanicity. Overall, 6.2% of Korean adolescents (8.9% of girls, 3.7% of boys) exhibited any DWCB. We found significant between-school variation among girls and boys and between-classroom variation among girls. Older age, overweight/obesity, pubertal maturity, high household economic status (vs. mid-range economic status), and vocational schooling (vs. general) were positively associated with DWCB among girls and boys. Low household economic status (vs. mid-range economic status), higher parental education, and coeducational schooling (vs. single-sex) were positively associated with DWCB among girls only. The findings suggest that DWCB are prevalent among Korean adolescents across age, sex, and socioeconomic status. Social contextual factors including school and familial environmental factors, as well as individual characteristics, should be considered when developing effective prevention strategies.

Weight misperception and disordered weight control behaviors among U.S. high school students with overweight and obesity: Associations and trends, 1999–2013

ObjectiveTo examine prevalence of weight misperception (incongruence between one's perceived weight status and one's actual weight status) and disordered weight control behaviors (DWCBs; unhealthy behaviors aiming to control or modify weight), associations between weight misperception and DWCBs, and temporal trends in prevalence and associations among adolescents with overweight and obesity from 1999 to 2013. MethodsSelf-reported data from eight biennial cycles (1999–2013) of the cross-sectional national Youth Risk Behavior Survey were used in analyses restricted to respondents with overweight/obesity. Data on weight status perception, use of fasting, purging, and diet pills to control weight, sex, race/ethnicity, and grade in school were used in multivariate logistic regression models. ResultsAmong U.S. high school students with overweight and obesity, no linear temporal trends were detected for prevalence of weight misperception, fasting, or purging between 1999 and 2013, while a significant linear decrease was observed for prevalence of diet pill use between 1999 and 2013 (b=−0.81, p<0.01). Using data pooled across 1999–2013, weight misperception predicted lower use of all DWCBs examined in this study among females and lower use of fasting to control weight among males. No significant changes over time in associations of weight misperception with fasting or purging were observed, though the association between weight misperception and diet pill use weakened somewhat across 1999–2013. DiscussionIn the context of increasing prevalence of overweight and obesity, weight misperception appears to be a robust protective factor for DWCBs.

Racial/ethnic and weight status disparities in dieting and disordered weight control behaviors among early adolescents

BackgroundThis study examined whether racial/ethnic minority early adolescents with overweight/obesity are at increased risk of disordered weight control behaviors, defined as unhealthy behaviors aiming to control or modify shape and weight, ranging from self-induced vomiting to the use of dietary supplements. MethodsU.S. Middle school children (n=12.511) provided self-report of gender, race/ethnicity, height, and weight as well as dieting and disordered weight control behaviors. ResultsIn the entire sample, 25.6% (n=1514) of girls and 16.6% (n=1098) of boys reported dieting within the last month, while 3.5% (n=200) of girls and 2.7% (n=176) of boys reported DWCB. Within all racial/ethnic groups, participants classified as being overweight/obese (34% to 50%) were more likely to report dieting compared to their counterparts without overweight/obesity (9.6% to 29.6%). Racial/ethnic minority children with overweight/obesity had an increased risk of dieting and disordered weight control behaviors compared to their counterparts without overweight/obesity, and, for some outcomes, compared to their White peers with overweight/obesity. ConclusionsRacial/ethnic minority early adolescents with overweight/obesity are a particularly vulnerable group for disordered eating.

Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system.

BackgroundAbuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. Yet only a small percentage of youth with disordered weight control behaviors receive treatment. The objective of this study was to examine how often clinicians communicate with youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products.We used electronic medical records and administrative claims for services for 53,229 12 to 17 year old patients receiving care from an integrated health system in the U.S. Northwest from August 2007 to December 2010. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and then assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control.ResultsWe identified 130 (0.2% of sample) patients with clinical notes indicating one or more of the metabolic conditions. In clinical notes for only four (3.1%) of these patients did clinicians document suspicion or communication about possible abuse of the OTC products. All four had a previous eating disorder diagnosis. In the 12 months subsequent to the clinical encounter in which a metabolic disturbance was identified, medical notes for only three (2.3%) of the 130 patients indicated clinician suspicion or communication about possible abuse of these products or an eating disorder.ConclusionsClinicians are missing a critical window of opportunity to query adolescents when presenting with suspicious metabolic disturbances about possible abuse of OTC products for weight control. Clinicians may need more training to detect OTC product abuse, and electronic medical records should prompt more thorough enquiry.

Family Physical Activity and Meal Practices Associated With Disordered Weight Control Behaviors in a Multiethnic Sample of Middle-School Youth

ObjectiveFamily practices around weight-related behaviors can shape children's development of disordered weight control behaviors (DWCB), such as vomiting, taking laxatives, or taking diet pills without a prescription. This study examined family meal and physical activity (PA) practices associated with DWCB among a multiethnic sample of youth. MethodsWe assessed self-report data on frequency of family sit-down dinners, types of parental involvement in their children's PA, and DWCB are from 15,461 6th to 8th grade girls and boys in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). ResultsYouth who had family sit-down dinners every day had lower odds of DWCB (girls: odds ratio [OR] 0.3; 95% confidence interval [CI] 0.2–0.5; boys: OR 0.6; 95% CI 0.4–0.9) than youth who never had family sit-down dinners. Similar effect estimates were found for youth who had family sit-down dinners most days. Parental provision of rides to and from a PA event was also found to be protective against DWCB among girls (OR 0.7; 95% CI 0.5–0.9). In contrast, parental participation in PA with their children was associated with increased risk for DWCB (girls: OR 1.4; 95% CI 1.0–1.8; boys: OR 1.9; 95% CI 1.4–2.4). These associations did not differ by race/ethnicity or weight status. ConclusionsPrograms emphasizing the importance of family meals may be beneficial in preventing DWCB in youth of all ethnicities. Further research is needed on how various methods of parental involvement in their children's PA are associated with DWCB.

The Contribution of School Environmental Factors to Individual and School Variation in Disordered Weight Control Behaviors in a Statewide Sample of Middle Schools

We investigated the contribution of school environmental factors to individual and school variation in disordered weight control behaviors (DWCB). Analyses were based on self-report data gathered from 18,567 middle-school students in 2005 and publicly available data on school characteristics. We observed large differences across schools in percent of students engaging in DWCB in the past month, ranging from less than 1% of the student body to 12%. School-neighborhood poverty was associated with higher odds of DWCB in boys. Preventive strategies need to account for wide variability across schools and environmental factors that may contribute to DWCB in early adolescence.

Dietary and Physical Activity Factors Related to Eating Disorder Symptoms Among Middle School Youth

Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth. Self-reported data on dietary weight management behaviors, strengthening/toning exercises, moderate-to-vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools. Disordered weight control behaviors were reported by 3.6% of girls and 3.1% of boys. Youth who engaged in strengthening/toning exercises 7 days per week versus 0-3 days per week had increased odds of DWCB (girls odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.3 - 3.0; boys OR = 1.5; 95% CI = 1.0 - 2.2). Dietary weight management behaviors were associated with increased odds of DWCB (girls OR = 1.2; 95% CI = 1.1 - 1.3; boys OR = 1.3; 95% CI = 1.2 - 1.4) for each additional behavior. These associations did not differ by race/ethnicity or weight status. Persons promoting healthy dietary and PA behaviors among youth should consider the co-occurrence of strengthening/toning and dietary weight management behaviors with DWCB and the consistency in these associations across racial/ethnic and weight status groups.