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Healthy eating: what does it mean to adolescents?

OBJECTIVE: The objective of this study was to investigate the meanings of "healthy" and "unhealthy" eating and the importance of healthy eating among adolescents. DESIGN: Twenty-five structured focus groups were conducted. SUBJECTS: These focus groups consisted of 203 adolescent girls and boys enrolled in three senior high schools and one junior high school. VARIABLES MEASURED: The variables measured were adolescents' self-report of perceptions of healthy and unhealthy eating and their descriptions of the importance of healthy eating to adolescents. ANALYSIS: Data analysis was done by general content coding and specific content coding. RESULTS: Adolescents have a significant amount of knowledge regarding healthy foods and believe that healthy eating involves moderation, balance, and variety. Despite this knowledge, they find it difficult to follow healthy eating recommendations and frequently consume foods that they perceive as unhealthy. Barriers to healthy eating include a lack of time, limited availability of healthy foods in schools, and a general lack of concern regarding following healthy eating recommendations. IMPLICATIONS: These findings suggest that healthy eating messages based on the Dietary Guidelines for Americans are reaching adolescents, but interventions are needed that assist adolescents with the translation of this knowledge into healthy behaviors. Interventions should help make healthy eating easy for youth to apply and explain the consequences of unhealthy eating in terms that they value, stressing meaningful short-term benefits.

Adolescent↗

PubMed2005

Positive maternal attitude to the family eating together decreases the risk of adolescent overweight.

OBJECTIVES: To determine whether maternal attitude towards the family regularly eating together and maternal report of how often the family eat together are associated with adolescent offspring overweight. RESEARCH METHODS AND PROCEDURES: A cross-sectional mother-child-linked analysis was carried out using 14-year follow-up data from a population-based prospective birth cohort of 3795 children (52% males) who were participants in the Mater-University study of pregnancy, Brisbane, Australia. Maternal reports on family eating pattern reported at age 14 were used. RESULTS: The prevalence of overweight at age 14 was 24.1% (95% confidence interval (CI), 22.3, 26.1) for males and 27.1% (CI, 25.1, 29.2) for females. The majority of mothers (78%) reported that the family ate together at least once a day, but only 43% reported that they felt that family eating together was important. The offspring of women who felt that the family eating together was not important had increased odds of being overweight at age 14 (odds ratio, 1.27; 95% CI, 1.05, 1.53) in age- and sex-adjusted models. Adjustment for potential confounding factors had no substantive effect on the association. There was no association between maternal reports of how often the family actually did eat together and overweight at age 14 in the offspring. DISCUSSION: These findings suggest that maternal attitude towards family eating patterns, but not maternal report of how often the family do eat together, are associated with childhood overweight status. Maternal attitude towards family eating (as opposed to a report of actual frequency at one time-point) may reflect broader maternal influences (beyond family eating pattern) on their child's diet and eating patterns over a long time course.

Adolescent↗

PubMed1999

The impact of pregnancy on eating behaviour and aspects of weight concern.

BACKGROUND: Excessive weight gain in pregnancy and retention of this weight gain is a well known problem. How women with a history of dietary restraint adjust to being pregnant, is of interest, as pregnancy epitomises many of the factors known to trigger overeating. OBJECTIVE: To examine the impact of pregnancy on eating behaviour and weight concern and the role of dietary restraint in mediating any changes. METHODS: Primigravid (n = 50) and non-pregnant nulliparous (n = 50) women completed a questionnaire to describe their profile characteristics, current health behaviours, eating behaviour and weight concern. The pregnant women completed additional retrospective items relating to these factors for the period prior to their pregnancy. RESULTS: The pregnant women reported eating more, showed lower levels of dietary restraint, were less dissatisfied with their body shape and showed higher eating self efficacy than non-pregnant women. Compared to the months prior to their pregnancy, the pregnant women rated themselves as less restrained in their eating behaviour and nearly half stated that they were eating more. In terms of the impact of pre pregnancy levels of dietary restraint, the results showed a significant interaction between restrained eating and pregnancy for both hunger and eating self efficacy. The results showed that the restrained eaters, when pregnant, rated themselves as significantly less hungry and reported less difficulty controlling their food intake than the non pregnant restrained eaters but showed comparable hunger and eating control to the other groups. The results showed no effect of restrained eating on weight change. CONCLUSION: The results suggest that pregnancy both legitimises increased food intake and removes any previous intentions to eat less.

Adult↗

PubMed2004

Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioural factors among African Americans in North Carolina.

OBJECTIVE: To examine associations of the frequency of eating at fast-food restaurants with demographic, behavioural and psychosocial factors and dietary intake in African American adults. METHODS: Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20-70 years, in North Carolina. An 11-page questionnaire assessed eating at fast-food restaurants, demographic, behavioural and diet-related psychosocial factors, and dietary intake (fruit, vegetable, total fat and saturated fat intakes, and fat-related dietary behaviours). RESULTS: The participants were aged 43.9+/-11.6 years (mean+/-standard deviation), 41% were male, 37% were college graduates and 75% were overweight or obese. Seventy-six per cent reported eating at fast-food restaurants during the previous 3 months: 4% usually, 22% often and 50% sometimes. Frequency of eating at fast-food restaurants was positively associated with total fat and saturated fat intakes and fat-related dietary behaviours (P<0.0001) and inversely associated with vegetable intake (P<0.05). For example, mean daily fat intake was 39.0 g for usually/often respondents and 28.3 g for those reporting rare/never eating at fast-food restaurants. Participants who reported usual/often eating at fast-food restaurants were younger, never married, obese, physically inactive and multivitamin non-users (all P<0.01). Frequency of eating at fast-food restaurants was positively associated with fair/poor self-rated health, weak belief in a diet-cancer relationship, low self-efficacy for healthy eating, weight dissatisfaction, and perceived difficulties of preparing healthy meals and ordering healthy foods in restaurants (all P<0.05). Frequency of eating at fast-food restaurants did not differ significantly by sex, education, smoking, ability to purchase healthy foods or knowledge of the Food Guide Pyramid. CONCLUSIONS: Eating at fast-food restaurants is associated with higher fat and lower vegetable intakes in African Americans. Interventions to reduce fast-food consumption and obesity in African Americans should consider demographic and behavioural characteristics and address attitudes about diet-disease relationships and convenience barriers to healthy eating.

Adult↗

PubMed2004

Eating attitudes of Native American and white female adolescents: a comparison of BMI- and age-matched groups.

OBJECTIVE: To explore the differences in eating attitudes between groups of Native American and white female adolescents based on data derived from the Eating Attitudes Test (EAT-26). DESIGN: Selected data presented here were derived from a larger convenience sample of (2,000 students in grades 5-12 using a self-report questionnaire, which included the EAT-26 and various demographic questions, administered by teachers at 17 schools across Montana (USA). RESULTS: Comparing the eating attitudes of age- and body-mass-index (BMI)-matched Native American and White girls (mean age=14.2 years) revealed that Native ethnicity was associated with significantly higher dieting and restricting/purging scores. BMI was strongly positively associated with greater food preoccupation, independently of ethnicity. Both Native ethnicity and low BMI scores contributed to higher restricting/purging and social pressure/oral control scores. CONCLUSION: In general, Native American girls reported significantly higher scores on the EAT-26 due mainly to more dieting, more perceived social pressure to eat, and more restricting and purging. By contrast, higher BMI was associated with greater food preoccupation, less restricting/purging, and less social pressure to eat. Thus, while Native American ethnicity and BMI both influence the risk of eating problems, these results are the first to suggest how ethnicity and BMI may differentially influence specific eating attitudes and behaviors among these groups of adolescent girls. Nevertheless, many questions about the causes and consequences of eating-related problems among Native American adolescents remain to be answered.

Adolescent↗

PubMed2001

Managing healthy eating: definitions, classifications, and strategies.

This study sought to enhance understanding of how people conceptualize and manage healthy eating. An interpretivist approach employed the constant comparative method to analyze 79 open-ended interviews with individuals about food choices and eating behaviors for health-related themes. Participant reports depicted cognitive systems for defining healthy eating, where personal meanings evolved through ongoing exposure to a variety of experiential and informational sources. Participants' definitions of healthy eating clustered around seven themes forrelating food and eating to their personal health. Healthy eating definitions shaped how participants categorized food and eating situations as healthy and unhealthy. Participants described healthy eating strategies that were differentially associated with various healthy eating themes. These findings provide an emic perspective of how a diverse sample of adults conceptualize and manage healthy eating. Exposing the implicit and multiplistic nature of healthy eating conceptions provides information useful to health educators promoting behavior changes.

Adolescent↗

PubMed2001

Eating behavior in morbidly obese patients undergoing gastric surgery: differences between obese people with and without psychiatric disorders.

BACKGROUND: This study analyzes eating behavior in a group of morbidly obese patients who have undergone gastric reduction surgery for weight loss, and evaluates whether the existence of psychiatric comorbidity marks significant differences in their eating behavior. METHODS: The study group was composed of 100 morbidly obese patients (85 females, 15 males) who had received surgical treatment for weight reduction (vertical banded gastroplasty). 40 of these patients (40%) met ICD-10 criteria for the diagnosis of psychiatric disorders and were included in the "Psychiatric Obese group" (PO). The other 60 patients (60%) did not show ICD-10 diagnostic criteria and were included in the "Non-Psychiatric Obese group" (NO). Each patients completed the Binge Eating Scale (BES), the Three Factor Eating Questionnaire, the Bulimia Investigatory Test-Edinburgh (BITE), and the Eating Disorder Inventory (EDI). RESULTS: Significant differences were found between the two groups (PO and NO) in the Binge Eating Scale (p < 0.001), Three Factor Eating Questionnaire subscale Disinhibition (p < 0.001), BITE (p < 0.001), Eating Disorder Inventory subscale Perfectionism (p < 0.002), and Global EDI (p < 0.001). Logistic regression analysis showed correlation between PO group and Global EDI (Odds Ratio OR = 1.43) and BITE (OR = 1.16). No significant gender differences were found for eating behavior, clinical diagnosis, age, percentage of weight loss, time after operation, and BMI before surgery. CONCLUSION: Surgically treated morbidly obese patients with a psychiatric disorder (PO) have a more destructured eating pattern (with a predominance of binge eating and disinhibition) than NO.

Adult↗

PubMed2004

Binge eating and its relationship to outcome after laparoscopic adjustable gastric banding.

BACKGROUND: The aim of this cross-sectional study was to examine short and long-term eating behavior after laparoscopic adjustable gastric banding (LAGB) and the relationship of binge eating with weight and quality of life outcome. METHODS: 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate quality of life and eating behavior: 93 patients before LAGB, 48 with a follow-up duration of 8 through 24 months, and 109 patients 25 through 68 months after LAGB. RESULTS: Compared with patients before surgery, patients after surgery, in both follow-up groups, reported less binge eating, fat intake, external eating, and more restrained eating and eating self-efficacy. After surgery, about one-third of the patients showed binge eating problems, which were associated with a worse postoperative outcome. CONCLUSION: Our results suggest that eating behavior improves both short- and long-term after surgery for severe obesity. Although LAGB could be a long-term solution to part of preoperatively eating disordered patients, the identification and treatment of postoperative binge eating appear critical to promote successful outcome after bariatric surgery.

Adult↗

PubMed2005

Sociotropy and perceptions of interpersonal relationships as predictors of eating disturbances among college women: two prospective studies.

The authors examined the relationship between sociotropy and perceptions of interpersonal relationships and subsequent eating disorder symptoms among young women. In Study 1, 118 women from a liberal arts college in northern Wisconsin completed self-report measures of sociotropy, perceived close social support, and eating disorder symptoms. The women returned 6 weeks later to complete the same measures. After controlling for initial levels of reported eating disturbances, higher levels of Time 1 sociotropy and reductions in perceived social support at Times 1 and 2 made unique contributions to eating disturbances at Time 2, although the interaction of Time 1 sociotropy and Time 2 social support did not add to the model. In Study 2, 138 women completed measures of eating disturbances, sociotropy, and interpersonal hassles on two occasions, 10 weeks apart. Self-reported eating pathology at Time 1 accounted for most of the variance in Time 2 eating disorder symptoms, but increased eating disturbances also were predicted by measures of interpersonal hassles. A final regression analysis using combined samples indicated that both T1 and T2 measures of interpersonal functioning made unique contributions to changes in reported eating disturbances. In sum, the findings suggested that perceptions of reduced support in close relationships and increased interpersonal hassles contribute to increases in reported eating disturbances among college-aged women, independent of baseline levels of eating disturbances and a highly sociotropic personality style.

Adolescent↗

PubMed2004

Application of a latent class analysis to empirically define eating disorder phenotypes.

CONTEXT: Diagnostic criteria for eating disorders influence how we recognize, research, and treat eating disorders, and empirically valid phenotypes are required for revealing their genetic bases. OBJECTIVE: To empirically define eating disorder phenotypes. DESIGN: Data regarding eating disorder symptoms and features from 1179 individuals with clinically significant eating disorders were submitted to a latent class analysis. The resulting latent classes were compared on non-eating disorder variables in a series of validation analyses. SETTING: Multinational, collaborative study with cases ascertained through diverse clinical settings (inpatient, outpatient, and community). PARTICIPANTS: Members of affected relative pairs recruited for participation in genetic studies of eating disorders in which probands met DSM-IV-TR criteria for anorexia nervosa (AN) or bulimia nervosa and had at least 1 biological relative with a clinically significant eating disorder. Main Outcome Measure Number and clinical characterization of latent classes. RESULTS: A 4-class solution provided the best fit. Latent class 1 (LC1) resembled restricting AN; LC2, AN and bulimia nervosa with the use of multiple methods of purging; LC3, restricting AN without obsessive-compulsive features; and LC4, bulimia nervosa with self-induced vomiting as the sole form of purging. Biological relatives were significantly likely to belong to the same latent class. Across validation analyses, LC2 demonstrated the highest levels of psychological disturbance, and LC3 demonstrated the lowest. CONCLUSIONS: The presence of obsessive-compulsive features differentiates among individuals with restricting AN. Similarly, the combination of low weight and multiple methods of purging distinguishes among individuals with binge eating and purging behaviors. These results support some of the distinctions drawn within the DSM-IV-TR among eating disorder subtypes, while introducing new features to define phenotypes.

Adolescent↗

PubMed1997

Femininity, masculinity, and disordered eating: a meta-analytic review.

OBJECTIVE: To understand the developmental psychopathology of eating disorders, it is crucial to explain the large gender discrepancy in the rates of these disorders, especially anorexia nervosa and bulimia nervosa. In this paper, meta-analysis was used to examine the relationship between gender role adherence and the existence of eating problems. METHOD: Of the 69 studies examined, 22 contained data deemed valid for the analyses. Measures of difference (d) and homogeneity were calculated. These studies used the Personal Attributes Questionnaire (PAQ) or the Bem Sex Role Inventory (BSRI) to measure gender role adherence. RESULTS: Findings indicated a small, heterogeneous positive relationship between femininity and eating problems and a small, heterogeneous negative relationship between masculinity and eating problems. Studies that used a clinical sample showed a larger discrepancy in masculinity scores between the eating-disordered and the control groups than did studies using surveys to identify eating problems. Six studies measured gender role traditionalism. The eating-disordered groups did not differ significantly on these measures compared to the control groups. DISCUSSION: Despite construct validity problems with the use of the PAQ and the BSRI in this area of study, data suggest that gender role is related to eating problems. Crucial aspects of femininity likely to be related to eating problems need to be operationalized and their link to eating disorders examined.

Adolescent↗

PubMed1999

Binge eating disorder in females: a population-based investigation.

OBJECTIVE: The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD: A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS: Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION: Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.

Adolescent↗

PubMed1999

Eating problems in female Japanese high school students: a prevalence study.

OBJECTIVES: This study was conducted to estimate the prevalence of eating problems and to identify factors associated with the eating problems among Japanese high school girls. METHODS: This study used a cross-sectional design. The study population was 3,032 female students attending three high schools in Fukushima, Japan. The 26-item version of the Eating Attitudes Test (EAT-26) was administered to assess eating problems. Inquiries were also made regarding possible risk factors for the eating problems. RESULTS: Of the 2,685 subjects, 5.4% had a total EAT-26 score above the cutoff point (20 < or =). Logistic regression analysis demonstrated that older age, higher body mass index, a distorted body image, obsessive-compulsive tendency, and some familial issues were independently related to the eating problems. DISCUSSION: The prevalence of eating problems in the Japanese female population was low compared with reports from Western countries. In addition, distorted body image was suggested to have the greatest influence on eating problems.

Adolescent↗

PubMed2001

Specificity in the relationship between depressive and eating disorder symptoms in remitted and nonremitted women.

OBJECTIVE: There is a strong association between eating disorders and depression. However, because both eating disorder symptoms and depression are multifactorial, this study explored the relationship between these two disorders in women with eating disorders and women in remission. METHOD: Two hundred and eight (mostly female) volunteers with a history of eating disorders participated. They completed a self-report questionnaire of eating disorder symptoms, the Short Evaluation for Eating Disorders (SEED), and a questionnaire measuring depression, the Beck Depression Inventory (BDI). RESULTS: According to the SEED, 57 volunteers were classified as being in remission and 151 were classified as being ill. Those who were in remission were significantly less depressed overall than those who were still ill with 72% of the former falling in the "not depressed" or "mildly depressed" categories and 73% of the latter falling in the "moderately" or "severely depressed" categories. Factor analyses of the SEED and BDI identified three subscales of eating disorder symptoms (dietary restriction, bulimia, and body mass index [BMI]/menstruation) and two subscales of depression (cognitive and somatic/affective). Dietary restriction and bulimia, but not BMI/menstruation, were uniquely associated with the cognitive symptoms of depression. However, none of the eating disorder symptoms were uniquely associated with the somatic/affective symptoms of depression. DISCUSSION: Although eating disorders and depression share considerable comorbidity, a specific association is restricted to that between the cognitive and behavioral symptoms of eating disorders and the cognitive symptoms of depression.

Adolescent↗

PubMed2005

Psychosocial correlates, outcome, and stability of abnormal adolescent eating behavior in community samples of young people.

OBJECTIVE: The current study investigated psychosocial correlates of abnormal adolescent eating behavior at three times during adolescence and young adulthood and its association with psychiatric diagnosis in young adulthood in a community sample. METHOD: Sixty-four (10.5%) high-risk subjects (mean age 15 years) with abnormal eating behavior were identified at Time 1, another 252 (16.9%) were identified at Time 2 (mean age 16.2 years), and 164 (16.9%) were identified at Time 3 (mean age 19.7 years) and compared with three control groups matched for age and gender. Dependent measures included emotional and behavioral problems, life events, coping capacities, self-related cognition, social network, and family functions. Outcome was measured additionally by structured psychiatric interviews, and stability of abnormal eating behavior was studied in a longitudinal sample of 330 subjects. RESULTS: Few subjects showed more than one of five criteria of abnormal eating behavior. High-risk subjects shared a very similar pattern at all three times. They were characterized by higher scores for emotional and behavioral problems, more life events including more negative impact, less active coping, lower self-esteem, and less family cohesion. Among 10 major psychiatric disorders, only clinical eating disorders at Time 3 shared a significant association with abnormal eating disorder at the same time whereas high-risk status at Times 1 and 2 did not predict any psychiatric disorder at Time 3. Stability of abnormal eating behavior across time was very low. Stability of abnormal eating behavior across time was very low. DISCUSSION: Abnormal eating behavior in adolescence and young adulthood is clearly associated with various indicators of psychosocial maladaption. In adolescence, it does not significantly predict any psychiatric disorder including eating disorder in young adulthood and it is predominantly a transient feature.

Adaptation, Psychological↗

PubMed2007

Relationships among attachment styles, personality characteristics, and disordered eating.

OBJECTIVE: Insecure attachment styles and certain personality characteristics (i.e., high levels of neuroticism) have been associated with eating pathology. However, previous research has not examined these variables simultaneously and has not examined possible mediating relationships between attachment and personality characteristics for disordered eating. Because personality characteristics have emerged as some of the most robust predictors of disordered eating, it was predicted that the link between attachment and disordered eating might be through personality styles. METHOD: Participants included 85 female twins and triplets who took part in the Michigan State University Twin Study. Disordered eating, attachment style, and personality characteristics were assessed. Hierarchical linear models were used to examine relationships among the variables. RESULTS: Overall, neuroticism, and extraversion to a lesser extent, mediated the relationship between insecure-resistant attachment and disordered eating. Specifically, higher scores on the neuroticism scale predicted more disordered eating and explained the relationship between insecure-resistant attachment and disordered eating. CONCLUSION: These results suggest that relationships between attachment style and disordered eating are indirect, in that neuroticism fully mediates associations between insecure-resistant attachment and disordered eating.

Adolescent↗

PubMed2004

Prevalence and clinical manifestations of eating disorders in Austrian adolescents with type-1 diabetes.

OBJECTIVES: To investigate prevalence and clinical manifestations of DSM-IV clinical eating disorders and subsyndromal eating problems among adolescents with type-1 diabetes. METHOD: A clinical sample of 251 adolescents with type-1 diabetes was recruited from multiple centres. Of these adolescents, 199 (96 girls and 103 boys--79.3% participation rate) with a mean age of 14.1 years (SD: 2.6) were screened for eating disorders and then underwent DSM-IV-based clinical assessment of eating disorders by interview. RESULTS: 11.5% of the girls and none of the boys with type-1 diabetes had DSM-IV eating disorders, whereas 13.5% of the girls and 1% of the boys had subsyndromal problems of eating and shape. Girls with both type-1 diabetes and a clinical or subclinical eating disorder had a significantly higher body-mass index than those without eating problems. CONCLUSION: This Austrian study supports cumulative international evidence that among youths with type-1 diabetes, adolescent girls and especially those having a higher body mass are particularly vulnerable for manifesting pathology of eating, weight and shape. Thus, this particular population requires screening of eating behaviour and relevant psychopathology, close monitoring, and psychosocial interventions through cooperative efforts of specialised centres.

Adolescent↗

PubMed2004

Eating attitudes across age and gender groups: a Canadian study.

OBJECTIVE: The purpose was to examine the eating attitudes across gender and age groups. METHOD: The study included 343 individuals over 18 years of age (range: 18 to 94 years; mean 48 +/- 22), who were divided into 3 age categories: 18 to 34 years, 35 to 64 years and 65 years and above with a distribution of 35% (119), 37% (128) and 28% (97) respectively. The participants completed a background questionnaire and the Eating Attitudes Test (EAT-26). RESULTS: A total of 30 participants (8.7%) scored above the cut-off point on the EAT-26 which is indicative of potential eating disturbances. Only statistically significant gender differences were observed in the total EAT-26 scores. Factor analysis revealed three subscales of EAT-26, food preoccupation, image preoccupation, and external focus or social pressure, with acceptable level of reliability and these were used for age and gender comparison. Age and gender differences were observed in the food and image preoccupation subscales only. DISCUSSION: Although EAT-26 is widely used in clinical and non-clinical population, age and gender comparisons have not been made in a population-based sample. Use of the subscales of eating attitudes should help health professionals better identify those at risk for eating disturbances and provide the opportunity for intervention.

Adolescent↗