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Overweight and Disordered Eating in Adolescents
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, according to a study in the November American Journal of Preventive Medicine. Dianne R. Neumark-Sztainer, PhD, and colleagues found that weight-related problems, including obesity, disordered-eating behaviors, and eating disorders, occurred in 44% of females and in 29% of males.
The researchers included in their analysis 2,380 adolescents (1,311 girls and 1,069 boys), most of whom were from inner-city schools. The adolescents were examined in 1998-1999 and then again five years later. In 2003-2004, 361 of the girls (27.5%) were overweight, 290 (22.1%) reported extreme weight-control behaviors, and 138 (10.5%) reported binge eating with loss of control. In addition, 577 (44%) had at least one problematic weight-related outcome, and 176 (13.4%) had more than one problematic outcome. Among the 361 girls who were overweight, 36 (10%) reported both binge eating and extreme weight-control behaviors, 23 (6.4%) engaged in binge eating only, and 85 (23.5%) reported extreme weight-control behaviors only.
Among the boys, 269 (25.2%) were overweight, 70 (6.5%) reported extreme weight-control behaviors, and 28 (2.6%) reported binge eating with loss of control. A total of 312 (29.2%) boys had at least one problematic weight-related outcome, and 50 (4.7%) had more than one problematic outcome. Of the 269 boys who were overweight, five (1.9%) reported both binge eating and extreme weight-control behaviors, 10 (3.7%) reported binge eating only, and 33 (12.3%) engaged in extreme weight-control behaviors only.
SHARED RISK AND PROTECTIVE FACTORS
Several socioenvironmental, personal, and behavioral variables were significant predictors of all three problematic weight-related outcomes (being overweight, binge eating, extreme weight control) that were observed five years later in the girls, according to the researchers. Socioenvironmental predictors included maternal weight concerns or behaviors, being teased about their weight by family or peers, and being exposed to magazine articles on weight loss. Body image and weight-concern variables were personal predictors. Behavioral risk factors included dieting, unhealthy weight-control behaviors, binge eating, and diet soda intake.
Weight teasing by family, weight concern, and dieting were predictors of increases in all three weight-related outcomes during the study period. Girls who reported being teased about their weight at the first visit were approximately twice as likely to be overweight five years later and about 1.5 times as likely to be a binge eater or engage in extreme weight-control behaviors at follow-up. Other variables at the first visit that predicted two of three weight-related outcomes included maternal and paternal weight concerns or behavior, body dissatisfaction, and exposure to magazines on weight loss.
Protective factors were frequent family meals, positive atmosphere at family meals, and frequent lunch intake. Girls who reported a more positive meal atmosphere at the initial visit had three-fourths the risk for binge eating and extreme weight-control behaviors at the second visit compared with other adolescents. However, they did not have an increased or decreased risk for being overweight.
For boys, predictors of all three weight-related outcomes at the second visit included maternal weight concerns or behaviors, peer dieting behaviors, weight concern, weight status, dieting, and unhealthy and extreme weight-control behaviors.
PREVENTION AND INTERVENTION
“We found that risk factors traditionally addressed within eating disorder prevention, such as being teased about one’s weight, being dissatisfied with one’s body, or dieting, not only increased the risk for disordered-eating behaviors but also for being overweight five years later,” said Dr. Neumark-Sztainer, Professor of Public Health at the University of Minnesota in Minneapolis. “We also found that a high percentage of overweight teens, particularly girls, engage in extreme weight-control and binge-eating behaviors. Thus, obesity prevention messages and interventions may be more effective if they address these weight-related socioenvironmental, personal, and behavioral variables typically addressed in eating disorder behaviors.”
Dr. Neumark-Sztainer noted that clinicians may be able to develop interventions to address the broad spectrum of weight-related problems, as well as help develop strategies for parents of teens. “For example, I encourage families to talk less about weight and do more to provide children with a home environment that makes it easier to engage in healthy eating and physical activity,” she said.
—Michelle Stephenson
Suggested Reading
Neumark-Sztainer DR, Wall MM, Haines JI, et al. Shared risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med. 2007;33(5):359-369.
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