Research articleShared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents
Introduction
Weight-related problems, including obesity, eating disorders, and disordered eating behaviors such as unhealthy weight-control practices and binge eating, are major public health problems in adolescents given their high prevalence and adverse health consequences.1, 2, 3, 4, 5, 6 Research suggests that these weight-related problems can occur simultaneously, increase in severity over time, and lead to the onset of different weight-related problems.7, 8, 9 These observations suggest a need for developing interventions to simultaneously prevent a spectrum of weight-related problems.10, 11, 12, 13, 14 Such an integrated approach could have advantages in terms of cost effectiveness, practicality, and consistency of public health messages.13
Behavioral research suggests that interventions will be more successful if they address factors that have been found to influence targeted outcomes.15 Thus, if effective integrated prevention approaches are to be developed, it is essential to identify predictors of multiple weight-related problems, both shared risk and protective factors. A review of the literature suggests that little research has investigated the shared risk and protective factors for obesity and eating disorders, although there is some theoretic and empiric support for the existence of such factors.14 For example, dieting can be a precursor to an eating disorder16, 17, 18, 19, 20 and can also increase risk for binge eating and weight gain over time.8, 21 Additionally, media use may increase risk for unhealthy weight-control behaviors and eating disorders through its negative effect on body image.22, 23 Media use, particularly television viewing, also may increase risk for obesity through the encouragement of sedentary behaviors and promotion of high-calorie foods.24, 25, 26
The authors are unaware of any large population-based studies on adolescents that have presented a comprehensive analysis of shared risk and protective factors for both obesity and disordered eating. While it is possible to review the obesity and eating-disorders literature to identify shared risk and protective factors, comparisons across studies can be difficult to interpret due to methodologic differences in study populations, time frames, assessment of variables, and data analysis. Many of these limitations could be addressed by examining risk and protective factors for a broad spectrum of weight-related problems within the same study.
The current study examines the prevalence of adolescent overweight, binge eating, and use of extreme weight-control behaviors, and their simultaneous occurrence. This study further examines 5-year longitudinal associations among socioenvironmental, personal, and behavioral variables and these three weight-related problems, to identify shared risk and protective factors for the occurrence of these problems. The aim of this paper is to inform the development of interventions to prevent a broad spectrum of weight-related problems. If risk and protective factors relevant to multiple weight-related problems in adolescents can be identified, the next step will be to design interventions to address those shared risk and protective factors, and thus target multiple weight-related problems simultaneously. Since the aim is to inform the development of prevention interventions, the focus is on factors that are commonly addressed within either obesity or eating-disorder interventions,27, 28 are potentially modifiable, and are suitable for addressing within health promotion programs for home, school, or community settings (Figure 1).
Section snippets
Study Design and Population
Project EAT-II (Eating Among Teens-II) is a longitudinal, follow-up study of Project EAT-I (Eating Among Teens-I), a study of socioenvironmental, personal, and behavioral factors potentially relevant to dietary intake and weight-related outcomes in adolescents.7, 8 The study population includes 2516 ethnically and socioeconomically diverse adolescents (1386 girls and 1130 boys).
Project EAT-I surveyed adolescents from 31 primarily urban (27 inner-city and 4 inner-ring suburban) schools in the
The Intersection of Weight-Related Problems
Among girls (N=1311), 27.5% (n=361) were overweight, 22.1% (n=290) reported extreme weight-control behaviors, and 10.5% (n=138) reported binge eating with loss of control at Time 2 (Figure 2). Among all girls, 44% (n=577) had at least one of the three problematic weight-related outcomes and 13.4% (n=176) had more than one problematic outcome. Among overweight girls (N=361), 10.0% (n=36) reported both binge eating and extreme weight control behaviors, 6.4% (n=23) reported binge eating only, and
Discussion
The prevalence of weight-related problems, including overweight, binge eating, and extreme weight-control behaviors, was found to be high among adolescents, indicating a need for interventions aimed at their prevention, early identification, and treatment. The large number of overweight adolescents reporting extreme weight control and binge eating behaviors suggests that obesity prevention and treatment interventions might do well to broaden their focus to address a fuller spectrum of
References (67)
- et al.
Type 2 diabetes among North American children and adolescents: An epidemiologic review and a public health perspective
J Pediatr
(2000) - et al.
Eating disorders
Lancet
(2003) - et al.
Overweight status and weight control behaviors in adolescents: Longitudinal and secular trends from 1999–2004
Prev Med
(2006) - et al.
Integrating primary prevention of eating disorders and obesity: Feasible or futile?
Prev Med
(2002) - et al.
Reading magazine articles about dieting and associated weight control behaviors among adolescents
J Adolesc Health
(2003) - et al.
Predictors of overweight and overfatness in a multiethnic pediatric population
Am J Clin Nutr
(1998) - et al.
Factors influencing food choices of adolescents: Findings from focus-group discussions with adolescents
J Am Diet Assoc
(1999) - et al.
Lessons learned about adolescent nutrition from the Minnesota Adolescent Health Survey
J Am Diet Assoc
(1998) - et al.
Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and tricep skinfold thickness
Am J Clin Nutr
(1991) - et al.
Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2)—A correction
Am J Clin Nutr
(1991)
Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: Findings from Project EAT
J Psychosom Res
Couch potatoes or french fries: Are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents?
J Am Diet Assoc
Validation of a youth/adolescent food frequency questionnaire
Prev Med
Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents
J Am Diet Assoc
Potential risk factors associated with weight control behaviors in elementary and middle school girls
J Psychosom Res
A prospective study of pressures from parents, peers, and the media on extreme weight change behaviors among adolescent boys and girls
Behav Res Ther
Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings
J Psychosom Res
Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analyses
Behav Therap
Unhealthy weight management behavior among adolescent girls with type 1 diabetes mellitus: The role of familial eating patterns and weight-related concerns
J Adolesc Health
Trends in breakfast consumption for children in the United States from 1965–1991
Am J Clin Nutr
Potentially protective factors associated with healthful body mass index in adolescents with obese and nonobese parents: A secondary data analysis of the third national health and nutrition examination survey, 1988–1994
J Am Diet Assoc
Factors associated with errors in self-reports of stature, weight, and body mass index in Minnesota adolescents
Ann Epidemiol
Prevalence of overweight and obesity in the United States, 1999–2004
JAMA
Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood
Am J Psychiatry
Review of the prevalence and incidence of eating disorders
Int J Eat Disord
Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls
Pediatrics
Overweight status and eating patterns among adolescents: Where do youth stand in comparison to the Healthy People 2010 Objectives?
Am J Public Health
Weight-related concerns and behaviors among overweight and non-overweight adolescents: Implications for preventing weight-related disorders
Arch Pediatr Adolesc Med
Obesity and eating disorder prevention: An integrated approach?
Adolesc Med
Preventing the broad spectrum of weight-related problems: working with parents to help teens achieve a healthy weight and a positive body image
J Nutr Educ Behav
Can we simultaneously work toward the prevention of obesity and eating disorders in children and adolescents
Int J Eat Disord
Prevention of obesity and eating disorders: A consideration of shared risk factors
Health Educ Res
Creating health behavior change: How to develop community-wide programs for youth
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