Problem dieting behaviors among young adolescents

OBJECTIVE: To examine dieting, eating and exercise behaviors, use of diet pills, and vomiting or use of laxatives to lose weight among younger adolescents. DESIGN: Analysis of data from a modified version of the Youth Risk Behavior Survey administered to middle school students in North Carolina in 1995. SETTING: Fifty-three randomly selected middle schools in North Carolina. SUBJECTS: Two thousand three hundred thirty-one students in the sixth, seventh, and eighth grades. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to questions regarding weight control practices, including vomiting or laxative use, dieting, exercise, or diet pill use. RESULTS: Of the students surveyed, 110 (9.7%) of the girls and 46 (4.0%) of the boys reported vomiting or using laxatives to lose weight. Among the girls, vomiting or laxative use was associated with feeling overweight, other weight loss practices, older age, being a poor student, smoking, eating more salads or vegetables, and eating more candy or other sweets (P< or =.01). A logistic regression model consisting of diet pill use, dieting to lose weight, lower academic achievement, and currently trying to lose weight correctly classified 92% of female students who had or had not vomited or used laxatives. Among boys, vomiting or laxative use was associated with feeling overweight, other weight loss practices, minority racial status, smoking, frequency of eating hamburgers or other high-fat meats, and frequency of eating french fries or potato chips (P< or =.01). A model consisting of diet pill use, minority race, dieting to lose weight, smoking, feeling overweight, and number of servings of hamburgers, hot dogs, or barbecue correctly classified 97% of the boys who had or had not vomited or used laxatives. CONCLUSION: Younger adolescents trying to lose weight engage in a variety of problem dieting and weight loss behaviors that can compromise health and may be associated with eating disorders.     

Obesity as a prospective predictor of depression in adolescent females.

Objective: Both obesity and depression are prominent during adolescence, and it is possible that obesity is a trigger for adolescent depression. The purpose of this paper is to evaluate whether overweight or obese status contributes to the development of depression in adolescent girls. Design: Participants were 496 adolescent girls who completed interview based measures of depression and had their height and weight measured at four yearly assessments. Repeated measures logistic regressions with generalized estimating equations were used to evaluate whether overweight or obese status were associated with major depression or an increase in depressive symptoms the following year. Main Outcome Measures: Major depression and depressive symptoms were evaluating using a modified version of the K-SADS interview. Overweight and obese status was determined by using standardized protocols to measure height and weight. Results: Results showed that obese status, not overweight status, was associated with future depressive symptoms, but not major depression. This study demonstrated that obesity is a risk factor for depressive symptoms, but not for clinical depression. Conclusions: As depressive symptoms are considered along the spectrum of depression with clinical depression at the high end, these results suggest that weight status could be considered a factor along the pathway of development of depression in some adolescent females. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term results of fasting. Results from 132 consecutive patients after 1-6 1/2 years

132 consecutive patients were reexamined 1-6.5 years (m = 2.8) after total fasting in hospital. 37 patients had continued to lose weight, 20 patients had maintained their fasting result (+/-2 kg) and 7 patients had slightly regained (less than 1/3 of their weight loss during fast). These 3 groups, totalling 64 patients (48%), were considered successful. Their mean overweight was diminished from 57 to 29%, corresponding to a 60% reduction of mortality in certain age groups. On the other hand, 63 patients (48%) had regained more than 1/3 of their original weight loss. Five patients (4%) were lost to follow-up. Selection of patients and long-term follow-up appeared to have a decisive bearing on long-term results of fasting, whereas factors such as age, sex, degree of overweight, onset of overweight in childhood and sports were without significant effect. From the long-term results presented, it is concluded that under certain conditions fasting in hospital is warranted. Behaviour therapy is a possible alternative in the treatment of obesity.     

Body mass and social class: a comparison of Finland and Sweden in the 1990s

High physical weight affects public health as well as people's social relations. This study seeks to examine the distribution of physical weight across the social structure in Finland and Sweden in the early 1990s. We compare physical weight, classified by overweight and obesity, 1) between men and women, 2) between different age groups, and 3) between social classes in these two countries. Comparable interview surveys were conducted in Finland 1994 (N = 8,650, response rate 73%) and in Sweden 1991 (N = 5,306, response rate 79%). Physical weight, overweight and obesity of populations are described in terms of body mass index (BMI = weight (kg)/height (m2)). The average BMI is higher in Finnish men (25.6) and women (24.6) than in their Swedish counterparts (24.6 and 23.2, respectively). In both countries, the average BMI is higher in men than in women below the age of about 55-64 years. In both countries and in both genders the average BMI is higher, the higher the age. The level of overweight as well as obesity is lower in Sweden than in Finland. Social class differences can be found in both countries. The odds ratio for overweight is higher in Finnish male and female farmers (OR = 1.57 and 1.94, respectively) as compared to upper white collars (OR = 1.0). In Sweden, high odds ratio for overweight can be found among male entrepreneurs (OR = 1.80) and female unskilled manuals (OR = 2.65). Obesity varies by social class in Swedish men and women as well as in Finnish women, but not in Finnish men. The results show that Finnish men and women are more often overweight and obese than their Swedish counterparts, but social class differences in overweight and obesity are larger in Sweden than in Finland.     

Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children

All students in grades 5 and 8 of three randomly chosen schools in Uppsala (n = 236) were eligible, and 197 participated. The survey included a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a demographic and dieting questionnaire. In total, 47% of the children (girls 70%, boys 25%) wanted to be thinner and 25% had tried to lose weight. In the 5th grade, 49% of the girls reported that they wanted to be thinner and in the 8th grade 83%. Fifty-three percent of the girls in the 8th grade reported that they had tried to lose weight; 36% admitted that they felt too fat but only 5% reported that other people found them too fat. The methods used were caloric restriction and exercise. Compared with US data, the Swedish students dieted less often and showed lower ChEAT scores. Compared with earlier data, our results show that weight concerns begin at an earlier age among Swedish children today.     

Current status of the internal–external hypothesis for obesity: What went wrong?

Although the consequences of obesity that maintain fatness can be specified, the causes of obesity are far less clear. The internal–external distinction is a widely held and cited framework used to explain differences between overweight and average weight persons, but this article challenges that application. Externality appears in persons of all weight categories and can lead to overeating in these individuals under specifiable conditions. But degree of weight gain and level of obesity depend on a variety of other factors. Moreover, the data suggest that internal sensitivity is not a unique characteristic of normal weight persons. The extreme separation of external and internal cues in the regulation of eating is not empirically supported. External stimuli can be shown to directly influence internal physiological state, and a hypothesis regarding ways in which short-term internal signals may influence external cue salience can be tested. Thus, there is now considerable evidence challenging a simplistic internal–external dichotomy. (90 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing obesity: classification and epidemiology

Obesity is generally defined as a body mass index (BMI) of 30 kg/m2 and higher. Overweight is defined as a BMI between 25 and 30 kg/m2. The prevalence varies considerably between countries, and between regions within countries. It is estimated that more than half of adults aged 35-65 living in Europe are either overweight or obese. Overweight is more common among men than among women but obesity is more common among women. The prevalence of obesity in Europe is probably in the order of 10-20% in men and 15-25% in adult women. In most European countries who have reliable data on time-trends the prevalence of obesity seems to be increasing. In most European countries, obesity is usually inversely associated with socio-economic status, particularly among women. New classifications of overweight may be based on cut-off points for simple anthropometric measures which reflects both total adiposity as well as abdominal fatness.     

Defining obesity in children by biological endpoint rather than population distribution

OBJECTIVE: To investigate the association of fatness in children with dyslipoproteinemia and high blood pressure, with the purpose of proposing standards for childhood obesity which are directly related to intermediate biological parameters that predict future disease. DESIGN: A cross-sectional study of a large, nationally representative sample of Australian schoolchildren. SUBJECTS: 1834 children aged 9 or 15 years, with skinfolds blood lipid measurements on 1144 and with skinfolds and blood pressure measurements on 1757. MEASUREMENTS: Skinfolds thicknesses measured at four locations (triceps, biceps, subscapular and suprailiac) using holtain calipers, percent body fat calculated from the sum of four skinfolds, Quetelet's index calculated from weight and height, waist and hip circumferences, plasma total cholesterol and triglycerides determined using a Technicon Autoanalyser II, high density lipoprotein cholesterol (HDLC) analysed following precipitation with heparin manganese, and systolic blood pressure (SBP) measured using a standard mercury sphygmomanometer. RESULTS: For 9 years old girls, 15 year old girls and 9 years old boys, dichotomising their HDLC and SBP measurements by percent body fat defined the two groups most homogeneous in terms of a measure of within-group variation. The cut-points in percent body fat were in the ranges 29-35% (girls) and 17-20% (boys). CONCLUSION: It is feasible to use the current biomedical status of individual children to define criteria for obesity. A cut-off point of 30% body mass as fat for girls and 20% for boys appears to be an appropriate standard.     

Free toe transplantation in reconstructive hand surgery]

PURPOSE: Increased understanding of the early determinants of obesity is essential because of the increasing prevalence of obesity in many industrialized countries. METHOD: As part of the evaluation of a school-based heart health promotion intervention, we measured height, weight, and triceps skinfold thickness at baseline in 2108 students aged 9-12 years (80.5% of eligible students) in 24 inner-city elementary schools located in multiethnic, low income neighbourhoods in Montreal, Canada. Data on student's socio-demographic and lifestyle characteristics were collected in classroom-administered questionnaires, and parents completed an at-home self-administered questionnaire. RESULTS: Overall, 35.2% of boys and 33.0% of girls were overweight (> or = 85th age and gender-specific percentiles from NHANES 11, for body mass index and triceps skinfold thickness); 15.1% of boys and 13.3% of girls were obese (> or = 95th age and gender-specific percentiles for body mass index and triceps skinfold thickness). Younger age, having lived all one's life in Canada, and being of European or Central American/Caribbean family origin were independent correlates of obesity in boys. Younger age, ever smoked, mother obese and father obese were independent correlates of obesity in girls. Girls of Asian family origin were protected. CONCLUSIONS: The very high prevalence of overweight students in this low income, multiethnic population suggests an important need for preventive intervention.     

Ambulatory computer-assisted therapy for obesity: A new frontier for behavior therapy.

Implemented a behavioral treatment program for obesity and tested an interactive microcomputer system small enough to be carried by Ss throughout their normal daily routines. Treatment effects observed in 6 30–50 yr old females (at least 35% overweight) who received this experimental treatment were compared with those observed in 6 matched female controls (also at least 35% overweight) who received a similar treatment program implemented without computer assistance. The self-monitoring, goal-setting, and feedback treatment packages were computer-assisted or involved paper and pencil. Mean weight loss after the 8 postbaseline study weeks was 8.1 lb for the experimental Ss compared with 3.3 lb for the control Ss. Mean weight loss 8 mo posttreatment was 17.7 lb for the experimental Ss compared with 2.3 lb for the control Ss. It is concluded that ambulatory computer-assisted therapy provides important new opportunities for conducting behavior therapy and research in real-life settings. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight-related attitudes and behaviors of black women

Weight-related attitudes and practices of women who attended health department clinics or who worked for a health and human services agency were assessed by means of an anonymous, self-administered questionnaire. Black women who were 25 to 64 years old and were not pregnant or had not given birth within the past year were included in this analysis (n = 500). The overweight women perceived themselves as being overweight. They were less likely to be satisfied with their weight and more likely to have dieted and to be currently dieting than nonoverweight women. Awareness of obesity-related health risks was high, but the perceived psychosocial consequences of being overweight were somewhat limited. Approximately 40% of moderately and severely overweight women considered their figures to be attractive or very attractive, which indicates a relatively positive body image. The overweight women were less likely to exercise, less likely to skip meals, and more likely to eat between meals than the nonoverweight women. Among the subset who had ever attempted to lose weight (n = 368), the overweight women were significantly more likely to have regained all or more of the weight lost during their most recent attempt. The findings of this exploratory survey suggest that although overweight black women are weight conscious, the absence of strong negative social pressure combined with a relatively positive body image may limit the extent to which weight loss efforts are sustained. Findings about eating and exercise patterns suggest some specific factors that may interfere with the effectiveness of weight control among black women.     

Mothers, daughters, and disordered eating.

Examined features of 77 mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. Mothers whose daughters reported a level of disordered eating comparable with clinical samples of bulimic patients were compared with mothers whose daughters reported a low level of eating disturbances. As hypothesized, mothers of daughters with disordered eating were more dissatisfied with the general functioning of the family system. Also, mothers whose daughters were eating disordered were themselves more eating disordered and differed in their dieting history compared with mothers of the girls who were not eating disordered. Furthermore, mothers of girls with disordered eating thought their daughters should lose more weight than mothers of girls who were not eating disordered. They also thought that their daughters were less attractive than the girls judged themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of weight reducing and weight gaining in adolescent girls and boys.

Surveyed the prevalence of weight reducing and weight gaining in 1,373 high school students. 63% of the girls and 16.2% of the boys reported being on weight-reducing regimens; 9.1% of the girls and 28.4% of the boys were trying to gain weight. Most female reducers and male gainers were already normal weight. Whites and Hispanics were more likely to be reducing, whereas Blacks were more likely to be gaining. Exercise and moderate caloric reduction were most popular for weight reducing, and a small but significant number were regularly using fasting, vomiting, laxatives, and appetite suppressants. The rate of weight reducing in female high school adolescents has increased significantly since similar surveys of American youths 20 yrs ago. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

GP documentation of obesity: what does it achieve?

BACKGROUND: Obesity is a major and increasing health problem in the United Kingdom, and, until recently, the government health promotion package for general practice reimbursed general practitioners for documenting obesity. Despite poor evidence for effectiveness of interventions in primary care, documentation of obesity could possibly improve patient awareness and knowledge, or provide public health information. AIM: To assess patient perception of obesity and its health risk, and the accuracy of estimating obesity using patient information. METHOD: Subjects were consecutive attenders to a general practitioner (GP) at a single urban practice in the South and West Region. Outcome measures were 'measured' body mass index (BMI) calculated from measured weight and height, 'estimated' BMI using patient information, and patient perception of obesity and the health risks of obesity. RESULTS: There is good correlation between 'estimated' and 'measured' BMI (intraclass correlation 0.91). Estimated BMI is lower than measured BMI (mean 0.77 lower), and the difference increases with age and level of BMI: for BMIs of < 20, 20-24.99, 25-29.99, and > or = 30 the mean differences (estimated-measured) were -0.06, -0.46, -0.98 and -1.72 respectively. Estimated obesity (BMI > 30) is reasonably sensitive (70%), specific (99%), and predictive (93% positive predictive value) of measured obesity (kappa 0.78). All obese subjects are aware that they are overweight, and most of them (78%, 95% confidence interval 66-88%) are aware that their weight is a health risk. CONCLUSION: Obese patients attending GPs' surgeries are likely to know if they are overweight, or could easily estimate from their knowledge of height and weight that they were overweight with reasonable accuracy. Obese subjects also know that their weight carries health risks. Thus, measurement of obesity in the general population is not likely to improve risk assessment or patient knowledge significantly. Without evidence for effective intervention or improved decision-making in primary care, reimbursement guidelines linked to the documentation of obesity in the population are probably an inefficient use of resources.     

Relationships between an index of body fat distribution (based on waist and hip circumferences) and stature, and biochemical complications in obese children

OBJECTIVE: To determine the clinical utility of a new age-adjusted measure of body fat distribution (based on waist and hip circumferences) and stature, in relation to biochemical complications in obese children. DESIGN: Cross-sectional, clinical study. The formula to calculate the common standard deviation score (SDS) of waist-to-hip ratio/height (WHR/Ht) was obtained from the data of control children. The relationship between WHR/Ht SDS, as the age-adjusted measure, in obese children and their clinical laboratory data was evaluated. SUBJECTS: Outpatient obese Japanese children (102 boys and 75 girls) and control children (508 boys and 549 girls), ranging in age from 6-15 y. MEASUREMENTS: Height, body weight, waist girth, hip girth, triceps and subscapular skinfold thicknesses, as anthropometric measures. Percent overweight, percent body fat, waist girth, WHR and WHR/Ht SDS as criteria for obesity. Clinical laboratory analyses for fasting blood samples of obese children. RESULTS: The WHR/Ht SDS closely correlated with age in obese children, thus reflecting the progress of abdominal obesity during growth. The obese boys were more hyperlipidaemic than the girls were, although the percent overweight was similar in both genders. The percent overweight, percent body fat, waist girth and WHR/Ht SDS all correlated well with triglyceride (TG), alanine aminotransferase (ALT) and insulin in boys, whereas only waist girth and WHR/Ht SDS showed a close correlation with TG and insulin in girls. The obese subjects were subdivided according to the number of abnormal values observed in TG, ALT and insulin. For obese boys, all five indices of obesity were higher in the groups with complications than in the group without. In the girls, only the WHR/Ht SDS constantly differed between subgroups. WHR/Ht SDS most obviously distinguished the groups with complications from the other group with a wide margin of difference (2-fold in boys and > 2-fold in girls) in the mean values. CONCLUSION: The WHR/Ht SDS can serve as an index predicting the occurrence of biochemical complications in obese children ranging from the age of 6-15 y.     

Cardiac hemangioma of the right ventricle--report of a case

OBJECTIVE: The prevalence of obesity and thinness is unknown among Iranian high-school age girls. We determined the prevalence of overweight and underweight among Iranian high-school girls from Kerman (south-east province of Iran). DESIGN: A cross-sectional study of indicative cluster sample. MEASUREMENTS: Weight, height, body mass index (BMI), chest, waist, abdomen, hip and thigh circumference of 1000 Iranian high-school girls aged 14-21 y (mean (standard deviation, s.d.) 16.2 (1.3)) were measured. The criteria for very underweight, underweight, desirable weight, grade 1, 2 and 3 overweight used in the present study were: BMI in kg/m2 < 15, 15-19.9, 20-24.9, 25-29.9, 30-39.9 and > or = 40, respectively. RESULTS: 4.6% (95% confidence interval (CI): 3.4%-6.1%) were grade 1 overweight (BMI = 25.0-29.9), 0.7% (95% CI: 0.3%-1.4%) were grade 2 overweight (BMI = 30-39.9), and none were grade 3 overweight (BMI > or = 40), while 54.6% (95% CI: 51.5%-57.7%) were underweight (BMI = 15-19.9) and 1.6% (95% CI: 0.9%-2.6%) were very underweight (BMI < 15). The mean (s.d.) BMI was 19.8 (2.9) (95% CI: 19.6-20.0). The mean (s.d.) waist-to-hip ratio (WHR), abdomen-to-hip ratio and chest-to-hip ratio values were 0.8 (0.06) (95% CI: 0.8-0.81), 0.8 (0.07) (95% CI: 0.8-0.81) and 0.9 (0.07) (95% CI: 0.9-0.91), respectively, in this sample. CONCLUSION: The results suggest a low prevalence of overweight among Iranian young women.     

Predictors of child psychological changes during family-based treatment for obesity

OBJECTIVE: To explore the influence of 1-year changes in child obesity and maternal psychopathology on changes in child psychological problems. DESIGN: Hierarchical regression models were used to predict child psychological change, with demographic variables, maternal psychological change, and child percentage overweight change as predictors. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Clinic sample of 116 obese 8- to 12-year-old children and their mothers. INTERVENTIONS: Family-based behavioral weight-control program. MAIN OUTCOME MEASURES: Child psychopathology was assessed via mother-reported Child Behavior Checklists and maternal psychopathology was determined by standardizing scores on the Cornell Medical Index and the Symptoms Checklist-90-Revised. RESULTS: Significant improvements were observed in child percentage overweight (-20.1% overweight), and child and maternal psychopathology. Improved maternal psychopathology accounted for a significant amount of variance in improvements in the Child Behavior Checklist total Problems Scale and internalizing and externalizing problems subscales. Decreased obesity accounted for a significant amount of variance in improvements in the Total Competence scale and, somatic complaints, social problems and social competence subscales of the Child Behavior Checklist. Significant interactions of child obesity change by sex were found for Total Problems and externalizing scores. The interactions were due to girls with greater obesity reduction showing greater improvement in Total Problems, whereas boys with greater obesity reduction showed less improvement in externalizing problems. CONCLUSIONS: These results highlight the multidimensional nature of psychosocial functioning in obese children and call attention to multiple avenues for intervention to improve their psychosocial functioning.     

Gender differences in food-related concerns, beliefs and behaviours of north Queensland adolescents

OBJECTIVE: To describe the beliefs, attitudes, behaviours and knowledge of North Queensland adolescents about food and nutrition. METHODOLOGY: A questionnaire surveyed 791 Year 8 students from private schools. RESULTS: More girls than boys felt guilt about food, sometimes ate from boredom, reported trying to select foods that were good for them and were concerned about the fat content of food; 30% of boys and 17% of girls thought they should be concerned about their food intake only when overweight. Low daily dietary intakes were reported for bread, fruit, vegetables and dairy products with only 24% eating at least one fruit, one vegetable, one dairy product and one core cereal food daily. Fat and sugar intake was high: 41% students ate high fat savoury foods and 53% ate high sugar foods at least seven times during the week. Parents, television and school provided information about food and nutrition to 70-80% of these students, followed by friends and magazines with doctors and teachers providing information on weight and weight loss to 10% of students. CONCLUSIONS: Doctors should be aware of the low intake of recommended foods as well as the high intakes of fat and sugar among adolescents and the gender differences in food related beliefs and behaviours when treating nutrition related diseases and providing guidance for their prevention.     

Treatment of mild, moderate, and severe obesity in children.

This paper examines treatment alternatives for children and adolescents as a function of degree of obesity. Treatment for mild obesity (20-40% overweight) should be preventive, emphasizing long-term changes in eating and activity patterns with the goal of weight maintenance and relative weight reduction. Short-term behaviour modification programmes, which include parental support, are effective in achieving these goals. Outpatient clinics or schools where social support is available are appropriate treatment settings. More comprehensive behavioural programmes are needed for treating moderate obesity (41-100% overweight). Such programmes include extended treatment periods, depositrefund contracts, direct parental involvement, and increased emphasis on lifestyle exercise. Outpatient clinics and schools remain optimal treatment settings, but more research is needed on camp settings. Radical treatments such as surgery, drugs, and very low calorie diets cannot be recommended for moderate childhood obesity. Severe obesity (> 100% overweight) requires consideration of radical interventions, and evidence to date supports the experimental use of very low calorie diets (protein-sparing modified fasts) together with behaviour modification. Such dietary treatment must be conducted in hospitals under strict medical supervision. Neither drugs nor surgery can be recommended for severe obesity in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Processes linking weight status and self-concept among girls from ages 5 to 7 years.

This study assessed the relationship between girls' weight status and self-concept and examined peer teasing and parent criticism as potential mediators of this relationship. Data were collected for 182 girls and their parents when the girls were 5 and 7 years old. At each age, girls' body mass index, self-concept, peer weight-related teasing (child report), and parents' criticism of girls' weight status (spouse report) were assessed. At ages 5 and 7, girls who were more overweight reported lower self-concept. Peer teasing and parent criticism mediated the relationship between weight status and self-concept at age 7, but not at age 5. In addition, the duration and timing of parent criticism across ages 5 and 7 mediated the association between girls' weight status at age 5 and perceived peer acceptance at age 7. (PsycINFO Database Record (c) 2010 APA, all rights reserved)