New approach to management of overeating in children

Overeating, whether in children or adults, often takes place even in the absence of hunger, resulting in weight gain and obesity. Current methods to treat such overeating in youth focus on therapies that restrict what kids may eat, requiring them to track their food intake and engage in intensive exercise.

But for most children, such behavioral therapy techniques don't work long term, according to Kerri Boutelle, PhD, associate professor of psychiatry and pediatrics at the University of California, San Diego School of Medicine. Boutelle and colleagues are developing new ways to treat overeating in children and adults.

Their study, published in the Journal of Consulting and Clinical Psychology this week, describes two new methods for reducing overeating. The overall aim of these studies is to improve responses to internal hunger and satiety cues and decrease physiological and psychological responses to foods in the environment. Basically, how do we learn to stop eating when we are no longer hungry?

The first treatment group, called appetite awareness training, trains children and parents to recognize, and appropriately respond to, hunger and satiety cues. The other treatment group, called cue exposure training, trains children and their parents to resist the food that is in front of them.

"We teach children and parents how the environment tricks us into eating foods even when we're not hungry," said Boutelle, citing examples of food triggers such as TV commercials, the abundance of easy-to-eat and high-calories snacks, and the use of food as a reward.

In this study, 36 obese 8-to-12-year olds with high levels of overeating and their parents were assigned to eight-week-long training, either in appetite awareness or a cue-exposure treatment. Children were provided a toolbox of coping skills to "ride out their cravings" — identifying such cravings and learning strategies to ride them out until the urges diminished (but only when they were not physically hungry).

Participants also learned how to manage potential overeating situations when they might not listen to their bodies' signals, because of the availability of foods or even their own moods.

While the appetite awareness group focused on training the participants to regulate eating by focusing on internal cues of hunger and appetite, the cue exposure group trained the participants to tolerate cravings to reduce overeating.

Children and parents in the appetite awareness group brought dinner into the clinic and practiced monitoring their hunger and satiety cues throughout the meal. Children and parents in the cue exposure group brought in their highly craved foods and "stared them down" — holding, smelling and taking small bites of the food — for up to 20 minutes while rating their cravings, after which they threw away the food.

In post-treatment surveys, 75 percent of the children in the appetite awareness group and more than 50 percent of children in the cue exposure group liked the program "a lot" or "loved it." A high percentage (81 and 69 percent, respectively) reported feeling more in control of their eating due to the program.

The researchers assessed the impact of these two different eight-week treatments on body weight, overeating, binge eating and caloric intake in both the children and parents.

"While this was a pilot study, our initial results suggest that the 'cue exposure' approach might be very helpful in reduction of eating in the absence of hunger," said Boutelle. She added that significant reduction in such overeating was found in the cue-exposure group, even six months post-treatment, though there was very little long-term impact on overeating in the appetite awareness group. There was only a small effect on body weight and no effect on reported calories eaten in either group; however, both approaches resulted in decreased binge eating in children and their parents.

"These findings are exciting because they offer a completely new paradigm for controlling overeating and binge eating," Boutelle said. "By reducing overeating and binge eating, we hope to provide a new way of preventing weight gain and providing children with a sense of control over what they chose to eat. This is really important, because a loss of control can lead to depression and other psychiatric problems, and of course childhood obesity."

Additional contributors to the study include Nancy L. Zucker, Duke University; Carol B. Peterson and Sarah A. Rydell and Lisa Harnack University of Minnesota; and Guy Cafri, UC San Diego. The project was funded by a University of Minnesota Faculty Development Grant to Boutelle and Harnack.

This study was the first to develop and test interventions that specifically target overeating in children. The researchers plan larger, randomized trials, starting in summer 2012.

A clinical study for adults called "Regulation of Cues" — testing this intervention separately within an adult binge eating group — is now recruiting participants in San Diego.

Family meals help children to be less fussy about food

A study has found that eating together as a family may encourage children to be more open to trying new types of food. This finding will be presented at the Developmental Psychology Section Annual Conference to be held at Northumbria University, Newcastle upon Tyne from 7-9 September.

Faye Powell, from Loughborough University and member of the British Psychological Society, observed over 75 families during mealtimes to determine the factors linked with the development of fussy eating behaviour among children.

The results showed that friendly interaction between mother and child instead of coercive strategies, like pressure and physical prompting, may encourage young children to try different foods.

These findings are the first stage of a longitudinal study. The children involved will be re-visited next year to see how different feeding practices impact on their eating behaviour.

Miss Powell said: "The dietary habits and eating behaviours of young children are a top priority amongst governing bodies, healthcare professionals and parents alike.

"As many as one in four parents express concern about their child's eating during routine paediatric checkups. Child feeding problems are an important concern which can create a great deal of stress and anxiety for families.

"In order to prevent feeding problems and improve child diet, a thorough understanding is needed of the early life risk factors and how to modify them.."

Habit makes bad food too easy to swallow

Do you always get popcorn at the movies? Or snack while you're on the couch watching television? A new paper by USC researchers reveals why bad eating habits persist even when the food we're eating doesn't taste good. The study also reveals the surprisingly simple ways we can counter our habits to gain control over what we eat.

In an ingenious experiment, researchers gave people about to enter a movie theater a bucket of either just-popped, fresh popcorn or stale, week-old popcorn.

Moviegoers who didn't usually eat popcorn at the movies ate much less stale popcorn than fresh popcorn. The week-old popcorn just didn't taste as good.

But moviegoers who indicated that they typically had popcorn at the movies ate about the same amount of popcorn whether it was fresh or stale. In other words, for those in the habit of having popcorn at the movies, it made no difference whether the popcorn tasted good or not.

"When we've repeatedly eaten a particular food in a particular environment, our brain comes to associate the food with that environment and make us keep eating as long as those environmental cues are present," said lead author David Neal, who was a psychology professor at USC when the research was conducted and now heads a social and consumer research firm.

The study, in the current issue of the journal Personality and Social Psychology Bulletin, has important implications for understanding overeating and the conditions that may cause people to eat even when they are not hungry or do not like the food.

"People believe their eating behavior is largely activated by how food tastes. Nobody likes cold, spongy, week-old popcorn," said corresponding author Wendy Wood, Provost Professor of Psychology and Business at USC. "But once we've formed an eating habit, we no longer care whether the food tastes good. We'll eat exactly the same amount, whether it's fresh or stale."

The researchers controlled for hunger and whether the participants liked the popcorn they received. The researchers also gave popcorn to a control group watching movie clips in a meeting room, rather than in a movie theater.

In the meeting room, a space not usually associated with popcorn, it mattered a lot if the popcorn tasted good. Outside of the movie theater context, even habitual movie popcorn eaters ate much less stale popcorn than fresh popcorn, demonstrating the extent to which environmental cues can trigger automatic eating behavior.

"The results show just how powerful our environment can be in triggering unhealthy behavior," Neal said. "Sometimes willpower and good intentions are not enough, and we need to trick our brains by controlling the environment instead."

In another movie theater experiment, the researchers tested a simple disruption of automatic eating habits. Once again using stale and fresh popcorn, the researchers asked participants about to enter a film screening to eat popcorn either with their dominant or non-dominant hand.

Using the non-dominant hand seemed to disrupt eating habits and cause people to pay attention to what they were eating. When using the non-dominant hand, moviegoers ate much less of the stale than the fresh popcorn, and this worked even for those with strong eating habits.

"It's not always feasible for dieters to avoid or alter the environments in which they typically overeat," Wood said. "More feasible, perhaps, is for dieters top actively disrupt the established patterns of how they eat through simple techniques, such as switching the hand they use to eat."


Journal Reference:

  1. David T. Neal, Wendy Wood, Mengju Wu, and David Kurlander. The Pull of the Past: When Do Habits Persist Despite Conflict With Motives?Personality and Social Psychology Bulletin, August 22, 2011 DOI: 10.1177/0146167211419863

Mindless eating: Losing weight without thinking

Dieters may not need as much willpower as they think, if they make simple changes in their surroundings that can result in eating healthier without a second thought, said a consumer psychologist at the American Psychological Association's 119th Annual Convention.

"Our homes are filled with hidden eating traps," said Brian Wansink, PhD, who presented his findings and strategies for a healthier lifestyle in a plenary address entitled "Modifying the Food Environment: From Mindless Eating to Mindlessly Eating Better."

"Most of us have too much chaos going on in our lives to consciously focus on every bite we eat, and then ask ourselves if we're full. The secret is to change your environment so it works for you rather than against you," Wansink said

Wansink identified several myths about eating behaviors as a way to explain why Americans, on average, have been getting fatter. "People don't think that something as simple as the size of a bowl would influence how much an informed person eats," he said.

However, several studies show exactly that, including Wansink's study of 168 moviegoers, who ate either fresh or stale popcorn from different size containers. People ate 45 percent more fresh popcorn from extra-large containers than large ones and the people who were eating stale popcorn ate 34 percent more from the extra-large buckets than people eating fresh popcorn, according to the study.

They just don't realize they're doing it," said Wansink. This strategy also applies to what we drink. His research found that people pour about 37 percent more liquid in short, wide glasses than in tall, skinny ones of the same volume.

Even a kid's cereal bowl can be a trap, according to Wansink. One study showed children of different weights who were given a 16 ounce bowl were more likely to serve themselves twice as much cereal than children given an 8 ounce bowl.

Another myth, according to Wansink, is that people know when they are full and stop before they overeat. His Food and Brand Lab at Cornell University tested this by designing a "bottomless bowl." They brought in 60 people for a free lunch and gave 22 ounce bowls of soup to half, while the other half unknowingly got 22 ounce bowls that were pressure-fed under the table and slowly refilled. The results: people with bottomless bowls ate 73 percent more than those with normal bowls, yet when asked, they didn't realize they had eaten more. "The lesson is, don't rely on your stomach to tell you when you're full. It can lie," Wansink said.

Simply being aware of such findings can help people make healthier choices, especially those who are already trying to eat healthier foods, according to Wansink. One of his studies showed that people lost up to two pounds a month after making several simple changes in their environment, including:

  • eating off salad plates instead of large dinner plates.
  • keeping unhealthy foods out of immediate line of sight and moving healthier foods to eye-level in the cupboard and refrigerator.
  • eating in the kitchen or dining room, not in front of the television.

"These simple strategies are far more likely to succeed than willpower alone. It's easier to change your environment than to change your mind," Wansink concluded.

School obesity-prevention curriculum can reduce medical costs

Teaching middle-school children about nutrition and exercise and encouraging them to watch less TV can save the health care system a substantial amount of money, suggests an economic analysis from Children's Hospital Boston and the Centers for Disease Control and Prevention.

Using data from a randomized, controlled study conducted at 10 Massachusetts middle schools, five of which adopted the obesity prevention curriculum Planet Health, the researchers created a model projecting a net savings of $14,000 for the 254 girls receiving the curriculum, by averting the costs of treating obesity and eating disorders. They project that expanding the program to even just 100 schools could save the health care system $680,000.

The study, published in the August issue of the Archives of Pediatrics & Adolescent Medicine, was led by S. Bryn Austin, ScD, an epidemiologist in Children's Hospital Boston's Division of Adolescent Medicine, and CDC health economist Li Yan Wang.

Planet Health, developed at the Harvard School of Public Health, is a curriculum for academic, physical education and health education teachers to guide middle-school students in choosing healthy foods, increasing physical activity and limiting TV and other screen time. It provides teacher training, lesson plans, materials and FitCheck, a self-assessment tool for students.

In an earlier study of 10 middle schools, half offering the Planet Health program and half offering regular programs (schools were matched by town, school size and ethnic composition), obesity prevalence declined in the schools with Planet Health but increased in control schools over the two years of follow-up. In addition, overweight girls in Planet Health schools were twice as likely as girls in control schools to return to a healthy weight over the two years.(Gortmaker SL et al, 1999). Unexpectedly, girls in Planet Health schools were also less than half as likely as girls in control schools to begin purging or using diet pills to control their weight (Austin SB et al, 2005); this study was later replicated in a separate group of middle schools (Austin SB et al, 2007). The effects were not statistically significant for boys.

"We were really surprised and encouraged to see how protective Planet Health was for eating disorder symptoms in girls," says Austin, the study's senior author. "When we found the same protective effect — cutting the risk for girls in half — in a different set of middle schools several years later, we knew we were on to something important."

Bulimia typically develops in adolescence, and often begins with a few behaviors, such as using diet pills or purging to control weight. Full-blown bulimia is a life-threatening disorder that carries a variety of medical complications such as electrolyte imbalances, dehydration, metabolic alkalosis (an imbalance in the body's acid/base balance), heart rhythm disturbances, tooth erosion and bowel dysfunction.

"Eating disorders cause an enormous amount of suffering," says Austin. "They can also be chronic and expensive to treat, which is often a big financial burden on individuals, their families, and society. That's what led us to want to do the economic study."

In their economic analysis, Austin and Wang first estimate that 3.4 percent of girls receiving the Planet Health intervention would be prevented from developing disordered weight-control behaviors by the age of 13 ½, based on numbers from the original randomized study (7 of 254 girls in the Planet Health schools, or 2.8 percent, developed these behaviors, versus 14 of 226 controls, or 6.2 percent). Based on current knowledge about the progression of eating disorders, they calculate that, in turn, 1 case of bulimia would be prevented by the age of 17 among the 254 girls.

Factoring in typical treatment costs — which can be tens of thousands of dollars over a decade — and known rates of remission and relapse, Austin and Wang estimate that an average of $34,000 would be saved by preventing one girl in the five Planet Health study schools from developing bulimia nervosa. Adding Wang's previous finding of $27,042 in savings resulting from prevention and reduction of obesity in the same schools (Wang LI et al, 2003), the program would yield a net savings of $14,238 after subtracting the $46,803 cost of offering Planet Health in those schools.

"Because eating disorders can be so expensive to treat, preventing even one case in the five Planet Health schools translated into reducing medical costs by $34,000," says Austin. "But if we scale up our calculations to include, say, 100 middle schools in Massachusetts, the medical costs reduced by preventing bulimia increase to over half a million dollars. And if we scale up nationwide, to say 1,000 schools, the potential reduction in the medical cost burden is sizable."

Austin notes that obesity prevention programs that stigmatize obesity or create a sense of blame can actually contribute to eating disorders. "We need to be smart about choosing obesity prevention strategies that, at the same time, can prevent eating disorders," she says. "Our study shows that when we do both, we substantially increase the benefits, both in terms of health and reducing medical costs."

The study was funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration. Lauren Nichols of the Division of Adolescent and Young Adult Medicine at Children's Hospital Boston was coauthor.

'Love your body' to lose weight

Almost a quarter of men and women in England and over a third of adults in America are obese. Obesity increases the risk of diabetes and heart disease and can significantly shorten a person's life expectancy. New research published by BioMed Central's open access journal International Journal of Behavioral Nutrition and Physical Activity shows that improving body image can enhance the effectiveness of weight loss programs based on diet and exercise.

Researchers from the Technical University of Lisbon and Bangor University enrolled overweight and obese women on a year-long weight loss program. Half the women were given general health information about good nutrition, stress management, and the importance of looking after yourself. The other half attended 30 weekly group sessions (the intervention plan) where issues such as exercise, emotional eating, improving body image and the recognition of, and how to overcome, personal barriers to weight loss and lapses from the diet were discussed.

On the behavioral intervention plan women found that the way they thought about their body improved and that concerns about body shape and size were reduced. Compared to the control group they were better able to self-regulate their eating and they lost much more weight, losing on average 7% of their starting weight compared to less than 2% for the control group.

Dr Teixeira from Technical University of Lisbon, who led the research, said, "Body image problems are very common amongst overweight and obese people, often leading to comfort eating and more rigid eating patterns, and are obstacles to losing weight. Our results showed a strong correlation between improvements in body image, especially in reducing anxiety about other peoples' opinions, and positive changes in eating behavior. From this we believe that learning to relate to your body in healthier ways is an important aspect of maintaining weight loss and should be addressed in every weight control program."


Journal Reference:

  1. Minderico, Luis B Sardinha and Pedro J Teixeira Eliana V Carraca, Marlene N Silva, David Markland, Paulo N Vieira, Claudia S. Body image change and improved eating self-regulation in a weight management intervention in women. International Journal of Behavioral Nutrition and Physical Activity, 2011 (in press) [link]

Family meals remain important through teen years, expert says

— As children become teenagers, it may be more challenging to regularly include them in family meals, but doing so is key to heading off such problems as eating disorders, obesity, and inadequate nutrition in adolescence, said Barbara Fiese, a University of Illinois professor of human development and family studies and director of the U of I's Family Resiliency Center.

"The common belief is that teens don't want to be around their parents very much, and that teens are just too busy for regular meals with the family," she said. "Parents may not be able to get their families together around the table seven days a week, but if they can schedule three family meals a week, they will safeguard their teens' health in significant ways."

She advises family members to pull out their schedules and find out which nights they can commit to, then follow through and make family meals on those nights a priority.

In the June issue of Pediatrics, Fiese and postdoctoral research associate Amber Hammons reviewed 17 recent studies on eating patterns and nutrition involving more than 182,000 children and adolescents.

The results showed that teens who eat at least five meals a week with their families are 35 percent less likely to engage in disordered eating than teens who don't. The researchers defined disordered eating as binging and purging, taking diet pills, self-induced vomiting, using laxatives or diuretics, fasting, eating very little, skipping meals, and/or smoking cigarettes to lose weight.

"For children and adolescents with disordered eating, mealtime provides a setting in which parents can recognize early signs and take steps to prevent detrimental patterns from turning into full-blowing eating disorders," she said.

Children who ate at least three family meals a week were also 12 percent less likely to be overweight than those who ate with their families less often. And they were 24 percent more likely to eat healthy foods and have healthy eating habits than those who didn't share three meals with their families.

The researcher said that families who share meals together are likely to be more connected, which may encourage teens to talk within their families about unhealthy behaviors they've slipped into and other problems they're experiencing.

"If you look at national surveys, the frequency of shared mealtimes does begin to drop off in the teen years, but a lot of that is due to competing demands on teenagers' time due to after-school activities, jobs, and social life, and not for lack of interest," she said.

The study showed that teens are interested in participating in family mealtimes and believe that they eat healthier when they share meals with their families, she said.

According to the expert, research on adolescent development indicates that teens want to stay connected with their parents. "Family meals give them a place where they can go regularly to check in with their parents and express themselves freely," she said.

"If family meals are not a forced activity, if parents don't totally control the conversation, and if teens can contribute to family interaction and feel like they're benefiting from it, older kids are likely to welcome participating," she added.

If you've gotten out of the family meal habit and don't relish the prospect of receiving one-word answers from your teenagers (Q: What happened at school today? A: nothing), Fiese and her colleagues have compiled some conversation starters for both English- and Spanish-speaking families.

Here's one: If you won a million dollars, what would you do with it and why?


Journal Reference:

  1. A. J. Hammons, B. H. Fiese. Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Adolescents?Pediatrics, 2011; 127 (6): e1565 DOI: 10.1542/peds.2010-1440

Eating disorders impact brain function, new brain research suggests

— Bulimia nervosa is a severe eating disorder associated with episodic binge eating followed by extreme behaviors to avoid weight gain such as self-induced vomiting, use of laxatives or excessive exercise. It is poorly understood how brain function may be involved in bulimia. A new study led by Guido Frank, MD, assistant professor, Departments of Psychiatry and Neuroscience and Director, Developmental Brain Research Program at the University of Colorado Anschutz Medical Campus, examined the brain response to a dopamine related reward-learning task in bulimic and healthy women.

Dopamine is an important brain chemical or neurotransmitter that helps regulate behavior such as learning and motivation. Frank found that bulimic women had weakened response in brain regions that are part of the reward circuitry. This response was related to the frequency of binge/purge episodes. Overeating and purging episodes thus could cause such a weaker response and set off a vicious cycle of altered brain function.

These findings are important for several reasons. First, they directly implicate the brain reward system and related dopamine function in this disorder. Second, bulimic behavior appears to directly affect brain reward function and it is uncertain whether such alterations return to normal with recovery or not. Third, brain dopamine could be a treatment target in bulimia nervosa using specific medication that targets those abnormalities.

"This is the first study that suggests that brain dopamine related reward circuitry, pathways that modulate our drive to eat, may have a role in bulimia nervosa. We found reduced activation in this network in the bulimic women, and the more often an individual had binge/purge episodes the less responsive was their brain. That suggests that the eating disorder behavior directly affects brain function. These findings are important since the brain dopamine neurotransmitter system could be an important treatment target for bulimia nervosa," said Frank.

This study was published in Biological Psychiatry.


Journal Reference:

  1. Guido K.W. Frank, Jeremy R. Reynolds, Megan E. Shott, Randall C. O'Reilly. Altered Temporal Difference Learning in Bulimia Nervosa. Biological Psychiatry, 2011; DOI: 10.1016/j.biopsych.2011.05.011

Patients with eating disorders have an elevated rate of death

 Individuals who have eating disorders have an elevated mortality rate, especially those with anorexia nervosa (AN), according to a meta-analysis of previous studies, reported in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

According to background information in the article, the majority of studies of eating disorder-related death rates focus on AN. Some research of bulimia nervosa (BN) implies that death rates are low for this condition. Moreover, there is limited information about the likelihood of death with eating disorders not otherwise specified (EDNOS), disordered eating that does not meet the criteria for AN or BN, say the authors: "Despite EDNOS being a common presentation in eating disorders services, few published data exist regarding mortality rates in patients given this diagnosis." In this study, the investigators sought to determine the death rates (and the factors thereof) for each of these types of eating disorders.

Jon Arcelus, L.M.S., M.Sc., M.R.C.Psych., Ph.D., from Leicester General Hospital in Leicester, England, and colleagues systematically searched, assessed and analyzed studies related to eating disorder death rates. They included English-language, peer reviewed articles published between January 1966 and September 2010 from a variety of scientific-literature databases and collections. The researchers examined 36 studies; almost all included AN, one-third included BN, and one-fifth included EDNOS. The studies included 17,272 different patients with eating disorders and reported a total of 755 deaths.

The total number of person-years represented by the studies was 166,642 for AN; 32,798 for BN; and 22,644 for EDNOS. For each 1,000 person-years, the AN group experienced 5.1 deaths (1.3 of which were from suicide), the BN group experienced 1.7 deaths, and the EDNOS group experienced 3.3 deaths. The standardized mortality ratio (the number of actual deaths compared with the number of expected deaths) was 5.86 for AN, 1.93 for BN and 1.92 for EDNOS. The age at which a patient presented for treatment was found to correlate with AN deaths, with patients in their late teens and 20s having a higher death rate than younger patients or those in their 30s.

The authors acknowledge that some of the deaths included in the studies may be due to factors other than an eating disorder. However, they found that death rates for eating disorders — especially AN — are higher than for some other psychiatric disorders, such as schizophrenia and depression. The elevated death rate for BN and EDNOS as well "highlights the seriousness of those conditions," write the authors. They call for more research into what factors might predict death risk in those two conditions in particular.


Journal Reference:

  1. Jon Arcelus; Alex J. Mitchell; Jackie Wales; Soren Nielsen. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Archives of General Psychiatry, 2011; 68 (7): 724-731 DOI: 10.1001/archgenpsychiatry.2011.74

Adolescents' dieting and disordered eating behaviors continue into young adulthood, study finds

— Adolescents who diet and develop disordered eating behaviors (unhealthy and extreme weight control behaviors and binge eating) carry these unhealthy practices into young adulthood and beyond, according to a study conducted by University of Minnesota researchers and published in the July 2011 issue of the Journal of the American Dietetic Association.

"The findings from the current study argue for early and ongoing efforts aimed at the prevention, early identification, and treatment of disordered eating behaviors in young people," commented lead investigator. Dianne Neumark-Sztainer, PhD, MPH, RD, Professor, Division of Epidemiology & Community Health, School of Public Health, University of Minnesota. "Within clinical practices, dietitians and other health care providers should be asking about the use of these behaviors prior to adolescence, throughout adolescence, and into young adulthood. Given the growing concern about obesity, it is important to let young people know that dieting and disordered eating behaviors can be counterproductive to weight management. Young people concerned about their weight should be provided with support for healthful eating and physical activity behaviors that can be implemented on a long-term basis, and should be steered away from the use of unhealthy weight control practices."

Using data from Project EAT-III (Eating and Activity in Teens and Young Adults), a 10-year longitudinal study aimed at examining eating, activity, and weight-related variables among young people, investigators from the Division of Epidemiology & Community Health, School of Public Health and the Department of Pediatrics, University of Minnesota, examined the records for 1,030 young men and 1,257 young women. One third of participants (29.9%) were in early adolescence (mean age = 12.8 years) at the beginning of the study and were in early young adulthood (mean age = 23.2 years) at the 10-year follow-up. Two thirds of participants (70.1%) were in middle adolescence (mean age = 15.9 years) at the beginning and were in middle young adulthood (mean age = 26.2 years) after 10 years.

Subjects were asked about dieting, extreme weight control behaviors such as fasting, using food substitutes and skipping meals, and binge eating with loss of control. Additional socioeconomic, gender, age, and race/ethnicity data was also collected.

About half of the females reported dieting in the past year compared to about a fourth of the males. The prevalence of dieting remained fairly constant from adolescence through young adulthood for females in both age groups. Among males, the prevalence of dieting stayed constant over time in the younger age cohort, but significantly increased in the older cohort as they progressed from middle adolescence to middle young adulthood (21.9% to 27.9%). In the younger females, unhealthy weight control behaviors remained constant from early adolescence to early young adulthood. Among older females, unhealthy weight control behaviors showed a statistically significant decrease from middle adolescence to middle young adulthood, but still remained very high (60.7% to 54.4%). Approximately one-third of males reported unhealthy weight control behaviors, and the prevalence remained fairly constant over the study period in both age cohorts.

For extreme weight control behaviors, significant increases from adolescence to young adulthood were found in females for both age cohorts and for the older cohort of males. Among females, the use of extreme weight control behaviors increased from 8.4% to 20.4% between early adolescence and early young adulthood and from 12.6% to 20.6% between middle adolescence and middle young adulthood. For the older males, extreme weight control behaviors increased from 2.1% in middle adolescence to 7.3% in middle young adulthood.

These behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors 10 years later. Tracking was particularly consistent for the older females and males transitioning from middle adolescence to middle young adulthood. The tracking of these potentially harmful behaviors suggests that their use is not just "a phase" that adolescents go through, but instead indicates that early use of dieting and disordered eating behaviors may set the stage for continued use of these behaviors later on.


Journal Reference:

  1. Dianne Neumark-Sztainer, Melanie Wall, Nicole I. Larson, Marla E. Eisenberg, Katie Loth. Dieting and Disordered Eating Behaviors from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study. Journal of the American Dietetic Association, 2011; 111 (7): 1004-1011 DOI: 10.1016/j.jada.2011.04.012