Katie Loth

Dieting and Disordered Eating Behaviors from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study

BACKGROUND Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood. OBJECTIVE To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood. DESIGN Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010). PARTICIPANTS/SETTING The study population included 2,287 young adults (55% girls, 52% nonwhite). The sample included a younger group (mean age 12.8±0.7 years at baseline and 23.2±1.0 years at follow-up) and an older group (mean age 15.9±0.8 at baseline and 26.2±0.9 years at follow-up). STATISTICAL ANALYSES PERFORMED Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline. RESULTS In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, 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 girls and boys transitioning from middle adolescence to middle young adulthood. CONCLUSIONS Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts before the onset of harmful behavioral patterns as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.

Parenting Style as a Predictor of Adolescent Weight and Weight-Related Behaviors

PURPOSE Current research indicates that specific parenting styles are associated with adolescent overweight, dietary intake, and physical activity; but most of the research has been cross-sectional, making it difficult to determine the temporal order of these associations. The current study adds to the previous research by examining 5-year longitudinal associations between parenting style and adolescent weight and weight-related behaviors. METHODS Data from Project EAT, a population-based study with adolescents from diverse ethnic and socioeconomic backgrounds, were used. Adolescents (N = 2,516) from 31 Minnesota schools completed in-class assessments in 1999 (Time 1) and mailed surveys in 2004 (Time 2). Multiple linear regression models were used to predict mean levels of adolescent outcomes at Time 2 from parenting style at Time 1. RESULTS Time 1 maternal authoritative parenting style predicted lower body mass index in adolescent sons and daughters at Time 2. Time 1 paternal permissive parenting style predicted more fruits and vegetables intake in daughters at Time 2. Significant associations were not found between parenting style and adolescent physical activity. CONCLUSIONS Findings suggest that authoritative parenting style may play a protective role related to adolescent overweight and that the dimension of warmth and/or caring in the parent-adolescent relationship may be important in relation to female adolescent healthy dietary intake. Further exploration of opposite sex parent-adolescent dyad patterns related to parenting style and adolescent weight and weight-related behaviors is warranted.

Family Functioning: Associations With Weight Status, Eating Behaviors, and Physical Activity in Adolescents

PURPOSE This article examines the relationship between family functioning (e.g., communication, closeness, problem solving, behavioral control) and adolescent weight status and relevant eating and physical activity behaviors. METHODS Data are from EAT 2010 (Eating and Activity in Teens), a population-based study that assessed eating and activity among socioeconomically and racially/ethnically diverse youths (n = 2,793). Adolescents (46.8% boys, 53.2% girls) completed anthropometric assessments and surveys at school between 2009 and 2010. Multiple linear regression was used to test the relationship between family functioning and adolescent weight, dietary intake, family meal patterns, and physical activity. Additional regression models were fit to test for interactions by race/ethnicity. RESULTS For adolescent girls, higher family functioning was associated with lower body mass index z score and percent overweight, less sedentary behavior, higher intake of fruits and vegetables, and more frequent family meals and breakfast consumption. For adolescent boys, higher family functioning was associated with more physical activity, less sedentary behavior, less fast-food consumption, and more frequent family meals and breakfast consumption. There was one significant interaction by race/ethnicity for family meals; the association between higher family functioning and more frequent family meals was stronger for nonwhite boys compared with white boys. Overall, strengths of associations tended to be small, with effect sizes ranging from -.07 to .31 for statistically significant associations. CONCLUSIONS Findings suggest that family functioning may be protective for adolescent weight and weight-related health behaviors across all race/ethnicities, although assumptions regarding family functioning in the homes of overweight children should be avoided, given small effect sizes.

What's for dinner? Types of food served at family dinner differ across parent and family characteristics.

OBJECTIVE To examine the types of food served at family dinner in the homes of adolescents and correlations with parent and family sociodemographic characteristics, psychosocial factors and meal-specific variables. DESIGN A cross-sectional population-based survey completed by mail or telephone by parents participating in Project F-EAT (Families and Eating and Activity in Teens) in 2009-2010. SETTING Homes of families with adolescents in Minneapolis/St. Paul urban area, MN, USA. SUBJECTS Participants included 1923 parents/guardians (90·8% female; 68·5% from ethnic/racial minorities) of adolescents who participated in EAT 2010. RESULTS Less than a third (28%) of parents reported serving a green salad at family dinner on a regular basis, but 70% reported regularly serving vegetables (other than potatoes). About one-fifth (21%) of families had fast food at family dinners two or more times per week. Variables from within the sociodemographic domain (low educational attainment) psychosocial domain (high work-life stress, depressive symptoms, low family functioning) and meal-specific domain (low value of family meals, low enjoyment of cooking, low meal planning, high food purchasing barriers and fewer hours in food preparation) were associated with lower healthfulness of foods served at family dinners, in analyses adjusted for sociodemographic characteristics. CONCLUSIONS There is a need for interventions to improve the healthfulness of food served at family meals. Interventions need to be suitable for parents with low levels of education; take parent and family psychosocial factors into account; promote more positive attitudes toward family meals; and provide skills to make it easier to plan and prepare healthful family meals.

Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study

OBJECTIVE: To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs. METHODS: Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone. RESULTS: Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status. CONCLUSIONS: Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children’s ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.

Eat this, not that! Parental demographic correlates of food-related parenting practices

To understand how parents of adolescents attempt to regulate their childrens eating behaviors, the prevalence of specific food-related parenting practices (restriction, pressure-to-eat) by sociodemographic characteristics (parent gender, race/ethnicity, education level, employment status, and household income) were examined within a population-based sample of parents (n=3709) of adolescents. Linear regression models were fit to estimate the association between parent sociodemographic characteristics and parental report of food restriction and pressure-to-eat. Overall, findings suggest that use of controlling food-related parenting practices, such as pressuring children to eat and restricting childrens intake, is common among parents of adolescents, particularly among parents in racial/ethnic minority subgroups, parents with less than a high school education, and parents with a low household income. Results indicate that that social or cultural traditions, as well as parental access to economic resources, may contribute to a parents decision to utilize specific food-related parenting practices. Given that previous research has found that restriction and pressure-to-eat food-related parenting practices can negatively impact childrens current and future dietary intake, differences in use of these practices by sociodemographic characteristics may contribute, in part, to the disparities that exist in the prevalence of overweight and obesity among adolescents by their race/ethnicity and socioeconomic status.

Feeding a Family in a Recession: Food Insecurity Among Minnesota Parents

OBJECTIVES We assessed current levels of food insecurity among a large, diverse sample of parents and examined associations between food insecurity and parental weight status, eating patterns, and the home food environment. METHODS Project F-EAT (Families and Eating and Activity Among Teens) examined the home food environments of adolescents. Parents and caregivers (n = 2095) living with adolescents from the Minneapolis-St. Paul, Minnesota school districts completed mailed surveys during a 12-month period in 2009-2010. We performed our assessments using multivariate regressions. RESULTS Almost 39% of the parents and caregivers experienced household food insecurity, whereas 13% experienced very low food security. Food insecurity was significantly associated with poorer nutrition-related variables such as higher rates of parental overweight and obesity, less healthy foods served at meals, and higher rates of binge eating. Food-insecure parents were 2 to 4 times more likely to report barriers to accessing fruits and vegetables. CONCLUSIONS Food insecurity was highly prevalent. Environmental interventions are needed to protect vulnerable families against food insecurity and to improve access to affordable, healthy foods.

Parent conversations about healthful eating and weight associations with adolescent disordered eating behaviors

IMPORTANCE The prevalence of weight-related problems in adolescents is high. Parents of adolescents may wonder whether talking about eating habits and weight is useful or detrimental. OBJECTIVE To examine the associations between parent conversations about healthful eating and weight and adolescent disordered eating behaviors. DESIGN Cross-sectional analysis using data from 2 linked multilevel population-based studies. SETTING Anthropometric assessments and surveys completed at school by adolescents and surveys completed at home by parents in 2009-2010. PARTICIPANTS Socioeconomically and racially/ethnically diverse sample (81% ethnic minority; 60% low income) of adolescents from Eating and Activity in Teens 2010 (EAT 2010) (n = 2793; mean age, 14.4 years) and parents from Project Families and Eating and Activity in Teens (Project F-EAT) (n = 3709; mean age, 42.3 years). EXPOSURE Parent conversations about healthful eating and weight/size. MAIN OUTCOMES AND MEASURES Adolescent dieting, unhealthy weight-control behaviors, and binge eating. RESULTS Mothers and fathers who engaged in weight-related conversations had adolescents who were more likely to diet, use unhealthy weight-control behaviors, and engage in binge eating. Overweight or obese adolescents whose mothers engaged in conversations that were focused only on healthful eating behaviors were less likely to diet and use unhealthy weight-control behaviors. Additionally, subanalyses with adolescents with data from 2 parents showed that when both parents engaged in healthful eating conversations, their overweight or obese adolescent children were less likely to diet and use unhealthy weight-control behaviors. CONCLUSIONS AND RELEVANCE Parent conversations focused on weight/size are associated with increased risk for adolescent disordered eating behaviors, whereas conversations focused on healthful eating are protective against disordered eating behaviors.

Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors?

Intuitive eating (i.e., reliance on physiologic hunger and satiety cues to guide eating) has been proposed as a healthier, more effective, and more innate alternative to current strategies of weight management. The current study explored intuitive eating among young adults according to socio-demographic characteristics and body mass index (BMI), and examined associations between intuitive and disordered eating behaviors. Data were drawn from Project EAT-III, a population-based study of 2287 young adults (mean age: 25.3 years). More males reported trusting their bodies to tell them how much to eat than did females. Intuitive eating was inversely associated with BMI in both genders. Males and females who reported trusting their body to tell them how much to eat had lower odds of utilizing disordered eating behaviors compared to those that did not have this trust. Females who reported that they stop eating when they are full had lower odds of chronic dieting and binge eating than those who do not stop eating when full. Overall, this study found that intuitive eating practices are inversely associated with a number of harmful outcomes. Clinicians should discuss the concept of intuitive eating with their young adult patients to promote healthier weight-related outcomes.

Preventing Eating Disorder Pathology: Common and Unique Features of Successful Eating Disorders Prevention Programs

Over the past two decades, the field of eating disorders has made remarkable strides in identifying, evaluating, and disseminating successful prevention programs. The current review identifies and discusses nine distinct eating disorders prevention programs that reduce existing eating disorder pathology or prevent the onset of future pathology. Each program was evaluated in one or more controlled trial with a follow-up period of at least six months. We review the evidence base for these nine successful programs and discuss their common and unique features. Based on authors’ descriptions of their programs in published trials, we found that all programs were theory-driven, targeted one or more eating disorder risk factor (e.g., body dissatisfaction), were delivered across multiple group sessions, and included at least some interactive content. Most programs included content related to healthy eating/nutrition, media literacy/sociocultural pressures, and body acceptance/body satisfaction. Notably, there was wide variation in some participant features (e.g., participant age, sex, risk status) and intervention features (e.g., setting and format, length and dose, providers), suggesting that a variety of programs are beneficial in impacting eating disorder pathology. Implications and directions for future research are discussed, including an increased focus on universal and indicated prevention programs, expanding programs to a wider age range and a broader spectrum of weight-related problems, and rigorous evaluation of programs through efficacy, effectiveness, and implementation research.