Nicole I Larson

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

BACKGROUNDnDisordered 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.nnnOBJECTIVEnTo examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood.nnnDESIGNnPopulation-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010).nnnPARTICIPANTS/SETTINGnThe 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).nnnSTATISTICAL ANALYSES PERFORMEDnLongitudinal 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.nnnRESULTSnIn 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.nnnCONCLUSIONSnStudy 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.

A Review of Environmental Influences on Food Choices

BackgroundDiet-related environmental and policy interventions are being advocated at a population level because individual change is more likely to be facilitated and sustained if the environment within which choices are made supports healthful food options.PurposeThis study aims to review research that examines factors having an influence on food choices in social environments, physical environments, and macroenvironments.MethodsA snowball strategy was used to identify relevant peer-reviewed studies and reviews, with a focus on research completed in the US and published within the past 10xa0years.ResultsResearch has identified a number of environmental factors associated with dietary intake; however, the majority of completed studies have methodological limitations which limit their credibility to guide interventions and policy changes.ConclusionsFuture research will need to emphasize multilevel investigations, examine how associations vary across population subgroups, develop a standard set of measures for assessing food environments and policies, and improve dietary assessment methodology.

What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts

Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers promotion of childrens health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings.

Review of the Nutritional Implications of Farmers' Markets and Community Gardens: A Call for Evaluation and Research Efforts

The development and promotion of farmers markets and community gardens is growing in popularity as a strategy to increase community-wide fruit and vegetable consumption. Despite large numbers of farmers markets and community gardens in the United States, as well as widespread enthusiasm for their use as a health promotion tool, little is known about their influence on dietary intake. This review examines the current scientific literature on the implications of farmers market programs and community gardens on nutrition-related outcomes in adults. Studies published between January 1980 and January 2009 were identified via PubMed and Agricola database searches and by examining reference lists from relevant studies. Studies were included in this review if they took place in the United States and qualitatively or quantitatively examined nutrition-related outcomes, including dietary intake; attitudes and beliefs regarding buying, preparing, or eating fruits and vegetables; and behaviors and perceptions related to obtaining produce from a farmers market or community garden. Studies focusing on garden-based youth programs were excluded. In total, 16 studies were identified for inclusion in this review. Seven studies focused on the impact of farmers market nutrition programs for Special Supplemental Nutrition Program for Women, Infants, and Children participants, five focused on the influence of farmers market programs for seniors, and four focused on community gardens. Findings from this review reveal that few well-designed research studies (eg, those incorporating control groups) utilizing valid and reliable dietary assessment methods to evaluate the influence of farmers markets and community gardens on nutrition-related outcomes have been completed. Recommendations for future research on the dietary influences of farmers markets and community gardens are provided.

Food Insecurity and Weight Status Among U.S. Children and Families

CONTEXTnFood insecurity disproportionately affects U.S. demographic groups of children and adult family members at the highest risk for obesity and may lead to weight gain through various pathways. This article reviews research regarding the relationship between food insecurity and weight status, and the potential role of federal food and nutrition assistance programs.nnnEVIDENCE ACQUISITIONnA search for relevant peer-reviewed research studies among U.S. children and nonelderly adults, published between 2000 and March 2010, identified 42 studies regarding the relationship between food insecurity and weight status. There were 22 studies regarding the potential role of food and nutrition assistance programs.nnnEVIDENCE SYNTHESISnAmong children and men, support for an association between food insecurity and weight status has been mixed. Women who experience food insecurity are more likely to be overweight or obese compared to women with adequate household resources for food; however, there is little evidence that food insecurity promotes increased weight gain over time. Long-term participation in the Supplemental Nutrition Assistance Program may increase risk for excess weight gain.nnnCONCLUSIONSnAdditional research addressing the limitations of current studies is needed to fully understand the observed linkages between food insecurity and risk for obesity. Nevertheless, there is substantial evidence these nutritional problems coexist, and it is critical that future efforts to eliminate hunger consider opportunities to promote healthy food choices and physical activity. Evaluations of policy changes and other intervention strategies are needed to determine the potential for food and nutrition assistance programs to more effectively reduce obesity among participants.

Are Family Meal Patterns Associated with Overall Diet Quality during the Transition from Early to Middle Adolescence

OBJECTIVEnTo examine longitudinal associations of participation in regular family meals (>or= 5 meals/week) with eating habits and dietary intake during adolescence.nnnDESIGNnPopulation-based, longitudinal study (Project EAT: Eating Among Teens). Surveys were completed in Minnesota classrooms at Time 1 (1998-1999) and by mail at Time 2 (2003-2004).nnnSETTINGnBaseline surveys were completed in Minneapolis/St. Paul, Minnesota, schools and by mail at follow-up.nnnPARTICIPANTSn677 adolescents (303 males and 374 females) who were in middle school at Time 1 (mean age = 12.8 +/- 0.74 years) and high school at Time 2 (mean age = 17.2 +/- 0.59 years).nnnMAIN OUTCOME MEASURESnDietary intake, frequency of meals, and fast-food intake patterns.nnnANALYSISnGeneralized linear modeling stratified by gender and adjusted for race/ethnicity, socioeconomic status, and the Time 1 outcome.nnnRESULTSnRegular family meals were positively associated with Time 2 frequency of breakfast, lunch, and dinner meals for males and breakfast and dinner meals for females. Among males, regular family meals were negatively associated with Time 2 fast-food intake. Regular family meals were also positively associated with Time 2 mean daily intakes of vegetables, calcium-rich food, fiber, calcium, magnesium, potassium, iron, zinc, folate, and vitamins A and B(6) among both genders.nnnCONCLUSIONS AND IMPLICATIONSnRegular family meals during early adolescence may contribute to the formation of healthful eating habits 5 years later. Parents should be made aware of the importance of shared mealtime experiences.

Family meals and adolescents: what have we learned from Project EAT (Eating Among Teens)?

OBJECTIVEnThe purpose of the present paper is to provide an integrated overview of the research methodology and key findings from a decade of research on family meals as part of Project EAT (Eating Among Teens), a large, population-based study of adolescents.nnnDESIGNnFocus groups conducted with 141 middle-school and high-school adolescents suggested the importance of family meals in influencing adolescents food choices. These findings led to the inclusion of questions on family meals in the Project EAT-I survey, completed by 4746 middle-school and high-school students, and in the Project EAT-II longitudinal survey, completed by 2516 of the original participants five years later. A subset of 902 parents also participated in telephone interviews as part of Project EAT-I.nnnRESULTSnFindings indicate that many adolescents and parents view family meals in a positive light, but there is great diversity in the context and frequency of family meal patterns in the homes of adolescents. Findings further suggest that family meals may have benefits in terms of dietary intake, disordered eating behaviours, substance use and psychosocial health.nnnCONCLUSIONSnFindings from Project EAT, in conjunction with other research studies on family meals, suggest the importance of working with families to increase the frequency and improve the quality of family meals. Further research is needed in order to elucidate the pathways that underpin the relationships between family meals and health outcomes. Suggestions for a future research agenda based on what was learned from Project EAT are provided.

Young adults and eating away from home: associations with dietary intake patterns and weight status differ by choice of restaurant.

BACKGROUNDnYoung adults report frequent away-from-home eating; however, little is known regarding what types of restaurants are patronized or whether associations with dietary intake and weight status differ according to restaurant type.nnnOBJECTIVEnThis cross-sectional study in a diverse sample of young adults examines sociodemographic differences in the frequency of eating at different types of fast-food and full-service (server brings food to table) restaurants. In addition, this study examines whether associations between away-from-home eating, dietary intake, and weight status differ according to restaurant type.nnnDESIGNnThere were 1,030 men and 1,257 women (mean age=25.3 years) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). Participants were members of a longitudinal cohort who completed baseline surveys at schools in Minneapolis/St Paul, MN, and completed the EAT-III surveys online or by mail in 2008-2009.nnnMAIN OUTCOME MEASURESnHeight, weight, and usual dietary intake were self-reported.nnnSTATISTICAL ANALYSES PERFORMEDnRegression models adjusted for sociodemographic characteristics were used to examine associations between frequency of restaurant use, dietary intake, and weight status.nnnRESULTSnMore frequent use of fast-food restaurants that primarily served burgers and french fries was associated with higher risk for overweight/obesity; higher intake of total energy, sugar-sweetened beverages, and fat; and with lower intake of healthful foods and key nutrients. For example, those who reported burger-and-fries restaurant use on three or more occasions per week consumed nearly one additional sugar-sweetened beverage per day compared to those who reported burger-and-fries restaurant use on less than one occasion per week. More frequent use of fast-food restaurants that primarily served sandwiches/subs was related to a few markers of poorer diet quality, but unrelated to weight status. More frequent use of full-service restaurants was also unrelated to weight status and related to higher intake of vegetables.nnnCONCLUSIONSnThere may be a need for interventions to promote healthier food choices among young adults who report frequent burger-and-fries restaurant use.

A Review of Snacking Patterns among Children and Adolescents: What Are the Implications of Snacking for Weight Status?

Given the growing contribution of snacks to dietary intake and the need for effective strategies to reduce obesity, it is important to consider whether snacking behaviors contribute to high BMI in childhood. This review summarizes US research that has addressed trends in snacking behavior and its contribution to dietary intake, as well as research describing snack food availability in settings where youth spend their time. In addition, it comprehensively reviews studies conducted in the United States and internationally that have examined associations of snacking behavior with weight. Research published between January, 2000, and December, 2011, was identified by searching PubMed and MEDLINE databases, and by examining bibliographies of relevant studies. Recent analyses of trends in dietary intake have shown there were significant increases in the contribution of energy-dense, nutrient-poor foods to snacking kilocalories over the past few decades. Although snacks can contribute to intake of key nutrients, frequent snacking has been associated with higher intake of total energy and energy from added and total sugars. Assessments in schools and retail stores have further indicated that energy-dense, nutrient-poor snacks are widely available in settings where youth spend their time. The majority of studies either found no evidence of a relationship between snacking behavior and weight status or found evidence indicating that young people who consumed more snacks were less likely to be obese; however, additional research is needed to address various methodological limitations. Recommendations for future research are provided to address knowledge gaps and inform the development of interventions.

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

PURPOSEnThis 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.nnnMETHODSnData 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.nnnRESULTSnFor 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.nnnCONCLUSIONSnFindings 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.