Psychometric evaluation of the Disordered Eating Attitude Scale (DEAS). English version.

UNLABELLED: Eating attitudes are defined as beliefs, thoughts, feelings, behaviors and relationship with food. They could influence people's food choices and their health status. OBJECTIVE: This study aimed to adapt from Portuguese to English the Disordered Eating Attitude Scale (DEAS) and evaluate its validity and reliability. The original scale in Portuguese was translated and adapted into English and was applied to female university students of University of Minnesota-USA (n=224). Internal consistency was determined (Cronbach's Alpha). Convergent validity was assessed by correlations between Eating Attitude Test-26 (EAT-26) and Restrain Scale (RS). Reliability was evaluated applying twice the scale to a sub-sample (n=30). The scale was back translated into Portuguese and compared with the original version and discrepancies were not found. The internal consistency was .76. The DEAS total score was significantly associated with EAT-26 (r=0.65) and RS (r=0.69) scores. The correlation between test-retest was r=0.9. The English version of DEAS showed appropriate internal consistency, convergent validity and test-retest reliability and will be useful to assess eating attitudes in different population groups in English spoken countries.

Monetary costs associated with bulimia.

OBJECTIVE: The direct monetary costs for food and laxatives, diet pills, and diuretics used by individuals with bulimia nervosa (BN) have not been studied. METHOD: Ten participants with a presenting clinical diagnosis of BN completed a 7-day food record at the outset of treatment in order to provide estimates of weekly and yearly monetary costs for food and associated symptoms. RESULTS: Participants reported means of 3.6 purge episodes, 2.5 objective binge episodes, and 2.4 subjective binge eating episodes per week. Mean total food costs were $106.98/week (SD = $53.88) or $5,581.79/year (SD = $2,811.58). Costs associated with binge eating and purging were 32.7% of all food costs (average: $1,599.45/year). CONCLUSION: Financial costs of bulimia symptoms are significant, and appear to constitute a substantial minority of all food spending by individuals with BN.

Informing family approaches to eating disorder prevention: perspectives of those who have been there.

OBJECTIVE: The study explored how aspects of the family environment may relate to the onset of eating disorders. METHOD: Semi-structured interviews were conducted with 27 individuals currently receiving treatment for eating disorders. Data were analyzed using principles of content analysis. RESULTS: Eight themes emerged regarding recommendations for families to prevent the onset of eating disorders: (1) Enhance parental support; (2) Decrease weight and body talk; (3) Provide a supportive home food environment; (4) Model healthy eating habits and physical activity patterns; (5) Help your children build self-esteem beyond looks and physical appearance; (6) Encourage appropriate expression of feelings and use of coping mechanisms; (7) Increase your understanding of eating disorder signs and symptoms; and (8) Gain support in dealing appropriately with your own struggles. DISCUSSION: Our results can be utilized to generate new theoretical insights as to how parents can raise children with healthy weight-related attitudes and behaviors.

Adolescents involved in weight-related and power team sports have better eating patterns and nutrient intakes than non-sport-involved adolescents.

OBJECTIVE: To examine eating habits and energy and nutrient intake among adolescents participating in weight-related and power team sports and non-sport-involved adolescents. DESIGN: Data were drawn from Project EAT (Eating Among Teens), which was conducted with 4,746 adolescents from 31 middle and high schools in the Minneapolis/St Paul metropolitan area. SETTING: Urban secondary schools. SUBJECTS: Adolescents reporting participation in a weight-related sport, a power team sport, or no consistent participation in a sport. MAIN OUTCOME MEASURES: Meal and snack frequency, mean energy and nutrient intake, and mean physical activity. STATISTICAL ANALYSES PERFORMED: Analyses were conducted by sex across the three groups. General linear models were used to compare mean energy and nutrient intake, composite nutrient adequacy, and mean physical activity across the three groups. Percentages of youth meeting nutrient recommendations were compared across the three groups using chi(2) tests. RESULTS: For both males and females, youth involved in weight-related sports ate breakfast more frequently than non-sport-involved peers (females: 3.6 and 3.2 times per week, respectively, P<0.01; males: 4.7 and 3.7 times per week, respectively, P<0.01). Weight-related and power team sport-involved youth also had higher mean protein, calcium, iron, and zinc intakes than non-sport-involved peers. However, adolescent females had low calcium intake, regardless of sports involvement (weight-related sports 1,091 mg/day, power team sports 1,070 mg/day, and non-sport-involved 1,028 mg/day, P<0.05). CONCLUSIONS: Sport-involved adolescents have better eating habits and nutrient intake than their non-sport-involved peers. However, they are still in need of nutrition interventions, particularly around calcium intake.

Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents.

OBJECTIVE: To examine family meal patterns and associations with sociodemographic characteristics and dietary intake in adolescents. DESIGN: A population-based cross-sectional study design was employed. Adolescents completed the Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire within their schools. Subjects/setting The study population included 4,746 middle and high school students from Minneapolis/St. Paul public schools with diverse racial and socioeconomic backgrounds. Statistical analyses Associations were examined using cross tabulations, log-linear modeling, and linear regressions. RESULTS: There was a wide distribution in the frequency of family meals during the previous week: never (14.0%), 1 or 2 times (19.1%), 3 to 6 times (40.1%), and 7 or more times (24.8%). Sociodemographic characteristics associated with more frequent family meals included gender (boys), school level (middle school), race (Asian American), mother's employment status (not employed), and socioeconomic status (high). Frequency of family meals was positively associated with intake of fruits, vegetables, grains, and calcium-rich foods and negatively associated with soft drink consumption. Positive associations were also seen between frequency of family meals and energy; protein (percentage of total calories); calcium; iron; folate; fiber; and vitamins A, C, E, and B-6. CONCLUSIONS: Family meals appear to play an important role in promoting positive dietary intake among adolescents. Feasible ways to increase the frequency of family meals should be explored with adolescents and their families.

Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: findings from Project EAT.

OBJECTIVE: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls. METHODS: The study population included 4746 adolescents from urban public schools in the state of Minnesota who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers. Main outcome measures included measured body mass index (BMI), weight-related concerns (perceived weight status, weight disparity, body satisfaction and attitudes about weight control) and weight-related behaviors (general/specific weight control behaviors and binge eating). RESULTS: In comparison to White girls, African American girls tended to report fewer weight-related concerns/behaviors, while Hispanic, Asian American and Native American girls tended to report similar or more concerns/behaviors. Among boys, weight-related concerns/behaviors were equally or more prevalent among all non-Whites than among Whites. In particular, African American and Asian American boys were at greater risk for potentially harmful weight-related concerns/behaviors than White boys. CONCLUSIONS: Weight-related concerns and behaviors are prevalent among adolescents, regardless of their ethnic/racial background, indicating a need for prevention and treatment efforts that reach adolescents of different ethnic backgrounds. However, ethnic differences demonstrate a need for ensuring that the specific needs of different groups are addressed in the development of such interventions.

Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity.

PURPOSE: To examine the current prevalence of disordered eating behaviors in a large sample of adolescents, by gender and ethnicity, and to identify gender and ethnic-specific risk and protective factors. METHODS: The study population included 81,247 9th- and 12th-graders who completed the 1998 Minnesota Student Survey, a self-report, school-based survey which included questions about disordered eating behaviors and a variety of psychosocial characteristics. RESULTS: Fifty-six percent of 9th-grade females and 28% of 9th-grade males report disordered eating behaviors (i.e. one or more of the following to lose or control weight: fasting or skipping meals, diet pills, vomiting, laxatives or smoking cigarettes; and binge-eating), with slightly higher rates among 12th-grade females and males, 57% and 31%, respectively. Among both genders, Hispanic and American Indian youth reported the highest prevalence of disordered eating. Risk factors for disordered eating among both males and females included cigarette smoking, appearance concerns, and alcohol use. Protective factors for both males and females were positive self-esteem, emotional well-being, school achievement, and family connectedness. While risk and protective factors were similar across gender, they differed across ethnicity particularly among females. CONCLUSIONS: Health professionals working with youth need to be aware of the high prevalence of these subclinical disordered eating behaviors, ask appropriate screening questions, and provide resources and referral, if necessary, for youth reporting these behaviors. Knowledge of risk and protective factors can serve to guide intervention and prevention efforts, particularly as they apply across ethnicity.

Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives?

OBJECTIVES: This study determined the prevalence of Minnesota urban youths reaching the Healthy People 2010 objectives for obesity and intake of fat, calcium, fruits, vegetables, and grains and compared prevalence rates across sociodemographic characteristics. METHODS: The study sample included 4746 adolescents (aged 11-18 years) from the Minneapolis/St. Paul area who completed dietary surveys and participated in anthropometric measurements as part of a school-based population study. RESULTS: Considerable gaps were seen between the existing prevalence rates for obesity and nutrient and food patterns and the targeted Healthy People 2010 prevalence rates. For example, 12.5% of the girls and 16.6% of the boys had body mass index values at or greater than the 95th percentile (target = 5%). Only 29.5% of the girls and 42.5% of the boys were meeting the daily recommended intakes for calcium (target = 75%). Similarly, percentages of youths consuming the recommended amounts of fat, fruits, vegetables, and grains were lower than the targeted percentages. There were large sociodemographic disparities in obesity and eating patterns, particularly across race/ethnicity and socioeconomic status. CONCLUSIONS: Concerted public health efforts are needed to achieve the Healthy People 2010 objectives for obesity and nutrition and to reduce racial/ethnic and socioeconomic disparities.

Dieting frequency among college females: association with disordered eating, body image, and related psychological problems.

OBJECTIVE: To examine associations between dieting frequency and eating disorder behaviors, body satisfaction, and related factors. METHOD: Females (N=345) whose average age and body mass index (BMI) were 20.58 and 21.79, respectively, were grouped into three categories of lifetime dieting frequency (never, 1-5 times, or 6 or more times) and matched on current BMI across categories. RESULT: Positive associations were found between dieting frequency and eating disorder symptoms and related problems such as body dissatisfaction, current body size perception, depression, exercise preoccupation, and feelings of ineffectiveness and insecurity. Dieting frequency was inversely associated with self-esteem, ideal body size, emotional regulation, and impulse control. DISCUSSION: Independent of current BMI, frequency of dieting behaviors is strongly associated with negative emotions and problematic behaviors. As this study is correlational in nature, future longitudinal studies should ascertain the sequence of onset of these experiences.