Body image, dieting and disordered eating and activity practices among teacher trainees: implications for school-based health education and obesity prevention programs

The aim was to investigate and compare body image, body dissatisfaction, dieting, disordered eating, exercise and eating disorders among trainee health education/physical education (H&PE) and non-H&PE teachers. Participants were 502 trainee teachers randomly selected from class groups at three Australian universities who completed the questionnaire. H&PE males and females had significantly poorer body image and higher levels of body dissatisfaction, dieting and disordered eating behaviors than non-H&PE participants. H&PE teachers were more likely to over-exercise and have exercise disorders, but very few self-identified problems with objectively assessed excessive exercise behaviors. Lifetime prevalence of eating disorders was 12.5% in H&PE males, 0% in non-H&PE males, 7.7% in H&PE females and 6% in non-H&PE females. Few participants had received any past or current treatment. Of particular concern is the likelihood of the teachers' inappropriate and dangerous attitudes and behaviors being intentionally or unintentionally conveyed to their school students. Those planning school health education, nutrition education and school-based obesity prevention programs should provide suitable training for the teachers involved. Screening and treatment services among teachers may also be helpful in order to detect, treat and educate young teachers about body image, dieting, disordered eating and physical activity practices.     

Binge eating and purging in a multi-ethnic community sample

OBJECTIVE: The purpose of the present study is to document the frequency of three eating disorder-related behaviors (binge eating; self-induced vomiting; and use of laxatives, diuretics, and diet pills) among a multi-ethnic community sample. METHOD: A questionnaire was administered to 1225 Hispanic, Asian, black, and white women and men. Participants responded to items (based on DSM-IV diagnostic criteria for eating disorders) about binge eating and purging behavior. RESULTS: Binge eating and purging were more common among women than among men in Hispanic, black, and white subsamples (frequency rates were similar among Asian men and women). Ethnic differences were found in frequency of purging among women (ethnicity was not associated with behavior rates among men). Fewer Asian than Hispanic, black, and white women induced vomiting and used laxatives, diuretics, and diet pills as weight control methods. CONCLUSION: The fact that frequency rates differed as a function of participant sex and ethnicity underscores the importance of considering both of these group variables when examining disordered eating and weight control behaviors.     

Correlates of problematic eating behaviors in less acculturated Latinas

We examined whether body weight, depression, and body dissatisfaction could predict problematic eating behaviors in a community sample of less acculturated adult Latina women. Three hundred and forty-nine Latina women ages 20-40 were classified as non-overeater (n=244), eating disorder not otherwise specified-binge eating disorder features (EDNOS-BED) (n=65), or eating disorder not otherwise specified-bulimia nervosa features (EDNOS-BN) (n=40). Participants completed measures of problematic eating behaviors, depression, and body image. Results revealed that normal weight and overweight women were at a higher risk only for EDNOS-BN, while obese women were at a higher risk for either EDNOS-BN or EDNOS-BED. Women with high depression scores were 16 times more likely to be assigned to the EDNOS-BN group than women with lower depression scores. Results illustrate the important role of depression and body weight in predicting problematic eating in less acculturated Latinas.     

Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate men

Normative data on the Eating Disorder Examination Questionnaire for samples of undergraduate men in the United States are presented. Participants were 404 undergraduate men aged 18–26 who completed the EDE-Q as part of two larger survey studies. Mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores are provided. Data regarding the frequency of objective binge eating episodes and compensatory behaviors also are reported. Although the overall prevalence of full threshold eating disorders remains lower in men than in women, body dissatisfaction and disordered eating behaviors are fairly common among young men. These results will help researchers and clinicians interpret the EDE-Q scores of undergraduate men.     

Influence of eating behaviors on short-term weight loss by orlistat and anorectic agent

Little data exists concerning whether eating behaviors determine the response to orlistat treatment, especially with added anorectic agents. This study was a sub-investigation of a 12-week randomized controlled trial for the additive effect of orlistat on sibutramine treatment. The analysis presented here was restricted to 98 women who had fulfilled the protocol. The Dutch eating behavior questionnaire and three-factor eating questionnaire were used to assess eating behaviors. Scores of emotional eating, external eating, disinhibition and hunger are significantly interrelated. Using multiple logistic analysis with adjustment for potential confounders, such as age, initial BMI and the other 2 eating behavior scores, traits of emotional eating (OR 0.30, 95% CI 0.13–0.74) and disinhibition (OR 0.61, 95% CI 0.40–0.82) have a significant influence on prediction for additional 5% weight loss in the treatment with orlistat and sibutramine. Subjects with less vulnerability to emotional cues had significantly more weight loss with orlistat treatment and anorectic agents.     

Three studies on the factorial distinctiveness of binge eating and bulimic symptoms among nonclinical men and women

OBJECTIVE: According to DSM-IV's proposed nosology, binge eating disorder is separable from bulimia nervosa. The basis for separation rests with compensatory behaviors (e.g., induced vomiting)-people with bulimia nervosa engage in compensatory behaviors, whereas those with binge eating disorder do not. We addressed the validity of this nosology. METHODS: In three studies on 2,015 young men and women, we used factor-analytic techniques to assess whether bulimic and binge eating symptoms are separable in men and women. Results and Discussion Results of the three studies converged: Although binge eating symptoms may be distinct from bulimic symptoms among young men, the two syndromes are factorially inseparable among young women. Nosologic and sociocultural implications are noted.     

An update on the definition of "excessive exercise" in eating disorders research

OBJECTIVE: The current study informed the definition of "excessive exercise" by examining relations between exercise behavior, eating-disordered behavior, and quality of life (QOL) in a community sample of women. METHOD: Self-report measures of frequency of exercise, obligatory exercise and motivation for exercise, and of eating disorder psychopathology and QOL, were completed by 3,472 women aged 18-42 years who engaged in regular exercise. RESULTS: The extent to which exercise is intended to influence weight or shape and the degree to which guilt is experienced when exercise is postponed were the exercise variables most strongly associated with elevated levels of eating disorder psychopathology and reduced QOL. Subgroups of participants who reported exercising solely for weight and shape reasons (n = 322 [9.3%]), intense guilt after postponement of exercise (n = 136 [3.9%]), or both (n = 116 [3.3%]), had markedly elevated levels of eating disorder psychopathology. There was no association between excessive exercise and reduced QOL after the effects of eating disorder psychopathology were statistically controlled. CONCLUSION: The findings suggest that exercise is excessive when its postponement is accompanied by intense guilt or when it is undertaken solely to influence weight or shape. Operational definitions of excessive exercise might usefully include reference to these terms. The findings may also be of benefit in informing the content of prevention programs, which address dysfunctional exercise behavior. Excessive exercise is unlikely to be associated with impairment in psychosocial functioning in the absence of eating disorder psychopathology. It may, however, be a useful indicator of such psychopathology.     

Weight regulation practices of young adults. Predictors of restrictive eating

Young adults frequently use restrictive eating (i.e., going for long periods [?8h] without eating to influence their shape or weight) to control their weight. The purpose of this study was to determine the prevalence of restrictive eating in young adults, compare eating behaviors of restrictive and non-restrictive eaters, and predict restrictive eaters. A diverse (56% white, 63% female) sample of young adults (n=2449) completed an online survey that included eating behavior scales (Restraint, Eating, Shape, and Weight Concerns, and Inappropriate Compensatory Behaviors from the Eating Disorder Examination-Questionnaire, Emotional and Disinhibited Eating from the Three-Factor Eating Questionnaire, and Night Eating from the Night Eating Questionnaire) and demographics. A quarter of women and 20% of men were classified as restrictive eaters. Independent t-tests revealed restrictive eaters had significantly (p<0.001) higher BMIs than non-restrictive eaters. Restrictive eaters also had significantly higher scores on all eating behavior scales than non-restrictive eaters even after controlling for potential confounding factors (BMI, race). Stepwise binary logistic regression revealed that increased eating, shape, and weight concerns, higher BMI, endorsement of inappropriate compensatory behaviors and night eating, being female, and white increased the odds of participants being restrictive eaters. This study can help healthcare professionals become more aware of weight control practices of young adults and create appropriate interventions.     

Eating behaviours, dietary profile and body composition according to dieting history in men and women of the Québec Family Study

The purpose of the present cross-sectional study was to compare eating behaviours (cognitive dietary restraint, disinhibition and susceptibility to hunger), dietary profile and physiological variables according to the practice of dieting: current dieting; history of dieting in the 10-year period that preceded the study; no dieting during the same period. Dieting history, anthropometric markers of adiposity, RMR, dietary profile (3 d food record) and eating behaviours (three-factor eating questionnaire) were determined in a sample of 244 men and 352 women. A greater proportion of women (31.8 %) than men (16.8 %) reported that they had been on a diet over the past 10 years (P=0.0001). In both genders, current and past dieters had a higher BMI (P<0.05) than non-dieters and current dieters had lower reported energy intakes than past dieters and non-dieters (only in women) (P<0.05). Current and past dieters also had higher scores for all eating behaviours and their subscales (P<0.05; except for susceptibility to hunger in men) compared with non-dieters (adjusted for age, reported energy intake, percentage of dietary fat, BMI and RMR). Moreover, for each dieting-history category, women had significantly higher scores for cognitive dietary restraint than men (P<0.05). In conclusion, the present study showed that current and past dieters had higher scores for cognitive dietary restraint and disinhibition compared with non-dieters. As disinhibition has previously been associated with a greater risk of subsequent weight gain, interventions aimed at preventing an increase in disinhibition may be promising for long-term weight maintenance.     

Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? Correlations with gender,education, and body mass index

Investigating eating disorders and orthorexia nervosa, especially in the young population, is an important step in taking protective precautions and identifying disease. This study was carried out to determine the relationship of eating disorders and orthorexia nervosa to gender, BMI, and field of study in a population of university students in Turkey. In all, 900 university students aged 17–23 years participated in this study. EAT-40 and ORTO-15, which are validated instruments for the screening of participants with anormal eating behaviors and orthorexia nervosa, respectively, were used. There was not a significant difference in EAT-40 scores according to gender and BMI classification. However, EAT-40 scores were high among the students in social science. The number of orthorectic participants among women is higher than that among men, and ORTO-15 scores were not associated with BMI classification and field of study. A significant negative correlation was found between EAT-40 and ORTO-15 scores.     

Food for thought: Examining the relationship between food thought suppression and weight-related outcomes

The current study sought to extend previous eating behaviors and thought suppression literature by assessing the relationship between food thought suppression and weight-related outcomes. Three hundred and twelve overweight/obese community men and women completed self-report measures of thought suppression, weight history, and eating behaviors. Women were more likely than men to endorse food thought suppression, as were individuals who currently were dieting, when compared with those nondieters. Food thought suppression also predicted binge eating, food cravings, and other eating disordered symptoms. Results have implications for obesity and support further exploration of third wave interventions, such as Acceptance and Commitment Therapy and Mindfulness, in the treatment of obesity.     

Sex differences in psychosocial impairment associated with eating-disordered behavior: What if there aren't any?

ObjectiveWe sought to test the hypothesis that eating-disordered behavior (EDB) is associated with comparable levels of impairment in psychosocial functioning in men and women.MethodPostal questionnaires that assessed EDB (binge eating, purging, extreme dietary restriction, excessive exercise and weight/shape overvaluation) and psychosocial impairment (general psychological distress, life satisfaction and social support) were completed by a general population sample of men (n = 957) and women (n = 1899).ResultsBinge eating, purging and overvaluation were associated with comparable levels of psychosocial impairment for both men and women and this was the case for each of the three measures of psychosocial functioning employed. Extreme dietary restriction was associated with greater psychosocial impairment in women than in men, whereas excessive exercise was not associated with psychosocial impairment in either women or men.ConclusionsThere appear to be few differences between men and women in terms of psychosocial impairment associated with EDB. It may no longer be appropriate to base the development of eating disorder prevention programs on the premise that EDB is primarily a problem of women. Health professionals may be more likely to see more men with EDB in their practices in the future.     

Similarities and differences between women and men on eating disorder risk factors and symptom measures

Researchers studying eating disorders in men often use eating disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, we report on the validity of doing so with a set of measures chosen to reflect a wide range of risk factors and symptoms. The Bulimia Test-revised (BULIT-R), the restraint scale (RS), the three-factor eating questionnaire (TFEQ), the Eating Expectancy Inventory, and the eating attitudes test (EAT) all had the same factor structures for both genders, and tests of invariance showed that factor loadings, factor variances, and intercorrelations among factors were equivalent across gender. A modified Structured Clinical Interview for DSM-IV anorexic symptoms questionnaire did not perform adequately for either gender. Men produced slightly less reliable scores on virtually all measures, with the result that Pearson-based estimates of correlations among the measures were slightly lower for men. Men had lower scores on symptom and risk measures, but not on other eating measures.     

Risk for disordered eating relates to both gender and ethnicity for college students

OBJECTIVE: To estimate the frequency of disordered eating behaviors among college students and associations by gender, ethnicity, participation in social organizations and college athletics and to determine whether responses to eight health behavior and attitude questions and body weight predicted a high score on the Eating Attitudes Test (EAT)-26, a screening instrument used to identify risks of developing an eating disorder. METHODS: Subjects were a convenience sample of 1,899 college students (cleaned to 1620) who attended four classes, were members of 14 sororities or lived in five residence halls. Students reported height and weight and responded to the EAT-26 and eight items regarding health behaviors and attitudes. RESULTS: Among women and men, 4.5% and 1.4%, respectively, reported previous treatment for an eating disorder, and 10.9% of women and 4.0% of men were at risk for eating disorders (scores > or = 20 on EAT). Among African-Americans, 8.3% of women were at risk. One group of women who lived separately in a social sorority had the highest risk of 15%. The frequency of "weight concerns interfering with academic performance" and "eliminating high fat foods" was moderately correlated to risk for disordered eating for both genders. Body mass only weakly related to risk for disordered eating and the association varied by subgroup. CONCLUSION: Students at risk for disordered eating report weight concerns interfering with their academic performance and include both men and African-Americans, as well as Caucasian American women. Sorority women living in separate residences might be at increased risk.     

Weight overestimation as an indicator of disordered eating behaviors among young women in the United States

OBJECTIVE: This paper examines the association between weight overestimation and symptoms of disordered eating behaviors using a nationally representative sample of young women. METHOD: We use data from Wave III of the National Longitudinal Study of Adolescent Health to compare self-reported weight (in pounds) to measure weight obtained by interviewers using a scale. Focusing on normal weight women between the ages of 18 and 24 (n = 2,805) we compare the discrepancy in self-reported and measured weight among women with and without any disordered eating behaviors. RESULTS: Women who over report their weight by at least five percent are significantly more likely than those who either under report or accurately report their weights to exhibit disordered eating behaviors. These results persist despite controlling for distorted body image. CONCLUSION: Our findings support both motivational and perceptual bias explanations for overestimating weight among those who exhibit disordered eating behaviors. We argue that weight over-estimation, together with other important information regarding women's nutrition, exercise, mental health, and health-related behaviors, should be treated as a potential indicator for the diagnosis of an eating disorder among young normal weight women.     

Functional impairment associated with bulimic behaviors in a community sample of men and women

OBJECTIVE: To examine functional impairment associated with bulimic behaviors in a community sample of men and women. METHOD: Binge eating, purging, fasting, extreme weight and shape concerns, and "days-out-of-role" were assessed in a community sample of men (n = 1,290) and women (n = 1,757) aged 15-94 years. RESULTS: Participants who reported regular eating disorder behaviors had higher levels of functional impairment than those who did not. This was the case for both men and women and for each of the behaviors assessed, although differences between purgers and nonpurgers were not statistically significant. Also in both men and women, participants who reported eating disorder behaviors and weight or shape concerns had higher levels of impairment than those who reported these behaviors in the absence of weight or shape concerns. In multivariate analysis, binge eating, fasting and weight or shape concerns all contributed to the likelihood of impairment in men, whereas only the presence of weight or shape concerns was significantly associated with impairment in women. CONCLUSION: Whereas bulimic behaviors are associated with elevated levels of functional impairment in both men and women, weight or shape concerns may be more central to the experience of this impairment in women.     

Eating habits among employees of a state-owned bank: food consumption profile

In order to investigate the health conditions of current employees in a government-owned bank in the State of Rio de Janeiro, we performed a cross-sectional study in two departments where systematic sampling was applied. Among the health conditions, we focused on the employees' eating habit profile using a questionnaire on frequency of food group consumption analyzed through a summary measure (eating score). Although the majority of the study population display good eating habits, the results confirmed a major difference between genders. Some 60% of men had scores higher than the population mean (51.2), as compared to only 45% of women. In addition, we observed that men, and particularly younger men, consumed more foodstuffs that were rich in saturated fat, salt, and sugar as compared to women. The findings indicate that quality of one's diet along with changes in other habits and behaviors (like smoking and sedentary life style) should be part of programs to promote health in the workplace, with a view towards controlling cardiovascular and other diseases.     

Psychiatric and medical symptoms in binge eating in the absence of compensatory behaviors

OBJECTIVE: To explore the extent to which binge eating in the absence of compensatory behaviors (BE) is associated with psychiatric and medical symptoms in men and women and to control for the independent effects of BMI. RESEARCH METHODS AND PROCEDURES: A series of regression models was applied to questionnaire data on 8045 twins, 18 to 31 years old, from a population-based Norwegian registry. RESULTS: BE was significantly associated with elevated obesity, overweight, symptoms of eating disorders, symptoms of anxiety and depression, panic attacks, depressive episodes, and reduced life satisfaction in both men and women. In women, BE was independently associated with insomnia and early menarche. In men, BE was independently associated with specific phobia, daily smoking, alcohol use, use of pain medication, impairment due to mental health, neck-shoulder, lower back, and chronic muscular pain, and impairment due to physical health. Both men and women with BE reported higher rates of psychiatric treatment. DISCUSSION: Our results indicate that there is substantial comorbidity between BE and psychiatric symptoms independently of BMI for both men and women. Medical symptoms co-occur less frequently than previously reported from treatment-seeking populations in women. Across all domains, the array of symptoms exhibited by men with BE was broader than that observed in women with BE. This observation suggests the importance of considering gender differences in future studies of psychiatric and medical morbidity, binge eating, and obesity.     

Features associated with excessive exercise in women with eating disorders

OBJECTIVE: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. METHOD: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). RESULTS: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. CONCLUSION: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.     

Natural history of disordered eating attitudes and behaviors over a 6-year period.

OBJECTIVE: This study investigated the course of eating attitudes and eating-disordered behaviors in a community sample of adult women. METHOD: Participants (N = 166; mean age = 32.8 years) completed the Eating Disorder Inventory (EDI), the Three-Factor Eating Questionnaire (TFEQ), and a questionnaire assessing bulimic behaviors at two time points, 6 years apart. RESULTS: Correlations for rank ordering of scores on these measures were all significant, indicating high rank stability over time. Although rates of specific bulimic behaviors decreased over time, mean scores on eating disorder attitude scales tended to increase. DISCUSSION: Findings challenge the commonly held belief that disturbed eating attitudes decline with age.