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Disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to examine the relationship between disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents as well as the moderating role of gender and body mass index (BMI) in this relationship.

Methods

Ninety adolescents, 11–18 years old, were assessed using anthropometric measurements; demographics, eating attitudes and level of emotional/behavioral adjustment were examined via self-reported questionnaires.

Results

Disordered eating attitudes were prevalent in 17.8% of the sample. A significant relationship was found between disordered eating attitudes and Youth Self-Report (YSR) anxiety score (r = .22, p < .05). Gender significantly moderated the relationship between YSR anxiety symptoms and Eating Attitudes Test (EAT) scores (b = .59, p = .01) and this effect held true for the EAT bulimia subscale (b = .20, p = .03), but not for the dieting or the oral control subscales. Contrary to our hypothesis, BMI did not moderate the relationship between EAT and YSR anxiety sub-scores (b = .13, p > .05).

Conclusion

Girls with elevated anxiety levels appear to be at risk for exhibiting disordered eating attitudes, especially bulimic behaviors. This finding highlights the importance of developing gender-based preventive interventions tailored to these specific emotional/behavioral aspects.

Level of evidence

Level V, cross-sectional descriptive study.

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References

  1. Herpertz-Dahlmann B (2015) Adolescent eating disorders. Child Adolesc Psychiatr Clin N Am 24:177–196. https://doi.org/10.1016/j.chc.2014.08.003

    Article  PubMed  Google Scholar 

  2. Goldschmidt AB, Aspen VP, Sinton MM et al (2008) Disordered eating attitudes and behaviors in overweight youth. Obesity 16:257–264. https://doi.org/10.1038/oby.2007.48

    Article  PubMed  Google Scholar 

  3. Tanofsky-Kraff M, Cohen ML, Yanovski SZ et al (2006) A prospective study of psychological predictors of body fat gain among children at high risk for adult obesity. Pediatrics 117:1203–1209. https://doi.org/10.1542/peds.2005-1329

    Article  PubMed  Google Scholar 

  4. Field AE, Austin SB, Taylor CB et al (2003) Relation between dieting and weight change among preadolescents and adolescents. Pediatrics 112:900–906. https://doi.org/10.1542/peds.112.4.900

    Article  PubMed  Google Scholar 

  5. Croll J, Neumark-Sztainer D, Story M, Ireland M (2002) Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity. J Adolesc Heal 31:166–175. https://doi.org/10.1016/S1054-139X(02)00368-3

    Article  Google Scholar 

  6. Goldschmidt AB, Wall M, Choo T-HJ et al (2015) Shared risk factors for mood-, eating-, and weight-related health outcomes. Heal Psychol 35:245–252. https://doi.org/10.1037/hea0000283

    Article  Google Scholar 

  7. Goldschmidt AB, Wall MM, Loth KA, Neumark-Sztainer D (2015) Risk factors for disordered eating in overweight adolescents and young adults. J Pediatr Psychol 40:1048–1055. https://doi.org/10.1093/jpepsy/jsv053

    Article  PubMed  PubMed Central  Google Scholar 

  8. Blasczyk-Schiep S, Sokoła K, Fila-Witecka K, Kazén M (2016) Are all models susceptible to dysfunctional cognitions about eating and body image? The moderating role of personality styles. Eat Weight Disord 21:211–220. https://doi.org/10.1007/s40519-015-0228-6

    Article  PubMed  Google Scholar 

  9. Ciarma JL, Mathew JM (2017) Social anxiety and disordered eating: The influence of stress reactivity and self-esteem. Eat Behav 26:177–181. https://doi.org/10.1016/j.eatbeh.2017.03.011

    Article  PubMed  Google Scholar 

  10. Sala M, Levinson CA (2016) The longitudinal relationship between worry and disordered eating: is worry a precursor or consequence of disordered eating? Eat Behav 23:28–32

    Article  PubMed  PubMed Central  Google Scholar 

  11. Faith MS, Butryn M, Wadden TA et al (2011) Evidence for prospective associations among depression and obesity in population-based studies. Obes Rev. https://doi.org/10.1111/j.1467-789X.2010.00843.x

    Article  PubMed  Google Scholar 

  12. Green MA, Scott NA, Cross SE et al (2009) Eating disorder behaviors and depression: a minimal relationship beyond social comparison, self-esteem, and body dissatisfaction. J Clin Psychol 65:989–999. https://doi.org/10.1002/jclp.20586

    Article  PubMed  Google Scholar 

  13. Sonneville KR, Horton NJ, Micali N et al (2013) Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults: does loss of control matter? JAMA Pediatr 167:149–155. https://doi.org/10.1001/2013.jamapediatrics.12

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kaplan HL, Kaplan HS (1957) The psychosomatic concept of obesity. J Nerv Ment Dis 125:181–201

    Article  CAS  PubMed  Google Scholar 

  15. Ganley RM (1989) Emotion and eating in obesity: a review of the literature. Int J Eat Disord 8:343–361. https://doi.org/10.1002/1098-108X(198905)8:3<343::AID-EAT2260080310>3.0.CO;2-C

    Article  Google Scholar 

  16. Tanofsky-Kraff M, Yanovski SZ, Wilfley DE et al (2004) Eating-disordered behaviors, body fat, and psychopathology in overweight and normal-weight children. J Consult Clin Psychol 72:53–61. https://doi.org/10.1037/0022-006X.72.1.53

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hannan PJ, Perry CL, Irving LM (2002) Weight-related concerns and behaviours among overweight and nonoverweight adolescents. Arch Pediatr Adolesc Med 156:171–178. https://doi.org/10.1001/archpedi.156.2.171

    Article  PubMed  Google Scholar 

  18. Boutelle K, Neumark-Sztainer D, Story M, Resnick M (2002) Weight control behaviors among obese, overweight, and nonoverweight adolescents. J Pediatr Psychol 27:531–540. https://doi.org/10.1093/jpepsy/27.6.531

    Article  PubMed  Google Scholar 

  19. Neumark-Sztainer D, Story MT, Hannan PJ et al (2002) Weight-related concerns and behaviors among overweight and nonoverweight adolescents: implications for preventing weight-related disorders. Arch Pediatr Adolesc Med 156:171–178. https://doi.org/10.1001/archpedi.156.2.171

    Article  PubMed  Google Scholar 

  20. Hankin BL (2009) Development of sex differences in depressive and co-occurring anxious symptoms during adolescence: descriptive trajectories and potential explanations in a multiwave prospective study. J Clin Child Adolesc Psychol 38:460–472. https://doi.org/10.1080/15374410902976288

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ferreiro F, Seoane G, Senra C (2012) Gender-related risk and protective factors for depressive symptoms and disordered eating in adolescence: a 4-year longitudinal study. J Youth Adolesc 41:607–622. https://doi.org/10.1007/s10964-011-9718-7

    Article  PubMed  Google Scholar 

  22. Hollingshead A (1975) Four factor index of social status. Yale J Sociol 8:21–52

    Google Scholar 

  23. Douka A, Grammatopoulou E, Skordilis E, Koutsouki D (2009) Factor analysis and cut-off score of the 26-item eating attitudes test in a Greek sample. J Biol Exerc 5:51–67. https://doi.org/10.4127/jbe.2009.0025

    Article  Google Scholar 

  24. Serra-Majem L, Ribas L, Ngo J et al (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean diet quality index in children and adolescents. Public Heal Nutr 7:931–935. https://doi.org/10.1079/PHN2004556

    Article  Google Scholar 

  25. Kowalski KC, Crocker PRE, Donen RM (2004) The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. Coll Kinesiol Univ Saskatchewan 1–37

  26. Kowalski KKC, Crocker PRE, Kowalski NP (1997) Convergent validity of the physical activity questionnaire for adolescents. Pediatr Exerc Sci 9:342

    Article  Google Scholar 

  27. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243. https://doi.org/10.1136/bmj.320.7244.1240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Achenbach TM (1991) Manual for the Youth Self-Report and 1991 Profile. University of Vermont, Department of Psychiatry, Burlington, VT

  29. Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth, and Families, Burlington

    Google Scholar 

  30. Vierhaus M, Lohaus A (2007) Children and parents as informants of emotional and behavioural problems predicting female and male adolescent risk behaviour: a longitudinal cross-informant study. J Youth Adolesc 37:211–224. https://doi.org/10.1007/s10964-007-9193-3

    Article  Google Scholar 

  31. Abad J, Forns M, Gómez J (2002) Emotional and behavioral problems as measured by the YSR. Eur J Psychol Assess 18:149–157. https://doi.org/10.1027//1015-5759.18.2.149

    Article  Google Scholar 

  32. Roussos A, Francis K, Zoubou V et al (2001) The standardization of Achenbach’s youth self-report in Greece in a national sample of high school students. Eur Child Adolesc Psychiatry 10:47–53. https://doi.org/10.1007/s007870170046

    Article  CAS  PubMed  Google Scholar 

  33. Hayes AF (2012) PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf

  34. Bilali A, Galanis P, Velonakis E, Katostaras T (2010) Factors associated with abnormal eating attitudes among greek adolescents. J Nutr Educ Behav 42:292–298. https://doi.org/10.1016/j.jneb.2009.06.005

    Article  PubMed  Google Scholar 

  35. Costarelli V, Antonopoulou K, Mavrovounioti C (2011) Psychosocial characteristics in relation to disordered eating attitudes in Greek adolescents. Eur Eat Disord Rev 19:322–330. https://doi.org/10.1002/erv.1030

    Article  CAS  PubMed  Google Scholar 

  36. Yannakoulia M, Matalas AL, Yiannakouris N et al (2004) Disordered eating attitudes: an emerging health problem among Mediterranean adolescents. Eat Weight Disord 9:126–133. https://doi.org/10.1007/BF03325056

    Article  CAS  PubMed  Google Scholar 

  37. Swinbourne JM, Touyz SW (2007) The co-morbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev 15:253–274. https://doi.org/10.1002/erv.784

    Article  PubMed  Google Scholar 

  38. Goossens L, Braet C, Van Vlierberghe L, Mels S (2009) Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating. Eur Eat Disord Rev 17:68–78. https://doi.org/10.1002/erv.892

    Article  PubMed  Google Scholar 

  39. Young D, Limbers CA (2017) Avoidant coping moderates the relationship between stress and depressive emotional eating in adolescents. Eat Weight Disord. https://doi.org/10.1007/s40519-017-0396-7

    Article  Google Scholar 

  40. Neumark-Sztainer D, Hannan PJ (2000) Weight-related behaviors among adolescent girls and boys: results from a national survey. Arch Pediatr Adolesc Med 154:569–577. https://doi.org/10.1001/archpedi.154.6.569

    Article  CAS  PubMed  Google Scholar 

  41. Crow S, Eisenberg ME, Story M, Neumark-Sztainer D (2006) Psychosocial and behavioral correlates of dieting among overweight and non-overweight adolescents. J Adolesc Heal 38:569–574. https://doi.org/10.1016/j.jadohealth.2005.05.019

    Article  Google Scholar 

  42. McDermott B, Forbes D, Harris C et al (2006) Non-eating disorders psychopathology in children and adolescents with eating disorders: implications for malnutrition and symptom severity. J Psychosom Res 60:257–261. https://doi.org/10.1016/j.jpsychores.2005.08.004

    Article  PubMed  Google Scholar 

  43. Santos M, Steven Richards C, Kathryn Bleckley M (2007) Comorbidity between depression and disordered eating in adolescents. Eat Behav 8:440–449. https://doi.org/10.1016/j.eatbeh.2007.03.005

    Article  PubMed  Google Scholar 

  44. Nguyen-Rodriguez ST. Unger JB. Spruijt-Metz D (2009) Psychological determinants of emotional eating in adolescence. Eat Disord 17:211–224. https://doi.org/10.1080/10640260902848543.Psychological

    Article  PubMed  PubMed Central  Google Scholar 

  45. Juarascio AS, Felton JW, Borges AM et al (2016) An investigation of negative affect, reactivity, and distress tolerance as predictors of disordered eating attitudes across adolescence. J Adolesc 49:91–98. https://doi.org/10.1016/j.adolescence.2016.02.005

    Article  PubMed  PubMed Central  Google Scholar 

  46. Nguyen-Rodriguez ST, Chou CP, Unger JB, Spruijt-Metz D (2008) BMI as a moderator of perceived stress and emotional eating in adolescents. Eat Behav 9:238–246. https://doi.org/10.1016/j.eatbeh.2007.09.001

    Article  PubMed  Google Scholar 

  47. Doumit R, Zeeni N, Sanchez Ruiz MJ, Khazen G (2016) Anxiety as a moderator of the relationship between body image and restrained eating. Perspect Psychiatr Care 52:254–264. https://doi.org/10.1111/ppc.12126

    Article  PubMed  Google Scholar 

  48. Ter Bogt TFM, van Dorsselaer SAFM, Monshouwer K et al (2006) Body mass index and body weight perception as risk factors for internalizing and externalizing problem behavior among adolescents. J Adolesc Heal 39:27–34. https://doi.org/10.1016/j.jadohealth.2005.09.007

    Article  Google Scholar 

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Authors and Affiliations

  1. Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 3 Thivon Street, 11527, Athens, Greece

    Flora Bacopoulou, Elizabeth Foskolos, Charikleia Stefanaki & Eleni Tsitsami

  2. First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece

    Elizabeth Foskolos & Eleni Vousoura

Authors
  1. Flora Bacopoulou
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  2. Elizabeth Foskolos
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  3. Charikleia Stefanaki
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  4. Eleni Tsitsami
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  5. Eleni Vousoura
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Corresponding author

Correspondence to Flora Bacopoulou.

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Funding

Funding for the study was provided to the Centre for Adolescent Medicine and UNESCO Chair on Adolescent Health Care of the First Department of Pediatrics of the National and Kapodistrian University of Athens in Greece, through Coca Cola Community Request - Grant 14,870,909 of the Fund for ‘Health & Nutrition Web Site & Internet Based Intervention Program for Adolescent Obesity in Greece’.

Conflict of interest

Author Bacopoulou Flora declares that she has no conflict of interest. Author Foskolos Elizabeth declares that she has no conflict of interest. Author Stefanaki Charikleia declares that she has no conflict of interest. Author Tsitsami Eleni declares that she has no conflict of interest. Author Vousoura Eleni declares that she has no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study and their parents.

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Bacopoulou, F., Foskolos, E., Stefanaki, C. et al. Disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents. Eat Weight Disord 23, 621–628 (2018). https://doi.org/10.1007/s40519-017-0466-x

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  • DOI: https://doi.org/10.1007/s40519-017-0466-x

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