Advertisement

Disordered eating behaviours and attitudes among adolescents in a middle-income country

  • Abigail N. HarrisonEmail author
  • Caryl C. B. James Bateman
  • Novie O. M. Younger-Coleman
  • Michelle C. Williams
  • Kern D. Rocke
  • Stephanie C. Clato-Day Scarlett
  • Susan M. Chang
Original Article
  • 33 Downloads

Abstract

Purpose

Adolescent-disordered eating behaviours and attitudes (DEBA) are noted to be increasing in prevalence internationally. The aim of this study was to explore the DEBAs among Jamaican adolescents and identify those adolescents most at risk.

Methods

521 high school participants (females, n = 292), ages 11–19 years, completed measures assessing socio-demographic factors, self-esteem, symptoms of anxiety and depression, behavioural factors, and anthropometry. Weight-related behaviours and attitudes were explored using the Eating Attitudes Test (EAT-26).

Results

Thirty-one percent of participants reported engaging in at least one disordered eating behaviour, with bingeing as the most common. Female participants had significantly higher mean body mass index (p < 0.01) and mean EAT-26 score (p < 0.05) compared to males. Adolescents with EAT-26 score ≥ 20 were more desirous of being thinner (p < 0.01) and having a lighter skin complexion (p < 0.05). A greater proportion of adolescents with an EAT-26 score ≥ 20 had engaged in self-harm (p < 0.05), had smoked cigarettes (p < 0.05), had been sexually active (p < 0.01), and gave a history of sexual abuse (p < 0.01). Adolescents with overweight/obesity reported higher use of chemical weight manipulation (laxatives, diuretics, and diet pills) (p = 0.01).

Conclusions

Our data are consistent with the global figures showing both male and female adolescents endorsing disordered eating behaviours and attitudes (DEBAs). While this study highlights weight and shape dissatisfaction and associated DEBAs, it also raises the concern of an association with skin bleaching and elevated EAT-26 scores among Jamaican adolescents.

Level of evidence

Level V: cross-sectional descriptive study.

Keywords

Adolescents Body dissatisfaction Developing country Feeding and eating disorders Skin bleaching 

Notes

Acknowledgements

This study was funded by the Caribbean Public Health Agency (CARPHA). The authors also thank the school administrators and student participants for their cooperation and help in making this study possible.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

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

References

  1. 1.
    World Health Organization (WHO) (2003). Caring for children and adolescents with mental disorders: setting WHO directions. https://www.who.int/mental_health/media/en/785.pdf. Accessed 9 June 2019
  2. 2.
    Le Grange D, Telch CF, Tibbs J (1998) Eating attitudes and behaviors in 1435 South African Caucasian and Non-Caucasian College students. Am J Psychiatr 155(2):250–254.  https://doi.org/10.1176/ajp.155.2.250 CrossRefPubMedGoogle Scholar
  3. 3.
    Hölling H, Schlack R (2007) Essstörungen im Kindes- und Jugendalter. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):794–799.  https://doi.org/10.1007/s00103-007-0242-6 CrossRefPubMedGoogle Scholar
  4. 4.
    Hong S, Jung Y, Kim M, Lee C, Hyun M, Bahk W, Yoon B, Lee K (2015) Prevalence of distorted body image in young Koreans and its association with age, sex, body weight status, and disordered eating behaviors. Neuropsychiatr Dis Treat 11:1043–1049.  https://doi.org/10.2147/NDT.S82504 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jones JM, Bennett S, Olmsted MP, Lawson ML, Rodin G (2001) Disordered eating attitudes and behaviours in teenaged girls: a school-based study. Can Med Assoc J 165(5):547–552Google Scholar
  6. 6.
    Tam C, Ng C, Yu C, Young B (2007) Disordered eating attitudes and behaviours among adolescents in Hong Kong: prevalence and correlates. J Paediatr Child Health 43(12):811–817.  https://doi.org/10.1111/j.1440-1754.2007.01195.x CrossRefPubMedGoogle Scholar
  7. 7.
    Herpertz-Dahlmann B, Wille N, Holling H, Vloet TD, Ravens-Sieberer U (2008) Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: results of the BELLA study. Eur Child Adolesc Psychiatr 17(Suppl 1):82–91.  https://doi.org/10.1007/s00787-008-1009-9 CrossRefGoogle Scholar
  8. 8.
    Bacopoulou F, Foskolos E, Stefanaki C, Tsitsami E, Vousoura E (2018) Disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents. Eating Weight Disord 23(5):621–628.  https://doi.org/10.1007/s40519-017-0466-x CrossRefGoogle Scholar
  9. 9.
    Caran LG, Santana DD, Monteiro LS (2018) Disordered eating behaviors and energy and nutrient intake in a regional sample of Brazilian adolescents from public schools. Eat Weight Disord 23(6):825–832.  https://doi.org/10.1007/s40519-018-0519-9 CrossRefPubMedGoogle Scholar
  10. 10.
    Pereira RF, Alvarenga M (2007) Disordered eating: identifying, treating, preventing, and differentiating it from eating disorders. Diabetes Spectr 20(3):141–148.  https://doi.org/10.2337/diaspect.20.3.141 CrossRefGoogle Scholar
  11. 11.
    Anderson-Fye EP (2008) Cross-cultural issues in body image and eating problems among children and adolescents. In: Smolak L, Thompson JK (eds) Body image, eating disorders, and obesity in youth: assessment, prevention, and treatment. APA Press, Washington, p 144Google Scholar
  12. 12.
    Calam R, Waller G (1998) Are eating and psychosocial characteristics in early teenage years useful predictors of eating characteristics in early adulthood? A 7-year longitudinal study. Intl J Eat Disord 24(4):351–362.  https://doi.org/10.1002/(sici)1098-108x(199812)24:4%3c351:aid-eat2%3e3.0.co;2-1 CrossRefGoogle Scholar
  13. 13.
    Ortega-Luyando M, Alvarez-Rayón G, Garner DM, Amaya-Hernández A, Bautista-Díaz ML, Mancilla-Díaz JM (2015) Systematic review of disordered eating behaviors Methodological considerations for epidemiological research. Rev Mex de Trastor Aliment 6(1):51–63.  https://doi.org/10.1016/j.rmta.2015.06.001 CrossRefGoogle Scholar
  14. 14.
    Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M (2006) Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc 106(4):559–568.  https://doi.org/10.1016/j.jada.2006.01.003 CrossRefPubMedGoogle Scholar
  15. 15.
    Patton GC, Johnson-Sabine E, Wood K, Mann AH, Wakeling A (1990) Abnormal eating attitudes in London schoolgirls–a prospective epidemiological study: outcome at twelve month follow-up. Psychol Med 20(2):383–394.  https://doi.org/10.1017/S0033291700017700 CrossRefPubMedGoogle Scholar
  16. 16.
    McGuire MT, Story M, Neumark-Sztainer D, Halcon L, Campbell-Forrester S, Blum RW (2002) Prevalence and correlates of weight-control behaviors among Caribbean adolescent students. J Adol Health 31(2):208–211.  https://doi.org/10.1186/1753-2000-3-10 CrossRefGoogle Scholar
  17. 17.
    Ramberan K, Austin M, Nichols S (2006) Ethnicity, body image perception and weight-related behaviour among adolescent females attending secondary school in Trinidad. West Indian Med J 55:388–393CrossRefGoogle Scholar
  18. 18.
    Nichols SD, Dookeran SS, Ragbir KK, Dalrymple N (2009) Body image perception and the risk of unhealthy behaviours among university students. West Indian Med J 58(5):465–471PubMedGoogle Scholar
  19. 19.
    Hoek HW, van Harten PN, Hermans KM, Katzman MA, Matroos GE, Susser ES (2005) The incidence of anorexia nervosa on Curacao. Am J Psychiatr 162(4):748–752.  https://doi.org/10.1176/appi.ajp.162.4.748 CrossRefPubMedGoogle Scholar
  20. 20.
    White VO, Gardner JM (2002) Presence of anorexia nervosa and bulimia nervosa in Jamaica. West Indian Med J 51(1):32–34PubMedGoogle Scholar
  21. 21.
    Ferguson C (2011) The relationship between american media exposure and Trinidadian female adolescents’ body image satisfaction. University of South Florida, TampaGoogle Scholar
  22. 22.
    James C, Harrison A (2014) Eating disorders in the Caribbean—The Jamaican experience. dying to be beautiful? Body image, eating behaviours and health in the Caribbean, Biennial conference. University of the West Indies, Mona. Conference proceedings, 2014Google Scholar
  23. 23.
    Statistical Institute of Jamaica [STATIN] (2014) End of Year Population by Age and Sex 2017. http://statinja.gov.jm/Demo_SocialStats/Newpopulation.aspx. Accessed 9 June 2019
  24. 24.
    Miller E (1990) Jamaican society and high schooling. University of the West Indies, MonaGoogle Scholar
  25. 25.
    Wilks R, Younger N, McFarlane S, Van Den Broeck J (2007) Jamaican youth risk and resiliency behaviour survey 2006: community-based survey on risk and resiliency behaviours of 15–19 year olds. https://www.measureevaluation.org/resources/publications/tr-07-64. Accessed 9 June 2019
  26. 26.
    Walker SP, Chang SM, Younger N, Grantham-McGregor SM (2010) The effect of psychosocial stimulation on cognition and behaviour at 6 years in a cohort of term, low-birth weight Jamaican children. Dev Med Child Neuro 52(7):e148–e154.  https://doi.org/10.1111/j.1469-8749.2010.03637.x CrossRefGoogle Scholar
  27. 27.
    Garner D, Olmsted M, Bohr Y, Garfinkel P (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12(4):871–878CrossRefGoogle Scholar
  28. 28.
    Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363.  https://doi.org/10.4103/2455-5568.196883 CrossRefPubMedGoogle Scholar
  29. 29.
    Baumgartner JN, Geary CW, Tucker H, Wedderburn M (2009) The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case-control study in Jamaica. Intl Perspect Sex Reprod Health 35(1):21–28CrossRefGoogle Scholar
  30. 30.
    Morgan KAD, Brodie-Walker SN (2008) Impact of environment and behaviour on self-esteem in Jamaican adolescent girls. West Indian Med J 57(5):470PubMedGoogle Scholar
  31. 31.
    Spitzer RL, Kroenke K, Williams JB, Lowe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097.  https://doi.org/10.1001/archinte.166.10.1092 CrossRefPubMedGoogle Scholar
  32. 32.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 10(2):77–84.  https://doi.org/10.1016/S0749-3797(18)30622-6 CrossRefPubMedGoogle Scholar
  33. 33.
    World Health Organization [WHO] (2007) WHO Reference 2007 STATA macro package. https://www.who.int/growthref/tools/readme_stata.pdf. Accessed 9 June 2019
  34. 34.
    World Health Organization (2006) Child growth standards based on length/height, weight and age. Acta Paediatrica 450:76–85Google Scholar
  35. 35.
    StataCorp. 2013. Stata: Release 13. Statistical Software. College Station, TX: StataCorp LP. STATA User’s Guide release 13. A Stata Press Publication, StataCorp LP College Station, TexasGoogle Scholar
  36. 36.
    Fadipe B, Oyelohunnu MA, Olagunju AT, Aina OF, Akinbode AA, Suleiman TF (2017) Disordered eating attitudes: demographic and clinico-anthropometric correlates among a sample of Nigerian students. Afr Health Sci 17(2):513–523.  https://doi.org/10.4314/ahs.v17i2.27 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Musaiger AO, Al-Mannai M, Al-Lalla O (2014) Risk of disordered eating attitudes among male adolescents in five Emirates of the United Arab Emirates. Int J Eat Disord 47(8):898–900.  https://doi.org/10.1002/eat.22256 CrossRefPubMedGoogle Scholar
  38. 38.
    Rauof M, Ebrahimi H, Asghari Jafarabadi M, Malek A, Babapour Kheiroddin J (2015) Prevalence of eating disorders among adolescents in the northwest of Iran. Iran Red Crescent Med J 17(10):e19331.  https://doi.org/10.5812/ircmj.19331 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Fox K, Gordon-Strachan G (2007) Jamaican youth risk and resiliency behaviour survey 2005: School-based survey on risk and resiliency behaviours of 10–15 year olds. https://www.measureevaluation.org/resources/publications/tr-07-58. Accessed 9 June 2019
  40. 40.
    Mitchison D, Hay P, Slewa-Younan S, Mond J (2012) Time trends in population prevalence of eating disorder behaviors and their relationship to quality of life. PLoS One.  https://doi.org/10.1371/journal.pone.0048450 CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Makino M, Tsuboi K, Dennerstein L (2004) Prevalence of eating disorders: a comparison of western and Non-Western countries. Medscape Gen Med 6(3):49Google Scholar
  42. 42.
    Sherwood NE, Neumark-Sztainer D (2001) Internalization of the sociocultural ideal: weight-related attitudes and dieting behaviors among young adolescent girls. Am J Health Promot 15(4):228–231.  https://doi.org/10.4278/0890-1171-15.4.228 CrossRefPubMedGoogle Scholar
  43. 43.
    Cash TF (2005) The influence of sociocultural factors on body image: searching for constructs. Clin Psychol Sci Pr 12(4):438–442.  https://doi.org/10.1093/clipsy.bpi055 CrossRefGoogle Scholar
  44. 44.
    Buckingham-Howes S, Armstrong B, Pejsa-Reitz MC, Wang Y, Witherspoon DO, Hager ER, Black MM (2018) BMI and disordered eating in urban, African American, adolescent girls: The mediating role of body dissatisfaction. Eat Behav 29:59–63.  https://doi.org/10.1016/j.eatbeh.2018.02.006 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Peltzer K, Pengpid S, James C (2016) The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 26 countries. Intl J Dermatol 55(2):165–172.  https://doi.org/10.1111/ijd.12860 CrossRefGoogle Scholar
  46. 46.
    Benn EK, Alexis A, Mohamed N, Wang YH, Khan IA, Liu B (2016) Skin bleaching and dermatologic health of African and Afro-Caribbean populations in the US: new directions for methodologically rigorous, multidisciplinary, and culturally sensitive research. Dermatol Ther 6(4):453–459.  https://doi.org/10.1007/s13555-016-0154-1 CrossRefGoogle Scholar
  47. 47.
    James C, Seixas AA, Harrison A, Jean-Louis G, Butler M, Zizi F, Samuels A (2016) Childhood physical and sexual abuse in caribbean young adults and its association with depression, post-traumatic stress, and skin bleaching. J Depress Anxiety.  https://doi.org/10.4172/2167-1044.1000214 CrossRefPubMedGoogle Scholar
  48. 48.
    Charles C, McLean S (2017) Body image disturbance and skin bleaching. Br J Psychol 108(4):783–796.  https://doi.org/10.1111/bjop.12241 CrossRefPubMedGoogle Scholar
  49. 49.
    Karkkainen U, Mustelin L, Raevuori A, Kaprio J, Keski-Rahkonen A (2018) Do disordered eating behaviours have long-term health-related consequences? Eur Eat Disord Rev 26(1):22–28.  https://doi.org/10.1002/erv.2568 CrossRefPubMedGoogle Scholar
  50. 50.
    Lipps G, Lowe GA, Gibson RC, Halliday S, Morris A, Clarke N, Wilson RN (2012) Parenting and depressive symptoms among adolescents in four Caribbean societies. Child Adolesc Psychiatr Ment Health 6(1):31.  https://doi.org/10.1186/1753-2000-6-31 CrossRefGoogle Scholar
  51. 51.
    Nagata JM, Garber AK, Tabler JL, Murray SB, Bibbins-Domingo K (2018) Prevalence and correlates of disordered eating behaviors among young adults with overweight or obesity. J Gen Intern Med 33(8):1337–1343.  https://doi.org/10.1007/s11606-018-4465-z CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378(9793):804–814.  https://doi.org/10.1016/s0140-6736(11)60813 CrossRefPubMedGoogle Scholar
  53. 53.
    Harrison A, Pierre R, Gordon-Strachan G, Campbell-Forrester S, Leslie K (2011) Adolescent health screening practices by physicians in Jamaica. Rev Panam Salud Publ 29(4):252–258.  https://doi.org/10.1590/S1020-49892011000400006 CrossRefGoogle Scholar
  54. 54.
    Hayes JF, Fitzsimmons-Craft EE, Karam AM, Jakubiak J, Brown ML, Wilfley DE (2018) Disordered eating attitudes and behaviors in youth with overweight and obesity: implications for treatment. Curr Obes Rep 7(3):235–246.  https://doi.org/10.1007/s13679-018-0316-9 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Maine M (2013) Father hunger revisited: fathers, global girls, and eating disorders. Adv Eat Disord 1(1):61–72.  https://doi.org/10.1080/21662630.2013.742973 CrossRefGoogle Scholar
  56. 56.
    Miller E (1988) The rise of matriarchy in the Caribbean. Caribb Q 34(3–4):1–21.  https://doi.org/10.1080/00086495.1988.11829430 CrossRefGoogle Scholar
  57. 57.
    UNICEF. (2000). Parenting in Jamaica. https://www.unicef.org/jamaica/parenting_corner.html. Accessed 9 June 2019
  58. 58.
    Nunes MA, Camey S, Olinto MTA, Mari JJ (2005) The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26. Braz J Med Biol Res 38:1655–1662.  https://doi.org/10.1590/S0100-879X2005001100013 CrossRefPubMedGoogle Scholar
  59. 59.
    Le Grange D, Louw J, Breen A, Katzman MA (2004) The meaning of ‘self-starvation’ in impoverished black adolescents in South Africa. Cul Med Psychiatr 28(4):439–461.  https://doi.org/10.1007/s11013-004-1064-8 CrossRefGoogle Scholar
  60. 60.
    Lee S, Kwok K, Liau C, Leung T (2002) Screening Chinese patients with eating disorders using the Eating Attitudes Test in Hong Kong. Int J Eat Disord 32(1):91–97.  https://doi.org/10.1002/eat.10064 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Abigail N. Harrison
    • 1
    Email author
  • Caryl C. B. James Bateman
    • 2
  • Novie O. M. Younger-Coleman
    • 3
  • Michelle C. Williams
    • 1
  • Kern D. Rocke
    • 3
  • Stephanie C. Clato-Day Scarlett
    • 1
  • Susan M. Chang
    • 3
  1. 1.Department of Child and Adolescent Health, Faculty of Medical SciencesUniversity of the West Indies (UWI)MonaJamaica
  2. 2.Department of Sociology, Psychology and Social Work, Faculty of Social SciencesUWIMonaJamaica
  3. 3.Caribbean Institute for Health Research (CAIHR), UWIMonaJamaica

Personalised recommendations