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Risk and protective factors for disturbed eating: A 7-year longitudinal study of eating attitudes and psychological factors in adolescent girls and their parents

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Abstract

The aims of this seven-year longitudinal study of 228 girls (9- and 13-yr olds) were to examine 1) the predictive value of eating attitudes, a wish to be thinner, dieting, perfectionism, self-esteem and Body Mass Index; 2) the girls’ parents’ eating attitudes and perfectionism in relation to the development of disturbed eating attitudes, seven years later; and 3) whether normal body weight, healthy eating attitudes and low perfectionism together with high self-esteem might operate as protective factors for the later development of disturbed eating attitudes. The pre-adolescent girls (9-yr olds) “wish to be thinner” and fathers’ EAT scores contributed most to the prediction of disturbed eating attitudes seven years later. Corresponding analysis for the adolescent girls (13-yr olds) showed that a “wish to be thinner” and mothers’ rating on perfectionism contributed most to the prediction of disturbed eating attitudes seven years later. Protective factors were low BMI and more healthy eating attitudes — especially moderated by high selfesteem, and a low-to-medium degree of perfectionism. High self-esteem appeared to be a protective factor when the girls had a high degree of perfectionism. These results suggest that it is important to focus on healthy eating attitudes at home to prevent overweight in early childhood, enhance self-esteem and to take a critical stand toward the thinness ideal in our society.

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References

  1. Patton GC, Selzer R, Coffey C, et al. Onset of adolescent eating disorders: Population-based cohort study over 3 years. BMJ 1999; 318: 765–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Stice E. A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. J Abnorm Psychol 2001; 110: 124–35.

    Article  CAS  PubMed  Google Scholar 

  3. Neumark-Sztainer D, Wall MM, Haines JI, et al. Shared risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med 2007; 33: 359–69.

    Article  PubMed  Google Scholar 

  4. Halvarsson K, Lunner K, Westerberg J, et al. A longitudinal study of the development of dieting among 7–17-year-old Swedish girls. Int J Eat Disord 2002; 31: 32–42.

    Article  PubMed  Google Scholar 

  5. Westerberg-Jacobson J, Edlund B, Ghaderi A. A 5-year longitudinal study of the relationship between the wish to be thinner, lifestyle behaviours and disturbed eating in 9–20-year old girls. Eur Eat Disord Rev 2010; 18: 207–19.

    Article  PubMed  Google Scholar 

  6. Swenne I. Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder. Acta Paediatr 2001; 90: 677–81.

    Article  CAS  PubMed  Google Scholar 

  7. Zachrisson HD, Vedul-Kjelsås E, Götestam K, et al. Time trends in obesity and eating disorders. Int J Eat Disord 2008; 41: 673–80.

    Article  PubMed  Google Scholar 

  8. WHO Technical Report Series number 894. Obesity: Preventing and managing the global epidemic. Geneva, WHO, 2000.

  9. Flodmark CE. Management of the obese child using psychological-based treatments. Acta Paediatr Suppl 2005; 94: 14–22.

    Article  PubMed  Google Scholar 

  10. Halmi KA, Sunday SR, Strober M, et al. Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am J Psychiatry 2000; 157: 1799–805.

    Article  CAS  PubMed  Google Scholar 

  11. Sutandar-Pinnock K, Woodside DB, Carter JC, et al. Perfectionism in anorexia nervosa: a 6–24-month follow-up study. Int J Eat Disord 2003; 33: 225–9.

    Article  PubMed  Google Scholar 

  12. Wade TD, Tiggemann M, Bulik CM, et al. Shared temperament risk factors for anorexia nervosa: A twin study. Psychosom Med 2008; 70: 239–44.

    Article  PubMed  Google Scholar 

  13. Bardone-Cone AM, Wonderlich SA, Frost RO, et al. Perfectionism and eating disorders: current status and future directions. Clin Psychol Rev 2007; 27: 384–405.

    Article  PubMed  Google Scholar 

  14. Woodside DB, Bulik CM, Halmi KA, et al. Personality, perfectionism, and attitudes toward eating in parents of individuals with eating disorders. Int J Eat Disord 2002; 31: 290–9.

    Article  PubMed  Google Scholar 

  15. Cohen DL, Petrie TA. An examination of psychosocial correlates of disordered eating among undergraduate women. Sex Roles 2005; 52: 29–42.

    Article  Google Scholar 

  16. Button EJ, Loan P, Davies J, et al. Self-esteem, eating problems and psychological well-being in a cohort of schoolgirls aged 15–16: A questionnaire and interview study. Int J Eat Disord 1997; 21: 39–47.

    Article  CAS  PubMed  Google Scholar 

  17. Fairburn CG, Cooper Z, Doll HA, et al. Risk factors for anorexia nervosa. Three integrated case-control comparisons. Arch Gen Psychiatry 1999; 56: 468–76.

    Article  CAS  PubMed  Google Scholar 

  18. Ghaderi A, Scott B. The reliability and validity of the Swedish version of the Body Shape Questionnaire. Scand J Psychol 1999; 45: 319–24.

    Article  Google Scholar 

  19. Courtney EA, Gamboz J, Johnson JG. Problematic eating behaviors in adolescents with low self-esteem and elevated depressive symptoms. Eat Behav 2008; 4: 408–14.

    Article  Google Scholar 

  20. Gual P, Perez-Gaspar M, Martinez-Gonzalez MA, et al. Self-esteem, personality, and eating disorders: Baseline assessment of a prospective population-based cohort. Int J Eat Disord 2002; 31: 261–73.

    Article  PubMed  Google Scholar 

  21. Silverstone PH, Salsali M. Low self-esteem and psychiatric patients: Part I — the relationship between low self-esteem and psychiatric diagnosis. Ann Gen Hosp Psychiatry 2003; 11: 1–9.

    Google Scholar 

  22. Pesa J. Psychosocial factors associated with dieting behaviors among female adolescents. J Sch Health 1999; 69: 196–201.

    Article  CAS  PubMed  Google Scholar 

  23. Kling KC, Hyde JS, Showers CJ, et al. Gender differences in self-esteem: A meta-analysis. Psychol Bull 1999; 125: 470–500.

    Article  CAS  PubMed  Google Scholar 

  24. Robins RW, Trzesniewski KH. Self-esteem development across the life span. Psychol Sci 2005; 14: 158–62.

    Google Scholar 

  25. Steiger H, Stotland S, Trottier J, et al. Familial eating concerns and psychopathological traits: Causal implications of transgenerational effects. Int J Eat Disord 1996; 19: 147–57.

    Article  CAS  PubMed  Google Scholar 

  26. Edmonds H, Hill AJ. Dieting and the family context of eating in young adolescent children. Int J Eat Disord 1999; 25: 435–40.

    Article  Google Scholar 

  27. Davis C, Shuster B, Blackmore E, et al. Looking good — family focus on appearance and the risk for eating disorders. Int J Eat Disord 2003; 35: 136–44.

    Article  Google Scholar 

  28. Schwartz DJ, Phares V, Tantleff-Dunn S, et al. Body image, psychological functioning and parental feedback regarding physical appearance. Int J Eat Disord 1999; 25: 339–43.

    Article  CAS  PubMed  Google Scholar 

  29. Smolak L, Levine MP, Schermer F. Parental input and weight concerns among elementary school children. Int J Eat Disord 1999; 25: 263–71.

    Article  CAS  PubMed  Google Scholar 

  30. Pike KM, Rodin J. Mothers, daughters, and disordered eating. J Abnorm Psychol 1991; 100: 198–204.

    Article  CAS  PubMed  Google Scholar 

  31. Cooley E, Toray T, Wang MC, et al. Maternal effects on daughters’ eating pathology and body image. Eat Behav 2008; 9: 52–61.

    Article  PubMed  Google Scholar 

  32. The McKnight Investigators. Risk factors for the onset of eating disorders in adolescent girls: Results of the McKnight longitudinal risk factor study. Am J Psychiatry 2003; 160: 248–54.

    Article  Google Scholar 

  33. Field AE, Austin SB, Striegel-Moore R, et al. Weight concerns and weight control behaviors of adolescents and their mothers. Arch Pediatr Adolesc Med 2005; 159: 1121–6.

    Article  PubMed  Google Scholar 

  34. Dixon R, Adair V, O’Connor S. Parental influences on the dieting beliefs and behaviors of adolescent females in New Zealand. J Adolesc Health 1996; 19: 303–7.

    Article  CAS  PubMed  Google Scholar 

  35. Agras WS, Bryson S, Lawrence D, et al. Childhood risk factors for thin body preoccupation and social pressure to be thin. J Am Acad Child Adolesc Psychiatry 2007; 46: 171–8.

    Article  PubMed  Google Scholar 

  36. Westerberg J, Edlund B, Ghaderi A. A 2-year longitudinal study of eating attitudes, BMI, perfectionism, asceticism and family climate in adolescent girls and their parents. EatWeight Disord 2008; 13: 64–72.

    Article  CAS  Google Scholar 

  37. Rutter M. Psychosocial resilience and protective mechanisms. In: Rolf J, Masten AS, Cicchetti D, et al. (Eds) Risk and protective factors in the development of psychopathology. Cambridge, Cambridge University Press, 1990, pp 181–214.

    Chapter  Google Scholar 

  38. Edlund B, Hallqvist G, Sjödén P-O. Attitudes to food, eating, and dieting in 11- and 14-year old Swedish children. Acta Paediatr 1994; 83: 572–7.

    Article  CAS  PubMed  Google Scholar 

  39. Maloney MJ, McGuire JB, Daniels SR, et al. Dieting behavior and eating attitudes in children. Pediatrics 1989; 84: 482–9.

    CAS  PubMed  Google Scholar 

  40. Smolak L, Levine MP. Psychometric properties of the children’s eating attitudes test. Int J Eat Disord 1994; 16: 275–82.

    Article  CAS  PubMed  Google Scholar 

  41. Garner DM, Olmsted MP, Bohr Y, et al. The Eating Attitude Test: Psychometric features and clinical correlates. Psychol Med 1982; 12: 871–8.

    Article  CAS  PubMed  Google Scholar 

  42. Basaran A. Pregnancy-induced hyperlipoproteinemia: A review of the literature. Reprod Sci 2009; 16: 431–7.

    Article  CAS  PubMed  Google Scholar 

  43. Woo JG, Zeller MH, Wilson K, et al. Obesity identified by discharge ICD-9 codes underestimates the true prevalence of obesity in hospitalized children. J Pediatr 2009; 154: 327–31.

    Article  PubMed  Google Scholar 

  44. Lunner K, Wertheim EH, Thompson K, et al. A crosscultural examination of weight-related teasing, body image, and eating disturbance in Swedish and Australian samples. Int J Eat Disord 2000; 28: 430–5.

    Article  CAS  PubMed  Google Scholar 

  45. Gustafsson SA, Edlund B, Kjellin L, et al. Personal standards, self-evaluation and perceived benefits of thinness in girls and young women with disturbed eating. Eur Eat Disord Rev 2008; 16: 463–71.

    Article  Google Scholar 

  46. Keys A, Fidanza F, Karvonen MJ, et al. Indices of relative weight and obesity. J Chronic Dis 1972; 25: 329–43.

    Article  CAS  PubMed  Google Scholar 

  47. Cole TJ, Flegal KM, Nicholls D, et al. Body mass index cut offs to define thinness in children and adolescents: International survey. BMJ 2007; 28: 166–7.

    Google Scholar 

  48. Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000; 320: 1240–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Garner DM, Olmsted MP, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 1983; 2: 14–34.

    Article  Google Scholar 

  50. Edlund B, Halvarsson K, Gebre-Medhin M, Sjödén PO. Psychological correlates of dieting in Swedish adolescents: A cross-sectional study. Eur Eat Disord Rev 1999; 7: 47–61.

    Article  Google Scholar 

  51. Schoemaker C, van Strien T, van der Staak C. Validation of the Eating Disorders Inventory in a nonclinical population using transformed and untransformed responses. Int J Eat Disord 1994; 15: 387–93.

    Article  CAS  PubMed  Google Scholar 

  52. Thurfjell B, Edlund B, Arinell H, et al. Psychometric properties of Eating Disorder Inventory for Children (EDI-C) in Swedish girls with and without a known eating disorder. EatWeight Disord 2003; 8: 296–303.

    CAS  Google Scholar 

  53. Ouvinen-Birgerstam P. Jag Tycker Jag Är Manual [I Think I Am Manual]. Stockholm, Psykologiförlaget, 1985.

    Google Scholar 

  54. Garner DM, Garfinkel PE. The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychol Med 1979; 9: 273–9.

    Article  CAS  PubMed  Google Scholar 

  55. Sohlberg S, Berg I, Holmgren S. A cross-cultural multi-sample validation of the Eating Attitudes Test. Uppsala, Rapport från Institutionen för Psykiatri, Akademiska sjukhuset, 1984.

    Google Scholar 

  56. Garner DM. Manual for the Eating Disorder Inventory. Odessa, FL, Psychological Assessment Resources Inc, 1991.

    Google Scholar 

  57. Cohen J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed. New Jersey, Lawrence Erlbaum Associates, 1988.

    Google Scholar 

  58. Jose PE. ModGraph-I: A programme to compute cell means for the graphical display of moderational analyses: The internet version, Version 2.0. Wellington, New Zealand, Victoria University of Wellington, http://www.victoria.ac.nz/psyc/staff/paul-josefiles/modgraph/modgraph.php

  59. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–82.

    Article  CAS  PubMed  Google Scholar 

  60. Gusella J, Goodwin J, Roosmalen E. “I want to lose weight”: Early risk for disordered eating? Paediatr Child Health 2008; 13: 105–10.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Latzer Y, Azaiza F, Tzischinsky O. Eating attitudes and dieting behavior among religious subgroups of Israeli-Arab adolescent females. J Relig Health 2009; 48: 189–99.

    Article  PubMed  Google Scholar 

  62. Prouty AM, Protinsky HO, Canady D. Collage women: eating behaviours and help-seeking preferences. Adolescence 2002; 37: 353–63.

    PubMed  Google Scholar 

  63. Strauss RS. Self-reported weight status and dieting in a cross-sectional sample of young adolescents — National Health and Nutrition Examination Survey III. Arch Pediatr Adolesc Med 1999; 153: 741–7.

    Article  CAS  PubMed  Google Scholar 

  64. Snoek HM, van Strien T, Janssens JMAM, et al. Longitudinal relationships between fathers’, mothers’, and adolescents’ restrained eating. Appetite 2009; 52: 461–8.

    Article  PubMed  Google Scholar 

  65. Rodgers RF, Paxton SJ, Chabrol H. Effects of parental comments on body dissatisfaction and eating disturbance in young adults: A sociocultural model. Body Image 2009; 6: 171–7.

    Article  PubMed  Google Scholar 

  66. Krug I, Treasure J, Anderluh M, et al. Associations of individual and family eating patterns during childhood and early adolescence: A multicentre European study of associated eating disorder factors. Br J Nutr 2009; 101: 909–18.

    Article  CAS  PubMed  Google Scholar 

  67. Canals J, Sancho C, Arija MV. Influence of parent’s eating attitudes on eating disorders in school adolescents. Eur Child Adolesc Psychiatry 2009; 18: 353–9.

    Article  CAS  PubMed  Google Scholar 

  68. Wade TD, Lowes J. Variables associated with disturbed eating habits and overvalued ideas about the personal implications of body shape and weight in a female adolescent population. Int J Eat Disord 2002; 32: 39–45.

    Article  PubMed  Google Scholar 

  69. Kraemer HC, Stice E, Kazdin AE, et al. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 2001; 6: 848–56.

    Article  Google Scholar 

  70. O’Dea JA, Abraham S. Improving the body image, eating attitudes, and behaviours of young male and female adolescents: A new educational approach that focuses on self-esteem. Int J Eat Disord 2000; 28: 43–57.

    Article  PubMed  Google Scholar 

  71. Weltzin TE, Weisensel N, Franczyk D, et al. Eating disorders in men: Update. J Mens Health Gend 2005; 2: 186–91.

    Article  Google Scholar 

  72. Dominé F, Berchtold A, Akré C, et al. Disordered eating behaviors: What about boys? J Adolesc Health 2009; 44: 111–7.

    Article  PubMed  Google Scholar 

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Westerberg-Jacobson, J., Edlund, B. & Ghaderi, A. Risk and protective factors for disturbed eating: A 7-year longitudinal study of eating attitudes and psychological factors in adolescent girls and their parents. Eat Weight Disord 15, e208–e218 (2010). https://doi.org/10.1007/BF03325302

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