Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents.

PURPOSE: To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents. METHODS: The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression. RESULTS: Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05). CONCLUSIONS: Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.

The moderating effects of acculturation on the relation of parenting strategies to unhealthy weight control behaviors in Hispanic daughters.

There is a dearth of research regarding the association of child and parent traits to the use of unhealthy weight control behaviors among minority girls with obesity. This study examined the moderating effects of mothers' and daughters' acculturation in the relation of parenting strategies (setting limits, monitoring and discipline) to unhealthy weight control behaviors in Hispanic girls with obesity. Participants included 148 Hispanic mother-daughter dyads (Mage = 39.1, SD = 6.4 years; Mage = 11.3, SD = 1.5 years, respectively). Two-thirds of the mothers were born in Mexico and 46% of them reported low levels of acculturation. In contrast, almost all daughters (90%) were born in the United States and reported high levels of acculturation. Participants were recruited through school nurses and social agencies community coordinators. Mothers and daughters completed surveys on demographic, acculturation, unhealthy weight control behaviors (daughters only) and parenting strategies (mothers only), and had their height, weight, and adiposity assessed. Results from a hierarchical regression analysis revealed that daughters' acculturation, but not mothers' acculturation, moderated the relation of parenting limit setting to daughters' reported engagement in unhealthy weight control behaviors (ß = 1.12, p = 0.007). That is, mothers who used more limit setting were less likely to have daughters engaging in unhealthy weight control behavior and this association was stronger among low acculturated girls than among their highly acculturated counterparts. Future research should assess cultural influences and parenting practices in a sample of Hispanic mothers and their adolescent daughters of varied weight statuses and acculturation levels.

Psychosocial predictors of weight regain in the weight loss maintenance trial.

This study's purpose was to identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial, following a group-based weight loss program. Participants (N = 1025) were predominately women (63%) and 38% were Black (mean age = 55.6 years; SD = 8.7). At 12 months, higher SF-36 mental health composite scores were associated with less weight regain (p < .01). For Black participants, an interaction existed between race and friends' encouragement for exercise, where higher exercise encouragement was related to more weight regain (p < .05). At 30 months, friends' encouragement for healthy eating was associated with more weight regain (p < .05), whereas higher SF-36 mental health composite scores were related to less weight regain (p < .0001). Perceived stress and select health-related quality of life indices were associated with weight regain; this relationship varied across gender, race, and treatment conditions. Temporal changes in these variables should be investigated for their impact on weight maintenance.

How active are rural children and adolescents during PE class? An examination of light physical activity.

BACKGROUND: Few studies have examined non-exercise activity thermogenesis (NEAT) or light physical activity among a group of rural youth, particularly during physical education (PE) class. The purpose of this study was to determine whether the percent of PE class time spent in NEAT is related to school level (elementary versus high school) in a group of rural youth. METHODS: Accelerometer data from 357 students (192 elementary, 165 high school) were included in the analysis. Mixed model linear regression was performed to examine the effect of school level on the percent of PE class time spent in NEAT. Covariates included gender, PE teacher, and the duration of the PE class. RESULTS: School level was a significant predictor of the percent of PE class time spent in NEAT. Specifically, elementary school students spent more of their PE class time in NEAT than high school students (p < .001). No other significant predictors were identified. CONCLUSIONS: The results of this study suggest an association between lower levels of light (NEAT) physical activity among high school versus elementary school students during PE class.

Assessing moderate to vigorous physical activity in rural West Virginia elementary school physical education classes.

BACKGROUND: Physical education (PE) provides a natural opportunity for students to be physically active during the school day; however, the amount and intensity of this activity varies. The Centers for Disease Control and Prevention recommends that students engage in MVPA for at least 50% of their PE class period. The purpose of the present study was to quantify the amount of MVPA that occurs during elementary school PE. METHODS: Accelerometer data were collected from 203 students (100 2nd grade; 103 5th grade) in 10 West Virginia elementary schools. At each school, PE teachers identified three 2nd grade classes and three 5th grade classes in which to collect the physical activity data. For each selected class, the teachers identified the first 4 students on their alphabetic roll to wear the accelerometers. PE teachers recorded the date and time of the class and the gender of the students wearing the accelerometers. RESULTS: Using 5-second epochs and Puyau's cut-offs, results indicated that, on average, students engaged in MVPA for 27% of their PE class. No significant differences were observed in MVPA between 2nd and 5th grade students or between males and females. Male and female students spent equal amounts of PE class in MVPA. CONCLUSION: Findings support policy to increase the required minimum amount of MVPA during each PE class.

Weight perceptions, disordered eating behaviors, and emotional self-efficacy among high school adolescents.

Although emotional disorders and disordered eating behaviors are known to be related, the relationship between emotional self-efficacy (ESE) and disordered eating is unknown. This study examined the relationship between ESE and disordered eating in a statewide sample of public high school adolescents (n=2566). The Centers for Disease Control Youth Risk Behavior Survey and an adolescent ESE scale were utilized. Logistic regression adjusted for key covariates explored the relationship between low ESE and disordered eating among selected race and gender groups. Self-perceived weight as underweight or overweight; and dieting, vomiting or taking laxatives, taking diet pills, and fasting to lose weight were each associated (p<.05) with lower levels of ESE for certain race/gender groups. Findings provide increased justification for tailoring disordered eating interventions and treatments to accommodate the highest risk groups. Measures of ESE should be considered for adolescent mental health assessments in fieldwork, research, and evaluation efforts.

Hispanic maternal influences on daughters' unhealthy weight control behaviors: The role of maternal acculturation, adiposity, and body image disturbances.

This study examined whether maternal adiposity, acculturation, and perceived-ideal body size discrepancy for daughters were associated with daughters' engagement in unhealthy weight control behaviors. A total of 97 Hispanic mother-daughter dyads completed surveys, rated a figure scale, and had their height, weight, and adiposity assessed. Mothers (Mage=39.00, SD=6.20 years) selected larger ideal body sizes for their daughters (Mage=11.12, SD=1.53 years) than their daughters selected for themselves. Mothers had a smaller difference between their perception of their daughters' body size and ideal body size compared to the difference between their daughters' selection of their perceived and ideal body size. More acculturated mothers and those mothers with larger waist-to-hip ratios were more likely to have daughters who engaged in unhealthy weight control behaviors. These findings highlight the relevant role that maternal acculturation and adiposity may have in influencing daughters' unhealthy weight control behaviors.

An exploratory factor analysis of the Parenting strategies for Eating and physical Activity Scale (PEAS) for use in Hispanic mothers of adolescent and preadolescent daughters with overweight.

Existing measures of feeding and physical activity parenting strategies have not been validated for use among Hispanic mothers of adolescent and preadolescent daughters with overweight. The purpose of this study was to investigate the factor structure of the Parenting strategies for Eating and Activity Scale (PEAS) among 134 Hispanic mothers (Mage=38.81, SD±6.34) of adolescent and preadolescent daughters with overweight. Results from this exploratory study revealed that a three-factor structure (Limit Setting, Monitoring, and Discipline) and a 13-item revised PEAS measure might be better suited for use with this population. The revised Limit Setting, Monitoring, Discipline, and total subscales had good reliability (α=0.89, α=0.88, α=0.90, and α=0.87, respectively) and the subscale inter-item correlations were strong. To assess the concurrent validity, the revised PEAS subscales were correlated with both subscales of the Behavioral Strategies to Reduce Fat and Increase Fiber (Parent Report) in a subset of the sample (n=78). The Monitoring and Discipline subscales were found to be correlated with the Behavioral Strategies to Reduce Fat (r=.36 and r=.27, p<.05, respectively) and Increase Fiber (r=.40 and r=.35, p<.01, respectively) subscales. However, the revised PEAS Limit Setting subscale was not correlated with either Reduce Fat or Increase Fiber strategy. Taken together, these results indicated some degree of concurrent validity. Results from this study should be cross-validated using confirmatory factor analysis approaches.

Predictors for selection of insurance-funded weight loss approaches in individuals with severe obesity.

OBJECTIVE: To determine whether there are differences in baseline psychological and behavioral characteristics between individuals with severe obesity who chose a surgical or nonsurgical intervention for weight loss. METHODS: The current study utilized data from a larger study funded by a state insurance company and is unique in that the insurance company funded the weight loss interventions. Participants indicated their preferred method of weight loss, and completed several self-report psychological questionnaires, as well as demographic information. RESULTS: Participants (N = 605) were 58.8% Caucasian and mostly (86%) female. Logistic regression results indicated that an increased number of weight loss attempts, and select other measures of eating behavior and quality of life may influence individuals' selection for either surgical or nonsurgical treatments for weight loss. CONCLUSIONS: Practitioners should pay particular attention to these baseline characteristics that influence choice to examine potential characteristics that may influence the success of these weight loss treatments.

Sexual orientation and disordered eating behaviors among self-identified male and female college students.

This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008-2009) were utilized (N=110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2 weeks), stress (last 12 months), smoking (past 30 days), depression (past 12 months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p<.002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p<.002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men.

Why patients seek bariatric surgery: does insurance coverage matter?

Despite increasing prevalence of bariatric surgery, little is known about why patients seek out this treatment option. Heads Up is an observational study sponsored by a large benefits management group that examines surgical and nonsurgical approaches to weight management in obese adults. This study examined patients' reasons for choosing surgery. The sample included 360 adult obese patients seeking bariatric surgery who were invited to volunteer for a surgical or a medical weight loss program by their insurer. Participants rank ordered their top three reasons as a deciding factor for choosing to consider surgery. The top three reasons were concerns regarding health (52%), current obesity-related medical conditions (28%), and improved physical fitness (5%). Overall, 13% endorsed insurance coverage as one of their top three choices. When insurance coverage is assured, health and functionality issues were the major reasons reported for obese adults choosing to undergo bariatric surgery.