DISORDERED EATING ATTITUDES, OBESITY INDICES AND PSYCHOLOGICAL FACTORS. A CROSS-SECTIONAL STUDY IN PRIMARY SCHOOLCHILDREN IN THE PREFECTURE OF IOANNINA, GREECE. : DISORDERED EATING ATTITUDES, OBESITY INDICES AND PSYCHOLOGICAL FACTORS. A CROSS-SECTIONAL STUDY IN PRIMARY SCHOOLCHILDREN IN THE PREFECTURE OF IOANNINA, GREECE.
P. Angelopoulos1, G. Tsitsas2, H. Milionis1, C. Blachaki2, Z. Bouloumbasi2,
Y. Manios2 1Department of Internal School of Medicine University of Ioannina Greece ²Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
Slide2 :
INTRODUCTION
Eating disorders— anorexia nervosa, bulimia nervosa, binge-eating disorder, and their variants — in children and adolescents are characterized by a serious disturbance in eating, such as restriction of intake or bingeing, as well as distress or excessive concern about body shape or body weight. In addition to their effects on psychological well-being, they have a potentially devastating effect on health through the physiologic squeal of altered nutritional status or purging. Sullivan et al. Am J Psychiatry 1995;152:1073-1074
Patton et al. BMJ 1999;318:765768 1999
Slide3 :
Eating disorders are a group of psychiatric disorders unified by highly disturbed eating behavior and a constellation of psychological traits and symptoms. The psychological traits and symptoms include preoccupation with body weight and shape, distortions of body image, and severely disturbed attitudes toward food, calories, and eating.
Eating disorders have high medical and psychiatric comorbidity and the highest mortality rate of the psychiatric disorders, mostly by suicide . American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994 Steinhausen HCAm J Psychiatry 159:1284–1293, 2002
Factors : Factors Genetics
Society that idolizes thinness yet pushes food that causes obesity
Unrealistic ideals
Endocrine system
Family’s attitude
Controlling family
Inability to cope with stress
Sports Teams
Dieting
AIM OF THE STUDY The aim of the study was to determine the associations between eating disorders, obesity and psychological factors in Greek primary school children. : AIM OF THE STUDY The aim of the study was to determine the associations between eating disorders, obesity and psychological factors in Greek primary school children.
Slide6 : Design and Methods
Cross-sectional study of primary schoolchildren aged 11 years old from rural and urban population.
Demographic information,
Anthropometric measurements,
percentage body fat,
Eating Attitudes Test (EAT-26),
Harter’s Self-Perception Profile for Children (Harter,1985) and
Body Shape Questionnaire (BSQ-34) were obtained for 282 students: 86% natives, and 14% of non-Greek origin.
Setting
14 primary schools in the Prefecture of Ioannina, Greece.
Slide7 : Anthropometrical measurements
Body weight was measured using a digital scale (Seca Personal Floor Scale 861).
Standing height was measured to the nearest 0.1 cm with the Portable Leister height measure (Seca, Marsden, United Kingdom).
Waist circumference (WC) was measured to the nearest centimeter with tape-measure SECA 200.
Cole et al. BMJ 2000;320: 1240-1243
Taylor et al. Am J Clin Nutr. 2000;72:490-495
Slide8 : Anthropometrical measurements
Subcutaneous skinfold measurements were taken to the nearest mm in duplicate at four sites (biceps, triceps, subscapular, and suprailiac folds) with a Harpenden skinfold caliper (HARPENDEN HSK-ΒΙ).
Body Mass Index (BMI) was calculated as body weight (kg) / height squared (m²).
Percentage Body Fat % was estimated from skinfolds using the equations for children. Cole et al. BMJ 2000;320: 1240-1243 Slaughter et al. Human Biol 1988;60:7009–23.
Slide9 : Eating disorders (Eating Attitudes Test/EAT-26)
The EAT-26 inventory was designed to measure behaviors and attitudes symptomatic of AN. Garner et al. Psychol Med 1982;12:871-878
This 26-item has three subscales assessing Dieting, Bulimia and Food Preoccupation, and Oral Control. Using the standard scoring system, a score of 20 on the EAT-26 indicates serious eating problems and potential disorder. Graber et al. J Child Psychol Psych 2003 ;44:262–273
It was devised to reflect a range of symptoms that reflect eating disorders. It contains 26 items and has found to identify eating disturbances in non-clinical samples.
Szweda et al. Occup Med 2002 ;3:113-119
Slide10 :
Body image (Body Shape Questionnaire/BSQ-34)
The BSQ measures concerns with body shape and the relation to psychopathology.
Cooper et al. Int J Eat Disord 1987;6:485–494
Cooper et al. Int J Eat Disord 1993;13:385-389
The self-report Body Shape Questionnaire were developed to measure concern about body image and has been used in studies of both clinical and non-clinical populations.
Cooper et al., 1987; Evans and Dolan, 1993; Rosen et al., 1996
Slide11 :
Harter’s Self-Perception Profile for Children
The Self-Perception Profile for Children (SPPC) is a 36-item self-reporting scale developed to tap children's domain-specific judgments of their competence, as well as a global perception of their worth or esteem as a person. It contains six separate subscales consisting of five specific domains: 1) scholastic competence 2) social acceptance 3) athletic competence 4) physical appearance 5) behavioural conduct as well as a general domain of global self-worth. Harter S. Developmental perspectives on the self-system. Handbook of Child Psychology. Vol. 4. Socialization, personality and social development. New York: John Wiley, 1983:275-385.
Slide12 :
This scale was constructed on the assumption that an instrument providing separate measures of one's competence in different domains, as well as an independent assessment of one's global self-worth, would provide a more differentiated picture than those instruments providing only a single self-concept score. Saigal et al.Pediatrics. 2002 Mar;109(3):429-33 Burrows et al. Int J Obes Relat Metab Disord. 2002 Sep;26(9):1268-73
Slide13 : Results
There were strong positive correlations between
eating disorders (Eating Attitudes Test/EAT-26) and
body mass index (BMI) (Pearson’s correlation coefficient, r=0.153, p<0.012),
waist circumference (WC) (r=0.172, p<0.005),
hip circumference (HC) (r=0.167, p<0.006),
left triceps skinfold thickness (r=0.134, p<0.026),
scapular skinfold thickness (r=0.136, p<0.025),
body fatness (r=0.192, p<0.002),
body image (Body Shape Questionnaire/BSQ-34) (r=0.478, p<0.001) and
negative correlation with the physical appearance (Harter’s Self-Perception Profile for Children) (r=-0.127, p<0.041).
Slide14 : Correlation between EAT-26 and BMI, WC and HC
Slide15 : Correlation between EAT-26 and left triceps skinfold thickness , scapular skinfold thickness
Slide16 : Correlation between EAT-26 and body fatness and BSQ-34
Slide17 : Negative Correlation between EAT-26 and physical appearance (Harter’s Self-Perception Profile for Children)
Slide18 : Conclusion
The schoolchildren present eating disorders at a significant percentage (12%) even in non-industrialized regions of Greece. This finding may be partly explained by the effect of Westernized life-style changes. The negative body shape image and low physical appearance associated with eating attitudes may well be a start motivation for the prevention by educational programs.
Schools play a primary function in adolescent socialization, including the adoption of gender-role attitudes and behaviors.
Nutrition Topics: How to... : Nutrition Topics: How to... maintain a healthy weight
stop unhealthy behaviors
eat normally again
normalize metabolism
choose a nutritious diet
challenge distorted beliefs
Nutrition Topics : Nutrition Topics Increase self-esteem and self-acceptance
Nutrition education
Medical consequences of the disorde
Psychological Issues : Psychological Issues Eating d/o as the SYMPTOM, not the PROBLEM.
Coping mechanism
how does she/he benefit from the disorder?
Psychological Issues : Psychological Issues “Feeling fat” : catch all phrase for almost any negative emotion
Must work through the underlying issues in psychotherapy
Food behaviors are addictive
Psychological Issues : Psychological Issues Cannot simply stop starving,bingeing or purging
liabilities vs. the benefits of the disorder