Obesity & body image in children & adolescents Flashcards
Adipose tissue
- white “bad” fat
- brown “good” fat- generates heat, insulation
- fat- more around organs- takes years for it to gather on organs so overweight children not have on organs.
- enlargement of heart (led to death).
Measuring adiposity
-hard to do
Gold Standards
- cadaver (boil them).
- hydrostatic weighing
- dual energy x-ray adsorptiometry (expensive or need to be dead).
- magnetic resonance
- computerised tomography
- tracer
- -these are most expensive.
Pragmatic options
- skinfold
- BMI
- bio-impedance
- easier & cheaper
- -getting more accurate overtime
- -OK for approximations
BMI
- an index of adiposity
- Weight(kg)/Height(m^2)
- fine for adults but still issues:
–BMI cut offs due to race. muscularity, frame size, fat distribution.
Defining overweight & obesity in childhood by “analogy”
- Cole et al 2000
- Wang & Lobstein 2006
-unlike adults, no clear cut off points.
- Cole et al 2000- longitudinal study- “resulting curves were avged to provide age & sex specific cut off points from 2-18 y/o”
- look at ppl overtime to get a good judgement.
- help describe where child is.
- help hold weight more constant.
- not trying get child lose weight.
- just hold constant- don’t want dmg psych or physical of a child.
-Wang & Lobstein 2006- still say 50% North America & 38% EU children overweight.
Body fat in childhood
-McCarthy et al 2006
-McCarthy et al 2006- changes with age differ for boys & girls, particularly during & after puberty.
- boys wider before they get taller.
- girls slowly gain fat & remain similar in adulthood.
Media headlines
-National Child Measurement Programme 2014/15
- headline msgs that obesity in children is out of control- not actually true.
- National Child Measurement Programme 2014/15- 1.1 million children weighed & measured by NHS staff in school.
Obesity- Age
-National Child Measurement Programme 2014/15
-National Child Measurement Programme 2014/15:
Age- in reception (4-5 years) & Year 6 (10-11 years)
-it has remained pretty constant in reception.
-1/3 overweight or obese before high school, which is bad however it has not increases a huge amount- it has always been a problem (last decade+).
Obesity- Social Deprivation
- reception
- year 6
- Puhl & Brownell 2001
- Goffman 1963
Reception- 13% children living most deprived areas were obese v 6% in least deprived.
Year 6- 26% children living most deprived obese v 11% not living least deprived areas.
-key find these areas to focus.
-food instability? cooking equipment? no freezer?
–tower block less physical activity v village green village.
- diff b/w obese children attending schools in most & least deprived areas has increased overtime.
- Reception: 2007-2017 4.5-6.8% &
- Year 6: 2007-2017 8.5-15%
- -getting bigger.
- Puhl & Brownell 2001- social marginalisation & stigmatisation in obese adults- in healthcare. education, employment- therefore need combat it in children= cycle.
- Goffman 1963- devalued social identity due to child stigmatisation- for being obese/overweight.
Obesity- Ethnic Group
- Latner et al 2005
- Thompson et al 1997
Ethnic Group- ethnic diffs of where ppl carry weight.
-link b/w black, urban, decreased wealth & obesity.
Reception: 6% Chinese & 15% Black obese.
Year 6: 20% Chinese & 30% Black.
- Latner et al 2005- African American F more pos attitudes to obese peers v AA M & white M & F.
- Thompson et al 1997- AA girls & boys v white picked heavier ideal body size for self.
Obesity: Location
Reception: 5% Kingston upon Thames v 14% Wolverhampton= obese.
Year 6: 11% Rutland v 29% Barking & Dagenham- obesity.
–link- urban more obese, rural less- link social adversity.
-availability of takeaways, safe places to cook etc.
Obesity: Parental Perception
- Davidson & Birch 2004
- Thelen & Cormier 1995
-tend think overweight child is normal- fathers more so than mothers.
Mothers: obese child 41% about right weight or too light. 59% said too heavy.
Fathers: 55% right/too light. 45% too heavy.
-parents not always aware- which is an issue.
- Davison & Birch 2004- if parents emphasise importance thin shape/weight-child display neg stereotypes- obese parents are same. (fat child get less finical supp then thinner children).
- Thelen & Cormier 1995- desire to be thinner correlated encouragement lose weight from both mother & father.
Physical consequences
- short term
- cardiovascular -Riley et al 2003
- long-term
- Hoffmanns et al 1998
Short term:
- asthma, chronic systematic inflammation, increased serum C reactive protein concentration.
Cardiovascular risk factors: high bp, abnormalities in left ventricular mass &/or function, abnormalities in endorthelial function, insulin resistance, atherosclerosis, type 2 diabetes. -Riley et al 2003.
Long term:
- obesity persistence- most likely with 1 obese parent, obesity present at older ages.
- cardiovascular risk factors- similar profile to that seen in childhood + myocardial infarcts (dead tissue)
- -fat sitting on organs when obese for long time.
-Hoffmanns et al 1998- adult morbidity/mortality- BMI >25 at 18 years associated with increased mortality within 20 years of follow up.
Psychological & behavioural correlates of child obesity
- Puder & Munsch 2010
- Puder& Munsch 2010
- to help prevent & treat child obesity, we need to know which psychological or behavioural aspects to target.
- unfortunately, most evidence is correlational.
-Puder & Munsch 2010- child obesity not stable condition- dynamic process- which behaviour, cognition & emotional regulation interact mutually with each other- with biological parameters as well as contextual factors e.g. parental attitudes & familial eating, activity & nutritional patterns.
- New evidence- prevalence of food at early age, shapes what parents do.
- child temperament & adult feedings behaviour
- Puder & Munsch 2010- Clinical Groups: pos ass b/w obese weight status &:
- 1- Family Factors (behavioural modelling) portion sizes, eating styles etc…
- 2- Externalising Features: ADHD & impulsivity.
- 3- Internalising Features: depress symps, anx, social withdrawal, emotion regulation probs.
- -also evidence for inter-generational transmission of psychopathology & weight probs together.
Psychological consequences
- Reilly et al 2003
- Birch 2005
- Cash 2004
- Schwimmer et al 2003; William et al 2005
- (in community-based cohort & cross-sectional studies).
- Reilly et al 2003- in girls obesity ass with depress & low s-e- girls more neg impacted then boys however boys still effected.
- Birch 2005- depress in 5-7 y/o girls- predicted subsequent dietary restraint.
- Cash 2004- increased risk of ED, weight cycling & neg body image.
- Schwimmer et al 2003; William et al 2005- obese children & adolescents report lower health-related quality of life.
A conceptual model of weight, body image & disordered eating attitudes in children.
-Evans, Tovee, Boothroyd & Drewett 2013
(see model in notes)
(bmi, thin-ideal internalisation, dietary restraint, disordered eating attitudes, depression, body dissatisfaction).
-dieting symps in children in those overweight & more depressed.
Obesity- Weight Stigma
- Leeds 2013
- Latner & Stunkard 2003
- Cramer & Steinwert 1998
- Musher-Eizenman et al 2003
- Leeds 2013- 126 children read book with adult, 3 versions- main character either normal, wheelchair or fat- child rated fat as less favourable on athletic, academic, competence, s-e, social success & behaviours.
- -stigma occurs early.
- Latner & Stunkard 2003- stigmatisation not help- otherwise would be decrease in obesity over last 40 years.
- Cramer & Steinwert 1998- overweight pre-schoolers- show stronger neg stereotypes v normal weight peers.
- Musher-Eizenman et al 2003- 5 y/o wider range of acceptable body types v tee & adults.
Obesity- Peer Relationships
- Hill & Silver 1995
- Strauss & Pollack 2003
- Anesbury & Tiggemann 2000
- Richardson et al 1961
- Latner & Stunkard 2003
- Hill & Silver 1995- obese children stereotyped as unhealthy, academically unsuccessful, socially inept, unhygienic & lazy.
- Strauss & Pollack 2003- obese teens listed as other teens’ “friend” less freq than non-obese teens.
- Anesbury & Tiggemann 2000- extent of obesity stigma influenced by children’s controllability beliefs but changing controllability beliefs does not immediately reduce stereotyping.
- -can’t just educate, it’s hard to shift.
- Richardson et al 1961- 640 school children, 10-11 y/o- 6 pics, 4 disabilities, 1 normal, 1 fat- who want to be your friend= fat was lowest rated.
- -Latner & Stunkard 2003- worse now- increase 40%+
Obesity- Bullying
- Fairburn et al 1998
- Janssen et al 2004
- Rand & Wright 2000
-overweight & obese teens more likely to be victim of bullying than non-overweight teens at any age.
- Fairburn et al 1998- plausible teasing may lead to development of eating disturbances.
- relational (e.g. withdrawing friendship) & overt (name calling) bullying common, but not sexual harassment.
BUT -Janssen et al 2004- obese also more likely to bully at 15-16 years old.
-Rand & Wright 2000- older adolescents rated larger sized figures more acceptable v younger.
Factors that influence impact of obesity upon child psychological health.
- National Obesity Observatory 2011.
- (see diagram in notes)
-National Obesity Observatory 2011
Moderating Factors:
- Age- older children experience more probs.
- Gender- girls experience more probs.
Mediating Factors: for obesity causing psychological probs.
- lack of physical activity, low s-e, body dissatisfaction, EDs & weight-based teasing.
- -for psychological probs causing obesity: lack of energy to exercise, medication, family breakdown & poverty.
- -also mediators (social, behavioural, biological & psychological factors)
- –same as adults.
Obeso-genetic environment
-public health campaigns
-had to be normal weight in this enviro- fast food, bigger portions, computer games, more driving etc…
Public Health Campaigns- more stigmatised in America. -also mugshot esq.
-Change 4 Life (good) & Michelle Obama’s Let’s move campaign.
-shame of self= deceased motivation- can make it worse.
Body image schemas & attitudes
Schema:
-central Organising Constructs in the interplay of cog, behavioural & emotional processes, in context of enviro events.
Attitudes:
- i- Body Image Investment- cog-behavioural importance individuals place on appearance.
- ii- Body Image Evaluations- pos-to-neg appraisals of & beliefs about one’s appearance…
- -based on discrepancy b/w self-perceived characteristics & personally-valued appearance ideals.
Cognitive Behavioural model of body image- Cash 2004.
see diagram in notes
-Cash- 2004
History (dev factors): cultural socialisation, interpersonal experiences, physical characteristics, personality attributes.
Current ( precipitating & maintaining): appearance schematic processing, activating events, internal dialogues, body image emotions, self-regulatory, adjustive behaviours.
all feed into= Body Image Schemas & Attitudes.
What’s body image” when it comes to children?
- like their own bodies early.
- body image investment?
- body eval & satisfaction?
- weight & shape concerns?
Developmental of body image
- self percep & recog (0-2 y)
- self-representation (4-5 y)
- self-other comparison (5-7 y)
- self-image & ideal-image (8+y)
-multiple representations of body, conscious & unconscious (late adolescence)= adult.
developmental of body image: Self-Perception Recog
Self-Perception Recog
-schemata develop from birth, synchronic imitation, mirror-self recog, use of personal pronouns, photo self-recog, pretend play.
–pre 18 months- not recog it is them, 18 months+ they do (also trolley video with carpet).
developmental of body image: Self-Representation
Self-Representation
- Object-Mediated: toys, tools, drawing, photos.
- Perspective Taking: theory of mind.
—the meaning of “me”: gender, physical characteristics, personality, preferences, role, clothing, family, friends, school etc…
developmental of body image: Assessing Children’s Body Image
-Ricciardeli & McCabe 2002
- pick your ideal- girls tend to go 1 body size smaller- suggests slight pref for thinness.
- this was down with computer generated bodies.
- might also feel they have to pick one that was not their own.
- Ricciardeli & McCabe 2002- Body Change Inventory- consists 3 subscales.
- -1- Decrease Body Size.
- -2- Increase Body Size.
- -3- Increase Muscle Size.
- -applicable to M & F.
- –well developed scale.
developmental of body image: Social Comparison
Social Comparison
-to do this you need.. stable idea of your own body shape, size, proportions, ability to hold this in mind AND think about another’s shape, size etc…
- -AND to compare these directionally, poss from point of view of observer.
- -AND possibly an awareness & internalised image of socio-culturally-promoted thin-ideal.
- very complex cognitive task.
-it is almost impossible to access children’s idea of body image- 7 y/o won’t fully understand concepts of culture & society etc…
Children’s body image in numbers-
- Ricciardelli & McCabe 2011
- Smolak 2004
- Birch & Fisher 1998
-Ricciardelli & McCabe 2011- 50% girls & 30% boys aged 6-9 want to be thinner.
- Smolak 2004- 40% preadolescent children report that they have tried to lose weight.
- -not full blown diets, learn methods early due to adults doing it.
-Birch & Fisher 1998- early dieting in long run ass with chronic body image probs, weight cycling etc..
The developmental course of body dissatisfaction
- Tremblay, Lovsin, Zecevic & Lariviere 2011
- Davison, Markey & Birch 2000
- Murnen et al 2003
- Davison, Markey & Birch 2003
- Smolak 2004-
- Tremblay, Lovsin, Zecevic & Lariviere 2011- 4 y/o, articulate Weight Stigma.
- Davison, Markey & Birch 2000- 5 y/o knows own Weight Status & report weight concerns.
- Murnen et al 2003- 6 y/o awareness & Internalisation of thin ideal & muscular ideal.
- Davison, Markey & Birch 2003- 9 y/o body dissatisfaction Linked to BMI.
- Smolak 2004- 13 y/o body dissatisfaction as Common as in adults.
- pref thin ideal, show images, Disney princesses, hyper muscular.
Physical characteristics
- Stice 2002
- Smolak 2002
- social stigma, PE, less socially accepted= body dissatisfaction.
- Stice 2002- overweight men & women are most vulnerable to body diss in adulthood & adolescence.
- Smolak 2002- the same relationships gradually emerges during childhood, becoming stronger with age.
Cultural socialisation
- children like sponges.
- dove improvements on range of beauties but still not any fat ppl.
- parents need teach children to critically accept ads etc…
- men’s move to muscular.
Media consumption by age & modality
- OFCOM Report 2016
- Flannery-Schroeder & Chrisler 1996
- Stice 1994
- Blowers et al 2003
- OFCOM Report 2016- look at mean hours media consumption.
- -still increasing, more sedentary, media consumption= games, YouTube- not avg body- attractive, athletic etc…
- Flannery-Schroeder & Chrisler 1996- family, friends & media- fat bad, thin good.
- Stice 1994- media important transmitter of sociocultural ideals about body size & shape.
- Blowers et al 2003- most child exposed media thin beauty ideal before formal schooling.
Cultural socialisation
- a-d
- c- Cash 2004
- d- Murnen et al 2003
- via socialisation, children learn about:
- a- which physical characteristics are Valued.
- b- their social Meaning: what possessing them (or not) implies about the owner’s character, health & eating behaviour.
- c- Strategies to attain these characteristics, such as dieting & exercise- Cash 2004.
- d- implication that such standards are Attainable by all given sufficient effort
- –Murnen et al 2003- body modification- makeup, nails, hair etc…
Interpersonal Experiences
- Cramer & Steinwert 1998
- Musher-Eisenmann et al 2004
- Anesbury & Tiggemann 2000
- Cramer & Steinwert 1998- weight stigma: the “relative devaluation of an overweight figure size”.
- communicated by parents, teachers, doctors, peers & media.
-Musher-Eisenmann et al 2004 -children think being overweight means: child is unpopular, suggests laziness & non-conformity is child’s own fault
- Anesbury & Tiggemann 2000- weight discrimination widespread.
- -less likely to get a job.
- -attribute symptoms to weight etc…
What are longer-term consequences of body dissatisfaction?
- Field et al 2003; Stice & Bearman 2001
- Killen et al 1994
- Field et al 2003; Stice & Bearman 2001-
- -EDs, depress, binge-eating, weight gain, rigid dietary restraint, disengagement with physical activity, decreased fruit & veg consumption.
- –more true for girls but increase in boys, tend to gain more weight overtime.
-Killen et al 1994- + many others- longitudinal study of adolescent F & adult F- body diss one of main RFs leading to problematic eating attitudes.
Pathways from early body image to later disordered eating?
-Sroufe 2009
- Sroufe 2009 -not guaranteed.
- Alternative pathways may lead to the same common outcome (equi-finality).
- Similar pathways may lead to diff outcomes (multi-finality).
Adolescence as “trigger point” for EDs
-Wichstrom 2000
-body image & eating schemata are in place prior to puberty- they shape the Context in which pubertal changes are experienced by the individual.
- Schemata Strongly shape individual’s reaction to major changes ass with puberty: weight gain (40lbs), increased autonomy, increased sexual objectification, loosened parental ties.
- schemata continue to dev: depress &/or dieting pave way to disordered eating OR pos experiences mitigate risk.
-Wichstrom 2000- by 12 y/o already have ED symps similar to those in late adolescences.
(lec 9) EDs & adolescent prob?
- historically, the physical & psychosexual changes of puberty- thought underpin ED dev, so studies & theories have focussed on adolescents.
- idea was big in 1960s it was trigger- however now know it is not true.
2 key questions
what are diffs & similarities with adolescents & adult EDs?
- large number of children will dev symps with potential turn into later clinical EDs, though most won’t.
- what can this tell us about the dev processes that typically underline adolescent/adult EDs?
Age distribution of ED diagnoses
-Nicholls et al 2011
Nicholls et al 2010- 3 in 100,000 children = 13 years dev clinical EDs.
- most common in 12-13 y/o.
- younger children less EDs.
- not include avoidant/restrictive ED.
EDs in children
-van Son et al 2006
- serious cus disrupt normal physical & psychological growth & dev.
- often missed by clinicians/parents particularly in young children.
- -often think picky eater or autism etc… misdiagnoses.
- van Son et al 2006- age at presentation in AN is decreasing.
- longer child has harder is to recover from.
DSM-V ED diagnoses applied to children.
-Nicely et al 2014
- Avoidant & restrictive food intake disorder (ARFID), AN & BN= most common in children.
- BED, OSFED, Pica (non-food), rumination disorder (regurg), UFED- still occur but rare.
ARFID- food phobia, disturbance in eating as evidenced by 1 or more of:
- -substantial weight loss, nutritional deficient (vit c…), dependence feeding tube or dietary supplements, sig psychosocial interference,
- -not due to unavailability of food, AN or BN & no disturbances in body shape/weight.
- -not better explained by other medical condition.
- -sometimes ASD, however ED well beyond “typical” issues with other disorders.
- -shapes of food, diff foods can’t touch each other, carbs tend to be safe,
- -sometimes seen if premature birth: don’t ass food with pos emotions- feeding tubes & oxyegen etc…
- Nicely et al 2014- retrospectively reviewed charts patients 7-17 y/o seen in outpatient ED clinic b/w 2008-2012.
- -ARFID found in younger ptcpts & proportionally there were more boys than compared to other EDs.
- -AN, BN & OSFED- similar psych co-morbidities to each other & symps & features.
- —ARFID has diff with far higher Psych co-morbidities.
Challenges in diagnosis in children
- children may not experience their body weight, shape & size like adults.
- younger child lack vocab for their illness: may not state that afraid of certain foods, getting fat, dislike their bodies.
- even before vocab “catches up” actions still consistent with classic ED behaviour of food refusal, compensatory behaviours & resultant failure to grow as expected.
- -can’t express themselves.
- -extra running on spot & usually socially accepted/encouraged.
ED children v adolescents: features compared
- Peebles et al 2016
- Walsh & Sysko 2009
Peebles et al 2016- more males <13 years v older.
- EDs less prevalent <13 -sig less BN- less freedom eat & don’t have knowledge of laxatives etc.
- might be a move to muscular ideal from <13 to 13-19 y/o.
-Walsh & Sysko 2009- cognitions & behaviours may be full ED or sub-syndromal.
Treatment for EDs in children & adolescents.
-maudsley model of family therapy (FT-AN)
Maudsley Model of Family Therapy (FT-AN)
- doesn’t blame anyone, makes family part of treatment, empowers parents to combat early ED onset.
- -increasing use in BN not just AN.
- BN: FT-BN or CBT.
- BED: nothing clear -not very common in children.
- ARFID: still very new, but desensitization & CBT appear promising- works as a “phobia”
- minimise time child stays in hospitals- focus instead on restoring physical stability.
- use of day-treatment or/followed by outpatient treatment preferred.
Maudsley Family-Based Treatment
-steps 1-3
- deved at Maudsley hospital London.
- intensive outpatient treatment.
- for: children/adolescence, medically stable, ill for only relatively short time.
- opposes view the parents/families are part of prob or cause of illness: instead parents are essential resource for recovery.
3 phases of treatment (15-20 sessions over 12 months)
- 1- Weight Restoration: dangers malnutrition & low weight status- assessing family’s typical interaction, eating patterns & meals -focus is on eating & weight gain. (bring a meal in).
- 2- Returning Control Over Eating to Patient: once eating happens, child takes more control on what they eat & broader family issues are dealt with in therapy.
- 3- Establishing Healthy Adolescent Identity: catch-up with what missed & give them confidence & independence back to them.
Family based therapy for EDs
-Couturier et al 2013
- Couturier et al 2013- effectiveness v individual therapy.
- -Immediate Post-Treatment- no statistical significance that family was better than individual.
- -6-12 Month Follow-Up- overtime family based is more sustainable.
Disordered eating attitudes
- weight & shape issues from age of 5.
- exercise more common in children v purging.
- food rituals & compulsions.
Disordered eating attitudes are dimensional not categorical.
- attitudes/behaviours exist along continuum of severity rather than “all or nothing” distribution.
- the behaviours of children with clinical ED feats are at the extreme end of this distribution.
- as in EDs are the extreme of disordered eating.
Disordered eating attitudes arise early in childhood.
- Schur, Sanders & Steiner 2000
- Scunk & Birch 2004
Erickson & Gerstle 2007
-Damiano et al 2015
-Ricciardelli et al 2003-
Gordon 2000-
- b/w 7-11 y/0, key concepts, behaviours & attitudes to food & body emerge:
- Schur, Sanders & Steiner 2000- 8 y/o children an describe Weight Loss Strategies- bariatric surgery etc…
- Scunk & Birch 2004- 9 y/o girls with higher BMI report higher dietary restraint.
Erickson & Gerstle 2007- 10-20% pre-peri-pubertal children report clinically sig disordered eating attitudes.
- Damiano et al 2015- 34% 5 y/o girls report moderate dietary restraint- attempted cog restraint.
- Ricciardelli et al 2003- from age 8, boy desire muscles & large size then girls- utilize muscle gaining strats & perceive greater pressure to gain muscle size.
Gordon 2000- disordered eating attitudes involve, in exaggerated form, behaviour that is normal in our culture & highly valued.
–children like sponge- learn this early (weight/shape in magazines, TV- want to be part of it- emulate social ideals/norms.
Measures of childhood disordered eating attitudes
- Wood et al 1996
- Mendelson et al 1996
- Wood et al 1996- Body Dissatisfaction Scale of ED Inventory (BD-EDI)
- -questionnaire, used assess body image concerns- reliable & consistent with those 8 years+.
- Mendelson et al 1996- Body-Esteem Scale- attitudes & feeling their body & appearance- good internal consistency & moderate test/re-test reliability.
- Other questionnaires: Offer Self Image Questionnaire & Harter Scales- work both child & teen- good longitudinal.
what contributes to dev of disordered eating attitudes?- Gender
- Smolak 2004
- Murnen et al 2003
- Truby & Paxton 2002
- Ricciardelli & McCabe 2011
- Fredrickson & Roberts 1997
- Clark & Tiggemann 2006
- Kraig & Keel 2001
Gender
-Smolak 2004- girls have greater eating attitudes then boys aged 9.
- Murnen et al 2003- girls report greater Pressures Towards Thinness from age 6.
- Truby & Paxton 2002- girls id Thinner Ideal bodies than boys from age 7.
- Ricciardelli & McCabe 2011- girls express Greater Body Dissatisfaction than boys age 7.
- -this is very young.
- girls are Differentially “acculturated to internalise an observer’s perspective as a primary view of their physical states”.
- Fredrickson & Roberts 1997- internalise msgs that their body is a project to work on & be judged on.
- Clark & Tiggemann 2006- men look at women. Women watch themselves being looked at.
- -this determines not only most relations b/w men & women but also the relation of women to themselves.
-Kraig & Keel 2001- however found- no sex diffs in victimisation.
what contributes to dev of disordered eating attitudes
Weight Status/BMI
-NHS- Health & Social Care Information Centre
-Stice 2002; Hudson et al 2007
-
- NHS- Health & Social Care Information Centre- looked at adiposity/weight- reception & year 6.
- -larger children increased risk ED through body dissatisfaction.
- being, or having been overweight increase other risk factors for disordered eating:
-Stice 2002; Hudson et al 2007- body dissatisfaction, thin-ideal internalisation, perceived pressure to be thin, dieting, depress, weight stigma.
A conceptual model of disordered eating attitudes in children
-Evans, Tovee, Boothroyd & Drewett 2013
(look at notes for diagram)
- Evans, Tovee, Boothroyd & Drewett 2013- help base framework in essay for exams.
- -could be happening at same time, hard to disentangle (depress).
what contributes to dev of disordered eating attitudes- Psychological Variables -Jendrzyca & Warschburger 2016 -Nichols et al 2018 -Evans et al 2017
- Jendrzyca & Warschburger 2016- experiences weight stigma aged 6-11 led restrained eating 1 year later in girls not boys; body dissatisfaction explained this link for girls but not boys.
- Nichols et al 2018- internalisation of appearance ideals & perfectionism at 6 y/o predicted body dissatisfaction at 7 y/o for girls & boys= prediction overtime.
- Evans et al 2017- dietary restraint at age 7 predicted disordered eating at ages 9-13, but body dissatisfaction did not.
- -however body diss tended to happen at same time as dietary restraint- was not a warning symptom.
-Body dissatisfaction appears to function best as longitudinal predictor of disordered eating after the age of 12 (roughly).
what contributes to dev of disordered eating attitudes- Parents -Abramovitz & Birch 2000 -Damiano et al 2015 -Allen et al 2014 -Collins 1991
- Abramovitz & Birch 2000- 5 y/o daughters of dieting mothers had greater knowledge of & endorsement of dieting than girls of non-dieting mothers.
- -modelling behaviour?
- Damiano et al 2015- BUT no relationship b/w maternal dietary restraint & their 5 y/o daughter’s dietary restraint
- -just greater knowledge.
- Allen et al 2014- children of mothers with current or past ED reported sig higher lvls of ED symps & emotional eating than other children
- -shared enviro + hereditary.
-Collins 1991- preschoolers body size rating correlated with their mother’s rating of her own body.
What are the consequences of disordered eating attitudes?
- key 3:
- Keel et al 1997; Gardner et al 2000
- Stice & Bearman 2001
- Field et al 2003
- 1- predict subsequent disordered eating- Keel et al 1997; Gardner et al 2000.
- 2- predict subsequent depress- Stice & Bearman 2001.
- 3- may (counter-intuitively) predict weight gain- Field et al 2003.
Can we think of EDs as “developmental disorders”?
- emerges during developmental process, with diagnosis often coming at a predictable age/stage?
- -AN~ 13 years; BN ~ 17 years.
- manifests on a continuum of severity at least partially grounded in typical developmental process?
- -Dimensional , Not Categorical Phenomena, “Normative” Discontents.
- shows variations in incidence/prevalence for which biology cannot fully account?
- -More Prevalent Amongst Young Females- No Simple Physiological Reason For This.
- diagnosis of AN ~ 13 years, BN ~ 16 years therefore could partially as marked peaks of occurrence.
- diff b/w F & M is not simple physiological reason- developing in social context for F.
Adolescence as “trigger point” for EDs,
(second one)
-Stice 2001
-Sands et al 1997
Schemata continue to dev: depress &/or dieting pave way to disordered eating- (Stice 2001) OR pos experiences mitigate risk.
-Sands et al 1997- girls’ disturbances of body image & eating- freq occur well before puberty.
