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DISORDERED EATING ATTITUDES, OBESITY INDICES AND PSYCHOLOGICAL FACTORS' A CROSSSECTIONAL STUDY IN PR

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Title: DISORDERED EATING ATTITUDES, OBESITY INDICES AND PSYCHOLOGICAL FACTORS' A CROSSSECTIONAL STUDY IN PR


1
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
    Greece²Department of Nutrition and Dietetics,
    Harokopio University, Athens, Greece

2
  • 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
19951521073-1074 Patton et al. BMJ
1999318765768 1999
3
  • 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 15912841293, 2002
4
Factors
  • Genetics
  • Society that idolizes thinness yet pushes food
    that causes obesity
  • Unrealistic ideals
  • Endocrine system
  • Familys attitude
  • Controlling family
  • Inability to cope with stress
  • Sports Teams
  • Dieting

5
AIM OF THE STUDYThe aim of the study was to
determine the associations between eating
disorders, obesity and psychological factors in
Greek primary school children.
6
  • 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),
  • Harters 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.

7
  • 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 2000320 1240-1243 Taylor et
al. Am J Clin Nutr. 200072490-495
8
  • 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-??).
  • 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 2000320 1240-1243 Slaughter et
    al. Human Biol 198860700923.

9
  • 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
    198212871-878
  • 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
    44262273
  • 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 3113-119

10
  • 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 19876485494
  • Cooper et al. Int J Eat Disord
    199313385-389
  • 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


11
  • Harters 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, 1983275-385.
12
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 Mar109(3)429-33B
urrows et al. Int J Obes Relat Metab Disord. 2002
Sep26(9)1268-73
13
  • Results
  • There were strong positive correlations between
  • eating disorders (Eating Attitudes Test/EAT-26)
    and
  • body mass index (BMI) (Pearsons correlation
    coefficient, r0.153, plt0.012),
  • waist circumference (WC) (r0.172, plt0.005),
  • hip circumference (HC) (r0.167, plt0.006),
  • left triceps skinfold thickness (r0.134,
    plt0.026),
  • scapular skinfold thickness (r0.136, plt0.025),
  • body fatness (r0.192, plt0.002),
  • body image (Body Shape Questionnaire/BSQ-34)
    (r0.478, plt0.001) and
  • negative correlation with the physical
    appearance (Harters Self-Perception Profile for
    Children) (r-0.127, plt0.041).

14
Correlation between EAT-26 and BMI, WC and HC
15
Correlation between EAT-26 and left triceps
skinfold thickness , scapular skinfold thickness
16
Correlation between EAT-26 and body fatness and
BSQ-34
17
Negative Correlation between EAT-26 and physical
appearance (Harters Self-Perception Profile for
Children)
18
  • 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.

19
Nutrition Topics How to...
  • maintain a healthy weight
  • stop unhealthy behaviors
  • eat normally again
  • normalize metabolism
  • choose a nutritious diet
  • challenge distorted beliefs

20
Nutrition Topics
  • Increase self-esteem and self-acceptance
  • Nutrition education
  • Medical consequences of the disorde

21
Psychological Issues
  • Eating d/o as the SYMPTOM, not the PROBLEM.
  • Coping mechanism
  • how does she/he benefit from the disorder?

22
Psychological Issues
  • Feeling fat catch all phrase for almost any
    negative emotion
  • Must work through the underlying issues in
    psychotherapy
  • Food behaviors are addictive

23
Psychological Issues
  • Cannot simply stop starving,bingeing or purging
  • liabilities vs. the benefits of the disorder
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