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

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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

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• 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
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• 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
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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

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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.
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• 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.

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• 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
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• 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.

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• 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

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• 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

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• 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.
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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
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• 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).

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

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Nutrition Topics How to...

• maintain a healthy weight
• stop unhealthy behaviors
• eat normally again
• normalize metabolism
• choose a nutritious diet
• challenge distorted beliefs

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Nutrition Topics

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

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Psychological Issues

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

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Psychological Issues

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

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Psychological Issues

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