Pediatric Weight Management

PWM: Eating Behaviors of Children (2006)

Citation:
Pastore DR, Fisher M, Friedman SB. Abnormalities in weight status, eating attitudes, and eating behaviors among urban high school students: correlations with self-esteem and anxiety. J Adolesc Health 1996;18:312-9. PubMed ID: 9156542
 
Study Design:
Cross-Sectional Study
Class:
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To determine the prevalence of abnormalities in weight, eating attitudes and eating behaviors among an (inner-city) urban teenage population.

Inclusion Criteria:
Not specified.
Exclusion Criteria:

Not specified, but each questionnaire was successfully completed (if there were two or fewer blank answers) by approximately 75% of students.

Description of Study Protocol:

Recruitment

  • Not described.

Design

  • Data collected from students from a single New York City high school as a part of a health education program (Health Screening Week) developed by school-based clinic staff, faculty, administration and students. Each student attending regularly scheduled PE class was assessed for height, weight, visual acuity and blood pressure. Approximately 70 high school students on a nursing assistant career track were trained to do the assessments and were supervised by school staff. Several questionnaires were also administered during the week.

Statistical Analysis

  • X2 analysis to determine variations by age, gender and grade
  • ANOVA and two-tailed T-tests to determine significance of mean score differences
  • Spearman correlation coefficients to detect relationships among weight status and eating attitudes, self-esteem and anxiety.
Data Collection Summary:
  • Blinding: None.

Dependent Variables

  • Weight status: Height and weight measured; based on percentage IBW (ideal weight based on weight-for-height tables of Baldwin, 1961) (N=1,001)
    • Obese: =120% IBW (25% of subjects)
    • Overweight: 110-119% IBW (18% of subjects)
    • Normal weight: 86-109% IBW (52% of subjects)
    • Underweight: =85% (5% of subjects).

Independent Variables

  • Nutritional behaviors survey: More than three times in prior week; N=753
    • Breakfast skipping
    • Lunch skipping
    • Dinner skipping
    • Eating three meals per day
    • Eating fast food
    • Eating candy
    • Drinking soda
    • Drinking coffee
    • Eating fruits or vegetables
    • Eating bread or grains
    • Drinking milk.

Other Variables

  • Exercised: At least 30 minutes more than three times in prior week; N=753
  • Smoking: Five to 10,  more than three times in prior week; N=753
  • Weight status perceptions: Questionnaire; N=577
  • Eating attitudes: Eating Attitudes Test (EAT-26); questionnaire by Garner and Garfinkel (1979) to measure three factors: Dieting behavior, bulimic behavior and control around eating; N=683
  • Global self-esteem: Rosenberg Self-Esteem Scale (Rosenberg, 1979); N=711
  • Chronic anxiety: Spielberger Trait Anxiety Scale (Spielberger, 1973); N=691.

Control Variables

  • Gender (separate analyses).
Description of Actual Data Sample:

N

  • 1,001 (45% male, 55% female) high school students
  • Participation rate: Roughly 66% of total student body of approximately 1,500
  • Sample size varies by instrument (see data collection), but for outcomes of interest; N=753.

Age

  • Mean, 16 years.

Ethnicity

  • 66% black
  • 23% Hispanic
  • 8% white
  • 3% Asian (total student body).

Other Demographics

  • Low income: 66%
  • No health insurance: 20%
  • Medicaid: 14%
  • Private insurance (total student body): Over 50% of public housing in borough of Queens is located in Far Rockaway.

[Note: School would not allow individual student assessment of ethnicity and SES.]

Location

  • The Far Rockaway peninsula, New York City.
Summary of Results:

Reported Diet-related Behaviors

  • Breakfast skipping: 59% (male<female)
  • Lunch skipping: 43% (male<female)
  • Dinner skipping: 14%
  • Ate three meals per day: 43% (male>female)
  • Ate fast foods: 28%
  • Ate candy: 60% (male<female)
  • Drank soda: 55% (male>female)
  • Drank coffee: 10%
  • Ate fruits or vegetables: 55%
  • Ate bread or grains: 66% (male>female)
  • Drank milk: 70% (male>female).

Relationship of Diet-related Behaviors with Weight Status:

  • Breakfast skipping: Obese (72%) > underweight (30%); P<.001; among obese, male<female
  • Ate three meals per day: Obese (32%) < underweight (59%), Among obese, male>female
  • Lunch skipping: N/S
  • Dinner skipping: N/S
  • Fast food intake: N/S
  • No discussion of other diet-related behaviors.

[Note: See paper for additional details on the results of the other measures.]

Physical activity

  • 39% (male>female).

Smoking

  • 5%.

Eating attitude scores

  • Abnormal for 15% females and 6% males (similar to other studies).

Self-esteem scores

  • Mean score of 1.4 (higher self-esteem than in other studies).

Anxiety scores

  • High anxiety in 17% (similar to other studies).

Weight relationships

  • Spearman correlations: No significant relationships between %IBW and the Eat-26, self-esteem or anxiety
  • T-tests: Higher weight status students had more abnormal eating attitudes than those who were normal or underweight.
Author Conclusion:

Among this population of urban high school students there were:

  1. A large number of overweight adolescents
  2. A significant subgroup with eating attitudes suggestive of an eating disorder
  3. High levels of self-esteem and normal levels of anxiety, which were independent of weight status.
Funding Source:
Reviewer Comments:

Strengths

  • Large sample size of minority, low-income teens
  • Multiple measures.

Weaknesses

  • No comparison of those included and not included in the study or those that completed and did not complete questionnaires
  • Subject ethnicity and SES defined on the basis of school rather than personal data, which may result in misclassification
  • No inclusion or exclusion criteria
  • Recruitment not described
  • Used weight and height stated that it is not routinely used limiting comparison with other studies
  • Unclear how meal skipping and fast foods were defined (or if simply relied on self-perception of subjects
  • Incomplete reporting of results for diet-related behaviors in relation to weight status.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? No
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? N/A
  2.2. Were criteria applied equally to all study groups? No
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? No
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? No
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? ???
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? No
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? N/A
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? No
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? No
  8.7. If negative findings, was a power calculation reported to address type 2 error? No
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? ???
  10.2. Was the study free from apparent conflict of interest? Yes