Do disordered eating behaviours in girls vary by school characteristics? A UK cohort study

Abstract

Previous research on eating disorders, disordered eating behaviours, and whether their prevalence varies across schools, has produced inconsistent results. Our previous work using Swedish record-linkage data found that rates of diagnosed eating disorders vary between schools, with higher proportions of girls and higher proportions of highly educated parents within a school being associated with greater numbers of diagnosed eating disorders. We aimed to extend these findings to a UK population-based sample and hypothesised that a similar association would be evident when studying disordered eating behaviours. We used data from the Avon Longitudinal Study of Parents and Children to test the hypothesis that prevalence of self-and parent-reported disordered eating behaviours (binge eating, purging, fasting, restrictive eating, and fear of weight gain), and body dissatisfaction cluster by school. We had complete data on body dissatisfaction, school attended, and other possible risk factors for 2146 girls in 263 schools at age 14 and on disordered eating behaviours for 1769 girls in 273 schools at age 16. We used multilevel logistic regression modelling to assess whether prevalence varied between and within schools, and logistic regression to investigate the association between specific school characteristics and prevalence of disordered eating behaviours and body dissatisfaction. At age 14, there was no evidence for body dissatisfaction clustering by school, or for specific school characteristics being associated with body dissatisfaction. At age 16, there was no evidence for clustering, but higher rates of disordered eating behaviours were associated with attending all-girl schools and lower levels with attending schools with higher academic results. We found no evidence for clustering of disordered eating behaviours in individual schools, possibly because of the small cluster sizes. However, we found evidence for higher levels of disordered eating behaviours in 16 years in all-girl schools, and in schools with lower academic performance.

Patterns of weight control behavior persisting beyond young adulthood: Results from a 15‐year longitudinal study

“…These findings highlight the importance of delivering intervention early to those engaging in weight control behaviors that have a negative physical and psychological impact, since these patterns are unlikely to discontinue as an individual progresses throughout the lifespan. However, in line with other research (Bould et al, ; Nagata et al, ; Watson et al, ), we also noted several patterns of heterogeneity, revealing complexity in the data not captured by population‐level prevalence rates. Although persistence in use or non‐use of weight control behaviors was the norm across behaviors, other patterns were also common.…”

“…Estimates suggest that one‐third of adolescents (Neumark‐Sztainer & Hannan, ) and two‐thirds of adults (Reba‐Harrelson et al, ) engage in dieting. A smaller, but still substantial portion of adolescents and adults engage in the most unhealthy and disordered forms of weight control, such as severely restricting intake, fasting, or purging through vomiting or laxatives (Bould, De Stavola, Lewis, & Micali, ; Mitchison, Hay, Slewa‐Younan, & Mond, ). Although certain forms of weight management may be benign or, in some cases, recommended (Haynos, Field, Wilfley, & Tanofsky‐Kraff, ), even relatively common patterns of weight control behavior have been associated with negative psychological consequences.…”

“…For instance, although prior Project-EAT group-level analyses found that dieting decreased overall for male participants between Waves 1 and 2 (Neumark-Sztainer et al, 2011), during this same time period, approximately 25% of male participants continued or initiated dieting (Neumark-Sztainer, Wall, Story, & Standish, 2012) and this subset of males gained more weight by Wave 3. Other research has demonstrated that weight control patterns vary according to clinical and demographic characteristics, including body mass, sexual minority status, or school setting (Bould et al, 2018;Nagata et al, 2018;Watson et al, 2017). Thus, by averaging data, group-level time courses may fail to capture information about alternate patterns of weight control behavior that could have critical implications for outcome.…”

Disordered eating among Australian adolescents: Prevalence, functioning, and help received

“…Given evidence of the validity of the combined “purging” variable, we combined the measures of induced vomiting and use of laxatives or other medicines in the same way. All DE measures, aside from the measure of unhealthy exercise, have been used in published literature (Bould, De Stavola, Lewis, & Micali, ; Micali et al, ). Due to the narrow definition of unhealthy exercise (i.e., the measure only asked about timing of exercise and not its intensity or duration [Supporting Information File S1]), and because there is no published literature on its validity, it was excluded from our operationalization of DE.…”

Negative Affect and Situational Antecedents of Eating in Disordered Eating and Normal Population an Ecological Momentary Assessment Study

“…Disordered Eating (DE) refers to a range of unhealthy behaviours that occur at a lesser frequency, or lower level of severity, than an eating disorder. Even though the symptoms of DE might not be as extreme as those of a diagnosable eating disorder, individuals with DE are at increased risk of developing a full-blown eating disorder and are more likely to suffer of depression and/or anxiety and other mental health problems [1,2].…”