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Risky Dieting Amongst Adolescent Girls: Associations With Family Rela-tionship Problems And Depressed Mood

Gemma L.M. Hinchliff (Hons), Adrian B. Kelly, Gary C.K. Chan, George C.Patton, Joanne Williams

PII: S1471-0153(16)30081-2DOI: doi: 10.1016/j.eatbeh.2016.06.001Reference: EATBEH 1066

To appear in: Eating Behaviors

Received date: 17 March 2016Accepted date: 1 June 2016

Please cite this article as: Hinchliff (Hons), G.L.M., Kelly, A.B., Chan, G.C.K., Pat-ton, G.C. & Williams, J., Risky Dieting Amongst Adolescent Girls: Associations WithFamily Relationship Problems And Depressed Mood, Eating Behaviors (2016), doi:10.1016/j.eatbeh.2016.06.001

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RISKY DIETING AMONG ADOLESCENT GIRLS 1

BRIEF RESEARCH REPORT

RISKY DIETING AMONGST ADOLESCENT GIRLS: ASSOCIATIONS WITH

FAMILY RELATIONSHIP PROBLEMS AND DEPRESSED MOOD

Gemma L. M. Hinchliff (Hons) 1,2, Adrian B. Kelly PhD 1, Gary C. K. Chan PhD 1,

George C. Patton PhD 4,5, and Joanne Williams PhD 3

1. Centre for Youth Substance Abuse Research, The University of

Queensland, Brisbane, Australia

2. School of Psychology, The University of Queensland

3. Deakin University, Melbourne, Australia

4. Murdoch Children’s Research Institute, Melbourne, Australia

5. Department of Paediatrics, The University of Melbourne, Melbourne,

Australia

WORD COUNT (ABSTRACT): [134]

WORD COUNT (MANUSCRIPT): [1493]

RUNNING HEAD: [RISKY DIETING AMONG ADOLESCENT GIRLS]

CORRESPONDING AUTHOR: Adrian B. Kelly PhD, Centre for Youth Substance

Abuse Research, The University of Queensland, Brisbane, QLD 4072. Email:

a.kelly@uq.edu.au. Phone: +61 7 33655143. Fax: +61 7 33655488

ACKNOWLEDGEMENTS: This research was funded by an NHMRC Project

Grant to J. Williams, J. Toumbourou, R. Homel, and G. Patton. Data analysis and

preparation of this manuscript was supported by ARC DP130102015 to A. B. Kelly

(first investigator). The first author completed this research in fulfilment of an

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RISKY DIETING AMONG ADOLESCENT GIRLS 2

honours dissertation under the supervision of the second author. Study sponsors were

not directly involved in the production of this manuscript or decision to submit the

manuscript for publication. We thank Professor John Toumbourou for his assistance

and guidance with respect to this manuscript.

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RISKY DIETING AMONG ADOLESCENT GIRLS 3

Abstract

Objective: This study examined the association of risky dieting amongst

adolescent girls with depressed mood, family conflict, and parent-child emotional

closeness. Method: Grade 6 and 8 females (aged 11-14 years, N = 4,031) were

recruited from 231 schools in 30 communities, across three Australian States

(Queensland, Victoria, and Western Australia). Key measures were based on the

Adolescent Dieting Scale, Short Mood and Feelings Questionnaire, and widely used

short measures of family relationship quality. Controls included age, early pubertal

onset, and socioeconomic status. Results: Risky dieting was significantly related to

family conflict and depressed mood, depressed mood mediated the association of

family conflict and risky dieting, and these associations remained significant with

controls in the model. Conclusion: Family conflict and adolescent depressed mood

are associated with risky dieting. Implications: Prevention programs may benefit

from a broadening of behavioural targets to include depressed mood and family

problems.

Key Words: adolescent, female, dieting, family, conflict, depressed mood

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RISKY DIETING AMONG ADOLESCENT GIRLS 4

Preoccupations with weight and weight control are prevalent amongst

adolescent girls (1), and dieting may carry heightened health risks regardless of

overweightness (2). When dieting pre-occupations become excessive, there are

increased risks of psychological distress, nutritional deficiencies, and subsequent

eating disorders (3). In Australia, available data indicate that amongst 12-17 year

olds, approximately 39% of girls compared to 13% of boys are classified as

intermediate or extreme dieters (4).

In this study we examined the association of depressed mood and family

relationship problems with dieting in a large population of early adolescent girls (11-

14 years of age). While some research indicates simple associations between dieting

and depressed mood, family problems, and early pubertal onset, research is needed on

the extent to which these factors predict dieting independent of each other. This is

important because contextual factors are likely to be interrelated, and the

identification of significant independent contextual factors should inform prevention

policies and programs. The first hypotheses was that depressed mood and family

relationship quality would be associated with dieting. Drawing on research showing

that depressed mood mediates linkages between family distress and other adolescent

health risk behaviours (5), the second hypothesis was that depressed mood would

mediate any family relationship – dieting association.

METHOD Sample

The sample consisted of 4058 girls in Grade 6 (modal age 11 years) and

Grade 8 (modal age 13) from 231 schools located in 31 Australian communities

(Victoria/Queensland/Western Australia).

Survey Procedure

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RISKY DIETING AMONG ADOLESCENT GIRLS 5

Data was collected via a two-stage sampling strategy (community and

school). The community sampling frame consisted of Statistical Local Areas (6).

Within each community, primary (N = 164) and secondary schools (N = 82) were

randomly selected. Of schools invited to participate, 83% (n = 443) responded,

and of these, 52% agreed to participate. Adolescents only participated if signed

parent consent was obtained (67% response rate). The survey was approved by

the University of Melbourne Human Research Ethics Committee. Further details

of the survey methods are described elsewhere (7). Of the analysis sample, 684

girls had missing data on one or more variables, of which 8, 115, and 27

participants had missing data on depressed mood, family conflict, and dieting

respectively. Missing data were multiply imputed with chained equations using

STATA 13 (5 datasets). Twenty-seven girls were excluded because responses

were unreliable (e.g., reported Menarche under 6 years of age).

Measures

Participants completed a modified version of the Communities That Care

(CtC) Youth Survey (8). Dieting was assessed using the 8-item Adolescent Dieting

Scale (ADS) (4). The ADS assesses calorie counting, reducing food quantities at

meals, and skipping meals (e.g., “Do you try to eat less than a certain number of

calories as a means of controlling weight?”; 4-point Likert scales from 0

“Seldom/never” to 3 “almost always”; α=0.87).

Depressed mood was measured using the 13-item Short Mood and Feelings

Questionnaire (SMFQ) (9) (α = .91). Family conflict was assessed using three items

(e.g., “People in my family often insult and yell at each other”) (4-point Likert scale 1

‘YES!’ to 4 ‘NO!’; α=.80) (10). Parent-child emotional closeness was measured using

three items for each parent (e.g., “Do you feel close to your mother/father?”) (11) (4-

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RISKY DIETING AMONG ADOLESCENT GIRLS 6

point scale, α=.82-83). Pubertal timing was assessed with the items “Have you begun

to menstruate (had your first period)” (yes/no) (12), and “How old were you when

you started to menstruate (had your first period)?” (13). Participants who responded

„yes‟ to the first question were coded as having early pubertal onset if they reported

an age of menarche of 11 years or younger. Socioeconomic status (SES) was

determined using standard Australian census measures based on income and type of

occupation.

Analysis

Analyses were performed using STATA13. In Model 1, dieting was regressed

on family conflict, allowing for the estimation of the total effect of family conflict on

dieting. In Model 2, depressed mood was regressed on family conflict, to estimate the

statistical effect of family conflict on depressed mood. In Model 3, dieting was

regressed on family conflict and depressed mood. This allowed the estimation of the

direct and indirect effects of family conflict on dieting (via depressed mood). Control

variables were adjusted in each model. The product of the coefficient of family

conflict in Model 2 and the coefficient of depressed mood in Model 3 was calculated,

and its 95% confidence interval was computed using 5000 bootstrap replicates. A

95% confident interval that does not include zero indicates significant mediation.

RESULTS

For Model 1 there was a significant total effect of family conflict on dieting

after adjusting for controls (Table 1). There were significant yet small associations

between dieting and age (p<.001), early pubertal onset (p<.001), and socioeconomic

advantage (p<.001). The association of dieting and mother/father emotional closeness

was nonsignificant. For Model 2 there was a significant effect of family conflict on

depressed mood (p<.001). Depressed mood was also positively associated with early

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pubertal onset (p<.001), and negatively associated with high socioeconomic

advantage (p<.05) and emotional closeness to either parent (p<.001). For Model 3

there was a significant direct effect of family conflict on dieting (p<.001). The effect

of depressed mood was also significant (p < .001). The product of the relevant

coefficient was 0.05 (95% CIs = 0.04,0.06), indicating a significant indirect effect of

family conflict on dieting through depressed mood. Comparison of family conflict

coefficients across Models 1-3 indicated that 44% of the total effect was mediated by

depressed mood.

[TABLE 1 HERE]

DISCUSSION

The key findings of this study were that dieting behaviour was negatively

associated with family conflict, positively associated with depressed mood, and that

depressed mood mediated family conflict and dieting behaviour. Dieting behaviour

was also associated with socioeconomic disadvantage and early pubertal onset.

Emotional closeness to parents showed weak and consistent associations with

depressed mood. While this study is based on a large sample and controls for several

potential confounds, it is cross-sectional nature so it cannot address etiological

pathways. The results are consistent with earlier research that family conflict leads to

depressed mood, particularly in girls, and this may contribute to weight gain and

weight control behaviours, including excessive dieting. The present study points to

the need for further research on the longitudinal role of family distress and depressed

mood in driving excessive dieting. If family conflict and depressed mood are drivers

of early and excessive dieting, parents may benefit from education on effective

conflict management, and school-based programs might increase their focus on

depressed mood. The study is limited by its reliance on adolescent self-report and the

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RISKY DIETING AMONG ADOLESCENT GIRLS 8

positive parental consent mechanism may have biased the sample towards those with

fewer problems (14).

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RISKY DIETING AMONG ADOLESCENT GIRLS 9

References

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relation in African-American and Caucasian children. Journal of Clinical Child

Psychology. 1995;24(1):41-8.

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behavioral correlates of dieting among overweight and non-overweight adolescents.

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eating disorders: population based cohort study over 3 years. BMJ (Clinical research

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Adolescent dieting: healthy weight control or borderline eating disorder? Journal of

child psychology and psychiatry, and allied disciplines. 1997;38(3):299-306.

5. Chan GCK, Kelly AB, Toumbourou JW. Accounting for the association of

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6. ABS. Socio-economic indices for areas. Canberra: Australian Bureau of

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adolescent problem behaviors. The Communities That Care Youth Survey. Eval Rev.

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Catalano RF. Gender differences in the impact of families on alcohol use: A lagged

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RISKY DIETING 11

Table 1. Regression models of dieting and depressed mood (N = 3704 females, 11-13 years old).

Model 1

Dieting

Model 2

Depressed mood

Model 3

Dieting

b 95% CI b 95% CI b 95% CI

Age -0.06*** (-0.08, -0.04) -0.02 (-0.03, 0) -0.05*** (-0.08, -0.03)

Early puberty 0.11*** (0.05, 0.16) 0.08*** (0.04, 0.12) 0.09** (0.03, 0.14)

Socio-economic status (Ref: 1st Quartile - Least advantaged)

2nd quartile -0.09*** (-0.14, -0.04) 0.02 (-0.02, 0.05) -0.09*** (-0.14, -0.05)

3rd quartile -0.07** (-0.12, -0.02) 0.00 (-0.04, 0.04) -0.07** (-0.11, -0.02)

4th

quartile - Most advantaged -0.10*** (-0.14, -0.05) -0.05** (-0.09, -0.01) -0.08*** (-0.13, -0.04)

Emotional closeness with mother 0.00 (-0.03, 0.04) -0.09*** (-0.12, -0.07) 0.03 (0, 0.06)

Emotional closeness with father 0.00 (-0.03, 0.03) -0.07*** (-0.09, -0.05) 0.02 (-0.01, 0.05)

Family conflict 0.12*** (0.09, 0.14) 0.18*** (0.17, 0.2) 0.07*** (0.05, 0.09)

Depressed mood 0.26*** (0.22, 0.3)

R

2 = 0.05 R

2 = 0.20 R

2 = 0.09

Notes. * p < .05; ** p < .01; *** p < .001. Bold text indicates findings relating to the key research question. Model 1 tests

whether family conflict predicts dieting without depressed mood in the model. Model 3 includes depressed mood in the model,

and shows a significant drop in the effect for family conflict. Model 2 tests the association of family conflict with depressed mood.

Early Puberty was based on items relating to whether Menarche had occurred and the age at which Menarche occurred (see

Measures).

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AUTHOR DISCLOSURE STATEMENTS

Statement 1: Role of Funding Sources

This research was funded by an NHMRC Project Grant to J. Williams, J.

Toumbourou, R. Homel, and G. Patton. Data analysis and preparation of this

manuscript was supported by ARC DP130102015 to A. B. Kelly (first investigator).

Study sponsors were not directly involved in the production of this manuscript or

decision to submit the manuscript for publication.

Statement 2: Contributors

Hinchliff completed this project as part of her honours dissertation under the

supervision of the second author. Chan assisted in the data analysis. Hinchliff and

Kelly wrote the first draft of the manuscript. Patton provided conceptual input on the

study and reviewed the final manuscript. All authors contributed to and have

approved the final manuscript.

Statement 3: Conflict of Interest

All authors declare that they have no conflicts of interest.

Statement 4: Acknowledgements (optional)

The authors thank Professor John Toumbourou for his assistance and guidance with

respect to this manuscript.