Results
Project EAT is the largest and most comprehensive longitudinal body of U.S. research examining predictors of weight-related health in young people. Findings have been disseminated in more than 300 publications and numerous presentations.
Key Findings from Project EAT
Dieting and Weight Control Behaviors
The use of dieting and weight control behaviors was common among adolescents, and these behaviors remained high or increased as they move to young adulthood. Unhealthy weight control behaviors and dieting were associated with several negative health behaviors and outcomes, including poorer dietary intake, decreased physical activity, higher body mass index, increased risk for binge eating and extreme weight control behaviors, and poorer emotional well-being.
Overweight and Obesity
The prevalence of overweight and obesity were high among adolescents and increased as they transitioned to young adulthood. Racial/ethnic disparities were identified in the prevalence of overweight and obesity among adolescents in 1999 and found to secularly increase over the next decade when a new population-based sample of adolescents was measured in 2010.
Shared Risk Factors for Weight-related Health Outcomes
Weight stigma, weight concern, body dissatisfaction, dieting, and unhealthy weight control behaviors in adolescence are shared risk factors for disordered eating and overweight status in adulthood, indicating that prevention programs and interventions should simultaneously address these weight-related problems by reducing dieting and unhealthy weight control behaviors and improving body satisfaction.
Body Dissatisfaction
Higher levels of body dissatisfaction during adolescence are related to poorer emotional well-being, greater use of unhealthy weight control behaviors, and greater weight gain over time.
Weight Stigma
Experiencing weight stigma in adolescence predicted poorer emotional well-being, use of unhealthy weight control behaviors, and higher body mass index (BMI) in young adulthood.
Stressful Life Events
Experiencing stressful life events (e.g., harassment, violence) is related to poorer well-being and higher-risk behaviors.
Family Meals
Participation in family meals is related to a number of positive outcomes, including better dietary intake, fewer unhealthy weight control behaviors, higher family function, and better psychosocial health. Despite the benefits of eating together, frequency of family meal participation varies widely among youth.
Dietary Intake
Most adolescents did not meet recommended daily dietary intake of key nutrients or food groups, but diet generally improved in adulthood. Consumption of fast food, energy-dense, nutrient poor snacks, and sugary beverages was common among adolescents, but decreased between 1999-2010.
Sustainable Eating Practices
A sizable proportion of adolescents reported valuing sustainable eating practices (e.g., vegetarianism, organic, non-processed), and the prevalence of support grew as adolescents transitioned to young adulthood.
Use of Nutrition and Calorie Information Labels
The reading and use of nutrition labels (e.g., Nutrition Facts label, calorie labeling) in making food choices is related to better overall dietary intake, but use of labels is low among young adults.
Home/Family Environment
Several factors in the home/family environment (e.g., healthy eating and physical activity availability and support) play important roles in the weight-related attitudes and behaviors of youth.
Significant Others and Friends
Significant others and friends strongly influence the eating-, activity-, and weight-control behaviors of young people.
Media Environment
Portrayals of healthy and unhealthy weight-related behaviors and influences are prevalent in TV shows aimed at young people. Since the media environment has the ability to influence real-world behaviors, attitudes, and preferences, it is important to understand the content of the TV programs these audiences watch and the messages they send to young people.
Food Insecurity
A high number of parents/caregivers of adolescents experienced food insecurity in 2010 and were at increased risk for poor nutrition outcomes.
Physical Activity and Sedentary Behaviors
Many adolescents fall short of the current recommendations for physical activity and exceed recommendations for media use. Physical activity tends to decrease and media use tends to increase as young people transition from adolescence to adulthood.
Yoga
Regular yoga practice is associated with healthy weight-related behaviors and attitudes, including eating more fruits and vegetables, participating in more physical activity, and having higher body satisfaction.
Sleep
Sleep patterns were associated with eating patterns; going to bed at a later hour was associated with skipping breakfast and poorer dietary intake.
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Dieting and Weight Control Behaviors
Results from the EAT 2010 survey found that the use of dieting and weight control behaviors was common among adolescents:
- Nearly one third of boys and 46% of girls went on a diet in the past year.
- Fifty-four percent of boys and 58% of girls regularly used healthy weight control behaviors such as eating less high-fat food, eating less sweets, and eating more fruits and vegetables over the past year.
- Thirty-eight percent of boys and 50% of girls used unhealthy weight control behaviors such as skipping meals, taking diet pills, and smoking more cigarettes specifically to lose or control their weight.
- A small but concerning percentage of students (4% of boys and 7% of girls) reported use of extreme weight control behaviors such as taking laxatives or diuretics, vomiting after meals, or fasting.
- Encouragingly, there were decreases in the percent of young people using unhealthy weight control behaviors, and increases in young people using healthy weight control behaviors between 1999 and 2010 (EAT-I and EAT 2010).
Results from Project EAT have also shown the prevalence of weight control behaviors remains high or increases among young people during the transition from adolescence to adulthood, and these behaviors tend to track within individuals over time. For example, findings from the 15-year follow-up survey of Project EAT-I participants showed:
- The prevalence of dieting increased from 23% to 44% among male participants and 56% to 65% among female participants from adolescence to adulthood.
- The use of unhealthy weight control behaviors increased from 29% to 38% for male participants from adolescence to adulthood; in contrast, there was a small decrease in use among female participants (from 59% to 56%) during this transition.
- The prevalence of extreme weight control behaviors also increased during the transition from adolescence to adulthood, from 2% to 9% for male participants and 11% to 18% for female participants.
The use of dieting and unhealthy weight control behaviors may counterintuitively led to weight gain and the long-term adoption of unhealthy behaviors. Results from Project EAT indicate that dieting and unhealthy weight control behaviors were associated with poorer dietary intake, decreased physical activity, higher body mass index, and increased risk for binge eating and extreme weight control behaviors. These behaviors were also related to poor emotional well-being, including increased risk for depression and suicidal behaviors and ideation.
Sources:
Crow SJ, Eisenberg ME, Story M, Neumark-Sztainer D. Are body dissatisfaction, eating disturbances, and body mass index predictors of suicidal behavior in adolescents? A longitudinal study. Journal of Consulting and Clinical Psychology. 2008;76:887-892.
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Overweight and Obesity
The increasing prevalence of overweight and obesity among adolescents is a major public health problem. Between 1999 and 2010 (EAT-I and EAT 2010), the overall prevalence of obesity and ethnic/racial disparities increased, particularly among boys.
Results from the EAT 2010 survey indicated that approximately 19% of girls and 26% of boys had body mass index (BMI) values at or above the 95th percentile, which is the cut-off point used for defining obesity in youth. Another 20% of girls and 16% of boys had BMI values classified as overweight (defined as at or above the 85th percentile but less than the 95th percentile).
Girls: Obesity was most common among girls who identified their ethnic/racial background as African American, Hispanic, or Native American. The prevalence of obesity was considerably lower among girls who identified as Asian American or White, but there was evidence of an increase in the prevalence of obesity over the past decade among Asian youth from 7% to 13%.
Boys: Obesity was more common among boys who identified their ethnic/racial background as Hispanic, Asian, or Native American boys than among boys of White or African American ethnicity/race. Evidence of increases in the prevalence of obesity between 1999 and 2010 were observed for African American (from 14% to 21%) as well as Asian (from 21% to 33%) and Hispanic youth (from 20% to 34%).
Longitudinal results from Projects EAT-I, -II, -III, and -IV have also shown overweight/obesity increases among young people during the transition from adolescence to young adulthood. The prevalence of obesity tripled in females (from 10% to 30%) and doubled in males (from 15% to 29%) during this transition. Nearly 30% of both females and males had BMI values in the obesity range in young adulthood.
Sources:
Neumark-Sztainer D, Wall MM, Chen C, Larson N, Christoph M, Sherwood N. Eating, activity, and weight-related problems across the life course from adolescence to adulthood. American Journal of Preventive Medicine. 2018;55(2):133-141.
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Shared Risk Factors For Weight-related Health Outcomes
Weight-related problems, including obesity and disordered eating behaviors such unhealthy weight control behaviors and binge eating, are major public health problems given their high prevalence and adverse health consequences. Research suggests that these weight-related problems can occur simultaneously and lead to the onset of different weight-related problems.
Results from Project EAT I-IV indicate that several socio-environmental, personal, and behavioral factors are strong and consistent predictors of both overweight status and disordered eating later in adolescence and into adulthood. These factors include:
- Weight-based stigma (i.e., teasing)
- Body dissatisfaction/weight concerns
- Dieting
- Unhealthy weight control behaviors
Since there is considerable overlap both in the prevalence of and risk factors for disordered eating and overweight status, prevention programs and interventions should simultaneously address both of these weight-related problems by reducing dieting and unhealthy weight control behaviors and improving body satisfaction.
Sources:
Larson N, Chen Y, Wall M, Winkler MR, Goldschmidt AB, Neumark-Sztainer D. Personal, behavioral, and environmental predictors of healthy weight maintenance during the transition to adulthood. Preventive Medicine. 2018;113:80-90.
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Body Dissatisfaction
A high prevalence of young people express body dissatisfaction, which has emerged as a predictor of a broad range of unhealthy weight-control behaviors and weight-related outcomes, as well as psychological health problems such as depression and poor self-esteem.
Findings from Project EAT have shown…
- Forty-six percent of girls and 26% of boys had high levels of body dissatisfaction as adolescents (Project EAT-I), and these rates increased as young people transition from adolescence to adulthood.
- Young people with higher levels of body dissatisfaction at Project EAT-I were more likely to report unhealthy weight control behaviors, binge eating, and lower levels of physical activity at five-year follow-up.
- Higher levels of body dissatisfaction at EAT-I predicted greater weight gain over time, even after taking starting body mass index into account.
- Higher levels of body dissatisfaction at Project EAT-I were further related to increased risk for depression and poor self-esteem over time.
Sources:
Wang SB, Haynos AF, Wall MM, Chen C, Eisenberg ME, Neumark-Sztainer D. 15-year prevalence, trajectories, and predictors of body dissatisfaction from adolescence to middle adulthood. Clinical Psychological Science. In Press.
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Weight Stigma
Approximately 22% of adolescent males and 25% of adolescent females who participated in Project EAT-I reported being teased about their weight at least a few times per year. These young people reported teasing by both peers and family members.
These findings are concerning as being teased about one’s weight in middle school or high school was found to predict poorer emotional well-being five years later in Project EAT-II. Adolescents who were ever teased about their weight reported lower levels of self-esteem and higher levels of body dissatisfaction. Among females and older males (in high school at EAT-I), ever being teased about one’s weight also predicted more depressive symptoms five years later.
Females who reported being teased about their weight at Project EAT-I were also more likely to report frequent dieting at five-year follow-up than their peers who were not teased.
Males who reported being teased about their weight at Project EAT-I were more likely than their peers to report binge eating and the use of unhealthy weight control behaviors five years later.
Findings from Project EAT-III further indicate that weight teasing remains a concern as young people transition from adolescence to young adulthood. The prevalence of weight teasing remained stable among most groups and, among males, transitioning from early adolescence (mean age = 13 years) to early young adulthood (mean age = 23 years), reports of experiencing weight teasing at least a few times each year were found to increase from 18% to 27%.
Weight-based teasing in adolescence may also have long-term implications for weight-related health outcomes in adulthood. Findings from Project EAT-IV indicate that being teased about one’s weight in adolescence predicted higher BMI and obesity 15 years later (mean age = 31 years). For females, weight-based teasing from peers and family during adolescence also predicted binge eating, unhealthy weight control, eating to cope, poor body image, and recent dieting 15 years later.
Sources:
Puhl RM, Wall MM, Chen C, Austin SB, Eisenberg ME, Neumark-Sztainer D. Experiences of weight teasing in adolescence and weight-related outcomes in adulthood: A 15-year longitudinal study. Preventive Medicine. 2017;100:173-179.
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Stressful Life Events
Harassment
Harassment among children and adolescents is a significant societal problem with serious consequences for health and well-being. EAT 2010 examined diverse adolescents’ experience with harassment (i.e., relating to race, weight, class, or sex) and its associations with health and well-being. The majority of participants—57% of girls and 53% of boys—reported experiencing some type of harassment, and almost one in three reported multiple types of harassment.
Among female adolescents, weight-based harassment was the most prevalent (38.2%), followed by race-based (31.4%), sexual harassment (29.0%), and class-based harassment (14.0%). Among male adolescents, race-based harassment was most prevalent (39.5%), followed by weight-based (31.8%), sexual harassment (20.4%), and class-based harassment (18.6%). Adolescents who had body mass indexes (BMIs) that were classified as overweight or obese reported higher rates of all forms of harassment than adolescents with nonoverweight BMIs, as did Asian and mixed-race adolescents.
These harassment experiences were associated with a broad range of negative behaviors and conditions. In general, adolescents who reported some form of harassment had lower self-esteem and body satisfaction, greater symptoms of depression, and greater odds of substance use and self-harm behaviors than did those who had not been harassed. Weight-based and sexual harassment were particularly potent correlates with these negative health outcomes.
Given the high prevalence and cumulative effects of harassment reported by adolescents, interventions should address the full spectrum of identity-based mistreatment that young people experience.
Sources:
Intimate Partner Violence
Among the adolescents who participated in Project EAT-II, 20.8% of girls and 9.6% of boys reported they had been victims of physical and/or sexual dating violence.
Report of dating violence was associated with several negative health behaviors and outcomes, including substance use (e.g., cigarette, marijuana use), binge eating, weight gain, depressive symptoms, and suicidal ideation and attempts. It was also associated with high-risk sexual behaviors (e.g., multiple sexual partners, no contraceptive use, unprotected intercourse).
Sources:
Ackard DM, Eisenberg ME, Neumark-Sztainer D. Associations between dating violence and high-risk sexual behaviors among male and female older adolescents. Journal of Child & Adolescent Trauma. 2012;5(4):344-352.
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Family Meals
Project EAT has extensively explored the health benefits of family meals and the predictors and barriers to eating together; contributing more to the scientific literature on family meals in the homes of adolescents than any other study.
Project EAT-I found that family meals can be a challenge to implement and maintain for various reasons, including parent and adolescent schedules, adolescents’ desire for autonomy, dissatisfaction with family relationships, and dislike of foods served at family meals, but eating together is beneficial when it does occur. Adolescents who ate regular family meals had higher fruit, vegetable, and calcium intakes than their peers who reported not having regular family meals, and they drank significantly fewer sodas. Results from Project EAT-II further showed that young people who had more family meals during high school had higher daily intakes of fruit, vegetables, calcium, and other important nutrients in early young adulthood.
Project EAT-III survey results showed that having more frequent shared household meals in young adulthood was associated with better dietary intake, including greater intake of fruits and vegetables, milk products, and some key nutrients among females, and greater intake of fruits among males. Young adults who had frequent family meals during adolescence were more likely to have shared household meals with their own children in young adulthood.
In addition to the observed nutritional benefits, family meals have also been associated with greater psychosocial well-being, higher family functioning, and a reduced risk of using unhealthy weight control behaviors.
Between 1999 and 2010 (EAT-I and EAT 2010), increased attention has been given to family meals in the scientific literature and popular media. Despite the attention to the benefits of eating together, results from the EAT 2010 survey indicated the frequency of family meals either remained stable or decreased in the homes of adolescent girls, middle school students, Asian adolescents, and youth from low-socioeconomic backgrounds.
Sources:
Neumark-Sztainer D, Wall M, Fulkerson JA, Larson N. Changes in the frequency of family meals from 1999-2010 in the homes of adolescents: Trends by sociodemographic characteristics. Journal of Adolescent Health. 2013;52(2):201-6.
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Dietary Intake
Nutrition Recommendations vs. Actual Intake
Project EAT-I found there are large gaps between nutrition recommendations and the actual dietary patterns of adolescents.
Among the students surveyed, only 30% of girls and 42% of boys consumed the recommended amount of calcium (1300 mg or more per day). Approximately 45% of both girls and boys ate more than two servings of fruit per day, while only about 16% ate more than three servings of vegetables per day. Middle school students had higher calcium, fruit, and vegetable intakes than older students in high school.
Across ethnicity/race, nutrient intakes varied considerably. Fewer young people identifying as Asian American or Hispanic met calcium intake recommendations compared to their peers. However, young people of Asian American and Hispanic ethnicity/race were most likely to report eating five or more fruits and vegetables daily.
Findings from Project EAT-IV indicated that as young people transition from adolescence to adulthood, diet generally improves; however, the prevalence of meeting recommended daily intake for key MyPlate food groups remains low. As participants aged from their mid-twenties to early thirties, vegetable intake increased (18% for females and 9% for males), dairy intake decreased (15% for females and 17% for males), and fruit intake increased for females (8%) but decreased slightly for males (7%).
Sources:
Fast Food
Foods consumed away from home, as well as a growing proportion of those consumed at home, are frequently purchased at fast-food restaurants. These patterns are of public health concern given that frequent consumption of fast food is linked to poor diet quality and may lead to greater weight gain.
Project EAT-I found that 24% of males and 21% of females reported frequent intake of fast food (3 or more times per week) during adolescence. Fast food intake increased at follow-up five years later, and then subsequently decreased at 10- and 15-year follow-up.
Eating more frequently at fast food restaurants that serve primarily burgers and French fries was associated with higher intake of total energy, sugar-sweetened beverages, and fat, and lower intake of healthy foods. It was also associated with higher risk of overweight/obesity. In contrast, sandwich/sub shop use and full-service restaurant use were unrelated to weight status. While sandwich/sub shop use was related to higher total energy, fat, and sodium intake, full-service restaurant use was related only to higher intake of vegetables and dark green/orange vegetables.
Between 1999 and 2010 (EAT I and EAT 2010), frequent fast food consumption decreased among adolescents—from 25% to 19%—and mothers—from 17% to 11%. However, fast food consumption did not decrease among some ethnic/racial groups most vulnerable to poor nutrition. For example, prevalence of frequent fast food consumption remained highest and did not decrease among young people who identified their ethnicity/race as Black or Native American.
Sources:
Snacks and Sugary Beverages
Consuming energy-dense, nutrient-poor snack foods (e.g., potato chips, cookies, candy) is common among adolescents, and these snacks and drinks may replace foods recommended to maintain good health.
Results from the EAT 2010 survey indicated that adolescents consumed an average of 4.3 snacks per day and 2.2 energy-dense snack food servings per day. Adolescents that snacked had higher total energy intake, and consumed more sugar-sweetened beverages and fast foods and fewer fruits and vegetables.
Sugary drink consumption among adolescents was also common. On average, EAT 2010 participants consumed 0.8 servings of sugary drinks per day. Over a third of the participants had consumed sports drinks and 14.7% consumed energy drinks once per week. Both sports and energy drink consumption were related to unhealthy behaviors including higher sugar-sweetened beverage intake, video game use, and smoking cigarettes.
Between 1999 and 2010 (EAT-I and EAT 2010), there were small deceases in the number and daily servings of energy-dense, nutrient-poor snacks and sugary drinks consumed by adolescents, but disparities persisted among ethnic and racial subgroups. For example, consumption of energy-dense, nutrient-poor snacks and sugary drinks remained highest among young people who identified as Black, Native American, and mixed/other races.
Sources:
Larson N, Miller J, Watts A, Story M, Neumark-Sztainer D. Adolescent snacking behaviors are associated with dietary intake and weight status. Journal of Nutrition. 2016;146(7):1348-1355.
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Sustainable Eating Practices
Vegetarianism was reported by about 6% of adolescents who participated in Project EAT-I, nearly 75% were females, and 75% had been so for longer than one year. When asked why they were vegetarian, participants reported the following top five reasons:
- To lose or not gain weight (35%)
- Do not want to kill animals (28%)
- Don’t like the taste of meat (27%)
- To have a healthier diet (25%)
- To help the environment (17%)
Adolescents who participated in Project EAT also valued sustainable eating practices. Among those surveyed, nearly 21% reported it was important that their food be locally grown and 23% reported it was important for it to be organic. Over a third of respondents reported that it was it was important that their food be nongentically engineered and approximately 30% felt it was important that their food be non-processed. Support of these sustainable eating practices grew as adolescents transitioned from adolescence to young adulthood. Approximately one third of participants reported supporting 2+ practices in middle to late adolescence. By young adulthood, 53% reported supporting 2+ practices.
Vegetarians and those that supported sustainable eating practices were more likely to meet certain dietary recommendations and consumed significantly less fast food and sugar-sweetened beverages (e.g., soda, fruit drinks). Specifically, young people who were vegetarians and/or supported sustainable practices had significantly higher intakes of several nutrient-rich foods, including whole fruits, vegetables, and dark green vegetables, and lower intake of total and saturated fats.
While results indicated that vegetarians had healthier dietary patterns and were less likely than those who were never vegetarians to have a body mass index that was classified as overweight or obese, they were also more likely to use unhealthy weight control behaviors (e.g., purging, using diet pills), particularly males. Since vegetarians are more likely to meet dietary guidelines and be at a healthy weight, and the environmental benefits are of importance to young people, education regarding healthy vegetarianism is critical to help prevent unhealthy weight control behaviors among youth.
Also, since a growing number of young people support environmental sustainability, it would be helpful for future studies to evaluate the effectiveness of addressing sustainable diet practices as part of public health messaging and programming designed to promote healthy food choices.
Sources:
Larson N, Laska MN, Neumark-Sztainer D. Do young adults value sustainable diet practices? Continuity in values from adolescence to adulthood and linkages to dietary behavior. Public Health Nutrition. 2019 [Epub Ahead of Print].
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Use of Nutrition and Calorie Information Labels
Nutrition Facts on Packaged Foods
Most packaged food products have a Nutrition Facts label, which is intended to provide consumers with information to help them make informed food choices. Research suggests that, if used, Nutrition Facts labels support food shoppers in making healthy food choices. However, studies have also found some unhealthy eating behaviors to be associated with frequent use of Nutrition Fact labels.
Results from EAT-IV indicated…
- Only just over 30% of young adult participants used nutrition fact labels frequently (i.e., most of the time or always)
- People with the following demographics were more likely to read Nutrition Facts frequently:
- Women
- People with high education and income
- People who regularly prepare food
- People who are physically active
- People classified as overweight
- People who were trying to lose, gain or maintain weight
- Label users consumed more fruits and vegetables and whole grains and fewer sugary drinks than those who didn’t use labels.
- Greater nutrition facts use was associated with a greater likelihood of engaging in healthy (e.g., watching portion sizes, eating more fruits and vegetables, exercising) and unhealthy (e.g., using food substitutes, fasting/eating very little food (men), binge eating (women)) weight control behaviors.
Calorie Labeling on Restaurant Menus
Project EAT-IV also examined the use of calorie information on restaurant menus among young adult participants and its relationship to weight-related concerns and behavior.
- More than half of participants noticed calorie information while purchasing food in a restaurant, but nearly 40% reported that they did not use it to decide what to order.
- The most common use of calorie information by participants was to avoid high-calorie items or deciding on smaller portion sizes.
- Participants who reported using menu labels to limit calorie intake were more likely than others who noticed menu labels to also report weight-related concerns, dieting, and the use of unhealthy weight control behaviors.
Calorie labeling on restaurant menus may lead consumers to select lower calorie choices and encourage restaurants to offer lower-calorie menu items. However, health professionals that provide care for patients with weight-related concerns should consider assessing patients for anxiety around eating in restaurants, increased use of unhealthy weight control behaviors in response to calorie information, and excessive concern with calorie information that interferes with eating an overall healthy diet.
Sources:
Larson NI, Haynos AF, Roberto CA, Loth KA, Neumark-Sztainer D. Calorie labels on the restaurant menu: Is the use of weight-control behaviors related to ordering decisions? Journal of the Academy of Nutrition and Dietetics. 2018;118(3):399-408.
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Home/Family Environment
Results from EAT 2010 indicate that several factors within the home/family environment play important roles in the weight-related attitudes and behaviors of children and adolescents:
Healthy Food Availability and Preparation
- When healthy foods were available in the home, adolescents ate more fruits and vegetables and fewer sodas and snack foods.
- Adolescents that lived in homes where healthy foods were readily available were more likely to have lower BMIs.
- Planning and preparing healthy meals and eating as a family were also associated with higher intake of fruits and vegetables among adolescents.
Physical Activity Environment
- Adolescents who had access to physical activity equipment in the home engaged in more moderate-to-vigorous physical activity.
- Adolescents who had access to equipment for media viewing (e.g., TV, computer) reported more TV viewing time.
Parental/Family Support
- Parental support, encouragement, and modeling of healthy eating and activity behaviors was associated with higher intake of fruits and vegetables and more moderate-to-vigorous physical activity.
- Adolescents who reported high family functioning and strong parental connection were less likely to engage in dieting and disordered eating behaviors.
Sources:
Berge JM, Wall M, Larson N, Eisenberg MA, Loth KA, Neumark-Sztainer D. The unique and additive associations of family functioning and parenting practices with disordered eating behaviors in diverse adolescents. Journal of Behavioral Medicine. 2014;37(2):205-17.
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Significant Others and Friends
Significant Others
Having a significant other has been shown to be improve individuals’ physical and psychological health conditions. Less is known about how significant others impact weight-related health behaviors, such as healthy dietary intake, physical activity, and weight-control behaviors. Result from Project EAT-III and IV indicate that significant others play a significant role in the weight-related health of young adults.
Women who had who had significant others with health-promoting attitudes and behaviors were less likely to be at a weight status classified as overweight or obese. They were also more likely to engage in physical activity and eat more fruits and vegetables. Men with significant others with health-promoting attitudes and behaviors were more likely to engage in physical activity.
Weight-based comments made by significant others were also found to impact an individuals’ weight-control behaviors. Among participants who completed the Project EAT-III survey, 21.2% of females and 23.8% of males with a significant other had received hurtful weight-related comments from them. These weight-based comments, as well as the perceived encouragement to diet by a significant other, were associated with participants’ own unhealthy weight control behaviors, especially among females.
Project EAT-IV further found that the type of weight-based comments made by significant others was significantly associated with body satisfaction, self-esteem, and depressive symptoms, for both men and women. Those who received only positive comments had the best emotional well-being, and those who received only negative comments had the worst emotional well-being.
Sources:
Friends
Friends and peers have been found to be an important influence on weight-related behaviors and outcomes. Findings from Project EAT have shown that friends influence both healthy and unhealthy weight-related behaviors of young people.
When young people had friends that engaged in healthy weight-related behaviors, including participating in physical activity and eating healthier foods, they were more likely to engage in those same behaviors.
Conversely, when young people had friends that engaged in unhealthy weight-related behaviors, they were more likely to engage in those same behaviors. For example, Project EAT found that friends’ dieting behaviors were associated with unhealthy weight control behaviors among females; and the dieting behavior of friends was associated with chronic dieting, unhealthy and extreme weight control behaviors, and binge eating 5 years later. Project EAT also found that friends’ intake of sugar-sweetened beverages and fast food, as well as screen time activity, was associated with the same behaviors in participants.
Sources:
Watts AW, Miller J, Larson N, Eisenberg ME, Story MT, Neumark-Sztainer D. Multicontextual correlates of adolescent sugar-sweetened beverage intake. Eating Behaviors. 2018;30:42-48.
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Media Environment
Watching television is common and frequent among young people; adolescents aged 12-17 years spend more than 18 hour per week watching TV. Given such high TV usage among adolescents, it is important to understand the content of the TV programs these audiences watch and the messages they send to young people. EAT 2010 examined the most popular TV shows watched by survey participants, analyzing the content for important factors that could influence weight-related health.
Weight stigma
Half of the episodes analyzed contained at least one weight-stigmatizing incident. Both youth and adult programming contained weight-stigmatizing comments, but the percent of comments was higher for youth-targeted (55.6%) than general audience-targeted shows (8.3%). Male characters were more likely than females to engage in and be targets of weight stigma. Watching shows with weight stigma was associated with lower body satisfaction among girls.
Snacks and Beverages
Snacks were shown often in the episodes analyzed and typically included unhealthy foods or behaviors, such as watching television while eating. Snacking incidents disproportionately included low-socioeconomic status and overweight young characters. Snacking was also more common in sitcoms than in other types of shows and less common in shows that target adult audiences.
Beverage incidents were also common, with alcohol being the most common (38.8%). Significant differences were found by the shows’ target audience; water and sugar-sweetened beverages were prevalent in youth shows and less common in shows created for a general or adult audience. Likewise, young characters were shown consuming sugar-sweetened beverages, milk, and juice more than older characters.
Physical Activity
Almost all of the analyzed shows included at least one incident of physical activity, and the most common reason for TV character involvement in physical activity was for fun and/or recreation. Male and female characters were equally likely to engage in physical activity; however, there were fewer incidents of female character involvement in physical activity for competitive sport. Though fewer in number, overweight characters were just as involved in physical activity as average weight characters.
TV content has the ability to influence youth behaviors, attitudes, and preferences in the real world. Therefore, efforts to increase understanding of this content and minimize portrayals of weight stigma and unhealthy foods and eating behaviors, and instead maximize portrayals of messages around healthy eating and physical activity, could be very helpful in promoting weight-related health.
Sources:
Eisenberg ME, Ward E, Linde JA, Gollust SE, Neumark-Sztainer D. Exposure to teasing on popular television shows and associations with adolescent body satisfaction. Journal of Psychosomatic Research. 2017;103:15-21.
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Food Insecurity
Household food insecurity was experienced by almost 39% of the parents and caregivers who participated in Project F-EAT and 13% reported very low food security. Food-insecure parents of adolescents were more likely than food-secure parents to have body mass indexes classified as overweight and reported poorer nutrition-related outcomes:
- Food-insecure parents ate breakfast less frequently, consumed more sugar-sweetened beverages, and were more likely to report binge eating compared to those who were food secure.
- Among parents who reported having family dinners, those who were food insecure reported more often serving sugar-sweetened beverages at dinner and less often serving healthy items such as green salad, vegetables, and fruit compared to those who were food secure.
- In comparison to food-secure parents, those who were food insecure reported greater barriers to purchasing fruits and vegetables in terms of neighborhood access to a variety of affordably-priced and high-quality produce.
Food insecurity may also influence parenting practices used to regulate children’s eating. The EAT 2010 and Project F-EAT studies found that mothers from households experiencing low or very low food security were more likely to report that they engage in parenting practices that have been linked to higher child BMI and disordered eating. Specifically, food-insecure mothers were more likely to be concerned about and comment on their sons’ weight and use restrictive feeding practices with their daughters.
Source:
Bauer KW, MacLehose R, Loth KA, Fisher JO, Larson NI, Neumark-Sztainer D. Eating and weight-related parenting of adolescents in the context of food insecurity. Journal of the Academy of Nutrition and Dietetics. 2015;115(9):1408-16.
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Physical Activity & Sedentary Behaviors
Physical activity has numerous benefits, including better cardiovascular health, stronger bones, and improved mental health and mood. The Physical Activity Guidelines for Americans recommend that adolescents participate in 60 minutes or more of physical activities every day. It is also recommended that young people limit the time they spend doing more sedentary activities. Specifically, the American Academy of Pediatrics (AAP) recommends that parents/caregivers place consistent limits on the time adolescents spent using media, and make sure media does not take the place of adequate sleep, physical activity, and other behaviors essential to health. AAP also recommends designating media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.
Results from the EAT 2010 survey indicated that, on average, boys engaged in 6.7 hours of moderate-to-vigorous physical activity (MVPA) and girls participated in 5 hours per week. Boys also reported more screen time compared to girls (45 hours/week vs. 36.5 hours/week). Over a quarter of parents of EAT 2010 participants reported frequent TV watching during family meals.
Longitudinal results from Projects EAT-I, II, III, and IV have also shown that moderate and vigorous physical activity (MVPA) tends to decrease and media use tends to increase as young people transition from adolescence to adulthood. Having a child, getting married, and moving out of your parent’s home were life events associated with significant decreases in MVPA among participants as they transitioned to adulthood.
Sources:
Miller JM, Nelson TF, Barr-Anderson DJ, Christoph MJ, Winkler M, Neumark-Sztainer D. Life events and longitudinal effects on physical activity: adolescence to adulthood. Medicine & Science in Sports & Exercise. 2018 Nov 8.
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Yoga
Yoga is an activity that combines physical movement, breathing, meditation, and mindfulness. There is growing evidence that practicing yoga may positively impact health, including improving body image and addressing other weight-related problems, such as disordered eating, body dissatisfaction, and obesity.
Project EAT-IV found that 56% of young adult women and 29% of young adult men reported ever practicing yoga. The number of young adults that regularly practiced yoga (30 minutes/week) was significantly lower, with 20% of women and 6% of men practicing regularly.
Regular yoga practice was positively associated with several healthy weight-related behaviors and attitudes. Those that reported that they practiced yoga regularly also reported that they:
- Ate more fruits and vegetables and fewer snacks and sugary drinks
- Ate out at fast food restaurants less often
- Engaged in higher levels of moderate to vigorous physical activity
- Had higher body satisfaction
Practicing yoga regularly may be helpful in weight gain prevention. Results from Project EAT-IV found that young adults who were overweight and practiced yoga regularly had a non-significant 5-year decrease in their BMIs, while those who did not had significant increases in their BMIs.
While the potential for yoga to promote healthy behaviors and prevent weight gain among young adults is encouraging, several barriers could keep yoga from becoming widely practiced if not addressed. Young adults from all ethnic/racial backgrounds and socioeconomic levels reported practicing yoga, but percentages were lower among those who identified with a background other than white and among those who reported lower levels of educational attainment and household income.
Sources:
Neumark-Sztainer D, MacLehose RF, Watts AW, Eisenberg ME, Laska MN, Larson N. How is the practice of yoga related to weight status? Population-based findings from Project EAT-IV. Journal of Physical Activity and Health. 2017;14(12):905-912.
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Sleep
The Academy of Sleep Medicine and several other organizations currently recommend that adults sleep for at least 7 hours per night. Failing to meet these recommendations has been associated with poor physical health, mental health, and quality of life. Research also suggests that shorter sleep duration may be a risk factor for increased BMI and obesity.
Results from the Project EAT-III survey indicated that the vast majority (88.5%) of young adult participants met the current guidelines for sleep duration. Those who slept less than the currently recommended 7 hours were more likely to be males, identify with an ethnic/racial background other than white, have less formal education, and have higher depressive symptoms than those who slept longer.
Going to bed at a later time was associated with some unhealthy eating behaviors. Those who went to bed after 12:30 a.m. consumed more servings of sugary drinks, skipped breakfast more often, and consumed fast food more times per week compared to those that went to bed before 10:30 p.m.
Project EAT-III also found that sleeping less than 7 hours per day was positively associated with BMI, overweight, and obesity among men, but not women. Men who sleep less than 7 hours per day had 1.4 unit higher BMIs than those that sleep between 7-9 hours per day.
Sources:
Meyer, Wall MM, Larson NI, Laska MN, Neumark-Sztainer D. Sleep duration and body mass index in a sample of young adults. Obesity. 2012;102(3):520-526.
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