Eating habits and physical activity in dieter and non-dieter youth: A gender analysis of English and Spanish adolescents

This is an Accepted Manuscript version of the following article, accepted for publication in The Social Science Journal, P. Ramos, F. Brooks, I. García-Moya, F. Rivera & C. Moreno (2013) Eating habits and physical activity in dieter and non-dieter youth: A gender analysis of English and Spanish adolescents, The Social Science Journal, 50:4, 575-582, DOI: 10.1016/j.soscij.2013.09.017 It is deposited under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. Eating habits and physical activity in dieter and non-dieter youth: A gender analysis of English and Spanish adolescents Ramos, P.a, Brooks, F.b, García-Moya, I. c, Rivera, F.d & Moreno, C.e aDepartment of Developmental and Educational Psychology, University of Seville. C/ Camilo José Cela s/n. Facultad de Psicología. Sevilla 41018, Spain. Email: [email protected]. Phone: (34) 954557696. bDepartment of Adolescent and Child Health, University of Hertfordshire, Hatfield AL10 9AB, United Kingdom. Email: [email protected]. Phone: +44 (0)1707 285992. cDepartment of Developmental and Educational Psychology, University of Seville. C/ Camilo José Cela s/n. Facultad de Psicología. Sevilla 41018, Spain. Email: [email protected]. Phone: (34) 954554331. dDepartment of Clinical, Experimental and Social Psychology, University of Huelva. Huelva 21071, Spain. Email: franci[email protected].es. Phone: (34) 959218427. eDepartment of Developmental and Educational Psychology, University of Seville. C/ Camilo José Cela s/n. Facultad de Psicología. Sevilla 41018, Spain. Email: [email protected]. Phone: (34) 954557678. Running title:Eating habits and physical activity in young dieters. Eating habits and physical activity in dieter and non-dieter youth: A gender analysis of English and Spanish adolescents Abstract A high prevalence of youth is overweight or obese, and a frequent lack of monitoring of their weight control strategies is observed. Consequently, this paper compares the eating habits and physical activities of male and female dieters and non-dieters. Data are obtained from the large cross-national WHO collaborative study “Health Behavior in School-aged Children 2010”. The current sample consists of 9,444 students aged 11, 13 and 15 years from England and Spain. Participants are asked about dieting, vigorous and moderate-to-vigorous physical activity, breakfast frequency and fruit, vegetable, sweet and soft drink consumption. A logistic regression is used to examine the differences between dieters and non-dieters with regard to the aforementioned eating and physical activity habits. Differences between genders, countries, and those associated with BMI (body mass index) are also considered. The results suggest that the reality of weight control differs from the major health promotion recommendations during adolescence. Keywords: weight control, eating habits, physical activity, body mass index, adolescence, England, Spain 1. Introduction The increasing prevalence of youths who are overweight or obese (Currie et al., 2008; World Health Organization, 2009) is a global issue that has further increased societal concerns regarding youth nutrition. International public health guidelines in response to obesity suggest that youths improve their nutrition by reducing their intake of high caloric foods and salt, as well as increasing their physical activity levels and consumption of fruits, vegetables, and fish (World Health Organization, 2006). Several studies also indicate that eating fruits and vegetables during adolescence is a health-promoting habit that reduces the risk of cancer and other chronic diseases in later life (Maynard et al., 2003). Despite such protective benefits of a healthy diet during adolescence, numerous studies report low rates of fruit and vegetable intake in adolescent populations (Lorson, Melgar-Quinonez, & Taylor, 2009). On the contrary, the intake of high caloric food, such as sweets and sugar rich soft drinks, is increasing among youths at a vertiginous pace, especially among the adolescent population in Europe and North America (Kassem & Lee, 2004). In addition, the relationship between physical activity and weight is extensively studied, and the results suggest that the increasing rate of obesity among Western societies is related to the global reduction in physical activity (Janssen et al., 2005). Short-term intervention trials also indicate that physical activity is the most effective weight control strategy (McGuire et al., 1999). Adolescence marks a time of increased independence and self-determination with regard to food choices and consumption. Among those adolescents who are dissatisfied with their body image, some will undertake weight control methods. However, the weight-reduction behaviors that adolescents undertake are not always appropriate. A common strategy among youth to control weight is skipping breakfast (Timlin et al., 2008). This meal is more frequently missed than lunch or dinner (Woodruff et al., 2008). In fact, skipping or having an inappropriate or insufficient breakfast is a relatively frequent habit among adolescents (Alexy, Wicher, & Kersting, 2010). Thus, dieting usually involves reducing one’s daily caloric intake more than is recommended. Furthermore, medical monitoring is generally absent during dieting, which can increase the potential for serious health risks caused by uncontrolled extreme dieting (Eisenberg et al., 2005; Larson, Neumark-Sztainer, & Story, 2009). Consequently,comparing the eating and physical activity habits of adolescents who diet with those who do not allows us to explore types of dieting and weight control that might be distinctive during adolescence, as well as to understand youth’s relationship with food consumption and nutrition. Lastly, this study might add insight to our knowledge of youth conceptions of health and well-being. This paper compares dieting adolescents between two European countries: England and Spain. A cross-cultural comparison is valuable because both England and Spain have made efforts to promote healthy eating and weight control behaviors in schoolchildren. The prevalence data from both countries indicates that their youth obesity rates are comparable; in 2009, the Health Survey of England found obesity rates of 19.7% for boys and 15.4% for girls among 11- to 15-year-olds (Coleman, Brooks, &Treadgold, 2011). In Spain, data from the 2010 Health Behavior in School-aged Children (HBSC) indicate that rates of obese and overweight adolescents are 20.6% for boys and 13.5% for girls (Moreno, Ramos, Rivera, Jiménez-Iglesias, & García-Moya, 2012). In both England and Spain, one of the priority health promotion interventions and education strategies within schools is the achievement of healthy physical activities and eating habits. Strategies to achieve these goals include the promotion of healthy eating behaviors, the inclusion of physical activity as an everyday life activity both inside and outside the schools, and the reduction of overweight and obese children, as well as their unhealthy eating behaviors (Salvador, & Suelves, 2009). In Spain, national and regional strategies primarily target schools. In England, the areas that influence healthy weight are targeted, such as the recommended levels of physical activity, as well as the adequate intake of fruits and vegetables (Department of Health, 2010). In both countries, similar school-based interventions are developed to encourage healthy eating behaviors and physical activity, including advice for schools to provide nutritionally appropriate menus for school dining rooms and ensure that only healthy food is available in the school cafeterias and vending machines, thereby reducing access to food with poor nutritional value (Department of Health, Department for Children, Schools and Families, 2005; Spanish Ministry of Health and Consumption, 2005). However, England and Spain have different cultural contexts with regard to patterns of food consumption. For example, England has a longer history with and higher consumption rates of processed and convenience foods, and fewer English youths eat with their families on a daily basis compared with Spanish youths. Consequently, given the similar policy approaches regarding the promotion of healthy eating habits among youths between these countries, exploring the potential differences in eating habits and physical activities among young dieters and non-dieters in both countries is useful because the influence of the macro-level determinants on health behaviors, such as cultural norms and differences within physical and social environments, offers ways to refine the policies to ensure effective health promotion strategies (Hawks et al., 2002; Orleans, 2000). This study explores the differences between dieters and non-dieters from England and Spain with regard to breakfast frequency; the consumption of fruits, vegetables, sweets, and soft drinks; and physical activity. In addition, important gender differences exist with regard to weight control and body image (Larson et al., 2009; Neumark-Sztainer, Story, Falkner, Beuhring, & Resnick, 1999; Ramos, Rivera, & Moreno, 2012); therefore, it is necessary to examine and account for gender differences in eating habits and physical activity among young dieters. This paper also aims to achieve a deeper understanding of the key gender issues related to patterns of eating and physical activities among young dieters from both countries. Finally, it is important to consider the high proportion of young dieters who are not overweight; in other words, a portion of average-weight or even low-weight adolescents also diet, especially girls (Bun, Schwiebbe, Schütz, Bijlsma-Schlösser, & Hirasing, 2012; Ursoniu, Putnoky, & Vlaicu, 2011). Accordingly, this study also analyzes whether significant differences in eating habits and physical activity exist among average-weight or low-weight dieters, as well as overweight and obese dieters. This analysis will also account for the potential influence of the adolescents’ genders and countries of residence. 2. Methods 2.1. Participants Data for this study is from the 2010 edition of the large cross-national WHO collaboration,“Health Behavior in School-aged Children” (HBSC) from England and Spain. Thus, the current sample consists of 9,444 schoolchildren aged 11, 13 and 15 years – 46% males and 54% females – from England and Spain with a mean age of 13.72 years. The sampling procedure of the HBSC is similar between all participating countries. Specifically, cluster sampling in which the primary sampling unit is the school is used to obtain national representative samples. Additional information regarding the sampling procedure and other aspects of data collection can be found in Roberts et al. (2009). 2.2. Measures The HBSC is a broad survey that investigates adolescent health behaviors from a multidisciplinary perspective. The relevant University Research Ethics Committees in England and Spain approve the use of this self-report questionnaire. The HBSC collects information from adolescents with regard to various lifestyles topics including their well-being and the contexts in which they were reared, such as their families, peers, and schools. This study includes a large bank of questions throughout its 30-year history, and the vast majority of them are reliable and valid. The following paragraphs describe the instruments used in this work. The independent variable is dieting as measured by the item "At present, are you on a diet or doing something else to lose weight?" The dependent variables are participants’ eating and physical activity habits. The following eating habits are examined: days per week that the adolescents report having more than a glass of milk or a piece of fruit for breakfast from 0 to 7 days a week; and the times per week that the adolescents report consuming the following: fruits, vegetables, sweets, and soft drinks: (never/less than once a week/once a week/2-4 days a week/5-6 days a week/once a day, every day/every day more than once. To analyze these variables, they are categorized into three groups based on consumption frequency. The three breakfast consumption categories are daily (7 days a week), irregular (1-6 days a week), and never (0 days a week). The three food or drinks consumption groups are daily (at least once a day), medium (more than once a week), and low (once a week or less). The physical activity instruments are based on the recommendations regarding moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) from the "Young and Active?" international meeting held in 1997 (Biddle, Sallis, & Cavill, 1998). The frequency of MVPA is measured using the question,"Over the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?" The response categories range from 0 to 7 days. VPA is measured using the question,"How often do you usually engage in vigorous physical activity so much that you get out of breath or sweat?" The seven possible answers include every day, 4 to 6 times a week, 2 to 3 times a week, once a week, once a month, less than once a month, and never. These variables are classified as appropriate for data analyses when the reported frequency complies with the experts’ recommendations for youths: (a) at least 60 minutes, 5 days a week for MVPA or (b) at least 2 times a week for VPA (Pate et al., 2002). Otherwise, they are classified as inappropriate. Finally, the following variables are also included: country of residence, gender, and body mass index (BMI). BMI is the ratio between self-reported weight and height (kg/m2). Overweight and obese categories are distinguished from average or low weight categories using the cut-off points proposed by Cole et al. (2000). 2.3. Procedure The study’s international organization, HBSC, dictates that three data collection procedure conditions must be fulfilled: the students must answer the questionnaire themselves; the anonymity of the answers must be strictly guaranteed; and the questionnaires must be administered at their school. 2.4. Data Analyses The data analyses are performed using IBM SPSS Statistics 19. Specifically, we employ logistic regression models that control for the effects of country and gender. Furthermore, we examine the potential interaction effects involving those variables. Models are interpreted using odds ratios and 95% CIs. The significance threshold is a p-value lower than .05. 3. Results 3.1. Dieting, eating habits and physical activity in male and female adolescents from Spain and England Table 1 displays the percentages of adolescents by country, gender, and the interaction of country by gender with regard to dieting, eating habits, and physical activity. Patterns of fruit consumption are similar among Spanish and English adolescents (p>.005). In contrast, differences are found between adolescents from Spain and England with regard to the regularity of breakfast eating (p<.001, OR = 0.513, 95% CIs = 0.365-0.721), vegetable consumption (p<.001, OR = 1.931, 95% CIs = 1.770-2.106), sweets consumption (p<.001, OR = 2.280, 95% CIs = 1.944-2.674), and soft drink consumptions (p<.001, OR = 2.759, 95% CIs = 2.394-3.180). Specifically,the latter show a higher likelihood of consuming vegetables, sweets, and soft drinks daily and a lower likelihood of having breakfast everyday. The results also show that girls are more likely to be on a diet than boys (p<.001, OR = 2.232, 95% CIs = 1.862-2.676). This gender difference is stronger in England than Spain (p = .009, OR = 0.22, 95% CIs = 0.566-0.922). In addition, although eating habits do not differ by gender (p>.005), boys are more likely to report appropriate levels of MVPA (p<.001, OR = 2.187, 95% CIs = 1.896-2.522) and VPA (p<.001, OR = 2.127, 95% CIs = 1.875-2.412) compared with girls. -Table 1- 3.2. Comparisons of eating habits and physical activity between male and female adolescent dieters and non-dieters from Spain and England The comparisons of eating and physical activity habits between adolescent dieters and non-dieters are shown in Table 2. The comparison of adolescent dieters and non-dieters in both countries reveals significant differences in breakfast regularity (p<.001, OR = 3.259, 95% CIs = 2.282-4.655), sweets consumption (p<.001, OR = 0.493, 95% CIs = 0.396-0.613), and VPA (p<.001, OR = 1.915, 95% CIs = 1.553-2.361). Specifically, adolescent dieters are more likely to have irregular or nonexistent breakfasts and to show a low consumption of sweets compared with non-dieters. With regard to physical activity, dieters are more likely to report appropriate levels of VPA, especially in England (p = .011, OR = 0.700, 95% CI = 0.533-0.921). The interaction of diet by country reveals that the proportion of dieters who practice appropriate levels of MVPA is lower in Spain than England (p = .037, OR = 0.776, 95% CIs = 0.612-0.98). Finally, the diet by gender interaction reveals that only male dieters are more likely to consume fruits (p = .030, OR = 0.584, 95% CIs = 0.359-0.949), andVPA is more frequent in dieting females (p = .038, OR = 0.765, 95% CIs = 0.567-0.961). -Table 2- 3.3. BMI status, eating habits, and physical activity among male and female dieters from Spain and England According to the BMI results, the percentages of overweight and obese adolescents are similar in both countries: 16.9% in Spain and 13% in England. Gender differences only appear References Alexy, U., Wicher, M., & Kersting, M. (2010). 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Available at: http://www.who.int/child_adolescent_health/topics/prevention_care/adolescent/de/en/ Table 1. Percentage of adolescents with regard to dieting, eating habits and physical activity indicators by country, gender and gender by country Country Gender Gender by Country Spain England Boy Girl Spain England Boy Girl Boy Girl On a diet No 86.1% 84.2% 89.4% 81.6% 88.9% 83.3% 89.9% 80.0% Yes 13.9% 15.8% 10.6% 18.4% 11.1% 16.7% 10.1% 20.0% Breakfast Daily 56.2% 49.9% 57.9% 49.5% 59.8% 52.7% 55.3% 46.0% Irregular 41.6% 46.4% 39.4% 47.5% 38.0% 45.0% 41.4% 50.1% Never 2.2% 3.6% 2.7% 3.0% 2.2% 2.3% 3.4% 3.8% Fruits Daily 48.0% 49.2% 45.5% 51.1% 46.2% 49.7% 44.6% 52.5% Medium 41.6% 41.8% 43.8% 39.9% 43.4% 39.9% 44.2% 40.0% Low 10.4% 9.1% 10.7% 9.0% 10.4% 10.4% 11.2% 7.5% Vegetables Daily 33.6% 47.5% 37.1% 42.6% 31.6% 35.6% 44.4% 49.8% Medium 59.0% 42.8% 52.9% 50.4% 59.5% 58.5% 43.9% 42.0% Low 7.4% 9.7% 10.1% 7.0% 8.9% 5.9% 11.7% 8.2% Sweets Low 40.7% 26.1% 35.7% 32.5% 42.4% 39.1% 26.6% 25.8% Medium 44.0% 48.6% 44.7% 47.3% 43.3% 44.8% 46.7% 49.9% Daily 15.2% 25.3% 19.6% 20.2% 14.3% 16.1% 26.7% 24.3% Soft drinks Low 41.0% 25.7% 29.5% 37.6% 35.5% 46.3% 21.6% 28.7% Medium 36.9% 37.0% 39.9% 34.4% 40.9% 33.0% 38.5% 35.9% Daily 22.1% 37.3% 30.6% 28.0% 23.6% 20.7% 39.9% 35.4% VPA Appropriate 63.7% 67.6% 75.4% 57.1% 74.1% 53.5% 77.2% 60.7% Inappropriate 36.3% 32.4% 24.6% 42.9% 25.9% 46.5% 22.8% 39.3% MVPA Appropriate 45.4% 48.3% 57.4% 37.6% 56.3% 34.9% 59.0% 40.4% Inappropriate 54.6% 51.7% 42.6% 62.4% 43.7% 65.1% 41.0% 59.6% Note.Significant differences (in bold) according to OR from logistic regression analyses. Table 2. Adolescent dieter and non-dieter comparisons of eating habits and physical activity On a diet Country Gender No Yes Spain England Boy Girl Nondieters Dieters Nondieters Dieters Nondieters Dieters Nondieters Dieters Breakfast Daily 55.3% 42.1% 57.9% 46.2% 52.0% 37.8% 58.8% 50.3% 52.1% 38.1% Irregular 42.3% 52.5% 40.3% 49.1% 44.8% 56.2% 38.8% 45.1% 45.5% 56.2% Never 2.4% 5.4% 1.8% 4.8% 3.2% 6.0% 2.4% 4.6% 2.4% 5.8% Fruits Daily 48.2% 51.5% 47.6% 50.9% 48.9% 52.1% 45.4% 47.8% 50.7% 53.2% Medium 41.7% 40.9% 41.9% 39.8% 41.5% 42.0% 43.4% 45.8% 40.2% 38.5% Low 10.1% 7.6% 10.6% 9.3% 9.6% 5.9% 11.1% 6.4% 9.2% 8.2% Vegetables Daily 39.8% 41.9% 33.3% 35.7% 47.6% 48.4% 37.1% 36.4% 42.3% 44.6% Medium 51.6% 51.1% 59.3% 57.4% 42.4% 44.5% 52.7% 55.6% 50.6% 48.9% Low 8.6% 7.0% 7.4% 6.9% 10.0% 7.1% 10.2% 7.9% 7.2% 6.5% Sweets Low 32.5% 42.1% 39.1% 50.4% 24.4% 33.5% 34.3% 45.8% 30.8% 40.3% Medium 46.6% 43.9% 44.8% 39.7% 48.8% 48.2% 45.5% 40.0% 47.6% 45.7% Daily 20.9% 14.0% 16.1% 9.9% 26.8% 18.3% 20.2% 14.2% 21.6% 14.0% Soft drinks Low 33.4% 36.4% 40.2% 45.4% 25.3% 27.2% 29.1% 33.4% 37.5% 37.9% Medium 37.3% 35.2% 37.5% 33.7% 37.1% 36.8% 40.4% 37.6% 34.5% 34.0% Daily 29.2% 28.4% 22.3% 20.9% 37.6% 36.0% 30.5% 29.0% 28.1% 28.1% VPA Appropriate 64.5% 70.5% 63.2% 66.0% 66.0% 75.1% 75.0% 78.9% 54.9% 66.5% Inappropriate 35.5% 29.5% 36.8% 34.0% 34.0% 24.9% 25.0% 21.1% 45.1% 33.5% VMPA Appropriate 47.2% 44.0% 46.2% 40.7% 48.4% 47.5% 57.6% 55.8% 37.4% 38.2% Inappropriate 52.8% 56.0% 53.8% 59.3% 51.6% 52.5% 42.4% 44.2% 62.6% 61.8% Note. Significant differences (in bold) according to OR from logistic regression analyses. Table 3. Overweight/obese and non-overweight dieter comparisons with regard to eating habits and physical activity Overweight or obese Country Gender Yes No Spain England Boy Girl Yes No Yes No Yes No Yes No Breakfast Daily 43.7% 43.0% 46.5% 46.8% 38.6% 33.7% 55.9% 47.9% 38.9% 39.2% Irregular 50.2% 51.4% 48.1% 48.5% 54.0% 58.7% 38.8% 47.9% 54.6% 54.1% Never 6.1% 5.6% 5.4% 4.8% 7.4% 7.6% 5.3% 4.2% 6.5% 6.6% Fruits Daily 51.5% 53.5% 50.8% 53.8% 52.7% 52.7% 52.3% 49.0% 51.1% 57.1% Medium 41.4% 39.4% 41.4% 38.5% 41.5% 41.9% 42.0% 46.2% 41.2% 34.2% Low 7.1% 7.0% 7.9% 7.7% 5.8% 5.4% 5.7% 4.9% 7.7% 8.7% Vegetables Daily 39.0% 41.3% 32.5% 39.7% 50.4% 45.2% 29.9% 39.2% 42.6% 42.9% Medium 55.2% 52.0% 60.7% 54.7% 45.5% 45.2% 60.9% 53.8% 52.9% 50.5% Low 5.8% 6.7% 6.9% 5.6% 4.0% 9.7% 9.2% 7.0% 4.5% 6.5% Sweets Low 40.9% 50.8% 46.4% 56.8% 31.3% 35.5% 43.7% 51.7% 39.9% 50.0% Medium 44.0% 39.8% 42.1% 36.3% 47.3% 48.4% 39.7% 40.6% 45.7% 39.1% Daily 15.0% 9.5% 11.4% 6.8% 21.4% 16.1% 16.7% 7.7% 14.4% 10.9% Soft drinks Low 40.9% 39.8% 45.2% 44.9% 33.5% 26.9% 33.3% 36.4% 43.9% 42.4% Medium 35.0% 32.4% 35.5% 32.1% 33.9% 33.3% 40.2% 39.2% 32.9% 27.2% Daily 24.1% 27.8% 19.3% 23.1% 32.6% 39.8% 26.4% 24.5% 23.2% 30.4% VPA Appropriate 68.7% 69.4% 65.9% 65.9% 73.5% 77.9% 79.9% 75.6% 64.2% 64.9% Inappropriate 31.3% 30.6% 34.1% 34.1% 26.5% 22.1% 20.1% 24.4% 35.8% 35.1% VMPA Appropriate 46.2% 40.4% 44.1% 39.7% 50.0% 42.2% 65.3% 48.6% 38.7% 33.9% Inappropriate 53.8% 59.6% 55.9% 60.3% 50.0% 57.8% 34.7% 51.4% 61.3% 66.1% Note. Significant differences (in bold) according to OR from logistic regression analyses. Yes = overweight or obese, No = non-overweight.