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Sub- Title Understanding and Prevention of Disordered Eating in Malaysian Adolescents Chin YS 1,2 , Tay CW 1 , Sharifah Intan Zainun SI 1 , Mohd Nasir MT 1 , and Zalilah MS 1,2 1 Department of Nutrition and Dietetics, Faculty of Medicine and

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Sub- Title

Understanding and Prevention of Disordered Eating in Malaysian Adolescents

Chin YS1,2, Tay CW1, Sharifah Intan Zainun SI1, Mohd Nasir MT1, and Zalilah MS1,2

1Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 2Research Centre of Excellence Nutrition and Non-Communicable Diseases, Faculty of Medicine

and Health Sciences, Universiti Putra Malaysia

3Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

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OUTLINE:

  • Impacts of disordered eating in adolescents
  • Disordered eating related studies in

Malaysian adolescents

  • Factors associated with disordered eating
  • Intervention related to disordered eating

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DISORDERED EATING VS. EATING DISORDERS

Any difference?

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Eating Disorders

 Characterized by a persistent cognitive

distortions related to food and body weight, and disturbed eating patterns

 Defined by clinical criteria in the Diagnostic and

Statistical Manual of Mental Disorders (DSM- 5; APA, 2013)

i.

Anorexia nervosa (AN)

ii.

Bulimia nervosa (BN)

  • iii. Binge Eating Disorder (BED)

iv.

Other Specified Feeding of Eating Disorder (OSFED)

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No clinically diagnosis

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a constellation of unhealthy eating and weight related behaviours and attitudes that do not meet the criteria for an eating disorder, but that have medical and/or psychological consequences

(Ackard, 2004)

involves a pattern of eating which can lead to eating disorders.

Disordered eating

tend to be considered common and normal among people

(Neumark-Sztainer, 1996; US Department of Health and Human Services, 2005; Nattiv et al., 2007)

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Disordered Eating and Eating Disorders

6 (adapted from Family and Community Development Committee, 2005)

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Disordered eating

  • The Eating Attitudes Test-26 (EAT-26; Garner et al., 1982)

– is commonly used to assess disordered eating

(Ortega-Luyando et al., 2015)

– Total scores ≥20 indicates at-risk of eating disorders or have disordered eating

  • Dieting is one of the commonly accepted beliefs for

being an effective weight control technique.

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Disordered eating in adolescents

  • Adolescence involves rapid changes

in physical growth and psychosocial development

  • One major developmental task is to

cope with the pubertal changes and to build a positive body image.

– A considerable number of adolescents face significant problems to master this task and may develop disordered eating

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The 5-year follow-up of the Project EAT (Eating Among Teens) surveys in 2004 – adolescent girls who were practicing dieting & unhealthful weight-control behaviors in 1999

  • 6x higher risk of binge eating with loss of control

(OR=6.4)

  • ~ 3x higher risk of being obese (OR=2.7)
  • ~ 3x higher risk of adopting extreme weight-control

behaviors such as self-induced vomiting and use of diet pills, laxatives and diuretics (OR=2.5)

(Neumark-Sztainer et al., 2006)

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Disordered eating in adolescents

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Prevalence of Disordered Eating in Different Countries

Study Location Subject Age (years) Prevalence

Ho et al. (2006) Singapore 4461 females 12-26 Overall: 7.4% Tam et al. (2007) Eastern district

  • f Hong Kong

2382 students 10-21 Overall: 5.1% Male: 3.9% Female: 6.5% Austin et al. (2008) United States 5567 high schools students Mean age: 15.9±1.0 Male: 4.0% Female: 15.0% Yang et al. (2010) Gwangju, South Korea 2226 students 10-13 Overall: 7.0% Male: 7.6% Female: 6.4% Lai et al. (2013) Hong Kong 909 students 12-18 Male:18.5% Female: 26.7% Lee et al. (2013) Korea 6943 students 12-18 Overall: 12.7% Male: 10.5% Female: 14.8% Musaiger et al. (2014) United Arab Emirates 731 male students 15-18 Average: 41.2% Range: 33.1-49.1%

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Prevalence of Disordered Eating in Malaysia

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%

Male: 28.8%; Female: 26.9% Male: 18.3%; Female: 20.4% Male: 32.8%; Female: 29.7%

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Malaysian Overweight and Disordered Eating among Teens (MODEST): a Nationwide Study

13 Acknowledgement: Research funded by ERGS, MOHE

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Prevalence of Disordered Eating by Sex (N=9677)

14 31.4 (30.4,32.5) 68.6 (67.5,69.6) 29.0 (27.6,30.4) 71.0 (69.6,72.4) 34.8 (33.2,36.5) 65.2 (63.5,66.8)

Disordered eating was more prevalent among male adolescents (34.8%) as compared to their female counterparts (29.0%).

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FACTORS ASSOCIATED WITH DISORDERED EATING AMONG MALAYSIAN ADOLESCENTS

Body Image Perceptions

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Body image?

How do you see yourself in the mirror?

Body image is more than what we see when we look in the mirror

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(1) What is your perception of current body size?

1 2 3 4 5 6 7 8 9

(2) What is your perception of ideal body size?

(1)Current body size – (2)Ideal body size = Discrepancy score Category of discrepancy score (Body size satisfaction) = satisfied +ve = dissatisfied (desired to have smaller body size)

  • ve

= dissatisfied (desired to have bigger body size)

(Contour Drawing Rating Scale; Thompson & Gray, 1995)

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Body weight status perception

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“I think my weight status is….” ‘severely thin’, ‘thin’, ‘normal weight’, ‘overweight’ and ‘obese’

(Simko et al.,1989)

Incorrect body weight status perception Perception of body weight status ≠ actual bodyweight status (WHO Growth

Reference 2007).

Classified into:

Correct body weight status perception Perception of body weight status = actual body weight status (WHO Growth

Reference 2007).

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How adolescents perceived their weight status?

The formation of a healthy body image can be considered as an essential part of adolescent development.

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FACTORS ASSOCIATED WITH DISORDERED EATING AMONG MALAYSIAN ADOLESCENTS

Body Weight Status (BMI-for-age)

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Association between Body Weight Status and Disordered Eating

21 (Goldschmidt et al., 2008)

  • Overweight increases

the risk for disordered

  • eating. (Shisslak et al., 1998 ;

Neumark-Sztainer et al., 2002; Neumark-Sztainer et al., 2006; Goldschmidt et la., 2015)

  • Disordered eating

predicts further weight

  • gain. (Tanofsky-Kraff et al., 2006;

Field et al., 2003; Stice et la., 2005: Herpertz-Dahlmann et al., 2014)

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Obesity-related behaviors of Malaysian adolescents: a sample from Kajang district of Selangor state

Fara Wahida R, Chin YS, Barakatun Nisak MY Nutrition Research and Practice 2012;6(5):458-465

  • Overweight and obesity were associated not only with dietary (energy)

intake and physical activity, but also body image.

  • Promoting healthy eating, active lifestyle and positive body image should

be incorporated in future obesity prevention programs in adolescents.

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Intervention studies in Malaysia

  • Several interventions developed to promote healthy eating and

active lifestyle among primary school children: – Healthy Lifestyle in Children (HELIC) (Siti Sabariah, 2003) – Healthy Kids Programme (Zawiah, Tee, Norimah, & Chin, 2012) – Nutrition Education Interventions (Zalilah et al., 2008; Ruzita, Wan Azdie, & Ismail, 2007) – Malaysian Childhood Obesity Treatment Trial (MASCOT) (Wafa et al., 2011) – Juara Sihat (Mok, Poh, Wee, Devanthini, & Ruzita, 2018) – REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) program (Norliza, Zalilah, Firdaus, & Lye, 2018)

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Intervention studies in Malaysia

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  • Limited published intervention studies focused among

adolescents

– Body image education package developed (Rasyedah et al., 2003) – Physical Fitness Intervention (Rengasamy, 2012) – Healthy Lifestyle Program (Teng, Chin, Mohd Taib & Chan, 2018)

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Intervention studies in Malaysia

  • In response to the growing problems of overweight and
  • besity, as well as disordered eating, an intervention

program that promote three components in Malaysian adolescents

– healthy eating, positive body image and active lifestyle

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Intervention program: “EAT RIGHT, BE POSITIVE ABOUT YOUR BODY & LIVE ACTIVELY (EPaL)” (MAKAN SECARA SIHAT, BERFIKIRAN POSITIF TERHADAP TUBUH ANDA & HIDUP DENGAN AKTIF) was developed to prevent overweight and disordered eating in adolescents

(Sharifah Intan Zainun, Chin, Mohd Nasir & Zalilah, 2016)

Acknowledgement: Research funded by ERGS, MOHE

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Components of the EPaL intervention programme

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Healthy eating Active living Positive body image

(Sharifah Intan Zainun, Chin, Mohd Nasir & Zalilah, 2016)

Intervention program “EAT RIGHT, BE POSITIVE ABOUT YOUR BODY & LIVE ACTIVELY”

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EPaL Educational Package:

Educational Module for EPaL

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EPaL Educational Package:

Activity Book for EPaL

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EPaL Educational Package: EPaL Educational Cards, EPaL Activity Cards and EPaL Posters

30 EPaL Educational Cards EPaL Activity Cards EPaL Posters Pedometer Skipping rope

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Training of trainers (TOT)

In the EPaL intervention, the peer educators were chosen among Form 2 students.

  • They delivered the programme to Form 1 and Form 2 (aged 13

and 14 years) students.

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Training of trainers (TOT)

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  • 72 peer educators were trained in the TOTs by 19 well-trained

facilitators.

  • 2 TOT workshops (2 days/TOT)
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Training of trainers (TOT)

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Intervention activities

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Intervention activities

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Quality of peer educators

  • Difficulty in

standardizing the way peer educator convey the knowledge and skills to their peers. Sustainability of the EPaL programme

  • Funds, manpower,
  • Supports from

schools (school canteen) and parents/family

Best timing for intervention activities

  • After school (during

the co-curriculum period) programme

Challenges

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Extend to other group using the adult-led or teacher- led approach as comparison group. Apply the intervention programme among adolescents (eg. other ethnicities, areas)

Use as a reference and teaching material by various agencies who work with adolescents.

Opportunities

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Summary

  • Disordered eating among Malaysian adolescents

is a public health concern

  • about 3 in 10 of the Malaysian adolescents (31.4%)

were at-risk of eating disorders.

  • Disordered eating was more prevalent among males,

12-15 years old, Indians, and at the beginning of the pubertal stage.

  • The EPaL intervention programme:
  • incorporated promoting healthy eating, active living &

positive body image using peer education approach

  • improved perception of body weight status,

uncontrolled eating and emotional functioning among the adolescents.

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TERIMA KASIH / THANK YOU

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