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 Health Sciences, Universiti Putra Malaysia 2 Research Centre of Excellence Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 3 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
OUTLINE: • Impacts of disordered eating in adolescents • Disordered eating related studies in Malaysian adolescents • Factors associated with disordered eating • Intervention related to disordered eating 2
DISORDERED EATING VS. EATING DISORDERS Any difference? 3
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 ) Anorexia nervosa (AN) i. Bulimia nervosa (BN) ii. iii. Binge Eating Disorder (BED) Other Specified Feeding of Eating Disorder iv. (OSFED) 4
Disordered eating 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) No clinically involves a pattern of eating diagnosis which can lead to eating disorders . tend to be considered common and normal among people (Neumark-Sztainer, 1996; US Department of Health and Human Services, 2005; Nattiv et al., 2007) 5
Disordered Eating and Eating Disorders (adapted from Family and Community Development Committee, 2005) 6
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. 7
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 8
Disordered eating in adolescents 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) 9
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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 2382 students 10-21 Overall: 5.1% of Hong Kong Male: 3.9% Female: 6.5% Austin et al. (2008) United States 5567 high schools Mean age: Male: 4.0% students 15.9±1.0 Female: 15.0% Yang et al. (2010) Gwangju, South 2226 students 10-13 Overall: 7.0% Korea 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. United Arab 731 male students 15-18 Average: 41.2% (2014) Emirates Range: 33.1-49.1% 11
Prevalence of Disordered Eating in Malaysia % Male: 32.8%; Male: 28.8%; Female: 29.7% Female: 26.9% Male: 18.3%; Female: 20.4% 12
Malaysian Overweight and Disordered Eating among Teens (MODEST): a Nationwide Study Acknowledgement: Research funded by ERGS, MOHE 13
Prevalence of Disordered Eating by Sex (N=9677) 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%). 14
FACTORS ASSOCIATED WITH DISORDERED EATING AMONG MALAYSIAN ADOLESCENTS Body Image Perceptions 15
Body image? How do you see yourself in the mirror? Body image is more than what we see when we look in the mirror 16
(1) What is your perception of current body size ? (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) 0 = satisfied +ve = dissatisfied (desired to have smaller body size) -ve = dissatisfied (desired to have bigger body size) 1 2 3 4 5 6 7 8 9 17 (Contour Drawing Rating Scale; Thompson & Gray, 1995)
Body weight status perception “I think my weight status is….” ‘severely thin’, ‘thin’, ‘normal weight’, ‘overweight’ and ‘obese’ Classified into: Correct body weight status perception Incorrect body weight status perception Perception of body weight status ≠ Perception of body weight status = actual body weight status (WHO Growth actual bodyweight status (WHO Growth Reference 2007). Reference 2007). (Simko et al.,1989) 18
How adolescents perceived their weight status? The formation of a healthy body image can be considered as an essential part of adolescent development. 19
FACTORS ASSOCIATED WITH DISORDERED EATING AMONG MALAYSIAN ADOLESCENTS Body Weight Status (BMI-for-age) 20
Association between Body Weight Status and Disordered Eating • 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) (Goldschmidt et al., 2008) 21
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. 22
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) 23
Intervention studies in Malaysia • 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) 24
Intervention studies in Malaysia • In response to the growing problems of overweight and obesity, as well as disordered eating, an intervention program that promote three components in Malaysian adolescents – healthy eating, positive body image and active lifestyle 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 25
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Intervention program “EAT RIGHT, BE POSITIVE ABOUT YOUR BODY & LIVE ACTIVELY” Components of the EPaL intervention programme Active living Healthy Positive body eating image (Sharifah Intan Zainun, Chin, Mohd Nasir & Zalilah, 2016) 27
EPaL Educational Package: Educational Module for EPaL 28
EPaL Educational Package: Activity Book for EPaL 29
EPaL Educational Package: EPaL Educational Cards, EPaL Activity Cards and EPaL Posters EPaL Educational Cards EPaL Activity Cards Pedometer Skipping rope EPaL Posters 30
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. 31
Training of trainers (TOT) • 72 peer educators were trained in the TOTs by 19 well-trained facilitators. • 2 TOT workshops (2 days/TOT) 32
Training of trainers (TOT) 33
Intervention activities 34
Intervention activities 35
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