Prevalence of Weight Control Behaviors among Adolescent Girls

Monique Elizabeth Sukamto

1,2

, Fajrianthi

and Hamidah

Faculty of Psychology, Universitas Airlangga

Faculty of Psychology, Universitas Surabaya

Keywords: Body mass index, dieting, disordered eating, weight perception.

Abstract: Dieting or weight control behaviors have become increasingly widespread among adolescents, particularly

adolescent girls. Girls may engage in a range of weight control behaviors, from healthy, such as exercising

and eating more fruit and vegetables, to unhealthy and extreme strategies including fasting, skipping meals,

and taking diet pills. The purpose of this study was to systematically review existing literatures on the

prevalence of weight control behaviors among adolescent girls in Western and non-Western countries. Studies

were identified through a systematic search using PsycINFO, Google Scholar and secondary references.

Thirty studies published between 1983 and 2016 in 10 countries were identified and divided into 3 groups of

years, i.e. 1980-1999, 2000-2009 and 2010- 016. The findings across the three groups showed that: (a) the

prevalence of weight control behaviors among adolescent girls was associated with weight status and weight

perception; (b) exercising was the most frequently reported healthy strategy; (c) skipping meals, fasting, self-

induced vomiting, taking diet pills and using laxatives were the frequently reported unhealthy and extreme

weight control behaviors. Implications for future research include conducting more studies on weight control

behaviors among adolescents in different countries for designing prevention and intervention programs to

combat the negative consequences of unhealthy and extreme behaviors.

1 INTRODUCTION

The onset of puberty in adolescence causes changes

in the distribution of fat and muscle tissue in

adolescent boys and girls. Consequently, both boys

and girls become more concerned about their weight

and physical appearance. However, studies have

shown that adolescent girls are more likely than boys

to consider themselves overweight, so they manifest

greater efforts to lose weight (Gonsalves, Hawk and

Goodenow, 2014; Grunbaum et al., 2002; Neumark-

Sztainer and Hannan, 2000; Rosen, Gross and Vara,

1987). Dieting behavior is motivated by concerns

about obesity and the belief that dieting will help

improve physical appearance (French and Jeffery,

1994; Tam et al., 2007; Neumark-Sztainer and

Hannan, 2000).

Around the 1990s up to now, researchers have

used the term 'weight control behavior' besides

'dieting behavior' (Serdula et al., 1993; Utter et al.,

2003; Balantekin, Birch and Savage, 2015; Park and

Lee, 2017; Bojorquez et al., 2018). Balantekin et al.

(2015) indicated that dieting was an umbrella term

for a wide range of both healthy and unhealthy

weight control behaviors instead of just a singular

behavior. Weight control behaviors can be divided

into healthy, unhealthy and extreme behaviors

(Neumark-Sztainer et al., 2002; Quick et al., 2013;

Al Sabbah et al., 2010). Healthy weight control

behaviors include exercising, eating more fruit and

vegetables, eating less high-fat food, eating fewer

sweets, drinking less soda pop, and watching portion

sizes. Whereas fasting, eating very little food, using

a food substitute, skipping meals and smoking

cigarettes are categorized as unhealthy weight

control behaviors. Furthermore, using laxatives,

using diuretics, taking diet pills and self-induced

vomiting are included in extreme behaviors because

of their harmful consequences for health. Unhealthy

and extreme weight control behaviors can lead to

several negative consequences, such as greater

weight gain and increased risk of obesity (Field et al.,

2010; Neumark-Sztainer et al., 2012; Stice et al.,

2005); increased risk of developing eating disorder

(Patton et al., 1990, 1999; Polivy and Herman, 1985)

and nutritional deficiencies (Neumark-Sztainer et al.,

2004).

120

Sukamto, M., Fajrianthi, . and Hamidah, .

Prevalence of Weight Control Behaviors among Adolescent Girls.

DOI: 10.5220/0008586201200132

In Proceedings of the 3rd International Conference on Psychology in Health, Educational, Social, and Organizational Settings (ICP-HESOS 2018) - Improving Mental Health and Harmony in

Global Community, pages 120-132

ISBN: 978-989-758-435-0

To date, studies on the prevalence of dieting or

weight control behaviors in adolescents have been

widely conducted in Western countries, but a few

were still conducted in non-Western contexts. The

aim of this present study is to provide a description

of he literature on the prevalence of dieting or weight

control behaviors in adolescent girls by reviewing

empirical studies from 1980 to 2016 conducted in the

US and other Western and non-Western countries.

Results are expected to contribute insights for further

research in other countries, particularly non-Western

countries, about this problem and suggest the

necessity of more effective prevention and

intervention programs.

2 METHODS

2.1 Data Sources and Literature

Researchers used electronic databases (PsycINFO

and Google Scholar) to search for relevant articles

published from 1980 to 2016 using the following

keywords: “weight control behavior”, “dieting

behavior”, “excessive dieting”, ''disordered eating”,

“eating disorder”, “body dissatisfaction” and

“adolescence”. All previous review articles (i.e.

systematic and unsystematic reviews identified

during the database search) were also read for

additional published articles. Theses and

dissertations were not included in this systematic

review because their peer review status is not always

reported and they are often not easily accessible.

Researchers also conducted a manual examination of

selected articles’ reference lists to acquire further

relevant studies. Each article was read in full to

determine whether it fitted the inclusion criteria for

this review.

2.2 Selection Procedures

Following the database searches, 118 studies were

identified by screening the titles and abstracts of

selected studies. The inclusion criteria for selected

studies were as follows: (a) empirical studies using

quantitative or qualitative methods, or both, in peer

reviewed journals from 1980 to 2016; (b) studies

conducted with adolescents or adolescent girls,

especially those in middle and high school; (c)

studies with a focus on the prevalence of dieting or

weight control behaviors. The exclusion criteria were

as follows: (a) studies conducted with children or

adults; (b) articles not written in English. Hereinafter,

the researchers verified the full texts of those selected

studies using the inclusion and exclusion criteria

established. Figure 1 illustrates the flowchart of the

literature selection process.

ure 1: Flow chart of the literature selection

rocess.

Prevalence of Weight Control Behaviors among Adolescent Girls

121

Table 1: Prevalence of dieting or weight control behaviors in 1980-1999.

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

United

States,

1980s

Storz & Greene

(1983);

Philadelphia

Adolescent

girls (203),

14-18

Desired to lose weight (83%), although (62%) actually fell within

average range of body weight; gain weight (14%); maintain weight

(2%). Low-energy crash diet was second in popularity only to an

exercise program; the less healthful methods comprised 41.5% of

the attempts mentioned.

Rosen et al.

(1987); Rosen &

Gross (1987);

Northeast

Adolescents

(698 boys;

675 girls),

grade 9-12

Girls: reducers (63%), maintainers (27.9%), gainers (9.1%). Boys:

reducers (16.2%), maintainers (55.4%), gainers (28.4%). Most

female reducers and male gainers were already normal weight.

Exercise, reducing calories, omitting snacks, and skipping meals

were the four most popular methods of weight reduction for boys

and

irls.

Israel,

1990s

Neumark

Sztainer et al.

(1995);

Jerusalem

Adolescent

girls (341),

15.3 (mean)

A high percentage of the girls (41.9%) viewed themselves to be

overweight compared with girls (17.4%) who could objectively be

defined as overweight with BMI values of at least 23.8. Girls desired

to weigh an average of 4 kg less than their perceived weight. Girls

exclusively used healthy weight loss methods in the past (8.2%),

used unhealthy methods (39%), and an additional 23.2% used very

unhealthy methods: fasting, vomiting, laxatives or diet pills.

United

States,

1990s

Story et al.

(1991); French

et al. (1995);

Minnesota

Adolescents

(16725

boys; 17471

girls), grade

7-12

Dieted to lose weight during the last year (61.9%) of female students

and 20.1% of male students; chronic dieters (12.1% and 2.1%,

respectively). Chronic dieters (reported had been on a diet > 10

times or always dieting during the past year): feel overweight

(75.7% of female students and 42.7% of male students); self-

induced vomiting weekly or more (11.9% and 4.7%, respectively);

use of laxatives (7.9% and 4.4%, respectively); use of ipecac (2.5%

and 1.1% respectively); and use of diuretics (7.3% and 2.7%,

respectively). Others: feel overweight (38.4% of female students

and 16.3% of male students); self-induced vomiting weekly or more

(1.2% and 0.5%, respectively); use of laxative (1.1% and 0.4%,

respectively): use of ipecac (0.3% and 0.1%, respectively), and use

of diuretics (1.0% and 0.2%, respectively).

Serdula et al.

(1993); 50

states, District

of Columbia,

Virgin Islands

Adolescents

(5585 boys;

5882 girls),

grade 9-12

and adults ≥

18 years

(60861)

Female students: reported trying to lose weight (44%); trying to

keep from gaining weight (26%); trying to gain weight (7%); and

not trying to do anything about their weight (23%). Male students:

reported trying to lose weight (15%); trying to keep from gaining

weight (15%); trying to gain weight (26%); and not trying to do

anything about their weight (44%). Among both male and female

students, attempts to lose weight were most strongly associated with

weight perception, although less so among blacks. Methods used to

lose or maintain weight in the 7 days preceding the survey:

exercising (51% of female students and 30% of male students),

skipping meals (49% and 18%, respectively), using diet pills (4%

and 2%, respectively), and vomiting (14% and 4%, respectively).

Neumark-

Sztainer et al.

(1999);

Connecticut

Adolescents

(9118), grade

7, 9, 11

Weight loss behaviors over the past 7 days: exercise (61% of female

students and 42.8% of male students); dieting (38.2% and 12.4%,

respectively); disordered eating (vomiting, diet pills, laxatives or

diuretics, 7.4% and 3.1%, respectively). BMI was positively

associated with dieting and exercise among the girls. The very

overweight girls were at greater risk of disordered eating behaviors.

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

122

Table 1 (Continued).

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

Japan,

1990s

Kaneko et al.

(1999); Osaka

Prefecture

Preadoles-

cents (547)

and

adolescents

(1085), 10-

Forty-eight per cent of 10-year-old girls and 84% of 17-year-old girls

categorized themselves as ‘fat’ or ‘too fat’. Approximately 30% of boys

in each age group categorized themselves as ‘fat’ or ‘too fat’. The fear

of weight gain and desire for thinness was reported in 35% and 51% of

10-year-old girls, respectively, and increased progressively with ageing

to 79% and 87% of 17-year-old girls. In contrast, these were reported

by 20–30% of boys in the corresponding age groups. Some practices to

be slim were found in 22% of the 10-year-old girls, and increased to

37% among the 17-year-old girls, whereas they were found in around

20% of the boys at each age.

3 RESULTS

3.1 Studies’ Characteristics

After going through the selection process, we

identified 30 studies to be reviewed further. All of

these studies were conducted between 1980 and 2016

with adolescents. The majority of these studies were

conducted in the United States (n = 22) and the

remaining in other countries, including Israel, Japan,

Europe, Hong Kong, Palestine, Greece, New

Zealand, Spain, and Korea. Studies published in 2016

were also included so that the researchers could

describe the latest research on the prevalence of

weight control behaviors in adolescents.

The 30 studies were selected for further review

because they described specifically the prevalence of

dieting or weight control behaviors, which could be

categorized into healthy, unhealthy and extreme

behaviors. The description of prevalence was often

associated with sex, weight status and weight

perception. Through the specific descriptions,

researchers could gain an insight into the severity of

weight control behaviors in adolescents, particularly

adolescent girls, thus raising the need to prevent or

overcome this problem.

3.2 Prevalence of Dieting or Weight

Control Behaviors in 1980-1999

(see Table 1)

Adolescent girls in the US were significantly more

likely than adolescent boys to engage in dieting and

mostly were trying to lose weight (French et al.,

1995; Rosen et al., 1987; Serdula et al., 1993; Story

et al., 1991). For example, Serdula et al. (1993) found

that nearly half of girls (44%) attempted to lose

weight compared with only 15% of boys trying to

lose weight. Interestingly, we also found a similar

prevalence among adolescent girls and boys in Japan

(Kaneko et al., 1999).

Dieting behaviors in adolescents girls were

more likely to be associated with weight perception

than weight status (Kaneko et al., 1999; Neumark-

Sztainer et al., 1995; Rosen & Gross 1987; Rosen et

al.. 1987; Serdula et al., 1993; Storz & Greene 1983).

For example, Rosen and Gross (1987) and Rosen et

al. (1987) found that most adolescent girls who tried

to lose weight actually already had a normal weight.

Storz and Greene (1983) also found high percentage

of girls (62%) who desired to lose weight actually

had normal body weight.

Healthy weight control behavior, mostly

performed by adolescent girls was exercising

(Neumark-Sztainer et al., 1999; Rosen and Gross,

1987; Serdula et al., 1993; Storz and Greene, 1983).

Nevertheless, adolescent girls also engaged in

unhealthy weight control behaviors, such as skipping

meals and fasting, and extreme behaviors including

self-induced vomiting, using laxatives, and taking

diet pills (Neumark-Sztainer, Palti and Butler, 1995;

Serdula et al., 1993; Story et al., 1991).

Prevalence of Weight Control Behaviors among Adolescent Girls

123

Table 2: Prevalence of dieting or weight control behaviors in 2000-2009.

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

United

States,

2000s

Neumark-

Sztainer &

Hannan (2000);

Minnesota

Adolescents

(6728),

grade 5-12

Almost half of the girls (45%) reported that they had at some point

been on a diet, compared with 20% of the boys. Among girls and boys,

there were strong direct associations between BMI and dieting

behaviors. Younger girls (grades 5-8) were significantly less likely to

engage in dieting than older girls (grades 9-12).

Boutelle et al.

(2002);

Connecticut

Adolescents

(4081 boys;

4249 girls),

grade 7, 9,

The prevalence of unhealthy weight control behaviors (laxatives, diet

pills, vomiting) was directly related to overweight status in both

female and male adolescents. A higher percentage of obese girls and

boys engaged in unhealthy weight control behaviors, followed by the

overweight girls and boys, and with the lowest level of these behaviors

seen in the non-overweight girls and boys.

Croll et al.

(2002);

Minnesota

Adolescents

(39,714

boys;

40,640

girls), grade

9 and 12

Fifty-six percent of 9th-grade females and 28% of 9th-grade males

report disordered eating behaviors to lose or control weight (fasting or

skipping meals, diet pills, vomiting, laxatives or smoking cigarettes;

and binge-eating), with slightly higher rates among 12th-grade females

and males, 57% and 31%, respectively. Fasting or skipping meals was

the most commonly reported behavior, followed by smoking cigarettes

to control weight, taking diet pills, vomiting and laxatives.

Grunbaum et

al. (2002); 50

states and

District of

Columbia

Adolescents

(13,601),

grade 9-12

Female students (34.9%) were significantly more likely than male

students (23.3%) to consider themselves overweight. Overall, female

students (62.3%) were significantly more likely than male students

(28.8%) to be trying to lose weight. Female students (58.6%) were

significantly more likely than male students (28.2%) to have eaten less

food, fewer calories, or foods low in fat to lose weight or to avoid

gaining weight. Unhealthy behaviors to lose weight or avoid gaining

weight: had gone without eating for ≥ 24 hours (19.1% of female

students and 7.6% of male students); had taken diet pills, powders, or

liquids without a doctor’s advice (12.6% and 5.5%, respectively); had

vomited or taken laxatives (7.8% and 2.9%, respectively).

Neumark-

Sztainer et al.

(2002);

Neumark-

Sztainer et al.

(2003);

Minnesota

Adolescents

(4746,

50.2% boys;

49.8%

girls), 14.9

(mean)

Healthy weight control behaviors (85% of adolescent girls and 70% of

adolescent boys); unhealthy behaviors (57% and 33%, respectively);

or extreme behaviors (12% and 5%, respectively). The use of

unhealthy and extreme weight control behaviors was high among

overweight youth, particularly adolescent girls. Extreme weight

control practices (taking diet pills, laxatives, or diuretics or vomiting)

were reported by 18% of very overweight adolescent girls, compared

with 6% of very overweight adolescent boys. Unhealthy weight

control behaviors: ate very little food (girls: 44.9%; boys: 19.3%);

skipped meals (girls: 44.7%; boys: 18.3%); fasted (girls: 18.0%; boys:

11.1%); used food substitutes (girls: 9.6%; boys: 6.2%); smoked more

cigarettes (girls: 9.1%; boys: 4.6%); self-induced vomiting (girls:

6.6%; boys: 2.2%); took diet pills (girls: 6.7%; boys: 1.7%); took

diuretics (girls: 1.6%; boys: 1.7%); and used laxatives (girls: 1.7%;

boys: 1.0%). Frequent dieting (more than 5 times over the past year)

was reported by 18.2% of girls and 7.9% of boys.

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124

Table 2 (Continued).

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

United

States,

2000s

Eisenberg et al.

(2005);

Minnesota

Adolescent

girls (2308)

Many girls (44.9%) reported engaging in UWCBs. Overweight girls

(60.1%) were more likely to engage in UWCBs than moderately

overweight (54.0%), average weight (40.2%), or underweight (21.3%)

girls.

Europe,

Israel,

United

States,

2000s

Ojala et al.

(2007); Over

30 countries in

Europe, Israel,

North America

Adolescents

(50965

boys; 55154

girls), 13

and 15

Weight loss attempts at the time of the survey were significantly higher

in overweight adolescents than non-overweight adolescents. Overall,

overweight girls tended to try to lose weight and feel the need to lose

weight more commonly than overweight boys. The majority (76-98%)

of overweight girls, in all countries and regions, were either currently

trying or felt that they should lose some weight. By contrast, overweight

boys considered their weight to be fine or wanted to gain weight (range:

19-64%) more commonly than overweight girls. Specific weight control

practices used during the previous 12 months by weight status:

Exercising (range 71-97%) and eating fewer sweets (28-100%) were the

most commonly indicated weight control practices among both

overweight and non-overweight adolescents in all countries and both

genders, with the exception of Latvian overweight girls. Unhealthy

practices such as fasting (range 4-30%), vomiting (1-14%), diet pills or

laxative use (0-19%) and smoking more (3-17%) were less frequently,

but still considerably, mentioned. Self-perception of overweight was the

most effective individual-level factor. Self-perception of overweight was

followed by body weight status and age.

Hong

Kong,

2000s

Tam et al.

(2007); Hong

Kong

Adolescents

(1335 boys,

14.6

(mean);

1047 girls,

14.8

(mean))

Weight loss behaviors were reported by 638 (26.8%) participants.

Among them, 58% were female. Exercise and dieting were the most

popular means whereas the expensive beauty salon slimming treatment

was the least common. A significant number of them (20.5%) had

resorted to hazardous weight control methods like the use of diet pills

(19.5%) and/or self-induced vomiting (3%). Overall, only 22% of

slimmers had received professional advice from health-care

professionals while 30% underwent weight reduction without the

awareness of their families.

3.3 Prevalence of Dieting or Weight

Control Behaviors in 2000-2009

(see Table 2)

Adolescent girls in the US, Europe, Israel and Hong

Kong showed a higher percentage of weight loss

attempts than boys (Neumark-Sztainer & Hannan,

2000; Grunbaum et al., 2002; Ojala et al., 2007; Tam

et al., 2007). Grunbaum et al. (2002) showed that

more than half of adolescent girls in the US (62.3%)

compared with 28.8% of adolescent boys in the US

tried to lose weight. Tam et al. (2007) also reported

that 58% female adolescents in Hong Kong showed

weight-loss behaviors.

Dieting behaviors in adolescent girls were more

associated with weight status (Neumark-Sztainer and

Hannan, 2000; Boutelle et al., 2002; Eisenberg et al.,

2005; Ojala et al., 2007) (Boutelle et al. 2002;

Eisenberg et al., 2005; Neumark-Sztainer & Hannan

2000; Ojala et al., 2007) than weight perception

(Grunbaum et al., 2002). In over 30 countries, Ojala

et al. (2007) found that the majority of overweight

girls were trying or felt that they should lose some

weight.

The most common healthy weight control

behavior applied by adolescent girls was exercising

Prevalence of Weight Control Behaviors among Adolescent Girls

125

(Ojala et al., 2007; Tam et al., 2007). However,

adolescent girls also utilized unhealthy and extreme

weight control behaviors, such as skipping meals,

fasting, smoking more cigarettes, taking diet pills,

using laxatives and self-induced vomiting (Croll et

al., 2002; Grunbaum et al., 2002; Neumark-Sztainer

et al., 2003; Eisenberg et al., 2005; Tam et al., 2007).

Neumark-Sztainer et al. (2003) found that while most

adolescent girls (85%) reported using healthy weight

control behaviors, they also engaged in unhealthy

weight control behaviors (57%) and extreme

behaviors (12%).

3.4 Prevalence of Dieting or Weight

Control Behaviors in 2010-2016

(see Table 3)

Adolescent girls in the US (Haley, Hedberg and

Leman, 2010; Lõpez-Guimerà et al., 2013;

Gonsalves, Hawk and Goodenow, 2014), Palestine

(Al Sabbah et al., 2010), Spain (Lõpez-Guimerà et

al., 2013), and New Zealand (Utter et al., 2012) were

more likely than boys to engage in dieting to lose

weight. For example, Utter et al. (2012) reported that

a higher percentage of girls (67%) than boys (36%)

in New Zealand attempted to lose weight in the past

year.

Weight control behaviors in adolescent girls

were associated with weight status (Lee and Lee,

2016; Vander Wal, 2011; Al Sabbah et al., 2010) and

weight perception (Haley, Hedberg and Leman,

2010; Lee and Lee, 2016; Vander Wal, 2011). Al

Sabbah et al. (2010) reported that overweight

adolescent girls (16.6%) were more likely than

normal and underweight adolescent girls (6.5% and

5.4%, respectively) to engage in dieting to lose

weight. In addition, Haley et al. (2010) found that

more girls than boys perceived themselves as

overweight and tried to lose weight. Exercising was

the most common healthy weight control behavior

utilized by adolescent girls (Lee and Lee, 2016; Utter

et al., 2012). Nevertheless, quite a lot of adolescent

girls in the US (Bucchianeri et al., 2016; Johnson et

al., 2016; Mayer-Brown et al., 2016; Vander Wal,

2011), US and Spain (Lõpez-Guimerà et al., 2013),

Greece (Thøgersen-Ntoumani, Ntoumanis and

Nikitaras, 2010), and New Zealand (Utter et al.,

2012) engaged in unhealthy and extreme weight

control behaviors, such as skipping meals, fasting,

eating very little food, taking diet pills, using

laxatives and self-induced vomiting. Lõpez-Guimerà

et al. (2013) found that unhealthy weight control

behaviors were prevalent among North American

and Spanish adolescent girls. In addition, Mayer-

Brown et al. (2016) found that US girls were more

likely and more frequently to utilize unhealthy

weight control behaviors than boys, such as eating

very little food (32%), skipping meals (27.8%),

skipping breakfast (23.7%) and fasting (10.3%).

Table 3: Prevalence of dieting or weight control behaviors in 2010-2016.

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

Palestine,

2010s

Al Sabbah et al.

(2010);

Palestine

Adolescents

(8,885), 12-

Dieting to lose weight was significantly higher among overweight

adolescents (boys: 10.8%; girls: 16.6%) than underweight (boys: 8.2%;

girls: 5.4%) and normal weight pupils (boys: 5.2%; girls: 6.5%).

Healthy weight-control behaviors were highly prevalent in both

genders; underweight adolescents reported the lowest rates and

overweight reported the highest rates. Unhealthy and extreme behaviors

to control weight were more prevalent among overweight adolescents

than normal weight and underweight counterparts. Adolescents who

perceived their body as too thin were less likely than adolescents who

perceived their body as normal size to exercise, whereas adolescents

who perceived their body as too fat were more likely than adolescents

who perceived their body as average size to follow an unhealthy diet.

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126

Table 3 (Continued).

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

Greece,

2010s

Thøgersen-

Ntoumani,

Ntoumanis, &

Nikitaras

(2010); Athens

Adolescent

girls (350),

12-16

Many Greek adolescent females engaged in unhealthy weight control

behaviors: skipping meals (67.4%), fasting for a day or more (31.1%),

vomiting (10.3%), laxatives and/or water pills (3.4%) and diet pills

(3.1%).

United

States,

2010s

Haley,

Hedberg, &

Leman (2010);

Oregon

Adolescents

(16289,

49.8% boys;

50.1%

girls), grade

8 and 11

Unhealthy weight loss practices (UWLP) were reported by 11.6% of

students, more often by girls than boys. Prolonged fasting was more

prevalent than vomiting, taking laxatives or taking dietary medication

without a doctor’s advice. More girls than boys perceived themselves as

overweight and reported trying to lose weight. Interestingly, 45% of

respondents who perceived themselves as slightly overweight, and 17%

of those who perceived being very overweight had healthy BMIs. Being

overweight, or at risk of it, was associated with UWLP, as was self-

perception of being very underweight or overweight.

Vander Wal

(2011)

Adolescents

(2,120 boys;

2,409 girls),

grade 9 and

Unhealthy weight control behaviors were skipping meals (23.3% of

boys; 46.6% of girls), fasting (7.4% of boys; 16.0% of girls), restricting

one’s diet to one or more food groups (7.5% of boys; 12.9% of girls),

using diet pills (3.6% of boys; 8.9% of girls), smoking to lose weight

(5.6% of boys; 6.6% of girls) and vomiting (2.4% of boys; 6.6% of girls).

Adolescents with overweight and obese BMI classifications were more

likely to engage in unhealthy weight control behaviors than adolescents

with a healthy weight classification. Adolescents who perceived

themselves to be too fat were more likely to engage in unhealthy weight

control behaviors than adolescents who did not perceive themselves to

be too fat.

New

Zealand,

2010s

Utter et al.

(2012);

New

Zealand

Adolescents

(9,170), 13-

Half of the students (50.1%) have made a weight loss attempt in the past

year (67% of girls; 36% of boys). Exercising (90%), eating less fatty

foods (72%), eating fewer sweets (52%) and skipping meals (31%) were

the most commonly used strategies for weight loss.

United

States and

Spain,

2010s

Lõpez-Guimerà

et al. (2013),

14.3 (mean);

Twin Cities,

Minnesota and

Barcelona

Adolescents

(1501

Barcelona:

48% girls,

52% boys;

and 2793

Twin Cities:

53% girls,

47% boys)

Dieting and UWCB were prevalent in both samples, particularly among

girls, but the prevalence was higher in the US sample (dieting: 45.7%;

eating very little food: 38.8%; skipping meals: 36.6%; fasting: 13.5%)

than Spain (dieting: 33.9%; eating very little food: 19%; skipping meals:

14.6%; fasting: 8.5%). Among adolescent girls, 27.9% of the BCN

sample and 48.9% of the TC sample reported use of any less extreme

UWCB. Among adolescent boys, these corresponding percentages were

12.0% for BCN and 38.0% for TC. With regard to extreme UWCB, in

girls the prevalences in BCN and TC were statistically indistinguishable,

whereas in boys differences in prevalences in BCN (0.8%) and in TC

(3.6%) were statistically significant despite low numbers. In both

countries, the report of dieting and use of UWCB was highest among

overweight and obese youth.

Prevalence of Weight Control Behaviors among Adolescent Girls

127

Table 3 (Continued).

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

United

States,

2010s

Gonsalves et al.

(2014);

Massachusetts

Adolescents

(11,515),

grade 6-12

Among middle and high school students, females were more likely

than males to report unhealthy weight control behaviors (10.9 vs.

6.9%, 15.8 vs. 7.3%, respectively). Among both middle and high

school females, those who had an overweight or obese BMI were more

likely to report unhealthy weight control behaviors than those with a

normal weight BMI (16.0, 18.6 vs. 10.0% in middle school and 26.2,

27.9 vs. 12.1%, in high school). Among middle and high school

females, those who thought they were slightly or very overweight were

more likely to report unhealthy weight control behaviors than those

who thought they were about the right weight (16.0 vs. 9.2% in middle

school and 28.0 vs. 10.3% in high school). The same pattern held for

high school males (14.2 vs. 4.2%).

Bucchianeri et

al. (2016);

Minnesota

Adolescents

(2,793,

46.8% boys;

53.2%

girls), 14.4

(mean)

Dieted to lose weight during the last year (45.9% of adolescent girls

and 31.1% of adolescent boys); unhealthy WCBs (50.3% and 38.1%,

respectively); extreme WCBs (6.7% and 3.9%, respectively).

Johnson et al.,

(2016); 5 states

Adolescents

(2004 boys;

2144 girls),

grade 9-12

Unhealthy WCBs to keep from gaining weight during past 30 days:

fasted for at least 24 hours (12.7%); used diet pills, powders or liquids

(5.3%); vomited or used laxatives (5.2%). Girls were more likely to

report fasting (69.9% vs. 30.1%), using diet pills, powders or liquids

(67.0% vs. 33%), and vomiting or taking laxatives (71.2% vs. 28.8%)

to lose weight compared with boys.

Lampard et al.

(2016);

Minnesota

Adolescents

(1307 boys;

1486 girls),

grade 6-12

Mixed healthy and unhealthy (34% of adolescent girls and 25.2% of

adolescent boys); unhealthy only (16.4% and 13%, respectively);

healthy only (24% and 29.2%, respectively). The exclusive use of

healthy weight control behaviors was more prevalent among girls who

were not overweight (27.5%) as compared to girls who were

overweight (21.0 %) or obese (17.5 %).

Mayer-Brown,

Lawless,

Fedele,

Dumont-

Driscoll, &

Janicke (2016)

Adolescents

(82 boys; 97

girls), 10-17

Overall, 40.8% of youth endorsed using at least one unhealthy weight

control behavior over the past year. Ate very little food at meals (28%)

and skipped meals (24%) were the most commonly reported UWCBs.

Girls reported using more UWCBs, as well as engaging in UWCBs

more frequently than boys. Endorsed UWCBs: ate very little food

(32% of girls and 23.2% of boys); skipped meals (27.8% and 19.5%,

respectively); skipped breakfast (23.7% and 12.2% respectively); and

fasted (10.3% and 6.1%, respectively). The most commonly endorsed

extreme UWCB among boys in the last year was using laxatives

(3.7%), while taking diet pills and using laxatives (4.1%) were the

most common among girls.

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

128

Table 3 (Continued).

Context

Researcher,

Year; Location

Sample (N),

Age / Grade

Summary of Findings

Korea,

2010s

Lee & Lee

(2016); South

Korea

Adolescents

(9,211 boys;

11,053

girls), 12-18

Higher percentage of subjects in the under-estimation group did

nothing to control their weight (66.5%) compared to 54.5% in the

correct estimation group and 40.3% in the overestimation group.

Half of subjects in the over-estimation group made an effort to lose

weight (49.6%). However, almost one out of three subjects made an

effort to lose weight in the correct estimation group (30.6%). The

most common weight control behavior was ‘doing regular exercise’

(68.5%), followed by ‘eating less’

(68.1%), fasting ≥ 24 h (8.5%),

eating food substitute (8.5%) and eating one-food diet (6.7%).

4 DISCUSSION

A literature review of studies conducted from 1980

to 2016 found that the prevalence of dieting or weight

control behaviors in adolescent girls was high, either

in the United States (e.g. Rosen, Gross & Vara, 1987;

Story et al., 1991; Serdula et al., 1993; Grunbaum et

al., 2002; Neumark-Sztainer et al., 2002; Eisenberg

et al., 2005; Vander Wal, 2011; Gonsalves, Hawk &

Goodenow, 2014; Bucchianeri et al., 2016; Mayer-

Brown et al., 2016) or in other countries, such as

Japan (Kaneko et al., 1999), Europe and Israel (Ojala

et al., 2007), Palestine (Al Sabbah et al., 2010),

Greece (Thøgersen-Ntoumani, Ntoumanis and

Nikitaras, 2010), New Zealand (Utter et al., 2012)

and Korea (Lee and Lee, 2016). Dieting behavior

becomes a complex issue in adolescence because

they are still undergoing rapid changes in growth,

physical maturity, self-concept, body image and

relationships with peers (Brownell and Rodin, 1994).

According to Attie and Brooks-Gunn (1989), body

weight and shape became the main focus for most

adolescent girls since the onset of puberty and efforts

to control weight were increasing.

A literature review on studies over three

decades found that the prevalence of weight control

behaviors in adolescent girls was more associated

with weight perception in 1980-1999 (e.g. Storz &

Greene, 1983; Neumark-Sztainer, Palti & Butler,

1995; Kaneko et al., 1999); with weight status in

2000-2009 (e.g. Neumark-Sztainer & Hannan, 2000;

Boutelle et al., 2002; Ojala et al., 2007); and

associated with weight status and weight perception

in 2010-2016 (e.g. Al Sabbah et al., 2010; Vander

Wal, 2011; Gonsalves, Hawk & Goodenow, 2014;

Lee & Lee, 2016).

Based on this literature review, it can be

concluded that the use of weight control behaviors by

adolescent girls was quite similar. Although exercise

was the most commonly reported weight control

behavior of adolescent girls in the United States and

other countries, such as Europe and Israel, Hong

Kong, New Zealand and Korea, engagement in

unhealthy and extreme weight control behaviors was

also prevalent. The most common unhealthy weight

control behaviors were skipping meals and fasting,

whereas self-induced vomiting, using laxatives and

taking diet pills were the most frequently reported

extreme behaviors (e.g. Serdula et al., 1993;

Neumark-Sztainer et al., 2003; Vander Wal, 2011;

Mayer-Brown et al., 2016). For example, Neumark-

Sztainer et al. (2003) reported that unhealthy and

extreme weight control behaviors utilized by

adolescent girls included eating very little food

(44.9%), skipping meals (44.7%), fasting (18%),

using food substitutes (9.6%), smoking more

cigarettes (9.1%), self-induced vomiting (6.6%),

taking diet pills (6.7%), using laxatives (1.7%) and

using diuretics (1.6%).

5 CONCLUSIONS

The aim of the current review was to obtain a

description of the prevalence of dieting or weight

control behaviors among adolescent girls in the US

and other Western and non-Western countries.

Findings indicate that the prevalence of unhealthy

Prevalence of Weight Control Behaviors among Adolescent Girls

129

and extreme weight control behaviors among the

adolescent girls in various countries is relatively

high. This is very worrying because it can cause some

negative consequences, such as an increased risk of

obesity, lack of food intake and the development of

clinical eating disorders. Therefore, recommendation

for future research is conducting more research into

the prevalence and risk factors of unhealthy weight

control behaviors among adolescents in other

countries, particularly non-Western countries, to give

direction for the development of more effective

prevention and intervention programs to overcome

this problem.

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