Peer-reviewed article
Psychological, Biological, and Behavioral Predictors of Changes in Eating Attitudes from Age 13 to 17 Y Among Urban, Black South African Adolescents (P18-102-19)
Alysse J. Kowalski, Shane Anthony Norris, Linda Richter, Rachel Waford, Aryeh D. Stein ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed Black South African adolescents from age 13 to 17 to understand what predicts changes in eating attitudes. Girls showed worse eating attitudes than boys by age 17, and larger weight gain was linked to worse eating attitudes in both sexes. Improving self-esteem was associated with better eating attitudes. The relationship between weight control attempts and eating attitudes differed between boys and girls.
Key points
- At age 13, eating attitudes were similar between girls and boys, but by age 17, girls reported worse eating attitudes than boys
- Among both girls and boys, greater BMI increase from ages 13-17 was associated with worse eating attitudes
- Increased self-esteem was associated with improved eating attitudes in both sexes
- Girls who attempted weight loss at age 13 but not 17 showed improved eating attitudes, while boys showed the opposite pattern
- More girls reported weight loss attempts at age 17 (32%) compared to age 13 (19%)
Limitations
The study does not establish causation, only associations over time. It focuses on a specific urban South African population and may not generalise to other settings or ethnic groups.
Abstract
Psychological, biological, and behavioral predictors of change in adolescent eating attitudes have not previously been examined in a South African context. We aimed to characterize patterns and predictors of trends in eating attitudes from age 13 to 17 y in an urban South African cohort. Data come from the Birth to Twenty Plus birth cohort in Soweto-Johannesburg. The 26-item Eating Attitudes Test (EAT-26) was administered at ages 13 and 17 y. Self-esteem, weight control behavior, and body mass index (BMI) were assessed at the same ages. Sex-specific associations of changes in predictors over time with changes in the EAT-26 were modeled using linear regression. At age 13 y, EAT-26 (mean ± SD) was 9.92 ± 7.34 with no difference between girls and boys. At age 17 y, EAT-26 was higher, reflecting poorer eating attitudes, among girls (11.14 ± 8.75) than boys (10.06 ± 6.77). From age 13 to 17 y, self-esteem scores improved slightly (0.36 ± 4.95), with no difference by sex, while BMI increased more among girls (2.57 ± 2.34 kg/m2) than boys (1.72 ± 2.21 kg/m2). More girls reported a weight loss attempt at age 17 (32%) than at 13 y (19%), while more boys reported trying to lose weight at age 13 (14%) than at 17 y (9%). Among girls, greater BMI increase from age 13 to age 17 y was associated with higher EAT-26 (β = 0.52 per kg/m2, 95% confidence interval [CI]: 0.09, 0.95), and increased self-esteem score was associated with decreased EAT-26 (β = −0.40, CI: −0.59, −0.22). Similar associations were observed among boys. Compared to those whose weight control behavior did not change, attempted weight loss at age 13 y but not at age 17 y was associated with decreased EAT-26 (β = −3.67, CI: −7.3, −0.03) among girls, while among boys, attempted weight loss at age 17 y but not at age 13 y was associated with increased EAT-26 (β = 7.16, CI: 3.53, 10.8). In a longitudinal sample of Black South African adolescents, improved self-esteem and decreased BMI were each associated with improved eating attitudes in both boys and girls, while associations of patterns of weight control behavior with eating attitudes differed by sex. NIH Fogarty International Center, Bill & Melinda Gates Foundation, Wellcome Trust, University of the Witwatersrand, South African Medical Research Council.