Eating and weight problems in the community: prevalence, implications for mental health and community beliefs

Star, Anita Mary (2012) Eating and weight problems in the community: prevalence, implications for mental health and community beliefs. PhD thesis, James Cook University.

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Background and Study Aims: Whilst often regarded as distinct, problems with eating and problems with weight have many common characteristics, including dietary restriction, binge eating, poor body image and psychosocial difficulties. Furthering our understanding of these commonalities may lead to improvements in prevention and treatment efforts for eating disorders (EDs), obesity and mental health. The goal of this thesis was to examine the prevalence, relationships between and impact on psychological health, of co-morbid eating and weight problems, while also exploring public knowledge and beliefs regarding these problems.

First, this thesis sought to determine the prevalence of ED behaviour and cognitions in obese and non-obese women and to elucidate time trends in the population prevalence of co-morbid ED behaviour and obesity. Second, the thesis examined how ED behaviour relates to psychological distress in obese and non-obese women and how ED behaviour and psychological distress impact on weight over time, in community women with ED symptoms. Third, the thesis explored community knowledge and beliefs regarding the nature and treatment of eating problems occurring in sufferers of differing body weights.

Method: These issues were addressed in various community-based samples, namely: 1) a large, general population sample of young women from the Australian Capital Territory (ACT), 2) a two year longitudinal follow up sample of women with ED symptoms identified from the larger sample; and 3) general population samples (1995 and 2005) of adults aged 15 years or more from South Australia recruited, independently, in 1995 and 2005. Anthropometric measures included self-reported height and weight, used to calculate Body Mass Index (BMI), categorical weight status i.e. underweight, normal weight, overweight and obese, and change in weight over time. Self-report surveys were used to assess ED behaviours, shape concern, weight concern, eating concern and dietary restraint. General psychological distress was measured via the Kessler (10- item) Psychological Distress Scale (K10). Community beliefs and attitudes regarding ED recognition, treatment, stigma and regard for symptoms, were modelled on previous, community-based studies of ED 'mental health literacy'. These surveys presented participants with a vignette describing a sufferer of an ED and then asked them to answer a range of questions addressing recognition, treatments, stigma and favourable regard. A range of univariate and multivariate data analysis were performed using the SPSS software.

Results: In 2005 ED behaviours affected approximately 1 in 5 obese persons in the Australia population and young obese women were particularly likely to have ED symptoms. Increases over time from 1995 to 2005, in the prevalence of co-morbid obesity and ED behaviour were more rapid than increases in the prevalence of obesity or ED behaviour alone. Specific aspects of ED psychopathology, namely, the cognitive aspects of weight, shape and eating concerns and dietary restraint, were associated with psychological distress in obese women, whereas for non-obese women ED behaviours were additionally associated. Overall better psychological health was associated with weight stability in community women with EDs of various weight categories. A sizable minority of individuals in the community expressed a favourable regard for the weight and shape control aspects of ED behaviour, despite the adverse impacts on mental health. Obese participants, younger participants and those with existing ED psychopathology were more likely to express positive regard for ED. Obese persons were more likely to highly regard the weight loss seen in Anorexia Nervosa. Community stigma towards individuals with an ED was high, and both obese and underweight sufferers of EDs were more often perceived as being likely to experience discrimination when compared with a normal-weight ED sufferer. Mental health literacy relating to underweight individuals with ED symptoms was satisfactory in that the features of anorexia nervosa were generally recognised and both primary care physicians and mental health professionals were favourably regarded as potential treatment providers. Conclusion: This research has contributed to the literature and the collective understanding of co-morbid eating and weight problems. There was a strong relationship between ED, obesity and psychological distress, a concerning increase in the prevalence of comorbid ED behaviour and obesity, and community beliefs regarding ED behaviour characterised by both stigma and favourable regard, particularly among obese persons. These observations have important implications for the prevention and treatment of eating and weight problems and for future research. In particular, it adds further support to calls for an integrated approach to obesity and ED prevention. It suggests that improving body image and changing attitudinal aspects of eating and dieting, may improve the psychological health of sufferers of co-morbid disordered eating and obesity, which may in turn promote weight stability. Furthermore reducing weight based and ED stigma, whilst simultaneously reducing positive regard for ED behaviours, may assist in reversing the rising prevalence of co-morbid obesity and EDs in the community.

Item ID: 24549
Item Type: Thesis (PhD)
Keywords: body image, community health, co-morbid eating, comorbidity, eating behaviours, eating disorders, mental health, obesity, psychological distress, psychological health, public opinion, social opinion, social stigma, weight problems, weight stability
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Additional Information:

Appendices 1 and 2 (permissions) are not available through this repository.

Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 2: Darby, A., Hay, P., Mond, J., Rodgers, B., and Owen, C. (2007) Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status. International Journal of Obesity, 31 (5). pp. 876-882.

Chapter 6: Darby, A., Hay, P., Quirk, F., Mond, J., Buettner, P.G., Paxton, S.J., and Kennedy, R.L. (2009) Better psychological health is associated with weight stability in women with eating disorders. Eating and Weight Disorders, 14 (1). pp. 13-22.

Date Deposited: 13 Jan 2013 22:56
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110399 Clinical Sciences not elsewhere classified @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110319 Psychiatry (incl Psychotherapy) @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 33%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health @ 34%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920410 Mental Health @ 33%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920120 Zoonoses @ 33%
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