Eating behaviour, body image, and mental health: updated estimates of adolescent health, well-being, and positive functioning in Aotearoa New Zealand
Katie M. Babbott
1 2 * , Nathan S. Consedine 2 , Marion Roberts 1
1 General Practice & Primary Healthcare, University of Auckland, Auckland, New Zealand.
2 Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
Abstract
Body image dissatisfaction and its associated challenges have been related to poorer health outcomes among adolescents worldwide, including disordered eating behaviour, depression, and anxiety. However, current prevalence estimates of these issues in Aotearoa New Zealand or, relatedly, the estimates of positive attitudes and behaviours, such as intuitive eating and body appreciation are dated.
The primary aim of this paper was to provide updated estimates for a variety of constructs related to eating behaviours and body image, sourced from a diverse range of early adolescent participants.
For this report, a brief online survey was advertised to adolescents throughout Aotearoa New Zealand (n = 893) via school and community noticeboards.
Approximately one-in-three male participants and one-in-two female participants reported body image dissatisfaction. One in four participants reported clinically significant symptoms of depression and anxiety.
Given such issues, there is clearly still much progress to be made in advancing positive health among early adolescents. Identifying potentially protective constructs such as intuitive eating and body appreciation may offer guidance into the best targets for prevention and early intervention.
Keywords: adolescent health, body appreciation, body dissatisfaction, early adolescence, eating behaviour, health promotion, intuitive eating, mental health, paediatrics.
References
2 Azzopardi PS, Hearps SJC, Francis KL, et al. Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990–2016. Lancet 2019; 393(10176): 1101-18.
| Crossref | Google Scholar |
3 Erskine HE, Baxter AJ, Patton G, et al. The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiol Psychiatr Sci 2017; 26(4): 395-402.
| Crossref | Google Scholar |
4 Patton GC, Coffey C, Cappa C, et al. Health of the world’s adolescents: a synthesis of internationally comparable data. Lancet 2012; 379(9826): 1665-75.
| Crossref | Google Scholar |
5 Patton GC, Sawyer SM, Santelli JS, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387(10036): 2423-78.
| Crossref | Google Scholar |
6 Herpertz-Dahlmann B, Dempfle A, Konrad K, et al. Eating disorder symptoms do not just disappear: the implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood. Eur Child Adolesc Psychiatry 2015; 24(6): 675-84.
| Crossref | Google Scholar |
7 Kieling C, Baker-Henningham H, Belfer M, et al. Child and adolescent mental health worldwide: evidence for action. Lancet 2011; 378(9801): 1515-25.
| Crossref | Google Scholar |
8 Oellingrath IM, Svendsen MV, Hestetun I. Eating patterns and mental health problems in early adolescence – a cross-sectional study of 12–13-year-old Norwegian schoolchildren. Public Health Nutr 2014; 17(11): 2554-62.
| Crossref | Google Scholar |
9 Fleming JE, Offord DR. Epidemiology of childhood depressive disorders: a critical review. J Am Acad Child Adolesc Psychiatry 1990; 29(4): 571-80.
| Crossref | Google Scholar |
10 Bos HMW, Sandfort TGM, de Bruyn EH, et al. Same-sex attraction, social relationships, psychosocial functioning, and school performance in early adolescence. Dev Psychol 2008; 44: 59-68.
| Crossref | Google Scholar |
11 Davison TE, McCabe MP. Adolescent body image and psychosocial functioning. J Soc Psychol 2006; 146(1): 15-30.
| Crossref | Google Scholar |
12 Deighton J, Humphrey N, Belsky J, et al. Longitudinal pathways between mental health difficulties and academic performance during middle childhood and early adolescence. Br J Dev Psychol 2018; 36(1): 110-26.
| Crossref | Google Scholar |
13 Oberle E, Ji XR, Guhn M, et al. Benefits of extracurricular participation in early adolescence: associations with peer belonging and mental health. J Youth Adolesc 2019; 48(11): 2255-70.
| Crossref | Google Scholar |
14 McCabe MP, Vincent MA. The role of biodevelopmental and psychological factors in disordered eating among adolescent males and females. Eur Eat Disord Rev 2003; 11(4): 315-28.
| Crossref | Google Scholar |
15 Lee G, Han K, Kim H. Risk of mental health problems in adolescents skipping meals: the Korean National Health and Nutrition Examination Survey 2010 to 2012. Nurs Outlook 2017; 65(4): 411-9.
| Crossref | Google Scholar |
16 Oddy WH, Robinson M, Ambrosini GL, et al. The association between dietary patterns and mental health in early adolescence. Prev Med 2009; 49(1): 39-44.
| Crossref | Google Scholar |
17 Claus L, Braet C, Decaluwé V. Dieting history in obese youngsters with and without disordered eating. Int J Eat Disord 2006; 39(8): 721-8.
| Crossref | Google Scholar |
18 Bryla KY. Disordered eating among female adolescents: prevalence, risk factors, and consequences. Health Educ 2003; 35(2): 25-9.
| Google Scholar |
19 Das JK, Salam RA, Thornburg KL, et al. Nutrition in adolescents: physiology, metabolism, and nutritional needs. Ann N Y Acad Sci 2017; 1393(1): 21-33.
| Crossref | Google Scholar |
20 Sundgot-Borgen J, Torstveit MK. Aspects of disordered eating continuum in elite high‐intensity sports. Scand J Med Sci Sports 2010; 20: 112-21.
| Crossref | Google Scholar |
21 Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J 2011; 10(1): 9.
| Crossref | Google Scholar |
22 Rosewall JK, Gleaves DH, Latner JD. An examination of risk factors that moderate the body dissatisfaction-eating pathology relationship among New Zealand adolescent girls. J Eat Disord 2018; 6(1): 38.
| Crossref | Google Scholar |
23 Popat A, Tarrant C. Exploring adolescents’ perspectives on social media and mental health and well-being – A qualitative literature review. Clin Child Psychol Psychiatry 2023; 28(1): 323-37.
| Crossref | Google Scholar |
24 Fergusson DM, Horwood JL. The Christchurch Health and Development Study: review of findings on child and adolescent mental health. Aust N Z J Psychiatry 2001; 35(3): 287-96.
| Crossref | Google Scholar |
25 Clark T, Fleming T, Bullen P, et al. Health and well-being of secondary school students in New Zealand: trends between 2001, 2007 and 2012. J Paediatr Child Health 2013; 49(11): 925-34.
| Crossref | Google Scholar |
26 Fear J, Bulik C, Sullivan P. The prevalence of disordered eating behaviours and attitudes in adolescent girls. N Z J Psychol 1996; 25: 7-12.
| Google Scholar |
27 Racine N, McArthur BA, Cooke JE, et al. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr 2021; 175(11): 1142-50.
| Crossref | Google Scholar |
28 Balanovic J, Stuart J, Jeffrey J. “Harden Up and Face Reality:” exploring underlying bullying beliefs in New Zealand. J Sch Violence 2018; 17(1): 46-57.
| Crossref | Google Scholar |
30 Garisch JA, Wilson MS. Prevalence, correlates, and prospective predictors of non-suicidal self-injury among New Zealand adolescents: cross-sectional and longitudinal survey data. Child Adolesc Psychiatry Ment Health 2015; 9: 28.
| Crossref | Google Scholar |
31 Kljakovic M, Hunt C, Jose P. Incidence of bullying and victimisation among adolescents in New Zealand. N Z J Psychol 2015; 44(2): 57-67.
| Google Scholar |
32 Ricciardelli LA, McCabe MP. Children’s body image concerns and eating disturbance: a review of the literature. Clin Psychol Rev 2001; 21(3): 325-44.
| Crossref | Google Scholar |
33 Gouveia MJ, Frontini R, Canavarro MC, et al. Quality of life and psychological functioning in pediatric obesity: the role of body image dissatisfaction between girls and boys of different ages. Qual Life Res 2014; 23(9): 2629-38.
| Crossref | Google Scholar |
34 Cattarin JA, Thompson JK. A three-year longitudinal study of body image, eating disturbance, and general psychological functioning in adolescent females. Eat Disord 1994; 2(2): 114-25.
| Crossref | Google Scholar |
36 Bacon L, Stern JS, Van Loan MD, et al. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc 2005; 105(6): 929-36.
| Crossref | Google Scholar |
37 Bégin C, Carbonneau E, Gagnon-Girouard M-P, et al. Eating-related and psychological outcomes of Health at Every Size intervention in health and social services centers across the province of Québec. Am J Health Promot 2019; 33(2): 248-58.
| Crossref | Google Scholar |
38 Provencher V, Bégin C, Tremblay A, et al. Health-At-Every-Size and Eating Behaviors: 1-year follow-up results of a size acceptance intervention. J Am Diet Assoc 2009; 109(11): 1854-61.
| Crossref | Google Scholar |
39 Van Dyke N, Drinkwater EJ. Review Article Relationships between intuitive eating and health indicators: literature review. Public Health Nutr 2014; 17(8): 1757-66.
| Crossref | Google Scholar |
40 Tylka TL, Annunziato RA, Burgard D, et al. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes 2014; 2014: 983495.
| Crossref | Google Scholar |
41 Moy J, Petrie TA, Dockendorff S, et al. Dieting, exercise, and intuitive eating among early adolescents. Eat Behav 2013; 14(4): 529-32.
| Crossref | Google Scholar |
42 Babbott KM, Mitchison D, Basten C, et al. Intuitive Eating Scale-2: psychometric properties and clinical norms among individuals seeking treatment for an eating disorder in private practice. Eat Weight Disord 2022; 27(5): 1821-33.
| Crossref | Google Scholar |
43 Neumark-Sztainer D, Wall M, Larson NI, et al. Dieting and disordered eating behaviors from adolescence to young adulthood: findings from a 10-year longitudinal study. J Am Diet Assoc 2011; 111(7): 1004-11.
| Crossref | Google Scholar |
44 Menzel JE, Schaefer LM, Burke NL, et al. Appearance-related teasing, body dissatisfaction, and disordered eating: a meta-analysis. Body Image 2010; 7(4): 261-70.
| Crossref | Google Scholar |
45 Collins ME. Body figure perceptions and preferences among preadolescent children. Int J Eat Disord 1991; 10(2): 199-208.
| Crossref | Google Scholar |
47 Anton SD, Perri MG, Riley III JR. Discrepancy between actual and ideal body images: impact on eating and exercise behaviors. Eat Behav 2000; 1(2): 153-60.
| Crossref | Google Scholar |
48 Swami V, Begum S, Petrides KV. Associations between trait emotional intelligence, actual–ideal weight discrepancy, and positive body image. Pers Individ Dif 2010; 49(5): 485-9.
| Crossref | Google Scholar |
49 Adami F, Frainer DES, de Souza Almeida F, et al. Construct validity of a figure rating scale for Brazilian adolescents. Nutr J 2012; 11(1): 24.
| Crossref | Google Scholar |
50 Thompson JK, Altabe MN. Psychometric qualities of the figure rating scale. Int J Eat Disord 1991; 10(5): 615-9.
| Crossref | Google Scholar |
51 Sherman DK, Iacono WG, Donnelly JM. Development and validation of body rating scales for adolescent females. Int J Eat Disord 1995; 18(4): 327-33.
| Crossref | Google Scholar |
52 Chorpita BF, Moffitt CE, Gray J. Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behav Res Ther 2005; 43(3): 309-22.
| Crossref | Google Scholar |
53 Esbjørn BH, Sømhovd MJ, Turnstedt C, et al. Assessing the Revised Child Anxiety and Depression Scale (RCADS) in a national sample of Danish youth aged 8–16 years. PLoS One 2012; 7(5): e37339.
| Crossref | Google Scholar |
54 Klaufus L, Verlinden E, Van Der Wal M, et al. Psychometric evaluation of two short versions of the Revised Child Anxiety and Depression Scale. BMC Psychiatry 2020; 20(1): 47.
| Crossref | Google Scholar |
55 de Ross RL, Gullone E, Chorpita BF. The revised child anxiety and depression scale: a psychometric investigation with Australian youth. Behav Change 2002; 19: 90-101.
| Crossref | Google Scholar |
57 Tylka TL, Wood-Barcalow NL. The Body Appreciation Scale-2: item refinement and psychometric evaluation. Body Image 2015; 12: 53-67.
| Crossref | Google Scholar |
58 Lemoine JE, Konradsen H, Lunde Jensen A, et al. Factor structure and psychometric properties of the Body Appreciation Scale-2 among adolescents and young adults in Danish, Portuguese, and Swedish. Body Image 2018; 26: 1-9.
| Crossref | Google Scholar |
59 Dohnt HK, Tiggemann M. Body image concerns in young girls: the role of peers and media prior to adolescence. J Youth Adolesc 2006; 35(2): 135-45.
| Crossref | Google Scholar |
60 Eisenberg ME, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional well-being among adolescents. Arch Pediatr Adolesc Med 2003; 157(8): 733-8.
| Crossref | Google Scholar |
61 Greenleaf C, Petrie TA, Martin SB. Relationship of weight-based teasing and adolescents’ psychological well-being and physical health. J Sch Health 2014; 84(1): 49-55.
| Crossref | Google Scholar |
62 Croll J, Neumark-Sztainer D, Story M, et al. Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity. J Adolesc Health 2002; 31(2): 166-75.
| Crossref | Google Scholar |
63 Miller JL, Schmidt LA, Vaillancourt T. Shyness, sociability, and eating problems in a non-clinical sample of female undergraduates. Eat Behav 2008; 9(3): 352-9.
| Crossref | Google Scholar |
64 Halliday S, Gregory T, Taylor A, et al. The impact of bullying victimization in early adolescence on subsequent psychosocial and academic outcomes across the adolescent period: a systematic review. J Sch Violence 2021; 20(3): 351-73.
| Crossref | Google Scholar |
65 Yilmaz Z, Gottfredson NC, Zerwas SC, et al. Developmental premorbid body mass index trajectories of adolescents with eating disorders in a longitudinal population cohort. J Am Acad Child Adolesc Psychiatry 2019; 58(2): 191-9.
| Crossref | Google Scholar |
66 Fleming T, Ball J, Bavin L, et al. Mixed progress in adolescent health and wellbeing in Aotearoa New Zealand 2001–2019: a population overview from the Youth2000 survey series. J R Soc N Z 2022; 52: 426-49.
| Crossref | Google Scholar |
67 Ministry of Health. New Zealand Health Survey. 2019. Available at https://www.health.govt.nz/publication/annual-update-key-results-2018-19-new-zealand-health-survey
68 Ministry of Health. New Zealand Health Survey. 2022. Available at https://www.health.govt.nz/publication/annual-update-key-results-2021-22-new-zealand-health-survey
69 Stormshak EA, Connell AM, Véronneau M-H, et al. An ecological approach to promoting early adolescent mental health and social adaptation: family-centered intervention in Public Middle Schools. Child Dev 2011; 82(1): 209-25.
| Crossref | Google Scholar |
70 Linardon J, Tylka TL, Fuller-Tyszkiewicz M. Intuitive eating and its psychological correlates: a meta-analysis. Int J Eat Disord 2021; 54(7): 1073-98.
| Crossref | Google Scholar |
71 Andrew R, Tiggemann M, Clark L. Predictors and health-related outcomes of positive body image in adolescent girls: a prospective study. Dev Psychol 2016; 52(3): 463-74.
| Crossref | Google Scholar |
72 Lucassen MF, Stasiak K, Fleming T, et al. Computerized cognitive behavioural therapy for gender minority adolescents: analysis of the real-world implementation of SPARX in New Zealand. Aust N Z J Psychiatry 2021; 55(9): 874-82.
| Crossref | Google Scholar |
73 Tan KK, Byrne JL, Treharne GJ, et al. Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand. J Public Health 2022; 45: e225-33.
| Crossref | Google Scholar |
74 Mehling WE, Price C, Daubenmier JJ, et al. The multidimensional assessment of interoceptive awareness (MAIA). PLoS One 2012; 7(11): e48230.
| Crossref | Google Scholar |
75 Wiens S. Interoception in emotional experience. Curr Opin Neurol 2005; 18(4): 442-7.
| Crossref | Google Scholar |
76 Todd J, Aspell JE, Barron D, et al. An exploration of the associations between facets of interoceptive awareness and body image in adolescents. Body Image 2019; 31: 171-80.
| Crossref | Google Scholar |
77 Avalos L, Tylka TL, Wood-Barcalow N. The body appreciation scale: development and psychometric evaluation. Body Image 2005; 2(3): 285-97.
| Crossref | Google Scholar |
