16-year-old Sabrina was my neighbour a couple of years ago. Though initially, she was a bubbly girl with a very positive attitude, she became a changed girl after she went to college. She was often concerned about her looks and went to beauty parlors frequently. She always felt that she could have looked much better with less number of pimples and more thin structure. She said that her friends fitted into any clothes because of their figure and that even her sister and mother were better looking than her. Because of such feelings, she resorted to dieting several times. She also involved in purging and taking dieting pills. Though she did lose some significant weight and appeared thinner, she looked less happy, less healthy, and always in a low mood. One day, it came as shocking news to all of us that she attempted suicide. The doctor said that it was mainly because of severe dieting and that suicidal tendency are common among dieters. This event instigated me to conduct further research on the effects of dieting on adolescents, and this essay will discuss the impact of dieting on British Adolescents.
Evidence
Currently, dieting is widespread in most parts of the World, including the UK, for two reasons. One is because of the ideals of thinness circulating among adolescents (Daee et al., 2002). The other is because of the soaring incidence and prevalence of adolescent obesity. According to studies, more than 16 percent of adolescents in the current generation are mildly overweight, and 9.9 percent are severely obese (Daee et al., 2002). Adolescent obesity is a significant public health challenge because of an increased risk of certain diseases like gout, colorectal cancer, atherosclerosis, cardiac ischemia, and stroke. Besides, those who are obese in adolescence have a 70 percent risk of turning into obese adults. Obesity in youth is associated with several diseases like hypertension, obstructive sleep apnea, adverse lipoprotein levels, coronary artery disease, diabetes mellitus, colorectal cancer, stroke, and death due to several causes (Nemet et al., 2005; Daee et al., 2002). Other than these disease states, obesity is also associated with discontinuation of education, poverty, and a lower marriage rate (Daee et al., 2002). Considering the prevalence of obesity and the need to refer to this disease as early as possible in life, prevention and management of obesity must be initiated in early adolescence or even childhood (Reilly et al., 2006). However, quick strategies for fixing have become a standard mode to tackle this problem, which is unhealthy. Unhealthy dieting practices among adolescents can lead to several physiologic and psychologic effects, many of which are detrimental (Daee et al., 2002).
Comparison with Official Documents
Approximately 60 percent of girls and 25 percent of boys of the adolescent age diet at some point in time during adolescence. A significant percentage of those individuals resort to unhealthy or even dangerous methods of dieting like intake of pills, the use of deficient calorie diets, and fasting. Adolescents are often concerned about their weight and shape (Gruber et al., 2001). In addition to the real health risks of obesity and poor eating habits, these youngsters are also exposed to thin beauty ideals that are unrealistic. Unfortunately, there is an overemphasis of thinness among youngsters, because of which they equate thinness and beauty with success and health. The media provides ideas for various means of losing weight to achieve the thin ideal (Morris and Katzman, 2003). The information delivered by media thus is often based on fad trends, with a financial incentive, and without any scientific backing. The net result is that several adolescents feel the cultural pressure for becoming thinner, more than that required for optimum health, and they attempt to fit into this through nutritional choices that are either poor or dangerous or both (Adolescent Health Committee, 2004).
Comparison with Headlines of Newspapers
According to BBC News (2006), “Teenagers often choose food in response to peer pressure or as an act of defiance against parents.” Dr. Andrew McCulloch, chief executive of the Mental Health Foundation, said: “We are well aware of the effect of diet upon our physical health. But we are only just beginning to understand how the nutrients influence the brain as an organ it derives from the foods we eat and how diets have an impact on our mental health.” And he added that addressing mental health problems with changes in the diet was showing better results in some cases than using drugs or counselling.
Assumptions
While the reasons for dieting among adolescents are varied, in the majority of teenagers, the motivating factors are dissatisfaction with body image and desire to appear thinner. Losing weight attempts are often associated with different behavioral changes like alterations in regular eating habits and change in the frequency of exercising. There is no clear cut definition for dieting. Most professionals define dieting as “an intentional, often temporary, change in eating to achieve weight loss” (Adolescent Health Committee, 2004). Extreme dieting has been defined as “self-induced emesis, laxative use, and diet pill use.” Self-induced emesis has been reported in 5-12 percent of adolescent girls. Crash diets, skipping of meals, and fasting have been reported in 22- 46 percent of youngsters in several parts of the World, including Canada, the US, and the UK. Several studies have classified chronic dieting, fasting, fad dieting, and skipping meals as unhealthy dieting strategies. Thus, dieting consists of a spectrum of behaviors that range from healthy to harmful. One surprising sick action arising out of an urge to become thin is smoking. Smoking for controlling weight is reported in12- 18 percent of young women (Adolescent Health Committee, 2004).
Model of Health
According to WHO (1946), “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” However, several researchers have argued the completeness of this definition. Thus several other meanings and models of health have come up like the biomedical model, biopsychosocial model, public health model, wellness model, health belief model, etc. (Curtis, 2002). According to the health belief model, it is possible to explain health-related behavior if beliefs about health care clear. According to this model, individuals will act to protect or promote their health based on what they believe, and this belief is influenced by several factors, including media (Turner et al., 2004).
There are several determinants of dieting among adolescents, and it is often challenging to ascertain as to which group of adolescents resort to dieting. Generally, dieting is more common among girls and increases with age. Adolescent girls who are dissatisfied with their image and are overweight are likely to resort to dieting. The more the degree of overweight, the more is the risk of dieting and disordered eating (Neumark-Sztainer et al., 2002). However, there is a high prevalence of dieting, even in those with normal and underweight. Some studies have determined that dieting is prevalent in 36 percent of normal-weight adolescent girls when compared to 50 percent of overweight and 55 percent of obese girls. Thus, the perception of overweight is an essential factor for dieting among adolescent girls, even though they are actually overweight (Adolescent Health Committee, 2004; Wertheim, 1997).
Several cross-sectional studies have identified self-esteem as an influential factor for unhealthy dieting practices to control weight (Cameron, 1999). Factors that protect adolescents from unhealthy dieting are “having a sense of control over one’s life, family connectedness, having positive adult role models and positive involvement in school” (Adolescent Health Committee, 2004). In fact, there are reports that parental criticism of the adolescent’s weight, the pressure to lose weight, and parental role modeling of dieting are associated with an increased rate of dieting and increased risk of development of extreme dieting behaviors (Adolescent Health Committee, 2004). According to French et al. (1997), perceived overweight, low body pride, and dissatisfaction of body image among adolescent females are consistent correlates of binge eating and dieting, and ethnic subculture does not seem to influence the prevalence of these correlates. The study demonstrated that while purging was significantly associated with the dissatisfaction of weight, perception of overweight, lower pride of body, increased risk of suicide and increased risk of alcohol abuse; binge eating is associated with the dissatisfaction of weight, perceived overweight, decreased body pride, lower family connectedness, emotional stress and increased acceptance of concerns of peers.
Another important risk factor is the presence of chronic illnesses like epilepsy, asthma, diabetes, and attention deficit disorder. The presence of psychiatric problems like anxiety and depression also leads to extreme dietary practices. Other essential factors include weight-related teasing, peer group influence, vegetarianism, involvement in sports compared to weight like gymnastics and dance, puberty at an early age and engagement in risky behaviors like smoking, substance abuse, illegal activity, and unprotected sex (Byely et al., 2000, Adolescent Health Committee, 2004).
Discussion
Moderate dieting is associated with some positive outcomes. These are a decrease in hyperinsulinemia, improvement in insulin resistance, and a decrease in high cholesterol levels occurring because of weight reduction. In a study by Escobar et al. (1999), the researchers found that weight loss in obese children led to an improvement in the altered insulin clearance, leading to normalization of serum insulin levels. Weight loss in obese children also causes an increase in sleep function and upper respiratory obstruction (Willi et al., 1998). In a large study (Sothern et al., 2000) on adolescents with obesity, weight reduction strategies involving calorie restriction with moderate grade exercise contributed to sustained growth velocity while at the same time causing a decrease in body weight. Positive consequences of dieting are associated with intake of more fruits and vegetable that is a part of dieting.
Several negative consequences can occur as a result of dieting among adolescents, the most common of which are delay in the linear growth and delayed pubarche. According to a study that evaluated children with either short stature or delayed puberty or both, it was evident that 7 percent of children suffered from growth failure as a result of malnutrition secondary to willful and conscious decreased calorie intake. In these children, while the healthy weight gain fell at 12 years of age, followed by a decrease in the linear growth velocity, there was also delay in puberty and also delay in bone age. Another significant physical impact of adolescent dieting is the increased risk of gaining weight in the long term. This is evident from a prospective cohort study that evaluated high school girls who limited calorie intake and performed moderate exercise for weight loss. Predictors for future weight gain are vomiting, use of appetite suppressants and laxatives, and binge eating. Another significant predictor for future weight gain is the use of substantial efforts for weight loss (Daee et al., 2002).
One important point worth mentioning at this juncture is that adolescent dieting is associated with a decrease in the expenditure of resting energy. This is because, more often than not, diet during dieting is a low-energy diet with predominant calorie restriction, and this causes a significant decrease in the expenditure of energy during resting. Thus, unless the physical activity is increased or further calorie intake is reduced, weight loss becomes challenging to achieve (Daee et al., 2002).
Other than physical consequences, dieting can also result in psychological effects on adolescents who are undergoing rapid mental, physical, and social development. Several studies have shown the association between dieting in adolescents and problem behavior. Worst psychological problems have been reported in those who diet frequently and purge. Smoking is one of the behavioral consequences of dieting. When adolescents resort to smoking as a deviation from food intake, they become addicted to tobacco and fall prey to the health and financial consequences of smoking (Daee et al., 2002). Smoking and consumption of other substances like alcohol and illicit drugs are more likely to occur in dieters who are purgers when compared to a dieter who is not purgers. French et al. (1995) opined that persistent efforts of dieting in adolescents must be viewed in the broader context of health and behaviors that are risk-taking rather than just an isolated issue.
Dieters, especially purgers, perform poorly at school, and they are more likely to be active sexually and frequently get involved in sexual or physical abuse. They are also more likely to attempt suicide. Purging and dieting are both associated with family stress, emotional turmoil, negative body image, and lower connectedness with family members (Daee et al., 2002).
Dieting is also associated with the development of eating disorders like bulimia, disordered eating, and binge eating. According to some reports, while 2-3 percent of adolescents have bulimia, 1 percent of them suffer from anorexia nervosa, and 3-5 percent suffer from disordered eating. All these disorders are associated with several consequences like estrogen deficiency, amenorrhea, hypophosphatemia, osteopenia, anemia, renal dysfunction, cardiac abnormalities, and leucopenia. On the other hand, bulimia is associated with electrolyte disturbances like hypokalemia and also other problems like cardiac arrhythmias, gastric dilatation, irregularities in the menstrual cycle, esophageal rupture and gastric rupture, parotid gland enlargement, erosion of tooth, upper gastrointestinal bleeding and esophagitis (Daee et al., 2002)s. The most common erratic eating disorder is binge eating, which is likely to occur in those who diet frequently and resort to purging (Daee et al., 2002). Studies on binge eaters have revealed that these adolescents are not able to control their urge to eat, because of which they eat and then purge out of guilty feeling. According to a population-based study, 1 in 40 adolescent females was likely to develop an eating disorder within six months of dieting when compared to non-dieting adolescent females. The latter were at risk of developing the diseases at 1 in 500 rates. More than three fourth’s of bulimia patients developed the eating disorder when they were on a low-carbohydrate diet, which they could not maintain. Keys et al. (cited in ) conducted a study on military adolescents who were placed on a diet that was very low in calories. Most of them had developed one or more types of eating disorders like food hoarding, preoccupation with food, and emotional instability. According to Butyrn and Wadden (2005), weight loss programs under professional advice minimize the risk of developing eating disorders in children and adolescents.
According to the American Heart Association, a low carbohydrate diet contains too much protein and saturated heart, which is not suitable for bones, kidneys, and heart (Harvard Medical School, 2007). Also, the diet does not include other healthy foods like fruits and vegetables, which decrease the risk of stroke, dementia, and some types of cancers.
Though Atkin’s diet has been proven to reduce intake in those who are overweight, recent reports have questioned the health effects of this diet. Lack of fruits and whole cereals and the presence of big fat questions the safety of this diet when it comes to cardiovascular aspects. Most of the concerns related to the acute effects of dieting are about deaths that have been reported in otherwise healthy dieters. Potential etiologies for such severe outcomes include sudden onset of severe hypertension due to pills, cardiac arrhythmias, acute disturbances in electrolytes especially potassium, that can be fatal, and finally primary effects of the low-calorie diets that can affect the contractility of the myocardium (Daee et al., 2002). These problems may be due to dieting also, or due to the worsening of a previously undiagnosed potentially dangerous condition like prolonged QT syndrome. The most common cause of acute adverse effects of dieting is due to pills, which are readily available over the counter. Most of the over the counter and prescription diet pills have hunger suppressing drugs and drugs to increase metabolic rates. More often than not, these drugs are sympathomimetic. Other types of medicines include thyroid supplements. Both categories of drugs have side effects like hypertension, arrhythmias, myocardial ischemia, tremulousness, psychosis, insomnia, and seizures (Daee et al., 2002). Sympathomimetic drugs can also affect the peripheral vascular resistance and systemic vascular resistance and heart rate, leading to an imbalance in supply and demand, resulting in myocardial ischemia. Other than these acute side effects, the pills also have some chronic side effects. Dexfenfluramine and fenfluramine are known to cause pulmonary hypertension and cardiac valvular lesions and are now removed from the market (Daee et al., 2002).
Summarise the Model
When the health belief model is applied for Sabrina’s case, it is evident that Sabrina believed that being thin is health and beauty. This was because of the image provided by the media and her peers. There are several determinants of dieting among adolescents, and it is often challenging to ascertain as to which group of adolescents resort to dieting. Generally, dieting is more common among girls and increases with age. Adolescent girls who are dissatisfied with their image and are overweight are likely to resort to dieting. The more the degree of overweight, the more is the risk of dieting and disordered eating (Neumark-Sztainer et al., 2002). However, there is a high prevalence of dieting, even in those with normal and underweight. Some studies have determined that dieting is prevalent in 36 percent of normal-weight adolescent girls when compared to 50 percent of overweight and 55 percent of obese girls. Thus, the perception of overweight is a vital factor for dieting among adolescent girls, even though they are actually overweight (Adolescent Health Committee, 2004; Wertheim, 1997).
Thus, Sabrina was concerned more about her looks and beauty because of various factors her and resorted to dieting because; that is what she believed in.. The health belief model helps understand the behavior of Sabrina as an adolescent dieter desperate to look thin despite adverse consequences.
Conclusion
Dieting is very common among adolescents in the UK and other parts of the World. A significant proportion of dieters resort to unhealthy and dangerous methods of dieting, leading to several adverse and unexpected outcomes of dieting. Dieting can be associated with positive and negative consequences, and this, of course, depends on the type of dieting. Diets involving intake of pills, meager calories, and skipping of meals are dangerous, while those associated with positive consequences are due to increased consumption of fruits and vegetables, increased exercise, and decreased intake of fat. In general, however, dieting appears to have more negative consequences than positive consequences. Weight loss among adolescents is mainly associated with poor body image, decreased coping mechanisms, and adverse psychosocial and family risk factors. There does exist a strong association between dieting and onset of eating disorders like anorexia nervosa, bulimia, and erratic eating habits like binge eating. Other psychosocial consequences include involvement in risky health behaviors like smoking, substance abuse and alcoholism, unprotected sex, suicide attempts, and delinquency. Besides these negative consequences, dangerous effects of dieting include mortality and morbidity related to dieting because of biochemical and physiological consequences like acute electrolyte disturbances in blood and serum, loss of minerals and essential trace elements, changes in the myocardium, and adverse effects of free fatty acids on the myocardium.
Given the consequences of dieting, the primary intervention point should be at the prevention of dieting. This can be done by the education of parents during primary health visits and also the learning of older children and adolescents about eating patterns, behaviors, and physical activity. In the case of dieting has to be done, the food intake must be taken under physician guidance who can monitor the consequences and detect side effects at an early stage itself and revert them.
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