Dietary and Physical Activity Factors Related to Eating Disorder Symptoms Among Middle School Youth


  • The authors would like to thank Sylvia Stevens-Edouard, Vanessa Cavallero, Vivian Morris, Christine Horan, Maria Bettencourt, and Christine Nordstrom for their contributions to the Healthy Choices Study and school staff and students who participated in the study. This research was supported by the Ellen Feldberg Gordon Fund for Eating Disorders Research and the Massachusetts Department of Public Health in collaboration with the International Nutrition Foundation, Inc. Partial funding for this project was provided by Cooperative Agreement U58/CCU12282 with the Centers for Disease Control and Prevention. S.B. Austin is supported by the Leadership Education in Adolescent Health project, Maternal and Child Health Bureau, HRSA grant 6T71-MC00009. M.L. Wang is supported by the Strategic Training Initiative for the Prevention of Eating Disorders Dissertation Award.

Monica L. Wang, Postdoctoral Fellow, (, Division of Preventive & Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.


BACKGROUND: Dietary and physical activity (PA) behaviors can predict disordered weight control behaviors (DWCB) among youth. This study examines dietary and PA correlates of DWCB and differences by race/ethnicity and weight status in a diverse sample of youth.

METHODS: Self-reported data on dietary weight management behaviors, strengthening/toning exercises, moderate-to-vigorous physical activity, and DWCB (vomiting, taking laxatives, and/or taking diet pills without a prescription) were obtained from 15,260 sixth to eighth graders in 47 middle schools participating in the Massachusetts Healthy Choices Study at baseline (2005). Generalized estimating equations were used to estimate odds of DWCB associated with dietary and PA behaviors and to examine for differences by race/ethnicity and weight status, adjusting for covariates and clustering of individuals within schools.

RESULTS: Disordered weight control behaviors were reported by 3.6% of girls and 3.1% of boys. Youth who engaged in strengthening/toning exercises 7 days per week versus 0-3 days per week had increased odds of DWCB (girls odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.3 − 3.0; boys OR = 1.5; 95% CI = 1.0 − 2.2). Dietary weight management behaviors were associated with increased odds of DWCB (girls OR = 1.2; 95% CI = 1.1 − 1.3; boys OR = 1.3; 95% CI = 1.2 − 1.4) for each additional behavior. These associations did not differ by race/ethnicity or weight status.

CONCLUSIONS: Persons promoting healthy dietary and PA behaviors among youth should consider the co-occurrence of strengthening/toning and dietary weight management behaviors with DWCB and the consistency in these associations across racial/ethnic and weight status groups.