Dieting and "Watching" Behaviors Among Adolescent Females: Report of a Multimethod Study

J O U R N A L OF A D O L E S C E N T H E A L T H 1995;17:153-162

ORIGINAL ARTICLE

Dieting and "Watching" Behaviors Among Adolescent Females: Report of a Multimethod Study

MIMI NICHTER, Ph.D., CHERYL RITENBAUGH, Ph .D .M.P .H . , M A R K NICHTER, Ph.D.

M.P.H., N A N C Y VUCKOVIC, Ph.D., A N D MIKEL AICKIN, Ph.D.

Purpose: This study posits a distinction between "watching what you eat" and dieting behaviors in a sample of adolescent females. Findings suggest that the dichotomy of dieter/nondieter fails to capture a range of healthful behaviors practiced by many adolescent girls.

Methods: Anthropologic and nutritional research methods were used in this study. Data were drawn from 1 year of a longitudinal study of food intake and dieting behaviors in a sample of 231 adolescent females. Multi- ple methods including one ethnographic interview, a survey questionnaire, a telephone interview, and food records were collected from each informant.

Results: Although 44% of the girls in this sample reported trying to lose weight on the day of the survey, only 8.6% of the food records reflected dieting days. In interviews, many identified "watching what they eat" as a health-promoting strategy that allowed them to maintain their weight. Analysis of food record data confirmed a trend toward higher intakes of micronutrients.

Conclusions: Research concerned with adolescent weight loss behaviors has focused more on negative than positive health attitudes and behaviors. The present study identified the behavior of "watching" as distinct from dieting. "Watching" was widely utilized by girls in this sample as a way to maintain weight and promote health.

KEY WORDS:

Weight control Nutrient intake Dieting Qualitative methods

From the Department of Anthropology, Graduate Program in Public Health, and Arizona Cancer Center, University of Arizona, Tucsoll, Arizona.

Address reprint requests to: Mimi Nichter, Department o( Anthre~ pology, Haury Building, University of Arizona, Tucson, AZ 85721.

Manuscript accepted December 15, 1994

Numerous surveys have found that dissatisfaction with body weight and inappropriate dieting behaviors are pervasive among adolescent Caucasian females (1-8). Reports have generally concluded that there is an "epidemic" of dieting among adolescent females, with as many as 60-80% dieting at any given time (1,2). The use of extreme methods is reportedly escalating and this may lead to a higher incidence of eating disorders (3-6). Research indi- cates that adolescent girls adopt a variety of weight- reducing strategies including purging, fasting, and excessive exercising (6,7).

Existing data on dieting behaviors among adolescent females have largely been generated by self- report surveys that require girls to describe their behavior using researcher specified categories (1-8). An evaluation of the instruments and question frames utilized to assess dieting behavior is rarely reported (9). Research on weight control among adolescent females has typically focused on issues such as ideal weight versus actual weight, present dieting status, number of dieting incidents per year, and weight loss strategies utilized (10-14). Table 1 summarizes questions typically asked on dieting questionnaires.

Despite the quantity of articles on dieting, we know little about the meaning of the term "dieting" to adolescents, the duration of their diets, or what behaviors girls follow when they diet. Indeed, con- sidering how little is known about normative eating patterns among adolescents, it is difficult to assess what constitutes dieting behavior among this age cohort (15,16). Moreover, research focused on adolescent health behaviors has paid far more attention

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154 NICHTER ET AL. JOURNAL OF ADOLESCENT HEALTH Vol. 17, No. 3

Table 1. Weight Questions Commonly Asked by Researchers (Author and Year of Citation)

In your opinion, are you very underweight, underweight, just right, overweight, very overweight?

Youth Risk Behavior Survey, 1990 Koff & Rierdan, 1991 Greenfield, Quinlan, Harding et al., 1987 Davies and Furnham, 1986

Are you currently trying to lose weight or gain weight?

Davies and Furnham, 1986 Koff and Rierdan, 1991 Rosen and Gross, 1987 Rosen and Poplawski, 1987 Youth Risk Behavior Survey, 1990

In order to control your weight or lose weight, how often have you used diet pills, laxatives, diuretics, vomited after eating?

Greenfield et al., 1987 Rosen & Gross, 1987 Youth Risk Behavior Survey, 1990

How often have you skipped meals to control your weight or lose weight?

Koff & Rierdan, 1991 Stein & Reichert, 1990 Youth Risk Behavior Survey, 1990

to negat ive behaviors than to identifying posit ive health at t i tudes and behaviors.

Drawing on anthropological and nutri t ional research methods , this interdiscipl inary s tudy explored the "cul ture" of teens with regard to weight- related behaviors . Girls were invited to part icipate in the s tudy as "experts in teen culture" f rom w h o m the researchers might learn about the experience of being an adolescent.

Findings der ived f rom e thnographic interviews were used to deve lop i tems and responses on surveys. Food record data were compared to weight control a t tempts repor ted on surveys to check for the val idi ty of self-report behavior .

Methods

Study Sample

This cross-sectional report is d r awn f rom a 3-year longitudinal s tudy known as the Teen Lifestyle Project. The pape r reports on data f rom the third year of the s tudy and includes 231 adolescent girls (134 10th graders and 97 11th graders). The mean age of the 10th graders was 16.02 _+ 0.44 (mean _ SD), and 16.99 _+ 0.49 for l l t h graders. Sixty-eight percent of the sample were Caucasian, 13% were Mexican- American, 3% were As ian-Amer ican , and 3% were Nat ive-Amer ican . The remaining 13% of informants did not categorize themselves into any ethnic group.

The project was in t roduced in physical educat ion (PE) classes, and was described to the s tudents as an oppor tun i ty for them to express their opinions about issues impor tan t to teenagers, such as body image

and dieting. Approx ima te ly 80% of girls chose to part icipate and re turned consent forms s igned by themselves and a parent or guardian.

Data Collection and Management

Multiple me thods were util ized in this study. Each year, each par t ic ipant comple ted a survey, an in- person interview, a te lephone interview, and food records. Table 2 summar izes data collection and questions der ived f rom each method.

Quantitative data collection. A survey quest ionnaire was adminis te red in the schools in the Spring of 1992. I tems on the quest ionnaire were der ived f rom the l i terature and f rom informat ion gained in e thnographic interviews as described below. Evalu- ation of the reliability and val idi ty of the data collection strategies was under t aken dur ing the pilot year (17).

A structured, open-ended te lephone interview that focused on actual diet ing or weight main tenance and exercise behaviors in the previous few weeks and months was adminis te red in the Spring of 1992. Girls were contacted at home by telephone, and the phone interview lasted approx imate ly 10 minutes.

Qualitative data collection. In the third year of the study, each girl par t ic ipated in one in-depth semi- s t ructured interview that took place in the school. The interviews were tape recorded, and then were transcribed and entered into No tebook II sof tware to permi t retrieval of quotat ions on part icular topics.

September 1995 ADOLESCENT DIETING AND WATCHING 155

Table 2. Summary of Data Collection and Questions Derived from Each Method, Year 3, Teen Lifestyle Project

Ethnographic Interviews Survey Telephone Interview Food Records

Frequency One per girl. One per girl, Height One per girl. Phone call lasted 6 days per girl (2 Interview lasted and weight 10-15 minutes, weekdays, 1 45 minutes, measured at time of weekend day each

survey, semester).*

Timing November 1991~ April 1992 March-April 1992 3 in Fall 1991; 3 in March 1992 Spring 1992

Questions Have you been Are you trying to dieting to lose change your >,'eight weight recently? now? (Table 3).

What does it How often did you try mean to you to to lose weight last be on a diet? year?

Do you consider How long do your yourself diets usually last? someone who I watch what 1 eat watches what because.....(Table 5) she eats? What does that mean When 1 watch what to win? I eat, I.... (Table q)

How long did your most recent attempt to lose >.'eight last? (For girls who had tried to lose weight, this additional question was asked: I'm going to read you a list of weight loss methods, and you can tell me if you used this method or not.)

All ,~,,irls in tile study were asked the following questions: Would you call yourself a dieter?

Would you call yourself someone who watches what she eats?

Are you someone who doesn't think about it at all?

How many times did you exercise for at least 30 minutes in the past week?

What did you eat today?

Were you dieting to lose weight today?

* Holiday seasons were avoided

E thnog raph i c research enab led the researchers to ga ther data on the w a y in which ea t ing and die t ing behav io r s were d i scussed and to ident i fy issues and themes re levant to ou r sample . W h e n i m p o r t a n t issues e m e r g e d in in te rv iews that had not p r ev ious ly been repor ted in the l i terature (such as "wa tch ing w h a t I eat"), in te rv iew data were used to deve lop su rvey and t e l ephone ques t ions (18,19). For example , the ques t ions "1 wa tch w h a t I eat because..." and " W h e n I wa tch w h a t I eat, I..." were bo th d e v e l o p e d and inc luded on the su rvey in s t rumen t (Table 5). Cu l tu ra l ly app rop r i a t e r e sponse categories were also d r a w n f rom e thnog ra ph i c in te rv iew data. For example, in r e sponse to the in te rv iew ques t ion " W h a t does w a t c h i n g w h a t you eat m e a n to you?" , m a n y girls had descr ibed that they a vo i de d " junk food" or "ate heal thier foods" , therefore these were inc luded on the s u r v e y as responses .

To fur ther explore the dis t inct ion be t we e n die t ing and "watch ing , " certain ques t ions were inc luded in the t e l ephone interview. The ques t ions " W o u l d you call yourse l f a dieter?", " W o u l d you call yourse l f s o m e o n e w h o wa tches w h a t she eats?", or "Are you

s o m e o n e w h o d o e s n ' t th ink abou t it at all?" were inc luded (Figure 1).

Dietary data collection and coding. Food records were reques ted f rom each girl for a total of 6 days per year , sp read ou t as 1 d a y per w e e k for 3 weeks each semester . The two da ta collection per iods w e r e ap- p rox ima te ly 6 m o n t h s apart . The r eco rd ing d a y s were r a n d o m l y ass igned, b locked as 2 w e e k d a y s a n d 1 w e e k e n d d a y in each semester . This da ta collection s t ra tegy was a d a p t e d f r o m the m e t h o d o l o g y of the C o n t i n u i n g Survey of Food Intake of Ind iv idua l s (CSFII-85 and -86) (20-22). Food records ra ther than food f r equency ques t ionna i res were used because the latter have substant ia l p rob l ems of val idi ty, are not avai lable for specific use wi th a t eenage popu l a - tion, and could not p r o v i d e the level of detai l on d ie t ing and nond ie t i ng behav io r requ i red for the present s t u d y (22).

Dur ing the first yea r of the s tudy, project nu t r i t ion staff c o n d u c t e d a food record t ra in ing session in each par t ic ipa t ing PE class. Subjects w h o were absent that d a y a t t ended a m a k e - u p session. Subjects were


taught and practiced estimating portion sizes, recording foods in adequate detail, recording all items consumed, and proper use of the recording form.

Twenty-four hour food intake record forms and return self-addressed envelopes were sent to each participant before each assigned date. Food record forms included the date on which they should be kept, instruction reminders for noting what was eaten and when, and additional questions including whether this day was a day on which the subject was dieting to lose weight. Staff members called girls on the night of the assigned record to remind them to complete the form.

Every returned food record was reviewed upon receipt by nutrition staff, and girls were telephoned promptly to follow-up on inadequate information. By year three, reported here, the food records were of consistently high quality. Participant observations by the researchers within the schools and local eating establishments confirmed reported food choices and portion sizes. In the third year, all girls in our sample completed at least one food record, with an average of 3.23 food records per girl. The response of our study sample was similar to response levels of adult women in national surveys. Reasons for nonresponse usually related to girls not being at home to receive reminder telephone calls or being too busy to complete the forms. Because of our desire to maintain participation of the girls in all aspects of the study, we only attempted one make-up call for each missed day.

Food records were coded and entered by trained staff using Nutritionist IIIv. 6, utilizing all standard quality control/quality assurance (QC/QA) proto- cols of the Nutrition Core of the Arizona Cancer Center. The project developed an extensive database of foods eaten by these teens, including standard portion sizes and nutrients for all local fast foods and all foods prepared and/or served at the schools. Twenty-five percent of the records were duplicate entered and reconciled as a standard QC/QA proce- dure. Food code/gram weight files were matched to the USDA survey food codes and analyzed for nutrient composition using the CSFII-86 food composition data base with a matching program developed and validated by the Nutrition Core of the Arizona Cancer Center.

Analysis

All data were analyzed using the STATA analysis program. A significance level of 0.05 was used throughout as a standard. Comparisons of continu-

ous variables (e.g., weight, body mass index, exercise) between dieting groups were done using student's t-tests (Table 4). Comparisons of closed choice responses from the survey were made using a binomial test of proportions (Table 5). For nutrient intake analyses (Tables 6 and 7), girls had different numbers of days of data. Therefore, an average was computed over all available days for each girl. The group averages were calculated, with number of days of data as the weighting factor for each girl. For Table 6, this was done within the dieting days set and within the nondieting days set separately. For Table 7, all data were averaged for each girl. This was done in both cases to downweight the girls from whom less data were available. Distributions of numbers of total days of food intake records were similar in each group. Paired student's t-tests were used to compare dieting and nondieting day averages within groups. Student's t-tests were used for all comparisons between groups.

Results

Prevalence of Weight Change Efforts

To assess the comparability of the reporting of weight loss behaviors in this sample to a nationwide sample, the survey responses of Teen Lifestyle Project respondents to the question "Are you trying to change your weight now?" were compared with responses from girls queried in the nationwide Youth Risk Behavior Survey (13). Results are shown in Table 3, indicating the close similarity of responses between our study sample and the national sample. Combining the responses from two categories in the Youth Risk Behavior Survey (to achieve a composite of informants who were not dieting), one finds that 49.7% of girls nationwide, compared to 50.7% of Teen Lifestyle Project girls, reported not pursuing weight loss behaviors at the time of the survey. Dieting behaviors, such as the use of diet pills, vomiting, and increased exercise were all reported considerably less often by Teen Lifestyle Project informants when compared to the nationwide survey.

Duration and Methods for Weight Loss

Of 231 girls who were asked "How long did your most recent attempt to lose weight last?", 150 reported having dieted (63%). For the girls who reported dieting, duration of attempt was clustered into four groups: less than a week (31%), 7-14 days


Table 3. Comparison of Teen Lifestyle Project and Youth Risk Behavior Survey Results to the Question "Are You Trying to Change Your Weight Now?"

Teen Lifestyle Project n = 231 Youth Risk Behavior Survey n = 11,631 (13)

Response Percent Response Percent

No 50.7 | Not doing anything 23.4 / Trying to keep from gaining 26.3

Yes, trying to lose 43.6 Yes, trying to lose 43.6 Yes, trying to gain 5.2 Yes, trying to gain 6.6 Practices ever used to lose weight: Practices ever used to lose weight:

Diet pills 7.6 Diet pills 20.6 Vomiting 9.0 Vomiting 13.8 Exercise 54.0 Exercise 79.5

(23%), 15-31 days (25%), and over a month (18%). Girls who responded that they had dieted were next read a list of weight-toss methods (generated from interview data) ranging from extreme methods to healthy eating. They were asked to answer yes or no to having used these methods dur ing their most recent diet. Girls were asked to respond to every me thod used. Notably, all girls who repor ted attempts to lose weight used multiple methods. A majority of these girls, irrespective of the durat ion of their diets, reported that they ate healthy foods (such as salads and fruits) (91%), watched what they ate (see below) (95%), exercised (82%), and ate less (77%) as strategies for losing weight. Few girls reported using extreme methods of weight loss. Three percent repor ted self-induced vomiting, 4% used diet pills, and 4% used diet aids. Twenty- two percent of girls who repor ted dieting for more than 30 days were involved is s tructured commercial diet programs.

Behavioral Strategies

In e thnographic interviews (n = 231), it was found that girls classified their eating behavior in relation to both. These behaviors were distinct, but not nec- essarily mutual ly exclusive. Because the distinction between the two categories, "dieting" and "watching what I eat" had previously been unrepor ted in the literature, we investigated their meaning. Dieting was often found to be associated with a specific regimen or plan and involved a dramatic reduction of food intake. Not uncommonly , girls described how dieting was problematic and difficult for them.

We also probed the meaning of "watching" in interviews. Some girls described how they preferred to call their eating behaviors "watching" rather than "dieting", al though both involved being conscious of food intake.

I think I'm always conscious of what I'm eating. Whether it's good or bad, I'm always thinking "What's this gonna do?" Especially, I mean, if I'm eating something like candy or something, I go "I shouldn't be doing this," but I don't like saying "I'm on a diet."

If I feel I'm gaining weight, I'll just eat a little less. I don't consider that dieting. If you consider it a diet, then you're in trouble. Because then you'll have to lose weight and if you don't, you know, you realize you've failed. Then, you know, you get more upset and you eat more.

The difference between these two behaviors seemed to be a matter of at t i tude as well as degree. Whereas failure to adhere to a diet often led to an admission of personal failure and frustration, "watching" was described as a positive behavior that girls were able to manage on their own.

Watching what they ate afforded girls greater agency by permit t ing them to manage and negotiate their eating behavior in context. Their behavior was flexible and relative to their present situation, as well as to eating behavior p lanned in the immedia te future (e.g., tradeoffs).

Girls identified several reasons for watching behaviors: to be healthy, to maintain their weight, to lose weight, and to gain control over their environment. Girls who watched to be healthy often described avoiding candy, chips, soda, and fatty foods, and eating more fruits and vegetables.

Differences Between Dieting and Watching

Once the categories of dieting and "watching" had emerged as meaningful concepts to these girls in e thnographic interviews, items were incorporated into the te lephone interview and survey to allow for quantification and further exploration of the specific


attitudes and behaviors associated with them. In ethnographic interviews, girls seemed to identify themselves in one category or another (e.g., as a "dieter," as a "watcher"). Therefore, we developed nonoverlapping categories of girls based on their responses to the following questions in the telephone interview: "Would you call yourself a dieter?" and "Would you call yourself someone who watches what she eats?" Response options for each question were: always, most of the time, sometimes, or never (Figure 1).

For the purpose of the present analyses, dieters were defined as girls who said they dieted always or most of the time. Notably, all of these girls "watched" at least sometimes. Watcher/dieters were defined as girls who said they watched always, most of the time, sometimes, and somet imes dieted. Watch- ers were defined as girls who never dieted but did watch. The neither category included girls who responded "never" to both questions about dieting and watching. Four girls who "never" watched and "sometimes" dieted were excluded from further analysis because the group was too small to analyze separately and too conceptually distinct to be joined with another category.

We further explored whether differences might exist in the physical characteristics and exercise levels of girls who had reported dieting and "watching" behaviors. Table 4 shows the weight, body mass index, and exercise levels of girls in each behavioral category. The highest proportions of girls were in the two intermediate categories, watcher/dieters (42%) and watchers (36%). Only 8% of the sample fell in the dieter category. Thirteen percent reported that they neither dieted nor watched what they ate.

The dieters and watcher/dieters were significantly heavier than girls in the other categories, and had significantly higher body mass indices (wt(kg)/

Would you call yourself a dieter?

Would you call yourself someone who watches what

she eats?

Never

Never 3 0 ~

Sometimes 4

Most of 0 the Time

Always 0

Sometimes Most of Always the time

45 i 32 7

48 38 12

!3 8 1 I

Figure 1. Self-class(ficatio~t t)t girls. Dtcttsly, ~at "a,atchi~t~" status.

ht2(m)). In response to the telephone interview question "How many times did you exercise at least 30 minutes in the past week?," dieters gave significantly higher responses than any other group. Therefore lower body weight and body mass index of girls in the "neither" category is not attributable to their greater physical activity.

We also wanted to compare girls in these four telephone-based categories in terms of frequency and duration of weight loss behaviors. We therefore analyzed responses to two survey questions: "How often did you try to lose weight last year?" and "How long do your diets usually last?" Results indicate that the most common response of girls who identified themselves as dieters was that they tried to lose weight once a month or more often (55%). The modal response on duration was "more than a month" (55%). Thus, the dieters seemed to be trying to lose weight most of the time. By contrast, the most frequent response of girls who identified themselves as watcher/dieters was that they attempted to lose weight approximately one to three times per year (52%). The most frequent duration was 1-3 weeks per episode (54%). Watchers and neithers predomi- nantly reported not dieting at all (82% and 92%, respectively).

M o t i v a t i o n s and Behav iors of "Watchers"

To further clarify the category of watching, two question frames were added to the survey, "I watch what I eat because..." and "When I watch what I eat, I..." followed by a series of choices. Table 5 provides the response choices for these two questions and the response frequencies for the girls in the four groups. Results indicate that "watching what you eat" is a strategy adopted for a variety of reasons ranging from weight control to maintaining a sense of good health. Dieters commonly watched what they ate to try to lose weight (74%). Girls in the watcher/dieter category also watched in an effort to lose weight, but to a much lesser extent (41%). Only 12% of watchers adopted this behavior to try to lose weight. Girls classified as watchers were most likely to do so to be healthy (60%). In contrast, less than one-third of the girls in both the dieter and watcher/dieter categories reported watching to be healthy. Both watchers and dieters avoided what they termed "junk food" and increased their consumption of fruits and vegetables as a watching strategy. Dieters, however, were far more likely to eat less food as a watching strategy (42%) when compared to watcher/dieters (23%) and watchers (8%).

S e p t e m b e r 1995 A D O L E S C E N T D I E T I N G A N D W A T C H I N G 159

Table 4. Characteristics of Girls Using Different Weight Control Strategies (Spring 1992)

Var iab le Die te rs W a t c h e r / D i e t e r s W a t c h e r s N e i t h e r s

N u m b e r ((;{) 19 ( 8 q l 98 (42~;) 84 (36%) 30 (13%)

W e i g h t (lbs) x - SD 144.6 + 21.4 ̀ '> 141.6 -+ 25.9 ~a 123.6 - 18.5 ~c 115.6 -+ 18.8 bd

Body Mass Index x + SD 24.4 + 3.6 ''l~ 23.2 Z 3 .6 td 20.8 -- 2.8 °~ 19.6 2 3 .5 bd

( k g / m 2)

Exercise x + SE { t imes / 3.7 * {).5 '~t'' 3.4 ~ 0 . 3 a d 2.9 -- 0.3 t' 1.9 -+ 0.4 cd

w ee k )

,~t,,d Values in s a m e r o w wi th s a m e s u p e r s c r i p t a re s ign i f ican t ly d i f f e ren t f r o m each o the r at p < 0.05.

Food Consumption Patterns

To further explore possible behavioral differences among the groups, we examined the third-year food record data (Table 6). Each food record included a designator indicating whether the girl considered herself to be dieting to lose weight on that day (Table 6). Only 33 girls (14%) reported at least one dieting day on their food records. All but four of these girls were from the dieter or watcher/dieter category. The total number of dieting days indicated on food records was 65. Thus, only 8.6% (65/756) of all food records contained "dieting days". Notably, food records failed to confirm the high prevalence of dieting suggested by survey data, in which 44q7{ of the girls reported dieting on the day of the survey (Table 2). However, among girls who reported at least one dieting day, 50% of their food records were designated as dieting days. Thus, there is a small core of girls in our study who self-report to be dieters and actually engage in dieting behaviors.

To compare behaviors on dieting days versus nondieting days, we examined energy intake for the two types of records within each behavioral category (Table 6). Average energy intake on nondieting days was not significantly different from the mean reported in 1980 for United States females aged 15-17 years, (1,731 kcal) for all categories (23). Energy intake on dieting days was significantly less than on nondieting days only for watcher/dieters. Fat intake was 34% of energy overall, and did not vary by group or dieting day designation.

To determine whether the usual micronutrient intakes of the girls as reported on the food records differed by behavioral category in ways consistent with their self-described behaviors on the survey, we analyzed the micronutrient intakes. Table 7 provides the average intakes per day per girl of selected micronutrients for the four groups of girls, both in basic units and as percents RDA for girls aged 15-18 years. Findings tend to confirm the girls' self-reports on the survey. Dieters reported significantly lower

micronutrient intakes than all the other groups. Watchers had a tendency to report higher micronutrient intakes than the dieters or watcher/dieters. Given that watchers and watcher/dieters had nearly the same energy intake, it appears that the watchers may have been making healthier choices, consistent with their reports on the survey. "Neithers" had the highest energy intake and the highest intakes of iron and vitamin E. Intakes of folate and vitamin C did not differ among groups, nor did intake of fat as a percent of energy (data not shown). Using consumption of less than two-thirds RDA as the criterion for nutritional risk, the averages for the dieting girls are at levels low enough to suggest inadequate intake. The food intake records thus confirm the self-reports in the survey.

Discussion In the present study, attention to the details of teen language generated in ethnographic interviews permitted a refinement in the description and analysis of adolescent female weight control behaviors. Such gradations in weight control behavior have not been reported previously. Contrary to the usual findings of survey questionnaires that have tended to empha- size negative behaviors, the attitudes and behaviors that emerged from the present analysis contained evidence of an emphasis on healthy goals and behaviors by a majority of informants. Actual dieting episodes as recorded on food records and reported in telephone interviews were much less frequent than suggested by surveys, and tended to be less severe in their structure. The group of girls who claimed on the survey to be attempting to eat in a healthy manner demonstrated higher micronutrient intakes on food records. To our knowledge, healthy behaviors, such as watching, have not been described previously, and questions and responses that would substantiate their commonality have not previously been included in survey questionnaire design.


Table 5. Behaviors and Motivations Associated with "Watching"

Watcher/ Dieters Dieters Watchers Neithers (n = 19) (n 98) (n = 84) (n = 30)

n (%) n (%) n (%) n (%)

I watch what I eat because:* I want to be healthier 6 (32)" 29 (30) b 50 (60) a'b'c 5 (17) e 1 want to maintain mv weight 1 (5) 23 (24) 19 (23) 4 (13) I want to lose weight 14 (74) ~'~''~ 40 (41) a'd'e 10 (12) b'd 2 (6) ~'~

When I watch what I eat:* I avoid junk food 5 (26) 31 (32) ~ 27 (32) b 2 (6) ~'b I eat healthier foods 7 (37) 43 (44) ~ 41 (49) b 5 (16) ~'b I eat less food 8 (42Y 't~ 23 (23) ~'d 7 (8) a'c 2 (6) b'd

1 eat the same but notice 0 (0) 5 (5) 2 (2) 2 (6)

~bcae Responses in same row with same superscript are significantly different by binomial test of proportions at p < 0.05.

* Multiple responses were permitted.

The d i e t e r / n o n d i e t e r d i c h o t o m y p r e s e n t l y f o u n d in the l i t e r a tu r e is p e r h a p s too s imp l i s t i c b e c a u s e it fai ls to c a p t u r e a c o n t i n u u m of pos i t ive , hea l th - o r i e n t e d b e h a v i o r s a d o p t e d b y m a n y a d o l e s c e n t g i r l s w h o o c c a s i o n a l l y diet . In the p r e s e n t s t u d y the t e r m "d ie t e r , " as u s u a l l y f o u n d in s u r v e y s , e n c o m p a s s e s no t o n l y g i r l s w h o d i e t al l o r m o s t of the t i m e - - a s the t e r m m i g h t l e ad us to b e l i e v e - - b u t a lso g i r l s w h o s o m e t i m e s d i e t b u t m o s t l y w a t c h w h a t t hey eat. F i n d i n g s f r o m e t h n o g r a p h i c i n t e r v i e w s s u g g e s t t ha t a m o n g gir ls w h o c o n s i d e r t h e m s e l v e s " n o n d i e t e r s , " t h e r e a re gi r ls w h o ne i t he r d i e t nor w a t c h w h a t t hey ea t ( "ne i the r s" ) as w e l l as g i r l s w h o d o w a t c h w h a t t h e y eat b u t d o no t d i e t ( "wa tche r s " ) . The l a t t e r g r o u p of g i r l s c l a ims to be m a k i n g c o n s c i o u s b e h a v - io ra l cho ices to m a i n t a i n h e a l t h y b o d i e s r a the r t han r e m a i n i n g pas s ive , a n d is p r o b a b l y s im i l a r to t hose w h o r e s p o n d e d to the Y o u t h Risk B e h a v i o r S u r v e y (Table 3) w i t h " I ' m t r y i n g to m a i n t a i n m y w e i g h t . " The t e r m " n o n d i e t e r " m a y no t a c c u r a t e l y p o r t r a y the c o m p l e x i t y a n d r a n g e of b e h a v i o r p a t t e r n s tha t h a v e

e m e r g e d in the p r e s e n t s t u d y . It is h o p e d tha t f u t u r e s u r v e y s , c o n d u c t e d in d i f f e r en t g e o g r a p h i c r e g i o n s a n d w i t h l a r g e r s a m p l e s , can i n c o r p o r a t e i t ems tha t w o u l d a l l o w for the e x p r e s s i o n of b e h a v i o r s i den t i - f ied in this s t u d y .

A l t h o u g h 44% of the g i r l s in th is s a m p l e r e p o r t e d t r y ing to lose w e i g h t on the d a y of the s u r v e y (Table 3), on ly 8.6% of the food r e c o r d s w e r e d e s i g n a t e d as d i e t i n g days . The l a rge d i s c r e p a n c y b e t w e e n these t w o d a t a sou rces s u g g e s t s t ha t p a s t r e s e a r c h r e su l t s tha t h a v e r e p o r t e d tha t 6 0 - 8 0 % of g i r l s w e r e d i e t i n g to lose w e i g h t on the d a y of the s u r v e y (1,2) m a y o v e r s t a t e d i e t i n g b e h a v i o r . Fu r the r , w i t h r e g a r d to d u r a t i o n of d i e t ing , a l m o s t o n e - t h i r d of the g i r l s w h o sa id t hey h a d t r i ed to lose w e i g h t (n = 150) h a d d o n e so for less t h a n 1 w e e k , a n d o v e r o n e - h a l f of t h e m h a d d i e t e d for less t h a n 2 weeks .

Se l f - r epo r t r e s p o n s e s f r o m this c o h o r t of a d o l e s - cen t f ema le s m a y i n d e x k e y cu l tu r a l c o n c e r n s a b o u t w e i g h t r a t h e r t han ref lec t a c tua l s u s t a i n e d w e i g h t loss b e h a v i o r (24,25). I n d e e d , p r e v i o u s r e s e a r c h has

Table 6. Behaviors on Dieting Days versus Nondiet ing Days

Dieters Watcher/Dieters Watchers Neithers

Total number of food records* 53 293 300 110 Dieting days (%) 29 (55%) 32 (12%) 4 (1%) 0

Energy intakes on dieting and nondieting days* (mean + S.E.)

Dieting days (Kcals) 1464 -+ 152 1379 + 193"* 2272 -+ 248 01) 13 15 4

Nondieting days (Kcals) 1664 ~ 138 1842 _~ 65** 1829 -~ 60 1988 z 102 (n) 9 86 82 30

* Not all records had answers to the "'dieting day" question. Only those records with an answer are included in this table. Twenty-one records had missing dieting day information, distributed as follows: 6 dieters, 6 watcher/dieters, 9 watchers, 0 neithers.

** Nondieting days are significantly different from dieting days for watcher/dieters only at p -< 0.05, by paired student's t-test.


Table 7. Average Nutrient Intakes by Behavioral Category (Mean ± S.E.)

Watcher/Dieters Watchers Neithers Nutrient Dieters H - 19 n 98 n - 84 n = 30

Energy (Kcals) 1533 -+- 109.3 ">* 1806 + 58.1 ~ 1840 + 54.3 b 1993 + 104.3 c Vitamin A (RE) 485.8 + 113.9 "b'- ~77.8 ± 38.1 "J 842.1 _+ 5 0 . 4 bd 717.2 _+ 78.3 ~

RDA 60.7 _+ 14.2 84.7 + 4.7 105.2 + 6.3 89.7 _+ 9.8 Vitamin E (TE) 5.52 + 0.73 ~bc ~.76 ± 0.34 "~ 6.77 _+ 0.31 b 7.74 + 0.46 ~ ~ RDA 69.0 ~ 9.1 84.5 + 4.3 84.6 + 3.9 96.8 + 5.8 Calcium (mg) 629.3 _+ 78.2 ~ 844.5 + 40.5 ~' 941.8 + 41.7 b 842.6 ± 70.2 c ~7c RDA 52.4 _+ 6.5 70.3 - 3.4 78.5 _+ 3.5 70.2 ± 5.9 Iron (mg) 8.6 ~q~ 0,8 abL ll .0 -+ 0.4 '~ 11.5 + 0.4 b 12.8 + 1.2 ~ % RDA 57.3 ± 5.3 73.3 ~ 2.7 76.7 ± 2.7 85.3 -+ 8.0

abed Values in same row with same superscript are significantly different from each other at p --< 0.05, by student 's t-test.

demonstrated that many adolescent girls feel that there is a cultural pressure to say that they feel fat and that they are trying to lose weight, even when they are not actively engaged in this behavior (25).

Research concerned with adolescent weight loss behaviors has paid far more attention to describing negative behaviors than to identifying positive health attitudes and behaviors. As Antonovsky (26,27) has noted, research has assumed a pathogenic rather than a salutogenic stance; that is, attention has been directed more toward factors that lead to sick- ness and less toward describing successful coping or adaptive behaviors. Hype about weight control has been present in the United States for many years and has been contributing to the very problem it address- es--by propagating negative images of dieting behavior and failing to give equal attention to positive weight control behaviors engaged in by a growing percentage of American youth (24,28).

In a recent study of adolescent females, it was found that the healthiest eating attitudes were associated with good self-esteem and low levels of anxiety (29). These authors suggest "that it may be time to explore eating attitudes in adolescents not only for the psychopathology they may uncover, but also as evidence of good mental health" (p. 382). In the present study, we were led to consider positive dimensions of adolescent girls' weight-related behavior as a result of using ethnographic methods which placed girls' behavior in context.

Conclusion

Findings from this study suggest that "watching what you eat" is an emergent category that reflects public health messages advising Americans to adopt a "healthful lifestyle." Such messages coexist in an environment full of temptation to eat otherwise, and

in an environment permeated by injunctions to both control and release (24,28,30,31). In a world saturated with junk food, "watching what you eat" and "eating healthy" emerge as expressions of positive attempts to influence one's life and maintain a sense of control.

Interventions to foster healthy eating need to be responsive to the lifeworld of adolescents and build on behaviors perceived to be positive. Attitudes and behaviors expressed by girls such as "watching what you eat" and "losing weight in a healthy way" might serve as an effective counter to dieting messages encountered through the media and associated with diet programs and products.

This research was supported by NIH Grant No. HD24727 from the National Institutes of Health, National Institute of Child Health and Human Development.

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Dieting and "Watching" Behaviors Among Adolescent Females: Report of a Multimethod Study

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