Factors Affecting Food Intake and BMI in Adolescents Using the Social-Ecological Model

Eun Me Cha, The University of Texas School of Public Health


During the past 30 years, the prevalence of obesity has increased among children and adolescents in the United States. Since 1988, the prevalence of obesity escalated from 10% to 18.5% in all age groups (ages 2-19 years) with the most increase in prevalence observed in adolescent population (ages 12-19 years). In addition, despite the fact that the prevalence of snack and sugary drink consumption has declined since 1999-2000, current obesity trends remain a major public health concern in adolescents. Therefore, it is important to identify the specific eating patterns and behaviors that lead to obesity, especially in the adolescent population. Thus far, the existing body of literature has identified the intake of snack and sugary drinks, timing of the last food intake, and eating in the absence of hunger (EAH) as important factors for obesity. However, most studies have identified these factors as determinants in children or adults, not in adolescents. Given this gap in the literature and the fact that the social-ecological model is a frequently adopted model for obesity research and intervention, the primary goal of this study is to examine factors affecting food intake and body mass index (BMI: a measure of body weight relative to height) in adolescents using the social-ecological model as a framework. This study comprised three primary aims. The first aim was to examine the trends of snack and sugary drink consumption through secondary data analysis of School Physical Activity and Nutrition Survey (SPAN) from 2000 to 2016. Adjusted trends were assessed using a weighted logistic regression model. The second aim was to evaluate the association between the hours of media use and the timing of last food intake using SPAN data. In addition, the timing of last food intake was tested for a mediation effect between hours of media exposure and BMI status. The third aim was to evaluate the EAH and other eating behaviors in parent-adolescent paired data in relation to food-related parenting practices using dyadic data analysis. Results from this study elucidated several new determinants of healthy eating and weight status in adolescent population. First, the prevalence of overall snack and sugary drink consumption decreased from 2000-2002 to 2015-2016 in 8th and 11th grade students in Texas. However, it is concerning that the prevalence of overweight and obesity increased significantly in Texas despite of decreasing trend in consumption of unhealthy foods. Second, hours of media use were significantly associated with nighttime eating, unhealthy food intake, and inadequate sleep hours. Also, the pathway between hours of media use and unhealthy food intake was significant via timing of last food intake. Third, APIM analyses revealed that adolescent-reported parenting practices on fruits and vegetables (F/V) consumption and restriction of junk foods and sugary drinks (JF/SD) were negatively associated with EAH behavior. In this study, the social-ecological framework was used to understand the current trends of snack and sugary drink consumption with respect to food policies in the societal level, the impact of exposure to media on the timing of last food intake in the community level, and the influence of food-related parenting practices on adolescent EAH behavior in the individual level with an ultimate goal of using this information to develop intervention strategies that would lead to a decline in the prevalence of adolescent obesity.

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Recommended Citation

Cha, Eun Me, "Factors Affecting Food Intake and BMI in Adolescents Using the Social-Ecological Model" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10790233.