Numerous studies have found a high percentage of adolescents, particularly adolescent females, report using weight control behaviors^1-2. Attempts to lose weight involving the implementation of healthy lifestyle behaviors (e.g., eating more Fruits and Vegetables (F&V)) may lead to improvements in health and help to prevent excess weight gain over time³. In contrast, dieting and the use of other unhealthy weight control behaviors (e.g., skipping meals) may compromise dietary intake during critical periods of adolescent development and have been found to predict a greater tendency towards obesity^4-6. The available evidence suggests that health practitioners should encourage the use of healthy lifestyle behaviors and discourage dieting to help promote adequate nutritional intake. However, few studies have distinguished between different types of weight control behaviors in examining associations between weight control behaviors and dietary intake over time among adolescents.

We examined patterns of engaging in four healthy weight control behaviors and nine unhealthy weight control behaviors over five years in a US population-based sample of adolescents⁷. Participants were junior and senior high schools students at baseline when they completed the Project EAT (Eating Among Teens) survey and a food frequency questionnaire in school classrooms. Follow-up surveys were collected by mail five years later as participants progressed from early adolescence (junior high) to middle adolescence (high school) or from middle adolescence (high school) to late adolescence (post-high school). There were 1,242 females and 1,007 males who completed all assessments at both baseline and follow-up.

Persistent use of healthy and unhealthy weight control behaviors throughout adolescence is not uncommon and most young people report using weight control behaviors at some point during these years.

Only a small percentage of adolescents (5% of females, 18% of males) did not report the use of any weight control behaviors at either time point. Use of unhealthy weight control behaviors at either baseline or follow-up was reported by 76% of females and 45% of males. Among these participants, 59% of females and 37% of males reported using unhealthy weight control behaviors at both assessments. Most participants (99%) who reported using unhealthy weight control behaviors also reported using healthy weight control behaviors at either baseline or follow-up. In addition, use of only healthy weight control behaviors was reported by 19% of females and 37% of males. Among these participants, 55% of females and 41% of males reported using only healthy weight control behaviors at both assessments.

Persistent use of unhealthy weight control behaviors was related to lower intakes of several healthy dietary components and less frequent meals among female adolescents.

Among females, those who reported using unhealthy weight control behaviors throughout adolescence or initiating these behaviors at follow-up tended to have less frequent meals and poorer dietary intake at follow-up compared to those who stopped or never-engaged. Mean differences in intake were generally not large; however, persistent use of unhealthy weight control behaviors was associated with lower intakes of essential micronutrients, fiber, vegetables, and whole grains. Among males, findings for meal frequency were similar but few differences in dietary intake were found.

Persistent use of only healthy weight control behaviors was related to some measures of better dietary intake among female adolescents.

Among females, those who reported using only healthy weight control behaviors throughout adolescence tended to consume less fast food, saturated fat, snack foods, and sugar-sweetened drinks at follow-up compared to those who never or inconsistently reported these behaviors. Mean differences in intake among females were generally not large and, among males, no evidence of improved dietary intake was found.

Conclusion

Our study highlights the importance of nutritional guidance for adolescents with weight concerns. The results suggest that guidance provided to youth and their families should encourage taking a lifestyle approach to weight management.

FUNDING
This study was supported by grant no. R40 MC 00319 from the Maternal and Child Health Bureau (Title
V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and
Human Services.