Psychosocial Predictors of Weight Loss Behaviors and Binge Eating in Adolescent

Girls and Boys

Eleanor H. Wertheim Susan 1. Paxton

Dana Maude George I. Szmukler

Kay Gibbons Lynne Hiller

(Accepted 17 April 1991)

This study.examined the predictors of dieting, extreme weight loss behaviors, and binge eat- ing in adolescents (606 femafes and 375 males}. High school classes were administered measures of weight loss behaviors, binge eating, perceived current and ideal body size, body dissatisfaction, advantages of being thinner and physically fitter, satisfaction with fit- ness, depression, self-esteem, parental overprotection, parental caring, and family adapt- ability and cohesion. Principal component analyses grouped predictor (body image, psychosocial) and criterion (weight loss behaviors, binge eating} variables. The primary pre- dictor of weight loss behaviors in both sexes and binge eating in girls was the desire to be thinner which included a larger current body size. Psychological and family variables played lesser roles but were significantly predictive in a number of cases. Sex differences in factor structures and important predictors emerged. 0 1992 lohn Wiley & Sons, Inc.

In recent years, eating disorder researchers have been turning attention to weight loss behaviors and, to a lesser extent, binge eating in adolescents. One reason is that these behaviors may be risk factors for the development of eating disorders (Patton, Johnson-Sabine, Woods, Mann, & Wakeling, 1990). While this is uncertain, it is clear that dieting is the forerunner of eating disorders in many cases (Wertheim & Weiss, 1989). More extreme weight loss behaviors, such as vomiting or crash dieting, are

Eleanor H. Wertheim, Ph.D., i s a Senior Lecturer in the Psychology Department, La Trobe University, Melbourne. Susan J. Paxton, Ph.D., is a Senior Lecturer in the Behavioural Health Sciences Department, La Trobe University, Melbourne. Dana Maude, B.Sc.(Hons), i s enrolled in the Master of Psychology course at La Trobe University. George 1. Szmukler, M.D., D.P.M., FRC Psych., i s a Consultant Psychiatrist, Royal Melbourne Hospital, and Senior Associate of the Department of Psychiatry, University of Melbourne. Kay Gibbons, B.App.Sc., is Chief Dietitian at the Royal Melbourne Hospital. Lynne Hillier, B.Sc.(Hons.), i s a Research Assistant in the Psychology Department, La Trobe University. Address reprint requests to Dr. fleanor Wertheim, Department of Psychology, La Trobe Uni- versity, Bundoora, Victoria, 3083, Australia.

international journal of Eating Disorders, Vol. 12, No. 2, 151 -1 60 ( 1 992) 0 1992 by John Wiley & Sons, Inc. CCC 0276-3478/92/020151-10$04.00

152 Wertheirn et at.

likely to pose even greater risks. Consequently, information about psychosocial corre- lates of these behaviors may be of use in developing a theory of the course of eating disorder from an early stage. Further, it has been argued that dieting behavior can be seen as lying on a continuum with no dieting at one extreme and eating disorder at the other, with increasing levels of dieting between (e.g., Nylander, 1971). Although not all researchers agree (Garfinkel & Kaplan, 1986), the continuum hypothesis would sug- gest that adolescents who use extreme dieting techniques or binge eating should show similar psychosocial features as those with disordered eating but of a lesser intensity.

The present study asks the following questions. What are the correlates of dieting behaviors in adolescents? What are the characteristics of those adolescents who appear to have gone beyond occasional experimental weight loss attempts and report regular use of more extreme methods? Finally, how is self-reported binge eating related to weight loss behaviors in adolescents, and what are the predictors of frequent binge eat- ing in this group?

A number of variables were examined. The first set related to body size and body image. A major predictor of dieting in adolescents is being above average weight (e.g., Patton et al., 1990; Paxton et al., 1991) and dietary restraint and dieting have been sig- nificantly predicted by body dissatisfaction, deviation from desired weight, and low body "cathexis" in adolescent girls (Gralen, Levine, Smolak, & Murnen, 1990; Rosen, Gross & Vara, 1987). In addition, indicators of low body satisfaction are typical of eat- ing disordered individuals (e.g., Brown, Cash, & Lewis, 1989; Gross & Rosen, 1988). Therefore, quite likely the most direct correlates of weight loss behaviors will be want- ing to be thinner, seeing greater psychosocial advantages to being thinner, and being dissatisfied with one's current body shape and weight. Furthermore, a small ideal body size in conjunction with a large current body size is likely to be associated with dieting.

The second set of variables examined were psychological. Specifically, self-esteem and depression have been implicated in the development of eating disorders in adoles- cents (Fabian & Thompson, 1989; Gross & Rosen, 1988) and, in the few studies that have examined subclinical dieters, have been associated with greater dieting (Dykens & Gerrard, 1986; Kagan & Squires, 1984; Rosen et al., 1987).

A third group of variables examined here were family characteristics. Family interac- tion styles of adolescents who engage in regular or extreme dieting or binge eating but do not satisfy criteria for disordered eating have not yet been examined. In a review of studies with families of disordered individuals, Strober and Humphrey (1987) found some evidence that the families were "characterized by enmeshment, poor conflict res- olution, emotional overinvolvement or detachment, and a lack of affection and empa- thy" (p. 658). Less clear have been findings regarding family rigidity (Garfinkel et al., 1983; Harding & Lachenmeyer, 1986; Humphrey, 1986; Stern et al., 1989), and parental overprotection (Humphrey, 1986; Steiger, Vander Feen, Goldstein, & Leicher 1989). This study will ask how family characteristics relate to weight loss behaviors and binge eating in an adolescent population.

METHOD

Subjects

Subjects were 606 female and 315 male high school students from the greater Mel- bourne (Australia) area. Schools were selected to include the range of geographic and

Predictors of Weight Loss Behaviors and Binging 153

socioeconomic status areas (Ross, 1984), including a girls' and a boys' private, two girls' public, and seven coeducational public schools. In each school three or four classes, from different years, were assessed. Compulsory subject classes were used to prevent subject bias. There were 153, 145, 171, 125, and 12 girls (age R = 13.9, s.d. = 1.2), and 57, 96, 82, 71, and 9 boys from grades 7 to 11 (age X = 14.1, s.d. = 1.3) re- spectively.

Procedure

Prior to the study, students were given parental consent forms. In two adjacent classes, students completed number coded self-report questionnaires. While one exper- imenter supervised, a second took weight and height measurements in another room. Body mass index (BMI; Keys, Fidanza, Karvonen, Kimura, & Taylor, 1972) was calcu- lated from this.

Body image measures included the Body Dissatisfaction subscale of the Eating Disor- ders Inventory (EDI, Garner, Olmstead, & Polivy, 1983) and the Body Figure Perception Questionnaire (Fallon & Rozin, 1985). The latter test consists of two sets of figures (fe- male if the subject is female, male if subject is male) in which nine figures range from emaciated to obese. On the sets, subjects rate (91) their current figure (2) the size they would like to be (ideal), The scale ranged from 1 to 17, with odd numbers associated with figures and even numbers midway between figures. Current figure minus ideal represented body dissatisfaction.

An eight item Advantages of Thinness Scale measured perceived impact of being thin- ner. Subjects rated how aspects of their lives would change if they were thinner, for example, "If you were thinner you would be: Much more happy; more happy; the same as now; less happy; much less happy." A similar scale, Advantages of Fitness, fo- cused on impact of physical fitness. A Satisfaction with Fitness scale was also adminis- tered (Paxton et al., 1991).

In a questionnaire designed for the study, subjects indicated how many diets they had been on in the past and rated from never to at least daily how often they used six extreme methods to lose weight: fasting, crash dieting, vomiting, using diet pills, laxa- tives, and fluid tablets. The sum of these six items made up an extreme weight loss behaviors (EWLB) scale. Binge eating was assessed using the ED1 Bulimia Subscale score (Garner et al., 1983), and Item 1 of the Bulimia Test (Smith & Thelen, 1984), "How of- ten do you eat uncontrollably to the point of stuffing yourself ?" (once a month or less [l] to once a day or more 161).

Psychological assessment included the Rosenberg Self-Esteem Inventory (Rosenberg, 1965), and the Wakefield Depression Inventory (Snaith, Ahmed, Mehta, & Hamilton, 1971). The Family Adaptability and Cohesion Evaluation Scale I11 (FACES 111; Olson et al., 1986) assessed family Cohesion or degree of emotional bonding between family members, and family Adaptability or the degree to which the family system is able to change. The Parental Bonding Instrument (Parker, Tupling, & Brown, 1979) assessed perceived Mother Caring, Father Caring, Mother Overprotection, and Father Overprotection.

RESULTS

Using the ED1 Body Dissatisfaction norms from Garner et al., (1983), 35% of girls and 3% of boys had scores equal to or exceeding the mean for restricting anorectics while 23% of girls and 2% of boys had scores equal to or exceeding the mean for bulimic an-

154 Wertheim rt al.

orectics. Seventeen percent of girls and 18.3% of boys had body dissatisfaction scores 1 s.d. or more above the mean for similar sex adolescents (Shore & Porter, 1990). Cur- rent-ideal figure discrepancy indicated that, of girls and boys, respectively, 22% and 31% wanted to have the same body size, 71% and 34% would like to have been smaller, while 7% and 35% wanted to be larger.

Of girls, 48.4% reported never having been on a diet, while 20.7% reported having been on one, 19.1% two to three, and 11.8% four or more. Of boys, 84.2% reported never having been on a diet, 12% having been on one, 1.0% on two to three, and 2.8% on four or more diets. Eleven percent of girls and 7.2% of boys reported using at least one extreme weight loss behavior weekly or more often. Table 1 shows the percentage of subjects who reported engaging in the extreme weight loss behaviors. The percent- ages of females and males, respectively, reporting eating "uncontrollably to the point of stuffing yourself" once a day or more were 4.7% and 6.7%; three to six times a week, 2.8% and 3.8%; one to two times a week 12.8% and 14.7%; and two to three times a month 18% and 15.1%. When compared to ED1 norms (Garner et al., 1983), 2% of girls and 1% of boys were equal to or exceeded the mean score of bulimic anorectics on ED1 Bulimia, while 10% of girls and 9.6% of boys had Bulimia scores greater than 1 s.d. above the norms of similar sex adolescents (Shore & Porter, 1990).

Predictors of Dieting and Binge Eating

To reduce the number of variables for subsequent analyses, principal components analyses (PCA) were conducted for each sex first on the predictor variables and then on the criterion variables, using orthogonal rotations. Subsequent analyses on subjects with complete data use these factor scores and are followed by factor examination when predictor factors are significant.

In the first PCA, predictor variables (body image, self-esteem, depression scores, and family functioning scores) in girls were entered. BMI was excluded due to 44 girls refusing to be weighed. Current figure, which correlated .71 with BMI, was included. Four factors were generated (see Table 2) accounting for 58.7% of the variance. The factors were named (in order) Desire to be Thinner, Family CohesionlAdaptability and Gen- eral Satisfaction, Parental Overprotection and Low Caring, and Ideal and Current Figure.

In the second PCA, the predictor variables were entered for boys. This produced six factors which accounted for 70.5% of the variance (see Table 2). The factors were named Parental Overprotection and Low Caring, Desire to be Thinner, Dissatisfaction with Self, Ideal and Current Figure, Adaptive and Cohesive Family, and Advantages of Fitness.

Table 1. never, occasionally, at least weekly, and daily (girls n = 596; boys n = 303)

Percentage of subjects who reported engaging in extreme weight loss behaviors,

Girls Boys

Weight Loss At Least At Least Method Never Occasionally Weekly" Daily Never Occasionally Weekly" Daily

Fast 72 23 5 1 80 13 5 2 Crash diet 72 23 5 1 91 7 2 0 Vomit 92 6 2 1 94 5 1 0 Diet pills 94 4 1 1 97 2 1 0 Laxatives 94 4 1 1 95 3 2 0 Diuretics 97 2 1 0 95 3 2 0

"At least weekly but less than daily.

Predictors of Weight Loss Behaviors and Binging 155

Table 2. image, self-esteem, depression, and family functioning scores

Factor loadings in principal components analyses of body

Girls Boys

Factor 1 Desire to be Thinner Eigenvalue = 4.14 Variance = 27.6% Current-Ideal Figure .83 Advantages of Thinness .79 ED1 Body Dissatifaction .75

Advantages of Fitness .54 Current Figure .71

Factor 2 Family CohesioniAdaptability

Eigenvalue = 2.18 Variance = 14.5% Cohesion .82 Adaptability .62 Self-esteem p.53 PBI Father Caring .50

Satisfaction with Fitness .45

Factor 3 Parental Overprotection and

Eigenvalue = 1.32 Variance = 8.8% PBI Mother Overprotection .80

and General Satisfaction

Wakefield Depression - .49

Low Caring

PBI Father Overprotection .74

PBI Father Caring .49 PBI Mother Caring - .62

Factor 4 Ideal and Current Figure Eigenvalue = 1.17 Variance = 7.8%

Current figure .62 Ideal Figure .93

Factor 1 Parental Overprotection and

Eigenvalue = 3.16 Variance = 21.0% Low Caring

PBI Father Caring - .83 PBI Mother Caring - .79

PBI Mother Overprotection .44

PBI Father Overprotection .64 Cohesion - .50

Factor 2 Desire to be Thinner Eigenvalue = 2.25 Variance = 15.0% Current-Ideal Figure .92 Current Figure .80 Advantages of Thinness .77 ED1 Body Dissatisfaction .43

Factor 3 Dissatisfaction with Self Eigenvalue = 1.47 Variance = 9.8% Satisfaction with Fitness -.74 Wakefield depression .70 Self-esteem .60 ED1 Body Dissatisfaction .55

Factor 4 Ideal and Current Figure Eigenvalue = 1.30 Variance = 8.7% Ideal Figure .98

Factor 5 Adaptive and Cohesive Family Eigenvalue = 1.06 Variance = 7.1% Adaptability .92 Cohesion .53

Factor 6 Advantages of Fitness Eigenvalue = 1.02 Variance = 6.8% Advantages of Fitness .81

Current Figure .54

Note: ED1 = Eating Disorder Inventory; PBI = Parental Bonding Instrument.

The criterion variables analysis included Number of Diets, EWLB, the binge eating item, and ED1 Bulimia scores. Two factors were similarly identified in boys and girls. For girls, Factor 1, Dieting, accounted for 41.5% of the variance (Eignvalue = 1.7) with Number of Diets loading .85, and EWLB score loading .77. Factor 2, Binge Eating, ac- counted for 26.3% of the variance (Eigenvalue = 1.1) with Binge Frequency = .85 and ED1 Bulimia = .75. For boys, Factor 1, Binge Eating, accounted for 35.5% of the variance (Eigenvalue = 1.4), with Binge Frequency = .84 and ED1 Bulimia = .83. Factor 2, Diet- ing, accounted for 29.2% of the variance (Eigenvalue = 1.2) with Number of Diets = .77 and EWLB = .74.

To examine which factors predicted Dieting and Binge Eating, regression analyses (all variables entered at once) were conducted. The Dieting factor was significantly pre- dicted in both girls, (F = 30.3, df = 4,321, .OOOO, R = .52, R2 = .274) and boys (F = 4.45, df = 6,152, p = .0004, R = .387, R - .149). In both sexes the only significant rr

156 Wertheim et al.

predictor factor was Desire to be Thinner (girls t = 10.82, p = .OOOO, boys t = 4.54, p = .OOOO, all other predictor factors p > .09). The Binge Eating factor was only significantly predicted for girls (girls F = 12.1, df = 4,321, p = 4,321, p = .OOOO, R = .36, R2 = .131, boys F = .40, df = 6,152, p = .88, R = .12, R2 = .015). In girls, all predictor variables were significantly predictive (Desire to be Thinner, Beta = .25, t = 4.80, p = .OOOO; Family CohesionlAdaptability and General Satisfaction, Beta = -.12, t = -2.37, p = .02; Parental Overprotection and Low Curing, Beta = .17, t = 3.32, p = .001; Ideal and Current Figure, Beta = -.13, t = -2.41, p = .02).

Possibly psychosocial variables are only important in predicting dieting behaviors in low to normal weight subjects where a strong desire to be thinner would be less un- derstandable. Therefore, only subjects with BMI below 22 were next examined. The re- gression using girls (variables entered at once) was significant ( R = .41, R2 = .168, df = 4,201, F = 10.1, p = .OOOO) with two predictors adding to the equation: Desire to be Thin- ner ( t = 5.51, p = .OOOO, Beta = .36) and Family CohesionlAdaptability and General Satisfac- tion ( t = 2.27, p = .02, Beta = -.15). The two non-significant predictors were Parental Overprotection and Low Care (Beta = - .01) and Current and Ideal Figure (Beta = - .01). The regression using males replicated that of the full sample ( R = .40, R2 = .161, df = 4,93, F = 4.5, p = .002) with only Desire to be Thinner contributing to prediction ( t = 4.11, p = .0001, all other ts less than .70).

Correlations of variables in significant predictor factors with the criterion factors are shown in Table 3.

Extreme Groups Analyses

Variables associated with extreme dieting may be obscured by the relatively large number of non-dieting or minimally dieting subjects. Therefore analyses were per- formed on selected subjects.Each subject who scored 3 or more on the EWLB scale (Frequent group) was matched on school, class, and age with a subject who scored 0 on the scale (Never group). Enough female pairs (41) but not male pairs were found to conduct analyses. Females groups were examined in a discriminant function analysis (DFA) in which the four factor scores were used as predictors. A forward stepwise method entered Desire to be Thinner first and Family Cohesion/Adaptability and General Sat- isfaction second resulting in a significant Wilks lambda = .72, x2 = 26.4, p = .OOOO. The standardized canonical coefficients were Desire to be Thinner, .95, Family Cohesion-Adapt- ability and General Satisfaction, .27, and the Frequent group received higher scores on the function. The function correctly classified 74.4% of cases (78% Never group, 70.7% Frequent group).

Frequent users of EWLBs had a larger current figure than Nevers (t = 3.74, df = 80, p < .0005, Frequent R = 7.71, s.d. = 2.39; Never R = 5.80, s.d. = 2.22). They also had a higher BMI than Nevers (Frequent R = 22.43, s.d. = 2.68; Never R = 19.75, s.d. = 3.11; t = 3.86, df = 69, p < ,0005). There was no significant difference between groups on ideal figure (t = 1.20, df = 80, p = .23). Current-ideal figure discrepancy (t = 4.66, df = 80, p < .0005; Frequent W = 2.9, s.d. = 2.41; Never X = .6, s.d. = 1.92), Advantages of Thinness ( t = 6.0, df = 80, p < .0005), ED1 Body Dissatisfaction ( t = 5.27, df = 80, p < .0005), and Advantages of Fitness ( t = 2.06, df=68.95, p < .05) were also significantly greater in the Frequent group.

Contributions of variables making up the Family Cohesion/Adaptability and General Sat- isfaction factor were further examined. T-tests between the EWLB groups found the Frequent group to be lower in self-esteem (t = -3.57, p = .001), higher in depression

Predictors of Weight Loss Behaviors and Binging 157

Table 3. factors and the Dieting and Binge Eating factors scores

Correlations between variables making up significantly predicting

Predictor Variable

Desire to be Thinner Current-Ideal Figure Advantages of Thinness Current Figure Advantages of Fitness ED1 Body Dissatisfaction

Family CohesionlAdaptability and General Satisfaction Cohesion Adaptability Self-esteem Wakefield Depression Satisfaction with Fitness PBI Father Caring

Parental Overprotection and Low Caring PBI Mother Overprotection PBI Father Overprotection PBI Mother Caring PBI Father Caring

Ideal and Current Figure Ideal Figure Current Figure

Dieting Factor Binge Eating Factor

All Girls Girls BMI <22 All Boys All Girls

.50'** .33**' .34*** .30***

.46*** .35**" .30"* .14*

.44'** .24*** .32*** .20***

.18** .I0 NA .17

.39**" .30*** .29*** .20**'

fsns -.14* fsns -.13 fsns - .08 fsns - .08 fsns .19*" fsns .24*** fsns .23** fsns .33*** fsns -.06 fsns -.13* fsns - .12* fsns - .08

fsns fsns fsns .24*** fsns fsns fsns .18*" fsns fsns fsns - .20*" fsns fsns fsns - .08

fsns fsns fsns - .09 fsns fsns fsns .20**

Note: NA = not applicable, variable not in the factor; fsns = factor score not signifi- cant; ED1 = Eating Disorder Inventory; PBI = Parental Bonding Instrument.

* = p < .05, ** = p < .01, *** = p < .001.

( t = -2.32, p < .05), lower in family Cohesion (t = 2.26, p < .05), and lower in Father Caring ( t = 2.17, p < .05). Adaptability and Satisfaction with Fitness did not differ signifi- cantly between groups (t's < 1.0, p's > .30).

On ED1 Bulimia, scores over 4 for boys and over 5 for girls (90th percentile) were con- sidered high (Shore & Porter, 1990). Every high score subject was matched with a sub- ject of the same school, class, and age who scored 0 on the subscale (No Bulimia group). Twenty-eight female pairs, but too few male pairs were found to conduct anal- yses.

For girls, in stepwise DFA all four factors significantly added to the prediction. Or- der of entry and Standardized Canonical Coefficients were: Desire to be Thinner (.69), Parental Overprotection and Low Caring (.51), Current and Idea2 Figure (-.50), and Family Cohesion Adaptability and General Satisfaction (- .39). This function was significant (Wilks Lambda = .69, x2 = 19.0, df = 4, p = .0008) and correctly classified 73.2% of subjects (82.1% No Bulimia, 64.3% High Bulimia).

T-tests of variables loading on the significant factors indicated that the High Bulimia group had higher scores on current-ideal discrepancy (t = 2.24, df = 44.51, p < .05), ED1 Body Dissatisfaction ( t = 4.52, df = 54, p < .0005), and Advantages of Thinness ( t = 2.81, df = 45.58, p < .Ol ) , and tended to higher scores on Advantages of Fitness ( t = 1.91, df = 54, p = .06) and Ideal Figure ( t = 1.82, df = 46.89, p = .07). The High Bulimia group had lower self-esteem ( f = 2.33, p < .05), higher depression ( f = -3.65, p < .001), and tended to lower Cohesion ( t = 1.67, p < .lo). There were no differences between groups on Satisfaction with Fitness, Adaptability, or Father Caring (ts < 1.0, ps > .30). High Bu-

I58 Wertheim et al.

limia subjects reported higher Mother Overprotection (t = -2.03, df = 46.32, p < .05) and Father Overprotection ( t = 3.00, df = 54, p = .004) and tended to lower Mother Caring ( t = 1.91, df = 54, p < .lo).

Frequent EWLB females received significantly higher scores on the Binge Eating fac- tor ( t = 2.97, df = 67.21, p = .001).

DISCUSS1 ON

Consistent with previous findings (Rosen & Gross, 1987), this study found extreme weight loss behaviors to be used at least occasionally by a substantial proportion of ad- olescent girls. The use of weight loss behaviors in both sexes was related primarily to a desire to be thinner. Those subjects who dieted more had a larger discrepancy between current and ideal body sizes, saw greater advantages in being thinner, and were less satisfied with their body characteristics. These subjects rated themselves as signifi- cantly larger and had a higher actual BMI. Ideal figure did not discriminate between dieters and non-dieters. These findings agree with those of Patton et al. (1990) in ado- lescents, and Van Strien (1989) in older women and suggest that dieters are not trying to live up to a smaller ideal than non-dieters, but rather they may simply be trying to live up to societal norms of appropriate size. Therefore, a high risk factor for extreme weight loss behaviors is being heavier than ones peers yet wanting to be as thin as they do.

Other psychosocial variables examined failed to predict weight loss behaviors when all females were included. However, when heavier girls were removed, or when a matched extreme group method controlling for effects of school, class, and age, was used, further variables became predictive. Low self-esteem and high depression were most strongly implicated, with perceived lack of family cohesion, and a tendency for less father caring also apparent.

It appears that in the general adolescent population dieting and experimentation with extreme weight loss methods are relatively independent from other emotional and family issues. However, those girls who diet despite being thin and those who have gone beyond experimentation and crash diet, vomit, or use other extreme meth- ods on a regular basis report greater psychological distress and lesser perceived emo- tional bonding in the family. Binge eating and weight loss behaviors were found to be independent in factor analyses. Nonetheless, those girls who most frequently used ex- treme weight loss methods reported more binge eating than matched subjects who never used such methods.

In relation to prediction of Binge Eating, both the regression and discriminant func- tion analyses coincided; in girls all variables including psychosocial ones, predicted binge eating. Certain variables in the factors predicted most strongly: high desire to be thin, large current body size, small ideal body size, overprotective parents, low mater- nal care, less cohesive family, depressed affect, and low self-esteem. These findings support the continuum view of disordered eating in girls. In boys, binge eating is un- related to any of the factors assessed in this study. Perhaps Binge Eating in boys is not seen as abnormal or inappropriate as it is in girls.

Factors identified were different for girls and boys. In particular, satisfaction with self variables for boys, but not girls, were independent of perception of family func- tioning. A boy’s sense of well being may be more independent of perceived cohesion and adaptability in the family. In addition, advantages of fitness in girls loaded with

Predictors of Weight Loss Behaviors and Binging 159

variables related to wanting an attractive, thin body. In contrast, this variable was in- dependent for boys suggesting they see fitness as valuable in its own right, not just as a way to be thin.

The discussion thus far has assumed that social and familial variables influenced the development of weight loss behaviors and binge eating. However, these causal inter- pretations must be made tentatively. Dieting and binging may not be the result of poor psychological adjustment, rather eating disturbances may lead to the observed psycho- social difficulties (Rosen et al., 1987) or simply be non-causally correlated with them. The self-report nature of the data should also be noted; e.g., the family may not actu- ally lack cohesiveness and be high in overprotection, but at a minimum the child per- ceives the family in this way. Longitudinal studies may help to clarify some of the cause and effect issues. Such studies are also needed to discover whether the dieting and binging noted here persist over time, develop into more severe conditions, or dis- appear.

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