Int J Adolesc Med Health 2015; 27(1): 11–17
Marigold Castillo*, Ronald Feinstein, James Tsang and Martin Fisher
An assessment of basic nutrition knowledge of adolescents with eating disorders and their parents Abstract Objective: This study aims to determine and compare the level of basic nutrition knowledge of adolescents with eating disorders and their parents to adolescents without eating disorders and their parents. Materials and methods: This six-month convenience based survey recruited a total of 182 adolescents with and without an eating disorder and their parents. The surveys were conducted in a suburban adolescent medicine office. Main outcome measures were based on the 18 basic nutrition questions, while means, standard deviations, Wilcoxon Rank Sum Test, and χ2 were all employed for the analysis. Results: None of the groups correctly answered more than half of the questions. In terms of the percentage of correct responses, there was a statistically significant difference between adolescents with eating disorders and their parents compared with adolescents without an eating disorder and their parents. Fewer than 16% of respondents in each group correctly answered the recommended daily caloric balance of fats, carbohydrates, and proteins. Conclusions: There is a deficiency in basic nutrition knowledge among adolescents with and without eating disorders and their parents. A significant increase in basic nutrition education needs to occur in order to increase the understanding of what is a “healthy” diet. Keywords: adolescents; eating disorders; nutrition knowledge.
*Corresponding author: Marigold Castillo, MD, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, USA, Phone: +516 465 5204, Fax: +516 465 5299, E-mail: [email protected] Marigold Castillo, Ronald Feinstein and Martin Fisher: Division of Adolescent Medicine, Department of Pediatrics, Cohen Children’s Medical Center of New York, NY, USA James Tsang: Biostatistics Unit, Feinstein Institute for Medical Research, North Shore- Long Island Jewish Health System, New Hyde Park, NY, USA; and Hofstra-North Shore LIJ School of Medicine, Hempstead, NY, USA
DOI 10.1515/ijamh-2013-0340 Received December 13, 2013; accepted March 23, 2014; previously published online May 8, 2014
Introduction The incidence and prevalence of eating disorders in children and adolescents have increased dramatically over the past 50 years. Estimates show that approximately 0.5% of adolescent females in the U.S. have anorexia nervosa (AN) and 1%–2% of adolescents meet the diagnostic criteria for bulimia nervosa (BN). Today, between 5% and 10% of all cases of eating disorders in the U.S. occur in males. The mortality rate associated with AN is approximately 5.6% per decade, the highest among all psychiatric disorders (1, 2). Adolescents with an eating disorder appear to know a great deal about nutrition. Oftentimes, they prepare meals for their families, are extremely knowledgeable about how many calories are in any given food, and frequently report being interested in eating a “healthy” diet (1). Unfortunately, the “healthy” diet of the majority of adolescents with eating disorders is distorted and translates into extreme restriction of daily caloric intake, usually with excessive limitation of the amount of fat that they consume. It is an accepted belief that the first step in altering behavior is to provide individuals with appropriate information (3–7). Prior to implementing any educational program, it is imperative that an individual assessment be completed. The purpose of this survey was to determine and compare the level of basic nutritional knowledge of adolescents with eating disorders to that of adolescents without eating disorders. This survey also aimed to compare the nutritional knowledge of the parents/guardians of both groups. Our hypothesis was that the level of nutrition knowledge of both patient groups would be poor and that the knowledge of their parents would be somewhat, though minimally, greater.
Brought to you by | Carleton University OCUL Authenticated Download Date | 10/26/15 8:27 AM
12 Castillo et al.: Basic nutrition knowledge of adolescents
Materials and methods
Results
Population
Demographics
A convenience sample of new patients and their parents/guardians seen in a suburban New York Adolescent Medicine office completed an 18-question, confidential nutrition survey (Appendix 1). The survey consisted of multiple choice questions, each with four possible answers. Adolescent patients included those who were referred for eating disorder evaluations, health maintenance evaluations, reproductive health issues, acute care needs, and obesity/lipid assessments. Of the approximately 600 new patients seen each year in this Adolescent Medicine office, approximately half are seen for the evaluation of a possible eating disorder. Survey questions were designed to measure basic nutritional information/knowledge. Seven categories were created: 1) daily caloric intake (questions 1 and 2), 2) caloric composition (questions 3–5), 3) energy expenditure (questions 6–8), 4) calorie counts (questions 9 and 10), 5) vitamins and minerals (questions 11–14), 6) portion sizes (questions 15 and 16), and 7) sample meals (questions 17 and 18). Correct responses were based on national recommendations of peer-reviewed organizations, published manufacturers’ “nutritional facts”, and peer-reviewed public information. Untimed surveys were distributed by the staff of the Adolescent Medicine office, while the adolescents and their parents/guardians were waiting to be seen. Following the separate completion of the surveys by patients and their parents, the surveys were placed in a folder, collected at the end of the day, and stored in the Principal Investigator’s locked office. Approval for this study was obtained through the organization’s Institutional Review Board.
Statistical analysis Survey responses were entered into a Microsoft® Excel file and data analysis was performed using SAS® 9.2 for Windows®. Means and standard deviations were calculated for continuous variables, and the nonparametric Wilcoxon Rank Sum Test was used to test for differences between groups. The χ2-test was used for categorical values, and the Fisher’s Exact test was used if cell counts were
Marigold Castillo*, Ronald Feinstein, James Tsang and Martin Fisher
An assessment of basic nutrition knowledge of adolescents with eating disorders and their parents Abstract Objective: This study aims to determine and compare the level of basic nutrition knowledge of adolescents with eating disorders and their parents to adolescents without eating disorders and their parents. Materials and methods: This six-month convenience based survey recruited a total of 182 adolescents with and without an eating disorder and their parents. The surveys were conducted in a suburban adolescent medicine office. Main outcome measures were based on the 18 basic nutrition questions, while means, standard deviations, Wilcoxon Rank Sum Test, and χ2 were all employed for the analysis. Results: None of the groups correctly answered more than half of the questions. In terms of the percentage of correct responses, there was a statistically significant difference between adolescents with eating disorders and their parents compared with adolescents without an eating disorder and their parents. Fewer than 16% of respondents in each group correctly answered the recommended daily caloric balance of fats, carbohydrates, and proteins. Conclusions: There is a deficiency in basic nutrition knowledge among adolescents with and without eating disorders and their parents. A significant increase in basic nutrition education needs to occur in order to increase the understanding of what is a “healthy” diet. Keywords: adolescents; eating disorders; nutrition knowledge.
*Corresponding author: Marigold Castillo, MD, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, USA, Phone: +516 465 5204, Fax: +516 465 5299, E-mail: [email protected] Marigold Castillo, Ronald Feinstein and Martin Fisher: Division of Adolescent Medicine, Department of Pediatrics, Cohen Children’s Medical Center of New York, NY, USA James Tsang: Biostatistics Unit, Feinstein Institute for Medical Research, North Shore- Long Island Jewish Health System, New Hyde Park, NY, USA; and Hofstra-North Shore LIJ School of Medicine, Hempstead, NY, USA
DOI 10.1515/ijamh-2013-0340 Received December 13, 2013; accepted March 23, 2014; previously published online May 8, 2014
Introduction The incidence and prevalence of eating disorders in children and adolescents have increased dramatically over the past 50 years. Estimates show that approximately 0.5% of adolescent females in the U.S. have anorexia nervosa (AN) and 1%–2% of adolescents meet the diagnostic criteria for bulimia nervosa (BN). Today, between 5% and 10% of all cases of eating disorders in the U.S. occur in males. The mortality rate associated with AN is approximately 5.6% per decade, the highest among all psychiatric disorders (1, 2). Adolescents with an eating disorder appear to know a great deal about nutrition. Oftentimes, they prepare meals for their families, are extremely knowledgeable about how many calories are in any given food, and frequently report being interested in eating a “healthy” diet (1). Unfortunately, the “healthy” diet of the majority of adolescents with eating disorders is distorted and translates into extreme restriction of daily caloric intake, usually with excessive limitation of the amount of fat that they consume. It is an accepted belief that the first step in altering behavior is to provide individuals with appropriate information (3–7). Prior to implementing any educational program, it is imperative that an individual assessment be completed. The purpose of this survey was to determine and compare the level of basic nutritional knowledge of adolescents with eating disorders to that of adolescents without eating disorders. This survey also aimed to compare the nutritional knowledge of the parents/guardians of both groups. Our hypothesis was that the level of nutrition knowledge of both patient groups would be poor and that the knowledge of their parents would be somewhat, though minimally, greater.
Brought to you by | Carleton University OCUL Authenticated Download Date | 10/26/15 8:27 AM
12 Castillo et al.: Basic nutrition knowledge of adolescents
Materials and methods
Results
Population
Demographics
A convenience sample of new patients and their parents/guardians seen in a suburban New York Adolescent Medicine office completed an 18-question, confidential nutrition survey (Appendix 1). The survey consisted of multiple choice questions, each with four possible answers. Adolescent patients included those who were referred for eating disorder evaluations, health maintenance evaluations, reproductive health issues, acute care needs, and obesity/lipid assessments. Of the approximately 600 new patients seen each year in this Adolescent Medicine office, approximately half are seen for the evaluation of a possible eating disorder. Survey questions were designed to measure basic nutritional information/knowledge. Seven categories were created: 1) daily caloric intake (questions 1 and 2), 2) caloric composition (questions 3–5), 3) energy expenditure (questions 6–8), 4) calorie counts (questions 9 and 10), 5) vitamins and minerals (questions 11–14), 6) portion sizes (questions 15 and 16), and 7) sample meals (questions 17 and 18). Correct responses were based on national recommendations of peer-reviewed organizations, published manufacturers’ “nutritional facts”, and peer-reviewed public information. Untimed surveys were distributed by the staff of the Adolescent Medicine office, while the adolescents and their parents/guardians were waiting to be seen. Following the separate completion of the surveys by patients and their parents, the surveys were placed in a folder, collected at the end of the day, and stored in the Principal Investigator’s locked office. Approval for this study was obtained through the organization’s Institutional Review Board.
Statistical analysis Survey responses were entered into a Microsoft® Excel file and data analysis was performed using SAS® 9.2 for Windows®. Means and standard deviations were calculated for continuous variables, and the nonparametric Wilcoxon Rank Sum Test was used to test for differences between groups. The χ2-test was used for categorical values, and the Fisher’s Exact test was used if cell counts were
