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Eating Behavior in an Adolescent

Population

David Greenfeld, M.D.


Donald M. Quinlan, Ph.D.
Pamela Harding, M.A.
Elaine Glass, M.S.W.
Anne Bliss, M.S.W.

An anonymous questionnaire on eating behavior and attitudes was admin-


istered to the student body of a coeducational private preparatory school.
There were 424 males and 337 females, ranging in age from I3 to 19 years
and representing 86.5% of h e available student body, who completed the
questionnaire. Results indicated a high frequency of concern with weight,
body image, and dieting, particularly among women. In particular the fe-
male subjects reported high frequencies of binge eating, fasting, crash di-
eting, and feeling obese. A sizable number of women reported self-induced
vomiting and amenorrhea secondary to weight loss. These concerns and
behaviors were more highly correlated with subjects’ opinions about the
desirability of their weight rather than with their reported body weight
(prorated for height and age). There were 4.0% of women and 0.8% of
men who answered questions that would meet strict DSM 111 criteria for
bulimia. These results provide additional evidence that troubled eating be-
havior and attitudes towards weight and body image are widespread
among adolescent women.

David Greenfeld, M.D. is Assistant Clinical Professor of Psychiatry, Yale University School of
Medicine, and Medical Director, Adolescent and Young Adult Treatment Unit, Yale-New
Haven Hospital. L)onald M. Quinlan, W.D. is Professor of Psychiatry and Psychology, Yale
University School of Medicine. Pamela Harding, MA. is Associate in Research, Department
of Psychiatry, Yale University School of Medicine. Elaine Glass, MAW. is Assistant Clinical
Professor of Psychiatry (Social Work), Yale University School of Medicine, Director, Inpatient
Psychiatric Social Work, Yale-New Haven Hospital. Anne Bliss, MAW. is Assistant Clinical
Professor, Department of Medicine (Social Work), Yale University School of Medicine. Ad-
dress reprint requests to David Creenfeld, M.D., Yale New Haven Hospital, 20 York Street,
New Haven, CT 06504.

international /ourna/ of Eating Disorders, Vol. 6, No. 1, 99-1 1 1 (1 987)


8 1987 by JohnWiley & Sons, Inc. CCC 0276-3478/87/010099-13604.00
100 Greenfeld et al.

INTRODUCTION

During the past two decades the increasing preoccupation of young


women with weight, diet, and body image appears to reflect a change
in the "ideal" shape for women and a growing cultural pressure on
women to diet and to be thin. Disordered eating behavior (preoccupa-
tion with weight and food, crash diets, fasting, binge eating, and purg-
ing behaviors) appears to be quite common, especially among
adolescent and young adult women. A number of investigators have
reported the incidence of various aspects of attitudes towards eating
and atypical eating behaviors in young women. Huenemann, Shapiro,
Hampton, and Mitchel(l966) surveyed a group of high school students
and found that 45% of 9th grade women described themselves as "fat."
Dwyer, Feldman, and Mayer (1967) surveyed a group of middle and
upper middle class surburban high school seniors, finding that 61%
had dieted, 37% were currently dieting, but only 15% were actually
obese. A survey (Nylander, 1971) of Swedish high school students age
14 through 19 years revealed that approximately 25% of 14year-old
women and 50% of 18-year-old women thought they were currently
"fat" by their self-defined use of the term. There were 8% of the 14
year-old women and 44% of the 18-year-old women who had dieted at
some time.
A number of investigators have reported a high incidence of subclin-
ical forms of anorexia nervosa and bulimia in groups of young women.
Nylander (1971) reported that nearly 10% of surveyed female high
school students reported 3 or more dieting related symptoms of the
same type as occur with anorexia nervosa. Button and Whitehouse
(1981) administered the Eating Attitudes Test (Gamer & Garfinkle,
1979) to a group of university students; 6.3% of females scored in the
"anorectic range." After interviewing these "high scorers," they con-
cluded that approximately 5% of postpubertal women developed a
subclinical form of anorexia nervosa. A mail survey of symptoms of
anorexia in university students (Clark & Palmer, 1983) revealed that
11%of female respondents scored in the "anorexic range" on the Eat-
ing Attitudes Test. Pope, Hudson, and Yurgelun-Todd (1984) con-
ducted a questionnaire survey of two colleges and a small secondary
school; 85% of the 310 secondary school students returned question-
naires. These investigators found that 1.9% of female respondents met
criteria for anorexia nervosa, 8.4% reported a history of bulimia, and
5.6% reported binge eating once per week or more.
Bulimic symptoms have also been reported to be common in a vari-
ety of surveys of school and community populations. (Fairburn &
Cooper, 1983; Pope et al., 1984). Hawkins and Clement (1980) reported
that 79% of female and 49% of male college psychology students sur-
veyed reported episodes of binge eating (defined as "uncontrolled, ex-
Adolescent Eating Behavior 101

cessive”). Stangler and Printz (1980) reported that 5.3% of female


patients attending a university health service met DSM I11 criteria for
bulimia. Halmi, Falk, and Schwartz (1981) reported that 19% of women
and 5% of male college students responding to a mail survey reported
that they had experienced all major symptoms of bulimia. Pyle et al.
(1983) conducted a questionnaire survey of college freshman, obtaining
a 98.3% response rate. They reported that 4.5% of women and 0.4% of
men “modified DSM I11 criteria.” The modifications involved a require-
ment that subject engage in at least weekly binge eating and Criterion
C (awareness that the eating pattern is abnormal and fear or not being
able to stop eating voluntarily) was omitted. Katzman, Wolchick, and
Braver (1984) surveyed a group of college students and found that 56%
of women reported that they “binge eat,” although 7.2% reported one
or more episodes per month. These investigators found that 4% of
women respondents met “operationalized” DSM 111criteria for bulimia.
Not all investigators have concluded that such eating behavior and at-
titudes are abnormal. Abraham, Mira, Beumont, Sowerbutts, and
Llewellyn-Jones (1983) surveyed four groups of young women and
concluded that most young women may pass through a phase of what
is currently called disordered eating and that for most of these women
this behavior should be considered a part of normal development.
Nevo (1985) surveyed a group of college women and found binge
eating, dieting, and weight concern constituted a continuous dimen-
sion, with 40% of Caucasian women binging at least once per month,
50% trying to lose weight at least once per month, and 60% worrying
greatly about weight. She found purging considerably less prevalent
(11%of women). Grey and Ford (1985) conducted a questionnaire sur-
vey of college students and reported that 13% of responding women
and 4.2% of responding men met DSM I11 criteria for bulimia. “Near-
bulimic” subjects who fulfilled all but one of the DSM I11 criteria in-
cluded 18% of female and 4% of male respondents. Crowther, Post,
and Zaynor (1985) conducted a questionnaire survey of a group of ad-
olescent girls. 34% of subjects invited to participate returned complete
questionnaires. These investigators found that 46% of responding ad-
olescent women reported episodes of binge eating, 36.4%reported ep-
isodes of fasting, 11.2% induced vomiting, and 4.7% abused laxatives.
They reported that 7.7% of responding subjects met DSM I11 criteria
for bulimia and an additional 4.4% suffered “problematic binge eat-
ing.”
The present study surveyed the eating attitudes and behaviors of a
nearly complete sample of a high school student body of adolescent
men and women (mean age 15.7 years). In addition to inquiring about
specific eating behaviors and attitudes, questions were added to assess
the presence of other behaviors included as symptoms of either an-
orexia nervosa or bulimia in DSM III. Of particular interest were simi-
102 Greenfeld et al.

larities and differences between students’ opinion of their weight,


feeling overweight, and the reported weight expressed as a percentage
of ideal weight for age and height. Ideal weights were obtained from
adolescent weight tables in Miller and Keane (1985).

METHOD

The subjects were drawn from a large private preparatory boarding


school with a highly selected student body located in a small New En-
gland town. The student body consisted of 985 students, 545 males and
440 females, ranging in age from 13 to 19, with a mean age of 15.7
years. Three groups totalling 70 males and 25 females were unavailable
for participation: one group was participating in sports away from the
school at the time of the study (59 males and 12 females), a second was
touring abroad (10 males and 10 females), and a third was in the infir-
mary (1male and 3 females). All questionnaires were reviewed by one
or more of the investigators; 10 were discarded because of impossible
and/or obviously flippant answers. Useable completed questionnaires
were received from 424 males and 337 females, or 78% of eligible males
and 76% of eligible females, 89% and 79% respectively, of those avail-
able for completing the form.

Procedure
The questionnaire employed an adaptation of the one used by Halmi
et al. (1981). The questionnaire was modified for administration in
anonymous form. All the original questions were included; 18 ques-
tions were added at the end to ascertain in detail symptoms and be-
havior mentioned in the DSM 111 diagnosis of anorexia nervosa and
bulimia. The resulting questionnaire (see Appendix I) consisted of 38
questions for all subjects, with three additional questions for female
respondents regarding menstrual function. Each subject was given the
option of extending answers and providing comments at the end of the
questionnaire.
The study was completed with the assistance of school administra-
tion and faculty. All students were instructed to attend one of the two
sessions immediately following the evening meal: one group for 11th
and 12th grade, the second for 9th and 10th grade. The two sessions
were 1 week apart. A school dean addressed each session, explaining
the role of the investigators and assuring the anonymity of the respon-
dent. During the session, school faculty and student monitors assisted
in the data collection. The questionnaires were completed in a large
building used principally for a chapel but also the normal site for large
school meetings. Students were required to spend a minimum amount
Adolescent Eating Behavior 103

of time (20 minutes), after which those wishing to could leave. No sub-
ject took more than 45 minutes; the majority were completed within
20-30 minutes. One limitation of the data was the proximity of stu-
dents to each other, probably restricting the reporting of more unusual
and pathological responses.

RESULTS

The study data revealed a widespread concern with the subject pop-
ulation with weight, body image, dieting, and eating behaviors (Table
1). Although present in both sexes, these concerns were significantly
more marked in female subjects. Large and sigruficant sex differences
occurred on questions regarding concerns about eating disorders: feel-
ing "fat," describing onself as overweight; using diets, crash diets, and
diet pills for weight control; losing 10 lb or more over the previous
year; consulting a physician for a weight related eating problem; and
counting calories one or more times daily. It is particularly interesting
to note that, although 46% of women and 17%of men described them-
selves as overweight, fewer women than men reported weights that

Table 1. Eating attitudes and dieting behaviors.

Females Males XZ

Concerned they might N 93 41 40.29-


have an eating % 28.1 10.0
disorder
Often feel fat N 271 107 223.%***
% 81.4 26.2
Describes self as N 151 71 72.65-
overweight % 45.9 17.1
Are actually overweight N 40 99 17.28**
% 12.3 23.8
Employ crash diets N 149 22 153.06-
% 43.6 5.4
Often fast more than one N 131 51 72.90%***
full day % 39.7 12.5
Lost 10 Ib or more past N 132 107 16.0-
year % 40.4 26.4
Use diet pills N 50 5 52.11***
% 15.0 1.22
Have seen MD for eating N 45 12 29.14*-
or weight problems % 13.6 2.9
Weigh self one or more N 41 45 6.80
times daily % 13.6 10.1
Count calories one or N 29 5 175.510n
more times daily % 8.22 1.2

* p < .05.
**p < .01.
***p < .001.
104 Greenfeld et al.

weights that placed them more than 10% above the ideal weight for
their height, age, and sex. (p < 0.01)
No subjects met the DSM I11 criteria for anorexia nervosa. The school
health authorities were aware of three female students diagnosed as
suffering from anorexia nervosa who were temporarily out of school
and not included in this subject population and six female students
regarded as "possibly anorectic." In our sample there were 13 female
subjects and 17 male subjects between 75% and 80% of ideal body
weight. Six of the female subjects in the group and none of the male
subjects in this weight range reported that they often "felt fat": x2 (1)
= 9.81 (p < 0.01). There were 44 female subjects (13.5% of females)
who reported secondary amenorrhea associated with weight loss.
Bulimic behaviors were also common in both sexes but were signifi-
cantly more prevalent in female subjects (Table 2). There were 44.6%
of female subjects and 16.4% of male subjects who described more se-
rious binge eating behaviors, e.g., "uncontrollable urges to eat and eat
until they felt physically ill." Smaller percentages of subjects acknowl-
edged self-induced vomiting, laxative abuse, and diuretic abuse. Large
and significant sex differences occurred in all the bulimic symptoms.
Despite the prevalence of bulimic behavior, comparatively few sub-
jects had a pattern of responses suggesting that they met DSM 111 cri-
teria for bulimia (Table 3). Thus, if DSM 111 criteria are applied
rigorously (including at least weekly binge eating), 0.8% of males and
4.0% of females responded in ways that suggested they might meet

Table 2. Symptoms of bulimia.

Female Male X2

Acknowledge any symptoms of N 245 133 126.91'*'


bulimia % 73.4 32.0
Acknowledge more serious N 149 68 71.98***
symptoms of bulimia % 44.6 16.4
Usually binge-eat alone (of those N 62 30 4.63'
who binge) % 29.4 19.5
Make self vomit after overeating N 38 5 35.86"'
% 11.6 1.2
Induce vomiting one time per week N 13 2 9.33"
or more % 4.0 0.5
Use laxatives to control weight N 19 6 19.P"
% 5.7 1.5
Use diuretics to control weight N 11 4 12.56'
% 3.3 1 .o
' p < .05.
'*p < .01.
***p < ,001.
Adolescent Eating Behavior 105

Table 3. Bulimics.
Females Males

Known to school health service N 9 1


% 2.7 0.2
Subjects meeting strict DSM 111 N 15 4
criteria % 4.0 0.8
Subjects meeting modified N 28 5
E M 111 criteria (including at 90 8.4 1.2
least weekly binges)
Subjects meeting modified N 47 7
DSM 111 criteria (including at % 14.1 1.7
least monthly binges)

criteria for bulimia. If DSM 111 criteria are modified, maintaining a re-
quirement for at least weekly binging and excluding criterion C (aware-
ness that the eating pattern is abnormal and fear of not being able to
stop eating voluntarily), the number of women whose responses sug-
gested they met DSM 111 criteria for bulimia is doubled (8.4%). If crite-
rion "C" is excluded and only monthly binging is required, the number
of affected females is again nearly doubled (14.1%).
In both sexes atypical eating behaviors generally were more highly
correlated with students' subjective weight opinion than with the ac-
tual degree of under- or overweight (expressed as a percent of ideal
weight for age and height). Correlations with weight opinion were sig-
nificant for a majority of variables in female subjects (Table 4), far more
than would be expected by chance with the number of variables.

DISCUSSION

The current study surveyed a group of high achieving adolescents at


a prestigious private secondary school. Based on clinical experience,
this population might be expected to have a particularly high incidence
of troubled eating attitudes and behavior. Indeed, the school authori-
ties requested the survey because of their awareness of increasing eat-
ing problems, particularly among female students. The findings
suggest that preoccupation with weight, body image, diet, and eating
behavior is widespread among this group of adolescents, particularly
among women. These concerns appear to be associated with a variety
of undesirable eating behaviors such as crash diets, fasting, binge eat-
ing, self-induced vomiting, and the use of diet pills, laxatives, and di-
uretics. The number of different types and frequencies of subjects'
undesirable eating behaviors and preoccupations with weight and diet
106 Greenfeld et al.

Table 4. Correlation coefficients of weight and weight opinions with eating


attitude and behavior variables by sex.
Fema1es Males

Percent Percent
Ideal Weight Ideal Weight
Weight Opinion Weight Opinion

Percent Ideal Weight - 0.54"' - 0.5P"


Often Feel Fat 0.22'" 0
.
3
9
' 0.31'*' 0.47''
Worry I have an eating disorder 0.14" 0.26"' 0.05 0.06
Seen an MD for an eating disorder 0.22'- 0.20-' 0.07 0.02
Others worry you are too thin -0.31'" -0.22'" - 0.32"" -0.42'"
How often do you count calories? 0.15'' 0.21*'* 0.08 0.19'
How often count calories lost during 0.05 O.ll* 0.06 0.08
exercise?
How often weigh self? 0.07 0.16" O.Il* - 0.02
Gained 10 Ib or more past year 0.18'" 0.18"' 0.09 - 0.02
Number of times gained 10 Ib or more 0.12 0.20' 0.10 0.06
past year
Lost 10 Ib or more past year 0.17- 0.17- 0.15" 0.11'
Number of times lost 10 Ibs or more 0.10 0.2w 0.01 0.07
past year
Do you use diet pills? 0.12' 0.14** 0.16"* 0.01
Do you use laxatives for weight loss? 0.04 0.03 0.15" O.ooo6
Do you use diuretics for weight loss? 0.10 0.10 - 0.09 0.01
Do you use crash diets? 0.27" 0.36"' 0.10 0.13"
Do you ever fast for more than one 0.14" 0.26". 0.2V" 0.20-
day?
Frequency of fasts longer than one 0.09 0.34"' -0.16 0.09
day
Age of first menstrual period - 0.23"' - 0.09 - -
Amenorrhea associated with weight 0.02 -0.03 - -
loss
Ever had an eating binge? 0.1 0.14"" 0.08 0.006
Do you have urges to binge-eat? 0.06 0.14'* - 0.02 0.001
Do you consider yourself a binge 0.23,'' 0.2W'' 0.03 - 0.04
eater?
Afraid I can't stop eating 0.16" 0.23"' 0.04 0.13,'
Feel miserable after eating binge 0.21''' 0.32"' 0.25"' 0.33***
Number of days between binges - 0.02 - 0.25** .05 0.13
Usually binge-eat alone 0.02 -0.02 -0.06 0.03
Usually binge on high calorie food - 0.04 -0.12' - 0.06 -0.02
Do you ever vomit after eating? 0.01 0.15" - 0.002 0.04
Do you make self vomit after eating? 0.05 0.06 0.01 0.05
How often vomit after eating? 0.03 0.10 - 0.02 0.01
' p < .05.
**p < .01.
'*'p < .001.

correlated more closely with attitudes toward weight and appearance


than with actual heighvweight scores. This pattern of marked concern
and undesirable eating behaviors was far more marked in female sub-
jects and did not vary significantly with age over the range surveyed
(13 through 19 years).
Adolescent Eating Behavior 107

Despite the expectations that this population represented a particu-


larly high risk group, the results are remarkably similar to those re-
ported by Crowther et al. (1985), who surveyed a group of adolescent
female high school students. They found that 46% of women reported
binging episodes, 11.2% induced vomiting, 36.4% fasted, and 7.7%
met DSM III criteria for bulimia (including weekly binging). These fig-
ures are nearly identical to the current study that found 44.6% of
women reporting serious binging behavior, 11.6% induced vomiting,
39.7% fasted, and 8.4% who met modified DSM I11 criteria (including
weekly binging). Crowther et al. (1985) found that serious bulimic
symptoms in adolescent women increased with age. The present study
differs in that the increase in serious symptoms with age in women did
not reach statistical significance, p = 0.06.
In general, results of the present study also were roughly compara-
ble to those reported in surveys of older college populations. Given the
variety of questionnaires and criteria used, comparisons are difficult.
However, the current study reports an incidence of clinically significant
eating problems in both males and females roughly comparable to
those reported by Pope et al., (1984), Pyle et al., (1983), Hawkins and
Clement (1980), and Halmi (1981).
Methodological weaknesses of the present study include problems
inherent in any questionnaire survey. The fact that 85.5% of the avail-
able student body participated in the study provides some assurance
that the whole sample is representative of the student body as a whole.
However, the fact that 71 athletes (59 males) were not available at the
time of the study may have caused the incidence of eating symptoms,
particularly in males, to be underreported, since adolescent athletes
have been observed clinically to be more weight conscious and more
likely to resort to disturbed eating behavior than nonathlete adoles-
cents.
The present study confirms earlier reports that preoccupations with
weight and eating behavior are very prevalent in adolescent popula-
tions, particularly among adolescent women. These concerns appear to
be especially marked in this competitive, middle and upper middle
class preparatory school setting. Despite the nearly universal concerns
about these issues, especially among women, the disturbed eating at-
titudes and behaviors appeared to constitute a broad continuum rang-
ing from mild to severe abnormality. While this high school population
manifested pervasive concern and problems with weight and eating
behavior, the number of individuals who seemed vulnerable to severe
eating disorder symptoms appears no higher than in other adolescent
populations. Although women are more affected, it is important that
the males with disordered eating symptoms not be overlooked. A small
but significant group of men reported serious symptoms and appears
to need clinical assesment and intervention.
108 Creenfeld et al.

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(1983).Eating behaviors among young women. Medical Journal of Australia, 2,225-228.
Button, E. J. & Whitehouse, A. (1981). Subclinical anorexia anorexia. Psychological Medi-
cine, 11, 509-516.
Clarke, M. G. & Palmer, R. L. (1983). Eating attitudes and symptoms in university stu-
dents. British Jouml of Psychiatry, 142, 299-304.
Crowther, J. H., Post, G.,& Zaynor, L. (1985). The prevalence of bulimia and binge
eating in adolescent girls. Znternatiaal Journal of Eating Disorders, 4 , 29-42.
Dwyer, J. T., Feldman, J. J., & Mayer, J. (1%7). Adolescent dieters: W h o are they: Amer-
ican Journal of Clinical Nutrition, 20, 1045-1056.
Fairbum, C. G., & Cooper, P. J. (1983). Epidemiology of bulimia two community studies.
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Gamer, D. M.,& Garfinkle, P. E. (1979). The Eating Attitudes Test. Psychological Medi-
cine, 9, 273-279.
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Journal of Eating Disorders, 4, 201-210.
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a college population. Psychological Medicine, 11,697-706.
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Disorders, 3(3), 53-62.
Miller, B. F., & Keane, C. B. (1983). Encyclopedia and dictionary of medicine, nursing, and
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among 300 surburban women shoppers. American Journal of Psychiatry, 242(2), 292-
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Pyle, R. L., Mitchell, J. E., Eckert, E. D., Halvorson, P. A., Neuman, P. A., & Goff, G.
M.(1983). The incidence of bulimia in freshmen college students. International Iournal
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population. American Journal of Psychiahy, 137(8), 937-940.

APPENDIX I: EATING HABITS QUESTIONNAIRE

1. Grade in School: CIRCLE ONE 7 8 9 10 11 12


2. Sex: Male Female
3. Year of Birth: 19 -
4. What is your PRESENT WEIGHT? - pounds
5. What is your present HEIGHT? - inches
6. How many inches have you grown in the past year? - inches
7. What is the LOWEST YOU'VE WEIGHED since reaching your
present height? - pounds
8. What is the MOST YOU'VE WEIGHED since reaching your present
height? - pounds
Adolescent Eating Behavior 109

9. In your opinion, you are now: 1 - very underweight


2 - underweight
3 - average
4 - overweight
5 - very overweight
10. What was the most you have weighed during the past year? -
pounds
11. What was the least you have weighed during the past year? -
pounds
12. Do you get uncontrollable urges to eat and eat until you feel phys-
ically ill?
13. Are there times when you are afraid that you cannot voluntarily
stop eating?
14. Do you make yourself vomit after eating too much?
15. Do you feel miserable and annoyed with yourself after an eating
binge?
16. Have you ever had an episode of eating an enormous amount of
food in a short space of time (an eating binge)?
17. Do you consider yourself a binge eater?
18. In order to CONTROL YOUR WEIGHT, do you use . . .
DIET PILLS
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every day
7 - more than once every day
19. In order to CONTROL YOUR WEIGHT, do you use . . .
LAXATIVES
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every day
7 - more than once every day
20. In order to CONTROL YOUR WEIGHT, do you use . . .
DIURETICS OR WATER PILLS
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every day
7 - more than once every day
110 Greenfeld et at.

21. What is the average number of days between your episodes of


binge eating? (If never, leave blank) - days
22. Have you ever vomited after eating?
23. How frequently do you vomit after eating?
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every day
7 - more than once every day
24. If you binge eat, do you usually do it when you are alone?
25. If you binge eat, do you usually do it with high-calorie food like
candy, cake, chips, etc.?
26. Have you tried more than one “crash diet” in the last year?
27. Have you ever stopped eating for more than 1 day at a time in
order to lose weight? If yes, how many times has this happened?
-
28. Have you gained more than 10 lbs. in the past year? If yes, how
many times has this happened? -
29. Have you lost more than 10 lbs. in the past year? If yes, how many
times has this happened? - If yes, was there any special reason?
-
30. How often do you engage in regular strenuous exercise?
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every day
7 - more than once every day
31. How often do you count the number of calories you use by exer-
cising?
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every day
7 - more than once every day
32. Do you often “feel fat?”
33. Have you ever worried that you might have an eating disorder?
34. Have other people ever worried about your being too thin?
35. Have you ever seen a doctor for weight or eating problems? At
what age - years
Adolescent Eating Behavior 111

36. How often do you weigh yourself?


1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every week
7 - more than once every day
37. Do you count calories?
1 - never
2 - less than once every 4 weeks
3 - 1 to 3 times every 4 weeks
4 - once every week
5 - 2 to 6 times every week
6 - once every week
7 - more than once every day
38. Do you have any other type of eating problems? Specify
FOR WOMEN ONLY
39. How old were you when your periods started? - years - not yet
40. Are your periods regular?
41. Have your periods stopped at any time during the past year?
For how many months? -
Was this due to a physical illness? -
Was this at a time you had lost weight? -

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