UNDER EMBARGO UNTIL NOVEMBER 9, 2015, 12:01 AM ET … Advance... · 2015-11-03 · Self-Weighing Throughout Adolescence and Young ... self-weighingcanbehelpfulforweight management

Podcast available onlineat www.jneb.org Research Article

Self-Weighing Throughout Adolescence and YoungAdulthood: Implications for Well-BeingCarly R. Pacanowski, PhD, RD; Katie A. Loth, PhD, RD; Peter J. Hannan, MStat;Jennifer A. Linde, PhD; Dianne R. Neumark-Sztainer, PhD, MPH, RD

ABSTRACT

Objective: To describe the prevalence of self-weighing in the transition period from adolescence toyoung adulthood and examine cross-sectional and longitudinal associations between self-weighing andweight status, psychological, and behavioral outcomes.Design: Project Eating and Activity in Teens and Young Adults, a longitudinal cohort study that assessed vari-ables 3 times over 10 years.Participants: A total of 1,868 adolescents and young adults.Main Outcome Measures: Weight, body mass index, weight disparity, body satisfaction, weightconcern, self-esteem, depression, and unhealthy weight control behaviors.Analysis: Cross-sectional and longitudinal.Results: Significant positive correlations were found at each time point between self-weighing andweight concern for both genders. Self-weighing was significantly inversely related to self-esteem ateach time point in female participants. Increases in endorsement of self-weighing were significantly relatedto decreases in body satisfaction and self-esteem and increases in weight concern and depression in femaleparticipants and to increases in weight concern in male participants.Conclusions and Implications: Findings suggest that self-weighing may not be an innocuous behaviorfor young people, particularly women. Interventions should assess potential harmful consequences of self-weighing in addition to any potential benefits. It may be appropriate for clinicians to ask about self-weighing, and if it is frequent, to explore motivations, perceived benefits, and potential adverse correlatesor consequences.KeyWords: self-weighing, weight, well-being, psychological, self-esteem, adolescent (J Nutr Educ Be-hav. 2015;47:506-515.)

Accepted August 10, 2015.

INTRODUCTION

Obesity in adolescents is a publichealth concern, and because obesitytracks from adolescence into adult-hood,1 cost-effective ways are neededto prevent excessive weight gain dur-ing this critical life transition. Bodydissatisfaction and weight concerns,2 predictors of disordered eating be-haviors, are also elevated among ado-lescents,2 which makes it crucial that

interventions aimed at obesity preven-tion among adolescents also takecare to not exacerbate predictors ofdisordered eating behaviors. There issome evidence suggesting that self-weighingmay facilitate weight controlin some adults and not be psycholog-ically detrimental.3,4 However, thereis reason to believe that self-weighingmay not be advisable for certainadults5 or other age groups, such asadolescents and young adults.4,6 Thus,

it is important to determine whetherself-weighing can be helpful for weightmanagement in adolescents, whilesimultaneously not contributing topoor well-being, by developing a betterunderstanding of the long-term out-comes of self-weighing for bothweightmanagement and behavioral or psy-chosocial outcomes.

There is scarce literature exploringself-weighing in adolescents andyoungadults andfindings are inconsis-tent. Two cross-sectional studies foundassociations between self-weighingand less chance of weight regain in ad-olescents,7,8 but for current weight,findings have been mixed. In 1 study,self-weighing was positively associatedwith body mass index (BMI)9 whereas2 others found no relationship10,11

and 1 study found an inverseassociation.8 Two longitudinal studiesalso reported inconsistent results: Self-weighing frequency was positivelyassociated with prospective weight

Department of Epidemiology and Community Health, School of Public Health, Universityof Minnesota, Minneapolis, MNConflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found onlinewith this article on www.jneb.org.Address for correspondence: Carly R. Pacanowski, PhD, RD, Department of Epidemi-ology and Community Health, School of Public Health, University of Minnesota, WestBank Office Bldg, 1300 South 2nd St, Ste 300, Minneapolis, MN 55415; Phone: (215)630-0397; E-mail: [email protected] by Elsevier, Inc. on behalf of the Society for Nutrition Education and Behaviorhttp://dx.doi.org/10.1016/j.jneb.2015.08.008

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gain in one study12 but in anotherstudy, no association was found.10

Regarding well-being, self-weighinghas been found to be associated withhigher depressive symptomatology,lower self-esteem, and lower bodysatisfaction, with some differencesacross gender.9,11,13 Consideringbehaviors, self-weighing has beenfound to be associated with bothhealthy (eg, eating fewer foods withlittle nutritional value) and unhealthy(eg, skippingmeals) weight control be-haviors in 3 studies.10,11,13 However, 1study found no association betweenfrequency of self-weighing and un-healthy weight control behaviors.8

These disparate and inconsistentfindings call for further investigation,notably more research studies withlong-term follow-up. Project Eating andActivity in Teens and Young Adults (EAT),a longitudinal cohort study in apopulation-based sample of female andmale adolescents and young adults, pre-sents an opportunity to further exploreself-weighing and its relationship withbodyweightandotherpsychosocial out-comes while investigating how thesevariables changed over a 10-year period.This study expands onprevious analysesfrom Project EAT11-13 by assessing self-weighing and outcomes indicative ofwell-being at 3 timepoints over 10years.The current study has 3 objectives: (1) todescribe the prevalence of self-weighingduring the transition from adolescenceto young adulthood; (2) to examinecross-sectional associations betweenself-weighing and selected outcomes;and (3) to investigate contemporaneouschanges in self-weighing with changesin weight status, psychological, andbehavioral outcomes over 10 years.Based on previous work, the authorshypothesized that more frequent self-weighing would be associated withpoorer psychological status (greaterbody dissatisfaction and depressivesymptoms, and lower self-esteem) andgreater likelihood of engaging in un-healthy weight control behaviors.

METHODSStudy Design, Participants, andRecruitment

The researchers drew data for theseanalyses from Project EAT-I, -II, and-III, 3 waves of a 10-year longitudinalstudy designed to examine dietary

intake, physical activity, weight con-trol behaviors, weight status, and fac-tors associated with these outcomesamong young people. In Project EAT-I (1998–1999), middle school and se-nior high school students at 31 publicschools in the Minneapolis/St Paulmetropolitan area completed surveysand anthropometric measures.14,15 InProject EAT-II (2003–2004), originalparticipants were mailed follow-upsurveys.16,17 Project EAT-III (2008–2009) observed participants as theyprogressed from adolescence toyoung adulthood. The University ofMinnesota Institutional Review BoardHuman Subjects Committee approvedall protocols.

The analytic sample used in thisarticle to address objectives 1 and 2 in-cludes the 1,902 young adults who re-sponded at all 3 time points. Therewere 819 male participants (43%)and 1,083 female participants (57%)who completed surveys for EAT-I(time 1), EAT-II (time 2), and EAT-III(time 3). To address objective 3, partic-ipants had to respond to the self-weighing item at all 3 time points,which slightly decreased the analyticsample to 1,868 (female participants,n¼ 1,058; male participants, n¼ 810).

Because attrition from the time 1sample did not occur at random, datawere weighted using the response pro-pensity method.18 Response propen-sities (ie, the probability of respondingto the Project EAT-III survey) were esti-mated using a logistic regression ofresponse at time 3 on a large numberof predictor variables from EAT-I.Weights were calibrated so that theweighted total sample sizes used in an-alyses for eachgender cohort accuratelyreflect the actual observed sample sizesin thosegroups. Theweightingmethodresulted in estimates representativeof the demographic makeup of theoriginal school-based sample, therebyallowing results to be more generaliz-able to the population of young peoplein the Minneapolis/St Paul metropol-itan area.

MeasuresSelf-weighing. The authors assessedengagement in self-weighing byasking participants to respond to thestatement, ‘‘I weigh myself often.’’Participants responded at each surveytime point using a 4-point Likert scale

in which 1 ¼ strongly disagree and4 ¼ strongly agree (test-retest agree-ment [agree vs disagree] ¼ 85%19). Asmall study comparing the assessmentof self-weighing used in the currentarticle with a more objective assess-ment yielded a correlation of r¼ .60.12

Weight status variables: weight andBMI. At time 1, trained research assis-tants following standardized proce-dures measured height and weight,from which BMI was calculated. Bodymass index at later time points wascalculated from self-reported heightand weight; validation of self-reportsis described elsewhere.20 Age andgender were assessed via self-report.

Psychological variables: weightdisparity, body satisfaction, weightconcern, depression, and self-esteem.The researchers calculated weightdisparity by comparing self-assessedideal weight and self-reported currentweight. Participants responded to thequestion, At what weight do you thinkyou would look best?2,15 This valuewas divided by self-reported weightand multiplied by 100 to make a per-centage (repeat correlation at EAT-III¼ 0.95). Body satisfaction was as-sessed using items based on the BodyShape Satisfaction scale.21 Partici-pants described level of satisfactionrelated to 10 different body parts us-ing a 5-point Likert scale (Cronbacha ¼ .92). Weight concern was assessedwith 2 items: I think a lot about beingthinner and I am worried about gainingweight (4-point Likert scale, stronglydisagree to strongly agree) (Cronbacha ¼ .87).2,14 Depressive symptomswere assessed using 6 items from theKandel and Davies Depressive Moodscale 22 (Cronbach a ¼ .82). The re-searchers assessed self-esteem using 6items from the Rosenberg Self-esteemscale23 (Cronbach a ¼ .79).

Behavioral variables: less extremeand extreme unhealthy weight con-trol behaviors. Participants wereasked to indicate whether they hadengaged in each of 9 behaviors forreducing weight in the past year (yes/no).2,15 Five of these behaviorsconstituted less extreme unhealthyweight control behaviors: fasted, atevery little food, used a food substitute,skipped meals, or smoked more

Journal of Nutrition Education and Behavior � Volume 47, Number 6, 2015 Pacanowski et al 507

cigarettes (test-retest agreement ¼83%). The remaining 4 behaviorsconstituted extreme unhealthy weightcontrol behaviors: used laxatives,pills, diuretics, or vomited (test-retestagreement ¼ 96%). Less extreme andextreme unhealthy weight controlbehavior variables were dichotomizedinto individuals reporting any of thebehaviors vs none.

Data Analysis

The researchers calculated the per-centage of male and female partici-pants choosing each response optionfor the self-weighing variable at EAT-I, EAT-II, and EAT-III. To explore rela-tionships between self-weighing andoutcomes at EAT-I, EAT-II, and EAT-III, cross-sectional Spearman rank-order correlations were used.

To examine contemporaneouschanges in self-weighing and out-comes, models were developed ac-cording to the type of outcome(continuous or dichotomous). Com-pound symmetry of variance com-ponents was included in the modelsto account for the correlationbetween repeated measures on thesame person. The researchers em-ployed decomposition of the repeatedself-weighing into an average leveland deviation from that average atthe 3 surveys. This decomposes therepeated measures into the orthog-onal dimensions of between-personassociations and within-person con-temporaneous change. Although itdoes not allow an inference of cau-sality, a contemporaneous change inoutcome and in self-weighing isstronger evidence of possible causal-ities (of ambiguous directionality)than the cross-sectional relationship.The model included a linear time ef-fect (slope) modeled as a randomslope per person. Effect size24 is pre-sented, which is the change in theoutcome as a fraction of the SD ofthe outcome associated with a unitchange in the independent variable.

For dichotomous outcomes, asimilar model was used, but with logitlink function and binomial error dis-tribution. Expected logits were in-verted to yield an estimate (in eachgender) of the change in the probabil-ity of using any extreme weight con-trol behavior associated with acontemporaneous change of 1 unit

in the scale of self-weighing (eg, mov-ing from disagree to agree). Odds ratiosare presented.

All analyses were weighted asdescribed earlier. Attention is drawnto statistical P# .001 becausemultipletests were run. Younger and older co-horts appeared to follow the samepattern of self-weighing frequency re-porting over time; a statistical interac-tion between age-cohort (2 categories)and survey (3 time points) was testedand found to be nonsignificant.Consequently, the age cohorts werecombined. Analyses were not con-trolled for covariates to portray thetrue prevalence of the outcomes as-sessed; although associations maydiffer across potential covariates, thisarticle is descriptive in nature and pre-sents prevalence numbers free of addi-tional adjustments.

RESULTS

Table 1 outlines participant character-istics for the Project EAT study at time1. At EAT-I, more than two thirds ofboth female participants and maleparticipants were of non-overweight

status. In the overall sample, aboutone third of participants were in mid-dle school and two thirds were in highschool. The sample was both ethni-cally and socioeconomically diverse,as displayed in Table 1. Socioeco-nomic status was determined usingthe highest parental level of educa-tion, described in detail elsewhere.14

Objective 1: Prevalence ofEndorsement of Self-WeighingOver Time

In both female and male participants,endorsement of self-weighing, referredto here simply as self-weighing,remained fairly stable over the 10-yearperiod (Figures 1 and 2). At EAT-Iand EAT-II, most female participantsdisagreed that they weighed them-selves often. At EAT-III, most stilldisagreed but the proportion offemales who strongly disagreed thatthey weighed themselves often washigher than at previous time points.For male participants, a similarpattern was seen, with the majorityof males disagreeing that they weigh

Table 1. Project Eating and Activity in Teens and Young Adults–I Study ParticipantCharacteristics

VariablesFemale

Participants, n (%)Male

Participants, n (%)

Weight statusNormal 700 (67.2) 555 (68.8)Overweight 195 (18.7) 105 (13.1)Obese 147 (14.1) 147 (18.1)

School levelIn middle school 291 (28.2) 244 (30.3)In high school 742 (71.8) 561 (69.7)

RaceWhite 484 (46.9) 410 (51.1)Asian 54 (5.2) 46 (5.8)African American 215 (20.9) 117 (14.6)Hawaiian/Pacific Islander 5 (0.5) 5 (0.6)Hispanic 196 (19.0) 165 (20.6)Native American 33 (3.2) 31 (3.8)Mixed race 44 (4.3) 28 (3.5)

SESLow 183 (18.1) 124 (16.1)Low-middle 184 (18.2) 160 (20.8)Middle 277 (27.4) 190 (24.6)High-middle 229 (22.6) 195 (25.3)High 139 (13.7) 102 (13.2)

SES indicates socioeconomic status, determined by parent’s education level.Note: These values are weighted for nonresponse.

508 Pacanowski et al Journal of Nutrition Education and Behavior � Volume 47, Number 6, 2015

themselves often at the first 2 timepoints and a larger proportion ofmales strongly disagreeing that theyweighed themselves often at EAT-IIIcompared with previous time points.

Objective 2: Cross-SectionalRelationships Between Self-Weighing and OutcomeVariables

For female participants, no significantassociations were found between self-weighing and either weight or BMI atany of the 3 time points (Table 2). Self-weighing was inversely but weaklyrelated to weight disparity, a measureof how ideal weight compares withactual weight, at EAT-II (r ¼ –.14; P <.001). Self-weighing was associatedwith lower body satisfaction at EAT-Iand EAT-III (r ¼ –.17 and –.17, respec-tively; P < .001). The authors found aconsistently positive correlation be-tween self-weighing and weight

concern at the 3 time points (r ¼ .30,.34, and .34; P < .001). More frequentself-weighing was associated withmore depressive symptoms at EAT-I(r ¼ .14; P < .001). More frequentself-weighing was consistentlyinversely related to self-esteem (r ¼–.18, –.19, and –.15; P < .001). Forbehavioral variables, Table 3 lists thepercentage of female participantsshowing agreement with the self-weighing question and engaging inless extreme and extreme unhealthyweight control behaviors at eachtime point. At EAT-I, of the femaleparticipants who strongly agreedwith weighing themselves often,80.9% reported engaging in at least 1less extreme unhealthy weight con-trol behavior and 20.8% reportedengaging in at least 1 extreme un-healthy weight control behavior. AtEAT-II, of the female participantswho strongly agreed with weighingthemselves often, 81.3% reportedengaging in at least 1 less extreme un-

healthy weight control behavior and39.7% reported engaging in at least 1extreme unhealthy weight controlbehavior. At EAT-III, these valueswere 74.8% and 39.1%, respectively.

In male participants, fewer signifi-cant relationships were found be-tween self-weighing and selectedvariables (Tables 2 and 3). Self-weighing and weight status variables(weight and BMI) were not signifi-cantly associated any time point. Theresearchers found no relationship be-tween self-weighing and weightdisparity or body satisfaction. Self-weighing and weight concern showeda positive and significant relationshipat all time points (EAT-I, r ¼ .24; EAT-II, r ¼ .27; and EAT-III, r ¼ .28; P <.001). Self-weighing was not associ-ated with depression or self-esteem atany time point. For behavioral vari-ables, Table 3 lists the percentage ofmale participants engaging in lessextreme and extreme unhealthyweight control behaviors. At EAT-I,of the male participants who stronglyagreed with weighing themselvesoften, 44.5% reported engaging in atleast 1 less extreme unhealthy weightcontrol behavior (eg, fasted) and 7.9%reported engaging in at least 1extreme unhealthy weight controlbehavior (eg, vomited). At EAT-II, ofthe male participants who stronglyagreed with weighing themselvesoften, 47.5% reported engaging in atleast 1 less extreme unhealthy weightcontrol behavior and 6.4% reportedengaging in at least 1 extreme un-healthy weight control behavior. AtEAT-III, these values were 42.8% and6.9%, respectively.

Objective 3: ContemporaneousChange in Self-Weighing andOutcome Variables Over 10Years

To further investigate the relationshipbetween change in self-weighing andchange in outcome variables, beta co-efficients and odds ratios fromrandom coefficient models are pre-sented (Table 4). In female partici-pants, no significant relationshipswere found between change in self-weighing and change in weight statusvariables. The researchers discoveredsignificant relationships betweenchange in self-weighing and change

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Female Participants: response to "I weigh myself often" in 1999, 2005, and 2010

Strongly Disagree Disagree Agree Strongly Agree

EAT I (14.9 ± 1.6 years; n = 1,083) EAT II (19.4 ± 1.7; n = 1,079) EAT III (25.3 ± 1.7 years; n = 1,083)

Figure 1. Percentage of female participants strongly disagreeing, disagreeing,agreeing, and strongly agreeing with the statement I weigh myself often in 1999,2005, and 2010. Note: Only those with completed data are included. Data areweighted for nonresponse. EAT-I, EAT-II, and EAT-III indicate three waves of Eatingand Activity in Teens and Young Adults.


in psychological variables. A 1-unit in-crease in the response to I weigh myselfoften was significantly (P # .001) asso-ciated with an almost 1-unit (–0.97)decrease in body satisfaction, an in-crease in weight concern (0.55) anddepression (0.41), and a decrease inself-esteem (–0.34). These findingsindicate that on average, a femalewho changed her response to I weighmyself often from agree at EAT-I tostrongly agree at EAT-II would have re-ported a corresponding 0.97-pointdecrease in body satisfaction, 0.34-point decrease in self-esteem, 0.55-point increase in weight concern,and a 0.41-point increase in depres-sion over the 5-year interval. Corre-sponding effect sizes ranged from0.09 to 0.21 in magnitude, indicatingsmall effects.24 If endorsement of self-weighing changed by 1 unit, the cor-responding change in probability ofengaging in less extreme or extremeunhealthy weight control behaviorswas not significant.

In male participants, no significantrelationships were found betweenchange in self-weighing and changein weight status variables or psycho-

logical variables, except for weightconcern. A 1-unit increase in responseto I weigh myself often corresponded toa significant (P # .001) change ofabout a half-unit (0.53) increase inweight concern. This indicates that amale increasing endorsement of self-weighing between EAT-I and EAT-II,for example, would have a 0.53 in-crease in weight concern over this5-year period. The effect size for thisassociation, 0.24, was small.24 As in fe-males, a change in the frequency ofself-weighing was not significantlyassociated with a change in the prob-ability of engaging in unhealthyweight control behaviors.

DISCUSSION

This study examined the percentage ofadolescents endorsing self-weighingand relationships between self-weighing and weight status, psycho-logical, and behavioral variables in alongitudinal cohort during the transi-tion from adolescence to youngadulthood. In female participants, sig-nificant positive correlations were

found at each time point betweenself-weighing and weight concern andself-esteem. In male participants, sig-nificant positive correlations werefound at each time point betweenself-weighing and weight concern.Contemporaneous change analyses re-vealed that increases in self-weighingwere significantly related to decreasesin body satisfaction and self-esteem infemale participants (thus showing anegative correlation), increases inweight concern and depression in fe-male participants, and increases inweight concern in male participants.

The first aim of this article was todescribe the prevalence of self-weighing during the transition fromadolescence to young adulthood. Theresearchers did not observe a markedtrend over time in the percentage of ad-olescents or young adults expressingagreement with the statement I weighmyself often. That said, the percentageof both female participants and maleparticipants selecting strongly disagreeincreased between times 2 and 3,whereas the percentage selectingdisagree decreased. Participants wereaged about 15–25 years throughoutthis 10-year period.

The second aim was to examinecross-sectional associations betweenself-weighing and various measures. Infemale participants, cross-sectionalrelationships were found betweenendorsing more frequent self-weighingand higher discrepancy betweendesired and ideal weight (significant atEAT-II), lower body satisfaction (signifi-cant at EAT-I and EAT-III), greaterweight concern (significant at all timepoints), greater depressive symptom-atology (significant at EAT-I), and lowerself-esteem (significant at all timepoints). Other researchers11,13 havealso found these constructs to berelated to self-weighing. The onlyconsistent relationship across genderwas between self-weighing and weightconcern. Similarly, Klos andcolleagues9

found a cross-sectional relationship be-tween self-weighing and the weightconcern subscale of the Eating DisorderExamination questionnaire in both fe-male participants and male partici-pants; however, this relationship wasno longer significant when controllingfor BMI.

This article’s third aim was toinvestigate contemporaneous chan-ges in self-weighing and changes in

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EAT I (15.0 ± 1.6 years; n=819) EAT II (19.5 ± 1.7 years; n=813) EAT III (25.3 ± 1.6 years; n=819)

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Male Participants: responses to "I weigh myself often" in 1999, 2005, and 2010

Strongly Disagree Disagree Agree Strongly Agree

Figure 2. Percentage of male participants strongly disagreeing, disagreeing,agreeing, and strongly agreeing with the statement I weigh myself often in 1999,2005, and 2010. Note: Only those with complete data are included. Data are weightedfor nonresponse. EAT-I, EAT-II, and EAT-III indicate three waves of Eating and Activityin Teens and Young Adults.


Table 2. Cross-Sectional Pearson Correlations Between Response to I Weigh Myself Often (Strongly Disagree [SD],Disagree [D],Agree [A], or Strongly Agree [SA]) and Continuous Variables

Variables EAT-I EAT-II EAT-III

Females

Weight status variables

Weight �0.01 0.07 0.10

I weigh myself often SD D A SA SD D A SA SD D A SA

Mean 129.0 125.7 128.9 125.5 137.4 139.0 146.1 139.3 149.9 148.7 160.9 156.8

BMI, kg/m2 �0.02 0.07 0.09

SD D A SA SD D A SA SD D A SA

22.5 22.2 22.5 21.9 23.4 23.7 24.9 23.7 25.6 25.7 27.3 26.6

Psychological variables

Weight disparity (%) �0.01 �0.14* �0.09

SD D A SA SD D A SA SD D A SA91.6 92.7 91.2 92.0 93.5 92.3 88.5 90.1 89.2 88.7 86.7 86.6

Body satisfaction �0.17* �0.24 �0.17*


33.9 32.1 30.9 27.9 34.3 32.3 28.4 28.0 31.8 28.1 28.5 26.8

Weight concern 0.30* 0.34* 0.34*


6.6 7.5 8.3 9.3 6.5 7.5 8.6 9.1 6.9 8.1 8.3 9.7

Depression 0.14* 0.10 0.11SD D A SA SD D A SA SD D A SA

17.7 18.2 19.2 19.6 19.2 19.2 19.9 21.1 18.8 19.3 19.0 21.5

Self-esteem �0.18* �0.19* �0.15*


17.9 17.6 16.9 15.4 18.5 18.2 17.0 16.6 18.6 17.6 17.8 16.9

Males

Weight status variables

Weight 0.07 0.06 0.13

I weigh myself often SD D A SA SD D A SA SD D A SA

Mean 140.9 148.7 144.0 157.9 167.9 173.1 177.8 163.6 178.5 198.3 189.4 192.2

BMI, kg/m2 �0.02 0.08 0.12


21.8 22.7 22.6 23.8 23.9 24.7 25.4 23.7 25.5 28.7 26.8 26.9

Psychological variables

Weight disparity (%) 0.02 0.00 �0.06


99.5 98.7 103.6 93.9 99.7 98.1 98.6 102.6 97.2 90.8 96.0 95.7

Body satisfaction �0.07 �0.11 �0.11


38.0 36.6 36.3 36.4 37.3 35.1 35.6 31.5 36.4 32.3 33.8 35.5

Weight concern 0.24* 0.27* 0.28*


5.0 5.9 6.0 7.8 4.8 6.3 6.5 6.9 5.3 6.8 6.7 7.2

Depression 0.05 0.08 -0.02


15.9 16.0 16.2 17.5 17.1 17.4 17.1 21.0 17.3 17.6 17.0 17.1

Self-esteem �0.11 �0.06 �0.02


19.6 18.8 18.4 18.6 19.5 18.5 19.3 17.8 19.1 18.1 18.8 19.5

BMI indicates body mass index; EAT-I, EAT-II, and EAT-III, three waves of Eating and Activity in Teens and Young Adults.*Correlation significant at P < .001.Note: Models are weighted for nonresponse but not otherwise adjusted for covariates. Numbers differ based on variables.Means appear below the correlation at each time point. Weight disparity % ¼ self-assessed ideal weight divided by actualweight, multiplied by 100. Body satisfaction: Body Shape Satisfaction Scale minus scores ranging from 5 (dissatisfied) to 50(satisfied). Weight concern: assessed with items I think a lot about being thinner and I am worried about gaining weight: scoresrange from 3 (lowweight concern) to 12 (high weight concern). Depression: Six items fromKandel and Davies DepressiveMoodscale22; scores range from 10 (low depressive symptoms) to 50 (high depressive symptoms). Self-esteem: Six items from theRosenberg Self-esteem scale23; scores range from 6 (low) to 24 (high).


weight status, psychological, andbehavioral outcomes over 10 years.An increase in endorsement offrequent self-weighing was associatedwith a decrease in self-esteem andbody satisfaction, an increase inweight concern and depression in fe-male participants, and an increase inweight concern in male participants.Corroborating these findings, studiesusing different nonclinical samplesof adolescents and young adultshave found a relationship betweenself-weighing and lower self-esteem,6

body satisfaction/weight concern,9

and higher depression6 and disor-dered eating score.25 However, othershave not found evidence for theserelationships.26,27 In the previouslymentioned longitudinal studyassessing self-weighing at EAT-I andchange in outcomes between EAT-Iand EAT-II,16 greater self-weighing atEAT-I significantly predicted larger in-creases in BMI 5 years later in theyounger cohort of female adolescentsand predicted more binge eating andunhealthy weight control behaviorsin both the younger and older cohortof female adolescents 5 years later.The most likely reason for an associa-tion between self-weighing and BMInot being replicated here is that inthe 2006 study, greater self-weighingfrequency predicted greater changes

in BMI in the younger cohort of fe-males who were in middle school atEAT-I (results for the older cohortwere not statistically significant), andfor the current analyses, cohortswere combined because there was noreason to believe self-weighing fre-quency changed differently bycohort. It is possible that engaging atself-weighing at a younger age (duringmiddle school) contributes to largerBMI gains compared with self-weighing in the teenage years (duringhigh school). In addition, the 2006study controlled for covariates andthe current article did not, to allowfor the true prevalence of the out-comes assessed. Concerning un-healthy weight control behaviors,the current study found increasingodds of unhealthy weight control be-haviors with greater endorsement ofself-weighing; however, owing to thestringent significance level (P # 01)set to control for multiple compari-sons, the result was not significant.The findings presented here are inalignment with previous Project EATstudies, although statistical signifi-cance being met may vary as a resultof sample size, strength of relation-ship, or a priori P.

The current study builds on previ-ous analyses from Project EAT inwhich associations were examined be-

tween self-weighing and various mea-sures.11-13 Specifically, the currentstudy uses measures of self-weighingcollected at 3 separate time points at5-year intervals. In addition todescribing cross-sectional relation-ships between self-weighing and out-comes at each of 3 Project EAT timepoints, assessing self-weighing at mul-tiple time points allowed for an exam-ination of contemporaneous changesin self-weighing and measures ofwell-being. Examining change inself-weighing and change in out-comes provides stronger evidence ofpossible causalities than cross-sectional relationships.

Strengths of this study include alarge sample size, which allowed foradequate power to detect relation-ships, and weighting to adjust fornonresponse in a sample followed fora decade, which enhanced the general-izability of the final sample. The pri-mary limitation of this studyconcerns the operationalization of theindependent variable. Asking partici-pants about the degree to which theyagree with the statement I weigh myselfoften on a 4-point Likert response scalemay not equate to a measure askingparticipants to rate self-weighing interms of frequency per unit of time,as used in other studies (eg, Quicket al11). However, as mentioned, a

Table 3. Percentage of Female and Male Participants Choosing Response Category for I Weigh Myself Often (Strongly Disagree[SD], Disagree [D], Agree [A], or Strongly Agree [SA]) Who Reported Engaging in Less Extreme and Extreme UWCBs

EAT-I EAT-II EAT-III

Behavioral variables

FemalesLess extreme UWCBI weigh myself often SD D A SA SD D A SA SD D A SAPrevalence 43.3 54.1 66.3 80.9 43.6 60.7 71.1 81.3 54.9 62.0 66.9 74.8

Extreme UWCBSD D A SA SD D A SA SD D A SA11.5 6.9 13.4 20.8 12.1 17.2 26.5 39.7 14.7 15.3 25.7 39.1

MalesLess extreme UWCBI weigh myself often SD D A SA SD D A SA SD D A SAPrevalence 27.7 30.3 34.2 44.5 17.7 35.9 43.7 47.5 24.3 40.2 38.0 42.8

Extreme UWCBSD D A SA SD D A SA SD D A SA3.7 1.3 2.7 7.9 5.9 8.0 6.6 6.4 1.7 10.1 8.0 6.9

EAT-I, EAT-II, and EAT-III indicate three waves of Eating and Activity in Teens and Young Adults; UWCB, unhealthy weight con-trol behaviors.Note: Models are weighted for nonresponse but not otherwise adjusted for covariates. Numbers differ based on variables.


small study comparing the assessmentof self-weighing used in the currentarticle with a more objective assess-ment yielded a moderate correlation.It is possible that over this 10-yearperiod, cultural shifts in body imageand the media had an impact on theoutcome variables assessed in thiscohort. A meta-analysis found the me-dia’s conception of thinness to beinversely related to self-esteem andpositively associated with worseningdepression, with small but significanteffect sizes.28 However, researchershave found little difference betweenCaucasian and Chinese students andno difference in BMI of African orCaucasian models, which brings intoquestion the role of the media in bodyimage and associated constructs.29,30

Despite these limitations, the strongexternal validity of this study makes itan important contribution to theliterature and directs attention to keypsychological factors: self-esteem,depression, and body satisfaction.Future studies could address limita-

tions of internal validity by usingmore detailed measures of weighingfrequency.

This study builds on the extant liter-ature examining links between self-weighing and adverse outcomes. In 1study, female participants self-reportedthat the number on the scale affectedtheirmood.31Mercurio andRima32 sug-gested that Objectification Theorymight help to link self-weighing andbody dissatisfaction conceptually andposited that this relationship wasmedi-ated by body surveillance. They foundempirical support for this idea. Objecti-fication Theory asserts that a focus onone’s physical attributes and the impor-tance of this self-evaluation imposedby society breeds self-consciousness,and unduly focusing on appearanceand imagining others’ evaluation ofphysical looks makes self-monitoringthis appearance important.33 Futureresearch examining interrelationshipsbetween self-weighing and weightstatus, psychological, and behavioraloutcomesover timearewarranted, espe-

cially those using a more objectiveassessment of self-weighing frequency.Because of the suggestion of changesin self-weighing frequency and adversechanges in body dissatisfaction, weightconcern, depressive symptoms, andself-esteem, caution is advised in recom-mending this behavior to adolescentsand young adults. At the same time,self-weighing is a frequently usedbehavior among young adults,31 it hasbeen found to be associated with im-provements in binge eating and depres-sion as part of weight loss treatment,27

and it can serve as inexpensiveobjectivefeedback about weight control in a pop-ulation with high rates of overweight/obesity,34 which can also be associatedwith adverse psychological outcomes.35

Future experimental research inhealthyyoung adult participants should be de-signed carefully to exclude participantsfor whom self-weighing might not beadvisable (eg, female individuals withlow body satisfaction, self-esteem, orhigh depressive symptoms) and tomonitor and address weight status,

Table 4. Longitudinal Contemporaneous Change Beta Coefficients or Odds Ratios Corresponding to a 1-Unit Change inResponse to I Weigh Myself Often (Strongly Disagree to Strongly Agree) Over 10 Years

Continuous outcomes

Females (n ¼ 1,058) Males (n ¼ 810)

b SD ES P b SD ES P

Weight status variablesWeight �.15 28.47 �0.01 .70 �.08 35.99 0.00 .88Body mass index �.08 4.64 �0.02 .28 �.07 4.46 �0.02 .32

Cognitive variablesWeight disparity (%) .39 12.36 0.03 .19 .18 15.47 0.01 .38Body satisfaction L.97 9.16 L0.11 < .001 �.29 8.52 �0.03 .20Weight concern .55 2.60 0.21 < .001 .53 2.21 0.24 < .001

Psychological variablesDepression .41 4.41 0.09 < .001 .08 4.39 0.02 .52Self-esteem –.34 3.43 –0.10 < .001 �.12 3.38 �0.04 .16

Dichotomous outcomes Females (n ¼ 1,058) Males (n ¼ 810)OR % Mean % Change P OR % Mean % Change P

Behavioral variablesLess extreme UWCB 1.15 60.2 �3.3 .05 1.22 32.2 �4.5 .03Extreme UWCB 1.21 17.1 �2.8 .01 1.16 5.2 �0.8 .31

ES indicates effect size (change as a fraction of SD); OR, odds ratio of probability of behavior for 1-step change within anindividual in reporting agreement (strongly disagree, disagree, agree, or strongly agree) with the statement I weigh myself often;UWCB, unhealthy weight control behavior.Statistically significant beta coefficients (P # .001) are shown in bold type. Weight disparity % ¼ self-assessed ideal weightdivided by actual weight, multiplied by 100. Body satisfaction: Body Shape Satisfaction scale minus scores range from 5(dissatisfied) to 50 (satisfied). Weight concern: assessedwith items I think a lot about being thinner and I amworried about gain-ingweight: scores range from3 (lowweight concern) to 12 (highweight concern). Depression: Six items fromKandel andDaviesDepressive Mood scale; scores range from 10 (low depressive symptoms) to 50 (high depressive symptoms). Self-esteem: Sixitems from the Rosenberg Self-esteem scale; scores range from 6 (low) to 24 (high).Note: For less extreme and extreme UWCB, table entries are from the logistic model. Models are weighted for nonresponse.


psychological, and behavioral out-comes. This would allow for evidenceof potential causality, direction of thatcausality, and further informationabout those for whom specifically self-weighingbehavior is or isnotbeneficial.

IMPLICATION FORRESEARCH ANDPRACTICE

Because self-weighing is a behaviorthat carries relatively little social stig-matization, adolescents or youngadults may feel more comfortable re-porting to their primary care providerinformation about how often theyweigh themselves, compared withdiscussing how depressed they feel orresponding to questions about self-esteem. Because results from the cur-rent study suggest that self-weighingand changes in self-weighing fre-quency are associated with adversepsychological changes, especially infemale participants, it may be advis-able for clinicians to ask aboutself-weighing at office visits, notingchange over time, as a proxy for inves-tigating other, more concerningchanges in well-being.

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