Weight stigma is prevalent among young people and harmful to health. The current study used a health equity lens to examine cross-sectional and longitudinal associations between experiencing weight teasing (a form of weight stigma) with a range of weight-related health behaviors and weight status in an ethnically/racially and socioeconomically diverse sample of young people. We also assessed whether ethnicity/race and adolescent socioeconomic status (SES) operated as effect modifiers in these relationships. Adolescents (n = 1568) were enrolled in EAT 2010–2018 (Eating and Activity over Time) and followed into young adulthood. Weight teasing; screen time; moderate-to-vigorous physical activity (MVPA); sleep duration; breakfast frequency; fruit, vegetable, sugar-sweetened beverage (SSB), and fast-food intake; and body mass index (BMI) were assessed at baseline (mean age = 14.4 years) and eight-year follow-up (mean age = 22.2 years). Multivariate linear regression estimated marginal means and 95% confidence intervals. All analyses adjusted for BMI and sociodemographic characteristics. Weight teasing was cross-sectionally associated with longer screen time, shorter sleep duration, and higher BMI during adolescence; and cross-sectionally associated with shorter sleep duration, lower breakfast frequency, higher fast-food intake, higher SSB intake, and higher BMI during young adulthood. In the longitudinal analyses, weight teasing was not associated with health behaviors but did predict higher BMI (teased: 28.2 kg/m2, not teased: 26.4 kg/m2, p < 0.001). White and higher adolescent SES subgroups had higher MVPA, more frequent breakfast intake, lower fast-food intake, and lower BMI than their respective counterparts. The relationships between weight teasing and health behaviors and weight status were largely consistent across ethnic/racial and adolescent SES subgroups. Findings add to growing evidence that weight-based mistreatment poses a threat to weight-related health and that young people across ethnic/racial and SES subgroups are vulnerable to the negative effects of weight teasing. Limitations include attrition at follow-up and the self-reported nature of many measures. Results suggest a need for increased attention to existing recommendations to reduce weight stigma in young people from diverse ethnic/racial and socioeconomic backgrounds including training for healthcare providers to better equip them to address the harms of weight teasing and foster more compassionate care to promote health-supporting behaviors in young people.

Objective: Disordered eating behaviors (DEBs) have long-term, deleterious effects on health and are more prevalent among socially marginalized groups, likely as a result of systemic inequities across social determinants of health (SDoH). This exploratory study aimed to identify subgroups of emerging adults characterized by main and interactive associations between SDoH and two forms of DEB (binge eating, extreme unhealthy weight control behaviors). Method: Participants (n = 1568; age 22.2 ± 2.1 years) from the United States were drawn from the EAT 2010-2018 longitudinal study. Conditional inference tree (CIT) analyses derived main and intersecting SDoH related to DEB across 33 input variables collected during adolescence and emerging adulthood. Results: The binge eating CIT revealed five subgroups (prevalence: 6.3-23.2%) shaped by variables collected during emerging adulthood: appearance-based teasing (p < .001), financial difficulty (p = .003), gender (p < .001), and everyday discrimination (p = .008). The CIT results for extreme unhealthy weight control behaviors derived six subgroups (prevalence: 2.3-45.5%) shaped by weight teasing (p < .001) and gender (p < .001) during emerging adulthood and public assistance (p = .008) and neighborhood safety (p = .007) in adolescence. Discussion: This exploratory study revealed distinct subgroups of emerging adults with varying DEB prevalence, suggesting that variability in DEB prevalence may be partially explained by intersecting SDoH during adolescence and emerging adulthood. Hypothesis-driven research and replication studies are needed to further explore the associations between SDoH and DEB during emerging adulthood. Public Significance Statement: Disordered eating behaviors are common among young people in the United States and have long-term health consequences. This exploratory study identified subgroups of young people, characterized by combinations of social inequities (e.g., financial difficulties, teasing). Results highlight high-risk

Emerging evidence suggests a cross-sectional association between food insecurity (FI) and disordered eating among adults, while evidence among adolescents is limited. Longitudinal research is needed to elucidate the temporality of this relationship and clarify whether the association differs by age. Three waves of prospective data came from 1813 participants in the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. Data were collected at five-year intervals, with the baseline survey in 1998–1999 (EAT-I; Mage = 14.9 years) and follow-up surveys in 2003–2004 (EAT-II; Mage = 19.5 years) and 2008–2009 (EAT-III; Mage = 24.9 years). Severe FI was assessed as any past-year hunger with one item from the U.S. Household Food Security Survey Module, and a range of disordered eating behaviors were self-reported. Associations adjusted for sociodemographic characteristics were examined with generalized estimating equations. Effect modification by age was also tested. Cross-sectionally, severe FI was significantly associated with greater prevalence of all disordered eating behaviors examined, with the strongest associations observed for extreme weight-control behaviors (prevalence ratio [PR] = 1.49, 95% confidence interval [CI]: 1.13–1.95) and binge eating (PR = 1.49, 95% CI: 1.04–2.12). Longitudinally, severe FI significantly predicted 1.41 (95% CI: 1.05–1.90) times greater prevalence of binge eating five years later after accounting for prior binge eating. Effect modification by age indicated a stronger cross-sectional association between severe FI and unhealthy weight-control behaviors among younger participants. Results support a cross-sectional link between severe FI and disordered eating and provide longitudinal evidence suggesting severe FI is a risk factor for binge eating.

Objective: Digital technology use and muscle-building behaviors reflect a wide range of behaviors with associated health risks. However, links between digital technology use and muscle-building behaviors remain unknown and this study aimed to address this gap. Method: Data were collected from a diverse sample of 1,483 young adults (mean age 22.2 ± 2.0 years) participating in the population-based Eating and Activity over Time 2018 study. Gender-stratified-modified Poisson regression models were used to determine cross-sectional associations between three types of digital technology use (screen time, social media, weight-related self-monitoring apps) and five types of muscle-building behaviors (changing eating, exercise, protein powders/shakes, pre-workout drinks, steroids/growth hormone/creatine/amino acids) in young adulthood, adjusted for sociodemographic characteristics and body mass index. Results: Screen time and social media were either not found to be associated with muscle-building behaviors or in a few instances, associated with less use of these behaviors (e.g., screen time and pre-workout drinks in men). In contrast, the use of weight-related self-monitoring apps was positively associated with all muscle-building behaviors, including steroids/growth hormone/creatine/amino acids in men (prevalence ratio [PR] = 1.83; 95% confidence interval [CI]: 1.13–2.97) and women (PR = 4.43; 95% CI: 1.68–11.68). Discussion: While most recreational screen time may represent sedentary behaviors not related to muscle-building behaviors, weight-related self-monitoring apps are highly associated with more muscle-building behaviors and could be a future target for interventions to discourage the use of steroids and other harmful muscle-building substances.

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18–30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3–3.7] and PR = 3.1, [95% CI = 2.0–4.7], respectively) and lower intuitive (β = −0.4, [95% CI = −0.7, −0.2] and β = −0.5 [95% CI = −0.8, −0.3], respectively), and mindful eating scores (β = −0.3, [95% CI = −0.6, −0.1] and β = −0.5 [95% CI = −0.8, −0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

Purpose: Growing evidence indicates that experiencing household food insecurity during adolescence is associated with disordered eating and elevated body mass index (BMI). However, little is known about the temporal nature of these relationships. The current longitudinal study examined how adolescent experiences of household food insecurity are related to disordered eating and weight status 8 years later. Methods: A population-based sample of ethnically/racially and socioeconomically diverse participants (n = 1,340) were surveyed as adolescents (mean age = 14.5 years) and as young adults (mean age = 22.0 years). Parents/caregivers completed the six-item U.S. Household Food Security Survey Module at baseline. Results: Household food insecurity was common at baseline (37.8% of sample). In analyses adjusted for ethnicity/race and parental education, adolescent food insecurity longitudinally predicted a higher new onset of binge eating (food insecure: 21.3% vs. food secure: 16.2%, p = .038) and BMI ≥30 kg/m2 (food insecure: 15.9% vs. food secure: 11.0%, p = .024), but not unhealthy weight control behaviors in young adulthood. The majority of adolescents with unhealthy weight control behaviors and elevated BMI still had these problems in young adulthood, but persistence was not associated with adolescent household food insecurity for any outcome. Discussion: Results of this longitudinal study suggest that household food insecurity during adolescence is a risk factor for disordered eating and elevated BMI in young adulthood, highlighting a need to comprehensively address these intersecting problems.

Use of weight-related self-monitoring (WRSM) apps is common among emerging adults, as are weight and shape concerns. The present study aimed to examine (1) whether emerging adult use of dietary-focused (e.g., MyFitnessPal) and physical activity-focused (e.g., Fitbit) WRSM apps was associated with weight-control and muscle-building behaviors, including commonly recommended/conventional behaviors and disordered behaviors and (2) whether prior use of weight-control and muscle-building behaviors in adolescence might explain such relationships. Data were collected as part of the EAT (Eating and Activity over Time) 2010–2018 study (n = 1446) and analyzed using gender-stratified logistic regression models adjusted for demographic characteristics and body mass index. Among women and men, physical activity- and dietary-focused app use were associated with greater adjusted prevalence of disordered weight-control behaviors (e.g., fasting, purging), and disordered muscle-building behaviors (e.g., using steroids). Physical activity- and dietary-focused app use were also associated with a higher adjusted prevalence of commonly recommended weight-control and conventional muscle-building behaviors (e.g., exercising, changing eating habits), but only among those who were also engaging in disordered behaviors. The observed associations remained statistically significant in models that further adjusted for adolescent use of the respective behaviors. Findings suggest that emerging adults who use physical activity- and dietary-focused WRSM apps are more likely to engage in disordered weight-control and muscle-building behaviors and that associations are not explained by engagement in these behaviors during adolescence. Future research is needed to examine if there are aspects of WRSM apps that could be modified to reduce potential harm.

Purpose: This study was designed to examine (1) the types of technologies or other applications (apps) emerging adults use to track their eating, physical activity, or weight; (2) who uses these apps and (3) whether eating and weight-related concerns during adolescence predict app use in emerging adulthood. Methods: Longitudinal survey data were obtained from EAT 2010–2018 (Eating and Activity over Time study, N = 1428), a population-based sample of ethnically/racially and socioeconomically diverse adolescents (mean age: 14.5 ± 2.0 years), who were followed into emerging adulthood (mean age: 22.0 ± 2.0 years). Data were used to examine sociodemographic correlates of physical activity- and dietary-focused app use. Adjusted, gender-stratified logistic regressions were used to investigate longitudinal relationships between eating and weight-related concerns in adolescence and app use in emerging adulthood. Results: Compared to men, women were more likely to use physical activity- (23.2 versus 12.5%, p < 0.001) and dietary-focused apps (16.1 versus 5.5%, p < 0.001). Among women, eating and weight-related concerns in adolescence, particularly unhealthy muscle-building behaviors (OR = 1.73, 95% CI 1.03–2.92), were associated with later dietary-focused app use. Among men, use of other muscle-building behaviors and body dissatisfaction in adolescence predicted use of physical activity- (ORother muscle-building = 1.60, 95% CI 1.03–2.49 and ORbody dissatisfaction = 1.67, 95% CI 1.06–2.65) and dietary-focused (ORother muscle-building = 2.18, 95% CI 1.07–4.47 and ORbody dissatisfaction = 2.35, 95% CI 1.12–4.92) apps 8 years later. Conclusions: Eating and weight-related concerns may predict later use of physical activity- and dietary-focused apps; future research is needed to understand whether use of such apps further increases eating and weight-related concerns. Level of evidence: III, well-designed longitudinal cohort study.

Background: Parents have a role in shaping the eating behaviors of young children and the intergenerational transmission of eating attitudes. However, little is known regarding how parental intuitive eating practices are related to characteristics of home food and meal environments. Objective: To investigate the relationship between parental intuitive eating and the home food and meal environment. Design: Cross-sectional analysis of survey data collected online and by mail in 2015–2016 as part of the Project EAT cohort study. Participants and Setting: Participants from 750 unique households (470 mothers, 280 fathers) were surveyed in young adulthood (Mean [M] age = 31.4 years, Standard Deviation [SD] = 1.5). Baseline enrollment of participants in the population-based Project EAT study was conducted in Minneapolis-St. Paul, Minnesota, schools. Main Outcome Measures: Intuitive eating was assessed via self-report. Statistical Analyses: Modified Poisson regression models were conducted, adjusting for age, race/ethnicity, and socioeconomic status. Results: Among mothers, higher intuitive eating scores were associated with greater likelihood of usually having fruits and vegetables in the home (prevalence ratio [PR] = 1.03) and with lower likelihood of usually having salty snacks and soda pop in the home (PR = 0.91). Higher intuitive eating scores were also associated with greater likelihood of usually serving fruits and vegetables at dinner among mothers (PR = 1.07). Among both mothers (PR = 1.08) and fathers (PR = 1.07), higher intuitive eating scores were associated with greater likelihood of usually having enough time and energy to prepare meals. Conclusions: Intuitive eating practices in parents are associated with specific home food environment characteristics. Extending the understanding of these relationships in longitudinal data has the potential to inform the directionality of influences and may help to identify targets for intervention.

Despite the increased availability of vaccines, masking and social distancing remain important strategies to mitigate COVID-19 transmission. This qualitative study aimed to understand experiences n...

This study examined kitchen adequacy in a racially/ethnically diverse low-income sample and associations with child diet quality. Families with children age five to seven years old (n = 150) from n...

This study characterized common patterns of weight talk and examined associations with unhealthy weight control behaviors (UWCBs) in young adults. Participants (n = 1298) were from EAT 2018 (Eating and Activity Over Time), a population-based study of emerging adults (mean age = 22.2; 53.6 % women). Latent class analyses (LCA) derived classes based on weight talk exposure for men and women. Generalized linear models examined the association between weight talk classes and extreme/less extreme UWCBs. LCA results revealed 4 patterns of weight talk exposure among young adult women: minimal weight talk (38.8 %), peer weight talk (35.2 %), multi-source weight talk (13.5 %), and parental weight talk (12.6 %). Three classes emerged among men: minimal weight talk (44.0 %), peer weight talk (29.7 %), and multi-source weight talk (26.3 %). Among young adult women, the parental weight talk class reported the highest levels of extreme and less extreme UWCBs. Among young adult men, the multi-source weight talk class reported the highest levels of less extreme UWCBs. Results provide evidence regarding the importance of parental weight talk, even among young adult children, whether or not parental weight talk is accompanied by peer weight talk. Parents have the potential to improve their young adults’ weight-related behaviors through avoiding weight talk.

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n=20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

Objective: Assess how intuitive eating relates to dietary intake. Methods: Survey data were collected in Project Eating and Activity in Teens and Young Adults, the fourth wave of a longitudinal cohort study (weighted n = 1,830, 49% women; mean age = 31 years). Intuitive eating was assessed using a 7-item scale adapted from the Intuitive Eating Scale and Intuitive Eating Scale-2. Dietary intake was measured via a semiquantitative food frequency questionnaire. Mean servings were stratified by gender and intuitive eating quartiles and adjusted for sociodemographic characteristics and caloric intake. Results: Women and men in the top intuitive eating quartile consumed 0.6–0.3 servings more fruit and 0.4–0.6 servings more vegetables daily, respectively, compared with the bottom quartile, whereas men in the top quartile also consumed 0.6 servings fewer whole grains (all P < 0.05) than the bottom quartile. Conclusions and Implications: Intuitive eating shows promise as a healthier alternative to practices such as dieting.

Background: This study examined who is engaging in family/shared meals and associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being among young adults during the COVID-19 pandemic. Methods: A rapid-response online survey was sent to participants in a ten-year longitudinal study (Eating and Activity over Time: EAT 2010–2018). A total of 585 young adults (mean age = 24.7 ± 2.0 years, 63.3% female) living with at least one family member completed the COVID-EAT (C-EAT) survey during the U.S. outbreak of COVID-19. Items assessed changes in family/shared meal frequency, eating behaviors, and emotional well-being. Regression models adjusting for sociodemographic characteristics examined associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being. Results: Participants reported an average of 4.6 ± 3.4 family/shared meals per week during COVID-19, a 0.5 meal/week increase from prior to the pandemic (p =.002). Family/shared meal frequency during COVID-19 differed by race/ethnicity, with Asian American participants being most likely to report only 1–2 family/shared meals per week. Family/shared meals during COVID-19 were associated with higher vegetable intake, greater availability of fruits, vegetables, and whole wheat bread in the home, lower levels of depressive symptoms and perceived stress, and greater perceived ability to manage stress in young adults. Conclusions: Results suggest that engaging in a regular routine, such as family/shared meals, during COVID-19 may have protective associations with dietary health and emotional well-being for young adults. Results may inform practices/routines to offer protective benefits during public health crises such as the current pandemic.

Objective: Sociocultural theories hold that family and peer weight-related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross-sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and family teasing (occurrence and perceived impact) in early adolescence, body satisfaction in late adolescence, and UWCBs in young adulthood among a racially/ethnically and socioeconomically diverse population. Method: Data were drawn from three waves of Project EAT over a 15-year period (Eating and Activity in Teens and Young Adults), and included responses from 1,902 young adults (57% female). Results: Among female participants, a mediated indirect pathway emerged with family weight-related teasing predicting increased engagement in UWCBs in early adulthood via poorer body image in late adolescence. In contrast, peer teasing did not predict body image or UWCBs. Among boys, the mediated indirect pathways were not significant. However, poor body image in late adolescent males predicted higher likelihood of engaging in UCWBs in early adulthood. Discussion: These findings support the long-term impact of family weight-related teasing on greater risk for UWCBs among girls and young women, and poor body image as a mechanism accounting for this relationship. Moreover, the results highlight the poor body image among adolescent boys as a factor for increased risk of engaging in UWCBs in early adulthood. Pending replication in current cohorts, health promotion and prevention involving family members of early adolescents that address family weight teasing and body image are needed.