The influence of selected micro-environmental factors on pro

98
Probl Hig Epidemiol 2009, 90(1): 98-101
The influence of selected micro-environmental factors on
pro-anorectic behaviours in teenagers – preliminary studies
Wpływ wybranych czynników mikrośrodowiskowych na zachowania pro-anorektyczne
u nastolatków – badania wstępne
Witold Kołłątaj 1/, Barbara Kołłątaj 2/, Irena D. Karwat 2/, Halina Piecewicz-Szczęsna 2/
1/
2/
III Katedra Pediatrii, Klinika Endokrynologii I Neurologii Dziecięcej, Uniwersytet Medyczny w Lublinie
Katedra i Zakład Epidemiologii, Uniwersytet Medyczny w Lublinie
Wprowadzenie. Z danych szacunkowych wynika, że w Polsce zaburzenia
odżywiania pod postacią pro-anorektycznych zachowań mogą dotyczyć
nawet 200 000 osób. Stanowić to może problem nie tylko diagnostyczny, ale
także profilaktyczny, bowiem zaburzenia odżywiania powodują następstwa
zarówno somatyczne, jak i społeczne.
Cel pracy. Celem pracy było określenie najważniejszych czynników,
które mogą mieć wpływ na pojawianie się zachowań pro-anorektycznych
u nastolatków.
Materiał i metody. Badaniem objęto 57 nastolatków (32 chłopców i 35
dziewcząt) – uczniów losowo wybranych lubelskich szkół. Był to pierwszy
etap badań – badania pilotażowe. Do badań zastosowano specjalnie do
tego celu opracowany kwestionariusz wywiadu.
Wyniki. W opinii respondentów, występowanie takich elementów
mikrośrodowiska, jak: preferowany przez rówieśników model urody, presja
psychiczna kolegów i koleżanek szkolnych oraz przyjaciół, nieprawidłowe
relacje nastolatek – rodzina mają wpływ na pojawianie się nieprawidłowych
nawyków dotyczących odżywiania. Częstość udzielanych odpowiedzi na ten
temat jest bardzo zbliżona u badanych obojga płci. Wpływ wymienionych
czynników dotyczy szczególnie nastolatków z istotnymi niedoborami masy
ciała i obniżonym nastrojem.
Wnioski. Wyniki badań sugerują, że nieprawidłowe relacje interpersonalne
w rodzinach badanych osób, a także zakłóconych relacji między nastolatkami
a szkołą i nastolatkami a rówieśnikami, pojawiają się częściej wśród osób
z zachowaniami pro-anorektycznymi. Problem wymaga dalszych badań
w celu bliższego poznania zjawiska pod kątem przyczynowo-skutkowym.
Introduction. According to the approximate data in Poland there are about
200 000 people with eating disorders in forms of pro-anorectic behaviours.
This creates not only diagnostic but prophylactic problems because eating
disorders have both somatic and social consequences.
Aim. The determination of factors influencing pro-anorectic behaviours
in teenagers.
Material and methods. The study group consisted of 57 teenagers
(22 boys and 35 girls) – the pupils from randomly selected schools in
Lublin. It was the first stage of research – the pilot study. The research tool
was an original questionnaire prepared for the purpose of the study with
questions directed to teenagers.
Results. Respondents suggested evident influence of micro-environmental
factors such as peer-preferred beauty ideals, psychological pressure of
schoolmates and friends and disturbed teenager-family relations on the
appearance of incorrect eating behaviours. The opinions of boys and
girls were much the same. The influence of the enumerated factors was
more evident in cases with serious body mass deficiencies and coexisting
depressive mood.
Conclusions. The results suggest that disturbed interpersonal relations
between teenagers and their parents as well as their school friends and
teachers are more frequent among teenagers with pro-anorectic behaviours.
This problem should be studied to determine the real cause-and-effect
proportions and interrelationships.
Key words: teenagers, pro-anorectic behaviours, micro-environment
Słowa kluczowe: nastolatki, zachowania pro-anorektyczne, mikrośrodowisko
© Probl Hig Epidemiol 2009, 90(1): 98-101
Adres do korespondencji / Address for correspondence
www.phie.pl
dr n. med. Witold Kołłątaj
Klinika Endokrynologii i Neurologii Dziecięcej, Uniwersytet Medyczny
Dziecięcy Szpital Kliniczny, ul. Chodźki 2, 20-093 Lublin
tel. 0-81-7185-440, fax. 0-81-743-13-72, e-mail: [email protected]
Nadesłano: 20.02.2009
Zakwalifikowano do druku: 28.03.2009
Introduction
Eating disorders are very serious medical
problems. Among them there are anorexia nervosa
and pro-anorectic behaviours. They are the most
common among people of higher socio-economic
classes and usually affect teenagers, mainly girls. In
most teenagers, these disorders begin at the age of 11
to 13 years. The distinction between the diagnoses of
anorexia nervosa and not otherwise specified eating
disorders is often difficult and there is a considerable
overlap between the patients diagnosed with these
conditions. In some cases they are the symptoms
of a lifestyle choice rather than an eating disorder,
but sometimes they are the symptoms of serious,
potentially life-threatening illnesses. Despite the
causes and motives, all of them cause great harm to
young, growing and maturing bodies. They result in
Kołłątaj W i wsp. The influence of selected micro-environmental factors on pro-anorectic behaviours in teenagers ...
somatic, mental and social problems, such as: bone
mineral content disorders, digestive tract diseases,
potential immune system disorders, orthopaedic
problems (as the effect of excessive physical exercises),
endocrine disorders etc. [1, 2].
According to the approximate data in Poland
there are about 200 000 people with eating disorders
[3] in forms of pro-anorectic behaviours. The microenvironmental factors (the immediate physical and
social surroundings of the individual) especially living
conditions, family influence, family dietary habits,
ties of friendship and problems with interpersonal
communication, conflicts with teachers and school
friends, are suggested to have an impact on proanorectic behaviours appearance [4,5,6].
The scale of their occurrence in Poland and possible
after-effects (future somatic and mental disorders) are
reasons for epidemiological investigation.
Aims
The aim of this study was to estimate the influence
of micro-environmental factors on the pro-anorectic
behaviours appearance. The attention was focused
on social conditions (the norms and values of small
groups of population). It was especially important to
learn the teenagers’ feelings and opinions. Teenagers
as a group are especially suggestible to dangerous and
strange ideas and quick to make ill-judged decisions.
Material and Methods
The study group consisted of 57 teenagers (22
boys and 35 girls) – pupils from randomly selected
schools in Lublin (28 from the XXI St. Stanislaw
99
Kostka High School and 29 from the Junior High
School ‘Biskupiak’) aged 13-17 years (mean 14.9
years, s.d.1.53). 54.4% of them were Lubliners, 28.8%
– small town dwellers, 15.8% – village dwellers. It was
the first stage of research – the pilot study.
The method was a questionnaire. A special original
63-item inquiry questionnaire with questions directed
to teenagers was applied. The questions concerned
anthropometric parameters, eating behaviours, physical
activity, mental state (signs of depressions) as well as
some known factors influencing the pro-anorectic
lifestyle appearance. The nutritional status and body
mass deficiency of the subjects were determined on the
basis of the standards published as tables and centile
charts describing the optimum physical development
of Polish children and teenagers [7, 8].
Results
The obtained data – presented in table 1- revealed
that 12% (7 teenagers – 1 boy and 6 girls (17%
of polled girls)) of the respondents reported proanorectic behaviours – active efforts to reduce body
mass despite the evident weight deficiency. These
efforts (indicated by the respondents) were described
as excessive physical exercises, reducing caloric value,
volume or number of meals.
Among the teenagers with body mass deficiency
and pro-anorectic behaviours, 5 (71%) reported
problems in relations with their parents (in the group
without eating disorders: 12 (24%)), all the teenagers
with pro-anorectic behaviours declared disturbed
relations with school friends (in the group with-out
eating disorders: 11 (22%)).
Table 1. Disturbed relations with parents, teachers and peers reported by polled teenagers
Reported problems
Number of
polled teenagers
Problems with
parents
Problems with
school friends
Girls with pro-anorectic behaviours
6
4
6
4
6
2
Girls without eating disorders
29
8
7
15
10
12
Boy with pro-anorectic behaviour
1
1
1
0
1
1
Boys without eating disorders
21
4
4
6
12
10
Total
57
17
18
25
29
25
Subgroup of polled teenagers
Perceiving school
environment as
annoying
disturbed relations
with teachers
Psychological pressure from friends to
become thin
Table 2. Dietary habits and obesity cases in families of polled teenagers
Number of polled
teenagers
Improper, high caloric
intake preferred by
parents
Girls with pro-anorectic behaviours
6
Girls without eating disorders
29
Boy with pro-anorectic behaviour
1
Boys without eating disorders
21
Total
57
Subgroup of polled teenagers
Proper caloric intake
preferred by parents
Improper, low caloric
intake preferred by
parents
0
6
0
2
1
27
1
10
0
1
0
0
2
17
2
6
3
51
3
18
Obesity cases in
immediate families
100
25(44%) of all the respondents indicated the
pressure from friends as the most evident (decisive)
factor forcing teenagers to make effort to reduce body
mass.
4 (57%) pupils with pro-anorectic behaviours
described school environment as annoying (21 (42%)
pupils in the group without eating disorders). All the
teenagers with pro-anorectic behaviours suggested
disturbed relations with teachers (these problems were
reported by 22 (44%) pupils without eating disorders).
The majority of pupils with eating disorders revealed
that the psychological problems were overwhelming,
(4 (57%) of them felt lost, 4 (86%) – had a sense of
utter emptiness).
There were no significant differences between the
reported caloric values of meals preferred by parents as
well as the episodes of obesity in immediate families of
both teenager groups (cases of obesity in the immediate
families of 2 (29%) of the teenagers with pro-anorectic
behaviours and in the families of 16 (32%) of the
teenagers without eating disorders) (tab. 2).
Discussion
The obtained data suggest that the problem of proanorectic behaviours is still present in our society. The
scale of these abnormalities seem to be even greater
then it is commonly thought. The obtained result: proanorectic behaviours in 12% of the teenage members of
2 classes in randomly selected schools (17% of polled
teenage girls) is so alarming that it should be verified
by continued diversified research covering the whole
of Poland. It should be done as fast as possible because
the eating disorders may affect physical and mental
development of young organisms. The deficiencies of
proteins, vitamins, minerals, microelements, PUFA
(polyunsaturated fatty acids), fibre, antioxidants and
sterols may result in: bone mineral content disorders,
digestive and urinary tract diseases, possible immune
system problems, orthopaedic problems (as the effects
Probl Hig Epidemiol 2009, 90(1): 98-101
of osteoporosis or excessive physical exercises),
endocrine disorders such as menstrual problems,
infertility, and psychological problems (depressive
mood) [9, 10, 11, 12, 13].
The obtained data do not suggest whether proanorectic behaviours is caused by family traditions
(improper eating habits) or is a form of overcoming
a stress caused by the cases of obesity in the family.
The results, however, suggest the presence of disturbed
interrelations between the teenagers with proanorectic behaviours and their parents, teachers and
school friends. These abnormal interpersonal relations
are reported statistically more often by the teenagers
with eating disorders. Of course, these observations
are not the decisive factors in determining causes and
effects. It is necessary to conduct further investigation
to resolve doubts concerning the influence of longterm malnutrition on mental state and depressive
mood presence as well as the role of psychological
problems on personal inter-relationships.
It is obvious that the pupils with eating disorders
need psychological help and it is equally obvious that
without active methods of identifying and diagnosing
the teenagers with eating disorders they will stay
undiagnosed and helpless. At present, these young
people are unhappy and conflicted with others. In
the future they will continue to be unhappy – because
of the after-effects of chronic malnourishment, i.e.
medical problems resulting in disabilities, shortened
life span as well as psychological after-effects of being
disabled, ignored or infertile [14, 15].
Conclusions
1. The results suggest that the disturbed interrelations between teenagers and their parents, school
friends and teachers are more frequent among the
teenagers with pro-anorectic behaviours.
2. This problem should be thoroughly studied to
determine real cause-and-effect proportions and
interrelationships.
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