Environmental factors associated with disordered weight-control behaviours among youth: a systematic review

Abstract

Objective: Environmental factors may be very important in the development of disordered weight-control behaviours (DWCB) among youth, yet no study to date has conducted a review that synthesizes these findings. The purpose of the present study was to systematically review existing literature on environmental influences on DWCB among youth and to identify conceptual and methodological gaps in the literature.

Design: Systematic review.

Setting: Studies were identified through a systematic search using PubMed, PsycINFO, Google Scholar and secondary references. Inclusion criteria included observational studies published in peer-reviewed journals from 1994 to 2012 that examined environmental exposure(s) associated with DWCB among youth.

Subjects: Ninety-three studies, the majority of which utilized a cross-sectional design (75 %; n 70), were identified. Longitudinal studies' follow-up time ranged from 8 months to 10 years.

Results: Parental, peer and media influences have been extensively studied as factors associated with DWCB among youth. Fewer studies have examined behavioural settings (i.e. homes, schools, neighbourhoods) or sectors of influence other than the media on DWCB. No studies utilized multilevel methods to parse out environmental influences on DWCB. Most studies (69 %, n 64) did not explicitly utilize a theory or model to guide the research.

Conclusions: Findings indicate that exploring a wider range of environmental influences on DWCB, specifically behavioural settings and sectors of influence, using diverse study samples and multilevel methodology is needed to advance the field and to inform the design of comprehensive prevention programmes that target DWCB and other weight-related behaviours.

Fig. 1

Adaptation of the social-ecological model (modified from the Institute of Medicine^{( 132 )}) in understanding environmental influences on disordered weight-control behaviours (DWCB). *Behavioural settings include a wide range of common settings to which individuals are exposed. ‘Homes’ are often included in this level of influence. Sectors of influence include established institutions, industries or markets in society

Fig. 2

Frequency of environmental constructs* (, family, n 153; , peers, n 68; , other interpersonal influences, n 9; , behavioural settings, n 16; , media, n 28; , sociocultural influences, n 13; , environmental influences (from twin studies), n 10; , built environment (BM), n 0; , policy, n 0) examined as exposure variables to disordered weight-control behaviours among youth. *Studies that examined multiple environmental constructs were counted multiple times, with ninety-three studies and a total of 297 constructs counted (grouped by the categories shown); n refers to the number of times a particular construct was examined, not the number of studies

Fig. 3

Length of study () and methodological rigour (Methodological Quality Rating Scale (MQRS) score, ) of the longitudinal studies reviewed (n 23)