Investigation of the Effect of Eating Attitude on Depression and Behaviors in the in Adolescents and Young Individuals

Nutrition is essential for the survival of individuals. The body needs to get the nutrients it needs for growth and development. Especially in recent times, body shape and physical appearance have become important with the uniform acceptance of body perception. Adolescent and young individuals were selected as the target group in this study. Eating disorders have emerged as a result. These disorders negatively affect a person's mental and social behavior. Depression is the most common mental disorder that reduces a person's energy, self-confidence, and quality of life. Some of the depressed individuals have less eating behavior and some have more eating behavior. Research shows that people with eating disorders are more likely to suffer from depression. Nutrition can be used in the prevention and treatment of behavioral health problems.

Nutrition is the intake of the essential nutrients that the body needs through food [1]. Nutrition is particularly important for growth and development, as well as for ensuring the continuity of an individual's life. Many studies have shown that regular and balanced nutrition can prevent diseases or reduce symptoms of illness [2]. The increasing prevalence of fast-food consumption in recent times is causing a rise in obesity rates. Recent statistics indicate that obesity rates have surpassed 30% of the global population. In 2017, the Global Burden of Disease Group reported that obesity prevalence has been steadily increasing since 1980. While efforts have been made to reduce obesity prevalence by 2025, it seems unlikely to achieve [3]. Obesity can lead to many health problems, such as cardiovascular disease, diabetes, cancer, hypertension, and eating disorders [4].

In our daily lives, the classification of people based on their physical appearance leads to changes in eating behavior. This situation leads to the emergence of eating disorders. Eating disorders are serious psychiatric problems characterized by abnormal eating behaviors. Body shape and weight play a key role in the development of these disorders. Eating disorders in women are associated with weight loss, while in men, they are associated with a desire for a muscular body [5].

Depression is a mood disorder characterized by a lack of pleasure in previously enjoyable activities, a lack of self-confidence, withdrawal from others, and dissatisfaction with one's own life. Depression has the highest prevalence among psychological disorders. Data has found that depression symptoms are more prevalent in women than in men [6]. Nutrition plays a key role in the treatment of behavioral disorders. Considering the role of nutrients in the neuroendocrine system, it has been observed that nutrition can affect behavioral disorders [7]. The aim of this article is to investigate the relationship between eating attitudes and depression.

An eating disorder is a serious psychiatric problem characterized by abnormal eating behaviors. Today, the acceptance of a single physical appearance has led to an increase in eating disorders. Eating disorders are evaluated as a criterion in the DSM (The Diagnostic and Statistical Manual of Mental Disorders) [8]. The DSM-5 criteria include six different eating disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, rumination syndrome, and avoidant/restrictive food intake disorder [9].

Anorexia nervosa is an eating disorder characterized by inadequate nutrition and starvation accompanied by psychiatric problems. In general, individuals with eating disorders have a very low body mass index. This causes rapid weight loss. The main reason for the occurrence of eating disorders is the fear of gaining weight. These individuals place great emphasis on their body weight and shape. It is seen in adolescence or early adulthood. Eating disorders can lead to serious illness and even death [10].

Bulimia nervosa is a serious eating disorder characterized by periods of rapid and excessive food consumption, usually of high-calorie foods. After consuming substantial amounts of food, individuals often engage in compensatory behaviors such as self-induced vomiting or fasting to rid themselves of the excess calories. It is more commonly observed in women than men and the onset typically range from ages 12 to 40 [11].

Binge-eating disorder is characterized by uncontrolled eating and consuming significantly more food than most people would in a comparable situation. What sets it apart from other eating disorders is the absence of compensatory behaviors such as purging or excessive exercise to compensate for overeating. To diagnose this disorder, the binge eating episodes must occur at least once a week for three months. Binge-eating disorder is the most common eating disorder and is more prevalent in women than in men [12].

Pica is an eating disorder characterized by persistent consumption of non-nutritive substances for at least one month. It is named after the Latin word for magpie, a bird known for eating anything. Pica was initially observed in pregnant women, but since the consumption of non-food items is common during pregnancy, it is not recommended to diagnose pica in pregnant women. Pica has different subtypes, including hair-eating (trichophagia), dirt and clay eating (geophagia), and feces eating (coprophagia) [13,14].

Rumination syndrome is the repeated regurgitation and re-chewing or expulsion of recently ingested food that occurs without any apparent retching or vomiting. The regurgitation in rumination syndrome can occur during or immediately after eating but is not triggered by nausea or vomiting. It is more commonly observed in children with autism, developmental delays, and adolescents, with a prevalence of 0.8% to 0.9% in adults. The pathophysiology of rumination syndrome is not well understood [15].

Avoidance/Restrictive Food Intake Disorder (ARFID) is an eating disorder with no body mass index concern and characterized as eating less food. This eating disorder can lead to psychosocial impairment, enteral feeding, or malnutrition [16].

Depression is the most common mental disorder seen in societies. It can occur in every age group from childhood to old age. The riskiest periods are stated to be between the ages of 16-19 and 25-29. General symptoms include not enjoying life, feeling unhappy and tired, lack of self-confidence and energy. Patients with depression are prone to suicide. Therefore, the death rate in depression has been reported as 15% in research. It is more common in women than in men [17].

Eating disorders and depression often coexist. The chronicity of both conditions can alter the course of the illness and lead to increased severity [18]. Eating disorders are frequently observed in adolescents, and depression is the most common comorbidity in adolescents with eating disorders [19]. In a study of thirty-six severe adolescents anorexia nervosa patients who were hospitalized for 41 days, anxiety, depression, and eating disorder levels were assessed. Despite the treatment, it was observed that at the end of the hospitalization period, patients needed longer time to observe the expected improvement in their depression, anxiety and eating disorders levels. The prolongation of this period is due to the fact that anxiety and eating disorders trigger each other [20].

A meta-analysis of sixteen randomized controlled trials involving 45,826 depressed participants showed a significant reduction in symptoms after dietary interventions [21]. A study conducted in 2022 on 227 women and 144 men aged 18-25 examined the relationship between depression and eating attitudes, and the results showed that they indirectly affected each other but were not directly related [22]. Another study in 2020, involving 301 students, found that 18% of the students had abnormal eating attitudes. Additionally, 38% of the students had negative body image, and 33% of those with negative body image had moderate to severe depression. The relationship between depression and low weight in women was found to be negative. The study also found that female participants had higher levels of depression than male participants [23].

Eating disorders are serious health problems that emerge at an early age and have a negative impact on overall health. Eating disorders not only affect physical health but also mental health. Research have showed that mood states cause an increase or decrease of 30% to 48% on the increase or decrease in appetite. This eating disorder, known as emotional eating, emerged as a result of consuming food to control mood. Depressive symptoms are seen in most individuals with eating disorders. The early onset of eating disorders can lead to the continuation of depressive symptoms in individuals' future lives. The selection of foods in dietary treatment of eating disorders is important. The positive effects of nutrition interventions on depressive symptoms have been proven by many studies. It has been observed that probiotics, omega-3, tea, and coffee consumption can reduce depression in the dietary treatment of depression. It should be considered that depression triggers eating disorders and eating disorders trigger depression, and there is a bidirectional relationship between them. The relationship between eating attitudes and depression particularly affects each other in adolescents. Women pay more attention to body image and body shape than men. The likelihood of developing depression based on eating attitudes is higher for women than for men.

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