الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Egypt‘s young population is rapidly growing. According to Central Agency for Public
Mobilization and Statistics (CAPMAS) 2015 the adolescents (aged 10-19) are around 17
million, representing approximately 19 percent of the total population. Together with youth in
the age group 20-24 years, an additional 9 million, adolescents and youth represent almost one
third of the Egyptian population. So, promoting the healthy development of adolescents is one
of the most important investments that any society can make.
Adolescence is the period of transition between childhood and adulthood and is the
time of sudden growth spurt associated with hormonal, cognitive, and emotional changes.
These changes make the adolescence a vulnerable period of life which is characterized by a
greater demand for calories and nutrients due to the dramatic increase in physical growth,
changing in lifestyles and food habits that affect both nutrient needs and intake. Finally,
adolescent drive for individuation means more opportunity to assert food choices and
expand or narrow healthy options.
Additionally, food is necessary, and it is a means of survival, but there are people
who have a bad behavior towards food as governed by lack of ability and desire, lost their
ability to control the amount of food that must be eaten and reach addiction. When the
word addiction is mentioned our minds go to addiction to alcohol or drugs, but there is
another type of addiction that is not less dangerous to health, which is a very serious
condition that has negative health consequences, such as obesity, diabetes, cardiovascular
diseases, and others.
Hence, the aim of the present study is to assess eating behaviors and food addiction
pattern among adolescents in Alexandria.
This study was conducted using a descriptive research design, Alexandria
governorate include 8 zones namely; El-Montazah, East, West, Middle, El-Ajmi, El-
Amria, El-Gomrok and Borg Elarab. A 25% at out of these zones was selected randomly
(East and El-Gomrok zone).One youth center was selected from each zone harvesting the
highest attendance rate of the adolescents according to the Sport & Youth Directorate data
2018,namly Smouha and El-Anfushi youth center. A 363 adolescents attending the
previously mentioned youth centers has been selected to participate in the study, according
to inclusion criteria, (age group 10-19 years for both sexes).
Five tools were used in this study to collect the necessary data:
Tool I: Adolescents socio-demographic characteristics and health profile structured
Interview schedule which include two parts:
Part (1): A structured Interview schedule was designed and used to collect
information about socio-demographic data of adolescent including age, sex, birth order,
religious, place of residence, family income, parent education, and number of siblings
….etc.
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Part (2): Adolescent’s health profile was consists of the anthropometric assessment
based on the standard methods, health history, practicing of exercise and emotional eating
behaviors.
Tool (II): General Nutritional Knowledge Assessment Questionnaire (GNKQ): was
used to assess nutritional knowledge of the adolescents. It consists of four sections; dietary
recommendations, food groups, healthy food choices and diet, diseases and weight
management.
Tool (III): Adolescent’s Food Habits Checklist (AFHC): was used to assess the
healthy eating pattern of the adolescents.
Tool IV: Food Preference Questionnaire for Adolescents and Adults (FPQ): was used
to assess food preference among adolescents & adults.
And finally, Tool (V): Yale Food Addiction Scale Version 2.0(YFAS 2.0): was used
to assess 11 FA criteria and significant distress/impairment associated with food. The
YFAS 2.0 is a 35-item self-report questionnaire designed to assess symptoms of FA
experienced over the past year based on the Diagnostic and Statistical Manual of Mental
Disorders, 5th edition (DSM-5) diagnostic criteria for substance use disorder (SUD).
The main findings obtained from the study were as follows:
Adolescent’s and families socio-demographic characteristics
The studied adolescent’s age ranged from 10 to 19 years with a mean of 13.8 ±
2.1years. Less than half (45.5%) of them aged 10 to13 years old (early adolescent)
and less than half (45.2%) of them aged 14 to 16 years old (middle adolescent).
While the rest less than one fifth (9.4%) of them aged 17 to 19 years old (late
adolescent).
Regarding adolescent’s educational level, the minority (6.1%) of them could just read
and write, less than one fifths (17.1%) of them had finished primary education, while
more than two thirds (62.0%) of them had finished preparatory education. And only
one tenth (14.9%) of them had secondary education.
Regard to adolescent’s sex, more than half (52.6%) of them were females, while
about half (47.4%) of them were males.
Regarding father education, around one third of them had finished secondary and
university education (36.9% and 30.9% respectively), while less than one quarter of
them could just read and write and had finished basic education (14.9%and12.9%
respectively), around one third of them had finished secondary and university
education (36.9%and30.9% respectively). Only 4.4% of them illiterate.
Regarding mother education where about two fifths to one third of them had finished
secondary and university education (40.5% and 30.6% respectively), while less than
one quarter of them could just read and write and had finished basic education
(14.9% and 11.5% respectively). Only 2.8% of them were illiterate.
With respect to family income, less than one quarter (13.8%) of them reported that
their income was enough, while less than three quarters (62%) of them hadn’t enough
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family income. Nearly one quarter (24.2%) of them reported that their income was
enough and could save.
In relation to crowding index, less than two thirds (60.6%) of the adolescents
families’ had moderate crowding index, one third (31.1%) of them had high crowding
index. Only 8.3% of them had low crowding index.
The adolescent’s health profile
Adolescent’s weight ranged from 30- 110 Kg with a mean of 50.8 ± 12.0Kg. Nearly
one quarters (24.5%) of the adolescents weight ranged from less than or equal 40
kg, whereas more than half (59%) of them their weight ranged from 41 to 60 kg,
less than one quarter (15.2%) of them their weight ranged from 61 to 80 kg. Only
1.4% of them their weight more than 85 kg.
Concerning body mass index, it was noticed 50.7%of adolescents are normal (18.5-
24 kg/m2), followed by 27.8% who categorized as underweight (<18.5 kg/m2),
while overweight adolescents (18-24.9 kg/m2) constituted only 12.9% of them.
However very few of them were obese class I (30.00-34.99 kg/m2), obese class II
(35.00-39.99 kg/m2) and obese class III (≥40 kg/m2) (4.7%, 1.1%, and 2.8%
respectively).
Lastly, the table reveals that evaluation of weight from adolescents perspective,
more than half (58.7%) perceived that their weight is normal/normal weight within
average, less than one fifth (18.2%) perceived that their weight is less than
normal/under weight, more than one tenth (14.3%) perceived that their weight is
over the normal/above average. Only 8.8% of them perceived that they are had
obesity.
Health history
More than one quarter (28.9%) of the studied adolescent’s were suffering from
previous health problems. Anemia was the main health problems reported by these
adolescent’s (30%), while more than one quarter of them were suffering from
diabetes and thyroid disorders (28.5% and26.6 respectively). less than one
quarter(22.8% )of them were previous suffering from cholecystitis. On the other
hand, 5.2% of the studied adolescent’s were suffering from previous digestive
surgery, mainly hernia of the abdominal wall and Cholecystectomy was reported by
few (2.7%, 2.4% respectively) of them.
Adolescents’ life style
More than two third (64.5%) of the studied adolescents were practicing physical
exercises.
Regarding to type of exercises, about two fifths (41.8%) of the studied adolescents were
practicing football, while those who were practicing walking or running represented
(24.7% and18.3% respectively), about one tenth (11.1%) of these adolescents were
practicing wrestling, followed by swimming 8.5%, while those who were practicing
boxing or zumba or karate represented (5.9%, 3.8% and 2.5% respectively).
Additionally, the time spent to practice these exercises ranged from 1 to 7 day/ week
with a mean of 2.3 ± 2.4 day. adolescents practicing exercise for one to two day weekly
represented more than two fifths (44.4%) of the adolescents, while more than one quarter
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(29.9%) of them were practicing exercise for three to five day weekly and those
practicing for more than five times constituted 25.6%.
Concerning the duration of practicing exercise, it ranged from 1 to 7 hours/ week
with a mean of 1.2 ± 1.3 hours. adolescents practicing exercise for one to two hours
weekly represented more than three quarters (81.6%) of the adolescents, whilst
more than one tenth (17%) of them were practicing exercise for three to five hours
weekly and those practicing for more than five hours constituted only 1.2%.
Emotional Eating Behaviors of adolescents
Regarding to internal emotion, it was found that about two fifths (41%) of them stated
that they sometimes like to eat in spare time, while less than one third (28.4%) of
them stated that they like to eat in spare time the most of time.
It was found that more than one fifth (22%) of them stated that they sometimes
eating when they depressed or frustrated, while more than one tenth (14.3%) of
them stated that the most of time eating when have depressed or frustrated. When
asking them about their desire to eat when they are alone, it was found that more
than one quarter (26.2%) of them stated that they sometimes have a desire to eat
when they are alone, while more than one tenth (16%)of them stated that they the
most of time have a desire to eat when they are alone.
It was found that one fifth (21.2%) of them stated that they sometimes eating
when have sad, while only 8% of them eating the most of time when they are sad.
On the other hand, when asking them about their desire to eat when feeling
anxious or stressed, it was found that less than one fifth (17.4%) of them stated
that they sometimes have the desire to eat when they are anxious or stressed, while
only 9.1% of them have a desire to eat most of the time when they are anxious or
stressed.
Less than one fifth of them stated that sometimes like to eat when things go
against them and want to eat when they afraid (17.6%and 16.3 respectively),
moreover it was found that less than one tenth of them stated that they most of the
time like to eat when things go against them and want to eat when they are afraid.
(7.7%among both of them)
Less than one fifth (19.8%) of them stated that they sometimes have a desire to eat
when they are disappointed (feeling failure), while only7.4% of them have a desire
to eat most of the time when they are disappointed (feeling failure), more than one
quarter (29.2%) of them stated that they sometimes refuse the food or drink
provided as they afraid of being overweight, while less than one fifth (17.6%) of
them most of the time they have refuse the food or drink provided for as they
afraid of being overweight and less than two fifths (38%) of them stated that they
sometimes try to eat at meal time less than they want to eat compared to 15.7% of
them who stated that most of the time they try to eat at meal time less than they
want to eat.
Regarding to external emotion the table shows that, more than two fifth to two
fifths of them sometimes eat more than usual if they the food like, sometimes they
eat more than usual if the smell of food is good and if they see tasty food they are
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ready to eat it (42.1%, 41.9% and 38.6% respectively) of them. While about one
fifth to one quarter and more than one third of them reported that they most of the
time eaten with this emotion (19.8%, 25.1%and 35.8% respectively).
Only more than one third (36.4%) of them sometimes want to eat if they see
people eating compared to15.2% who stated that they the most of time eat if they
see people eating, about two fifth (40.5%) of them sometimes like to eat in snack
bar compared to 27% who stated that they the most of time like to eat in snack bar,
while more than one third (36.4%) of them sometimes tend to eat food when
preparing it compared to 27% said that they the most of time tend to eat food
when preparing it.
Adolescents’ knowledge about dietary recommendations
Regarding adolescents’ knowledge about the daily dietary recommendations which
indicates that food and drinks that they should eat daily the table revealed that the
majority (85.7%) of the studied adolescents had incomplete &correct knowledge.
The majority of them had incorrect knowledge regarding the number of fruits cups,
the number of meals, number of milk cups, the number spoon of oil should eaten
daily, the amount of starchy food, the number of vegetables cups that should eating
daily (99.4%, 96.7%, 94%, 91.2%, 87.9%, 81.6% respectively). In addition, about
three quarters to two thirds of them have incorrect knowledge regarding kind of
dairy and the number of water cups should taken daily (75.8% and 67.8%
respectively).
More than half (57.3%) of the adolescents had complete& correct knowledge
regarding the number of times a week can they eat fish, less than three quarter
(70%) of them have complete& correct knowledge regarding the number of times a
week can that they eat breakfast .
About half (51%) of the adolescents had incomplete & correct knowledge
regarding the food that should eaten which contains less unsaturated fats or transfat
or saturated fat.
Regarding adolescents’ knowledge about the dietary recommendations which
indicates that Foods and drinks should eat daily, the majority (85.7%) of the studied
adolescents have incomplete &correct knowledge.
The majority of them have incorrect knowledge regarding the number of fruits cups, the
number of meals, number of milk cups, the number spoon of oil should eating daily, the
amount of starchy food, the number of vegetables cups that should eating daily (99.4%,
96.7%, 94%, 91.2%, 87.9%, 81.6% respectively). In addition, about three quarters to two
thirds of them have incorrect knowledge regarding kind of dairy and the number of
water cups should eating daily (75.8% and 67.8% respectively).
More than half (57.3%) of the adolescents have complete & correct knowledge
regarding the number times a week can we eat fish, less than three quarter (70%) of
them have complete& correct knowledge regarding the number times a week can we
eat breakfast a week.
About half (51%) of the adolescents have incomplete & correct knowledge regarding
the foods should eaten less contains unsaturated fats or transfat or saturated fat.
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Adolescents’ Knowledge about Food Groups
Regarding the food groups it was found that, the vast majority (99.2%) of the
adolescents had incomplete &correct answers about starchy foods, followed by
74.7% who have knowledge regarding foods that are typically high or low in
salt, foods are typically high or low in fiber, foods and drinks are typically high
or low in added sugar (61% for both) and 51.3% who have knowledge about
foods are as a good sources of protein.
Less than three quarter to more than two thirds of the studied adolescents had
incorrect knowledge about starchy or fiber or fat has the most calories for the same
weight of food, processed foods are higher in calories or higher in fiber or lower in
salt (72.2% and 68% respectively).
Adolescents’ Knowledge about healthy Food Choices
Less than two thirds (64.5%) of the adolescents had complete & correct knowledge
about when a person should to buy a yogurt at the supermarket, followed by 47.4%
the healthiest and most balanced choice for a main meal in a restaurant and 38.6%
the cooking methods that requires fat to be added.
More than two thirds (69.9%) of them had incorrect knowledge regarding the
healthiest and most balanced choice for a main meal, followed by 52.7% who have
knowledge about soup with lowest fat option, nearly half of them have knowledge
about the best choice for reduce the amount of fat in their diet, combinations of
vegetables in a salad would give in greatest variety of vitamins and
antioxidants(50.1% and 49.8% respectively) and more than two fifth (43.5%) have
incorrect answer regarding ”Light‖ foods (or diet foods) as a good options.
About two fifths of the studied adolescents did not know the healthy way to add
flavor to food without adding extra fat or salt and symbols are often used on
nutrition labeling and what would amber mean for the fat content of a food (41.6%
and 40.8% respectively).
Adolescents’ Knowledge about Diet, Diseases and Weight Management
Less than half and two fifths of the studied adolescents did not know about foods
leads to high blood sugar and diseases related to a low intake of fiber (43.3% and
38.9% respectively).
More than half of them had correct knowledge regarding the diseases related to the
amount of sugar consumed by people, and options that experts recommend to prevent
diabetes (56.5% and 54.5%, respectively), followed by 38.9% who have correct
knowledge regarding foods are more likely to raise cholesterol in the blood and more
than one third (36.9%) who have correct knowledge regarding diseases associated with
the amount of salt (or sodium) people eat are.
Less than three quarters to about half of them had incorrect knowledge regarding
options that prevent heart disease and options that reduce the chances of getting
cancers (70.5%, 48.2% respectively).
The vast majority (91.7%) of the adolescents had incorrect knowledge about food
labels, followed by 82.1% who know the importance of taking nutritional
supplements, more than three quarters (79.1%) who monitor their eating and 71.9%.