FACTORS AFFECTING THE SELECTION OF HEALTHY AND UNHEALTHY DIET BEHAVIOR IN ADOLESCENT GIRLS IN BANDAR LAMPUNG

Abstract

Adolescence is a period of transitional development from children to adult women who are generally 10-21 years old. Adolescents has significant physical, psychosocial, and cognitive changes that can affect adolescent dietary behavior. The purpose of this study was to determine the effect of affecting factors on unhealthy dietary behavior in adolescent girls. This research is an analytic observational study, with a cross-sectional design approach using primary data, which was conducted from April to June 2022. The sample is 135 adolescent girls aged 15-21 years old taken using multistage random sampling who met the inclusion and exclusion criteria. The data was obtained by filling out the questionnaire and analyzed by using the chi square test. The results showed that 56.3% of respondents had unhealthy dietary behavior. The results of bivariate analysis showed that nutritional status (p = 0.000; PR = 2.072) and body image (p = 0.000; PR = 0.559) had an influence on unhealthy dietary behavior. Meanwhile, knowledge (p=0,227), age (p=0,158), pocket money (p=0,452) and peers (p = 0.120) had no influence on unhealthy dietary behavior. It can be concluded that there is an influence of nutritional status and body image factors on unhealthy diet behavior.

Full text

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 72
RESEARCH ARTICLE
OPEN ACCESS
Manuscript received February 5, 2023; revised March 20, 2023; accepted April 20, 2023; date of publication April 30, 2023
Digital Object Identifier (DOI): https://doi.org/10.35882/ijahst.v3i2.216
Copyright © 2023 by the authors. This work is an open-access article and licensed under a Creative Commons Attribution-ShareAlike 4.0
International License (CC BY-SA 4.0)
How to cite: Dian Isti Angraini, Asiah Nurul Izzah, Khairun Nisa, Reni Zuraida, “Factors Influencing the Selection of Healthy and Unhealthy Diet
Behavior in Adolescent Girls in Bandar Lampung”, International Journal of Advanced Health Science and Technology, vol. 3, no. 2, pp. 72–78,
April. 2023.
Factors Influencing the Selection of Healthy
and Unhealthy Diet Behavior in Adolescent
Girls in Bandar Lampung
Dian Isti Angraini1, Asiah Nurul Izzah2, Khairun Nisa3, Reni Zuraida1
1Departement of Community Medicine and Public Health, Medical Faculty, Lampung University, Bandar Lampung, Indonesia
2Medical Faculty, Lampung Univesrity, Bandar Lampung, Indonesia
3Departement of Physiology and Biomolecular, Medical Faculty, Lampung University, Bandar Lampung, Indonesia
Corresponding author: Dian Isti Angraini (e-mail: riditie@gmail.com).
ABSTRACT Adolescence is a period of a transitional development from children to adult women who are generally 10-21
years old. Adolescents have significant physical, psychosocial, and cognitive changes that can affect adolescent dietary
behavior. The purpose of this study was to determine the effect of affecting factors on unhealthy dietary behavior in adolescent
girls. This research is an analytic observational study, with a cross-sectional design approach using primary data, which was
conducted from April to June 2022. The sample is 135 adolescent girls aged 15-21 years old taken using multistage random
sampling who met the inclusion and exclusion criteria. The data was obtained by filling out the questionnaire and analyzed by
using the chi-square test. The results showed that 56.3% of respondents had unhealthy dietary behavior. The results of the
bivariate analysis showed that nutritional status (p = 0.000; PR = 2.072) and body image (p = 0.000; PR = 0.559) influenced
unhealthy dietary behavior. Meanwhile, knowledge (p=0,227), age (p=0,158), pocket money (p=0,452), and peers (p = 0.120)
did not influence unhealthy dietary behavior. It can be concluded that there is an influence of nutritional status and body image
factors on unhealthy diet behavior. Based on the research results, adolescent girls must have a healthy diet according to balanced
nutrition guidelines in achieving normal nutritional status and a good body image.
INDEX TERMS adolescent girls, factors, unhealthy diet.
I. INTRODUCTION
Adolescent girls are in the developmental period of transition
from children to adult women who are generally 10-21 years
old. Adolescent girls experience significant physical,
psychosocial, and cognitive changes at this time. The physical
development of female adolescents, which is characterized by
drastic weight gain, occurs during puberty due to an increase
in the composition of fat mass, whereas in male adolescents it
is due to an increase in the composition of muscle mass [1].
Increasing the composition of fat mass in adolescent girls is
needed for growth and development, one of which is sexual
maturity because fat is one of the nutrients needed in the
formation of sexual hormones [2]. Adolescent girls who
experience puberty have specific fat that appears as a sign of
secondary sex which is usually stored in the breasts, upper
arms, lower abdomen, genitals, and thighs [3].
Psychosocial development also occurs in adolescent girls.
Erikson states that adolescence is the peak of the search for
self-identity. The process of searching for self-identity is
social, meaning that the search or formation of identity is
influenced by the interaction of adolescents with the people
around them. Three periods of adolescent psychosocial
development namely, early adolescence, middle adolescence,
and late adolescence. Early adolescents aged 10-14 years tend
to compare things with their peers and attach great importance
to peer acceptance. Middle adolescents aged 15-17 years begin
to pay attention to physical growth and have a body image that
tends to be wrong. Late adolescents aged 18-21 years have felt
comfortable with their self-worth and the influence of their

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 73
peers has diminished [4]. Young women who do a lot of diets
are also influenced by clothing trends published in the mass
media. Today's women seem to be required to have a thin and
tall posture [5].
Research conducted regarding the prevalence of
overweight, obesity, and adolescent dietary behavior in Dubai
schools, it was found that the dietary habits of adolescents 30
days before the surveys didn't eat fruits 21,3% of adolescents
and 19,7% of adolescents who did not eat vegetables.
Consumption of milk in adolescents in the 7before the survey
was found to be 3,3% of adolescents who did not drink milk
or dairy products. 31% of adolescents consume carbonated
drinks every day. 18,4% of adolescentsdid not have breakfast
in the 7 days before the survey. Consumption of fast food
among adolescents was so high in the 7 days before the survey
was conducted, namely 78,9% of adolescents [6].
The proportion of the Indonesian population aged more than
10 years who have the behavior of consuming fatty foods,
cholesterol, and fried foods is 40,7%, consuming salty foods
is 26,2%, and consuming sweet foods is 53,1%. As well as the
percentage of behavior that consumes fewer vegetables and
fruit is 93,5% [7]. Research conductedin the Central region of
Ghana on 1.311 in-school adolescents who had a healthy diet
found that as many as 49,4% [8]. The proportion of the
population aged 15-19 years in Lampung who has the
behavior of consuming fatty foods, cholesterol, and fried
foods is 42,93%, consuming salty foods is 32,4%, consuming
sweet foods is 41.75%, and consuming fewer vegetables and
fruit 67,32% [9].
Adolescent diets that are not optimal and causedunfulfilled
nutrients will be associated with poor health [10]. Unhealthy
dietary behavior that causes deviant eating behavior also has
the potential to occur in adolescents [11]. Research regarding
deviant eating behavior in adolescents in Jakarta states that
individuals who have a good metabolism will be able to
implement a good diet and get satisfactory results, but for
individuals who are not gifted with these abilities, dieting
methods are rarelysuccessful[12]. It is these individuals who
are not successful that begin to feel hopeless and start to
engage in deviant eating behaviors (Eating Disorders). The
three major eating disorders are anorexia nervosa, anorexia
bulimia, and binge eating disorder [13].
Factors that influence adolescent eating behavior are
parental income, peers, and knowledge [14]. Research
regarding body dissatisfaction and dietary behavior in female
adolescents found that several factors can trigger dietary
behavior, including health values (health beliefs), personality,
the influence of family relationships, family socioeconomic
status,and body dissatisfaction. Teachers at school are another
factor that influences diet in adolescents [15]. Research
regarding the quality of the diets of elementary and secondary
school teachers in the United States, it was found that
respondents had quite unhealthy personal dietary habits.
Respondents who had the least healthydiets were more likely
to engage in classroom practices that could adversely affect
their students' dietary patterns [16].
Adolescents' dietary behavior is also inseparable from
media and advertising factors. Of the 54 respondents who
were influenced by the media or advertising, 45 female
students (83,3%) had healthy dietary behaviors and 9 female
students (16,7%) had unhealthy dietary behaviors [17]. Peers
have a huge influence on adolescents on dietary behavior[18].
Nutritional status and pocket money do not have a significant
relationship with dietary behavior, while psychological factors
have a relationship with dietary behavior [17].
Dietary behavior carried out by adolescents has a
relationship with poor nutritional status because adolescents
often limit food consumption with consumption patterns that
are not following the principles of nutrition. Physical changes
during puberty can also affect body image because this is a
time of heightened self-awareness. The body image that
appears tends to be negative so teenagers often experience
body dissatisfaction or dissatisfaction with body shape. Age is
also one of the factors that influence dieting behavior because
middle adolescents aged 15-17 years begin to pay attention to
physical growth and have a body image that tends to be wrong
[19].
Research on adolescent girls aged 15-19 years in Central
Java states that the factors that influence the level of nutritional
intake and eating practices of adolescent girls aged 15-19 are
food intake (energy, protein, carbohydrates, fat),
socioeconomic status, and food availability at the household
[20].
Research on adolescent girls aged 15-19 years in Benin city
concluded that factors influencing adolescent girls eating
habits are knowledge, family income, self-efficacy, food
appeal, family influence, food access and availability, food
safety, health services, societal influence, media, and
advertisement [21].
Research conducted in the Central Region of Ghana,
concluded that factors that influence Ghanaian adolescent
eating habits are media, parents, and peers. It appears that peer
influence in the life of adolescent students should be takeninto
account when dealing with eating habits. As stated earlier, too
much of p influence can result in unhealthy eating habits. It
would be recommended that adolescents are guided on healthy
eating habits with the assistance of guidance coordinators in
their schools, parents, teachers, and dieticians [22].
The purpose of this research was to determine the effect of
affecting factors (knowledge, age, nutritional status, body
image, pocket money, and peer influence) on unhealthy
dietary behavior in adolescent girls in Bandar Lampung city.
II. METHOD
Thisresearchis observational analytical research with across-
sectional design. This study was conforming April until June
2022, located in Bandar Lampung City. The sample size was
135 adolescent girls counted using independent analytical
categoric sampling formula. The sample was taken using

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 74
Multistage Random Sampling. The inclusion criteriaincluded
adolescent girls aged 15-21 years old with approval from
themselves and their parents.
The independent variables in this study are knowledge,
age, nutritional status, body image, pocket money, and peer
influence. The dependent variable in this study is diet
behavior. Knowledge is categorized as poor and good
knowledge based on the questionnaire. Age was categorized
into mid-adolescent girls and late-adolescent girls based on a
questionnaire. Nutritional status is categorized into
malnutrition and normal nutrition based on body mass index.
Body image is categorized as satisfied and dissatisfied based
on thebody shape questionnaire. Pocket money is categorized
as low and adequate pocket money based on the average
pocket money of adolescents. Peers are categorized as having
influence and not based on the questionnaire. Diet behavior is
categorized intohealthy and unhealthy dietbehavior based on
the semi-quantitative food questionnaire (SQFFQ) which
includes the amount and type of food according to the
principle of balanced nutrition. All the questionnaires used
have been tested for validity and reliability. The data were
processed and analyzed using univariate, and bivariate using
chi-square. This research has obtained ethical clearance from
the research ethics committee of the medical faculty of the
University of Lampung with the ethical approval number
1408/UN26.18/PP.05.02.00/2022.
III. RESULTS
The univariate analysis provides an overview of the
characteristics of all the variables studied, namely the diet
behavior of adolescent girls and the factors that affect the
selection of it. The results showed that the research subjects
had healthydiet behaviorin as many as59 people (43,7%)and
unhealthy diet behavior in as many as 76 people (56,3%),
knowledge regarding balanced nutrition was poor in as many
as 117 people (86,7%) and good as many as 18 people
(13,3%), middle adolescent girls as many as 125 people
(92,6%) and lateadolescentgirls as many as 10 people(7,4%).
The results showed that the research subjects had nutritional
status malnutrition in as many as 69 people (51,1%) and
normal nutritional status in as many as 66 people (48,9%),
dissatisfied body image in as many as 67 people (49,6%) and
satisfied body image as many as 68 people (50,4%), adequate
pocket money as many as 49 people (36,3%) and low pocket
money as many as 86 people (63,7%), influenced by peers as
many as 64 people (47,4%) and not influenced by peers as
many as 71 people (52,6%). Characteristics of subjects are
presented in TABLE 1. The bivariate analysis resulted in the
effect of affecting factors (knowledge, age, nutritional status,
body image, pocket money, and peer influence) on unhealthy
dietary behavior in adolescent girls. The results showed that
adolescent girls who have poor knowledge will behave
unhealthy diet behavioras many as63 people (53,8%)smaller
than adolescent girls who have good knowledgeas many as13
people (72,2%). The results of statistical tests showed that
knowledgedid not influencethe selection ofunhealthy dietary
behavior (p = 0,227).
The resultsof this researchshowed thatadolescent girls who
were middle adolescent girls will behave with unhealthy diet
behavioras many as 73people (56,4%) larger than adolescent
girls who were late adolescent girls as many as 3 people
(30%). The results of statistical tests showed that age had no
influence on selection of unhealthy dietary behavior (p =
0,158).
TABLE 1
The Characteristics of Subjects
Variable
Amount
(f)
Percentage
(%)
Diet Behavior
a. Unhealthy
b. Healthy
76
59
56,3
43,7
Knowledge
a. Poor
b. Good
117
18
86,7
13,3
Age a. Middle
adolescent
b. Late adolescent
125
10
92,6
7,4
Nutritional Status
a. Malnutrition
b. Normal
69
66
51,1
48,9
Body Image
a. Dissatisfied
b. Satisfied
67
68
49,6
50,4
Pocket Money
a. Low
b. Adequate
86
49
63,7
36,3
Peer Influence
a. Yes
b. No
64
71
47,4
52,6
The resultsof this researchshowed thatadolescent girls who
was malnutritionwill behaveunhealthy dietbehavior as many
as 52 people (75,4%) larger than adolescent girls who was
normal nutrition status as many as 24 people (37,2%). The
results of statistical tests showed that nutritional status had an
influence on selection of unhealthy dietary behavior (p =
0,000). Nutritional status is a risk factor for unhealthy diet
behavior in adolescent girls with OR = 2 (CI: 1,466-2,931),
which means adolescent girls withmalnutritionhave a2 times
higher risk for unhealthy diet behavior, better than adolescent
girls with normal nutritional status.
The resultsof this researchshowed thatadolescent girls who
was satisfied body image will behave unhealthy diet behavior
as many as49 people (72,1%) larger than adolescent girls who
was dissatisfied body image as many as 27 people (40,3%).
The results of statistical tests showed that body image had an
influence on selection of unhealthy dietary behavior (p =
0,000). Body image is a risk factor for unhealthy dietbehavior
in adolescent girls with OR = 1,8 (CI: 0,403-0,775), which
means adolescent girls with satissfied body image have a 1,8
times higher risk for unhealthy diet behavior, better than
adolescent girls with dissatisfied body image.
The resultsof this researchshowed thatadolescent girls who
had low pocket money will behave unhealthy diet behavior as

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 75
many as 25 people (51%) smaller than adolescent girls who
had adequate pocket money as many as 51 people (59,3%).
The results of statistical tests showed that pocket money had
no influence on selection of unhealthy dietary behavior (p =
0,860).
The resultsof this researchshowed thatadolescent girls who
had peers influence will behave unhealthy diet behavior as
many as 41 people (64,1%) larger than adolescent girls who
had no peers influence as many as 35 people (49,3%). The
results of statistical tests showed that peers had no influence
on selection of unhealthy dietary behavior (p = 0,120). The
influence of factors affecting the selection of healthy and
unhealthy diet behavior in adolescent girls in Bandar
Lampung is presented in TABLE 2.
TABLE 2
The Influence of Factors Affecting The Selection Of Healthy And
Unhealthy Diet Behavior In Adolescent Girls
Variable
Unhealthy Diet
Behavior
Healthy Diet
Behavior
pvalue
OR
95%
CI
n
%
n
%
Knowledge
a. Poor
b. Good
63
13
53,8
72,2
54
5
46,2
27,8
0,227
NA
0,53-
1,03
Age
a. Middle
b. Latel
73
3
56,4
30
52
7
41,5
79
0,158
NA
0,74-
5,07
Nutritional
Status
a. Malnutrition
b. Normal
52
24
75,4
37,2
17
42
24,6
63,6
0.000*
2
1,46-
2,93
Body Image
a. Satissfied
b. Dissatisfied
49
27
72,1
40,3
19
40
27,9
59,7
0.000*
1,8
0,40-
0,77
Pocket Money
a. Low
b. Adequate
51
25
59,3
51
35
24
40,7
49
0,452
NA
0,62-
1,19
Peer Influence
a. Yes
b. No
41
35
64,1
49,3
23
36
35,9
50,7
0,12
NA
0,96-
1,75
IV. DISCUSSION
The results of this study indicate that 56,3% of adolescent girls
have unhealthy dietary behaviors. This shows that the
incidence of unhealthy dietary behavior in young women is
still high. An unhealthy diet is the habit of consuming food
that does not provide the essential nutrients needed in the
body's metabolism [22].
Essential substances that are not met will affect the process
of energy metabolism. Energy is a substance that is needed by
living things to sustain life, support growth, and carry out
physical activity which is obtained from the metabolism of
carbohydrates, proteins, and fats [23]. To meet energy needs,
it is necessary to enter sufficient nutrients into the body. Less
energy intake can occur if the body consumes less energy
through food than the energy expended. Meanwhile, more
energy intake can occur if the body consumes more energy
through food than the energy expended. Both of these are
caused by unhealthy dietary behavior [17].
The impact of unhealthy dietary behavior on adolescents
will have an impact on physical growth. Nutritional
deficiencies, especially iron and calcium, often occur in
adolescents with unhealthy dietary behaviors. Reducing
energy intake during the growth period can also be associated
with slowed growth[10]. Adolescent girls who eat irregularly
but do not lose weight will have an impact on the menstrual
cycle to become irregular and can be included in secondary
amenorrhea. There is a long-term risk of osteopenia and
osteoporosis in young women who have an unhealthy diet.
Anemia in young women is often experienced due to poor
eating habits and monthly menstrual cycles [22].
The results of this study found that knowledge has no effect
on the behavior of selecting healthy or unhealthy diets in
adolescent girls. Adolescent girls who have unhealthy dietary
behavior are mostly young women with good knowledge
(72,2%). This is because sufficient dietary knowledge does not
guarantee that a person will have appropriate dietary behavior,
if that knowledge is not based on a strong attitude or desire to
meet nutritional needs [24].
Increasing knowledge in adolescents does not always lead to
changes in behavior. Knowledge is an important factor, but
does not underlie changes in health behavior. This shows that,
even though young women know about healthy diet behaviors,
it is not certain that these young women want to carry out
healthy diet behaviors. In addition, providing information
about ways of healthy dietary behavior will increase
knowledge and raise awareness, but changing behavior in this
way will take a long time [25].
Respondents lack knowledge because they generally do not
know and do not understand well about a healthy diet, they do
not seek information in the mass media or electronic media,
and they have never been given health education about a
healthy diet. Meanwhile, good knowledge is obtained from the
respondent's memory of a material that has been previously
studied regarding a healthy diet.
The results of this study found that age had no effect on the
behavior of selecting healthy or unhealthy diets in adolescent
girls. Adolescent girls with unhealthy diet behavior were
mostly young women in their mid-teens (56,4%). Middle age
is the age of adolescence with significant physical growth
accompanied by the development of self-identity and starting
to care about social issues related to others. Adolescents with
an age range of 15-18 years tend to carry out experiments that
have a positive developmental impact or developmental
impacts that pose a risk to health [26].
Adolescence is a time when growth and development spurts
occur and the brain's reward system is overhauled.
Remodeling that occurs will affect emotional activity,
cognitive control, and self-regulation that affect decision
making, including choices about what and when to eat. Middle
adolescence is a period marked by the development of a sense
of identity and increasing self-autonomy. During this time,
many teenagers are concerned about social and environmental
issues, and have a high desire to experiment [27].
Adolescence is also a factor that affects body fat mass [28].
In addition, age has a big relationship with food consumption
patterns and energy needs because as you get older, there are

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 76
changes in fulfilling energy and other nutritional needs [29].
Increasing age also affects the body's metabolism in meeting
energy needs. Adolescents tend to still have a good
metabolism although on the other hand they experience a
higher increase in body fat mass, especially in young women.
The results showed that nutritional status had an influence
on the behavior of selecting healthy or unhealthy diets in
adolescent girls. Adolescent girls with unhealthy dietary
behavior were mostly young women with malnutrition
nutritional status (75,4%). Nutritional status is a macro picture
of the body's nutrients. Nutritional problems in adolescents
often occur due to wrong eating habits, including obesity,
chronic malnutrition, and micronutrient deficiencies such as
nutritional anemia [30]. Malnutrition nutritional status in this
study showed young women who had less nutritional status or
more nutritional status.
Good nutritional status or optimal nutritional status occurs
when the body obtains enough nutrients to be used efficiently,
thus enabling physical growth, brain development, work
ability, and general health at the highest possible level.
Malnutrition nutritional status occurs when eating behavior is
not according to needs so that the body experiences a
deficiency or excess of one or more essential nutrients[31].
The results showed that body image has an influence on the
behavior of selecting healthy or unhealthy diets in adolescent
girls. Adolescent girls with unhealthy dietary behavior were
mostly young women who were satisfied with body image
(72,1%).The results of this study state that adolescent girls are
satisfied with their body image, so they no longer pay attention
to the food they eat, and ultimately tend to eat unhealthy
patterns.
Body image is a person's view of his physical appearance.
Young women who are satisfied with their body image tend to
have unhealthy dietary behaviors because they feel sufficient
with their physical appearance, so they feel they do not need
to maintain their physical appearance and choose to eat food
carelessly without the need to follow rules or as needed. In
addition, the dietary behavior of young women is one of the
steps that can form self-identity. Adolescent girls who are
satisfied with their body image are able to recognize
themselves and understand their body's needs [32]. However,
this does not necessarily result in behavior that is in
accordance with his needs and abilities.
The results of this study found that pocket money had no
effect on the behavior of selecting healthy or unhealthy diets
in adolescent girls. Adolescent girls with unhealthy dietary
behaviors are more likely to have low pocket money (59.3%).
This is because most of the respondents in this study came
from families with low incomes, which affected the
distribution of pocket money from parents to children. Low
pocket money makes most young women prefer to eat less
nutritious foods because prices are lower and foods with
higher nutritional quality tend to be more expensive per
calories [33].
In this study, it was found that the income of fathers and
mothers was mostly at the Regional Minimum Wage. Father's
occupation and family income significantly influence
adolescents' dietary behavior. Meanwhile, the mother's
employment status and family size did not influence the
dietary behavior of adolescents. This is presumably because
the mother's time availability in determining adolescent
dietary behavior is not determined by the amount of mother's
time, but by its quality. However, if the mother's quality time
is waiting but not supported by the father's income as the head
of the family, then it will not contribute to family eating
behavior.
The high need for young women today also causes
respondents with low pocket money to tend to allocate their
pocket money for transportation costs, beauty products,
internet packages, and hobbies/plays, stationery needs, or
others instead of using it for snacks[34].
The results of this study found that peers did not influence
the behavior of selecting healthy or unhealthy diets in
adolescent girls.The results of this study indicate that peers do
not greatly influence the choice of a healthy diet because each
adolescent girls has her own concept of what to eat and shape
their body image. Respondents admit that peers have more
influence on how they get along, take care of their beauty and
play together.
Peers can indeed influence adolescent girls in terms of
choosing food. This is because most teenagers do a lot of
activities outside the home and make them rarely with their
families and spend a lot oftime with their friends and eating is
a form of socialization and recreation[35].
The power of playmates is very strong during childhood and
adolescence because most time is spent at school or other
places with friends, so playmates can change good andhealthy
behaviors and habits related to eating patterns. The influence
of these environmental factors also makes young women want
to look like their friends who have ideal body shapes,
especially young women. This feeling can cause young
women to try to change their body shape by limiting their
consumption of balanced nutritious foods[36].
The influence of friends begins to play an important role in
the formation of adolescent self-concept. The influence of
friends is high because most of the time adolescents spend at
school or other places with their friends, so that friends can
change good and healthy behaviors and habits related to
healthy and unhealthy diet behaviors. The high influence of
peers on unhealthy dietary behavior tends to be caused by the
attitude of adolescents who like to try new things, in this case
they begin to learn to determine their own food to be
consumed [37].
The weakness of this study is that several variables used a
questionnaire so that there is a risk of bias, namely the
respondent fills in at random; and also researchers could not
see the direct reaction of respondents in filling out the
questionnaire.

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 77
V. CONCLUSION
The purpose of this study was to determine the effect of
affecting factors on unhealthy dietary behavior in adolescent
girls. This study results found that the influencing factors of
unhealthy dietary behavior in adolescent girls were nutritional
status and body image. Even though knowledge, age, pocket
money, and peers had no statistical effect in this study,
interventions carried out to change the dietary behavior of
adolescent girls to a healthy diet should also consider these
factors. Subsequent studies use different research instruments
so that they can assess variables more validly and reduce bias.
REFERENCES
[1] A. R. Kansra, S. Lakkunarajah, and M. S. Jay, “Childhood and
Adolescent Obesity: A Review,” Frontiers in Pediatrics, vol. 8.
Frontiers Media S.A., Jan. 12, 2021. doi: 10.3389/fped.2020.581461.
[2] J. K. Das et al., “Nutrition in adolescents: physiology, metabolism,
and nutritional needs,” Annals of the New York Academy of Sciences,
vol. 1393, no. 1. Blackwell Publishing Inc., pp. 21–33, Apr. 01, 2017.
doi: 10.1111/nyas.13330.
[3] S. A. Widyaningtyas and A. Kartini, “HUBUNGAN USIA
MENARCHE DENGAN OBESITAS PADA REMAJA PUTRI DI
SMA THERESIANA 1 SEMARANG,” 2013. [Online]. Available:
http://ejournal-s1.undip.ac.id/index.php/jnc
[4] J. H. Pfeifer and E. T. Berkman, “The Development of Self and
Identity in Adolescence: Neural Evidence and Implications for a
Value-Based Choice Perspective on Motivated Behavior,” Child Dev
Perspect, vol. 12, no. 3, pp. 158–164, Sep. 2018, doi:
10.1111/cdep.12279.
[5] T. Heiman and D. Olenik-Shemesh, “Perceived body appearance and
eating habits: The voice of young and adult students attending higher
education,” Int J Environ Res Public Health, vol. 16, no. 3, Jan. 2019,
doi: 10.3390/ijerph16030451.
[6] M. Abdullatif, K. AlAbady, A. Altheeb, F. Rishmawi, H. Jaradat, and
S. Farooq, “Prevalence of Overweight, Obesity, and Dietary
Behaviors among Adolescents in Dubai Schools: A Complex Design
Survey 2019,” Dubai Medical Journal, vol. 5, no. 1, pp. 1–9, Nov.
2021, doi: 10.1159/000519863.
[7] Ministry of Health Republic of Indonesia, “Indonesia Basic Health
Research 2013,” Jakarta, 2013.
[8] T. Hormenu, “Dietary intake and its associated factors among in-
school adolescents in Ghana,” PLoS One, vol. 17, no. 5 May, May
2022, doi: 10.1371/journal.pone.0268319.
[9] Ministry of Health Republic of Indonesia, “Indonesia Basic Health
Research 2018,” Jakarta, 2018.
[10] D. A. Bundy, N. de Silva, S. Horton, D. T. Jamison, and G. C. Patton,
“Child and Adolescent Health and Development 8 VOLUME
DISEASE CONTROL PRIORITIES • THIRD EDITION,”
Washington DC, 2017.
[11] N. U. Habibah, A. F. A. Tsani, and S. DW, “The effect of Korean wave
on body image and eating disorders among female adolescents in
Yogyakarta, Indonesia,” Indonesian Journal of Clinical Nutrition, vol.
18, no. 2, p. 78, Oct. 2021, doi: 10.22146/ijcn.63151.
[12] C. N. Rachmi, H. Jusril, I. Ariawan, T. Beal, and A. Sutrisna, “Eating
behaviour of Indonesian adolescents: A systematic review of the
literature,” Public Health Nutrition. Cambridge University Press,
2020. doi: 10.1017/S1368980020002876.
[13] V. S. Helgeson, “Psychology of Gender,” New York, May 2017.
[Online]. Available: www.routledge.com/cw/Helgeson
[14] K. S. N. Liu, J. Y. Chen, M. Y. C. Ng, M. H. Y. Yeung, L. E. Bedford,
and C. L. K. Lam, “How does the family influence adolescent eating
habits in terms of knowledge, attitudes and practices? A global
systematic review of qualitative studies,” Nutrients, vol. 13, no. 11.
MDPI, Nov. 01, 2021. doi: 10.3390/nu13113717.
[15] A. O. Safitri, R. Novrianto, and A. K. E. Marettih, “BODY
DISSATISFACTION DAN PERILAKU DIET PADA REMAJA
PEREMPUAN,” Psibernetika, vol. 12, no. 2, Feb. 2020, doi:
10.30813/psibernetika.v12i2.1673.
[16] E. A. Parker et al., “Diet quality of elementary and middle school
teachers is associated with healthier nutrition-related classroom
practices,” Prev Med Rep, vol. 18, Jun. 2020, doi:
10.1016/j.pmedr.2020.101087.
[17] D. Y. Putri, “Faktor-faktor Yang Berhubungan Dengan Perilaku
Makan Pada Remaja Putri di SMA Negeri 10 Padang,” Jurnal
Keperawatan Komunitas, vol. 1, no. 1, pp. 1–10, 2014.
[18] R. Nurjanah, “Faktor-faktor Pola Makan Pada Remaja di SMK Negeri
4 Yogyakarta,” Universitas Negeri Yogyakarta, Yogyakarta, 2017.
[19] K. Mulgrew, “Puberty and Body Image,” in Encyclopedia of Child
and Adolescent Development, 1st ed., S. Hupp and J. Jewell, Eds.
Wiley , 2020, pp. 1–9.
[20] Z. Shaluhiyah, R. Indraswari, and A. Kusumawati, “Faktor-Faktor
yang Mempengaruhi Tingkat Asupan Gizi dan Praktik Makan pada
Remaja Putri Usia 15-19 Years di Pedesaan Jawa Tengah Factors
Influencing the Dietary Intake and Eating Practices among Adolescent
Girls Aged 15-19 in Rural Area Central Java,” Amerta Nutr, pp. 105–
114, 2021, doi: 10.20473/amnt.v5i2.2021.
[21] S. Mama Chabi, N. Fanou-Fogny, E. Nago Koukoubou, B. Deforche,
and W. van Lippevelde, “Factors Explaining Adolescent Girls’ Eating
Habits in Urban Benin: A Qualitative Study,” Adolescents, vol. 2, no.
2, pp. 205–219, Apr. 2022, doi: 10.3390/adolescents2020017.
[22] P. M. Amos, F. D. Intiful, and L. Boateng, “Factors that were found
to influence Ghanaian Adolescents’ Eating Habits,” Sage Open, vol.
2, no. 4, pp. 1–6, Oct. 2012, doi: 10.1177/2158244012468140.
[23] H. Cena and P. C. Calder, “Defining a healthy diet: Evidence for the
role of contemporary dietary patterns in health and disease,” Nutrients,
vol. 12, no. 2. MDPI AG, Feb. 01, 2020. doi: 10.3390/nu12020334.
[24] C. Molnar et al., “Concepts of Biology-1st Canadian Edition,”
Victoria, 2015.
[25] A. Kabir, S. Miah, and A. Islam, “Factors influencing eating behavior
and dietary intake among resident students in a public university in
Bangladesh: A qualitative study,”PLoS One, vol. 13, no. 6, Jun. 2018,
doi: 10.1371/journal.pone.0198801.
[26] N. M. Eze et al., “Awareness of food nutritive value and eating
practices among Nigerian bank workers,” Medicine (United States),
vol. 96, no. 10, Mar. 2017, doi: 10.1097/MD.0000000000006283.
[27] C. Stangor and J. Walinga, “Introduction to Psychology-1st Canadian
Edition,” 2015.
[28] M. Sharma, R. Kupka, V. Tyler, and V. Aguayo, “Programming
Guidance: Nutrition in Middle Childhood and Adolescent,” New
York, 2021.
[29] S. C. Schmidt, A. Bosy-Westphal, C. Niessner, and A. Woll,
“Representative Body Composition Percentile From Bioelectrical
Impedance Analyses Among Children and Adolescent: The Momo
Study,” Clinical Nutrition, vol. 38, no. 6, pp. 2712–2720, 2019.
[30] S. M. Robinson, “Improving nutrition to support healthy ageing: What
are the opportunities for intervention?,” in Proceedings of the
Nutrition Society, Aug. 2018, vol. 77, no. 3, pp. 257–264. doi:
10.1017/S0029665117004037.
[31] A. Soliman et al., “Nutritional interventions during adolescence and
their possible effects,” Acta Biomedica, vol. 93, no. 1, Mar. 2022, doi:
10.23750/abm.v93i1.12789.
[32] C. R. Titaley, I. Ariawan, D. Hapsari, A. Muasyaroh, and M. J. Dibley,
“Determinants of the stunting of children under two years old in
Indonesia: A multilevel analysis of the 2013 Indonesia basic health
survey,” Nutrients, vol. 11, no. 5, May 2019, doi:
10.3390/nu11051106.
[33] P. Arum, L. Putri, and H. Warsito, “DIETARY KNOWLEDGE,
BODY IMAGE, AND DIETARY PRACTICES IN 18-20 YEAR
OLD YOUNG WOMEN.”
[34] C. D. Pfledderer et al., “Mothers’ Diet and Family Income Predict
Daughters’ Healthy Eating,” Prev Chronic Dis, vol. 18, 2021, doi:
10.5888/PCD18.200445.
[35] R. A. Putri, Z. Shaluhiyah, and A. Kusumawati, “FAKTOR-FAKTOR
YANG BERHUBUNGAN DENGAN PERILAKU MAKAN SEHAT
PADA REMAJA SMA DI KOTA SEMARANG,” vol. 8, no. 4, 2020,
[Online]. Available: http://ejournal3.undip.ac.id/index.php/jkm
[36] V. L. Gadsden, M. Ford, and H. Breiner, Parenting matters:
Supporting parents of children ages 0-8. National Academies Press,
2016. doi: 10.17226/21868.

International Journal of Advanced Health Science and Technology
Multidisciplinary :Rapid Review :Open Access Journal e-ISSN:2808-6422; p-ISSN:2829-3037
Vol. 3 No.2, April 2023, pp:72-78
Homepage: ijahst.org 78
[37] G. W. N. Tay et al., “Children’s perceptions of factors influencing
their physical activity: a focus group study on primary school
children,” Int J Qual Stud Health Well-being, vol. 16, no. 1, 2021, doi:
10.1080/17482631.2021.1980279.
[38] G. Tomé, M. Matos, C. Simões, J. A. Diniz, and I. Camacho, “How
can peer group influence the behavior of adolescents: explanatory
model.,” Glob J Health Sci, vol. 4, no. 2, pp. 26–35, 2012, doi:
10.5539/gjhs.v4n2p26.