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Belle SH, Berk PD, Courcoulas AP, Flum DR, Miles CW, Mitchell JE, Pories WJ, Wolfe BM, Yanovski SZ. Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery. Surg Obes Relat Dis 2007; 3:116-26. [PMID: 17386392 PMCID: PMC3805365 DOI: 10.1016/j.soard.2007.01.006] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 01/22/2007] [Accepted: 01/23/2007] [Indexed: 01/17/2023]
Abstract
BACKGROUND Obesity is a leading health concern in the United States. Because traditional treatment approaches for weight loss are generally unsuccessful in the long term, bariatric surgical procedures are increasingly being performed to treat extreme obesity. To facilitate research in this field, the National Institute of Diabetes and Digestive and Kidney Diseases responded to this knowledge gap by establishing the Longitudinal Assessment of Bariatric Surgery (LABS) consortium. METHODS A competitive National Institute of Diabetes and Digestive and Kidney Diseases grant process resulted in the creation of a group of investigators with expertise in bariatric surgery, internal medicine, endocrinology, behavioral science, outcomes research, epidemiology, biostatistics, and other relevant fields. These investigators have worked closely to plan, develop, and conduct the LABS study. The LABS consortium protocol is a prospective, multicenter observational cohort study of consecutive patients undergoing bariatric surgery at 6 clinical centers. LABS includes an extensive database of information systematically collected preoperatively, at surgery, perioperatively during the 30-day postoperative period, and longer term. RESULTS The LABS study has been organized into 3 phases. LABS-1 will include all patients > or =18 years of age who have undergone bariatric surgery by LABS-certified surgeons with the goal to evaluate the short-term safety of bariatric surgery. LABS-2, a subset of approximately 2400 LABS-1 patients, will evaluate the relationship of patient and surgical characteristics to the longer term safety and efficacy of bariatric surgery. LABS-3 will involve a subset of LABS-2 subjects who will undergo detailed studies of mechanisms involved in weight change. The rationale, goals, and approach to study bariatric surgery are detailed in this report, along with a description of the outcomes, measures, and hypotheses used in LABS-1 and -2. CONCLUSION The goal of the LABS consortium is to accelerate clinical research and understanding of extreme obesity and its complications by evaluating the risks and benefits of bariatric surgery. LABS investigators use standardized definitions, high-fidelity data collection, and validated instruments to enhance the ability of clinicians to provide meaningful evidence-based recommendations for patient evaluation, selection for surgery, and follow-up care.
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Kaplan LM, Klein S, Boden G, Brenner DA, Gostout CJ, Lavine JE, Popkin BM, Schirmer BD, Seeley RJ, Yanovski SZ, Cominelli F. Report of the American Gastroenterological Association (AGA) Institute Obesity Task Force. Gastroenterology 2007; 132:2272-5. [PMID: 17498517 DOI: 10.1053/j.gastro.2007.03.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Theim KR, Tanofsky-Kraff M, Salaita CG, Haynos AF, Mirch MC, Ranzenhofer LM, Yanovski SZ, Wilfley DE, Yanovski JA. Children's descriptions of the foods consumed during loss of control eating episodes. Eat Behav 2007; 8:258-65. [PMID: 17336796 PMCID: PMC1820891 DOI: 10.1016/j.eatbeh.2006.10.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 08/14/2006] [Accepted: 10/31/2006] [Indexed: 11/23/2022]
Abstract
Binge and loss of control (LOC) eating appear to be common among youth; however, little is known about the foods consumed during such eating episodes. Two-hundred forty-nine children, age 6-18 years, were interviewed to determine if they engaged in eating episodes with LOC over the past month. In the absence of reported LOC eating, overeating episodes or normal meals without LOC were recorded. Participants were asked to describe the type and quantity of foods eaten during an episode. Eighty-one children reported LOC eating episodes and 168 reported no such episodes (No LOC). Although total energy intake did not differ between LOC and No LOC episodes, LOC episodes consisted of a lower percentage of calories from protein (14.2+/-0.7 v. 18.0+/-0.7%, p<.001) and a higher percentage from carbohydrates (49.8+/-1.6 v. 45.2+/-1.1%, p<.05). Specifically, LOC episodes consisted of a higher percentage of calories from snacks (13.2+/-2.7 v. 7.4+/-1.2%, p<.05) and desserts (18.1+/-3.1 v. 12.8+/-1.5%, p<.05). The quality of LOC episodes may help explain why LOC eating promotes excessive weight gain among children who report such episodes.
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Tanofsky-Kraff M, Theim KR, Yanovski SZ, Bassett AM, Burns NP, Ranzenhofer LM, Glasofer DR, Yanovski JA. Validation of the emotional eating scale adapted for use in children and adolescents (EES-C). Int J Eat Disord 2007; 40:232-40. [PMID: 17262813 PMCID: PMC1995096 DOI: 10.1002/eat.20362] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Eating in response to negative emotions is associated with binge or loss of control (LOC) eating in adults. Although children report engaging in LOC eating, data on emotional eating among youth are limited. METHOD We adapted the adult Emotional Eating Scale (Arnow et al., Int J Eat Disord, 18, 79-90, 1995) to be used with children and adolescents (EES-C). Fifty-nine overweight (BMI > or = 95th percentile for age and sex) and 100 non-overweight (BMI 5th-94th percentile) participants (mean age +/- SD 14.3 +/- 2.4 years) completed the EES-C, and measures of recent LOC eating and general psychopathology. Test-retest reliability was assessed in 64 children over a 3.4 +/- 2.6 month interval. RESULTS A factor analysis generated three subscales: eating in response to anxiety, anger, and frustration (EES-C-AAF), depressive symptoms (EES-C-DEP), and feeling unsettled (EES-C-UNS). Internal consistency for the subscales was established; Cronbach's alphas for the EES-C-AAF, EES-C-DEP, and EES-C-UNS were 0.95, 0.92, and 0.83, respectively. The EES-C had good convergent validity: children reporting recent LOC eating episodes scored higher on all subscales (p's < 0.05). The EES-C-AAF and EES-C-UNS subscales demonstrated good discriminant validity and the EES-C-DEP revealed adequate discriminant validity. Intra-class correlation coefficients revealed good temporal stability for each subscale (EES-C-AAF = 0.59, EES-C-DEP = 0.74, EES-C-UNS = 0.66; p's < 0.001). CONCLUSION The EES-C has good convergent and discriminant validity, and test-retest reliability for assessing emotional eating in children. Further investigation is required to clarify the role emotional eating may play in children's energy intake and body weight.
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Fleisch AF, Agarwal N, Roberts MD, Han JC, Theim KR, Vexler A, Troendle J, Yanovski SZ, Yanovski JA. Influence of serum leptin on weight and body fat growth in children at high risk for adult obesity. J Clin Endocrinol Metab 2007; 92:948-54. [PMID: 17179198 PMCID: PMC1862865 DOI: 10.1210/jc.2006-1390] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our objective was to examine serum leptin prospectively as a predictor of weight and body fat growth in children at high risk for adult obesity. We hypothesized that leptin measurements would be positively associated with increased growth of adipose tissue because children with high baseline leptin for their body fat mass have greater leptin resistance and thus would have greater susceptibility to weight gain. METHODS Children ages 6-12 yr at high risk for adult obesity because of early-onset childhood overweight and/or parental overweight were recruited from 1996-2004. Growth in body mass index (BMI) was studied in 197 children, and growth in total body fat mass was examined in 149 children over an average follow-up interval of 4.4 yr (range, 1-8 yr). Longitudinal analyses accounted for sex, race, socioeconomic status, initial body composition, age, skeletal age, and physical activity and included all available interim visits for each individual so that a total of 982 subject visits were included in the analysis. RESULTS At baseline, 43% of children studied were overweight (BMI > or = 95th percentile); during follow-up, an additional 14% became overweight. Independent of initial body composition, baseline leptin was a statistically significant positive predictor of increased BMI (P = 0.0147) and increased total body fat mass (P < 0.007). CONCLUSIONS High serum leptin, independent of body fat, may be an indicator of increased leptin resistance, which predisposes children at high risk for adult obesity to somewhat greater growth in weight and body fat during childhood.
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Young-Hyman D, Tanofsky-Kraff M, Yanovski SZ, Keil M, Cohen ML, Peyrot M, Yanovski JA. Psychological status and weight-related distress in overweight or at-risk-for-overweight children. Obesity (Silver Spring) 2006; 14:2249-58. [PMID: 17189553 PMCID: PMC1862955 DOI: 10.1038/oby.2006.264] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To associate psychological status, weight-related distress, and weight status during childhood in overweight or at-risk-for-overweight children. RESEARCH METHODS AND PROCEDURES We associated self-report of depression, trait anxiety, and weight-related distress (body size dissatisfaction and weight-related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 +/- 2.5 years; girls 51%) who were overweight or at-high-risk-for-overweight and were not seeking weight loss. RESULTS Overall, heavier children reported more psychological and weight-related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight-related distress than boys. Depression was associated with weight-related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction. DISCUSSION Regardless of race or sex, increasing weight is associated with emotional and weight-related distress in children. However, associations of psychological status, weight, and weight-related distress differ for girls and boys, and for black and white children.
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Mirch MC, McDuffie JR, Yanovski SZ, Schollnberger M, Tanofsky-Kraff M, Theim KR, Krakoff J, Yanovski JA. Effects of binge eating on satiation, satiety, and energy intake of overweight children. Am J Clin Nutr 2006; 84:732-8. [PMID: 17023698 PMCID: PMC1864961 DOI: 10.1093/ajcn/84.4.732] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children who report episodes of binge eating gain more weight than do children not reporting binge eating. However, how binge eating affects children's food intake at meals is unknown. OBJECTIVE We compared the energy intake and postmeal satiety of children with and without a history of binge eating during buffet meals. DESIGN Sixty overweight children aged 6-12 y were categorized into those reporting past binge-eating episodes (n = 10) and those reporting no such episodes (n = 50). Children selected lunch twice from a multiple-item, 9835 kcal, buffet meal: after an overnight fast and after a standardized breakfast. Children ate ad libitum, until they reported they were full. The main outcome measures were energy intake during meals and duration of postmeal satiety, after adjustment for covariates, including age, race, sex, socioeconomic status, and body composition. RESULTS After the overnight fast, children in the binge-eating group consumed more energy [x (+/-SD): 1748 +/- 581 compared with 1309 +/- 595 kcal; P = 0.04] and exhibited a shorter satiety duration (194 +/- 84 compared with 262 +/- 89 min; P = 0.03) than did children in the non-binge-eating group. After the standardized breakfast, binge-eating children reported a shorter satiety duration (75 +/- 62 compared with 132 +/- 62 min; P = 0.01) and consumed more energy at the postbreakfast meal (1874 +/- 560 compared with 1275 +/- 566 kcal; P = 0.004). CONCLUSION The ability to consume large quantities of palatable foods, coupled with decreased subsequent satiety, may play a role in the greater weight gain found in binge-eating children.
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Tanofsky-Kraff M, Rahimi AM, Yanovski SZ, Ranzenhofer LM, Roberts MD, Theim KR, Menzie CM, Mirch MC, Yanovski JA. Differences between the perceived and actual age of overweight onset in children and adolescents. MEDGENMED : MEDSCAPE GENERAL MEDICINE 2006; 8:18. [PMID: 17406158 PMCID: PMC1781270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Little is known about whether children or their parents can accurately recall the age at which they became overweight. DESIGN, SUBJECTS AND MAIN OUTCOME MEASURES: We interviewed 64 overweight children (7-18 years old) about their weight history and compared reported age of overweight onset with actual onset, as determined by the age at which the child's measured BMI first exceeded the 95th percentile. RESULTS Only 28% of children reported overweight onset within 1 year of actual overweight onset. Reported overweight onset age (7.6 +/- 2.5 y) and actual onset age (5.3 +/- 2.5 y; P < .001) were not significantly correlated (r2 = .03, P = .22). Children who became overweight before 8 years of age tended to report becoming overweight at a later age than actual onset, whereas children who became overweight after 8 years of age tended to report becoming overweight at an earlier age than actual onset (P < .001), with 27% of children either underreporting or overreporting their overweight onset by at least 5 years. Similar results were found when analyzing parent reports of their children's overweight onset. CONCLUSIONS Reported and actual overweight onset ages were uncorrelated in our sample, suggesting that families may not be cognizant of children's growth trajectories. Greater efforts should be made to help parents and children understand and track growth patterns with the aim of preventing excessive weight gain.
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Glasofer DR, Tanofsky-Kraff M, Eddy KT, Yanovski SZ, Theim KR, Mirch MC, Ghorbani S, Ranzenhofer LM, Haaga D, Yanovski JA. Binge eating in overweight treatment-seeking adolescents. J Pediatr Psychol 2006; 32:95-105. [PMID: 16801323 PMCID: PMC1862866 DOI: 10.1093/jpepsy/jsl012] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the frequency and recency of binge eating in relation to psychopathology in overweight, treatment-seeking adolescents. METHODS We investigated psychological correlates of the frequency and recency of reported loss of control (LOC) eating episodes in 160 overweight (body mass index [BMI]: 40.7 +/- 8.8 kg/m(2)) adolescents. On the basis of the responses to the eating disorder examination (EDE), participants were categorized into one of four groups: full-syndrome binge eating disorder (BED); recent but infrequent binge eating (episodes within the 3 months before interview; RECENT-BINGE); remote and infrequent LOC eating (episodes occurring >3 months before assessment; PAST-LOC), or no history of LOC episodes (NE). RESULTS The BED group reported higher EDE scores (global, p < .01), and more negative mood and anxiety than all other groups (p's < .01). Compared with NE, RECENT-BINGE also reported more anxiety and higher EDE scores (p's < .01). CONCLUSIONS Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.
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Yanovski SZ. Can we predict treatment response to antiobesity medication? NATURE CLINICAL PRACTICE. ENDOCRINOLOGY & METABOLISM 2006; 2:314-5. [PMID: 16932307 DOI: 10.1038/ncpendmet0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 03/07/2006] [Indexed: 05/11/2023]
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Tanofsky-Kraff M, Cohen ML, Yanovski SZ, Cox C, Theim KR, Keil M, Reynolds JC, Yanovski JA. A prospective study of psychological predictors of body fat gain among children at high risk for adult obesity. Pediatrics 2006; 117:1203-9. [PMID: 16585316 PMCID: PMC1863068 DOI: 10.1542/peds.2005-1329] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Limited data suggest that psychological factors, including binge eating, dieting, and depressive symptoms, may predispose children to excessive weight gain. We investigated the relationship between baseline psychological measures and changes in body fat (measured with dual-energy x-ray absorptiometry) over time among children thought to be at high risk for adult obesity. METHODS A cohort study of a convenience sample of children (age: 6-12 years) recruited from Washington, DC, and its suburbs was performed. Subjects were selected to be at increased risk for adult obesity, either because they were overweight when first examined or because their parents were overweight. Children completed questionnaires at baseline that assessed dieting, binge eating, disordered eating attitudes, and depressive symptoms; they underwent measurements of body fat mass at baseline and annually for an average of 4.2 years (SD: 1.8 years). RESULTS Five hundred sixty-eight measurements were obtained between July 1996 and December 2004, for 146 children. Both binge eating and dieting predicted increases in body fat. Neither depressive symptoms nor disturbed eating attitudes served as significant predictors. Children who reported binge eating gained, on average, 15% more fat mass, compared with children who did not report binge eating. CONCLUSIONS Children's reports of binge eating and dieting were salient predictors of gains in fat mass during middle childhood among children at high risk for adult obesity. Interventions targeting disordered eating behaviors may be useful in preventing excessive fat gain in this high-risk group.
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Tanofsky-Kraff M, Faden D, Yanovski SZ, Wilfley DE, Yanovski JA. The perceived onset of dieting and loss of control eating behaviors in overweight children. Int J Eat Disord 2005; 38:112-22. [PMID: 16134103 PMCID: PMC2270699 DOI: 10.1002/eat.20158] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The current study investigated the self-reported temporal relationships of dieting, binge eating, and overweight in childhood. METHOD One hundred five non-treatment-seeking overweight children ages 6-13 years were interviewed with the children's Eating Disorder Examination (ChEDE) and queried regarding dieting, loss of control (LOC) eating, and overweight history. Questionnaires of depressive symptoms, trait anxiety, and parent-reported problems were completed. RESULTS Sixty percent of the children reported having attempted at least one diet. These children had higher ChEDE scores (global, p < .001), greater body mass index (BMI) and body fat mass (p < or = .001), and a trend towards an earlier reported age of overweight onset (p = .06) compared with children who had never dieted. The 29.5% of children who reported LOC eating had significantly higher ChEDE scores (global, p < .001), ineffectiveness, negative self-esteem, and externalizing scores (all ps < .05) compared with those who had never experienced LOC eating. Most children reported becoming overweight before either dieting (79.4%) or experiencing LOC eating (63.6%). Among the 25.7% reporting both dieting and LOC eating, two thirds reported LOC eating before dieting. Participants who reported dieting before overweight had higher negative mood scores (p < .01). Children reporting dieting before LOC eating had higher ChEDE Weight Concern (p < .01) and global (p < .05) scores. DISCUSSION For overweight, non-treatment-seeking children, both dieting and LOC eating are common. Dieting precedes the development of LOC eating only one third of the time, but is associated with greater disordered eating cognitions. The relationship between childhood-onset dieting and LOC eating in overweight children requires further investigation to determine the causal pathways for the subsequent development of eating disorders.
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Tanofsky-Kraff M, Yanovski SZ. Eating disorder or disordered eating? Non-normative eating patterns in obese individuals. ACTA ACUST UNITED AC 2005; 12:1361-6. [PMID: 15483199 DOI: 10.1038/oby.2004.171] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Binge eating disorder (BED) and night eating syndrome (NES) are putative eating disorders frequently seen in obese individuals. Data suggest that BED fulfills criteria for a mental disorder. Criteria for NES are evolving but at present do not require distress or functional impairment. It remains unclear whether BED and NES, as they are currently defined, are optimally useful for characterizing distinct patient subgroups. We propose that a distinction be made between "eating disorders" and "non-normative" eating patterns without associated distress or impairment. Although non-normative eating patterns may not be considered mental disorders, they may be very important in terms of their impact on body weight and health. More precise behavioral and metabolic characterization of subgroups with eating disorders and non-normative eating behaviors has important implications for understanding the etiology, pathophysiology, and treatment of obesity. Ultimately, better understanding of the many pathways to increased energy intake may lead to targeted strategies for prevention of overweight and obesity in at-risk individuals and populations.
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Tanofsky-Kraff M, Yanovski SZ, Yanovski JA. Comparison of child interview and parent reports of children's eating disordered behaviors. Eat Behav 2005; 6:95-9. [PMID: 15567115 PMCID: PMC2266589 DOI: 10.1016/j.eatbeh.2004.03.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Revised: 12/09/2003] [Accepted: 03/22/2004] [Indexed: 11/25/2022]
Abstract
Self-report questionnaires of child eating behavior have demonstrated poor agreement with child interview methods and parent report. However, no study has investigated the relationship between child interview and parent report. Therefore, we compared results from a diagnostic interview, the Eating Disorder Examination adapted for Children (ChEDE) to those from a questionnaire, the Adolescent Version of the Questionnaire on Eating and Weight Patterns-parent version (QEWP-P), in a nontreatment sample of overweight and normal weight children. Both instruments were administered to 88 overweight (BMI >or= 85th percentile) and 79 normal weight (BMI<85th percentile) children, age 10.2 +/- 1.7 years, recruited from the community. The ChEDE and QEWP-P were not concordant in terms of the type of eating episodes that occurred in the past month. Using the ChEDE as the criterion method, the QEWP-P had reasonably high specificity, but low sensitivity for the presence of binge episodes (sensitivity 50%, specificity 83%) or objective overeating (sensitivity 30%, specificity 79%) during the past month. ChEDE subscales were, however, significantly related to items assessing eating-related distress on the QEWP-P. While parent report of child eating behaviors may provide some general information regarding eating psychopathology in young nontreatment-seeking children, they do not accurately reflect the results of a structured interview.
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Steinberg E, Tanofsky-Kraff M, Cohen ML, Elberg J, Freedman RJ, Semega-Janneh M, Yanovski SZ, Yanovski JA. Comparison of the child and parent forms of the Questionnaire on Eating and Weight Patterns in the assessment of children's eating-disordered behaviors. Int J Eat Disord 2004; 36:183-94. [PMID: 15282688 PMCID: PMC2376841 DOI: 10.1002/eat.20022] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The assessment of eating-disordered behaviors in middle childhood is challenging. Frequently, both child and parents are queried about the child's eating behavior. However, no direct comparisons between parent and child reports of child eating disturbance have been published. We compared results from the adolescent and parent versions of the Questionnaire on Eating and Weight Patterns (QEWP-A and QEWP-P, respectively) in a nontreatment sample of overweight and normal weight children. METHOD The QEWP-A and QEWP-P were administered to 142 overweight (body mass index [BMI] > or = 85th percentile) and 121 normal weight (BMI 15th-84th percentile) children, age 9.7 +/- 1.9 years, recruited from the community. RESULTS The QEWP-A and QEWP-P showed good agreement for the absence of eating-disordered behavior but were not concordant in terms of the number or type of binge eating, overeating episodes, or compensatory weight control behaviors in the past 6 months. Children categorized by their own reports (QEWP-A) as engaging in no overeating, simple overeating, or binge eating behaviors did not differ significantly in body composition or in eating and general psychopathology. Children categorized according to their parents' reports (QEWP-P) as engaging in binge eating had significantly greater body adiposity, eating-disordered cognitions, body dissatisfaction, and parent-reported problems (all ps <.001) than children engaging in no overeating or simple overeating according to the QEWP-P. DISCUSSION Child and parent reports of eating behaviors are not concordant regarding the presence of binge eating or compensatory behaviors. Further investigation of the utility of these questionnaires is needed before either can serve as a surrogate for a clinical interview.
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Tanofsky-Kraff M, Yanovski SZ, Wilfley DE, Marmarosh C, Morgan CM, Yanovski JA. Eating-disordered behaviors, body fat, and psychopathology in overweight and normal-weight children. J Consult Clin Psychol 2004; 72:53-61. [PMID: 14756614 PMCID: PMC2630209 DOI: 10.1037/0022-006x.72.1.53] [Citation(s) in RCA: 239] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined eating-disordered pathology in relation to psychopathology and adiposity in 162 non-treatment-seeking overweight (OW) and normal weight (NW) children, ages 6-13 years. Participants experienced objective or subjective binge eating (S/OBE; loss-of-control eating), objective overeating (OO), or no episodes (NE). OW children experienced significantly higher eating-disordered cognitions and behaviors than NW children and more behavior problems than NW children: 9.3% endorsed S/OBEs, 20.4% reported OOs, and 70.4% reported NEs. OW children reported S/OBEs more frequently than did NW children (p =.01), but similar percentages endorsed OOs. S/OBE children experienced greater eating-disordered cognitions (ps from <.05 to <.01) and had higher body fat (p <.05) than OOs or NEs. OOs are common in childhood, but S/OBEs are more prevalent in OW children and associated with increased adiposity and eating-disordered cognitions.
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Yanovski SZ. Binge eating disorder and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic? Int J Eat Disord 2003; 34 Suppl:S117-20. [PMID: 12900992 DOI: 10.1002/eat.10211] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of this paper is to explore the relationship between binge eating disorder (BED) and obesity. METHODS Recent literature relating to the etiology, risk factors, pathophysiology, and treatment of binge eating disorder was reviewed. RESULTS The data suggest that binge eating may be a contributor to the development of obesity in susceptible individuals. Although eating disorders treatment in the absence of obesity treatment does not result in large weight losses, amelioration of binge eating does result in small weight losses and decreased weight regain over time. DISCUSSION Our challenge in the future is to understand better the ways in which BED and obesity co-exist, and to find treatment strategies that will relieve the distress and dysfunction due to this disordered eating while enhancing appropriate weight loss or preventing further weight gain.
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Ryan DH, Espeland MA, Foster GD, Haffner SM, Hubbard VS, Johnson KC, Kahn SE, Knowler WC, Yanovski SZ. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. ACTA ACUST UNITED AC 2003; 24:610-28. [PMID: 14500058 DOI: 10.1016/s0197-2456(03)00064-3] [Citation(s) in RCA: 565] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Overweight and obesity are major contributors to both type 2 diabetes and cardiovascular disease (CVD). Moreover, individuals with type 2 diabetes who are overweight or obese are at particularly high risk for CVD morbidity and mortality. Although short-term weight loss has been shown to ameliorate obesity-related metabolic abnormalities and CVD risk factors, the long-term consequences of intentional weight loss in overweight or obese individuals with type 2 diabetes have not been adequately examined. The primary objective of the Look AHEAD clinical trial is to assess the long-term effects (up to 11.5 years) of an intensive weight loss program delivered over 4 years in overweight and obese individuals with type 2 diabetes. Approximately 5000 male and female participants who have type 2 diabetes, are 45-74 years of age, and have a body mass index >or=25 kg/m(2) will be randomized to one of the two groups. The intensive lifestyle intervention is designed to achieve and maintain weight loss through decreased caloric intake and increased physical activity. This program is compared to a control condition given diabetes support and education. The primary study outcome is time to incidence of a major CVD event. The study is designed to provide a 0.90 probability of detecting an 18% difference in major CVD event rates between the two groups. Other outcomes include components of CVD risk, cost and cost-effectiveness, diabetes control and complications, hospitalizations, intervention processes, and quality of life.
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Tanofsky-Kraff M, Morgan CM, Yanovski SZ, Marmarosh C, Wilfley DE, Yanovski JA. Comparison of assessments of children's eating-disordered behaviors by interview and questionnaire. Int J Eat Disord 2003; 33:213-24. [PMID: 12616588 DOI: 10.1002/eat.10128] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In adults, interview methods may detect eating-disordered behaviors more accurately than self-report methods. However, no studies have investigated the relationships between interview and self-report assessments in children. We compared results from the Eating Disorder Examination adapted for Children (ChEDE) with the Adolescent version of the Questionnaire on Eating and Weight Patterns (QEWP-A) and with the Children's Eating Attitude Test (ChEAT) in a nontreatment sample of overweight and normal weight children. METHOD The ChEDE, QEWP-A, and ChEAT were administered to 46 overweight (body mass index [BMI] at or above the 85th percentile) and 42 normal weight (BMI at the 15th-85th percentile) children, 10 +/- 1.8 years, recruited from the community. RESULTS The ChEDE and QEWP-A were not concordant for the number or type of eating episodes that occurred in the past month. Compared with the ChEDE, the QEWP-A was reasonably specific, but it was not sensitive for the presence of objective (17 % sensitivity, 91% specificity) or subjective bulimic episodes (0 % sensitivity, 89 % specificity) during the past month. ChEDE and ChEAT global scores were significantly related (Kendall's tau = 0.286, p <.001), but specific items assessing guilt in relation to eating and preoccupation with food were not. DISCUSSION Although self-report methods of eating disorder assessment in children may provide some general information regarding eating psychopathology in non-treatment-seeking children, they do not accurately reflect the results of a structured interview.
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Leser MS, Yanovski SZ, Yanovski JA. A low-fat intake and greater activity level are associated with lower weight regain 3 years after completing a very-low-calorie diet. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:1252-6. [PMID: 12792622 DOI: 10.1016/s0002-8223(02)90277-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the roles of diet, exercise, and lifestyle factors in determining long-term weight regain after weight loss with a very-low-calorie diet (VLCD). SUBJECTS Twenty-seven of 38 women who lost weight with a VLCD. DESIGN Graduates of a weight loss intervention study returned for follow-up 3 years after program completion. Percentage of initial weight loss that was regained was correlated with subjects' fat intake (assessed via 7-day food records and a Diet Habit Survey), energy intake (assessed via 7-day food records), activity level and lifestyle factors (assessed via questionnaires) that are supportive of weight loss maintenance. STATISTICAL ANALYSES PERFORMED Regression analysis was used to assess the relationship of weight regain with fat intake, activity level, and energy intake. Contingency table analysis was used to assess the association between weight regain and lifestyle factors. RESULTS Subjects followed experienced a -20.7kg+/-9.2kg (-19.2%+/-7%) (mean+/-standard deviation) weight change during the original VLCD program and a 13.9kg+/-11.3kg (76.6%+/-52.1%) weight change 3 years post-VLCD. Fat intake, assessed by a 7-day food diary, was positively correlated with weight regain at 3 years (r=0.66, P=.0004). Less weight regain was also seen with a lower percent fat intake as reflected by a higher Diet Habit Survey score (r=-0.55, P=.004). Women with the lowest tertile of reported fat intake (<25% of energy) from the Diet Habit Survey regained the least amount of weight (P=.05). Activity level was negatively correlated with weight regain (r=-0.53, P=.005). After correction for multiple comparisons, there was no association between total energy intake and weight regain. Lifestyle factors were also not associated with weight regain. APPLICATIONS/CONCLUSIONS Identifying strategies to maintain weight loss is crucial because of the negative health effects and increasing prevalence of obesity. For women who have lost weight on a VLCD, limiting dietary fat intake and maintaining physical activity are both important factors for the prevention of weight regain. To promote better weight loss outcomes, registered dietitians should help clients who have lost weight limit their fat intake to less than 30% of energy and encourage high activity levels.
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Morgan CM, Yanovski SZ, Nguyen TT, McDuffie J, Sebring NG, Jorge MR, Keil M, Yanovski JA. Loss of control over eating, adiposity, and psychopathology in overweight children. Int J Eat Disord 2002; 31:430-41. [PMID: 11948648 PMCID: PMC5804341 DOI: 10.1002/eat.10038] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the relationship between loss of control over eating, adiposity, and psychological distress in a nontreatment sample of overweight children. METHOD Based on self-reports of eating episodes, 112 overweight children, 6-10 years old, were categorized using the Questionnaire of Eating and Weight Patterns-Adolescent Version into those describing episodes of loss of control over eating (LC), and those with no loss of control (NoLC). Groups were compared on measures of adiposity, dieting, and eating behavior, and associated psychological distress. RESULTS LC children (33.1%) were heavier and had greater amounts of body fat than NoLC children. They also had higher anxiety, more depressive symptoms, and more body dissatisfaction. 5.3% met questionnaire criteria for BED. Episodes of loss of control occurred infrequently, were often contextual, and involved usual meal foods. DISCUSSION As in adults, overweight children reporting loss of control over eating have greater severity of obesity and more psychological distress than those with no such symptoms. It remains unknown whether children who endorse loss of control over eating before adolescence will be those who develop the greatest difficulties with binge eating or obesity in adulthood.
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Morrison JA, Guo SS, Specker B, Chumlea WC, Yanovski SZ, Yanovski JA. Assessing the body composition of 6-17-year-old Black and White girls in field studies. Am J Hum Biol 2001; 13:249-54. [PMID: 11460870 DOI: 10.1002/1520-6300(200102/03)13:2<249::aid-ajhb1035>3.0.co;2-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of the study was to develop ethnic-specific equations for fat-free mass (FFM) from selected anthropometric dimensions and bioelectrical impedance measures of resistance (R) and reactance (Xc) for use in the NHLBI Growth and Heath Study. Using dual-energy X-ray absorptiometry measures of body composition as the dependent variable and field measures of body composition by anthropometry and bioelectrical impedance as the explanatory variables, ethnic-specific prediction equations were developed on a sample of girls representing a wide range of ages and BMI. The equations were cross-validated using (1) the Prediction of Sum of Squares (PRESS) statistic and (2) an independent sample of 20 girls of each race from a study conducted at the National Institute of Child Health and Human Development (NICHD). Subjects were 65 White and 61 Black girls 6-17 years of age. The best race-specific equations for FFM each explained 99% and 97% of the variance in the White and Black girls, respectively. Root mean square errors (RMSE) ranged from 1.14 to 1.95 kg. The equation for Black girls used Stature2/Resistance (R), weight, and reactance (Xc) as predictor variables; the equation for White girls used Stature2/R, weight, and triceps skinfold thickness. The results indicate that (1) equations to predict FFM in girls should be ethnic-specific and that (2) accurate values for TBF and %BF can be calculated from the predicted FFM.
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