Content of children's loss of control eating episodes assessed by self-report and laboratory test meal

Youth's energy intake during a laboratory-based loss-of-control eating paradigm: Associations with reported current dieting

Dieting is theorized as a risk factor for loss-of-control (LOC)-eating (i.e., feeling a sense of lack of control while eating). Support for this association has largely relied on retrospective self-report data, which does not always correlate with objectively assessed eating behavior in youth. We hypothesized that during a laboratory-based LOC-eating paradigm, children and adolescents who reported current (at the time of the visit) dieting would consume meals consistent with LOC-eating (greater caloric intake, and intake of carbohydrates and fats, but less intake of protein). Participants were presented with a buffet-style meal and instructed to "Let yourself go and eat as much as you want." Current dieting (i.e., any deliberate change to the amount or type of food eaten to influence shape or weight, regardless of how effective the changes are) was assessed via interview. General linear models were adjusted for fat mass (%), lean mass (kg), height, sex, protocol, race and ethnicity, pre-meal hunger and minutes since consumption of a breakfast shake. Of 337 participants (Mage 12.8 ± 2.7y; 62.3 % female; 45.7 % non- Hispanic White and 26.1 % non-Hispanic Black; MBMIz 0.78 ± 1.11), only 33 (9.8 %) reported current dieting. Current dieting was not significantly associated with total energy intake (F = 1.63, p = .20, ηp2 = 0.005), or intake from carbohydrates (F = 2.45, p = .12, ηp2 = 0.007), fat (F = 2.65, p = .10, ηp2 = 0.008), or protein (F = 0.39, p = .53, ηp2 = 0.001). Contrary to theories that dieting promotes LOC-eating, current dieting was not associated with youth's eating behavior in a laboratory setting. Experimental approaches for investigating dieting are needed to test theories that implicate dieting in pediatric LOC-eating.

Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).

Developmental Trajectories of Boys' Driven Exercise and Fasting During the Middle School Years

Boys appear to engage in eating disorder behavior, particularly nonpurging compensatory behaviors such as driven exercise and fasting, at higher rates than previously thought. Little is known about the development of these behaviors in adolescent boys. In a sample of 631 non-binge eating and non-purging boys studied once in 5th grade and 6 times over the 3 years of middle school (grades 6 through 8), we found that (a) for some youth, driven exercise and fasting were present from grade 6; (b) different boys progressed along different trajectories of engagement in driven exercise and fasting, with some boys engaging in no driven exercise or fasting (65.8 % and 83.5 %, respectively), some boys engaging in driven exercise and fasting throughout middle school (25.2 % and 16.5 %, respectively), and other boys discontinuing engagement in driven exercise (9 %); (c) 5th grade depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership; and (d) boys engaging in driven exercise and fasting in 8th grade remained distressed. Boys' engagement in driven exercise and fasting behavior merits the attention of researchers and clinicians.