Overvaluation of shape and weight among overweight children and adolescents with loss of control eating

Addressing psychosocial health in the treatment and care of adolescents with obesity

Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self-directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self-esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer-term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.

Measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in adolescents and adults

Adolescence is a common period for eating disorder (ED) onset. The availability of psychometrically sound measures of ED psychopathology enables clinicians to accurately assess symptoms and monitor treatment outcomes continuously from adolescence and adulthood. The purpose of this study was to assess if the Eating Pathology Symptoms Inventory (EPSI) is invariant across adolescents and adults. Participants (N = 29,821) were adolescent (n = 5250) and adult (n = 24,571) users of the Recovery Record (RR) mobile phone application who provided EPSI responses through the application. Measurement invariance testing was conducted to assess invariance of the EPSI Body Dissatisfaction, Restricting, Excessive Exercise, Purging, Cognitive Restraint, and Binge Eating scales across adolescents (age 13 through 17) and adults (age 18 and older). Findings indicated that all EPSI factors administered in the RR app replicated in both adolescent and adult users. The EPSI factor structure was largely equivalent in adolescents and adults, demonstrating evidence for configural and metric invariance, as well as some evidence for scalar invariance. Our results indicated that EPSI scales measured the same constructs across development. Clinicians and researchers may benefit from utilizing the EPSI to measure ED psychopathology in adolescents and for continued progress monitoring into adulthood.

Sex differences in eating related behaviors and psychopathology among adolescent military dependents at risk for adult obesity and eating disorders

Stressors unique to military families may place dependents of military service members of both sexes at high-risk for disordered-eating. Yet, there are no data examining sex-related differences in eating pathology and distress among this population. Therefore, we examined disordered-eating attitudes and associated psychosocial characteristics in adolescent military dependents at high-risk for both eating disorders and adult obesity (i.e., BMI ≥ 85th percentile and elevated anxiety symptoms and/or loss-of-control eating). One-hundred-twenty-five (55.2% female) adolescent (12-17 y) military dependents were studied prior to entry in an eating disorder and obesity prevention trial. Youth were administered the Eating Disorder Examination interview to determine disordered-eating attitudes, and completed questionnaires to assess self-esteem, social functioning, and depression. Girls and boys did not differ in BMIz (p = .66) or race/ethnicity (p = .997/p = .55). Adjusting for relevant covariates, girls and boys did not differ significantly with regard to disordered-eating global scores (p = .38), self-esteem (p = .23), or social functioning (p = .19). By contrast, girls reported significantly more symptoms of depression (p = .001). Adolescent male and female dependents at high-risk for eating disorders and adult obesity reported comparable levels of eating-related and psychosocial stress. Data are needed to elucidate how adolescent military dependents respond to intervention and whether sex moderates outcome.

Network analysis of pediatric eating disorder symptoms in a treatment-seeking, transdiagnostic sample

Classifying eating disorders in youth is challenging in light of developmental considerations and high rates of diagnostic migration. Understanding the transactional relationships among eating disorder symptoms, both across the transdiagnostic spectrum and within specific diagnostic categories, may clarify which core eating disorder symptoms contribute to, and maintain, eating-related psychopathology in youth. We utilized network analysis to investigate interrelationships among eating disorder symptoms in 636 treatment-seeking children and adolescents (90.3% female) ages 6-18 years (M age = 15.4 ± 2.2). An undirected, weighted network of eating disorder symptoms was created using behavioral and attitudinal items from the Eating Disorder Examination. Across diagnostic groups, symptoms reflecting appearance-related concerns (e.g., dissatisfaction with shape and weight) and dietary restraint (e.g., a desire to have an empty stomach) were most strongly associated with other eating disorder symptoms in the network. Binge eating and compensatory behaviors (e.g., self-induced vomiting) were strongly connected to one another but not to other symptoms in the network. Network connectivity was similar across anorexia nervosa, bulimia nervosa, and otherwise specified feeding or eating disorder subgroups. Among treatment-seeking children and adolescents, dietary restraint and shape- and weight-related concerns appear to play key roles in the psychopathology of eating disorders, supporting cognitive-behavioral theories of onset and maintenance. Similarities across diagnostic categories provide support for a transdiagnostic classification scheme. Clinical interventions should seek to disrupt these symptoms early in treatment to achieve maximal outcomes. (PsycINFO Database Record

Form and formulation: Examining the distinctiveness of body image constructs in treatment-seeking patients with binge-eating disorder

OBJECTIVE

Body-image disturbance is a core aspect of eating disorders, yet the clinical manifestations of individuals' weight and shape concerns are complex, vary considerably, and are poorly understood by clinicians and researchers. This study aimed to distinguish different aspects of body-image disturbance-including weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain-in patients with binge-eating disorder (BED). Examining how each specific body image construct relates to biopsychosocial features of BED could contribute to the refinement of conceptualization and treatment planning.

METHOD

The current study assessed body-image disturbance and eating-disorder psychopathology in 748 treatment-seeking patients with BED using established investigator-based interviews reliably administered by doctoral clinicians.

RESULTS

The 4 body image constructs, although related to one another, showed some important similarities in associations with biopsychosocial clinical features, as well as some important distinctions. The relation between overvaluation and self-esteem was, as conceptualized, more strongly negative than for other body image variables, and preoccupation was more associated than other body image variables with eating concerns. Biopsychosocial features of BED were associated with different forms of body-image disturbance, but associations of body image variables with body mass index (BMI) were not significant and associations with binge-eating frequency did not differ across body image variables.

CONCLUSION

Manifestations of body-image disturbance in BED are complex and understanding the distinctions between different body image constructs can contribute to treatment formulation. (PsycINFO Database Record

Secretive eating among youth with overweight or obesity

PURPOSE

Secretive eating, characterized by eating privately to conceal being seen, may reflect eating- and/or body-related shame, be associated with depression, and correlate with binge eating, which predicts weight gain and eating disorder onset. Increasing understanding of secretive eating in youth may improve weight status and reduce eating disorder risk. This study evaluated the prevalence and correlates of secretive eating in youth with overweight or obesity.

METHODS

Youth (N = 577) presented to five research/clinical institutions. Using a cross-sectional design, secretive eating was evaluated in relation to eating-related and general psychopathology via linear and logistic regression analyses.

RESULTS

Secretive eating was endorsed by 111 youth, who were, on average, older than youth who denied secretive eating (mean age = 12.07 ± 2.83 versus 10.97 ± 2.31). Controlling for study site and age, youth who endorsed secretive eating had higher eating-related psychopathology and were more likely to endorse loss of control eating and purging than their counterparts who did not endorse secretive eating. Groups did not differ in excessive exercise or behavioral problems. Dietary restraint and purging were elevated among adolescents (≥13y) but not children (<13y) who endorsed secretive eating; depression was elevated among children, but not adolescents, who endorsed secretive eating.

CONCLUSIONS

Secretive eating may portend heightened risk for eating disorders, and correlates of secretive eating may differ across pediatric development. Screening for secretive eating may inform identification of problematic eating behaviors, and understanding factors motivating secretive eating may improve intervention tailoring.

Prevalence of binge and loss of control eating among children and adolescents with overweight and obesity: An exploratory meta-analysis

OBJECTIVE

Due to the inconsistency of the research findings in the current literature, the prevalence of binge and loss of control (LOC) eating among children and adolescents with overweight and obesity remains unclear. By using the meta-analytic approach, this article aimed at exploring the prevalence of binge/LOC eating among children and adolescents with overweight and obesity, and at identifying potential moderators, which may have contributed to the heterogeneity of the existing research findings.

METHOD

Four electronic databases (PubMed, Web of Science, EBSCOhost, and ProQuest Dissertations & Theses Global) were searched. The search period covered the research literature up to April 2016. A random-effects meta-analysis model was used to estimate the overall prevalence. Weighted random-effects model ANOVAs and univariate random-effects meta-regression were applied for the analysis of categorical moderators and continuous moderators, respectively.

RESULTS

Thirty-six studies were identified. The overall prevalence of binge/LOC eating was estimated to be 26.3% (95% CI: 23.1-29.7%), with 22.2% (95% CI: 18.6-26.3%) and 31.2% (95% CI: 26.1-36.9%) for binge eating and LOC eating, respectively. Treatment status, binge eating vs. LOC eating and assessment methods appeared to be associated with the inconsistencies of the prevalence rates across the studies.

DISCUSSION

The findings of this meta-analysis indicated that binge/LOC eating was prevalent among more than one quarter of children and adolescents with overweight and obesity. Considering the close relationship between disordered eating behaviors and obesity, future research concerning overweight and obesity among children and adolescents needs to take binge/LOC eating into consideration. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:91-103).

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Prospective association between overvaluation of weight and binge eating among overweight adolescent girls

PURPOSE

We investigated whether overvaluation of weight, defined as having a high degree of concern with weight such that it unduly influences self-evaluation, was prospectively associated with binge eating onset among overweight adolescent girls and whether overvaluation of weight signaled greater impairment among those with weekly binge eating.

METHODS

We used generalized estimating equations to assess the prospective association between weight overvaluation at Time 1 and the onset of weekly binge eating at Time 2 among 767 overweight adolescent girls (ages 12-18 years) participating in the Growing Up Today Study. In a cross-sectional analysis of overweight girls with weekly binge eating at Time 2, we examined whether overvaluation of weight was associated with greater impairment assessed by examining their rates of more severe depressive symptoms and low subjective social status.

RESULTS

At Time 1, 24.5% of overweight/obese girls overvalued weight. Overweight girls who overvalued weight were more likely to have started binge eating weekly 2 years later (odds ratio, 2.9; 95% confidence interval [CI], 1.2-7.3). Among overweight girls who reported weekly binge eating at Time 2, those who overvalued weight were at greater risk of having more severe depressive symptoms (odds ratio, 10.4; 95% CI, 1.3-85.6). Also among girls with weekly binge eating at Time 2, we saw a significant association between continuous measures of overvaluation and subjective social status (β, .71; 95% CI, .08-1.34) but not in analyses using binary measures.

CONCLUSIONS

We found that overvaluation was associated with the development of weekly binge eating in overweight girls and with greater impairment among those with weekly binge eating.

Pediatric feeding and eating disorders: current state of diagnosis and treatment

The Diagnostic and Statistical Manual of Mental Disorders now recognizes six primary feeding and eating disorders including pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa and binge-eating disorder. Guided by research from the past 3 years, the current review outlines diagnostic criteria for each disorder, their clinical correlates and treatment options. Recent modifications to diagnostic criteria will likely help to improve treatment outcomes and prognosis. Nevertheless, several concerns remain regarding the validity of current diagnostic criteria for youth, including the clinical relevance of the size and frequency of binge eating episodes. Additionally, the lack of randomized controlled trials has led to an overreliance on data from quasi-experimental studies, case series and single case studies that impede development of strong clinical recommendations for treating feeding and eating disorders. Recommendations for future research include identifying empirically supported treatments and prevention programs focused on early markers of pediatric feeding and eating concerns.

Binge eating in obese adolescents: an evolutionary concept analysis

PURPOSE

The purpose of this paper is to provide an analysis of the concept of binge eating in obese adolescents.

METHODS

Rodgers' evolutionary approach was used to frame this analysis. A search was conducted within the Cumulative Index to Nursing and Allied Health Literature, Medline, and PsycINFO for publications between 1980 and 2011.

FINDINGS

Conceptual shifts in the meaning of binge eating have occurred over the past 30 years, yet the two enduring attributes are consumption of a large amount of food and a loss of control over eating.

CONCLUSION

Though this analysis demonstrates a consensus concerning the core attributes of binge eating, further refinement of the nuances, subtleties, and use of the concept in relation to adolescents is needed.

Loss of control eating with and without the undue influence of weight or shape on self-evaluation: evidence from an adolescent population

BACKGROUND

The overvaluation of weight and/or shape ("overvaluation"), a diagnostic criterion for anorexia nervosa and bulimia nervosa, is increasingly supported for inclusion in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria of binge eating disorder (BED). However, current evidence has been largely confined to adult populations. The current study aims to examine the status of overvaluation among adolescents with loss of control (LOC) eating recruited from a large, population-based sample.

METHOD

Subgroups of female adolescents - LOC eating with overvaluation (n = 30); LOC eating without overvaluation (n = 58); obese no LOC eating ("obese control") (n = 36); and "normal-weight control" (normal-weight, no LOC eating) (n = 439) - recruited from secondary schools within the Australian Capital Territory (ACT) were compared on measures of eating disorder psychopathology, general psychological distress and quality of life.

RESULTS

Participants in the LOC eating with overvaluation subgroup reported significantly higher levels of eating disorder psychopathology than all other groups, while levels did not differ between participants in the LOC eating without overvaluation and obese control subgroups. On measures of distress and quality of life there were no significant differences between LOC eating with and without overvaluation subgroups. Both reported significantly greater distress and quality of life impairment than normal-weight controls. LOC eating with overvaluation participants had significantly higher levels of distress and quality of life impairment than obese controls, whereas scores on these measures did not differ between LOC eating without overvaluation and obese control subgroups.

CONCLUSION

The results suggest that the presence of overvaluation among adolescents with LOC eating indicates a more severe disorder in terms of eating disorder psychopathology, however may not indicate distress and disability as clearly as it does among adults with BED.