An open trial targeting emotional eating among adolescents with overweight or obesity

Emotional Eating Prevalence and Correlates in Adolescents in the United States

Background: Adolescent obesity rates continue to rise. A better understanding of who engages in emotional eating, a maladaptive eating style, is needed. Despite emotional eating being a frequent research target, the prevalence of emotional eating in US adolescents is currently unknown. Methods: Nationally representative adolescents (n = 1622, m = 14.48 years, 63.8% non-Hispanic White, 50.6% female) reported eating behaviors in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Frequencies and one-way ANOVAs were conducted to examine the rates of emotional eating across demographic and weight status groups. Correlations between emotional eating and dietary intake were examined. Results: In total, 30% of adolescents engaged in emotional eating. Older adolescents (35% of 17-year-olds), females (39%), non-Hispanic White individuals (32%), and adolescents with obesity (44%) had significantly higher rates of emotional eating. Controlling for weight status, greater adolescent emotional eating was correlated with more frequent intake of energy-dense/nutrient-poor foods (β = 0.10, p < 0.001), junk food (β = 0.12, p < 0.001), and convenience foods (β = 0.13, p < 0.001). Conclusions: This study fills a critical gap by providing insight into how common adolescent emotional eating is and highlighting demographic factors that are associated with higher rates. Nearly a third of adolescents in the United States reported eating due to anxiety or sadness, with rates higher in older adolescents, girls, non-Hispanic White adolescents, and adolescents with obesity. Emotional eating was associated with consuming less healthy foods, which conveys immediate and long-term health risks. Practitioners can intervene with emotional eating to reduce obesity and comorbid health risks.

The effect of middle and high school students' emotional eating behavior on obesity

AIM

This study was conducted to determine the effect of middle and high school students' emotional eating behavior on obesity.

METHOD

A descriptive, correlational, and cross-sectional study design was used. The sample consisted of 267 students studying in 5th, 6th, 7th, 8th, 9th, 10th, 11th, and 12th grades. Data were collected using a Child Information Form and the Emotional Eating Scale. The researchers measured the students' height and weight and calculated their body mass indices (BMI), and BMI percentiles were evaluated according to age and gender. Percentage calculations, mean scores, Spearman correlation analysis, Pearson's correlation analysis, and multiple regression analysis were used in the analysis of the data.

RESULTS

Of the students participating in the study, 54.7% were girl and 45.3% were boy. It was determined that 28.4% of the students were overweight and obese. As a result of multiple regression analysis, it was determined that students' emotional eating behavior explained 25% of obesity (p < 0.001). It was found that anxiety-anger- frustration, one of the subscales of the emotional eating scale, was the only variable that significantly predicted students' obesity status (β = 0.387). Emotional eating significantly predicted the obesity status of boy and girl students (p < 0.001).

CONCLUSION

In this study, it was concluded that students' emotional eating behavior affected obesity.

IMPLICATIONS FOR PRACTICE

In line with these results, it is recommended that studies on other variables that may predict the effect of students' emotional eating behavior on obesity should be conducted and that nurses should contact schools to conduct emotional eating behavior screenings and provide emotional eating education for students who exhibit emotional eating behavior.

The Relationship between Depressiveness and Eating Behaviors among Women

(1) The objective of the study was to determine the relationship between depressiveness and the occurrence of eating disorders, i.e., emotional eating, uncontrolled eating, cognitive restraint of eating, and the risk of orthorexia. (2) The study was conducted among 556 women from the West Pomeranian Voivodeship (Poland). The study employed the diagnostic survey method using a questionnaire technique: The Beck Depression Inventory, the ORTO-15 Questionnaire, the Three-Factor Eating Questionnaire, and a sociodemographic questionnaire. (3) Higher depressiveness severity is associated with a higher score on the "Cognitive Restraint of Eating" scale. The authors' original study demonstrated a statistically significant relationship only between depressiveness and the "Uncontrolled Eating" subscale (p = 0.001). (4) The results of this study suggest that depressiveness is an important factor that contributes to a better understanding of eating behaviors. In addition, the results of this study suggest that eating behaviors and psychological factors should be taken into account in psychological interventions in the treatment of eating disorders. The clinical goal can be considered to be an improvement in non-normative eating behaviors, such as a reduction in overeating episodes or eating less frequently in the absence of a feeling of hunger.

Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents

OBJECTIVE

This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents.

METHOD

Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022.

RESULTS

Family-based treatment (FBT) remains a well-established treatment for overweight and obesity in children and is now well-established in adolescents and toddlers. Parent-only behavioral treatment remains well-established in children and is now well-established among adolescents and children. Possibly effective treatments continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered possibly effective including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for possibly effective treatments. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth).

CONCLUSIONS

Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.

Lace Up and Mindfulness: A Randomized Controlled Trial Intervention to Reduce Emotional Eating, Anxiety, and Sleep Disturbances in Latinx and Black Youth

This study assessed the effects of a 12-week afterschool mindfulness-based diet and exercise intervention on mental and physical health in Latinx and Black youth. One hundred forty-eight boys and girls (average age = 10.1 years, SD = 1.3 years; 52% girls; 72.3% Latinx) were randomized to either the experimental group (n = 80) or the control group (n = 68). The experimental group participants engaged in fitness yoga, kickboxing, and/or spinning sessions, and mindfulness practices (e.g., breathing, meditation, and mindful eating) twice per week for 12 weeks. The control group participants engaged in a recreational play session once per week for 12 weeks. All participants completed surveys (demographics, acculturation, anxiety, emotional eating, sleep, and food intake) and had their height, weight, and percent body fat measured pre- and post-intervention. Participants wore an accelerometer for 7 days pre- and post-intervention. Repeated measures analysis of covariance indicated that the experimental group participants reported lower scores in emotional eating, anxiety, and sleep latency post-intervention compared to the control group participants. Conversely, no significant differences were observed in physical activity between the experimental and control group participants post-intervention. These findings indicate that a mindfulness-based intervention has a positive effect on emotional eating, anxiety, and sleep latency among youth of color.

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1-9, and sessions 10-16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.

Couple and family interventions for high mortality health conditions: A strategic review (2010-2019)

The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.

Rethinking emotional eating: Retrospective and momentary indices of emotional eating represent distinct constructs

Emotional eating (EE) has been proposed as a key weight loss barrier. However, most investigations of EE rely on retrospective self-reports, which may have poor construct validity. This study evaluated concordance between a common self-report EE measure and a novel method for assessing momentary EE using ecological momentary assessment (EMA). We further assessed the utility of both measures for predicting both BMI and weight outcomes. Participants with overweight or obesity enrolled in a weight loss trial (N = 163) completed a self-report measure of EE and underwent an EMA protocol that assessed momentary emotions and eating behaviors. Momentary EE was derived from EMA data using generalized linear mixed-effects models. Linear regression models examined associations between both EE measures and concurrent BMI as well as weight losses over 30 months. Retrospectively self-reported EE and momentary EE were negatively correlated with one another (r = -0.27). Higher momentary EE and higher retrospectively reported EE both predicted higher concurrent BMI, and higher retrospectively reported EE predicted poorer weight loss outcomes at all time points (p < 0.05). By contrast, higher momentary EE predicted improved weight outcomes at 1-year and 2-year follow-up (p < 0.05). Our findings extend prior research suggesting that retrospective self-report EE measures capture a different construct than intended and suggest that momentary EE could predict improved weight loss outcomes.

Emotional eating among Lebanese adults: scale validation, prevalence and correlates

OBJECTIVES

The present study aimed at developing an Arabic version of the Emotional Eating Scale (EES) and examining its reliability and validity among a sample of the Lebanese population. The secondary objective was to evaluate the correlation between emotional eating and body dissatisfaction along with depression and/or self-esteem among a representative sample of the Lebanese population.

METHODS

This cross-sectional study was conducted between January and May 2018. The sample was drawn proportionately from all Lebanese Mohafazat.

RESULTS

All items could be extracted from the list, except items 17 and 19. The EES items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 67.06% of the variance (KMO = 0.939; Bartlett's test of sphericity p < 0.001; α_Cronbach = 0.952). A higher body dissatisfaction was significantly associated with higher emotional eating (β = 0.31) and lower self-esteem (β =  - 0.054); however, no significant association was found with depression. Self-esteem and depression were not found to be significantly associated with emotional eating. When introducing depression and self-esteem as mediator factors for body dissatisfaction and emotional eating, body dissatisfaction did not remain significantly associated with emotional eating.

CONCLUSION

In this study, the Emotional Eating Scale was validated in Arabic among the Lebanese adult population, making this scale usable in further Lebanese research. Moreover, our results showed that body dissatisfaction was positively correlated with emotional eating and self-esteem, but not with depression. A positive association between body dissatisfaction and emotional eating was also demonstrated. This research offers new perspectives for the evaluation of emotional eating among the Lebanese adult population.

LEVEL OF EVIDENCE

Level V Cross-sectional descriptive study.

Emotional Eating and Weight Status in Adolescents: A Systematic Review

BACKGROUND

Despite evidence that emotional eating is associated with weight gain in adults, less is known about this association in adolescents. The purpose of the current study was to conduct a systematic review to assess the association between emotional eating and weight status in adolescents. This study also sought to describe existing measures of emotional eating in adolescents and explore weight-loss interventions that assessed emotional eating in relation to weight status in this population.

METHODS

Two independent reviewers searched the database PubMed for published or in press peer-reviewed studies that assessed the association between emotional eating and weight status in adolescents aged 12 to 19 years. Studies were excluded from this review if they were not written in the English language, did not include a measure of emotional eating, or were a dissertation study.

RESULTS

A total of 13 studies met full inclusion criteria and were included in the systematic review. Of the six longitudinal studies in the review, only one found a prospective association between emotional eating and weight status. The Dutch Eating Behavior Questionnaire was the most widely used measure of emotional eating in the systematic review (n = 6; 46.2%). The one intervention study included in this review found that baseline emotional eating was not associated with weight outcomes 2 years following gastric bypass surgery in obese Swedish adolescents (13-18 years).

CONCLUSIONS

While there were some inconsistent findings across the studies included in this review, taken as a whole, the results largely do not support an association between emotional eating and elevated weight status or reduced weight loss in adolescents.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image

Emotional eating is associated with an increased risk of binge eating, eating in the absence of hunger and obesity risk. While previous studies with children and adolescents suggest that emotion regulation may be a key predictor of this dysregulated eating behavior, little is known about what other factors may be influencing the link between emotional regulation and emotional eating in adolescence. This multi-method longitudinal study (n = 138) utilized linear regression models to examine associations between childhood emotion regulation, adolescent weight status and negative body image, and emotional eating at age 17. Emotion regulation predicted adolescent emotional eating and this link was moderated by weight status (β = 1.19, p < 0.01) and negative body image (β = -0.34, p < 0.01). Higher engagement in emotional eating was predicted by lower emotional regulation scores among normal-weight teens (β = -0.46, p < 0.001) but not among overweight/obese teens (β = 0.32, p > 0.10). Higher scores on emotion regulation were significantly associated with lower emotional eating at high (β = -1.59, p < 0.001) and low (β = -1.00, p < 0.01) levels of negative body image. Engagement in emotional eating was predicted by higher negative body image among overweight/obese teens only (β = 0.70, p < 0.001). Our findings show that while better childhood emotion regulation skills are associated with lower emotional eating, weight status and negative body image influence this link and should be considered as important foci in future interventions that aim to reduce emotional eating in adolescence.

Preliminary Impact of an Adapted Emotion Regulation Intervention for Adolescents with Overweight and Obesity Attempting to Lose Weight

OBJECTIVE

This study examines the acceptability, feasibility, and preliminary impact of a program (HealthTRAC) combining 2 efficacious interventions (one targeting emotion regulation [TRAC] and the other a standardized behavioral weight management intervention [SBWC]) to improve weight management outcomes among a sample of adolescents with overweight and obesity.

METHOD

Adolescents with overweight or obesity (N = 38), ages 13 to 17 years, were enrolled and randomized into either the SBWC or HealthTRAC. Data were collected at baseline (before intervention), at the end of the 16-week intervention (postintervention), and 4 months after completing the intervention (4 months). Assessments included adolescent self-reports of intervention acceptability and reported emotion regulation (ER) abilities and caregiver report of adolescent ER skills. Body mass index (BMI) was used to examine the impact on adolescent weight outcomes. Analyses of covariance controlling for baseline values were used to evaluate study outcomes.

RESULTS

Eighty-four percent (n = 32) of participants completed the immediate postintervention and 4-month follow-up assessments. Adolescents in both conditions reported high treatment satisfaction. Adolescents randomized to HealthTRAC demonstrated greater reductions in BMI relative to SBWC and reported greater use of emotion regulation skills. Finally, caregivers of adolescents randomized to HealthTRAC also reported greater improvements in emotion regulation abilities among their adolescents at the 4-month follow-up.

CONCLUSION

Findings suggest that the HealthTRAC intervention was acceptable, feasible to deliver, and demonstrated a positive impact on BMI and emotion regulation abilities. These data suggest that ER is related to health decision-making and is relevant to most overweight/obese adolescents seeking to lose weight.

Eating behaviors in relation to gestational weight gain and postpartum weight retention: A systematic review

Preventing obesity is of utmost public health importance. This paper systematically reviews associations between eating behaviors and peripartum weight change. This knowledge is crucial in the development of interventions that reduce long-term obesity, often triggered and boosted in the peripartum. Through MEDLINE, EMBASE, and Web of Science, we identified 20 studies that fulfilled inclusion criteria: studies on food cravings, disinhibition, restrained, external, emotional, uncontrolled, intuitive, or mindful eating in relation to gestational or postpartum weight among adult women. Higher gestational weight gain was associated with lower intuitive eating (in 3/3 studies) and higher restrained eating (in 4/11 studies), external eating (in 2/2 studies), emotional eating (in 3/4 studies), food cravings (in 3/3 studies), and disinhibition (in 1/3 studies). No association with uncontrolled eating was found (in one study). No studies on mindful eating and gestational weight were identified. Higher postpartum weight loss was associated with higher restrained (in 2/4 studies) and intuitive eating (in 1/1 study). No associations between postpartum weight and food cravings, disinhibition, and mindful eating were found. No studies on external, emotional and uncontrolled eating, and postpartum weight were identified. Concluding, certain eating behaviors might be related to peripartum weight change.

Psychosocial, behavioral and clinical correlates of children with overweight and obesity

BACKGROUND

Psychological and behavioral correlates are considered important in the development and persistence of obesity in both adults and youth. This study aimed to identify such features in youth with severe obesity (BMI ≥ 120% of 95thpercentile of sex-specific BMI-for-age) compared to those with overweight or non-severe obesity.

METHODS

Youth with BMI ≥ 85th percentile were invited to participate in a prospective research registry where data was collected on attributes such as family characteristics, eating behaviors, dietary intake, physical activity, perception of health and mental well-being, and cardiometabolic parameters.

RESULTS

In a racially/ethnically diverse cohort of 105 youth (65% female, median age 16.1 years, range 4.62-25.5), 51% had severe obesity. The body fat percent increased with the higher levels of obesity. There were no differences in the self-reported frequency of intake of sugar sweetened beverages or fresh produce across the weight categories. However, the participants with severe obesity reported higher levels of emotional eating and eating when bored (p = 0.022), levels of stress (p = 0.013), engaged in fewer sports or organized activities (p = 0.044), and had suboptimal perception of health (p = 0.053). Asthma, depression and obstructive sleep apnea were more frequently reported in youth with severe obesity. The presence of abnormal HDL-C, HOMA-IR, hs-CRP and multiple cardiometabolic risk factors were more common among youth with severe obesity.

CONCLUSIONS

Youth with severe obesity have identifiable differences in psychosocial and behavioral attributes that can be used to develop targeted intervention strategies to improve their health.

Household food insecurity: associations with disordered eating behaviours and overweight in a population-based sample of adolescents

OBJECTIVE

To examine how household food insecurity is related to adolescent weight status and disordered eating.

DESIGN

Cross-sectional, population-based study. Adolescents self-reported unhealthy weight control behaviours, binge eating and meal frequency; weight status was measured. Household food insecurity was assessed by asking parents to respond to the validated six-item US Household Food Security Survey Module.

SETTING

Adolescents surveyed within Minneapolis/St. Paul public middle and high schools completed surveys at school, and their parents/guardians were surveyed by mail during the 2009-2010 academic year.

PARTICIPANTS

Ethnically/racially diverse, primarily low-income adolescents (mean age: 14·4 years, range: 10-22 years) and their parents/guardians (n 2285 dyads).

RESULTS

More than one-third (38·9 %) of the adolescents experienced past-year household food insecurity, 43·2 % reported disordered eating and 39·6 % were overweight. Generalised regression models showed that food insecure (FI) compared with food secure (FS) adolescents had higher prevalence of overweight (FI: 42·3 % v. FS: 37·9 %, P = 0·039), lower breakfast consumption (FI: 4·1 times/week v. FS: 4·4 times/week, P = 0·005) and greater use of unhealthy weight control behaviours (FI: 49·0 % v. FS: 39·5 %, P < 0·001) in unadjusted models. Models adjusted for parental education, ethnicity/race, sex and age found that food insecurity was associated with higher prevalence of unhealthy weight control behaviours (FI: 44·5 % v. FS: 37·8 %, P = 0·007), but not with weight status or other eating behaviours.

CONCLUSIONS

These results suggest that food insecurity may be an independent risk factor for unhealthy weight control behaviours, indicating a need to approach these intersecting issues in a comprehensive manner.

Adolescents' Addictive Phone Use: Associations with Eating Behaviors and Adiposity

Concerns have been raised about excessive or "addictive" phone use among adolescents, and the impact that addictive phone use (APU) can have on adolescent development and health. Most research on the physical health correlates of smartphone use has been limited to sleep health, whereas other outcomes, such as eating behaviors and obesity risk have not received as much attention. To address this gap in the literature, we examined the association between APU and emotion regulation difficulties, impulsivity, maladaptive eating behaviors, and adiposity in a sample of 111 adolescents. We found that APU is associated with greater emotion regulation difficulties, dysregulated eating, restrained eating, food addiction, and higher percent body fat. Further, we found that emotion regulation difficulties mediated the association between APU and dysregulated eating, restrained eating, and food addiction. Findings suggest that addictive phone use may confer increased risk for obesogenic eating behaviors and food addiction via challenges in regulating emotions.

Emotional eating is more frequent in obese rheumatoid arthritis patients

BACKGROUND & AIM

Obesity is a risk factor for both cardiovascular mortality and poor disease control. Unfavourable eating behaviours may have a role in obesity and increase the risk for obesity. In this study, we evaluated the eating behaviours of the patients with rheumatoid arthritis and compare these with controls. Also, we assessed the eating behaviour differences between obese and non-obese rheumatoid arthritis patients.

METHODS

It was a cross sectional case control study. We enrolled 157 rheumatoid arthritis patients and 60 controls to the study in one year period. We evaluated the eating behaviours of the patients with Three-Factor Eating Questionnaire R-18. Firstly, we compared eating behaviours of the rheumatoid arthritis patients with controls, and then we evaluated the differences in eating features between obese rheumatoid arthritis patients with non-obese rheumatoid arthritis patients. We compared the continuous variables with Mann-Whitney u test. Furthermore, categorical variables were compared with Chi-square test.

RESULTS

Sixty-three (40.2%) of the rheumatoid arthritis patients were obese. Eating behaviours of rheumatoid arthritis patients and controls were similar, out of uncontrolled eating score. This score was found higher in control group than rheumatoid arthritis patients (p = 0.01). Moreover, emotional eating domain scores were higher in obese RA patients (p = 0.04).

CONCLUSIONS

Even though there were no negative eating features in general rheumatoid arthritis population, obese rheumatoid arthritis patients may have an emotional eating problem. Herein, treatments that address psychosomatic sides of eating may be effective for treatment of obesity in rheumatoid arthritis.

Association of Pediatric Obesity Treatment, Including a Dietary Component, With Change in Depression and Anxiety: A Systematic Review and Meta-analysis

IMPORTANCE

Children and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider.

OBJECTIVE

To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity.

DATA SOURCES

Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies.

STUDY SELECTION

Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included.

DATA EXTRACTION AND SYNTHESIS

Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019.

MAIN OUTCOMES AND MEASURES

Change in symptoms of depression and anxiety postintervention and at the latest follow-up.

RESULTS

Of 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], -0.31 [0.04]; P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], -0.25 [0.07]; P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], -0.38 [0.10]; P < .001) and at follow-up (4 studies; standardized mean difference [SE], -0.32 [0.15]; P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R2 = 0.82; P < .001). Higher body mass index z score at baseline was associated with a greater reduction in depression (R2 = 0.19; P = .03).

CONCLUSIONS AND RELEVANCE

Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.

Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis

This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre-post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow-up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post-intervention. Meta-analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], -0.326 [0.09], P < 0.001), emotional eating (six studies, -0.149 [0.06], P = 0.008), binge eating (three studies, -0.588 [0.10], P < 0.001), and drive for thinness (three studies, -0.167 [0.06], P = 0.005) post-intervention. At follow-up, a reduction in ED risk (six studies, -0.313 [0.13], P = 0.012), emotional eating (five studies, -0.259 [0.05], P < 0.001), eating concern (three studies, -0.501 [0.06], P < 0.001), and drive for thinness (two studies, -0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.

Longitudinal Associations between Emotion Regulation and Adiposity in Late Adolescence: Indirect Effects through Eating Behaviors

The prevalence of obesity among U.S. youth continues to increase, with many adolescents engaging in unhealthy eating behaviors. Increasingly, research points to the role of self-regulation in obesity development, yet existing work has largely focused on young children and/or clinical adult populations. This multi-method longitudinal study (N = 153) utilized a path analysis to delineate links between emotion regulation (age 15), emotional eating and dietary restraint (age 16), and adiposity (% body fat) using a BodPod for body composition assessment (age 19). Emotion regulation was negatively associated with emotional eating (β = -0.30, p < 0.001) and positively associated with dietary restraint (β = 0.15, p < 0.05) at age 16, but was not associated with age 19 adiposity (β = -0.01, p = ns). Emotional eating was positively associated with adiposity (β = 0.24, p < 0.01). Indirect effects suggested that emotional eating, but not dietary restraint, at age 16 serves as a mechanism that helps explain the associations between emotion regulation and adiposity four years later. Results from this study suggest that both emotion regulation and emotional eating represent promising targets for that should be included in future interventions aimed at preventing adolescent obesity.

Updates in the treatment of eating disorders in 2018: A year in review in eating disorders: The Journal of Treatment & Prevention

Current evidence suggests that the majority of patients with eating disorders will not fully recover during treatment, and little doubt can exist around the urgent need for improved treatment outcomes across the field of eating disorders. While empirical efforts are underway to optimize outcomes, this article reviews treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2018. Importantly, this review encapsulates research addressing (i) barriers to access and the uptake of empirically supported treatments, (ii) research assessing the delivery of empirically supported treatments across the full spectrum of patient care, and (iii) research aiming to isolate treatment mechanisms and optimize treatment outcomes across a transdiagnostic array of eating disorders. Ultimately, while much ground has been covered in 2018, further research is needed to enhance the accessibility and uptake existing treatments, since only a fraction of those with eating disorders are currently engaged in treatment. Further, with the expanding scope of non-outpatient eating disorder treatment settings, further research is required to adapt and assess the implementation of empirically supported treatments in higher levels of patient care. Lastly, in aiming to optimize patient outcomes, treatment outcome research must seek to identify (i) mechanisms that underlie illness eating disorder psychopathology, and (ii) the active mechanisms of existing treatments.