Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being

Longitudinal Associations among Identity, Internalization of Appearance Ideals, Body Image, and Eating Disorder Symptoms in Community Adolescents and Emerging Adults: Adaptive and Maladaptive Pathways

Previous research examined the role of identity confusion and body dissatisfaction in eating disorder symptoms, but an integrative perspective including identity synthesis and positive body image is lacking. The current study used three-wave longitudinal data (T1: N = 403; 52.1% female; Mage = 14.85, SD = 0.89) spanning two years to examine the directionality of effects among identity, internalization of appearance ideals, body image, and eating disorder symptoms, with attention to adaptive mechanisms. Results revealed a maladaptive pathway in which internalizing appearance ideals posed a risk for body dissatisfaction and eating disorder symptoms. Conversely, an adaptive pathway highlighted the potential protective role of positive body image regarding identity formation and internalization of appearance ideals. This study provides further insight into the critical role of appearance ideal internalization in the development of eating disorders and the potential value of positive body image. Future research and prevention/intervention efforts should focus on promoting resilience to appearance ideal internalization and enhancing positive body image in the context of identity struggles and eating disorder symptoms.

Family pressure and support on young adults' eating behaviors and body image: The role of gender

Families play a key role in establishing eating habits of children, yet whether families continue to influence eating behaviors of young adults remains an open question. It is also not clear whether associations between family variables (i.e., support and pressure) are similar for adult sons and daughters regarding eating pathology. The present cross-sectional study examined family correlates on disordered eating, body satisfaction, and drive for muscularity. The aim was to examine the associations of family support and family pressure with eating pathology, and to determine whether gender moderated the associations. Among 365 undergraduates (Mage = 18.9 years, 62 % Caucasian, 48 % female), neither family pressure nor family support were significantly associated with the drive for muscularity, whereas both were associated with disordered eating, and family pressure was associated with body satisfaction. Gender moderated the relationship of family pressure and body satisfaction (p = 0.03) and, unexpectedly, the relationship of family support and disordered eating (p = 0.02). Contrary to prediction, family pressure had stronger associations with body satisfaction for men (i.e., men had a more robust association (beta = -0.31, p < .001) than women (beta = -0.19, p = 0.004)). For women, the relationship of family support and disordered eating was not significant (beta = 0.07, p = 0.452); but, was significant for men (beta = -0.25, p < .001). These findings suggest that family pressure and support are associated with eating pathology among young adults, and that in some instances the associations were larger for men, thus highlighting the importance of including men in eating pathology research. Pending replication, these results suggest that family attitudes, behaviors, and support may be necessary topics to address when designing prevention programs for young adults.

New understandings meet old treatments: putting a contemporary face on established protocols

In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.

Body-mass index trajectories from childhood to mid-adulthood and their sociodemographic predictors: Evidence from the International Childhood Cardiovascular Cohort (i3C) Consortium

Background

Understanding lifecourse trajectories of body-mass index (BMI) is important for identifying groups at high risk of poor health and potential target points for intervention. This study aimed to describe BMI trajectories from childhood to mid-adulthood in four population-based cohorts established in the 1970s and 1980s and to identify childhood sociodemographic factors related to trajectory membership.

Methods

Between Dec 17, 1970 and Dec 15, 1994, data were collected at the first visit from 9830 participants from the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes participants from Australia (1985), Finland (1980) and the USA (1970-1994). Participants had at least three measures of height and weight, including one in childhood (6-18 years) and one in adulthood (>18 years), and were aged 30-49 years at last measurement. Latent Class Growth Mixture Modelling was used to identify lifecourse BMI trajectory groups and log multinomial regression models were fit to identify their childhood sociodemographic predictors.

Findings

Five consistent BMI trajectory groups were identified amongst the four cohorts: persistently low (35.9-58.6%), improving from high (0.7-4.8%), progressing to moderate (9.3-43.7%), progressing to high (1.1-6.0%), and progressing to very high (0.7-1.3%). An additional three BMI trajectory groups were identified in some, but not all, cohorts: adult onset high (three cohorts; 1.8-20.7%), progressing to moderate-high (two cohorts; 5.2-13.8%), and relapsing yo-yoers (alternating upward and downward; one cohort; 1.3%). In pooled analyses, each predictor variable in childhood, including age, gender, parental education and race, was associated with increased likelihood of belonging to the most (e.g., improving from high) and least (e.g., progressing to very high) favourable BMI trajectory groups, suggesting a U-shaped (or inverse U-shaped) pattern of association.

Interpretation

Five consistent BMI trajectory groups were identified across four cohorts from Australia, Finland, and the USA, mainly across two eras of birth. While most participants remained on a persistently low trajectory (50%), many demonstrated worsening BMI trajectories (47%), with only few demonstrating improving trajectories (<5%). Age, gender, parental education, and race appear to be important predictors of BMI trajectory group membership and need consideration in preventive and management strategies.

Funding

This study was supported by funding from the National Institutes of Health, National Heart, Lung and Blood Institute (grant number R01 HL121230).

Randomized controlled psychotherapy trials in eating disorders: Improving their conduct, interpretation and usefulness

BACKGROUND

While randomized controlled trials (RCTs) inform the efficacy and effectiveness of treatments, we need to understand that even RCTs can be associated with sub-optimal execution. This is of special pertinence to eating disorders given the majority of treatment studies involving cognitive behaviour therapy are of poor quality with respect to managing risk of bias adequately.

METHODS

The current paper outlines the components of a good RCT for psychotherapy, and examines ways to improve the conduct, interpretation, and usefulness of RCTs.

RESULTS

This includes managing reporting bias, recognizing the limits of randomization, applicability, and ethical considerations.

CONCLUSIONS

We highlight a number of strategies for future research, including issues related to utilizing a variety of designs to examine treatment outcomes, integrity, openness and reproducibility.