The assessment of eating behaviour in children who are obese: a psychological approach. A position paper from the European childhood obesity group

The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment

In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.

Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers

INTRODUCTION

People with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails.

OBJECTIVE

To explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice.

MATERIALS AND METHODS

An online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes.

RESULTS

59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways.

CONCLUSION

Individualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.

Subtyping youngsters with obesity: A theory-based cluster analysis

Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments. Data were collected in N = 572 participants (51% boys, aged 7-19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7-13, boys 14-19, girls 7-13, girls 14-19). In all four age and gender subsamples, an "Emotional Eating" cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a "Reward Deficiency" cluster displaying a more resilient profile were detected. In girls 7-13, a "Weak Executive Functioning" indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the "Mean Level Functioning" cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments.

Feel Good, Eat Better: The Role of Self-Compassion and Body Esteem in Mothers' Healthy Eating Behaviours

Mothers’ eating behaviours are important to ensure the health and well-being of themselves and their families. Recent research has pointed to self-compassion, defined as extending kindness to oneself in times of perceived inadequacy or general suffering, as a trait associated with healthy forms of eating, such as intuitive eating, and reduced maladaptive forms of eating, such as emotional eating. However, little is known about the psychological mechanism through which self-compassion relates to healthy eating behaviours. This study examined 100 mothers’ levels of self-compassion, body esteem and eating behaviours. Structural equation modelling revealed that self-compassion was positively associated with diet quality and intuitive eating, while being negatively associated with emotional eating. Moreover, these links occurred, in part, due to higher body esteem. This points to a mechanism through which self-compassion may positively contribute to mothers’ healthy eating behaviours. The implications for eating outcomes and women’s health are discussed.

Contextualising Eating Disorder Concerns for Paediatric Obesity Treatment

PURPOSE OF REVIEW

Eating disorders are complex mental health conditions that share risk factors with obesity. This review outlines the context for concerns that paediatric obesity treatment presents a risk for eating disorder development.

RECENT FINDINGS

Most children and adolescents undergoing professionally supervised obesity treatment will have improvements or no change to eating disorder risk profiles. However, some may subsequently develop a clinical eating disorder, and this is proposed to relate to weight-focussed dietary interventions that are standard in paediatric obesity treatment. Nevertheless, dietary restraint may not be a strong predictor of eating disorder risk in the context of paediatric obesity treatment. Most international guidelines recommend weight maintenance or weight loss as a treatment goal, and weight loss is related to improvements in cardiometabolic health but not eating disorder risk in the short term. The risk of inducing or exacerbating an eating disorder during paediatric weight management is likely to be low; however, the serious consequences combined with increasing scale of obesity treatment, and lack of empirical evidence, are of concern. There is a need for further research to identify long-term predictors of eating disorder development for children and adolescents who seek treatment for their obesity.

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.

Efficacy of a smartphone application-based intervention for encouraging children's healthy eating in Denmark

The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity.

Dietary Restraint Related to Body Weight Maintenance and Neural Processing in Value-Coding Areas in Adolescents

BACKGROUND

There is an alarming increase in the obesity prevalence among children in an environment of increasing availability of preprocessed high-calorie foods. However, some people maintain a healthy weight even in such obesogenic environments. This difference in body weight management could be attributed to individual differences in dietary restraint; however, its underlying neurocognitive mechanisms in adolescents remain unclear.

OBJECTIVES

This study aimed to elucidate these neurocognitive mechanisms in adolescents by examining the relationships between dietary restraint and the food-related value-coding region located in the ventromedial prefrontal cortex (vmPFC).

METHODS

The association between dietary restraint and BMI was tested using a multilinear regression analysis in a large early adolescent cohort (n = 2554; age, 12.2 ± 0.3 years; BMI, 17.9 ± 2.5 kg/m2; 1354 boys). Further, an fMRI experiment was designed to assess the association between the vmPFC response to food images and dietary restraint in 30 adolescents (age, 17.6 ± 1.9 years; BMI, 20.7 ± 2.2 kg/m2; 13 boys). Additionally, using 54 individuals from the cohort (age, 14.5 ± 0.6 years; BMI, 18.8 ± 2.6 kg/m2; 31 boys), we assessed the association between dietary restraint and intrinsic vmPFC-related functional connectivity.

RESULTS

In the cohort, adolescents with increased dietary restraint showed a lower BMI (β = -0.38; P < 0.001; B = -0.06; SE = 0.003). The fMRI results showed a decreased vmPFC response to high-calorie food were correlated with greater dietary restraint. Moreover, there was an association of attenuated intrinsic vmPFC-related functional connectivity in the superior and middle frontal gyrus and the middle temporal gyrus with greater dietary restraint.

CONCLUSIONS

Our findings suggest that dietary restraint in adolescents could be a preventive factor for weight gain; its effect involves modulating the vmPFC, which is associated with food value coding.

Liraglutide combined with intense lifestyle modification in the management of obesity in adolescents

OBJECTIVES

Childhood obesity is a public health concern worldwide, with rates continuing to rise, despite preventive measures. Lifestyle modification remains the mainstay in the treatment of patients with excessive weight, but unfortunately, this is not always successful. Options for medical management of obesity in the paediatric population are limited.

METHODS

Seven adolescents (all girls, mean age 14.9 years) with a body mass index (BMI) above 98th percentile and serious complications secondary to obesity were offered an intense weight management programme. The participants were reviewed by a multidisciplinary team every two weeks for advice and support, and treated with daily subcutaneous injections of liraglutide (dose range 1.2-3.0 mg). Scores for anxiety and depression were evaluated using the Revised Child Anxiety and Depression Scale.

RESULTS

The results showed a significant weight loss over the three months with an average reduction of 5.4 kg (4.2%; 95% CI 1.93-8.78; p=0.0087). The mean drop in BMI was 2.1 kg/m², which is statistically significant (95% CI 0.973-3.199; p=0.0037). Resolution of complications (raised intracranial pressure and steatohepatitis) was noted following weight loss. Anxiety and depressive symptoms improved over the three-month intervention course, especially features of separation anxiety disorder. Liraglutide was well tolerated by all patients.

CONCLUSIONS

Liraglutide medication, alongside a dedicated multidisciplinary team guided lifestyle therapy, is effective and safe in the treatment for excessive weight in adolescents, leading to the reversal of the complications related to obesity and improvement in the psychological symptoms.

Eating disorder risk in adolescents with obesity

The intersection between adolescent obesity and eating disorder risk is one that requires urgent attention. This review aimed to synthesize the literature on the risk of clinical eating disorders in adolescents with obesity, discuss challenges with assessing risk, and examine implications for clinical practice and future research. Obesity and eating disorders can coexist resulting in exacerbated physical and psychological health issues. Recognized eating disorder risk factors, including body dissatisfaction, poor self-esteem, depression, and engaging in dieting behaviors, are elevated and frequently reported in adolescents with obesity, highlighting a vulnerability to the development of eating disorders. Unsupervised dieting to manage weight may exacerbate eating disorder risk, while structured and supervised weight management is likely to reduce eating disorder risk for most adolescents. However, some adolescents may present to an obesity service with an undiagnosed eating disorder or may develop an eating disorder during or following treatment. We conclude that a risk management approach, with screening or monitoring for eating disorder-related risk factors and behaviors, should be utilized to identify those at risk. Future research to identify eating disorder risk factors specific to adolescents with obesity is required to inform screening and monitoring protocols, patient care, and address current knowledge gaps.

A 6-month randomized, double-blind, placebo-controlled trial of weekly exenatide in adolescents with obesity

BACKGROUND

Pharmacological treatment options for adolescents with obesity are very limited. Glucagon-like-peptide-1 (GLP-1) receptor agonist could be a treatment option for adolescent obesity.

OBJECTIVE

To investigate the effect of exenatide extended release on body mass index (BMI)-SDS as primary outcome, and glucose metabolism, cardiometabolic risk factors, liver steatosis, and other BMI metrics as secondary outcomes, and its safety and tolerability in adolescents with obesity.

METHODS

Six-month, randomized, double-blinded, parallel, placebo-controlled clinical trial in patients (n = 44, 10-18 years, females n = 22) with BMI-SDS > 2.0 or age-adapted-BMI > 30 kg/m² according to WHO were included. Patients received lifestyle intervention and were randomized to exenatide extended release 2 mg (n = 22) or placebo (n = 22) subcutaneous injections given once weekly. Oral glucose tolerance tests (OGTT) were conducted at the beginning and end of the intervention.

RESULTS

Exenatide reduced (P < .05) BMI-SDS (-0.09; -0.18, 0.00), % BMI 95th percentile (-2.9%; -5.4, -0.3), weight (-3 kg; -5.8, -0.1), waist circumference (-3.2 cm; -5.8, -0.7), subcutaneous adipose tissue (-552 cm³ ; -989, -114), 2-hour-glucose during OGTT (-15.3 mg/dL; -27.5, -3.1), total cholesterol (11.6 mg/dL; -21.7, -1.5), and BMI (-0.83 kg/m² ; -1.68, 0.01) without significant change in liver fat content (-1.36; -3.12, 0.4; P = .06) in comparison to placebo. Safety and tolerability profiles were comparable to placebo with the exception of mild adverse events being more frequent in exenatide-treated patients.

CONCLUSIONS

Treatment of adolescents with severe obesity with extended-release exenatide is generally well tolerated and leads to a modest reduction in BMI metrics and improvement in glucose tolerance and cholesterol. The study indicates that the treatment provides additional beneficial effects beyond BMI reduction for the patient group.

The Emotional Eating Scale Adapted for Children and Adolescents (EES-C): development and preliminary validation of a short-form

The 25-item Emotional Eating Scale for children and adolescents (EES-C) is a psychometrically sound instrument that measures the extent to which youth eat in response to negative emotions. Nonetheless, questionnaire length may serve as a barrier to routine administration in clinical and school settings, and diminish the likelihood of the measure being utilized in population-wide health studies. The present study reported on the development and preliminary validation of a short-form of EES-C using data from two previously published studies. Guidelines for the development of short-form questionnaires, content and factor analyses, and other indices including standard deviations, item-total correlations, inter-item correlations, Cronbach's alpha without the item, and floor/ceiling effects were examined to develop a 10-item EES-C Short-Form. The EES-C Short-Form demonstrated acceptable psychometric properties, including good internal consistency reliability (alpha = .87) and a high degree of overlapping variance with the original EES-C Total Score and Subscale Scores (r = .71 to .96). The EES-C Short-Form also manifested a unidimensional factor structure in an Exploratory Factor Analysis, supporting construct validity. Taken together, results from the current study provide preliminary evidence of the reliability and validity of a 10-item EES-C Short-Form.

The relative importance of social anxiety facets on disordered eating in pediatric obesity

PURPOSE

Children with obesity demonstrate increased risk for eating disorders and internalizing psychopathology. Research in adults indicates unique facets of social anxiety differentially relate to eating pathology. These associations remain understudied in pediatric samples. The current study evaluated associations between social anxiety and disordered eating, and tested the relative importance of distinct social anxiety constructs-fear of negative evaluation, social anxiety in general situations, and social anxiety in new situations-for disordered eating in weight-loss treatment-seeking youth with obesity.

METHODS

One-hundred and thirty-five youth (M_age 12.6 years; Range 8-17 years; M_BMIz = 2.6) from a multidisciplinary outpatient pediatric obesity clinic completed questionnaires assessing dimensions of social anxiety and the Children's Eating Attitudes Test (ChEAT). Dominance analyses were used to evaluate the relative importance of social anxiety facets associated with ChEAT subscales.

RESULTS

Social anxiety subscales did not correlate with Dieting scores. Dominance analyses indicated Fear of Negative Evaluation (FNE) evinced complete dominance, thus, emerging as the most important predictor relative to other social anxiety components for Body/Weight Concern and Food Preoccupation. General dominance weights for FNE accounted for more than twice the shared and unique variance, relative to other independent variables within the Body/Weight Concern and Food Preoccupation models, respectively.

CONCLUSIONS

Unique facets of social anxiety differentially relate to disordered eating in youth with obesity. Findings suggest nuanced assessment of anxiety constructs, such as FNE, in pediatric obesity treatment settings may aid in identifying youth at risk for disordered eating attitudes and behaviors.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Delineating the psychological and behavioural factors of successful weight loss maintenance

Overweight and obesity present alarming global health problems including detrimental health risks that call for effective interventions. Considerable research has examined behavioural and psychological factors associated with weight loss to advance the field of obesity and overweight. In line with the literature, this study aimed to develop a behavioural and psychological profile based on factors of personality, eating behaviours, emotional functioning, physical well-being, and psychopathology. The sample consisted of 105 community participants who had reduced their bodyweight by at least 10% and had either successfully maintained their weight loss for a minimum 12-month period (n = 41) or had regained their weight loss within 12 months (n = 64). Participants completed an online survey comprising demographic items and four empirical measures (Mini Marker Personality Scale, Patient Health Questionnaire, Three-Factor Eating Questionnaire-Revised, and a food screening tool). Based on significant bivariate correlations results, four factors (fat intake, restrained eating, uncontrolled eating, and emotional eating) were entered into a binary logistic regression. Restrained eating was the only factor that significantly increased the likelihood of predicting successful long-term weight loss. Findings have implications for overweight and obesity future research, which may guide the direction of obesity and overweight treatments.

Effects of social exclusion and maternal rejection on Children's high-caloric food consumption

Research has shown that the quality of interpersonal relationships plays an important role in influencing childhood obesity-risk behavior. However, studies conducted so far have focused mostly on self-report data. But they rarely control for the effect of experimentally-induced social rejection or perceived maternal rejection. The aim of this study was to investigate the effects of the quality of the maternal relationships as well as experimentally-induced social rejection on children's motivation to consume high-caloric food. Eighty children (8-12 years of age) and their mothers participated in an experimental study. Participants were randomly assigned to a social inclusion (acceptance) or exclusion (rejection) condition in a computer-based ball-toss game (Cyberball). After completing the Cyberball game, children were presented with high-caloric food and were evaluated on the amount of the food they consumed. Participants also completed a self-report questionnaire assessing their perceptions of their mothers' acceptance-rejection. Further, mothers' Body Mass Index (BMI) was measured, and a semi-structured interview was conducted to assess the tendency of mothers to regulate their child's stress with food. Results showed that the consumption of high-caloric food was directly influenced by the children's perceptions of maternal acceptance-rejection, and by the experience of brief, experimentally-induced social exclusion (rejection). Additionally, children's consumption of high-caloric food was related to their mothers' use of food to help regulate children's distress, and by the children's own BMI. The results document the importance of affective-relational experiences in the development of childhood obesity. The results also highlight the apparent fact that regardless of individual and family characteristics, the experience of even short-term social rejection can activate obesity-risk behaviors which deplete children's self-regulatory mechanisms, thereby resulting in more consumption of high-caloric food.

Effects of a 3-month vigorous physical activity intervention on eating behaviors and body composition in overweight and obese boys and girls

PURPOSE

This study aims to analyze the effects of a 3-month vigorous physical activity (VPA) intervention on eating behavior and body composition in overweight and obese children and adolescents.

METHODS

Forty-seven participants (7-16 years) took part in the study: 28 were assigned to the intervention group (IG) (10 boys and 18 girls) and 19 in a control group (CG) (8 boys and 11 girls). Body composition (dual-energy X-ray absorptiometry), anthropometrics (body mass, height, and body mass index (BMI)), and eating behavior traits (Three-Factor Eating Questionnaire-R21C) were determined before and after the VPA intervention.

RESULTS

A decrease in the percentage of body fat and BMI (-2.8% and -1.8%, respectively), and an increase in most lean mass variables were found in the IG (all p ≤ 0.05). In relation to the eating behavior traits, IG subjects showed a 14% reduction in the Emotional Eating score (p = 0.04), while Cognitive Restraint score did not change after the VPA intervention. The baseline factors of the questionnaire predicted changes in body mass and fat mass variables only in the CG.

CONCLUSION

A 3-month VPA intervention influenced eating behaviors of overweight or obese young, especially the Emotional Eating factor, in the presence of favorable body composition changes.

Is Mindful Parenting Associated With Adolescents' Emotional Eating? The Mediating Role of Adolescents' Self-Compassion and Body Shame

This study aimed to explore whether parents' mindful parenting skills were associated with adolescents' emotional eating through adolescents' levels of self-compassion and body shame. The sample included 572 dyads composed of a mother or a father and his/her child (12-18 years old), with normal weight (BMI = 5-85th percentile) or with overweight/obesity with or without nutritional treatment (BMI ≥ 85th percentile) according to the WHO Child Growth Standards. Parents completed self-report measures of mindful parenting (Interpersonal Mindfulness in Parenting Scale), and adolescents completed measures of self-compassion (Self-Compassion Scale-Short Form), body shame (Experience of Shame Scale), and emotional eating (Dutch Eating Behavior Questionnaire). Two path models, one with the total score for mindful parenting and the other with its dimensions, were tested in AMOS. Mindful parenting, specifically the dimension of compassion for the child, was indirectly associated with emotional eating through adolescents' self-compassion (point estimate = -0.27, p = 0.03, CI 95% [-0.61, -0.06]) and through self-compassion and body shame sequentially (point estimate = -0.19, p = 0.03, CI 95% [-0.37, -0.05]). The path model was invariant across weight groups but not across adolescents' sex (the indirect effects were significant among girls only). This study provides a novel comprehensive model of how mindful parenting, especially the dimension of compassion for the child, can be associated with adolescents' emotional eating behaviors by suggesting a potential sequence of mechanisms that may explain this association. This study suggests the beneficial effect of both mindful parenting and adolescents' self-compassion skills for adolescent girls struggling with feelings of body shame and emotional eating behaviors.

A cross-sectional model of eating disorders in Argentinean overweight and obese children

Despite the fact that past research identified childhood obesity as an antecedent of eating disorders, not all obese children further develop this pathology. With this regard, our first purpose was to isolate which characteristics differentiate overweight children who have an eating disorder from those who have not. Second, considering that there is little evidence collected in Latin American countries, we provided overweight children data from an Argentinean sample. Specifically, we investigated if weight-teasing, perfectionism, disturbed eating attitudes and behaviors, and body image dissatisfaction are related to the occurrence of an eating disorder in 100 school-aged overweight/obese children (37 girls and 63 boys; mean age 10.85, SD 0.88). Participants completed self-report instruments and were interviewed between 1 and 2 months later to confirm the presence of eating disorders. Seventeen percent participants confirmed to have an eating disorder. Further, the multivariate logistic analysis revealed that perfectionism (Exp β = 1.19) and disturbed eating attitudes and behaviors (Exp β = 4.78) were jointly associated with the presence of an eating disorder. These results were maintained even when the overall model was adjusted for covariates such as age, gender, body mass index, and school type. Weight-teasing and body image dissatisfaction did not contribute to the multivariate model. Prevalence rates of ED and model findings were discussed.

Eating-related Psychopathology and Food Addiction in Adolescent Psychiatric Inpatients

OBJECTIVE

Our aims were to investigate the relationship between food addiction and mental disorders including eating disorders (ED), eating-related psychopathology and body mass index-standard deviation score in a sample of adolescent psychiatric inpatients.

METHODS

Food addiction was assessed with the Yale Food Addiction Scale (YFAS). Eating-related psychopathology was measured with the Three-Factor Eating Questionnaire (TFEQ). Psychiatric diagnoses were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The sample consisted of n = 242 adolescent psychiatric inpatients, of which n = 37 (15.3%) met criteria for an ED. Multiple regression analysis was used to examine the association between YFAS symptom count, TFEQ scales and ED controlling for age and gender.

RESULTS

Food addiction frequency was 16.5%, and the mean YFAS symptom count was 2.39 (SD: 1.60). In patients with food addiction, TFEQ scale scores were significantly higher than patients without food addiction. Frequency of ED was 42.9% in patients with and 9.9% in patients without food addiction. The TFEQ subscales disinhibition and hunger as well as diagnosis of ED were associated with YFAS symptom count.

DISCUSSION

Food addiction in adolescent psychiatric inpatients occurs with rates higher than those seen in community samples of children, adolescents and adults. Food addiction might be associated with eating styles related to susceptibility to hunger and feelings of loss of control. The implications of high-YFAS scores in restricting-type anorexia nervosa warrant further investigations to explore which and how the respective items are interpreted in this ED subgroup. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Weight Status as a Mediator of the Association Between Preschool Extraversion and Adolescent Restrained Eating

Objectives

To determine the longitudinal association between preschool extraversion and weight/dieting outcomes in adolescence.

Methods

Children (N = 180) were recruited as part of a longitudinal study, with child temperament assessed in preschool (age 5.25 years), weight assessed in 2nd grade and early adolescence, and eating outcomes assessed in early adolescence (mean age = 12.02 years).

Results

Preschoolers high in extraversion were significantly more likely to have higher body mass index z-scores (zBMI) and more restrained eating behaviors in adolescence. zBMI was found to mediate the relationship between extraversion and restrained eating, such that children with high levels of extraversion were more likely to have higher zBMI in adolescence and, owing to this higher weight status, to engage in more restrained eating.

Conclusions

Temperament is an important predictor of later maladaptive weight/dieting outcomes in adolescence, making it a potentially important early factor to consider in weight management interventions.

Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale

OBJECTIVE

To investigate the performance of a simple and developmentally appropriate 10-item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity.

STUDY DESIGN

We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The ?² or Fisher exact tests were used.

RESULTS

There were 94 adolescents aged 12-18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%).

CONCLUSIONS

The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.

The Relationship of Parental Mental Health and Dietary Pattern With Adolescent Mental Health

Background

Today, ensuring people’s health and well-being has become a concern for societies. Health status results from an interaction of an individuals’ various psychological, social, and physical aspects.

Objectives

This study aims to investigate the relationship of parental mental health and dietary pattern with adolescent mental health.

Patients and Methods

In this study, 250 high school students in Shiraz were selected using random cluster sampling. The samples were analyzed using the Food Frequency Questionnaire (FFQ) and the General Health Questionnaire (GHQ-28).

Results

According to the findings, parental mental health explains 22% of the variance in children’s mental health, so that in simultaneous regression, physical dimensions, anxiety, social functioning, and depression predicted 13%, 24%, 11%, and 24% of the variance of criterion variables, respectively. No significant relationship was observed between dietary pattern and adolescent mental health dimensions. There was a significant negative relationship only between depression and vegetable intake. Moreover, fruit (r = 0.15, P < 0.05) and vegetable (r = 0.16, P < 0.05) intake had a significant relationship with parental mental health dimensions.

Conclusions

Parents’ mental health and their psychological characteristics can be related to children’s mental health and affect their dietary intake patterns.

Dietary restraint and impulsivity modulate neural responses to food in adolescents with obesity and healthy adolescents

OBJECTIVE

Despite alarming prevalence rates, surprisingly little is known about neural mechanisms underlying eating behavior in juveniles with obesity. To simulate reactivity to modern food environments, event-related potentials (ERP) to appetizing food images (relative to control images) were recorded in adolescents with obesity and healthy adolescents.

METHODS

Thirty-four adolescents with obesity (patients) and 24 matched healthy control adolescents watched and rated standardized food and object images during ERP recording. Personality (impulsivity) and eating styles (trait craving and dietary restraint) were assessed as potential moderators.

RESULTS

Food relative to object images triggered larger early (P100) and late (P300) ERPs. More impulsive individuals had considerably larger food-specific P100 amplitudes in both groups. Controls with higher restraint scores showed reduced food-specific P300 amplitudes and subjective palatability ratings whereas patients with higher restraint scores showed increased P300 and palatability ratings.

CONCLUSIONS

This first ERP study in adolescents with obesity and controls revealed impulsivity as a general risk factor in the current obesogenic environment by increasing food-cue salience. Dietary restraint showed paradoxical effects in patients, making them more vulnerable to visual food-cues. Salutogenic therapeutic approaches that deemphasize strict dietary restraint and foster healthy food choice might reduce such paradoxical effects.