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Muha J, Schumacher A, Campisi SC, Korczak DJ. Depression and emotional eating in children and adolescents: A systematic review and meta-analysis. Appetite 2024; 200:107511. [PMID: 38788931 DOI: 10.1016/j.appet.2024.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/24/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
Major Depressive Disorder in youth is associated with obesity and adult cardiovascular disease (CVD) risk. Eating in response to emotions (emotional eating) is a potential contributing factor to this association. Although emotional eating is associated with Major Depressive Disorder in adults, findings in children and adolescents are mixed. This systematic review and meta-analysis aims to determine the association between depression and emotional eating in children and adolescents. Systematic searches were conducted in seven databases. Studies were included if the study population had a mean age of ≤18 years and assessed both depression and emotional eating using validated measures. The search generated 12,241 unique studies, of which 37 met inclusion criteria. Random-effects meta-analyses of study outcomes were performed. Thirty-seven studies (26,026 participants; mean age = 12.4 years, SD = 3.1) were included. The mean effect size was significant for both cross-sectional and longitudinal data (Hedges' g = 0.48, p < 0.0001; g = 0.37, p = 0.002, respectively), revealing a positive moderately strong association between depressive symptoms and emotional eating in youth. Among longitudinal studies, the association was stronger when depressive symptoms and emotional eating were assessed using child and adolescent self-report versus parent-report. No studies examined youth with a clinical diagnosis of depression. Meta-analyses revealed that depressive symptoms and emotional eating are positively associated in children and adolescents. However, further research in clinical samples is needed. Results raise the possibility for the importance of emotional eating in the link between depression and early CVD risk, though further examination is required to determine whether emotional eating is a potential treatment target to decrease CVD risk among adolescents with increased depression symptoms.
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Affiliation(s)
- Jessica Muha
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anett Schumacher
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Susan C Campisi
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada; Nutrition and Dietetics Program, Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Daphne J Korczak
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Spinner H, Thompson KA, Bauman V, Lavender JM, Thorstad I, Schrag R, Sbrocco T, Schvey NA, Ford B, Ford C, Wilfley DE, Jorgensen S, Klein DA, Quinlan J, Yanovski JA, Haigney M, Tanofsky-Kraff M. Emotional dysregulation moderates the relation between perceived stress and emotional eating in adolescent military dependents. Int J Eat Disord 2024; 57:1609-1615. [PMID: 38600832 PMCID: PMC11262967 DOI: 10.1002/eat.24217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Adolescent children of US service members (i.e., military-dependent youth) face unique stressors that increase risk for various forms of disinhibited eating, including emotional eating. Difficulties with adaptively responding to stress and aversive emotions may play an important role in emotional eating. This study examined emotion dysregulation as a potential moderator of the association between perceived stress and emotional eating in adolescent military dependents. METHOD Participants were military-dependent youth (N = 163, 57.7% female, Mage = 14.5 ± 1.6, MBMI-z = 1.9 ± 0.4) at risk for adult binge-eating disorder and high weight enrolled in a randomized controlled prevention trial. Prior to intervention, participants completed questionnaires assessing perceived stress and emotional eating. Parents completed a questionnaire assessing their adolescent's emotion dysregulation. Moderation analyses were conducted using the PROCESS macro in SPSS and adjusted for theoretically relevant sociodemographic covariates. RESULTS The interaction between adolescent perceived stress and emotion dysregulation (parent-reported about the adolescent) in relation to adolescent emotional eating was found to be significant, such that higher emotion dysregulation magnified the association between perceived stress and emotional eating (p = .010). Examination of simple slopes indicated that associations between perceived stress and emotional eating were strongest for youth with above-average emotion dysregulation, and non-significant for youth with average or below-average emotion dysregulation. DISCUSSION Findings suggest that greater emotion dysregulation may increase risk for emotional eating in response to stress among military-dependent youth at risk for binge-eating disorder or high weight. Improving emotion regulation skills may be a useful target for eating disorder prevention among youth who are at risk for emotional eating. PUBLIC SIGNIFICANCE Prior research has shown that adolescent military dependents are at increased risk for eating disorders and high weight. The current study found that emotion dysregulation moderated the relationship between perceived stress and emotional eating among military-dependent youth. There may be clinical utility in intervening on emotion regulation for adolescent dependents at particular risk for emotional eating and subsequent eating disorders.
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Affiliation(s)
- Holly Spinner
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Katherine A. Thompson
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Viviana Bauman
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Isabel Thorstad
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Ruby Schrag
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, USU, USA
| | - Natasha A. Schvey
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
- Department of Medical and Clinical Psychology, USU, USA
| | | | - Caitlin Ford
- Department of Family Medicine, Fort Belvoir Community Hospital, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, USA
| | - Sarah Jorgensen
- Department of Family Medicine, University of Iowa Hospitals & Clinics, USA
| | - David A. Klein
- Department of Family Medicine, USU, USA
- Department of Pediatrics, USU, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Hospitals & Clinics, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Mark Haigney
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, USA
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
- Department of Medical and Clinical Psychology, USU, USA
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Peschel SKV, Sigrist C, Voss C, Fürtjes S, Berwanger J, Ollmann TM, Kische H, Rückert F, Koenig J, Beesdo-Baum K. Subclinical patterns of disordered eating behaviors in the daily life of adolescents and young adults from the general population. Child Adolesc Psychiatry Ment Health 2024; 18:69. [PMID: 38845025 PMCID: PMC11157754 DOI: 10.1186/s13034-024-00752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Disordered eating behaviors (DEBs), a risk factor for the development of eating disorders (EDs), are prevalent in young people and different DEBs frequently co-occur. Previous studies on DEB-patterns have largely used traditional retrospective questionnaires to assess DEBs. In addition, most previous studies did not specifically exclude individuals with clinical EDs, which limits current knowledge concerning purely subclinical patterns of DEBs. In the present study, we aimed to explore phenotypes and group sizes of subclinical patterns of DEBs reported in everyday life via smartphone-based ecological momentary assessment (EMA) in adolescents and young adults from the general population without lifetime EDs. In secondary analyses, we further aimed to investigate whether DEB-patterns would be associated with additional previously identified risk factors for ED-development. METHODS EMA was conducted in a community sample of 14-21-year-olds from Dresden, Germany, over four days for up to eight times a day and covered engagement in four DEBs: skipping eating, restrained eating, eating large amounts of food, and loss-of-control eating. Data were analyzed from N = 966 individuals without lifetime EDs with an EMA compliance rate of at least 50% (81.9% of the total sample; average compliance: 84.6%). Latent profile analyses were performed to identify subclinical patterns of DEBs, stratified by sex. Associations between symptomatic profiles and ED-risk factors were tested via regression analyses. RESULTS Based on theoretical deliberations, statistical indices, interpretability, and parsimony, a three-profile solution, namely no DEBs, high-mixed DEBs, and low-mixed DEBs, was selected for both sexes. Both symptomatic profiles in both sexes were associated with more unfavorable manifestations in additional ED risk factors compared to the no DEBs profile, with the highest number of associations being observed in the female high-mixed profile. CONCLUSIONS The present findings suggest that problematic manifestations of DEBs in young people may occur even in the absence of an ED diagnosis and that they are associated with additional risk factors for EDs, warranting increased efforts in targeted prevention, early identification and intervention in order to counteract symptom progression.
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Affiliation(s)
- Stephanie K V Peschel
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany.
| | | | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
| | - Sophia Fürtjes
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
| | - Johanna Berwanger
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
| | - Theresa M Ollmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
| | - Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, TUD Dresden University of Technology, Dresden, Germany
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Beckers D, Larsen JK, Burk WJ. Self-esteem and negative affectivity as mediators of the prospective links between adolescent interpersonal peer problems and disordered eating behaviors. Appetite 2023; 186:106558. [PMID: 37059399 DOI: 10.1016/j.appet.2023.106558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
The current prospective study examined whether both self-esteem and negative affectivity mediate subsequent associations between interpersonal peer problems (i.e., peer victimization, peer rejection, lack of friendships) and disordered eating behaviors (i.e., loss of control while overeating, emotional eating, restrained eating) in adolescents using secondary data. The sample included 2051 adolescents (Mage baseline = 13.81, SDage baseline = 0.72; 48.5% female) who participated in a longitudinal project, which includes three annually collected waves of data. Participants completed self-report and peer-report measures describing interpersonal problems with peers, and self-report measures describing negative affectivity, self-esteem, and disordered eating behaviors. The results provided no support for either self-esteem or negative affectivity as mediators of the associations between interpersonal peer problems and disordered eating behaviors two years later. However, self-esteem was more robustly linked to all three types of subsequent disordered eating behaviors than negative affectivity. This highlights the importance of adolescent's self-evaluations in the development of disordered eating behaviors.
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Affiliation(s)
- Desi Beckers
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500HE, Nijmegen, the Netherlands.
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500HE, Nijmegen, the Netherlands
| | - William J Burk
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500HE, Nijmegen, the Netherlands
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Bicaker E, Schell SE, Racine SE. The role of self-compassion in the relationship between rejection and unhealthy eating: An ecological momentary assessment study. Appetite 2023; 186:106568. [PMID: 37054819 DOI: 10.1016/j.appet.2023.106568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/19/2023] [Accepted: 04/11/2023] [Indexed: 04/15/2023]
Abstract
Available studies suggest that experiencing interpersonal rejection heightens negative affect and, in turn, triggers unhealthy eating behaviors. Elucidating individual differences that attenuate the negative consequences of rejection could inform interventions targeting unhealthy eating. This study examined the buffering role of self-compassion in the relationship between rejection experiences and unhealthy eating behaviors, defined as snacking on junk food and overeating. Two-hundred undergraduate students (50% women) completed ecological momentary assessments measuring rejection experiences, emotions, and unhealthy eating seven times a day for 10 consecutive days. Self-compassion was measured after the 10-day assessment period. Reports of rejection were low (2.6%) in our university sample. Multilevel mediation analyses examined whether the relationship between experiencing rejection and subsequent unhealthy eating was mediated by negative affect. Multilevel moderated mediation analyses further considered whether relationships between rejection and negative affect and between negative affect and unhealthy eating were moderated by self-compassion. Experiencing rejection predicted more unhealthy eating behaviors at the next time point, and this relationship was fully explained by increases in negative affect. Participants with high levels of self-compassion experienced less intense negative affect after rejection and reported less unhealthy eating behaviors when feeling negative emotions, compared to their counterparts with lower levels of self-compassion. The indirect effect of rejection on unhealthy eating was moderated by self-compassion, and there was no statistically significant relationship between rejection and unhealthy eating behaviors among highly self-compassionate participants. Findings suggest that cultivating self-compassion may help attenuate the negative impact of rejection experiences on emotions and unhealthy eating behaviors.
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Affiliation(s)
- Ege Bicaker
- Department of Psychology, McGill University, Canada
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Bernstein R, Conte I, Gulley LD, Miller RL, Clark ELM, Lucas-Thompson RG, Shomaker LB. Bringing attention to friendship: moderating Effects of Mindfulness on the interpersonal model of disordered eating in adolescents. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-022-03874-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Pine AE, Schvey NA, Shank LM, Burke NL, Neyland MKH, Hennigan K, Young JF, Wilfley DE, Klein DA, Jorgensen S, Seehusen D, Hutchinson J, Quinlan J, Yanovski JA, Stephens M, Sbrocco T, Tanofsky-Kraff M. A Pilot Feasibility Study of Interpersonal Psychotherapy for the Prevention of Excess Weight Gain Among Adolescent Military-dependent Girls. Mil Med 2021; 186:344-350. [PMID: 33241297 PMCID: PMC7909453 DOI: 10.1093/milmed/usaa514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Adolescent military-dependents face unique psychosocial stressors due to their parents' careers, suggesting they may be particularly vulnerable to excess weight gain and symptoms of depression and anxiety. Despite these risk factors, there is a lack of tested preventative interventions for these youths. Given the transient nature of military family deployments, research may be hindered due to difficulty in collecting long-term prospective outcome data, particularly measured height and weight. The primary aim of this study was to examine the feasibility and acceptability of collecting body mass index (BMI, kg/m2) outcome data up to 2 years following a randomized controlled pilot trial of an adapted interpersonal psychotherapy (IPT) program aimed at preventing excess weight gain and improving psychological functioning for adolescent military-dependents. In exploratory analyses, patterns in body composition over time were examined. MATERIALS AND METHODS Twenty-seven adolescent military-dependent girls (baseline: Mage: 14.4 ± 1.6 years; MBMI: 30.7 ± 4.9 kg/m2; MBMI-z: 1.9 ± 0.4) participated in this study. After a baseline assessment, utilizing a computerized program to create a randomization string, girls were assigned to either an IPT or a health education (HE) program. Participants completed three follow-up visits (posttreatment, 1-year follow-up, and 2-year follow-up). Girls completed a Treatment Acceptability Questionnaire at posttreatment; at all time points, height and fasting weight were collected. For the primary aim, Fisher's exact tests examined the rate of obtained follow-up data and lost to follow-up status between the two groups, Mann-Whitney U tests examined the session attendance between groups, and treatment acceptability ratings were compared between the two groups at posttreatment using an independent samples t-test. For the exploratory aim, one-way analyses of covariance (ANCOVAs) examined the group differences in BMI at each time point, adjusting for baseline values, and paired samples t-tests examined the within-group differences at each time point relative to baseline. Using imputed data in the full intent-to-treat sample, mixed model ANCOVAs were conducted to examine the group differences over time. RESULTS Across both groups, girls attended an average of 72.0% of sessions. At least partial data were collected at posttreatment, 1-year follow-up, and 2-year follow-up for 96.3%, 85.2%, and 74.1% of the participants, respectively. There were no significant group differences in follow-up data collection rates, follow-up status, number of sessions attended, or treatment acceptability. BMI-z stabilized across groups, and there were no group differences in BMI-z. In adjusted ANCOVA models with imputed data, no significant group-by-time effects emerged. CONCLUSIONS For this randomized controlled prevention trial, long-term outcome data collection of measured BMI was possible in adolescent military-dependents and IPT was an acceptable and feasible intervention. An adequately powered trial is required to assess the efficacy of this intervention among military-dependents for obesity prevention and improvements in BMI.
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Affiliation(s)
- Abigail E Pine
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
| | - M K Higgins Neyland
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
- Metis Foundation, San Antonio, TX 78205, USA
| | - Kathrin Hennigan
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
- Metis Foundation, San Antonio, TX 78205, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Denise E Wilfley
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David A Klein
- Departments of Family Medicine and Pediatrics, USU, Bethesda, MD 20814, USA
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Sarah Jorgensen
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Dean Seehusen
- Department of Family Medicine, Medical College of Georgia, Augusta, GA 30912, USA
| | | | - Jeffrey Quinlan
- Departments of Family Medicine and Pediatrics, USU, Bethesda, MD 20814, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
| | - Mark Stephens
- Departments of Family and Community Medicine and Humanities, Pennsylvania State University, Old Main, State College, PA 16801, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
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