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Rhee KE, Corbett T, Patel S, Eichen DM, Strong DR, Anderson C, Marcus B, Boutelle KN. A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design. Contemp Clin Trials 2024:107562. [PMID: 38704118 DOI: 10.1016/j.cct.2024.107562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.
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Affiliation(s)
- Kyung E Rhee
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Takisha Corbett
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Shamin Patel
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University, School of Public Health 121 South Main Street, Box G-S121-3, Providence, RI 02912-G, USA
| | - Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Karam Jones AM, Fitzsimmons-Craft EE, D'Adamo L, Eichen DM, Graham AK, Kolko Conlon RP, Balantekin KN, Welch RR, Agras WS, Wilson GT, Wilfley DE. A pilot study evaluating online training for therapist delivery of interpersonal psychotherapy for eating disorders. Int J Eat Disord 2024. [PMID: 38623931 DOI: 10.1002/eat.24197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) often do not receive evidence-based care, such as interpersonal psychotherapy (IPT), partly due to lack of accessible training in these treatments. The standard method of training (i.e., in-person workshops) is expensive and time consuming, prompting a need for more scalable training tools. The primary aim of this pilot and open trial was to examine the effects of an IPT online training platform on training outcomes (i.e., IPT fidelity, knowledge, and acceptance) and, secondarily, whether online training was different from in-person training (using a comparative sample from a separate study) in terms of training outcomes and patient symptoms. METHOD Participants were therapists (N = 60) and student patients (N = 42) at 38 college counseling centers. Therapists completed baseline questionnaires and collected data from a student patient with ED symptoms. Therapists then participated in an IPT online training program and completed post-training assessments. RESULTS Following online training, acceptance of evidence-based treatments, therapist knowledge of IPT, therapist acceptance of IPT, and treatment fidelity increased; acceptance of online training was high at baseline and remained stable after training. Using the 90% confidence interval on outcome effect sizes, results suggested IPT online training was not different from in-person training on most outcomes. Results are based on 60% of therapists who originally enrolled due to high dropout rate of therapist participants. CONCLUSIONS Findings from this preliminary pilot study support the use of IPT online training, which could increase access to evidence-based ED treatment and improve patient care. PUBLIC SIGNIFICANCE Lack of accessible therapist training has contributed to many therapists not delivering, and therefore many patients not receiving, evidence-based treatment. This study evaluated a highly disseminable online training and compared outcomes to traditional in-person training and found that training and patient outcomes were not different. Online training has the potential to enhance access to evidence-base care, which could in turn optimize patient outcomes.
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Affiliation(s)
- Anna M Karam Jones
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- University of California San Diego, San Diego, California, USA
| | | | - Laura D'Adamo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dawn M Eichen
- University of California San Diego, San Diego, California, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Pasquale EK, Strong DR, Manzano MA, Eichen DM, Peterson CB, Boutelle KN. Exploring relationships among appetitive traits, negative affect, and binge eating in adults with overweight or obesity. Eat Behav 2024; 53:101871. [PMID: 38518632 DOI: 10.1016/j.eatbeh.2024.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
Binge eating (BE) is a significant public health concern due to its prevalence and impact on mental and physical health. While research has suggested both negative affect and appetitive traits are associated with BE, few studies have investigated these constructs concurrently. Structural equation modeling (SEM) evaluated relationships between negative affect, reward-related appetitive traits, and BE among 293 adults with overweight or obesity (OW/OB) seeking treatment for BE, overeating, and weight management (m age = 46.6; m body mass index[BMI] = 34.5; 81.2 % female; 20.1 % Latinx, 60.8 % White non-Latinx). BE was related to negative affect (β = 0.53; p < 0.01) and appetitive traits (β = 1.53; p < 0.001). Negative affect and appetitive traits were related to one another (r = 0.42; p < 0.001), and the full model accounted for 77 % of the variance in BE. In an exploratory follow-up analysis, multigroup SEM evaluated the above relationships in models stratified by sex. Exploratory findings demonstrated both negative affect and appetitive traits were related to BE across sex, particularly when examining BE cognitions and behaviors. However, relationships in men depended upon BE assessment tool. These findings highlight that both negative affect and appetitive traits are related to BE, and jointly may represent significant risk and maintenance factors, particularly in adults with OW/OB. Our findings also highlight the importance of future investigation of sex differences in BE and the potential impact of assessment method.
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Affiliation(s)
- Ellen K Pasquale
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Michael A Manzano
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Kerri N Boutelle
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Rozzell‐Voss KN, Klimek‐Johnson P, Eichen DM, Brown TA, Blashill AJ. Executive function differences as a function of parent-reported binge eating and weight: Results from the adolescent brain cognitive development study. Obes Sci Pract 2024; 10:e703. [PMID: 38263994 PMCID: PMC10804330 DOI: 10.1002/osp4.703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/16/2023] [Accepted: 07/31/2023] [Indexed: 01/25/2024] Open
Abstract
Background Binge eating is a relatively common disordered eating behavior among children, and is associated with poor health outcomes. Executive function (EF)-higher order cognitive abilities related to planning and impulse control-may be implicated in both binge eating and pediatric obesity. Although EF deficits are evident among individuals with obesity and/or binge eating, findings are mixed across the lifespan. Methods The present study examined differences in EF among children with varying weight statuses and parent-reported binge eating. The sample included 10,017 children from the Adolescent Brain Cognitive Development study, aged 9-10 years. Results Children with parent-reported binge eating-either with overweight/obesity or normal weight-had significantly lower EF than those with no binge eating and a normal weight status but did not differ from those with no binge eating and overweight/obesity. Children with no binge eating and overweight/obesity also had statistically significantly lower EF than those with normal weight status. Although all significant differences between groups were negligible to very small, results may indicate similar neurocognitive profiles among children with binge eating and those with overweight/obesity. Conclusions Alterations in EF among children with binge eating may not be solely related to weight-specific factors, as significant differences also emerged among children with normal weight status, with versus without parent-reported binge eating. Future research is needed to understand temporal associations between obesity, disordered eating, and neurocognition in children using multi-informant methods for assessing binge eating.
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Affiliation(s)
| | | | | | | | - Aaron J. Blashill
- San Diego State UniversitySan DiegoCaliforniaUSA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
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5
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Boutelle KN, Pasquale EK, Strong DR, Eichen DM, Peterson CB. Reduction in eating disorder symptoms among adults in different weight loss interventions. Eat Behav 2023; 51:101787. [PMID: 37639734 DOI: 10.1016/j.eatbeh.2023.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
Restriction of food intake and counting calories as part of weight loss programs are thought to trigger eating behaviors and attitudes which can lead to eating disorders. We have developed a treatment model, Regulation of Cues (ROC), that targets appetitive traits, including food responsiveness and satiety responsiveness, which could address overeating at an implicit level and reduce risk of detrimental behaviors and attitudes. This manuscript evaluates eating disorder symptoms, attitudes, and behaviors among adults with overweight or obesity randomized to ROC, behavioral weight loss (BWL), a combination of ROC + BWL (ROC+) and an active comparator (AC). Participants included 271 adults with a body mass index of 25 to 45, age 18 to 65 years, and a lack of comorbidities that could interfere with participation. Assessments occurred at baseline, mid-treatment (6 months), post-treatment (12-months) and 6- and 12-month follow-up. During treatment, participants in all four arms showed decreases in Eating, Weight, and Shape concerns on the Eating Disorder Examination-Questionnaire and binge eating symptoms on the Binge Eating Scale which were maintained at 6-month follow-up but increased at the 12-month follow-up. Both the ROC+ and BWL arms showed increases in Restraint during treatment which dissipated after treatment ended. This study contributes to a growing body of literature demonstrating that weight loss programs are not associated with increases in eating disorder symptoms. Future studies should evaluate interventions to maintain improvements in eating disorder symptoms following weight loss programs.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Ellen K Pasquale
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
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6
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Eichen DM, Strong DR, Twamley EW, Boutelle KN. Adding executive function training to cognitive behavioral therapy for binge eating disorder: A pilot randomized controlled trial. Eat Behav 2023; 51:101806. [PMID: 37660487 PMCID: PMC10840715 DOI: 10.1016/j.eatbeh.2023.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 08/04/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
Evidence-based treatments for binge eating disorder (BED), such as cognitive behavioral therapy (CBT) lead to successful outcomes only about half the time. Individuals with BED often have measurable deficits in executive function (EF) that may challenge adherence to or impact of cognitive behavioral intervention components. The aim of this study was to evaluate the impact of adding EF training to CBT by combining CBT with a compensatory cognitive training approach (EF-CBT). Participants were 32 adults with BED, overweight/obesity, and comorbid anxiety or depression who were randomly assigned to four months of group treatment in either standard CBT or EF-CBT. Outcomes were assessed at baseline, post-treatment, and at 2-month follow-up. Results showed that EF-CBT was feasible and acceptable, comparable to CBT. Both groups significantly decreased loss of control (LOC) days, clinical impairment, and depression at post-treatment and 2-month follow-up; though there were no differences between groups. Neither group significantly reduced anxiety or weight. Exploratory analyses found that participants with lower EF treated with EF-CBT were less likely to have LOC at post-treatment than those with lower EF treated with CBT. Higher self-monitoring rates during treatment were associated with lower LOC at post-treatment and participants with lower EF were more likely to self-monitor in the EF-CBT arm relative to the CBT arm. These findings suggest that EF-CBT is feasible, acceptable and efficacious, although larger scale research is needed. EF-CBT may be particularly suited for individuals with BED who have lower EF.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of Pediatrics, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - David R Strong
- University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Elizabeth W Twamley
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - Kerri N Boutelle
- University of California San Diego, Department of Pediatrics, 9500 Gilman Drive, La Jolla, CA 92093, USA; University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, La Jolla, CA 92093, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093, USA
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7
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Jebeile H, Lister NB, Libesman S, Hunter KE, McMaster CM, Johnson BJ, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Askie L, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit AM, Cooper K, Kyle TK, Heeren FA, Quigley F, Barnes RD, Bean MK, Beaulieu K, Bonham M, Boutelle KN, Branco BHM, Calugi S, Cardel MI, Carpenter K, Cheng HL, Dalle Grave R, Danielsen YS, Demarzo M, Dordevic A, Eichen DM, Goldschmidt AB, Hilbert A, Houben K, Lofrano do Prado M, Martin CK, McTiernan A, Mensinger JL, Pacanowski C, do Prado WL, Ramalho SM, Raynor HA, Rieger E, Robinson E, Salvo V, Sherwood NE, Simpson SA, Skjakodegard HF, Smith E, Partridge S, Tanofsky-Kraff M, Taylor RW, Van Eyck A, Varady KA, Vidmar AP, Whitelock V, Yanovski J, Seidler AL. Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management. PLoS One 2023; 18:e0282401. [PMID: 37428754 PMCID: PMC10332604 DOI: 10.1371/journal.pone.0282401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/07/2023] [Indexed: 07/12/2023] Open
Abstract
The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Denise E Wilfley
- Washington University in St. Louis, St Louis, Missouri, United States of America
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- The University of Western Australia, School of Human Sciences, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan, Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, United Kingdom
- NIHR ACR Northwest London, London, United Kingdom
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia M Grunseit
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kelly Cooper
- Weight Issues Network, New South Wales, Australia
| | - Theodore K Kyle
- ConscienHealth, Pittsburgh, Pennsylvania, United States of America
| | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Fiona Quigley
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Co. Antrim, Northern Ireland
| | - Rachel D Barnes
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Kristine Beaulieu
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | - Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | | | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
- WW International, Inc., New York, NY, United States of America
| | - Kelly Carpenter
- Optum Center for Wellbeing Research, Seattle, Washington, United States of America
| | - Hoi Lun Cheng
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | | | - Marcelo Demarzo
- Mente Aberta, The Brazilian Center for Mindfulness and Health Promotion, Univesidade Federal de São Paulo, UNIFESP, Brazil
| | | | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Philadelphia, United States of America
| | - Anja Hilbert
- Research Unit Behavioral Medicine, Integrated Research and Treatment Center Adiposity Diseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katrijn Houben
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Mara Lofrano do Prado
- Department of Psychology, California State University, San Bernardino, California, United States of America
- Department of Kinesiology, California State University, San Bernardino, California, United States of America
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Carly Pacanowski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, United States of America
| | - Wagner Luiz do Prado
- Department of Kinesiology, California State University, San Bernardino, California, United States of America
| | - Sofia M Ramalho
- Psychology Research Centre, School of Psychology, University of Minho, Campus Gualtar, Braga, Portugal
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Vera Salvo
- Mente Aberta, The Brazilian Center for Mindfulness and Health Promotion, Univesidade Federal de São Paulo, UNIFESP, Brazil
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon A Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Evelyn Smith
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Stephanie Partridge
- Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marian Tanofsky-Kraff
- Departments of Medical and Clinical Psychology and Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Krista A Varady
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, Illinois, United States of America
| | - Alaina P Vidmar
- Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Los Angeles, California, United States of America
| | | | - Jack Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Anna L Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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8
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Boutelle KN, Afari N, Obayashi S, Eichen DM, Strong DR, Peterson CB. Design of the CHARGE study: A randomized control trial evaluating a novel treatment for Veterans with binge eating disorder and overweight and obesity. Contemp Clin Trials 2023; 130:107234. [PMID: 37210072 PMCID: PMC10409628 DOI: 10.1016/j.cct.2023.107234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023]
Abstract
A large number of Veterans experience binge eating and overweight or obesity, which are associated with significant health and psychological consequences. The gold-standard program for the treatment of binge eating, Cognitive Behavioral Therapy (CBT), results in decreases in binge eating frequency but does not result in significant weight loss. We developed the Regulation of Cues (ROC) program to reduce overeating and binge eating through improvement in sensitivity to appetitive cues and decreased responsivity to external cues, an approach that has never been tested among Veterans. In this study, we combined ROC with energy restriction recommendations from behavioral weight loss (ROC+). This study is a 2-arm randomized controlled trial designed to evaluate the feasibility and acceptability of ROC+, and to compare the efficacy of ROC+ and CBT on reduction of binge eating, weight, and energy intake over 5-months of treatment and 6-month follow-up. Study recruitment completed in March 2022. One hundred and twenty-nine Veterans were randomized (mean age = 47.10 (sd = 11.3) years; 41% female, mean BMI = 34.8 (sd = 4.7); 33% Hispanic) and assessments were conducted at baseline, during treatment and at post-treatment. The final 6-month follow-ups will be completed in April 2023. Targeting novel mechanisms including sensitivity to internal cures and responsivity to external cues is critically important to improve binge eating and weight-loss programs among Veterans. Clinicaltrials.govNCT03678766.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Niloofar Afari
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - Saori Obayashi
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
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9
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Graham AK, Fitzsimmons-Craft EE, Sadeh-Sharvit S, Balantekin KN, Eichen DM, Firebaugh ML, Goel NJ, Monterubio GE, Karam AM, Flatt RE, Jo B, Jacobi C, Wilfley DE, Taylor CB, Trockel M. Moderators and mediators of a digital cognitive behavior therapy-guided self-help intervention for eating disorders: Informing future design efforts. J Consult Clin Psychol 2023; 91:280-284. [PMID: 36634022 PMCID: PMC10198808 DOI: 10.1037/ccp0000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The Student Bodies-Eating Disorders intervention (SB-ED), a digital cognitive behavior therapy-guided self-help intervention for college women with an eating disorder, is effective for reducing eating disorder psychopathology. The purpose of this study was to evaluate moderators and mediators of the SB-ED intervention. To our knowledge, this is the first evaluation of clinical mediators of a digital intervention for women with eating disorders. METHOD This is an exploratory secondary analysis of a cluster randomized trial comparing the SB-ED intervention to referral to usual care among 690 women at 27 United States colleges. Moderators included body mass index (BMI), race, ethnicity, weight/shape concerns, eating disorder impairment, thin ideal internalization, depression, anxiety, and motivation for treatment, assessed at baseline. Thin ideal internalization and depressive symptoms were tested as predictors at postintervention and mediators at 2-year follow-up. Outcome was change in global eating disorder psychopathology. RESULTS BMI moderated the effect of the intervention at follow-up (but not posttreatment), with individuals with a lower BMI experiencing more continued improvements in eating disorder psychopathology following the intervention than individuals with a higher BMI. Thin ideal internalization mediated the effect of the intervention at follow-up, and depression partially mediated the effect of the intervention at follow-up. CONCLUSIONS Results of the mediator analyses suggest that helping college women reduce inflated internalization of the thin ideal and improve depressive symptoms leads to improvements in eating disorder psychopathology. Results also suggest opportunities to optimize the intervention so individuals across the BMI spectrum experience ongoing improvements over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, California
- Institute of Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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10
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Eichen DM, Sim DJEK, Appleton-Knapp SL, Strong DR, Boutelle KN. Adults with overweight or obesity use less efficient memory strategies compared to adults with healthy weight on a verbal list learning task modified with food words. Appetite 2023; 181:106402. [PMID: 36460122 PMCID: PMC9836657 DOI: 10.1016/j.appet.2022.106402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
Several studies suggest poorer episodic memory among adults with overweight (OW) relative to those with healthy weight (HW); however, few have used food stimuli. To understand the salience of food-related items when assessing memory, we adapted an episodic memory task, by replacing some non-food words with snack foods. Participants were 96 weight-loss seeking adults with OW compared to 48 adults with HW from the community matched on age, gender, ethnicity, and education. Overall memory ability was similar, although a trend showed the adults with HW performed better than adults with OW on immediate recall (d = 0.32, p = 0.07). However, there were clear differences in the use of learning strategies. Adults with HW utilized sematic clustering more effectively than adults with OW during all test phases (ds = 0.44-0.62; ps ≤ 0.01). Adults with HW also utilized serial clustering more effectively (d = 0.51; p < 0.01). Adults with HW showed better semantic clustering for both food and non-food words during immediate and short delay recall (ds = 0.42-0.78; ps ≤ 0.01) but semantic clustering was only better for the non-food category at long delay (d = 0.55; p < 0.01). These results show that adults with OW utilized less efficient learning strategies throughout the task and food-related content may impact learning. Clinically, these findings may suggest that weight-loss treatments should consider incorporating the teaching of learning and memory strategies to help increase utilization of new skills.
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Affiliation(s)
- Dawn M. Eichen
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA,Corresponding author. University of California, San Diego, 9500 Gilman Drive #0874, La Jolla, CA, 92093, USA., (D.M. Eichen)
| | - Dong-Jin E. Kang Sim
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA
| | | | - David R. Strong
- University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
| | - Kerri N. Boutelle
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA,University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA,University of California San Diego, Department of Psychiatry, San Diego, CA, USA
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11
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Kang Sim DE, Eichen DM, Strong DR, Manzano MA, Boutelle KN. Development and validation of the food cue responsivity scale. Physiol Behav 2023; 258:114028. [PMID: 36368562 PMCID: PMC9754925 DOI: 10.1016/j.physbeh.2022.114028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
Food cues are ubiquitous in today's environment; however, there is heterogeneity as to the extent to which these cues impact eating behavior among individuals. This study examines the validity and reliability of the Food Cue Responsivity Scale (FCRS) to assess responsivity to distinct types of food cues. Items gathered from existing measures were combined in the FCRS to reflect two subdomains, uncontrolled eating behavior and cognitive rumination. The criterion validity of the FCRS was established using a paradigm that assesses psychophysiological responsivity to a craved food among adults with overweight or obesity. Higher overall FCRS scores were associated with greater physiological responsivity to food exposures. These findings may help identify specific phenotypes of individuals with overweight or obesity with high responsivity to food cues, which could be used to understand overeating and response to weight-loss programs.
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Affiliation(s)
- D Eastern Kang Sim
- Department of Pediatrics, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093, United States.
| | - Dawn M Eichen
- Department of Pediatrics, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093, United States
| | - David R Strong
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, United States
| | - Michael A Manzano
- Department of Pediatrics, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093, United States; San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, United States
| | - Kerri N Boutelle
- Department of Pediatrics, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093, United States; Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, United States; Department of Psychiatry, University of California, San Diego, United States
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12
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Boutelle KN, Rhee KE, Manzano MA, Bernard RS, Strong DR, Eichen DM, Anderson CCA, Marcus BH, Akshoomoff N, Crow SJ. Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity. Contemp Clin Trials 2023; 124:106996. [PMID: 36343880 PMCID: PMC9968239 DOI: 10.1016/j.cct.2022.106996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Michael A Manzano
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court Suite 102, San Diego, CA 92120, USA
| | - Rebecca S Bernard
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Cheryl C A Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, 121 South Main Street, box G-S121-3, Providence, RI 02912-G, USA
| | - Natacha Akshoomoff
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
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13
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Pasquale EK, Manzano MA, Strong DR, Eichen DM, Tanofsky-Kraff M, Boutelle KN. Psychometric properties of the Eating in the Absence of Hunger Questionnaire in treatment-seeking adults with overweight and obesity. Appetite 2023; 180:106376. [PMID: 36379306 PMCID: PMC9808922 DOI: 10.1016/j.appet.2022.106376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
Understanding eating behaviors that contribute to overweight and obesity (OW/OB) is an important public health objective. One eating behavior known to contribute to overeating is eating in the absence of hunger (EAH). The Eating in the Absence of Hunger Questionnaire for Children was developed to assess external events and internal experiences that lead children to overeat. Despite the measure's adaptation for use with adults (i.e., EAH-A), its psychometric properties within this population have not been explored. This study assessed the psychometric properties of the EAH-A in sample of 311 treatment-seeking adults with OW/OB (mean BMI = 34.5 [5.1]; mean age = 46.3 [12.1]; 81.7% female; 20.6% Latinx, 59.2% white). The EAH-A contains 14 items and assesses three domains: negative affect eating (EAH-NAE), external eating, and fatigue/boredom eating, through two parallel sets of items assessing initiating EAH and continuing EAH. Exploratory Factor Analysis was performed with promax rotation and maximum likelihood factor extraction. Results supported a unitary factor of EAH, with scale responses driven by EAH-NAE items. Results may be explained in part by scale structure and domain imbalance favoring EAH-NAE items, or the true internal structure of EAH may consist of a singular latent construct. Follow-up analyses indicated redundancy of the scale's parallel sections. If researchers are primarily interested in EAH-NAE, only the three "start eating" or "keep eating" items may be needed. This study highlights the importance of validating the psychometric properties of a measure within intended populations to ensure interpretations are valid.
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Affiliation(s)
- Ellen K. Pasquale
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Michael A. Manzano
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA
| | - Marian Tanofsky-Kraff
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814 USA
| | - Kerri N. Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92037 USA
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14
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Boutelle KN, Eichen DM, Peterson CB, Strong DR, Kang-Sim DJE, Rock CL, Marcus BH. Effect of a Novel Intervention Targeting Appetitive Traits on Body Mass Index Among Adults With Overweight or Obesity: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2212354. [PMID: 35583870 PMCID: PMC9118075 DOI: 10.1001/jamanetworkopen.2022.12354] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Behavioral weight loss (BWL) programs result in weight loss for some, but most individuals regain the weight. The behavioral susceptibility theory proposes that genetically determined appetitive traits, such as food responsiveness (FR) and satiety responsiveness (SR), interact with the environment and lead to overeating and weight gain; the regulation of cues (ROC) intervention was developed specifically to target FR and SR. OBJECTIVE To evaluate the efficacy of ROC, ROC combined with BWL (ROC+), BWL, and an active comparator (AC) over 12 months of treatment and 12 months of follow-up. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from December 2015 to December 2019 in a university clinic. A total of 1488 volunteers from the community inquired about the study; 1217 were excluded or declined to participate. Eligibility criteria included body mass index (BMI) of 25 to 45, age 18 to 65 years, and lack of comorbidities or other exclusionary criteria that would interfere with participation. Data were analyzed from September 2021 to January 2022. INTERVENTIONS ROC uniquely targeted FR and SR. BWL included energy restriction, increasing physical activity, and behavior therapy techniques. ROC+ combined ROC with BWL. AC included mindfulness, social support, and nutrition education. MAIN OUTCOMES AND MEASURES Change in body weight as measured by BMI. RESULTS A total of 271 adults (mean [SD] age, 46.97 [11.80] years; 81.6% female [221 participants]; mean [SD] BMI, 34.59 [5.28]; 61.9% White [167 participants]) were assessed at baseline, midtreatment, posttreatment, and 6-month and 12-month follow-up. Sixty-six participants were randomized to AC, 69 to ROC, 67 to ROC+, and 69 to BWL. Results showed that ROC, ROC+, and BWL interventions resulted in significantly lower BMI at the end of treatment (BMI ROC, -1.18; 95% CI, -2.10 to -0.35; BMI ROC+, -1.56; 95% CI, -2.43 to -0.67; BMI BWL, -1.58; 95% CI, -2.45 to -0.71). Compared with BWL, BMI at the end of treatment was not significantly different from ROC or ROC+ (BMI ROC, 0.40; 95% CI, -0.55 to 1.36; BMI ROC+, 0.03; 95% CI, -0.88 to 0.93); however, the BMI of the AC group was substantially higher (BMI AC, 1.58; 95% CI, 0.72 to 2.45). BMI reductions at 24 months after randomization were similar for ROC, ROC+, and BWL. Importantly, FR was a moderator of treatment effects with more weight loss for participants who scored higher in FR in the ROC and ROC+ groups. CONCLUSIONS AND RELEVANCE These findings suggest that ROC and ROC+ provide alternative weight loss approaches for adults. These models could be particularly effective for individuals who struggle with FR and could be used as a precision approach for weight loss. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02516839.
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Affiliation(s)
- Kerri N. Boutelle
- Department of Pediatrics, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Health, University of Minnesota, Minneapolis
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | | | - Cheryl L. Rock
- Department of Family Medicine, University of California, San Diego, La Jolla
| | - Bess H. Marcus
- Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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15
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Flatt RE, Karam AM, Fitzsimmons-Craft EE, Balantekin KN, Graham AK, Eichen DM, Monterubio GE, Goel NJ, Fowler LA, Sadeh-Sharvit S, Wilfley D, Mazina V, Taylor CB, Trockel M. Psychometric properties of the Perceived Benefits of Thinness Scale in college-aged women. Body Image 2022; 40:103-109. [PMID: 34896896 PMCID: PMC8891087 DOI: 10.1016/j.bodyim.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Thin ideal internalization is a risk factor for disordered eating behaviors, poor body image, and eating disorders (EDs). This paper evaluated the psychometric properties of a novel measure, the Perceived Benefits of Thinness Scale (PBTS), which assesses how individuals feel being thinner would affect various aspects of their lives. Three separate studies with unique samples of college-aged women over 18 years were conducted to assess reliability and validity. In Study 1, exploratory and confirmatory factor analyses suggested all PBTS items loaded onto one factor that was distinct from a measure of weight and shape concerns. A large correlation between changes in PTBS scores and changes in ED psychopathology scores over 8 months (r = .57, p < .01) suggested sensitivity to change. Greater severity in ED pathology was also associated with higher scores on the PBTS. In Study 2, the PBTS showed good test-retest reliability (r = .84, p < .001) and, in Study 3, expected correlations with existing measures of thin ideal internalization (rs = .38-.60, ps < .001). Overall, the PBTS displayed good factor structure, reliability, concurrent validity, and sensitivity to change. By emphasizing social, emotional, and quality of life benefits, the PBTS may serve clinicians, researchers, and patients in understanding thin ideal internalization and associated ED risk.
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Affiliation(s)
- Rachael E. Flatt
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for m2Health, Palo Alto University, Palo Alto, CA, USA,Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Denise Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Varvara Mazina
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA,Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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16
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Eichen DM, Strong DR, Rhee KE, Boutelle KN. The complicated relationship among parent and child disinhibited eating behaviors. Appetite 2022; 171:105923. [PMID: 35026372 DOI: 10.1016/j.appet.2022.105923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
Disinhibited eating behaviors (e.g., loss of control eating (LOC) and eating in the absence of hunger (EAH)) contribute to overeating and obesity. This study aimed to evaluate whether these traits are related in parent-child dyads and how the reporter of child eating behavior (parent or child) impacts this relationship. Two-hundred and ninety treatment-seeking children, ages 8-13, with overweight or obesity (BMI percentile for age and sex 85-99.9%) and their parents were included. LOC and EAH were assessed by child report for self, parent report for self, and parent report for child. Parent and child disinhibited eating behaviors were related only when parents reported on both their own and their child's eating behaviors (p-values < 0.04). Child report of LOC and EAH for self was not associated with parent report of LOC and EAH for self (p-values > 0.05). There was a significant interaction between parent's EAH and BMI as it related to parent report of child EAH (B = 0.02; SE = 0.005; p = 0.004) such that parents with lower BMI reported their own EAH to be lower than parents with higher BMI, but parent report of child EAH was similar regardless of the parent's BMI. Disinhibited eating behaviors were related only when a single parent reported on both their own and their child's behavior, suggesting a potential reporting bias. Given that the relation between parent and child disinhibited eating behaviors varies based on who is reporting the child's behavior, it may be important to consider both parent and child report when designing research studies or in clinical settings while also recognizing potential reporting biases.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA.
| | - David R Strong
- University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
| | - Kyung E Rhee
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA
| | - Kerri N Boutelle
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA; University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, San Diego, CA, USA
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17
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Fitzsimmons-Craft EE, Eichen DM, Monterubio GE, Firebaugh ML, Goel NJ, Taylor CB, Wilfley DE. Longer-term follow-up of college students screening positive for anorexia nervosa: psychopathology, help seeking, and barriers to treatment. Eat Disord 2020; 28:549-565. [PMID: 31109255 PMCID: PMC6864248 DOI: 10.1080/10640266.2019.1610628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to conduct a longer-term (i.e., 9-month) follow-up of students identified with possible anorexia nervosa (AN) as part of the Healthy Body Image Program, an online platform for screening and delivering tailored feedback and interventions, offered at 36 US universities. Participants were 61 individuals who screened positive for AN and who completed the follow-up. Regarding results, some indices of ED pathology and psychiatric comorbidity decreased over time, while others did not. Participants most commonly endorsed feeling ashamed, nervous, validated, and sad in response to receiving the referral. One-third (33%) reported already being in treatment at the time they received the referral, 26% initiated treatment since that time, and 41% did not initiate treatment. The most common reasons for seeking treatment were emotional distress, concern with eating, and health concerns. The strongest treatment barriers were believing one should be able to help themselves, believing the problem was not serious enough to warrant treatment, and not having time. Findings highlight the high level of pathology in students identified with possible AN, even nine months after they were first identified and provided resources, and the relatively low rates of treatment utilization given the seriousness of these illnesses.
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Affiliation(s)
| | - Dawn M Eichen
- Department of Pediatrics, University of California , San Diego, California, USA
| | - Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine , St. Louis, Missouri, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine , St. Louis, Missouri, USA
| | - Neha J Goel
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia, USA.,Institute for Inclusion, Inquiry and Innovation (iCubed), Virginia Commonwealth University , Richmond, Virginia, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA, USA.,Center for mHealth, Palo Alto University , Palo Alto, California, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine , St. Louis, Missouri, USA
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18
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Fitzsimmons-Craft EE, Taylor CB, Graham AK, Sadeh-Sharvit S, Balantekin KN, Eichen DM, Monterubio GE, Goel NJ, Flatt RE, Karam AM, Firebaugh ML, Jacobi C, Jo B, Trockel MT, Wilfley DE. Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2015633. [PMID: 32865576 PMCID: PMC7489868 DOI: 10.1001/jamanetworkopen.2020.15633] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022] Open
Abstract
Importance Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap. Objective To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care. Design, Setting, and Participants This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019. Interventions Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care. Main Outcomes and Measures The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access. Results A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (β [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (β [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (β [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001). Conclusions and Relevance In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders. Trial Registration ClinicalTrials.gov Identifier: NCT02076464.
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Affiliation(s)
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Center for m 2 Health, Palo Alto University, Palo Alto, California
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Center for m 2 Health, Palo Alto University, Palo Alto, California
- Interdisciplinary Center, Baruch Ivcher School of Psychology, Herzliya, Israel
| | | | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego
| | - Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Neha J Goel
- Department of Psychology, Virginia Commonwealth University, Richmond
- Institute for Inclusion, Inquiry, and Innovation (iCubed), Virginia Commonwealth University, Richmond
| | - Rachael E Flatt
- Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill, Chapel Hill
| | - Anna M Karam
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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19
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Mestre Z, Grethe AB, Wierenga CE, Jernigan T, Eichen DM, Chang L, Ernst T, Boutelle KN. Associations Between Body Weight, Hippocampal Volume, and Tissue Signal Intensity in 12- to 18-Year-Olds. Obesity (Silver Spring) 2020; 28:1325-1331. [PMID: 32501641 PMCID: PMC7927957 DOI: 10.1002/oby.22841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The hippocampus is a key structure in feeding behaviors and weight regulation. Obesity may lead to disruptions in hippocampal structure. In animals, obesity-related factors (e.g., high-fat/sugar foods) are associated with hippocampal insult (e.g., alterations in the blood brain barrier). In humans, individuals with obesity, relative to healthy weight, have smaller hippocampal volumes. Few studies have examined the association between body weight and the hippocampus during adolescence, a critical brain development period. This study examined hippocampal volume and tissue signal intensity in adolescents across the weight spectrum. METHODS Structural magnetic resonance imaging and anthropomorphic data were available for 102 12- to 18-year-old adolescents (53% female; 15.07 [SD 1.84] years; standardized BMI [BMIz] scores using the Centers for Disease Control and Prevention growth charts: 0.54 [SD 1.17]) from the Pediatric Imaging, Neurocognition, and Genetics database. Linear regression models controlling for age, sex, genetic ancestry, scanner, and household income examined the relationship between BMIz, hippocampal volume, and T2-weighted hippocampal signal intensity. RESULTS BMIz was negatively associated with T2-weighted hippocampal signal intensity in the left (t = -3.05; P = 0.003; r = -0.21) and right (t = -2.50; P = 0.01; r = -0.36) hippocampi. BMIz was not significantly associated with hippocampal volume. CONCLUSIONS BMIz is associated with hippocampal tissue characteristics during adolescence, which could impact later brain development.
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Affiliation(s)
- Zoe Mestre
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
| | | | - Christina E. Wierenga
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
- Veterans Affairs San Diego Healthcare System,Research Service, San Diego CA, USA
| | - Terry Jernigan
- Department of Cognitive Science, University of California San Diego, La Jolla CA, USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California San Diego, La Jolla CA, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, and Departrment of Neurology, University of Maryland School of Medecine, Baltimore MD, USA
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, and Departrment of Neurology, University of Maryland School of Medecine, Baltimore MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kerri N. Boutelle
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla CA, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
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20
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Eichen DM, Mestre ZL, Strong DR, Rhee KE, Boutelle KN. Defining and identifying predictors of rapid response to pediatric obesity treatment. Pediatr Obes 2020; 15:e12621. [PMID: 32100412 PMCID: PMC7202991 DOI: 10.1111/ijpo.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
Early weight loss (rapid response [RR]) is associated with better outcomes in adults. Less is known about RR in children enrolled in weight-loss treatment. The aim of the current study was to establish an RR weight-loss threshold following 4 weeks of pediatric obesity treatment and identify characteristics associated with achieving RR. One hundred thirty-seven children aged 8 to 12 with overweight/obesity and parents participated in 6 months of family-based or parent-based treatment. Receiver operating characteristic curves evaluated how weight loss at week 4 related to decreases of 5% at posttreatment and 10% at 6- and 18-month follow-ups of standardized body mass index (BMIz), percentage distance of a child's BMI from the median BMI for sex and age, and percentage above the 95th percentile. Weight loss of 2.4% to 3.4% at week 4 predicted 5% change at posttreatment (AUC's = .68-.75; P's ≤ .002) and 10% change at 6-month follow-up (AUC's = .63-.70; P's ≤ .02). No model was significant at 18-month follow-up. Amount of parent weight (lbs) change at week 4 was associated with child achieving RR. Males and Non-Hispanic Whites were more likely to achieve RR. This threshold could be used to mark early significant progress and guide clinical evaluations of treatment response to paediatric obesity treatment.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA
| | - Zoe L Mestre
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA USA
| | - David R Strong
- University of California San Diego, Department of Family
Medicine and Public, San Diego, CA USA
| | - Kyung E Rhee
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA
| | - Kerri N Boutelle
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA,University of California San Diego, Department of Family
Medicine and Public, San Diego, CA USA,University of California San Diego, Department of
Psychiatry, San Diego, CA USA
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21
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Funk B, Sadeh-Sharvit S, Fitzsimmons-Craft EE, Trockel MT, Monterubio GE, Goel NJ, Balantekin KN, Eichen DM, Flatt RE, Firebaugh ML, Jacobi C, Graham AK, Hoogendoorn M, Wilfley DE, Taylor CB. A Framework for Applying Natural Language Processing in Digital Health Interventions. J Med Internet Res 2020; 22:e13855. [PMID: 32130118 PMCID: PMC7059510 DOI: 10.2196/13855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are poised to reduce target symptoms in a scalable, affordable, and empirically supported way. DHIs that involve coaching or clinical support often collect text data from 2 sources: (1) open correspondence between users and the trained practitioners supporting them through a messaging system and (2) text data recorded during the intervention by users, such as diary entries. Natural language processing (NLP) offers methods for analyzing text, augmenting the understanding of intervention effects, and informing therapeutic decision making. OBJECTIVE This study aimed to present a technical framework that supports the automated analysis of both types of text data often present in DHIs. This framework generates text features and helps to build statistical models to predict target variables, including user engagement, symptom change, and therapeutic outcomes. METHODS We first discussed various NLP techniques and demonstrated how they are implemented in the presented framework. We then applied the framework in a case study of the Healthy Body Image Program, a Web-based intervention trial for eating disorders (EDs). A total of 372 participants who screened positive for an ED received a DHI aimed at reducing ED psychopathology (including binge eating and purging behaviors) and improving body image. These users generated 37,228 intervention text snippets and exchanged 4285 user-coach messages, which were analyzed using the proposed model. RESULTS We applied the framework to predict binge eating behavior, resulting in an area under the curve between 0.57 (when applied to new users) and 0.72 (when applied to new symptom reports of known users). In addition, initial evidence indicated that specific text features predicted the therapeutic outcome of reducing ED symptoms. CONCLUSIONS The case study demonstrates the usefulness of a structured approach to text data analytics. NLP techniques improve the prediction of symptom changes in DHIs. We present a technical framework that can be easily applied in other clinical trials and clinical presentations and encourage other groups to apply the framework in similar contexts.
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Affiliation(s)
- Burkhardt Funk
- Leuphana University, Institute of Information Systems, Lueneburg, Germany
| | - Shiri Sadeh-Sharvit
- Palo Alto University, Center for m2Health, Palo Alto, CA, United States
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | | | - Mickey Todd Trockel
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Grace E Monterubio
- Washington University in St Louis, Department of Psychiatry, St Louis, MO, United States
| | - Neha J Goel
- Palo Alto University, Center for m2Health, Palo Alto, CA, United States
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Katherine N Balantekin
- Washington University in St Louis, Department of Psychiatry, St Louis, MO, United States
- University at Buffalo, Department of Exercise and Nutrition Sciences, Buffalo, NY, United States
| | - Dawn M Eichen
- Washington University in St Louis, Department of Psychiatry, St Louis, MO, United States
- University of California San Diego, Department of Pediatrics, San Diego, CA, United States
| | - Rachael E Flatt
- Palo Alto University, Center for m2Health, Palo Alto, CA, United States
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
- University of North Carolina at Chapel Hill, Department of Psychology and Neurosciences, Chapel Hill, NC, United States
| | - Marie-Laure Firebaugh
- Washington University in St Louis, Department of Psychiatry, St Louis, MO, United States
| | - Corinna Jacobi
- Technische Universität, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Andrea K Graham
- Northwestern University, Department of Medical Social Sciences, Chicago, IL, United States
| | - Mark Hoogendoorn
- Vrije Universiteit, Department of Computer Science, Amsterdam, Netherlands
| | - Denise E Wilfley
- Washington University in St Louis, Department of Psychiatry, St Louis, MO, United States
| | - C Barr Taylor
- Palo Alto University, Center for m2Health, Palo Alto, CA, United States
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
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22
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Wilfley DE, Agras WS, Fitzsimmons-Craft EE, Bohon C, Eichen DM, Welch RR, Jo B, Raghavan R, Proctor EK, Wilson GT. Training Models for Implementing Evidence-Based Psychological Treatment: A Cluster-Randomized Trial in College Counseling Centers. JAMA Psychiatry 2020; 77:139-147. [PMID: 31693069 PMCID: PMC6865264 DOI: 10.1001/jamapsychiatry.2019.3483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Progress has been made in establishing evidence-based treatments for psychiatric disorders, but these are not often delivered in routine settings. A scalable solution for training clinicians in evidence-based treatments is needed. OBJECTIVE To compare 2 methods of training college (university) counseling center therapists to treat psychiatric disorders using interpersonal psychotherapy. The hypothesis was that the train-the-trainer condition would demonstrate superior implementation outcomes vs the expert condition. Moderating factors were also explored. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized trial was conducted from October 2012 to December 2017 in 24 college counseling centers across the United States. Therapist participants were recruited from enrolled centers, and student patients with symptoms of depression and eating disorders were recruited by therapists. Data were analyzed from 184 enrolled therapists. INTERVENTIONS Counseling centers were randomized to the expert condition, which involved a workshop and 12 months of follow-up consultation, or the train-the-trainer condition, in which a staff member from the counseling center was coached to train other staff members. MAIN OUTCOMES AND MEASURES The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, as assessed via audio recordings of therapy sessions. Therapist knowledge of interpersonal psychotherapy was a secondary outcome. RESULT A total of 184 therapists (mean [SD] age, 41.9 [10.6] years; 140 female [76.1%]; 142 white [77.2%]) were included. Both the train-the-trainer-condition and expert-condition groups showed significant within-group improvement for adherence to interpersonal psychotherapy (change: 0.233 [95% CI, 0.192-0.274] and 0.190 [0.145-0.235], respectively; both P < .001), with large effect sizes (1.64 [95% CI, 1.35-1.93] and 1.34 [95% CI, 1.02-1.66], respectively) and no significant difference between conditions. Both groups also showed significant within-group improvement in interpersonal therapy competence (change: 0.179 [95% CI, 0.132-0.226] and 0.106 [0.059-0.153], respectively; both P < .001), with a large effect size for the train-the-trainer condition (1.16 [95% CI, 0.85-1.46]; P < .001) and a significant difference between groups favoring the train-the-trainer condition (effect size, 0.47 [95% CI, 0.05-0.89]; P = .03). Knowledge of interpersonal psychotherapy improved significantly within both groups (effect sizes: train-the-trainer, 0.64 [95% CI, 0.28-0.99]; P = .005; expert, 0.69 [95% CI, 0.38-1.01]; P < .001), with no significant difference between groups. The significant moderating factors were job satisfaction for adherence (b, 0.120 [95% CI, 0.001-0.24]; P = .048) and competence (b, 0.133 [95% CI, 0.001-0.27]; P = .048), and frequency of clinical supervision for competence (b, 0.05 [95% CI, 0.004-0.09]; P = .03). CONCLUSIONS AND RELEVANCE Results demonstrate that the train-the-trainer model produced training outcomes comparable with the expert model for adherence and was superior on competence. Given its potential capability to train more therapists over time, it has the potential to facilitate widespread dissemination of evidence-based treatments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02079142.
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Affiliation(s)
- Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - W. Stewart Agras
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | | | - Cara Bohon
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego
| | - R. Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Booil Jo
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | - Ramesh Raghavan
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick,Now with Silver School of Social Work, New York University, New York
| | - Enola K. Proctor
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - G. Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway
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23
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Eichen DM, Rhee KE, Strong DR, Boutelle KN. Impact of Race and Ethnicity on Weight-Loss Outcomes in Pediatric Family-Based Obesity Treatment. J Racial Ethn Health Disparities 2020; 7:643-649. [PMID: 31919695 DOI: 10.1007/s40615-019-00694-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Minority children are disproportionately affected by obesity and little is known about how race/ethnicity impacts outcomes in pediatric weight-loss treatment. This study aimed to evaluate whether race/ethnicity affected weight-loss outcomes in a pediatric obesity intervention. Secondary aims included evaluating whether race/ethnicity was associated with energy intake, exercise, program adherence, acceptability, and attendance. METHODS One hundred fifty parent/child dyads (age 8-12 years, BMI% 85-99.9; 32% Hispanic, 24% Non-Hispanic, Non-White, 44% Non-Hispanic White) participated in a randomized control trial evaluating weight loss in family-based behavioral treatment with (FBT) or without child participation (i.e., Parent-Based Treatment, PBT). Assessments occurred at baseline, mid-treatment (month 3), post-treatment (month 6), and follow-up (months 12 and 24). Analyses included linear mixed effect models, linear models, and a negative binomial model. RESULTS Weight loss in Hispanic, Non-Hispanic White, and Non-Hispanic, Non-White children was not significantly different by race/ethnicity at months 6, 12, and 24 (p = 0.259) and was similar across both treatments (FBT = - 0.16 BMIz; PBT = - 0.21 BMIz; p = 0.61). There were no differences in energy intake, physical activity, acceptability ratings, or adherence to treatment (as measured by a post-treatment survey) (p's > 0.123). However, Hispanic families attended fewer treatment visits than Non-Hispanic White families (p = 0.017). CONCLUSION On average, children lost weight participating in our pediatric obesity treatment and there was no statistical difference in weight loss between groups. Future research evaluating whether culturally adapted treatments would be more effective for racial/ethnic minorities or whether the personalization inherent in family-based behavioral treatment may be sufficient is needed.
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Affiliation(s)
- Dawn M Eichen
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Karam AM, Eichen DM, Fitzsimmons-Craft EE, Wilfley DE. An examination of the interpersonal model of binge eating over the course of treatment. Euro Eating Disorders Rev 2020; 28:66-78. [PMID: 31497914 PMCID: PMC7031004 DOI: 10.1002/erv.2700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/26/2019] [Accepted: 08/06/2019] [Indexed: 11/12/2022]
Abstract
The current study examined the interpersonal model of binge eating, which posits that interpersonal problems lead to negative affect, which results in binge eating, over the course of two psychotherapy treatments (interpersonal psychotherapy and cognitive behavioural therapy) in 162 adults with binge-eating disorder. A series of longitudinal simple mediation analyses preliminarily showed that treatment addresses the mechanisms of the interpersonal model of binge eating as theoretically proposed in predicting reductions in binge eating, the primary dependent variable, and the secondary dependent variables including global eating disorder psychopathology, shape concern, and weight concern, but not reductions in restraint or eating concern. Moderated mediation analyses did not fully support treatment differences, as changes in the mechanisms of the interpersonal model occurred in both treatments and suggest both treatments addressed negative affect and interpersonal precipitants of eating disorder symptomatology. Future research should replicate this study using variables that do not overlap in time to investigate causation of the model, and more generally, further examine theoretical treatment models and treatment mediators as this research could help improve efficacy of treatment for binge-eating disorder.
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Affiliation(s)
- Anna M Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | | | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Fitzsimmons-Craft EE, Eichen DM, Kass AE, Trockel M, Crosby RD, Taylor CB, Wilfley DE. Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset. Eat Weight Disord 2019; 24:1189-1198. [PMID: 29285745 PMCID: PMC6170712 DOI: 10.1007/s40519-017-0469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 12/02/2017] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Understanding how known eating disorder (ED) risk factors change in relating to one another over time may inform efficient intervention targets. We examined short-term (i.e., 1 month) reciprocal longitudinal relations between weight/shape concern and comorbid symptoms (i.e., depressed mood, anxiety) and behaviors (i.e., binge drinking) over the course of 24 months using cross-lagged panel models. METHODS Participants were 185 women aged 18-25 years at very high risk for ED onset, randomized to an online ED preventive intervention or waitlist control. We also tested whether relations differed based on intervention receipt. RESULTS Weight/shape concern in 1 month significantly predicted depressed mood the following month; depressed mood in 1 month also predicted weight/shape concern the following month, but the effect size was smaller. Likewise, weight/shape concern in 1 month significantly predicted anxiety the following month, but the reverse was not true. Results showed no temporal relations between weight/shape concern and binge drinking in either direction. Relations between weight/shape concern, and comorbid symptoms and behaviors did not differ based on intervention receipt. CONCLUSIONS Results support focusing intervention on reducing weight/shape concern over reducing comorbid constructs for efficient short-term change. LEVEL OF EVIDENCE Level I, evidence obtained from a properly designed randomized controlled trial.
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Affiliation(s)
- Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Dawn M Eichen
- Department of Pediatrics, University of California, 8950 Villa La Jolla Dr., Suite C-203, San Diego, CA, 92037, USA
| | - Andrea E Kass
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 1000, Chicago, IL, 60637, USA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
| | - Ross D Crosby
- Neuropsychiatric Research Institute, 120 S. 8th St., Box 1415, Fargo, ND, 58107, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA.,Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
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26
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Kang Sim DE, Strong DR, Manzano M, Eichen DM, Rhee KE, Tanofsky-Kraff M, Boutelle KN. Evaluating psychometric properties of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) in a clinical sample of children seeking treatment for obesity: a case for the unidimensional model. Int J Obes (Lond) 2019; 43:2565-2572. [PMID: 31395924 PMCID: PMC6957223 DOI: 10.1038/s41366-019-0427-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Emotional Eating Scale - Adapted for Children and Adolescents (EES-C) assesses children's urge to eat in response to experiences of negative affect. Prior psychometric studies have demonstrated the high reliability, concurrent validity, and test-retest reliability of theoretically defined subconstructs among non-clinical samples of children and adolescents who were primarily healthy weight; however, no psychometric studies exist investigating the EES-C among clinical samples of children with overweight/obesity (OW/OB). Furthermore, studies conducted in different contexts have suggested a discordant number of subconstructs of emotions related to eating. The purpose of this study was to evaluate the validity of the EES-C in a clinical sample of children seeking weight-loss treatment. METHOD Using a hierarchical bi-factor approach, we evaluated the validity of the EES-C to measure a single general construct, a set of two separate correlated subconstructs, or a hierarchical arrangement of two constructs, and determined reliability in a clinical sample of treatment-seeking children with OW/OB aged 8-12 years (N = 147, mean age = 10.4 years.; mean BMI z = 2.0; female = 66%; Hispanic = 32%, White and other = 68%). RESULTS Comparison of factor-extraction methods suggested a single primary construct underlying EES-C in this clinical sample. The bi-factor indices provided clear evidence that most of the reliable variance in the total score (90.8 for bi-factor model with three grouping factors and 95.2 for bi-factor model with five grouping factors) was attributed to the general construct. After adjusting for relationships with the primary construct, remaining correlations among sets of items did not suggest additional reliable constructs. CONCLUSION Results suggest that the primary interpretive emphasis of the EES-C among treatment-seeking children with overweight or obesity should be placed on a single general construct, not on the 3- or 5- subconstructs as was previously suggested.
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Affiliation(s)
- D Eastern Kang Sim
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA.
| | - David R Strong
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA
| | - Michael Manzano
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Dawn M Eichen
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
| | - Kyung E Rhee
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kerri N Boutelle
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA
- Department of Psychiatry, UC San Diego, 9500 GiIman Drive, MC 0874, La Jolla, CA, 92093, USA
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27
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Fitzsimmons-Craft EE, Balantekin KN, Eichen DM, Graham AK, Monterubio GE, Sadeh-Sharvit S, Goel NJ, Flatt RE, Saffran K, Karam AM, Firebaugh ML, Trockel M, Taylor CB, Wilfley DE. Screening and offering online programs for eating disorders: Reach, pathology, and differences across eating disorder status groups at 28 U.S. universities. Int J Eat Disord 2019; 52:1125-1136. [PMID: 31268183 PMCID: PMC6996115 DOI: 10.1002/eat.23134] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Internet-based Healthy Body Image (HBI) Program, which uses online screening to identify individuals at low risk of, high risk of, or with an eating disorder (ED) and then directs users to tailored, evidence-based online or in-person interventions to address individuals' risk or clinical status, was deployed at 28 U.S. universities as part of a randomized controlled trial. The purpose of this study is to report on: (a) reach of HBI, (b) screen results, and (c) differences across ED status groups. METHOD All students on participating campuses ages 18 years or older were eligible, although recruitment primarily targeted undergraduate females. RESULTS The screen was completed 4,894 times, with an average of 1.9% of the undergraduate female student body on each campus taking the screen. ED risk in participating students was high-nearly 60% of students screened were identified as being at high risk for ED onset or having an ED. Key differences emerged across ED status groups on demographics, recruitment method, ED pathology, psychiatric comorbidity, and ED risk factors, highlighting increasing pathology and impairment in the high-risk group. DISCUSSION Findings suggest efforts are needed to increase reach of programs like HBI. Results also highlight the increasing pathology and impairment in the high-risk group and the importance of programs such as HBI, which provide access to timely screening and intervention to prevent onset of clinical EDs.
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Affiliation(s)
| | | | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA,Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA,Institute for Inclusion, Inquiry and Innovation (iCubed), Virginia Commonwealth University, Richmond, VA, USA
| | - Rachael E. Flatt
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Kristina Saffran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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28
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Boutelle KN, Eichen DM, Peterson CB, Strong DR, Rock CL, Marcus BH. Design of the PACIFIC study: A randomized controlled trial evaluating a novel treatment for adults with overweight and obesity. Contemp Clin Trials 2019; 84:105824. [PMID: 31400516 PMCID: PMC6988991 DOI: 10.1016/j.cct.2019.105824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
The majority of adults in the United States have overweight or obesity which is associated with significant health and psychological consequences. Behavioral Weight Loss (BWL) is the current gold-standard weight-loss program for adults but recidivism rates continue to be disturbingly high. Given the health consequences of excess weight and the lack of long-term effectiveness of BWL, it is important to identify novel weight-loss programs. We developed the ROC (Regulation of Cues) program to reduce overeating through improvement in sensitivity to appetitive cues and decreased responsivity to external food cues. This study is a 4-arm randomized control trial designed to evaluate the efficacy of ROC, ROC combined with BWL, BWL alone and an active comparator over 24 months. Study recruitment completed in November 2017. Two hundred and seventy-one participants were randomized (mean age = 46.97 years; 82% female, mean BMI = 34.59; 20% Hispanic) and assessments were conducted at baseline, mid-treatment (6 months) and post-treatment (12 months). At this time, participants are completing 6- (18 months) and 12-month (24 months) follow-ups. Targeting novel mechanisms is critically important to improve weight-loss programs. Through this trial, we hope to identify treatments for adults with overweight and obesity to facilitate long-term weight loss and improved health.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA.
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West 2450, Riverside Ave, Minneapolis, MN 55454, USA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Cheryl L Rock
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI 02912-G, USA
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29
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Eichen DM, Strong DR, Rhee K, Rock CL, Crow SJ, Epstein L, Wilfley DE, Boutelle KN. Change in eating disorder symptoms following pediatric obesity treatment. Int J Eat Disord 2019; 52:299-303. [PMID: 30638271 PMCID: PMC6408261 DOI: 10.1002/eat.23015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate whether children with overweight or obesity participating in an evidence-based treatment, family-based behavioral treatment (FBT) for obesity, or a parent-only variant of FBT (PBT), experience an increase of eating disorder (ED) symptoms during and following treatment. METHOD Children (N = 150) participating in a randomized controlled trial of FBT or PBT completed measures of EDs attitudes and behaviors at baseline, following 6-months of treatment, 6 months, and 18 months after treatment. RESULTS Linear-mixed effects models suggest that ED attitudes did not significantly increase. Rather, significant decreases of shape, weight, and eating concerns were shown following treatment. Loss of control over eating significantly decreased over treatment and follow-up. No participant endorsed purging at any time point. DISCUSSION Results confirm the hypothesis that ED symptoms do not increase after participating in FBT or a FBT-based treatment. These findings should help assuage fears of parents that enrolling their child will exacerbate ED symptoms and aid children to access evidence-based treatments that may help reduce significant physical and psychosocial complications of childhood obesity.
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Affiliation(s)
| | - David R. Strong
- Department of Family Medicine and Public Health, UC San Diego
| | | | - Cheryl L. Rock
- Department of Family Medicine and Public Health, UC San Diego
| | | | | | | | - Kerri N. Boutelle
- Department of Pediatrics, UC San Diego,Department of Family Medicine and Public Health, UC San Diego,Department of Psychiatry, UC San Diego
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30
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Bergmann K, Mestre Z, Strong D, Eichen DM, Rhee K, Crow S, Wilfley D, Boutelle KN. Comparison of Two Models of Family-Based Treatment for Childhood Obesity: A Pilot Study. Child Obes 2019; 15:116-122. [PMID: 30720354 PMCID: PMC6386083 DOI: 10.1089/chi.2018.0250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Family-based weight loss treatment (FBT) for childhood obesity, the current "gold standard," is typically provided in weekly groups for 6 months. Although this program is considered effective, it poses limitations to treatment engagement, due to time commitment and lack of widespread availability. A guided self-help version of FBT (gshFBT; eleven 20-minute sessions and one 1-hour over 5 months) was developed to circumvent such limitations. The current study examined the comparative efficacy of a 5-month FBT and gshFBT program. METHODS Participants included 50 parent-child dyads enrolled in FBT between 2011 and 2013 and 50 parent-child dyads enrolled in gshFBT between 2009 and 2010. Data were collected at baseline, posttreatment, and 6-month follow-up. Noninferiority analyses were conducted to assess comparative efficacy of changes in parent and child weight status, child nutrition, child physical activity, and drop-out. RESULTS Results indicated that gshFBT was noninferior to FBT in changes in child BMI z-score, overweight parent BMI, child nutritional intake, child vigorous physical activity, and drop-out. Results did not support noninferiority for changes in moderate to vigorous physical activity. CONCLUSIONS gshFBT is less intensive, more flexible, and may be similarly effective to FBT and could reach a greater proportion of the pediatric overweight population. Further research, including a randomized clinical trial, is needed to confirm these results.
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Affiliation(s)
- Kristie Bergmann
- California School of Professional Psychology, Alliant International University, San Diego, CA.,Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Zoe Mestre
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, La Jolla, CA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA.,Address correspondence to: Zoe Mestre, MS, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0984, La Jolla, CA 92093
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Kyung Rhee
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Scott Crow
- Department of Psychiatry, University of Minnesota, Saint Paul, MN
| | - Denise Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, MO
| | - Kerri N. Boutelle
- Department of Pediatrics, University of California, San Diego, La Jolla, CA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
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31
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Fitzsimmons-Craft EE, Firebaugh ML, Graham AK, Eichen DM, Monterubio GE, Balantekin KN, Karam AM, Seal A, Funk B, Taylor CB, Wilfley DE. State-wide university implementation of an online platform for eating disorders screening and intervention. Psychol Serv 2018; 16:239-249. [PMID: 30407047 DOI: 10.1037/ser0000264] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Internet-based Healthy Body Image (HBI) Program platform uses online screening to identify individuals at low risk for, high risk for, or with an eating disorder (ED) and then directs users to tailored, evidence-based online/mobile interventions or referral to in-person care to address individuals' risk/clinical status. We examined findings from the first state-wide deployment of HBI over the course of 3 years in Missouri public universities, sponsored by the Missouri Eating Disorders Council and the Missouri Mental Health Foundation. First, the screen was completed 2,454 times, with an average of 2.5% of the undergraduate student body on each campus taking the screen. Second, ED risk level in the participating students was high-over 56% of students screened were identified as being at high risk for ED onset or having a clinical/subclinical ED. Third, uptake for the HBI online/mobile interventions ranged from 44-51%, with higher rates of uptake in the high-risk compared with low-risk group. Fourth, results showed that, for students with a clinical/subclinical ED, use of the clinical mobile application Student Bodies-Eating Disorders intervention resulted in significantly decreased restrictive eating and binge eating. Neither vomiting nor diet pill/laxative use was found to decrease, but reports of these behaviors were very low. This is the first deployment of a comprehensive online platform for screening and delivering tailored interventions to a population of individuals with varying ED risk and symptom profiles in an organized care setting. Implications for future research and sustaining and broadening the reach of HBI are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Andrea K Graham
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago
| | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego
| | | | | | - Anna M Karam
- Department of Psychiatry, Washington University School of Medicine
| | - Annie Seal
- Department of Mental Health, Missouri Eating Disorders Council
| | | | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine
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32
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Wilfley DE, Fitzsimmons-Craft EE, Eichen DM, Van Buren DJ, Welch RR, Robinson AH, Jo B, Raghavan R, Proctor EK, Wilson GT, Agras WS. Training models for implementing evidence-based psychological treatment for college mental health: A cluster randomized trial study protocol. Contemp Clin Trials 2018; 72:117-125. [PMID: 30146493 PMCID: PMC6419733 DOI: 10.1016/j.cct.2018.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/22/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Abstract
Mental disorders often emerge in adolescence and young adulthood, and these disorders can have lasting effects on students' health, social functioning, and education. Although evidence-based treatments have been established for many mental disorders, few community therapists use such treatments. What is needed is a practical, economically feasible means of training clinicians to implement evidence-based treatments suitable for widespread use. This cluster randomized trial will randomize 26 college counseling centers to one of two implementation strategies for training counselors to use interpersonal psychotherapy (IPT), an evidence-based treatment for depression and eating disorders: 1) an external expert consultation model comprising a workshop, therapy manual, and expert follow-up consultation (n = 13); or 2) a train-the-trainer model in which a staff member from the counseling center is coached to train other staff members to implement IPT (n = 13). The primary outcome is therapist adherence to IPT, with secondary outcomes of therapist competence in IPT and client outcomes for depression and eating disorders. Therapist and organizational characteristics will be explored as potential moderators and mediators of implementation outcomes. Implementation costs for each of the training methods will also be assessed. The present study involves partnering with college counseling centers to determine the most effective method to implement IPT for depression and eating disorders in these settings. The results of this study will inform future large-scale dissemination of clinical interventions to mental health service providers by providing evidence for the selection of training methods when an agency chooses to adopt new interventions.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, 8950 Villa La Jolla Dr., Suite C-203, San Diego, CA 92037, USA.
| | - Dorothy J Van Buren
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Athena H Robinson
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd., Stanford, CA 94305, USA.
| | - Booil Jo
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd., Stanford, CA 94305, USA.
| | - Ramesh Raghavan
- School of Social Work, Rutgers, The State University of New Jersey, 536 George St., New Brunswick, NJ 08901, USA.
| | - Enola K Proctor
- George Warren Brown School of Social Work, Washington University in St. Louis, CB 1196, One Brookings Drive, St. Louis, MO 63130, USA.
| | - G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd., Piscataway, NJ 08854, USA.
| | - W Stewart Agras
- George Warren Brown School of Social Work, Washington University in St. Louis, CB 1196, One Brookings Drive, St. Louis, MO 63130, USA.
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33
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Hayes JF, Eichen DM, Barch DM, Wilfley DE. Executive function in childhood obesity: Promising intervention strategies to optimize treatment outcomes. Appetite 2018; 124:10-23. [PMID: 28554851 PMCID: PMC5702584 DOI: 10.1016/j.appet.2017.05.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/23/2022]
Abstract
Executive functions (EFs) are hypothesized to play a role in the development and maintenance of obesity due to their role in self-regulatory processes that manage energy-balance behaviors. Children with obesity have well-documented deficits in EF, which may impede effectiveness of current, evidence-based treatments. This review examines top-down EF processes (e.g., inhibitory control, working memory, cognitive flexibility), as well as bottom-up automatic processes that interact with EFs (e.g., attentional bias, delay discounting) and their relation to weight-loss treatment success in children. It then evaluates EF-related interventions that may improve treatment response. Empirical studies that included an intervention purported to affect EF processes as well as pre-post measurements of EF and/or relative weight in populations ages 19 or younger with overweight/obesity were reviewed. Findings indicate that poorer EF may hinder treatment response. Moreover, there is preliminary evidence that behavioral weight loss intervention and physical activity may positively affect EF and that improvements in EF are related to enhanced weight loss. Finally, novel intervention strategies, such as computer training of core EFs, attention modification programs, and episodic future thinking, show promise in influencing both EFs and EF-related skills and weight. Further research is needed to provide more conclusive evidence of the efficacy of these interventions and additional applications and settings should be considered.
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Affiliation(s)
- Jacqueline F Hayes
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, United States.
| | - Dawn M Eichen
- University of California, San Diego, 9500 Gilman Drive #0874, La Jolla, CA 92093, United States
| | - Deanna M Barch
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, United States
| | - Denise E Wilfley
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, United States
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Matheson BE, Eichen DM. A Review of Childhood Behavioral Problems and Disorders in the Development of Obesity: Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Beyond. Curr Obes Rep 2018; 7:19-26. [PMID: 29411333 DOI: 10.1007/s13679-018-0293-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Given the high rates of pediatric and adult obesity, it is imperative to identify early risk factors that might contribute to excess weight gain. This review aims to investigate the relationship between childhood behavioral problems with the development and persistence of obesity. Specifically, this review highlights the association of obesity with (1) neurocognitive constructs, such as executive functioning and inhibition/impulsivity, and (2) disorders commonly diagnosed in childhood, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). RECENT FINDINGS Consistent evidence supports a relationship between childhood behavioral problems, executive functioning, inhibition/impulsivity, ADHD, and ASD with obesity across the lifespan. Longitudinal studies suggest behavior problems, neurocognitive functioning deficits, and ADHD symptoms in childhood predict weight gain over time. Identifying risk factors in childhood that promote obesity may help develop targeted intervention and prevention programs. Additional research should elucidate mechanisms that account for these relationships.
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Affiliation(s)
- Brittany E Matheson
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, 6363 Alvarado Court, San Diego, CA, 92120, USA.
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Dr. Suite C-203, San Diego, CA, 92037, USA.
| | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, 8950 Villa La Jolla Dr. Suite C-203, San Diego, CA, 92037, USA
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Cassidy O, Eichen DM, Burke NL, Patmore J, Shore A, Radin RM, Sbrocco T, Shomaker LB, Mirza N, Young JF, Wilfley DE, Tanofsky-Kraff M. Engaging African American Adolescents and Stakeholders to Adapt Interpersonal Psychotherapy for Weight Gain Prevention. Journal of Black Psychology 2017. [DOI: 10.1177/0095798417747142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Developing culturally appropriate obesity prevention programs for African American (AA) adolescent girls that account for psychological risk factors is paramount to addressing health disparities. The current study was part of an investigation utilizing a community-based participatory research framework to gather qualitative data from urban AA girls, their caregivers, and community health liaisons to develop a novel obesity prevention program based on interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). In the current study with urban AAs, data from seven focus groups (total sample size, N = 40) were analyzed using thematic analysis. Participants identified problematic eating behaviors, including binge or loss of control eating; highlighted the importance of interpersonal relationships, mood functioning, and eating; and supported the tenets of IPT-WG. While features of IPT-WG generally resonated with participants, culturally based modifications were suggested. These data will be used to inform the development of a culturally relevant IPT-WG program.
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Affiliation(s)
- Omni Cassidy
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Dawn M. Eichen
- Washington University School of Medicine, St. Louis, MO, USA
| | - Natasha L. Burke
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Allison Shore
- Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel M. Radin
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Nazrat Mirza
- Children’s National Health System, Washington, DC, USA
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Abstract
PURPOSE OF REVIEW Recent research has highlighted executive function and neurocognitive deficits among individuals with eating and weight disorders, identifying a potential target for treatment. Treatments targeting executive function for eating and weight disorders are emerging. This review aims to summarize the recent literature evaluating neurocognitive/executive function-oriented treatments for eating and weight disorders and highlights additional work needed in this area. RECENT FINDINGS Cognitive remediation therapy (CRT) for anorexia nervosa has been the most extensively studied neurocognitive treatment for eating disorders. Results demonstrate that CRT improves executive function and may aid in the reduction of eating disorder symptomatology. Computer training programs targeting modifying attention and increasing inhibition are targeting reduction of binge eating and weight loss with modest success. Neurocognitive treatments are emerging and show initial promise for eating and weight disorders. Further research is necessary to determine whether these treatments can be used as stand-alone treatments or whether they need to be used as an adjunct to or in conjunction with other evidence-based treatments to improve outcomes.
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Affiliation(s)
- Dawn M. Eichen
- Department of Pediatrics, University of California San Diego, La Jolla, California,Corresponding Author Contact: , Dawn Eichen, 9500 Gilman Dr, MC0874, La Jolla CA, 92093
| | - Brittany E. Matheson
- Department of Pediatrics, University of California San Diego, La Jolla, California,San Diego State University/University of California, San Diego
| | | | - Kerri N. Boutelle
- Department of Pediatrics, University of California San Diego, La Jolla, California
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Mestre ZL, Bischoff-Grethe A, Eichen DM, Wierenga CE, Strong D, Boutelle KN. Hippocampal atrophy and altered brain responses to pleasant tastes among obese compared with healthy weight children. Int J Obes (Lond) 2017; 41:1496-1502. [PMID: 28572588 DOI: 10.1038/ijo.2017.130] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/17/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The hippocampus is a key structure implicated in food motivation and intake. Research has shown that the hippocampus is vulnerable to the consumption of a western diet (i.e., high saturated fat and simple carbohydrates). Studies of patients with obesity (OB), compared with healthy weight (HW), show changes in hippocampal volume and response to food cues. Moreover, evidence suggests that OB children, relative to HW, have greater hippocampal response to taste. However, no study has examined the association of hippocampal volume with taste functioning in children. We hypothesized that OB children, relative to HW, would show a significant reduction in hippocampal volume and that decreased volume would be significantly associated with greater activation to taste. Finally, we explored whether hippocampal activation would be associated with measures on eating and eating habits. SUBJECTS Twenty-five 8-12-year-old children (i.e., 13 HW, 12 OB) completed a magnetic resonance imaging scan while participating in a taste paradigm (i.e., 1 ml of 10% sucrose or ionic water delivered pseudorandomly every 20 s). RESULTS Children with OB, relative to HW, showed reduced left hippocampal volume (t=1.994, P=0.03, 95% confidence interval (CI)=-40.23, 755.42), and greater response to taste in three clusters within the left hippocampus (z=3.3, P=0.001, 95% CI=-0.241, -0.041; z=3.3, P=0.001, 95% CI=-0.2711, -0.0469; z=2.7, P=0.007, 95% CI=-0.6032, -0.0268). Activation within the hippocampus was associated with eating in the absence of hunger (EAH%; t=2.408, P=0.025, 95% CI= 1.751708, 23.94109) and two subscales on a measure of eating behaviors (Food responsiveness, t=2.572, P=0.017, 95% CI= 0.9565195, 9.043440; Food enjoyment, t=2.298, P=0.032, 95% CI=0.2256749, 4.531298). CONCLUSION As hypothesized, OB children, relative to HW, had significantly reduced hippocampal volume, and greater hippocampal activation to taste. Moreover, hippocampal activation was associated with measures of eating. These results contribute to research on the relationship between OB, overeating and cognitive impairment.
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Affiliation(s)
- Z L Mestre
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, UCSD Center for Healthy Eating and Activity Research (CHEAR), La Jolla, CA, USA
| | - A Bischoff-Grethe
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
| | - D M Eichen
- Department of Pediatrics, University of California San Diego, La Jolla CA, USA
| | - C E Wierenga
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA.,Veterans Affairs San Diego Healthcare System, Research Service, San Diego CA, USA
| | - D Strong
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - K N Boutelle
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA.,Department of Pediatrics, University of California San Diego, La Jolla CA, USA
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Kass AE, Jones M, Kolko RP, Altman M, Fitzsimmons-Craft EE, Eichen DM, Balantekin KN, Trockel M, Taylor CB, Wilfley DE. Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses. Eat Behav 2017; 25:74-80. [PMID: 27090854 PMCID: PMC5042805 DOI: 10.1016/j.eatbeh.2016.03.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Given shared risk and maintaining factors between eating disorders and obesity, it may be important to include both eating disorder intervention and healthy weight management within a universal eating disorder care delivery program. This study evaluated differential eating disorder screening responses by initial weight status among university students, to assess eating disorder risk and pathology among individuals with overweight/obesity versus normal weight or underweight. METHODS 1529 individuals were screened and analyzed. Screening was conducted via pilot implementation of the Internet-based Healthy Body Image program on two university campuses. RESULTS Fifteen percent of the sample had overweight/obesity. Over half (58%) of individuals with overweight/obesity screened as high risk for an eating disorder or warranting clinical referral, and 58% of individuals with overweight/obesity endorsed a ≥10-pound weight change over the past year. Compared to individuals with normal weight or underweight, individuals with overweight/obesity were more likely to identify as Black, endorse objective binge eating and fasting, endorse that eating disorder-related concerns impaired their relationships/social life and made them feel badly, and endorse higher weight/shape concerns. CONCLUSIONS Results suggest rates of eating disorder pathology and clinical impairment are highest among students with overweight/obesity, and targeted intervention across weight categories and diverse races/ethnicities is warranted within universal eating disorder intervention efforts. Integrating eating disorder intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of eating disorders, unhealthy weight control practices, and obesity among university students.
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Affiliation(s)
- Andrea E. Kass
- Department of Medicine, The University of Chicago, Chicago, IL, USA,Corresponding author at: Department of Medicine, The University of Chicago, 5841 S. Maryland Avenue, MC 1000, Chicago, IL 60637, USA. (A.E. Kass)
| | - Megan Jones
- Lantern, San Francisco, CA, USA,Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel P. Kolko
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Myra Altman
- Department of Psychology, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | | | - Mickey Trockel
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - C. Barr Taylor
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, MO, USA,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Lipson SK, Jones JM, Taylor CB, Wilfley DE, Eichen DM, Fitzsimmons-Craft EE, Eisenberg D. Understanding and promoting treatment-seeking for eating disorders and body image concerns on college campuses through online screening, prevention and intervention. Eat Behav 2017; 25:68-73. [PMID: 27117825 PMCID: PMC5403617 DOI: 10.1016/j.eatbeh.2016.03.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/15/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
While there have been important recent advances in the development of effective universal prevention and intervention programs, it is not yet clear how to engage large numbers of students in these programs. In this paper, we report findings from a two-phase pilot study. In the first phase, we used a population-level, online survey to assess eating disorder symptom level and habits/attitudes related to service utilization (N=2180). Using validated screening tools, we found that roughly one in three students has significant symptoms of eating disorders or elevated weight concerns, the vast majority of whom (86.5%) have not received treatment. In the second phase, we referred students to online prevention and selective/indicated intervention programs based on symptom classification (N=1916). We find that program enrollment is highest for students in the indicated intervention (18.1%) and lowest for students in the universal prevention (4.1%). We find that traditionally-emphasized barriers such as stigma, misinformation, and financial limitations do not appear to be the most important factors preventing treatment-seeking. Rather students report not seeking help for reasons such as lack of time, lack of perceived need, and a desire to deal with the issue "on my own." Findings offer insight into the treatment-seeking habits and attitudes of college students, including those barriers that may be overcome by offering online programs and those that persist despite increased access to and convenience of relevant resources.
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Affiliation(s)
- Sarah Ketchen Lipson
- University of Michigan School of Public Health, Department of Health Management & Policy, 1415 Washington Heights M3517, SPH II, Ann Arbor, MI 48109, USA; University of Michigan School of Education, Center for the Study of Higher and Postsecondary Education, 610 East University Avenue, Ann Arbor, MI 48109, USA.
| | - J. Megan Jones
- Lantern, 589 Howard Street, San Francisco, CA 94105, USA,Medical University of Vienna, Spitalgasse 23, 1090 Wien, AUSTRIA
| | - C. Barr Taylor
- Department of Psychiatry, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA,Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA
| | - Denise E. Wilfley
- Washington University School of Medicine, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 6311, USA
| | - Dawn M. Eichen
- University of California, San Diego, Department of Pediatrics, 9500 Gilman Drive, MC 0874 La Jolla, CA 92093
| | - Ellen E. Fitzsimmons-Craft
- Washington University School of Medicine, Department of Psychiatry, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 6311, USA
| | - Daniel Eisenberg
- University of Michigan School of Public Health, Department of Health Management & Policy, 1415 Washington Heights M3517, SPH II Ann Arbor, MI 48109, USA,University of Michigan, Population Studies Center, Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48104, USA
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40
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Affiliation(s)
- Denise E Wilfley
- From Washington University School of Medicine, St. Louis, Missouri
| | | | - Dawn M Eichen
- From Washington University School of Medicine, St. Louis, Missouri
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Eichen DM, Chen E, Boutelle KN, McCloskey MS. Behavioral evidence of emotion dysregulation in binge eaters. Appetite 2016; 111:1-6. [PMID: 27989564 DOI: 10.1016/j.appet.2016.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/07/2016] [Accepted: 12/14/2016] [Indexed: 11/18/2022]
Abstract
Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ2 = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (rpb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.
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Affiliation(s)
- Dawn M Eichen
- Temple University, Department of Psychology, 1701 N. 13th St., Philadelphia, PA 19122, United States
| | - Eunice Chen
- Temple University, Department of Psychology, 1701 N. 13th St., Philadelphia, PA 19122, United States
| | - Kerri N Boutelle
- University of California, San Diego Department of Pediatrics, 9500 Gilman Drive, MC #0874, La Jolla, CA 92093, United States
| | - Michael S McCloskey
- Temple University, Department of Psychology, 1701 N. 13th St., Philadelphia, PA 19122, United States
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42
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Byrne ME, Eichen DM, Fitzsimmons-Craft EE, Taylor CB, Wilfley DE. Perfectionism, emotion dysregulation, and affective disturbance in relation to clinical impairment in college-age women at high risk for or with eating disorders. Eat Behav 2016; 23:131-136. [PMID: 27673706 PMCID: PMC5124520 DOI: 10.1016/j.eatbeh.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/10/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023]
Abstract
Individuals with eating disorders (EDs) demonstrate impaired quality of life; however, less than one-third report severe clinical impairment. Thus, it is important to determine factors that may identify those who are most likely to report marked impairment. Perfectionism, emotion dysregulation, and aspects of affective disturbance, such as anxiety and depression, are independently associated with eating pathology and clinical impairment in eating and other disorders. However, little research has explored these three factors concurrently in relation to eating pathology. It is possible that the combined interaction effect of these constructs could be especially harmful. The current study examined the influence of these constructs and their interactions on clinical impairment in college-aged women at high risk for or with a DSM-5 clinical or subclinical ED. Although the three-way interaction of perfectionism, emotion dysregulation, and affective disturbance (i.e., anxiety or depression) was not significant, the two-way interaction between perfectionism and emotion dysregulation was significant such that those who were high in both perfectionism and emotion dysregulation reported the highest levels of clinical impairment. This suggests that the combination of perfectionism and emotion dysregulation may be especially problematic for those with or at high risk for EDs. Interestingly, perfectionism alone was not a predictor of clinical impairment when accounting for the other constructs, implying that perfectionism may have a greater impact when in conjunction with emotion dysregulation. Understanding the impact of combined perfectionistic tendencies and emotion dysregulation on clinical impairment may better inform treatment and more directly target contributors to impaired quality of life.
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Affiliation(s)
- Meghan E Byrne
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
| | - Dawn M Eichen
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, CA, United States
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Gibbs EL, Kass AE, Eichen DM, Fitzsimmons-Craft EE, Trockel M, Wilfley DE, Taylor CB. Attention-deficit/hyperactivity disorder-specific stimulant misuse, mood, anxiety, and stress in college-age women at high risk for or with eating disorders. J Am Coll Health 2016; 64:300-308. [PMID: 26822019 PMCID: PMC4904716 DOI: 10.1080/07448481.2016.1138477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. PARTICIPANTS Four hundred forty-eight college-age women aged 18-25 at high risk for or with a clinical or subclinical eating disorder. METHODS Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. RESULTS Greater eating disorder pathology, objective binge eating, purging, eating disorder-related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. CONCLUSIONS ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.
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Affiliation(s)
| | - Andrea E. Kass
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | | | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- The mHealth Institute, Palo Alto University, Palo Alto, CA, USA
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Eichen DM, Chen EY, Schmitz MF, Arlt J, McCloskey MS. Addiction Vulnerability and Binge Eating in Women: Exploring Reward Sensitivity, Affect Regulation, Impulsivity & Weight/Shape Concerns. Pers Individ Dif 2016; 100:16-22. [PMID: 27773957 DOI: 10.1016/j.paid.2016.03.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Almost 40% of individuals with eating disorders have a comorbid addiction. The current study examined weight/shape concerns as a potential moderator of the relation between the hypothesized latent factor "addiction vulnerability" (i.e., impairments in reward sensitivity, affect regulation and impulsivity) and binge eating. Undergraduate women (n=272) with either high or low weight/shape concerns completed self-report measures examining reward sensitivity, emotion regulation, impulsivity and disordered (binge) eating. Results showed that (1) reward sensitivity, affect regulation and impulsivity all loaded onto a latent "addiction vulnerability" factor for both women with high and with low weight/shape concerns, (2) women with higher weight/shape concerns reported more impairment in these areas, and (3) weight/shape concerns moderated the relation between addiction vulnerability and binge eating. These findings suggest that underlying processes identified in addiction are present in individuals who binge eat, though weight/shape concerns may be a unique characteristic of disordered eating.
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Affiliation(s)
- Dawn M Eichen
- Temple University - Department of Psychology, 1701 N 13 St, Philadelphia, PA 19122, USA (DME, EYC, JA, MSM)
| | - Eunice Y Chen
- Temple University - Department of Psychology, 1701 N 13 St, Philadelphia, PA 19122, USA (DME, EYC, JA, MSM)
| | - Mark F Schmitz
- Temple University - School of Social Work, 1301 W Cecil B Moore Ave, Philadelphia, PA 19122, USA (MFS)
| | - Jean Arlt
- Temple University - Department of Psychology, 1701 N 13 St, Philadelphia, PA 19122, USA (DME, EYC, JA, MSM)
| | - Michael S McCloskey
- Temple University - Department of Psychology, 1701 N 13 St, Philadelphia, PA 19122, USA (DME, EYC, JA, MSM)
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45
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Eichen DM, Kass AE, Fitzsimmons-Craft EE, Gibbs E, Trockel M, Taylor CB, Wilfley DE. Non-suicidal self-injury and suicidal ideation in relation to eating and general psychopathology among college-age women. Psychiatry Res 2016; 235:77-82. [PMID: 26654754 PMCID: PMC4724479 DOI: 10.1016/j.psychres.2015.11.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 12/28/2022]
Abstract
Non-suicidal self-injury (NSSI) and suicidal ideation are potent risk factors for suicide and are associated with general and eating disorder-specific psychopathology. Limited research has examined the effects of combined NSSI+suicidal ideation thus concurrent examination is needed to understand potential differential effects on psychopathology. College-aged women (N=508) completed self-report measures of NSSI, suicidal ideation, general psychopathology, and Eating Disorder-specific psychopathology. MANOVAs determined whether the NSSI/SI status groups differed on general and eating disorder pathology measures as a set. Significant MANOVAs were followed up with univariate ANOVAs and posthoc tests. Thirteen women endorsed NSSI+Suicidal Ideation, 70 endorsed NSSI-only, 25 endorsed Suicidal Ideation-only, and 400 endorsed no NSSI/Suicidal Ideation. Both general and eating disorder-specific psychopathology differed across groups. NSSI+Suicidal Ideation and Suicidal Ideation-only groups typically endorsed higher general psychopathology than the no NSSI/Suicidal Ideation and NSSI-only groups. Regarding eating disorder pathology, the NSSI+Suicidal Ideation group was more pathological than no NSSI/Suicidal Ideation and NSSI-only, except on the weight concerns scale, where NSSI+Suicidal Ideation only differed from no NSSI/Suicidal Ideation. The NSSI+Suicidal Ideation group was only greater than Suicidal Ideation-only on measures of depression and eating concern. Results highlight the importance of screening for both NSSI and suicidal ideation, especially for individuals with eating disorder symptoms. Likewise, screening for eating disorder pathology may be beneficial for individuals presenting with NSSI and suicidal ideation.
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Affiliation(s)
- Dawn M. Eichen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea E. Kass
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | | | - Elise Gibbs
- PGSP-Stanford PsyD Consortium, Palo Alto, CA, USA
| | - Mickey Trockel
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - C. Barr Taylor
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA,Center for M-Health, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Lent MR, Eichen DM, Goldbacher E, Wadden TA, Foster GD. Relationship of food addiction to weight loss and attrition during obesity treatment. Obesity (Silver Spring) 2014; 22:52-5. [PMID: 23776067 PMCID: PMC3784622 DOI: 10.1002/oby.20512] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/01/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The relationship between food addiction (FA) and weight and attrition outcomes in overweight and obese adults participating in weight loss interventions were prospectively examined in this study. DESIGN AND METHODS Participants were 178 adults (51.2 ± 11.7 y, 36.1 ± 4.8 kg/m(2) ) in one of two outpatient weight loss treatment programs for approximately 6 months. The Yale Food Addiction Scale (YFAS) assessed FA diagnosis and symptom count. The relationship between FA and weight loss and attrition was assessed. RESULTS After controlling for treatment arm, gender, and baseline weight, there was no effect of FA status on weight loss (P = 0.17) or attrition (P = 0.37). Similarly, baseline FA symptom count was not associated with weight loss (P = 0.14) or attrition (P = 0.10). CONCLUSIONS Neither FA status nor symptom count affects weight loss or attrition during weight loss treatment.
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Affiliation(s)
- Michelle R. Lent
- Center for Obesity Research and Education, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA 19140
| | - Dawn M. Eichen
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Edie Goldbacher
- La Salle University, 1900 W. Olney Ave., Philadelphia, PA 19141, USA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Gary D. Foster
- Center for Obesity Research and Education, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA 19140
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Eichen DM, Lent MR, Goldbacher E, Foster GD. Exploration of "food addiction" in overweight and obese treatment-seeking adults. Appetite 2013; 67:22-4. [PMID: 23535004 PMCID: PMC3660457 DOI: 10.1016/j.appet.2013.03.008] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/29/2022]
Abstract
There is growing interest in conceptualizing obesity as a "food addiction." The current study investigated the prevalence and correlates of "food addiction" (FA), as defined by the Yale Food Addiction Scale (YFAS) in 178 (133 F, 45M) persons seeking weight loss treatment. Participants had a mean age of 51.2±11.7years and a body mass index of 36.1±4.8kg/m(2). Fifteen percent of individuals met the YFAS proposed diagnostic criteria for FA. Those who met criteria for FA reported significantly greater depressive symptomatology. There were no differences in BMI, age, race, or gender between participants with and without FA. Among those not meeting criteria, 35% reported 3 or more symptoms in the absence of self-reported clinical distress or impairment. YFAS symptom count was also significantly correlated with depressive symptoms. These findings suggest that 15% of adults presenting for weight loss treatment meet YFAS criteria for FA. The clinical significance of this classification is unknown and needs to be validated in prospective studies.
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Affiliation(s)
- Dawn M Eichen
- Department of Psychology, Temple University, 400 Weiss Hall, Philadelphia, PA 19122, USA.
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Lenhart CM, Daly BP, Eichen DM. Is accuracy of weight perception associated with health risk behaviors in a diverse sample of obese adolescents? J Sch Nurs 2011; 27:416-23. [PMID: 21976189 DOI: 10.1177/1059840511423381] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Current evidence is equivocal as to whether adolescent's perception of weight status is linked to both healthy and risky behaviors. This study examined the association between accurate and inaccurate perception of weight and self-reported health and risk behaviors among a diverse sample of obese, urban adolescents. Data were analyzed from 1,180 participants in the 2009 Philadelphia Youth Risk Behavior Survey. Health behaviors of obese students self-identifying as very or slightly overweight were compared to obese students who underestimated their weight status. Accurate self-identifiers of weight status were significantly more likely to report trying to lose weight, bullying victimization, and suicide attempts as compared to obese students underestimating their weight status. Findings suggest that it is important for school nurses to understand that perceived weight status confers distinct risk profiles and differing needs for health-related services related to the physical, mental, and social health of adolescents.
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Affiliation(s)
- Clare M Lenhart
- Department of Public Health, Temple University, Philadelphia, PA 19122, USA.
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Eichen DM, Conner BT, Daly BP, Fauber RL. Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students. J Youth Adolesc 2010; 41:1-13. [PMID: 21113735 DOI: 10.1007/s10964-010-9612-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
Abstract
Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.
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Affiliation(s)
- Dawn M Eichen
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA.
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