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Lister NB, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit A, Cooper K, Kyle TK, Heeren FA, Hunter KE, McMaster CM, Johnson BJ, Seidler AL, Jebeile H. Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design. Nutr Res Rev 2024; 37:32-42. [PMID: 36788665 PMCID: PMC7615933 DOI: 10.1017/s0954422423000045] [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: 02/16/2023]
Abstract
The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Kids Research, Sydney Children's Hospital Network, Westmead, New South Wales2145, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Denise E Wilfley
- School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales2145, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, 2nd Floor, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Grunseit
- The Children's Hospital at Westmead, Nutrition and Dietetics, Weight Management Services, Westmead, New South Wales, NSW 2145, Australia
| | | | | | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia5042, Australia
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
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Lister NB, Melville H, Jebeile H. What adolescents see on Instagram: Content analysis of #intermittentfasting, #keto, and #lowcarb. Nutr Diet 2023. [PMID: 37963606 DOI: 10.1111/1747-0080.12853] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
AIM To describe popular diet content visible on #intermittentfasting, #keto, and #lowcarb on adolescent social media accounts. METHODS An adolescent Instagram profile captured 200 'top' images from three popular diet hashtags (#intermittentfasting, #keto, and #lowcarb) across two timepoints. Images were coded using a pre-determined ontology as food (core or discretionary; common foods/food groups), people (group, individual, before/after), or informative. Descriptive statistics were used to summarise these categories across hashtags. RESULTS At the time of first data collection, there were 3.8 million #intermittentfasting, 19 million #keto, and 22 million #lowcarb posts on Instagram. At the second timepoint there were 4.3 million #intermittentfasting, 21.5 million #keto, and 24.3 million #lowcarb posts. Images tagged #intermittentfasting were categorised as 44% food, 39% people, 10% information; #keto were 64% food, 28% people, 5% information; and #lowcarb were 69% food, 14% people, 16% information. Food images mostly depicted animal proteins (58.6% of #intermittentfasting; 62.9% of #keto; and 40.1% of #lowcarb). Images of people were individual (44%) or before/after (39%); mostly female (77%), of white (53%) ethnicity. Across all posts, 12.5% were linked to a commercial product/program, and 2.3% provided nutrition information. CONCLUSION Diet-related images visible when adolescents search #intermittentfasting, #keto, and #lowcarb on Instagram promote animal-based foods with or without vegetables. These diet hashtags on Instagram do not provide nutrition information and are not helpful for young people searching for diet information online.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Hannah Melville
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
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Sharp G, Girolamo T, Hay P, Mitchison D, Cooper K, Sumithran P, Jebeile H. New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders. Aust J Gen Pract 2023; 52:651-653. [PMID: 37666788 DOI: 10.31128/ajgp-02-23-6731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Gemma Sharp
- PhD, Associate Professor and National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow, Department of Neuroscience, Monash University, Melbourne, Vic; Senior Clinical Psychologist, Alfred Health, Melbourne, Vic
| | - Teresa Girolamo
- MBBS, DCH, FRACGP, Director and Co-Founder Re:You Health, Adelaide Weight Management Solutions, Adelaide, SA
| | - Phillipa Hay
- DPhil, MD, MBChB, Foundation Chair of Mental Health and Academic Lead: Eating Disorders and Body Image, Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW; Director Mental Health Research, South West Sydney Local Health District, Sydney, NSW
| | - Deborah Mitchison
- PhD, Associate Professor in Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW; Adjunct Associate Professor, Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW; Clinical Psychologist, Basten and Associates, Sydney, NSW; Adjunct Fellow, Centre for Emotional Health, Macquarie University, Sydney, NSW
| | - Kelly Cooper
- APD, Program Manager, The Obesity Collective, Sydney, NSW
| | - Priya Sumithran
- MBBS, FRACP, PhD, Senior Research Fellow, Department of Medicine (St Vincent@s), The University of Melbourne, Fitzroy, Vic; Head, Obesity Medicine, Department of Endocrinology, Austin Health, Heidelberg, Vic
| | - Hiba Jebeile
- PhD, NHMRC Emerging Leadership Fellow Children@s Hospital at Westmead Clinical School, The University of Sydney, Westmead, NSW
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Lang S, Day K, Gallaher E, Jebeile H, Collins CE, Baur LA, Truby H. Participant recruitment for paediatric research using social media: A practical 'how-to' guide for researchers. Nutr Diet 2023; 80:338-350. [PMID: 37154014 PMCID: PMC10952907 DOI: 10.1111/1747-0080.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/22/2022] [Revised: 02/28/2023] [Accepted: 03/21/2023] [Indexed: 05/10/2023]
Abstract
AIM Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies. METHODS The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process. RESULTS A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase. CONCLUSION Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.
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Affiliation(s)
- Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical SciencesMonash UniversityNotting HillAustralia
| | - Kaitlin Day
- Department of Nutrition, Dietetics and Food, School of Clinical SciencesMonash UniversityNotting HillAustralia
- School of Agriculture and FoodFaculty of Science, University of MelbourneParkvilleAustralia
| | | | - Hiba Jebeile
- Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadAustralia
- The Children's Hospital at WestmeadInstitute of Endocrinology and DiabetesWestmeadAustralia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- Food and Nutrition Research ProgramHunter Medical Research InstituteRankin ParkAustralia
| | - Louise A. Baur
- Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadAustralia
- Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| | - Helen Truby
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneAustralia
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Pearl RL, Austin SB, Jebeile H, D'Adamo L, Wilfley DE. Opportunities to advance research, intervention, and policy on stigma, eating disorders, and body image. J Eat Disord 2023; 11:132. [PMID: 37553695 PMCID: PMC10408083 DOI: 10.1186/s40337-023-00857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Affiliation(s)
- Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA.
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Laura D'Adamo
- Department of Psychological & Brain Sciences and Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
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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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Gow ML, Lam YWI, Jebeile H, Craig ME, Susic D, Henry A. Antenatal diet quality and perinatal depression: the Microbiome Understanding in Maternity Study (MUMS) cohort. J Hum Nutr Diet 2023; 36:754-762. [PMID: 36106616 PMCID: PMC10947382 DOI: 10.1111/jhn.13081] [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: 03/28/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and (b) depression during pregnancy and PPD. METHODS This analysis represents data from 73 women participating in the Microbiome Understanding in Maternity Study (MUMS) cohort in Sydney, Australia, which followed women from Trimester 1 of pregnancy to 1-year postpartum (PP). Participants' diet quality was assessed using the Australian Eating Survey at Trimester 1 and 3 to calculate diet quality, known as the Australian Recommended Food Score (lower diet quality defined as score <39; higher diet quality ≥39). Depression was assessed using the Edinburgh Depression Scale at Trimesters 1, 2, 3 and 6 weeks PP (defined as score ≥11). RESULTS Depression scores during pregnancy were significantly associated with depression score 6 weeks PP (Trimester 1: r = 0.66, Trimester 2: r = 0.69, Trimester 3: r = 0.67; all p < 0.001). Diet quality during pregnancy was not significantly correlated with 6-week PPD score. In unadjusted analysis, diet quality during pregnancy was not associated with pregnancy depression scores. When adjusted for age, parity and Trimester 1 body mass index, Trimester 1 physical activity levels and gestational weight gain, higher Trimester 3 diet quality was associated with reduced Trimester 3 depression only. CONCLUSIONS Depression scores during pregnancy were positively associated with PPD, highlighting the importance of screening for depression during pregnancy and postnatally. Larger longitudinal prospective studies may elucidate the association between diet quality and PPD.
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Affiliation(s)
- Megan L. Gow
- The University of Sydney Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
| | - Yei W. I. Lam
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Hiba Jebeile
- The University of Sydney Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Maria E. Craig
- The University of Sydney Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Daniella Susic
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
| | - Amanda Henry
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
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Jebeile H, Libesman S, Melville H, Low‐wah T, Dammery G, Seidler AL, Jones RA, McMaster CM, Paxton SJ, Hill AJ, Ahern AL, Garnett SP, Braet C, Wilfley DE, Baur LA, Lister NB. Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis. Obes Rev 2023; 24:e13561. [PMID: 36919475 PMCID: PMC10909435 DOI: 10.1111/obr.13561] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 08/30/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Sol Libesman
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Hannah Melville
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Timothy Low‐wah
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Genevieve Dammery
- InsideOut Institute for Eating DisordersThe University of SydneySydneyNew South WalesAustralia
| | - Anna L. Seidler
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Caitlin M. McMaster
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeCB2 0QQUK
| | - Sarah P. Garnett
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Kids ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityHenri Dunantlaan 2Ghent9000Belgium
| | - Denise E. Wilfley
- School of Medicine, Washington University in St. LouisMissouriSt. LouisUSA
| | - Louise A. Baur
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Natalie B. Lister
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
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9
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McMaster CM, Paxton SJ, Maguire S, Hill AJ, Braet C, Seidler AL, Nicholls D, Garnett SP, Ahern AL, Wilfley DE, Lister NB, Jebeile H. The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment. Int J Eat Disord 2023; 56:914-924. [PMID: 36694273 PMCID: PMC10946556 DOI: 10.1002/eat.23898] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.
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Affiliation(s)
- Caitlin M. McMaster
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating DisordersCharles Perkins Centre, The University of SydneySydneyNew South WalesAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityGhentBelgium
| | - Anna L. Seidler
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah P. Garnett
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
- Kids ResearchSydney Children's Hospital NetworkWestmeadNew South WalesAustralia
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | | | - Natalie B. Lister
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
| | - Hiba Jebeile
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
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10
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Lister NB, Jebeile H, Khalid R, Pryde S, Johnson BJ. Deconstructing Complex Interventions: Piloting a Framework of Delivery Features and Intervention Strategies for the Eating Disorders in Weight-Related Therapy (EDIT) Collaboration. Nutrients 2023; 15:nu15061414. [PMID: 36986143 PMCID: PMC10056322 DOI: 10.3390/nu15061414] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
(1) Background: weight-management interventions vary in their delivery features and intervention strategies. We aimed to establish a protocol to identify these intervention components. (2) Methods: a framework was developed through literature searches and stakeholder consultation. Six studies were independently coded by two reviewers. Consensus included recording conflict resolutions and framework changes. (3) Results: more conflicts occurred for intervention strategies compared to delivery features; both required the updating of definitions. The average coding times were 78 min (SD: 48) for delivery features and 54 min (SD: 29) for intervention strategies. (4) Conclusions: this study developed a detailed framework and highlights the complexities in objectively mapping weight-management trials.
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Affiliation(s)
- Natalie B. Lister
- Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney 2145, Australia
- Correspondence:
| | - Hiba Jebeile
- Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney 2145, Australia
| | - Rabia Khalid
- Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
| | - Samantha Pryde
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide 5042, Australia
| | - Brittany J. Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide 5042, Australia
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11
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Kwok C, Forward V, Lister NB, Garnett SP, Baur LA, Jebeile H. Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers. Obes Res Clin Pract 2023; 17:151-157. [PMID: 36906489 DOI: 10.1016/j.orcp.2023.02.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION People with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails. OBJECTIVE To explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice. MATERIALS AND METHODS An online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes. RESULTS 59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways. CONCLUSION Individualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.
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Affiliation(s)
- Cathy Kwok
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Victoria Forward
- Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2005, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia; Kids Research, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia.
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12
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Jebeile H, McMaster CM, Johnson BJ, Garnett SP, Paxton SJ, Seidler AL, Jones RA, Hill AJ, Maguire S, Braet C, Dammery G, Wilfley DE, Baur LA, Lister NB, On Behalf Of The Eating Disorders In Weight-Related Therapy Edit Collaboration. Identifying Factors Which Influence Eating Disorder Risk during Behavioral Weight Management: A Consensus Study. Nutrients 2023; 15:1085. [PMID: 36904085 PMCID: PMC10005214 DOI: 10.3390/nu15051085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
This study aimed to understand clinician, researcher and consumer views regarding factors which influence eating disorder (ED) risk during behavioral weight management, including individual risk factors, intervention strategies and delivery features. Eighty-seven participants were recruited internationally through professional and consumer organizations and social media and completed an online survey. Individual characteristics, intervention strategies (5-point scale) and delivery features (important/unimportant/unsure) were rated. Participants were mostly women (n = 81), aged 35-49 y, from Australia or United States, were clinicians and/or reported lived experience of overweight/obesity and/or ED. There was agreement (64% to 99%) that individual characteristics were relevant to ED risk, with history of ED, weight-based teasing/stigma and weight bias internalization having the highest agreement. Intervention strategies most frequently rated as likely to increase ED risk included those with a focus on weight, prescription (structured diets, exercise plans) and monitoring strategies, e.g., calorie counting. Strategies most frequently rated as likely to decrease ED risk included having a health focus, flexibility and inclusion of psychosocial support. Delivery features considered most important were who delivered the intervention (profession, qualifications) and support (frequency, duration). Findings will inform future research to quantitatively assess which of these factors predict eating disorder risk, to inform screening and monitoring protocols.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
| | - Caitlin M McMaster
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide 5042, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney 2145, Australia
- Kids Research, The Children's Hospital at Westmead, Sydney 2145, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Anna L Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney 2050, Australia
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, 9000 Ghent, Belgium
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
| | - Denise E Wilfley
- School of Medicine, Washington University in St. Louis, St Louis, MO 63110, USA
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- Weight Management Services, The Children's Hospital at Westmead, Sydney 2145, Australia
| | - Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
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13
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Hoare JK, Lister NB, Garnett SP, Baur LA, Jebeile H. Weight-neutral interventions in young people with high body mass index: A systematic review. Nutr Diet 2023; 80:8-20. [PMID: 35411702 PMCID: PMC10084274 DOI: 10.1111/1747-0080.12729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/16/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
AIM This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity. METHODS Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance >80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p < 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p < 0.001) following mindful eating (-1.1 kg/m2 ), compared with single-session lifestyle education (+0.7 kg/m2 ); Studies 2 and 3 found no change in body mass index or body mass index z-score. CONCLUSIONS Weight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.
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Affiliation(s)
- Johanna K Hoare
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- 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.,Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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14
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Gow ML, Jebeile H, Lister NB, Roth H, Skouteris H, Bergmeier H. Content Analysis of #Postpartumbody Images Posted to Instagram. Healthcare (Basel) 2022; 10:healthcare10091802. [PMID: 36141414 PMCID: PMC9498984 DOI: 10.3390/healthcare10091802] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Understanding the imagery on social media targeting postpartum women is an important step in determining the utility of Instagram as a potential avenue for targeting public health messages to this group. This study (1) describes the content of images on Instagram tagged with #postpartumbody and; (2) compares images from ‘Top’ posts (‘trending’ or ‘popular’) with ‘Recent’ posts. 600 images tagged with #postpartumbody (300 ‘Top’ and 300 ‘Recent’) were systematically captured from Instagram and coded using a predefined framework. Images of women were coded for adiposity, muscularity, pose and attire. Chi-square tests were used to compare ‘Top’ and ‘Recent’ posts. Most (n = 409) images were of a woman who generally had low/average adiposity (91%) and little-to-none/some visible muscle definition (93%). Most women (52%) were posing in a non-specific manner, 5% were posing to accentuate a postpartum body feature and 40% were wearing fitness attire. Compared with ‘Recent’, ‘Top’ posts were less likely to be text-focused (p < 0.001), photos of food (p < 0.001) or linked to a product/program (p < 0.001). Women of lower adiposity are more likely to post images of themselves on Instagram tagged with #postpartumbody than women of higher adiposity, which may reflect increased body pride in this group, but could reduce body satisfaction for some viewers. Conveying health information on Instagram may be necessary to interrupt potentially harmful content.
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Affiliation(s)
- Megan L. Gow
- Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW 2145, Australia
- Discipline of Paediatrics, School of Clinical Medicine, The University of New South Wales, Sydney, NSW 2031, Australia
- Correspondence:
| | - Hiba Jebeile
- Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW 2145, Australia
- The Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Natalie B. Lister
- Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW 2145, Australia
- The Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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15
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Hoare JK, Lister NB, Garnett SP, Baur LA, Jebeile H. Mindful and Intuitive Eating Imagery on Instagram: A Content Analysis. Nutrients 2022; 14:nu14183834. [PMID: 36145207 PMCID: PMC9502653 DOI: 10.3390/nu14183834] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Non-dieting approaches, including mindful/intuitive eating, to health improvement are of increasing interest, yet little is known about young adults' social media exposure to them. Therefore, this study aimed to describe the imagery related to mindful/intuitive eating which is visible to young adult Instagram users. Images categorized under the hashtags 'mindfuleating' and 'intuitiveeating' were searched in September 2021 using the 'top posts' view. Screen captures of 1200 grid-view images per hashtag were used to construct coding frameworks and to determine saturation. Sample sizes for #mindfuleating and #intuitiveeating were 405 and 495 images, respectively. Individual images were coded collaboratively. Almost half of each sample depicted food or drink, of which 50-60% were healthy foods. Approximately 17% were single-person images, of which the majority were young, female adults with healthy weight. Approximately one-third of text suggested credibility through credentials, profession, or evidence. Messaging was similar for both hashtags, encompassing mindful/intuitive eating (~40%), nutrition/eating behaviours (~15%), physical/mental health (~20%), disordered eating (~12%), and body-/self-acceptance (~12%). Differences were observed between hashtags for weight-related concepts (20%/1%) and anti-diet/weight-neutral approaches (10%/35%). The representation on Instagram of mindful and intuitive eating portrays healthy lifestyles without a focus on weight but lacks demographical and body-type diversity. Instagram holds the potential for health professionals to disseminate culturally/demographically inclusive, evidence-based health/nutrition information to youth.
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Affiliation(s)
- Johanna K. Hoare
- Children’s Hospital Westmead Clinical School, The University of Sydney, Westmead 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead 2145, Australia
| | - Natalie B. Lister
- Children’s Hospital Westmead Clinical School, The University of Sydney, Westmead 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead 2145, Australia
| | - Sarah P. Garnett
- Children’s Hospital Westmead Clinical School, The University of Sydney, Westmead 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead 2145, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead 2145, Australia
| | - Louise A. Baur
- Children’s Hospital Westmead Clinical School, The University of Sydney, Westmead 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead 2145, Australia
- Weight Management Services, The Children’s Hospital at Westmead, Westmead 2145, Australia
| | - Hiba Jebeile
- Children’s Hospital Westmead Clinical School, The University of Sydney, Westmead 2145, Australia
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead 2145, Australia
- Correspondence:
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16
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House ET, Lister NB, Seidler AL, Li H, Ong WY, McMaster CM, Paxton SJ, Jebeile H. Identifying eating disorders in adolescents and adults with overweight or obesity: A systematic review of screening questionnaires. Int J Eat Disord 2022; 55:1171-1193. [PMID: 35809028 PMCID: PMC9545314 DOI: 10.1002/eat.23769] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This review aimed to examine the validity of self-report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity. METHOD Five databases were searched from inception to September 2020 for studies assessing validation of self-report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013). RESULTS Twenty-seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge-eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16-.88, specificity = .62-1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07-1.0, specificity = .0-1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge-Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general. DISCUSSION Questionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co-morbid EDs and overweight/obesity. PUBLIC SIGNIFICANCE Individuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.
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Affiliation(s)
- Eve T. House
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia
| | - Natalie B. Lister
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia
| | - Anna L. Seidler
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Haozhen Li
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of ScienceThe University of SydneyCamperdownNew South WalesAustralia
| | - Wee Yee Ong
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of ScienceThe University of SydneyCamperdownNew South WalesAustralia
| | - Caitlin M. McMaster
- Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia,Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hiba Jebeile
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadNew South WalesAustralia
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17
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Grammer AC, Jebeile H, Wilfley DE. Parent Guide to Child Healthy Weight Programs. JAMA Pediatr 2022; 176:952. [PMID: 35877112 DOI: 10.1001/jamapediatrics.2022.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, New South Wales, Australia
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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18
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Hoare J, Garnett S, Baur L, Lister N, Jebeile H. A Novel Method to Determine a Custom Sample Size for Image-Based Instagram Content Analysis. Curr Dev Nutr 2022. [DOI: 10.1093/cdn/nzac063.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Most Instagram users are young people, and social media is often used to search nutrition information. Health interventions aimed at young people should consider such information sources. Content analyses of Instagram images offer insights into types of content that may influence nutrition-related decision making and health behaviors. However, the number of analyzed images in existing studies has varied, and methods to determine data-specific sample sizes to reach saturation have not been explored. We aimed to develop a method to determine sample sizes for image-based content analyses on Instagram. We piloted the method and determined the reliability by identifying the saturation point for content categorized under two separate nutrition-related hashtags.
Methods
Instagram ‘top posts’ for a 21-year-old user were searched using hashtags ‘mindfuleating’ and ‘intuitiveeating’. 1200 images from each were extracted. Hashtag-specific coding frameworks were constructed inductively by two authors, initially coding the image- and text-based elements of the first 90 images collaboratively. Next, increments of 45 images were coded independently, then compared, solving disagreements by discussion. The process was repeated until saturation occurred when no new codes emerged. This was repeated seven weeks later to determine reliability.
Results
The coding frameworks constructed for #mindfuleating at first and second capture comprised 63 and 74 distinct codes, with saturation occurring at 360 and 405 images, respectively. The #intuitiveeating frameworks comprised 83 and 86 codes, with saturation at 450 and 495 images, respectively. The codes captured detailed pictorial content (e.g., ‘female’, ‘White’, ‘young adult’) and text (e.g., ‘nutrition information’, ‘relationship with food’). For both hashtags, the number of image-based codes decreased while text-based codes increased between coding.
Conclusions
Variations in coding frameworks and sample sizes over a short timeframe reflect the dynamic nature of Instagram content. Assessment of diet trends on social media requires accurate sampling to ensure nuances of a specific topic are captured, while research efficiency benefits from reduced data redundancy.
Funding Sources
NHMRC Peter Doherty Early Career Fellowship; Sydney Medical School Foundation, The University of Sydney.
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Affiliation(s)
- Johanna Hoare
- The University of Sydney Children's Hospital Westmead Clinical School
| | - Sarah Garnett
- The University of Sydney Children's Hospital Westmead Clinical School
| | - Louise Baur
- The University of Sydney Children's Hospital Westmead Clinical School
| | - Natalie Lister
- The University of Sydney Children's Hospital Westmead Clinical School
| | - Hiba Jebeile
- The University of Sydney Children's Hospital Westmead Clinical School
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19
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Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol 2022; 10:351-365. [PMID: 35248172 PMCID: PMC9831747 DOI: 10.1016/s2213-8587(22)00047-x] [Citation(s) in RCA: 195] [Impact Index Per Article: 97.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
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Affiliation(s)
- Hiba Jebeile
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Louise A Baur
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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20
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Jebeile H, Baur LA. 3.6 Management of Child and Adolescent Obesity. World Rev Nutr Diet 2022; 124:256-261. [PMID: 35240598 DOI: 10.1159/000516698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.,Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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21
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Hoare JK, Jebeile H, Garnett SP, Lister NB. Novel dietary interventions for adolescents with obesity: A narrative review. Pediatr Obes 2021; 16:e12798. [PMID: 33955208 DOI: 10.1111/ijpo.12798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 12/17/2022]
Abstract
Adolescent obesity is increasing and a range of treatment approaches are needed. Provision of tailored treatment options accounting for individual and family needs, preferences, and capacity may encourage adolescents with obesity to seek treatment, and/or improve treatment outcomes. Delivered by trained health care professionals, novel dietary interventions may have utility for adolescents not responding to conventional diets, adolescents with comorbidities or severe obesity, and/or when rapid or substantial weight loss is required. This review describes current evidence and clinical considerations relating to the use of very low energy diets, low carbohydrate diets, and intermittent energy restriction in the treatment of adolescent obesity. Emerging evidence on the use of these novel dietary interventions demonstrates short-term weight-related and cardiometabolic improvements. While the evidence is encouraging, and no serious adverse effects have been reported, monitoring of intervention safety is essential. Considerations for health care professionals providing care to adolescents include nutritional adequacy, psychosocial health and social relationships during the intervention. Furthermore, long-term weight-related, cardiometabolic and psychological health outcomes of these dietary interventions are not well understood. Large randomised controlled trials are warranted to inform clinical practice and future guidelines for the use of novel dietary interventions in adolescents with obesity.
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Affiliation(s)
- Johanna K Hoare
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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22
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Abstract
PURPOSE OF REVIEW Eating disorders are complex mental health conditions that share risk factors with obesity. This review outlines the context for concerns that paediatric obesity treatment presents a risk for eating disorder development. RECENT FINDINGS Most children and adolescents undergoing professionally supervised obesity treatment will have improvements or no change to eating disorder risk profiles. However, some may subsequently develop a clinical eating disorder, and this is proposed to relate to weight-focussed dietary interventions that are standard in paediatric obesity treatment. Nevertheless, dietary restraint may not be a strong predictor of eating disorder risk in the context of paediatric obesity treatment. Most international guidelines recommend weight maintenance or weight loss as a treatment goal, and weight loss is related to improvements in cardiometabolic health but not eating disorder risk in the short term. The risk of inducing or exacerbating an eating disorder during paediatric weight management is likely to be low; however, the serious consequences combined with increasing scale of obesity treatment, and lack of empirical evidence, are of concern. There is a need for further research to identify long-term predictors of eating disorder development for children and adolescents who seek treatment for their obesity.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia.
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
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23
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Jebeile H, Cardel MI, Kyle TK, Jastreboff AM. Addressing psychosocial health in the treatment and care of adolescents with obesity. Obesity (Silver Spring) 2021; 29:1413-1422. [PMID: 34431234 DOI: 10.1002/oby.23194] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self-directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self-esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer-term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
| | | | - Ania M Jastreboff
- Department of Internal Medicine (Endocrinology & Metabolism), Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, Connecticut, USA
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24
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Skinner J, Jebeile H, Burrows T. Food addiction and mental health in adolescents: a systematic review. Lancet Child Adolesc Health 2021; 5:751-766. [PMID: 34174201 DOI: 10.1016/s2352-4642(21)00126-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
The intersection between eating behaviours and mental health has garnered substantial attention in recent years. For this Review, we systematically reviewed the available research to find out the prevalence of food addiction as measured by the Yale Food Addiction Scale, and to investigate its association with mental health-related outcomes in adolescents. Eight databases were searched using keywords from Jan 1, 2009, to Aug 5, 2020, to identify studies reporting a Yale Food Addiction Scale diagnosis or symptom score, or both. In total, 27 studies were included. The prevalence of a food addiction diagnosis ranged from 2·6% to 49·9% in non-clinical and clinical populations, and prevalence was higher in women and adolescents with a higher weight status. Food addiction was associated with disordered eating, depressive and anxiety symptoms, and a poorer quality of life and self-esteem. These associations have important implications for the assessment and management of eating behaviours and mental health in adolescents. Transdiagnostic prevention and management intervention strategies could be explored.
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Affiliation(s)
- Janelle Skinner
- Nutrition and Dietetics, School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - Tracy Burrows
- Nutrition and Dietetics, School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia.
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25
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Abstract
Background: Social media is a source of weight loss information for adolescents. However, engagement with image-based social media has been associated with reduced body image. This study describes weight loss imagery visible on an adolescent Instagram account. Methods: The "top" 600 images were captured from "#weightloss" on an adolescent (16 years, gender not specified) Instagram account in August 2020. Images were categorized and coded based on a predetermined ontology as food (nutrient-dense, energy-dense), people (group, individual, before/after), or text-focused by one coder (20% in duplicate, 90% agreement). Images of people were coded for sex and ethnicity and images of individuals coded for adiposity, muscularity, and pose. Results: Of 600 images, 208 (34.7%) were of individuals, predominantly females (83%) with white (37%), non-white (23%), or unclear (41%) ethnicity. Body types were thin (31%), average (43%), or higher weight (6%) with little-to-none (25%), visible (26%), or high (7%) muscularity. Almost half of images accentuated body features with a fitness/muscle accentuating (21%) or sexualized (21%) pose or both (3%). From 165 (27.5%) food images, 71% were nutrient-dense and 29% energy-dense. Of 107 (17.8%) before/after images, 90% depicted weight loss, 4% muscle building with 85% in females. From 93 (15.5%) text-focused images, 46% related to weight loss programs/products and few provided nutrition (n = 12, 13%) or exercise (n = 2, 2%) information. Conclusions: Most "#weightloss" imagery visible to adolescents on Instagram were of people, frequently females, with almost half of body-focused poses or before/after weight loss images. Few provide nutrition and exercise-related content.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Stephanie R Partridge
- Westmead Applied Research Center, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Megan L Gow
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia.,Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia.,Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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26
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Jebeile H, Lister NB, Baur LA, Garnett SP, Paxton SJ. Eating disorder risk in adolescents with obesity. Obes Rev 2021; 22:e13173. [PMID: 33410207 DOI: 10.1111/obr.13173] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 08/03/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 01/13/2023]
Abstract
The intersection between adolescent obesity and eating disorder risk is one that requires urgent attention. This review aimed to synthesize the literature on the risk of clinical eating disorders in adolescents with obesity, discuss challenges with assessing risk, and examine implications for clinical practice and future research. Obesity and eating disorders can coexist resulting in exacerbated physical and psychological health issues. Recognized eating disorder risk factors, including body dissatisfaction, poor self-esteem, depression, and engaging in dieting behaviors, are elevated and frequently reported in adolescents with obesity, highlighting a vulnerability to the development of eating disorders. Unsupervised dieting to manage weight may exacerbate eating disorder risk, while structured and supervised weight management is likely to reduce eating disorder risk for most adolescents. However, some adolescents may present to an obesity service with an undiagnosed eating disorder or may develop an eating disorder during or following treatment. We conclude that a risk management approach, with screening or monitoring for eating disorder-related risk factors and behaviors, should be utilized to identify those at risk. Future research to identify eating disorder risk factors specific to adolescents with obesity is required to inform screening and monitoring protocols, patient care, and address current knowledge gaps.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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27
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House ET, Gow ML, Lister NB, Baur LA, Garnett SP, Paxton SJ, Jebeile H. Pediatric weight management, dietary restraint, dieting, and eating disorder risk: a systematic review. Nutr Rev 2021; 79:1114-1133. [PMID: 33608718 DOI: 10.1093/nutrit/nuaa127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Whether dietary restraint and dieting are risk factors associated with eating disorders has not been explored in the context of pediatric weight management. OBJECTIVE To review associations between dietary pediatric weight management, dietary restraint, dieting, and eating disorder risk. DATA SOURCES, SELECTION, AND EXTRACTION Four databases - MEDLINE, EMBASE, Cochrane Library, and PsycINFO - were searched to May 2020 to identify pediatric weight management interventions with a dietary component for children and adolescents with overweight or obesity. The review was limited to studies reporting dietary restraint and/or dieting at preintervention, postintervention, and/or follow-up. Screening and quality assessment were conducted in duplicate, and data extraction was completed by 1 reviewer and cross-checked for accuracy. Data extracted included study characteristics, dietary restraint/dieting, and eating disorder-related outcomes (including disordered eating, body image, self-esteem, depression, and anxiety). RESULTS A total of 26 papers, representing 23 studies, were included. Of these, 20 studies reported on dietary restraint, which increased (10 postintervention, 6 follow-up) or remained unchanged (7 postintervention, 5 follow-up), and 5 studies reported on dieting, which increased (1 study), remained unchanged (2 studies) or decreased (2 studies) postintervention. All studies that reported on other eating disorder risk factors (eg, binge eating, body dissatisfaction, and depression) and weight-related outcomes found improvement or no change postintervention or at follow-up. CONCLUSION The results of this review suggest that current measures of dietary restraint and dieting are not associated with eating disorder risk within the context of pediatric weight management; however, long-term data is limited. In addition, those current measures may not be suitable risk markers. Concerns about dietary restraint and dieting leading to eating disorders should not prevent access to quality care for young people with obesity. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. 2017 CRD42017069488.
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Affiliation(s)
- Eve T House
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, 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
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, 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
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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28
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Alman KL, Lister NB, Garnett SP, Gow ML, Aldwell K, Jebeile H. Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines. Obes Rev 2021; 22:e13132. [PMID: 32896058 DOI: 10.1111/obr.13132] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/25/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first-line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low-energy diet (n = 4), protein-sparing modified fast (n = 2), and very low-carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.
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Affiliation(s)
- Kim L Alman
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Camperdown, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie B Lister
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Hiba Jebeile
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
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Gow ML, Pham-Short A, Jebeile H, Varley BJ, Craig ME. Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth. Diabetes Metab Syndr Obes 2021; 14:215-225. [PMID: 33500642 PMCID: PMC7822089 DOI: 10.2147/dmso.s238419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
In both developed and developing countries, pediatric obesity and type 2 diabetes are an increasing public health concern: globally 5.6% of girls and 7.8% of boys aged ≥5 years have obesity. The incidence of type 2 diabetes has increased in youth in recent decades and disproportionately affects those from ethnic/racial minority groups and disadvantaged backgrounds. For the treatment of both conditions, conventional lifestyle intervention is frequently ineffective, access to bariatric surgery is very limited and many young people are unsuitable or unwilling to undergo surgery. A very-low-energy diet (VLED) provides a viable alternative and may be effective for weight reduction and improved glycemic control in youth, based on one systematic review. In particular, in the treatment of type 2 diabetes, a chart review and a pilot study both demonstrated that a VLED can reduce the requirement for medications, including insulin, and lead to the remission of diabetes. However, long-term follow-up and safety data remain limited and therefore a VLED is inconsistently recommended by clinical practice guidelines for the treatment of pediatric obesity and type 2 diabetes. In clinical practice, VLED use in children and adolescents is uniquely challenging due to intolerance of expected side effects, difficulty adhering to the highly restrictive diet and difficulty with behaviour change within the current social context and environment. Ultimately, more research, including larger, longer-term trials with comprehensive safety monitoring are required to strengthen the evidence base. This would inform clinical practice guidelines, which may facilitate more widespread utilization of VLED programs in the management of obesity and type 2 diabetes in youth.
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Affiliation(s)
- Megan L Gow
- The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
- Correspondence: Megan L Gow The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, AustraliaTel +61 2 9845 0000Fax +61 2 9845 3170 Email
| | - Anna Pham-Short
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Hiba Jebeile
- The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
| | - Benjamin J Varley
- The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
| | - Maria E Craig
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Jebeile H, Grunseit AM, Thomas M, Kelly T, Garnett SP, Gow ML. Low-carbohydrate interventions for adolescent obesity: Nutritional adequacy and guidance for clinical practice. Clin Obes 2020; 10:e12370. [PMID: 32424989 DOI: 10.1111/cob.12370] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
Low-carbohydrate dietary patterns are re-emerging as a popular method of weight reduction. However, their nutritional adequacy to meet the needs of growing adolescents should be considered. This study aimed to design theoretical low-carbohydrate meal plans for clinical use in the management of adolescent obesity and assess nutritional adequacy. Meal plans were created for three levels of carbohydrate restriction (≤30, ≤50 and ≤120 g/day) without energy, protein or total fat restriction. Nutrient analysis was conducted using the FoodWorks Australia Ltd software (databases: AUSNUT 2013, AusBrands 2017, AusFoods 2017, NUTTAB 2010, New Zealand FOODfiles 2016), and compared with Australian Nutrient Reference Values for male and female adolescents aged 14 to 18 years. All low-carbohydrate meal plans met the Recommended Dietary Intake, Adequate Intake or Estimated Average Requirements for most micronutrients at an energy intake of 6.3 to 7.2 MJ/day (1510-1730 kcal/day). The proportion of energy from saturated fat exceeded recommendations across all models (11.3%-17.1%). Dietary manipulation was required to minimize saturated fat and reach micronutrient adequacy, particularly for calcium in males and females, and iron for females. In practice, this may be challenging considering individual lifestyle and preferences. Therefore, the use of low-carbohydrate diets with adolescents should be monitored by a trained professional to ensure nutritional adequacy.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
| | - Alicia M Grunseit
- The Children's Hospital at Westmead, Weight Management Services and Department of Nutrition and Dietetics, Westmead, New South Wales, Australia
| | - Maddison Thomas
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tara Kelly
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
- DDM Research Centre, Digital Diabetes Media, Coventry, UK
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L Gow
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
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Jebeile H, Gow ML, Lister NB, Haghighi MM, Ayer J, Cowell CT, Baur LA, Garnett SP. Reply to C Vanderwall and AL Carrel. J Nutr 2020; 150:1338-1340. [PMID: 32367135 DOI: 10.1093/jn/nxaa072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hiba Jebeile
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Megan L Gow
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Natalie B Lister
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Marjan Mosalman Haghighi
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Cardiology, The Children's Hospital at Westmead, Sydney, Australia
| | - Julian Ayer
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Cardiology, The Children's Hospital at Westmead, Sydney, Australia
| | - Christopher T Cowell
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Louise A Baur
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Weight Management Services, The Children's Hospital at Westmead, Sydney, Australia
| | - Sarah P Garnett
- From The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,Kids Research, The Children's Hospital at Westmead, Sydney, Australia
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Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. A response to the comments by Ms Adams on our paper "Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis". Obes Rev 2020; 21:e12971. [PMID: 31702109 DOI: 10.1111/obr.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Hiba Jebeile
- The University of Sydney, The Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Megan L Gow
- The University of Sydney, The Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Louise A Baur
- The University of Sydney, The Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Sarah P Garnett
- The University of Sydney, The Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Natalie B Lister
- The University of Sydney, The Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
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Gow ML, Tee MSY, Garnett SP, Baur LA, Aldwell K, Thomas S, Lister NB, Paxton SJ, Jebeile H. Pediatric obesity treatment, self-esteem, and body image: A systematic review with meta-analysis. Pediatr Obes 2020; 15:e12600. [PMID: 32020780 DOI: 10.1111/ijpo.12600] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 08/18/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric obesity impacts on multiple domains of psychological health, including self-esteem and body image. OBJECTIVE To determine the effect of multicomponent pediatric obesity treatment interventions on self-esteem and body image. METHODS A systematic search of published literature up to June 2019 was undertaken using electronic databases MEDLINE, EMBASE, Cochrane Library, and PsychINFO. Eligible studies implemented an obesity treatment intervention, including a dietary and physical activity component with/without a behavioral component, in children and adolescents with overweight/obesity, and assessed self-esteem and/or body image. Data were extracted by one reviewer and cross-checked. Meta-analysis was used to combine outcome data and moderator analysis conducted to identify intervention characteristics influencing outcomes. RESULTS 64 studies were identified. Meta-analysis of 49 studies (n = 10471) indicated that pediatric obesity treatment results in increased self-esteem postintervention (standardized mean difference, [SE] 0.34 [0.03], P < .001, I2 87%), maintained at follow-up (0.35 [0.05] P < .001, I2 79%, 17 studies). Similarly, meta-analysis of 40 studies (n = 2729) indicated improvements in body image postintervention (0.40 [0.03], P < .001, I2 73%), maintained at follow-up (0.41 [0.08], P < .001, I2 89%, 16 studies). CONCLUSIONS Pediatric obesity treatment improves self-esteem and body image in the short and medium term. These findings may underpin improvements in other psychological outcomes.
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Affiliation(s)
- Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Melissa S Y Tee
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Weight Management Services, The Children's Hospital at Westmead, Sydney, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Sarah Thomas
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
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Lister NB, Jebeile H, Truby H, Garnett SP, Varady KA, Cowell CT, Collins CE, Paxton SJ, Gow ML, Brown J, Alexander S, Chisholm K, Grunseit AM, Aldwell K, Day K, Inkster MK, Lang S, Baur LA. Fast track to health - Intermittent energy restriction in adolescents with obesity. A randomised controlled trial study protocol. Obes Res Clin Pract 2020; 14:80-90. [PMID: 31818675 DOI: 10.1016/j.orcp.2019.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/28/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intermittent energy restriction (IER) has shown early success in adolescents with obesity, however efficacy trials are needed. This study aims to determine if IER results in lower body mass index (BMI) z-score after 52 weeks in metabolically unhealthy adolescents with obesity compared with continuous energy restriction (CER). METHODS/DESIGN This is a prospective, randomised, multi-centre trial conducted in tertiary care settings, with three phases: jumpstart (weeks 0-4); intensive intervention (weeks 5-16); continued intervention and/or maintenance (weeks 17-52). During the jumpstart phase, all participants follow a very low energy diet (∼800kcal/3350kJ/day), then transition to their allocated intervention: IER or CER. IER involves three energy-restricted days/week, consuming one-third of daily energy requirements (∼600-700kcal/2500-2950kJ/day), and four days/week of a healthy meal plan. The CER, which is current standard care, has individually tailored energy prescription based on age and sex (13-14years, 1430-1670kcal/6000-7000kJ/day; 15-17years, 1670-1900kcal/7000-8000kJ/day). The study will recruit 186 (93 per arm) treatment-seeking adolescents aged 13-17years with obesity and at least one metabolic co-morbidity. The primary outcome is change in BMI z-score at 52 weeks. Secondary outcomes are changes at 4, 16 and 52 weeks in: body composition; diet quality, food choices and food patterns; cardio-metabolic risk factors; physical activity and sedentary behaviour; sleep and psycho-behavioural measures. DISCUSSION This study challenges existing clinical paradigms that CER is the only method for weight management in metabolically unhealthy adolescents. If successful, IER may offer an alternate medical nutrition therapy approach for those seeking treatment in tertiary settings. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12617001630303.
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Affiliation(s)
- Natalie B Lister
- The University of Sydney, Sydney Medical School, Discipline of Child and Adolescent Health, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW 2145, Australia.
| | - Hiba Jebeile
- The University of Sydney, Sydney Medical School, Discipline of Child and Adolescent Health, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW 2145, Australia
| | - Helen Truby
- Monash University, Nutrition, Dietetics & Food, Melbourne, VIC, Australia
| | - Sarah P Garnett
- The University of Sydney, Sydney Medical School, Discipline of Child and Adolescent Health, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW 2145, Australia; Kids Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Krista A Varady
- University of Illinois, Department of Kinesiology and Nutrition, Chicago, USA
| | - Christopher T Cowell
- The University of Sydney, Sydney Medical School, Discipline of Child and Adolescent Health, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW 2145, Australia; Kids Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Clare E Collins
- University of Newcastle, Priority Research Centre in Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, Newcastle, NSW 2308, Australia
| | - Susan J Paxton
- La Trobe University, School of Psychology and Public Health, Melbourne, VIC, Australia
| | - Megan L Gow
- The University of Sydney, Sydney Medical School, Discipline of Child and Adolescent Health, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW 2145, Australia
| | - Justin Brown
- Monash University, Department of Paediatrics, Clayton, VIC 3168, Australia; Monash Children's Hospital, Department of Paediatric Endocrinology and Diabetes, Clayton, VIC 3168, Australia
| | - Shirley Alexander
- The Children's Hospital at Westmead, Weight Management Services, Westmead, NSW 2145, Australia
| | - Kerryn Chisholm
- The Children's Hospital at Westmead, Weight Management Services, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Nutrition and Dietetics, Westmead, NSW 2145, Australia
| | - Alicia M Grunseit
- The Children's Hospital at Westmead, Weight Management Services, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Nutrition and Dietetics, Westmead, NSW 2145, Australia
| | - Katharine Aldwell
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW 2145, Australia
| | - Kaitlin Day
- Monash University, Nutrition, Dietetics & Food, Melbourne, VIC, Australia
| | - Mary-Kate Inkster
- Monash University, Nutrition, Dietetics & Food, Melbourne, VIC, Australia; Monash Children's Hospital, Department of Paediatric Endocrinology and Diabetes, Clayton, VIC 3168, Australia
| | - Sarah Lang
- Monash University, Nutrition, Dietetics & Food, Melbourne, VIC, Australia
| | - Louise A Baur
- The University of Sydney, Sydney Medical School, Discipline of Child and Adolescent Health, Westmead, NSW 2145, Australia; The Children's Hospital at Westmead, Weight Management Services, Westmead, NSW 2145, Australia
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Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. Association of Pediatric Obesity Treatment, Including a Dietary Component, With Change in Depression and Anxiety: A Systematic Review and Meta-analysis. JAMA Pediatr 2019; 173:e192841. [PMID: 31524933 PMCID: PMC6749546 DOI: 10.1001/jamapediatrics.2019.2841] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 12/20/2022]
Abstract
IMPORTANCE Children and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider. OBJECTIVE To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity. DATA SOURCES Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies. STUDY SELECTION Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019. MAIN OUTCOMES AND MEASURES Change in symptoms of depression and anxiety postintervention and at the latest follow-up. RESULTS Of 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], -0.31 [0.04]; P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], -0.25 [0.07]; P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], -0.38 [0.10]; P < .001) and at follow-up (4 studies; standardized mean difference [SE], -0.32 [0.15]; P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R2 = 0.82; P < .001). Higher body mass index z score at baseline was associated with a greater reduction in depression (R2 = 0.19; P = .03). CONCLUSIONS AND RELEVANCE Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L. Gow
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A. Baur
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P. Garnett
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and 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
| | - Natalie B. Lister
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis. Obes Rev 2019; 20:1287-1298. [PMID: 31131531 PMCID: PMC6851692 DOI: 10.1111/obr.12866] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 12/20/2022]
Abstract
This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre-post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow-up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post-intervention. Meta-analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], -0.326 [0.09], P < 0.001), emotional eating (six studies, -0.149 [0.06], P = 0.008), binge eating (three studies, -0.588 [0.10], P < 0.001), and drive for thinness (three studies, -0.167 [0.06], P = 0.005) post-intervention. At follow-up, a reduction in ED risk (six studies, -0.313 [0.13], P = 0.012), emotional eating (five studies, -0.259 [0.05], P < 0.001), eating concern (three studies, -0.501 [0.06], P < 0.001), and drive for thinness (two studies, -0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, Australia.,Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
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Jebeile H, Gow ML, Lister NB, Mosalman Haghighi M, Ayer J, Cowell CT, Baur LA, Garnett SP. Intermittent Energy Restriction Is a Feasible, Effective, and Acceptable Intervention to Treat Adolescents with Obesity. J Nutr 2019; 149:1189-1197. [PMID: 31006807 DOI: 10.1093/jn/nxz049] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 11/07/2018] [Revised: 12/11/2018] [Accepted: 02/28/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Intermittent energy restriction (IER) is an effective obesity management strategy in adults. OBJECTIVE The aim of this study was to investigate the feasibility, effectiveness, and acceptability of IER in adolescents (aged 12-17 y) with obesity [adult equivalent body mass index (BMI; kg/m2) ≥30]. METHODS During weeks 1-12 participants followed an IER dietary plan consisting of a very-low-energy diet (VLED) 3 d/wk (500-600 kcal/d) and an eating plan consistent with national dietary guidelines 4 d/wk. For weeks 13-26 participants chose to continue with 1-3 VLED d/wk or follow a prescriptive eating plan. Primary outcomes were feasibility and change in BMI expressed as a percentage of the 95th percentile (BMI %95th percentile) at 12 wk. Secondary outcomes were diet acceptability, body composition, cardiometabolic risk, vascular structure and function, quality of life (Pediatric Quality of Life Inventory), and eating behaviors [Dutch Eating Behavior Questionnaire (DEBQ-C)]. Linear mixed models were used to assess change in outcome measures. RESULTS Of 45 adolescents invited to participate, 30 adolescents (mean ± SD age: 14.5 ± 1.4 y, female n = 25) with a median BMI of 34.9 (range: 27.7-52.4) were recruited. At 12 wk, 23 participants chose to continue with the VLED 2-3 d/wk, and 21 completed the study, indicating the feasibility of IER. Consistent with intention-to-treat analysis, BMI %95th percentile was reduced at 12 wk (difference in estimated marginal means ± SEMs: -5.6 ± 1.1, P < 0.001) and 26 wk (-5.1 ± 1.9, P = 0.013) compared with baseline. Plasma triglycerides were reduced at 26 wk from baseline (-0.33 ± 0.12 mmol/L, P = 0.03). Body fat percentage reduced between 12 and 26 wk (-1.57% ± 0.76%, P = 0.05). Carotid intima-media thickness (CIMT) (-0.06 ± 0.01 mm, P < 0.001) and flow-mediated dilation (absolute increase 0.44% ± 0.11%, P = 0.001) improved between baseline and 12 wk, with reduced CIMT maintained at 26 wk (P < 0.001). DEBQ-C and Pediatric Quality of Life Inventory scores improved throughout the intervention. Nineteen adolescents completed an acceptability interview, rating IER as easy and pleasant to follow (mean ± SD: +2.1 ± 1.2; +1.9 ± 1.2, respectively) on a Likert scale from -4 to +4. CONCLUSION IER is a feasible, effective, and acceptable intervention in adolescents with obesity achieving reductions in BMI and cardiovascular disease risk. This trial was registered at www.anzctr.org.au as ACTRN12618000200280.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital at Westmead Clinical School.,Institute of Endocrinology and Diabetes
| | - Megan L Gow
- Children's Hospital at Westmead Clinical School.,Institute of Endocrinology and Diabetes
| | - Natalie B Lister
- Children's Hospital at Westmead Clinical School.,Institute of Endocrinology and Diabetes
| | | | - Julian Ayer
- Children's Hospital at Westmead Clinical School.,Cardiology
| | | | - Louise A Baur
- Children's Hospital at Westmead Clinical School.,Weight Management Services, The Children's Hospital at Westmead, Sydney, Australia
| | - Sarah P Garnett
- Children's Hospital at Westmead Clinical School.,Institute of Endocrinology and Diabetes.,Kids Research
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Tee MSY, Lister N, Gow ML, Paxton SJ, Aldwell K, Thomas S, Garnett S, Baur L, Jebeile H. Change in self-esteem following paediatric weight management interventions: a systematic review and meta-analysis. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2018.11.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jebeile H, Gow ML, Paxton S, Aldwell K, Thomas S, Garnett SP, Baur LA, Lister NB. Childhood obesity, weight management and depression: a systematic review and meta-analysis. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2018.11.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jebeile H, Mijatovic J, Louie JCY, Prvan T, Brand-Miller JC. A systematic review and metaanalysis of energy intake and weight gain in pregnancy. Am J Obstet Gynecol 2016; 214:465-483. [PMID: 26739796 DOI: 10.1016/j.ajog.2015.12.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gestational weight gain within the recommended range produces optimal pregnancy outcomes, yet many women exceed the guidelines. Official recommendations to increase energy intake by ∼ 1000 kJ/day in pregnancy may be excessive. OBJECTIVE To determine by metaanalysis of relevant studies whether greater increments in energy intake from early to late pregnancy corresponded to greater or excessive gestational weight gain. DATA SOURCES We systematically searched electronic databases for observational and intervention studies published from 1990 to the present. The databases included Ovid Medline, Cochrane Library, Excerpta Medica DataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Science Direct. In addition we hand-searched reference lists of all identified articles. STUDY ELIGIBILITY CRITERIA Studies were included if they reported gestational weight gain and energy intake in early and late gestation in women of any age with a singleton pregnancy. Search also encompassed journals emerging from both developed and developing countries. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were individually assessed for quality based on the Quality Criteria Checklist obtained from the Evidence Analysis Manual: Steps in the academy evidence analysis process. Publication bias was plotted by the use of a funnel plot with standard mean difference against standard error. Identified studies were meta-analyzed and stratified by body mass index, study design, dietary methodology, and country status (developed/developing) by the use of a random-effects model. RESULTS Of 2487 articles screened, 18 studies met inclusion criteria. On average, women gained 12.0 (2.8) kg (standardized mean difference = 1.306, P < .0005) yet reported only a small increment in energy intake that did not reach statistical significance (∼475 kJ/day, standard mean difference = 0.266, P = .016). Irrespective of baseline body mass index, study design, dietary methodology, or country status, changes in energy intake were not significantly correlated to the amount of gestational weight gain (r = 0.321, P = .11). CONCLUSION Despite rapid physiologic weight gain, women report little or no change in energy intake during pregnancy. Current recommendations to increase energy intake by ∼ 1000 kJ/day may, therefore, encourage excessive weight gain and adverse pregnancy outcomes.
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