Eating disorder pathology among overweight treatment-seeking youth: Clinical correlates and cross-sectional risk modeling

Center for Anxiety and Related Disorders, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 11/2007; 45(10):2360-71. DOI: 10.1016/j.brat.2007.03.017
Source: PubMed

ABSTRACT Preliminary research suggests that pediatric overweight is associated with increased eating disorder pathology, however, little is known about which overweight youth are most vulnerable to eating disorder pathology. We therefore investigated 122 overweight treatment-seeking youth to describe eating disorder pathology and mental health correlates, and to identify psychopathological constructs that may place overweight youth at increased risk for eating disorder pathology. Youth participated in a comprehensive assessment of eating disorders, mood and anxiety disorders, general psychopathology, and risk variables involving semi-structured clinical interviews and self- and parent-report questionnaires prior to the initiation of weight-loss treatment. Ten youth met criteria for an eating disorder, and over one-third endorsed recent binge eating. Eating disorder pathology was associated with depressive and anxious symptoms (p's<0.001). Structural equation modeling indicated increased negative affect, teasing experience, and thin-ideal internalization, and decreased perfectionism were associated with increased eating disorder pathology. Findings corroborate earlier work indicating that eating disorder pathology is elevated and clinically significant in overweight treatment-seeking youth, bolstering the need for mental health assessment of such individuals. Cross-sectional modeling proposed key variables that relate to eating disorder pathology in overweight treatment-seeking youth, which following prospective replication, may inform the development of effective interventions for overweight and eating disorders.

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Available from: Marian Tanofsky-Kraff, May 07, 2014
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    • "Two prospective studies suggest that dieters most at risk for developing clinically significant eating disturbances are those with severe disordered eating symptoms and cognitions [9] [10]; however, there has been limited exploration of other psychosocial factors that may be involved in the relationship between dieting and binge eating. Depression symptoms, poor selfesteem , and teasing experiences have been identified as potential moderators in adolescents and young adults based on crosssectional research [15] [16] [17] [18] [19] and prospective studies of up to 2 years [12] [20], with most theoretical models implicating binge eating as a method of coping with negative affect related to these factors [12]. The generalizability of study findings could be enhanced by examining the relation between these psychosocial variables and binge eating over longer time frames, and using large, community-based samples, including both males and fe- males. "
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    ABSTRACT: Dieting is a well-established risk factor for binge eating, yet the majority of dieters do not develop binge eating problems. The purpose of the current study was to examine psychosocial factors involved in the relation between dieting and binge eating over a 10-year follow-up period. A population-based sample (n = 1,827) completed surveys assessing eating habits, psychological functioning, and weight status at 5-year intervals spanning early/middle adolescence (time 1), late adolescence/early young adulthood (time 2), and early/middle young adulthood (time 3). Dieting, along with depression symptoms, self-esteem, and teasing experiences at time 1 and time 2, was used to predict new onset binge eating at time 2 and time 3, respectively. Interactions between dieting status and varying degrees of these psychosocial factors in relation to binge eating onset were also tested. Dieters were two to three times more likely than nondieters to develop binge eating problems over 5-year follow-ups. At most time points, depression symptoms and self-esteem predicted binge eating onset beyond the effects of dieting alone. Detrimental levels of these factors among dieters (relative to nondieters) increased the likelihood of binge eating onset only during the later follow-up period. Depression and self-esteem appear to be particularly salient factors involved in the relation between dieting and binge eating onset among adolescents and young adults. Early identification of these factors should be a priority to prevent the development of binge eating problems among already at-risk individuals.
    Journal of Adolescent Health 07/2012; 51(1):86-92. DOI:10.1016/j.jadohealth.2011.11.001 · 2.75 Impact Factor
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    • "were overweight and obese children and adolescents (8 to 18 years) presenting for behavioral weight loss treatment at the Optimal Weight for Life Clinic (Eddy, et al., 2007). Participants were excluded for the following reasons: obesity-related disorders associated with mental retardation, psychotic disorders, or developmental disorders associated with cognitive impairment. "
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    ABSTRACT: Little is known about the phenomenology of pediatric loss of control (LOC) eating. Overvaluation of shape and weight, however, appears to be diagnostically meaningful among binge eating adults. We explored the significance of shape and weight overvaluation among children and adolescents with LOC eating. Participants (n = 526) included 149 overweight youth with LOC eating and 377 overweight controls (CON). Participants were categorized as those reporting at least moderate overvaluation (LOC-Mod, n = 74; CON-Mod, n = 106) or less than moderate overvaluation (LOC-Low, n = 75; CON-Low, n = 271), and compared on measures of eating-related and general psychopathology. LOC-Mod evidenced lower self-esteem than CON-Low, and greater behavioral problems than CON-Mod and CON-Low, but did not differ from LOC-Low in these domains. With the exception of LOC-Low and CON-Mod, all groups differed on global eating-disorder severity, with LOC-Mod scoring the highest. Overvaluation of shape and weight appears to be of questionable importance in defining subtypes of youth with LOC eating. However, as overvaluation and LOC eating each independently predicts eating-disorder onset, their confluence may confer even further risk for eating-disorder development. Longitudinal studies should address this possibility. Developmentally appropriate discussion about body image disturbance may be indicated in interventions targeting pediatric LOC eating and/or obesity.
    Behaviour Research and Therapy 07/2011; 49(10):682-8. DOI:10.1016/j.brat.2011.07.011 · 3.85 Impact Factor
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    • "Up to 30% of overweight and obese children and adolescents report occasional or recurrent loss of control eating episodes ( Ackard et al . , 2003 ; Allen et al . , 2008 ; Berkowitz , Stunkard , & Stallings , 1993 ; Britz et al . , 2000 ; Decaluwe , Braet , & Fairburn , 2003 ; Eddy et al . , 2007 ; Glasofer et al . , 2006 ; Goossens , Braet , & Decaluwe , 2007 ; Isnard et al . , 2003 ; Levine , Ringham , Kalarchian , Wisniewski , & Marcus , 2006 ; Tanofsky - Kraff , Faden , Yanovski , Wilfley , & Yanovski , 2005 ; Tanofsky - Kraff et al . , 2004 ) ."
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    ABSTRACT: Associations between negative mood and binge eating in the laboratory are well-established in adults, but such data are limited in youth. We investigated the relation between mood and binge eating in children using a laboratory feeding paradigm. Overweight girls, aged 6-12 years, with (BE; n=23) and without (control, CON; n=23) reported objective and/or subjective binge eating underwent both sad and neutral mood inductions, followed by multi-item buffet meals. The Group × Mood Condition interaction for overall energy intake was non-significant. However, BE girls consumed more energy from fat in the sad condition as compared to the neutral condition. Baseline mood predicted BE girls' likelihood of reporting loss of control during the sad condition test meal. Results suggest that emotional eating episodes in children reporting aberrant eating may be characterized by the experience of loss of control, rather than the consumption of objectively large amounts of food. Interventions focused on affect regulation may minimize the adverse consequences of pediatric binge eating.
    Eating behaviors 01/2011; 12(1):37-43. DOI:10.1016/j.eatbeh.2010.11.001
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