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


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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    • "Nevertheless, although binge eating is defined identically in children, adolescents and adults, converging evidence indicates that it is difficult to systematically diagnose BED in young children with accepted adult criteria [105,130]. Factors considered of particular relevance for this diagnostic ambiguity are the inclination of children either not to understand the meaning of loss of control when it comes to binge-eating, or to frankly deny such behaviors when asked, out of shame and embarrassment [46,109,127]. Moreover, parents also tend to deny binge-eating in their children for similar reasons. "
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    ABSTRACT: Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents’ perceptions of their child’s overweight highly influence the well-being of obese children and the way in which they perceive themselves. The present review paper aims to broaden the scope of knowledge of clinicians about several important psychosocial and familial dimensions of childhood obesity: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children’s perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child.
    Journal of Eating Disorders 02/2013; 1(1). DOI:10.1186/2050-2974-1-7
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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 · 3.61 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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