Support for parents of children with anorexia : what parents want

Parents\u27 encounters with health professionals can influence their ability to cope with having a daughter with anorexia nervosa. Using qualitative analysis of in-depth interviews with 24 parents, we examine the question &ldquo;What support do parents of teenage girls with anorexia want from clinicians?&rdquo; The analysis shows that parents wanted clinicians to include them in treatment, support and guide them in their daughters\u27 care, and demonstrate positive attitudes toward them. The implications for clinicians are discussed, including being sensitive to parents\u27 vulnerability, ensuring congruence between clinicians\u27 and parents\u27 expectations about treatment, and strengthening formal channels of communication.<br /

Managerial Objectives: A Retrospective on Utility Maximization in Pro Team Sports

This is an essay review of the literature on utility maximization as a managerial objective in pro team sports. It ends up that there is a heretofore‐unrecognized parallel development of the idea, in English football by Sloane [Scottish Journal of Political Economy (1971), 17, 121] and in North American pro sports by Quirk and El Hodiri, presented in that same year but not published as a conference proceeding until 1974. I review these works and place the rest of the extant literature chronologically, noting their level of generality along a couple of dimensions. I also observe a lack of a clear reference lineage in this literature and suggest one. Adopting it should aid future researchers who are trying to place their work in the context of this literature. [It would have helped me, for example.]Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110578/1/sjpe12061.pd

Parental strategies used in the family meal session of Family-Based Treatment adolescent anorexia nervosa : links with treatment outcomes

Examine relationships between parental mealtime strategies used in the family meal session of Family-Based Treatment (FBT) and adolescent outcomes at EOT (session 20). Method: Eighteen families with an adolescent receiving FBT-AN participated. Parental strategies during videoed family meals were assessed using a family mealtime coding system. Change scores were calculated for both adolescent %EBW and EDE scores. Results: Increased use of parental direct and non-direct eating prompts during the family meal was associated with greater adolescent weight gain at EOT. Use of parental mealtime strategies was not associated with any significant change in adolescent eating psychopathology at EOT. Discussion: Parental verbal eating prompts during the family meal may be effective in promoting short-term weight gain. During the family meal session, parents should be encouraged to maintain a direct focus on their adolescent child’s eating behaviour which may assist their child with food consumption and potential weight gain. Further research examining food-based interactions among parents and their adolescent child with AN is needed

Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa

Background: For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. Method: A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. Results: Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. Conclusions: These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients’ engagement in treatment. Trial registration ACTRN12610000585022 . Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922

Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features

BackgroundHigh levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress.MethodData were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10).ResultsOn the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others.ConclusionsResults indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered

Neural response to high and low energy food images in anorexia nervosa

To compare neural responses to high and low-energy food images in patients with Anorexia Nervosa (AN) and an age-matched Healthy Control (HC) group. 25 adolescents with AN and 21 HCs completed a diagnostic interview, self-report questionnaires and fMRI, during which they viewed food images evoking responses of disgust, happiness, or fear. Following whole brain analyses, neural responses in six regions of interest were examined in a series of between-group contrasts, across the three emotive categories. Compared to the HCs, people in the AN group showed increased responsivity to high-energy (1) disgust images in temporal lobe, frontal lobe, insula, and cerebellum anterior lobe; (2) fear images in occipital lobe, temporal, and frontal lobes and (3) happy images in frontal lobe, cerebellum anterior lobe, sub-lobar, and cuneus. More activity was observed in response to low-energy (1) disgust food images in the temporal lobe, frontal lobe, insula, cerebellum anterior and posterior lobes, parietal lobe, occipital lobe, and limbic lobe; (2) and happy food images in frontal lobes. Few correlations were found with levels of eating disorder symptoms. The findings highlight the emotional impact of diverse high and low-energy foods for people with AN. People without AN may have a better capacity to filter salient from non-salient information relating to the current task when viewing high energy foods. In summary, for those with AN, it would seem their ability to efficiently ‘sort-out’ information (especially information pertaining to disorderrelevant stimuli such as food images) to complete the task at hand, may be diminished

Parental strategies used in the family meal session of family-based treatment for adolescent anorexia nervosa: Links with treatment outcomes

Objective: Examine relationships between parental mealtime strategies used in the family meal session of Family-Based Treatment (FBT) and adolescent outcomes at EOT (session 20). Method: Eighteen families with an adolescent receiving FBT-AN participated. Parental strategies during videoed family meals were assessed using a family mealtime coding system. Change scores were calculated for both adolescent ëW and EDE scores. Results: Increased use of parental direct and non-direct eating prompts during the family meal was associated with greater adolescent weight gain at EOT. Use of parental mealtime strategies was not associated with any significant change in adolescent eating psychopathology at EOT. Discussion: Parental verbal eating prompts during the family meal may be effective in promoting short-term weight gain. During the family meal session, parents should be encouraged to maintain a direct focus on their adolescent child’s eating behaviour which may assist their child with food consumption and potential weight gain. Further research examining food-based interactions among parents and their adolescent child with AN is needed

How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment

Objective: To examine the range and frequency of parental mealtime strategies used during the family meal session of Family-Based Treatment (FBT) for adolescent anorexia nervosa, and to explore the relationships between parental mealtime strategies, mealtime emotional tone and parental 'success' at encouraging adolescent food consumption. Method: Participants were 21 families with a child aged between 12 and 18 years receiving FBT for adolescent anorexia nervosa. Video recordings of the family meal session (FBT session two) were coded using the Family Mealtime Coding System adapted in this study for use with adolescents (FMCS-A) to identify frequency of parental strategies, emotional tone of the meal (measured by adolescent positive and negative vocalisations) and frequency of prompted mouthfuls consumed by the adolescent (measured by the number of mouthfuls consumed by the adolescent immediately following parental interactions). Results: A range of parental mealtime strategies were in use. Those used repeatedly included direct eating prompts, non-direct eating prompts, physical prompts, and providing information or food-related choices. Several parental mealtime strategies (direct and non-direct eating prompts) were found to be consistently associated with the tone of adolescents' vocalisations and the number of mouthfuls consumed in response to a parental prompt. Discussion: Despite associations with negativity from the adolescent, the use of food-related prompts (both verbal and physical) seems to be associated with increased eating. This indicates the potentially important role of parental control of eating. Following replication, these findings might provide a focus for therapists when supporting and coaching parents during the family meal session. © 2014 Wiley Periodicals, Inc