Preadolescents\u27 and Parents\u27 Dietary Coping Efficacy During Behavioral Family-Based Weight Control Treatment

Developmentally relevant high-risk dietary situations (e.g., parties where tempting foods are available) may influence overweight youth\u27s weight control, as they increase risk for overeating. Better self-efficacy for coping with these situations-which preadolescents may learn from their parents-could foster successful weight control. Overweight preadolescents (N = 204) ages 7-12 years (67% female), each with one parent, separately completed the Hypothetical High-Risk Situation Inventory (HHRSI) pre- and post-weight loss treatment. The HHRSI assesses temptation to overeat and confidence in refraining from overeating in response to four high-risk dietary scenarios. Participants generated coping strategies for each scenario. Coping strategies and confidence increased and temptation decreased from pre- to post-weight loss treatment. Parents\u27 increase in confidence from pre- to post-treatment was associated with preadolescents\u27 and parents\u27 weight loss. Tailoring treatments to enhance parents\u27 coping skills (e.g., building strategies, targeting high temptation/low confidence scenarios) may maximize preadolescents\u27 weight control

Adherence to Behavioral Targets and Treatment Attendance During a Pediatric Weight Control Trial

Objective: Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children\u27s adherence to a range of behaviors relevant for weight maintenance over long-term follow-up. Design and Methods: Overweight children (N = 101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up. Results: Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally focused MT group. Conclusions: Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children\u27s sustained weight control

Reducing Eating Disorder Onset in a Very High Risk Sample With Significant Comorbid Depression: A Randomized Controlled Trial

Objective: Eating disorders (EDs) are serious problems among college-age women and may be preventable. An indicated online eating disorder (ED) intervention, designed to reduce ED and comorbid pathology, was evaluated. Method: 206 women (M age = 20 +/- 1.8 years; 51% White/Caucasian, 11% African American, 10% Hispanic, 21% Asian/Asian American, 7% other) at very high risk for ED onset (i.e., with high weight/shape concerns plus a history of being teased, current or lifetime depression, and/or nonclinical levels of compensatory behaviors) were randomized to a 10-week, Internet-based, cognitive-behavioral intervention or waitlist control. Assessments included the Eating Disorder Examination (EDE, to assess ED onset), EDE-Questionnaire, Structured Clinical Interview for DSM Disorders, and Beck Depression Inventory-II. Results: ED attitudes and behaviors improved more in the intervention than control group (p = .02, d = 0.31); although ED onset rate was 27% lower, this difference was not significant (p = .28, NNT = 15). In the subgroup with highest shape concerns, ED onset rate was significantly lower in the intervention than control group (20% vs. 42%, p = .025, NNT = 5). For the 27 individuals with depression at baseline, depressive symptomatology improved more in the intervention than control group (p = .016, d = 0.96); although ED onset rate was lower in the intervention than control group, this difference was not significant (25% vs. 57%, NNT = 4). Conclusions: An inexpensive, easily disseminated intervention might reduce ED onset among those at highest risk. Low adoption rates need to be addressed in future research

Psychosocial Correlates of Shape and Weight Concerns in Overweight Pre-Adolescents

Shape and weight concerns among overweight pre-adolescents heighten risk for eating disorders and weight gain. Treatment and prevention efforts require consideration of psychosocial factors that co-occur with these concerns. This study involved 200 overweight pre-adolescents, aged 7-12 years (M age = 9.8; SD = 1.4), presenting for family-based weight control treatment. Hierarchical regression was used to examine the influence of pre-adolescents\u27 individual characteristics and social experiences, and their parents\u27 psychological symptoms, on shape and weight concerns as assessed by the Child Eating Disorder Examination. Findings revealed that higher levels of dietary restraint, greater feelings of loneliness, elevated experiences with weight-related teasing, and higher levels of parents\u27 eating disorder symptoms predicted higher shape and weight concerns among overweight pre-adolescents. Interventions addressing overweight pre-adolescents\u27 disordered eating behaviors and social functioning, as well as their parents\u27 disordered eating behaviors and attitudes, may be indicated for those endorsing shape and weight concerns

What constitutes clinically significant binge eating? Association between binge features and clinical validators in college-age women

Objective: To investigate the association between binge features and clinical validators. Method: The Eating Disorder Examination assessed binge features in a sample of 549 college-age women: loss of control (LOC) presence, binge frequency, binge size, indicators of impaired control, and LOC severity. Clinical validators were self-reported clinical impairment and current psychiatric comorbidity, as determined via a semistructured interview. Results: Compared with women without LOC, those with LOC had significantly greater odds of reporting clinical impairment and comorbidity (ps \u3c 0.001). Among women with LOC (n = 252), the indicators of impaired control and LOC severity, but not binge size or frequency, were associated with greater odds of reporting clinical impairment and/or comorbidity (ps \u3c 0.05). Dicussion: Findings confirm that the presence of LOC may be the hallmark feature of binge eating. Further, dimensional ratings about the LOC experienceand possibly the indicators of impaired controlmay improve reliable identification of clinically significant binge eating. (c) 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013

An examination of the Clinical Impairment Assessment among women at high risk for eating disorder onset

Identifying measures that reliably and validly assess clinical impairment has important implications for eating disorder (ED) diagnosis and treatment. The current study examined the psychometric properties of the Clinical Impairment Assessment (CIA) in women at high risk for ED onset. Participants were 543 women (20.6 +/- 2.0 years) who were classified into one of three ED categories: clinical ED, high risk for ED onset, and low risk control. Among high risk women, the CIA demonstrated high internal consistency (alpha = 0.93) and good convergent validity with disordered eating attitudes (rs = 0.27-0.68, ps \u3c 0.001). Examination of the CIA\u27s discriminant validity revealed that CIA global scores were highest among women with a clinical ED (17.7 +/- 10.7) followed by high risk women (10.6 +/- 8.5) and low risk controls (3.0 +/- 3.3), respectively (p \u3c 0.001). High risk women reporting behavioral indices of ED psychopathology (objective and/or subjective binge episodes, purging behaviors, driven exercise, and ED treatment history) had higher CIA global scores than those without such indices (ps \u3c 0.05), suggesting good criterion validity. These data establish the first norms for the CIA in a United States sample. The CIA is psychometrically sound among high risk women, and heightened levels of impairment among these individuals as compared to low risk women verify the relevance of early intervention efforts. (C) 2012 Elsevier Ltd. All rights reserved

Internet-based preventive intervention for reducing eating disorder risk: A randomized controlled trial comparing guided with unguided self-help

Student Bodies, an internet-based intervention, has successfully reduced weight/shape concerns and prevented eating disorders in a subset of college-age women at highest risk for an eating disorder. Student Bodies includes an online, guided discussion group; however, the clinical utility of this component is unclear. This study investigated whether the guided discussion group improves program efficacy in reducing weight/shape concerns in women at high risk for an eating disorder. Exploratory analyses examined whether baseline variables predicted who benefitted most. Women with high weight/shape concerns (N = 151) were randomized to Student Bodies with a guided discussion group (n = 74) or no discussion group (n = 77). Regression analyses showed weight/shape concerns were reduced significantly more among guided discussion group than no discussion group participants (p = 0.002; d = 0.52); guided discussion group participants had 67% lower odds of having high-risk weight/shape concerns post-intervention (p = 0.02). There were no differences in binge eating at post-intervention between the two groups, and no moderators emerged as significant. Results suggest the guided discussion group improves the efficacy of Student Bodies in reducing weight/shape concerns in college students at high risk for an eating disorder. (C) 2014 Elsevier Ltd. All rights reserved