Adaptation and implementation of family-based treatment enhanced with dialectical behavior therapy skills for anorexia nervosa in community-based specialist clinics.

Although family-based therapy (FBT) is a well-established treatment for anorexia nervosa, its implementation and effectiveness in clinical settings has been neglected. A group of seven therapists at a community-based eating disorders clinic were trained in skills-enhanced FBT and provided treatment to 11 youth with anorexia nervosa. Family-based skills training, which borrowed heavily from dialectical behavior therapy, was introduced in four additional sessions and then integrated throughout the remainder of FBT. FBT was perceived as appropriate and acceptable by all participants. Therapists reported high treatment fidelity. There was a large improvement in weight and moderate improvement in caregiver-reported eating disorder psychopathology but no clinically significant change by youth report. This study provides preliminary data on the implementation and effectiveness of FBT in the community

The importance of loss of control while eating in adolescents with purging disorder.

ObjectiveAlthough many individuals with purging disorder (PD) report loss of control (LOC) eating, it is unclear whether they differ from those who do not, or from other eating disorders involving purging and/or LOC.MethodWe compared PD with LOC (PD-LOC), PD without LOC (PD-noLOC), bulimia nervosa (BN), and anorexia nervosa-binge/purge subtype (AN-B/P) on measures of eating-related and general psychopathology in treatment-seeking adolescents.ResultsPD-LOC comprised ∼30% of PD diagnoses. PD-LOC and PD-noLOC did not differ from one another, or from BN and AN-B/P, on most measures of psychopathology, with some exceptions. PD-noLOC was similar to AN-B/P (p = 0.99) and significantly different from BN on eating concerns (p < 0.001), while PD-LOC was similar to BN, AN-B/P, and PD-noLOC on this measure (ps ≥ 0.06). PD-LOC reported higher self-esteem than BN, AN-B/P, and PD-noLOC (ps < 0.001).DiscussionPD was largely similar to other eating disorders characterized by purging, regardless of whether LOC eating was present. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:801-804)

Executive functioning in a racially diverse sample of children who are overweight and at risk for eating disorders

Difficulties with executive functioning may underlie both overweight and loss of control (LOC) eating behavior across the age spectrum, but there is a relative paucity of research in children with both conditions. This study aimed to characterize general executive functioning among children with overweight and LOC eating as compared to their overweight and normal-weight peers. Participants were 75 racially diverse children (58.7% female; 81.3% African-American), aged 9-12y (M age = 10.5 ± 1.1), of whom 26 were overweight/obese and endorsed LOC eating (OW-LOC), 34 were overweight controls (OW-CON), and 15 were normal-weight controls (NW-CON). All children completed interview-based measures of eating pathology, and behavioral measures of executive functioning. Parents reported on behavioral facets of children's executive functioning. Groups were compared across parent-report measures and behavioral tasks using analyses of covariance (ANCOVAs) and multivariate analyses of covariance (MANCOVAs) which adjusted for general intellectual functioning. Significant group differences were revealed on a behavioral measure of planning, the Tower of London task [F (5,65) = 3.52; p = 0.007], and a behavioral measure of working memory, the List Sorting task [F (2,71) = 6.45; p = 0.003]. Post-hoc tests revealed that OW-LOC and OW-CON performed worse than NW-CON on the Tower of London, with relative decrements in accuracy rather than performance time. Further, OW-LOC performed worse than both OW-CON and NW-CON on the List Sorting task. Overweight with or without concomitant LOC eating in children may characterize a unique pattern of executive dysfunction. Interventions for eating- and weight-related problems in youth should address underlying deficits in planning and working memory

Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome?

BackgroundOvervaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); however, limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. This study examined differences in treatment outcome between individuals whose primary concern was weight versus those whose primary concern was shape in a randomized controlled trial of treatment for adolescent AN.MethodsData were drawn from a two-site randomized controlled trial that compared family-based treatment and adolescent focused therapy for AN. Chi-square tests and logistic regression analyses were conducted.ResultsThirty percent of participants presented with primary weight concern (n = 36; defined as endorsing higher Eating Disorder Examination (EDE) Weight Concern than Shape Concern subscale scores); 60 % presented with primary shape concern (n = 72; defined as endorsing higher EDE Shape Concern than Weight Concern scores). There were no significant differences between the two groups in remission status at the end of treatment. Treatment did not moderate the effect of group status on achieving remission.ConclusionsResults suggest that treatment outcomes are comparable between adolescents who enter treatment for AN with greater weight concerns and those who enter treatment with greater shape concerns. Therefore, treatment need not be adjusted based on primary weight or primary shape concerns

A Pilot Study of Neural Correlates of Loss of Control Eating in Children With Overweight/Obesity: Probing Intermittent Access to Food as a Means of Eliciting Disinhibited Eating.

Objective:Neural substrates of loss of control (LOC) eating are undercharacterized. We aimed to model intermittent access to food to elicit disinhibited eating in youth undergoing neuroimaging, given evidence that restricted food access may increase subsequent food intake via enhancing reward value of food and diminishing eating-related self-control. Methods:Participants were 18 preadolescents (aged 9-12 years) who were overweight/obese with recent LOC eating (OW-LOC; n = 6); overweight/obese with no history of LOC eating (OW-CON; n = 5); or non-overweight with no history of LOC eating (NW-CON; n = 7). Participants underwent functional magnetic resonance imaging during a simulated food restriction paradigm in which they were alternately given restricted or unrestricted access to milkshake solutions. Results:There were no significant main effects of restricted versus unrestricted access to milkshake flavors. Group main effects revealed increased activation for OW-LOC relative to OW-CON in areas related to attentional processes (right middle frontal gyrus), inhibitory control/attentional shifts (right and left cuneus), and emotion regulation (left cingulate gyrus); and for OW-LOC relative to NW-CON in areas related to response inhibition (right inferior frontal gyrus). Significant block type × group interaction effects were found for the right middle frontal gyrus, left cingulate gyrus, and left cuneus, but these appeared to be accounted for primarily by group. Discussion:There were clear group differences in neural activity in brain regions related to self-regulation during a food restriction paradigm. Elevations in these regions among OW-LOC relative to OW-CON and NW-CON, respectively, may suggest that youth with LOC eating expended more cognitive effort to regulate ingestive behavior