Three- and Five-Year Follow-Up of a Combined Inpatient-Outpatient Treatment of Obese Children and Adolescents

Aim. “The combined DAK therapy for obesity in children and adolescents” combines a 6-week inpatient with a 10.5-month outpatient treatment. The aim of the study is to evaluate whether the therapeutic achievements are maintained two and four years after intervention. Method. All subjects who had participated in the 12-month program in 2004/2005 were included in the follow-up study. Body weight, height, and physical fitness were assessed through direct measurements, behaviour, and quality of life by self-report questionnaires. Statistical analysis is based on an intention-to-treat analysis. Results. The response rate after three years was 63.4% and 42.2% after five years. Within three years, participants reduced their BMI-SDS significantly by 0.20 (SD 0.49) and by 0.15 (SD 0.51) within five years. Significant positive changes could be observed with respect to the participants eating behaviour. Similarly, the food intake, particularly the consumption of calorie-reduced beverages, increased significantly while that of nonrecommended foods decreased. Improvement was also seen in the subjective quality of life as well as several aspects of self-perception. Conclusion. Compared to baseline data, significant reduction of BMI-SDS and positive changes of health-related behaviours could be observed even three and five years after the start of the initial program

Cognitive and weight-related correlates of flexible and rigid restrained eating behaviour

Objectives: Examine the association between components of restrained eating, cognitive performance and weight loss maintenance. Methods: 106 women, all members of a commercial slimming organisation for at least 6. months (mean ± SD: 15.7 ± 12.4 months), were studied who, having lost 10.1 ± 9.7 kg of their initial weight, were hoping to sustain their weight loss during the 6. month study. Dietary restraint subcomponents flexible and rigid restraint, as well as preoccupying cognitions with food, body-shape and diet were assessed using questionnaires. Attentional bias to food and shape-related stimuli was measured using a modified Stroop test. Working memory performance was assessed using the N-back test. These factors, and participant weight, were measured twice at 6. month intervals. Results: Rigid restraint was associated with attentional bias to food and shape-related stimuli (r = 0.43, p < 0.001 resp r = 0.49, p < 0.001) whereas flexible restraint correlated with impaired working memory (r = - 0.25, p < 0.05). In a multiple regression analyses, flexible restraint was associated with more weight lost and better weight loss maintenance, while rigid restraint was associated with less weight loss. Conclusions: Rigid restraint correlates with a range of preoccupying cognitions and attentional bias to food and shape-related stimuli. Flexible restraint, despite the impaired working memory performance, predicts better long-term weight loss. Explicitly encouraging flexible restraint may be important in preventing and treating obesity. © 2012 Elsevier Ltd

Three-and Five-Year Follow-Up of a Combined Inpatient-Outpatient Treatment of Obese Children and Adolescents

Aim. &quot;The combined DAK therapy for obesity in children and adolescents&quot; combines a 6-week inpatient with a 10.5-month outpatient treatment. The aim of the study is to evaluate whether the therapeutic achievements are maintained two and four years after intervention. Method. All subjects who had participated in the 12-month program in 2004/2005 were included in the followup study. Body weight, height, and physical fitness were assessed through direct measurements, behaviour, and quality of life by self-report questionnaires. Statistical analysis is based on an intention-to-treat analysis. Results. The response rate after three years was 63.4% and 42.2% after five years. Within three years, participants reduced their BMI-SDS significantly by 0.20 (SD 0.49) and by 0.15 (SD 0.51) within five years. Significant positive changes could be observed with respect to the participants eating behaviour. Similarly, the food intake, particularly the consumption of calorie-reduced beverages, increased significantly while that of nonrecommended foods decreased. Improvement was also seen in the subjective quality of life as well as several aspects of self-perception. Conclusion. Compared to baseline data, significant reduction of BMI-SDS and positive changes of health-related behaviours could be observed even three and five years after the start of the initial program

Is intuitive eating the same as flexible dietary control? Their links to each other and well-being could provide an answer

Researchers have found that rigid dietary control is connected to higher psychological distress, including disordered and disinhibited eating. Two approaches have been touted by certain scholars and/or health organizations as healthier alternatives: intuitive eating and flexible control—yet these approaches have not been compared in terms of their shared variance with one another and psychological well-being (adjustment and distress). The present study explored these connections among 382 community women and men. Findings revealed that intuitive eating and flexible control are inversely related constructs. Intuitive eating was related to lower rigid control, lower psychological distress, higher psychological adjustment, and lower BMI. In contrast, flexible control was strongly related in a positive direction to rigid control, and was unrelated to distress, adjustment, and BMI. Further, intuitive eating incrementally contributed unique variance to the well-being measures after controlling for both flexible and rigid control. Flexible control was positively associated with psychological adjustment and inversely associated with distress and BMI only when its shared variance with rigid control was extracted. Collectively, these results suggest that intuitive eating is not the same phenomenon as flexible control, and that flexible control demonstrated substantial overlap and entanglement with rigid control, precluding the clarity, validity, and utility of flexible control as a construct. Discussion addresses the implications of this distinction between intuitive eating and flexible control for the promotion of healthy eating attitudes and behaviors

Spinach-associated Escherichia coli O157:H7 Outbreak, Utah and New Mexico, 2006

In 2006, Utah and New Mexico health departments investigated a multistate cluster of Escherichia coli O157:H7. A case–control study of 22 case-patients found that consuming bagged spinach was significantly associated with illness (p<0.01). The outbreak strain was isolated from 3 bags of 1 brand of spinach. Nationally, 205 persons were ill with the outbreak strain

A prospective study on the link between weight‐related self‐stigma and binge eating: role of food addiction and psychological distress

Objectives: This prospective study investigated the link between weight‐related self‐stigma and binge eating by (a) examining the temporal association between weight‐related self‐stigma and binge eating; (b) investigating the mediating role of food addiction in the association between weight‐related self‐stigma and binge eating; and (c) examining the mediating role of psychological distress in the association between weight‐related self‐stigma and binge eating. Method: Participants comprised 1,497 adolescents (mean = 15.1 years; SD = 6.0). Body mass index and weight bias were assessed at baseline; psychological distress (i.e., depression, anxiety, and stress) assessed and food addiction at 3 months; and binge eating at 6 months. The mediation model was analyzed using Model 4 in the PROCESS macro for SPSS with 10,000 bootstrapping resamples. Results: There was no significant direct association between weight‐related self‐stigma and binge eating. However, food addiction and psychological distress significantly mediated the association between weight‐related self‐stigma and binge eating. Discussion: These findings highlight the indirect association between weight‐related self‐stigma and binge eating via food addiction and psychological distress. Consequently, intervention programs targeting food addiction and psychological distress among adolescents may have significant positive effects on outcomes for weight‐related self‐stigma and binge eating. The findings will be beneficial to researchers and healthcare professionals working with adolescents during this critical developmental period

Acute hunger modifies responses on the Three Factor Eating Questionnaire hunger and disinhibition, but not restraint, scales

It is widely assumed that responses on the Three Factor Eating Questionnaire (TFEQ) represent long-term (trait) attitudes to eating behaviour. However, the questionnaire requires agreement with a number of food related statements, and it is possible that some are easier to agree with when assessed hungry than sated. To test this potential state-dependency, participants completed a 100 mm visual analogue scale rating of their current hunger at the time they completed the TFEQ. Data were collected from two cohorts: Cohort 1 (507 women and 119 men) completed both measures on paper, while the hunger rating was computerised in Cohort 2 (179 women). Regression analysis revealed significant effects of rated hunger on scores on the hunger (TFEQ-H) and disinhibition (TFEQ-D) but not restraint (TFEQ-R) subscales, with higher TFEQ-H and TFEQ-D scores when participants were more hungry. In addition, 61 women and two men from Cohort 1 completed the measures on two separate occasions. Here, scores on TFEQ-H were higher on days when these participants were hungrier, but no differences in TFEQ-D or TFEQ-R were found. Overall these data suggest TFEQ-H could be interpreted as an indirect measure of current hunger, that scores on TFEQ-D are partly moderated by hunger but TFEQ-R is a more trait-like measure of restraint

A qualitative exploration of self-kindness and 'treating oneself'' in contexts of eating, weight regulation and other health behaviours: Implications for mindfulness-based eating programmes

Background: Caring for oneself through mindfulness and compassion to improve or enhance health behaviors, and specifically eating behaviors has come to the forefront of scientific inquiry. The experiences and challenges for people in decision making around food within the context of self-kindness for body and mind care have not been previously explored.Aims: This study explored the experiences of eating behaviors in a community sample and examined the understanding of self-kindness and its relationship to eating behaviors and wellbeing of body and mind.Methods: A phenomenological theoretical position was taken; data were collected using individual semi-structured interviews. The sample was twenty-five members of the wider community in the West Midlands in England. The data were analyzed using Braun and Clarke’s (2006) procedural steps for thematic analysis.Results: Two overarching themes were inductively formulated: ‘Thinking about eating’ and ‘Caring for body and mind’. Five themes were constructed: (a) Treat food is exceptional eating, (b) The proof of the pudding is in the planning, (c) Dieting is a dirty word, which are subsumed under Thinking about eating, and (d) Self-kindness is a disavowed abstract noun, and (e) Self-kindness: A rose by any other name; under Caring for body and mind. Participants described a number of ways of treating themselves both with food and with other activities and pleasure in eating was discussed in terms of social aspects of eating rather than food. Two clear contradictions within narratives around eating and health behaviors were shown. Participants largely eschewed the concept of dieting, but described engaging in highly regulated and restrained eating. There was a lack of connection with the notion of self-kindness; although positive eating and exercise health behaviors were undertaken, they were described as necessary self-regulation, not construed as acts of self-kindness.Conclusion: The results suggests a lack of ease in the interpretation of being kind to oneself as a means of improving mental wellbeing, and an inability to relate self-kindness to physical health behaviors. The association of self-kindness with self-indulgence, and the described disconnect between hunger, satiety and pleasure in eating has implications for interpretation of mindful eating scales, practices and interventions

Diet, physical activity, and adiposity in children in poor and rich neighbourhoods: a cross-sectional comparison

BACKGROUND: Obesity in Canadian children increased three-fold in twenty years. Children living in low-income neighborhoods exercise less and are more overweight than those living in more affluent neighborhoods after accounting for family socio-economic status. Strategies to prevent obesity in children have focused on personal habits, ignoring neighborhood characteristics. It is essential to evaluate diet and physical activity patterns in relation to socio-economic conditions to understand the determinants of obesity. The objective of this pilot study was to compare diet, physical activity, and the built environment in two Hamilton area elementary schools serving socio-economically different communities. METHODS: We conducted a cross-sectional study (November 2005-March 2006) in two public elementary schools in Hamilton, Ontario, School A and School B, located in low and high socioeconomic areas respectively. We assessed dietary intake, physical activity, dietary restraint, and anthropometric measures in consenting children in grades 1 and higher. From their parents we assessed family characteristics and walkability of the built environment. RESULTS: 160 children (n = 48, School A and n = 112, School B), and 156 parents (n = 43, School A and n = 113, School B) participated in this study. The parents with children at School A were less educated and had lower incomes than those at School B. The School A neighborhood was perceived to be less walkable than the School B neighborhood. Children at School A consumed more baked foods, chips, sodas, gelatin desserts, and candies and less low fat dairy, and dark bread than those at School B. Children at School A watched more television and spent more time in front of the computer than children studying at School B, but reported spending less time sitting on weekdays and weekends. Children at both schools were overweight but there was no difference in their mean BMI z-scores (School A = 0.65 versus School B = 0.81, p-value = 0.38). CONCLUSION: The determinants of overweight in children may be more complex than imagined. In future intervention programs researchers may consider addressing environmental factors, and customizing lifestyle interventions so that they are closer to community needs

Eating behaviour associated with differences in conflict adaptation for food pictures

Objective: The goal conflict model of eating (Stroebe, Mensink, Aarts, Schut, & Kruglanski, 2008) proposes differences in eating behaviour result from peoples’ experience of holding conflicting goals of eating enjoyment and weight maintenance. However, little is understood about the relationship between eating behaviour and the cognitive processes involved in conflict. This study aims to investigate associations between eating behaviour traits and cognitive conflict processes, specifically the application of cognitive control when processing distracting food pictures. Method: A flanker task using food and non-food pictures was used to examine individual differences in conflict adaptation. Participants responded to target pictures whilst ignoring distracting flanking pictures. Individual differences in eating behaviour traits, attention towards target pictures, and ability to apply cognitive control through adaptation to conflicting picture trials were analysed. Results: Increased levels of external and emotional eating were related to slower responses to food pictures indicating food target avoidance. All participants showed greater distraction by food compared to non-food pictures. Of particular significance, increased levels of emotional eating were associated with greater conflict adaptation for conflicting food pictures only. Conclusion: Emotional eaters demonstrate greater application of cognitive control for conflicting food pictures as part of a food avoidance strategy. This could represent an attempt to inhibit their eating enjoyment goal in order for their weight maintenance goal to dominate