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Kelly NR, Osa ML, Luther G, Guidinger C, Folger A, Williamson G, Esquivel J, Budd EL. Preliminary evaluation of a brief worksite intervention to reduce weight stigma and weight bias internalization. EVALUATION AND PROGRAM PLANNING 2024; 104:102434. [PMID: 38615372 DOI: 10.1016/j.evalprogplan.2024.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Weight-based discrimination (WBD) is common and associated with reduced physical and emotional functioning. WBD is common in the workplace, yet no studies have evaluated a WBD intervention delivered in a worksite setting. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a 3-hour, remote-delivered WBD intervention at a large public university. Six workshops including 94 participants (41.76 ± 9.37 y; 92.8% women) were delivered December 2020 through May 2021; 88.3% of participants enrolled in the study and 88.8% of enrolled participants completed pre- and post-intervention surveys. Participants strongly agreed the workshop contributed to a more inclusive work environment (M=4.98 ± 0.2; 1 =Strongly Disagree to 5 =Strongly Agree); and was highly needed (4.9 ± 0.3) and liked (4.8 ± 0.5). Qualitative feedback cited benefits of remote delivery in providing body size anonymity and wanting access to intervention materials and more time for discussion and action steps to reduce WBD. Participants experienced significant, medium reductions in explicit weight bias (ps < .001), significant, small reductions in weight bias internalization (p < .001), and statistically non-significant (p = .08), small-to-medium reductions in implicit bias. Targeting worksites as a delivery mechanism has the potential to reduce WBD, thereby improving the health and well-being of diverse employees and creating a more inclusive workspace.
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Affiliation(s)
- Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA.
| | - Maggie L Osa
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Gabriella Luther
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Austin Folger
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Juliana Esquivel
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Elizabeth L Budd
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
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Muha J, Schumacher A, Campisi SC, Korczak DJ. Depression and emotional eating in children and adolescents: A systematic review and meta-analysis. Appetite 2024; 200:107511. [PMID: 38788931 DOI: 10.1016/j.appet.2024.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/24/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
Major Depressive Disorder in youth is associated with obesity and adult cardiovascular disease (CVD) risk. Eating in response to emotions (emotional eating) is a potential contributing factor to this association. Although emotional eating is associated with Major Depressive Disorder in adults, findings in children and adolescents are mixed. This systematic review and meta-analysis aims to determine the association between depression and emotional eating in children and adolescents. Systematic searches were conducted in seven databases. Studies were included if the study population had a mean age of ≤18 years and assessed both depression and emotional eating using validated measures. The search generated 12,241 unique studies, of which 37 met inclusion criteria. Random-effects meta-analyses of study outcomes were performed. Thirty-seven studies (26,026 participants; mean age = 12.4 years, SD = 3.1) were included. The mean effect size was significant for both cross-sectional and longitudinal data (Hedges' g = 0.48, p < 0.0001; g = 0.37, p = 0.002, respectively), revealing a positive moderately strong association between depressive symptoms and emotional eating in youth. Among longitudinal studies, the association was stronger when depressive symptoms and emotional eating were assessed using child and adolescent self-report versus parent-report. No studies examined youth with a clinical diagnosis of depression. Meta-analyses revealed that depressive symptoms and emotional eating are positively associated in children and adolescents. However, further research in clinical samples is needed. Results raise the possibility for the importance of emotional eating in the link between depression and early CVD risk, though further examination is required to determine whether emotional eating is a potential treatment target to decrease CVD risk among adolescents with increased depression symptoms.
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Affiliation(s)
- Jessica Muha
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anett Schumacher
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Susan C Campisi
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada; Nutrition and Dietetics Program, Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Daphne J Korczak
- Neurosciences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Al-Shoaibi AAA, Lavender JM, Kim SJ, Shao IY, Ganson KT, Testa A, He J, Glidden DV, Baker FC, Nagata JM. Association of body mass index with progression from binge-eating behavior into binge-eating disorder among adolescents in the United States: A prospective analysis of pooled data. Appetite 2024; 200:107419. [PMID: 38759754 DOI: 10.1016/j.appet.2024.107419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/11/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
The association between body mass index (BMI) and binge-eating disorder (BED) is well-established. However, data on the extent to which BMI is associated with progression from binge-eating behavior into BED among adolescents are limited, which was the aim of this investigation. Participants were 9964 U.S. adolescents from the Adolescent Brain Cognitive Development (ABCD) Study, aged 9-13 at the time of study enrollment. A computerized parent-reported assessment was used to establish adolescents' binge-eating behaviors and BED. Cox proportional hazards models adjusting for sociodemographic covariates were used to examine prospective associations between BMI and likelihood of BED onset among a) adolescents with binge-eating behavior, and b) adolescents with no binge-eating behavior. Of 975 adolescents who met the study criteria for binge-eating behavior, 89 (9.1%) subsequently met the study criteria for BED. Of 8989 adolescents with no binge-eating behavior, 82 (0.9%) subsequently met the study criteria for BED. BMI percentile was significantly associated with the likelihood of BED onset in participants with (adjusted HR = 1.03, 95% confidence interval [CI] 1.00, 1.06) and participants without (adjusted HR = 1.05, 95% CI 1.03, 1.07) binge-eating behavior. Results were also significant when examining BMI as a dichotomous predictor (above and below 85th percentile) among those with (adjusted HR = 2.60, 95% CI 1.00, 6.68) and those without (adjusted HR = 6.01, 95% CI 3.90, 11.10) binge-eating behavior. Overall, results indicate that elevated BMI is prospectively associated with a greater risk for BED onset among U.S. adolescents with or without binge-eating behavior. Adolescents with a higher BMI may benefit from screening for binge eating, and prevention/early intervention strategies to mitigate the risk for developing BED.
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Affiliation(s)
- Abubakr A A Al-Shoaibi
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA 94143, USA.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; The Metis Foundation, 84 NE Interstate 410 Loop # 325, San Antonio, TX 78216, USA.
| | - Sean J Kim
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA 94143, USA.
| | - Iris Yuefan Shao
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA 94143, USA.
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON M5S 1V4, Canada.
| | - Alexander Testa
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030, USA.
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, 2001 Longxiang Boulevard, Longgang District, Shenzhen 518172, China.
| | - David V Glidden
- Department of Epidemiology & Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA 94158-2549, USA.
| | - Fiona C Baker
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA.
| | - Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA 94143, USA.
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Zancu AS, Diaconu-Gherasim LR. Weight stigma and mental health outcomes in early-adolescents. The mediating role of internalized weight bias and body esteem. Appetite 2024; 196:107276. [PMID: 38367911 DOI: 10.1016/j.appet.2024.107276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Weight stigma is increasingly common in early adolescence and may lead to weight bias internalization, with negative consequences for mental health outcomes. This study aimed to: examine the relations of perceived weight stigma and internalized weight bias with early adolescents' internalizing symptoms and disordered eating behavior; explore the mediating role of internalized weight bias on the relations of perceived weight stigma with internalizing symptoms and disordered eating behaviors; examine body esteem as a mediator between internalized weight bias and mental health outcomes. METHODS A sample of 406 early adolescents (59.6% girls) aged between 11 and 13 participated in this cross-sectional study. They completed self-report measures assessing perceived weight stigma, internalized weight bias, body esteem, internalizing symptoms and disordered eating. RESULTS Path analysis indicated that perceived weight stigma was positively related with internalizing symptoms and internalized weight bias. Further, internalized weight bias was negatively related with body esteem and positively related with internalizing symptoms and disordered eating. Internalized weight bias mediated the relations of perceived weight stigma with internalizing symptoms, disordered eating and body esteem. Further, body esteem mediated the relations of internalized weight bias with internalizing symptoms and disordered eating behavior. CONCLUSIONS The findings highlight internalized weight bias as a psychological mechanism potentially explaining negative links of weight stigma with internalizing symptoms and disordered eating in early adolescence. The results emphasize the need for early intervention during this developmental stage, in order to prevent psychological and behavioral outcomes of weight stigma and internalized weight bias.
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Affiliation(s)
- Alexandra Simona Zancu
- Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University of Iași, Romania.
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5
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Cheon BK, Smith MR, Bittner JMP, Loch LK, Haynes HE, Bloomer BF, Te-Vazquez JA, Bowling AI, Brady SM, Tanofsky-Kraff M, Chen KY, Yanovski JA. Lower subjective social status is associated with increased adiposity and self-reported eating in the absence of hunger due to negative affect among children reporting teasing distress. J Pediatr Psychol 2024:jsae024. [PMID: 38637284 DOI: 10.1093/jpepsy/jsae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Low social standing and teasing are independently associated with increased body mass index (BMI) and overeating in children. However, children with low social status may be vulnerable to teasing. METHODS We tested the statistical interaction of subjective social status (SSS) and subjective socioeconomic status (SSES) and teasing distress on BMI, fat mass index (FMI), and eating in the absence of hunger (EAH) in children (Mage = 13.09 years, SD = 2.50 years; 27.8% overweight/obese). Multiple linear regressions identified the main effects of self-reported SSS (compared to peers in school), distress due to teasing, and their interaction on BMI (n = 115), FMI (n = 114), and child- (n = 100) and parent-reported (n = 97) EAH. RESULTS Teasing distress was associated with greater BMI, FMI, and child-reported EAH due to negative affect (a subscale of EAH) and total EAH scores. There were no associations of SSS with these outcomes. However, there was an interaction between SSS and teasing distress for BMI, FMI, and EAH from negative affect such that lower SSS was associated with higher BMI, FMI, and EAH from negative affect in the presence of teasing distress. However, there were no main effects or interactions (with teasing distress) of SSES on the outcomes. CONCLUSIONS These findings suggest that the relationship between lower SSS and increased adiposity and overeating behaviors may be exacerbated by other threats to social standing, such as teasing. Children exposed to multiple social threats may be more susceptible to eating beyond physiological need and obesity than those who experience a single form of perceived social disadvantage.
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Affiliation(s)
- Bobby K Cheon
- Social and Behavioral Sciences Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Meegan R Smith
- Social and Behavioral Sciences Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Julia M P Bittner
- Social and Behavioral Sciences Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Lucy K Loch
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Hannah E Haynes
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Metis Foundation, San Antonio, TX, United States
| | - Bess F Bloomer
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Jennifer A Te-Vazquez
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Andrea I Bowling
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Sheila M Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Kong Y Chen
- Diabetes, Endocrinology, and Obesity Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
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Levinson JA, Kinkel-Ram S, Myers B, Hunger JM. A systematic review of weight stigma and disordered eating cognitions and behaviors. Body Image 2024; 48:101678. [PMID: 38278088 PMCID: PMC11180546 DOI: 10.1016/j.bodyim.2023.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/28/2024]
Abstract
Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.
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Affiliation(s)
- Jordan A Levinson
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, United States
| | - Shruti Kinkel-Ram
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States
| | - Bethany Myers
- University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Jeffrey M Hunger
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States.
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Beauquesne A, Roué A, Loisel A, Hassler C, Moro MR, Lachal J, Lefèvre H. Mental health in adolescents with obesity: conflicting views among physicians, a qualitative study. Eur J Pediatr 2024; 183:483-491. [PMID: 37932489 DOI: 10.1007/s00431-023-05313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
Mental health issues in adolescents with obesity are multifold, with no explicit screening recommendations. The aim of this research is to explore how this screening is performed by physicians and, thus, how it impacts adolescents' care pathways, offering insights into how to improve it through a qualitative study using interpretative phenomenological analysis. Twenty physicians (non-psychiatrist physicians and child and adolescent psychiatrists) involved at various stages in the care pathway were interviewed with semi-structured questionnaires. The findings connect 2 meta-themes. Non-psychiatrist physicians perceive widespread but ill-defined suffering in adolescents with obesity. Non-psychiatrist physicians see screening for mental conditions as mandatory. Unlike child and adolescent psychiatrists, they are not experts in distinguishing psychosocial suffering from psychiatric disorders. Screening is clinical. Adolescents' demand to lose weight in a context of shaming and alexithymia limits their access to psychiatric care. Child and adolescent psychiatrists then redefine the medical response to polymorphous symptoms. Psychiatric diagnoses mainly involve anxiety and depression symptoms, seldom eating disorders. Conclusion: Physicians have overtly conflicting perspectives over the intensity of mental conditions. Non-psychiatrists, sensitive to perceived distress, seek to have it quickly appraised if they detect a significant suffering. Child and adolescent psychiatrists find appraisal complex to perform in the absence of means, interest, and/or experience. Improving screening requires training health professionals and using multidisciplinary assessment means. What is Known: • Mental health and eating disorders are contributing factors of obesity but their relationship remains complex between cause and consequence. • Mental health conditions and psychosocial suffering are the main complications among adolescents suffering from obesity with guilt, sadness, or stigma. What is New: • Non-psychiatric physicians express their need of a specialized diagnosis to define this suffering, but the lack of availability of psychiatrists and the necessity of time and of a multidisciplinary team lead to a delayed assessment. • For psychiatrists, this suffering is often not a psychiatric condition. Though requiring attention, this can lead to a misunderstanding between professionals.
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Affiliation(s)
- A Beauquesne
- AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, Maison de Solenn, 75014, Paris, France.
- Sorbonne Université, 75006, Paris, France.
| | - A Roué
- AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, Maison de Solenn, 75014, Paris, France
- Université Paris-Cité, 92100, Boulogne-Billancourt, France
| | - A Loisel
- AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, Maison de Solenn, 75014, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94800, Villejuif, France
- French Clinical Research Group in Adolescent Medicine and Health, Paris, France
| | - C Hassler
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94800, Villejuif, France
| | - M R Moro
- AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, Maison de Solenn, 75014, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94800, Villejuif, France
- Université Paris-Cité, 92100, Boulogne-Billancourt, France
| | - J Lachal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94800, Villejuif, France
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - H Lefèvre
- AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, Maison de Solenn, 75014, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94800, Villejuif, France
- French Clinical Research Group in Adolescent Medicine and Health, Paris, France
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Wilson OWA, Nutter S, Russell-Mayhew S, Ellard JH, Alberga AS, MacInnis CC. Weighty words: exploring terminology about weight among samples of physicians, obesity specialists, and the general public. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023:1-7. [PMID: 38131299 DOI: 10.1080/17538068.2023.2297122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND The words used to refer to weight and individuals with large bodies can be used to reinforce weight stigma. Given that most previous research has examined preferred terminology within homogenous groups, this research sought to examine terminology preferences across populations. METHODS This paper reports on data gathered with the general public, family physicians, and obesity researchers/practitioners. Participants were asked about the words they commonly: (1) used to refer to people with large bodies (general public); (2) heard in their professional contexts (physicians and obesity specialists); and (3) perceived to be the most socially or professionally acceptable (all samples). RESULTS Similarities and differences were evident between samples, especially related to weight-related clinical terms, the word fat, and behavioral stereotypes. CONCLUSION The results provide some clarity into the differences between populations and highlight the need to incorporate use of strategies that may move beyond person-first language to humanize research and clinical practice with people with large bodies.
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Affiliation(s)
- Oliver W A Wilson
- Werklund School of Education, University of Calgary, Calgary, Canada
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, Canada
| | | | - John H Ellard
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Angela S Alberga
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
| | - Cara C MacInnis
- Department of Psychology, Acadia University, Wolfville, Canada
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Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:8. [PMID: 36650572 PMCID: PMC9847054 DOI: 10.1186/s40337-022-00717-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. METHODS The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. RESULTS A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. CONCLUSION Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia. .,Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW, 2006, Australia.
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
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Bernstein R, Conte I, Gulley LD, Miller RL, Clark ELM, Lucas-Thompson RG, Shomaker LB. Bringing attention to friendship: moderating Effects of Mindfulness on the interpersonal model of disordered eating in adolescents. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-022-03874-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Simonazzi C, Natali L, Valmaggia L, Rowlands K, Meregalli V, Rabarbari E, De Luca Comandini A, Favaro A, Fontana F, Treasure J, Cardi V. Food-related aversion in a female sample of people with anorexia nervosa: Cognitive-behavioural correlates, somatic and subjective anxiety, and early experiences. Appetite 2023; 180:106366. [PMID: 36356912 DOI: 10.1016/j.appet.2022.106366] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Food-related anxiety and avoidance are key features of anorexia nervosa, and among the most arduous maintaining processes to address in treatment. This study gathered information on the behavioural and cognitive correlates of food-related anxiety, including their associations with early experiences of aversive learning related to food, and more general anxiety. METHODS One-hundred and forty-four patients with anorexia nervosa were recruited from clinical services in Italy. They completed online questionnaires to assess food-related anxiety, eating disorder psychopathology, eating disorder safety behaviours and threat cognitions, early experience of aversive learning related to food, and somatic anxiety. RESULTS Experiences of food-related aversive learning were recalled by the majority of the sample (87.86%), with negative psychological consequences following eating being the most often reported (75%). Safety behaviours and threat cognitions related to the consequences of eating were also reported (14.29%-87.86%, and 36.43-90% respectively, depending on the behaviour/cognition). Eating disorder psychopathology was predicted by both somatic anxiety and negative psychological consequences following eating, whereas self-reported food anxiety was only predicted by somatic anxiety. CONCLUSION Findings validate an anxiety-based model of anorexia nervosa which establishes the role of safety behaviours, threat cognitions, early aversive learning experiences, and anxiety in the psychopathology of the illness. Exposure-based interventions have the potential to target these factors, and inhibit food-related fear.
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Affiliation(s)
| | - Ludovica Natali
- University of Padova, Department of General Psychology, Padova, Italy.
| | - Lucia Valmaggia
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, London, BR3 3BX, United Kingdom; KU Leuven, Department of Psychiatry, Belgium.
| | - Katie Rowlands
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom.
| | - Valentina Meregalli
- University of Padova, Department of Neuroscience, Padova, Italy; University of Padova, Padova Neuroscience Center, Padova, Italy.
| | - Elisa Rabarbari
- University of Padova, Department of General Psychology, Padova, Italy.
| | | | - Angela Favaro
- University of Padova, Department of Neuroscience, Padova, Italy; University of Padova, Padova Neuroscience Center, Padova, Italy.
| | - Francesca Fontana
- Centro Provinciale di Treviso per i Disturbi del Comportamento Alimentare, Aulss2 Marca Trevigiana, Treviso, Italy.
| | - Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom.
| | - Valentina Cardi
- University of Padova, Department of General Psychology, Padova, Italy; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom.
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Measuring adolescents' eating in the absence of hunger in the home environment using subjective and objective measures. Appetite 2023; 180:106354. [PMID: 36309230 DOI: 10.1016/j.appet.2022.106354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents' BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8-741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.
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Subclinical binge eating symptoms in early adolescence and its preceding and concurrent factors: a population-based study. J Eat Disord 2022; 10:180. [PMID: 36424658 PMCID: PMC9685858 DOI: 10.1186/s40337-022-00688-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Binge eating, loss of control eating and overeating often develop during late childhood or early adolescence. Understanding the presentation of binge eating as early as symptoms manifest and its preceding and concurrent factors is essential to hamper the development of eating disorders. This study examined the prevalence, concurrent and preceding factors (e.g. compensatory behaviors, emotional and behavioral problems) of subclinical binge eating symptoms in early adolescence. METHODS Data from the population-based Generation R Study were used (n = 3595). At 10 years and 14 years, preceding and concurrent factors including eating behaviors, body dissatisfaction, emotional and behavioral problems and body composition were assessed. At 14 years, 3595 adolescents self-reported on binge eating symptoms in the past 3 months and were categorized into four groups: no symptoms (n = 3143, 87.4%), overeating only (n = 121, 3.4%), loss of control (LOC) eating only (n = 252, 7.0%) or binge eating (i.e. both, n = 79, 2.2%). RESULTS In total, 452 (12.6%) young adolescents reported subclinical binge eating symptoms. Those who reported LOC eating and binge eating showed most compensatory behaviors (e.g. hide or throw away food, skipping meals). Concurrent emotional and behavioral problems, body dissatisfaction, more emotional-, restrained- and uncontrolled eating, and a higher BMI were associated with subclinical binge eating symptoms. Preceding self-reported emotional and behavioral problems, body dissatisfaction, more restrained eating and higher BMI (both fat mass and fat-free mass) at 10 years were associated with LOC eating and binge eating, but not with overeating. DISCUSSION Among young adolescents, subclinical binge eating symptoms were common. Considering the high prevalence of LOC eating, and the overlapping preceding and concurrent factors of LOC eating and binge eating compared to overeating, LOC eating seems to be a key symptom of binge eating in early adolescence.
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Factors Associated with Eating in the Absence of Hunger among Children and Adolescents: A Systematic Review. Nutrients 2022; 14:nu14224715. [PMID: 36432407 PMCID: PMC9699171 DOI: 10.3390/nu14224715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Eating in the absence of hunger (EAH) has been extensively studied over the past two decades and has been associated with excess body weight and the development of obesity. However, determinants of EAH remain uncertain. This systematic review aims to identify individual, familial, and environmental factors associated with EAH among children and adolescents. We included studies with a measure of EAH in participants aged 3-17 years old and including ≥1 factor associated with EAH. Our search identified 1494 articles. Of these, we included 81 studies: 53 cross-sectional, 19 longitudinal and nine intervention studies. In childhood (≤12 years old), EAH increases with age, it is greater in boys compared to girls, and it is positively associated with adiposity. Moreover, EAH development seems to be influenced by genetics. In adolescence, the number of studies is limited; yet, studies show that EAH slightly increases or remains stable with age, is not clearly different between sexes, and findings for overweight or obesity are less consistent across studies in adolescence. For familial factors, parental restrictive feeding practices are positively associated with EAH during childhood, mostly for girls. Studies assessing environmental factors are lacking and robust longitudinal studies spanning from early childhood to adolescence are needed.
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Huckins LM, Signer R, Johnson J, Wu YK, Mitchell KS, Bulik CM. What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding. Mol Psychiatry 2022; 27:3929-3938. [PMID: 35595976 PMCID: PMC9718676 DOI: 10.1038/s41380-022-01601-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
Substantial progress has been made in the understanding of anorexia nervosa (AN) and eating disorder (ED) genetics through the efforts of large-scale collaborative consortia, yielding the first genome-wide significant loci, AN-associated genes, and insights into metabo-psychiatric underpinnings of the disorders. However, the translatability, generalizability, and reach of these insights are hampered by an overly narrow focus in our research. In particular, stereotypes, myths, assumptions and misconceptions have resulted in incomplete or incorrect understandings of ED presentations and trajectories, and exclusion of certain patient groups from our studies. In this review, we aim to counteract these historical imbalances. Taking as our starting point the Academy for Eating Disorders (AED) Truth #5 "Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses", we discuss what we do and do not know about the genetic underpinnings of EDs among people in each of these groups, and suggest strategies to design more inclusive studies. In the second half of our review, we outline broad strategic goals whereby ED researchers can expand the diversity, insights, and clinical translatability of their studies.
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Affiliation(s)
- Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Mental Illness Research, Education and Clinical Centers, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, 14068, USA
| | - Rebecca Signer
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ya-Ke Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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