Preventing obesity and eating disorders in adolescents: what can health care providers do?

Partnerships with primary care providers: Opportunities to prevent eating disorders and mitigate their progression in young people

Epidemiologic research has identified numerous interpersonal and individual risk factors for and warning signs of emerging eating disorders in adolescents. These findings have informed public health prevention and treatment strategies, including translation of findings to clinical recommendations for primary care providers (PCPs). A next step in this translational work could include a comprehensive approach where PCPs are seen as partners in efforts to improve population health outcomes. PCPs have great potential to implement high-yield interventions that prevent or attenuate the course of adolescent eating disorders. To illustrate this potential, we present a case that highlights missed opportunities for a PCP to prevent, detect, and intervene during a patient's developing eating disorder. We then relate the case to two emerging research programs that utilize PCP partnerships: one trains PCPs in Strengths-Based Adolescent Healthcare to improve eating disorder prevention; the other adapts Family-Based Treatment for primary care to improve early access to evidence-based treatment. In addition to these promising areas of research, efforts are needed to widen requirements for eating disorder curricula in medical training programs and to address weight stigma in primary care. Together these efforts will help PCPs become effective partners in the prevention and treatment of eating disorders.

Social Media Effects Regarding Eating Disorders and Body Image in Young Adolescents

The following study investigates how eating problems and young people's body image are affected by social media. As social media becomes more pervasive, young teenagers are exposed to many pictures, messages, and influencers encouraging unachievable body and beauty ideals. The study investigates the link between social media usage and the development of binge eating disorder patterns and undesirable body image judgments. It also sheds light on the influence that so-called social media influencers and celebrities have on encouraging disordered eating patterns and forming negative body image perceptions. On websites like Instagram and TikTok, exposure to deliberately selected photographs of "ideal" body types encourages body dissatisfaction and poor self-worth. The research emphasizes social media's possible harm to this vulnerable group's physical and mental health by examining pertinent literature and empirical evidence. It also looks at potential safeguards and methods for fostering good mental and physical health in early adolescents during pervasive social networking site use. Promoting fad diets, weight-loss aids, and the exaltation of extreme thinness aids in the normalization of harmful behaviours. Social media's negative consequences on eating disorders and body image in young teenagers are highlighted by this study in its conclusion. As a critical developmental stage, early adolescence is vulnerable due to the effect of social media, which could normalize unhealthy behaviours and maintain negative body image and insecurities. The findings underscore the need for targeted interventions and educational programs to mitigate the adverse effects of eating problems and young people's body image in light of social media.

Experiences of childhood weight management among Norwegian fathers of children with overweight or obesity - a qualitative interview study

OBJECTIVE

Paternal participation and experiences in childhood weight management is an understudied studied area. Given the important role fathers play in childhood obesity prevention and treatment, the aim of this study was to explore Norwegian fathers' experiences of helping to prevent further weight gain in their children with overweight or obesity.

METHODS

Data were collected through semi-structured interviews with eight fathers of ten children with overweight or obesity and analysed by qualitative content analysis.

RESULTS

The analysis resulted in one overall theme: Balancing between assuming and avoiding responsibility for weight management with a desire to preserve the child's dignity, comprising two themes: 1) Alternating between concern, helplessness and responsibility, 2) Needing acknowledgement, and flexible and tailored professional support, both of which have several sub-themes.

CONCLUSION

Fathers need guidance on how to talk to their children to prevent further weight gain, while at the same time emphasizing safeguarding the child's dignity. Healthcare professionals should address parents' own emotional barriers and include fathers to a greater extent as a resource in family-centred counselling and tailor guidance and support to help with childhood weight management.

An exploration of the association between premorbid weight status on patient and caregiver factors at pre and post-treatment among youth with anorexia nervosa/atypical anorexia nervosa

Patients with atypical anorexia nervosa (AAN) or anorexia nervosa (AN) with premorbid history of higher weight (PHW; median BMI ≥ 85th %ile) may report greater eating disorder (ED) pathology, anxiety, and depression, than patients with premorbid history of lower weight (PLW; mBMI <85th %ile). Less is known about caregiver attitudes or treatment outcome related to premorbid weight history. The current study examined associations between premorbid weight history and patient/caregiver factors at presentation, during treatment, and end of treatment among adolescents (N = 138) diagnosed with AN/AAN and their caregivers who received interdisciplinary ED treatment. The sample comprised adolescents with PHW (n = 58, 40.6 %) or PLW (n = 82, 59.4 %). Adolescents with PHW did not differ with regard to patient- or caregiver-reported ED symptoms, comorbid psychopathology, rates of treatment completion, and attainment of estimated body weight compared to PLW (ps > .05). Adolescents with PHW (vs. PLW) were more likely to be diagnosed with AAN (67.9 %, p < .001), identify as cisgender male (p < .001) and to have lost more weight prior to presentation (p < .001). Perceived caregiver burden was lower among adolescents with PHW vs. PLW (p < .001). Further research should expand on this preliminary study exploring associations between premorbid weight history on patient and caregiver factors at treatment presentation and conclusion to enhance the efficacy of evidence-based treatment across the weight-spectrum.

Efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina

OBJECTIVE

This study aimed to examine the efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina.

METHOD

A quasi-experimental study was conducted by comparing an experimental group versus a control group. The final sample included 509 girls aged 13-18 (M = 15.39 and SD = 1.30) from nine schools located in three geographical regions. They provided data at three assessment time points: baseline, post-intervention and a 3-month follow-up. Dependent variables included skipping breakfast, physical activity, eating disorder risk and thin-ideal internalization. The program was carried out in three 90-minute sessions within usual school hours, at 1-week intervals.

RESULTS

Participants who received the intervention decreased more than the control group in skipping breakfast month by month. However, a significant effect of the intervention was not found on physical activity, eating disorder risk, and thin-ideal internalization.

DISCUSSION

The presence of mixed findings shows the need to adjust the intervention to enhance the results. The importance of working jointly with other Latin American countries is emphasized, in order to promote the growth of the field of prevention, regarding cultural particularities shared by our societies.

PUBLIC SIGNIFICANCE

Integrated programs aimed at reducing risk factors for the entire spectrum of problems related to eating, weight and body image could lead to beneficial and more efficient effects. However, their development is still incipient in Latin America. PIA-2 Program, designed for female adolescents, produced positive results in one of the four variables studied, decreasing the weekly frequency of skipping breakfast among adolescents. This is pioneering research in Argentina and the region since very few studies on integrated prevention have been published in Latin America. It is crucial to continue with efforts aimed at developing programs that are suited to the specific needs of the population of Latin American countries. In this aspect, our study is undoubtedly an important contribution.

Does Weight-Motivation for Exercise Predict Physical Activity Levels Across the Life Course From Adolescence to Adulthood?

Healthcare professionals may motivate their patients to exercise to lose weight, but it is unknown how weight-focused motivations influence young peoples' PA trajectories.

PURPOSE

To examine if weight-motivated exercise predicts moderate-to-vigorous physical activity (MVPA) from adolescence to adulthood in a population-based sample and if this relationship differs by age and body mass index (BMI).

METHODS

Participants (N = 1,428; 13-18 years at baseline; 48.6% female; 49.0% white) responded to surveys in the 15-year longitudinal study, Project EAT (Eating and Activity in Teens and Young Adults). Weight-motivated exercise was examined as a predictor of MVPA across the life course at five-year intervals using linear regression generalized estimating equations and adjusting for demographics (age modeled continuously), BMI (modeled continuously), weight-related intentions, and prior MVPA.

RESULTS

Weight-motivated exercise predicted higher subsequent MVPA at five-year intervals among females (B = .57, 95% CI:0.13, 1.00) but not males (B = .31, 95% CI:-.09, .72). The association differed by BMI in females (p = .02); weight-motivated exercise was associated with higher subsequent MVPA at lower BMI but lower subsequent MVPA at higher BMI. The association also differed by age in males (p = .008), such that older males who reported weight-motivated exercise had higher subsequent MVPA, whereas this association was not present in younger males.

CONCLUSION

Weight-motivated exercise may have a deleterious influence on MVPA for females with higher BMI and may have an advantageous influence on older males. Understanding how motivations for exercise may influence PA trajectories can inform PA promotion over the life course by providing more nuanced guidance by age, BMI, and sex.

First, Do No Harm: Understanding Primary Care Providers' Perception of Risks Associated With Discussing Weight With Pediatric Patients

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

Parental Contributors to the Prevalence and Long-term Health Risks of Family Weight Teasing in Adolescence

PURPOSE

Weight teasing from family members is common during adolescence. However, little is known about parental factors that increase adolescents' risk for family weight teasing and its adverse health sequelae. Using multi-informant data from adolescents, mothers and fathers, the current longitudinal study examined how parental concerns about their child's weight and their own weight contribute to family weight teasing in adolescence and its long-term health consequences.

METHODS

Data were collected in the population-based Project EAT 2010-2018 (Eating and Activity over Time) study, following a longitudinal cohort of young people (N = 2,793). Parental weight concerns for their adolescent and themselves were reported by mothers (N = 2,298) and fathers (N = 1,409) at baseline and examined as a predictor of family weight teasing in adolescence as well as a moderator of family weight teasing effects on health eight years later.

RESULTS

Mothers' and fathers' concerns about their child's weight, as well as mothers' dieting frequency, increased the likelihood of adolescents experiencing family weight teasing. Longitudinal analyses revealed that adolescents teased about their weight by family had higher levels of stress (β = .21, 95% confidence interval [CI] = .09-.33) and substance use (β = .16, 95% CI = .04-.28), and lower self-esteem (β = -.16, 95% CI = -.28 to -.05) in young adulthood.

CONCLUSIONS

Findings highlight parent weight concern, particularly concern for their child's weight, as a risk factor for family weight teasing. These findings underscore the importance of encouraging parental attention to health, rather than weight, in family-based treatment and public health initiatives.

Disordered eating among Arab and Jewish youth in Israel: the role of eating dinner with the family

Background

Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE.

Methods

A nationally representative school-based survey of 4926 middle and high-school children (11–19 years old) was conducted during 2015–2016. Participants indicated where and with whom they had eaten dinner the day before. The 5-item SCOFF questionnaire was used (> 2 affirmative items were considered a likely case of DE). Height and weight were measured by personnel.

Results

DE was more prevalent among girls (29.7%) relative to boys (12.2%), Arabs (25.1%) relative to Jews (19.5%), and older (25.3%) relative to younger (17.6%) adolescents. Arabs were more likely to eat dinner at home with parents/family (chi² = 10.75, p = .001), or not to eat dinner at all (chi² = 63.27, p < .001), while Jews were more likely to eat dinner alone (chi² = 5.37, p = .021) or to eat dinner out of the home (chi² = 67.65, p < .001). Logistic regressions (stratified by ethnicity and adjusted for gender, age, weight) revealed that family dinners acted as a protective factor against DE, relative to eating out of the home or relative to not eating dinner at all among both ethnic groups, and relative to eating dinner alone among Arabs.

Conclusion

There are differences between Arab and Jewish adolescents in terms of rates of yesterday’s family dinners and DE. Given that eating dinner with the family was linked with lower rates of DE, possible interventions to reduce DE may include educating parents of both Arab and Jewish adolescents regarding the importance of family meals.

Preventing Nutritional Disorders in Adolescents by Encouraging a Healthy Relationship With Food

Nutritional disorders, including overweight, underweight, and/or nutrient deficiency, are a significant cause of morbidity and mortality. These disorders are frequently related to abnormal patterns of eating and/or physical activity, which commonly begin in adolescence and persist into adulthood. Abnormal eating and exercise behaviors may stem from an unhealthy relationship with food, which often takes root in preadolescence or early adolescence. To prevent eating disorders, overweight, underweight, and nutritional deficiencies in adolescence and beyond, health care providers need to proactively support early adolescents and their caregivers to develop a healthy relationship with food and their bodies. Anticipatory guidance, nutrition and exercise counseling, and encouragement of body positivity and healthy self-image during the vulnerable period of early adolescence can prevent maladaptive behaviors from emerging later on. Advocacy beyond the health care setting is also needed to ensure that adolescents are exposed to consistent and positive nutritional messaging. In this position article, authors from both the Nutrition/Obesity Committee and the Eating Disorder Committee of the Society of Adolescent Health and Medicine provide practical recommendations for health care professionals to guide their young patients and caregivers toward a flexible, balanced, and satisfying approach to nutrition that will lead to physical and emotional wellness throughout their lifetimes.

Sounds unrealistic: an adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: what happens to the physiology?

BACKGROUND

Adolescents with eating disorders (EDs) may present not only with abnormal eating behaviors but also with abnormal drinking behaviors varying widely. These behaviors include water loading to cheat on weight measurements, to feel full and suppress appetite and/or to induce vomiting; as well as restricting fluid intake in addition to food.

METHOD

We present a 16-year-old female adolescent with anorexia nervosa restrictive type and major depressive disorder who was hospitalized due to acute food refusal and developed generalized seizures due to dilutional hyponatremia in consequence of consuming excessive amount of water. Psychiatric diagnoses were made according to 'The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.; DSM-5) criteria.

RESULTS

After starting nutritional rehabilitation with a low calorie meal plan to avoid refeeding syndrome, a weight gain of 2 kg was noted in the second day of hospitalization. At the bedside visit, she was observed in a disoriented manner and consecutively in seconds, lost consciousness with a generalized tonic-clonic seizure lasting 2 min. Her serum sodium level was measured as 116 mEq/L, which was normal at the time of admission. It was later learned that she secretly ingested 19 L of water in a short amount of time. She regained consciousness and no further seizures were observed after intravenous sodium deficit correction and fluid restriction therapy. Her serum sodium level was normalized (137 mEq/L) within 12 h.

CONCLUSION

A thorough clinical assessment of hydration and drinking behaviors as well as eating behaviors is essential for patients with EDs to avoid serious medical complications with high mortality and morbidity during follow-up. It is interesting that this amount of fluid consumption in such a short period of time did not present to the clinic with vomiting, gastric dilatation or bowel irrigation symptoms in a case with acute food refusal and restriction for a year, instead absorbed very quickly causing acute and severe symptomatic hyponatremia with generalized seizures.

[Association between sharing meals with parents or guardians and obesity in Brazilian adolescents]

The study aimed to analyze the association between sharing lunch or supper with parents/guardians and obesity in Brazilian adolescents participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA in Portuguese). This was a cross-sectional, school-based study with adolescents 12 to 17 years of age. Obesity was classified by body mass index based on World Health Organization criteria, according to age and sex. The association between obesity and sharing lunch and supper with parents/guardians (never, sometimes, almost every day, and every day) was analyzed according to crude and sex- and age-adjusted prevalence ratios. A total of 71,740 adolescents were assessed. Of these, 48% and 60% of girls and 56% and 65% of boys, respectively, shared lunch and supper every day or nearly every day. Boys who shared lunch and supper with their parents/guardians nearly every day and every day showed lower prevalence of obesity. Stratified by age bracket, only younger boys that ate lunch with their parents/guardians sometimes (PR = 0.64; 95%CI: 0.46-0.89), nearly every day (PR = 0.50; 95%CI: 0.37-0.69), and every day (PR = 0.65; 95%CI: 0.49-0.85) and supper with their parents/guardians every day (PR = 0.61; 95%CI: 0.43-0.87) showed lower prevalence of obesity. The findings highlight the importance of promoting healthy eating behaviors in the family setting as part of strategies to prevent obesity in adolescents.

Psychological well-being and weight-related teasing in childhood obesity: a case-control study

PURPOSE

The prevalence of childhood obesity continues to increase worldwide. The aims of this study were to (1) assess the psychological well-being and rates of teasing of Spanish children with obesity (OG) and compare them with their non-overweight peers (NG), and (2) analyze the mediating role of weight-related teasing on the relation between children's BMI z score and psychological well-being.

METHODS

The cross-sectional study included 50 preadolescents with obesity, matched with non-overweight children according to age, sex, and socioeconomic status, who were assessed via self-report instruments measuring anxiety, depression, self-esteem, and teasing.

RESULTS

The OG reported higher anxiety, depression, and teasing, and lower self-esteem. SEM revealed that children who scored worse on instruments assessing psychological well-being had higher BMI z scores. Weight-related teasing predicted poor psychological well-being scores and weight-related teasing mediated the relation between BMI and psychological well-being.

CONCLUSIONS

The high rates of anxiety, depression, and weight-related teasing, as well as the low self-esteem, which was observed amongst the children with obesity, raise concerns about the quality of life of this population. Furthermore, the finding that weight-related teasing mediated the relationship between BMI and psychological well-being adds to a growing body of research, highlighting the harmful effects of weight-related stigma. Overall, these results highlight the importance of early intervention to assess for, and address, the presence of weight-related teasing and psychological well-being difficulties in preadolescents with obesity.

LEVEL OF EVIDENCE

Level III, case-control study.

Household food insecurity: associations with disordered eating behaviours and overweight in a population-based sample of adolescents

OBJECTIVE

To examine how household food insecurity is related to adolescent weight status and disordered eating.

DESIGN

Cross-sectional, population-based study. Adolescents self-reported unhealthy weight control behaviours, binge eating and meal frequency; weight status was measured. Household food insecurity was assessed by asking parents to respond to the validated six-item US Household Food Security Survey Module.

SETTING

Adolescents surveyed within Minneapolis/St. Paul public middle and high schools completed surveys at school, and their parents/guardians were surveyed by mail during the 2009-2010 academic year.

PARTICIPANTS

Ethnically/racially diverse, primarily low-income adolescents (mean age: 14·4 years, range: 10-22 years) and their parents/guardians (n 2285 dyads).

RESULTS

More than one-third (38·9 %) of the adolescents experienced past-year household food insecurity, 43·2 % reported disordered eating and 39·6 % were overweight. Generalised regression models showed that food insecure (FI) compared with food secure (FS) adolescents had higher prevalence of overweight (FI: 42·3 % v. FS: 37·9 %, P = 0·039), lower breakfast consumption (FI: 4·1 times/week v. FS: 4·4 times/week, P = 0·005) and greater use of unhealthy weight control behaviours (FI: 49·0 % v. FS: 39·5 %, P < 0·001) in unadjusted models. Models adjusted for parental education, ethnicity/race, sex and age found that food insecurity was associated with higher prevalence of unhealthy weight control behaviours (FI: 44·5 % v. FS: 37·8 %, P = 0·007), but not with weight status or other eating behaviours.

CONCLUSIONS

These results suggest that food insecurity may be an independent risk factor for unhealthy weight control behaviours, indicating a need to approach these intersecting issues in a comprehensive manner.

The case for body positivity on social media: Perspectives on current advances and future directions

In recent years, the body-positive movement has emerged on social media and has generated both support and criticism in pop-cultural discourse. We review the potential benefits and disadvantages of 'body positivity' on social media in light of theory and the available research. Based on the early evidence showing potential benefits of engaging with body-positive content on social media for positive body image, a case is made in support of this emerging content. Nevertheless, recommendations are made for future research with an emphasis on experimental and longitudinal investigations of actual health outcomes of engaging with body positivity on social media and clarification of the potential relationship between body positivity and objectification.

Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents

PURPOSE

To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents.

METHODS

The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression.

RESULTS

Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05).

CONCLUSIONS

Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.

Predictors of Complications in Anorexia Nervosa and Atypical Anorexia Nervosa: Degree of Underweight or Extent and Recency of Weight Loss?

PURPOSE

Adolescents with atypical anorexia nervosa (AAN) can experience severe physical complications despite not being underweight, posing questions about the contribution of weight loss to complications experienced in restrictive eating disorders (EDs). This study compared total weight loss and recent weight loss with admission weight as predictors of physical and psychological complications.

METHODS

Retrospective (2005-2010) and prospective (2011-2013) studies were undertaken of 12- to 19-year-old hospitalized adolescents with anorexia nervosa (AN) or AAN, defined as meeting criteria for AN except underweight (≥85% median body mass index). Predictors were total weight loss (from lifetime maximum), recent weight loss (past 3 months), and admission weight. Outcomes were hypophosphatemia, clinical, anthropometric, and psychometric markers during admission.

RESULTS

In 171 participants (AN, 118 [69%]; AAN, 53 [31%]), there was little evidence of an association between weight measures and hypophosphatemia. Greater total weight loss (regression coefficient [Coeff]: -1.70, 95% confidence interval [CI]: -2.77, -.63, p = .002) and greater recent weight loss (Coeff: -3.37, 95% CI: -5.77, -.97, p = .006), but not admission weight, were associated with a lower pulse rate nadir. Greater total weight loss (odds ratio [OR]: 1.70, 95% CI: 1.19, 2.24, p = .003) and greater recent weight loss (OR: 2.12, 95% CI: 1.11, 4.02, p = .02) were also associated with a higher incidence of bradycardia.

CONCLUSIONS

In adolescents with restrictive EDs, total weight loss and recent weight loss were better predictors than admission weight of many physical complications. This suggests that future diagnostic criteria for AN place greater emphasis on weight loss.

Eating, Activity, and Weight-related Problems From Adolescence to Adulthood

INTRODUCTION

Determining the population-based scope and stability of eating, activity, and weight-related problems is critical to inform interventions. This study examines: (1) the prevalence of eating, activity, and weight-related problems likely to influence health; and (2) the trajectories for having at least one of these problems during the transition from adolescence to adulthood.

METHODS

Project EAT I-IV (Eating and Activity in Teens and Young Adults) collected longitudinal survey data from 858 females and 597 males at four waves, approximately every 5 years, from 1998 to 2016, during the transition from adolescence to adulthood. Analyses were conducted in 2017-2018. Measures included high fast-food intake (≥3 times/week), low physical activity (<150 minutes/week), unhealthy weight control, body dissatisfaction, and obesity status.

RESULTS

Among females, the prevalence of having at least one eating, activity, or weight-related problems was 78.1% at Wave 1 (adolescence) and 82.3% at Wave 4 (adulthood); in males, the prevalence was 60.1% at Wave 1 and 69.2% at Wave 4. Of all outcomes assessed, unhealthy weight control behaviors had the highest prevalence in both genders. The stability of having at least one problem was high; 60.2% of females and 34.1% of males had at least one problematic outcome at all four waves.

CONCLUSIONS

The majority of young people have some type of eating, activity, or weight-related problem at all stages from adolescence to adulthood. Findings indicate a need for wide-reaching interventions that address a broad spectrum of eating, activity, and weight-related problems prior to and throughout this developmental period.

[Not Available]

People with a positive body image are more content with their body, reflect their society's beauty ideals more critically, have the ability to care for their body and are better protected from depression. Adolescence represents a particularly critical period relating to the development of the body image. The results of 1023 adolescents between the age of 13 and 16 years are unambiguous: In both analyzed language parts of the country, the positive body image correlates significantly positive with mental health and significantly negative with the influence by the media. For the future it is recommended to develop target-group-specific and gender-specific awareness and communication measures, particularly by including social media, as well as associated means to strengthen adolescents' mental health.

Identifying and Preventing Eating Disorders in Adolescent Patients with Obesity

Adolescents with obesity are not immune to developing disordered eating and eating disorders. They most commonly present with atypical or subthreshold criterion due to excess body weight or questions regarding the presence of a distorted body image. Patients with premorbid overweight/obesity and subsequent achievement of weight loss may lead to delays in the recognition and treatment of disordered eating and eating disorders. In fact, disordered eating and eating disorders tend to be higher in those undergoing weight management. This article describes risk factors for the development of eating disorders, common features of eating disorders in adolescents with obesity, and provides recommendations for prevention strategies. [Pediatr Ann. 2018;47(6):e232-e237.].

Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma

Very little attention has been given to unintended consequences of government reporting on obesity. This paper argues that the 2016 Senate report, "Obesity in Canada: A Whole-Of-Society Approach," exemplifies the systemic public health issue of weight stigma. The purpose of this viewpoint is to critique the approach taken in the Report, by illustrating that it (1) takes a weight-centric approach to health, (2) does not acknowledge important limitations of the definition and measurement of obesity, (3) reifies obesity as a categorical phenomenon that must be prevented, and (4) uses aggressive framing and disrespectful terminology. The Report perpetuates a focus on the individual, thereby failing to recognize the role that governments can play in reducing weight stigma and addressing social determinants of health. If steps are taken to avoid propagating weight stigma, future reports could more constructively address health promotion, equity, and social determinants of health in their policies.

Obesity Prevention Interventions in US Public Schools: Are Schools Using Programs That Promote Weight Stigma?

Introduction

Despite substantial research on school-based obesity prevention programs, it is unclear how widely they are disseminated. It is also unknown whether schools use obesity programs that inadvertently promote weight stigma or disordered weight-control behaviors.

Methods

In spring 2016, we distributed an online survey about school wellness programming to a simple random sample of US public school administrators (N = 247 respondents; 10.3% response rate). We analyzed survey responses and conducted immersion/crystallization analysis of written open-ended responses.

Results

Slightly less than half (n = 117, 47.4%) of schools offered any obesity prevention program. Only 17 (6.9%) reported using a predeveloped program, and 7 (2.8%) reported using a program with evidence for effectiveness. Thirty-seven schools (15.0%) reported developing intervention programs that focused primarily on individual students’ or staff members’ weight rather than nutrition or physical activity; 28 schools (11.3% of overall) used staff weight-loss competitions. School administrators who reported implementing a program were more likely to describe having a program champion and adequate buy-in from staff, families, and students. Lack of funding, training, and time were widely reported as barriers to implementation. Few administrators used educational (n = 12, 10.3%) or scientific (n = 6, 5.1%) literature for wellness program decision making.

Conclusion

Evidence-based obesity prevention programs appear to be rarely implemented in US schools. Schools may be implementing programs lacking evidence and programs that may unintentionally exacerbate student weight stigma by focusing on student weight rather than healthy habits. Public health practitioners and researchers should focus on improving support for schools to implement evidence-based programs.

Dietary patterns change over two years in early adolescent girls in Hawai'i

BACKGROUND AND OBJECTIVES

In investigating diet-disease relationships, examination of dietary patterns allows for conclusions to be drawn based on overall intake. This study characterized dietary patterns of early adolescent girls over a two-year period and examined the relationship between dietary patterns and body mass index (BMI).

METHODS AND STUDY DESIGN

Cross-sectional analyses were performed using longitudinal data from food records of early adolescent girls (n=148) 9 to 14 years in Hawai'i from the Female Adolescent Maturation (FAM) study. Dietary patterns were identified using principal component analysis (PCA). Pearson's correlations between BMI percentile and z-score and dietary pattern factor scores at Times 1 (2001-2002) and 2 (2002-2003) were calculated. For each dietary pattern, participants were divided into low, intermediate, and high scorers. Mean BMI percentiles and z-scores were compared between groups using analysis of covariance.

RESULTS

At Time 1, three patterns were identified, characterized by: (1) whole grains, nuts and seeds, added sugar; (2) non-whole grain, tomatoes, discretionary fat; and (3) deep yellow vegetables, other starchy vegetables, cooked dry beans/peas. At Time 2, three different dietary patterns emerged: (1) non-whole grains, meat, discretionary fat; (2) other vegetables, fish, eggs; and (3) whole grain, tomatoes, other vegetables. BMI percentile and z-score differed between high and low scorers on Time 1-Pattern 1 and Time 2-Pattern 3.

CONCLUSION

Results revealed changes in dietary patterns over time and an association between intake and BMI. Findings demonstrate the importance of frequent nutrition assessment to monitor changes in intake that may be improved to prevent obesity.

Stigma Experienced by Children and Adolescents With Obesity

The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.

Socioenvironmental, Personal, and Behavioral Correlates of Severe Obesity among an Ethnically/Racially Diverse Sample of US Adolescents

BACKGROUND

Severe obesity among adolescents, also known as class 2 and 3 obesity, is increasing in prevalence, yet, little is known about adolescents with severe obesity. The objective of this study was to identify the socioenvironmental, personal, and behavioral correlates of severe obesity among an ethnically/racially diverse sample of US adolescents.

METHODS

A cross-sectional analysis of data from participants in the EAT 2010 study (n = 2706) was conducted. Adolescents completed in-class surveys, and height and weight were measured. Severe obesity was defined as a BMI ≥120% of the 95th percentile or ≥35 kg/m²; class 1 obesity as a BMI ≥95th percentile but below severe obesity cut points, overweight as a BMI <95th percentile but ≥85th percentile, and normal weight as a BMI <85th but >5th percentile. General linear models were used to identify differences between adolescents by weight status, adjusted for covariates.

RESULTS

Nine percent of adolescents had severe obesity. Compared with peers of other weight statuses, a greater proportion of adolescents with severe obesity reported parental encouragement to diet and peer weight teasing. Adolescents with severe obesity also reported lower self-esteem and body satisfaction. Binge eating was three times as prevalent among adolescents with severe obesity compared with peers of normal weight and twice as prevalent as among peers with class 1 obesity.

CONCLUSIONS

Adolescents with severe obesity report several unique socioenvironmental, personal, and behavioral concerns that may diminish quality of life and may predict increased weight gain over time.

Addressing weight bias and discrimination: moving beyond raising awareness to creating change

Weight discrimination is the unjust treatment of individuals because of their weight. There have been very few interventions to address weight discrimination, due in part to the lack of consensus on key messages and strategies. The objective of the third Canadian Weight Bias Summit was to review current evidence and move towards consensus on key weight bias and obesity discrimination reduction messages and strategies. Using a modified brokered dialogue approach, participants, including researchers, health professionals, policy makers and people living with obesity, reviewed the evidence and moved towards consensus on key messages and strategies for future interventions. Participants agreed to these key messages: (1) Weight bias and obesity discrimination should not be tolerated in education, health care and public policy sectors; (2) obesity should be recognized and treated as a chronic disease in health care and policy sectors; and (3) in the education sector, weight and health need to be decoupled. Consensus on future strategies included (1) creating resources to support policy makers, (2) using personal narratives from people living with obesity to engage audiences and communicate anti-discrimination messages and (3) developing a better clinical definition for obesity. Messages and strategies should be implemented and evaluated using consistent theoretical frameworks and methodologies.

An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selective obesity and eating disorder prevention program

OBJECTIVE

Compare the Healthy Weight obesity and eating disorder prevention program, which promotes participant-driven gradual lifestyle changes to bring energy intake and expenditure into balance, to a new intervention, Project Health, which adds activities to create cognitive dissonance about unhealthy eating, a sedentary lifestyle, and excess body fat, and an obesity education video-control condition.

METHOD

College students at risk for both outcomes because of weight concerns (N=364, 72% female) were randomized to condition, completing pretest, posttest, and 6, 12 and 24-month follow-up assessments.

RESULTS

Project Health participants showed significantly smaller increases in measured body mass index (BMI) through 2-year follow-up than both Healthy Weight participants and controls (both d=-0.18), and significantly lower onset of overweight/obesity over 2-year follow-up than Healthy Weight participants and controls (13 vs 21% and 22%). Healthy Weight and Project Health participants showed significantly greater eating disorder symptom reductions than controls through 2-year follow-up. Healthy Weight and Project Health participants showed marginally lower eating disorder onset over follow-up than controls (3 and 3% vs 8% respectively).

CONCLUSIONS

The reduced increases in BMI and future overweight/obesity onset for Project Health relative to both an active matched intervention and a minimal intervention control condition are noteworthy, especially given the short 6-h intervention duration. The reduction in eating disorder symptoms for Healthy Weight and Project Health relative to controls was also encouraging. Results suggest that adding dissonance-induction activities increased weight loss effects. Yet, effects for both were generally small and the eating disorder onset prevention effects were only marginal, potentially because intervention groups included both sexes, which reduced eating disorder incidence and sensitivity.

Dyslipidemia management in overweight or obese adolescents: A mixed-methods clinical trial of motivational interviewing

Background:

Lifestyle management for dyslipidemic adolescents often occurs in the context of family-centered care, which necessitates adaptation of counseling strategies.

Objective:

To determine the effectiveness of motivational interviewing for lifestyle behavior change for dyslipidemic adolescents in a dyad with a parent versus alone.

Methods:

A total number of 32 adolescents were randomized 1:1 to receive a series of motivational interviewing sessions either together with a parent or alone for a 6-month intervention, with both quantitative and qualitative assessment of outcomes.

Results:

Both groups were similar at baseline. Following the intervention, there were no significant differences between groups in physical, laboratory, lifestyle or psychosocial measures, except for a reduction in dietary fats/sugars (p = 0.02) and in screen time (p = 0.02) in the alone group. When both groups were combined, significant reductions at 6 months were noted for body mass index (p < 0.001), waist circumference (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein cholesterol (p < 0.001), triglycerides (p = 0.01), non–high-density lipoprotein cholesterol (p < 0.001), fasting insulin (p = 0.01), and homeostatic model (p = 0.02). Reduced screen time and increased fruit and vegetable intake were also noted for both groups combined. These changes were also reflected in self-efficacy (p = 0.004), self-esteem (p = 0.03), and improvement in quality of life measures. Interview data provided insights into the utility and acceptability of the motivational interviewing intervention.

Conclusion:

Motivational interviewing was an efficient strategy for inspiring healthy lifestyle and physiological changes among adolescents in both groups. Family centered pediatric approaches should consider the autonomy and individual preferences of the adolescent prior to counseling.

Predictors of dieting and non-dieting approaches among adults living in Australia

BACKGROUND

There is a dearth of research comparing why dieting and non-dieting approaches are adopted. A greater understanding of reasons underlying dieting and non-dieting attempts will help to identify target beliefs for interventions to support and motivate adults to attempt whatever approach they are willing and/or able to pursue. We investigated the predictors of dieting and non-dieting approaches in Australian adults using predictors that were identified in a previous qualitative study.

METHODS

We conducted a prospective study, with two waves of data collection occurring 4 weeks apart. At baseline, participants completed a questionnaire assessing constructs drawn from the theory of planned behaviour (attitude, subjective norm, and self-efficacy), past behaviour, non-planning, attributions for dieting failure, weight control beliefs, and dieting and non-dieting intentions. We used path modelling to analyse responses.

RESULTS

At baseline, 719 adults (52.2% male) aged between 18 and 76 completed the questionnaire. Four weeks later, 64% of participants (n = 461) reported on their dieting and non-dieting behaviour in the past month. Past behaviour, attitude, subjective norm, and self-identity significantly predicted dieting intentions. Dieting intentions and past behaviour significantly predicted dieting behaviour, while non-planning and self-efficacy did not. The model explained 74.8% of the variance in intention and 52.9% of the variance in behaviour. While most findings were similar for the non-dieting model, subjective norms and self-identity did not predict intention, while self-efficacy and self-identity both predicted non-dieting behaviour directly. The non-dieting model explained 58.2% of the variance in intention and 37.5% of the variance in behaviour.

CONCLUSIONS

The findings from this study provide support for the application of TPB and identity theory constructs in the context of both dieting and non-dieting behaviour. Self-efficacy and self-identity appear more relevant to non-dieting behaviour than dieting behaviour, while subjective norms was more influential in predicting dieting. Practitioners wishing to encourage either approach in their clients should attempt to modify the constructs that influence each approach.

Development of guidelines for giving community presentations about eating disorders: a Delphi study

BACKGROUND

Concerns exist around how to talk about eating disorders (EDs) due to evidence that suggests discussing ED symptoms and behaviours may cause or worsen symptoms in vulnerable people. Using expert consensus, we developed a set of guidelines for giving safe community presentations about EDs.

METHODS

Participants with professional ED expertise, and people with lived experience of an ED, were recruited for a Delphi study. N = 26 panel members rated 367 statements for both a) inclusion in guidelines, and b) their potential to be helpful (increase knowledge, reduce stigma) or harmful (increase stigma, cause/worsen ED symptoms). After each round of the study, statements were classified as endorsed, re-rate, or not endorsed.

RESULTS

208 statements were endorsed by the panel over three rounds. 13 statements were strongly endorsed in the first round, with both people with lived experience and professionals agreeing it is important for presentations to include information on etiology of EDs and to promote help-seeking. Several statements had a high level of disagreement between those with lived experience and professionals, including the idea that presentations should suggest dieting is likely to result in weight gain.

DISCUSSION

The experts were able to develop consensus on a wide range of issues. Panel members, particularly people with lived experience, were sensitive to aspects of presentations that may be harmful to an audience. The guidelines fill an important gap in the literature and provide guidance to those educating the public about EDs; they should, however, be further evaluated to test their efficacy.

Preventing Obesity and Eating Disorders in Adolescents

Obesity and eating disorders (EDs) are both prevalent in adolescents. There are concerns that obesity prevention efforts may lead to the development of an ED. Most adolescents who develop an ED did not have obesity previously, but some teenagers, in an attempt to lose weight, may develop an ED. This clinical report addresses the interaction between obesity prevention and EDs in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs.

Correlates of Body Dissatisfaction in Children

OBJECTIVE

To assess body dissatisfaction among children between 9 and 14 years of age and to examine factors (age, sex, body mass index, perceived shape, and self-esteem) associated with wanting a thinner or a larger shape.

STUDY DESIGN

Through at-school questionnaires, 1515 preadolescent children (51.2% girls) were asked to fill out the Culture Free Self-Esteem Inventory and the Contour Drawing Rating Scale (body dissatisfaction). Trained assessors then weighed and measured the students individually.

RESULTS

Overall, 50.5% of girls wanted a thinner shape compared with 35.9% of boys. More boys wanted a larger shape compared with girls (21.1% vs 7.2%). Most of the preadolescents who were overweight or obese were unsatisfied whereas 58.0% of girls and 41.6% of boys who were underweight were satisfied with their body. Results of a multinomial logistic regression revealed that age, sex, body mass index, perceived shape, and self-esteem were significant correlates of the 4 body dissatisfaction contrasts (wanting a slightly thinner, much thinner, slightly larger, and much larger shape) and explained 50% of the variance. An interaction between sex and perceived shape was found, revealing that girls who perceived themselves as having a larger shape were more likely to desire a thinner shape than boys.

CONCLUSIONS

The high prevalence rate of body dissatisfaction among children suggests that current approaches in our society to prevent problems related to body image must be improved. The different results between girls and boys highlight the need to take into account sex differences when designing prevention programs that aim to decrease body dissatisfaction.

The association of eating styles with weight change after an intensive combined lifestyle intervention for children and adolescents with severe obesity

The main purpose of this prospective intervention study was to determine whether eating styles after an intensive, partly inpatient, one year combined lifestyle intervention are associated with weight change in the following year in severely obese children and adolescents. A total of 120 participants (8-19 years) with an average SDS-BMI of 3.41 (SD = 0.38) was included. Measurements were conducted at baseline (T0), at the end of treatment (T12) and at the end of follow up two years after baseline (T24). The primary outcome measurement was the ΔSDS-BMI between T12 and T24. As primary determinant of weight change after treatment, the participants eating styles were evaluated with the Dutch Eating Behavior Questionnaire - child report that measures external, emotional and restraint eating. The association between outcome and determinant was assessed in linear regression analyses. Complete data were available for 76 of the 120 participants. This study shows that for girls a higher score on restraint eating at T12 and a higher score on external eating at T12 were associated with more weight (re)gain in the year after treatment. No statistically significant association with emotional eating at T12 was found. In addition for girls a higher score on external eating at T0 was associated with more weight (re)gain in the year after treatment. Furthermore, the observed changes in eating styles suggest that on average it is possible to influence these with treatment, although the detected changes were different for girls and boys and for the different eating styles. More generally, this study indicates that for girls the levels of restraint and external eating after treatment were associated with the weight change during the following year.

TRIAL REGISTRATION

Netherlands Trial Register (NTR1678, registered 20-Feb-2009).

Pharmacological approaches to the management of binge eating disorder

In the USA, binge eating disorder (BED) is the most common eating disorder, with a lifetime prevalence of ~3.5 % in adult women, 2.0 % in adult men, and 1.6 % in adolescents. BED is characterized by frequent episodes of binge eating that are accompanied by a sense of loss of control over eating and result in marked psychological distress. BED is highly co-morbid with obesity and with depression and other psychiatric conditions, and it is associated with substantial role impairment. Currently, there are no US FDA-approved pharmacological treatments for BED. Animal and human studies implicate underlying dysregulation in dopamine, opioid, acetylcholine, and serotonin neurocircuitry within brain reward regions in the pathogenesis and maintenance of BED. To date, the efficacy of various agents that target these and other neurotransmitter systems involved in motivated feeding behavior, mood regulation, and impulse control have been investigated in the treatment of BED. Several antidepressant and anticonvulsant agents have demonstrated efficacy in reducing binge eating frequency, but only in limited cases have these effects resulted in patients achieving abstinence, which is the primary goal of treatment; they also range from less (fluvoxamine) to more (topiramate) effective in achieving weight loss that is both clinically meaningful and significantly greater than placebo. Collectively, the literature on pharmacological treatment approaches to BED is limited in that very few agents have been studied in multiple, confirmatory trials with adequate follow up, and almost none have been evaluated in large patient samples that are diverse with respect to age, sex, and ethnicity. In addition, prior trials have not adequately addressed, through study design, the high placebo response commonly observed in this patient population. Several novel agents are in various phases of testing, and recent animal studies focusing on glutamate-signaling circuits linking the amygdala to the lateral hypothalamus offer new avenues for exploration and potential therapeutic development. Studies of newly FDA-approved medications for long-term obesity treatment and further explorations of dietary supplements and neutraceuticals with appetite- and mood-altering properties may also be worthwhile.

Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk?

Despite the poor prognosis of dieting in obesity management, which often results in repeated attempts at weight loss and hence weight cycling, the prevalence of dieting has increased continuously in the past decades in parallel to the steadily increasing prevalence of obesity. However, dieting and weight cycling are not limited to those who are obese or overweight as substantial proportions of the various population groups with normal body weight also attempt to lose weight. These include young and older adults as well as children and adolescents who perceive themselves as too fat (due to media, parental and social pressures), athletes in weight-sensitive competitive sports (i.e. mandatory weight categories, gravitational and aesthetic sports) or among performers for whom a slim image is professionally an advantage. Of particular concern is the emergence of evidence that some of the potentially negative health consequences of repeated dieting and weight cycling are more readily seen in people of normal body weight rather than in those who are overweight or obese. In particular, several metabolic and cardiovascular risk factors associated with weight cycling in normal-weight individuals have been identified from cross-sectional and prospective studies as well as from studies of experimentally induced weight cycling. In addition, findings from studies of experimental weight cycling have reinforced the notion that fluctuations of cardiovascular risk variables (such as blood pressure, heart rate, sympathetic activity, blood glucose, lipids and insulin) with probable repeated overshoots above normal values during periods of weight regain put an additional stress on the cardiovascular system. As the prevalence of diet-induced weight cycling is increasing due to the opposing forces of an 'obesigenic' environment and the media pressure for a slim figure (that even targets children), dieting and weight cycling is likely to become an increasingly serious public health issue.

Family meals and disordered eating in adolescents: are the benefits the same for everyone?

OBJECTIVE

To examine the association between family meals and disordered eating behaviors within a diverse sample of adolescents and further investigate whether family-level variables moderate this association.

METHOD

Data from adolescents (EAT 2010: Eating and Activity in Teens) and their parents (Project F-EAT: Families and Eating and Activity among Teens) were collected in 2009-2010. Surveys were completed by 2,382 middle and high school students (53.2% girls, mean age = 14.4 years) from Minneapolis/St. Paul, MN, public schools. Parents/guardians (n = 2,792) completed surveys by mail or phone.

RESULTS

Greater frequency of family meals was associated with decreased odds of engaging in unhealthy weight control behaviors in boys, and dieting, unhealthy and extreme weight control behaviors in girls. Results indicate that the protective effects of family meals are, in general, robust to family-level variables; 64 interactions were examined and only seven were statistically significant. For example, among girls, the protective nature of family meals against dieting and unhealthy weight control behaviors was diminished if they also reported family weight-related teasing (both p < .01).

DISCUSSION

The results confirmed previous research indicating that participation in family meals is protective against disordered eating for youth, particularly girls. However, results suggest that in some cases, the protection offered by family meals may be modified by family-level variables.

Racial and ethnic differences in the home food environment explain disparities in dietary practices of middle school children in Texas

OBJECTIVE

To examine racial and ethnic differences among middle school children in the home food environment (HFE) and the extent to which associations of healthy and unhealthy eating with the HFE differ by race and ethnicity.

DESIGN

Cross-sectional secondary analyses of baseline data from Coordinated Approach to Child Health Middle School, a school-based intervention targeting obesity and obesogenic behaviors among middle school children in Austin, TX.

PARTICIPANTS

A total of 2,502 children (mean age, 13.9 years; 58% Hispanic, 28% white, and 14% black).

VARIABLES MEASURED

Availability and accessibility of healthy foods, and parental support of healthy eating, and family meals. Consumption of both healthy and unhealthy foods was examined.

ANALYSIS

Differences across racial and ethnic groups in aspects of HFE were estimated using linear regression. Models also examined racial and ethnic differences in consumption of healthy and unhealthy foods. If adjusting for HFE, such differences were accounted for.

RESULTS

White children had significantly better HFEs than Hispanic and black children with greater availability and accessibility of healthy foods (P < .001). Adjusting for a healthy HFE reduced disparities in consumption of healthy foods but not in consumption of unhealthy foods.

CONCLUSIONS AND IMPLICATIONS

Improved HFE may increase healthy eating among ethnic minorities but is unlikely to reduce unhealthy eating.

Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders

PURPOSE

Although the relationship between increased body weight and eating disorders such as bulimia nervosa and binge eating disorder is well established, the relationship between overweight or obesity and eating disorders characterized by dietary restriction and/or weight loss such as anorexia nervosa (AN) is less well known.

METHODS

To understand the prevalence of a history of overweight or obesity among treatment-seeking adolescents with restrictive eating disorders, a retrospective cohort study was conducted on all new patients aged 9-22 years diagnosed with either anorexia nervosa or eating disorder not otherwise specified characterized by weight loss and/or dietary restriction, seen in a specialty eating disorder clinic from January 2007 to July 2013.

RESULTS

Of 179 adolescents, 36.7% were found to have a body mass index (BMI) history above the 85th percentile. Patients with a BMI history above the 85th percentile had a larger BMI decrease at presentation (p < .0001) and a longer duration of illness before presentation (p < .0001). There were no differences in the number of physical symptoms or eating disorder severity.

CONCLUSIONS

Findings suggest that adolescents with a history of overweight or obesity represent a substantial portion of treatment-seeking adolescents with restrictive eating disorders, underscoring that extreme weight loss in adolescents is not healthy, regardless of whether the end weight is theoretically within a healthy range. Because eating disorders in adolescents who have history of overweight take longer to be identified, they consequently may have a poorer prognosis.

Meet OLAF, a good friend of the IAPS! The Open Library of Affective Foods: a tool to investigate the emotional impact of food in adolescents

In the last decades, food pictures have been repeatedly employed to investigate the emotional impact of food on healthy participants as well as individuals who suffer from eating disorders and obesity. However, despite their widespread use, food pictures are typically selected according to each researcher's personal criteria, which make it difficult to reliably select food images and to compare results across different studies and laboratories. Therefore, to study affective reactions to food, it becomes pivotal to identify the emotional impact of specific food images based on wider samples of individuals. In the present paper we introduce the Open Library of Affective Foods (OLAF), which is a set of original food pictures created to reliably select food pictures based on the emotions they prompt, as indicated by affective ratings of valence, arousal, and dominance and by an additional food craving scale. OLAF images were designed to allow simultaneous use with affective images from the International Affective Picture System (IAPS), which is a well-known instrument to investigate emotional reactions in the laboratory. The ultimate goal of the OLAF is to contribute to understanding how food is emotionally processed in healthy individuals and in patients who suffer from eating and weight-related disorders. The present normative data, which was based on a large sample of an adolescent population, indicate that when viewing affective non-food IAPS images, valence, arousal, and dominance ratings were in line with expected patterns based on previous emotion research. Moreover, when viewing food pictures, affective and food craving ratings were consistent with research on food cue processing. As a whole, the data supported the methodological and theoretical reliability of the OLAF ratings, therefore providing researchers with a standardized tool to reliably investigate the emotional and motivational significance of food. The OLAF database is publicly available at zenodo.org.