Exploring associations between positive and negative valanced parental comments about adolescents' bodies and eating and eating problems: a community study

Feasibility and acceptability of a pilot randomized trial of a single session of imagery rescripting targeting the primary consequences of negative experiences with eating and appearance

BACKGROUND

Negative experiences related to eating and appearance (NEREAs), such as critical commentary from parents about food, are common and associated with depression and disordered eating. Imagery rescripting (IR) is a therapeutic process during which individuals are guided through recalling and bringing support into distressing memories, like NEREAs. Single sessions of IR demonstrate promise in shifting the primary negative consequences of NEREAs in clinical samples of women. The primary objectives of this pilot trial were to evaluate the feasibility and acceptability of a remote-delivered, single session of IR and a nutrition education control group in a community sample of adults with NEREAs.

METHODS

In this parallel two-arm pilot trial, participants completed an in-person baseline visit, one remote-delivered, single-session intervention (IR or attention-matched nutrition education control), and in-person 1- and 3-month follow-up visits between February 2023 and April 2024 in Oregon, USA. Markers of feasibility included recruitment, visit and survey completion rates, and intervention fidelity; acceptability was evaluated using participant feedback and instances of adverse events.

RESULTS

One hundred one adults completed a phone screen; 96% reported at least one NEREA. Most of these adults were ineligible because they met psychiatric disorder criteria and/or were taking medication known to influence mood and/or appetite. Thirty-two participants completed a baseline study visit; 89% of these participants (N = 27; mean age [SD] = 32.52 [15.78], range = 18-73; 56% cisgender women; 74.1% non-Hispanic White, 14.8% Asian, 11.1% Hispanic/Latine, 7.4% Black, and 3.7% multiracial) were randomly assigned (using a random number generator) to and completed an intervention condition (13 IR, 14 control). Curriculum adherence, on average, was 94% for IR and 97% for control. One-month retention was 82%, and 3-month retention was 59%. Post-intervention ratings indicated good acceptability for both arms. No adverse events occurred.

CONCLUSIONS

The delivered interventions are feasible and acceptable to a community sample of men and women; as such, a future definitive trial is recommended. Additional strategies for increasing retention are needed. Single-session interventions, like IR, have the potential for high impact and reach. They are inherently flexible and cost-effective interventions that can be delivered across systems of care, while remote delivery mitigates concerns with stigma and access.

TRIAL REGISTRATION

ClinicalTrial.gov, NCT06610318 . Registered on 23 September 2024-retrospectively registered.

Celiac Disease, Gluten-Free Diet, and Eating Disorders: From Bench to Bedside

Celiac disease (CD) and eating disorders (EDs) are complex chronic conditions in adolescents, sharing symptoms such as weight change, malnutrition, and gastrointestinal symptoms. CD, an autoimmune disorder triggered by gluten ingestion, is managed through a strict gluten-free diet that can unintentionally foster disordered eating behaviors due to dietary restrictions. Conversely, EDs may mask and complicate CD symptoms, leading to diagnostic delays and treatment challenges. Evidence reveals an increased risk of EDs in CD individuals and vice versa, indicating a potential bidirectional relationship. This review explores the mechanisms and clinical implications of this interplay and proposes integrated screening and care strategies to improve the quality of life for individuals with both conditions.

"Be more positive and more kind to your own bodies": Adolescent and young adult preferences for how parents can support their children with weight-related pressures

Body dissatisfaction is a key factor contributing to the development of disordered eating, and body dissatisfaction is often influenced by media, peer, and parental pressures during adolescence. Little research has explored ways in which parents can help their children manage pressures from social media and their peers. The present study used the MyVoice National Poll of Youth, a large text-message cohort of young people (14-24 years old) in the United States, to collect and examine qualitative data about their experiences with parental weight-related communication and how they think parents can best support their children regarding messages they see/hear surrounding weight, body shape and size by their peers and media sources. 801 participants responsed to at least one question. Results from the present study suggest that young people want their parents to model healthy relationships with food and their body, teach body neutrality/acceptance, and normalize all body types. Findings suggest that there are many proactive, practical approaches parents can adopt to help support their children and offset weight-related pressures from other sources.

A systematic review of weight stigma and disordered eating cognitions and behaviors

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.

Health Consequences of Familial Negative Weight Talk Across the Spectrum of Gender Diversity

PURPOSE OF REVIEW

To synthesize differences in familial negative weight talk and health-related correlates across gender identities and to highlight gaps relevant to the unique experiences and health correlates of boys and transgender and gender diverse youth.

RECENT FINDINGS

Most of the studies included in this review observed no difference by gender in familial negative weight talk health correlates. Gender biases in existing measures, however, may have contributed to underreporting of health correlates in boys. Moreover, transgender and gender diverse youth are severely underrepresented in this research. Future research should consistently examine effect modification across gender identities and include measures that are specific to the weight-based concerns and experiences of boys and transgender and gender diverse youth.

An exploration of how adolescents experience and reason their parents' comments on their weight, shape, and eating

INTRODUCTION

Disordered eating among adolescents is of increasing concern given associated physical and mental health sequelae. Cognitions underlying disordered eating are formed in childhood and adolescence. Parents are a significant presence during this period, so it is critical to understand how they influence their adolescent's eating cognitions and behaviors.

METHODS

Qualitative analysis using interpretative phenomenological analysis (IPA) methodology was employed to consider the lived experiences of 10 Australian adolescents (14-19 years), 60% female, as they engaged with their parents in a range of weight, shape, and eating communications.

RESULTS

Our inductive IPA revealed three key themes representing adolescents' experiences and meaning-making: Parents as Influencers-adolescents acknowledged parents are influencers (objects) within a wider context of community and cultural norms (symbols) and can be protective for peer influence on body image ideals; Expression and Perception-the "what" (weight-talk as an object) and the "how" (objects as independent influences) of gendered parental communication related to health and fitness ideals and illustrated diverse interpretations of both verbal and non-verbal expression; and Fertile Soil and Maturity-the adolescent's characteristics and context influence perceptions of communication, a fear of deviating from norms, and an overarching focus on being "healthy" yet not always knowing what that was. Perception of bidirectional communication also offered valuable insights into potential dangers through family loyalty and in-group permissions.

CONCLUSIONS

Findings highlight implications for the nuanced influence of parental communication and illustrate the pivotal role of parents within the bioecosystem of adolescent development.

Parental Pressure on Child Body Image, BMI, Body Image Dissatisfaction Associated with Eating Disorders in School-Age Children in China: A Path Analysis

Background

Children's eating behaviors, body shape and body image cognition may be more susceptible to the influence of their parents, but these influences may be weakened with age. There may be different association pathways between parental pressure on children's body image (PPCBI), body mass index (BMI), body image dissatisfaction (BID) and eating disorders (EDs) among children and adolescents at different developmental stages.

Methods

The stratified cluster sampling method (Stratified by grade, and took the classes as clusters) was used to select 486 students aged 8-15 years in two 9-year schools. Children's body height, weight, testicular volume and breast development were measured. PPCBI, BID, and EDs were investigated using the Appearance-related Social Stress Questionnaire, Body Size Questionnaire (BID-14), and EDI-1 scale, respectively.

Results

The boys before puberty initiation had significantly higher EDs score (182.3±50.8) than girls before puberty initiation (164.1±58.1) (P<0.05). There were significant association pathways of PPCBI→BMI→BID→EDs and PPCBI→BID→EDs in boys before puberty initiation (β=0.035, P<0.01; β=0.059, P<0.01), in boys after puberty initiation (β=0.032, P<0.01; β=0.175, P<0.001), and in girls after puberty initiation (β=0.026, P<0.01; β=0.172, P<0.001). There was a positive association pathway of PPCBI→EDs in boys before puberty initiation (β=0.30, P<0.001) and PPCBI→BID→EDs in girls before puberty initiation (β=0.176, P<0.01).

Conclusion

Parental pressure on children's body image may positively associate with children's eating disorders through BMI and body image dissatisfaction in boys and girls after puberty initiation and directly associate with eating disorders in boys before puberty initiation; however, it may indirectly associate with eating disorders only through BID in girls before puberty initiation.

Associations between Parents' Body Weight/Shape Comments and Disordered Eating Amongst Adolescents over Time-A Longitudinal Study

Parents are key influencers of adolescents' attitudes on weight, shape, and eating, and make more positive than negative comments, with negative comments most impactful. This study examined prospective unique associations of parental positive and negative comments in a community sample of adolescents with paediatric psychosocial quality of life (PED-QoL), Eating Disorder Weight/Shape Cognitions (EDEQ-WS), BMI percentile, and Psychological Distress (K10) scales. Data were from 2056 adolescents from the EveryBODY study cohort. Multiple regressions were conducted for the impacts of parental positive and negative comments on four dependent variables at one year after controlling for their stage of adolescence (early, middle, late). Multiple imputation and bootstrapping were used for handling missing data and violations of normality. Results indicated that positive maternal comments on eating were associated with increased EDCs and better quality of life at one year. Paternal positive weight shape comments were associated with a decrease in psychological distress, but positive eating comments saw a decrease in quality of life. Findings highlight the nuances of parental comments and how these are perceived and interpreted, and could alert health care workers and family practitioners who have weight, shape, and eating conversations to be aware of the potential influence of their communication.

Prevention of eating disorders: 2022 in review

This review of 17 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion ➔ types of prevention ➔ case identification/referral ➔ treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews ➔ clarifying risk and protective factors ➔ program innovation and feasibility studies ➔ efficacy and effectiveness research ➔ program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Five articles fell into the category of prevention rationale, theory, and critical analyses, while seven articles addressed risk factors (RFs) for various aspects of DE. Eating Disorders also published two pilot studies, two prevention efficacy trials, and one effectiveness study in 2022. One implication of the 17 articles reviewed is that RF research toward construction of selective and indicated prevention programs for diverse at-risk groups should address a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses, protective factor research, and case studies of multi-step activism at the local, state (province, region), and national levels.

Food-related aversion in a female sample of people with anorexia nervosa: Cognitive-behavioural correlates, somatic and subjective anxiety, and early experiences

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.

"I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar

Introduction

Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region.

Methods

We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University.

Results

Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood.

Conclusion

WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.

Factors Affecting Body Image Distortion in Adolescents

Body image distortion is an important problem in physical and psychological health in adolescents. This study examined the factors affecting body image distortion in Korean adolescents. A Rao−Scott χ2 test and a complex samples logistic regression was conducted using the statistics from the 17th (2021) Korea Youth Risk Behavior Web-based Survey. The study sample included 41,124 middle and high school students. There was a difference in the presence or absence of body image distortion according to the subject’s gender, school grade, school achievement, and economic status (p < 0.001). Approximately 49.5% of subjects with body image distortion had tried to lose weight, but there were few cases where they attempted to lose weight through physical activities, such as moderate physical activity (22.8%), vigorous physical activity (23.3%), and muscle physical activity (23.9%) (p < 0.001). The group with body image distortion was 1.77 times more likely to sit for more than four hours a day on average (p < 0.001). To prevent various factors influencing the distortion of the adolescent’s body image, the development of a systematic intervention program for forming no distortion of adolescents’ body image is required.