Preventing Obesity and Eating Disorders in Adolescents

Measures of nutrition status and health for weight-inclusive patient care: A narrative review

In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

Serum vitamin D and obesity among US adolescents, NHANES 2011-2018

Background and objectives

Childhood obesity is highly prevalent worldwide. We aimed to assess whether serum 25-hydroxyvitamin D was associated with general/central obesity among US adolescents, and further to explore the mediatory impact of homeostasis model assessment of insulin resistance (HOMA-IR) on this association.

Methods

This study is cross-sectional in design. Study adolescents were enrolled from the National Health and Nutrition Examination Survey (NHANES), 2011-2018. Serum 25-hydroxyvitamin D categories associated with general (indexed by body mass index) and central (indexed by waist circumference to height ratio) obesity were regressed. The possible mediatory effect of HOMA-IR on this association was explored. The nonlinear and dose-response association was examined by restricted cubic spline (RCS) test.

Results

Total 2,696 adolescents were eligible for inclusion, and the mean age of all adolescents was 15.4 years. Overall, the percentage of general and central obesity was 38.0% and 38.6%, respectively. Compared with adolescents with sufficient vitamin D, adolescent with deficient and insufficient vitamin D intake were associated with general obesity and central obesity; fully-adjusted OR for general obesity was 1.602 (95% CI: 1.161-2.211) and 1.659 (1.385-1.986), and fully-adjusted OR for central obesity was 2.025 (1.445-2.837) and 1.557 (1.287-1.884), respectively, while there was no observable significance in adolescents with possibly harmful vitamin D. The proportion mediated by HOMA-IR was estimated to be 31.7% for global obesity and 50.3% for central obesity (both P < 0.05). More stratified analyses were presented, and identified that the association with general obesity was particularly present among Mexican American, while with central obesity among Non-Hispanic Black adolescents.

Conclusions

Our findings indicate that deficient or insufficient 25-hydroxyvitamin D concentrations were associated with the significant risk of general and central obesity among US adolescents, and approximately 30% and 50%, respectively, of these associations were mediated by HOMA-IR.

Disparities in Medical Assessment Practices for Adolescents at Risk for Eating Disorders

PURPOSE

The United States Preventative Services Task Force found insufficient evidence to support universal screening for eating disorders (EDs) but did recommend assessing high-risk adolescents through laboratory tests, close follow-up, and referrals to other specialties. Yet, it is unclear whether youth at high risk for EDs receive such assessment and whether patient characteristics influence such practices.

METHODS

Using the Rochester Epidemiological Project, we identified adolescents (13-18 years) at risk for EDs (i.e., weight loss, underweight, or loss of appetite not explained by a medical condition) who presented for a medical appointment between January 1, 2005 to December 31, 2017 (n = 662; M age = 15.8 years; 66% female; 76% white). Patient and visit characteristics, assessment practices (i.e., tests, referrals, and follow-up), and ED diagnoses within 5 years following index visit were extracted.

RESULTS

Adolescents who received referrals to other providers were 4 times more likely to be diagnosed with a future ED (p < .001) and were diagnosed 137.8 days sooner (Est = -137.8, p = .04) compared to those who did not receive referrals. Compared to males, females were 2.2 times more likely to receive referrals (p < .001). Compared to those presenting at a lower body mass index, adolescents with a higher body mass index were more likely to receive medical tests (HR = 1.0, p < .01) and less likely to receive recommendations to improve eating/weight (HR = 0.99, p < .01) or follow up visits (HR = 0.99, p < .01).

DISCUSSION

Disparities in assessment practices for adolescents at high-risk for EDs underscore the need for improved tools to enhance early detection and treatment.

Cautioning the Role of Occupational Therapy in Addressing Obesity

The recent article by Muntefering et al. (2023) promotes occupational therapy as a tool for the primary prevention of obesity. In this letter, the authors argue that the article is not only misguided but also potentially harmful.

Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity-Is the Elephant in the Room Still the Biggest Challenge?

In this response to the Schwartz & Proffitt (2024) letter to the editor, Muntefering et al. (2023) agree that the profession has a duty to support the occupational participation of diverse individuals, including diverse body types, but also affirm that health management is an area of occupation within the practice framework.

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.

A Canadian longitudinal study of the associations between weight control status and lifestyle behaviors during adolescence

This study aimed to estimate associations between weight control status (trying to lose, gain or maintain weight) and lifestyle behaviors (moderate-to-vigorous physical activity (MVPA), screen time, and the consumption of breakfast, fast food, fruits and vegetables, and sugar-sweetened beverages (SSB)) in adolescents. Data from 919 adolescents in the MATCH study, in New Brunswick, Canada, who self-reported their weight control status at least once within 24 data collection cycles over 8 years (from 2011 to 2019) and from 812 who provided data at least once over the 7 cycles on eating behaviors were used. Generalized estimating equations were used. At the first cycle, mean age was 11.3 (SD = 1.2) years old and 56% were girls. Trying to gain (β = 0.47, CI = [0.15, 0.79]) and maintain weight (β = 0.35, CI = [0.12, 0.57]) were positively associated with MVPA. Trying to lose weight was negatively associated with breakfast (IRR = 0.90, CI = [0.85, 0.94]) and positively associated with screen time (β = 0.62, CI = [0.15, 1.10]), fruit and vegetable (IRR = 1.12, CI = [1.01, 1.25]) and SSB (IRR = 1.42, CI = [1.10, 1.84]). Changes from one weight control status to trying to lose weight were associated with increases in fast food consumption (β = 0.49, CI = [0.15, 0.84]). Weight control status was associated with healthy and unhealthy behaviors in adolescents. Trying to gain or maintain weight was generally associated with more favorable health-related behaviors. Education on healthy weight management behaviors is needed to improve adolescents' health.

Prevalence and risk factors of disordered eating behavior in youth with hypertension disorders

BACKGROUND

Adolescents with certain health conditions requiring lifestyle management, such as diabetes mellitus, have higher disordered eating behavior (DEB) risk than the general adolescent population, but DEB is underdiagnosed and can lead to adverse health consequences. In youth with other conditions requiring lifestyle counseling such as hypertension (HTN), DEB prevalence and associated risk factors are unknown. We hypothesized that youth with HTN disorders would have higher DEB prevalence than the general adolescent population, and that obesity, chronic kidney disease (CKD), and less specialized lifestyle counseling would be associated with higher DEB risk.

METHODS

Prospective cross-sectional study of youth aged 11-18 years with HTN disorders. We excluded patients with diabetes mellitus, kidney failure or transplantation, or gastrostomy tube dependence. We collected data via surveys and electronic health record abstraction. We administered the validated SCOFF DEB screening questionnaire. We compared DEB prevalence using a one-sample z-test of proportions (p0 = 0.1) and estimated DEB risk by obesity, CKD, and lifestyle counseling source using multivariable generalized linear models.

RESULTS

Of 74 participants, 59% identified as male, 22% as Black or African American, and 36% as Hispanic or Latino; 58% had obesity and 26% had CKD. DEB prevalence was 28% (95% CI 18-39%, p < 0.001). CKD was associated with higher DEB prevalence (adjusted RR 2.17, 95% CL 1.09 to 4.32), but obesity and lifestyle counseling source were not.

CONCLUSIONS

DEB prevalence is higher in youth with HTN disorders and comparable to other conditions requiring lifestyle counseling. Youth with HTN disorders may benefit from DEB screening. A higher resolution version of the Graphical abstract is available as Supplementary information.

Eating disorders among bariatric surgery patients: The chicken or the egg?

ABSTRACT

Postoperative eating behaviors and unhealthy weight control measures are leading causes of bariatric surgery complications. Candidates for bariatric surgery and individuals with eating disorders may share common risk factors, such as a history of dieting, and/or being bullied or teased for their weight. Binge-eating disorder, night eating syndrome, and bulimia nervosa are the most common eating disorders among candidates for bariatric surgery before the operation. Malnutrition, stress, and intense fear of weight gain can lead to the development of an eating disorder after surgery as well. Plugging, grazing, loss of control eating, dumping, and food avoidance are specific disordered behaviors that may present after bariatric surgery. To improve physical and psychological outcomes for individuals under their care, clinicians can screen for these disordered behaviors and distinguish them from a healthy diet and the expected postsurgical course.

The epidemiology and clinical features of pediatric acute pancreatitis in north of Guizhou, China

Background

The epidemiological data on distribution of pediatric acute pancreatitis was deficiency. And the purpose of this research was to investigate the epidemiology and clinical features of pediatric acute pancreatitis in the population in north of Guizhou, China.

Design and methods

A retrospective case analysis was conducted to accomplish the aim. Patients who were under 18 years old with acute pancreatitis were recruited. Data were collected directly from Hospital Information System (HIS) after patients were discharged from the hospital.

Results

A total of 95 children aged from 3 to 17 years were collected, 49 patients were boys and 46 were girls. In addition, the percentage of acute pancreatitis occurring in girls aged 15-17 years was significantly higher than that of boys (54.3% vs 36.7%). Meanwhile, the percentage of severe patients over 12 years exceeded 90.0%. Moreover, the proportion of severe acute pancreatitis in girls was significantly higher than that in boys (26.1% vs 10.2%), and 64.7% of severe patients were from 12 to 14. What's more, more patients occurred in May, June, and December and on weekends, 47.1% (8/17) severe cases occurred in May, June, and July, and 47.1% (8/17) severe patients occurred on weekend. The length of hospitalization and hospitalization costs of severe patients were found higher compared to mild patients.

Conclusions

Higher risk of pediatric acute pancreatitis, especially severe acute pancreatitis, in north of Guizhou, China occurred on weekend, during May and June, and among children aged 12-17 years, especially girls. Additionally, severe acute pancreatitis was associated with higher hospitalization costs and longer hospitalization length.

Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.

Factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil: a hierarchical approach

The objective of this article is to identify the prevalence and evaluate the factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil. Cross-sectional study with 2,439 adolescents from Sample 2 (2015) of the National School-based Health Survey. Extreme weight loss behaviors, such as self-induced vomiting, laxative use and use of medicines or formulas (outcome) and independent variables were evaluated using a self-administered electronic questionnaire. The statistical analysis was performed following a hierarchical conceptual model. The prevalence of extreme weight loss behaviors in the sample was 12.1%. Among the factors that showed significant association with the outcome, we emphasize the administration model of the private school (PR = 0.62; CI = 0.46-0.84), bullying related to body appearance and for other reasons (PR = 1.62; CI = 1.19-2.20), forced sexual intercourse (PR = 2.65; CI = 1.90-3.69), insomnia (PR = 1.84; CI = 1.43-2.37), and be perceived as fat or very fat (PR = 1.90; CI = 1.50-2.42). Moderate prevalence of extreme weight loss behaviors was identified among adolescents. Socioeconomic factors, exposure to violence, mental health, and body image were associated with the adoption of these behaviors.

Children's eating attitudes test (ChEAT): validation and reliability in Turkish children

OBJECTIVES

This study aims to examine the validity and reliability of the children's eating attitudes test (ChEAT) in Turkish children.

METHODS

The participants were 331 children (137 boys and 194 girls, ages 8-15). Data was collected through face-to-face interviews using a questionnaire containing socio-demographic characteristics, the ChEAT, and the children's eating behaviour questionnaire (CEBQ). Exploratory factor analysis (EFA) was performed to determine the factor structure of the Turkish version of the ChEAT. Additionally, the reliability was examined in terms of internal consistency and test-retest reliability. All statistical analyses were performed using Mplus Trial Version and SPSS 11.5 (SPSS, Chicago, IL, USA).

RESULTS

According to the goodness-of-fit statistic, a three-factor solution was appropriate and compatible with clinical considerations. The three factors explained 50.1% of the variance. Cronbach's alpha coefficient was 0.75 for ChEAT-26, 0.67 for "Preoccupation with thinness and food", 0.63 for "Social pressure to eat", and 0.71 for "Dieting". Furthermore, the test-retest reliability was 0.72, 0.62, 0.59, and 0.59 respectively. Statistically significant correlations between the ChEAT and CEBQ were found (p < 0.05). "Preoccupation with thinness and food" was significantly higher in obese children (p < 0.05), while "Social pressure to eat" was lower (p < 0.001). Sex, grade, BMI, parental education in addition to working status affected the ChEAT-26 scores.

CONCLUSIONS

The present study has provided preliminary evidence for the validity and reliability of a Turkish version of the ChEAT.

Family Meals and Cardiometabolic Risk Factors in Young Children

PURPOSE OF THE REVIEW

Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary patterns, and weight status in youth.

REVIEW FINDINGS

According to the American Heart Association's Life's Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality. Family meals may be an effective strategy for improved dietary patterns and weight status in youth.

Prevalence and Associated Factors of Eating Disorders Among Female Students at Jazan University, Kingdom of Saudi Arabia: A Survey Study

BACKGROUND AND OBJECTIVE

Concerns about the incidence of eating disorders (EDs) among university students are spreading throughout the world. In Saudi Arabia, little is known about the prevalence and associated factors of EDs among female university students. Thus, this study investigated the prevalence, common types, and potential associated factors of EDs among female students of Jazan University.  Methods: A cross-sectional survey was conducted between August 31, 2020, and November 2, 2020. The snowball technique was used to recruit female students via an electronic survey distributed in Arabic. The survey collected information about demographic characteristics, and SCOFF (Sick, Control, One, Fat, Food) and Eating Attitudes Test (EAT-26) scales. Cronbach's alpha for the SCOFF and EAT-26 scales was calculated to be 0.78 and 0.58, respectively, in this study.

RESULTS

A total of 566 female students participated in the survey, with a mean age of 22.12 ± 2.93 years. The results showed that 47.9% of participants were at risk for EDs based on SCOFF scores, while 26.5% were at risk based on EAT-26 scores. The most common types of EDs were bulimia nervosa and binge eating disorder. Furthermore, the study identified several sociodemographic characteristics, including year of study (p = 0.042), college type (p = 0.004), body weight (p = 0.001), and BMI (p = 0.001), that are significantly associated with EDs. However, no significant relationships were observed between marital status (p = 0.103), age (p = 0.147), and height (p = 0.509) with SCOFF scores. Some students reported frequent binge eating, purging, or laxative/diet pill misuse.

CONCLUSIONS

The study revealed a moderate to high prevalence of risk for EDs among female university students in Jazan, Saudi Arabia, associated with higher study years, college majors, and body weight and BMI. Dangerous ED behaviors reported by some students signal an urgent need for resources to identify and support those suffering from these disorders. Targeted interventions and services may help address this critical issue on campuses and support vulnerable students in need. Continued research and public health action are needed to curb the spread of these disorders.

Prevalence and associated factors of eating disorder symptoms in adolescents: a cross-sectional school-based study

PURPOSE

To estimate the prevalence of eating disorder symptoms and associated factors in adolescents between 14 and 17 years old.

METHODS

The data were obtained from a cross-sectional school-based study with 782 adolescents from public schools in Caxias do Sul, in Rio Grande do Sul, Brazil, in 2016. The Eating Attitudes Test (EAT-26) was used to investigate eating disorder symptoms. The chi-square test and Poisson regression with robust variance were performed to estimate the prevalence ratios and associations between the outcome and the variables of interest.

RESULTS

The prevalence of eating disorder symptoms was around 56.9% among adolescents and more prevalent in females. A significant association was found between eating disorders and female gender, mothers who did not study or had an incomplete elementary school, and body image dissatisfaction. To adolescents dissatisfied with being overweight, the prevalence was more than three times higher than that observed among those who did not report such dissatisfaction.

CONCLUSION

The presence of eating disorder symptoms was associated with female gender, maternal education, and body image dissatisfaction. The results show the need to identify early signs and symptoms related to changes in eating behavior and non-acceptance of their bodies in a population especially concerned with their physical appearance.

The Relationship between Certain Parental/Household Socio-Economic Characteristics and Female Adolescent Obesity in Montenegro

BACKGROUND

Considering that obesity is characterized today as a public health challenge and an epidemic in many countries in the world and that one of the main predictors for obesity is socio-economic status (SES), the aim of this paper was to assess the relationship between the SES of parents/guardians and female adolescent obesity in Montenegro.

METHODS

A stratified random probability sample method was used, and the number of participants in this study was 596, aged 15.8 ± 0.58, from all three regions in Montenegro. As SES was a factor in this research, specific SES parameters such as household wealth and parental educational level were collected for parent/guardian of each child. The following anthropometric indices were utilized to evaluate nutritional status: body mass index (BMI) and waist to height ratio (WHtR).

RESULTS

Regarding nutritional status, it can be said that no statistically significant difference between female adolescents according to the regions of Montenegro was found. Of all the adolescents in the study, 15.4% of them were above the normal nutrition level as measured by BMI, while 12.2% were classified as obese by the WHtR. Furthermore, the study found a significant negative relationship between a mother's level of education and obesity in female adolescents, with odds ratios of 0.31 (p = 0.035) and 0.19 (p = 0.009) for secondary and high level education, respectively. This suggests that daughters of mothers with higher levels of education are less likely to be obese.

CONCLUSIONS

In regard to the nutritional status of the respondents in this study, their values fell within the normal range compared to the European average. However, the results regarding the relationship between certain SES characteristics and obesity suggest a similarity to developed countries.

Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis

Importance

The 5-item Sick, Control, One, Fat, Food (SCOFF) questionnaire is the most widely used screening measure for eating disorders. However, no previous systematic review and meta-analysis determined the proportion of disordered eating among children and adolescents.

Objective

To establish the proportion among children and adolescents of disordered eating as assessed with the SCOFF tool.

Data Sources

Four databases were systematically searched (PubMed, Scopus, Web of Science, and the Cochrane Library) with date limits from January 1999 to November 2022.

Study Selection

Studies were required to meet the following criteria: (1) participants: studies of community samples of children and adolescents aged 6 to 18 years and (2) outcome: disordered eating assessed by the SCOFF questionnaire. The exclusion criteria included (1) studies conducted with young people who had a diagnosis of physical or mental disorders; (2) studies that were published before 1999 because the SCOFF questionnaire was designed in that year; (3) studies in which data were collected during COVID-19 because they could introduce selection bias; (4) studies based on data from the same surveys/studies to avoid duplication; and (5) systematic reviews and/or meta-analyses and qualitative and case studies.

Data Extraction and Synthesis

A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Main Outcomes and Measures

Proportion of disordered eating among children and adolescents assessed with the SCOFF tool.

Results

Thirty-two studies, including 63 181 participants, from 16 countries were included in this systematic review and meta-analysis. The overall proportion of children and adolescents with disordered eating was 22.36% (95% CI, 18.84%-26.09%; P < .001; n = 63 181) (I2 = 98.58%). Girls were significantly more likely to report disordered eating (30.03%; 95% CI, 25.61%-34.65%; n = 27 548) than boys (16.98%; 95% CI, 13.46%-20.81%; n = 26 170) (P < .001). Disordered eating became more elevated with increasing age (B, 0.03; 95% CI, 0-0.06; P = .049) and body mass index (B, 0.03; 95% CI, 0.01-0.05; P < .001).

Conclusions and Relevance

In this systematic review and meta-analysis, the available evidence from 32 studies comprising large samples from 16 countries showed that 22% of children and adolescents showed disordered eating according to the SCOFF tool. Proportion of disordered eating was further elevated among girls, as well as with increasing age and body mass index. These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders.

Prevalence of Disordered Eating and Its Associated Factors From a Socioecological Approach Among a Sample of Spanish Adolescents: The EHDLA Study

Objectives: The aim of this study was twofold: a) to establish the prevalence of adolescents with disordered eating and b) to determine the factors associated with this prevalence in a sample of Spanish adolescents from the Valle de Ricote (Region of Murcia, Spain).

Methods: This cross-sectional study analyzed data from 730 adolescents (56.2% girls) from the EHDLA study. To determine the prevalence of disordered eating, the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire was used. A socioecological approach was used to identify individual-, interpersonal-, or organizational-level factors associated with disordered eating.

Results: The prevalence of disordered eating was 30.1%. This condition was associated with female sex (odds ratio [OR] = 2.60; 95% confidence interval [CI], 1.81–3.73), immigrant status (OR = 2.22; 95% CI, 1.51–3.25), or excess weight (OR = 2.74; 95% CI, 1.93–3.89). Furthermore, for each additional hour slept, lower odds of having disordered eating were found (OR = 0.81; 95% CI, 0.67–0.98).

Discussion: Almost one-third of the sample of Spanish adolescents analyzed reported disordered eating. Female sex, immigrant status and excess weight are individual aspects that seem to be related to disordered eating among Spanish adolescents.

Nasogastric tube feeding under restraint: practical guidance for children's nurses

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

'Our time is precious': An exploration of parental feeding behaviours for boys with Duchenne muscular dystrophy

INTRODUCTION

Due to the increased risk of obesity for boys with Duchenne muscular dystrophy (DMD), recent guidelines recommend that dietary intake is carefully managed. Parents play an important role in the development of their child's eating behaviours and patterns. However, despite what is known about the increased risk of obesity for children with DMD, little is known about parental feeding behaviours in this population. The objective of this study was to qualitatively explore the experiences of parents of children with DMD around their child's weight management and understand what influences their feeding behaviours.

METHODS

This paper reports a secondary data analysis. Semi-structured, individual interviews were conducted and analysed using qualitative description.

RESULTS

Thirteen parents were interviewed for the study. Three themes were developed: (1) parent responses to healthcare provider interactions, (2) mixed emotions contributing to feeding approach and (3) variable parenting feeding styles. Within the third theme, two subthemes arose including (1) control and preoccupation and (2) striking a balance.

CONCLUSION

Given the potential impact of higher weights on the progression of DMD, it is important that healthcare providers explore feeding behaviours with families. However, it is essential that healthcare providers consider the impact of these conversations on parents, as well as the broader issues that may place additional pressure on the lives of families.

A Community Guide Systematic Review: School Dietary and Physical Activity Interventions

CONTEXT

Schools can play an important role in supporting a healthy lifestyle by offering nutritious foods and beverages and providing opportunities for physical activity. A healthy diet and regular physical activity may reduce the risk of obesity. This manuscript reports on a Community Guide systematic review examining the effectiveness of interventions in schools combining school meal or fruit and vegetable snack programs and physical activity.

EVIDENCE ACQUISITION

Studies meeting the intervention definition were identified from a literature search (search period: January 1990-November 2019). Community Guide systematic review methods were used to assess effectiveness as measured by dietary behavior, physical activity, and weight changes; analyses were conducted in 2020.

EVIDENCE SYNTHESIS

Interventions (n=24 studies) were considered effective for increasing physical activity (median increase=21.8 minutes/day; interquartile interval= -0.8 to 27.4 minutes/day), modestly increasing fruit and vegetable intake (median relative increase=12.1%; interquartile interval= -4.6%, 73.4%), and decreasing the prevalence of overweight and obesity (median decrease=2.5 percentage points; interquartile interval= -8.1, -1.6 percentage points) among elementary school students through sixth grade. There were not enough studies to determine the effectiveness of interventions for middle- and high-school students.

CONCLUSIONS

School meal or fruit and vegetable snack interventions combined with physical activity were effective in increasing physical activity, with modest effects for improving fruit and vegetable consumption and reducing the prevalence of overweight and obesity among elementary students. These results may inform researchers and school administrators about healthy eating and physical activity interventions.

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.

Usability Testing an mHealth Program with Tailored Motivational Messages for Early Adolescents

Obesity among children is a rising concern throughout the world. In the U.S., rates of childhood obesity are the highest among children from diverse and economically disadvantaged households. Obesity in adolescence increases the risk of negative physical and psychological health consequences. Mobile-app-based health interventions have been found to be an effective tool to encourage children to adopt a healthier living style. A novel mobile app prototype was developed for early adolescents to communicate with and engage them interactively about healthy eating and active living. To test the app's usability, students from a U.S. middle school, with a majority of children from low-income families, were recruited to use the app and report their feedback. The usability testing results confirmed that the app was equally well received by participants of different genders, normal weight versus overweight/obesity, and amounts of screen time. Study participants also provided overwhelming positive feedback for the embedded and tailored motivational messages that encourage healthy eating and active living. The conceptualization of the app prototype was guided by the self-determination theory, social cognitive theory, and priming theory, in addition to incorporating evidence-based obesity prevention principles. This prototype, hence, provides a valid platform for building theory-based behavioral interventions.

"We Feel Like We Are in It Alone": A Mixed-Methods Study of Pediatric Primary Care Barriers for Weight Management

Background: Obesity is a chronic multifactorial disease affecting approximately one in five youth. Many pediatric clinical strategies focus on behavioral change/lifestyle modification efforts, but are limited by their intensity and muted by their inability to address the sociocultural contexts of obesity. The primary objective of the study was to explore primary care pediatric clinicians' current barriers/management practices of patients with obesity. Methods: A mixed-methods study was conducted by distributing an electronic survey to pediatric providers in Washington, DC, and its surrounding metropolitan area. Three focus groups were conducted with a subgroup of these primary care clinicians to further explore their responses. Results: Pediatric clinicians (n = 81) completed the survey out of 380 invitations sent, and 20 took part in 3 focus groups, ranging in size between 4 and 8 clinicians. Over 90% of clinicians felt comfortable advising patients. However, 52% lacked confidence in addressing obesity and over 80% indicated that time constraint is a barrier to care and emphasized the need for more training in obesity management. Six themes emerged regarding clinician barriers to addressing obesity, including (1) limited time, (2) clinician perceived familial resistance, (3) challenges with racial and ethnic concordance, (4) perceived environmental barriers, (5) limited knowledge of community resources, and (6) inadequate collaborative support. Conclusions: Clinicians have difficulty implementing obesity management strategies into their everyday practice due to a variety of barriers. This study emphasized the need for better implementation strategies, tools, and collaboration with community stakeholders for clinicians to engage weight management more effectively.

The Effects of COVID-19 Pandemic and Lockdown on Pediatric Nutritional and Metabolic Diseases: A Narrative Review

SARS-CoV-2 was the first pathogen implied in a worldwide health emergency in the last decade. Containment measures have been adopted by various countries to try to stop infection spread. Children and adolescents have been less clinically involved by COVID-19, but the pandemic and consequent containment measures have had an important influence on the developmental ages. The COVID-19 pandemic and the subsequent lockdown periods have influenced the nutrition and lifestyles of children and adolescents, playing an epigenetic role in the development of nutrition and metabolic diseases in this delicate age group. The aim of our review is to investigate the effects of the COVID-19 pandemic on nutrition and metabolic diseases in the developmental ages. Moreover, we have analyzed the effect of different containment measures in children and adolescents. An increase in being overweight, obesity and type 2 diabetes mellitus has been detected. Concerning type 1 diabetes mellitus, although a validated mechanism possibly linking COVID-19 with new onset type 1 diabetes mellitus has not been yet demonstrated, barriers to the accessibility to healthcare services led to delayed diagnosis and more severe presentation of this disease. Further studies are needed to better investigate these relationships and to establish strategies to contain the nutritional and metabolic impact of new pandemics in the developmental ages.

The Follow-Up of Eating Disorders from Adolescence to Early Adulthood: A Systematic Review

Eating disorders (EDs) are common among children and adolescents and are characterized by excessive concerns for physical appearance, distorted body image, and fear of gaining weight. The purpose of this review is to evaluate the follow-up of EDs from adolescence to adulthood, analyzing persistence, relapses, and associated comorbidities. We searched scientific articles in PubMed, PsycInfo, Scopus, and Embase through two research strings, one for quantitative outcomes (recovery/persistence, relapse, and remission) and one for the other outcomes (psychiatric and medical comorbidities, substance use, and social-relational complications). From a total of 8043 retrieved articles, we selected 503 papers after exclusion of duplicates and title/abstract screening. After a full-text evaluation, we included 16 studies eligible for this review. We performed a meta-analysis describing the quantitative results, and we created a narrative synthesis for the qualitative outcomes. Results: Our results confirm that EDs can persist in early adulthood in 40.7% of cases with a relapse percentage of 24.5%. Individuals with an ED more frequently present with an empathy deficit and comorbid anxiety and depressive disorders. EDs are chronic and complex disorders, more frequent in females. In most cases, EDs reduce the autonomy of individuals who present many difficulties in affirming their independence from parental family.

Teen and caregiver perspectives on success, clinician role, and family involvement in ACTION PAC, a weight management intervention trial

OBJECTIVE

Describe perspectives of teens and caregivers regarding motivations, successes, and challenges related to participation in ACTION PAC (ClinicalTrials.gov: NCT02502383), a two-year weight management trial.

METHODS

Intervention group participants received 16 short motivational interviewing (MI) sessions with school-based health center (SBHC) primary care clinicians over two years. Post-study, we conducted semi-structured interviews with purposefully sampled intervention group teens and their caregivers. Interviews were audio recorded, transcribed, and managed in NVivo 11. Three independent coders analyzed the data, developed a coding tree, examined how codes intersected and clarified relationships through memo writing.

RESULTS

The clinician's role and use of motivational interviewing and family involvement in behavior changes were cited as critical to success. Some adolescents noted difficulty in sustaining behavior changes post-intervention and social and systemic barriers to behavior change.

CONCLUSION

Future studies should identify strategies to sustain teen motivation, better involve families, and address systemic barriers.

INNOVATION

In this study, which simulated real-world SBHC conditions, adolescents appreciated the use of an MI approach and felt that was key to their success, indicating the potential to continue use of this approach to motivating behavior changes in SBHC settings.

"It's Not the Stereotypical 80s Movie Bullying": A Qualitative Study on the High School Environment, Body Image, and Weight Stigma

BACKGROUND

Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools.

METHODS

We conducted 24 semi-structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach.

RESULTS

Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight-based teasing and self-directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups.

CONCLUSIONS

Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight-related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed.

The influence of front-of-pack nutritional labels on eating and purchasing behaviors: a narrative review of the literature

BACKGROUND

Front-of-Pack Nutritional Labels are considered a useful tool to help consumers orient themselves in their food choices and direct their behavior toward a healthier diet. FOPNL development and use are part of a framework that includes cognitive, biological, hedonic and cultural aspects, able to affect consumers' eating and purchasing behavior.

AIM

Given the complexity of the matter, the aim of this narrative review is to analyze the combination of different factors that drive food choices and eating behaviors and to highlight some aspects that are not fully studied.

METHODS

The authors conducted the research using a top-down approach at first, followed by a bottom-up approach; starting with general considerations about the purchasing process, gradually narrowing the discussion to a specific sub-population, and finally extending the discussion back to more general reasonings about the direction to adopt in future, or at least to evaluate, for effective communication.

RESULTS

Biases and attitudes toward food products were found to regularly interfere with buying behavior patterns, making it impossible to standardize an average consumer. This reflects in current research, increasing the complexity of the topic. All determinants influencing food choices are often assessed individually rather than in a synergistic and multidimensional context, while the purchasing scenario is characterized by multiple stimuli to which the consumer is subjected. FOPNLs' impact on perceived healthiness has been studied in different conditions, but some population subgroups have not been sufficiently represented. In particular, the effect of FOPNLs on consumers suffering from eating disorders is understudied and needs further attention. Furthermore, some approaches can be compared to "negative nutrition" or "loss-framed communication", putting nutrients out of context, emphasizing losses more than gains and risking promoting negative feelings in consumers.

CONCLUSION

Due to the heterogeneity of studies, evidence on what works best in driving people to adopt lasting lifestyle changes is still mixed. Science communicators and policymakers should consider the possibility that a multi-component approach incorporating nutrition information and education may be a key strategy to promote consumers' self-consciousness and to support them in their cognitive efforts toward a healthy and sustainable diet.

LEVEL OF EVIDENCE

Level V, narrative review.

Dietary and Nutritional Profiles among Brazilian Adolescents

(1) Background: The present study analyzed the prevalence of dietary and nutritional profiles among Brazilian adolescents and their associations with social determinants of health. (2) Methods: A population-based survey was administered to 16,409 adolescents assessed by the 2015 National School Health Survey. A multivariate model of dietary and nutritional profiles was estimated from correspondence analysis. (3) Results: The dietary and nutritional profiles more prevalent among Brazilian adolescents were “lower nutritional risk dietary pattern and eutrophic” (42.6%), “lower nutritional risk dietary pattern and overweight” (6.8%), and “higher nutritional risk dietary pattern and overweight” (6.0%). Healthier profiles were associated with less urbanized territories, health-promoting behaviors, and families with worse material circumstances. The less healthy profiles were associated with more urbanized environments, health risk behaviors, and families with better material circumstances. (4) Brazilian adolescents have different dietary and nutritional profiles that are characterized by sociopolitical and economic contexts, family material and school circumstances, and the behavioral and psychosocial health factors of the individuals. All of this points to the social determination of these health problems among adolescents in Brazil.

Weight Status and Mental Well-Being Among Adolescents: The Mediating Role of Self-Perceived Body Weight. A Cross-National Survey

PURPOSE

Overweight and obesity are associated with poor mental health in adolescents. However, little is known about whether the influence of overweight and obesity on mental well-being is mediated by self-perceived body weight. Exploring the mechanisms underlying the relationships between obesity and mental well-being is of interest to policy makers and others working in the field of adolescent health.

METHODS

This study was based on nationally representative data from adolescents (age 15 years) who participated in the 2017/2018 Health Behaviour in School-aged Children study (47 countries, N = 76,998). Mixed regression models that included gender and socioeconomic status as covariates were used to identify associations between weight status and mental well-being (life satisfaction and subjective health complaints) and to explore whether self-perceived body weight (feeling too thin or too fat) has a mediating effect. Associations between weight status, self-perceived weight, and mental well-being were further assessed country by country.

RESULTS

Self-perceived body weight mediated the observed associations between overweight or obesity and mental well-being. Perceiving one's body weight as "too thin" or "too fat" was associated with poorer mental well-being, regardless of weight status. Self-perceived body weight varied by gender, socioeconomic status, and country.

DISCUSSION

Self-perceived body weight may explain, to a greater extent than body mass index, variation in mental well-being among adolescents. These results are important to policy makers, clinicians, and others targeting adolescent health.

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.

Social determinants of health associated with the experience of hunger among Brazilian adolescents

The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Social Determinants of Obesity and Stunting among Brazilian Adolescents: A Multilevel Analysis

(1) Background: The purpose of this study was to identify the prevalence of obesity and stunting among Brazilian adolescents and its associations with social determinants of health (individual, family, and school), grounded on the necessity of investigating the determinants of nutritional problems within this population. (2) Methods: A population-based survey was administered to 16,556 adolescents assessed by the 2015 National School Health Survey. Multivariate models of obesity and stunting were estimated from Multilevel Poisson Regressions. (3) Results: The prevalence of obesity among Brazilian adolescents (10.0%; 95% CI: 9.4–10.6) was associated directly with indifference or dissatisfaction with body image, with eating breakfast four or fewer days a week, living with up to four people in the household, studying in private schools, and being from the South region, and was inversely associated with being female, 15 years old or older, with having the highest nutritional risk eating pattern, dining at fast-food restaurants, and eating while watching television or studying. The prevalence of stunting (2.3%; 95% CI: 2.0–2.8) was directly associated with the age of 15 years or older, and inversely associated with the lower number of residents living in the household, maternal education—decreasing gradient from literate to college level education, studying in urban schools, and being from the South and Central-West regions. (4) Conclusions: Obesity in adolescence presented behavioral determinants. Stunting and obesity have structural social determinants related, respectively, to worse and better socioeconomic position among Brazilian adolescents.

The Impact of Inpatient Multimodal Treatment or Family-Based Treatment on Six-Month Weight Outcomes in Youth with Anorexia Nervosa: A Naturalistic, Cross-Continental Comparison

In the USA, family-based treatment (FBT) with inpatient medical stabilization as needed is the leading evidence-based treatment for youth with anorexia nervosa (AN). In continental Europe, typically inpatient multimodal treatment targeting weight recovery followed by outpatient care (IMT) is standard care, if prior outpatient treatment was not sufficient. Our aim was to compare weekly weight gain and hospital days over six months for adolescents receiving FBT (USA) versus IMT (Germany) using naturalistic treatment data. To yield similar subgroups of youth aged 12−18 years, inclusion criteria were a percent median BMI (%mBMI) between 70−85 and the restrictive AN subtype. Weight gain and hospital days were compared, adjusted further in a multiple linear regression analysis (MLRA) for baseline group differences. Samples differed on baseline %mBMI (FBT [n = 71], 90.5 ± 12.8; IMT [n = 29], 78.3 ± 9.1, p < 0.05). In subgroups with comparable baseline %mBMI, the weekly weight gain over 6 months was similar (FBT [n = 21]: 0.35 ± 0.18 kg/week; IMT [n = 20]: 0.30 ± 0.18, p = 0.390, p = 0.166 after MLRA), but achieved fewer hospital days in FBT (FBT [n = 7]: 4 ± 6 days, IMT [n = 20]: 121 ± 42 days, p < 0.0001 before and after MLRA). FBT may be effective for a subgroup of adolescents with AN currently receiving IMT, but head-to-head studies in the same healthcare system are needed.

Factors associated with disordered feeding among high school students in Kerman City, Iran

BACKGROUND

Mental health problems and disordered eating, are more common in adolescents. This study investigated relationship between mental health and disordered eating in high school girls in southeast Iran.

METHODS

This cross-sectional descriptive correlational study accomplished in high school girls of Kerman at the southeast of Iran in 2019. Using three parts demographic, Standard General Health Questionnaire (GHQ-28) and Eating Attitudes questionnaire, (Eat-26) with three subscales: eating habits, desire to eat and oral control. We investigated high school girl's mental health and relationship with disordered eating with cluster sampling method (600 high school girl). Multivariate logistic regression was used to determine the association between significant variables and the risk of General Health (Yes/No) and Eating attitude (Yes/No). Spearman correlation test, Mann-Witheny U test and Kruskal-Wallis test were used, and Significant level was considered at P < 0.05.

RESULTS

A direct and significant relationship between mental health and disordered eating (r = 0/19, P < 0.001). In other words, the higher the mental health disorder score, the higher the disordered eating score, and the higher disordered eating score, the higher mental problems. There was a direct and significant relationship between mental health and all aspects of disordered eating including eating habits (r = 0/12, P < 0.05), desire to eat (r = 0/1, P < 0.05) and oral control (r = 0/14, P < 0.001).

CONCLUSIONS

It seems that the disordered eating and mental health have a determinant role in relationship with each other. Therefore, prevention and health promotion programs should be implemented to improve female adolescent mental health and reduce disordered eating.

Healthy Eating and Diets: Fad or Rad?

One of the top chronic diseases in the United States is pediatric obesity. As such, many pediatricians will have conversations with patients and families regarding the health effects of this disease process. This article will provide a broad overview of many of the popular diets as well as evidence for their effectiveness. Lastly, recommendations for healthy eating and nutritional counseling with patients and families will be discussed. [Pediatr Ann. 2022;51(3):e88-e92.].

Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society for Preventive Cardiology Clinical Practice Statement

Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.

Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation

Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.

Weight Pressures and Eating Disorder Symptoms among Adolescent Female Gymnasts of Different Performance Levels in Greece

This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11–17 years old) completed the Eating Attitudes Test (EAT-26), the Weight-Pressures in Sport-Females (WPS-F), the Social Desirability Scale (SDS) and provided information on their training. It was found that 16.3% of competitive gymnasts and 7.4% of non-competitive gymnasts scored ≥20 in EAT-26, indicating disordered eating behavior. Competitive gymnasts scored higher than non-competitive in the total score of EAT-26 (p = 0.027), as well as in the total score of WPS-F, the sport and coaches weight pressures sub-scale and the appearance and performance weight pressures sub-scale (p < 0.001). Multiple regression analyses indicated that sport and coaches weight pressures, appearance and performance weight pressures and body mass index accounted for 30.3% of the variance of EAT-26 in competitive gymnasts, while the appearance and performance weight pressures sub-scale accounted for 16.3% of the variance of EAT-26 in non-competitive gymnasts. Sport and coaches weight pressures are associated with ED in competitive gymnasts, while body appearance and performance demands correlate with ED in female gymnasts irrespective of competitive level.

Comparison of Hospital Consultation and Summer Camp Lifestyle Intervention Programs for Sustained Body Weight Loss in Overweight/Obese Greek Children

Two lifestyle intervention programs of a health initiative named "Evrostia" were conducted at (a) an outpatient obesity clinic of a children's hospital and (b) summer camp (SC), respectively. Thirty overweight/obese children were randomly selected to participate in each intervention arm to assess the efficacy of the SC intervention and its possible superiority over usual hospital consultation (HC) practice. There was a statistically significant decrease in body weight (BW), and body mass index (BMI) in both programs. A higher duration of reduced BW was observed in the SC compared to HC intervention. Regarding the nutritional behavior, there was a significant increase in the consumption of breakfast, fruit and vegetables, and a reduction in the consumption of beverages and sweets in the SC group. A significant increase in the hours of weekly physical activity was also observed in children of the SC program. The comparison between the two lifestyle intervention programs showed that the SC program improved nutritional behaviors and physical activity and promoted longer preservation of BW loss than that of the HC program. Thus, the holistic and experiential approach of the SC program was more successful in the treatment of overweight and obesity in children than a conventional HC program.

Social determinants of health associated with the experience of hunger among Brazilian adolescents

Abstract The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question “In the last 30 days, how often have you been hungry because there wasn’t enough food at home?” The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.