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Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12-17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.

Objective Pediatric loss of control (LOC) eating prospectively predicts the worsening of metabolic syndrome components. However, it is unknown if remission of LOC eating is associated with improvements in metabolic health. Therefore, we conducted a secondary analysis of a trial that enrolled adolescent girls with LOC eating, examining whether LOC remission (vs. persistence) at end-of-treatment was associated with changes in metabolic syndrome components at 6-month follow-up. Method One hundred three adolescent girls (age 14.5 ± 1.7 years; BMI-z 1.5 ± 0.3; 56.3% non-Hispanic White, 24.3% non-Hispanic Black) with elevated weight (75th-97th BMI %ile) and reported LOC eating were assessed for metabolic syndrome components at baseline and again six months following the interventions. The main effects of LOC status at end-of-treatment (persistence vs. remission) on metabolic syndrome components (waist circumference, lipids, glucose, and blood pressure) at 6-month follow-up were examined, adjusting for baseline age, depressive symptoms, LOC frequency, fat mass, and height, as well as race, change in height, change in fat mass, and the baseline value of each respective component. Results Youth with LOC remission at end-of-treatment had lower glucose (83.9 ± 6.4 vs. 86.5 ± 5.8 mg/dL; p = .02), higher high-density lipoprotein cholesterol (50.3 ± 11.8 vs. 44.8 ± 11.9 mg/dL; p = .01), and lower triglycerides (84.4 ± 46.2 vs. 96.9 ± 53.7 mg/dL; p = .02) at 6-month follow-up when compared with youth with persistent LOC, despite no baseline differences in these components. No other component significantly differed by LOC eating status (ps > .05). Discussion Reducing LOC eating in adolescent girls may have a beneficial impact on some components of the metabolic syndrome.

Objective Interpersonal psychotherapy (IPT) is aimed at improving negative affect that is purported to contribute to the development and maintenance of loss-of-control (LOC) eating. Although youth who report LOC over eating tend to consume more snack-foods than those without LOC, it is unknown if IPT impacts objective energy intake. Methods To test if IPT improves mood and eating in the laboratory, we examined a sample of 88 girls with LOC eating who were randomized to either IPT (n = 46) or a standard-of-care health education (HE) group program. At baseline, and 6-month (follow-up 1) and 1-year (follow-up 2) following the initiation of the groups, girls consumed lunch from a multi-item meal with an instruction designed to model a LOC episode. Girls also reported mood state immediately before each meal. Results Girls in IPT experienced no significant changes in pre-meal state depressive affect, while girls in HE experienced a non-significant improvement by follow-up 1 and then returned to baseline by follow-up 2 (p

This article presents a brief case study of "Jane Doe," a 13-year-old, non-Hispanic White girl 2 participating in a clinical research trial of interpersonal psychotherapy-weight gain (IPT-WG). Girls at-risk for adult obesity and binge eating disorder (BED) were randomly assigned to take part in 12 weeks of preventative group treatment. Jane's IPT-WG group included five other early adolescent girls (mostly aged 12-13) at risk for adult obesity and BED. The case of Jane illustrates a successful example of IPT-WG for the prevention of excessive weight gain and for the prevention of BED. (PsycINFO Database Record

Purpose Extant research indicates that some of the comorbidities associated with adult obesity may be adversely affected by the stress resulting from negative body image and weight-related stigma. This study examined the association between weight-related pressure and insulin sensitivity in adolescents, who are vulnerable to both weight-based teasing and the onset of metabolic dysregulation. Methods Participants were 215 adolescent healthy volunteers (55% female; 59% white; 35% overweight/obese; mean ± standard deviation age = 15.4 ± 1.4 year), who completed a self-report measure of pressure to be thin from parents, friends, and romantic partners. Fasting blood samples were obtained to assess serum insulin and glucose, which were used to calculate insulin sensitivity; fat mass (kg) and fat-free mass (%) were measured with air-displacement plethysmography. Pubertal stage was determined by physical examination. Results Pressure to be thin was positively associated with fasting insulin ( p = .01) and negatively associated with insulin sensitivity ( p = .02), after controlling for pubertal stage, sex, race, height, fat-free mass, and adiposity. Pressure to be thin was associated with a greater odds of having hyperinsulinemia (fasting insulin ≥ 15 μIU/mL; odds ratio (95% confidence interval): 1.65 [1.08–2.50], p = .02), adjusting for the same covariates. Conclusions Results indicate that adolescents perceiving more pressure to be thin have greater elevations of fasting insulin and poorer insulin sensitivity above and beyond the effect of fat mass. Future research is warranted to elucidate the mechanisms responsible for this relationship.

Summary Background Adults with binge eating disorder may have an exaggerated or blunted cortisol response to stress. Yet, limited data exist among youth who report loss of control (LOC) eating, a developmental precursor to binge eating disorder. Methods We studied cortisol reactivity among 178 healthy adolescents with and without LOC eating. Following a buffet lunch meal adolescents were randomly assigned to watch a neutral or sad film clip. After, they were offered snacks from a multi-item array to assess eating in the absence of hunger. Salivary cortisol was collected at −80, 0, 30 and 50 min relative to film administration, and state mood ratings were reported before and after the film. Results Adolescents with LOC had greater increases in negative affect during the experimental paradigm in both conditions (ps > 0.05). Depressive symptoms, but not LOC, related to a greater cortisol response in the sad film condition (ps > 0.05). Depressive symptoms and state LOC were related to different aspects of eating behaviour, independent of film condition or cortisol response (ps > 0.05). Conclusions A film clip that induced depressed state affect increased salivary cortisol only in adolescents with more elevated depressive symptoms. Adolescents with and without LOC were differentiated by greater increases in state depressed affect during laboratory test meals but had no difference in cortisol reactivity. Future studies are required to determine if adolescents with LOC manifest alterations in stress reactivity to alternative stress-inducing situations.

Data suggest that depressed affect and dietary restraint are related to disinhibited eating patterns in children and adults. Yet, experimental research has not determined to what extent depressed affect acutely affects eating in the absence of physiological hunger (EAH) in adolescents. In the current between-subjects experimental study, we measured EAH in 182 adolescent (13-17y) girls (65%) and boys as ad libitum palatable snack food intake after youth ate to satiety from a buffet meal. Just prior to EAH, participants were randomly assigned to view either a sad or neutral film clip. Dietary restraint was measured with the Eating Disorder Examination. Adolescents who viewed the sad film clip reported small but significant increases in state depressed affect relative to adolescents who viewed the neutral film clip (p < .001). Yet, there was no main effect of film condition on EAH (p = .26). Instead, dietary restraint predicted greater EAH among girls, but not boys (p < .001). These findings provide evidence that adolescent girls’ propensity to report restrained eating is associated with their greater disinhibited eating in the laboratory. Additional experimental research, perhaps utilizing a more potent laboratory stressor and manipulating both affective state and dietary restraint, is required to elucidate how state affect may interact with dietary restraint to influence EAH during adolescence.

Objective The purpose of this investigation was to examine the relationship of dispositional mindfulness to binge eating and associated eating attitudes and behaviors among adolescent girls at risk for type 2 diabetes (T2D). Methods Participants were 114 overweight or obese adolescents enrolled in a study of girls with a family history of T2D and mild depressive symptoms. Adolescent self-reports of mindfulness, eating in the absence of hunger, and depressive symptoms were collected. An interview was administered to determine presence of binge eating episodes and a behavioral task was used to assess the reinforcing value of food relative to other nonsnack food rewards. Body composition was assessed using dual-energy X-ray absorptiometry. Results In analyses accounting for race, percent body fat, lean mass, height, age, and depressive symptoms, dispositional mindfulness was associated with a lower odds of binge eating (p = .002). Controlling for the same potential confounds, mindfulness was also inversely associated with eating concern, eating in the absence of hunger in response to fatigue/boredom, and higher food reinforcement relative to physical activity (all p

Objective Eating in the absence of hunger (EAH) refers to the consumption of palatable foods in a sated state. It has been proposed that EAH promotes excess weight gain in youth; yet, there are limited prospective data to support this hypothesis. We examined whether EAH at baseline predicted increases in body mass (BMI and BMIz) and fat mass (kg) 1 year later among adolescent boys and girls.

Emerging data indicate that adults with binge eating may exhibit an attentional bias toward highly palatable foods, which may promote obesogenic eating patterns and excess weight gain. However, it is unknown to what extent youth with loss of control (LOC) eating display a similar bias. We therefore studied 76 youth (14.5 ± 2.3 years; 86.8% female; BMI-z 1.7 ± .73) with (n = 47) and without (n = 29) reported LOC eating. Following a breakfast to reduce hunger, youth participated in a computerized visual probe task of sustained attention that assessed reaction time to pairs of pictures consisting of high palatable foods, low palatable foods, and neutral household objects. Although sustained attentional bias did not differ by LOC eating presence and was unrelated to body weight, a two-way interaction between BMI-z and LOC eating was observed (p = .01), such that only among youth with LOC eating, attentional bias toward high palatable foods versus neutral objects was positively associated with BMI-z. These findings suggest that LOC eating and body weight interact in their association with attentional bias to highly palatable foods cues, and may partially explain the mixed literature linking attentional bias to food cues with excess body weight.

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.

Objective Preadolescent loss-of-control-eating (LOC-eating) is a risk factor for excess weight gain and binge-eating-disorder. We evaluated feasibility and acceptability of a preventive family-based interpersonal psychotherapy (FB-IPT) program. FB-IPT was compared to family-based health education (FB-HE) to evaluate changes in children's psychosocial functioning, LOC-eating, and body mass. Method A randomized, controlled pilot trial was conducted with 29 children, 8 to 13 years who had overweight/obesity and LOC-eating. Youth-parent dyads were randomized to 12-week FB-IPT (n = 15) or FB-HE (n = 14) and evaluated at post-treatment, six-months, and one-year. Changes in child psychosocial functioning, LOC-eating, BMI, and adiposity by dual-energy-X-ray-absorptiometry were assessed. Missing follow-up data were multiply imputed. Results FB-IPT feasibility and acceptability were indicated by good attendance (83%) and perceived benefits to social interactions and eating. Follow-up assessments were completed by 73% FB-IPT and 86% FB-HE at post-treatment, 60% and 64% at six-months, and 47% and 57% at one-year. At post-treatment, children in FB-IPT reported greater decreases in depression (95% CI −7.23, −2.01, Cohen's d = 1.23) and anxiety (95% CI −6.08, −0.70, Cohen's d = .79) and less odds of LOC-eating (95% CI −3.93, −0.03, Cohen's d = .38) than FB-HE. At six-months, children in FB-IPT had greater reductions in disordered-eating attitudes (95% CI −0.72, −0.05, Cohen's d = .66) and at one-year, tended to have greater decreases in depressive symptoms (95% CI −8.82, 0.44, Cohen's d = .69) than FB-HE. There was no difference in BMI gain between the groups. Discussion Family-based approaches that address interpersonal and emotional underpinnings of LOC-eating in preadolescents with overweight/obesity show preliminary promise, particularly for reducing internalizing symptoms. Whether observed psychological benefits translate into sustained prevention of disordered-eating or excess weight gain requires further study.

Background: The high prevalence and incidence of obesity and eating disorders in US adolescent girls are serious health problems. Because of the shared risk factors for obesity and eating disorders, a targeted prevention of both conditions is a priority. Objective: We determined whether an adapted interpersonal psychotherapy prevention program is more efficacious for reducing excess weight gain and worsening disordered eating than health education in adolescent girls at high risk of obesity and eating disorders. Design: A parallel-group, randomized controlled trial was conducted between September 2008 and January 2013 in a university-based laboratory and a federal research hospital. The study included 113 adolescent (12–17-y-old) girls deemed at high risk of adult obesity and eating disorders because of a body mass index (BMI) between the 75th and 97th percentiles and reports of episodes of a loss of control over their eating. Girls were randomly assigned to participate in an adapted interpersonal psychotherapy or a health-education group program for 12 weekly 90-min group sessions. Follow-up assessments occurred immediately after group programs and at 6 and 12 mo. Results: Participation in both conditions was associated with decreases in expected BMI gain, age-adjusted BMI metrics, the percentage of fat by using dual-energy X-ray absorptiometry, symptoms of depression and anxiety, and the frequency of loss-of-control eating over 12 mo of follow-up (Ps < 0.001) with no group difference. In follow-up analyses, interpersonal psychotherapy was more efficacious than health education at reducing objective binge eating at the 12-mo follow-up (P < 0.05). Conclusions: The intervention with adolescent girls with loss-of-control eating is associated with lower age-adjusted BMI and percentage of adiposity as well as improved mood symptoms over 1 y. Interpersonal psychotherapy further reduced objective binge eating. Additional research is needed to elucidate the mechanisms by which physical and psychological improvements were observed. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00680979","term_id":"NCT00680979"}}NCT00680979.

Context: The effect of obesity and concomitant insulin resistance on pubertal development is incompletely elucidated. Objective: To determine how measures of adiposity and insulin resistance are associated with pubertal maturation in boys and girls. Setting and Design: Breast and pubic hair Tanner stage and testicular volume by orchidometry were determined by physical examination in 1066 children. Ovarian volume was estimated by trans-abdominal ultrasound. Fat mass, skeletal age, and fasting serum for insulin and glucose, total T, estradiol, estrone, dehydroepiandrosterone-sulfate, and androstenedione were measured at the National Institutes of Health Clinical Research Center. Convenience sample; 52% obese, 59% female. Results: Logistic regression identified a significant interaction between sex and obesity for prediction of pubertal development (P ≤ .01). There was a negative association between boys' testicular volume and body mass index (BMI)/fat mass but a positive association between girls' breast stage and BMI/fat mass. Ovarian volume in girls was positively associated with insulin resistance but not with BMI/fat mass. There was a positive association between obesity and measures of estrogen exposure (breast development and skeletal age) in both sexes. Positive correlations were seen for girls between BMI and pubic hair development and between insulin resistance and T production, whereas adiposity was negatively associated with pubic hair in boys. Conclusions: Significant sexual dimorphisms in the manifestations of pubertal development are seen in obese girls and boys. Two known effects of obesity, increased peripheral conversion of low-potency androgens to estrogens by adipose tissue-aromatase and increased insulin resistance, may be in large part responsible for these differences.

Loss of control (LOC) eating refers to the subjective experience of being unable to control what or how much is eaten, regardless of the amount reportedly consumed (1). LOC eating has been well phenotyped, as LOC meals typically are low in protein, high in carbohydrate, and are comprised of highly palatable, energy dense foods (2–4). Pediatric LOC eating is a precursor to partial- and full-syndrome binge eating disorder (BED) and is predictive of exacerbated general and eating disorder psychopathology (5, 6), excessive weight and fat gain (7, 8), and metabolic dysfunction (9). At least one recent episode of LOC eating is reported by 5% to 50% of youth, with higher estimates among adolescent (vs. child), female (vs. male), and overweight (vs. non-overweight) samples (1). LOC eating typically emerges during middle childhood (10) or early adolescence (11, 12). While the presence of a lifetime history of LOC eating has been associated with adverse outcomes (6, 13), only about 50% of youth with LOC eating go on to experience persistent and exacerbated LOC eating patterns during middle to late adolescence and beyond (5, 6, 14). To improve the identification of high-risk youth with LOC eating and refine intervention targets, research is needed to elucidate developmental factors that may contribute to exacerbated disordered eating. Puberty has been identified as a critical risk period for the development of eating disorders and their symptoms, including binge and LOC eating (15). Research on puberty and binge eating lags behind the wealth of data examining the relationship between puberty and other forms of eating disorder psychopathology (15). Pubertal onset, as identified by self-reports of secondary sex characteristics, has been associated with concurrent binge eating among preadolescent girls and boys assessed in the fifth through seventh grades (16, 17). When examining this preadolescent cohort of boys and girls over time, pubertal onset predicted subsequent increases in binge eating frequency (17). Binge eating prevalence was higher at more advanced stages of pubertal development among girls, but not boys, in a large population-based sample, even after accounting for age (18). However, other cross-sectional studies failed to find a significant association between pubertal status and binge eating in girls and boys (19–21). Prior studies’ reliance upon self-report questionnaires to determine both pubertal stage and binge eating severity may have limited reliability and validity relative to interview methods, physical examination, and food intake assessed via laboratory test meals. Moreover, we know of no prior human studies investigating the relationship between pubertal stage and LOC eating. Existing developmental risk models suggest that pubertal development may increase risk for LOC eating through direct and indirect pathways that involve biological and psychosocial factors. Traditional theories posit that the physical changes associated with puberty lead to body dissatisfaction and negative mood, which in turn promote disordered eating behaviors such as classic binge episodes or LOC eating (22, 23). It is hypothesized that girls may be at greater risk for these psychosocial disturbances, as puberty-induced increases in adiposity move girls away from the socially reinforced “thin” body size ideals whereas gains in muscle mass propel boys closer to masculine body ideals (22, 23). Recent theories, by contrast, focus on biological factors and suggest that increases in gonadal hormone levels during puberty play a central role in activating and/or organizing genetic and phenotypic effects that exacerbate disordered eating risk (15). It is also conceivable that pubertal shifts in metabolic hormone levels, which dually regulate eating behaviors and the hypothalamic-pituitary-gonadal axis, may directly promote LOC eating and/or the phenotypic manifestation of LOC eating (24, 25). To date, no known studies have examined the interplay among puberty, LOC eating, and theoretically-driven LOC correlates such as disordered eating attitudes and eating behavior. The current study sought to investigate the association between pubertal development and manifestations of LOC eating in a community sample of children and adolescents. We hypothesized that youth in early-to-mid- and late-pubertal stages would exhibit higher rates of LOC eating than youth in pre-puberty. Based on the mechanisms put forth by psychosocial developmental risk models (22, 23), we hypothesized that associations between LOC eating and concerns about weight and shape would be more robust among post-pubertal youth relative to pre-pubertal youth. Given hypotheses made by biologically-driven developmental risk theories (15), we also expected post-pubertal youth with LOC eating to have greater palatable food consumption in the laboratory, even after adjusting for age and adiposity, relative to pre-pubertal youth with LOC eating and all youth without LOC eating.

This study investigated the links among interpersonal problem areas, depression, and alexithymia in adolescent girls at high risk for excessive weight gain and binge eating disorder. Participants were 56 girls (Mage = 14.30, SD = 1.56; 53% non-Hispanic White) with a body mass index (BMI, kg/m(2)) between the 75th and 97th percentiles (MBMI z = 1.57, SD = 0.32). By design, all participants reported loss of control eating patterns in the past month. Adolescents were individually interviewed prior to participating in a group interpersonal psychotherapy obesity and eating disorder prevention program, termed IPT for the prevention of excessive weight gain (IPT-WG). Participants' interpersonal problem areas were coded by trained raters. Participants also completed questionnaires assessing depression and alexithymia. Primary interpersonal problem areas were categorized as interpersonal deficits [as defined in the eating disorders (ED) literature] (n = 29), role disputes (n = 22), or role transitions (n = 5). Girls with interpersonal deficits-ED had greater depressive symptoms and alexithymia than girls with role disputes (p's ≤ 0.01). However, girls with role transitions did not differ from girls with interpersonal deficits-ED or role disputes. Interpersonal problem area had an indirect association with depression via alexithymia; interpersonal deficits-ED were related to greater alexithymia, which in turn, was related to greater depressive symptoms (p = 0.01). Among girls at risk for excess weight gain and eating disorders, those with interpersonal deficits-ED appear to have greater distress as compared to girls with role disputes or role transitions. Future research is required to elucidate the impact of interpersonal problem areas on psychotherapy outcomes.

Bardet-Biedl syndrome (BBS) is a rare, genetically heterogeneous disorder (1, 2) with retinal dystrophy, post-axial polydactyly, developmental delay, renal abnormalities, and obesity in 70–90% (1, 3, 4). Genes involved in formation, stability, and function of cilia are implicated as causes of BBS (5–7). The high penetrance of the obesity phenotype in patients suggests that ciliary proteins play an important role in body energy balance and weight regulation. Several mouse models of BBS recapitulate features of the human phenotype and have altered protein/vesicle trafficking in leptin-sensing hypothalamic neurons, possibly inducing leptin resistance and hyperphagia, consistent with the observation that BBS knockout mice consume 20–30% more energy than controls (8, 9). Human studies characterizing the obesity phenotype of patients with BBS are few (10–12) and do not provide definitive data for the contributions of increased energy intake, decreased physical activity or altered metabolism to their obesity. A study of energy homeostasis in 20 BBS overweight or obese subjects and 20 controls reported no differences in energy intake or resting energy expenditure, but found physical activity (by actigraphy) was slightly, but significantly, lower among patients with BBS (10). This study, however, used a self-report 7-day food diary for energy intake assessment that, given the cognitive impairment of patients with BBS, may need to be interpreted cautiously. There are several syndromes where obesity occurs together with cognitive dysfunction and the obesity is associated with hyperphagic symptoms (13–16). One example is the Prader-Willi syndrome (PWS) (13). Patients with PWS show defects in post-meal satiation and satiety in the laboratory setting (17, 18). They have many hyperphagic characteristics, in addition to overeating, that include preoccupation with food (hyperphagic drive), excessive food seeking such as waking up at night to seek food, foraging through trash, stealing and hiding food (hyperphagic behavior), and significant functional impairment and distress when denied food. To address the challenges of requiring intellectually-impaired participants to report their own behaviors, Dykens et al. (13) developed and validated in patients with PWS, a questionnaire that assesses hyperphagic symptoms by asking caregivers to report their observations. Given the convincing data for hyperphagia found in BBS mouse models (8, 9), we hypothesized that, if increased food intake was a cause of obesity in humans with BBS, the caregivers of patients with BBS would report greater hyperphagic symptoms than would caregivers of equally obese non-syndromic controls. We recruited a convenient sample of 13 patients diagnosed with BBS using clinical criteria (19) from among participants in an observational study of the genetic and clinical characteristics of patients with BBS (http://clinicaltrials.gov/ct2/show/NCT00078091). Healthy control subjects (with no known syndrome associated with obesity or major illness affecting appetite) were selected from among participants in studies of eating behavior and metabolism (http://clinicaltrials.gov/ct2/show/NCT00758108, http://clinicaltrials.gov/ct2/show/NCT00631644, and http://clinicaltrials.gov/ct2/show/NCT01237041). The studies were approved by the NICHD or NHGRI IRBs. Participants provided consent/assent for participation. The Hyperphagia Questionnaire (13) is a 13-item questionnaire with 11 items rated on a 5-point Likert scale (from 1= not a problem at all, to 5= extremely problematic) that produce a total hyperphagic score (range 11–55) and three sub-scales: hyperphagic behavior (range 5–25), hyperphagic drive (range 4–20), and hyperphagic severity (range 2–10) (13). Questions 12 and 13 seek information on the age when a child’s interest in food increased and on how much the child’s interest in food changes from day to day. The Hyperphagia Questionnaire was completed by the parent/guardian who spent the most time with the participant. Using analyses of covariance (ANCOVA), we compared Hyperphagia Questionnaire scale scores for BBS vs. the control group, adjusting for age, sex, race, and BMI-Z score. Chi-square test was used to compare the two groups for the additional questions; day-to-day variability in behavior is not reported because of many missing responses in the control group. Characteristics of study subjects are summarized in Table 1. The subjects in the two groups did not differ significantly in sex, age, race, or BMI-Z score, although height was significantly lower among BBS, which might be attributable to slower growth in adolescence (20). Among patients with BBS, genomic sequencing confirmed 1 case had mutations in BBS6, 1 in BBS7, and 6 in BBS10 (data not shown). In unadjusted comparisons, the total hyperphagia score (p=0.005), behavioral subscale (p=0.001), and drive subscale scores (p=0.040) were significantly greater in patients with BBS than controls (Figure 1). After adjustment for age, sex, race, and BMI-Z score, group differences remained significant for total hyperphagia score (p=0.032) and the behavioral subscale (p=0.003). Among those whose caregivers reported an age when they first observed increased interest in food, 91% (10/11) of patients with BBS, versus 42% (5/12) of controls reported increased interest in food before age 5 y (p=0.013). Each of the subscales and total hyperphagia score were highly correlated across the sample (r’s >0.85 for correlations between scores, all p

Objective Eating in the absence of hunger (EAH) typically was assessed by measuring snack intake after consumption of a meal. There were no validated self-report measures of EAH. The relationship of adolescent self-report and parent-reported EAH to adolescents' measured intake in the absence of hunger was examined. Design and Methods Ninety adolescents completed the Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C) to describe eating when not hungry. Parents described children's EAH on a parallel version designed for parents (EAH-P). In a randomized crossover study, adolescent EAH in response to external cues was measured as snack intake after a lunch meal standardized to provide 50% of daily energy requirements and after a large array (>10,000 kcal). Results Parents' reports of children's EAH in response to external cues were associated with greater EAH after both meals, adjusting for body composition, sex, age, race, puberty, and meal intake. Adolescent-reported EAH was unrelated or showed an inverse association with observed EAH. Conclusions Parent-reported EAH showed a positive association with adolescents' observed EAH and may be a useful research and clinical tool for assessing EAH in response to external cues in conditions when laboratory assessments are not feasible.

Appearance-related pressures have been associated with binge eating in previous studies. Yet, it is unclear if these pressures are associated with emotional eating or if specific sources of pressure are differentially associated with emotional eating. We studied the associations between multiple sources of appearance-related pressures, including pressure to be thin and pressure to increase muscularity, and emotional eating in 300 adolescents (Mage=15.3, SD=1.4, 60% female). Controlling for age, race, puberty, body mass index (BMI) z-score, and sex, both pressure to be thin and pressure to be more muscular from same-sex peers were positively associated with emotional eating in response to feeling angry/frustrated and unsettled (ps

The Eating Disorder Examination (EDE) was originally developed and validated in primarily white female samples. Since data indicate that eating pathology impacts black youth, elucidating the psychometric appropriateness of the EDE for black youth is crucial.A convenience sample was assembled from seven pediatric obesity studies. The EDE was administered to all youth. Confirmatory factor analyses (CFA) were conducted to examine the original four-factor model fit and two alternative factor structures for black and white youth. With acceptable fit, multiple-group CFAs were conducted. For measurement invariant structures, the interactive effects of race with sex, BMIz, adiposity, and age were explored (all significance levels p .05).For both black and white youth (N = 820; 41% black; 37% male; 6-18 years; BMIz -3.11 to 3.40), the original four-factor EDE structure and alternative eight-item one-factor structure had mixed fit via CFA. However, a seven-item, three-factor structure reflecting Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction had good fit and held at the level of strict invariance. Girls reported higher factor scores than boys. BMIz and adiposity were positively associated with each subscale. Age was associated with Dietary Restraint and Body Dissatisfaction. The interactional effects between sex, BMIz, and age with race were not significant; however, the interaction between adiposity and race was significant. At higher adiposity, white youth reported greater pathology than black youth.An abbreviated seven-item, three-factor version of the EDE captures eating pathology equivalently across black and white youth. Full psychometric testing of the modified EDE factor structure in black youth is warranted.

Objectives Short sleep duration and daytime sleepiness have been associated with an increased risk for the onset of type 2 diabetes in adults. There has been far less attention to the characterization of sleep in adolescents at-risk for diabetes or to the possible behavioral mechanisms, such as disinhibited eating, through which sleep may affect metabolic functioning. Methods We evaluated the associations of sleep duration and daytime sleepiness with a multi-modal assessment of disinhibited eating in 119 adolescent girls at-risk for type 2 diabetes based upon being overweight/obese and having a family history of diabetes. Girls also endorsed mild-to-moderate depressive symptoms. Adolescents reported sleep duration and daytime sleepiness with the Sleep Habits Survey and Children's Sleep Habits Questionnaire. They were administered a series of successive test meals to measure total energy intake and eating in the absence of hunger (EAH). Adolescent binge eating was assessed with the Eating Disorder Examination interview. Results Accounting for age, race, puberty, body composition, depressive symptoms, and perceived stress, reported sleep duration was positively related to test meal total energy intake (p = 0.04), but not to EAH. Adjusting for the same covariates, daytime sleepiness was associated with a greater odds of objective binge eating in the previous month (p = 0.009). Conclusions In adolescent girls at-risk for type 2 diabetes, reported sleep characteristics are associated with disinhibited eating behaviors that have been linked to excessive weight and adverse metabolic outcomes. Future studies are called for to evaluate these links using objective measures of sleep.

Research suggests that adults who engage in binge eating behaviors tend to report consuming meals and snacks with irregular frequency. In a community sample of women classified as having binge eating disorder (BED), bulimia nervosa, or no eating disorder, individuals with bulimia nervosa consumed fewer meals than both the control and BED groups.1 Notably, this study found that more frequent meal consumption and more frequent dinner consumption were correlated with fewer binge eating episodes among women with BED.1 This finding was replicated in a sample of obese treatment-seeking individuals with BED such that men and women who routinely ate three meals a day reported fewer binge eating episodes than those with irregular meal patterns.2 With regard to snack intake, there are data showing that adults’ consumption of evening snacks is associated with more frequent binge eating episodes.2, 3 Despite these studies in adults, there are no data examining the eating patterns among youth with binge or loss of control (LOC) eating episodes. LOC eating refers to an eating episode during which a subjective experience of being unable to control what or how much is being eaten occurs, regardless of the reported amount of food consumed.4 Although full-syndrome BED is uncommon among youth, infrequent LOC episodes (~1 time per month) are commonly reported and appear to be an indicator of emotional distress.4 LOC eating is associated with adiposity5 and predictive of excess weight gain over time.6 LOC eating also is predictive of the development of partial or full-syndrome BED.7 Thus, elucidating the eating patterns of children who report such episodes may help to guide intervention efforts. We therefore examined the relationship between LOC eating and meal and snack patterns in a convenience sample of adolescents. Based upon the literature in adults with binge eating, we hypothesized that LOC eating would be associated with the reported consumption of irregular meal patterns, such that youth with LOC would be less likely to consume all three meals each day. Furthermore, we hypothesized that youth with LOC eating would report more frequent consumption of afternoon or evening snacks compared to their peers without LOC eating.

Limited data exist regarding the association between binge eating and quality of life (QOL) in obese adolescent girls and boys. We, therefore, studied binge eating and QOL in 158 obese (BMI ≥ 95th percentile) adolescents (14.5 ± 1.4 years, 68.0% female, 59% African-American) prior to weight-loss treatment. Youth completed an interview to assess binge eating and a questionnaire measure of QOL. Controlling for body composition, binge eating youth (n = 35), overall, reported poorer QOL in domains of health, mobility, and self-esteem compared to those without binge eating ( ps < 0.05). Also, girls, overall, reported poorer QOL than boys in activities of daily-living, mobility, self-esteem, and social/interpersonal functioning (ps < 0.05). Girls with binge eating reported the greatest impairments in activities of daily living, mobility, self-esteem, social/interpersonal functioning, and work/school QOL (ps < 0.05). Among treatment-seeking obese adolescents, binge eating appears to be a marker of QOL impairment, especially among girls. Prospective and treatment designs are needed to explore the directional relationship between binge eating and QOL and their impact on weight outcomes.

OBJECTIVE The purpose of this study was to determine whether having childhood depressive symptoms is a risk factor that prospectively predicts impairment in glucose homeostasis. RESEARCH DESIGN AND METHODS A non–treatment-seeking sample of 115 children (aged 5–13 years), oversampled for being at risk for adult obesity, was assessed at baseline and again ~6 years later. Children self-reported depressive symptoms using the Children’s Depression Inventory at baseline. Insulin resistance was assessed at baseline and follow-up with the homeostasis model assessment of insulin resistance index (HOMA-IR). RESULTS Children’s depressive symptoms were a significant predictor of follow-up HOMA-IR, fasting insulin, and fasting glucose in models accounting for baseline HOMA-IR, insulin, or glucose values; sex; race; baseline age; baseline BMI; change in BMI at follow-up; family history of type 2 diabetes; and time in the study (P < 0.01). CONCLUSIONS In this study, depressive symptomatology at baseline predicted the progression of insulin resistance during child and adolescent development independent of changes in BMI. Research is needed to determine whether early intervention to decrease elevated depressive symptoms in youth ameliorates later development of insulin resistance and lessens the risk of type 2 diabetes.

Few studies have examined relationships between parents' and children's specific disinhibited eating behaviors. We investigated links among mothers' and children's binge/loss of control eating, eating in the absence of hunger, and children's adiposity in 305 non-treatment-seeking youth, aged 8-17 years (13.62±2.65 years; 49.8% female) and their mothers. Youths' loss of control eating and eating in the absence of hunger were assessed by interview and self-report questionnaire. Children's adiposity was assessed with BMI-z and air displacement plethysmography. Maternal binge eating, eating in the absence of hunger and highest, non-pregnant BMI were self-reported. In structural equation models controlling for mothers' BMI, mothers' binge eating related to children's loss of control eating, and mothers' eating in the absence of hunger related to children's eating in the absence of hunger. Mothers' binge eating and children's eating in the absence of hunger were unrelated, as were mothers' eating in the absence of hunger and children's loss of control. Further, mothers' binge eating was indirectly related to children's adiposity through children's loss of control eating. Likewise, mothers' eating in the absence of hunger indirectly related to children's adiposity through children's eating in the absence of hunger. Mothers and children share similar, specific disinhibited eating styles.

Background: Eating in the absence of hunger (EAH) is typically assessed by measuring youths’ intake of palatable snack foods after a standard meal designed to reduce hunger. Because energy intake required to reach satiety varies among individuals, a standard meal may not ensure the absence of hunger among participants of all weight strata. Objective: The objective of this study was to compare adolescents’ EAH observed after access to a very large food array with EAH observed after a standardized meal. Design: Seventy-eight adolescents participated in a randomized crossover study during which EAH was measured as intake of palatable snacks after ad libitum access to a very large array of lunchtype foods (.10,000 kcal) and after a lunch meal standardized to provide 50% of the daily estimated energy requirements. Results: The adolescents consumed more energy and reported less hunger after the large-array meal than after the standardized meal (P values , 0.001). They consumed ’70 kcal less EAH after the large-array meal than after the standardized meal (295 6 18 compared with 365 6 20 kcal; P , 0.001), but EAH intakes after the large-array meal and after the standardized meal were positively correlated (P values , 0.001). The body mass index z score and overweight were positively associated with EAH in both paradigms after age, sex, race, pubertal stage, and meal intake were controlled for (P values 0.05). Conclusion: EAH is observable and positively related to body weight regardless of whether youth eat in the absence of hunger from a very large-array meal or from a standardized meal. This trial was registered at clinicaltrials.gov as NCT00631644. Am J Clin Nutr 2010;92:697–703.

Background: Children with rs9939609 FTO variant alleles (homozygous = AA and heterozygous = AT) are predisposed to greater adiposity than are those with 2 wild-type alleles (TT). Objective: Because FTO is highly expressed in hypothalamic regions that are important for appetite, FTO genotype may affect energy balance by influencing eating behavior. Loss of control (LOC) eating, a behavior commonly reported by overweight youth, predicts excessive weight gain in children. However, the relation between FTO genotype and LOC eating has not been previously examined. Design: Two-hundred eighty-nine youth aged 6–19 y were genotyped for rs9939609, underwent body-composition measurements, and were interviewed to determine the presence or absence of LOC eating. A subset (n = 190) participated in a lunch buffet test meal designed to model an LOC eating episode. Subjects with AA and AT genotypes were grouped together for comparison with wild-type TT subjects. Results: Subjects with at least one A allele (67.7%) had significantly greater body mass indexes, body mass index z scores (P < 0.01), and fat mass (P < 0.05). Of the AA/AT subjects, 34.7% reported LOC compared with 18.2% of the TT subjects (P = 0.002). Although total energy intake at the test meal did not differ significantly by genotype (P = 0.61), AA/AT subjects consumed a greater percentage of energy from fat than did the TT subjects (P < 0.01). Conclusions: Children and adolescents with 1 or 2 FTO rs9939609 obesity-risk alleles report more frequent LOC eating episodes and select foods higher in fat at a buffet meal. Both LOC eating and more frequent selection of energy-dense, palatable foods may be mechanisms through which variant FTO alleles lead to excess body weight.

This study examined how parent—adolescent relationship qualities and adolescents’ representations of relationships with parents were related to interactions in 200 adolescent—close friend dyads. Adolescents and friends were observed discussing problems during a series of structured tasks. Negative interactions with mothers were significantly related to adolescents’ greater conflict with friends, poorer focus on tasks, and poorer communication skills. Security of working models (as assessed by interview) was significantly associated with qualities of friendship interactions, whereas security of attachment styles (as assessed by questionnaire) was not. More dismissing (versus secure) working models were associated with poorer focus on problem discussions and weaker communication skills with friends, even after accounting for gender differences and current parent—adolescent relationship qualities.

To examine the relationships between cognitive eating restraint and both bone mineral density (BMD) and markers of bone turnover in overweight adolescents.One hundred thirty-seven overweight (BMI 39.1 +/- 6.8 kg/m(2)) African American and Caucasian adolescent (age = 14.4 +/- 1.4 years) girls (66.4%) and boys were administered the Eating Disorder Examination (EDE) interview and Eating Inventory (EI) questionnaire and underwent dual energy X-ray absorptiometry (DXA) to measure total lumbar spine BMD. Markers of bone formation (serum bone specific alkaline phosphatase and osteocalcin), bone resorption (24-hour urine N-telopeptides), and stress (urine free cortisol) were measured.After accounting for the contribution of demographics, height, weight, serum 25-hydroxyvitamin D, and depressive symptoms, adolescents' weight concern, as assessed by interview, was a significant contributor to the model of urine free cortisol (beta = .30, p.05). Shape concern, as also assessed by interview, was significantly associated with lumbar spine bone mineral density (beta = -.15, p.05). Dietary restraint was not a significant predictor in any of these models.These findings suggest that among severely overweight adolescents, dissatisfaction with shape and weight may be salient stressors. Future research is required to illuminate the relationship between bone health and disordered-eating attitudes in overweight adolescents.

This study examined how same–sex peers influence young women's body image and mood. Eighty female undergraduates were randomly assigned to observe one of two different prearranged conversations between confederates. In one conversation condition, one confederate pressured the other to be thin. In the other conversation condition, one confederate provided positive encouragement to the other about her body image. There was no main effect of condition. Instead, social comparison tendency and appearance orientation moderated the effects of pressure to be thin on body image. Females high on these dimensions were particularly vulnerable to peer pressure to be thin. Similar findings were found with respect to positive and negative emotions. The findings contribute to our understanding of how same–sex peers influence young women's body image and mood.

OBJECTIVE To evaluate whether depressive symptoms predict change in fasting insulin among adolescents followed into young adulthood. We hypothesized that higher depressive symptoms would predict increased insulin and that puberty and race/ethnicity would moderate this relationship. METHODS Data came from the Princeton School District Study, a school-based longitudinal cohort of non-Hispanic black and white adolescents (2001-2011). Depressive symptoms, fasting insulin, and body mass index were measured at baseline (adolescence) and 8 years later (young adulthood) in 685 participants. Puberty was assessed using a validated protocol measuring sex steroids and physical changes. The primary outcome was change in fasting insulin. Analyses accounted for age, sex, race, parental education, baseline insulin, body mass index z score, puberty, and time to follow-up. RESULTS At baseline, depressive symptoms were correlated with insulin (ρ = 0.13, p = .001). High baseline insulin predicted insulin change (B = -11.50, standard error [SE] = 2.30, p < .001). Depressive symptoms also predicted insulin change, but only for pubertal adolescents (B = -0.23, SE = 0.11, p = .038). This relationship was moderated by race (p = .047); depressive symptoms predicted insulin change only among pubertal black adolescents (p = .030), not white (p = .49), and in the direction opposite that hypothesized (Bblacks = -0.51, SE = 0.23). Post hoc analyses revealed that pubertal black adolescents with high depressive symptoms had the highest baseline insulin, which stayed high across the follow-up period. CONCLUSIONS Among pubertal black adolescents, elevated depressive symptoms are associated with increased risk for sustained hyperinsulinemia from adolescence into adulthood. These youths may be particularly vulnerable for Type 2 diabetes.

The purpose of this investigation was to examine the relationship of dispositional mindfulness to binge eating and associated eating attitudes and behaviors among adolescent girls at risk for type 2 diabetes (T2D).Participants were 114 overweight or obese adolescents enrolled in a study of girls with a family history of T2D and mild depressive symptoms. Adolescent self-reports of mindfulness, eating in the absence of hunger, and depressive symptoms were collected. An interview was administered to determine presence of binge eating episodes and a behavioral task was used to assess the reinforcing value of food relative to other nonsnack food rewards. Body composition was assessed using dual-energy X-ray absorptiometry.In analyses accounting for race, percent body fat, lean mass, height, age, and depressive symptoms, dispositional mindfulness was associated with a lower odds of binge eating (p = .002). Controlling for the same potential confounds, mindfulness was also inversely associated with eating concern, eating in the absence of hunger in response to fatigue/boredom, and higher food reinforcement relative to physical activity (all p.05).In girls with a family history of T2D, independent of body composition and depressive symptoms, intraindividual differences in mindfulness are related to binge eating and associated attitudes and behaviors that may confer risk for obesity and metabolic problems. Further research is needed to determine the extent to which mindfulness plays a role in the etiology and/or maintenance of disinhibited eating in adolescents at risk for T2D.

Eating in the absence of hunger (EAH) refers to the consumption of palatable foods in a sated state. It has been proposed that EAH promotes excess weight gain in youth; yet there are limited prospective data to support this hypothesis. We examined whether EAH at baseline predicted increases in body mass (BMI and BMIz) and fat mass (kg) 1 year later among adolescent boys and girls.EAH was assessed as adolescents' consumption of palatable snack foods following eating to satiety from an ad libitum lunch buffet. Parents also completed a questionnaire about their children's EAH. Body composition was assessed using air displacement plethysmography.Of 196 adolescents assessed for EAH at baseline, 163 (83%) were re-evaluated 1 year later. Accounting for covariates, which included respective baseline values for each dependent variable, race, height, age, sex, and pubertal stage, there were no significant associations between baseline observed or parent-reported EAH and change in adolescent BMI, BMIz, or fat mass. Results did not differ by sex, child weight status, or maternal weight status.No evidence was found to support the hypothesis that EAH is a unique endophenotype for adolescent weight or fat gain.

Purpose Preliminary data in adults suggest that binge eating is associated with greater prevalence of metabolic syndrome (MetS) components. However, there are limited data in youth, and little is known of the role of binge episode size in these relationships. Methods We examined the relationship between loss of control eating and metabolic characteristics in a convenience sample of 329 treatment-seeking and non-treatment-seeking adolescent boys and girls. The sample was enriched by design with adolescents who were overweight or obese and with individuals who reported episodes of loss of control over their eating (either objectively large binge episodes, OBEs or subjectively large binge episodes, SBEs, in the past month), as assessed by clinical interview. MetS components (blood pressure, lipids, glucose, and waist circumference) were the primary variables of interest. Results 46% of the cohort reported loss of control eating; among those, 53% reported SBEs only and 47% reported OBEs. Youth with loss of control eating had higher systolic blood pressure ( p = .001) and higher low-density lipoprotein cholesterol (LDL-c) ( p = .002) compared to those without loss of control eating, in analyses adjusted for intervention-seeking status, fat mass and sociodemographic characteristics. Youth reporting OBEs had higher LDL-c ( p = .013) compared to those reporting only SBEs. Conclusions Adolescents reporting loss of control episodes had greater dysfunction in some components of the MetS compared to youth without loss of control; episode size may contribute to metabolic dysfunction.

The interpersonal model of loss of control (LOC) eating proposes that socially distressing situations lead to anxious states that trigger excessive food consumption. Self-reports support these links, but the neurobiological underpinnings of these relationships remain unclear. We therefore examined brain regions associated with anxiety in relation to LOC eating and energy intake in the laboratory. Twenty-two overweight and obese (BMIz: 1.9 ± 0.4) adolescent (15.8 ± 1.6 y) girls with LOC eating (LOC +, n = 10) and without LOC eating (LOC −, n = 12) underwent functional magnetic resonance imaging (fMRI) during a simulated peer interaction chatroom paradigm. Immediately after the fMRI scan, girls consumed lunch ad libitum from a 10,934-kcal laboratory buffet meal with the instruction to “let yourself go and eat as much as you want.” Pre-specified hypotheses regarding activation of five regions of interest were tested. Analysis of fMRI data revealed a significant group by peer feedback interaction in the ventromedial prefrontal cortex (vmPFC), such that LOC + had less activity following peer rejection (vs. acceptance), while LOC − had increased activity (p

We investigated the manifestations of pediatric loss of control (LOC) eating at different stages of pubertal development.Participants were a nonclinical sample of 468 youth (8-17 years). Physical examination determined pubertal stage. LOC eating and disordered eating attitudes were assessed with the Eating Disorder Examination. In a randomized crossover design, a subset (n = 244) ate ad libitum from two test meals designed to capture normal and LOC eating.There were no differences in the prevalence rates or frequency of reported LOC eating episodes across pubertal stages (ps ≥ 0.50). There were, however, puberty by LOC eating interactions in disordered eating attitudes and palatable food consumption (ps ≤ .05), even after adjusting for age and body composition. LOC eating was associated with elevated global disordered eating attitudes, weight concern, and shape concern in post-pubertal youth (ps ≤ .001), but not pre-pubertal youth (ps ≥ .49). In late-puberty, youth with LOC eating consumed less energy from protein (p .001) and more from carbohydrate (p = .003) and snack-type foods (p = .02) than those without LOC eating, whereas endorsement of LOC eating in pre- or early-to-mid-puberty was not associated with differences in eating behavior (ps ≥ 0.20).Findings suggest that puberty may be a critical risk period, when LOC eating behaviors in boys and girls may become accompanied by greater weight and shape concerns and more obesogenic food consumption patterns. Interventions for LOC eating during pre-puberty should be evaluated to determine if they are particularly beneficial for the prevention of exacerbated eating disorder psychopathology and adverse weight outcomes.

Eating in the absence of hunger (EAH) typically was assessed by measuring snack intake after consumption of a meal. There were no validated self-report measures of EAH. The relationship of adolescent self-report and parent-reported EAH to adolescents' measured intake in the absence of hunger was examined.Ninety adolescents completed the Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C) to describe eating when not hungry. Parents described children's EAH on a parallel version designed for parents (EAH-P). In a randomized crossover study, adolescent EAH in response to external cues was measured as snack intake after a lunch meal standardized to provide 50% of daily energy requirements and after a large array (10,000 kcal).Parents' reports of children's EAH in response to external cues were associated with greater EAH after both meals, adjusting for body composition, sex, age, race, puberty, and meal intake. Adolescent-reported EAH was unrelated or showed an inverse association with observed EAH.Parent-reported EAH showed a positive association with adolescents' observed EAH and may be a useful research and clinical tool for assessing EAH in response to external cues in conditions when laboratory assessments are not feasible.

BACKGROUND: Both insufficiency and resistance to the actions of the adipocyte-derived hormone leptin promote hunger, increased food intake and greater body weight. Some studies suggest that adults reporting binge eating have increased serum leptin compared with those without binge eating, even after adjusting for the greater adiposity that characterizes binge eaters. Pediatric binge or loss of control (LOC) eating are prospective risk factors for excessive weight gain and may predict development of metabolic abnormalities, but whether LOC eating is associated with higher leptin among children is unknown. We therefore examined leptin and LOC eating in a pediatric cohort. METHODS: A convenience sample of 506 lean and obese youth (7–18 years) was recruited from Washington, DC and its suburbs. Serum leptin was collected after an overnight fast. Adiposity was measured by dual-energy X-ray absorptiometry or air displacement plethysmography. LOC eating was assessed by interview methodology. RESULTS: Leptin was strongly associated with fat mass (r ¼ 0.79, Po0.001). However, even after adjusting for adiposity and other relevant covariates, youth with LOC eating had higher serum leptin compared with those without LOC episodes (15.42±1.05 vs 12.36±1.04 ng ml � 1 , Po0.001). Neither reported amount of food consumed during a recent LOC episode nor number of LOC episodes in the previous month accounted for differences in leptin (P40.05). The relationship between LOC eating and leptin appeared to be significant for females only (P ¼ 0.002). CONCLUSIONS: Reports of LOC eating were associated with higher fasting leptin in youth, beyond the contributions of body weight. Prospective studies are required to elucidate whether LOC eating promotes greater leptin or whether greater leptin resistance may promote LOC eating.

OBJECTIVE We used latent profile analysis (LPA) to classify children and adolescents into subtypes based on the overlap of disinhibited eating behaviors-eating in the absence of hunger, emotional eating, and subjective and objective binge eating. METHOD Participants were 411 youths (8-18 years) from the community who reported on their disinhibited eating patterns. A subset (n = 223) ate ad libitum from two test meals. RESULTS LPA produced five subtypes that were most prominently distinguished by objective binge eating (OBE; n = 53), subjective binge eating (SBE; n = 59), emotional eating (EE; n = 62), a mix of emotional eating and eating in the absence of hunger (EE-EAH; n = 172), and no disinhibited eating (No-DE; n = 64). Accounting for age, sex, race, and body mass index z score (BMI-z), the four disinhibited eating groups had more problem behaviors than the no disinhibited eating group (p = .001). OBE and SBE subtypes had greater BMI-z, percent fat mass, disordered eating attitudes, and trait anxiety than EE, EE-EAH, and No-DE subtypes (ps < .01). However, the OBE subtype reported the highest eating concern (p < .001), and the OBE, SBE, and EE subtypes reported higher depressive symptoms than the EE-EAH and No-DE subtypes. Across both test meals, OBE and SBE subtypes consumed a lesser percentage of protein and a higher percentage of carbohydrate than the other subtypes (ps < .02), adjusting for age, sex, race, height, lean mass, percent fat mass, and total intake. EE subtypes also consumed a greater percentage of carbohydrate and a lower percentage of fat than the EE-EAH and No-DE subtypes (ps < .03). The SBE subtype consumed the least total calories (p = .01). DISCUSSION We conclude that behavioral subtypes of disinhibited eating may be distinguished by psychological characteristics and objective eating behavior. Prospective data are required to determine whether subtypes predict the onset of eating disorders and obesity.

Parental feeding practices and sociocultural pressures theoretically influence eating behavior. Yet, whether these factors relate to eating in the absence of hunger (EAH) is unknown. We assessed if sociocultural pressures were associated with EAH among 90 adolescents (Mage = 15.27, SD = 1.39; 48% female). Parents completed the Child Feeding Questionnaire. Adolescents completed the Perceived Sociocultural Pressures Scale, Sociocultural Attitudes Towards Appearance Questionnaire-3, and Multidimensional Body Self-Relations Questionnaire-Appearance Scales. On two occasions, EAH was assessed as snack food intake after adolescents ate to satiety. Controlling for body composition and demographics, parental restriction and family pressure to be thin were associated with greater EAH. Media pressure was related to more EAH in girls. Appearance orientation and preoccupation with becoming overweight mediated links between sociocultural pressures and EAH. Findings support the notion that sociocultural pressures and their links to body image may contribute to the course of disinhibited eating behaviors during adolescence.

Binge eating predisposes children to excessive weight gain. However, it is unknown if pediatric binge eating predicts other obesity-associated adverse health outcomes.The objective of this study was to investigate the relationship between binge eating and metabolic syndrome (MetS) in children.Children aged 5-12 years at high risk for adult obesity, either because they were overweight/obese when first examined or because their parents were overweight/obese, were recruited from Washington, DC and its suburbs. Children completed a questionnaire assessment of binge eating at baseline and underwent measurements of MetS components at baseline and at a follow-up visit approximately 5 years later. Magnetic resonance imaging was used to measure the visceral adipose tissue (VAT) in a subset.In all, 180 children were studied between July 1996 and August 2010. Baseline self-reported binge eating presence was associated with a 5.33 greater odds of having MetS at follow-up (95% confidence interval (CI): 1.47, 19.27, P=0.01). The association between binge eating and body mass index (BMI) only partially explained changes in MetS components: baseline binge eating predicted higher follow-up triglycerides, even after accounting for baseline triglycerides, baseline BMI, BMI change, sex, race, baseline age and time in study (P = 0.05). Also, adjusting for baseline VAT and demographics, baseline binge eating predicted greater follow-up L(2-3) VAT (P = 0.01).Children's reports of binge eating predicted development of MetS, worsening triglycerides and increased VAT. The excessive weight gain associated with children's binge eating partly explained its adverse metabolic health outcomes. Reported binge eating may represent an early behavioral marker upon which to focus interventions for obesity and MetS.

Emotional eating, defined as eating in response to a range of negative emotions, is common in youths. Yet, there are few easily administered and well-validated methods to assess emotional eating in pediatric populations. The current study tested the construct validity of the Emotional Eating Scale (EES) Adapted for Children and Adolescents (EES-C) by examining its relationship to observed emotional eating at laboratory test meals. A total of 151 youths (8–18 years) participated in two multi-item lunch buffet meals on separate days. They ate ad libitum after being instructed to ‘eat as much as you would at a normal meal’ or to ‘let yourself go and eat as much as you want’. State negative affect was assessed immediately before each meal. The EES-C was completed 3 months, on average, before the first test meal. Among youths with high EES-C total scores, but not low EES-C scores, higher pre-meal state negative affect was related to greater total energy intake at both meals, with and without the inclusion of age, race, sex and body mass index (BMI) standard deviation as covariates (ps

Loss of control (LOC) eating in youth is associated cross-sectionally with eating-related and psychosocial distress and is predictive of excessive weight gain. However, few longitudinal studies have examined the psychological impact and persistence of pediatric LOC eating. We administered the Eating Disorder Examination and self-reported measures of depressive and anxiety symptoms to 195 boys and girls (mean age = 10.4 years, SD = 1.5) at baseline and again 4.7 years (SD = 1.2) later to 118 of these youth. Missing data were imputed. Baseline report of LOC was associated with the development of partial- or full-syndrome binge eating disorder (p = .03), even after accounting for the contribution of sex, race, baseline characteristics (age, disordered eating attitudes, and mood symptoms), body mass index growth between baseline and follow-up, and years in study. Half (52.2%; 95% CI [1.15, 6.22]) of children who endorsed experiencing LOC at baseline reported persistence of LOC at follow-up (p = .02). Compared with children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes (ps.001) and depressive symptoms (p = .027) over time. These data suggest that LOC eating in children is a problematic behavior that frequently persists into adolescence and that persistent LOC eating is associated with worsening of emotional distress.

The prevalence of pediatric overweight and its health consequences have become increasing public health concerns. This chapter describes disinhibited eating behaviors in youth that might serve to promote overweight. Disinhibited eating is used as an umbrella term to encompass behaviors that involve a lack of healthy restraint over food intake, including binge eating and loss of control (LOC) eating, emotional eating, and eating in the absence of hunger (EAH). Data on the prevalence and correlates of each type of disinhibited behavior are provided, and the similarities and differences among the specific eating behaviors are considered. A brief review of the options for assessment of disinhibited eating in youth is supplied, followed by a consideration of novel pediatric interventions targeting disinhibited eating behavior for the prevention and/or treatment of obesity.

Binge eating, defined as overeating an objectively large amount of food while experiencing a lack of control over what or how much is being eaten, is the core symptom of bulimia nervosa and binge eating disorder (BED).1 Although few children and adolescents meet full DSM-IV-R criteria for bulimia nervosa or the proposed research criteria for BED, the prevalence of binge eating behavior among school and community samples of children and adolescents is high, with estimates ranging from approximately 6% to 40%.2–7 The assessment of binge eating behavior in youth is complicated by difficulty in determining what constitutes an objectively large amount of food in developing children with varying nutritional needs. Thus, a number of research groups have opted to study the experience of loss of control (LOC) over what or how much is being eaten, regardless of the reported episode size. Objective binge eating (OBE) refers to episodes during which individuals report LOC while consuming an objectively, unambiguously large amount of food. Subjective binge eating (SBE) refers to episodes during which individuals perceive excessive consumption with LOC, but the amount consumed is not objectively large.8 Estimates of LOC eating among non-treatment seeking youth are substantial, ranging from approximately 4% to 33%.9–15 The experience of LOC itself, apart from the reported amount of food consumed, appears to be a salient marker of pediatric disordered eating. Studies examining children and adolescents' LOC eating have found that youth who report the presence of at least one episode of SBE or OBE in the month prior to assessment have greater disordered eating cognitions and behaviors as well as greater depressive and anxiety symptoms than those who report no such episodes.10,11,14 Pediatric LOC eating also may be a risk factor for excessive weight gain. Children with LOC are more likely to be overweight and to have greater body fat mass than their counterparts without LOC eating.10,11,14,16 Among 6 to 13 year-old children, those who report at least one episode of LOC in the month prior to assessment have been found to gain an additional 2.4 kg of weight per year over 4–5 years than children who do not report LOC.17 Laboratory observations of children and adolescents' food intake suggest that those with LOC may be susceptible to greater weight gain in part because they consume more energy-dense palatable foods such as desserts and snacks.18 Despite the available evidence supporting the salience of LOC for pediatric binge eating episodes, it is not yet well understood whether the reported size of LOC eating episodes (i.e., SBE versus OBE) is relevant for distinguishing the degree of disordered eating pathology, associated general psychopathology, and risk for higher body fat among youth. Based on current DSM-IV-TR criteria for a binge eating episode,1 it is often an assumption that those who report OBE have more psychopathology than those who only report SBE. However, a number of adult studies suggest that LOC, rather than the episode size distinction, may be most central to identifying psychological disturbance among adults with eating disorders or obesity.19–23 Nevertheless, among youth, weight-loss treatment-seeking, obese adolescents who meet full symptom criteria for BED have greater disordered eating attitudes, more negative mood, and higher anxiety than youth reporting sub-threshold OBE or SBE.24 To our knowledge, only one pediatric study13 has directly compared the associations of SBE and OBE with psychopathology and disordered eating attitudes among children and adolescents. In an obese, treatment-seeking sample, a small subset of youth with SBE (n=15) had eating concern, shape concern, and emotional and external eating scores intermediate between those of youth with OBE (n=20) and those with no LOC eating (n=161).13 Youth with SBE differed significantly from those with OBE or from those reporting no LOC eating only in their frequency of emotional eating.13 Further investigation into whether episode size matters for pediatric LOC eating episodes is thus needed. To our knowledge, no study has directly compared SBE and OBE and their correlates in a non-treatment-seeking sample of children of adolescents that is adequately powered to detect significant differences. Such a comparison is especially warranted. In non-treatment-seeking pediatric populations, youth who report LOC typically report only one recent episode (e.g., once in the past month) and also, only one type of episode (i.e., either OBE or SBE).8 Understanding possible similarities or differences in the psychological and anthropometric characteristics of such youth with OBE versus SBE has potential to inform preventative approaches by possibly identifying those at particular risk for future development of BED or obesity. The objective of the current study was to compare non-treatment-seeking youth with no reported episodes of overeating (NE), objective overeating without a sense of LOC (OO), SBE, and OBE in their body composition, disordered eating attitudes and behaviors, and general psychopathology. Based on the notion that LOC may be the most salient marker of aberrant eating episodes in youth, we hypothesized that youth with either type of LOC eating (SBE or OBE) would have greater body fat, disordered eating, and general psychopathology than youth with NE or OO. Further, we expected that youth with SBE or OBE would have similar scores on measures of body composition, disordered eating, and general psychopathology.

This project examined whether interpersonal pressure to be muscular predicted late adolescents’ pursuit of muscularity. Participants were 199 adolescents (16—19 years), mothers ( n = 175), and friends ( n = 159), assessed at two annual times. Pressure to be muscular was assessed with adolescents’, mothers’, and friends’ reports of their relationships. Adolescents reported pressure from fathers and romantic partners, appearance satisfaction, disordered eating, and pursuit of muscularity. Adolescents’, mothers’, and friends’ reports of pressure related to pursuit of muscularity at both times. Adolescents’ perceptions and mothers’ reports prospectively predicted pursuit of muscularity. Findings highlight the relevance of relationships to pursuit of muscularity in late adolescents.

This study examined how current parent-adolescent relationship qualities and adolescents’ representations of relationships with parents were related to friendship interactions in 200 adolescent-close friend dyads. Adolescents and friends were observed discussing problems during a series of structured tasks. Negative interactions with mothers were significantly related to adolescents’ greater conflict with friends, poorer focus on tasks, and poorer communication skills. Security of working models (as assessed by interview) was significantly associated with qualities of friendship interactions, whereas security of attachment styles (as assessed by questionnaire) was not. More dismissing (vs. secure) working models were associated with poorer focus on problem discussions and weaker communication skills with friends, even after accounting for gender differences and current parent-adolescent relationship qualities. We discuss possible mechanisms for the observed links between dimensions of parent-adolescent relationships and friendships. We also consider methodological and conceptual differences between working model and style measures of attachment representations.

The interpersonal model of binge eating disorder proposes that social problems lead to negative affect which, in turn, precipitates binge eating episodes. However, no study to date has examined this model among youth who report loss of control (LOC) eating. Participants were 219 non-treatment-seeking children and adolescent volunteers, age 8-17 years (13.1 +/- 2.8 y; 50% female). Children's social problems were assessed by parent report. Youth completed self-report questionnaires of negative affect that assessed depressive symptoms and anxiety. Participants were interviewed to determine the presence or absence of LOC eating in the month prior to assessment. Structural equation modeling analyses found that social problems were positively related to LOC eating presence (p = .02). Negative affect mediated the relationship between social problems and LOC eating (95% CI Product = .00247, .01336). These preliminary results suggest that the interpersonal model of binge eating may describe one possible pathway for the development of LOC eating among non-treatment-seeking youth.

Low insulin sensitivity is a major physiological precursor to type 2 diabetes and an important risk factor for the development of cardiovascular disease [1]. One of the primary pathways by which decreased insulin sensitivity develops is through excessive gain of body fat. Overweight youth have decreased insulin sensitivity compared to their non-overweight counterparts, placing them at heightened risk for negative health consequences including type 2 diabetes [2]. However, evidence from adult studies suggests that psychological factors may also affect insulin sensitivity [3–11]. In overweight and non-overweight adults, sub-clinical and clinical threshold depressive symptoms are correlates of, and potential risk factors for, the development of decreased insulin sensitivity [3, 6–10], type 2 diabetes [5, 12, 13], and other aspects of the metabolic syndrome [4, 11]. The degree of psychosocial stress and anxiety symptoms in a large community sample of women also has been shown to be significantly related to measures of insulin sensitivity, even after accounting for body mass index [4]. From a psychophysiological theoretical perspective, depression or anxiety are believed to impact insulin sensitivity through physiological mechanisms such as altered insulin signaling in the brain, pro-inflammatory activation, and/or distress-induced upregulation of counterregulatory hormone systems [14, 15]. In addition, from a behavioral psychology perspective, depression and stress may affect insulin sensitivity, in theory, through their impact on lifestyle factors such as physical inactivity. Given the possible role that adult studies suggest for depression and anxiety in the development of decreased insulin sensitivity, understanding how these factors are linked to glucose homeostasis during adolescence may be important for identifying early risks for potentially adverse health outcomes. Parents’ perceptions of their children’s negative emotionality have been found to be associated with children’s fasting insulin, particularly among boys, in a large study of Finnish youth ages 6 to 18 years [16]. To our knowledge, however, no studies to date have examined the links between depressive or anxiety symptoms and fasting insulin or measures of insulin sensitivity in youth. Adolescence represents an important developmental stage for understanding the links between psychological symptoms and insulin sensitivity. During adolescence, normative endocrine changes associated with puberty produce decreased insulin sensitivity relative to childhood. Moreover, adolescence marks a peak time for the onset of depressive symptoms, particularly among girls. Thus, these marked psychological and biological shifts render adolescence an important developmental stage for understanding how symptoms of depression are associated with insulin sensitivity. We, therefore, investigated whether symptoms of depression and anxiety were associated with insulin sensitivity among adolescents. Based upon prior data, we hypothesized that symptoms of depression and anxiety would be associated with higher fasting insulin and decreased insulin sensitivity. Since previous literature has indicated that sex may act as a moderator of the association between psychological symptoms and insulin sensitivity [9, 16], we expected that sex might interact with depression or anxiety and their association with insulin measures, such that the effects would be stronger for girls than for boys.