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Objectives This study aimed to understand barriers to engagement in healthy lifestyle behaviors among adolescents with comorbid Type 1 diabetes (T1D) and overweight/obesity (n  =   12), their caregivers (n  =   12), and pediatric endocrinologists (n  =   9). Methods Participants (n  =   33) completed individual, semi-structured interviews. Interviews were transcribed verbatim, and applied thematic analysis was used to analyze the interview data. Results Results from adolescents, caregivers, and pediatric endocrinologists revealed three thematic barriers to healthy lifestyle behaviors for adolescents with T1D and overweight/obesity: (1) discomfort with aspects of T1D that draw attention to the self; (2) T1D as a barrier to engagement in healthy lifestyle behaviors; and (3) physiological dysregulation due to T1D impacting health behaviors. Conclusions Results identify perceived limitations to engaging in recommended healthy lifestyle behaviors and diabetes management concurrently. Results may assist research and clinical care in identifying supports and guidance needed to support adolescents in meeting behavioral recommendations for their health. [ABSTRACT FROM AUTHOR]

Background: Emerging adults are underrepresented in standard behavioral weight loss interventions (BWLIs). Offering BWLIs in college health centers may help to address obesity in emerging adulthood by reducing student barriers associated with participation; however, implementation barriers and facilitators for health centers are unknown. Methods: Health services center administrators and providers (n = 14) and students eligible to participate in a BWLI (n = 9, average BMI = 29.8 ± 4.2 kg/m2) participated in semi‐structured interviews. Interviews focused on the need for and appropriateness of BWLIs in health centers and perceived barriers and facilitators to their implementation. Results: Participants generally believed that BWLIs delivered through a health center were appropriate and indicated that BWLIs would be a beneficial offering on‐campus. Facilitators of health center implementation included availability of trained health professionals, intradepartmental relationships, supportive infrastructure and resources, and in‐house planning and execution. Barriers included limited student use and knowledge of health center offerings, narrow referral/recruitment pathways related to stigma concerns, and challenges related to infrastructure, resources, and competing demands. Conclusions: College health centers are a feasible and appropriate setting to offer BWLIs, though barriers to implementation exist. It will be important to construct a plan for implementation to address unique barriers in health centers prior to BWLI implementation. [ABSTRACT FROM AUTHOR]

Pediatric obesity is an ongoing health concern within the United States, with one third of children being classified as overweight or obese (Ogden et al., 2016). Previous research has shown [...], Introduction: Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weight-related behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic. Method: Participants included 258 parents of children aged 6-18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample. Results: Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, [chi square](144) = 278.60, p < .001, comparative fit index = .90, root mean square error of approximation = .05, standardized root mean square residual = .06. Discussion: The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention. Keywords: pediatric obesity, health behaviors, barriers, weight management

Aims: The Diabetes Eating Problems Survey – Revised (DEPS‐R) is commonly used to assess disordered eating behaviour (DEB) in individuals with type 1 diabetes and has advantages compared to other measures not specifically tailored to diabetes. A score ≥20 on the DEPS‐R is used to indicate clinically significant DEB; however, it does not distinguish between eating disorder (ED) phenotypes necessary to guide treatment decisions, limiting clinical utility. Methods: The current study used latent class analysis to identify distinct person‐centred profiles of DEB in adults with type 1 diabetes using the DEPS‐R. Analysis of Variance with Games Howell post‐hoc comparisons was then conducted to examine the correspondence between the profiles and binge eating, insulin restriction and glycaemic control (HbA1c, mean blood glucose, and percent time spent in hyperglycaemia) during 3 days of assessment in a real‐life setting. Results: Latent class analysis indicated a 4‐class solution, with patterns of item endorsement suggesting the following profiles: Bulimia, Binge Eating, Overeating and Low Pathology. Differences in binge eating, insulin restriction and glycaemic control were observed between profiles during 3 days of at‐home assessment. The Bulimia profile was associated with highest HbA1c and 3‐day mean blood glucose. Conclusions: There are common patterns of responses on the DEPS‐R that appear to reflect different ED phenotypes. Profiles based on the DEPS‐R corresponded with behaviour in the real‐life setting as expected and were associated with different glycaemic outcomes. Results may have implications for the use of the DEPS‐R in research and clinical settings. [ABSTRACT FROM AUTHOR]

Adolescence is a vulnerable time for the development of obesity, likely because of poor diet, decreased physical activity, and increased stress during this sensitive developmental period (Jasik & Lustig, 2008). [...], Introduction: Stress has been consistently related to obesity-promoting eating patterns (i.e., emotional, external, and restrained eating) throughout the life span, including during adolescence. One particularly salient source of stress within adolescence is parent-adolescent conflict. The current study sought to examine whether parent-adolescent conflict is a significant predictor of adolescent obesity-promoting eating patterns, beyond general adolescent stress. Methods: A sample of adolescents (N = 51; 39.2% overweight or obese) completed a study examining stress and eating behaviors. As part of the larger study, adolescents completed measures related to parent-adolescent conflict, general adolescent stress, and obesity-promoting eating patterns. Adolescent height and weight were measured objectively and used to calculate adolescent body mass index (BMI) percentile for age and gender. Results: General adolescent stress predicted all three obesity-promoting eating patterns, emotional, external, and restrained eating, controlling for adolescent BMI percentile. Higher levels of parent-adolescent conflict significantly predicted greater restrained eating, controlling for adolescent BMI percentile and general adolescent stress. Conflict did not predict emotional or external eating patterns. Discussion: Adolescents&apos; perceptions of parent-adolescent conflict appear to present a unique source of stress, above and beyond general perceived stress, that is, particularly relevant to the experience of restrained eating patterns. These findings provide support for the potential integration of assessment and intervention for parent-adolescent conflict within previously established behavioral weight control interventions to decrease restrained eating behaviors. Keywords: pediatric obesity, obesity-promoting eating patterns, family conflict, stress

Author(s): Amy J. Fahrenkamp [sup.1] , Katherine E. Darling [sup.1] , Elizabeth B. Ruzicka [sup.1] , Amy F. Sato [sup.1] Author Affiliations: (Aff1) 0000 0001 0656 9343, grid.258518.3, Clinical Psychology, [...], Introduction The prevalence of pediatric obesity is an issue in the United States, in which approximately one-third of children and adolescents are overweight or obese. Youth living in low socioeconomic (SES) households are at an increased risk for developing obesity; yet, research is needed to understand the mechanisms that might better explain the relationship between SES and obesity risk. Maternal depression presents a potential mechanism by which SES might predict a later risk for obesity in pediatric populations. Methods The present study used a national dataset from the National Institute of Child Health and Human Development-Study of Early Child Care and Youth Development (NICHD-SECCYD) to examine whether maternal depressive symptoms (at an age of 9 years) mediated the association between early SES (the income-to-needs ratio measured at an age of 1 month) and adolescent weight outcomes [Body Mass Index z-scores (zBMI) for age and sex, at an age of 15 years]. Results The results suggested that greater maternal depressive symptoms helped to explain a significant amount of the variance of lower SES predicting poorer weight outcomes in adolescents. Discussion These findings illustrate the role of maternal depressive symptoms in explaining how SES predicts adolescent weight outcomes. Implications are discussed, and future research is needed to identify women from lower SES households who are experiencing depressive symptoms to provide support and initiate points of early intervention to address relevant health outcomes in youths.

Body talk among adolescent females has been associated with negative outcomes, including depressed mood, disordered eating, and body dissatisfaction. Yet, little work has investigated the manifestation of body talk in actual conversations between adolescent females or explored pathways through which body talk is spread (e.g., co-rumination). The present study examined body talk among adolescent female dyads (N = 23 dyads) ages 13 to 17 (M age = 15.12) using an observational design. Reciprocally nominated dyads were recruited from a high school in the southeastern United States. Conversations between dyads were qualitatively coded using an applied thematic analysis approach. Identified themes were related to weight, appearance, and personality. Results provide insight into the social context in which sociocultural norms of weight stigma, body dissatisfaction, and eating-related psychopathology may be reinforced. Findings have implications for informing the development of interventions to reduce co-rumination of negative weight- and appearance-related body talk and to promote positive body image and healthy weight among adolescent girls. [ABSTRACT FROM AUTHOR]

Objective: This study sought to (1) examine perceived stress and resources to cope with stress as predictors of emotional eating during the transition to college and (2) determine whether body mass index (BMI) moderated the emotional eating-stress relationship. Participants: Participants were 97 college freshmen (73% female; BMI: M = 25.3 kg/m[superscript 2], SD = 5.7 kg/m[superscript 2]). Research was conducted in September 2012. Methods: Participants completed the Perceived Stress Scale, Emotional Eating Scale, and Eating and Appraisal Due to Emotions and Stress Questionnaire during the first month of college. Height and weight were measured objectively. Results: BMI moderated the relationship between perceived stress and emotional eating. Higher stress predicted greater emotional eating for the lower BMI groups, but not the highest group. Greater resources to cope with stress predicted lower emotional eating. Conclusions: Greater perceived stress and poorer resources to cope with stress may contribute to emotional eating during the transition to college. The relationship between perceived stress and emotional eating may vary by BMI.

A range of barriers may negatively impact adolescents' ability to successfully alter or sustain healthy weight-related behaviors. However, there is a lack of validated measures to empirically assess these barriers. This study developed a measure of adolescent-reported barriers to healthy weight-related behaviors by adapting the previously validated parent-report Barriers to Child Weight Management. Adolescents (N = 154) ages 11–17 presenting to a tertiary weight management program completed Barriers to Weight Management in Adolescence (BWMA). This measure assessed adolescents' perspectives of barriers to healthy weight-related behaviors. Confirmatory factor analysis was used to examine model fit, with four hypothesized subscales—Parental Disengagement, Cost, Lack of Family Support, and Adolescent Disengagement. Overall, good model fit was model demonstrated, χ2 (98) = 130.44, p =.02, CFI =.92, RMSEA =.05, SRMR =.06, supporting a four-factor structure. A final 16-item measure demonstrated good initial psychometric properties. As hypothesized, BWMA was significantly associated with general healthy habits [ r = −.25, 95% CI(-.46, −.12)] and parent-reported barriers [ r =.40, 95% CI (.264,.586)]. This study adapted and tested preliminary validation of a quantitative measure of adolescent-reported barriers to weight-related behaviors. Identification of barriers may prompt providers to adequately assess, and in turn address, factors impeding adolescents' success in modifying eating and physical activity patterns. [ABSTRACT FROM AUTHOR]

Objective: Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth.Methods: A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined.Results: Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma.Conclusions: Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds. [ABSTRACT FROM AUTHOR]

Summary: Controlling child feeding practices (restriction and pressure‐to‐eat) have been theorized to predict increased child weight status. However, mixed evidence has been found for this association within previous narrative reviews. The present study quantitatively examined the association between controlling feeding practices and child weight status and examine potential study‐level and person‐level moderators. PubMed, PsychINFO, and Cochrane databases were utilized. Studies examining the association of controlling child feeding practices and child weight were included. Data from 51 studies, with 17 431 parent‐child dyads, were included. There was a small but significant association between restrictive child feeding practices and child weight (d =.22, 95% CI,.14 to.30). Restriction was significantly associated with higher child weight status. This association was significantly moderated by child age and household income. There was also a significant association between pressure‐to‐eat child feeding practices and child weight (d = −.30, 95% CI, −.38 to −.22). No significant moderators were identified. Pressure‐to‐eat was significantly associated with lower child weight status. There was a high degree of heterogeneity of effects between studies included in analyses. Longitudinal studies are needed to examine the effect of controlling feeding on child weight over time. [ABSTRACT FROM AUTHOR]

The current study examined the association between barriers that primary care providers (PCPs) face in addressing pediatric obesity and current pediatric weight management practices. Seventy-six (77% female) PCPs in a midwestern children's hospital system completed a survey of their current practices for obesity and barriers to addressing pediatric obesity. Regression analysis showed higher levels of barriers were associated with lower levels of current practices (β = -0.39, p = 0.001). Provider preferences of tools (e.g., handouts, trainings) for pediatric weight management are reported. Development of tools to aide intervention for pediatric weight management may be vital to optimal weight management intervention within primary care. [ABSTRACT FROM AUTHOR]

Although literature is mixed, some research suggests that food insecurity likely predicts obesity beginning in childhood. Child feeding practices may be one possible mechanism for this association. Parents of children ages 7-17 (n = 790) completed the USDA Core Food Security Module and the Child Feeding Questionnaire. Child BMI percentile was calculated using parent-reported child height and weight. Restrictive and controlling feeding practices each mediated the association between food insecurity and child BMI percentile, controlling for familial income and child age. Findings from this preliminary study suggest that feeding practices may be one mechanism through which food insecurity is related to obesity. [ABSTRACT FROM AUTHOR]

This study sought to examine whether social support moderates the relationship between stress eating and body mass index (BMI) change over the freshman year in males and females. This longitudinal study included 70 college students (72.9% female; M age = 18.23) who completed self-reported measures of stress eating and perceived social support, with objective height and weight measurements collected. Among males, social support moderated the relationship between stress eating and BMI change. Among males, social support may serve as a buffer against the impact of stress eating on weight gain during the freshman year of college. [ABSTRACT FROM AUTHOR]

Following a biopsychosocial model of food insecurity, this study examined differences in physical health and mental health outcomes among young adults (N = 98) with and without a history of food insecurity. Young adults with a history of food insecurity had higher average levels of body mass index, waist-to-height ratio, depressive symptoms, stress, and disordered eating scores than individuals with no history of food insecurity. No differences were found with symptoms of anxiety. Future research should examine interventions targeted at decreasing negative mental health outcomes and risk for overweight among young adults who have experienced food insecurity. [ABSTRACT FROM AUTHOR]

Adolescents with type 1 diabetes (T1D) have elevated eating disorder risk. No studies have examined weight stigma as a potential factor associated with disordered eating. This study investigated cross-sectional associations among weight-based victimization, weight bias internalization, and disordered eating in adolescents with T1D. Adolescents (12–17 years; N = 166) self-reported experiences of weight-based victimization from peers, family members, and healthcare professionals. The Weight Bias Internalization Scale (WBIS) and Diabetes Eating Problems Survey (DEPS-R) assessed internalized weight bias and disordered eating, respectively. In a series of multiple hierarchical linear regression analyses (controlling for zBMI, diabetes duration, HbA1c, sex), weight bias internalization, weight-based victimization, and frequency of weight-based victimization by peers, family, and healthcare professionals were all positively associated with disordered eating. Weight stigma is an understudied but potentially important factor to address in adolescents with T1D. Reducing weight stigma may be a promising, novel target for eating disorder prevention in this population. [ABSTRACT FROM AUTHOR]