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PURPOSE: To examine the relationships between cognitive eating restraint and both bone mineral density (BMD) and markers of bone turnover in overweight adolescents. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: Eating in response to negative emotions is associated with binge or loss of control (LOC) eating in adults. Although children report engaging in LOC eating, data on emotional eating among youth are limited. METHOD:: We adapted the adult Emotional Eating Scale (Arnow et al., Int J Eat Disord, 18, 79-90, 1995) to be used with children and adolescents (EES-C). Fifty-nine overweight (BMI >/= 95th percentile for age and sex) and 100 non-overweight (BMI 5th-94th percentile) participants (mean age +/- SD 14.3 +/- 2.4 years) completed the EES-C, and measures of recent LOC eating and general psychopathology. Test-retest reliability was assessed in 64 children over a 3.4 +/- 2.6 month interval. RESULTS:: A factor analysis generated three subscales: eating in response to anxiety, anger, and frustration (EES-C-AAF), depressive symptoms (EES-C-DEP), and feeling unsettled (EES-C-UNS). Internal consistency for the subscales was established; Cronbach's alphas for the EES-C-AAF, EES-C-DEP, and EES-C-UNS were 0.95, 0.92, and 0.83, respectively. The EES-C had good convergent validity: children reporting recent LOC eating episodes scored higher on all subscales (p's < 0.05). The EES-C-AAF and EES-C-UNS subscales demonstrated good discriminant validity and the EES-C-DEP revealed adequate discriminant validity. Intra-class correlation coefficients revealed good temporal stability for each subscale (EES-C-AAF = 0.59, EES-C-DEP = 0.74, EES-C-UNS = 0.66; p's < 0.001). CONCLUSION:: The EES-C has good convergent and discriminant validity, and test-retest reliability for assessing emotional eating in children. Further investigation is required to clarify the role emotional eating may play in children's energy intake and body weight. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) is a serious psychiatric illness associated with significant medical and psychiatric comorbidity and impairment. Theoretical models of AN and self-report studies suggest that negative self-evaluation (i.e., low self-esteem) is related to the development and maintenance of AN. The goal of this study was to extend findings from self-report methodology using a neurocognitive task that probes self-evaluation implicitly and explicitly., Method: We compared female adolescent and adult patients with AN (n = 35) and healthy controls (HC, n = 38) on explicit (i.e., endorsement of words as self-relevant), implicit (recall, recognition, reaction time), and composite (i.e., valence index, bias score, drift rates) indices of self-evaluation. We applied a drift-diffusion model to compute the drift rates, reflecting participants' decision-making process as to whether words were self-relevant. The association between self-evaluation indices and eating disorder severity was examined., Results: There were significant Group × Condition interaction effects for all explicit and implicit measures (all p's ≤ .01), where the AN group endorsed, recalled, and recognized more negative relative to positive words than HC. The AN group had more negative valence index and bias scores, and slower drift rate away from negative words, reflecting more negative self-evaluation. The finding for recall was attenuated when individuals with depression were excluded. Measures of self-evaluation bias were not related to eating disorder severity., Discussion: Using a neurocognitive approach that includes explicit and implicit indices of bias, results suggest that patients with AN have more negative self-evaluation. Due to the cross-sectional design, additional studies are needed to further evaluate directionality., Public Significance: Negative self-evaluation/low self-esteem is thought to contribute to eating disorder symptoms. Findings of this study using a neurocognitive task to probe self-evaluation suggested that individuals with anorexia nervosa have more negative self-evaluation, reflected by endorsing and remembering more negative (than positive) words compared to healthy controls, and doing so faster. Targeting the construct of negative self-evaluation in treatment of AN may be warranted., (© 2024 Wiley Periodicals LLC.)

Background: Loss-of-control (LOC) eating commonly develops during adolescence, and it predicts full-syndrome eating disorders and excess weight gain. Although negative emotions and emotion dysregulation are hypothesized to precede and predict LOC eating, they are rarely examined outside the self-report domain. Autonomic indices, including heart rate (HR) and heart rate variability (HRV), may provide information about stress and capacity for emotion regulation in response to stress., Methods: We studied whether autonomic indices predict LOC eating in real-time in adolescents with LOC eating and body mass index (BMI) ⩾70th percentile. Twenty-four adolescents aged 12-18 (67% female; BMI percentile mean ± standard deviation = 92.6 ± 9.4) who reported at least twice-monthly LOC episodes wore biosensors to monitor HR, HRV, and physical activity for 1 week. They reported their degree of LOC after all eating episodes on a visual analog scale (0-100) using a smartphone., Results: Adjusting for physical activity and time of day, higher HR and lower HRV predicted higher self-reported LOC after eating. Parsing between- and within-subjects effects, there was a significant, positive, within-subjects association between pre-meal HR and post-meal LOC rating. However, there was no significant within-subjects effect for HRV, nor were there between-subjects effects for either electrophysiologic variable., Conclusions: Findings suggest that autonomic indices may either be a marker of risk for subsequent LOC eating or contribute to LOC eating. Linking physiological markers with behavior in the natural environment can improve knowledge of illness mechanisms and provide new avenues for intervention.

Purpose: Anorexia nervosa (AN) commonly begins in adolescence; however, detailed knowledge of symptom trajectories, including their temporal sequence, is less well elucidated. The purpose of the present study is to describe the onset and duration of disordered eating behaviors prior to a diagnosis of AN, examine concordance between child and parent report, and examine the relationships between timing of symptom onset and illness severity., Methods: Seventy-one adolescents (ages 12-18 years) and their parents were interviewed about dieting, restriction, loss of control/binge eating, purging, excessive/compulsive exercise, weight history, and amenorrhea. Body mass index percentiles were calculated, and adolescents completed the Eating Disorder Examination-Questionnaire., Results: Restriction, being underweight, dieting, and excessive exercise were reported by most of the sample; purging, loss-of-control eating, and having been overweight were reported by less than a third. Dieting typically emerged first, on average around age 14; the remainder of behaviors tended to emerge between ages 14 and 14½; and average age of formal diagnosis was slightly over 15 years. Dyads had good agreement regarding presence and timing of all behaviors except for dieting, for which children reported about 6 months earlier onset/longer duration, compared to parents. Although older age at interview was associated with lower body mass index percentile and higher EDE-Q score, neither age of onset nor duration was associated with severity when controlling for current age., Discussion: Teens and parents describe a similar sequence of behavior changes leading up to a diagnosis of AN that typically begins with dieting and occurs over an approximate 1- to 1½-year period. Querying teens and parents about eating behavior changes may aid in identification and early intervention in AN; adolescents with normal weight who engage in persistent dieting or restrictive eating may warrant more frequent weight monitoring., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Affective instability is common during adolescence, but at high levels it is associated with a variety of internalizing and externalizing disorders, including eating disorders. Although most models focus on affective intensity as a mechanism for explaining eating disorders in adults, affective instability may be more developmentally relevant at predicting eating behaviors in youth. Using ecological momentary assessment, this manuscript explored the association between loss of control over eating (LOC), a key component of dysregulated eating in youth, and affective instability in youth with overweight/obesity in two separate studies, one with youth in middle childhood and early adolescence (Study 1: ages eight to 13) and one in youth in early through middle adolescence (Study 2: ages 12-17). Overall, there was no association between affective instability and LOC in Study 1, but in Study 2, age moderated the association between positive affective instability and LOC, such that greater between-person positive affective instability (i.e., relative to peers) was associated with lower average LOC for youth earlier in adolescence and higher average LOC for those later in adolescence. Negative affective instability was also associated with LOC in Study 2, such that on days when youth reported less within-person negative affective instability (i.e., relative to their own average), they also reported greater average LOC. Findings across the two studies indicate that the association between affective instability and LOC may not emerge until adolescence, and when it does, both positive and negative affective instability may be important to consider., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The present study was a secondary data analysis of a randomized controlled trial (RCT) to examine changes in depressive symptoms and eating-related cognitions in teens who participated in a nonclinic-based adolescent behavioral weight control treatment delivered by YMCA coaches. Differences in intervention effects were also examined by sex., Methods: Adolescents (N = 66; 13-17 years; 60.6% girls) with overweight (10.6%) or obesity (53.0% with severe obesity) participated in an RCT comparing 2 versions of an evidence-based intervention. Adolescents completed measures of eating-related cognitions (Eating Disorder Examination Questionnaire) and depressive symptoms (Children's Depressive Inventory-2) at baseline and end of active treatment (16 weeks)., Results: There were no significant effects of group, time, or group by time interaction for depressive symptoms, global eating-related cognitions, dietary restraint, or eating concerns (ps > 0.05). Shape concerns (p = 0.04) and weight concerns (p = 0.02) significantly decreased over the intervention. Significant interactions between sex and time on global eating-related cognitions (p < 0.001), eating (p = 0.002), shape (p = 0.02), and weight concerns (p = 0.004) were detected such that female participants' scores decreased over the course of the treatment, but male participants' scores did not., Conclusion: The results demonstrate some positive and no detrimental effects of a nonclinic-based behavioral weight control intervention on adolescents' eating-related cognitions and depressive symptoms. The findings may mitigate concerns that dissemination of structured, nonclinic-based weight management programs for adolescents will produce negative eating and mood outcomes; however, replication of results in larger trials is needed., Competing Interests: Disclosure: E. Jelalian is a consultant for WW. WW has not provided financial support, nor did it have any influence on the methods in this study. All other authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Stress negatively impacts adolescent weight status and eating behaviors. Previous research investigating this association has focused on traumatic events in childhood, but little is known about the impact of commonly experienced stressful life events and weight-related outcome. The aim of this cross-sectional study was to examine the association between negative life events and weight-related outcomes (i.e., weight status, disordered eating behaviors, insulin sensitivity) in a sample of treatment-seeking adolescents with overweight and obesity. A further aim of the study was to examine the potential mediating role of depression., Method: Adolescents (N = 170; M age = 14.8; 62% female) presenting to an interdisciplinary weight management program completed measures related to negative life events, disordered eating patterns, and depressive symptoms prior to initiating treatment. Weight status and insulin sensitivity (using fasting glucose and fasting insulin) were objectively measured., Results: Stressful experiences during childhood were significantly related to weight status, F = 2.78, p < .05, and disordered eating, F = 5.51, p < .001, in regression analyses. Stressful life events were not related to insulin sensitivity. Depressive symptoms mediated the association between stressful experiences and disordered eating (b = 0.001, [CI = 0.0002, 0.0011]). Depressive symptoms did not mediate this association for weight status or insulin sensitivity., Discussion: Findings from the present study suggest that relatively common stressful events may be associated with development of disordered eating patterns in adolescents with overweight or obesity presenting to treatment. Providers working in weight management settings should consider assessing a range of potentially stressful life events and their potential weight-related implications., Competing Interests: Declaration of competing interest Dr. Jelalian is a Consultant for WW. WW has not provided financial support for this study, nor did it have any influence on the methods in this study. All other authors declared no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Peer mentorship has been shown to be helpful for other mental health conditions, but it has been understudied for patients with eating disorders. The goal of the present study was to evaluate the feasibility and efficacy of peer mentorship for individuals with eating disorders by conducting a randomized controlled trial (RCT)., Trial Design: Parallel three-arm pilot RCT with 1:1:1 allocation to peer mentorship, social support mentorship (active comparison intervention), and waiting list., Method: Sixty outpatients with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) were randomly assigned to a condition. Outcome measures, including eating disorder symptoms and general psychopathology, were completed at baseline, mid-, and postintervention., Results: Session attendance and acceptability ratings were higher in peer mentorship than social support mentorship. More participants in social support mentorship (39%) dropped out compared to peer mentorship (5%). In intent-to-treat analysis, peer mentorship showed greater reductions in body dissatisfaction and anxiety compared with both control groups. Compared with social support mentorship, peer mentorship had greater reductions in depression. Compared with waiting list, peer mentorship had greater reduction in binge eating days/week in patients with BN/BED and restriction days/week in patients with AN. Peer mentorship did not impact body mass index or reentry into higher level of care., Discussion: This pilot RCT provides preliminary evidence that peer mentorship is effective for some cognitive and behavioral symptoms of eating disorders as an adjunct to outpatient treatment. Additional studies are needed to evaluate the efficacy of peer mentorship in absence of treatment., (© 2020 Wiley Periodicals, Inc.)

Objective: Genetic variation in the first intron of FTO (e.g., single-nucleotide polymorphism [SNP] rs9939609) is strongly associated with adiposity. This effect is thought to be mediated (at least in part) via increasing caloric intake, although the precise molecular genetic mechanisms are not fully understood. Prior pediatric studies of FTO have included youth with overweight and obesity; however, they have not informed whether a genotypic effect on ingestive behavior is present prior to obesity onset. Therefore, this study investigated the association between FTO and caloric intake in children aged 5 to 10 years without obesity (adiposity ≤ 95th percentile)., Methods: A total of 122 children were genotyped for rs9939609 and ate ad libitum from a laboratory lunch buffet following a standardized breakfast. Linear regressions, adjusting for body mass, were used to examine the association between FTO "dose" (number of copies of SNP rs9939609) and intake variables., Results: There was a significant association between FTO and total intake. Each risk allele predicted an additional 64 calories, accounting for 3% of the variance. There were no associations between FTO and macronutrient preference, energy density, or diet variety. Results were influenced by race., Conclusions: Results corroborate and extend prior work by showing a dose-dependent effect on food intake in children without obesity., (© 2019 The Obesity Society.)

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., (© 2017 Wiley Periodicals, Inc.)

Objective: To examine the associations among self-reported loss-of-control (LOC) eating, emotion dysregulation, body mass, and objective energy intake among youth. Emotion dysregulation may be 1 individual factor that promotes excess energy intake and increases in body mass among youth with LOC eating., Method: Children and adolescents (N = 230; 8 to 17 years) enrolled in a nonintervention study completed a structured interview to determine the presence or absence of self-reported LOC eating. Children's emotion dysregulation was assessed via parent-report with the Child Behavior Checklist. Youth also completed 2 test meals to capture "binge" and "normal" eating. Body composition was examined using air displacement plethysmography., Results: After controlling for relevant covariates, youth with self-reported LOC eating had higher parent-reported emotion dysregulation than those without LOC. Parent-reported emotion dysregulation was also associated with greater observed energy intake (after accounting for body mass), as well as higher fat mass. Emotion dysregulation also moderated associations between LOC status/gender and body mass variables; among youth with self-reported LOC eating and girls, those with high parent-described emotion dysregulation (vs. low) had significantly higher fat mass and BMIz., Conclusions: Data from the current study suggest that emotion dysregulation may play a role in energy intake and obesity, particularly among youth with self-reported LOC eating and girls. Additional studies are needed to identify the prospective mechanisms linking poor emotion regulation and LOC eating. These mechanisms, in turn, may inform future interventions targeting excess energy intake and obesity in pediatric samples. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Objective: Studying physiologic underpinnings of loss-of-control (LOC) eating may inform its etiology and contribute to intervention efforts. We therefore examined temporal relationships between autonomic indices [heart rate (HR), heart rate variability (HRV)] and LOC-eating in the natural environment., Method: For two days, adolescents (n = 17, 14.77 ± 1.55 years, BMI-Z 2.17 ± 0.48) with LOC-eating reported on LOC using an electronic device while HR and HRV were assessed continuously using Holter monitoring., Results: Higher HR and lower HRV in the 30-minutes before eating were significantly associated with LOC-eating overall (p's < 0.001) and at the within-participants level (p's < 0.001), but not at the between-participants level (p's > 0.44). Examined categorically, HR was significantly higher, and HRV significantly lower, prior to high-LOC compared to low-LOC episodes (p's < 0.001)., Discussion: This pilot study suggests that LOC-eating may involve physiologic underpinnings. Additional research with larger samples is needed to further investigate this phenomenon., (© 2015 Wiley Periodicals, Inc.)

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., (Published by Elsevier Ltd.)

Objective: Pediatric loss of control (LOC) eating is predictive of partial- and full-syndrome binge eating disorder. The interpersonal model proposes that LOC eating is used to cope with negative mood states resulting from interpersonal distress, possibly on a momentary level. We therefore examined temporal associations between interpersonal problems, negative affect, and LOC eating among overweight adolescent girls using ecological momentary assessment (EMA)., Method: Thirty overweight and obese (≥85th body mass index (BMI) percentile; BMI: M = 36.13, SD = 7.49 kg/m(2)) adolescent females (Age: M = 14.92, SD = 1.54 y; 60.0% African American) who reported at least two LOC episodes in the past month completed self-report momentary ratings of interpersonal problems, state affect, and LOC eating for 2 weeks. A series of 2-level multilevel models with centering within subjects was conducted., Results: Between- and within-subjects interpersonal problems (p's < .05), but not between- (p = .12) or within- (p = .32) subjects negative affect predicted momentary LOC eating. At the between-subjects level, interpersonal problems significantly predicted increases in negative affect (p < 001)., Discussion: Naturalistic data lend support to the predictive value of interpersonal problems for LOC eating among adolescents. Interventions targeting interpersonal factors on a momentary basis may be useful during this developmental stage., (© 2014 Wiley Periodicals, Inc.)

Objective: We investigated the manifestations of pediatric loss of control (LOC) eating at different stages of pubertal development., Method: 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., Results: 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)., Conclusions: 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., (© 2014 Wiley Periodicals, Inc.)

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 NCT00680979., (© 2014 American Society for Nutrition.)

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., (© 2013.)

Loss of control eating confers risk for excess weight gain and exacerbated disordered eating. Affect theory proposes that loss of control eating is used to cope with negative mood states. Self-report data suggest that negative affect may contribute to the etiology of loss of control eating, but this theory has not been well-tested using laboratory paradigms. We examined associations between pre-meal affective states and intake during a laboratory test meal. One-hundred and ten adolescent girls with reported loss of control eating whose body mass index fell between the 75th and 97th percentile for age and sex completed state mood ratings prior to a test-meal. Results indicated that pre-meal state negative affect was associated with greater carbohydrate and less protein consumption, as well as greater snack and dessert and less fruit and dairy intake. All girls experienced significant decreases in negative affect from pre- to post-meal, but intake during the meal was unassociated with post-meal affect. In support of affect theory, negative affective states reported among girls with loss of control may be a driving factor for increased energy-dense food intake, which may play a role in excess weight gain., (Published by Elsevier Ltd.)

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.

Background: 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., Objective: 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., Method: 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., Results: 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<0.03)., Discussion: The EES-C demonstrates good construct validity for children and adolescents' observed energy intake across laboratory test meals designed to capture both normal and disinhibited eating. Future research is required to evaluate the construct validity of the EES-C in the natural environment and the predictive validity of the EES-C longitudinally.

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.

Episodes of loss of control over eating (LOC) in children and adolescents--often characterized by the consumption of highly palatable dessert and snack-type foods--have been associated with a lack of awareness while eating that could lead to under- or over-estimation of how much food is consumed. However, little is known about the reporting accuracy of food intake in youth with and without LOC eating. One hundred fifty-six girls and boys were administered the Eating Disorder Examination to assess for the presence of LOC eating. Youth were queried regarding the amounts of foods consumed directly following a multi-item, laboratory buffet test meal. Children with LOC (n=42) did not differ significantly from youth without LOC (n=114) in reporting accuracy of total food intake (reported minus actual energy intake: 153.0 ± 59.6 vs. 96.9 ± 36.0 kcal; p=0.42). However, compared to those without LOC, children with LOC were less accurate at reporting percentage of energy intake from carbohydrate (p=0.01). Youth with LOC were also less accurate at reporting their intake of desserts (p=0.04). Findings point to the possibility that youth with LOC may have poorer recall of sweet food consumption. Future research is required to examine whether poorer recall reflects a lack of awareness while eating palatable, sweet foods., (Copyright © 2010. Published by Elsevier Ltd.)

Objective: The subjective experience of loss of control (LOC) during eating, independent of overeating, may be a salient marker of disordered eating and risk for overweight in youth. However, few studies have directly tested this notion in an adequately powered sample., Method: Three-hundred-sixty-seven youth (M ± SD age = 12.7 ± 2.8 y) were categorized as reporting objective binge eating (OBE; 12.5%), subjective binge eating (SBE; 11.4%), objective overeating without LOC (OO; 18.5%), or no episodes (NE; 57.5%). Disordered eating attitudes, general psychopathology, and adiposity were assessed., Results: Children with OBE and SBE generally did not differ in their disordered eating attitudes, emotional eating, eating in the absence of hunger, depressive and anxiety symptoms, or adiposity. However, both OBE and SBE youth had significantly greater disordered eating attitudes, emotional eating, eating in the absence of hunger, depressive and anxiety symptoms, and adiposity compared to those with OO or NE (ps < .05)., Discussion: For non-treatment-seeking youth, LOC during eating episodes, rather than episode size, appears to be the most salient marker of eating and weight problems., (© 2009 by Wiley Periodicals, Inc.)

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., (Published by Elsevier Ltd.)

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.

Aim: Maximal oxygen uptake (VO(2max)), the gold standard for measurement of cardiorespiratory fitness, is frequently difficult to assess in overweight individuals due to physical limitations. Reactance and resistance measures obtained from bioelectrical impedance analysis (BIA) have been suggested as easily obtainable predictors of cardiorespiratory fitness, but the accuracy with which ht(2)/Z can predict VO(2max) has not previously been examined in overweight adolescents., Methods: The impedance index was used as a predictor of VO(2max) in 87 overweight girls and 47 overweight boys ages 12 to 17 with mean BMI of 38.6 + or - 7.3 and 42.5 + or - 8.2 in girls and boys respectively. The Bland Altman procedure assessed agreement between predicted and actual VO(2max)., Results: Predicted VO(2max) was significantly correlated with measured VO(2max) (r(2)=0.48, P<0.0001). Using the Bland Altman procedure, there was significant magnitude bias (r(2)=0.10; P<0.002). The limits of agreement for predicted relative to actual VO(2max) were -589 to 574 mL O(2)/min., Conclusions: The impedance index was highly correlated with VO(2max) in overweight adolescents. However, using BIA data to predict maximal oxygen uptake over-predicted VO(2max) at low levels of oxygen consumption and under-predicted VO(2max) at high levels of oxygen consumption. This magnitude bias, along with the large limits of agreement of BIA-derived predicted VO(2max), limit its usefulness in the clinical setting for overweight adolescents.

Background: Eating in the absence of hunger (EAH), studied in the context of laboratory paradigms, has been associated with obesity and is predictive of excess weight gain in children. However, no easily administered questionnaire exists to assess for EAH in children., Objective: We developed an Eating in the Absence of Hunger Questionnaire to be administered to children and adolescents (EAH-C) and examined psychometric properties of the measure., Design: Two-hundred and twenty-six obese (BMI > or = 95th percentile for age and sex, n=73) and non-obese (BMI<95th percentile, n=153) youth (mean age+/-S.D., 14.4+/-2.5 y) completed the EAH-C and measures of loss of control and emotional eating, and general psychopathology. Temporal stability was assessed in a subset of participants., Results: Factor analysis generated three subscales for the EAH-C: Negative Affect, External Eating, and Fatigue/Boredom. Internal consistency for all subscales was established (Cronbach's alphas: 0.80-0.88). The EAH-C subscales had good convergent validity with emotional eating and loss of control episodes (p's<0.01). Obese children reported higher Negative Affect subscale scores than non-obese children (p

Background: In school-based samples of children, the Children's Eating Attitudes Test (ChEAT) has a four-factor structure; however, previous studies have not examined its factor structure in samples restricted to overweight youth., Methods: The ChEAT was administered to 220 overweight (BMI>or=95th percentile) and 45 at-risk for overweight (BMI 85th-<95th percentile) children and adolescents. Factors were identified by a principal component analysis with varimax rotation. ChEAT factor scores of children with BMI>or=85th percentile were contrasted with those of 152 non-overweight (BMI 5th to <85th percentile) children and adolescents., Results: Factor analysis generated four subscales described as 'body/weight concern,' 'food preoccupation,' 'dieting,' and 'eating concern.' ChEAT total score, body/weight concern, and dieting subscale scores were positively related to BMI-Z and body fat mass (p's<.05). Compared to non-overweight children, overweight and at-risk for overweight children had higher ChEAT total (9.9+/-7.4 vs. 6.6+/-7.8, p<.001), body/weight concern (3.2+/-3.1 vs. 1.3+/-3.0, p<.001), and dieting (1.8+/-2.2 vs. .8+/-2.3, p<.001) subscale scores., Conclusions: The previously elucidated factor structure of the ChEAT was primarily supported in a sample of overweight children. The emergence of separate body/weight concern and dieting subscales may relate to these children's experiences with attempted weight reduction.

Purpose: Peak oxygen uptake (VO2peak) is frequently difficult to assess in overweight individuals; therefore, submaximal measures that predict VO2peak are proposed as substitutes. Oxygen uptake efficiency slope (OUES) has been suggested as a submaximal measurement of cardiorespiratory fitness that is independent of exercise intensity. There are few data examining its value as a predictor of V O2peak in severely overweight adolescents., Methods: One hundred seven severely overweight (BMI Z 2.50 +/- 0.34) and 43 nonoverweight (BMI Z 0.13 +/- 0.84) adolescents, performed a maximal cycle ergometer test with respiratory gas-exchange measurements. OUES was calculated through three exercise intensities: lactate inflection point (OUES LI), 150% of lactate inflection point (OUES 150), and VO2peak (OUES PEAK)., Results: When adjusted for lean body mass, VO2peak and OUES at all exercise intensities were lower in overweight subjects (VO2peak: 35.3 +/- 6.4 vs 46.8 +/- 7.9 mL.kg(-1) LBM.min(-1), P < 0.001; OUES LI: 37.9 +/- 10.0 vs 43.7 +/- 9.2 mL.kg(-1) LBM.min(-1).logL(-1) P < 0.001; OUES 150: 41.6 +/- 9.0 vs 49.8 +/- 11.1 mL.kg(-1) LBM.min(-1).logL(-1) P < 0.001; and OUES PEAK: 45.1 +/- 8.7 vs 52.8 +/- 9.6 mL.kg(-1) LBM.min(-1).logL(-1) P < 0.001). There was a significant increase in OUES with increasing exercise intensity in both groups (P < 0.001). OUES at all exercise intensities was a significant predictor of VO2peak for both groups (r2 = 0.35-0.83, P < 0.0001). However, limits of agreement for predicted VO2peak relative to actual VO2peak were wide (+/- 478 to +/- 670 mL.min(-1))., Conclusions: OUES differs significantly in overweight and nonoverweight adolescents. The wide interindividual variation and the exercise intensity dependence of OUES preclude its use in clinical practice as a predictor of VO2peak.

Binge and loss of control (LOC) eating appear to be common among youth; however, little is known about the foods consumed during such eating episodes. Two-hundred forty-nine children, age 6-18 years, were interviewed to determine if they engaged in eating episodes with LOC over the past month. In the absence of reported LOC eating, overeating episodes or normal meals without LOC were recorded. Participants were asked to describe the type and quantity of foods eaten during an episode. Eighty-one children reported LOC eating episodes and 168 reported no such episodes (No LOC). Although total energy intake did not differ between LOC and No LOC episodes, LOC episodes consisted of a lower percentage of calories from protein (14.2+/-0.7 v. 18.0+/-0.7%, p<.001) and a higher percentage from carbohydrates (49.8+/-1.6 v. 45.2+/-1.1%, p<.05). Specifically, LOC episodes consisted of a higher percentage of calories from snacks (13.2+/-2.7 v. 7.4+/-1.2%, p<.05) and desserts (18.1+/-3.1 v. 12.8+/-1.5%, p<.05). The quality of LOC episodes may help explain why LOC eating promotes excessive weight gain among children who report such episodes.

Objective: To examine the frequency and recency of binge eating in relation to psychopathology in overweight, treatment-seeking adolescents., Methods: We investigated psychological correlates of the frequency and recency of reported loss of control (LOC) eating episodes in 160 overweight (body mass index [BMI]: 40.7 +/- 8.8 kg/m(2)) adolescents. On the basis of the responses to the eating disorder examination (EDE), participants were categorized into one of four groups: full-syndrome binge eating disorder (BED); recent but infrequent binge eating (episodes within the 3 months before interview; RECENT-BINGE); remote and infrequent LOC eating (episodes occurring >3 months before assessment; PAST-LOC), or no history of LOC episodes (NE)., Results: The BED group reported higher EDE scores (global, p < .01), and more negative mood and anxiety than all other groups (p's < .01). Compared with NE, RECENT-BINGE also reported more anxiety and higher EDE scores (p's < .01)., Conclusions: Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.

Objective: Little is known about whether children or their parents can accurately recall the age at which they became overweight. DESIGN, SUBJECTS AND MAIN OUTCOME MEASURES: We interviewed 64 overweight children (7-18 years old) about their weight history and compared reported age of overweight onset with actual onset, as determined by the age at which the child's measured BMI first exceeded the 95th percentile., Results: Only 28% of children reported overweight onset within 1 year of actual overweight onset. Reported overweight onset age (7.6 +/- 2.5 y) and actual onset age (5.3 +/- 2.5 y; P < .001) were not significantly correlated (r2 = .03, P = .22). Children who became overweight before 8 years of age tended to report becoming overweight at a later age than actual onset, whereas children who became overweight after 8 years of age tended to report becoming overweight at an earlier age than actual onset (P < .001), with 27% of children either underreporting or overreporting their overweight onset by at least 5 years. Similar results were found when analyzing parent reports of their children's overweight onset., Conclusions: Reported and actual overweight onset ages were uncorrelated in our sample, suggesting that families may not be cognizant of children's growth trajectories. Greater efforts should be made to help parents and children understand and track growth patterns with the aim of preventing excessive weight gain.