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The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

Background: This study explores the impact of weight gain during medical stabilization hospitalization on weight outcomes between three outpatient treatments for adolescent anorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy (SyFT), and Family Based Treatment (FBT). Methods: A secondary analysis of weight gain data (N = 215) of adolescents (12-18 years) meeting DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated in two randomized clinical trials (RCTs) was conducted. Main outcomes examined were changes in weight restoration (≥95% expected body weight or EBW) and differences in weight change attributable to hospital weight gain. Results: Weight gain resulting from hospitalizations did not substantially change weight recovery rates. Hospital weight gain contributed most to overall treatment weight gain in AFT compared to FBT and SyFT. Conclusion: Brief medical stabilization weight gain does not contribute substantially to weight recovery in adolescents with AN who participated in RCTs.

ObjectiveThis exploratory study is the first to examine family-based treatment (FBT) adherence and association to treatment outcome in the context of a large-scale, multi-centre study for the treatment of adolescents with anorexia nervosa.MethodOne hundred and ninety recorded FBT sessions from 68 adolescents with anorexia nervosa and their families were recruited across multiple sites (N = 6). Each site provided 1-4 tapes per family over four treatment time points, and each was independently rated for therapist adherence.ResultsThere were differences in adherence scores within and between sites. ANOVA produced a main effect for site, F(5, 46) = 8.6, p

ObjectiveThe purpose of this study is to evaluate whether children with overweight or obesity participating in an evidence-based treatment, family-based behavioral treatment (FBT) for obesity, or a parent-only variant of FBT (PBT), experience an increase of eating disorder (ED) symptoms during and following treatment.MethodChildren (N = 150) participating in a randomized controlled trial of FBT or PBT completed measures of EDs attitudes and behaviors at baseline, following 6-months of treatment, 6 months, and 18 months after treatment.ResultsLinear-mixed effects models suggest that ED attitudes did not significantly increase. Rather, significant decreases of shape, weight, and eating concerns were shown following treatment. Loss of control over eating significantly decreased over treatment and follow-up. No participant endorsed purging at any time point.DiscussionResults confirm the hypothesis that ED symptoms do not increase after participating in FBT or a FBT-based treatment. These findings should help assuage fears of parents that enrolling their child will exacerbate ED symptoms and aid children to access evidence-based treatments that may help reduce significant physical and psychosocial complications of childhood obesity.

Objective: This study examined the associations between insomnia, anxiety, and depression in college women with eating disorders (EDs). Participants: Six hundred and ninety women from 28 US colleges who screened positive for an ED were assessed for psychiatric comorbidities. Women were, on average, 22.12 years old, mostly White (60.1%) and undergraduates (74.3%). Methods: Two mediation models were tested to determine if depression and/or anxiety mediated the relationship between insomnia and ED symptomatology. Results: One-fifth of the sample (21.7%) reported clinically moderate and severe levels of insomnia. Both depression (B = 0.13, p < 0.001) and anxiety (B = 0.13, p < 0.001) significantly mediated the relationship between insomnia and ED psychopathology. Conclusions: Insomnia is relatively common in college-age women with EDs. Findings suggest that this association between ED and sleep disturbances can be explained, in part, by changes in depression and anxiety. Clinicians should consider incorporating mental health assessments for insomnia, depression, and anxiety into current ED prevention, intervention, and screening efforts on college campuses.

ImportanceFamily-based weight loss treatment (FBT) is considered the gold-standard treatment for childhood obesity and is provided to the parent and child. However, parent-based treatment (PBT), which is provided to the parent without the child, could be similarly effective and easier to disseminate.ObjectiveTo determine whether PBT is similarly effective as FBT on child weight loss over 24 months. Secondary aims evaluated the effect of these 2 treatments on parent weight loss, child and parent dietary intake, child and parent physical activity, parenting style, and parent feeding behaviors.Design, setting, and participantsRandomized 2-arm noninferiority trial conducted at an academic medical center, University of California, San Diego, between July 2011 and July 2015. Participants included 150 overweight and obese 8- to 12-year-old children and their parents.InterventionsBoth PBT and FBT were delivered in 20 one-hour group meetings with 30-minute individualized behavioral coaching sessions over 6 months. Treatments were similar in content; the only difference was the attendance of the child.Main outcomes and measuresThe primary outcome measure was child weight loss (body mass index [BMI] and BMI z score) at 6, 12, and 18 months post treatment. Secondary outcomes were parent weight loss (BMI), child and parent energy intake, child and parent physical activity (moderate to vigorous physical activity minutes), parenting style, and parent feeding behaviors.ResultsOne hundred fifty children (mean BMI, 26.4; mean BMI z score, 2.0; mean age, 10.4 years; 66.4% girls) and their parent (mean BMI, 31.9; mean age, 42.9 years; 87.3% women; and 31% Hispanic, 49% non-Hispanic white, and 20% other race/ethnicity) were randomly assigned to either FBT or PBT. Child weight loss after 6 months was -0.25 BMI z scores in both PBT and FBT. Intention-to-treat analysis using mixed linear models showed that PBT was noninferior to FBT on all outcomes at 6-, 12-, and 18-month follow-up with a mean difference in child weight loss of 0.001 (95% CI, -0.06 to 0.06).Conclusions and relevanceParent-based treatment was as effective on child weight loss and several secondary outcomes (parent weight loss, parent and child energy intake, and parent and child physical activity). Parent-based treatment is a viable model to provide weight loss treatment to children.Trial registrationClinicaltrials.gov Identifier: NCT01197443.

PurposeSecretive eating, characterized by eating privately to conceal being seen, may reflect eating- and/or body-related shame, be associated with depression, and correlate with binge eating, which predicts weight gain and eating disorder onset. Increasing understanding of secretive eating in youth may improve weight status and reduce eating disorder risk. This study evaluated the prevalence and correlates of secretive eating in youth with overweight or obesity.MethodsYouth (N = 577) presented to five research/clinical institutions. Using a cross-sectional design, secretive eating was evaluated in relation to eating-related and general psychopathology via linear and logistic regression analyses.ResultsSecretive eating was endorsed by 111 youth, who were, on average, older than youth who denied secretive eating (mean age = 12.07 ± 2.83 versus 10.97 ± 2.31). Controlling for study site and age, youth who endorsed secretive eating had higher eating-related psychopathology and were more likely to endorse loss of control eating and purging than their counterparts who did not endorse secretive eating. Groups did not differ in excessive exercise or behavioral problems. Dietary restraint and purging were elevated among adolescents (≥13y) but not children (

While there have been important recent advances in the development of effective universal prevention and intervention programs, it is not yet clear how to engage large numbers of students in these programs. In this paper, we report findings from a two-phase pilot study. In the first phase, we used a population-level, online survey to assess eating disorder symptom level and habits/attitudes related to service utilization (N=2180). Using validated screening tools, we found that roughly one in three students has significant symptoms of eating disorders or elevated weight concerns, the vast majority of whom (86.5%) have not received treatment. In the second phase, we referred students to online prevention and selective/indicated intervention programs based on symptom classification (N=1916). We find that program enrollment is highest for students in the indicated intervention (18.1%) and lowest for students in the universal prevention (4.1%). We find that traditionally-emphasized barriers such as stigma, misinformation, and financial limitations do not appear to be the most important factors preventing treatment-seeking. Rather students report not seeking help for reasons such as lack of time, lack of perceived need, and a desire to deal with the issue "on my own." Findings offer insight into the treatment-seeking habits and attitudes of college students, including those barriers that may be overcome by offering online programs and those that persist despite increased access to and convenience of relevant resources.

Childhood obesity is a pressing public health concern, with one in three children in the United States classified as having overweight or obesity (Skinner et al., 2018). Obesity rates are [...], Introduction: Minority and low-income children are underrepresented in school-based weight management programs despite higher risk of obesity and the external contexts that influence their success are largely unknown. This study examines predictors of weight outcomes following the socioecological model in a school-based weight management intervention implemented in an elementary school serving primarily lowincome, Black youth. Methods: Children (n = 145; ages 4-9) participated in an 8-month school-based weight management intervention that included components to increase physical activity, promote healthy eating, and engage parents. Children had height and weight measured at baseline and postprogram and parents completed questionnaires at baseline. Socioecological predictors (e.g., child demographic, parent beliefs and attitudes, family and home environment, and social contexts of the family) of zBMI change were assessed using linear regressions. Results: Weight change over the program differed by baseline weight status such that children with obesity lost weight, while children of healthy weight and with overweight gained weight. Children who were younger and had healthier family food choices at baseline were better able to maintain their weight, whereas children from food insecure families gained weight. Discussion: Children of different weight categories from low-income families vary in their response to universally delivered school-based weight management programs. Future work should consider how to address needs of children from different weight classes as well as to effectively target children with risk factors for excessive weight gain (e.g., older, food insecure, less healthful food choices), which may involve broader or more integrative approaches. Public Significance Statement This study shows elementary school children may respond differently to universallydelivered school-based weight management interventions based on different child and family characteristics. Tailoring school-based interventions based on child weight status, child age, household food insecurity, and family food choices may help to make school-based weight management interventions more effective for all children. Keywords: school-based program, weight management, children, food insecurity

Background: Internalized weight stigma (IWS) is highly prevalent and associated with deleterious mental and physical health outcomes. Initiatives are needed to address IWS and promote effective coping and resilience among individuals who are exposed to weight stigma. We conducted a systematic scoping review of the literature on psychological interventions for IWS and explored their intervention components, feasibility, acceptability, and preliminary efficacy at reducing IWS and related negative physiological and psychological health outcomes. Methods: Eight databases were searched. Inclusion criteria included: (1) Psychological intervention; (2) Published in English; and (3) Included IWS as an outcome. Exclusion criteria included: (1) Commentary or review; and (2) Not a psychological intervention. A narrative review framework was used to synthesize results. Results: Of 161 articles screened, 20 were included. Included interventions demonstrated high feasibility, acceptability, and engagement overall. Sixteen of 20 included studies observed significant reductions in IWS that were maintained over follow-up periods, yet data on whether interventions produced greater reductions than control conditions were mixed. Studies observed significant improvements in numerous physical and mental health outcomes. Conclusions: Findings suggest that existing interventions are feasible, acceptable, and may provide meaningful improvements in IWS and associated health outcomes, highlighting the potential for psychological interventions to promote improved health and wellbeing in individuals with IWS. High-quality studies using rigorous study designs (e.g., randomized controlled trials) are needed to further evaluate the efficacy of interventions for IWS. [ABSTRACT FROM AUTHOR]

Objective: Few individuals with eating disorders (EDs) receive treatment. Innovations are needed to identify individuals with EDs and address care barriers. We developed a chatbot for promoting services uptake that could be paired with online screening. However, it is not yet known which components drive effects. This study estimated individual and combined contributions of four chatbot components on mental health services use (primary), chatbot helpfulness, and attitudes toward changing eating/shape/weight concerns ("change attitudes," with higher scores indicating greater importance/readiness). Method s : Two hundred five individuals screening with an ED but not in treatment were randomized in an optimization randomized controlled trial to receive up to four chatbot components: psychoeducation, motivational interviewing, personalized service recommendations, and repeated administration (follow‐up check‐ins/reminders). Assessments were at baseline and 2, 6, and 14 weeks. Results: Participants who received repeated administration were more likely to report mental health services use, with no significant effects of other components on services use. Repeated administration slowed the decline in change attitudes participants experienced over time. Participants who received motivational interviewing found the chatbot more helpful, but this component was also associated with larger declines in change attitudes. Participants who received personalized recommendations found the chatbot more helpful, and receiving this component on its own was associated with the most favorable change attitude time trend. Psychoeducation showed no effects. Discussion: Results indicated important effects of components on outcomes; findings will be used to finalize decision making about the optimized intervention package. The chatbot shows high potential for addressing the treatment gap for EDs. [ABSTRACT FROM AUTHOR]

Objective: The eating disorders field has been limited by a predominant focus on White, Western women, and there is growing recognition of the need to understand cross‐cultural variation in key constructs (i.e., ideal body types). A transdisciplinary, cultural models approach systematizes the incorporation of an "emic" perspective (a culture's own understandings of phenomena) into assessments of relationships between body shapes and eating disorders. Method: Eighty‐one young South Korean men aged 19–34 years living in Seoul participated in this research. A cultural model of body fatness was identified using cultural consensus analysis during 18 months of ethnographic, mixed‐methods fieldwork. Participants also completed questionnaires assessing age, height, weight, sexual identity, university prestige, body dissatisfaction, eating disorder symptoms, and cultural consonance with the Korean cultural model of the ideal male body. Variation in these factors was analyzed using a series of chi‐squares and analyses of variance with the culturally defined categories of body fatness as the independent variables. Results: Cultural consensus analysis found that young South Korean men are consistent in identifying categories of "too thin," "balanced," and "too fat." The "balanced" category contained the lowest proportion of high‐prestige university attendees and the highest average cultural consonance. The "too fat" category was characterized by the highest levels of body dissatisfaction and dieting, as well as proportion of probable eating disorders. Discussion: A cultural models approach identified culturally important factors and patterns in disordered eating among young South Korean men and may be effective for understanding eating disorders in other populations not typically studied. Public Significance: This study applies a systematic, "emic" perspective to young South Korean men's body ideals. Young Korean men share a cultural model of body fatness, and this model frames how they experience risk for eating disorders. This study demonstrates a method for incorporating culture into research on eating disorder risk. [ABSTRACT FROM AUTHOR]

Objective: Using a sample of U.S. college students, the authors evaluated whether barriers to mental health treatment varied by race and ethnicity. Methods: Data were drawn from a large multicampus study conducted across 26 U.S. colleges and universities. The sample (N=5,841) included students who screened positive for at least one mental disorder and who were not currently receiving psychotherapy. Results: The most prevalent barriers to treatment across the sample were a preference to deal with issues on one's own, lack of time, and financial difficulties. Black and Hispanic/Latine students reported a greater willingness to seek treatment than did White students. However, Black and Hispanic/Latine students faced more financial barriers to treatment, and Hispanic/Latine students also reported lower perceived importance of mental health. Asian American students also reported financial barriers and preferred to handle their issues on their own or with support from family or friends and had lower readiness, willingness, and intentionality to seek help than did White students. Conclusions: Disparities in unmet treatment needs may arise from both distinct and common barriers and point to the potential benefits of tailored interventions to address the specific needs of students of color from various racial and ethnic backgrounds. The findings further underscore the pressing need for low-cost and brief treatment models that can be used or accessed independently to address the most prevalent barriers for students. [ABSTRACT FROM AUTHOR]

Approximately 1 out of 3 children in the United States is overweight or obese. Family-based treatment (FBT) is considered the gold-standard treatment for childhood obesity, but FBT is both staff and cost intensive. Therefore, we developed the FRESH (Family, Responsibility, Education, Support, & Health) study to evaluate the effectiveness of intervening with parents, without child involvement, to facilitate and improve the child's weight status. Targeting parents directly in the treatment of childhood obesity could be a promising approach that is developmentally appropriate for grade-school age children, highly scalable, and may be more cost effective to administer. The current paper describes the FRESH study which was designed to compare the effectiveness of parent-based therapy for pediatric obesity (PBT) to a parent and child (FBT) program for childhood obesity. We assessed weight, diet, physical activity, and parenting, as well as cost-effectiveness, at baseline, post-treatment, and at 6- and 18-month follow-ups. Currently, all participants have been recruited and completed assessment visits, and the initial stages of data analysis are underway. Ultimately, by evaluating a PBT model, we hope to optimize available child obesity treatments and improve their translation into clinical settings.

Objective: As eating disorders (EDs) often emerge during college, managing EDs would ideally integrate prevention and treatment. To achieve this goal, an efficient tool is needed that detects clinical symptoms and level of risk. This study evaluated the performance of a screen designed to identify individuals at risk for or with an ED. Participants: Five hundred forty-nine college-age women. Methods: Participants completed a screen and diagnostic interview. Results: Using parsimonious thresholds for ED diagnoses, screen sensitivity ranged from 0.90 (anorexia nervosa) to 0.55 (purging disorder). Specificity ranged from 0.99 (anorexia nervosa) to 0.78 (subthreshold binge eating disorder) compared to diagnostic interview. Moderate to high area under the curve values were observed. The screen had high sensitivity for detecting high risk. Conclusions: The screen identifies students at risk and has acceptable sensitivity and specificity for identifying most ED diagnoses. This tool is critical for establishing stepped care models for ED intervention.