Annick Buchholz

Olanzapine Use for the Adjunctive Treatment of Adolescents with Anorexia Nervosa

OBJECTIVE To examine assessment and treatment profiles of adolescent patients with anorexia nervosa and eating disorder not otherwise specified who received olanzapine as compared with an untreated matched sample. METHOD A retrospective, matched-groups comparison study was completed. Medical files of 86 female patients treated in the eating disorder program at the Childrens Hospital of Eastern Ontario were examined. Patients treated with olanzapine were initially identified through chart review and then matched to a diagnosis, age, and, when possible, treatment group that served as the active comparator. Weight gain was examined in a sample of 22 inpatients. RESULTS Patients treated with olanzapine displayed greater evidence of psychopathology and medical compromise at the time of first assessment compared with those not treated. Rate of weight gain was not statistically different between groups when olanzapine was started during inpatient admissions. Medication effect on eating disorder cognitions could not be assessed given the presence of multiple confounders relating to treatment. Notable side effects included sedation and dyslipidemia in 56% of patients. CONCLUSIONS Despite our best attempts at matching olanzapine-treated subjects with a control sample, analysis revealed significant differences between groups, suggesting greater illness severity in those augmented with olanzapine. Given these inherent differences, we were unable to draw any firm conclusions regarding the potential efficacy of olanzapine. Factors associated with the prescription of adjunctive pharmacotherapy in this cohort appear to be linked to illness severity, acuity, and associated comorbidity. The observed side-effect profile indicates the need for more consistent predrug screening and for closer monitoring during treatment.

Family meals and body mass index among adolescents: effects of gender

Family meals have been identified as a protective factor against obesity among youth. However, gender specificities with respect to the relationship between the frequency of family meals and body mass index (BMI) have not been investigated. The purpose of this study was to examine the relationship between the frequency of family meals and BMI in male and female adolescents, while controlling for potential confounding factors associated with BMI, such as parental education, adolescents age, and snack-food eating. Research participants were 734 male and 1030 female students (mean age, 14.12 years, SD = 1.62) recruited from middle schools and high schools in the capital region of Canada. Participants completed validated, self-report measures to assess the frequency of family meals and the risk factors associated with increased BMI, which was derived from objective measures of height and weight. After controlling for proposed confounding variables, a higher frequency of family meals was associated with lower BMI in females, but not in males. A Z-transformation test of the homogeneity of adjusted correlation coefficients showed a significant trend (p = 0.06), indicating that the relationship between family meals and BMI is stronger in females than males, consistent with our regression analyses. Our findings suggest that eating together as a family may be a protective factor against obesity in female adolescents, but not in male adolescents. Findings from this study have important implications for parents and health care practitioners advocating for more frequent family meals as part of a comprehensive obesity prevention and treatment program for female adolescents.

Factors Influencing Research Drug Trials in Adolescents With Anorexia Nervosa

This study examined factors that contributed to patients eligibility and participation in a randomized controlled trial involving olanzapine for the adjunctive treatment of anorexia nervosa (AN). Factors involving patient eligibility and willingness to participate were systematically recorded for all patients approached to participate. Of the 92 patients that were assessed and treated over the study timeframe, only 27 patients (29%) met full criteria for inclusion, of which just 7 enrolled (26%). The most common reasons for study refusal related to fears associated with medication effects and refusal to consider medication as a treatment option (70%). Factors affecting recruitment in psychopharmacological studies involving AN in youth are discussed.

Attachment Style and Obesity: Disordered Eating Behaviors as a Mediator in a Community Sample of Canadian Youth.

Objective: Obesity and overweight are associated with many negative health outcomes. Attachment style has been implicated in the development of obesity in youth. The present study examined if disordered eating behaviors mediate the relationship between attachment style and body mass index (BMI) in a large community sample of Canadian youth. Method: A total of 3,043 participants (1,254 males and 1,789 females, Mage = 14.20 years) completed self-report questionnaires including the Relationship Questionnaire and the Dutch Eating Behavior Questionnaire, and BMI was objectively measured. Disordered eating behaviors (restrained, emotional, and external) were examined as possible mediating mechanisms in the relationship between attachment style and BMI z-score, using a multiple mediation model using bootstrapping while controlling for socio-demographic covariates. Results: Insecure attachment was significantly associated with higher BMI, and disordered eating mediated this relationship. Restrained eating was the strongest mediator of this pathway. Conclusion: Results suggest that it may be important to take attachment history and restrained eating into account when designing treatment and prevention strategies for obesity in youth.

Socioemotional Predictors of Body Esteem in Adolescent Males.

This study explores the relationship between self-silencing, sociocultural attitudes toward appearance and negative body esteem in a large community-based sample of male youth, to better understand the interrelationship among these socioemotional characteristics and their effects on body esteem. A cross-sectional study of 1,253 males in Grades 7 to 12 asked participants to complete self-report measures of body esteem, sociocultural attitudes toward appearance, and self-silencing as part of a larger study, and also took anthropometric measurements of weight and height. Results revealed that increased body mass index, greater engagement in self-silencing behaviors and higher levels of internalization of the masculine body ideal all contributed to poor body esteem in male youth. Findings from this study demonstrate that males, like females, are vulnerable to low body esteem when they rely on an externalized view of self-perception and allow themselves to take care of others needs before attending to their own, leaving little room for their voice to be heard. It was also found that greater endorsement of the mostly unattainable masculine beauty ideal as a personal standard and higher body mass index both contributed to lower body esteem, most likely influencing each other in various ways. Prevention efforts geared toward media literacy, promoting positive body image and fostering authenticity in one’s relationships may be helpful at reducing poor body esteem in male youth.

Beyond Weight Loss: Experiences and Insights Related to Working Effectively with Families and Operating within the Health Care System to Manage Pediatric Obesity

Pediatric obesity is an urgent and complex public health issue. The high proportions of children who meet the definition of overweight or obesity highlight the need for effective and accessible servic