C. Nathan Marti

A Meta-Analytic Review of Obesity Prevention Programs for Children and Adolescents: The Skinny on Interventions that Work

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre- to post effects. Larger effects emerged for programs that targeted children and adolescents (vs. preadolescents) and females, programs that were relatively brief, programs that solely targeted weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must have self-selected into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects.

A Meta-Analytic Review of Depression Prevention Programs for Children and Adolescents: Factors that Predict Magnitude of Intervention Effects

In this meta-analytic review, the authors summarized the effects of depression prevention programs for youth as well as investigated participant, intervention, provider, and research design features associated with larger effects. They identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from pre-to-posttreatment (r = .15) and pretreatment to-follow-up (r = .11) were small, but 13 (41%) prevention programs produced significant reductions in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter duration and with homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on problem-solving training or reducing negative cognitions) and design features (e.g., use of random assignment and structured interviews) were unrelated to effect sizes. Results suggest that depression prevention efforts produce a higher yield if they incorporate factors associated with larger intervention effects (e.g., selective programs with a shorter duration that include homework).

DISSONANCE AND HEALTHY WEIGHT EATING DISORDER PREVENTION PROGRAMS: LONG-TERM EFFECTS FROM A RANDOMIZED EFFICACY TRIAL

Adolescent girls with body dissatisfaction (N = 481, SD = 1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset, and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring.

An 8-Year Longitudinal Study of the Natural History of Threshold, Subthreshold, and Partial Eating Disorders From a Community Sample of Adolescents

The authors examined the natural history of threshold, subthreshold, and partial eating disorders in a community sample of 496 adolescent girls who completed annual diagnostic interviews over an 8-year period. Lifetime prevalence by age 20 years was 0.6% and 0.6% for threshold and subthreshold anorexia nervosa (AN), 1.6% and 6.1% for threshold and subthreshold bulimia nervosa (BN), 1.0% and 4.6% for threshold and subthreshold binge-eating disorder (BED), and 4.4% for purging disorder (PD). Overall, 12% of adolescents experienced some form of eating disorder. Subthreshold BN and BED and threshold PD were associated with elevated treatment, impairment, and distress. Peak age of onset was 17-18 years for BN and BED and 18-20 years for PD. Average episode duration in months was 3.9 for BN and BED and 5.1 for PD. One-year recovery rates ranged from 91% to 96%. Relapse rates were 41% for BN, 33% for BED, and 5% for PD. For BN and BED, subthreshold cases often progressed to threshold cases and diagnostic crossover was most likely for these disorders. Results suggest that subthreshold eating disorders are more prevalent than threshold eating disorders and are associated with marked impairment.

Prevalence, Incidence, Impairment, and Course of the Proposed DSM-5 Eating Disorder Diagnoses in an 8-Year Prospective Community Study of Young Women

We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN, 3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2% had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these eating disorders typically reported greater functional impairment, distress, suicidality, mental health treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN, subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic categories.

Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study

OBJECTIVE Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways. METHOD Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years. RESULTS Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%). CONCLUSION This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.

Fasting increases risk for onset of binge eating and bulimic pathology: a 5-year prospective study.

Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. The authors tested the hypothesis that fasting (going without eating for 24 hr for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5 years. Results confirmed that only 23% of participants with elevated dietary restraint scores reported fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1- to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting.

Development and predictive effects of eating disorder risk factors during adolescence: Implications for prevention efforts

OBJECTIVE Although several prospective studies have identified factors that increase risk for eating disorders, little is known about when these risk factors emerge and escalate, or when they begin to predict future eating disorder onset. The objective of this report was to address these key research gaps. METHOD Data were examined from a prospective study of 496 community female adolescents (M = 13.5, SD = 0.7 at baseline) who completed eight annual assessments of potential risk factors and eating disorders from preadolescence to young adulthood. RESULTS Three variables exhibited positive linear increases: Perceived pressure to be thin, thin-ideal internalization, and body dissatisfaction; three were best characterized as quadratic effects: dieting (essentially little change); negative affectivity (overall decrease), and BMI (overall increase). Elevated body dissatisfaction at ages 13, 14, 15, and 16 predicted DSM-5 eating disorders onset in the 4-year period after each assessment, but the predictive effects of other risk factors were largely confined to age 14; BMI did not predict eating disorders at any age. DISCUSSION The results imply that these risk factors are present by early adolescence, although eating disorders tend to emerge in late adolescence and early adulthood. These findings emphasize the need for efficacious eating disorder prevention programs for early adolescent girls, perhaps targeting 14-year olds, when risk factors seem to be most predictive. In early adolescence, it might be fruitful to target girls with body dissatisfaction, as this was the most consistent predictor of early eating disorder onset in this study.

Dimensions of Student Engagement in American Community Colleges: Using the Community College Student Report in Research and Practice

The Community College Student Report (CCSR) is a widely-used survey instrument. This article examines the reliability and validity of the instrument to assess its usefulness in institutional research and practice. Confirmatory factor analyses demonstrate that factor analytic models adequately represent underlying constructs. Confirmatory factor analysis is also used to demonstrate measurement invariance across sex, part- and full-time status, and year of administration. The constructs have reasonable internal reliability and test-retest reliability. Grade point average was regressed on latent factors and consistently demonstrated a positive association with latent engagement constructs. These analyses establish the CCSR as a reliable instrument that can be used to inform institutional decision-making with regard to teaching practices, campus design, and institutional culture. Additionally, these analyses establish constructs that can be used for research with community college students.

Associations Between Serotonin Transporter Gene Promoter Region (5-HTTLPR) Polymorphism and Gaze Bias for Emotional Information

The serotonin transporter promoter region polymorphism (5-HTTLPR) is associated with neural response to negative images in brain regions involved in the experience of emotion. However, the behavioral implications of this sensitivity have been studied far less extensively. The current study used eye-tracking methodology to examine how individuals genotyped for the 5-HTTLPR, including the single nucleotide polymorphism (SNP) rs25531, allocated attention during prolonged (30-s) exposure to face stimuli depicting positive and negative emotion. Short 5-HTTLPR allele carriers and carriers of the long allele with guanine at the sixth nucleotide (S/LG) displayed a stronger gaze bias (total fixation time, number of fixations, mean fixation length) for positive than for sad, threat, or neutral stimuli. In contrast, those homozygous for the long 5-HTTLPR allele with adenine at the sixth nucleotide (LA) viewed the emotion stimuli in an unbiased fashion. Time course analyses indicated no initial 5-HTTLPR group differences; however, S/LG 5-HTTLPR allele carriers were more likely than LA 5-HTTLPR homozygotes to direct gaze toward happy than toward sad stimuli over time. This bias toward positive stimuli during the later stages of information processing likely reflects a strategic effort to downregulate heightened reactivity to negative stimuli among 5-HTTLPR S/LG allele carriers.