Corinna Jacobi

Behavioral Validation, Precursors, and Concomitants of Picky Eating in Childhood

OBJECTIVES To validate the concept of parent-reported picky eating using objective, laboratory-based measures and to identify both child and parental precursors and concomitants of picky eating. METHOD One hundred thirty-five infants were monitored from birth to 5.5 years. Behavioral measures of picky eating were obtained from standardized feedings at ages 3.5 and 5.5 years in the laboratory and at home. Child precursors were measures of infant sucking behavior; parental precursors were disinhibition of eating, restrained eating, body dissatisfaction, and body mass index. Parentally reported attitudes and behaviors thought to be related to pickiness and parental concomitants were taken from the Stanford Feeding Questionnaire. Child Temperament was assessed by the Childrens Behavior Questionnaire. RESULTS Picky eaters ate fewer foods and were especially more likely to avoid vegetables. Picky girls decreased their caloric intake between ages 3.5 and 5.5, whereas all other children increased their caloric intake. None of the included parental precursors was significantly related to pickiness. Picky eaters demonstrated a different sucking pattern with fewer sucks per feeding session at weeks 2 and 4. Finally, picky children displayed more parent-reported negative affect than nonpicky children. CONCLUSIONS Parentally reported picky eating is associated with a consistent pattern of inhibited and selective eating beginning in infancy.

Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample

BACKGROUND Numerous longitudinal studies have identified risk factors for the onset of most eating disorders (EDs). Identifying women at highest risk within a high-risk sample would allow for focusing of preventive resources and also suggests different etiologies. METHOD A longitudinal cohort study over 3 years in a high-risk sample of 236 college-age women randomized to the control group of a prevention trial for EDs. Potential risk factors and interactions between risk factors were assessed using the methods developed previously. Main outcome measures were time to onset of a subthreshold or full ED. RESULTS At the 3-year follow-up, 11.2% of participants had developed a full or partial ED. Seven of 88 potential risk factors could be classified as independent risk factors, seven as proxies, and two as overlapping factors. Critical comments about eating from teacher/coach/siblings and a history of depression were the most potent risk factors. The incidence for participants with either or both of these risk factors was 34.8% (16/46) compared to 4.2% (6/144) for participants without these risk factors, with a sensitivity of 0.75 and a specificity of 0.82. CONCLUSIONS Targeting preventive interventions at women with high weight and shape concerns, a history of critical comments about eating weight and shape, and a history of depression may reduce the risk for EDs.

Effects of an Internet-based Prevention Programme for Eating Disorders in the USA and Germany — A Meta-analytic Review†

A cross-cultural comparison of a cognitive-behavioural, Internet-based, 8-week prevention programme for eating disorders (StudentBodies™) evaluated in the USA and in Germany was performed. Six US and four German randomized controlled trials with a total (N) of 990 female high school and college students were included in the review. Two of the US and two of the German trials explicitly addressed high risk samples in a selective prevention approach. Effect sizes for main outcomes (disordered eating, weight and shape concerns) were calculated at postintervention and at follow-up. The intervention was associated with moderate improvements in eating disorder-related attitudes, especially reductions of negative body image and the desire to be thin. The reported effects remained significant at follow-up. No clear differences between US and German samples could be found on any of the outcome measures at postintervention. In conclusion, StudentBodies™ seems equally suitable and effective for American and German students.

Predicting Children's Reported Eating Disturbances at 8 Years of Age

OBJECTIVES To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship. METHOD One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry. RESULTS No gender differences were found for frequencies of childrens self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the childs eating disturbances and negative emotionality was found. CONCLUSIONS The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.

Reducing eating disorder onset in a very high risk sample with significant comorbid depression: A randomized controlled trial.

OBJECTIVE Eating disorders (EDs) are serious problems among college-age women and may be preventable. An indicated online eating disorder (ED) intervention, designed to reduce ED and comorbid pathology, was evaluated. METHOD 206 women (M age = 20 ± 1.8 years; 51% White/Caucasian, 11% African American, 10% Hispanic, 21% Asian/Asian American, 7% other) at very high risk for ED onset (i.e., with high weight/shape concerns plus a history of being teased, current or lifetime depression, and/or nonclinical levels of compensatory behaviors) were randomized to a 10-week, Internet-based, cognitive-behavioral intervention or waitlist control. Assessments included the Eating Disorder Examination (EDE, to assess ED onset), EDE-Questionnaire, Structured Clinical Interview for DSM Disorders, and Beck Depression Inventory-II. RESULTS ED attitudes and behaviors improved more in the intervention than control group (p = .02, d = 0.31); although ED onset rate was 27% lower, this difference was not significant (p = .28, NNT = 15). In the subgroup with highest shape concerns, ED onset rate was significantly lower in the intervention than control group (20% vs. 42%, p = .025, NNT = 5). For the 27 individuals with depression at baseline, depressive symptomatology improved more in the intervention than control group (p = .016, d = 0.96); although ED onset rate was lower in the intervention than control group, this difference was not significant (25% vs. 57%, NNT = 4). CONCLUSIONS An inexpensive, easily disseminated intervention might reduce ED onset among those at highest risk. Low adoption rates need to be addressed in future research.

Family‐based Early Intervention for Anorexia Nervosa

OBJECTIVE This study explores whether potential risk factors for anorexia nervosa (AN) can be modified by a family-based Internet-facilitated intervention and examines the feasibility, acceptability, and short-term efficacy of the Parents Act Now programme in the USA and Germany. METHOD Forty-six girls aged 11-17 were studied during a 12-month period and evaluated at screening, baseline, and post-intervention. Parents participated in the six-week intervention. RESULTS Twenty-four per cent of girls (n = 791) screened met the risk criteria for AN. Parents accessed the majority of the online sessions and rated the programme favourably. At post-assessment, 16 of 19 participants evidenced reduced risk status. Participants remained stable or increased in ideal body weight and reported decreased eating disorder attitudes and behaviours. DISCUSSION Results suggest that an easily disseminated, brief, online programme with minimal therapist support is feasible, accepted favourably by parents, and may be beneficial for prevention of exacerbation of AN pathology.

Interactions between disturbed eating and weight in children and their mothers.

Objective: This study assessed the interaction between disturbed eating behavior and body mass index (BMI) in children aged 8 to 12 and maternal eating problems and BMI. Method: In a cohort study, four hundred twenty-six 8- to 12-year-old children and their primary caretakers (91% mothers) were assessed in a small city. Disturbed eating behavior in children was measured by the “IEG-IEG-Child-Questionnaire,” a validated German self-report instrument for children. Disturbed eating behavior in mothers was assessed by TFEQ-subscale disinhibition. Results: Children’s BMI was a significant covariate of disturbed eating. Older girls with higher BMI endorsed more problems with eating and weight, and more body dissatisfaction than boys and younger children. Daughters of overweight mothers restrained their own eating behavior more than daughters of normal weight mothers and sons regardless of mothers’ weight. Older daughters of overweight mothers were more dissatisfied with their own bodies than younger daughters and children of normal weight mothers. Children of mothers with elevated disinhibition showed more body dissatisfaction than children of mothers with lower disinhibition. Conclusions: The results illustrate the complex and differential relationships between age, gender, BMI, and maternal variables and eating disturbances in children. Preventive interventions for the reduction of disturbed eating in children should be targeted at overweight mothers and mothers with disinhibited eating.

Adaptation and evaluation of an Internet-based prevention program for eating disorders in a sample of women with subclinical eating disorder symptoms: A pilot study

ABSTRACTOBJECTIVE: Women reporting subclinical eating disorder (ED) symptoms are at higher risk for the development of an ED. Preventive interventions should therefore be specifically tailored for this subgroup. Accordingly, the aim of this pilot study was to test the feasibility of the adapted Internet-based prevention program “Student Bodies™” for women with subclinical ED and to obtain effect size and sample size estimates for a subsequent randomized controlled trial. METHOD: Twenty-two women with subclinical ED participated in the 8-week intervention; pre-post data are available for 12 women. Measures of ED symptoms and established risk factors, such as weight and shape concerns, were assessed at preand post-intervention. RESULTS: Completers’ adherence and appraisal of the program were good. At post-intervention, completers reported significantly fewer ED symptoms and reduced weight and shape concerns. Pre-post-effect sizes ranged from medium to large. CONCLUSION: The pilot study showed the feasibility of the adapted online intervention and gave indications for its effectiveness.

Preventing Symptom Progression in Women at Risk for AN: Results of a Pilot Study

OBJECTIVE Despite the need, no targeted (indicated) prevention programs for women at risk for anorexia nervosa (AN) or with restrictive eating and normal body weight are available. Therefore, our aim was to develop a prevention program specific for these risk groups and to assess its feasibility and effectiveness in a pilot study. METHODS Thirty-six women selected by high weight and shape concerns, low BMI and/or high restrained eating participated in a 10-week Internet-based cognitive-behavioural prevention program for AN. RESULTS Feasibility, adherence and acceptance were assessed at post-intervention; symptoms of disordered eating and associated psychopathology were assessed at pre-intervention, post-intervention, and at 6-month follow-up. The 32 women who finished the study completed 88% of the sessions. Satisfaction with the program was also high. AN-specific eating and associated psychopathology improved significantly and differentially in the three weight-related subgroups. CONCLUSIONS Overall, the results of this pilot study are promising. The efficacy of this indicated preventive intervention should be tested in a larger randomized controlled trial.

Threat‐related attentional bias in anorexia nervosa

OBJECTIVE Attentional bias (AB) modification treatment targeting general or social anxiety has been recently highlighted as a potential novel approach for the treatment of anorexia nervosa (AN). The purpose of this study was to examine threat-related AB in patients with ANand healthy control participants (HC) and the relationship between AB and eating disorder and other psychopathology. METHOD Forty-nine female outpatients with AN or Eating Disorder Not Otherwise Specified, Anorexia Type (EDNOS-AN), and 44 female HC completed a dot-probe task with threat words and a range of self-report measures assessing eating disorder symptoms and other psychopathology. RESULTS There was no evidence for a differential threat-related AB in AN patients despite elevated anxiety in this group. The AB-index, a parameter of the magnitude of attention allocation when two competing stimuli are presented, did not correlate with any of the self-report measures. However, patients with AN responded significantly more slowly to the probe as compared to controls, regardless of the valence or position of the stimuli. DISCUSSION The results suggest that the AB in AN patients may be specific to eating disorder-relevant anxieties.