Dawn M. Eichen

Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students.

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.

Relationship of food addiction to weight loss and attrition during obesity treatment.

The relationship between food addiction (FA) and weight and attrition outcomes in overweight and obese adults participating in weight loss interventions were prospectively examined in this study.

Is Accuracy of Weight Perception Associated With Health Risk Behaviors in a Diverse Sample of Obese Adolescents

Current evidence is equivocal as to whether adolescent’s perception of weight status is linked to both healthy and risky behaviors. This study examined the association between accurate and inaccurate perception of weight and self-reported health and risk behaviors among a diverse sample of obese, urban adolescents. Data were analyzed from 1,180 participants in the 2009 Philadelphia Youth Risk Behavior Survey. Health behaviors of obese students self-identifying as very or slightly overweight were compared to obese students who underestimated their weight status. Accurate self-identifiers of weight status were significantly more likely to report trying to lose weight, bullying victimization, and suicide attempts as compared to obese students underestimating their weight status. Findings suggest that it is important for school nurses to understand that perceived weight status confers distinct risk profiles and differing needs for health-related services related to the physical, mental, and social health of adolescents.

Attention-deficit/hyperactivity disorder–specific stimulant misuse, mood, anxiety, and stress in college-age women at high risk for or with eating disorders

ABSTRACT Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.

Executive function in childhood obesity: Promising intervention strategies to optimize treatment outcomes

Executive functions (EFs) are hypothesized to play a role in the development and maintenance of obesity due to their role in self-regulatory processes that manage energy-balance behaviors. Children with obesity have well-documented deficits in EF, which may impede effectiveness of current, evidence-based treatments. This review examines top-down EF processes (e.g., inhibitory control, working memory, cognitive flexibility), as well as bottom-up automatic processes that interact with EFs (e.g., attentional bias, delay discounting) and their relation to weight-loss treatment success in children. It then evaluates EF-related interventions that may improve treatment response. Empirical studies that included an intervention purported to affect EF processes as well as pre-post measurements of EF and/or relative weight in populations ages 19 or younger with overweight/obesity were reviewed. Findings indicate that poorer EF may hinder treatment response. Moreover, there is preliminary evidence that behavioral weight loss intervention and physical activity may positively affect EF and that improvements in EF are related to enhanced weight loss. Finally, novel intervention strategies, such as computer training of core EFs, attention modification programs, and episodic future thinking, show promise in influencing both EFs and EF-related skills and weight. Further research is needed to provide more conclusive evidence of the efficacy of these interventions and additional applications and settings should be considered.

Non-suicidal self-injury and suicidal ideation in relation to eating and general psychopathology among college-age women.

Non-suicidal self-injury (NSSI) and suicidal ideation are potent risk factors for suicide and are associated with general and eating disorder-specific psychopathology. Limited research has examined the effects of combined NSSI+suicidal ideation thus concurrent examination is needed to understand potential differential effects on psychopathology. College-aged women (N=508) completed self-report measures of NSSI, suicidal ideation, general psychopathology, and Eating Disorder-specific psychopathology. MANOVAs determined whether the NSSI/SI status groups differed on general and eating disorder pathology measures as a set. Significant MANOVAs were followed up with univariate ANOVAs and posthoc tests. Thirteen women endorsed NSSI+Suicidal Ideation, 70 endorsed NSSI-only, 25 endorsed Suicidal Ideation-only, and 400 endorsed no NSSI/Suicidal Ideation. Both general and eating disorder-specific psychopathology differed across groups. NSSI+Suicidal Ideation and Suicidal Ideation-only groups typically endorsed higher general psychopathology than the no NSSI/Suicidal Ideation and NSSI-only groups. Regarding eating disorder pathology, the NSSI+Suicidal Ideation group was more pathological than no NSSI/Suicidal Ideation and NSSI-only, except on the weight concerns scale, where NSSI+Suicidal Ideation only differed from no NSSI/Suicidal Ideation. The NSSI+Suicidal Ideation group was only greater than Suicidal Ideation-only on measures of depression and eating concern. Results highlight the importance of screening for both NSSI and suicidal ideation, especially for individuals with eating disorder symptoms. Likewise, screening for eating disorder pathology may be beneficial for individuals presenting with NSSI and suicidal ideation.

Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses.

PURPOSE Given shared risk and maintaining factors between eating disorders and obesity, it may be important to include both eating disorder intervention and healthy weight management within a universal eating disorder care delivery program. This study evaluated differential eating disorder screening responses by initial weight status among university students, to assess eating disorder risk and pathology among individuals with overweight/obesity versus normal weight or underweight. METHODS 1529 individuals were screened and analyzed. Screening was conducted via pilot implementation of the Internet-based Healthy Body Image program on two university campuses. RESULTS Fifteen percent of the sample had overweight/obesity. Over half (58%) of individuals with overweight/obesity screened as high risk for an eating disorder or warranting clinical referral, and 58% of individuals with overweight/obesity endorsed a ≥10-pound weight change over the past year. Compared to individuals with normal weight or underweight, individuals with overweight/obesity were more likely to identify as Black, endorse objective binge eating and fasting, endorse that eating disorder-related concerns impaired their relationships/social life and made them feel badly, and endorse higher weight/shape concerns. CONCLUSIONS Results suggest rates of eating disorder pathology and clinical impairment are highest among students with overweight/obesity, and targeted intervention across weight categories and diverse races/ethnicities is warranted within universal eating disorder intervention efforts. Integrating eating disorder intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of eating disorders, unhealthy weight control practices, and obesity among university students.

Perfectionism, emotion dysregulation, and affective disturbance in relation to clinical impairment in college-age women at high risk for or with eating disorders.

Individuals with eating disorders (EDs) demonstrate impaired quality of life; however, less than one-third report severe clinical impairment. Thus, it is important to determine factors that may identify those who are most likely to report marked impairment. Perfectionism, emotion dysregulation, and aspects of affective disturbance, such as anxiety and depression, are independently associated with eating pathology and clinical impairment in eating and other disorders. However, little research has explored these three factors concurrently in relation to eating pathology. It is possible that the combined interaction effect of these constructs could be especially harmful. The current study examined the influence of these constructs and their interactions on clinical impairment in college-aged women at high risk for or with a DSM-5 clinical or subclinical ED. Although the three-way interaction of perfectionism, emotion dysregulation, and affective disturbance (i.e., anxiety or depression) was not significant, the two-way interaction between perfectionism and emotion dysregulation was significant such that those who were high in both perfectionism and emotion dysregulation reported the highest levels of clinical impairment. This suggests that the combination of perfectionism and emotion dysregulation may be especially problematic for those with or at high risk for EDs. Interestingly, perfectionism alone was not a predictor of clinical impairment when accounting for the other constructs, implying that perfectionism may have a greater impact when in conjunction with emotion dysregulation. Understanding the impact of combined perfectionistic tendencies and emotion dysregulation on clinical impairment may better inform treatment and more directly target contributors to impaired quality of life.

Academic giftedness and alcohol use in early adolescence

Adolescence is a period of development particularly vulnerable to the effects of alcohol use, with recent studies underscoring alcohol’s effects on adolescent brain development. Despite the alarming rates and consequences of adolescent alcohol use, gifted adolescents are often overlooked as being at risk for early alcohol use. Although gifted adolescents may possess protective factors that likely inhibit the use of alcohol, some gifted youth may be vulnerable to initiating alcohol use during adolescence as experimenting with alcohol may be one way gifted youth choose to compensate for the social price (whether real or perceived) of their academic talents. To address the dearth of research on alcohol use among gifted adolescents the current study (a) examined the extent to which gifted adolescents use alcohol relative to their nongifted peers and (b) examined the adjustment profile of gifted adolescents who had tried alcohol relative to nongifted adolescents who tried alcohol as well as gifted and nongifted abstainers. More than 300 students in seventh grade (42.5% gifted) participated in the present study. Results indicated gifted students have, in fact, tried alcohol at rates that do not differ from nongifted students. Although trying alcohol was generally associated with negative adjustment, giftedness served as a moderating factor such that gifted students who had tried alcohol were less at risk than their nongifted peers. However, evidence also suggests that gifted adolescents who tried alcohol may be a part of a peer context that promotes substance use, which may place these youth at risk for adjustment difficulties in the future. Putting the Research to Use This research demonstrates that a fruitful line of future research would focus on examining the potential mechanisms underlying alcohol use among gifted youth. Individual differences with regard to endorsing a high desirability of gaining social acceptance or fitting in with non-gifted peers or distancing oneself from a “gifted” image may explain why some gifted students use alcohol and others do not. Until the underlying reasons of alcohol use/experimentation among gifted adolescents are better understood and researched further, it is not clear whether current prevention and intervention programs are effective for this subgroup of adolescents.

Neurocognitive Treatments for Eating Disorders and Obesity

Purpose of ReviewRecent research has highlighted executive function and neurocognitive deficits among individuals with eating and weight disorders, identifying a potential target for treatment. Treatments targeting executive function for eating and weight disorders are emerging. This review aims to summarize the recent literature evaluating neurocognitive/executive function-oriented treatments for eating and weight disorders and highlights additional work needed in this area.Recent FindingsCognitive remediation therapy (CRT) for anorexia nervosa has been the most extensively studied neurocognitive treatment for eating disorders. Results demonstrate that CRT improves executive function and may aid in the reduction of eating disorder symptomatology. Computer training programs targeting modifying attention and increasing inhibition are targeting reduction of binge eating and weight loss with modest success.SummaryNeurocognitive treatments are emerging and show initial promise for eating and weight disorders. Further research is necessary to determine whether these treatments can be used as stand-alone treatments or whether they need to be used as an adjunct to or in conjunction with other evidence-based treatments to improve outcomes.