Diana Rancourt

Overlap in Eating Disorders and Obesity in Adolescence.

While eating disorders and obesity have traditionally been conceptualized as separate conditions, recent research suggests important overlap in several areas including etiology, comorbidity, risk factors, and prevention approaches. Examining the commonality among these conditions is particularly important as adolescents who present with both eating disorder symptomology and obesity demonstrate poorer outcomes within weight control treatments and are at greater risk for future development of full threshold eating disorders and additional weight gain. The purpose of this paper is to review the research examining the overlap in prevalence rates for eating disorders and obesity in adolescents, as well as shared etiology, risk factors, and psychiatric and medical comorbidities. Current preventive and treatment approaches also will be discussed, while highlighting the need for more integrated assessment, prevention, and treatment efforts that focus on maladaptive eating and activity patterns shared by both eating disorders and obesity.

A Qualitative Study of Successful Adolescent and Young Adult Weight Losers: Implications for Weight Control Intervention

BACKGROUND Our study aims to provide an in-depth analysis of behavioral strategies, psychological factors, and social contributors to adolescent weight loss and weight loss maintenance among participants in the Adolescent Weight Control Registry (AWCR). METHODS Qualitative analyses were conducted using semi-structured interview data from 40 participants from the AWCR who successfully lost ≥10 lbs and maintained their weight loss for at least one year. RESULTS In contrast to existing literature, our findings suggest that primary motivating factors for adolescent weight loss may be intrinsic (e.g., desire for better health, desire to improve self-worth) rather than extrinsic. In addition, life transitions (e.g., transition to high school) were identified as substantial motivators for weight-related behavior change. Peer and parental encouragement and instrumental support were widely endorsed as central to success. The most commonly endorsed weight loss maintenance strategies included attending to dietary intake and physical activity levels, and making self-corrections when necessary. CONCLUSIONS Results from this study highlight considerations for future adolescent weight control treatment development.

Adolescent Weight Control: An Intervention Targeting Parent Communication and Modeling Compared With Minimal Parental Involvement

OBJECTIVE Adolescent weight control interventions demonstrate variable findings, with inconsistent data regarding the appropriate role for parents. The current study examined the efficacy of a standard adolescent behavioral weight control (BWC) intervention that also targeted parent-adolescent communication and parental modeling of healthy behaviors (Standard Behavioral Treatment + Enhanced Parenting; SBT + EP) compared with a standard BWC intervention (SBT). METHODS 49 obese adolescents (M age = 15.10; SD = 1.33; 76% female; 67.3% non-Hispanic White) and a caregiver were randomly assigned to SBT or SBT + EP. Adolescent and caregiver weight and height, parental modeling, and weight-related communication were obtained at baseline and end of the 16-week intervention. RESULTS Significant decreases in adolescent weight and increases in parental self-monitoring were observed across both conditions. Analyses of covariance revealed a trend for greater reduction in weight and negative maternal commentary among SBT condition participants. CONCLUSIONS Contrary to hypotheses, targeting parent-adolescent communication and parental modeling did not lead to better outcomes in adolescent weight control.

Effects of weight‐focused social comparisons on diet and activity outcomes in overweight and obese young women

To investigate social comparison processes as a potential mechanism by which social networks impact young womens weight control thoughts and behaviors and to examine whether social comparisons with close social ties (i.e., friends) have a greater influence on weight control outcomes relative to more emotionally distant ties.

Differential impact of upward and downward comparisons on diverse women's disordered eating behaviors and body image

OBJECTIVE Etiological models of disordered eating are limited in their consideration of racial/ethnic differences in risk factors. Appearance comparisons are consistent predictors of disordered eating outcomes, but research predominantly examines these associations among White women and overlooks the potential differential impact of upward (comparing to someone perceived as better off) versus downward comparisons (comparing to someone perceived as worse off). This study investigated race/ethnicity as a moderator of the associations between upward and downward appearance comparisons and disordered eating outcomes and body satisfaction of young adult women. METHOD Measures of upward and downward appearance comparisons, body satisfaction, and disordered eating were administered to 1,014 young adult women. A multiple group (by race/ethnicity) path analysis was estimated using maximum likelihood estimation for each disordered eating and body satisfaction outcome, controlling for age and BMI. RESULTS Upward comparisons were associated with higher levels of disordered eating behaviors and lower body satisfaction for women of all racial/ethnic groups. Downward appearance comparisons emerged as detrimental for Hispanic/Latina women, but were protective for Asian and White women. DISCUSSION Findings challenge the belief that appearance comparisons impact all women similarly and that downward comparisons are universally protective, a position often promulgated by clinical treatment approaches.

Flexible Models of Change: Using Structural Equations to Match Statistical and Theoretical Models of Multiple Change Processes

OBJECTIVE To introduce and illustrate recent advances in statistical approaches to simultaneous modeling of multiple change processes. METHODS Provide a general overview of how to use structural equations to simultaneously model multiple change processes and illustrate the use of a theoretical model of change to guide selection of an appropriate specification from competing alternatives. The selected latent change score model is then fit to data collected during an adolescent weight-control treatment trial. RESULTS A latent change score model is built starting with the foundation of repeated-measures analysis of variance and illustrated using graphical notation. CONCLUSIONS The assumptions behind using structural equations to model change are discussed as well as limitations of the approach. Practical guidance is provided on matching the statistical model to the theory underlying the observed change processes and the research question(s) being answered by the analyses.

Tobacco Exposure and Conditional Weight-for-Length Gain by 2 Years of Age

Objective To prospectively examine dose-response and timing effects of prenatal (PTE) and postnatal tobacco exposure on obesity risk assessed by conditional weight-for-length gain (CWFLG), by 2 years of age. CWFLG over the first 2 years of life was examined for 117 PTE and 57 nonexposed children. Repeated assessments of PTE were conducted beginning in the first trimester of pregnancy, using multiple methods. PTE or postnatal exposure status was not predictive of CWFLG. However, there was a dose-response association and an association with fetal exposure ascertained by infant meconium positive for nicotine and metabolites. PTE is related to restricted growth at birth, yet associated with accelerated CWFLG by 2 years of age, a measure that controls for birthweight differences. Results highlight the importance of examining dose-response and timing of exposure associations, along with the importance of obesity risk-reduction interventions within the first 2 years of life among PTE children.

Weight Trajectories of Israeli Pediatric Cancer Survivors

Objective Cross-national replication of the high rates of overweight/obesity among U.S. pediatric cancer survivors (PCS) is limited. Predictors of weight trajectories of Israeli PCS were examined from diagnosis and end of active cancer treatment to 3 years posttreatment. Methods World Health Organization-derived body mass index (z-BMI) values were calculated at each time point from medical records of 135 Israeli PCS ( M diagnosis age = 11.4). A three-section piecewise multilevel model including age, ethnicity, gender, treatment length, and diagnosis as predictors was used to estimate z-BMI trajectories. Results Most participants remained at a healthy weight at all time points. Differing weight trajectories emerged for PCS diagnosed with lymphoma/leukemia versus other cancer diagnoses from diagnosis to end of treatment, but similar weight change patterns were observed posttreatment. Conclusion Replication of U.S. PCS weight trajectories was not observed in Israeli PCS, suggesting the importance of exploring environmental risk factors contributing to obesity among PCS.

Body mass index as a moderator of the association between weight status misperception and disordered eating behaviors

Weight status under-perception is protective against disordered eating behaviors and weight gain; however, it is unclear whether under-perception may confer protection across all weight classes. This work explored body mass index as a moderator of the association between weight status perception accuracy and disordered eating behaviors among adults with overweight or obesity. A total of 572 adults (58.7% female; age M = 39.50, SD = 11.57) with overweight or obesity (body mass index M = 31.50, SD = 6.24) completed a series of online questionnaires assessing uncontrolled, emotional, and restrained eating, eating disorder symptoms, weight status perception, and demographics. Controlling for race/ethnicity, age, and sex, linear and negative binomial regressions were used to test hypotheses. Compared to accurate weight status perception, under-perception was associated with less uncontrolled (p = .003) and restrained eating (p = .002). Under-perception was particularly protective against emotional eating (p = .022) and eating disorder symptoms (p = .017) for individuals of overweight or Class I obesity. In general, weight status under-perception was associated with fewer disordered eating behaviors. The protective effects of under-perception of weight status may be maximized for individuals of overweight or Class I obesity statuses.

Successful weight loss initiation and maintenance among adolescents with overweight and obesity: does age matter?

Treatments for adolescents with overweight/obesity demonstrate mixed success, which may be due to a lack of consideration for developmental changes during this period. Potential developmental differences in weight loss motivations, weight maintenance behaviours and the role of parents in these efforts were examined in a sample of successful adolescent weight losers. Participants enrolled in the Adolescent Weight Control Registry (n = 49) self‐reported demographic information and weight history, reasons for weight loss and weight control, weight loss approach and weight maintenance strategies, and perceived parental involvement with weight loss. Associations between age at weight loss initiation and the aforementioned factors were examined using linear and generalized regressions, controlling for highest z‐BMI and sex. Adolescents who were older (≥16 years) at their weight loss initiation were more likely to report losing weight on their own (37.5% vs. 75%, P = 0.01) and reported greater responsibility for their weight loss and weight loss maintenance (P < 0.001) compared to younger adolescents. Younger age at weight loss initiation was associated with greater parental involvement (P = 0.005), whereas older age was associated with greater adolescent responsibility for the decision to lose weight (P = 0.002), the weight loss approach (P = 0.007) and food choices (P < 0.001). Findings suggest the importance of considering developmental differences in responsibility for weight loss and maintenance among adolescents with overweight/obesity.