Lien Goossens

Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating.

The current study investigated loss of control (LC) over eating and the role of anxiety, depression and emotional eating in a sample of both treatment seeking (N = 115) and non-treatment seeking (N = 73) overweight youngsters (aged 8-18) using a semi-structured clinical interview and self-report questionnaires. It was found that treatment seekers reported twice as much LC (40%) compared to non-treatment seekers (21%). Cross-sectional prediction models indicated that increased anxiety was associated with emotional eating and LC. Emotional eating tended to mediate the relationship between anxiety and LC. Increased depression was associated with emotional eating but not with LC. Especially overweight treatment seekers turn out to be at risk for LC. Because LC may develop as a result of inadequate coping with negative emotions like anxiety, obesity treatment should focus on teaching more effective coping strategies. Longitudinal research is recommended to further elaborate affect regulation and LC.

Differences in eating style between overweight and normal-weight youngsters.

Differences in eating styles between overweight and normal-weight youngsters were investigated with a child version of the Dutch Eating Behavior Questionnaire (DEBQ). Subjects were children (n = 1458; M: 10.1; SD = 1.3) and adolescents (n = 1016; M: 14.9; SD =1.5). Overweight adolescent girls scored high on emotional eating while overweight adolescent boys displayed more external eating. In overweight children, already 10.5 per cent displayed emotional eating and 38.4 per cent reported external eating. All overweight youngsters reported restrained attitudes. Eating styles were positively associated with indicators of eating pathology. The results suggest the use of appropriate norms that take into account the childs age, gender and overweight status.

Executive function training with game elements for obese children: A novel treatment to enhance self-regulatory abilities for weight-control

For obese children behavioral treatment results in only small changes in relative weight and frequent relapse. The current study investigated the effects of an Executive Functioning (EF) training with game-elements on weight loss maintenance in obese children, over and above the care as usual in an inpatient treatment program. Forty-four children (aged 8-14 years) who were in the final months of a 10-months inpatient treatment program in a medical paediatric centre were randomized to either the 6 week EF-training condition or to a care as usual only control group. The EF-training consisted of a 25-session training of inhibition and working memory. Treatment outcomes were child performances on cognitive tasks of inhibition and working memory and childcare worker ratings on EF-symptoms as well as weight loss maintenance after leaving the clinic. Children in the EF-training condition showed significantly more improvement than the children in the care as usual only group on the working memory task as well as on the childcare worker reports of working memory and meta-cognition. They were also more capable to maintain their weight loss until 8 weeks post-training. This study shows promising evidence for the efficacy of an EF-training as weight stabilization intervention in obese children.

An empirical typology of perfectionism in early-to-mid adolescents and its relation with eating disorder symptoms

Although the association between perfectionism and eating disorder (ED) symptoms is well-established, debate remains about the relative contribution of two central dimensions of perfectionism, that is, Personal Standards (PS) perfectionism and Evaluative Concerns (EC) perfectionism, in the prediction of ED symptoms. This study used cluster analysis to establish naturally occurring combinations of PS and EC perfectionism in early-to-mid adolescents (N = 656; M age = 13.9 years). Evidence was obtained for four perfectionism profiles: (1) maladaptive perfectionism (high PS and high EC), (2) pure evaluative concerns perfectionism (high EC only), (3) adaptive perfectionism (high PS, low EC), and (4) non-perfectionism (low on both PS and EC). A comparison of participants in these four clusters in terms of ED symptoms suggests that a combination of high personal standards and evaluative concerns (rather than the presence of one of these two dimensions alone) is most strongly related to ED symptoms.

How is reward sensitivity related to bodyweight in children

Previous research assumes that there are two seemingly opposing hypotheses for the relation between reward sensitivity (RS) and bodyweight: hyper-responsiveness model and Reward Deficiency Syndrome (RDS), leading to the proposition of a feed forward process of weight gain. High RS may contribute to overeating and weight-gain among normal weight individuals. Over time the excessive food-intake may evolve in a down-regulation of dopamine (RDS), resulting in overeating as a form of self-medication and the progression to obesity. This process was evidenced in adults showing a curvi-linear relationship between self-reported RS and BMI. The aim of the current study was to investigate the association between self-reported RS and BMI in children (10-15 years). The results confirm the non-linear relationship between RS and bodyweight and support the suggestion of the same feed forward process in children. These findings imply that it is crucial to reduce the intake of high palatable foods in high RS children to prevent the decrease in RS and reduce the risk for future weight gain.

Prevalence and Characteristics of Binge Eating in an Adolescent Community Sample

The objective of this article was to investigate the prevalence and psychological correlates of binge eating among adolescents. Self-report questionnaires were administered to a community sample of 708 adolescents (M age = 14 years). Adolescents reporting loss of control over eating (17% of the sample) reported more eating pathology and more general maladjustment compared to those without loss of control. The combined presence of subjective and objective binge episodes was related to the most severe pattern of eating pathology. The results suggest that loss of control over eating is a relatively frequent experience among adolescents from the general population and it is related to eating pathology and maladjustment.

Norms and screening utility of the Dutch version of the Children's Depression Inventory in clinical and nonclinical youths.

This study aimed to (a) assess relationships between the Childrens Depression Inventory (CDI) and DSM-oriented depression and anxiety scales of the Youth Self Report, (b) develop reliable norms for the CDI, and (c) determine CDI cutoff scores for selecting youngsters at risk for depression and anxiety. A total of 3,073 nonclinical and 511 clinically referred children and adolescents from The Netherlands and Belgium were included. Results showed that CDI scores were significantly related to DSM-oriented symptoms of both depression and anxiety. CDI scores correlated highly with depression symptoms and moderately with anxiety symptoms. Norms for the CDI were determined by means of multiple regression analysis and depended on sex, age, and country. CDI cutoff scores for selecting individuals at risk for depression and anxiety as measured by the DSM-oriented depression and anxiety scales of the Youth Self Report were determined by means of multiple regression analysis and receiver operating characteristic analysis. A CDI score of 16 was found to have the most optimal balance between sensitivity and specificity for depression, whereas a score of 21 provided the best sensitivity and specificity for anxiety in a subsample of children. We conclude that the CDI is an effective instrument for screening depression and to a lesser extent anxiety in primary and secondary care centers, before applying further assessment of high-risk individuals.

Weight parameters and pathological eating as predictors of obesity treatment outcome in children and adolescents.

OBJECTIVE The current study investigated weight parameters and pathological eating as predictors of treatment outcome in obese youngsters. METHOD Obese youngsters (N=132) were examined before participating in an obesity treatment program. Weight loss was measured during and at the end of treatment. RESULTS Baseline adjusted BMI, restrained eating style and weight loss after 4 months of treatment positively predicted weight loss at the end, whereas larger weight loss after 1 month of treatment predicted less total weight loss. Lower baseline adjusted BMI was associated with more drop-out whereas subjective binge eating was positively related to program completion. CONCLUSION Specific weight and eating pathology parameters affected positive as well as negative obesity treatment outcome. Identifying more pre-treatment predictors for drop-out can ameliorate our treatment approach.

Punishment and Reward Sensitivity: Are Naturally Occurring Clusters in These Traits Related to Eating and Weight Problems in Adolescents?

Little is known about the role of sensitivity to punishment (SP) and reward (SR) in eating problems during adolescence. Therefore, the aim of the present study was to examine the naturally occurring clusters of high and low SP and SR among nonclinical adolescents and the between-cluster differences in various eating problems and weight. A total of 579 adolescents (14-19 years, 39.8% boys) completed the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), the Behavioural Inhibition System and Behavioural Activation System scales (BIS/BAS scales), the Dutch Eating Behaviour Questionnaire and the Child Eating Disorder Examination Questionnaire and were weighed and measured. On the basis of the SPSRQ, four clusters were established, interpreted as lowSP × lowSR, lowSP × highSR, highSP × highSR and highSP × lowSR. These were associated with eating problems but not with adjusted body mass index. It seemed that specifically the highSP × highSR cluster outscored the other clusters on eating problems. These results were partly replicated with the BIS/BAS scales, although less significant relations between the clusters and eating problems were found. The implications of the findings in terms of possible risk and protective clusters are discussed.

The Parent–Child Relationship as Predictor of Eating Pathology and Weight Gain in Preadolescents

The present study examined the role of attachment toward mother and father as a predictor of eating pathology and weight gain among preadolescent boys and girls. Self-report questionnaires and adjusted body mass index (BMI) were administered from a community sample of 601 preadolescents (8–11 years; 48% female) at baseline and once again 1 year later. Significant baseline associations were found between attachment toward both parents and several features of eating pathology. No baseline correlations were found between the attachment variables and adjusted BMI. However, after controlling for gender and baseline levels of eating pathology and weight, an insecure attachment toward mother significantly predicted increases in dietary restraint, eating concerns, weight concerns, and shape concerns, and adjusted BMI in the children 1 year later. An insecure attachment toward father was predictive for persistence in childrens subjective binge eating episodes. The present study provides preliminary evidence for the longitudinal association between attachment and eating pathology and weight gain in preadolescents. Moreover, attachment toward mother and attachment toward father appear to be differently associated with their childrens disordered eating attitudes and adjusted BMI. Future research should further elucidate the mechanisms underlying this differential association.