Nicole Obeid

Body Dissatisfaction, Dietary Restraint, Depression, and Weight Status in Adolescents.

BACKGROUND Adolescence may be a crucial period for developing obesity and associated mental health problems. This study examined the relationship of weight status on body image, eating behavior, and depressive symptoms in youth. METHODS A survey was conducted on 1490 youth attending grades 7-12. Participants completed questionnaires on body image, eating behavior, and mood and were measured for height and weight to calculate body mass index (BMI). Weight classification was based on the International Obesity Task Force guidelines, whereby youth at or above the 95th BMI percentile for age and sex were classified as obese, those between 85th and 94th BMI percentile as overweight, and those between 5th and 84th BMI percentile as normal weight. Several multivariate analyses of variance (MANOVAs) were conducted to examine these relationships. RESULTS Clear relationships emerged between body image and weight classification. Obese youth reported higher body dissatisfaction than overweight youth, who reported more body dissatisfaction than normal weight youth. These effects were independent of age and gender. A relationship was also found for dietary restraint and weight status whereby higher restraint scores were associated with greater adiposity. Similarly, obese youth reported greater depressive symptoms, including anhedonia, negative self-esteem, and higher overall depression scores compared with overweight and normal-weight youth. CONCLUSIONS Psychopathology in obese youth is well known in clinical samples but this study suggests that obese youth in the community may be at increased risk of developing body dissatisfaction, dietary restraint, and depressive symptoms compared with overweight or normal weight youth.

Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study

OBJECTIVE To assess and compare clinical characteristics of patients with avoidant/restrictive food intake disorder (ARFID) to those with anorexia nervosa (AN). METHOD A retrospective review of adolescent eating disorder (ED) patients assessed between 2000 and 2011 that qualified for a diagnosis of ARFID was completed. A matched AN sample was used to compare characteristics between groups. RESULTS Two hundred and five patients met inclusion criteria and were reviewed in detail. Of these, 34 (5%) patients met criteria for ARFID. A matched sample of 36 patients with AN was used to draw comparisons. Patients with ARFID were younger than those with AN, more likely to present before age 12, and more likely to be male. Patients in both groups presented at low weights. Common eating-specific behaviors and symptoms in the ARFID group included food avoidance, loss of appetite, abdominal pain, and fear of vomiting. Rates of comorbid psychiatric diagnoses and medical morbidity were high in both groups. Almost 80% of AN patients and one-third of ARFID patients required hospital admission as a result of medical instability. Symptom profiles in 4/34 ARFID patients resulted in eventual reclassification to AN. DISCUSSION This study supports the notion that a small percentage of adolescent patients presenting with restrictive eating disorders meet criteria for ARFID. Patients are younger than average, more likely to be male compared to adolescent AN samples, and have high rates of psychiatric and medical morbidity. The study also suggests that a proportion of patients evolve into AN as treatment progresses.

Screen time is associated with depression and anxiety in Canadian youth

OBJECTIVE This study examined the relationships between screen time and symptoms of depression and anxiety in a large community sample of Canadian youth. METHOD Participants were 2482 English-speaking grade 7 to 12 students. Cross-sectional data collected between 2006 and 2010 as part of the Research on Eating and Adolescent Lifestyles (REAL) study were used. Mental health status was assessed using the Childrens Depression Inventory and the Multidimensional Anxiety Scale for Children-10. Screen time (hours/day of TV, video games, and computer) was assessed using the Leisure-Time Sedentary Activities questionnaire. RESULTS Linear multiple regressions indicated that after controlling for age, sex, ethnicity, parental education, geographic area, physical activity, and BMI, duration of screen time was associated with severity of depression (β=0.23, p<0.001) and anxiety (β=0.07, p<0.01). Video game playing (β=0.13, p<.001) and computer use (β=0.17, p<0.001) but not TV viewing were associated with more severe depressive symptoms. Video game playing (β=0.11, p<0.001) was associated with severity of anxiety. CONCLUSION Screen time may represent a risk factor or marker of anxiety and depression in adolescents. Future research is needed to determine if reducing screen time aids the prevention and treatment of these psychiatric disorders in youth.

Family meals and body mass index among adolescents: effects of gender

Family meals have been identified as a protective factor against obesity among youth. However, gender specificities with respect to the relationship between the frequency of family meals and body mass index (BMI) have not been investigated. The purpose of this study was to examine the relationship between the frequency of family meals and BMI in male and female adolescents, while controlling for potential confounding factors associated with BMI, such as parental education, adolescents age, and snack-food eating. Research participants were 734 male and 1030 female students (mean age, 14.12 years, SD = 1.62) recruited from middle schools and high schools in the capital region of Canada. Participants completed validated, self-report measures to assess the frequency of family meals and the risk factors associated with increased BMI, which was derived from objective measures of height and weight. After controlling for proposed confounding variables, a higher frequency of family meals was associated with lower BMI in females, but not in males. A Z-transformation test of the homogeneity of adjusted correlation coefficients showed a significant trend (p = 0.06), indicating that the relationship between family meals and BMI is stronger in females than males, consistent with our regression analyses. Our findings suggest that eating together as a family may be a protective factor against obesity in female adolescents, but not in male adolescents. Findings from this study have important implications for parents and health care practitioners advocating for more frequent family meals as part of a comprehensive obesity prevention and treatment program for female adolescents.

Comparative Distribution and Validity of DSM-IV and DSM-5 Diagnoses of Eating Disorders in Adolescents from the Community

OBJECTIVES DSM-5 changes for eating disorders (EDs) aimed to reduce preponderance of non-specified cases and increase validity of specific diagnoses. The objectives were to estimate the combined effect of changes on prevalence of EDs in adolescents and examine validity of diagnostic groupings. METHOD A total of 3043 adolescents (1254 boys and 1789 girls, Mage  = 14.19 years, SD = 1.61) completed self-report questionnaires including the Eating Disorder Diagnostic Scale. RESULTS Prevalence of full-threshold EDs increased from 1.8% (DSM-IV) to 3.7% (DSM-5), with a higher prevalence of bulimia nervosa (1.6%) and the addition of the diagnosis of purging disorder (1.4%); prevalence of binge eating disorder was unchanged (0.5%), and non-specified cases decreased from 5.1% (DSM-IV) to 3.4% (DSM-5). Validation analyses demonstrated that DSM-5 ED subgroups better captured variance in psychopathology than DSM-IV subgroups. DISCUSSION Findings extend results from previous prevalence and validation studies into the adolescent age range. Improved diagnostic categories should facilitate identification of EDs and indicate targeted treatments.

An Examination of Medical and Psychological Morbidity in Adolescent Males With Eating Disorders

The objective of this study was to examine the clinical profile of adolescent male patients presenting for eating disorder (ED) assessment over a 17-year period. A retrospective cohort study was completed. A total of 52 patients (8% of the total sample) were included in the study. The average age of patients was 14.7 years and the most common diagnosis observed was Eating Disorder Not Otherwise Specified (EDNOS). Rates of concurrent depression and anxiety were very high, as were rates of medical co-morbidity, including osteoporosis. Our study supports findings documented in previously published reports of males with eating disorders and adds to the limited knowledge base which targets adolescents specifically. Multi-center controlled trials are required to further investigate male-specific ED symptomatology, treatment courses, and outcomes.

Self-Esteem and Social Anxiety in an Adolescent Female Eating Disorder Population: Age and Diagnostic Effects

This study explored symptoms of social anxiety and multidimensional self-esteem in a clinical, adolescent female eating disorder population. Using self-report measures, data from 344 females revealed significant negative relationships between dimensions of self-esteem and social anxiety. A diagnostic difference emerged, with the restricting subgroup reporting significantly higher perceived physical appearance and global self-worth than those with binge/purge symptoms or bulimia nervosa. No significant age differences or age by diagnosis interaction effects emerged. These findings suggest that in clinical samples of adolescent eating disorders, self-esteem and social anxiety share a significant inverse relationship and seem to remain fairly constant across adolescence.

Factors Influencing Research Drug Trials in Adolescents With Anorexia Nervosa

This study examined factors that contributed to patients eligibility and participation in a randomized controlled trial involving olanzapine for the adjunctive treatment of anorexia nervosa (AN). Factors involving patient eligibility and willingness to participate were systematically recorded for all patients approached to participate. Of the 92 patients that were assessed and treated over the study timeframe, only 27 patients (29%) met full criteria for inclusion, of which just 7 enrolled (26%). The most common reasons for study refusal related to fears associated with medication effects and refusal to consider medication as a treatment option (70%). Factors affecting recruitment in psychopharmacological studies involving AN in youth are discussed.

A Family-Based Eating Disorder Day Treatment Program for Youth: Examining the Clinical and Statistical Significance of Short-Term Treatment Outcomes

This article describes an innovative family-based day treatment program (DTP) for youth with moderate to severe eating disorders. A sample of 65 youth completed a battery of psychological measures pre- and post-treatment and 6 months after program completion. Treatment outcomes were assessed in three main domains: (a) medical stabilization, (b) normalization of eating behavior, and (c) improved psychological functioning. Overall, patients demonstrated statistically significant and clinically meaningful improvements on all outcome measures. Findings indicate that a comprehensive DTP can successfully facilitate positive outcomes in youth with eating disorders and that these improvements can be maintained 6 months post-treatment.

A Psycho-Education Intervention for Parents of Adolescents With Eating Disorders: A Randomized Controlled Trial

This study evaluated the efficacy of a 2-hour psycho-education session combined with bi-weekly telephone support in increasing parent/caregiver knowledge about eating disorders, increasing self-efficacy by empowering parents to support their child’s recovery, and decreasing the impact of eating disorder symptoms on the family. The intervention was targeted at parents/caregivers whose child was waiting to be assessed for an eating disorder. Participants included 51 parents/caregivers and 36 youths. The brief intervention successfully increased parent/caregiver knowledge of the illness, feelings of self-efficacy, and help-seeking behaviors. These findings are clinically useful as waiting lists are common in Canada.