Rebecca C. Kamody

Helpful or harmful? Prospective association between weight misperception and weight gain among overweight and obese adolescents and young adults

Background/Objective:Weight misperception is common among adolescents with obesity, but it is not known whether weight perception is related to future weight gain. The objective of the study was to examine the prospective association between accurate weight perception versus weight misperception and weight change among youth who are overweight or obese.Subjects/Methods:Using a subsample of The National Longitudinal Study of Adolescent to Adult Health Wave II cohort, we used linear regression modeling (adjusted for age, baseline body mass index (BMI), parental education, household percent federal poverty level, depression, race and ethnicity) to examine the prospective association between weight misperception (that is, perceiving oneself to be under or normal weight) among 2738 overweight and obese youth and subsequent BMI change from Wave II (1996) to Wave IV (2008–2009). Mean age at baseline (Wave II) was 15.9 (0.1).Results:Fifty-seven percent of males and 80% of females accurately perceived themselves as overweight. In fully adjusted models, weight misperception was associated with less BMI gain among youth who were overweight and obese. Specifically, youth who perceived themselves to be at a healthy weight had lower BMI gains (males: β= −1.43, 95% confidence interval (CI)=(−2.26, −0.60), P=0.001; females: β= −1.35, 95% CI=(−2.59, −0.11), P=0.035) from Wave II to IV relative to those who accurately perceived themselves as overweight or obese.Conclusions:Contrary to commonly held assumptions, weight misperception among a non-clinical sample of youth who were overweight or obese predicted lower future weight gain. Efficacy of efforts to correct weight misperception should be rigorously examined to assess for both intended and unintended consequences.

Measuring Health-Related Quality of Life With the Parental Opinions of Pediatric Constipation Questionnaire

OBJECTIVES The purpose of this study was to develop a caregiver-completed constipation condition-specific health-related quality of life (HRQL) instrument. METHODS 410 caregivers of children aged 2-18 years completed the Parental Opinions of Pediatric Constipation (POOPC), the PedsQL Generic Core Scales, PedQL Family Impact Module, Pediatric Symptom Checklist, the Functional Disability Inventory, the Pediatric Inventory for Parents, and a demographic questionnaire. Exploratory and confirmatory factor analyses were conducted to assess the psychometric properties of the POOPC. RESULTS Analyses yielded four factors called Parental Burden/Distress, Family Conflict, Difficulties with the Medical Team, and Worry about Social Impact that reflect problems in HRQL secondary to constipation and soiling, which were generally more strongly correlated with similar measures relative to a general measure of youths psychosocial functioning. CONCLUSION The POOPC is a psychometrically sound measure, which may be useful to clinicians and researchers identifying domains of treatment needs for children and their families.

Patterns of Family Functioning and Diabetes-Specific Conflict in Relation to Glycemic Control and Health-Related Quality of Life Among Youth With Type 1 Diabetes

Objective General and diabetes-specific family functioning may be associated with youth’s adaptation to type 1 diabetes (T1D); however, empirically derived patterns of family functioning and diabetes-specific conflict among youth have not been explored in relation to T1D adaptation. Methods Youth (N = 161, aged 12–18) with T1D and caregivers completed measures of family functioning and diabetes-specific conflict that served as indicators in latent profile analyses. Differences in glycemic control (measured by hemoglobin A1cs [HbA1c] and health-related quality of life [HRQoL]) were compared across profiles. Results Four profiles that varied by levels of family functioning, diabetes-specific conflict, and congruence between youth and caregiver perspectives emerged and related to T1D adaptation differently. Greater agreement between caregiver and youth and lower diabetes-specific conflict was associated with lower HbA1c and greater HRQoL. Conclusions Person-centered approaches are useful to quantify how many individuals fit into a particular pattern and determine how specific family dynamics may function together differently in relation to T1D adaptation for various subgroups of the population.

Physical Activity, Sedentary Behaviors, and Nutritional Risk Profiles and Relations to Body Mass Index, Obesity, and Overweight in Eighth Grade

The objective of this article was to determine (1) the existence of individually varying patterns of physical activity, sedentary behavior, and nutrition intake risk; and (2) how these risk-patterns relate to youths demographics, Body mass index (BMI) and psychosocial functioning. Participants (N = 9,304) from the 2007 8th Grade Early Childhood Longitudinal Study Cohort completed the revised Self-Description Questionnaire II. Age, sex, height, and weight were used to calculate body mass index (BMI) z scores and percentiles. Three risk profiles emerged via Latent Profile Analyses: “Active + Healthy Diet” (AHD; 16.3% Obese); “Sedentary + Unbalanced Diet” (SUD; 21.3% Obese); and “Screen-Time + Recreational Food” (STRF; 25.0% Obese). Significant differences in BMIs, psychosocial factors, and demographic characteristics were found across the profiles. Differential patterns of physical activity, sedentary behavior, and nutritional choices were found to predict BMI and psychosocial functioning. These findings may be helpful to refine and develop modular-based prevention and weight control intervention programs.

Assessing Measurement Invariance of the Diabetes Stress Questionnaire in Youth With Type 1 Diabetes

OBJECTIVE To evaluate the factor structure and measurement invariance of the Diabetes Stress Questionnaire (DSQ), a measure of diabetes-specific stress, across sex, age (<9th grade vs. ≥9th grade), and glycemic control (optimal vs. suboptimal). METHODS Data from 318 adolescent participants were pooled from four archival data sets and the ongoing Predicting Resiliency in Youth with Type 1 Diabetes study in which the DSQ was completed. Confirmatory factor and measurement invariance analyses were conducted to confirm the proposed factor structure and measurement invariance across sex, age, and glycemic control. RESULTS The DSQ factor structure was found to have an acceptable fit, which was invariant across sex, age, and glycemic control. CONCLUSIONS When using the DSQ, differences in diabetes-related stress with respect to sex, age, or glycemic control can be considered meaningful. This study supports the DSQ as an evidence-based and well-established assessment of perceived diabetes stress in youth with type 1 diabetes.

Disentangling the Longitudinal Relations of Race, Sex, and Socioeconomic Status, for Childhood Body Mass Index Trajectories

OBJECTIVE Race, sex, and socioeconomic status (SES) are associated with childhood obesity. The present research longitudinally examines these factors with 12,674 White and Black children from kindergarten through 8th grade. METHODS Body mass index (BMI) data were collected and standardized at six time points (zBMI). Using Latent Growth Curve Modeling, race and sex were evaluated as moderators for the relation between SES and initial zBMI and rate of zBMI change. RESULTS Higher SES significantly predicted higher initial zBMI for Black males and lower initial zBMI and rate of change for White males. A nonlinear relation between SES and zBMI was found for White females. CONCLUSIONS SES has a differential impact on adiposity for different demographic groups. The longitudinal nature of the study and the focus on younger school-aged children provide important information regarding the complex interplay of race, sex, and SES for the prediction of childhood adiposity.

Relating shape/weight based self-esteem, depression, and anxiety with weight and perceived physical health among young adults

Simultaneous contributions of self-esteem, depression, and anxiety to weight and perceived physical health in young adults is understudied. A diverse sample of 424 young adults completed measures of shape/weight based self-esteem, depression, anxiety, and perceived physical health. Height and weight were measured to calculate body mass index (BMI). Latent profile analysis was conducted to derive patterns of depression, anxiety, and shape/weight based self-esteem. Then, we examined the association of the profiles with weight status and perceived physical health. Three profiles emerged: (1) High Shape/Weight Influence (HSWI); (2) Low Shape/Weight, Depression, & Anxiety Influence (LSWDAI); and (3) High Depression & Anxiety Influence (HDAI). The HSWI profile had significantly higher BMI than the LSWDAI and HDAI profiles, and significantly lower perceived physical health than the LSWDAI profile. Over emphasis on shape/weight, regardless of depression and anxiety, is associated with elevated weight and negative internalized health views.

Psychological Flexibility Among Youth with Type 1 Diabetes: Relating Patterns of Acceptance, Adherence, and Stress to Adaptation

ABSTRACT Psychological flexibility, a complex concept encompassing both acceptance and action related factors, has been identified as a target for intervention for diabetes management. Research suggests acceptance, self-management, and stress, all factors that influence psychological flexibility, have an impact on adaptation to type 1 diabetes (T1D) by youth independently. However, yet to be explored is individually varying patterns of these variables and how they may relate to diabetes adaptation outcomes. The present study aimed to establish individual variations of patterns of these factors to derive profiles of psychological flexibility, and examine their relations to the adaptation outcomes of glycemic control and health-related quality of life. Youth (N = 162, aged 12–17 years) with T1D completed the Acceptance and Action Diabetes Questionnaire, Diabetes Stress Questionnaire, Self-Care Inventory, and Pediatric Quality of Life-Diabetes Module. Hemoglobin A1c values were abstracted from medical records. Latent profile analysis yielded three profiles: High Acceptance & Adherence/Low Stress, Low Acceptance/Moderate Adherence & Stress, and Low Acceptance & Adherence/High Stress. The High Acceptance & Adherence/Low Stress group displayed significantly higher health-related quality of life and lower HbA1c compared to other groups. Fluid psychological variables, such as acceptance and diabetes stress, and adherence behaviors may be salient targets to increase psychological flexibility for individual psychosocial interventions aimed at improving adaptation to type 1 diabetes in youth.

Differentiating Peer and Friend Social Information-Processing Effects on Stress and Glycemic Control Among Youth With Type 1 Diabetes

OBJECTIVE Many adolescents with Type 1 diabetes (T1D) find adherence difficult in social situations because they fear negative evaluations by others. These negative reaction attributions are associated with anticipated adherence difficulties, stress, and glycemic control. It is unclear whether peer versus friend attributions are distinct constructs, or whether there is a differential impact on glycemic control moderated by youth characteristics. METHOD Youth with T1D (n = 142; 58% female; 84% Caucasian, mean = 13.79 years, standard deviation = 2.10) completed the Peer Attribution and Diabetes Stress Questionnaires. HbA1cs were obtained from medical records. RESULTS Negative peer versus friend attributions appear distinct and were differentially related to anticipated adherence difficulties, stress, and glycemic control, with peer attributions having the strongest effect. Grade, age, and sex were not moderators for these relationships. CONCLUSION Peer-related attributions may be a particularly salient target for interventions to improve adherence and distress among youth with T1D.

Empirically Derived Parental Feeding Styles for Young Children and Their Relations to Weight, Mealtime Behaviors, and Childhood Behavior Problems

This study sought to establish empirically derived parental feeding styles based on their mealtime behaviors and strategies and determine how these styles relate to children’s weight, mealtime behaviors, and other childhood problems. Parents (N = 378) of children ages 2–6 completed questionnaires and reported children’s height and weight. Three feeding styles emerged via latent profile analyses: internal regulation (IR), external control (EC), and laissez faire regulation (LFR). BMI scores were highest in the EC profile, and LFR parents reported the most mealtime difficulties. These empirically derived feeding styles are associated with specific mealtime behaviors/characteristics and both high and low weight extremes.