Rebecca Ringham

Family-Based Treatment of Severe Pediatric Obesity: Randomized, Controlled Trial

OBJECTIVE: We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity. METHODS: Participants were 192 children 8.0 to 12.0 years of age (mean ± SD: 10.2 ± 1.2 years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance. RESULTS: Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-to-treat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended ≥75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants. CONCLUSIONS: Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended ≥75% of sessions.

Emotion Avoidance in Patients with Anorexia Nervosa: Initial Test of a Functional Model

OBJECTIVE This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group. METHOD Seventy-five patients with AN completed questionnaires to assess study variables. Rates of emotion avoidance were compared to published data, and regression models were used to test the hypothesis that emotion avoidance mediates the relation between depressive and anxiety symptoms and ED psychopathology in AN. RESULTS Patients with AN endorsed levels of emotion avoidance that were comparable to or higher than other psychiatric populations and exceeded community controls. As predicted, emotion avoidance significantly explained the relations of depressive and anxiety symptoms to ED psychopathology. DISCUSSION Findings confirm that emotion avoidance is present in patients with AN and provide initial support for the idea that anorexic symptoms function, in part, to help individuals avoid aversive emotional states.

Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy

OBJECTIVE To determine whether cognitive behavior therapy (CBT) targeted to problematic attitudes common among women with functional hypothalamic amenorrhea would restore ovarian function. DESIGN Randomized, prospective, controlled intervention. SETTING Clinical research center in an academic medical institution. PATIENT(S) Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise. INTERVENTION(S) Subjects were randomized to CBT or observation for 20 weeks. MAIN OUTCOME MEASURE(S) Serum levels of E(2) and P and vaginal bleeding were monitored. RESULT(S) Of eight women treated with CBT, six resumed ovulating, one had partial recovery of ovarian function without evidence of ovulation, and one did not display return of ovarian function. Of those randomized to observation, one resumed ovulating, one had partial return of ovarian function, and six did not recover. Thus, CBT resulted in a higher rate of ovarian activity (87.5%) than did observation (25.0%), chi(2) = 7.14. CONCLUSION(S) A cognitive behavioral intervention designed to minimize problematic attitudes linked to hypothalamic allostasis was more likely to result in resumption of ovarian activity than observation. The prompt ovarian response to CBT suggests that a tailored behavioral intervention offers an efficacious treatment option that also avoids the pitfalls of pharmacological modalities.

The clinical utility of personality subtypes in patients with anorexia nervosa.

OBJECTIVE Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients on the basis of comorbid personality psychopathology has utility in predicting treatment response and readmission in patients with AN. METHOD Data were collected from 154 AN patients (M [SD] age = 25.6[9.4] years; 95.5% female; 96.8% Caucasian) at admission, discharge, and 3 months postdischarge from intensive treatment. Latent profile analysis of personality traits assessed at admission was performed to classify participants into personality subtypes, which were then used to predict outcomes at discharge and risk of readmission. RESULTS The best fitting model identified 3 personality subtypes (undercontrolled, overcontrolled, low psychopathology) that contributed significantly to multivariate models predicting study outcomes. Undercontrolled patients were more likely to have a poor outcome at discharge than overcontrolled (OR = 3.56, p = .01) and low psychopathology patients (OR = 11.23, p < .001). Undercontrolled patients also had a greater risk of discharge against medical advice (HR = 2.08, p = .02) and readmission than overcontrolled patients (HR = 3.76, p = .009). Binge-eating/purging versus restricting subtypes did not predict discharge against medical advice or readmission in the multivariate models. CONCLUSIONS Findings support the clinical utility of personality subtypes in AN. Future work is needed to identify mechanisms that explain diminished treatment response in undercontrolled patients and to develop interventions for this high-risk group.

A family history study of binge-eating disorder ☆

Family studies of anorexia nervosa and bulimia nervosa have yielded important information about the etiologies of these eating disorders. By contrast, little is known about familial factors of etiologic importance for binge-eating disorder (BED). The purpose of the current family history study was to assess the prevalence of comorbid psychopathology in a non-treatment seeking female sample of 31 probands with BED, 32 control probands without BED, and their 283 first-degree relatives. In-person semistructured clinical interviews were conducted with the probands, who also served as informants for all of their first-degree relatives. Significantly higher lifetime rates of major depressive disorder, dysthymic disorder, and social phobia were found among women with BED compared with control women. Significantly higher lifetime rates of bipolar (I or II) disorder, any depressive disorder, nearly all anxiety disorders, anorexia nervosa, and BED were reported among the first-degree relatives of women with BED compared with the first-degree relatives of control women. Furthermore, female relatives of women with BED were reported to have higher rates of substance use disorders and dysthymic disorder compared with female relatives of control women without BED. Nearly all disorders that were elevated in relatives of women with BED followed a pattern of independent transmission from BED. The primary exception was substance use disorder among female relatives, whose transmission pattern was consistent with that of a shared etiology with BED. Thus, BED and substance use disorder may share a common mechanism of familial transmission among women.

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.

Temperament, mood, dietary restraint, and bulimic symptomatology in college women

The current study examined whether biologically-influenced temperamental traits implicated in the pathogenesis of disordered eating behaviors contribute to their development over and above current negative affect and dietary restraint. Participants (N=276) were undergraduate psychology women who completed the BULIT-R, BDI-II, STAIS, RS, and the MPQ. Temperamental characteristics, particularly increased Negative Emotionality and decreased Positive Emotionality, were significantly associated with increased levels of bulimic symptomatology. Moreover, these dimensions accounted for small, but statistically significant amounts of the variance of bulimic symptomatology over and above current negative affect and dietary restraint. Contrary to expectations, impulsivity did not predict bulimic symptoms. This study provides evidence that temperamental dimensions related to mood rather than impulsivity are associated with bulimic symptomatology and contribute to bulimic symptoms over and above state mood and dietary restraint. Future empirical studies are needed to clarify relationships between temperament and other risk factors for disordered eating.