Stephanie Knatz

Teasing, depression and unhealthy weight control behaviour in obese children

What is already known about this subject Overweight children are teased more than normal weight children. Weight‐related teasing can come from a variety of sources. Weight‐related teasing is associated with depression and disordered eating.

Temperament-based treatment for anorexia nervosa.

Anorexia nervosa (AN) tends to be a chronic and deadly disorder with no proven treatments that reverse core symptoms in adults. New insight into neurobiological mechanisms that contribute to symptoms may support development of more effective interventions. We describe the development of a temperament-based treatment for AN on the basis of empirically supported models. It uses a systemized approach and takes into consideration an understanding of how neurobiological mechanisms are expressed through behaviour and personality and contribute to specific AN symptomatology. This model integrates the development of AN-focused constructive coping strategies with carer-focused strategies to manage temperament traits that contribute to AN symptomatology. This intervention is consistent with the recent Novel Interventions for Mental Disorders initiative mandating that treatment trials follow an experimental medicine approach by identifying underlying mechanisms that are directly targeted by the intervention to influence symptoms.

Relationships Between Body Satisfaction and Psychological Functioning and Weight-Related Cognitions and Behaviors in Overweight Adolescents

PURPOSE To examine how differences in body satisfaction may influence weight control behaviors, eating, weight and shape concerns, and psychological well-being among overweight adolescents. METHODS A group of 103 overweight adolescents completed a survey assessing body satisfaction, weight control behaviors, eating-related thoughts and behaviors, importance placed on thinness, self-esteem, anger, and symptoms of depression and anxiety between 2004 and 2006. Logistic regression analyses compared overweight adolescents with high and low body satisfaction. RESULTS Higher body satisfaction was associated with a lower likelihood of engaging in unhealthy weight control behaviors, less frequent fears of losing control over eating, and less importance placed on thinness. Overweight adolescents with higher body satisfaction reported higher levels of self-esteem and were less likely to endorse symptoms of depression, anxiety, and anger than overweight adolescents with lower body satisfaction. CONCLUSIONS Adolescents with higher body satisfaction may be protected against the negative behavioral and psychological factors associated with overweight.

Short‐Term Intensive Family Therapy for Adolescent Eating Disorders: 30‐Month Outcome

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)-a 5-day treatment based on the principles of family-based therapy for EDs. We retrospectively examined the long-term efficacy of IFT in both single-family (S-IFT) and multi-family (M-IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥ 95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE-Q) global score within 1 SD of norms, and absence of binge-purging behaviours. Partial remission was defined as weight ≥ 85% of expected or ≥ 95% but with elevated EDE-Q global score and presence of binge-purging symptoms (<1/week). Over a mean follow-up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S-IFT and M-IFT showing comparable outcomes. Short-term, intensive treatments may be cost-effective and clinically useful where access to regular specialist treatment is limited.

An Open Trial Targeting Food Cue Reactivity and Satiety Sensitivity in Overweight and Obese Binge Eaters

Data suggests that individuals who binge eat are more responsive to food cues in the environment and less sensitive to satiety cues. The aim of this open trial was to evaluate the feasibility, acceptability, and initial effectiveness of a novel treatment grounded in Schachters externality theory targeting food cue reactivity and satiety responsiveness with obese adults who binge eat. Treatment was provided in groups, and utilized appetite monitoring, cue-exposure treatment, in vivo exercises, self-monitoring, and coping skills. Twenty-eight overweight and obese adults who binge eat (82% female; mean age = 47.5 years [SD = 12.8]; BMI = 38.9 [SD = 10.3]; 79% White non-Hispanic) participated in a 4-month group-based treatment program. Assessments were conducted at baseline, posttreatment, and 3-month follow-up time points. Results indicated that this treatment was well accepted and had high retention at posttreatment. Initial effectiveness showed significant decreases in BMI, and improvements in loss of control and overeating episodes, food responsiveness, and power of food. The majority of results were maintained at the 3-month follow-up time point. This open trial provides preliminary evidence for the feasibility, acceptability, and initial effectiveness of this treatment on both eating disorder symptoms and weight in obese adults who binge eat. Because these data are preliminary, further treatment development and randomized controlled studies are needed.

A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders.

There is a continued need to improve upon the efficacy and availability of treatments for anorexia nervosa. Family-based therapy for anorexia nervosa demonstrates strong empirical evidence; however, trained treatment providers are limited and a subsample of participants receiving the treatment fail to respond. The intensive family treatment program is a brief, time-limited, multi-family program that trains families of adolescents with eating disorders to oversee their adolescents’ recovery at home by providing psychoeducation, skills training, and immersive practice over the course of a 5-day period. This article provide a description of the program by summarizing underlying theoretical principles and key therapeutic components.

Treatment Manual for Anorexia Nervosa (2nd ed.)

Lock and le Grange’s Treatment Manual for Anorexia Nervosa is the second edition of a treatment manual initially published in 2002 that introduced an empirically supported family-based approach to the treatment of anorexia nervosa (AN) in adolescents. The introduction of family therapy to the treatment of adolescents with anorexia presented in the original version of this manual characterized an important paradigmatic shift from individual to family treatment, where family members are identified as primary agents of change and indispensable resources for the recovery of the family member stricken with AN. In this manual, the authors thoroughly outline a short-term treatment for adolescents with AN, which occurs within the context of family therapy. The manual serves as a session-by-session guide that summarizes treatment approaches and their rationales, as well as provides detailed case examples. The second edition of this manual expands upon the original version in important ways by presenting updated knowledge of the field of AN, refinements in treatment strategies through expanded rationales and methods, and information on future directions of family-based treatment. The result is a user-friendly guide for clinicians that will greatly assist with the delivery of family-based treatment (FBT) for adolescents with AN. Family-based treatment has become, arguably, the mainstay treatment for youth with AN due to its significant empirical backing, much of which is a product of the research of the authors and their collaborators. This manual is a thorough description of family therapy for AN, and does not assume that clinicians possess a background in family therapy. The authors begin by presenting a historical perspective on the use of family therapy for eating disorders and a review of family therapy treatment modalities that inform the FBT approach. In doing so, readers relatively unfamiliar with family therapy, a common occurrence among clinicians trained in eating disorders, are oriented to systemic treatment approaches. The provision of this background assists with fluency in clinical case formulations and theoretical conceptualization under this model, thereby allowing for treatment strategies to be delivered more fluently and fluidly by clinicians who are experienced

Parent Coaching Model for Adolescents With Emotional Eating

A significant proportion of both healthy and treatment-seeking youth report eating for emotional reasons. Emotional eating (EE) is associated with medical and psychological sequelae including overeating and eating disorder symptoms. Youth with EE are thought to have a predisposition toward a high level of emotional sensitivity, with a tendency to experience emotions intensely, and for a long duration. Interventions are needed to address emotion dysregulation associated with EE. Parent-focused interventions that emphasize training parents to respond to emotion dysregulation in their children have the potential to reduce the incidence of EE. This article describes an emotion-focused parent training intervention for youth who engage in EE.