Understanding the relationships between acculturation, food insecurity, and food parenting practices among socioeconomically/racially diverse parents.

Research suggests that acculturation and food insecurity are factors that are separately associated with the use of specific food parenting practices among United States (US) families. Certain food parenting practices, such as coercive control and unstructured food parenting practices, are related to negative health consequences in children, such as disordered eating behaviors. The current study aimed to explore associations between acculturation strategies and food parenting practices in a sample of 577 Latinx, Hmong, Somali/Ethiopian, and Multiracial families. A secondary objective was to understand whether food security status significantly modified the relationships between acculturation strategies and food parenting practices. Results showed that acculturation strategies were significantly related to food parenting practices, and patterns in these relationships differed across race and ethnicity. Further, food security status significantly modified the relationship between acculturation strategies and food parenting practices for Latinx, Hmong, and Somali/Ethiopian families, but not for Multiracial families. These results point to the complex relationships among acculturation strategies, food security status, and food parenting practices in immigrant populations in the US. Longitudinal studies exploring the temporal relationships between acculturation strategies, food security status, and food parenting practices would help tease apart how food parenting practices may evolve upon migrating to the US.

Parents and caregivers as key players in the prevention and identification of body image concerns and eating disorders among early adolescents.

Early adolescence (ages 11-14 years) is a key period for the emergence of body image and eating concerns, and early identification and access to treatment are imperative for positive outcomes. Despite research identifying this critical developmental period, few prevention resources are available for early adolescents. Parents are key players for this age group and important socializing agents. As such, they are well positioned to help youth access resources or support where needed. However, programs to position and involve parents as interventionists are lacking. Our aims are two-fold. First, we review the evidence for the effectiveness of parents as body image interventionists and the existing data regarding parental needs. Second, we provide directions for future research and outline a framework for empowering parents as interventionists, identifying key domains in which parents may play a role in addressing body image and eating concerns among early adolescents. Based on the extent literature, these domains include facilitating engagement with or co-utilizing intervention content to decrease body image and eating concerns in at-risk children, which may also help to increase parents' effectiveness in their efforts to support youth. In addition, parents may deliver content to decrease or reverse risk-factors and early symptoms, or disrupt the early disorder phase of illness. To date, parents constitute an underutilized resource in eating disorder and disordered eating prevention, and efforts should be made to increase the evidence-based strategies to leverage their relationship with at-risk children.

Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity.

BACKGROUND: Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS: A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS: Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS: Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.

Examination of the Interaction between Parental Military-Status and Race among Non-Hispanic Black and Non-Hispanic White Adolescents with Overweight/Obesity.

OBJECTIVES: Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispanic Black) youth. It is unknown if these disparities exist among adolescent military-dependents, or between civilian and military-dependent youth. METHODS: Non-Hispanic Black (187 civilian, 38 military-dependent) and non-Hispanic White (205 civilian, 84 military-dependent) adolescents with overweight/obesity (14.7 ± 1.6 years; 73.9% girls; body mass index adjusted for age and sex 1.9 ± 0.5) completed a disordered-eating interview; parents completed a measure assessing their child's internalizing and externalizing difficulties. Multiple linear regressions examined parental military-status as a moderator of the relationship of participant race with eating, internalizing, and externalizing difficulties. RESULTS: White civilian youth with overweight/obesity reported significantly greater disordered-eating than their Black peers (p < .001); there were no other significant racial differences. In all regressions, parental military-status significantly moderated the association between race and each dependent variable (ps < .047). Black military-dependents (vs. civilians) reported more disordered-eating and internalizing difficulties (ps = .01). White military-dependents (vs. civilians) reported fewer externalizing difficulties (p = .01). CONCLUSIONS: Black adolescent military-dependents with overweight/obesity may experience more eating and internalizing difficulties (vs. civilians), a pattern not observed among White participants. Future work should examine if being a military-dependent and a historically marginalized racial group member accounts for these findings. Such data may inform providers of youth with intersecting minority identities.

The development and validation of the Conscious Objectification Questionnaire.

OBJECTIVE: Self-objectification is linked to disordered eating (DE) behaviors in women. However, the awareness of objectification by the self and others, not just the objectifying experiences themselves, may be differentially related to DE. The proposed study examines the development and validity of the Conscious Objectification Questionnaire (COQ), which seeks to evaluate awareness of objectification by others and intentional self-objectification. METHOD: In Study 1, 24 participants who identify as women (≥18 years) will provide qualitative feedback on COQ items, and survey items will be updated based on participant feedback. In Study 2, separate participants will complete the COQ and questionnaires assessing DE, self-objectification, and mental health correlates. Exploratory factor analyses will be conducted on the COQ, and reliability and convergent and divergent validity will be assessed. RESULTS: Results will clarify whether the COQ is a reliable and valid instrument that measures the distinct construct of awareness of objectification. DISCUSSION: If proven psychometrically sound, the COQ may be useful for future research on the link between awareness of objectification and disordered eating. PUBLIC SIGNIFICANCE: The novel Conscious Objectification Questionnaire (COQ) assesses the degree to which women recognize and act upon being objectified. The COQ will be reviewed by self-objectification experts and pilot participants before being psychometrically evaluated with data from a larger sample. The COQ is expected to differentially relate to disordered eating above and beyond existing self-objectification measures and accurately represent the distinct construct of conscious awareness of societal and self-objectification.

Comparison of ad libitum snack consumption and acquisition between adolescents living with food security and food insecurity: A stage 1 registered report.

OBJECTIVE: Approximately 11% of the U.S. population experiences food insecurity (FI; insufficient access to healthy food due to financial constraints). FI is associated with detrimental health outcomes, including the development of eating disorders (EDs). However, additional studies are needed, particularly in adolescence when EDs are likely to emerge. The current study will utilize an experimental ad libitum snack paradigm to investigate snack consumption, acquisition (i.e., taking snacks home), and associated disordered eating behaviors among racially, ethnically, and financially diverse adolescents living with FI and food security (FS). METHOD: Sixty-four adolescents will be recruited and randomized into one of two conditions: prior knowledge condition (i.e., participants will know prior to snacking that they can take any remaining food home) and no prior knowledge condition (i.e., participants will not know ahead of time that they can take snacks home). RESULTS: We expect youth with FI to show increased eating and acquisition behaviors compared to youth with FS across both conditions. DISCUSSION: This study, utilizing a novel experimental design, is an important step in understanding how FI impacts adolescent eating behaviors among youth from marginalized backgrounds, who have historically been excluded from research.

Development and validation of the food availability and related eating behaviors questionnaire: A stage 1 registered report.

OBJECTIVE: Historically, eating disorder research has excluded marginalized and underserved populations, such as those with food insecurity (which also impacts higher numbers of Black/African American and Latinx communities). However, burgeoning research suggests an association between food insecurity and the development of eating disorder pathology. Examining patterns of food availability and related eating behaviors may elucidate the association between food insecurity and eating disorder pathology. However, to date, there are no comprehensive measures that accurately capture food availability patterns and related eating behaviors. METHOD: In Study 1, 40 participants (20 adolescents, 20 adults) will respond to and provide qualitative feedback on the Food Availability and Related Eating Behaviors Questionnaire (FAREB-Q). In study 2, 50 participants (approximately 25 with and without food insecurity) will complete the FAREB-Q at two time-points, and respond to questions about food insecurity, disordered eating, and every day stress to assess the FAREB-Q's reliability and validity. RESULTS: Results will clarify whether the FAREB-Q is a reliable and valid instrument that measures food availability and related eating behavior patterns. DISCUSSION: The present study aims to develop, pilot, and examine the psychometric properties of the FAREB-Q, a self-report measure examining food availability and related eating behaviors in community populations. PUBLIC SIGNIFICANCE: The novel FAREB-Q assesses food availability and related eating patterns in the general community. The FAREB-Q will be reviewed by experts in disordered eating, food insecurity, psychometric statisticians and piloted in the general public before being psychometrically evaluated in a larger sample. The FAREB-Q is anticipated to help elucidate the mechanisms linking food availability, food (in)security, disordered eating behaviors, and eating pathology.

Reporting racial and ethnic diversity in eating disorder research over the past 20 years.

OBJECTIVE: Recent public awareness of racial and ethnic disparities has again brought to light issues of diversity, equity, and inclusion in the eating disorders field. However, empirical information on racial and ethnic representation in eating disorders research is limited, making it difficult to understand where improvements are needed. METHOD: This study reviewed all studies including human participants published in the International Journal of Eating Disorders in 2000, 2010, and 2020. Differences in likelihood of reporting race and ethnicity were calculated based on study year, location, and diagnostic categories. RESULTS: Out of 377 manuscripts, 45.2% reported information on the race and ethnicity of study participants. Studies conducted in the United States were more likely to report (128/173), and those conducted in Europe were less likely to report (5/61) on race and ethnicity than those conducted outside of those regions. Rates of reporting increased from 2000 to 2020. White participants made up approximately 70% of the samples that reported race and ethnicity data. Hispanic participants made up approximately 10% of samples reporting race and ethnicity. Participants from all other races and ethnicities made up less than 5% each. DISCUSSION: Although rates of reporting race and ethnicity increased over time, most participants were White. Rates of reporting also differed by the geographical region, which may reflect variability in how information on race and ethnicity is collected across countries. More attention toward capturing the cultural background of research participants and more inclusivity in research are needed in the eating disorders field.

Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample.

OBJECTIVE: There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782). METHOD: We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option. RESULTS: Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections. DISCUSSION: This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups. PUBLIC SIGNIFICANCE: We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.

Open science practices for eating disorders research.

This editorial seeks to encourage the increased application of three open science practices in eating disorders research: Preregistration, Registered Reports, and the sharing of materials, data, and code. For each of these practices, we introduce updated International Journal of Eating Disorders author and reviewer guidance. Updates include the introduction of open science badges; specific instructions about how to improve transparency; and the introduction of Registered Reports of systematic or meta-analytical reviews. The editorial also seeks to encourage the study of open science practices. Open science practices pose considerable time and other resource burdens. Therefore, research is needed to help determine the value of these added burdens and to identify efficient strategies for implementing open science practices.

Where identities converge: The importance of intersectionality in eating disorders research.

Disparities in eating disorder (ED) risk, diagnosis, and treatment for those who occupy multiple marginalized social identities (e.g., combined racial/ethnic and sexual minority statuses), underscore the need for advancing multicultural research in the ED field. In this article, we argue that intersectionality-informed approaches, which examine the ways in which one's multiple social identities interact to inform risk for ED outcomes, offer an established framework for identifying frequently underserved individuals who may be at greatest risk for EDs. We highlight preliminary intersectional research in EDs and offer suggestions for further progression. In particular, we encourage future intersectionality-informed research to incorporate a broader range of social identities (e.g., age, ability status), consider the ways in which these identities may be dimensional and fluid, and embrace strengths-based approaches to illuminate dimensions of identity that may serve as protective factors. To support such research, we describe quantitative and qualitative methods for pursuing questions of intersectionality in ED investigations. Given the success of intersectionality-informed research in other areas of psychopathology and its relevance to ED as suggested by initial research, the continued pursuit of these approaches in EDs has high potential to improve identification and treatment for patients who have too often been overlooked.

Parental deployment and distress, and adolescent disordered eating in prevention-seeking military dependents.

OBJECTIVE: Parental military deployment can lead to stress in the family system due to concerns about the deployed service-member's safety and increased responsibilities for those not deployed. Parent-related stress can impact adolescent disordered eating. Given the important role that stress plays in disordered eating and obesity, it is crucial to understand the impacts of unique stressors to which vulnerable populations are exposed. METHOD: We studied 126 adolescent (14.3 ± 1.6 years; 59.5% girls; 44.4% non-Hispanic White; BMI-z, 1.91 ± .39) military dependents prior to entering an obesity and binge-eating disorder prevention trial. The Eating Disorder Examination was used to assess adolescent disordered eating. Parents self-reported their own distress and family deployment history that occurred during the adolescent's lifetime. RESULTS: Parental distress interacted with frequency of parental deployments such that for those with high parental distress, more frequent deployment was associated with greater adolescent shape and weight concerns (ß = .21, p = .012) and global eating pathology (ß = .18, p = .024). DISCUSSION: In this hypothesis-generating study, the combination of number of deployments and parental distress may be associated with disordered eating among adolescent military dependents seeking prevention of binge-eating disorder and adult obesity. If these preliminary findings are supported longitudinally, interventions to reduce parental stress related to deployment may be warranted to reduce disordered eating in adolescent dependents.

Examination of the Interpersonal Model With Adolescent Military Dependents at High Risk for Adult Obesity.

OBJECTIVE: Adolescent military dependents may be at higher risk for psychosocial stressors and disordered eating compared with civilian youths, but the mechanisms underlying these risks are unclear. Interpersonal theory proposes that difficult relationships lead to negative affect, thereby promoting emotional eating, which has been linked to and predictive of disordered eating. The interpersonal model may have particular relevance for understanding disordered eating among adolescent military dependents, given the unique stressors related to their parents' careers. This study aimed to examine the premise of the interpersonal model (that negative emotions mediate the association between multiple aspects of social functioning and emotional eating) among a cohort of adolescent military dependents. METHODS: Military dependents (N=136; 56% female, mean±SD age=14±2 years, body mass index adjusted for age and sex [BMIz]=2.0±0.4) at risk for adult obesity and binge eating disorder, as indicated by reported loss-of-control eating and/or anxiety symptoms, were assessed prior to participation in a study of excess weight-gain prevention. Bootstrapped mediation analyses were conducted to examine depressive symptoms as a potential mediator of the relationship between social functioning and emotional eating. Analyses were adjusted for age, sex, race-ethnicity, BMIz, and presence of reported loss-of-control eating and anxiety. RESULTS: Depressive symptoms were a significant mediator of the relationship between multiple domains of social functioning, including loneliness, social adjustment related to family and friends, attachment to father and peers, and emotional eating (p<0.05). CONCLUSIONS: The interpersonal model may contribute to our understanding of excess weight gain and binge eating disorder among adolescent military dependents. Prospective data are needed to determine the utility of interpersonal theory in predicting treatment response and outcomes among this population.

Pediatric Loss-of-Control Eating and Anxiety in Relation to Components of Metabolic Syndrome.

Objective: Pediatric loss-of-control (LOC) eating is associated with, and predictive of, gains in adiposity and adverse metabolic outcomes. In addition, some preliminary data suggest that anxiety may exacerbate the relationship of LOC eating with weight and metabolic syndrome (MetS)-related measures. We therefore examined whether anxiety moderated the relationship between LOC eating and body mass index z (BMIz), adiposity, and MetS-related measures in youth. Methods: A convenience sample of non-treatment-seeking boys and girls of varying weight strata were interviewed to determine the presence of LOC eating and completed a questionnaire assessing trait anxiety. BMIz and MetS-related measures (blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glucose, and insulin) were measured after an overnight fast. Adiposity was assessed by air displacement plethysmography or dual-energy x-ray absorptiometry. Analyses adjusted for age, sex, race, height, fat mass, and depressive symptoms, as appropriate. Results: In all, 379 youths (13.0 ± 2.8 years; 53% female; BMIz = 0.8 ± 1.1; 22% with LOC eating) were studied. Anxiety was not significantly related to BMIz, adiposity, or MetS-related measures. However, anxiety and LOC eating interacted such that only among youth with LOC eating, anxiety was positively associated with fasting insulin (p = .02) and insulin resistance (p = .01). The interaction of anxiety and LOC eating was not significantly related to BMIz, adiposity, or any other MetS-related measure (ps = ns). Conclusions: Only among non-treatment-seeking youth with LOC eating, anxiety may be associated with increased insulin secretion and insulin resistance. Longitudinal studies are required to confirm these findings and explore mechanisms for these relationships.

Thin-ideal internalization: How much is too much?

Internalization of the thin-ideal is a risk factor for eating disorders that frequently persists into recovery and increases patient risk for relapse. Addressing thin-ideal internalization as a core element of eating disorder prevention and treatment produces significant reductions in eating pathology. However, research has not yet quantified levels of thin-ideal internalization that may signal increased versus decreased risk for disordered eating. To address this gap in the literature, receiver operating characteristic (ROC) curve analysis was used to identify a thin-ideal internalization cutoff score that signified clinically-meaningful eating disorder pathology. 787 college women (age M = 20.17, SD = 2.41; BMI M = 23.58, SD = 5.29) were classified as "healthy" (N = 717) or those with significant disordered eating (N = 70) using established clinical cutoffs for the Eating Disorder Examination-Questionnaire. ROC curve analysis was used to test the performance of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) Internalization: Thin/Low Body Fat subscale in predicting disordered eating status, and to identify a cutoff score that maximized sensitivity and specificity to discriminate between healthy and disordered eating samples. Mean SATAQ-4 internalization scores were 3.29 (SD = 0.92) and 4.27 (SD = 0.62) for healthy and disordered eating participants, respectively. The SATAQ-4 internalization scores were good predictors of disordered eating status (area under the curve = 0.81, 95% CI: 0.76-0.86). The optimal cutoff of 3.78 (measured on a 1-5 Likert scale) yielded a sensitivity of 0.81 and specificity of 0.64. Overall, results provide preliminary support for the discriminant validity of SATAQ-4 thin internalization scores and suggest that even moderate levels of thin-ideal internalization may be predictive of clinically-significant eating pathology. It may be important for prevention and intervention work to actively seek to reduce internalization levels below this clinical cutoff, though future work is needed to bear this out.

Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia.

Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative outcomes may help to elucidate the prominence of specific risk factors within a given Western society and guide associated interventions. Women from the United States (US), Italy, England, and Australia completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Analysis of covariance controlling for age and BMI indicated significant cross-country differences for all SATAQ-4 subscales. Results typically indicated higher levels of appearance-ideal internalization and appearance pressures in the US and lower levels in Italy; however, associated effect sizes were generally small. A medium effect of country was observed for peer-appearance pressures, which were highest in the US compared with all other countries. Repeated-measures analysis of variance and paired samples t tests conducted within each country identified thin-ideal internalization and media appearance pressures as the predominant risk factors for all four countries. Overall, findings suggest more cross-country similarities than differences, and highlight the importance of delivering interventions to address thin-ideal internalization and media appearance pressures among women from Western backgrounds.Level of evidence Descriptive study, Level V.

Measurement invariance of the Eating Disorder Examination in black and white children and adolescents.

OBJECTIVE: The Eating Disorder Examination (EDE) was originally developed and validated in primarily white female samples. Since data indicate that eating pathology impacts black youth, elucidating the psychometric appropriateness of the EDE for black youth is crucial. METHODS: A convenience sample was assembled from seven pediatric obesity studies. The EDE was administered to all youth. Confirmatory factor analyses (CFA) were conducted to examine the original four-factor model fit and two alternative factor structures for black and white youth. With acceptable fit, multiple-group CFAs were conducted. For measurement invariant structures, the interactive effects of race with sex, BMIz, adiposity, and age were explored (all significance levels p < .05). RESULTS: For both black and white youth (N = 820; 41% black; 37% male; 6-18 years; BMIz -3.11 to 3.40), the original four-factor EDE structure and alternative eight-item one-factor structure had mixed fit via CFA. However, a seven-item, three-factor structure reflecting Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction had good fit and held at the level of strict invariance. Girls reported higher factor scores than boys. BMIz and adiposity were positively associated with each subscale. Age was associated with Dietary Restraint and Body Dissatisfaction. The interactional effects between sex, BMIz, and age with race were not significant; however, the interaction between adiposity and race was significant. At higher adiposity, white youth reported greater pathology than black youth. CONCLUSION: An abbreviated seven-item, three-factor version of the EDE captures eating pathology equivalently across black and white youth. Full psychometric testing of the modified EDE factor structure in black youth is warranted.

A randomized, comparative pilot trial of family-based interpersonal psychotherapy for reducing psychosocial symptoms, disordered-eating, and excess weight gain in at-risk preadolescents with loss-of-control-eating.

OBJECTIVE: Preadolescent loss-of-control-eating (LOC-eating) is a risk factor for excess weight gain and binge-eating-disorder. We evaluated feasibility and acceptability of a preventive family-based interpersonal psychotherapy (FB-IPT) program. FB-IPT was compared to family-based health education (FB-HE) to evaluate changes in children's psychosocial functioning, LOC-eating, and body mass. METHOD: A randomized, controlled pilot trial was conducted with 29 children, 8 to 13 years who had overweight/obesity and LOC-eating. Youth-parent dyads were randomized to 12-week FB-IPT (n = 15) or FB-HE (n = 14) and evaluated at post-treatment, six-months, and one-year. Changes in child psychosocial functioning, LOC-eating, BMI, and adiposity by dual-energy-X-ray-absorptiometry were assessed. Missing follow-up data were multiply imputed. RESULTS: FB-IPT feasibility and acceptability were indicated by good attendance (83%) and perceived benefits to social interactions and eating. Follow-up assessments were completed by 73% FB-IPT and 86% FB-HE at post-treatment, 60% and 64% at six-months, and 47% and 57% at one-year. At post-treatment, children in FB-IPT reported greater decreases in depression (95% CI -7.23, -2.01, Cohen's d = 1.23) and anxiety (95% CI -6.08, -0.70, Cohen's d = .79) and less odds of LOC-eating (95% CI -3.93, -0.03, Cohen's d = .38) than FB-HE. At six-months, children in FB-IPT had greater reductions in disordered-eating attitudes (95% CI -0.72, -0.05, Cohen's d = .66) and at one-year, tended to have greater decreases in depressive symptoms (95% CI -8.82, 0.44, Cohen's d = .69) than FB-HE. There was no difference in BMI gain between the groups. DISCUSSION: Family-based approaches that address interpersonal and emotional underpinnings of LOC-eating in preadolescents with overweight/obesity show preliminary promise, particularly for reducing internalizing symptoms. Whether observed psychological benefits translate into sustained prevention of disordered-eating or excess weight gain requires further study.

Examination of the interpersonal model of loss of control eating in the laboratory.

BACKGROUND: The interpersonal model of loss of control (LOC) eating proposes that interpersonal problems lead to negative affect, which in turn contributes to the onset and/or persistence of LOC eating. Despite preliminary support, there are no data examining the construct validity of the interpersonal model of LOC eating using temporally sensitive reports of social stress, distinct negative affective states, and laboratory energy intake. METHOD: 117 healthy adolescent girls (BMI: 75th-97th %ile) were recruited for a prevention trial targeting excess weight gain in adolescent girls who reported LOC eating. Prior to the intervention, participants completed questionnaires of recent social stress and consumed lunch from a multi-item laboratory test meal. Immediately before the test meal, participants completed a questionnaire of five negative affective states (anger, confusion, depression, fatigue, anxiety). Bootstrapping mediation models were conducted to evaluate pre-meal negative affect states as explanatory mediators of the association between recent social stress and palatable (desserts and snack-type) food intake. All analyses adjusted for age, race, pubertal stage, height, fat mass percentage, and lean mass. RESULTS: Pre-meal state anxiety was a significant mediator for recent social stress and palatable food intake (ps<.05). By contrast, pre-meal state anger, confusion, depression, and fatigue did not mediate the relationship between social stress and palatable food intake (ps>.05). DISCUSSION: Pre-meal anxiety appears to be the salient mood state for the interpersonal model among adolescent girls with LOC eating. Interventions that focus on improving both social functioning and anxiety may prove most effective at preventing and/or ameliorating disordered eating and obesity in these adolescents.

A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions.

PURPOSE OF REVIEW: Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions. RECENT FINDINGS: Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.