Interplay of polygenic liability with birth-related, somatic, and psychosocial factors in anorexia nervosa risk: a nationwide study.

BACKGROUND: Although several types of risk factors for anorexia nervosa (AN) have been identified, including birth-related factors, somatic, and psychosocial risk factors, their interplay with genetic susceptibility remains unclear. Genetic and epidemiological interplay in AN risk were examined using data from Danish nationwide registers. AN polygenic risk score (PRS) and risk factor associations, confounding from AN PRS and/or parental psychiatric history on the association between the risk factors and AN risk, and interactions between AN PRS and each level of target risk factor on AN risk were estimated. METHODS: Participants were individuals born in Denmark between 1981 and 2008 including nationwide-representative data from the iPSYCH2015, and Danish AN cases from the Anorexia Nervosa Genetics Initiative and Eating Disorder Genetics Initiative cohorts. A total of 7003 individuals with AN and 45 229 individuals without a registered AN diagnosis were included. We included 22 AN risk factors from Danish registers. RESULTS: Risk factors showing association with PRS for AN included urbanicity, parental ages, genitourinary tract infection, and parental socioeconomic factors. Risk factors showed the expected association to AN risk, and this association was only slightly attenuated when adjusted for parental history of psychiatric disorders or/and for the AN PRS. The interaction analyses revealed a differential effect of AN PRS according to the level of the following risk factors: sex, maternal age, genitourinary tract infection, C-section, parental socioeconomic factors and psychiatric history. CONCLUSIONS: Our findings provide evidence for interactions between AN PRS and certain risk-factors, illustrating potential diverse risk pathways to AN diagnosis.

Prevalence and recurrence of pica behaviors in early childhood within the ALSPAC birth cohort.

OBJECTIVE: The present study examined prevalence and correlates of pica behaviors during childhood using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) study. METHOD: Data on 10,109 caregivers from the ALSPAC study who reported pica behavior at 36, 54, 65, 77, and 115 months on their child were included. Autism was obtained through clinical and education records, while DD was derived from the Denver Developmental Screening Test. RESULTS: A total of 312 parents (3.08%) reported pica behaviors in their child. Of these, 19.55% reported pica at least at two waves (n = 61). Pica was most common at 36 months (N = 226; 2.29%) and decreased as children aged. A significant association was found between pica and autism at all five waves (p < .001). There was a significant relationship between pica and DD, with individuals with DD more likely to experience pica than those without DD at 36 (p = .01), and 54 (p < .001), 65 (p = .04), 77 (p < .001), and 115 months (p = .006). Exploratory analyses examined pica behaviors with broader eating difficulties and child body mass index. DISCUSSION: This study enhances understanding of childhood pica behaviors, addressing a significant gap in knowledge. Pica occurrence in the general population is poorly understood due to few epidemiological studies. Findings from the present study indicate pica is an uncommon behavior in childhood; however, children with DD or autism may benefit from pica screening and diagnosis between ages 36 and 115 months. Children who exhibit undereating, overeating, and food fussiness may also engage in pica behaviors.

More Than a Joke: The Intersection of Gender-Based Humor and Gender Inequities Experienced by Women Department Chairs in Academic Medicine.

Purpose: The purpose of this qualitative descriptive study is to describe how women academic department chairs in emergency medicine, surgery, and anesthesiology experience humor in the workplace. Method: Interviews were conducted with 35 women department chairs in academic medicine from 27 institutions that aimed to describe women's leadership emergence. The data from the primary study yielded rich and revealing themes involving participants' experiences with humor in the context of their leadership roles, justifying a secondary analysis focusing specifically on these experiences. Relevant remarks were extracted, coded, and summarized. Results: Participants discussed two broad types of humor-related experiences. First, they described how they responded to aggressive gender-based humor directed at themselves or their colleagues by tolerating it or expressing disapproval. This humor includes demeaning quips, insulting monikers, sexist jokes, and derogatory stories. Participants often did not confront this humor directly as they feared being rejected or ostracized by colleagues. Second, they described how they initiated humor to address gender-related workplace issues by highlighting gender inequalities, coping with sexual harassment and assault, and managing gender-based leadership challenges. Participants felt constrained in their own use of humor because of the need to be taken seriously as women leaders. Conclusion: Women leaders in academic medicine use humor to confront gender-related issues and experience aggressive gender-based humor in the workplace. The constraints placed on women leaders discourage them from effectively confronting this aggressive gender-based humor and perpetuating gender inequities. Eliminating aggressive gender-based humor is needed to create safe and equitable work environments in academic medicine.

Prevalence and Recurrence of Pica Behaviors in Early Childhood: Findings from the ALSPAC Birth Cohort.

Objective: Pica has been largely understudied in general population samples. Pica occurs most often in childhood and appears more prevalent in individuals with autism and developmental delays (DD). Pica occurrence in the general population is poorly understood due to few epidemiological studies. Method: Data on 10,109 caregivers from the Avon Longitudinal Study of Parents and Children (ALSPAC) study who reported pica behavior at 36, 54, 66, 77, and 115 months on their child were included. Autism was obtained through clinical and education records, while DD was derived from the Denver Developmental Screening Test. Results: A total of 312 parents reported pica behaviors in their child. Of these, 19.55% reported pica at least at two waves (n=61). Pica was most common at 36 months (N=226; 2.29%) and decreased as children aged. A significant association was found between pica and autism at all five waves (p < .001). There was a significant relationship between pica and DD, with individuals with DD more likely to experience pica than those without DD at 36 (p = .01), and 54 (p < .001), 65 (p=.04), 77 (p <.001), and 115 months (p=.006). Exploratory analyses examined pica behaviors with broader eating difficulties and child body mass index. Discussion: Pica is an uncommon behavior in childhood; however, children with DD or autism may benefit from pica screening and diagnosis between ages 36-115 months. Children who exhibit undereating, overeating, and food fussiness may also engage in pica behaviors.

Development and Rasch Analysis of the 18-Item Health Resilience Profile (HRP).

Existing resilience measures have psychometric shortcomings, and there is no current gold-standard resilience measure. Previous work indicates adults enrolled in a health coaching program may benefit from a resilience measure that is tailored and contextualized to this sample. This two-part study aimed to develop and evaluate a resilience instrument focused on health behavior change in adults in a health coaching program. Two studies were conducted to (1) create a resilience instrument (Health Resilience Profile; HRP) specific to adults attempting health behavior change (n = 427; female = 83.8%; age = 44.5 ± 11.9 years) and to (2) optimize the instrument performance using Rasch analysis (n = 493; female = 62.1%; age = 49.8 ± 12.5 years). Study 1 identified two issues: (1) four unacceptable misfit items and (2) inappropriate rating scale functioning. Study 2 evaluated an improved instrument based on the outcome of study 1 resulting in one more misfit item, and unidimensionality was supported. The new four-category rating scale functioned well. The item-person map indicated that item difficulty distribution was well matched to participants' resilience level, and items were free from measurement error. Finally, items did not show differential item functioning across age, sex, alcohol use, and obesity status. The 18-item HRP is optimized for adults in a health coaching program.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention.

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis.

BACKGROUND: The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%). METHODS: Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis. RESULTS: A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed. CONCLUSION: Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.

Examination of three-factor eating questionnaire subscale scores on weight loss and weight loss maintenance in a clinical intervention.

BACKGROUND: The purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity. METHODS: TFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight. RESULTS: Participants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months. CONCLUSION: Dietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.

Patterns of Weight Change in a Commercial Weight Loss Program.

Objectives: In this study, we examined compliance and progress factors associated with weight loss and maintenance, individual patterns of weight trends following weight loss, and impact of early weight loss on longer-term weight change. Methods: We conducted secondary analysis of pre-post data. Participants were 8769 persons (mean age = 47.63 ± 13.78 years; 77.74% women; mean weight = 97.20 ± 22.82 kilograms; BMI = 34.09 ± 6.84) in a commercial weight management program. We carried out multiple regression analyses on weight change and percentage, and used ANOVA and the Pearson chi-square test to examine participant characteristics, weight change patterns, and early weight loss success. Results: Participants were active in the program for 222 ± 158 days, completed 15 ± 13 appointments, achieving -8.53 ± 7.87 kilograms lost (-8.61% ± 7.64%). Greater weight loss was associated with appointment frequency (ß = -0.46) and total spending (ß = -2.89) (p < .01). We identified 5 weight change patterns (F = 37.56, p < .001) (total weight loss for each group was: Stable = -10.4% [N=2036]; Minimal Regain = -10.5% [N=3766]; Modest Regain = -8.8% [N=1476]; Large Regain = -7.3% [N=753]; No Loss/Gain = +3.7% [N=737]; all p < .05). Over 5000 participants achieved early weight loss (losing > 5%) within the first 2 months resulting in significantly greater final weight loss (-8.43% to -14.56% vs -1.18% to -3.15%). Conclusions: We identified several weight patterns; increased health coaching attendance was associated with greater weight loss.

Effectiveness of profile by Sanford behavioral weight loss program for weight loss following endometrial cancer treatment.

OBJECTIVE: To examine differences in weight change and Body Mass Index (BMI) at 12 months among women in remission from endometrial cancer who enrolled in a behavioral weight loss (BWL) program and a matched patient control group. METHODS: Women (n = 22) were enrolled into the BWL program and were compared against a control group (n = 28) that accounted for age, BMI, cancer type, cancer stage, and treatment dates. The BWL program included weekly health coaching meetings that targeted nutrition, activity, and behavior change topics. RESULTS: Women enrolled in the BWL program completed 28.3 ± 14.1 appointments over 12 months resulting in an average weight change of -14.2 ± 7.8 kg (-13.3 ± 7.4%) at 6 months and -16.4 ± 12.5 kg (-15.3 ± 11.4%) at 12 months (all p < 0.001). Women in the control group had a weight change of -1.7 ± 8.4 kg (-2.3 ± 7.6%) at 12 months which was significantly different than the BWL condition (p < 0.001). BMI was significantly reduced in the BWL group at 6 months (-4.8 ± 4.5, p < 0.001) and 12 months (-5.2 ± 5.9, p < 0.001) and significantly different than in the control group at 12 months (-0.9 ± 3.2, p = 0.007). CONCLUSIONS: The BWL program yielded clinically significant weight loss for endometrial cancer survivors. Future work should include longer follow up periods and include additional behavioral and psychosocial outcomes.