Scaling and sustaining research tested interventions: Lessons learned from Rhode Island Childhood Obesity Research Demonstration 3.0.

Childhood obesity is a significant health problem associated with negative physical and mental health outcomes. Although evidence-based family healthy weight programs (FHWPs), such as JOIN for ME, have been developed, there is a significant lag before these are disseminated more broadly. This study outlines the process of participating in the Speeding Research-tested Interventions (SPRINT) program, highlighting lessons learned, to increase the reach of a previously tested and efficacious FHWP, JOIN for ME. Qualitative interviews were conducted with policymakers, benefits providers, employers, philanthropists, community stakeholders, and medical providers to iteratively test the developed JOIN for ME business model and identify themes regarding effective scaling and sustainability of an evidence-based FHWP. Rapid qualitative analysis of 45 interviews identified four key themes regarding scaling of an FHWP. These were (i) virtual program delivery, (ii) focus on equity, (iii) return on investment, and (iv) tie-in to local community. The process of engaging stakeholders from multiple backgrounds is critical to refining an efficacious program to ensure scalability and sustainment. The SPRINT process allows researchers to understand the marketplace for evidence-based interventions and develop adaptations for sustaining and scaling research tested programs.

There is a lengthy lag in translation of effective research tested interventions into routine clinical practice. Researchers often lack the skills needed to broadly disseminate and implement their interventions. The SPeeding Research-tested INTerventions (SPRINT) program was developed by the National Cancer Institute to reduce the research-practice gap by training behavioral scientists to develop sustainable approaches to program dissemination. This article outlines the process and outcomes of participating in the SPRINT program for researchers focused on implementation and dissemination of an evidence-based family healthy weight program, JOIN for ME. Interviews with 45 key stakeholders identified four primary themes critical to translating JOIN for ME from research into practice. These included the importance of virtual program delivery, focus on equity, return on investment, and maintaining connections with local communities. Focus on the SPRINT process highlights the pathways through which future researchers may decrease the length of time from research to practice.

Profiles of disordered eating behaviour in type 1 diabetes using the DEPS-R and behaviour and glycaemic outcomes in a real-life setting.

AIMS: The Diabetes Eating Problems Survey - Revised (DEPS-R) is commonly used to assess disordered eating behaviour (DEB) in individuals with type 1 diabetes and has advantages compared to other measures not specifically tailored to diabetes. A score ≥20 on the DEPS-R is used to indicate clinically significant DEB; however, it does not distinguish between eating disorder (ED) phenotypes necessary to guide treatment decisions, limiting clinical utility. METHODS: The current study used latent class analysis to identify distinct person-centred profiles of DEB in adults with type 1 diabetes using the DEPS-R. Analysis of Variance with Games Howell post-hoc comparisons was then conducted to examine the correspondence between the profiles and binge eating, insulin restriction and glycaemic control (HbA1c, mean blood glucose, and percent time spent in hyperglycaemia) during 3 days of assessment in a real-life setting. RESULTS: Latent class analysis indicated a 4-class solution, with patterns of item endorsement suggesting the following profiles: Bulimia, Binge Eating, Overeating and Low Pathology. Differences in binge eating, insulin restriction and glycaemic control were observed between profiles during 3 days of at-home assessment. The Bulimia profile was associated with highest HbA1c and 3-day mean blood glucose. CONCLUSIONS: There are common patterns of responses on the DEPS-R that appear to reflect different ED phenotypes. Profiles based on the DEPS-R corresponded with behaviour in the real-life setting as expected and were associated with different glycaemic outcomes. Results may have implications for the use of the DEPS-R in research and clinical settings.

Adolescent Females' Dyadic Conversations About Body, Weight, and Appearance.

Body talk among adolescent females has been associated with negative outcomes, including depressed mood, disordered eating, and body dissatisfaction. Yet, little work has investigated the manifestation of body talk in actual conversations between adolescent females or explored pathways through which body talk is spread (e.g., co-rumination). The present study examined body talk among adolescent female dyads (N = 23 dyads) ages 13 to 17 (Mage = 15.12) using an observational design. Reciprocally nominated dyads were recruited from a high school in the southeastern United States. Conversations between dyads were qualitatively coded using an applied thematic analysis approach. Identified themes were related to weight, appearance, and personality. Results provide insight into the social context in which sociocultural norms of weight stigma, body dissatisfaction, and eating-related psychopathology may be reinforced. Findings have implications for informing the development of interventions to reduce co-rumination of negative weight- and appearance-related body talk and to promote positive body image and healthy weight among adolescent girls.

Leveraging seasonality and timing to optimize pediatric weight management interventions: Novel directions for future research.

National estimates suggest that more than 35% of American children, ages 2-19 years, are overweight or obese, which increases their risk for weight-related comorbidities including diabetes, cancer, cardiovascular disease risk factors, depression, and anxiety. While obesity prevention is most cost-effective, for youth with existing obesity, the United States Preventive Services Task Force recommends ≥26 h of comprehensive lifestyle intervention over 6-12 months. This include standard behavioral therapy, dietary counseling, and an emphasis on physical activity. Although such programs are effective in reducing weight status, there are many barriers to completing these programs. A novel consideration for both the prevention and treatment of childhood obesity is the recognition that the timing of intervention, both duration and time of the year, can impact family engagement and intervention effectiveness. This paper discusses the potential of targeting high-risk periods for weight gain and offering brief behavioral intervention, in hopes of inspiring research on novel approaches to the prevention and treatment of childhood obesity.

Referral to Adolescent Weight Management Interventions: Qualitative Perspectives From Providers.

OBJECTIVE: Current guidelines for treatment of obesity in adolescence include screening and referring youth with obesity to appropriate weight management (WM) care. However, prior work has not explored the referral process to adolescent WM programs, especially for youth from lower-income backgrounds, who are at increased risk of obesity and related negative health outcomes. This qualitative study sought to understand pediatricians' current practices regarding referrals to adolescent WM interventions with a focus on adolescents from lower-income backgrounds. METHODS: Individual interviews were conducted with 11 medical providers that had referred at least 5 adolescents from low-income backgrounds to WM interventions. Applied thematic analysis was used for data analysis. RESULTS: Identified themes included weight-related discussions with adolescents as potentially fraught, as providers want to address weight-related health concerns while being thoughtful about potential harm. Providers also noted varied factors affecting their decision to refer to WM programs, including health implications, perceived motivation of the patient and family, and availability of programs. Providers identified that many families experience shame or guilt around referral to WM. Few themes were identified regarding impact of income on weight-related conversations with adolescents. CONCLUSION: Findings were novel in regard to discussions of weight in adolescents with obesity leading to WM referral. Despite being a primary focus of the present study, few themes were identified regarding specific considerations for adolescents from low-income backgrounds. Future clinical research should focus on provider-focused interventions to increase sensitivity regarding weight-related discussions and attention to diversity, equity, and inclusion.

Formative Development of a Weight Management Intervention for Adolescents with Type 1 Diabetes Mellitus and Obesity.

The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes. Unfortunately, youth with T1D are often excluded from and/or not referred to standard behavioral lifestyle interventions. This is often attributed to the complexities of managing T1D and an effort not to overburden persons who have T1D. Furthermore, standard behavioral weight management intervention recommendations can be perceived as contradicting T1D disease management (e.g., removing sugar-sweetened beverages from diet, energy balance with exercise, and caloric restriction). A weight management intervention specifically designed for youth with T1D is needed to provide treatment to youth with comorbid T1D and overweight/obesity. The current study interviewed adolescents with T1D and overweight/obesity (n = 12), their caregivers (n = 12), and pediatric endocrinologists (n = 9) to understand (a) whether they would be interested in a weight management intervention adapted for youth with T1D and (b) specific adaptations they would want and need. Five central themes emerged following applied thematic analysis: (1) program content, (2) programmatic messaging, (3) program structure, (4) social support, and (5) eating disorder risk. Results provide detailed recommendations for the adaptation of a behavioral weight management intervention for youth with T1D.

The buffering effect of family support on the association between weight-based teasing and adolescent weight management outcomes.

Weight-based victimization (WBV) is associated with poor weight-related outcomes in adolescence. Family support may be one protective factor against the negative impact of WBV. The goal of this study is to examine the moderating effect of family support on the association between WBV and early weight loss for adolescents in a clinical weight management program. Parents of adolescents (N = 78) completed psychosocial measures at baseline. Objective height and weight were measured at baseline and follow-up (Visit 3). The overall model was significant (p = .02), explaining 12.76% of the variance in weight change over the first 2 months of treatment. As hypothesized, there was a significant moderating effect of family support on the association between WBV and weight change (p = .04), accounting 5.0% of the variance in weight change. Increased support from the family buffered the negative impact of WBV on early treatment outcomes for adolescents in a weight management program. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Engaging Stakeholders to Adapt an Evidence-Based Family Healthy Weight Program.

Childhood obesity is associated with negative physical and psychosocial outcomes, especially for children from low-income backgrounds. It is critical to adapt evidence-based family healthy weight programs to meet the needs of this population. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions was used to describe the process of using qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to guide adaptations to the JOIN for ME pediatric weight management intervention. Qualitative interviews were conducted with key community and intervention stakeholders (e.g., nurse care managers, prior JOIN for ME coaches; N = 21). Focus groups were conducted in both Spanish and English with children with overweight or obesity from low-income backgrounds (N = 35) and caregivers of children with overweight or obesity from low-income backgrounds (N = 71). Qualitative data analysis informed modifications including content adaptations to simplify and tailor materials, contextual adaptations to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to increase connections with community partners. The process of engaging multiple stakeholder perspectives to tailor an existing intervention can provide a model for future researchers to improve the potential disseminability of an intervention.

Obesity during childhood is related to a number of negative outcomes for youth, with children from low-income backgrounds at especially high risk for obesity and related negative outcomes. There is a pressing need for programs to address weight in children and families that meet the needs of families from low-income backgrounds. This study outlines adaptations made to an evidence-based family healthy weight program to increase the likelihood of dissemination in low-income communities. Interviews were conducted with community stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers of children with overweight or obesity from low-income backgrounds. These interviews led to simplification and tailoring of curriculum materials, changes to framing of weight management, increased information about available resources, remote intervention delivery, and changes to scale-up activities.

A biobehavioral examination of emotional eating in adolescents: Evaluating the role of acute cortisol stress reactivity in the context of a multi-method assessment of eating in response to stress.

Stress is linked to emotional eating among adolescents, which in turn increases risk for overweight/obesity (OW/OB) development and continuation. There is a lack of research disentangling chronic and acute stress as predictors of adolescent emotional eating. Further, there is a corresponding need to understand the effects of acute physiological stress reactivity within the context of adolescent emotional eating. The primary aim of this study was to examine the impact of cortisol stress reactivity on emotional eating in adolescents, above and beyond the effects of perceived chronic stress. The impact of subjective stress reactivity was also explored. Adolescents' (N = 49) intake of highly palatable snack foods was measured on separate control and stress-induction (following the Trier Social Stress Test for Children) days. A multi-method approach was used to assess objective (caloric intake) and subjective (self-report) emotional eating. Results indicated that greater cortisol reactivity, but not subjective stress reactivity, predicted subjective emotional eating, beyond the impact of chronic stress. Neither chronic stress nor subjective or objective stress reactivity predicted objective emotional eating following stress-induction. Findings point to the role of chronic stress and cortisol reactivity as risks for greater perceived emotional eating among adolescents, while elucidating differences between perceived and objective emotional eating. Future research should explore how chronic versus acute stress differentially contribute to adolescent weight management.

Weight Management Engagement for Teens From Low-Income Backgrounds: Qualitative Perspectives From Adolescents and Caregivers.

OBJECTIVE: Adolescents from low-income backgrounds are at increased risk for obesity and related negative health outcomes. Furthermore, these adolescents have less access to, and success in, weight management (WM) programs. This qualitative study sought to better understand engagement in a hospital-based WM program from the perspective of adolescents and caregivers at different levels of program initiation and engagement. METHODS: Qualitative interviews were conducted with 55 participants (29 adolescents and 26 caregivers). This included: (a) those that were referred to, but never initiated, WM treatment (non-initiators); (b) those that prematurely disengaged from treatment (drop-outs); and (c) those that had ongoing participation in treatment (engaged). Data were analyzed using applied thematic analysis. RESULTS: Related to program initiation, participants across all groups (including adolescents and caregivers) noted that they did not have a full understanding of the scope or goals of the WM program following initial referral. In addition, many participants identified misperceptions of the program (e.g., perceptions of a screening visit as compared to an intensive program). Both caregivers and adolescents identified caregivers as drivers of engagement, with adolescents often hesitant about participation in the program. However, engaged adolescents found the program valuable and sought ongoing participation following caregiver initiation. CONCLUSIONS: When considering initiation and engagement in WM services for adolescents at highest risk, healthcare providers should provide more detailed information concerning WM referrals. Future research is needed to improve adolescent perception of WM, especially for adolescents from low-income backgrounds, which could increase initiation and engagement for this population.

Barriers to weight management in adolescence: Measure adaptation among adolescents presenting to an interdisciplinary weight management clinic.

A range of barriers may negatively impact adolescents' ability to successfully alter or sustain healthy weight-related behaviors. However, there is a lack of validated measures to empirically assess these barriers. This study developed a measure of adolescent-reported barriers to healthy weight-related behaviors by adapting the previously validated parent-report Barriers to Child Weight Management. Adolescents (N = 154) ages 11-17 presenting to a tertiary weight management program completed Barriers to Weight Management in Adolescence (BWMA). This measure assessed adolescents' perspectives of barriers to healthy weight-related behaviors. Confirmatory factor analysis was used to examine model fit, with four hypothesized subscales-Parental Disengagement, Cost, Lack of Family Support, and Adolescent Disengagement. Overall, good model fit was model demonstrated, χ2 (98) = 130.44, p = .02, CFI = .92, RMSEA = .05, SRMR = .06, supporting a four-factor structure. A final 16-item measure demonstrated good initial psychometric properties. As hypothesized, BWMA was significantly associated with general healthy habits [r = -.25, 95% CI(-.46, -.12)] and parent-reported barriers [r = .40, 95% CI (.264, .586)]. This study adapted and tested preliminary validation of a quantitative measure of adolescent-reported barriers to weight-related behaviors. Identification of barriers may prompt providers to adequately assess, and in turn address, factors impeding adolescents' success in modifying eating and physical activity patterns.

The association between negative body talk and body shame on disordered eating symptoms among college students.

Negative body talk (NBT), defined as negative communication about one's body, is associated with disordered eating, yet factors that may enhance these effects are understudied. Using objectification theory as a framework, NBT may reflect a vocal manifestation of self-objectification and endorsement of body shame may enhance the association between NBT and disordered eating. Given relatively consistent NBT and objectification theory-based conclusions across male and female college samples, the current study hypothesized that for college students high in body shame, NBT would be more strongly associated with disordered eating than for those low in body shame. A total of 849 college students (77.4 % female) completed measures of NBT (sex-specific), body shame, and eating disorder symptoms. Negative binomial regressions tested hypotheses separately by sex. Moderation results identified that the association between NBT and eating disorder symptoms was stronger for females reporting lower body shame compared to higher body shame. Among males, only significant main effects of NBT and body shame were observed. Body image and disordered eating preventive interventions may benefit from targeting NBT and/or body shame in males and females, and college females reporting lower body shame may be at greatest risk for the negative impact of NBT.

Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis.

OBJECTIVE: Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth. METHODS: A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined. RESULTS: Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma. CONCLUSIONS: Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.

Protocol for the Rhode Island CORD 3.0 Study: Adapting, Testing, and Packaging the JOIN for ME Family-Based Childhood Obesity Program in Low-Income Communities.

Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.

Implementation of the JOIN for ME Program for Families from Low-Income Backgrounds: The Use of Theory-Driven Formative Evaluation: Rhode Island CORD 3.0.

Advances have been made in the development of effective interventions to address pediatric obesity; however, research findings often do not translate into clinical practice and a limited number of programs have been designed toward wide-spread dissemination and implementation. The Rhode Island (RI)-Childhood Obesity Research Demonstration (CORD) 3.0 Project involves adapting and testing an evidence-based pediatric weight management intervention (PWMI), JOIN for ME, for wide-scale dissemination and implementation in communities with a high proportion of families from low-income backgrounds. In this article, we describe the robust developmental formative evaluation (FE) process employed by RI-CORD as a model for the use of FE to drive dissemination of evidence-based PWMIs. The current project was guided by the Consolidated Framework for Implementation Research and Proctor Implementation Outcomes. This article also showcases examples of how the use of key informant interviews from engaged stakeholders in the community during a developmental FE process can drive selection of implementation strategies. The use of FE, driven by evidence-based theory, can help provide a roadmap to successful implementation of a pediatric weight management program, such as JOIN for ME.

Household income and loss of control eating in adolescence: Examining the role of food insecurity.

Loss of control (LOC) eating is prevalent among adolescents and has been related to significant mental and physical health concerns. A growing body of research suggests that youth from lower income households are at risk for LOC eating. Food insecurity is an understudied contextual factor that may compound the risk for LOC eating in adolescents from low-income backgrounds. The present study sought to: 1) clarify the association between food insecurity and LOC eating among adolescents; and 2) examine whether household food insecurity moderated the association between income-to-needs and LOC eating. As part of a laboratory-based study, adolescents ages 12-17 (N = 60; 33% from low-income households; 53.3% female) completed the Eating Disorder Examination-Questionnaire to measure LOC eating. Parents reported the household food insecurity status and household income, used to calculate income-to-needs ratio. Higher household food insecurity was positively associated with adolescent LOC eating (b = 0.662, t(59) = 5.09, p < .01), after controlling for adolescent BMI percentile, race, ethnicity, biological sex, and age. Food insecurity significantly moderated the association between income-to-needs and LOC eating, ΔF(1,56) = 11.99, p < .01, with the interaction effect explaining an additional 12% of variance. Specifically, lower household income-to-needs was associated with greater LOC eating among adolescents at higher levels of household food insecurity. This finding expands upon prior work by highlighting specific socioeconomic factors that place youth from low-income backgrounds at even greater risk for negative health outcomes. Future research is needed to understand potential ways to intervene for adolescents to prevent future LOC eating in the context of food insecurity.

Reactions to the U.S. Preventive Services Task Force guidelines for the management of adolescent obesity: A multi-informant qualitative approach.

The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6-18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi-informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In-depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families.

Adolescent Weight Management Intervention in a Nonclinical Setting: Changes in Eating-Related Cognitions and Depressive Symptoms.

OBJECTIVE: The present study was a secondary data analysis of a randomized controlled trial (RCT) to examine changes in depressive symptoms and eating-related cognitions in teens who participated in a nonclinic-based adolescent behavioral weight control treatment delivered by YMCA coaches. Differences in intervention effects were also examined by sex. METHODS: Adolescents (N = 66; 13-17 years; 60.6% girls) with overweight (10.6%) or obesity (53.0% with severe obesity) participated in an RCT comparing 2 versions of an evidence-based intervention. Adolescents completed measures of eating-related cognitions (Eating Disorder Examination Questionnaire) and depressive symptoms (Children's Depressive Inventory-2) at baseline and end of active treatment (16 weeks). RESULTS: There were no significant effects of group, time, or group by time interaction for depressive symptoms, global eating-related cognitions, dietary restraint, or eating concerns (ps > 0.05). Shape concerns (p = 0.04) and weight concerns (p = 0.02) significantly decreased over the intervention. Significant interactions between sex and time on global eating-related cognitions (p < 0.001), eating (p = 0.002), shape (p = 0.02), and weight concerns (p = 0.004) were detected such that female participants' scores decreased over the course of the treatment, but male participants' scores did not. CONCLUSION: The results demonstrate some positive and no detrimental effects of a nonclinic-based behavioral weight control intervention on adolescents' eating-related cognitions and depressive symptoms. The findings may mitigate concerns that dissemination of structured, nonclinic-based weight management programs for adolescents will produce negative eating and mood outcomes; however, replication of results in larger trials is needed.

Controlling child feeding practices and child weight: A systematic review and meta-analysis.

Controlling child feeding practices (restriction and pressure-to-eat) have been theorized to predict increased child weight status. However, mixed evidence has been found for this association within previous narrative reviews. The present study quantitatively examined the association between controlling feeding practices and child weight status and examine potential study-level and person-level moderators. PubMed, PsychINFO, and Cochrane databases were utilized. Studies examining the association of controlling child feeding practices and child weight were included. Data from 51 studies, with 17 431 parent-child dyads, were included. There was a small but significant association between restrictive child feeding practices and child weight (d = .22, 95% CI, .14 to .30). Restriction was significantly associated with higher child weight status. This association was significantly moderated by child age and household income. There was also a significant association between pressure-to-eat child feeding practices and child weight (d = -.30, 95% CI, -.38 to -.22). No significant moderators were identified. Pressure-to-eat was significantly associated with lower child weight status. There was a high degree of heterogeneity of effects between studies included in analyses. Longitudinal studies are needed to examine the effect of controlling feeding on child weight over time.

Negative childhood experiences and disordered eating in adolescents in a weight management program: The role of depressive symptoms.

OBJECTIVE: Stress negatively impacts adolescent weight status and eating behaviors. Previous research investigating this association has focused on traumatic events in childhood, but little is known about the impact of commonly experienced stressful life events and weight-related outcome. The aim of this cross-sectional study was to examine the association between negative life events and weight-related outcomes (i.e., weight status, disordered eating behaviors, insulin sensitivity) in a sample of treatment-seeking adolescents with overweight and obesity. A further aim of the study was to examine the potential mediating role of depression. METHOD: Adolescents (N = 170; M age = 14.8; 62% female) presenting to an interdisciplinary weight management program completed measures related to negative life events, disordered eating patterns, and depressive symptoms prior to initiating treatment. Weight status and insulin sensitivity (using fasting glucose and fasting insulin) were objectively measured. RESULTS: Stressful experiences during childhood were significantly related to weight status, F = 2.78, p < .05, and disordered eating, F = 5.51, p < .001, in regression analyses. Stressful life events were not related to insulin sensitivity. Depressive symptoms mediated the association between stressful experiences and disordered eating (b = 0.001, [CI = 0.0002, 0.0011]). Depressive symptoms did not mediate this association for weight status or insulin sensitivity. DISCUSSION: Findings from the present study suggest that relatively common stressful events may be associated with development of disordered eating patterns in adolescents with overweight or obesity presenting to treatment. Providers working in weight management settings should consider assessing a range of potentially stressful life events and their potential weight-related implications.