Food Insecurity Predicts Magnitude of Early BMI Change in a Pediatric Weight Management Intervention.

OBJECTIVE: The aim of this study was to estimate the prevalence of food insecurity among children with overweight/obesity presenting for weight management treatment and examine whether food insecurity predicts early change in body mass index (BMI), expressed as a percentage of the 95th percentile (%BMIp95). METHOD: Children (N = 69; ages 3-18 years) presenting to a hospital-based pediatric weight management intervention and 1 parent/guardian per child (N = 69) were included. At the first appointment, parents/guardians completed the US Household Food Security Survey Module: Six-item Short Form and a demographics questionnaire. Height and weight of the children were measured at the first and third appointments to calculate %BMIp95. RESULTS: Among participating families, 29.0% reported experiencing food insecurity. Controlling for the ratio of income to poverty, 11.4% of the variance in %BMIp95 change from the first to third appointments was accounted for by food insecurity, ▵F (1, 66) = 8.46, p = 0.01. Children with greater food insecurity demonstrated a smaller magnitude of %BMIp95 decrease, representing a small-to-medium effect size within the context of the regression model (f2 = 0.13). CONCLUSION: A high proportion of families with children receiving weight management treatment reported experiencing food insecurity in comparison with US households with children. There may be unique characteristics of food insecurity, as opposed to household income alone, that explain the smaller magnitude of BMI decrease observed early in treatment. Future research should explore complex associations among food insecurity, income, BMI, and race over time.

Weight and disordered eating among adolescents from low-income backgrounds.

Disordered eating affects youth from varying socioeconomic backgrounds; however, representation of youth from low-income backgrounds within disordered eating research has been limited. The aim of the current study was to examine the association between adolescent weight and disordered eating among a sample of youth from a low-income background and to examine specific socioenvironmental factors that might moderate this association. Adolescents ages 12-17 (N = 73) from a low-income background and their parents/guardians completed self-report questionnaires. Adolescent height and weight were objectively measured to calculate BMI z-score. Adolescent weight was significantly positively associated with global disordered eating (95 % CI [0.26, 0.54]), after controlling for sex. Parental weight concern moderated the association between weight and global disordered eating, F(4, 68) = 18.44, p < .01, such that the relation between adolescent zBMI and disordered eating was no longer significant at low levels of parental weight concern. Structured family meals moderated the association between weight and global disordered eating, F(4, 68) = 11.99, p < .01, such that more frequent meals weakened the association between adolescent zBMI and disordered eating. Findings suggest that higher weight is associated with greater levels of disordered eating among adolescents from a low-income background. In addition, lower levels of parental weight concern and more frequent family meals significantly buffered the association between weight and disordered eating in this at-risk, yet understudied population. Both parental weight concern and family meals present as factors within the family environment that may serve as targets for intervention.

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).

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.

Food Insecurity and Depressive Symptoms Among Adolescents: Does Federal Nutrition Assistance Act as a Buffer?

OBJECTIVE: Food insecurity has been associated with a variety of adverse outcomes in adolescents. However, further research is needed to elucidate whether adolescent self-report food insecurity contributes to depressive symptoms. This study examined the (1) association between food insecurity and depressive symptoms and (2) moderating role of federal nutrition assistance in a nonclinical sample of adolescents. METHOD: Adolescents aged 12 to 17 years (N = 141) and one parent/guardian completed self-report questionnaires as part of 2 larger studies examining adolescent stress and eating behaviors. Adolescents (M age = 13.79 years, SD = 1.60, 53.9% female) completed measures of food insecurity and depressive symptoms. RESULTS: A bootstrapped linear regression model demonstrated that adolescent food insecurity was significantly, positively associated with depressive symptoms, 95% confidence interval (CI) (0.19-1.64), after controlling for biological sex. Among dyads eligible for federal nutrition assistance (N = 64), the interaction between adolescent food insecurity and National School Lunch Program (NSLP) participation did not reach significance, ΔF(1, 59) = 1.06, 95% CI (-3.80 to 9.29). The interaction between adolescent food insecurity and Supplemental Nutrition Assistance Program (SNAP) participation trended toward significance, ΔF(1, 59) = 2.88, 95% CI (-5.73 to 0.47). CONCLUSION: Adolescents with food insecurity may be at a greater risk for experiencing elevated depressive symptoms. Whereas NSLP participation did not act as a buffer, SNAP participation may attenuate the association between food insecurity and depressive symptoms. Larger longitudinal studies are needed to develop a greater understanding of factors that may alter the relationship between adolescent food insecurity and depressive symptoms.

Toward a deeper understanding of food insecurity among college students: examining associations with emotional eating and biological sex.

OBJECTIVE: The present study sought to extend our understanding of food insecurity among college students, including aims to replicate the high prevalence of food insecurity among college student samples, examine the food insecurity - emotional eating association, and determine whether biological sex moderates this association. PARTICIPANTS: Participants included 232 students (82.3% female; 83.2% Caucasian) enrolled at a U.S. university. METHODS: Participants completed the Household Food Security Survey Module: Short Form and Emotional Eating Scale as part of a larger study. RESULTS: Of the participants, 37.5% reported food insecurity. Food insecurity was positively associated with emotional eating (B = 1.35, 95% CI[0.24, 2.48]), controlling for body mass index (BMI). The association was stronger for males (95% CI[1.07, 6.54]) than females (95% CI[-0.29, 2.07]). CONCLUSIONS: College students, particularly males, who experience food insecurity may be at greater risk for emotional eating. Future research should investigate risk factors linked to both food insecurity and emotional eating among college students.

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.

Rapid brain MRI protocols result in comparable differential diagnoses versus a full brain protocol in most canine and feline cases.

Evaluation of brain disease in veterinary patients uses a wide variety of MRI sequences. A shortened protocol that maintains consistency of interpretation would reduce radiologist reporting time, patient anesthetic time, and client cost. The aims of this retrospective, methods comparison, observer agreement study were to evaluate whether abbreviated MRI protocols alter differential diagnoses and recommendations compared to our institution's standard protocol; evaluate interobserver agreement on standard brain MRIs; and assess whether differential diagnoses change after postcontrast images. Normal and pathologic canine and feline brain MRIs were retrieved from hospital archives. Three protocols were created from each: a 5-sequence noncontrast enhanced Fast Brain Protocol 1 (FBP1); a 6-sequence contrast-enhanced Fast Brain Protocol 2 (FBP2); and an 11-sequence standard brain protocol (SBP). Three blinded veterinary radiologists interpreted FBP images for 98 cases (1 reader/case) and SBP images for 20 cases (3 readers/case). A fourth observer compared these interpretations to the original MRI reports (OMR). Overall agreement between FBPs and OMR was good (k = 0.75) and comparable to interobserver agreement for multiple reviews of SBP cases. Postcontrast images substantially altered conclusions in 17/97 cases (17.5%), as well as improved interobserver agreement compared to noncontrast studies. The conclusions reached with shortened brain protocols were comparable to those of a full brain study. The findings supported the use of a 6-sequence brain MRI protocol (sagittal T2-weighted [T2w] TSE; transverse T2w turbo spin echo fluid-attenuated inversion recovery, T2*-weighted gradient recalled echo, T1-weighted spin echo, and diffusion weighted imaging/apparent diffusion coefficient; and postcontrast transverse T1-weighted spin echo) for dogs and cats with suspected intracranial disease.

Disinhibited Eating and Executive Functioning in Children and Adolescents: A Systematic Review and Meta-Analysis.

A growing body of research suggests disinhibited eating and weaker executive function (EF) are two risk factors for pediatric obesity. Emerging brain imaging and behavioral findings support the notion that EF skills impact eating regulation. However, a major gap in the current literature is a synthesis of the association between various EF skills and disinhibited eating patterns across child development. To address this gap, a systematic review and meta-analysis was conducted to examine the effect of EF skills on disinhibited eating behaviors among youth ages 3-18 years old. PubMed and PsychINFO databases were utilized and data from 15 studies with a total sample of 4909 youth were included. A random effects meta-analysis revealed a small negative effect of overall EF skills on disinhibited eating behavior, r = -0.14, p < 0.01. Analysis of individual EF skills found working memory had an overall medium negative effect on disinhibited eating behavior, r = -0.25, p < 0.05. Taken together, findings from this meta-analysis support an inverse relationship between EF abilities and disinhibited eating patterns in children and adolescents, such that poorer EF abilities are associated with higher levels of disinhibited eating. Given the effect on eating behavior, future research is needed to assess whether EF difficulties may be a barrier to effective weight management in youth. Specifically, research is needed to examine whether EF skills may be a key target to consider for effective obesity prevention and treatment in children and adolescents.

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.

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.

Parent-perceived barriers to child weight management: Measure validation in a clinical sample.

INTRODUCTION: Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weight-related behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic. METHOD: Participants included 258 parents of children aged 6-18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample. RESULTS: Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, χ2(144) = 278.60, p < .001, comparative fit index = .90, root mean square error of approximation = .05, standardized root mean square residual = .06. DISCUSSION: The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Food Cravings and Eating: The Role of Experiential Avoidance.

Food cravings have been associated with problematic eating behaviors, such as emotional eating. Late adolescence is an important developmental period to examine this association, as late adolescents have greater independence in food choices as well as potentially higher demands during a transitional period of their lives. Mechanisms underlying the association between food cravings and problematic eating remain unclear. This study examined whether experiential avoidance (EA) may be one possible mechanism mediating the association between higher levels of food cravings and problematic eating behaviors. Late adolescents (n = 174) completed measures assessing EA, food cravings, and three problematic eating behaviors: emotional eating, cognitive restraint, and uncontrolled eating. Height and weight were measured objectively to calculate body mass index (BMI). Food cravings were positively associated with emotional eating and mediated by EA. EA also significantly mediated the association between greater cognitive restraint and greater food cravings. No significant mediation was detected for food cravings and uncontrolled eating. Future research may consider EA as a treatment target in intervention strategies for late adolescents seeking to decrease emotional or restrained eating behaviors.

Perceived stress and obesity-promoting eating behaviors in adolescence: The role of parent-adolescent conflict.

INTRODUCTION: Stress has been consistently related to obesity-promoting eating patterns (i.e., emotional, external, and restrained eating) throughout the life span, including during adolescence. One particularly salient source of stress within adolescence is parent-adolescent conflict. The current study sought to examine whether parent-adolescent conflict is a significant predictor of adolescent obesity-promoting eating patterns, beyond general adolescent stress. METHODS: A sample of adolescents (N = 51; 39.2% overweight or obese) completed a study examining stress and eating behaviors. As part of the larger study, adolescents completed measures related to parent-adolescent conflict, general adolescent stress, and obesity-promoting eating patterns. Adolescent height and weight were measured objectively and used to calculate adolescent body mass index (BMI) percentile for age and gender. RESULTS: General adolescent stress predicted all three obesity-promoting eating patterns, emotional, external, and restrained eating, controlling for adolescent BMI percentile. Higher levels of parent-adolescent conflict significantly predicted greater restrained eating, controlling for adolescent BMI percentile and general adolescent stress. Conflict did not predict emotional or external eating patterns. DISCUSSION: Adolescents' perceptions of parent-adolescent conflict appear to present a unique source of stress, above and beyond general perceived stress, that is, particularly relevant to the experience of restrained eating patterns. These findings provide support for the potential integration of assessment and intervention for parent-adolescent conflict within previously established behavioral weight control interventions to decrease restrained eating behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Unusual invasion of primary pulmonary adenocarcinoma in a cat.

CASE SUMMARY: An 11-year-old female spayed domestic shorthair cat was referred to the Foster Hospital for Small Animals, USA for suspected dysautonomia based on weight loss, vomiting and referral radiographs that showed severe dilation of the esophagus, stomach and entire gastrointestinal tract. After recheck radiographs revealed a decrease in gas compared with the referral images, persistently reduced gastrointestinal motility was deemed less likely; however, cardiomegaly and a soft tissue opacity overlying the esophagus were noted. Echocardiogram identified a pulmonary mass either impinging on or invading the local organs. At necropsy, gross pathology and histopathology showed an aggressive pulmonary carcinoma invading the heart, trachea and esophagus, resulting in a focal esophageal stricture. Gastrointestinal gas dilation was most likely secondary to aerophagia as a result of chronic partial esophageal obstruction. RELEVANCE AND NOVEL INFORMATION: To our knowledge, this is the first reported feline case of invasion of the esophagus and heart by a pulmonary adenocarcinoma. Other than weight loss, the clinical signs for this invasive neoplasm were not evident until the cat was diagnosed with hyperthyroidism and prescribed oral medications. This reinforces the fact that pulmonary adenocarcinoma is difficult to detect clinically until secondary problems from the primary or metastatic neoplasm arise.

Maternal Depressive Symptoms Mediate the Association between Socio-economic Status and Adolescent Weight Outcomes: A Longitudinal Analysis.

Introduction The prevalence of pediatric obesity is an issue in the United States, in which approximately one-third of children and adolescents are overweight or obese. Youth living in low socioeconomic (SES) households are at an increased risk for developing obesity; yet, research is needed to understand the mechanisms that might better explain the relationship between SES and obesity risk. Maternal depression presents a potential mechanism by which SES might predict a later risk for obesity in pediatric populations. Methods The present study used a national dataset from the National Institute of Child Health and Human Development-Study of Early Child Care and Youth Development (NICHD-SECCYD) to examine whether maternal depressive symptoms (at an age of 9 years) mediated the association between early SES (the income-to-needs ratio measured at an age of 1 month) and adolescent weight outcomes [Body Mass Index z-scores (zBMI) for age and sex, at an age of 15 years]. Results The results suggested that greater maternal depressive symptoms helped to explain a significant amount of the variance of lower SES predicting poorer weight outcomes in adolescents. Discussion These findings illustrate the role of maternal depressive symptoms in explaining how SES predicts adolescent weight outcomes. Implications are discussed, and future research is needed to identify women from lower SES households who are experiencing depressive symptoms to provide support and initiate points of early intervention to address relevant health outcomes in youths.