Childhood obesity and adolescent follow-up depressive symptoms: exploring a moderated mediation model of body esteem and gender.

Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8-12 years) to adolescence (13-18 years). In addition, potential gender moderation was examined. This study utilized data from a case-control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children's BE in preventive intervention programs among children with obesity to prevent future mental health problems.

Reduction in Pappalysin-2 Levels and Lower IGF-I Bioavailability in Female Adolescents With Anorexia Nervosa.

CONTEXT: Anorexia nervosa (AN) can cause severe undernutrition associated with alterations in the IGF axis. Pappalysins (PAPP-A, PAPP-A2) and stanniocalcins (STC-1, STC-2) modulate IGF binding-protein (IGFBP) cleavage and IGF bioavailability, but their implications in AN are unknown. OBJECTIVE: We determined serum levels of PAPP-As and STCs in relationship with classical IGF axis parameters in female adolescents with AN and their association with nutritional status and secondary amenorrhea. METHODS: Parameters of the IGF axis were determined in fasting serum samples of 68 female adolescents with AN at diagnosis and 62 sex- and age-matched controls. Standardized body mass index (BMI) and bone mineral density (BMD) were calculated. RESULTS: Patients with AN had lower concentrations of total and free IGF-I, total IGFBP-3, acid-labile subunit (ALS), insulin, PAPP-A2, STC-1, and STC-2 and higher levels of IGF-II and IGFBP-2. Their free/total IGF-I ratio was decreased and the intact/total IGFBP-3 and -4 ratios increased. BMI was directly related to total IGF-I and intact IGFBP-3 and inversely with IGFBP-2 and intact IGFBP-4. Weight loss was directly correlated with intact IGFBP-4 and negatively with intact IGFBP-3, ALS, STC-2, and PAPP-A2 concentrations. BMD was directly related to intact IGFBP-3 and inversely with intact IGFBP-4 and PAPP-A2 levels. Patients with amenorrhea had lower levels of total IGF-I and IGFBP-3 than those with menses. CONCLUSION: The reduction of PAPP-A2 in patients with AN may be involved in a decline in IGFBP cleavage, which could underlie the decrease in IGF-I bioavailability that is influenced by nutritional status and amenorrhea.

Examining associations between obesity and mental health disorders from childhood to adolescence: A case-control prospective study.

Childhood obesity and mental disorders often co-exist. To date, most of the studies are cross-sectional, involve the assessment of a specific disorder, and rely on self-report questionnaires. This study aimed to provide a comprehensive psychological assessment to examine the concurrent and prospective association between childhood obesity and mental health problems. We compared 34 children with obesity with 37 children with normal weight at baseline, and at a five-year follow-up, to examine the development of mental health disorders from childhood (8-12 years) to adolescence (13-18 years). Both assessments included a clinical interview and self-reported measures of psychosocial and family markers. Findings showed that the obesity group had a higher prevalence of mental disorders, and psychological comorbidity increased in five years. Prospectively, childhood obesity was associated with a psychological diagnosis in adolescence. Moreover, the obesity group displayed higher severity of symptoms at both times. Finally, body esteem contributed to predicting mental health disorders in adolescence regardless of weight status, while eating symptomatology was a specific marker for the obesity group. Therefore, in the management of childhood obesity is suggested to address also psychosocial variables such as weight-related teasing and body esteem, to prevent the onset or development of mental health problems.

Feasibility and acceptability of a hospital-at-home program for adolescents with eating disorders: Making progress in community/family-based treatments.

OBJECTIVE: To explore the feasibility and acceptability of a novel hospital-at-home (HaH) program for adolescent patients with a severe eating disorder (ED). METHOD: Retrospective description of the program during its first year of activity. The feasibility construct is based on accessibility, recruitment, rate of retention, avoidance of hospital stays, and management of crisis situations. Caregivers completed a satisfaction questionnaire on discharge, including an item on perceived safety. All patients referred to the program were included. RESULTS: Fifty-nine female patients with a mean age of 14.69 years (SD = 1.67) were admitted. The mean stay was 39.14 days (SD = 14.47). On admission, 32.2% of patients presented nonsuicidal self-harm behavior and 47.5% had comorbid mental disorders. All patients were screened in the first 48 h after referral, and the program retention rate was 91.52%. As for use of health services, 2016.03 hospital stays were avoided, and only 16.12% of the 31 calls received for urgent care required emergency department visits. Families gave the program an overall satisfaction score of 4.95/5, and all described it as "very safe." DISCUSSION: The HaH program described is a feasible and acceptable care model in adolescents with severe EDs and comorbidities. Effectiveness studies should be performed. PUBLIC SIGNIFICANCE: Eating disorders are a major concern for public health. The adolescent HaH program presented marks an advance in intensive community treatments for patients with severe EDs and comorbidities.

Executive dysfunction in eating disorders: Relationship with clinical features.

Eating disorders (ED) are severe mental disorders that may result in significant functional impairment and disability. Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation. In this study, impairment of executive functioning is investigated in patients with eating disorders and the associations with clinical features and clinical subtypes are analyzed. METHOD: 75 female patients (m = 22.01 years, sd = 9.15) with eating disorder (43 restrictive anorexia, 30 binge-eating anorexia and 13 bulimia nervosa) and 37 healthy controls (m = 18.54 years, sd = 4.21) were included in the study. An extensive assessment of executive function domains (verbal fluency, set shifting, attention span, selective attention, working memory, inhibitory control and processing speed) was carried out in both groups. Clinical scales for food intake restriction, binge-eating/purging, depression, anxiety and impulsivity were also administered and correlated with scores on executive function tests. RESULTS: Patients with an ED had significantly lower scores than healthy controls in performance of several executive function tests, particularly in set shifting, interference control and processing speed (p < .01, in all three domains). Executive function impairment was related to anxious, depressive and eating disorder symptoms (p < .05), regardless of clinical subtype. CONCLUSIONS: Executive function impairment in eating disorders is associated with greater ED symptomatic severity and might involve a negative treatment outcome. Therefore, cognitive remediation techniques should probably be considered in a number of severe patients with ED.

Interacción de los rasgos de personalidad de los padres con hijas adolescentes al inicio de la anorexia nerviosa: un estudio de casos y controles / Interaction of parental personality traits with adolescent daughters at the onset of anorexia nervosa: a case-control study

El objetivo del estudio fue examinar la relación entre los rasgos de personalidad de los padres y sus hijas con anorexia nerviosa (AN) mediante un estudio de casos y controles. Fueron evaluadas 50 chicas adolescentes con AN (G-AN) y 50 chicas sanas (GC), junto con sus padres, con el “Inventario de temperamento y carácter revisado” y el “Inventario de trastornos de la conducta alimentaria-2”. El G-AN y el GC no difirieron en los rasgos de personalidad. Los padres del G-AN mostraron diferencias significativas en los rasgos temperamentales y de carácter en comparación con los padres del GC. Se encontraron relaciones complementarias en la evitación del daño de las madres con la cooperación y la fantasía de las hijas en el G-AN, mientras que en los padres y las hijas se encontraron asociaciones entre la dependencia de la recompensa, la persistencia y la autodirección. La única escala que discriminó entre el G-AN y GC fue la obsesión por la delgadez (clasificación: 74,7%). La identificación de los rasgos de personalidad de padres y adolescentes al inicio de la AN permitirá mejorar la intervención. (AU)

ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care.

BACKGROUND: Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring). METHODS/DESIGN: The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling. DISCUSSION: To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.

Family-reported barriers and predictors of short-term attendance in a multidisciplinary intervention for managing childhood obesity: A psycho-family-system based randomised controlled trial (ENTREN-F).

OBJECTIVE: This study was aimed to examine patient enrolment in the pre-intervention stage, family-reported barriers, attendance rates and underlying predictors of short-term attendance in a family-system-based randomised controlled trial for managing childhood obesity in children aged 8-12-years-old (ENTREN-F). METHOD: Psychosocial and anthropometric measures were collected through primary health referral. The data were used for descriptive analyses of sample characteristics and linear regression analyses. RESULTS: Low enrolment rates and several family-reported barriers were observed in the pre-intervention stage. Logistical barriers were the most frequent family-reported reason for attrition in the different stages of the study. Having a first face-to-face orientation session with the families and the use of motivational interviewing helped to improve adherence in the initial phases of the study. After 6 months of intervention, family based treatments (FBTs) under consideration achieve greater adherence compared with the standard intervention. Moreover, family involvement was a predictor of success for better treatment adherence rates. By contrast, participants who attended a brief standard intervention, mothers with primary education, greater body mass index, higher levels of depressive symptomatology and more critical comments towards their children, children with higher weight status and lower levels of self-reported depressive symptoms at baseline attended interventions less frequently. CONCLUSIONS: In future programmes a comprehensive screening of modifiable factors related to family and their setting characteristics is paramount prior to intervention, identifying key barriers related to drop-out, especially in the case of less-advantaged families.

Biological, psychological and familial specific correlates in eating disorders at onset: a control-case study protocol (ANOBAS).

The complexity in the development of an eating disorder (ED) pose methodological challenges when addressing risk factors of this pathology. Pike et al. (2008) proposed to use a case-control design for this type of research.

Correlatos biológicos, psicológicos yfamiliares específicos en el inicio delos trastornos alimentarios: Estudio caso-control (ANOBAS) / Biological, psychological and familial specific correlates in eating disorders at onset: A control-case study protocol (ANOBAS)

Introducción. La complejidad asociada al desarrollo de los trastornos alimentarios (TCA) supone un reto metodológico en la investigación sobre los factores de riesgo implicados en el trastorno, siendo el diseño caso-control el adecuado para investigarlos. El Estudio de Factores de Riesgo de los TCA (ANOBAS) es un estudio caso-control con tres grupos de control que tiene el objetivo de evaluar distintos correlatos relacionados con el inicio de un TCA. El objetivo de este estudio es mostrar una nueva propuesta metodológica de evaluación y comprobar si los grupos de control son adecuados para estudiar cuáles son los correlatos específicos. Metodología. Se usó un estudio caso-control con 50 adolescentes con TCA al inicio de la patología, emparejadas por edad y estatus socioeconómico de los padres con 40 adolescentes con trastorno afectivo al inicio, 40 adolescentes con patología asmática y 50 adolescentes sin patología. El diagnóstico se realizó a través de la entrevista K-SADS y se hizo una evaluación de los correlatos biológicos, psicológicos y familiares. Resultados. Como se esperaba, altas similitudes fueron encontradas entre el grupo TCA y el grupo con trastorno afectivo en los correlatos psicológicos, mientras que las similitudes entre el grupo TCA y el grupo con patología asmática fueron encontradas en el plano familiar. Las principales diferencias fueron encontradas con el grupo sin patología. Conclusiones. Esta rigurosa propuesta metodológica permite investigar qué correlatos se asocian específicamente al inicio de un TCA, siendo los grupos de control seleccionados adecuados para investigarlo. (AU)

Background. The complexity in the development of an eating disorder (ED) pose methodological challenges when addressing risk factors of this pathology. Pike et al. (2008) proposed to use a case-control design for this type of research. The eating disorders’ risk factor study (ANOBAS) is a case-control study with three control groups aiming to evaluate several variables related to the onset of ED, thus the aim was to illustrate a new methodology proposal and to assess whether the chosen control groups are appropriate to research correlates on ED. Methods. We used a case-control design of 50 female adolescents with ED at onset matched by age and their parents’ socioeconomic status with 40 patients with an affective disorder, 40 patients with asthma pathology and 50 without pathology. Diagnoses were completed with K-SADS interview and an evaluation of biological, psychological, environmental and family correlates. Results. Higher similarities were found between the ED group and the affective disorder group across psychological variables, whereas the similarities between the ED group and the asthma group were found at the familial level, as we expected. The biggest differences were found with the non-pathology group. Conclusions. This rigorous research design allows investigating correlates associated specifically to the onset of an ED and the chosen control groups are suitable to investigate it. (AU)

Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale.

Early-onset psychosis (EOP) is a complex disorder characterized by a wide range of symptoms, including affective symptoms. Our aim was to (1) examine the dimensional structure of affective symptoms in EOP, (2) evaluate the predominance of the clinical dimensions and (3) assess the progression of the clinical dimensions over a 2-year period. STROBE-compliant prospective principal component factor analysis of Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale-21 (HDRS-21) at baseline, 6-months, 1-year and 2-year follow-up. We included 108 EOP individuals (mean age = 15.5 ± 1.8 years, 68.5% male). The factor analysis produced a four-factor model including the following dimensions: mania, depression/anxiety, sleep and psychosis. It explained 47.4% of the total variance at baseline, 60.6% of the total variance at 6-months follow-up, 54.5% of the total variance at 1-year follow-up and 49.5% of the total variance at 2-year follow-up. According to the variance explained, the mania factor was predominant at baseline (17.4%), 6-month follow-up (23.5%) and 2-year follow-up (26.1%), while the depression/anxiety factor was predominant at 1-year follow-up (23.1%). The mania factor was the most stable; 58.3% items that appeared in this factor (with a load > 0.4) at any time point appeared in the same factor at ≥ 3/4 time points. Affective symptoms are frequent and persistent in EOP. Mania seems to be the most predominant and stable affective dimension. However, depression and anxiety may gain predominance with time. A comprehensive evaluation of the dimensional structure and the progression of affective symptoms may offer clinical and therapeutic advantages.

Unveiling Metabolic Phenotype Alterations in Anorexia Nervosa through Metabolomics.

Anorexia nervosa (AN) is a mental disorder characterized by an intense fear of weight gain that affects mainly young women. It courses with a negative body image leading to altered eating behaviors that have devastating physical, metabolic, and psychological consequences for the patients. Although its origin is postulated to be multifactorial, the etiology of AN remains unknown, and this increases the likelihood of chronification and relapsing. Thus, expanding the available knowledge on the pathophysiology of AN is of enormous interest. Metabolomics is proposed as a powerful tool for the elucidation of disease mechanisms and to provide new insights into the diagnosis, treatment, and prognosis of AN. A review of the literature related to studies of AN patients by employing metabolomic strategies to characterize the main alterations associated with the metabolic phenotype of AN during the last 10 years is described. The most common metabolic alterations are derived from chronic starvation, including amino acid, lipid, and carbohydrate disturbances. Nonetheless, recent findings have shifted the attention to gut-microbiota metabolites as possible factors contributing to AN development, progression, and maintenance. We have identified the areas of ongoing research in AN and propose further perspectives to improve our knowledge and understanding of this disease.

Effects of Dog-Assisted Therapy in Adolescents with Eating Disorders: A Study Protocol for a Pilot Controlled Trial.

BACKGROUND: Eating disorders are characterized by a persistent disturbance that alters food intake and it is often accompanied by anxiety, depression, low self-esteem, or reduced functional capacity and quality of life. Animal-assisted therapies (AAT) have shown benefits in these variables in children and adult populations. Thus, the present pilot study will aim to evaluate the effects of a dog-assisted therapy on the eating disorders symptoms, mental, psychosocial, and physical health, quality of life, and handgrip strength of adolescents suffering from eating disorders. METHODS: The current pilot study will involve 32 patients, who will be assigned to a control or an experimental group. Intervention will be conducted once a week for seven weeks. Neither the experimental nor the control group will discontinue their usual care. The main outcome measures will be the eating disorder symptoms and the health-related quality of life measured with standardized questionnaires, while the secondary variables will be anxiety, depression, character, behavior, strength, and body mass. CONCLUSIONS: This pilot-controlled trial will be the first to evaluate the effects of dog-assisted therapy on the physical and mental health of adolescents with eating disorders. Significant improvements, in the primary and secondary outcomes, may be expected based on the known benefits of AAT on self-esteem, stress, and self-control in different populations. Finally, although the program is focused on the improvement of adolescents' health, animal welfare will be a priority in this study.

Toward a Biological, Psychological and Familial Approach of Eating Disorders at Onset: Case-Control ANOBAS Study.

Eating disorders (ED) are considered as heterogeneous disorders with a complex multifactor etiology that involves biological and environmental interaction. Objective: The aim was to identify specific ED bio-psychological-familial correlates at illness onset. Methods: A case-control (1:1) design was applied, which studied 50 adolescents diagnosed with ED at onset (12-17 years old) and their families, paired by age and parents' socio-educational level with three control samples (40 with an affective disorder, 40 with asthma, and 50 with no pathology) and their respective families. Biological, psychological, and familial correlates were assessed using interviews, standardized questionnaires, and a blood test. Results: After performing conditional logistic regression models for each type of variable, those correlates that showed to be specific for ED were included in a global exploratory model (R 2 = 0.44). The specific correlates identified associated to the onset of an ED were triiodothyronine (T3) as the main specific biological correlate; patients' drive for thinness, perfectionism and anxiety as the main psychological correlates; and fathers' emotional over-involvement and depression, and mothers' anxiety as the main familial correlates. Conclusion: To our knowledge, this is the first study to use three specific control groups assessed through standardized interviews, and to collect a wide variety of data at the illness onset. This study design has allowed to explore which correlates, among those measured, were specific to EDs; finding that perfectionism and family emotional over-involvement, as well as the T3 hormone were relevant to discern ED cases at the illness onset from other adolescents with or without a concurrent pathology.

Fronto-Parietal Gray Matter Volume Loss Is Associated with Decreased Working Memory Performance in Adolescents with a First Episode of Psychosis.

Cognitive maturation during adolescence is modulated by brain maturation. However, it is unknown how these processes intertwine in early onset psychosis (EOP). Studies examining longitudinal brain changes and cognitive performance in psychosis lend support for an altered development of high-order cognitive functions, which parallels progressive gray matter (GM) loss over time, particularly in fronto-parietal brain regions. We aimed to assess this relationship in a subsample of 33 adolescents with first-episode EOP and 47 matched controls over 2 years. Backwards stepwise regression analyses were conducted to determine the association and predictive value of longitudinal brain changes over cognitive performance within each group. Fronto-parietal GM volume loss was positively associated with decreased working memory in adolescents with psychosis (frontal left (B = 0.096, p = 0.008); right (B = 0.089, p = 0.015); parietal left (B = 0.119, p = 0.007), right (B = 0.125, p = 0.015)) as a function of age. A particular decrease in frontal left GM volume best predicted a significant amount (22.28%) of the variance of decreased working memory performance over time, accounting for variance in age (14.9%). No such association was found in controls. Our results suggest that during adolescence, EOP individuals seem to follow an abnormal neurodevelopmental trajectory, in which fronto-parietal GM volume reduction is associated with the differential age-related working memory dysfunction in this group.

Inflammatory dysregulation in women with an eating disorder: Relationships with altered emotional reactivity.

BACKGROUND: Some studies suggest that inflammatory signaling dysregulation may contribute to eating disorder (ED) pathophysiology. However, little is known about the influence of inflammatory response on altered processes seen among patients with ED, such as emotional processing and reactivity. OBJECTIVES: The objectives were: (a) to investigate the systemic inflammatory response in ED women; and (b) to analyze the role of inflammatory markers in emotional reactivity. METHOD: Concentrations of several intercellular and intracellular inflammatory mediators (cytokines, prostaglandin by-products and enzymes, TBARS, and MAPK proteins) were quantified in plasma and PBMCs from 68 women with an ED (m = 22.01 years, SD = 9.15) and 35 healthy controls (m = 18.54 years, SD = 4.21). Moreover, emotional reactivity to affective pictures (those without either food or thinness content) was studied using the adult (>18 years old) sample (n = 41). RESULTS: Between-group differences were revealed for most markers (TNF-α, PGE2 , COX2, and ratio of activated MAPK proteins), pointing to increased inflammatory response in patients (p < .01). Women with ED showed heightened emotional reactivity, regardless of picture valence. Principal components derived from inflammatory markers showed an explanatory loading on patient's emotional reaction, in terms of valence and arousal. CONCLUSION: This study corroborates the altered systemic inflammatory response in patients with ED. The inflammatory dysregulation may contribute to ED phenotype, as seen by its relationship with heightened emotional reactivity, even though the inflammatory markers were not evaluated throughout the emotional reactivity protocol.

Linking Psychosocial Stress Events, Psychological Disorders and Childhood Obesity.

There is scientific evidence that supports a strong association between early exposure to stressful life events and the presence of health complications throughout adulthood and, to a lesser extent, in adolescence and childhood. The aim of this study was to examine the accumulation of Psychosocial Stress Events (PSE) and the prevalence of mental disorders in children from 8 to 12 years. The association between these factors and child weight measurements was analysed. A cross-sectional study was conducted among 200 children classified by weight status (obesity, overweight and normal-weight). The assessment was carried out in primary care centres and primary schools. An experienced team carried out a structured medical-psychosocial history and a semi-structured interview aimed at identifying an early diagnosis of psychological disorders. Children filled out a questionnaire to evaluate PSE. The obesity group presented the greatest accumulation of PSE and highest prevalence of psychiatric diagnosis, compared to overweight and normal-weight children. To exceed four or more stressful events was positively associated with psychological problems and child body mass index (BMI z-score). A predictive model confirmed the interaction between a larger number of PSE and the occurrence of a psychiatric diagnosis as variables that predispose children by 26.2 times more to increased weight status. In conclusion, the accumulation of PSE in the family, school and social environments of the children was related to greater psychological distress. If not managed, the likelihood of suffering from other health complications, such as excess weight, may increase. It is important to monitor these variables to ensure positive health outcomes while specifically addressing childhood obesity. This is especially relevant for children from a disadvantaged social background and disharmonious family environments.

Adding maintaining factors to developmental models of anorexia nervosa: An empirical examination in adolescents.

OBJECTIVE: A biopsychosocial approach has been proposed to explain the pathogenesis of anorexia nervosa (AN), despite only a few of the existing etiological models having received empirical support. The aim of this study was to empirically investigate Herpertz-Dahlmann, Seitz, and Konrad (2011, https://doi.org/10.1007/s00406-011-0246-y)'s developmental model and to consider if interpersonal reactions to the illness might serve as maintaining factors following the model proposed by Treasure and Schmidt (2013, https://doi.org/10.1186/2050-2974-1-13) METHOD: One hundred adolescents and their families were participated in the study: 50 diagnosed with AN, paired by age and parents' socio-economic status with 50 adolescents without a pathology. Biological, psychological and familial variables were assessed using ten questionnaires and a blood analysis test. Additionally, structural equation modeling was conducted to assess two hypothetical models. RESULTS: The fit of both models was good after the addition of two covariate parameters (e.g., Comparative Fit Index > 0.96 and Tucker-Lewis Index > 0.95). Premorbid traits were linked to body dissatisfaction and to the number of stressful life events; this in turn was linked to AN symptoms. Biological and familial consequences reinforced this pathology. CONCLUSIONS: Our findings provide support for both models, suggesting that inter relationships between bio-psycho-familial variables can influence the course of AN during adolescence.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Identifying Loss of Control Eating within Childhood Obesity: The Importance of Family Environment and Child Psychological Distress.

This study aims to examine the differences in family environment, psychological distress, and disordered eating symptomatology between children classified by weight status with or without loss of control (LOC) eating and to test a model of the role of emotional regulation of LOC eating based on a dysfunctional family environment. A cross-sectional study was conducted among 239 families. The assessment measured family expressed emotion, family adaptability and cohesion, child levels of depression and anxiety, body esteem, and disordered eating attitudes. The assessment was carried out in primary care centers and primary schools. Child body mass index (BMI) was associated with higher expressed emotion, psychological distress, and disordered eating symptomatology. Children with obesity and LOC presented higher BMI, poorer body esteem, and more disordered eating attitudes than children without LOC. Children with overweight/obesity, both with or without LOC, exhibited higher psychological distress and emotional overinvolvement than normal-weight children. A partial mediation of depression or anxiety and disordered eating attitudes between expressed emotion and LOC was found. Findings support that children with overweight/obesity show more family and psychological distress. Body esteem issues and disordered eating attitudes could alert the presence of LOC in children with obesity. The function of LOC might be to cope with psychological distress that may appear in a dysfunctional family environment.