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Background: Functional abdominal pain (FAP) is not only a highly prevalent disease but also poses a considerable burden on children and their families. Untreated, FAP is highly persistent until adulthood, also leading to an increased risk of psychiatric disorders. Intervention studies underscore the efficacy of cognitive behavioral treatment approaches but are limited in terms of sample size, long-term follow-up data, controls and inclusion of psychosocial outcome data.
Methods/Design: In a multicenter randomized controlled trial, 112 children aged 7 to 12 years who fulfill the Rome III criteria for FAP will be allocated to an established cognitive behavioral training program for children with FAP (n = 56) or to an active control group (focusing on age-appropriate information delivery; n = 56). Randomization occurs centrally, blockwise and is stratified by center. This study is performed in five pediatric gastroenterology outpatient departments. Observer-blind assessments of outcome variables take place four times: pre-, post-, 3- and 12-months post-treatment. Primary outcome is the course of pain intensity and frequency. Secondary endpoints are health-related quality of life, pain-related coping and cognitions, as well as selfefficacy.
Discussion: This confirmatory randomized controlled clinical trial evaluates the efficacy of a cognitive behavioral intervention for children with FAP. By applying an active control group, time and attention processes can be controlled, and long-term follow-up data over the course of one year can be explored.
Objectives: Eating disorders are more prevalent in aesthetic sports such as figure skating or gymnastics. While many descriptive studies on their prevalence already exist, more and more studies are now examining the reasons for the specific risk of these athletes. The purpose of this study was to focus on sport-specific variables in aesthetic sports and to examine their relation to disordered eating.
Design: Cross-sectional.
Method: 96 Elite athletes from aesthetic sports (61 girls, 35 boys) were compared to a control group of 96 sex-matched non-athletes. The mean age of participants was M = 14.0 years (SD = 2.2). The questionnaire package included disordered eating, general body dissatisfaction, sports-related body dissatisfaction, desire to be leaner to improve sports performance and social pressure to be lean from sports environment.
Results: Athletes from aesthetic sports displayed more eating disorder symptoms but did not differ from the control group with respect to general body dissatisfaction. For athletes in aesthetic sports, the desire to be leaner to improve sports performance was a significant predictor for disordered eating, and mediated the relationship between social pressure from the sports environment and disordered eating.
Conclusions: The results suggest that sports-related parameters are relevant for understanding eating disorder symptomatology in aesthetic sports. Athletes from aesthetic sports seem to be more at risk if they perceive the possibility to enhance sports performance through weight-regulation, which appears to be triggered by social pressure to be lean from sports environment.
Background: There is an increasing awareness of the impact of parental risk perception on the weight course of the child and the parent's readiness to engage in preventive efforts, but only less is known about factors related to the parental perception of the right time for the implementation of preventive activities. The aim of this study was to examine parental perceptions of the appropriate time to engage in child weight management strategies, and the factors associated with different weight points at which mothers recognize the need for preventive actions.
Methods: 352 mothers with children aged 2-10 years took part in the study. We assessed mothers' perceptions of the actual and preferred weight status of their child, their ability to identify overweight and knowledge of its associated health risks, as well as perceptions of the right time for action to prevent overweight in their child. A regression analysis was conducted to examine whether demographic and weight related factors as well as the maternal general risk perception were associated with recognizing the need to implement prevention strategies.
Results: Although most of the parents considered a BMI in the 75th to 90th percentile a valid reason to engage in the prevention of overweight, 19% of the mothers were not willing to engage in prevention until their child reached the 97th percentile. Whereas the child's sex and the identification of an elevated BMI were significant predictors for parents' recognition of the 75th percentile as right point to engage in prevention efforts, an inability to recognize physical health risks associated with overweight silhouettes emerged as a significant factor predicting which parents would delay prevention efforts until a child's BMI reached the 97th percentile.
Conclusion: Parental misperceptions of overweight and associated health risks constitute unfavorable conditions for preventive actions. Feedback on the health risks associated with overweight could help increase maternal readiness for change.
The aim of this study was the development and psychometric assessment of a questionnaire for functions of OCD (FFZ). The instrument was analyzed using factor and item analyses with a sample of 120 OCD patients within the first 5 weeks of an inpatient cognitive-behavioral treatment. The revealed scales were OCD as self-confirmation, emotion regulation, avoidance of responsibility, interpersonal regulation and OCD as occupation. The reliabilities of all subscales and the total value were satisfactory to nearly excellent. The factorial validity was good, content validity was excellent. The FFZ shows correlations with measures of interpersonal problems and emotional competence, but none with measures of self-reflection and therapy experience. No differences were found for gender or age. The results provide initial support for the reliability and validity of the FFZ.
The current study explores the role of appearance-related social pressure regarding changes in body image in adolescent girls (n = 236) and boys (n = 193) over a 1-year-period. High school students aged 11-16 completed measures of body dissatisfaction (i.e., weight and muscle concerns) and appearance-related social pressure from peers and parents. Three aspects proved to be particularly crucial: Parental encouragement to control weight and shape was a strong predictor of weight concerns in boys and girls alike; influences of friends affected gender-specific body image concerns by leading to weight concerns in girls and muscle concerns in boys; finally appearance-based exclusion was a predictor of weight concerns in boys. The findings provide longitudinal evidence for the crucial impact of appearance-related social pressure and suggest that a detailed assessment of different types of social impacts can identify concrete targets for effective prevention and therapy for weight-related problems among adolescents.
Cognitive flexibility in adolescent patients with unipolar affective disorders - gender differences
(2013)
Objective: Several studies have revealed impairments in cognitive functions among patients with affective disorders (AD). However, to date there are few neuropsychological studies on cognitive flexibility among adolescent patients with AD, especially on gender differences in AD. Here, we investigate cognitive functions, especially cognitive flexibility, in adolescent patients with unipolar AD (UAD) compared to a healthy control group (CG). Method: The study population consists of 17 male patients (M-age = 15.4 +/- 1.3) and 22 female patients with UAD (M-age = 15.6 +/- 1.4) as well as 20 male (M-age = 16.0 +/- 1.0) and 30 female (M-age = 15.7 +/- 0.9) healthy adolescents. A neuropsychological test battery was conducted, and depressive symptoms, psychological stress, and intelligence were also assessed. Results: The analyses revealed no significant group differences regarding cognitive flexibility or visual processing speed, albeit slight better performance in motor processing speed for the CG. Furthermore, no gender differences were observed regarding cognitive flexibility, though female subjects general displayed better performance in processing speed. Conclusions: Overall, there are no indications for serious deficits and specific gender differences in cognitive flexibility or processing speed in adolescent patients with UAD. Independent of psychological distress, female subjects seem to have some advantages in processing speed.
The preference for fruits and vegetables is the main predictor for the longtime healthy eating behavior. There are many factors which affect the development of food preferences. The familiarity with different foods seems to be a special aspect associated with the corresponding preference. To establish a preference for fruits and vegetables during early childhood, we need to know more about the factors that affect this preference development. So far, research has mostly concentrated on the food intake and less on the corresponding preference. Additionally, it is often based on studies of the mere-exposure effect or on older children and their ability to label fruits and vegetables correctly. Findings about the level of food familiarity in young children and its relation to the actual food preference are still missing. Our study focuses on different aspects of food familiarity as well as on their relationship to the child's preference and presents results from 213 children aged 2 to 10 years. Using standardized photos, the food preference was measured with a computer-based method that ran automatically without influence from parents or interviewer. The children knew fewer of the presented vegetables (66 %) than fruits or sweets (78 % each). About the same number of vegetables (63 %) had already been tasted by the children and were considered tasty. Only 48 % of the presented vegetables were named correctly - an ability that increases in older children. Concerning the relationship between the familiarity with vegetables and their preference, the different familiarity aspects showed that vegetables of lower preference were less often recognized, tasted, considered tasty, or named correctly.
Sports-related correlates of disordered eating a comparison between aesthetic and ballgame sports
(2011)
Prevalence rates for disordered eating vary between different types of sports (Sundgot-Borgen & Torstveit, 2004). In this study, athletes of sports with a high risk and low risk for disordered eating were compared regarding potential sports-related risk factors for disordered eating. One hundred and seventy-one aesthetic and ballgame sports athletes participated in this study (mean age 14.1 +/- 1.8 years). Aesthetic sports athletes reported more disordered eating behaviors, sports-related body dissatisfaction, a greater desire to be leaner to improve sports performance and greater social pressure from the sports environment than did ballgame sports athletes. Emotional distress resulting from missed exercise sessions and the desire to be leaner to improve sports performance predicted disordered eating in both sport types. The results suggest that the kinds of risk factors for disordered eating are equal among sport types, but some potential risk factors are more prevalent in aesthetic sports.
Background: 'Stress' and 'health-related quality of life' (HRQoL) are two important theoretical constructs for modern therapy evaluation with clinical relevance. Eurythmy therapy (EYT) is a mind-body-therapy derived from anthroposophic medicine with promising effects on heart rate variability (HRV), HRQoL and disease scores. The purpose of this study was to investigate the impact of EYT on stress coping strategies (SCS) and HRQoL in a controlled study with moderately stressed participants.
Methods: 68 healthy, moderately stressed adults (mean age: 42.2; SD: 8.2) performed 10 h of EYT in a group setting over a period of six weeks. A non-randomised control group of 22 healthy adults (mean age: 43.6; SD: 13.7) received no intervention and did only complete the questionnaires at the same data points. Outcomes were measured before and after the intervention (AVEM & SF-36).
Results: A significant impact on SCS was found in seven AVEM scales (MANOVA, F (1/74) = 4.59; p = .04). With regard to changes in risk pattern affiliation (AVEM), 24% of the participants receiving EYT (n = 55) changed over time from a risky stress coping pattern to a healthier pattern. Concerning the HRQoL four normally distributed scales of the SF-36 ('vitality', 'social functioning', 'mental health' and 'physical functioning') showed a significant group x time interaction favouring the EYT group (MANOVA, F (1/74) = 17.26; p < .001). Statistically and clinically relevant mean differences over time of at least eight scale points were found for 'role physical', 'bodily pain', 'vitality' and 'mental health', and of at least 15 scale points for 'role emotional' and 'social functioning'.
Conclusions: A six-week period of EYT training can result in a significant reduction of stress and consequently improve QoL. Because a significant proportion of participants had high levels of stress at baseline the results suggest a health-enhancing benefit of EYT that may have clinical potential for prevention of stress and associated disorders in healthy individuals and possibly in patients with chronic diseases, for example.
Past research indicates an association in adults and young people of emotional and contextual factors with a higher risk for the development of eating disorders or obesity. Few studies focus on problematic eating patterns in childhood, especially in association with parental feeding strategies. 482 mothers completed a questionnaire about eating behaviors and the weight status of their 1- to 10-year-old child as well as their own feeding strategies. A classification of the child's eating behavior (food responsiveness, emotional eating, external eating, eating time and meal structure) using hierarchical cluster analysis revealed a conspicuous eating pattern (10 %) showing above-average values in all eating behaviors. Controlling for weight and demographic variables mothers of children with conspicuous eating patterns were characterized by restrictive strategies and were less likely to encourage or facilitate their child to control his or her eating. Similar problematic eating patterns were also identified in early childhood. The association of maternal feeding strategies - beyond weight control issues - with conspicuous eating patterns in children might indicate a possibility of early prevention through parent training.
As part of the POPS study (Potsdam prevention of eating disorders) 300 adolescents aged between 10 and 13 years completed questionnaires measuring satisfaction with weight and muscles, body change strategies and disturbed eating behavior. More than half of the girls and a third of the boys are dissatisfied with their weight. Nearly 70% of the male participants were unhappy with their muscles. Both forms of body dissatisfaction are influenced by similar sociocultural and psychological factors. While weight dissatisfaction leads to weight reduction strategies and disturbed eating, muscle dissatisfaction results in muscle enhancement methods. Potential harmful consequences of excessive muscle building techniques are discussed. The data emphasize the need for a sex-specific investigation of body dissatisfaction and its consequences. Body image aspects relevant to boys should be added to intervention and prevention approaches.
Body dissatisfaction and an unrealistic perception of own body size are particularly common in obese children and adolescents; however, little is known about the association with weight-related quality of life and the impact on successful long-term weight loss.
At the beginning of an inpatient child obesity rehabilitation program, 408 children and adolescents aged 9-12 years completed a questionnaire on body image (body silhouettes) and a body weight-specific questionnaire for overweight and obese children and adolescents (GW-LQ-KJ) on quality of life. Height and weight were measured by a physician at the beginning and 1 year after inpatient hospitalization.
Of the participants 91.9 % reported body dissatisfaction and 75.7 % underestimated their own body size. There were no gender-specific differences in body dissatisfaction but boys perceived their body size more realistically than girls. Participants with body dissatisfaction and realistic body size perception showed a reduced weight-related quality of life. Those participants who realistically perceived their body size also lost less weight in the long term.
The subjective underestimation of body size proved to be important for reduced weight-related quality of life and more pronounced long-term weight loss; therefore, body image should be taken into account in multimodal treatment programs.
The Specificity of Psychological Factors Associated with Binge Eating in Adolescent Boys and Girls
(2015)
Low self-esteem, lack of interoceptive awareness, perfectionism, body dissatisfaction, dietary restraint, weight teasing, and internalization of the societal body ideal are known to be associated with binge eating (BE) in adolescents. The purpose of the present cross-sectional study was to investigate whether these attributes are BE-specific and whether different patterns exist for boys and girls. We assessed BE, internalizing symptoms and psychological factors in 1039 adolescents from a community sample by self-report. Using multinomial logistic regression and controlling for measured height and weight, we compared adolescents with BE with individuals from a healthy control group and adolescents reporting internalizing symptoms. Individuals from the BE-group reported a greater lack of interoceptive awareness and higher body dissatisfaction than individuals from the healthy control group. Additionally, we found a significant interaction between gender and body dissatisfaction. Internalization of the societal body ideal was related to BE when compared to internalizing symptoms. Results suggest, that the lack of interoceptive awareness and body dissatisfaction display substantial associations with BE, and that the latter effect is especially strong in boys. The internalization of societal standards of beauty emerged as a BE-specific factor and this finding emphasizes the role of the societal body ideal in the nature of eating pathology in boys and in girls. Increasing body satisfaction and the acceptance of realistic body ideals might be effective strategies in preventing eating pathology.
Data derived from a nationwide consumer survey of 986 mothers with children between 5 and 36 months of age in Germany.
78.3 % reported that they ever breastfed their children, and 55.6 % of the mothers exclusively breastfed for at least 4 months. Mothers who did not breastfeed were less likely to be informed by their paediatrician or midwife and were more often not informed at all; 27.8 % of mothers used DHA supplements during pregnancy, 16.8 % postnatal. DHA supplementation was more common in women with a high versus a low fish intake. The social status was the major determinant of breastfeeding initiation and exclusivity and also DHA supplementation.
Breastfeeding initiation and duration of exclusive breastfeeding in Germany need to be improved. Professional counselling and support, with a focus on mothers from lower social classes, appears necessary to increase current rates of breastfeeding initiation, duration, and exclusiveness, but also to ensure a sufficient supply with DHA in pregnant and lactating women, particularly in women with low fish consumption.
Background: Obesity is not only a highly prevalent disease but also poses a considerable burden on children and their families. Evidence is increasing that a lack of self-regulation skills may play a role in the etiology and maintenance of obesity. Our goal with this currently ongoing trial is to examine whether training that focuses on the enhancement of self-regulation skills may increase the sustainability of a complex lifestyle intervention.
Methods/Design: In a multicenter, prospective, parallel group, randomized controlled superiority trial, 226 obese children and adolescents aged 8 to 16 years will be allocated either to a newly developed computer-training program to improve their self-regulation abilities or to a placebo control group. Randomization occurs centrally and blockwise at a 1:1 allocation ratio for each center. This study is performed in pediatric inpatient rehabilitation facilities specialized in the treatment of obesity. Observer-blind assessments of outcome variables take place at four times: at the beginning of the rehabilitation (pre), at the end of the training in the rehabilitation (post), and 6 and 12 months post-rehabilitation intervention. The primary outcome is the course of BMI-SDS over 1 year after the end of the inpatient rehabilitation. Secondary endpoints are the self-regulation skills. In addition, health-related quality of life, and snack intake will be analyzed.
Discussion: The computer-based training programs might be a feasible and attractive tool to increase the sustainability of the weight loss reached during inpatient rehabilitation.