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Institute
Objective
While cross-sectional studies underline that child and parent factors in pediatric chronic pain are reciprocally related, so far, little is known on their prospective relationship, especially in treatment contexts. This study aims to analyze directions of influence between child and parental outcomes using data from an intervention study.
Methods
The sample covered 109 families with children aged 7-13 years diagnosed with functional abdominal pain (FAP). Child outcomes included pain and impairment, and parental outcomes covered caregiver-specific distress including both parental personal time burden (i.e., less time available for personal needs) and emotional burden due to child's pain (i.e., increased worries). Cross-lagged panel analyses examined the directions of the relations between child and parental outcomes across time (pretreatment T1, post-treatment T2, and 3-month follow-up and 12-month follow-up T3/T4).
Results
First, a significant improvement over time in all measures was observed. Cross-lagged effects were found for less parental personal time burden at T2, predicting both less pain (beta = -0.254, p = .004) and less impairment (beta = -0.150, p = .039) at T3. Higher baseline pain was predictive for higher parental emotional burden after treatment (beta = -0.130, p = .049) and, reversely, for less emotional burden at 12-month follow-up (beta = 0.261, p = .004).
Conclusions
Addressing parental personal time burden in FAP treatment might possibly support the improvement on the child level. Replication of results in larger samples is warranted to gain more insight into the directions of influence and, in that way, to optimize treatment for pediatric FAP.
Purpose:
Current research supports the effectiveness of mindfulness-based interventions for maladaptive eating behaviors associated with obesity and eating disorders. To investigate potential underlying mechanisms at work, reliable and valid instruments that allow for an exhaustive assessment of the context-specific construct Mindful Eating (ME) are needed. Therefore, the current work aimed to develop a comprehensive inventory reflecting a wide range of ME attitudes and behaviors: The Mindful Eating Inventory (MEI).
Methods & Results:
Study 1 describes the item pool development for an initial version of the MEI comprising various steps (compilation of items, expert ratings, focus groups and think aloud protocols by laypersons). Within Study 2, the factor structure of this initial version was explored in an online sample of N = 828 participants and the item pool was shortened via a sequential process based on statistical and content-related considerations. Exploratory factor analyses yielded a seven-factor structure. This structure could be confirmed within Study 3 on an independent online sample of N = 612 participants using confirmatory factor analysis. Criterion validity was supported by hypotheses-confirming correlations with eating-specific and global health-relevant outcomes.
Conclusion:
Our findings demonstrate that the MEI is a valid and reliable (in terms of internal consistency and retest-reliability) tool, which allows for a comprehensive assessment of various ME attitudes and behaviors within one parsimonious inventory. It further enabled us to propose a so far missing, initial scientific operational definition of this eating-specific construct, that may help to advance future research and clinical application by clarifying mechanisms of action.
Objective:
Rejection sensitivity and justice sensitivity are personality traits that are characterized by frequent perceptions and intense adverse responses to negative social cues. Whereas there is good evidence for associations between rejection sensitivity, justice sensitivity, and internalizing problems, no longitudinal studies have investigated their association with eating disorder (ED) pathology so far. Thus, the present study examined longitudinal relations between rejection sensitivity, justice sensitivity, and ED pathology.
Method:
Participants (N = 769) reported on their rejection sensitivity, justice sensitivity, and ED pathology at 9-19 (T1), 11-21 (T2), and 14-22 years of age (T3).
Results:
Latent cross-lagged models showed longitudinal associations between ED pathology and anxious rejection sensitivity, observer and victim justice sensitivity. T1 and T2 ED pathology predicted higher T2 and T3 anxious rejection sensitivity, respectively. In turn, T2 anxious rejection sensitivity predicted more T3 ED pathology. T1 observer justice sensitivity predicted more T2 ED pathology, which predicted higher T3 observer justice sensitivity. Furthermore, T1 ED pathology predicted higher T2 victim justice sensitivity.
Discussion:
Rejection sensitivity-particularly anxious rejection sensitivity-and justice sensitivity may be involved in the maintenance or worsening of ED pathology and should be considered by future research and in prevention and treatment of ED pathology. Also, mental health problems may increase rejection sensitivity and justice sensitivity traits in the long term.
Poor dietary quality is a major cause of morbidity, making the promotion of healthy eating a societal priority. Older adults are a critical target group for promoting healthy eating to enable healthy aging. One factor suggested to promote healthy eating is the willingness to try unfamiliar foods, referred to as food neophilia. This two-wave longitudinal study explored the stability of food neophilia and dietary quality and their prospective relationship over three years, analyzing self-reported data from N = 960 older adults (MT1 = 63.4, range = 50–84) participating in the NutriAct Family Study (NFS) in a cross-lagged panel design. Dietary quality was rated using the NutriAct diet score, based on the current evidence for chronic disease prevention. Food neophilia was measured using the Variety Seeking Tendency Scale. The analyses revealed high a longitudinal stability of both constructs and a small positive cross-sectional correlation between them. Food neophilia had no prospective effect on dietary quality, whereas a very small positive prospective effect of dietary quality on food neophilia was found. Our findings give initial insights into the positive relation of food neophilia and a health-promoting diet in aging and underscore the need for more in-depth research, e.g., on the constructs’ developmental trajectories and potential critical windows of opportunity for promoting food neophilia.
Japanese parents and educators teach children to refrain from leaving food in their plates. Their teachings have direct (advising children to refrain from leaving food uneaten) and indirect (meal-related rituals before and after mealtimes) influence in enhancing gratitude for food in daily life.This cross-sectional study aimed to examine 1) the interaction of direct and indirect approaches to avoiding food waste behaviors and 2) the mediation of gratitude for food by preventing such behaviors. Overall, 400 Japanese adults (female: n = 200) responded to a self-administrated anonymous questionnaire survey measuring: the present food waste avoiding behaviors; current gratitude for food; direct and indirect childhood approaches for avoiding food waste behaviors. Participants' mean (standard deviation) age and body mass index were 40.0 (11.6) and 21.9 (3.9), respectively. A significant main effect of the indirect approach and the interaction of direct and indirect approaches were obtained by adjusting the participants' background. Moreover, through mediation analyses with percentile-corrected bootstrap confidence intervals, it was observed that gratitude for food mediated the association between direct and indirect childhood approaches and avoiding food waste behaviors. Despite no information on the current meal-related rituals of the respondents, this study suggests the potential of these approaches in enhancing gratitude for food as a new approach to reduce food waste worldwide.
Background
Eating in absence of hunger is quite common and often associated with an increased energy intake co-existent with a poorer food choice. Intuitive eating (IE), i.e., eating in accordance with internal hunger and satiety cues, may protect from overeating. IE, however, requires accurate perception and processing of one’s own bodily signals, also referred to as interoceptive sensitivity. Training interoceptive sensitivity might therefore be an effective method to promote IE and prevent overeating. As most studies on eating behavior are conducted in younger adults and close social relationships influence health-related behavior, this study focuses on middle-aged and older couples.
Methods
The present pilot randomized intervention study aims at investigating the feasibility and effectiveness of a 21-day mindfulness-based training program designed to increase interoceptive sensitivity. A total of N = 60 couples participating in the NutriAct Family Study, aged 50–80 years, will be recruited. This randomized-controlled intervention study comprises three measurement points (pre-intervention, post-intervention, 4-week follow-up) and a 21-day training that consists of daily mindfulness-based guided audio exercises (e.g., body scan). A three-arm intervention study design is applied to compare two intervention groups (training together as a couple vs. training alone) with a control group (no training). Each measurement point includes the assessment of self-reported and objective indicators of interoceptive sensitivity (primary outcome), self-reported indicators of intuitive and maladaptive eating (secondary outcomes), and additional variables. A training evaluation applying focus group discussions will be conducted to assess participants’ overall acceptance of the training and its feasibility.
Discussion
By investigating the feasibility and effectiveness of a mindfulness-based training program to increase interoceptive sensitivity, the present study will contribute to a deeper understanding of how to promote healthy eating in older age.
This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany.
Simply too much
(2022)
Purpose Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. Methods Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. Results WBIS-C scores >= 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score >= 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. Conclusion The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention.
How is intuitive eating related to self-reported and laboratory food intake in middle-aged adults?
(2020)
As intuitive eating (IE) is characterized by eating in response to internal cues of hunger and satiety and by monitoring the effect of food on the body, it has been hypothesized to lead to healthy food intake. Evidence concerning its link to food intake is scarce. This experimental study investigated the relationship between IE and food intake in middle-aged adults. Fifty-five participants aged 50-70 years completed the Intuitive Eating Scale 2 to measure IE. Usual consumption frequency of fruits, vegetables, snacks and sweets was assessed as a measure of healthy self-reported food intake. A taste test of apples, carrots, coated peanuts and chocolate was conducted as a measure of healthy and total laboratory food intake. Regression analyses were performed using Frequentist and Bayesian methods of inference. In line with our hypothesis, IE was associated with healthier self-reported food intake (medium effect size: f(2) = 0.24). The data were 49.80 times more likely under H-1 than under H-0. Contrary to our hypotheses, IE was neither associated with healthy nor total laboratory food intake in classical regression analyses. The accompanying Bayes factors revealed inconclusive evidence. Data only allow drawing cautious conclusions about the different relationship between IE and the self-reported consumption frequency of the foods vs. the amount of these foods consumed in a single test situation. Future studies combining different measures of IE (e.g., behavioral paradigms) and self-reported (e.g., diet quality, portion sizes) and laboratory (e.g., repeated taste tests with pre-selected foods) food intake are warranted to further explore their relationship.
The Body Appreciation Scale-2 (BAS-2) is the most current measure of body appreciation, a central facet of positive body image. This work aimed to examine the factor structure and psychometric properties of a German version. In Study 1 (N = 659; M-age = 27.19, SD = 8.57), exploratory factor analyses (EFA) revealed that the German BAS-2 has a one-dimensional factor structure in women and men, showing cross-gender factor similarity. In Study 2 (N = 472; M-age = 30.08, SD = 12.35), confirmatory factor analysis (CFA) further supported the original scale's one-dimensional factor structure after freeing correlated errors. The German BAS-2 also showed partial scalar invariance across gender, with women and men not differing significantly in latent mean scores. As predicted, we found convergent relationships with measures of self-esteem, intuitive eating, and variables associated with negative body image (i.e., weight-and shape concerns, drive for thinness). Correlations with BMI were small and in an inverse direction. Incremental validity was demonstrated by predicting self-esteem and intuitive eating over and above measures of negative body image. Additionally, the German BAS-2 showed internal consistency and 2-week test-retest reliability. Overall, our results suggest that the German BAS-2 is a psychometrically sound instrument.
Background
Benefit finding, defined as perceiving positive life changes resulting from adversity and negative life stressors, gains growing attention in the context of chronic illness. The study aimed at examining the psychometric properties of the Benefit Finding Scale for Children (BFSC) in a sample of German youth facing chronic conditions.
Methods
A sample of adolescents with various chronic conditions (N = 304; 12 – 21years) completed the 10-item BFSC along with measures of intra- and interpersonal resources, coping strategies, and health-related quality of life (hrQoL). The total sample was randomly divided into two subsamples for conducting exploratory and confirmatory factor analyses (EFA/CFA).
Results
EFA revealed that the BFSC scores had a one-dimensional factor structure. CFA verified the one-dimensional factor structure with an acceptable fit. The BFSC exhibited acceptable internal consistency (α = 0.87 – 0.88) and construct validity. In line with our hypotheses, benefit finding was positively correlated with optimism, self-esteem, self-efficacy, sense of coherence, and support seeking. There were no correlations with avoidance, wishful thinking, emotional reaction, and hrQoL. Sex differences in benefit finding were not consistent across subsamples. Benefit finding was also positively associated with age, disease severity, and social status.
Conclusions
The BFSC is a psychometrically sound instrument to assess benefit finding in adolescents with chronic illness and may facilitate further research on positive adaptation processes in adolescents, irrespective of their specific diagnosis.
Psychometric evaluation of the German version of the Variety Seeking Tendency Scale (VARSEEK)
(2021)
As part of a healthy diet, guidelines recommend eating a variety of foods to reduce risks associated with malnutrition. However, whether people follow this recommendation substantially depends on their willingness to try unfamiliar foods, also referred to as food neophilia. This study aimed at comprehensively validating the German version of the Variety Seeking Tendency Scale (VARSEEK), a common instrument to assess food neophilia. Two independent sub-studies were conducted to examine the German VARSEEK's psychometric properties. Study 1 (N = 532, aged 18-91 years) and Study 2 (N = 468, aged 18-73 years) each comprised a German community sample. Data were collected both online and via a paper-pencil version. Whereas Study 1 included an EFA, Study 2 comprised a CFA, analyses of the VARSEEK's reliability and construct validity, and different explorative group comparisons. EFA and CFA results supported the original scale's unidimensionality. Internal consistency (alpha = .93) and test-retest reliability (r = .87) of the scale were high. VARSEEK scores were positively associated with openness, sensation seeking, and extraversion and negatively associated with food neophobia, general neophobia, and trait anxiety. Construct validity was further established by showing positive associations with ratings of familiarity with and willingness to try familiar and unfamiliar foods. Whereas group comparisons revealed no significant differences for sex, age, and weight status, analyses showed that people who belonged to the upper class were more food neophilic than those assigned to the lower and middle class. Findings further underscore that the German VARSEEK is a reliable and valid instrument for the assessment of food neophilia in the German population.
Objective:
The purpose of this study was to examine the impact of age and weight status on adolescents' body dissatisfaction and its change over 20 months in a gender-comparing design. The influence of body image concern on eating concern was also investigated.
Method:
In a prospective study, 675 male and female adolescents aged 12–16 were assessed using self-report questionnaires on weight, shape, muscularity, and eating concerns. Height and weight measurements were taken by trained personnel. Data were analyzed using structural equation modeling.
Results:
Analyses of latent means revealed more pronounced weight/shape concern in females than males and more pronounced muscularity concern in males than females. Weight/shape concern increased in females over time, whereas muscularity concern remained stable in both genders. Baseline levels of weight/shape concern could be predicted by age and weight status in females and by weight status in males. The only predictor of change in weight/shape concern was weight status in males. Baseline levels of muscularity concern could be predicted by age in females and by weight status in males. Similar effects were found for changes in muscularity concern in both genders. Increases in weight/shape and muscularity concern were associated with more pronounced eating concern.
Discussion:
The results confirm gender differences in distinctive facets of body image concern and its prediction. The relevance of increase in body image concern in adolescents is underlined by its association with eating concern in both genders. Further explanatory variables for change in body dissatisfaction should be examined in future studies.
Background
Relatively little is known about protective factors and the emergence and maintenance of positive outcomes in the field of adolescents with chronic conditions. Therefore, the primary aim of the study is to acquire a deeper understanding of the dynamic process of resilience factors, coping strategies and psychosocial adjustment of adolescents living with chronic conditions.
Methods/design
We plan to consecutively recruit N = 450 adolescents (12–21 years) from three German patient registries for chronic conditions (type 1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). Based on screening for anxiety and depression, adolescents are assigned to two parallel groups – “inconspicuous” (PHQ-9 and GAD-7 < 7) vs. “conspicuous” (PHQ-9 or GAD-7 ≥ 7) – participating in a prospective online survey at baseline and 12-month follow-up. At two time points (T1, T2), we assess (1) intra- and interpersonal resiliency factors, (2) coping strategies, and (3) health-related quality of life, well-being, satisfaction with life, anxiety and depression. Using a cross-lagged panel design, we will examine the bidirectional longitudinal relations between resiliency factors and coping strategies, psychological adaptation, and psychosocial adjustment. To monitor Covid-19 pandemic effects, participants are also invited to take part in an intermediate online survey.
Discussion
The study will provide a deeper understanding of adaptive, potentially modifiable processes and will therefore help to develop novel, tailored interventions supporting a positive adaptation in youths with a chronic condition. These strategies should not only support those at risk but also promote the maintenance of a successful adaptation.
Trial registration
German Clinical Trials Register (DRKS), no. DRKS00025125. Registered on May 17, 2021.
There is evidence that intrapersonal psychological factors might contribute to the development of binge eating. However, studies considering reciprocal effects between risk factors and disordered eating are rare. The present article investigates the nature of the temporal relationships between binge eating and low self-esteem, depressive symptoms, interoceptive deficits, perfectionism, weight/shape concerns, dietary restraint, and the internalization of the societal body ideal in adolescence while taking into account the moderating effects of age and gender. A German population-based sample of 1039 boys and girls from 12 to 19 years of age answered self-report questionnaires on risk factors and eating pathology on 2 measurement points separated by 20months. Data were analyzed using a cross-lagged panel design. Low self-esteem, interoceptive deficits, weight/shape concerns, and the internalization of the societal body ideal predicted binge eating longitudinally in bivariate analyses. Binge eating predicted later depressive symptoms, whereas perfectionism and dietary restraint were not longitudinally linked to binge eating in either direction. Low self-esteem and weight/shape concerns emerged as multivariate predictors of binge eating in girls and boys, respectively. No moderating effects of age were observed. The results suggest that depressive symptoms might rather be a consequence of binge eating than a risk factor, and this underscores that even subclinical eating pathology might be associated with negative psychological outcomes. Central risk factors that should be targeted in prevention programs might be low self-esteem for girls and weight/shape concerns for boys.
Battle of plates
(2017)
Objective: Approach-avoidance training (AAT) is a promising approach in obesity treatment. The present study examines whether an AAT is feasible and able to influence approach tendencies in children and adolescents, comparing implicit and explicit training approaches. Design/Setting/Subjects: Fifty-nine overweight children and adolescents (aged 8-16 years; twenty-six boys) participated in an AAT for food cues, learning to reject snack items and approach vegetable items. Reaction times in the AAT and an implicit association rest (IAT) were assessed pre- and post-intervention. Results: A significant increase in the AAT compatibility scores with a large effect (eta(2) = 0.18) was found. No differences between the implicit and explicit training approaches and no change in the IAT scores were observed. Conclusions: Automatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.
The present study aimed at identifying latent profiles of body image concerns in adolescents and young adults. Subsequently, associations between these profiles and potentially harmful behaviors are examined. Self-report data of 758 male and female adolescents, aged 14 to 22 years, were analyzed. Participants provided demographic and anthropometric data and completed surveys on weight/shape and muscularity concern as well as on disturbed eating behaviors and dysfunctional exercise. Latent profile analyses of weight/shape concern and muscularity concern were performed separately for each gender. The analyses indicated three-class solutions in men and women. In both genders, the inconspicuous class, characterized by small amounts of weight/shape and muscularity concerns, was the largest one (86% in men, 68% in women). Whereas 10% of the men and 23% of the women were assigned to the borderline class, 4% of the men and 8% of the women formed the conspicuous class (marked weight/shape and muscularity concerns). Between genders, the degrees of muscularity concern differed in the borderline and inconspicuous classes, while the degrees of weight/shape concern differed in the inconspicuous class only. The comparable degrees of weight/shape and muscularity concerns in men and women in the affected classes underline the relevance of both aspects in both genders. Classes could be distinguished by harmful behaviors, like restrained eating or emotional exercise, proving the clinical significance of body image concerns.
Anti-fat bias is widespread and is linked to the internalization of weight bias and psychosocial problems. The purpose of this study was to examine the internalization of weight bias among children across weight categories and to evaluate the psychometric properties of the Weight Bias Internalization Scale for Children (WBIS-C). Data were collected from 1484 primary school children and their parents. WBIS-C demonstrated good internal consistency (alpha = .86) after exclusion of Item 1. The unitary factor structure was supported using exploratory and confirmatory factor analyses (factorial validity). Girls and overweight children reported higher WBIS-C scores in comparison to boys and non-overweight peers (known-groups validity). Convergent validity was shown by significant correlations with psychosocial problems. Internalization of weight bias explained additional variance in different indicators of psychosocial well-being. The results suggest that the WBIS-C is a psychometrically sound and informative tool to assess weight bias internalization among children.
Disordered eating is highly prevalent during adolescence and has a detrimental effect on further development. Effective prevention programs are needed to prevent unhealthy developmental trajectories. This study evaluated the efficacy of the POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents. In a cluster-randomized design, we compared the intervention group receiving the prevention program to a waiting control group. Outcomes included indicators of disordered eating and relevant risk factors for eating disorders (body dissatisfaction, internalization of the thin ideal, perceived media pressure, perfectionism, emotional element of exercise, social comparison, and perceived teasing). Questionnaires were administered at the start of the intervention, 3 and 12 months post intervention. At baseline, 1112 adolescents aged 10 to 16 years participated (49% girls; 51% intervention group). Intention-to-treat analyses with the complete data set and per-protocol analyses as a completer analysis were performed. The intervention group showed a more favorable course compared to the control group regarding all observed risk factors for eating disorders except for perceived teasing. Effect sizes were small but comparable to other primary prevention programs. At 1-year follow-up, a small but significant effect on disordered eating was observed. Results of the per-protocol analyses were mostly confirmed by the intention-to-treat analyses. Results were promising for both genders although girls benefited more regarding disordered eating and internalization of the thin ideal. Further studies are warranted examining successful program elements and whether gender-specific programs are needed.
Background: Most studies on food choice have been focussing on the individual level but familial aspects may also play an important role. This paper reports of a novel study that will focus on the familial aspects of the formation of food choice among men and women aged 50-70 years by recruiting spouses and siblings (NutriAct Family Study; NFS). Discussion: Until August 4th 2017, 4783 EPIC-Participants were contacted by mail of which 446 persons recruited 2 to 5 family members (including themselves) resulting in 1032 participants, of whom 82% had started answering or already completed the questionnaires. Of the 4337 remaining EPIC-participants who had been contacted, 1040 (24%) did not respond at all, and 3297 (76%) responded but declined, in 51% of the cases because of the request to recruit at least 2 family members in the respective age range. The developed recruitment procedures and web-based methods of data collection are capable to generate the required study population including the data on individual and inter-personal determinants which will be linkable to food choice. The information on familial links among the study participants will show the role of familial traits in midlife for the adoption of food choices supporting healthy aging.
Evaluation of an approach-avoidance training intervention for children and adolescents with obesity
(2018)
This study evaluated the efficacy of approach-avoidance training as an additional treatment for children and adolescents with obesity seeking inpatient treatment. Two hundred thirty-two participants (8-16years, 53.9% girls) were randomly assigned either to multisession approach-avoidance (IG) or to placebo training (CG). As outcomes, cognitive biases post intervention, body mass index, eating behaviour, food intake, self-regulation, and weight-related quality of life were assessed, also at 6- and 12-month follow-up. Modification of approach-avoidance bias was observed, but lacked in transfer over sessions and in generalization to attention and association bias. After 6months, the IG reported less problematic food consumption, higher self-regulation, and higher quality of life; effects did not persist until the 12-month follow-up; no significant interaction effects were observed regarding weight course. Despite there was no direct effect on weight course, approach-avoidance training seems to be associated with promising effects on important pillars for weight loss. Further research concerning clinical effectiveness is warranted.
Purpose: Dealing with a child who suffers from functional abdominal pain (FAP) is a major challenge for the child's parents. However, little is known about the quality of life (QoL) of this group of parents. Therefore, this cross-sectional study aimed to provide a comprehensive analysis of parental QoL among parents seeking treatment for their child's abdominal pain.
Methods: 133 parents of 7-13-year-old children diagnosed with FAP reported on their health-related QoL (HRQoL), as assessed by the SF-12, and on caregiver-related QoL, as assessed by two CHQ-PF50 scales (emotional impact, time impact). T tests were used to compare the parents' scores on these measures with reference scores. Subgroups which were at risk of impairment were defined by cut-off scores. Determinants of parental QoL were identified by hierarchical regression analyses.
Results: While the parents showed significantly poorer mental health compared to population-based reference samples (d = 0.33-0.58), their physical health did not differ. However, parents were severely strained with respect to the time impact and emotional impact of their child's health (d = 0.33-1.58). While 12.7-27.9% of the parents were at risk of poor HRQoL, 60.6-70.1% were highly strained due to the demands of their role as caregivers. Physical and mental health were best explained by parents' psychiatric symptoms, while parents' perception of their child's impairment additionally determined the high time and emotional impact.
Conclusions: Physical HRQoL is not impaired in the majority of parents seeking treatment for their child's functional abdominal pain. However, the time demands and worries due to the child's pain deserve specific attention. Psychosocial interventions for a child's FAP should include information provided to the parents about coping with time constraints and emotional impact. Further prospective studies are warranted.
Introduction: The goal of the present study was to identify the prospective relations between weight/shape and muscularity concerns and emotional problems in adolescents. Methods: Self-report data of 966 German male and female adolescents were analyzed in a cross lagged panel design. Results: Analyses of latent means revealed significant correlations between weight/shape concern and emotional problems as well as between muscularity concern and emotional problems in both genders. Moreover, weight/shape concern predicted emotional problems prospectively, but only in girls. Regarding muscularity concern, we could not find any prospective relation with emotional problems In boys or girls from the general population. Conclusions: It is assumed that as appearance is highly relevant for the self-concept in girls, concerns about the look might promote emotional problems. Thus, weight/shape concern should be addressed in the prevention of emotional problems in adolescent girls, whereas further research is necessary investigating the contribution of muscularity concern in this context.
Background
This cluster-randomised monocentric controlled trial focuses on improving the uptake symptoms of mental health care in adolescents with chronic medical conditions who have been identified by screening to have depression or anxiety. The study aims to determine the efficacy of motivational interviewing (MI) delivered by trained physicians to increase 12- to 20-year-old adolescents’ utilisation of psychological health care for symptoms of anxiety or depression.
Methods/design
In this single-centre approach, n = 1,000 adolescents will be screened (using PHQ-9 and GAD-7), and adolescents with results indicative of anxiety or depressive symptoms (n = 162) will be advised to seek psychological health care in clusters from treating physicians in specialised outpatient departments. Participants who screen positive will receive either two sessions of MI or treatment as usual (TAU; regarded as the typical daily clinical practice), which is focused on recommending them to seek psychological health care for further evaluation. MI efficacy will be compared to the current TAU as the control condition. The primary outcome is the utilisation rate of psychological health care after counselling by an MI-trained physician vs. an untrained physician. Additionally, reasons for not claiming psychological support and changes in disease-related parameters will be evaluated in a 6-month follow-up session.
Discussion
This trial will evaluate the feasibility of MI as a way to improve the utilisation of mental health-care services by adolescents who need further support other than that provided by standard care for chronic diseases. Physicians offering MI to adolescents may serve as a model for optimising health-care management in daily clinical practice, which may improve adolescents’ long-term well-being by improving adherence to medical treatment and preventing negative lifelong consequences into adulthood.
Common models propose that the internalization of societal beauty ideals influences disordered eating behaviors and muscularity-oriented behaviors via body image concerns. However, previous studies addressing these pathways have been mainly cross-sectional and primarily included female samples. We investigated these pathways prospectively in male and female adolescents and young adults, examining two pathways: a ‘weight/shape pathway,’ linking thin-ideal internalization, weight/shape concern, and restrained eating, and a ‘muscularity pathway,’ linking athletic-ideal internalization, muscularity concern, and muscularity-oriented behavior. Across three time points, 973 participants from the German general population were assessed. Although the hypothesized pathways could not be supported in their complete temporal sequence, several hypothesized pathways occurred across two time points. Among others, weight/shape concern predicted restrained eating and the athletic ideal played a prominent role in the prediction of muscularity-oriented behavior in both genders.
Self-regulation is a dispositional skill of regulating attention and emotion to attain a certain goal. Poor self-regulation is associated with a higher body mass index (BMI) and is a risk factor for the development of obesity. Intuitive eating, an adaptive eating style characterized by eating in response to internal cues of hunger and satiety, is associated with a lower BMI. Using cross-sectional data, this study examined whether intuitive eating mediates the relationship between self-regulation and BMI in a community sample of adults. Participants (N = 530) completed the Self-Regulation Scale, the Intuitive Eating Scale-2 with its facets Unconditional Permission to Eat (UPE), Eating for Physical Rather Than Emotional Reasons (EPR), Reliance on Hunger and Satiety Cues (RHSC) and Body-Food Choice Congruence (B-FCC). They also self-reported their height and weight. Using percentile bootstrap resampling procedures, the simple mediation analysis showed an indirect relationship between self-regulation and BMI through intuitive eating. The multiple mediation analysis revealed that EPR and B-FCC, but not UPE and RHSC, mediated the relationship between self-regulation and BMI. Intuitive eating seems to play an important intermediating role in the relationship between self-regulation and BMI. Regarding weight management interventions, it could be useful to promote intuitive eating, especially for individuals with low self-regulation. Prospective studies are needed to explore the causal and temporal relationships among self-regulation, intuitive eating and BMI.
Objective This prospective study explored bidirectional associations between attachment quality towards mother, father, and peers and disordered eating among a large population-based sample of boys and girls in the transition from preadolescence to adolescence. Specifically, we examined whether insecure attachment relationships emerged as a risk factor for or as an outcome of disordered eating. Method A population-based sample of 904 adolescent girls and boys was assessed four times, at baseline (T1; M-age = 10.8 years) and at 2-, 4-, and 6-year follow-up (T2, T3, and T4). Prospective data were analyzed using cross-lagged panel models for each attachment figure (i.e., mother, father, peers) in a multigroup design to compare genders. Results Better attachment to the mother led to less pronounced disturbed eating in girls across the entire age range and in boys across two time periods. In girls, more pronounced disordered eating at T3 predicted worse attachment to the mother at T4 and better attachment to the father at T1 predicted less disturbed eating at T2. In boys, disordered eating at T1 predicted better attachment to the father at T2. Concerning peer attachment, better attachment at T1 predicted disordered eating at T2, in boys only. No other significant cross-lagged effects emerged. Discussion These findings highlight the differential and gender-specific contribution of attachment figures to the development of disordered eating in adolescence. Programs aimed at improving communication and trust in the relationship with parents might be promising in the prevention of disordered eating and the subsequent deterioration of parent-child attachment relationships.
Background
Weight-related stigmatization is a widespread problem. Particularly the internalization of weight-related stereotypes and prejudices (weight bias internalization, WBI) is related to mental and physical health impairments. To date, little is known about the risk factors of WBI. Previous studies are mainly cross-sectional and based on adult samples. As childhood is a sensitive period for the development of a healthy self-concept, we examined predictors of WBI in children.
Methods
The final sample included 1,463 schoolchildren (6–11 years, 51.7% female) who took part in a prospective study consisting of three measurement waves. The first two waves delivered data on objective weight status and self-reported weight-related teasing, body dissatisfaction, relevance of one’s own figure, self-esteem and depressive symptoms; WBI was measured during the third wave. To examine predictors of WBI, we ran hierarchical regression analyses and exploratory mediation analyses.
Results
Lower parental education level, higher child weight status, female gender, experience of teasing, higher body dissatisfaction, higher figure-relevance, and higher depression scores were found to be predictive for higher WBI scores. Body dissatisfaction (only for girls) and the relevance of one’s own figure (both genders) mediated the association between self-esteem and WBI; no weight-related differences were observed.
Conclusions
Our study offers longitudinal evidence for variables that enable the identification of children who are at risk for WBI. Thus, the findings deliver starting points for interventions aimed at the prevention of adverse health developments that come along with WBI.
Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7-12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP.
The dual-pathway model proposes that body dissatisfaction might lead to binge eating (BE) through restraint eating and negative affect. Both pathways have been confirmed longitudinally, but there is evidence that the affect-pathway might rather be found in the short-term, whereas other variables might be involved over longer periods. Research suggests that self-esteem represents a key-factor in the etiology of BE in adolescent girls and might serve as a mediator between body dissatisfaction and eating pathology. Based on these findings, the aim of this study was to investigate the original dual-pathway model across 20 months and to evaluate a modified version of the model with self-esteem instead of negative affect as a mediator in the affect-pathway. We assessed eating pathology, negative affect and self-esteem by self-report in a sample of 523 adolescent girls at two time points separated by 20 months. Data were analyzed using a cross-lagged panel design. Both, the original and the modified model provided good fit to the data, but results yielded limited support for the assumptions of the original model. Neither restraint eating nor negative affect mediated the link between body dissatisfaction and BE. The modified model fit the data slightly better and results indicated that low self-esteem mediated the relationship between body dissatisfaction and BE. Notably, our results indicated that restraint eating might even reduce the risk for BE through the enhancement of self-esteem. Results suggest that the dual-pathway model could benefit from the inclusion of a more trait-like variable such as self-esteem when evaluated across the long-term. Furthermore, our findings indicate that healthy restraint eating might have positive effects on self-esteem, thereby reducing risk for BE in adolescent girls, who are dissatisfied with their bodies. (C) 2017 Elsevier Ltd. All rights reserved.
Psychometric evaluation of the German version of the Intuitive Eating Scale-2 in a community sample
(2017)
Weight-related teasing is a widespread phenomenon in childhood, and might foster the internalization of weight bias. The goal of this study was to examine the role of weight teasing and weight bias internalization as mediators between weight status and negative psychological sequelae, such as restrained eating and emotional and conduct problems in childhood. Participants included 546 female (52%) and 501 (48%) male children aged 7-11 and their parents, who completed surveys assessing weight teasing, weight bias internalization, restrained eating behaviors, and emotional and conduct problems at two points of measurement, approximately 2 years apart. To examine the hypothesized mediation, a prospective design using structural equation modeling was applied. As expected, the experience of weight teasing and the internalization of weight bias were mediators in the relationship between weight status and psychosocial problems. This pattern was observed independently of gender or weight status. Our findings suggest that the experience of weight teasing and internalization of weight bias is more important than weight status in explaining psychological functioning among children and indicate a need for appropriate prevention and intervention approaches.
Background. Pain symptoms, associated impairment, and parental perception of threat are reported to be predictors of health care utilization (HCU) in childhood chronic abdominal pain (CAP). However, mediating variables and their interrelations have not yet been systematically studied. Objectives. This study aims to identify mediating pathways of influence between child’s abdominal pain and the number of pain-related medical visits. Methods. In a multicenter study, we recruited N = 151 parent-child dyads with children aged 6–17 years suffering from CAP. A composite measure of pain symptoms was defined as predictor and the number of pain-related medical visits as outcome variable. This relation was analyzed by serial mediation, including child- and parent-reported impairment and parental threat perception as mediators. Results. Only parental threat perception significantly linked child’s pain symptoms to the number of medical visits. Measures of impairment did not have a significant effect. Conclusions. Parental pain-related threat perception is strongly related to health care seeking in childhood CAP. Addressing threat perception might be a fruitful parent-centered approach in clinical practice.
Cognitive Function in Adolescent Patients with Anorexia Nervosa and Unipolar Affective Disorders
(2016)
Studies have shown impairments in cognitive function among adult patients with anorexia nervosa (AN) and affective disorders (AD). The association between cognitive dysfunctions, AN and AD as well as the specificity for these psychiatric diagnoses remains unclear. Therefore, we examined cognitive flexibility and processing speed in 47 female adolescent patients with AN, 21 female adolescent patients with unipolar affective disorders and 48 female healthy adolescents. All participants completed a neuropsychological test battery. There were no significant group differences regarding cognitive function, except for psychomotor processing speed with poorer performance in patients with AN. A further analysis revealed that all groups performed with the normal range, although patients with AN were over represented in the poorest performing quartile. We found no severe cognitive impairments in either patient group. Nevertheless, belonging to the AN group contributed significantly to poor performances in neuropsychological tasks. Therefore, we conclude that the risk for cognitive impairments is slightly higher for patients with AN. Copyright (c) 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Purpose Introduction of complementary food usually leads to decreasing intakes of long-chain n-3 polyunsaturated fatty acids (n-3 LC-PUFA), compared to full breast-feeding. In the randomised controlled PINGU intervention trial, we tested the effects of complementary foods with different contents of alpha-linolenic acid (ALA) and docosahexaenoic acid (DHA) on term infant LC-PUFA status. Methods Healthy infants born at term were randomised to receive from the introduction of complementary feeding at the age of 4 to 6 months until age of 10 months ready-made complementary meals either with ALA-rich rapeseed oil (intervention group (IG)-R), with salmon twice weekly to provide preformed DHA (IG-F), or with linoleic acid-rich corn oil (control group, CG). Fatty acid composition was assessed in erythrocyte (RBC) and plasma glycerophospholipids. Results Complete data of fatty acids in RBC (plasma) were available from 158 (155) infants. After intervention, infants assigned to IG-F showed higher RBC and plasma percentages of eicosapentaenoic acid (EPA), DHA, and total n-3 LC-PUFA than CG (each p < 0.001). In IG-R, levels of ALA and the ratio of ALA to LA in plasma and RBC (all p < 0.0001) as well as RBC-EPA (p < 0.0001) were higher than in CG, while DHA levels did not differ between IG-R and CG. Conclusions Regular fish consumption during complementary feeding enhances infant EPA and DHA status. The usage of rapeseed oil in small amounts concordant with EU-law for commercial meals enhances endogenic EPA-synthesis, but does not affect DHA status. Provision of oily fish with complementary feeds is advisable to prevent a decline of DHA status. Clinical Trial Registration www.clinicaltrials.gov, identifier: NCT01487889, title: Polyunsaturated fatty acids in child nutrition-a German multimodal optimisation study (PINGU).
The relevance of weight stigma as an important factor in disordered eating has been supported by research. However, because most of the studies were cross-sectional and focussed on older children, the causal relationships could not be fully determined in childhood. The current study explores the role of weight stigma in body dissatisfaction and eating behaviours. The sample consisted of 773 girls and 713 boys, aged 6–11 years, who completed surveys assessing weight stigma experiences, body dissatisfaction and eating behaviours at two points of measurement, approximately one year apart. The children's external and disordered eating was rated via parental questionnaires. As expected, the pattern of the associations between weight status, weight stigma, body dissatisfaction and eating behaviours differed by gender. Experience of weight stigma in girls led to external and restrained eating one year later, whereas in boys no such association was observed. Body dissatisfaction mediated the association between weight stigma and restrained eating behaviours in girls, whereas in boys, body dissatisfaction directly influenced restrained eating behaviours. However, in both girls and boys weight status predicted body dissatisfaction and disordered eating, while weight stigma did not have a direct effect on disordered eating. Results suggest that interventions involving weight stigma should be a part of eating disorder prevention programmes, and gender-specific pathways should be considered.
Although inpatient lifestyle treatment for obese children and adolescents can be highly effective in the short term, long-term results are unconvincing. One possible explanation might be that the treatment takes place far from parents' homes, limiting the possibility to incorporate the parents, who play a major role in establishing and maintaining a healthy lifestyle in childhood and adolescence. The main goal was to develop a brief behaviorally oriented parent training program that enhances ‘obesity-specific’ parenting skills in order to prevent relapse. We hypothesized that the inclusion of additional parent training would lead to an improved long-term weight course of obese children. Parents of obese children (n = 686; 7–13 years old) either participated in complementary cognitive-behavioral group sessions (n = 336) or received written information only (n = 350) during the inpatient stay. Children of both groups attended multidisciplinary inpatient rehabilitation. BMI-SDS as a primary outcome was evaluated at baseline, post-intervention and at 6- and 12-month follow-up. Intention-to-treat (ITT) as well as per-protocol analyses (PPA) were performed. A significant within-group decrease of 0.24 (95% CI 0.18 to 0.30) BMI-SDS points from the beginning of the inpatient stay through the first year was found, but no group difference at the one-year follow-up (mean difference 0.02; 95% CI -0.04 to 0.07). We also observed an increase in quality of life scores, intake of healthy food and exercise for both groups, without differences between groups (ITT and PPA). Thus, while the inpatient treatment proved highly effective, additional parent training did not lead to better results in long-term weight maintenance or to better psychosocial well-being compared to written psycho-educational material. Further research should focus on subgroups to answer the question of differential treatment effects.
Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC)
(2016)
Background: Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. Methods: Five hundred twenty-three parents and their 7-13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. Conclusions: The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background.
Research on weight-loss interventions in emerging adulthood is warranted. Therefore, a cognitive-behavioral group treatment (CBT), including development-specific topics for adolescents and young adults with obesity (YOUTH), was developed. In a controlled study, we compared the efficacy of this age-specific CBT group intervention to an age-unspecific CBT group delivered across ages in an inpatient setting. The primary outcome was body mass index standard deviation score (BMI-SDS) over the course of one year; secondary outcomes were health-related and disease-specific quality of life (QoL). 266 participants aged 16 to 21 years (65% females) were randomized. Intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. For both group interventions, we observed significant and clinically relevant improvements in BMI-SDS and QoL over the course of time with small to large effect sizes. Contrary to our hypothesis, the age-specific intervention was not superior to the age-unspecific CBT-approach.
Electrophysiological evidence for an attentional bias in processing body stimuli in bulimia nervosa
(2015)
Empirical evidence suggests abnormalities in the processing of body stimuli in bulimia nervosa (BN). This study investigated central markers of processing body stimuli by means of event-related potentials in BN. EEG was recorded from 20 women with BN and 20 matched healthy controls while watching and evaluating underweight, normal and overweight female body pictures. Bulimics evaluated underweight bodies as less unpleasant and overweight bodies as bigger and more arousing. A higher P2 to overweight stimuli occurred in BN only. In contrast to controls, no N2 increase to underweight bodies was observed in BN. P3 was modulated by stimulus category only in healthy controls; late slow waves to underweight bodies were more pronounced in both groups. P2 amplitudes to overweight stimuli were correlated with drive for thinness and body dissatisfaction. We present novel support for altered perceptual and cognitive-affective processing of body images in BN on the subjective and electrophysiological level. (C) 2015 Elsevier B.V. All rights reserved.
Background
Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others' attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias.
Methods/Design
We analyzed eye movements in 30 overweight individuals (18 females) and 28 normal-weight individuals (16 females) with respect to the participants' own pictures as well as gender- and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires.
Discussion
The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive compared to unattractive regions of both their own and the control body. For one's own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.
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.
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.
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: 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.
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.
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: '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.
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: 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.
Are maternal weight, eating and feeding practices associated with emotional eating in childhood?
(2013)
Background: Research concerning children's emotional eating behavior has shown its negative impact on weight-related problems. Taking the model of Birch and Davison (2001) into account, we focus on the role of maternal feeding behavior on the association between emotional eating of the mother and the child. Methods: 482 mothers and their children participated in this cross-sectional study. The mothers were asked about their feeding strategies, their children's and their own emotional eating and weight. We tested a structural equation model for different feeding strategies. Results: In addition to an expected direct association between the mother's and child's emotional eating, the maternal feeding strategies are related to the child's eating behavior. A higher maternal restriction of food or its monitoring was associated with a higher level of children's emotional eating, while allowing the child more control about their eating was linked to less pronounced emotional eating behavior. Conclusions: The results highlight the relevance of maternal feeding behavior on emotional eating in childhood. In terms of preventing weight-related problems, the findings indicate the necessity of training parents in allowing their children more control and avoiding the restriction of food.
Previous studies have indicated a higher risk of disordered eating in certain types of elite sports such as aesthetic sports (e.g., rhythmical gymnastics, figure skating). But even though some studies on risk factors for disordered eating in sports exist, most research on this topic is based on cross-sectional data with limitations on causal inferences. We examined sports-related risk factors for disordered eating in a 1-year longitudinal study with two assessment points. The participants were 65 adolescent athletes from aesthetic sports (mean age 14.0 +/- 2.2years) who completed measures of disordered eating, social pressure from the sports environment, sports-related body dissatisfaction, desire to be leaner to improve sports performance, and emotional distress resulting from missed exercise sessions. All variables were relatively stable in the mean. Individual changes in the desire to be leaner to improve sports performance were associated with individual changes in disordered eating. Furthermore, a cross-lagged partial correlation analysis showed that the desire to be leaner to improve sports performance was predictive of disordered eating and not vice versa. The results of our study indicate that athletes are more at risk for disordered eating if they believe it is possible to enhance their sports performance through weight regulation.
The Eating Disorder Examination adapted for children (ChEDE) is the child version of the semi-structured gold standard eating disorder interview for adults. This study was a comprehensive test statistic evaluation of the German ChEDE in a large sample of children and adolescents with anorexia nervosa, binge eating disorder, loss of control eating, overweight and obesity, as well as non-eating-disordered and chronically ill control probands (n=352). Excellent inter-rater reliability, adequate internal consistency and satisfactory stability of ChEDE indicators were demonstrated. ChEDE indicators discriminated between diverse forms of eating and weight disturbances and normative eating and were significantly correlated with conceptually related measures. Factorial validity was not convincing; a brief eight-item scale showed the best fit. Item statistics were mostly acceptable. Overall, the ChEDE's German translation reliably and validly assesses psychopathology across the eating and weight disorder spectrum and facilitates international comparison of eating disorder research.
Background Chronic abdominal pain (CAP) in childhood is widely prevalent and has adverse effects on mental health and quality of life. Earlier research emphasized the positive effects of psychological intervention on pain symptoms. This study describes the results of a cognitive-behavioral pain management program for children with CAP. The newly developed cognitive-behavioral group program, "Stop the pain with Happy-Pingu," includes six sessions for the children and one meeting for the parents.
Purpose We hypothesized that the training would significantly reduce pain symptoms (frequency, duration, intensity, and pain-related impairment) and increase health-related quality of life compared to wait-list controls, with improvement seen both at the end of treatment and at a 3-month follow-up.
Method In all, 29 children were randomized into two groups: 15 in the intervention group (IG) and 14 as the wait-list controls (WLC). An intent-to-treat analysis was performed using two-factorial multivariate analyses of variance with repeated measures.
Results Children in the IG experienced both a reduction in pain (primary outcome) and an improvement in health-related quality of life (secondary outcome) as compared to the WLC. The effect sizes ranged from medium to high.
Conclusion Cognitive-behavioral methods seem to be appropriate for treating children with CAP.
OBJECTIVE: To examine factors associated with the maternal perception of the weight status in related and unrelated children and to examine whether associated health risks for children's physical and mental health are recognized. PATIENTS AND METHODS: Two hundred nineteen mothers with children between 3 and 6 years of age took part in this study. The participating mothers were recruited from inpatient clinics and kindergartens. Parents were presented with 9 silhouettes representing different age- and gender-specific BMI percentiles. Demographic and weight-related variables were assessed with regard to their influence on the accuracy of the maternal weight estimation in general and for their own child. RESULTS: Of the participating mothers, 64.5% identified the overweight silhouettes of preschool- aged children correctly. However, only 48.8% of the mothers identified the overweight silhouettes associated with an increased risk for physical health problems, and 38.7% identified the silhouettes associated with an increased mental health risk. Mothers with a lower educational background were more likely to misclassify the overweight silhouettes and underestimate the associated health problems. For their own child, only 40.3% of the mothers chose silhouettes that were in agreement with the objective weight status of their child. This underestimation was associated with a higher maternal and child weight status but not with a general inability to identify the weight status of children. CONCLUSIONS: Identifying unrelated overweight silhouettes is influenced by maternal education level, whereas estimating their own child's weight status is influenced by the weight status of the mother and the child. Hence, feedback on the child's risk to become overweight is necessary to increase maternal risk awareness and willingness to take part in prevention programs.
Background: Research concerning child's food intake have considered various influencing factors, for example parental feeding strategies, demographic and weight factors. At this time, however, there are few findings that explore these factors simultaneously. Accordingly, the aim of this study was to test a structural equation model regarding the associations between maternal feeding strategies and child's food intake. Methods: 556 mothers and their children between 1 and 10 years of age participated in this cross-sectional study. Besides socio-demographic and weight data, the mothers were asked about their feeding strategies as well as their child's food intake. Results: The well-fitting model explained 73% of the variance in the child's consumption of healthy and 34% of unhealthy food. In addition to the effect of the mother's social status and the child's age, a rewarding and modeling feeding behavior significantly influenced the child's food intake. Conclusion: The results highlight the relevance of maternal feeding behavior on the child's food intake. In terms of preventing eating- or weight-related problems, the findings indicate the usefulness of training parents in explicit modeling behavior and avoiding food as a reward.
An educational program for parents of asthmatic preschool children: Short and medium-Term Effects.
(2003)
Our aim was to assess the psychosocial well-being of asthmatic children and adolescents, the influencing factors, and to determine the effect of inpatient rehabilitation on their quality of life; 226 asthmatic children and adolescents participated in the inpatient rehabilitation (IG). The comparison group (CG) included 92 asthmatic children and adolescents receiving standard medical treatments. Patients were aged between 8 and 16 years and were predominantly male. The health-related quality of life was measured with the German version of the "Paediatric Asthma Quality of Life Questionnaire." Interviews were carried out for IG 2 weeks before the commencement of their inpatient stay and 1 year after their stay ended. The same time schedule was carried out for CG. All patients reported a mild to moderate impairment of their quality of life. Girls described a slightly lower quality of life than boys. With increasing asthma severity, quality of life decreased. Inpatients described a lower quality of life than CG at enrollment. Inpatient rehabilitation resulted in a greater improvement of quality of life over time for IG than for CG. Gender and severity status had no effect on this time course. The only modestly affected quality of life may reflect the good adaptation to the disease and medical treatment. Children and adolescents in the IG recorded improvements in their quality of life. Differences in quality of life based on gender and disease severity were not shown to influence the improvements. In summary, inpatient rehabilitation results in an improvement of health-related quality of life. Further research concerning the psychosocial situation of children and adolescents in this setting is needed
Background Bringing up children with atopic dermatitis (AD) is widely perceived as being stressful because parenting demands considerable time and energy. There have been only a few studies to assess the extent of problems experienced by the parents. Objective To assess the psychosocial well-being of parents caring for a young child with AD and to examine the relationship between parental quality of life and disease-related and sociodemographic variables. Methods One hundred and eighty-seven parents of young children with AD attending an inpatient rehabilitation clinic participated in the study. At admission, parents completed a set of questionnaires (assessing health-related quality of life, coping with the disease, family functioning). Dermatologists assessed disease severity using the severity scoring of AD index (SCORAD). Results In general, parents cope well with their situation. Compared with normal values, high rates of psychological distress were observed in a subsample of parents of children with AD. Parents of children with a higher severity of disease reported a significantly higher impact on family functioning, a greater financial burden and a higher level of disease management. Parental disease management could be predicted by the familial situation, their personal well-being and the severity of disease of their child. Differences attributed to their child's gender or age were not observed. Conclusions Childhood AD has a profound impact on the emotional and social well-being of many of the parents. The results underline the importance of psychological treatment approaches designed to increase parental well-being and ability to cope with stress and social strain
The unhappy obese child
(2005)
OBJECTIVE: One of the most painful aspects of obesity may be the emotional suffering it causes. The paper discusses the psychological and social effects of obesity. METHOD: Current studies examining the psychosocial strains of obese children and adolescents are reported. The report especially focuses on stigmatization, mental health disorders, school performance and health-related quality of life. DISCUSSION: Research is showing that obesity is associated with poorer psychosocial functioning-even compared with other chronic diseases. Future studies should further explicate the risk and protective factors for developing severe psychosocial strain
Obesity is associated with psychosocial strain and a lower quality of life. Health-related quality of life is an important indicator for evaluating intervention treatments. However, German disease-specific quality of life instruments are lacking. In this paper the development and psychometric results of a weight-specific quality of life questionnaire for overweight and obese children and adolescents (GQ-LQ-KJ) is described. To determine the psychometric properties of the instrument 448 children and adolescents treated for over-weight or obesity took part in the study. They filled in the quality of life questionnaire, the German version of the STAI for children, a body image avoidance questionnaire (BIAQ) and several subscales of a generic quality of life questionnaire, the Child Health Questionnaire (CHQ). Results support the item and scale properties. Furthermore we were able to form two economic parallel versions suitable for further intervention studies
Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC)
(2016)
Background
Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting.
Methods
Five hundred twenty-three parents and their 7–13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses.
Results
Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child’s quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant.
Conclusions
The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background.
Background
Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others’ attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias.
Methods/Design
We analyzed eye movements in 30 overweight individuals (18 females) and 28 normalweight individuals (16 females) with respect to the participants’ own pictures as well as gender-
and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires.
Discussion
The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive
compared to unattractive regions of both their own and the control body. For one’s own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.