Patterns of Eating Disorder Pathology are Associated with Weight Change in Family-Based Behavioral Obesity Treatment.

Katherine N Balantekin, Jacqueline F Hayes, Daniel H Sheinbein, Rachel P Kolko, Richard I Stein, Brian E Saelens, Kelly Theim Hurst, R Robinson Welch, Michael G Perri, Kenneth B Schechtman, Leonard H Epstein, Denise E Wilfley

Journal: Obesity (Silver Spring, Md.) 2018;25(12):2115-2122

PMID: 28984076

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Plain Language Summary

Children who are overweight or obese have higher rates of eating disorder pathology (extreme dietary restraint, loss of control eating and emotional eating) than their peers who are not overweight or obese, thus having an increased risk of developing a clinical eating disorder. The aim of the study is to classify overweight or obese children entering family-based treatment into groups with distinct patterns of eating disorder pathology and then examine eating disorder pattern differences in 3 categories. The study includes data from a multi-site randomised controlled trial. The analysis focused on data from the initial weight loss phase which included 241 obese or overweight children aged between 7 to 11 years. Results showed that eating disorders are more common among females than males, yet males also experience high levels of eating disorder pathology. Levels of eating disorder pathology decreased after family-based behavioural weight-loss treatment and so decreased the risk of the development of a clinical eating disorder. Authors conclude that eating disorder pathology is prevalent among children with overweight or obesity but has varying presentations.

Abstract

OBJECTIVE

Children with overweight or obesity have elevated eating disorder (ED) pathology, which may increase their risk for clinical EDs. The current study identified patterns of ED pathology in children with overweight or obesity entering family-based behavioral weight loss treatment (FBT) and examined whether children with distinct patterns differed in their ED pathology and BMI z score (zBMI) change across FBT.

METHODS

Before participating in a 16-session FBT, children (N = 241) completed surveys or interviews assessing ED pathology (emotional eating, shape/weight/eating concerns, restraint, and loss of control [LOC]). Shape and weight concerns (SWC) and LOC were also assessed post treatment. Child height and weight were measured at baseline and post treatment. Latent class analysis identified patterns of ED pathology. Repeated-measures ANOVA examined changes in zBMI and ED pathology.

RESULTS

Four patterns of ED pathology were identified: low ED pathology, SWC, only loss of control, and high ED pathology. SWC decreased across treatment, with the highest decreases in patterns characterized by high SWC. All groups experienced significant decreases in zBMI; however, children with the highest ED pathology did not achieve clinically significant weight loss.

CONCLUSIONS

ED pathology decreased after FBT, decreasing ED risk. While all children achieved zBMI reductions, further research is needed to enhance outcomes for children with high ED pathology.

Address: Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA.; Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA.; Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA.; Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; Seattle Children's Research Institute and the University of Washington, Seattle, Washington, USA.; National Center for Weight and Wellness, Washington, DC, USA.; Department of Clinical and Health Professions, University of Florida, Gainesville, Florida, USA.; Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA.; Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

DOI: 10.1002/oby.22028