Member, Maternal & Child Health Research Institute (MCHRI)
Internship, Lucile Packard Children's Hospital Stanford/Children's Health Council (2018)
Doctor of Philosophy, University of California San Diego (2018)
Master of Science, San Diego State University (2014)
Bachelor of Science, Duke University (2010)
Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach.
BACKGROUND: Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes.METHODS: Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms).RESULTS: The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission.CONCLUSIONS: Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.
View details for DOI 10.1017/S0033291721001604
View details for PubMedID 33952357
- Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities. Obesity surgery 2021
- Exploring Differences in the Role of Hospitalization on Weight Gain Based on Treatment Type From Randomized Clinical Trials for Adolescent Anorexia Nervosa FRONTIERS IN PSYCHIATRY 2020; 11
- OVERWEIGHT AND OBESITY ELSEVIER SCIENCE INC. 2020: S134
Descriptive analysis of binge eating in adult and adolescent females.
Eating and weight disorders : EWD
PURPOSE: Provide qualitative descriptions of context and characteristics of binge eating in adults and adolescents to explore consistency in precipitating factors.METHOD: Open-ended, qualitative interviews were administered to an adult sample (n=24) and an adolescent sample (n=20) to collect details about the context in which two binge episodes occurred.RESULTS: Factors and context of the binge episodes were similar between adults and adolescents. In contrast, the two binge episodes described by each individual were not consistent. Binge episodes were not strongly affect-driven or food cue-driven.CONCLUSIONS: Binge eating appears similar between adults and adolescents, which may have treatment implications. Similar treatment approaches may be used with both age groups and would benefit from covering a broad range of binge triggers rather than attempting to match individuals into an approach focused on particular triggers.LEVEL OF EVIDENCE: Level III, case-control analytic study.
View details for DOI 10.1007/s40519-020-01013-3
View details for PubMedID 32960440
Family-based treatment via videoconference: Clinical recommendations for treatment providers during COVID-19 and beyond.
The International journal of eating disorders
The necessity to employ distance-based methods to deliver on-going eating disorder care due to the novel coronavirus (COVID-19) pandemic represents a dramatic and urgent shift in treatment delivery. Yet, TeleHealth treatments for eating disorders in youth have not been adequately researched or rigorously tested. Based on clinical experience within our clinic and research programs, we aim to highlight the common challenges clinicians may encounter in providing family-based treatment (FBT) via TeleHealth for children and adolescents with anorexia nervosa and bulimia nervosa. We also discuss possible solutions and offer practical considerations for providers delivering FBT in this format. Additional research in TeleHealth treatment for eating disorders in youth may lead to improved access, efficiency, and effectiveness of FBT delivered via videoconferencing.
View details for DOI 10.1002/eat.23326
View details for PubMedID 32533799
Exploring Differences in the Role of Hospitalization on Weight Gain Based on Treatment Type From Randomized Clinical Trials for Adolescent Anorexia Nervosa.
Frontiers in psychiatry
2020; 11: 609675
Background: This study explores the impact of weight gain during medical stabilization hospitalization on weight outcomes between three outpatient treatments for adolescent anorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy (SyFT), and Family Based Treatment (FBT). Methods: A secondary analysis of weight gain data (N = 215) of adolescents (12-18 years) meeting DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated in two randomized clinical trials (RCTs) was conducted. Main outcomes examined were changes in weight restoration (≥95% expected body weight or EBW) and differences in weight change attributable to hospital weight gain. Results: Weight gain resulting from hospitalizations did not substantially change weight recovery rates. Hospital weight gain contributed most to overall treatment weight gain in AFT compared to FBT and SyFT. Conclusion: Brief medical stabilization weight gain does not contribute substantially to weight recovery in adolescents with AN who participated in RCTs.
View details for DOI 10.3389/fpsyt.2020.609675
View details for PubMedID 33304289
View details for PubMedCentralID PMC7693434
Remission in adolescents with bulimia nervosa: Empirical evaluation of current conceptual models.
European eating disorders review : the journal of the Eating Disorders Association
The few randomized clinical trials (RCTs) investigating adolescent treatment for bulimia nervosa (BN) suggest variability in both rates of, and criteria for remission. The current study examined reactivity in remission rates, relative to various conceptualizations of remission in a single RCT data set.A data set of adolescents with BN who participated in an RCT (N = 110) was used to evaluate remission models based upon behavioral symptoms (e.g., binge eating), psychological symptoms (Eating Disorder Examination [EDE] scores), and combinations of these criteria.At end-of-treatment (EOT), a remission model defined by behavioral symptom abstinence plus meaningful reduction in EDE global scores yielded comparable remission rates to a model defined by behavioral abstinence alone (i.e., 29% remitted). Participants with higher EOT EDE global scores were less likely to be abstinent from behavioral symptoms at 6- and 12-month follow-up (ps < .001).Reduction in psychological symptoms with behavioral abstinence did not inform remission status at EOT, over and above behavioral symptom change alone. However, psychological symptom improvement by EOT may predict positive prognosis in posttreatment assessment. Results underscore the necessity of including psychological symptom improvement, as well as consistency across research and practice, in defining remission in adolescent BN.
View details for DOI 10.1002/erv.2729
View details for PubMedID 32130757
Investigating Early Response to Treatment in a Multi-Site Study for Adolescent Bulimia Nervosa.
Frontiers in psychiatry
2020; 11: 92
Background: This secondary data analysis seeks to replicate and extend findings that early response to treatment in adolescent bulimia nervosa (BN) predicts outcome, resulting in earlier identification of patients who might need a different treatment approach.Methods: Participants were 71 adolescents (M ± SD: 15.69 ± 1.55 years; 93% female; 75% non-Hispanic) with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of BN or partial BN enrolled in a two-site treatment study. Participants were randomized to cognitive behavioral therapy for adolescents (CBT-A), family-based treatment for BN (FBT-BN), or supportive psychotherapy (SPT). The Eating Disorder Examination was administered at baseline, end-of-treatment (EOT), 6-month, and 12-month follow-up. Binge eating and purge symptoms were self-reported at each session. Outcome was defined as abstinence of binge eating and compensatory behaviors (self-induced vomiting, laxative use, diet pills, diuretics, compensatory exercise, fasting) in the 28 days prior to assessment. Receiver operating characteristic (ROC) analyses were utilized to assess the viability of predicting treatment outcomes based on reduction of symptoms within the first 10 sessions of treatment.Results: ROC analyses suggest that reduction in purging at session 2 (AUC =.799, p < .001) and binge eating at session 4 (AUC =.750, p < .01) were independently related to abstinence of symptoms at EOT, regardless of treatment type. Symptom reduction later in treatment predicted outcome at follow-up, as change in binge eating at session 8 and purging at session 9 were the strongest predictors of abstinence at 6-month follow-up (AUCs =.726-.763, ps < .01). Change in binge eating, but not purging behaviors, was significantly related to abstinence at 12-month follow-up (AUC =.766, p < .01). Only slight differences emerged based on treatment group, such that reductions in symptoms most predictive of abstinence at EOT occurred one session sooner in FBT-BN than SPT.Conclusion: Reductions in binge eating and purge symptoms early in adolescent BN treatment suggest better outcome, regardless of treatment modality. Additional research with larger samples is needed to better understand which treatments, if any, contribute to earlier change in BN symptoms and/or likelihood of improved patient response.
View details for DOI 10.3389/fpsyt.2020.00092
View details for PubMedID 32184746
Bariatric Surgery in Children and Adolescents with Cognitive Impairment and/or Developmental Delay: Current Knowledge and Clinical Recommendations.
Bariatric surgery is an effective treatment for children and adolescents with severe obesity. However, outcomes in youth with cognitive impairments and/or developmental delays are understudied. This paper reviewed the literature on bariatric surgery within this population. Fourteen studies published from 1975 to 2019 were identified. The majority (93%) of studies included patients with genetic disorders. Most studies reported no peri-operative complications (69%) and improved health outcomes (79%), with variable weight-loss results (29.2-86.2% excess weight loss). No significant differences were reported for youth with and without cognitive impairment and/or developmental delay in two studies. Limited available data suggest bariatric surgery may promote weight loss and improve health comorbidities for youth, irrespective of cognitive or developmental functioning. Clinical recommendations for working with patients and families are included.
View details for DOI 10.1007/s11695-019-04219-2
View details for PubMedID 31637672
A Pilot Study Investigating the Feasibility and Acceptability of a Parent-Only Behavioral Weight-Loss Treatment for Children with Autism Spectrum Disorder.
Journal of autism and developmental disorders
Evidence-based weight-loss treatments for children with autism spectrum disorder (ASD) are lacking. Therefore, a parent-based weight-loss treatment for children with ASD (PBT-ASD) was developed. A pilot study was conducted to test the initial efficacy, feasibility, and acceptability of this intervention. Parents of 20 children with ASD and overweight/obesity (mean age=9.90 (SD=2.31) years; 90% male; 40% Hispanic) participated in a 16-session PBT-ASD. The PBT-ASD program was found to be feasible and acceptable. Both children and parents lost weight from pre- to post-treatment (p's<.05). Parent-reported child physical activity and vegetable consumption increased at post-treatment (p's<.05). This pilot study provides a proof-of-concept for PBT-ASD. Randomized controlled trials with larger samples and follow-up are needed.
View details for DOI 10.1007/s10803-019-04178-8
View details for PubMedID 31414266
Development and validation of a short form Children's power of Food Scale.
To develop and validate a shortened form of the Children's Power of Food Scale (C-PFS), which measures anticipated reward from consuming highly palatable foods (i.e., hedonic hunger). Presently, two gaps exist with the C-PFS: the need for a shorter tighter measure, and evidence to support similar item function across populations.Ninth grade students (N = 3,277; 14.1 ± 0.4 years; 53.5% Female; 47% Hispanic) from 10 Los Angeles high schools completed the C-PFS and other surveys in class. Factor analysis, graded response modeling, and differential item functioning explored the structure of the 15 C-PFS items and identified a reduced set that parsimoniously taps hedonic hunger across the latent continuum and exhibits item-level invariance across sex, race/ethnicity, and weight status. Convergent validity was examined via associations of self-reported dietary intake, impulsivity, and body mass index (BMI) to C-PFS scores.Factor analytic models supported a single, primary dimension of hedonic hunger that accounted for 61% of the variance across all 15-items (α = 0.94). Adequate severity, discriminatory ability, and non-overlapping item-difficulty were observed for 11-items, of which 9-items were found to have item-level invariance across demographic and weight status groupings. Poor performing items were removed to create a 9-item scale (C-PFS-9; α = 0.93). Convergent validity was demonstrated as higher C-PFS-9 scores were significantly related to greater sweet (β = 0.32, [95%CI = 0.23, 0.41], p < .001) and fatty food intake (β = 0.34, [95%CI = 0.26, 0.43], p < .001) and impulsivity resulting from positive (β = 0.11, [95%CI = 0.02, 0.21], p < .05) and negative mood (β = 0.36, [95%CI = 0.28, 0.45], p < .001). Females, relative to males, reported higher C-PFS-9 scores (β = 0.10, [95%CI = 0.02, 0.17], p < .05) and associations with BMI were mixed.The C-PFS-9 possesses excellent psychometric properties and retains the original construct coverage of hedonic hunger without a marked decrease in information obtained.
View details for DOI 10.1016/j.appet.2019.104549
View details for PubMedID 31809813
The relationship between executive functioning and weight loss and maintenance in children and parents participating in family-based treatment for childhood obesity
BEHAVIOUR RESEARCH AND THERAPY
2018; 105: 10–16
We examined the relationship between executive function and weight loss among children (8-12 years) and parents enrolled in a behavioral weight-loss program. 150 overweight/obese children and their parents participated in a 6-month family-based weight-loss intervention and completed baseline (month 0), post-treatment (month 6) and 18-month follow-up assessments (month 24), which included Digit Span (DS), Stop Signal Task (SST), and Wisconsin Card Sorting Test (WCST). Anthropometrics were additionally measured at mid-treatment (month 3) and 6-month follow-up (month 12). Children with more baseline WCST perseverative errors regained more weight (p = .002) at 18-month follow-up. Change in child BMIz was not associated with change in child executive function (p > .05) or parent executive function (p > .05). Among parents, baseline measure of DS-backward (p < .001) and post-treatment changes in WCST perseverative errors (p < .001) were associated with post-treatment changes in parent BMI. SST was not related to parent or child weight loss. Thus, children's baseline set-shifting was associated with weight regain during follow-up whereas changes in parent set-shifting was associated with changes in parent weight. Future research is needed to examine the relationship between executive function and weight loss and how this translates to intervention success for both overweight/obese children and participating parents.
View details for DOI 10.1016/j.brat.2018.03.010
View details for Web of Science ID 000432501600002
View details for PubMedID 29609102
View details for PubMedCentralID PMC5924708
A Review of Childhood Behavioral Problems and Disorders in the Development of Obesity: Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Beyond
CURRENT OBESITY REPORTS
2018; 7 (1): 19–26
Given the high rates of pediatric and adult obesity, it is imperative to identify early risk factors that might contribute to excess weight gain. This review aims to investigate the relationship between childhood behavioral problems with the development and persistence of obesity. Specifically, this review highlights the association of obesity with (1) neurocognitive constructs, such as executive functioning and inhibition/impulsivity, and (2) disorders commonly diagnosed in childhood, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).Consistent evidence supports a relationship between childhood behavioral problems, executive functioning, inhibition/impulsivity, ADHD, and ASD with obesity across the lifespan. Longitudinal studies suggest behavior problems, neurocognitive functioning deficits, and ADHD symptoms in childhood predict weight gain over time. Identifying risk factors in childhood that promote obesity may help develop targeted intervention and prevention programs. Additional research should elucidate mechanisms that account for these relationships.
View details for DOI 10.1007/s13679-018-0293-z
View details for Web of Science ID 000426356900003
View details for PubMedID 29411333
Neurocognitive Treatments for Eating Disorders and Obesity
CURRENT PSYCHIATRY REPORTS
2017; 19 (9): 62
Recent research has highlighted executive function and neurocognitive deficits among individuals with eating and weight disorders, identifying a potential target for treatment. Treatments targeting executive function for eating and weight disorders are emerging. This review aims to summarize the recent literature evaluating neurocognitive/executive function-oriented treatments for eating and weight disorders and highlights additional work needed in this area.Cognitive remediation therapy (CRT) for anorexia nervosa has been the most extensively studied neurocognitive treatment for eating disorders. Results demonstrate that CRT improves executive function and may aid in the reduction of eating disorder symptomatology. Computer training programs targeting modifying attention and increasing inhibition are targeting reduction of binge eating and weight loss with modest success. Neurocognitive treatments are emerging and show initial promise for eating and weight disorders. Further research is necessary to determine whether these treatments can be used as stand-alone treatments or whether they need to be used as an adjunct to or in conjunction with other evidence-based treatments to improve outcomes.
View details for DOI 10.1007/s11920-017-0813-7
View details for Web of Science ID 000407672300008
View details for PubMedID 28744627
View details for PubMedCentralID PMC5669379
Behind binge eating: A review of food-specific adaptations of neurocognitive and neuroimaging tasks
PERGAMON-ELSEVIER SCIENCE LTD. 2017: 59–70
Recurrent binge eating, or overeating accompanied by a sense of loss of control, is a major public health concern. Identifying similarities and differences among individuals with binge eating and those with other psychiatric symptoms and characterizing the deficits that uniquely predispose individuals to eating problems are essential to improving treatment. Research suggests that altered reward and control-related processes may contribute to dysregulated eating and other impulsive behaviors in binge-eating populations, but the best methods for reliably assessing the contributions of these processes to binge eating are unclear. In this review, we summarize standard neurocognitive and neuroimaging tasks that assess reward and control-related processes, describe adaptations of these tasks used to study eating and food-specific responsivity and deficits, and consider the advantages and limitations of these tasks. Future studies integrating both general and food-specific tasks with neuroimaging will improve understanding of the neurocognitive processes and neural circuits that contribute to binge eating and could inform novel interventions that more directly target or prevent this transdiagnostic behavior.
View details for DOI 10.1016/j.physbeh.2017.03.037
View details for Web of Science ID 000402212000009
View details for PubMedID 28363840
View details for PubMedCentralID PMC5695923
- Overweight and Obesity in Children with Autism Spectrum Disorder (ASD): a Critical Review Investigating the Etiology, Development, and Maintenance of this Relationship REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017; 4 (2): 142–56
Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth
JOURNAL OF CHILD AND FAMILY STUDIES
2016; 25 (6): 1926–40
Misdiagnoses of racial/ethnic minority youth's mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: 1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth's mental health problems are misdiagnosed? 2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included "race", "ethnicity", "minority", "culture", "children", "youth", "adolescents", "mental health", "psychopathology", "diagnosis", "misdiagnosis", "miscategorization", "underdiagnosis", and "overdiagnosis". Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth's emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.
View details for DOI 10.1007/s10826-015-0351-z
View details for Web of Science ID 000376020200020
View details for PubMedID 27346929
View details for PubMedCentralID PMC4916917
Parental control and overconsumption of snack foods in overweight and obese children
2016; 100: 181–88
The associations between snack food consumption, parent feeding practices and general parenting in overweight in obese children are largely unknown. Therefore, we examined these relationships in 117 treatment-seeking overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± .39). Children consumed a dinner meal, completed an Eating in the Absence of Hunger (EAH) free access paradigm (total EAH intake = EAH%-total; sweet food intake = EAH%-sweet), and completed the Child Report of Parent Behavior Inventory. Parents completed the Child Feeding Questionnaire. Child EAH%-total and EAH%-sweet were positively associated with dinner consumption (p's < .01). Girls had significantly higher EAH%-total compared to boys (p < .05). In separate models, higher EAH%-total was associated with greater use of maternal psychological control (p < .05) and EAH%-sweet was positively associated with parent monitoring (p < .05). In analyses examining factors associated with the consumption of specific foods, EAH snack food, parent restriction, pressure to eat, monitoring, and maternal psychological control were positively correlated with intake of Hershey's(®) chocolate bars (p's < .05). In summary, parental monitoring is associated with child sweet snack food intake and maternal psychological control is associated with child total snack food consumption. Future research should evaluate the complex relationship between child eating and parenting, especially with regard to subgroups of foods.
View details for DOI 10.1016/j.appet.2016.02.030
View details for Web of Science ID 000373866200021
View details for PubMedID 26911259
View details for PubMedCentralID PMC4799726
The relationship between parent feeding styles and general parenting with loss of control eating in treatment-seeking overweight and obese children
INTERNATIONAL JOURNAL OF EATING DISORDERS
2015; 48 (7): 1047–55
To examine differences in parent feeding behaviors and general parenting of overweight children with and without loss of control (LOC) eating.One-hundred-and-eighteen overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± 0.39) and their parents (42.42 ± 6.20 years; 91% female; 70% Caucasian; BMI: 31.74 ± 6.96 kg/m(2) ) were seen at a baseline assessment visit for a behavioral intervention that targeted overeating. The Eating Disorder Examination, adapted for children (ChEDE) was administered to assess for LOC eating. Parents completed the Parental Feeding Styles Questionnaire (PFSQ) and the Child Feeding Questionnaire (CFQ) to assess parent feeding styles and behaviors. Children also completed a self-report measure of general parenting (Child Report of Parent Behavior Inventory, CRPBI-30).Forty-three children (36.40%) reported at least one LOC eating episode in the month prior to assessment. Parents who reported greater restriction and higher levels of pressure to eat were more likely to have children that reported LOC eating (ps < 0.05). Parents who utilized more instrumental feeding and prompting/encouragement to eat techniques were less likely to have children that reported LOC eating (ps < 0.05). Child-reported parenting behaviors were unrelated to child LOC eating (ps > 0.05).Parent feeding styles and behaviors appear to be differentially and uniquely related to LOC eating in treatment-seeking overweight and obese children. Future research is needed to determine if implementing interventions that target parent feeding behaviors may reduce LOC eating, prevent full-syndrome eating disorders, and reduce weight gain in youth.
View details for DOI 10.1002/eat.22440
View details for Web of Science ID 000363460300028
View details for PubMedID 26283589
The relationship between eating disorders and sexual trauma
EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY
2015; 20 (3): 281–93
Research aimed at understanding the causes and comorbidities of eating disorders (ED) identifies sexual trauma as one potential pathway to the development and maintenance of eating disorders. Based on current literature, there are two main etiological pathways between sexual trauma and ED-body perceptions and psychological difficulties. However, previously published reviews on this topic are outdated and have not yielded consistent findings. Therefore, authors completed a literature review covering years 2004-2014 to examine the relationship between sexual trauma and ED according to both proposed pathway models. Authors utilized PubMed, GoogleScholar, and PsychINFO as search engines. Search terms included "sexual assault", "sexual abuse", "sexual trauma", and "rape" in conjunction with relevant ED terminology. Thirty-two studies met inclusion criteria for this review. Current data indicate an increased prevalence of sexual trauma for individuals with ED. Although limited, recent evidence suggests that sexual trauma precedes and contributes to the development of ED. Existing literature indicates that the body perceptions pathway may impact ED through body dissatisfaction, shame, sexual dysfunction, and fear of future sexual trauma. The psychological difficulties pathway indicates a link between ED and the desire to cope with the failure of the average expected environment, psychological diagnoses, the need for control, and the regulation of emotions. However, further research is needed to assess the potential causal role that sexual trauma may play in the etiology of ED.
View details for DOI 10.1007/s40519-015-0195-y
View details for Web of Science ID 000360568600001
View details for PubMedID 25976911
A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders
2015; 23 (4): 315–24
There is a continued need to improve upon the efficacy and availability of treatments for anorexia nervosa. Family-based therapy for anorexia nervosa demonstrates strong empirical evidence; however, trained treatment providers are limited and a subsample of participants receiving the treatment fail to respond. The intensive family treatment program is a brief, time-limited, multi-family program that trains families of adolescents with eating disorders to oversee their adolescents' recovery at home by providing psychoeducation, skills training, and immersive practice over the course of a 5-day period. This article provide a description of the program by summarizing underlying theoretical principles and key therapeutic components.
View details for DOI 10.1080/10640266.2015.1042318
View details for Web of Science ID 000356267600005
View details for PubMedID 25984656
Parent Binge Eating and Depressive Symptoms as Predictors of Attrition in a Family-Based Treatment for Pediatric Obesity
2015; 11 (2): 165–69
Attrition is a significant problem in family-based treatment (FBT) for childhood obesity. Despite this, very few studies have examined factors associated with attrition. The current study examined parent symptoms of depression and binge eating as predictors of attrition in FBT.Participants included 77 parents of overweight children enrolled in FBT for childhood obesity. Data were collected at baseline and post-treatment. Binary logistic regression was used to assess associations between parent binge eating symptoms, depressive symptoms, and attrition.Results showed that parent binge eating symptoms (p=0.02), but not depressive symptoms (p=0.07), were significantly associated with attrition, after controlling for parent BMI, treatment group assignment, and family income.Higher reported parent binge eating symptoms were significantly related to attrition in FBT. Assessment of parent binge eating may be important in identifying families at risk for dropping out of FBT. Further, FBT may need to be adapted for families with parents who have a high level of psychopathology.
View details for DOI 10.1089/chi.2014.0109
View details for Web of Science ID 000352240100009
View details for PubMedID 25715322
View details for PubMedCentralID PMC4382825
Design and implementation of a study evaluating extinction processes to food cues in obese children: The Intervention for Regulations of Cues Trial (iROC)
CONTEMPORARY CLINICAL TRIALS
2015; 40: 95–104
Obesity and its health sequelae affect a significant portion of children in the United States. Yet, the current gold-standard family-based behavioral weight-loss treatments are only effective for one-third of children long-term. Therefore, we developed iROC (Intervention for Regulation of Cues) to specifically target a method to decrease overeating in overweight children, based on learning theory, to inform and enhance interventions targeting diet and obesity in youth. This study will rigorously test extinction processes as a method of decreasing physiological and psychological responses to food cues in overweight and obese children. Through exposing children to their highly craved foods, and 'training the brain and body' to decrease overeating, we are hoping to produce longer-lasting weight loss or weight-gain prevention over time.
View details for DOI 10.1016/j.cct.2014.11.011
View details for Web of Science ID 000349732000012
View details for PubMedID 25461494
View details for PubMedCentralID PMC4314468
Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents
INTERNATIONAL JOURNAL OF OBESITY
2014; 38 (4): 494–506
Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs.
View details for DOI 10.1038/ijo.2013.142
View details for Web of Science ID 000334344300003
View details for PubMedID 23913029
View details for PubMedCentralID PMC4456183
Links of Adolescent- and Parent-Reported Eating in the Absence of Hunger with Observed Eating in the Absence of Hunger
2013; 21 (6): 1243–50
Eating in the absence of hunger (EAH) typically was assessed by measuring snack intake after consumption of a meal. There were no validated self-report measures of EAH. The relationship of adolescent self-report and parent-reported EAH to adolescents' measured intake in the absence of hunger was examined.Ninety adolescents completed the Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C) to describe eating when not hungry. Parents described children's EAH on a parallel version designed for parents (EAH-P). In a randomized crossover study, adolescent EAH in response to external cues was measured as snack intake after a lunch meal standardized to provide 50% of daily energy requirements and after a large array (>10,000 kcal).Parents' reports of children's EAH in response to external cues were associated with greater EAH after both meals, adjusting for body composition, sex, age, race, puberty, and meal intake. Adolescent-reported EAH was unrelated or showed an inverse association with observed EAH.Parent-reported EAH showed a positive association with adolescents' observed EAH and may be a useful research and clinical tool for assessing EAH in response to external cues in conditions when laboratory assessments are not feasible.
View details for DOI 10.1002/oby.20218
View details for Web of Science ID 000322487000027
View details for PubMedID 23913735
View details for PubMedCentralID PMC3740450
Eating patterns in youth with and without loss of control eating
INTERNATIONAL JOURNAL OF EATING DISORDERS
2012; 45 (8): 957–61
To compare the characteristic meal patterns of adolescents with and without loss of control (LOC) eating episodes.The Eating Disorder Examination was administered to assess self-reported LOC and frequency of meals consumed in an aggregated sample of 574 youths (12-17 years; 66.6% female; 51.2% Caucasian; BMI-z: 1.38 ± 1.11), among whom 227 (39.6%) reported LOC eating.Compared to those without LOC, youth with LOC were less likely to consume lunch and evening meals (p's < .05), but more likely to consume morning, afternoon, and nocturnal snacks (p's ≤ .05), accounting for age, sex, race, socio-economic status, BMI-z, and treatment-seeking status.Adolescents with reported LOC eating appear to engage in different meal patterns compared to youth without LOC, and adults with binge eating. Further research is needed to determine whether the meal patterns that characterize adolescents with LOC play a role in worsening disordered eating and/or excessive weight gain.
View details for DOI 10.1002/eat.22063
View details for Web of Science ID 000311289700007
View details for PubMedID 23015352
View details for PubMedCentralID PMC3502711
Loss of control eating in African-American and Caucasian youth
2012; 13 (2): 174–78
Loss of control (LOC) eating, a disinhibited eating behavior shown to predict excessive weight gain in youth, has been reported by African-American children and adolescents. Yet, little is known about how LOC-eating manifests in this population. To investigate potential racial differences in LOC-eating, the Eating Disorder Examination was administered to 185 non-Hispanic African-American and Caucasian youth ages 8-17 y. Objective eating was assessed at two test meals during which youth ate ad libitum from a multi-item lunchtime food array. African-American and Caucasian youth reported a similar prevalence of LOC episodes (24.2% vs. 28.9%, p=.75). Yet, accounting for sex, age, fat-free mass, percent fat mass, height, and socioeconomic status, African-Americans consumed more total energy at both laboratory meals (1608±57 kcal vs. 1362±44 kcal; p<.001). Furthermore, African-American youth reporting LOC consumed the most total energy across both meals (1855±104 kcal) compared to African-Americans without LOC (1524±60 kcal), Caucasians with LOC (1278±68 kcal), and Caucasians without LOC (1399±46 kcal; p<.001). Future research is required to examine whether LOC-eating contributes to the high rates of obesity in African-American youth.
View details for DOI 10.1016/j.eatbeh.2012.01.003
View details for Web of Science ID 000301997500021
View details for PubMedID 22365807
View details for PubMedCentralID PMC3299485
Binge Eating and Weight-Related Quality of Life in Obese Adolescents
2012; 4 (3): 167–80
Limited data exist regarding the association between binge eating and quality of life (QOL) in obese adolescent girls and boys. We, therefore, studied binge eating and QOL in 158 obese (BMI ≥ 95th percentile) adolescents (14.5 ± 1.4 years, 68.0% female, 59% African-American) prior to weight-loss treatment. Youth completed an interview to assess binge eating and a questionnaire measure of QOL. Controlling for body composition, binge eating youth (n = 35), overall, reported poorer QOL in domains of health, mobility, and self-esteem compared to those without binge eating (ps < 0.05). Also, girls, overall, reported poorer QOL than boys in activities of daily-living, mobility, self-esteem, and social/interpersonal functioning (ps < 0.05). Girls with binge eating reported the greatest impairments in activities of daily living, mobility, self-esteem, social/interpersonal functioning, and work/school QOL (ps < 0.05). Among treatment-seeking obese adolescents, binge eating appears to be a marker of QOL impairment, especially among girls. Prospective and treatment designs are needed to explore the directional relationship between binge eating and QOL and their impact on weight outcomes.
View details for DOI 10.3390/nu4030167
View details for Web of Science ID 000302121200002
View details for PubMedID 22666544
View details for PubMedCentralID PMC3347025
Links between mothers' and children's disinhibited eating and children's adiposity
2011; 56 (2): 324–31
Few studies have examined relationships between parents' and children's specific disinhibited eating behaviors. We investigated links among mothers' and children's binge/loss of control eating, eating in the absence of hunger, and children's adiposity in 305 non-treatment-seeking youth, aged 8-17 years (13.62±2.65 years; 49.8% female) and their mothers. Youths' loss of control eating and eating in the absence of hunger were assessed by interview and self-report questionnaire. Children's adiposity was assessed with BMI-z and air displacement plethysmography. Maternal binge eating, eating in the absence of hunger and highest, non-pregnant BMI were self-reported. In structural equation models controlling for mothers' BMI, mothers' binge eating related to children's loss of control eating, and mothers' eating in the absence of hunger related to children's eating in the absence of hunger. Mothers' binge eating and children's eating in the absence of hunger were unrelated, as were mothers' eating in the absence of hunger and children's loss of control. Further, mothers' binge eating was indirectly related to children's adiposity through children's loss of control eating. Likewise, mothers' eating in the absence of hunger indirectly related to children's adiposity through children's eating in the absence of hunger. Mothers and children share similar, specific disinhibited eating styles.
View details for DOI 10.1016/j.appet.2010.12.014
View details for Web of Science ID 000289186000016
View details for PubMedID 21182882
View details for PubMedCentralID PMC3055954