November 2010

The influence of a behavioral weight management program on disordered eating attitudes and behaviors in children with overweight.

Katherine Follansbee-Junger, MS; David M. Janicke, PhD’ Bethany J. Sallinen, PhD

The purpose of this research was to determine if overweight youth enrolled in one of two behavioral weight loss interventions were more likely to self-report increases in disordered eating attitudes compared to a control group. In addition, the researchers wanted to determine potential predictors of eating-disordered attitudes in overweight.

The participants included 68 overweight youth, aged 8 to 13 years, and their parent(s) or legal guardian(s). Families were excluded from the study if the child was currently prescribed antipsychotics, systemic corticosteroids, or weight loss medications. Families were also excluded if the family was currently enrolled in another weight loss program. Out of the original 68 participants, 50 parent-child dyads completed the study through the 6-month follow-up.

The parent/guardian participants completed a demographic form and the Child Feeding Questionnaire, which assesses the extent to which parents control on their children’s eating habits. The youth participants completed the Children’s Eating Attitudes Test, which is used to assess the child’s self-reported disordered eating attitudes, the Schwartz Peer Victimization Scale, which assesses the child’s perceptions of peer victimization and the Children’s Body Image Scale, which includes seven silhouettes of male or female children that correspond to increasing weigh status and uses self-reported responses.

The interventions had 3 components: a behavioral family-based intervention, a behavioral parent-only intervention, and a waitlist control. Each behavioral intervention was made up of 12 90-minute group sessions conducted over a 16 week period from January 2006 to January 2008. For the family-based sessions, parents and children participated in separate groups, whereas in the parent-only intervention, children were not present. The interventions focused on improving dietary intake using an adapted version of the Stoplight Program. The participants recorded everything they ate for the first 4 months and were encouraged to decrease high-calorie foods, increase fruits and vegetables and increase physical activity. A pedometer-based program was used to facilitate an increase in physical activity. Additional topics that were covered included self esteem, body image, healthy and unhealthy eating patterns and parent use of behavioral management techniques. All of the measures were completed at baseline, post-intervention and at a 6-month follow-up.

Overall, the intervention program was not associated with increases in disordered eating attitudes and children who participated in the interventions did not report increases in unhealthy eating attitudes from baseline to follow-up compared to the control participants. Children in the family-based and parent-only interventions had significantly greater improvements in weight status than the waitlist participants, but there was no significant difference between the two types of interventions. In addition, there were no significant differences between the family-based and parent-only interventions in the ChEAT measure. The researchers did find that increased levels of body dissatisfaction, peer victimization, parent restrictive feeding practices and concern for child weight at baseline was a predictor of disordered eating attitudes at the 6-month follow-up.

The researchers conclude by stating that future research should include a more comprehensive assessment of disordered eating behaviors, such as cigarette smoking, using laxatives and skipping meals and should examine potential risk factors for disordered eating behaviors, such as depression and self-esteem. They also suggest focusing on the effect of incorporating eating disorder prevention in pediatric weight management programs.

Follansbee-Junger K, Janicke DM, Sallinen BJ. The influence of a behavioral weight management program on disordered eating attitudes and behaviors in children with overweight. J Am Diet Assoc. 2010; 110: 1653-1659.

Related Article:

Neumark-Sztainer D, Wall M, Guo J, Story M, Hanes, J, Eisenberg M. Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later? J Am Diet Assoc. 2006; 106: 559-568.