9500 Gilman Drive Mc 0985 University Of California San Diego
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Characteristics of a Favorable Weight Status Change From Adolescence to Young Adulthood. - The Journal of adolescent health : official publication of the Society for Adolescent Medicine
To explore 10-year longitudinal predictors (personal, psychological, behavioral, and socioenvironmental) of exiting obesity from adolescence to young adulthood.Data were collected from a population-based cohort of adolescents (nÂ = 2,287) attending middle/high schools in Minneapolis-St. Paul in 1998-1999 (mean ageÂ = 14.9) and again in 2008-2009 (mean ageÂ = 25.3) participating in Project Eating and Activity Among Teens and Young Adults. Self-reported height and weight were used to calculate weight status change between adolescence and young adulthood, among participants with obesity at baseline (nÂ = 175). Questionnaires assessed personal, psychological, behavioral, and socioenvironmental factors hypothesized to play a role in obesity. Modified Poisson regressions estimated adjusted relative risks (RRs) for exiting obesity as a function of each baseline and 10-year change in predictor, controlling for relevant covariates.Thirty-two percent of adolescents exited obesity in young adulthood. Reductions in fast food intake (RRÂ = .73, 95% confidence interval [CI]Â = .61-.87) and screen time (RRÂ = .98, 95% CIÂ = .96-.99), and increases in fruit/vegetable intake (RRÂ = 1.06, 95% CI 1.01-1.12), moderate-to-vigorous physical activity (RRÂ = 1.06, 95% CIÂ = 1.00-1.12), home fruit/vegetable availability (RRÂ = 1.58, 95% CIÂ = 1.19-2.09), family meals (RRÂ = 1.12, 95% CIÂ = 1.03-1.22), and serving vegetables at dinner (RRÂ = 1.45, 95% CIÂ = 1.10-1.92) were associated with exiting obesity. Not dieting as an adolescent and improvements in body satisfaction, depressive symptoms, self-esteem, and weight teasing were also associated with exiting obesity.Promoting healthy eating and activity, and improving the healthfulness of home food environments may be promising intervention targets for promoting healthier weights in adolescents and young adults with obesity. Addressing dieting behavior and the psychosocial health of adolescents with obesity may also be needed throughout the transition to young adulthood.Copyright Â© 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Design of the FRESH study: A randomized controlled trial of a parent-only and parent-child family-based treatment for childhood obesity. - Contemporary clinical trials
Approximately 1 out of 3 children in the United States is overweight or obese. Family-based treatment (FBT) is considered the gold-standard treatment for childhood obesity, but FBT is both staff and cost intensive. Therefore, we developed the FRESH (Family, Responsibility, Education, Support, & Health) study to evaluate the effectiveness of intervening with parents, without child involvement, to facilitate and improve the child's weight status. Targeting parents directly in the treatment of childhood obesity could be a promising approach that is developmentally appropriate for grade-school age children, highly scalable, and may be more cost effective to administer. The current paper describes the FRESH study which was designed to compare the effectiveness of parent-based therapy for pediatric obesity (PBT) to a parent and child (FBT) program for childhood obesity. We assessed weight, diet, physical activity, and parenting, as well as cost-effectiveness, at baseline, post-treatment, and at 6- and 18-month follow-ups. Currently, all participants have been recruited and completed assessment visits, and the initial stages of data analysis are underway. Ultimately, by evaluating a PBT model, we hope to optimize available child obesity treatments and improve their translation into clinical settings.Copyright Â© 2015 Elsevier Inc. All rights reserved.
The relationship between parent feeding styles and general parenting with loss of control eating in treatment-seeking overweight and obese children. - The International journal of eating disorders
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 Â±â€‰1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06â€‰Â±â€‰0.39) and their parents (42.42â€‰Â±â€‰6.20 years; 91% female; 70% Caucasian; BMI: 31.74â€‰Â±â€‰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 (psâ€‰<â€‰0.05). Parents who utilized more instrumental feeding and prompting/encouragement to eat techniques were less likely to have children that reported LOC eating (psâ€‰<â€‰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.Â© 2015 Wiley Periodicals, Inc.
Parent Coaching Model for Adolescents With Emotional Eating. - Eating disorders
A significant proportion of both healthy and treatment-seeking youth report eating for emotional reasons. Emotional eating (EE) is associated with medical and psychological sequelae including overeating and eating disorder symptoms. Youth with EE are thought to have a predisposition toward a high level of emotional sensitivity, with a tendency to experience emotions intensely, and for a long duration. Interventions are needed to address emotion dysregulation associated with EE. Parent-focused interventions that emphasize training parents to respond to emotion dysregulation in their children have the potential to reduce the incidence of EE. This article describes an emotion-focused parent training intervention for youth who engage in EE.
Implications of learning theory for developing programs to decrease overeating. - Appetite
Childhood obesity is associated with medical and psychological comorbidities, and interventions targeting overeating could be pragmatic and have a significant impact on weight. Calorically dense foods are easily available, variable, and tasty which allows for effective opportunities to learn to associate behaviors and cues in the environment with food through fundamental conditioning processes, resulting in measurable psychological and physiological food cue reactivity in vulnerable children. Basic research suggests that initial learning is difficult to erase, and that it is vulnerable to a number of phenomena that will allow the original learning to re-emerge after it is suppressed or replaced. These processes may help explain why it may be difficult to change food cue reactivity and overeating over the long term. Extinction theory may be used to develop effective cue-exposure treatments to decrease food cue reactivity through inhibitory learning, although these processes are complex and require an integral understanding of the theory and individual differences. Additionally, learning theory can be used to develop other interventions that may prove to be useful. Through an integration of learning theory, basic and translational research, it may be possible to develop interventions that can decrease the urges to overeat, and improve the weight status of children.Copyright Â© 2015 Elsevier Ltd. All rights reserved.
A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders. - Eating disorders
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.
Maternal Attitudes and Behaviors Regarding Feeding Practices in Elementary School-Aged Latino Children: A Pilot Qualitative Study on the Impact of the Cultural Role of Mothers in the US-Mexican Border Region of San Diego, California. - Journal of the Academy of Nutrition and Dietetics
This study aimed to explore the attitudes and behaviors of Latino mothers around feeding their children. Using qualitative methods, we conducted four focus groups in Spanish with 41 Latino mothers of elementary school-age children in San Diego County, CA. Latino mothers' mean age was 41 years; 90% were foreign-born; and 74% had a high school education or less. We explored cultural viewpoints around feeding and cooking and feeding strategies used. Focus groups were analyzed based on a priori and emergent themes. The following themes around feeding emerged: feeding attitudes central to the maternal responsibility of having well-fed children and feeding behaviors that centered on cooking methods, supportive behaviors, and reinforcement strategies for "eating well." These findings increase our understanding of the Latino maternal role to feed children and can help to inform more culturally appropriate research to effectively address nutritional issues and obesity prevention in Latino children.Copyright Â© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
Development of the General Parenting Observational Scale to assess parenting during family meals. - The international journal of behavioral nutrition and physical activity
There is growing interest in the relationship between general parenting and childhood obesity. However, assessing general parenting via surveys can be difficult due to issues with self-report and differences in the underlying constructs being measured. As a result, different aspects of parenting have been associated with obesity risk. We developed a more objective tool to assess general parenting by using observational methods during a mealtime interaction.The General Parenting Observational Scale (GPOS) was based on prior work of Baumrind, Maccoby and Martin, Barber, and Slater and Power. Ten dimensions of parenting were included; 4 were classified in the emotional dimension of parenting (warmth and affection, support and sensitivity, negative affect, detachment), and 6 were classified in the behavioral dimension of parenting (firm discipline and structure, demands for maturity, psychological control, physical control, permissiveness, neglect). Overweight children age 8-12 years old and their parent (nâ€‰=â€‰44 dyads) entering a weight control program were videotaped eating a family meal. Parents were coded for their general parenting behaviors. The Mealtime Family Interaction Coding System (MICS) and several self-report measures of general parenting were also used to assess the parent-child interaction. Spearman's correlations were used to assess correlation between measures.The emotional dimensions of warmth/affection and support/sensitivity, and the behavioral dimension of firm discipline/structure were robustly captured during the family meals. Warmth/affection and support/sensitivity were significantly correlated with affect management, interpersonal involvement, and communication from the MICS. Firm discipline/structure was inversely correlated with affect management, behavior control, and task accomplishment. Parents who were older, with higher educational status, and lower BMIs were more likely to display warmth/affection and support/sensitivity.Several general parenting dimensions from the GPOS were highly correlated with similar family functioning constructs from the MICS. This new observational tool appears to be a valid means of assessing general parenting behaviors during mealtimes and adds to our ability to measure parent-level factors affecting child weight-related outcomes. Future evaluation of this tool in a broader range of the population and other family settings should be conducted.
Short-term intensive family therapy for adolescent eating disorders: 30-month outcome. - European eating disorders review : the journal of the Eating Disorders Association
Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)-a 5-day treatment based on the principles of family-based therapy for EDs. We retrospectively examined the long-term efficacy of IFT in both single-family (S-IFT) and multi-family (M-IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (â‰¥ 95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE-Q) global score within 1 SD of norms, and absence of binge-purging behaviours. Partial remission was defined as weight â‰¥ 85% of expected or â‰¥ 95% but with elevated EDE-Q global score and presence of binge-purging symptoms (<1/week). Over a mean follow-up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S-IFT and M-IFT showing comparable outcomes. Short-term, intensive treatments may be cost-effective and clinically useful where access to regular specialist treatment is limited.Copyright Â© 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Parent binge eating and depressive symptoms as predictors of attrition in a family-based treatment for pediatric obesity. - Childhood obesity (Print)
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.
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