Binge eating in overweight treatment-seeking adolescents.

OBJECTIVE: To examine the frequency and recency of binge eating in relation to psychopathology in overweight, treatment-seeking adolescents. METHODS: We investigated psychological correlates of the frequency and recency of reported loss of control (LOC) eating episodes in 160 overweight (body mass index [BMI]: 40.7 +/- 8.8 kg/m(2)) adolescents. On the basis of the responses to the eating disorder examination (EDE), participants were categorized into one of four groups: full-syndrome binge eating disorder (BED); recent but infrequent binge eating (episodes within the 3 months before interview; RECENT-BINGE); remote and infrequent LOC eating (episodes occurring >3 months before assessment; PAST-LOC), or no history of LOC episodes (NE). RESULTS: The BED group reported higher EDE scores (global, p < .01), and more negative mood and anxiety than all other groups (p's < .01). Compared with NE, RECENT-BINGE also reported more anxiety and higher EDE scores (p's < .01). CONCLUSIONS: Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.

Orthopedic complications of overweight in children and adolescents.

OBJECTIVE: Few studies have quantified the prevalence of weight-related orthopedic conditions in otherwise healthy overweight children. The goal of the present investigation was to describe the musculoskeletal consequences of pediatric overweight in a large pediatric cohort of children that included severely overweight children. METHODS: Medical charts from 227 overweight and 128 nonoverweight children and adolescents who were enrolled in pediatric clinical studies at the National Institutes of Health from 1996 to 2004 were reviewed to record pertinent orthopedic medical history and musculoskeletal complaints. Questionnaire data from 183 enrollees (146 overweight) documented difficulties with mobility. In 250, lower extremity alignment was determined by bilateral metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements made from whole-body dual-energy x-ray absorptiometry scans. RESULTS: Compared with nonoverweight children, overweight children reported a greater prevalence of fractures and musculoskeletal discomfort. The most common self-reported joint complaint among those who were questioned directly was knee pain (21.4% overweight vs 16.7% nonoverweight). Overweight children reported greater impairment in mobility than did nonoverweight children (mobility score: 17.0 +/- 6.8 vs 11.6 +/- 2.8). Both metaphyseal-diaphyseal and anatomic tibiofemoral angle measurements showed greater malalignment in overweight compared with nonoverweight children. CONCLUSIONS: Reported fractures, musculoskeletal discomfort, impaired mobility, and lower extremity malalignment are more prevalent in overweight than nonoverweight children and adolescents. Because they affect the likelihood that children will engage in physical activity, orthopedic difficulties may be part of the cycle that perpetuates the accumulation of excess weight in children.

Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents.

OBJECTIVE: Relatively little is known about how excess body mass affects adolescents' capacity to perform sustained exercise. We hypothesized that most of the difficulty that severely overweight adolescents have with sustained exercise occurs because the metabolic costs of moving excess mass result in use of a high proportion of their total oxygen reserve. METHODS: We compared results from a maximal cycle ergometry fitness test in 129 severely overweight adolescents who had BMIs of 41.5 +/- 9.7 kg/m2 and ages of 14.5 +/- 1.8 years (range: 12.1-17.8 years) and 34 nonoverweight adolescents who had BMIs of 20.1 +/- 2.9 kg/m2 and ages of 14.5 +/- 1.5 years (range: 12.0-18.1 years). Oxygen uptake (Vo2) was compared at 3 times: during a 4-minute period of unloaded cycling (ULVo2), at the lactate threshold estimated by gas exchange (LTVo2), and at maximal exertion (Vo2 max). Heart rate was obtained at rest and at Vo2 max. Participants also completed a 12-minute walk/run performance test to obtain distance traveled (D12) and heart rate. RESULTS: Absolute LTVo2 and Vo2 max and LTVo2 as a percentage of Vo2 max were not different in overweight and nonoverweight adolescents during the cycle test. However, absolute ULVo2 was significantly greater in overweight adolescents: ULVo2 accounted for 35 +/- 8% of Vo2 max (and 63 +/- 15% of LTVo2) in overweight adolescents but only 20 +/- 5% of Vo2 max (and 39 +/- 12% of LTVo2) in nonoverweight adolescents. Resting heart rate before initiating the cycle test was significantly greater in overweight than nonoverweight adolescents (94 +/- 14 vs 82 +/- 15 beats per minute). However, maximal heart rate during the cycle test was significantly lower in overweight adolescents (186 +/- 13 vs 196 +/- 11 beats per minute). During the walk/run test, mean D12 was significantly shorter for overweight than for nonoverweight adolescents (1983 +/- 323 vs 1159 +/- 194 m). D12 was negatively related to BMI SDS (r = -0.81) and to ULVo2 (r = -0.98). DISCUSSION: Overweight and nonoverweight adolescents had similar absolute Vo2 at the lactate threshold and at maximal exertion, suggesting that overweight adolescents are more limited by the increased cardiorespiratory effort required to move their larger body mass through space than by cardiorespiratory deconditioning. The higher percentage of oxygen consumed during submaximal exercise indicates that overweight adolescents are burdened by the metabolic cost of their excess mass. Their greater oxygen demand during an unloaded task predicted poorer performance during sustained exercise. Exercise prescriptions for overweight adolescents should account for the limited exercise tolerance imposed by excess body mass, focusing on activities that keep demands below lactate threshold so that exercise can be sustained.