Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID.

The purpose of this paper is to provide a descriptive overview of a single-center ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID including rates of comorbidities, and to gain insight into treatment requirements. A retrospective cohort study was completed on patients meeting criteria for ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Over an 18 month period, a total of 26 patients were assessed and had follow-up data for a 12 month period. Patients presented with heterogeneous manifestations of ARFID and high rates of comorbid mood and anxiety disorders were noted. Treatment plans were tailored to meet individual needs at assessment and over the treatment period. A multidisciplinary approach was most often administered, including a combination of individual therapy, family therapy, medical monitoring, and prescribed medications. Only 30% of patients were treated exclusively by therapists on the eating disorder team. The experiences gained from this pilot study highlight the need for specialized resources for assessment and treatment of patients with ARFID, the importance of a multidisciplinary approach to treatment, and the necessity of utilization of ARFID-specific measures for program evaluation purposes.

Examining the Bidirectional Association Between Body Esteem and Body Mass Index During Adolescence.

OBJECTIVE: Research on body esteem (weight and appearance esteem) and weight suggests that having a positive body esteem may be associated with more stable weight trajectories during adolescence, and adolescents with higher weight report lower levels of body esteem. However, bidirectional relationships between body esteem and weight have not yet been examined. This 3-year longitudinal study examined (1) bidirectional relationships between body esteem and body mass index (BMI) and (2) how BMI and body esteem changed together throughout adolescence. METHODS: Participants (N = 1163 adolescents, at time 1 [T1] baseline; 60.3% female) from a school-based community sample completed surveys approximately annually for 3 years. RESULTS: Latent growth modeling revealed that (a) among boys and girls, appearance and weight esteem scores decreased over time, (b) higher initial BMI scores were associated with slower decreases in appearance esteem over time. However, evidence for bidirectionality was not found, in which baseline appearance and weight esteem did not predict changes in BMI over time and vice versa. CONCLUSION: Results suggest that changes in BMI and body esteem are co-occurring (rather than predictive) throughout adolescence. The decreasing trajectory of body esteem over time suggests the need for prevention efforts to improve body esteem throughout adolescence.

Asceticism, perfectionism and overcontrol in youth with eating disorders.

PURPOSE: Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs. However, as limited evidence exists in adolescents, the aim of the present study was to examine these links in a clinical sample of adolescents with EDs. METHOD: A retrospective chart review was conducted on 178 adolescents (91% females; Mage = 15.73 years, SD = 1.31) receiving services at a tertiary care pediatric ED program. An examination of variability in mean levels of perfectionism, asceticism, and overcontrol across ED symptom groups (restrictive and binge/purge ED subtypes) was conducted to learn of diagnostic differences, while correlations were used to explore the association of these personality traits with comorbid anxiety and depressive symptoms. Hierarchical linear regression was used to assess whether overcontrol was related to length of stay (LOS) in an inpatient program. RESULTS: Results indicated that adolescents with binge-purge symptoms had higher levels of perfectionism, asceticism and overcontrol compared to those with restrictive symptoms, and that greater levels of perfectionism, asceticism and overcontrol were associated with elevated depression and anxiety symptoms. Additionally, overcontrol predicted greater LOS in the inpatient ED program. CONCLUSION: Results suggest the importance of assessing, monitoring and targeting overcontrol in treatment for adolescents with EDs given its impact on comorbid symptoms and LOS. LEVEL OF EVIDENCE: Level III, evidence obtained from case-control analytic studies.

Mediating role of disordered eating in the relationship between screen time and BMI in adolescents: longitudinal findings from the Research on Eating and Adolescent Lifestyles (REAL) study.

OBJECTIVE: This study investigated whether the duration and type of screen time (ST) (TV viewing, recreational computer use, video gaming) is longitudinally associated with z-BMI and if these relationships are mediated by disordered eating (emotional, restrained). DESIGN: At baseline, participants were n 1197 (T1; 60 % female) adolescents (mean age = 13·51 years) who completed surveys over 2 years. ST was assessed by a self-reported measure created by the investigative team, while emotional and restrained eating was measured by the Dutch Eating Behaviour Questionnaire (DEB-Q). Height and weight were objectively measured to quantify z-BMI. SETTING: Thirty-one public and two private schools from the region of Ottawa, Canada. PARTICIPANTS: Students in grades 7-12. RESULTS: Parallel multiple mediation analyses revealed that more time spent watching TV at baseline is associated with higher z-BMI at T3 (total effect; B = 0·19, se = 0·07, P = 0·01, 95 % CI 0·05, 0·34), but no relationships were observed for total ST exposure or other types of ST and z-BMI. Disordered eating did not mediate the positive association between baseline TV viewing and z-BMI at T3. CONCLUSIONS: TV viewing was longitudinally associated with higher z-BMI in a community-based sample of adolescents, but disordered eating behaviours did not mediate this relationship. However, other non-pathological eating behaviours may mediate the association between ST and obesity and warrant further investigation. Finding suggests that targeting reduction in youth's TV viewing may be an effective component in the prevention of childhood obesity.

A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series.

BACKGROUND: Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders. METHODS: In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions). The DREAMS sessions consisted of five replicable family sessions given over 6 weeks, each with a specific area of focus for treatment, such as nutrition and eating disorder symptoms, mood, relationships and anxiety. Charts of these seven patients were reviewed in 2019 to determine whether this treatment might be worthy of further study. RESULTS: Based on a review of the progress notes, all seven patients reported an improvement in intake, a decrease in ED symptoms and an improvement in mood by the end of the sessions. All seven families reported that the sessions had been beneficial. CONCLUSION: Early intervention is recommended for adolescents who present in the early stages of an eating disorder, yet there are no guidelines to recommend which treatment should be offered to this population. Further research is required to determine whether a short course of modified FBT, such as these five FBT-inspired 'DREAMS' sessions, may be an effective intervention to offer to youth who present with mild eating disorders.

Bingeing, Purging, and Suicidal Ideation in Clinical and Non-Clinical Samples of Youth.

Suicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.

Characteristics and clinical trajectories of patients meeting criteria for avoidant/restrictive food intake disorder that are subsequently reclassified as anorexia nervosa.

OBJECTIVE: To examine the initial assessment profiles and early treatment trajectories of youth meeting the criteria for avoidant/restrictive food intake disorder (ARFID) that were subsequently reclassified as anorexia nervosa (AN). METHOD: A retrospective cohort study of patients assessed and treated in a tertiary care eating disorders (ED) program was completed. RESULTS: Of the 77 included patients initially meeting criteria for ARFID, six were reclassified as having AN (7.8%) at a median rate of 71 days after the first assessment. Patients in this cohort presented at very low % treatment goal weight (median 71.6%), self-reported abbreviated length of illness (median 6 months), and exhibited low resting heart rates (median 46 beats per minute). Nutrition and feeding focused worries related more to general health as opposed to specific weight and shape concerns or fears at assessment in half of those reclassified with AN. Treatment at the 6-month mark varied among patients, but comprised family and individual therapy, as well as prescription of psychotropic medication. CONCLUSION: Prospective longitudinal research that utilizes ARFID-specific as well as traditional eating disorder diagnostic measures is required to better understand how patients with restrictive eating disorders that deny fear of weight gain can be differentiated and best treated.

Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study.

Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.

Extracurricular Activity Involvement and Body Image in Youth with Obesity: The Mediating Role of Social Life.

Background: Youth with severe obesity are vulnerable to body dissatisfaction. Extracurricular activity (ECA) involvement has been linked to positive social interactions and body image in community samples; however, these links remain to be tested in clinical samples of youth with severe obesity. The present study explored ECA involvement [both physical and nonphysical activities (PAs)] in a clinical sample of youth with obesity to determine whether ECA involvement was related to body image (appearance and weight esteem) and social life (i.e., social experiences with peers). Methods: Participants were 209 adolescents (Mean age = 15.05; 50.2% female) who completed a baseline assessment at a tertiary care weight management program. Results: Of the participants, 70.3% of youth reported participating in PAs, and 56.5% reported participating in non-PAs. As hypothesized, weight esteem and social life were higher in those who participated in PA vs. those who did not. Mediation analyses revealed that social life positively mediated the relationship between PA participation and weight esteem. Conclusions: Social life may be a mechanism by which PA participation is positively related to weight esteem in youth with severe obesity. Findings could inform weight management programs for youth with obesity who are at risk for social inclusion and body dissatisfaction.

Effects of weight teasing and gender on body esteem in youth: A longitudinal analysis from the REAL study.

Weight teasing is associated with body dissatisfaction, but no study has examined the differential impact of the teasing source's gender. This study examined whether the longitudinal relationship between weight teasing (by peers), weight-related comments (by parents) and body esteem differed by the teasing sources' gender, and whether these relationships were moderated by victims' weight status and demographic factors. A school-based sample (N = 1197 at Time 1; 60% female) of adolescents completed surveys over approximately 2 years (Time 1-Time 3). Multilevel modeling showed that teasing from a male peer had a stronger, negative association with appearance esteem for female victims than males. Although weight teasing was more prevalent among youth with overweight/obesity, teasing from female peers had a stronger negative association with weight esteem for adolescents of average weight. Results suggest the weight teasing sources' gender may differentially impact the victims' body esteem, and highlights the need to consider these factors in weight teasing prevention strategies.