Objective Children with overweight/obesity have elevated eating disorder (ED) pathology, which may increase their risk for clinical EDs. The current study identified patterns of ED pathology in children with overweight/obesity entering family-based behavioral weight loss treatment (FBT), and examined whether children with distinct patterns differed in their ED pathology and zBMI change across FBT. Methods Before participating in 16-session FBT, children (N=241) completed surveys/interviews assessing ED pathology [emotional eating, shape/weight/eating concerns, restraint, and loss of control (LOC)]. Shape/weight concerns and LOC were also assessed post-treatment. Child height/weight were measured at baseline and post-treatment. Latent class analysis identified patterns of ED pathology. Repeated-measures ANOVA examined changes in zBMI and ED pathology. Results Four patterns of ED pathology were identified: Low ED Pathology, Shape and Weight Concerns, Only Loss of Control, and High ED Pathology. Shape/weight concerns decreased across treatment, with highest decreases in patterns characterized by high shape and weight concerns. All groups experienced significant decreases in zBMI; however, children with the highest ED pathology did not achieve clinically significant weight loss. Conclusions ED pathology decreased after FBT, decreasing ED risk. While all children achieved zBMI reductions, further research is needed to enhance outcomes for children with high ED pathology.

Summary Background Children with overweight/obesity are more likely to exhibit symptoms of depression and anxiety than are their peers without overweight/obesity; however, the rates and correlates of depression and anxiety symptoms among children seeking obesity treatment remain unclear. Objectives Examine the prevalence and associated factors of depression and anxiety symptoms among treatment‐seeking children with overweight/obesity. Methods Children 7 to 11 years old (N = 241) and their parents completed assessments before beginning family‐based behavioral weight‐loss treatment. Disorder‐specific self‐report questionnaires assessed child depression and anxiety. The social‐ecological model served as a framework for examining factors associated with depression and anxiety symptoms. Results Among our sample, 39.8% (96/241) met clinical cutoffs for depression and/or anxiety symptomatology. Specifically, of these 96, 48 met criteria for both depression and anxiety, 24 for depression only, and 24 for anxiety only. Child eating disorder pathology, parents' use of psychological control (ie, a parenting style characterized by emotional manipulation), and lower child subjective social status were significantly associated with greater child depression symptomatology. Child eating disorder pathology and parent psychological control were significantly associated with greater child anxiety symptomatology. Conclusion Nearly 40% of children exhibited psychopathology symptoms, and a variety of correlates were found. Thus, pediatric weight‐loss providers may consider screening for and addressing mental health concerns (and associated factors) prior to and during treatment.

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Summary Background Studies of the association between children's depressive symptoms and obesity treatment response show mixed results. Different measurement may contribute to the inconsistent findings, as children's depressive symptoms are often based on parent‐report about their child rather than child self‐report. Objectives We assessed both child‐ and parent‐report of child depressive symptoms as predictors of children's obesity treatment response. Methods Children with overweight/obesity (body mass index [BMI] ≥ 85th percentile; N = 181) and their parents reported on children's depressive symptoms prior to family‐based behavioral weight loss treatment. Results Child percent overweight reduction from baseline to post‐treatment was not predicted by child self‐reported depressive symptoms or parent‐report of child symptoms (P > 0.80), but was significantly predicted by the interaction between child self‐report and parent‐report on child (β = 0.14, P = 0.05). In analyses using clinical cutoffs, amongst children with high self‐reported symptoms, those whose parents reported low child depressive symptoms had greater reduction in percent overweight (t = 2.67, P = 0.008), whereas amongst children with low self‐reported symptoms, parent ratings were not associated with treatment outcome. Conclusions Including both child self‐report and parent‐report of child depressive symptoms may inform obesity care. Research is needed to examine differences amongst child and parent depressive symptom reports and strategies to address symptoms and optimize pediatric obesity treatment.

Background. Borderline personality disorder (BPD) is associated with severe psychiatric presentations and has been linked to variability in brain structure. Dimensional models of borderline personality traits (BPT) have grown influential; however, associations between BPT and brain structure remain poorly understood.Methods. We tested whether BPT are associated with regional cortical thickness, cortical surface area, and subcortical volumes (n=152 brain structure metrics) in the Duke Neurogenetics Study (DNS; n=1,299), and Human Connectome Project (HCP; n=1,099). Positive control analyses tested whether BPT are associated with related behaviors (e.g., suicidal thoughts and behaviors, psychiatric diagnoses) and experiences (e.g., adverse childhood experiences).Results. While BPT were robustly associated with all positive control measures, they were not significantly associated with any brain structure metrics in the DNS or HCP, or in a meta-analysis of both samples. The strongest findings from the meta-analysis showed a positive association between BPT scores and volumes of the left ventral diencephalon and thalamus (ps<0.005 uncorrected, pFDRs>0.1). Contrasting high and low BPT decile groups (N=552) revealed no FDR-significant associations with brain structure. Conclusions. We find replicable evidence that BPT are not associated with brain structure, despite being correlated with independent behavioral measures. Prior reports linking brain morphology to BPD may be driven by factors other than traits (e.g., severe presentations, comorbid conditions, severe childhood adversity, or medication) or reflect false positives. The etiology and/or consequences of BPT may not be attributable to MRI-measured brain structure. Future studies of BPT will require much larger sample sizes to detect these very small effects.