This study examined eating-disordered pathology in relation to psychopathology and adiposity in 162 non-treatment-seeking overweight (OW) and normal weight (NW) children, ages 6-13 years. Participants experienced objective or subjective binge eating (S/OBE; loss-of-control eating), objective overeating (OO), or no episodes (NE). OW children experienced significantly higher eating-disordered cognitions and behaviors than NW children and more behavior problems than NW children: 9.3% endorsed S/OBEs, 20.4% reported OOs, and 70.4% reported NEs. OW children reported S/OBEs more frequently than did NW children (p =.01), but similar percentages endorsed OOs. S/OBE children experienced greater eating-disordered cognitions (ps from <.05 to <.01) and had higher body fat (p <.05) than OOs or NEs. OOs are common in childhood, but S/OBEs are more prevalent in OW children and associated with increased adiposity and eating-disordered cognitions.

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-Comparedwith 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. Orthopedic complications of excess weight in adults include progression of degenerative osteoarthritis and articular cartilage breakdown, 4,5 a decline in physical functioning, 6 and poorer outcomes after orthopedic surgery for obesity-related disorders. 7,8 Some orthopedic disorders that are unique to childhood also have been suggested to be weight related. For example, retrospective analyses of children and adolescents with slipped capital femoral epiphysis and adolescent tibia vara (Blount's disease) reveal overrepresentation of overweight individuals. 9-11 However, few prospective data that quantify the prevalence and manifestations of potentially weight-related orthopedic conditions in overweight children and adolescents who are not referred for orthopedic concerns are available. Furthermore, the impact of such conditions on mobility in overweight children has not previously been examined. KeywordsThe goal of the present investigation was to describe the musculoskeletal consequences of pediatric overweight in a large cohort of children who ranged in BMI from normal to severely overweight. We hypothesized that, compared with nonoverweight children and adolescents, those who were...

Loss of control (LOC) eating in youth is associated cross-sectionally with eating-related and psychosocial distress, and is predictive of excessive weight gain. However, few longitudinal studies have examined the psychological impact and persistence of pediatric LOC eating. We administered the Eating Disorder Examination (EDE) and self-reported measures of depressive and anxiety symptoms to 195 boys and girls (M = 10.4, SD = 1.5 y) at baseline and again 4.7 (SD = 1.2) y later to 118 of these youth. Missing data were imputed. Baseline report of LOC was associated with the development of partial or full-syndrome binge eating disorder (p=.03), even after accounting for the contribution of sex, race, baseline characteristics (age, disordered eating attitudes and mood symptoms), body mass index growth between baseline and follow-up, and years in study. Half (52.2%, CI=1.15–6.22) of children who endorsed experiencing LOC at baseline reported persistence of LOC at follow-up (p=.02). Compared to children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes (ps<.001) and depressive symptoms (p=.027) over time. These data suggest that LOC eating in children is a problematic behavior that frequently persists into adolescence and that persistent LOC eating is associated with worsening of emotional distress.

Children's reports of binge eating and dieting were salient predictors of gains in fat mass during middle childhood among children at high risk for adult obesity. Interventions targeting disordered eating behaviors may be useful in preventing excessive fat gain in this high-risk group.