Patterns of Eating Disorder Pathology are Associated with Weight Change in Family‐Based Behavioral Obesity Treatment

Abstract

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.

Change in eating disorder symptoms following pediatric obesity treatment

“…These results contribute to the literature by further evaluating FBT, the current recommended treatment for childhood obesity. Consistent with Balantekin et al (), this study shows that ED symptoms did not increase immediately following treatment. This study extended upon previous research to demonstrate symptoms did not increase, and in fact decreased, in several domains through 6 months following treatment and 18 months following treatment.…”

“…The results in this study support previous research that pediatric behavioral weight‐loss treatment does not appear to exacerbate ED symptomatology (Balantekin et al, ; Butryn & Wadden, ; Carter & Bulik, ; Epstein, Paluch, Saelens, Ernst, & Wilfley, ; Hayes et al, ). These results contribute to the literature by further evaluating FBT, the current recommended treatment for childhood obesity.…”

“…A more recent review (Hayes et al, ) evaluated how family‐based behavioral treatment (FBT) for obesity, the current recommended treatment for childhood obesity (O'Connor et al, ), is positioned to both reduce weight and discourage EDs. One recent study that assessed change in ED symptoms following FBT in children 7–11 years old showed that weight concerns decreased across the entire sample, whereas shape concerns decreased in those who had high shape and weight concerns before treatment (Balantekin et al, ). No change in loss of control (LOC) eating episodes over the past month was found either.…”

Pediatric obesity treatment, self‐esteem, and body image: A systematic review with meta‐analysis

“…Three studies did not report on personnel involved in intervention delivery. Parental involvement was reported as part of the intervention in 50 studies …”

“…The change in body image between pre‐intervention and postintervention was reported in 27 studies, between pre‐intervention and follow‐up in three studies, and 13 studies reported data at all three time points. Of the 40 studies reporting body image pre‐intervention and postintervention ranging in duration from 2 weeks to 24 months, body image was reported to be significantly improved compared with baseline in 22 studies, not significantly changed in 10 studies, five studies did not state whether or not the change was significant and three studies reported a significant improvement in one body image measure and no change in another.…”