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Disordered Eating Behavior And Mental Health Status Of Obese Adolescents Seeking Weight Management
Abstracts / 44 (2009) S14–S47
BMI. Analysis was done for each gender and racial group, specifically non-Hispanic white, non-Hispanic African-American, and Hispanic youth. Results: ROC analysis suggest that WC measurements of 81.9 cm for males (AUC 0.823, sensitivity 73%, specificity 76.4%) and 78.9 cm for females (AUC 0.727, sensitivity 78.9%, specificity 70.3%) may help identify those at risk for ASCVD, with African-American males having a higher WC measurement, 85 cm (AUC 0.838, sensitivity 85.4%, specificity 86%), than other males. Gender specific WC cut-points predict abnormal values for all outcome variables except GLU, p < 0.05. Males with a normal BMI but elevated WC had an OR ¼ 14.6 (CI ¼ 5.4-39.6, p < 0.0001) of being high risk and increased odds of abnormal values in all but GLU and HDL. For females, BMI category was more predictive of abnormal values than WC alone. Conclusions: Gender specific WC cut-points may be useful in identifying those at risk for ASCVD. WC may be particularly useful to screen adolescent males with normal BMI. Results must be applied to African-Americans with caution due to small sample. Sources of Support: None.
61. DISORDERED EATING BEHAVIOR AND MENTAL HEALTH STATUS OF OBESE ADOLESCENTS SEEKING WEIGHT MANAGEMENT Carolyn Bradner Jasik, MD, Hadley Leggett, MD, Robert H. Lustig, MD, Andrea K. Garber, PhD, RD, and Kristine A. Madsen, MD, MPH. Dept. of Pediatrics, Div. of Adolescent Medicine, University of California, San Francisco, San Francisco, CA Purpose: Prior clinic-based studies of obese adolescents have investigated binge eating, but little is known about other types of disordered eating behaviors. We sought to examine the prevalence of disordered eating behaviors and associations with baseline demographic and mental health variables in obese adolescents seeking weight management. Methods: We conducted a retrospective chart review of 89 adolescents age 12-18 (mean 14.7, SD 1.73) presenting for weight management from January 2007-August 2008. Age, gender, and medical predictors were abstracted from physician notes. Adolescent report of disordered eating, depression (measured via the Center for Epidemiological Studies Depression Scale, CES-DC), and mental health symptoms in the past month were taken from self-administered intake forms. Parent report of adolescent race/ethnicity and mental health history were taken from self-administered intake forms. Our main outcome variable was the total number of disordered eating behaviors in the past month among 7 behaviors: binge eating, eating alone, hiding food, late-night eating, lying about intake, loss of control, and guilt/depression about intake. These measures were adapted from Project EAT, a validated school-based survey of teens age 11-18. T-tests compared differences in mean behaviors by demographics and mental health status. Results: Baseline rates of disordered eating behavior in the past month ranged from 12% (eating alone) to 37% (guilt/depression about eating) with a mean of 1.5 (95% CI 1.1, 1.9) behaviors in the past month. Females reported more mean behaviors in the past month (1.9 vs. 1.0, p ¼ 0.009). Mean behaviors did not significantly differ by race, age, or BMI. Adolescents who scored in the ‘‘depressive symptoms’’ range on the CES-DC had higher mean disordered eating behaviors (2.0 vs. 1.0, p ¼ 0.006). More behaviors were also seen in adolescents who reported change in mood (2.4 vs. 1.2, p ¼ 0.003), depression (3.4 vs. 1.1, p ¼ 0.001), and anxiety (3.0 vs. 1.3, p ¼ 0.003) in the past month. Parental report of any mental health history, including depression or anxiety, was associated with
S39
more disordered eating behavior (1.9 vs. 1.2, p ¼ 0.03). Finally, parental report of behavioral health history, specifically learning disability or behavioral problems, was also associated with more disordered eating behaviors (2.0 vs. 1.1, p ¼ 0.01). Conclusions: A range of disordered eating behaviors are prevalent among obese adolescents seeking weight management and are associated with female gender and multiple measures of mental and behavioral health morbidity. Adolescent weight management programs should incorporate screening and treatment for a wider range of disordered eating behaviors. Sources of Support: MCHB (T71MC00003), NICHD (T32HD044331).
62. A CLINIC-BASED NUTRITION INTERVENTION IMPROVES SELF-EFFICACY TO CHANGE BEHAVIOR IN OBESE ADOLESCENTS AND PARENTS Meghan Gould, Carolyn Jasik, MD, Robert Lustig, MD, and Andrea Garber, PhD, RD. Dept. of Pediatrics, Div. of Adolescent Medicine, University of California, San Francisco, San Francisco, CA Purpose: Despite national guidelines calling for nutrition counseling to treat childhood overweight, there is inconsistent evidence that nutrition education influences behavior. Self-efficacy, a key determinant of health behavior change, may partly explain this discrepancy. We examined the effect of a nutrition intervention on obese adolescents’ self-efficacy to change diet and activity and parents’ self-efficacy to support these changes. Methods: Fourteen adolescents, age 12-18 with BMI > 95th percentile and their parents participated in a clinic-based intervention to learn and model healthy eating behavior during a shared meal. Before (‘‘pre-’’) and immediately after (‘‘post-’’) the intervention, participants completed an 86-item questionnaire with 3 subscales: (1) Skills/Beliefs specific to the intervention (e.g., label reading), (2) General Nutrition Knowledge (Nutr Know) adapted from a validated questionnaire by Parmenter & Wardle (1999), and (3) Selfefficacy to change behavior (adolescents) or to support change (parents), scored on a 5-point Likert scale (5 ¼ completely confident). Ten key diet and activity behaviors were also assessed (e.g., soda intake). Our primary outcome was pre- to post-test change in Self-efficacy. Results: Twelve adolescents, age 13.8 6 1.1 years, BMI 38.3 6 8.9, and 12 parents completed pre- and post-test questionnaires. Self-efficacy was significantly correlated with healthier diet and activity in adolescents (r ¼ 0.71, p ¼ 0.01) and parents (r ¼ 0.67, p ¼ 0.023) at pre-test. Paired t-tests between pre- and post-test showed a significant increase in Self-efficacy in adolescents (4.20 6 0.54 to 4.46 6 0.48, p < 0.0001) and parents (4.38 6 0.43 to 4.64 6 0.39, p ¼ 0.007) and Skills/Beliefs (% correct) in adolescents (70.3 6 10.7 to 84.7 6 8.3, p ¼ 0.001) and parents (76.3 6 12.1 to 88.3 6 8.43, p ¼ 0.001), but no change in Nutr Know (% correct) in adolescents (66.8 6 14.4 to 64.6 6 20.3, p ¼ 0.534) or parents (78.3 6 19.6 to 78.8 6 16.3, p ¼ 0.781). Increased adolescent self-efficacy was strongly related to increased Skills/Beliefs (r ¼ 0.76, p ¼ 0.004), adjusted for Self-efficacy and Skills/Beliefs scores at pre-test. Increased parent self-efficacy was strongly related to increased Nutr Know (r ¼ 0.64, p ¼ 0.033), adjusted for Self-efficacy and Nutr Know scores at pre-test. Conclusions: A clinic-based nutrition intervention significantly improved adolescents’ self-efficacy to change diet and activity and parents’ self-efficacy to support these changes. Our findings indicate that nutrition counseling should include skills and beliefs to promote adolescent confidence to change behavior and general nutrition education to promote parents’ confidence to support
BMI. Analysis was done for each gender and racial group, specifically non-Hispanic white, non-Hispanic African-American, and Hispanic youth. Results: ROC analysis suggest that WC measurements of 81.9 cm for males (AUC 0.823, sensitivity 73%, specificity 76.4%) and 78.9 cm for females (AUC 0.727, sensitivity 78.9%, specificity 70.3%) may help identify those at risk for ASCVD, with African-American males having a higher WC measurement, 85 cm (AUC 0.838, sensitivity 85.4%, specificity 86%), than other males. Gender specific WC cut-points predict abnormal values for all outcome variables except GLU, p < 0.05. Males with a normal BMI but elevated WC had an OR ¼ 14.6 (CI ¼ 5.4-39.6, p < 0.0001) of being high risk and increased odds of abnormal values in all but GLU and HDL. For females, BMI category was more predictive of abnormal values than WC alone. Conclusions: Gender specific WC cut-points may be useful in identifying those at risk for ASCVD. WC may be particularly useful to screen adolescent males with normal BMI. Results must be applied to African-Americans with caution due to small sample. Sources of Support: None.
61. DISORDERED EATING BEHAVIOR AND MENTAL HEALTH STATUS OF OBESE ADOLESCENTS SEEKING WEIGHT MANAGEMENT Carolyn Bradner Jasik, MD, Hadley Leggett, MD, Robert H. Lustig, MD, Andrea K. Garber, PhD, RD, and Kristine A. Madsen, MD, MPH. Dept. of Pediatrics, Div. of Adolescent Medicine, University of California, San Francisco, San Francisco, CA Purpose: Prior clinic-based studies of obese adolescents have investigated binge eating, but little is known about other types of disordered eating behaviors. We sought to examine the prevalence of disordered eating behaviors and associations with baseline demographic and mental health variables in obese adolescents seeking weight management. Methods: We conducted a retrospective chart review of 89 adolescents age 12-18 (mean 14.7, SD 1.73) presenting for weight management from January 2007-August 2008. Age, gender, and medical predictors were abstracted from physician notes. Adolescent report of disordered eating, depression (measured via the Center for Epidemiological Studies Depression Scale, CES-DC), and mental health symptoms in the past month were taken from self-administered intake forms. Parent report of adolescent race/ethnicity and mental health history were taken from self-administered intake forms. Our main outcome variable was the total number of disordered eating behaviors in the past month among 7 behaviors: binge eating, eating alone, hiding food, late-night eating, lying about intake, loss of control, and guilt/depression about intake. These measures were adapted from Project EAT, a validated school-based survey of teens age 11-18. T-tests compared differences in mean behaviors by demographics and mental health status. Results: Baseline rates of disordered eating behavior in the past month ranged from 12% (eating alone) to 37% (guilt/depression about eating) with a mean of 1.5 (95% CI 1.1, 1.9) behaviors in the past month. Females reported more mean behaviors in the past month (1.9 vs. 1.0, p ¼ 0.009). Mean behaviors did not significantly differ by race, age, or BMI. Adolescents who scored in the ‘‘depressive symptoms’’ range on the CES-DC had higher mean disordered eating behaviors (2.0 vs. 1.0, p ¼ 0.006). More behaviors were also seen in adolescents who reported change in mood (2.4 vs. 1.2, p ¼ 0.003), depression (3.4 vs. 1.1, p ¼ 0.001), and anxiety (3.0 vs. 1.3, p ¼ 0.003) in the past month. Parental report of any mental health history, including depression or anxiety, was associated with
S39
more disordered eating behavior (1.9 vs. 1.2, p ¼ 0.03). Finally, parental report of behavioral health history, specifically learning disability or behavioral problems, was also associated with more disordered eating behaviors (2.0 vs. 1.1, p ¼ 0.01). Conclusions: A range of disordered eating behaviors are prevalent among obese adolescents seeking weight management and are associated with female gender and multiple measures of mental and behavioral health morbidity. Adolescent weight management programs should incorporate screening and treatment for a wider range of disordered eating behaviors. Sources of Support: MCHB (T71MC00003), NICHD (T32HD044331).
62. A CLINIC-BASED NUTRITION INTERVENTION IMPROVES SELF-EFFICACY TO CHANGE BEHAVIOR IN OBESE ADOLESCENTS AND PARENTS Meghan Gould, Carolyn Jasik, MD, Robert Lustig, MD, and Andrea Garber, PhD, RD. Dept. of Pediatrics, Div. of Adolescent Medicine, University of California, San Francisco, San Francisco, CA Purpose: Despite national guidelines calling for nutrition counseling to treat childhood overweight, there is inconsistent evidence that nutrition education influences behavior. Self-efficacy, a key determinant of health behavior change, may partly explain this discrepancy. We examined the effect of a nutrition intervention on obese adolescents’ self-efficacy to change diet and activity and parents’ self-efficacy to support these changes. Methods: Fourteen adolescents, age 12-18 with BMI > 95th percentile and their parents participated in a clinic-based intervention to learn and model healthy eating behavior during a shared meal. Before (‘‘pre-’’) and immediately after (‘‘post-’’) the intervention, participants completed an 86-item questionnaire with 3 subscales: (1) Skills/Beliefs specific to the intervention (e.g., label reading), (2) General Nutrition Knowledge (Nutr Know) adapted from a validated questionnaire by Parmenter & Wardle (1999), and (3) Selfefficacy to change behavior (adolescents) or to support change (parents), scored on a 5-point Likert scale (5 ¼ completely confident). Ten key diet and activity behaviors were also assessed (e.g., soda intake). Our primary outcome was pre- to post-test change in Self-efficacy. Results: Twelve adolescents, age 13.8 6 1.1 years, BMI 38.3 6 8.9, and 12 parents completed pre- and post-test questionnaires. Self-efficacy was significantly correlated with healthier diet and activity in adolescents (r ¼ 0.71, p ¼ 0.01) and parents (r ¼ 0.67, p ¼ 0.023) at pre-test. Paired t-tests between pre- and post-test showed a significant increase in Self-efficacy in adolescents (4.20 6 0.54 to 4.46 6 0.48, p < 0.0001) and parents (4.38 6 0.43 to 4.64 6 0.39, p ¼ 0.007) and Skills/Beliefs (% correct) in adolescents (70.3 6 10.7 to 84.7 6 8.3, p ¼ 0.001) and parents (76.3 6 12.1 to 88.3 6 8.43, p ¼ 0.001), but no change in Nutr Know (% correct) in adolescents (66.8 6 14.4 to 64.6 6 20.3, p ¼ 0.534) or parents (78.3 6 19.6 to 78.8 6 16.3, p ¼ 0.781). Increased adolescent self-efficacy was strongly related to increased Skills/Beliefs (r ¼ 0.76, p ¼ 0.004), adjusted for Self-efficacy and Skills/Beliefs scores at pre-test. Increased parent self-efficacy was strongly related to increased Nutr Know (r ¼ 0.64, p ¼ 0.033), adjusted for Self-efficacy and Nutr Know scores at pre-test. Conclusions: A clinic-based nutrition intervention significantly improved adolescents’ self-efficacy to change diet and activity and parents’ self-efficacy to support these changes. Our findings indicate that nutrition counseling should include skills and beliefs to promote adolescent confidence to change behavior and general nutrition education to promote parents’ confidence to support