Lauren B Shomaker1,2, Marian Tanofsky-Kraff1,3, Camden E Matherne1,3,4, Rim D Mehari1, Cara H Olsen5, Shannon E Marwitz1, Jennifer L Bakalar1,3, Lisa M Ranzenhofer1,3,6, Nichole R Kelly1,7, Natasha A Schvey1,3, Natasha L Burke1,3, Omni Cassidy1,3, Sheila M Brady1, Laura J Dietz8, Denise E Wilfley9, Susan Z Yanovski10, Jack A Yanovski1. 1. Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Hatfield Clinical Research Center, Bethesda, Maryland, 20892. 2. Department of Human Development and Family Studies and the Colorado School of Public Health, Colorado State University, Fort Collins, Colorado, 80523. 3. Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, 20814. 4. Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599. 5. Department of Preventive Medicine and Biostatistics, USUHS, Bethesda, Maryland, 20814. 6. Eating Disorder Research Unit, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, 10032. 7. Department of Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon, College of Education, University of Oregon, Eugene, Oregon, 97403. 8. Department of Psychology, University of Pittsburgh at Johnstown, Johnstown, Pennsylvania, 15904. 9. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, 63110. 10. Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK), NIH, Bethesda, Maryland, 20892.
Abstract
OBJECTIVE:Preadolescent loss-of-control-eating (LOC-eating) is a risk factor for excess weight gain and binge-eating-disorder. We evaluated feasibility and acceptability of a preventive family-based interpersonal psychotherapy (FB-IPT) program. FB-IPT was compared to family-based health education (FB-HE) to evaluate changes in children's psychosocial functioning, LOC-eating, and body mass. METHOD: A randomized, controlled pilot trial was conducted with 29 children, 8 to 13 years who had overweight/obesity and LOC-eating. Youth-parent dyads were randomized to 12-week FB-IPT (n = 15) or FB-HE (n = 14) and evaluated at post-treatment, six-months, and one-year. Changes in child psychosocial functioning, LOC-eating, BMI, and adiposity by dual-energy-X-ray-absorptiometry were assessed. Missing follow-up data were multiply imputed. RESULTS:FB-IPT feasibility and acceptability were indicated by good attendance (83%) and perceived benefits to social interactions and eating. Follow-up assessments were completed by 73% FB-IPT and 86% FB-HE at post-treatment, 60% and 64% at six-months, and 47% and 57% at one-year. At post-treatment, children in FB-IPT reported greater decreases in depression (95% CI -7.23, -2.01, Cohen's d = 1.23) and anxiety (95% CI -6.08, -0.70, Cohen's d = .79) and less odds of LOC-eating (95% CI -3.93, -0.03, Cohen's d = .38) than FB-HE. At six-months, children in FB-IPT had greater reductions in disordered-eating attitudes (95% CI -0.72, -0.05, Cohen's d = .66) and at one-year, tended to have greater decreases in depressive symptoms (95% CI -8.82, 0.44, Cohen's d = .69) than FB-HE. There was no difference in BMI gain between the groups. DISCUSSION: Family-based approaches that address interpersonal and emotional underpinnings of LOC-eating in preadolescents with overweight/obesity show preliminary promise, particularly for reducing internalizing symptoms. Whether observed psychological benefits translate into sustained prevention of disordered-eating or excess weight gain requires further study.
RCT Entities:
OBJECTIVE: Preadolescent loss-of-control-eating (LOC-eating) is a risk factor for excess weight gain and binge-eating-disorder. We evaluated feasibility and acceptability of a preventive family-based interpersonal psychotherapy (FB-IPT) program. FB-IPT was compared to family-based health education (FB-HE) to evaluate changes in children's psychosocial functioning, LOC-eating, and body mass. METHOD: A randomized, controlled pilot trial was conducted with 29 children, 8 to 13 years who had overweight/obesity and LOC-eating. Youth-parent dyads were randomized to 12-week FB-IPT (n = 15) or FB-HE (n = 14) and evaluated at post-treatment, six-months, and one-year. Changes in childpsychosocial functioning, LOC-eating, BMI, and adiposity by dual-energy-X-ray-absorptiometry were assessed. Missing follow-up data were multiply imputed. RESULTS: FB-IPT feasibility and acceptability were indicated by good attendance (83%) and perceived benefits to social interactions and eating. Follow-up assessments were completed by 73% FB-IPT and 86% FB-HE at post-treatment, 60% and 64% at six-months, and 47% and 57% at one-year. At post-treatment, children in FB-IPT reported greater decreases in depression (95% CI -7.23, -2.01, Cohen's d = 1.23) and anxiety (95% CI -6.08, -0.70, Cohen's d = .79) and less odds of LOC-eating (95% CI -3.93, -0.03, Cohen's d = .38) than FB-HE. At six-months, children in FB-IPT had greater reductions in disordered-eating attitudes (95% CI -0.72, -0.05, Cohen's d = .66) and at one-year, tended to have greater decreases in depressive symptoms (95% CI -8.82, 0.44, Cohen's d = .69) than FB-HE. There was no difference in BMI gain between the groups. DISCUSSION: Family-based approaches that address interpersonal and emotional underpinnings of LOC-eating in preadolescents with overweight/obesity show preliminary promise, particularly for reducing internalizing symptoms. Whether observed psychological benefits translate into sustained prevention of disordered-eating or excess weight gain requires further study.
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