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List at least 2 Reasons why we should develop preventive efforts for eating disorders
1. Large portion 25% or college students have preoccupation with weight and body dissatisfaction, 10 ednos and 2-3 BN
2. Studies have linked excessive weight concerns with sub clinical and clinical eating disorders with both short and longterm consequences.
3. Eating disorders are treatment resistent so better to try and prevent them-->relapse rates, cost
4. Binge eating is risk factor for obesity so preventing that could lessen severity of obesity
List some general risk factors for eating disorders
- Caucasian race
- parental bmi
- maternal eating disturbances
- social stress
- weight concerns
- Social biological processes
List and Give an example for each level of risk group in preventive interventions
- 1. Universal-->non-smoking campaigns
- 2. Selective-->those whose risk is higher than average--> lower ses, obesi
- 3. Indicated-->high risk individuals with minimal but detectable signs
- 4. Relapse and comorbidity->Individuals who have had an eating disorder
What is the rationale for using a targeted approach to prevention?
targeted prevention programs have been shown to work in other areas
opportunity to manipulate risk factor to determine if reduction in exposure leads to decreased risk
Individuals high risk may b more motivated to participate.
List atleast 4 advantages to Web-based interventions.
- Cost efficient
- Reduced time constraints
- Personalized intervention
- Support and encouragement
- reduced geogdraphical constraints
Summarize the student bodies Program and findings
An internet based preention program designed for at risk college aged women.
8 weeks of cognitive behavioral approach to weight/shape concerns adn unhealthy eating atttudes and behaviors with online assignments adn discusson grp.
FINDINGS: high interest, enrollment adn compliance. Was modestly effective. Positive association btw compliance adn outcome. People found online easy to do.
What was significant about the student bodies program?
First study to show onset of ED can b prevented in high-risk grps
first to show elevated wight and shape concens are causal risk factors for ED
Cost effective options can have lasting effects on women
Further replicaton is needed.
List 2 next steps for prevention research.
Further research needed to replicate findings and target new profiles
develop and implement easy screening for eating disorder risk and ensure prevention materials are easy.
Summarize the expanded risk factor model for ED
Eating disorders and related problems likly result from a complex interplay btw individual and environment-->such as emotion and peraonal characteristics
Summarize the enhanced student bodies program, synchonous, real time intervention
Same as before with addition of interpersonal functioning and targeting negative affect. Improved body image concerns and disordered eating
Summarize the second student bodies program
internet delivered early intervention program targeting weight loss, reduction of body dissatisfaction and eating disordered attitudes with adolescents who were overweight. Format similar to sb1.
Pyschoeducational readings, monitoring food, activity and weight
Weekly goal setting
Results: small but significant. shows its possible to provide weight efficacoious treatment to adolescnets over the internet. there was no increase in eating disorder psychopathy or significant improvement
- Low compliance,
- reduction in stress
List some potential pitfalls of prevention programs
With internet programs there are differences in computer technology, accessibility, difficulty in establishinig therapeutic alliance, lack of nonverbal cues
List some of the future directions of preventive research
- Continued evaluation on internet
- inverstigation of other risk factors
- Evaluation fo targeted interventions in univeral and environmental appraocahes
- Tailor program to fit risk profile
- Evaluate use of internet iwht younger populatons
- Integrate eating disorders and obesity prevention
Define obesity. What are the current trends? What is driving this? what is the bmi for obese?
Excess of adiposity that increases the risk for medical morbidity. Rapid increase in obesity in the last 20 years. Now, more the half of the country is obese. Obese are getting even more obese but overweight stay stable.
at least 30 or higher, 25 for overweight
What is the impact of obesity? List 3 example comorbid diseases.
- Increased mortality
- comordbid diseases
- decreased quality of life
- iincrease in medical costs
- Certain cancers, like breast
List and explain 3 psychosocial consequences of obesity
- Bias prejudice and discrimination due to weightism.
- Low self esteem/boddy image dissatisfaction
Explain the impact of obesity on self percieved quality of life. What is health related quality of life?
Reduction in this is one of the major personal consequences of obesity, even without having an impact on morbidity or other physiological markers. Significantly lower than normal wieght, just a little higher than htose with chronic illness.
Instruments that measure subjective experience of being overwieght.
Is it possible for obseity to be caused by genetic and birth disorders? What is another cause?
- Yes, like hypothyroidism. But VERY rare.
- Can also be caused by certain medications, like ssri's and some antipsychoitcs.
Is body weight heritable? Evidnence? Relate this to obesity
Yes, large portion is accounted for by genetic factors. Twin studies, fraternal twins are more variable in weight than identical. Adoption studies, like the danish study. Overweight child whose parents were overweight in adopted home of normal weight were still more likely to b overweight.
BUT, increases of severe obesity due to profound evironmental factors.
What is the argument for environmental contributions to obesity? Evidence?
The recent increases cannot be due to genetics alone. Pima indians, in their traditional living are not overweight, consume low fat diet and pyschially active as farmers but in western country here have high levels of obesity and overweight bc of high fat diet and sedentary lifestyle.
BC of obesogenic environment
What is the accepted cause of obesity?
Positive energy balance, too much energy in and not enough out. Food vs metabolic rate, activity or growth. Access wieght gain is a shift in balance.
How would you answer an obese person who says they follow a strict calorie diet and still cant lose weight? What do they think? Evidence?
They think its bc of metabolism but most of the time this is not impaired. Result in underreport in food intake and overreport in activity. Study: compared actual food intake and exercise to report intake and exercise for overweight individuals who previosusly could not lose weight when following a calorie diet, by almost half.
What does food in our environment have to do with the recent increases in obesity?
Healthy food cost more and is less excessible. Deregulation of corn market and meat led to lower costs in cattle so beef became cheap, which led rise in fast food industry. Correlate with rise in obesity.
what is the relationship btw poverty and obeisty?
lower income and african amerian areas are less likely to have access to food outlets and to healthy choices tahn higher income white neighborhoods.
List some environmental changes in intake.
What is the effect of portion size on intake?
- increased availibilty of inexpensive high fat food
- increase in meals away from home
- increased portion sizes in home and restaurant.
- increased snacking and soft drinks in children.
- INCREASE portion leads to increase in intake, in children also
What is the significance of the Taq1 allele found in many obese individuals.
makes food a greater reward, higher dopamine release. but poeple with allele who are not obese are less likely to find food rewardng.
List the benefits of modest weight loss
anywhere to 5-10% of body weight. Decreased medical risk, blood pressure, cholesterol
improved psychological functioning, lowered depressed and improved sefl esteem and body image.
what are the 3 treatments of obesity the medical model promotes?
- Life style modification, diet and exercsie
What is the effect of most short term weight loss programs? what could improve them? how? evidence?
- weight regain in 5 year trajectory.
- maintenence program is important for long term weight loss. in study, those without it gained half weight back after 1 year but with it stayed stable. Obesity requires long term care.
What is the behavioral weight loss approach to obesity? Summarize this treatemtn.
- view obesity as a chronic medical condition requiring continuous care
- weight loss using lcd with maintenence treatment
- encourage them to seek healthy weight rather than ideal weight
- Includes dietary intervention
- psychical activity intervention
- behavioral and cognitive interventions
List key elements to the physical activity intervention
- Gradually increase it to 200 mins week and experiment with different methods
- at home vs out of home exer
- long vs short bouts
- lifestyle activity vs programmed.
Summarize behavior therapy for obesity. List 4 components
- goal is to help patients change energy balance behaviors that contribute to obesity.
- help them initiate new dietary, eating and pshychical activity needed to get adn maintain weight loss.
- Self monitoring
- problem solving
- stress managenment
- cognitive techniques
- social support
- Set specific goals that can b measured
- develop reasonable plan to meet goals and prevent relapse
- make incremental vs large changes.
List some cardinal behaviors that have been found in successful longterm weight management.
- self monitoring
- low calorie, low fat diet
- eating patterns, daily breakfast
- regular physical activity
How do antiobesity drugs work?
subtimrerMeridia induces satiety so u feel satisfied with less food and less preoccupation with it and greater control. one a day. nasty side affects
Orlistat reduces bodies absorption of fat so it passes undigested. 3 times daily with meals and vitimin supplement. GI side affects. Found to be affective in placebo controlled studies.
What are the four defined goal weights?
- Dream weight
- Happy weight
- Acceptable wieght
- Disappointed weight-->less than current but one u wouldnt view as successful. in study, on 9% reached happy weight, nobody reached dream. Most didnt reach disappointed. acceptable and disappointed were each at abt 20%
How can we help overweight patients accept more?
- be clear abt what treatment can and cannot do
- discuss biological limits
- focus on nonweight outcomes
- be empathic abt dissatisfaction with weight and shape.
What is the primary treatment for obesity?
lifestyle modification. bwl has considerable past failures.
summarize childhood obesity. Why shoudl obese children and adolescents be treated?
recent changes have had an affect on our children as well. contributing to diseases and psychological and economic problems
- increasing prevalence-->has doubled int he last 20 years
- health consequences
- psychosocail consequences
- prevention of adult obesity-->70% will become obese adults
What contributes to obesity in children
- Television viewing and lack of exercise-->obesity increased with tv viewing increase
- changes in dietary patterns, increased snacking, soft drink consumption and meals away from home.
List and describe 5 health consequences to childhood overweight
- 60% developed cardiovascular risk
- hypertension, high cholesterol, sleep apnea
- type ii diabetes
- predicts adult obesity
- increased risk of adult morbidity and mortaility independent of adult obesity status
What are some social and psychological consequences of childhood obesity
- kids perceive overweight bod as dirty lazy ugly
- poor self esteem adn depression
- make less money in adulthood
- lowered pschosocial health score in comparison to cancer and normal kids
How are the affects of treatment for kids different from adults? why?
- more effective for kids.
- They require less self motivation
- have less established habits
- more opportunites for activity
- fewer fat cells than audlts
- increases in height and age.
Which treatment for childhood obesty is most effective currently? Benefits? is parental involvement important?
- child and family based treatment
- weight loss, improved cardiovascular risk factors, improved psychological adjustment
Summarize the general treatment approach.
- promote early intervention
- assess familys readiness for change
- educate family abt medical complications of obseity
- involve entire fam
- encourage small, gradual longterm changes
- emphasie successful beha changes
List 3 criterias for successful managementof childhood obesity
- use of modeling
- creation of supportive home environment
- incentive system for change.
Summarize the stoplight diet
- yellow, proceed with caution, adequate nutrients more calories
- Green, go ahead
- red, stop!
- IDEA that there are no bad foods.
Summarize the childhood obesity weight loss maintence treatment study. whats the difference btw behavioral skills and social facilitation?
used overweight kids with no medical or severe psychatric condition and no active weight loss treatment, randomized to bsm (behaviroal skills, sfm (social facilitation) and ntc.
- bsm-->specific strategies needed for weightloss maintenence, individual level change
- sfm-->importance of social environment, environmental level chagne. -->coping with teasing, engennered social support grp.
social did better than behavioral intervention although both were significant and no significant difference btw the 2. both were more effective than control. kids with low levels of social problems did much better than those with poor.
social did better than bsm with psychicla activity
what are the core componets of a treatment that can b manipulated? what the relation btw outcome and duration? y?
- duration-->treatment lenght
- dose-->how often delivered
the longer teh treatmetn the better teh results. oppurtunity to build and develop new more positive behaviors to mask the old.
summarize the social ecological model of treatment. which treatment is this combined with?
child behaviors-->self regulatory behs, weighing, low fat diet, failure to maintian beh associated with regain
caregivers-->parental support activity and weight loss, parents who do well have kids who do well .
peers--> influence beh, affects eating. spreads among grps. having overweight friend increases overweight inentire grp. social functioning important in adherence to behaviros.
- commuinty-->environmental features of neighborhood.
- all act upon weight status.
social facilitation with parents relevent on all levels. start on inside
Summarize BED in a short sentence. How is it link to Overweight and obesity?
clinically severe disorder characterize my several object losss of control eating episodes.
linked bc recuurent binge eating is a symptom of 25% of those seeking treatment for obesity. Those with distinct features are prone to gain weight and evidence of worse response to treatment for obesity.
Name and summarize the two models of symptom maintainence for BED. affectiveness?
cbt model: there is social pressure that leads to distorted thoughts and attitudes at eating, shape and weight which leads to dietary restraint and then binging bc too much restraint
IPT model asserts tahat interpersonal problems lead to low self esteem which leads to use of food as coping mechanism which leads to binging.
both found to b affective, no significant difference.
What are the drop out and remisson rates for bed treatment like? How does which will b effective have anything to do with psycholgocial state? what does stopping this behavior have to do with weight loss?
- high dropout rate for bwl and gsh, lower in ipt.
- Those with higher depression did better in ipt, those with lower did better in gsh and cbt
- binge remission lead to more weight loss, always, sometimes never
What are the future directions for BED therapy?
implementation of more specialy treamtments, like ipt and gsh are needed, instead of bwl. they both acheived weight stabilization
early intervention is important for weight loss and to prevent weight gain. Many first binging episodes occured in childhood and early adolescence
How does loss of control eating occur in youth. How common is it? How does this relate to obesity?
- mostly result from psychosocial impairment and occured more frequently in overweight youth. It predicts excessive weight gain.
- Very common. Necessary to target to serve as a way to reduce obesity. Need to provide prevention of excessive weight gain.
What is the role of implicit attitudes test on obesity?
consistently find that even outside of awareness people are biased against overweight and obese. And even explicitly. Understanding these attitudes can help us decrease discrimination
Summarize the CATCH program
it was a school based cardiovasuclar health promotion program taht targeted daily fat intake, physical activity and psychosocial factors. Found that kids in fat and daily vigorous activity group actaully ate less fat and did more vigorous activity at 3 year follow up. BUT no difference in bmi, skinfold thickness or lipid.
Summarize the planet health program
was a middle school curriculum added to decrease tv, increase activity and improve eating. Decreased obesity prevalence in girls and reduced tv in boys and girls.
What is the role of tv viewing and bmi in children?
less tv leads to lowered bmi in kids. even in kids who are not overweight prevents too much increase in bmi. Limiting tv can prevent development of obesity in kids.
summarize the relationship between eating disorders and obesity. Can binge eating drive the development of overweight? expl.
Most obese individuals don't have an eating disorder. Only a small fraction have BED, BN or Night eating syndrome with increasing severity increasing likelihood of disorder.
most peo who meet criteria for BED arent obese, only have are actually overweight. but they do gain weight rapidly.
both depressive adn disordered eating symptoms predict increases in bmi
What do ipt and cbt prove abt binging and weightloss?
both in the absence of weight loss program have little weightloss. BUT those who decrease binge eating are more likely to lose weight. and kept it off better
What is the delimma concerning eating disorder prevention programs and weight loss programs? How can this be solved? expl
that each my magnify and promote the other. Eating disorder will give youths permission to b fat. weight loss will promote body dissatisfaction.
- By emphasizing positive behaviors like physical activity and healthy eating. physical activity-->modify environment, increase chance in schools, enhance recreational activities.
- healhty eating-->encourage fruit adn vege consumption, low fat stuff, replace sugared drinks with water and milk. improve nutrient density.
Theres a need for a fundamental approach to both, instead of the traditional opposing strategies (restrict food, dont restrict food)
What are 3 factors neccessary for the development of effective, universal school based interventions? Summarize example study.
- easy and cost effective
- screen for those at risk
- help at risk without harming those at low risk
- minimize stigmatization
- address eating weight related factors while meeting needs and interests of low risk studenets.
- Examined internet delivered program to sort students into 4 risk groups and see if those in high risks would accept participation in interventions tailored for eating disorder. Female high school students completed this program as part of curriculum and did online assessment of weight concerns and height and weight. COre curriculum focused on nutritian, physical activity, appearance concersn and eating disorder awareness. body image enhancement program and cognitive behaviroal strategies.
- Results, Large portion of high risk signed up for bie or wmp. abt half of others accepted programs. showed that its possible to deliver universal and targeted interventions at same time. WS concerns were reduced in high risk adn not increased in low risk.
Professionals treating obesity and eating disorders should work together!