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.

Objective-Limited data suggest that disordered-eating may predispose children to excessive weight gain. We investigated the relationship between baseline responses to the Eating Disorder Examination adapted for Children (ChEDE) and change in BMI (kg/m 2 ) in children at high risk for adult obesity.Method-Children (6-12 years) were administered the ChEDE to assess loss of control (LOC) eating, dietary restraint, and eating, shape, and weight concern. Height and weight were measured at baseline and annually.Results-Between July, 1999, and August, 2007, 772 measurements were obtained from 143 children over 4.5 ± 1.9 years. LOC eating predicted an increased rate of BMI growth over time (p = .02). Compared with children without LOC, those reporting LOC gained an additional mean 2.4 kg of weight per year.Conclusion-LOC is a salient predictor of weight gain during middle childhood. Interventions that decrease LOC eating should be evaluated for their ability to prevent excessive pediatric weight gain.

Background The presence of loss of control (LOC) eating in youth predicts excessive weight gain. However, few studies have measured the actual energy intake of children reporting LOC eating. Objective To characterize energy intake and macronutrient composition of “normal” and “binge” laboratory meals in non-overweight and overweight boys and girls with LOC eating. Design 177 youth (8–17y) consumed two lunchtime meals ad libitum from a multi-item food array after being instructed either to binge-eat (binge meal) or to eat normally (normal meal). Prior LOC eating was determined by semi-structured clinical interview. Results Participants consumed more energy at the binge meal than the normal meal (p=0.001). Compared to youth without LOC episodes (n=127), those reporting LOC (n=50) did not consume more energy at either meal. However, at both meals, youth with LOC consumed a greater percentage of calories from carbohydrate and a smaller percentage from protein than those without LOC (ps<0.05). Children with LOC ate more snack and dessert-type foods and less meats and dairy (ps<0.05). LOC participants also reported greater increases in post-meal negative affect at both meals compared to those without LOC (ps≤0.05). Secondary analyses restricted to overweight and obese girls found that those with LOC consumed more energy at the binge meal (p=0.025). Conclusions When presented with an array of foods, youth with LOC consumed more high-calorie snack and dessert-type foods than those without LOC. Further research is required to determine whether habitual consumption of such foods may promote overweight.

Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.

The phenomenology of childhood and adolescent loss of control (LOC) eating is unknown. The authors interviewed 445 youths to assess aspects of aberrant eating. LOC was associated with eating NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript forbidden food before the episode; eating when not hungry; eating alone; and experiencing secrecy, negative emotions, and a sense of "numbing" while eating (ps < .01). Hierarchical cluster analysis revealed a subgroup, most of whom reported LOC eating. Cluster members reported having a trigger initiate episodes, eating while watching television, and having decreased awareness regarding the amount consumed. The authors conclude that aspects of LOC eating during youth are similar to aspects of adult episodes, but a youth-specific presentation may exist. Findings may provide an intervening point to prevent excessive weight gain and eating disorders.Keywords binge eating; loss of control eating; children; adolescentsThe prevalence of pediatric overweight has nearly tripled in recent years (Ogden et al., 2006). Overweight during youth puts individuals at high risk for becoming obese adults (Field, Cook, & Gillman, 2005;Freedman, Khan, Dietz, Srinivasan, & Berenson, 2001;Guo, Wu, Chumlea, & Roche, 2002;Whitaker, Wright, Pepe, Seidel, & Dietz, 1997;Williams, 2001). Given the serious untoward medical (Adams et al., 2006;Freedman et al., 2001) and psychosocial (Puhl & Brownell, 2002;Strauss & Pollack, 2003) consequences of excess weight, overweight during childhood and adolescence is a major public health problem. Prevention and early intervention are critical to reduce the current epidemically high prevalence of pediatric overweight (Styne, 2003). Targeting behavioral factors that promote excessive weight gain may be a potential point of intervention. However, clarification of relevant behavioral factors is required before prevention efforts may be designed and implemented.Binge eating is defined as eating a large amount of food given the context, during which a sense of lack of control over eating is experienced (American Psychiatric Association [APA], 2000). Recurrent binge eating is the hallmark behavior of binge eating disorder BED; (APA, 2000). Compared to obese adults without an eating disorder, adults with BED suffer from poorer physical health (J. G. Johnson, Spitzer, & Williams, 2001) and higher levels of eating disorder psychopathology (e.g., Masheb & Grilo, 2000;Wilfley et al., 2000) and are more likely to be diagnosed with a comorbid psychiatric disorder (e.g., Marcus, 1995;Wilfley et al., 2000;Yanovski, Nelson, Dubbert, & Spitzer, 1993). BED and subthreshold binge eating are often associated with excess body weight and obesity (de Zwaan, 2001;Yanovski et al., 1993). Not only is BED a disorder of clinical significance (Wilfley, Wilson, & Agras. 2003), but some (Sherwood, Jeffery, & Wing, 1999;Yanovski, Gormally, Leser, Gwirtsman, & Yanovski, 1994), although not all (Wadden, Foster, & Letizia, 1992), data suggest that the presence of the ...