Past weight loss an overlooked factor in disordered eating

PHILADELPHIA (September 24, 2013)— Dieters and weight loss researchers are familiar with the principle: The more weight you've lost, the harder it is to keep it off. A complex and vicious cycle of biological and behavioral factors make it so. But eating disorder research has largely overlooked this influence, and Dr. Michael Lowe, a professor of psychology at Drexel University, has published a flurry of research studies showing that needs to change. "The focus of eating disorder research has very much been on the state of patients' thoughts, beliefs, emotions and personalities," Lowe said. "And while these mental influences are undoubtedly part of the problem, historically there has been very little focus on how their current and past body weights contribute to their eating disorder." Lowe and colleagues' studies – about a dozen on bulimia nervosa have been published in the past several years – show that having an elevated past body weight, and being at a body weight well below highest past weight, may help cause and perpetuate disordered eating. The latest of Lowe's studies was just published in The Journal of Abnormal Psychology, the top journal for eating disorder research, and is the team's first to address this principle in anorexia nervosa. The findings, Lowe says, show that researchers and clinicians need to start taking into account how a person's historical and current body weight contribute to disordered eating. "This fundamentally changes the assumption that the problem is primarily psychological or emotional," Lowe said. The new study, led by doctoral student Laura A. Berner, was based on data collected at the Renfrew Center for eating disorders in Philadelphia, where Lowe is also a consultant. The researchers found that the level of eating disorder symptoms, as well as degree of improvement during treatment, depends on how much weight patients with anorexia nervosa had lost from their previous highest weight (a measure called "weight suppression"), how much they currently weigh and the interaction between the two LSW Continuing Education After controlling for patients' body mass index (BMI, which is a known indicator of disease severity), they found that patients with greater weight suppression had more severe symptoms of anorexia than patients whose low weight was closer to their historical highest weight. Standard measures of disordered eating such as shape concerns, eating concerns, binge eating, depression and menstrual abnormalities were correlated with weight suppression, current BMI, or both. Lowe said that researchers and clinicians who already use weight or BMI as an absolute measure of eating disorder severity should also consider weight suppression as a relative measure. These findings also may have important implications for treatment. "The standards for treating anorexia nervosa are all about 'how much weight do they need to gain to meet a minimally healthy body weight for their height,'" Lowe said. "What we've rarely asked, is 'what is this patient's weight history?'" Lowe said his ongoing research suggests that the answer is that many patients weighed more than their peers before developing anorexia nervosa. "If the patient's body somehow 'remembers' that past higher weight, then even at the minimally healthy body weight she is still going to be struggling mightily to maintain her weight," Lowe said. "That perspective is new. It suggests that future treatments might work toward finding a healthier 'balance point' between what patients once weighed and what they currently weigh." "It is really helpful to have more than one way to look at weight in the eating disorders; we now have evidence that absolute weight and relative weight are both important in predicting difficulties in our work towards full recovery," said Dr. Susan Ice, vice president and chief medical officer of The Renfrew Center. "And it is immensely satisfying to find that science has discovered that there is physical memory or a kind of 'wisdom' in the body." ### Lowe and his research team were recently funded by the National Institute of Mental Health to further investigate the role of these weight-related variables on bulimia nervosa. Individuals with symptoms of bulimia who are interested in participating in this federally funded study may call 215-762-1313 or email TEDS@drexel.edu for additional information. Another research laboratory at Drexel, the Laboratory for Innovations in Health-Related Behavior Change, is recruiting participants who have experienced binge eating problems but do not engage in compensatory behaviors such as self-induced vomiting or laxative use. One project is investigating a new smartphone app for binge eating and the other is evaluating an in-person treatment. Individuals who are interested in participating in these research studies may call 215-762-4900. Paper in the Journal of Abnormal Psychology: http://dx.doi.org/10.1037/a0033930

Marital problems in childhood affect teen adjustment

Marital discord is a significant social problem for children, sometimes leading to problems in health and well-being. A new longitudinal study finds that the impact of marital problems on children in their kindergarten years is long lasting and can lead to emotional problems that contribute to difficulties in adolescence. The study, by researchers at the University of Notre Dame and the University of Rochester, appears in the journal Child Development ceus for social workers "The results further highlight the possibility that there will be persistent negative effects of children's early experiences when there is conflict between their parents, at least when their emotional insecurity increases as a result of the conflict," according to E. Mark Cummings, professor and Notre Dame Endowed Chair in Psychology at the University of Notre Dame, the study's lead author. "This study has important implications for clinicians and parents," he added. Cummings and his colleagues examined 235 primarily middle-class mothers, fathers, and children over seven years, focusing on the links between marital conflict when the children were in kindergarten, children's emotional insecurity in the early school years, and subsequent problems when the children were teens. Children's emotional security about family ties is related to their sense of protection, safety, and security, and has implications for how they do socially and emotionally. The researchers observed parents discussing a topic they had identified as hard to handle, rating specific conflict behaviors. They also asked parents to report on their conflicts. The study found that conflict between parents when their children are young predicted children's emotional insecurity later in childhood, which, in turn, predicted adjustment problems in adolescence, including depression and anxiety. "Emotional insecurity appears to be an explanation for the effects of marital conflict on children's later problems," Cummings explained. "This mechanism lasts across relatively long periods of time and across the transition between childhood and adolescence." ###

In a nationally representative survey of 12- to 17-year-old youth and their trauma experiences, 39 percent reported witnessing violence, 17 percent reported physical assault, and 8 percent reported a lifetime prevalence of sexual assault.

April 2012 Social Media Message

In a nationally representative survey of 12- to 17-year-old youth and their trauma experiences, 39 percent reported witnessing violence, 17 percent reported physical assault, and 8 percent reported a lifetime prevalence of sexual assault. With help from families, friends, providers, and other Heroes of Hope, children and youth can be resilient when dealing with trauma. Visit www.samhsa.gov/children to learn more. When looking at rates of exposure to traumatic events, a nationally representative survey reported that among 12- to 17-year-old youth, 39 percent reported witnessing violence, 17 percent reported physical assault, and 8 percent reported a lifetime prevalence of sexual assault.1, 2 ceus for social workers Research has shown that caregivers can buffer the impact of trauma and promote better outcomes for children, even under stressful times, when the following Strengthening Families Protective Factors are present: •Parental resilience •Social connections •Knowledge of parenting and child development •Concrete support in times of need •Social and emotional competence of children3 Use these sample messages to share this childhood trauma and resilience data point with your connections on Twitter and Facebook and via email. Twitter: 39% of 12- to 17-year-old youths have reported witnessing violence, learn more: http://1.usa.gov/Ie4UjT via @samhsagov #HeroesofHope Facebook: A national survey of 12- to 17-year-old youths found that 17 percent reported physical assault and 8 percent reported a lifetime prevalence of sexual assault. Learn more about the behavioral health impact of traumatic events on children and youth and pass it on to observe National Children's Mental Health Awareness Day: http://1.usa.gov/Ie4UjT

References: 1. Kilpatrick DG, Acierno R. (2003). Mental health needs of crime victims: Epidemiology and outcomes. Journal of Traumatic Stress.16(2),119–132. Retrieved from http://onlinelibrary.wiley.com/doi/10.1023/A:1022891005388/abstract . 2.Saunders BE. (2003). Understanding Children Exposed to Violence Toward an Integration of Overlapping Fields. National Crime Victims Research and Treatment Center. J Interpers Violence. 18(4) 356-376. Retrieved from http://jiv.sagepub.com/content/18/4/356.short . 3.Horton, C. (2003). Protective factors literature review. Early care and education programs and the prevention of child abuse and neglect. Center for the Study of Social Policy.