Patterns of Disordered Eating are Associated with Weight Change in Family‐Based Behavioral Obesity Treatment
Authors: Balantekin Katherine N , Hayes Jacqueline F , Sheinbein Daniel H , Kolko Rachel P , Stein Richard I , Saelens Brian E , Welch R. Robinson , Perri Michael G , Schechtman Kenneth B , Epstein Leonard H , Wilfley Denise E. 
Published: November 2023

Disordered eating (DE) constructs, which can include attitudes (e.g., weight concern) and behaviors (e.g., emotional eating, loss of control over eating [LOC], restraint) may be prevalent in children with obesity. While research shows obesity treatment is beneficial for preventing eating disorder development in children with obesity, higher levels of DE constructs may affect treatment response. This study aimed to characterize DE in a sample of treatment‐seeking children with obesity, and to examine whether types of DE (i.e., combinations of attitudes and behaviors) affect family‐based behavioral obesity treatment (FBT) completion and response. Parent‐child dyads (n=241) completed baseline assessments prior to entering FBT; 174 dyads completed 4 months of FBT. Children with a body mass index (BMI) ≥85th percentile and at least 1 parent with a BMI ≥25 kg/m2 were eligible. To assess DE, children completed the Youth Eating Disorder Examination Questionnaire(Y‐EDEQ), Emotional Eating Scale (EES), and (to assess the presence of LOC) Children's Eating Disorder Examination interview. Latent class analysis (LCA) was used to identify patterns of DE; the LCA included: the 3 EES subscales (anxiety, anger, and frustration; feeling unsettled; depressive symptoms), the 4 Y‐EDEQ subscales (weight concern, shape concern, eating concern, restraint), and LOC. Each participant was assigned to the group corresponding to their maximum posterior probability of membership using the classify‐analyze approach. ANOVAs and chi‐square analyses examined differences in FBT completion and response (BMI z‐score [zBMI] change) among the groups. LCA identified 5 patterns of DE: 1) Low DE (LOW; 32% of the sample; no DE attitudes or behaviors), 2) Restraint + DE Attitudes (RDEA; 20%; high restraint and concern with eating, shape, and weight), 3) Emotional Eating Only (EEO; 17%; only high emotional eating), 4) Emotional Eating and DE Attitudes (EEDEA; 11%; high emotional eating and concern with eating, shape, and weight), and 5) Emotional Eating + DE Attitudes + Restraint + LOC (HIGH; 20%; high on all DE constructs). There were no differences in FBT completion among the groups. Overall, the groups differed on zBMI changes from pre‐to post‐FBT (p =0.012). While all groups lost weight during FBT, children in the HIGH group had significantly smaller zBMI changes compared to those in LOW, EEO, and EEDEA (ps< 0.05); the RDEA group was not significantly different than any of the other four groups, and there were no other significant differences among the groups. Results from the current study extend previous literature to suggest children with obesity have varied presentations of DE, with some endorsing little to no DE and others endorsing higher levels of DE, including some behaviors indicative of eating pathology (e.g., LOC). In addition, specific combinations of DE differentially predicted FBT response, such that children who had higher scores on all DE constructs, including restraint and LOC, had the smallest weight changes compared to children with fewer DE traits. Additional research is needed on how to best adapt obesity treatment to better suit the needs of children with a severe pattern of DE.Support or Funding InformationNIH T32HL139357; NICHD R01 HD036904