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| Publications of Nancy L. Zucker :chronological alphabetical combined listing:%% Journal Articles @article{fds326332, Author = {Kass, AE and Wilfley, DE and Eddy, KT and Boutelle, KN and Zucker, N and Peterson, CB and Le Grange and D and Celio-Doyle, A and Goldschmidt, AB}, Title = {Secretive eating among youth with overweight or obesity.}, Journal = {Appetite}, Volume = {114}, Pages = {275-281}, Year = {2017}, Month = {July}, url = {http://dx.doi.org/10.1016/j.appet.2017.03.042}, Abstract = {PURPOSE: Secretive eating, characterized by eating privately to conceal being seen, may reflect eating- and/or body-related shame, be associated with depression, and correlate with binge eating, which predicts weight gain and eating disorder onset. Increasing understanding of secretive eating in youth may improve weight status and reduce eating disorder risk. This study evaluated the prevalence and correlates of secretive eating in youth with overweight or obesity. METHODS: Youth (N = 577) presented to five research/clinical institutions. Using a cross-sectional design, secretive eating was evaluated in relation to eating-related and general psychopathology via linear and logistic regression analyses. RESULTS: Secretive eating was endorsed by 111 youth, who were, on average, older than youth who denied secretive eating (mean age = 12.07 ± 2.83 versus 10.97 ± 2.31). Controlling for study site and age, youth who endorsed secretive eating had higher eating-related psychopathology and were more likely to endorse loss of control eating and purging than their counterparts who did not endorse secretive eating. Groups did not differ in excessive exercise or behavioral problems. Dietary restraint and purging were elevated among adolescents (≥13y) but not children (<13y) who endorsed secretive eating; depression was elevated among children, but not adolescents, who endorsed secretive eating. CONCLUSIONS: Secretive eating may portend heightened risk for eating disorders, and correlates of secretive eating may differ across pediatric development. Screening for secretive eating may inform identification of problematic eating behaviors, and understanding factors motivating secretive eating may improve intervention tailoring.}, Doi = {10.1016/j.appet.2017.03.042}, Key = {fds326332} } %% Papers Published @article{fds373560, Author = {Zucker, NL and Strauss, GP and Smyth, JM and Scherf, KS and Brotman, MA and Boyd, RC and Choi, J and Davila, M and Ajilore, OA and Gunning, F and Schweitzer, JB}, Title = {Experimental Therapeutics: Opportunities and Challenges Stemming From the National Institute of Mental Health Workshop on Novel Target Discovery and Psychosocial Intervention Development.}, Journal = {Perspect Psychol Sci}, Pages = {17456916231197980}, Year = {2023}, Month = {October}, url = {http://dx.doi.org/10.1177/17456916231197980}, Abstract = {There has been slow progress in the development of interventions that prevent and/or reduce mental-health morbidity and mortality. The National Institute of Mental Health (NIMH) launched an experimental-therapeutics initiative with the goal of accelerating the development of effective interventions. The emphasis is on interventions designed to engage a target mechanism. A target mechanism is a process (e.g., behavioral, neurobiological) proposed to underlie change in a defined clinical endpoint and through change in which an intervention exerts its effect. This article is based on discussions from an NIMH workshop conducted in February 2020 and subsequent conversations among researchers using this approach. We discuss the components of an experimental-therapeutics approach such as clinical-outcome selection, target definition and measurement, intervention design and selection, and implementation of a team-science strategy. We emphasize the important contributions of different constituencies (e.g., patients, caregivers, providers) in deriving hypotheses about novel target mechanisms. We highlight strategies for target-mechanism identification using published and hypothetical examples. We consider the decision-making dilemmas that arise with different patterns of results in purported mechanisms and clinical outcomes. We end with considerations of the practical challenges of this approach and the implications for future directions of this initiative.}, Doi = {10.1177/17456916231197980}, Key = {fds373560} } @article{fds370370, Author = {Andrade, FC and Erwin, S and Burnell, K and Jackson, J and Storch, M and Nicholas, J and Zucker, N}, Title = {Intervening on Social Comparisons on Social Media: Electronic Daily Diary Pilot Study.}, Journal = {JMIR Ment Health}, Volume = {10}, Pages = {e42024}, Year = {2023}, Month = {April}, url = {http://dx.doi.org/10.2196/42024}, Abstract = {BACKGROUND: Literature has underscored the dark aspects of social media use, including associations with depressive symptoms, feelings of social isolation, and diminished self-esteem. Social comparison, the process of evaluating oneself relative to another person, is thought to contribute to these negative experiences such that people with a stronger tendency to compare themselves with others are particularly susceptible to the detrimental effects of social media. Social media as a form of social connection and communication is nevertheless an inevitable-and arguably integral-part of life, particularly for young adults. Therefore, there is a need to investigate strategies that could alter the manner in which people interact with social media to minimize its detrimental effects and maximize the feelings of affiliation and connection. OBJECTIVE: This pilot study examined the feasibility, acceptability, and effectiveness of a brief web-based intervention designed to alter engagement with social media and promote psychological well-being by encouraging social savoring as an alternative to social comparison. Social savoring was operationalized as experiencing joyful emotions related to the happiness of someone else's experiences (ie, feeling happy for someone else). METHODS: Following an intensive longitudinal design, 55 college students (mean age 19.29, SD 0.93 years; n=43, 78% women and n=23, 42% White) completed baseline measures (individual differences, psychological well-being, connectedness, and social media use) and then 14 days of daily surveys on their social media activity and well-being. On day 8, the group that was randomized to receive the intervention watched a video instructing them on the skill of social savoring and was asked to practice this skill during days 8 to 14. RESULTS: Overall, participants reported positive perceptions of the intervention. Participants who watched the intervention video reported significantly higher performance self-esteem (P=.02) at posttest than those in the control condition, after controlling for baseline levels. Participants also reported significantly higher state self-esteem (P=.01) on days in which they engaged in more social savoring while using social media, and the use of social savoring increased significantly (P=.01) over time, suggesting that participants found it helpful. Participants in both conditions reported significantly lower levels of social comparison (control: P=.01; intervention: P=.002) and higher levels of connectedness (control: P<.001; intervention: P=.001) at posttest than at baseline. CONCLUSIONS: Initial evidence from this pilot study suggests that a web-based social savoring intervention may help minimize the potentially harmful consequences of social media use, at least in some domains. Future work is needed to examine the effectiveness and acceptance of this intervention in different age groups and in clinical samples that are in part characterized by higher levels of comparison with others (eg, people with eating disorders).}, Doi = {10.2196/42024}, Key = {fds370370} } @article{fds369354, Author = {Crone, C and Fochtmann, LJ and Attia, E and Boland, R and Escobar, J and Fornari, V and Golden, N and Guarda, A and Jackson-Triche, M and Manzo, L and Mascolo, M and Pierce, K and Riddle, M and Seritan, A and Uniacke, B and Zucker, N and Yager, J and Craig, TJ and Hong, S-H and Medicus, J}, Title = {The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders.}, Journal = {Am J Psychiatry}, Volume = {180}, Number = {2}, Pages = {167-171}, Year = {2023}, Month = {February}, url = {http://dx.doi.org/10.1176/appi.ajp.23180001}, Doi = {10.1176/appi.ajp.23180001}, Key = {fds369354} } @article{fds365875, Author = {Walton, E and Bernardoni, F and Batury, V-L and Bahnsen, K and Larivière, S and Abbate-Daga, G and Andres-Perpiña, S and Bang, L and Bischoff-Grethe, A and Brooks, SJ and Campbell, IC and Cascino, G and Castro-Fornieles, J and Collantoni, E and D'Agata, F and Dahmen, B and Danner, UN and Favaro, A and Feusner, JD and Frank, GKW and Friederich, H-C and Graner, JL and Herpertz-Dahlmann, B and Hess, A and Horndasch, S and Kaplan, AS and Kaufmann, L-K and Kaye, WH and Khalsa, SS and LaBar, KS and Lavagnino, L and Lazaro, L and Manara, R and Miles, AE and Milos, GF and Monteleone, AM and Monteleone, P and Mwangi, B and O'Daly, O and Pariente, J and Roesch, J and Schmidt, UH and Seitz, J and Shott, ME and Simon, JJ and Smeets, PAM and Tamnes, CK and Tenconi, E and Thomopoulos, SI and van Elburg, AA and Voineskos, AN and von Polier, GG and Wierenga, CE and Zucker, NL and Jahanshad, N and King, JA and Thompson, PM and Berner, LA and Ehrlich, S}, Title = {Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group.}, Journal = {Biol Psychiatry}, Volume = {92}, Number = {9}, Pages = {730-738}, Year = {2022}, Month = {November}, url = {http://dx.doi.org/10.1016/j.biopsych.2022.04.022}, Abstract = {BACKGROUND: The pattern of structural brain abnormalities in anorexia nervosa (AN) is still not well understood. While several studies report substantial deficits in gray matter volume and cortical thickness in acutely underweight patients, others find no differences, or even increases in patients compared with healthy control subjects. Recent weight regain before scanning may explain some of this heterogeneity. To clarify the extent, magnitude, and dependencies of gray matter changes in AN, we conducted a prospective, coordinated meta-analysis of multicenter neuroimaging data. METHODS: We analyzed T1-weighted structural magnetic resonance imaging scans assessed with standardized methods from 685 female patients with AN and 963 female healthy control subjects across 22 sites worldwide. In addition to a case-control comparison, we conducted a 3-group analysis comparing healthy control subjects with acutely underweight AN patients (n = 466) and partially weight-restored patients in treatment (n = 251). RESULTS: In AN, reductions in cortical thickness, subcortical volumes, and, to a lesser extent, cortical surface area were sizable (Cohen's d up to 0.95), widespread, and colocalized with hub regions. Highlighting the effects of undernutrition, these deficits were associated with lower body mass index in the AN sample and were less pronounced in partially weight-restored patients. CONCLUSIONS: The effect sizes observed for cortical thickness deficits in acute AN are the largest of any psychiatric disorder investigated in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium to date. These results confirm the importance of considering weight loss and renutrition in biomedical research on AN and underscore the importance of treatment engagement to prevent potentially long-lasting structural brain changes in this population.}, Doi = {10.1016/j.biopsych.2022.04.022}, Key = {fds365875} } @article{fds365598, Author = {Bardone-Cone, AM and White, JP and Thompson, KA and Zucker, N and Watson, HJ and Bulik, CM}, Title = {Examination of perfectionism and self-concept constructs across stages of eating disorder recovery in men: An exploratory study.}, Journal = {Eat Behav}, Volume = {46}, Pages = {101658}, Year = {2022}, Month = {August}, url = {http://dx.doi.org/10.1016/j.eatbeh.2022.101658}, Abstract = {OBJECTIVE: This study examined perfectionism and self-concept constructs across eating disorder recovery stages in men, using a conceptualization of recovery that encompasses physical, behavioral, and cognitive recovery. METHOD: Participants were 35 men with an eating disorder history (Mage = 26.60 years, SD = 10.81), categorized as in full recovery, in partial recovery, or with a current eating disorder diagnosis/pathology, and 27 men with no eating disorder history (controls; Mage = 26.44 years, SD = 10.08). Data for determining recovery status were collected from surveys, interviews, and measured weight and height; perfectionism and self-concept were assessed via surveys. RESULTS: Among the perfectionism constructs, the greatest magnitude of effect sizes involving the fully recovered group was for socially prescribed perfectionism where this group had lower levels of perfectionism than the eating disorder diagnosis/pathology group (Hedge's g = -1.72) or the partially recovered group (Hedge's g = -1.56). For the self-concept constructs, effect sizes involving the fully recovered group and the other recovery status groups were all large (absolute values: 0.76-1.58) and reflected a large magnitude of difference with fully recovered men having higher self-esteem and self-efficacy and lower social comparison than men with a current eating disorder diagnosis or pathology or those partially recovered. CONCLUSION: Full recovery in men was associated with healthy self-concept constructs and with low socially prescribed perfectionism. Future research with larger samples should seek to replicate these findings and, using a longitudinal design, examine these constructs as potential predictors or maintenance factors of comprehensive eating disorder recovery in men.}, Doi = {10.1016/j.eatbeh.2022.101658}, Key = {fds365598} } @article{fds364241, Author = {Erwin, SR and Liu, PJ and Datta, N and Nicholas, J and Rivera-Cancel, A and Leary, M and Chartrand, TL and Zucker, NL}, Title = {Experiences of mimicry in eating disorders.}, Journal = {J Eat Disord}, Volume = {10}, Number = {1}, Pages = {103}, Year = {2022}, Month = {July}, url = {http://dx.doi.org/10.1186/s40337-022-00607-9}, Abstract = {BACKGROUND: People unknowingly mimic the behaviors of others, a process that results in feelings of affiliation. However, some individuals with eating disorders describe feeling "triggered" when mimicked. This study explores the effects of implicit non-verbal mimicry on individuals with a history of an eating disorder (ED-His) compared to healthy controls (HCs). METHOD: Women (N = 118, nED-His = 31; Mage = 21 years) participated in a laboratory task with a confederate trained to either discreetly mimic (Mimicry condition) or not mimic (No-Mimicry condition) the mannerisms of the participant. Participants rated the likability of the confederate and the smoothness of the interaction. RESULTS: Participants in the No-Mimicry condition rated the confederate as significantly more likable than in the Mimicry condition, and ED-His rated the confederate as more likable than HCs. ED-His in the Mimicry condition rated the interaction as less smooth than HCs, whereas this pattern was not found in the No-Mimicry condition. Among ED-His, longer disorder duration (≥ 3.87 years) was associated with less liking of a confederate who mimicked and more liking of a confederate who did not mimic. CONCLUSIONS: We discuss the implications of these findings for interpersonal therapeutic processes and group treatment settings for eating disorders. Our study on subtle, nonverbal mimicry revealed differences in social behavior for women with a history of an eating disorder compared to healthy women. For participants with an eating disorder history, a longer duration of illness was associated with a worse pattern of affiliation, reflected in lower liking of a mimicker. Further research on how diverging processes of affiliation may function to perpetuate the chronicity of eating disorders and implications for treatment is needed.}, Doi = {10.1186/s40337-022-00607-9}, Key = {fds364241} } @article{fds362716, Author = {Breslav, ADS and Zucker, NL and Schechter, JC and Majors, A and Bidopia, T and Fuemmeler, BF and Kollins, SH and Huettel, SA}, Title = {Shuffle the Decks: Children Are Sensitive to Incidental Nonrandom Structure in a Sequential-Choice Task.}, Journal = {Psychol Sci}, Volume = {33}, Number = {4}, Pages = {550-562}, Year = {2022}, Month = {April}, url = {http://dx.doi.org/10.1177/09567976211042007}, Abstract = {As children age, they can learn increasingly complex features of environmental structure-a key prerequisite for adaptive decision-making. Yet when we tested children (N = 304, 4-13 years old) in the Children's Gambling Task, an age-appropriate variant of the Iowa Gambling Task, we found that age was negatively associated with performance. However, this paradoxical effect of age was found only in children who exhibited a maladaptive deplete-replenish bias, a tendency to shift choices after positive outcomes and repeat choices after negative outcomes. We found that this bias results from sensitivity to incidental nonrandom structure in the canonical, deterministic forms of these tasks-and that it would actually lead to optimal outcomes if the tasks were not deterministic. Our results illustrate that changes in decision-making across early childhood reflect, in part, increasing sensitivity to environmental structure.}, Doi = {10.1177/09567976211042007}, Key = {fds362716} } @article{fds362309, Author = {Gupta, A and Bhatt, RR and Rivera-Cancel, A and Makkar, R and Kragel, PA and Rodriguez, T and Graner, JL and Alaverdyan, A and Hamadani, K and Vora, P and Naliboff, B and Labus, JS and LaBar, KS and Mayer, EA and Zucker, N}, Title = {Complex functional brain network properties in anorexia nervosa.}, Journal = {J Eat Disord}, Volume = {10}, Number = {1}, Pages = {13}, Year = {2022}, Month = {February}, url = {http://dx.doi.org/10.1186/s40337-022-00534-9}, Abstract = {BACKGROUND: Anorexia nervosa (AN) is a disorder characterized by an incapacitating fear of weight gain and by a disturbance in the way the body is experienced, facets that motivate dangerous weight loss behaviors. Multimodal neuroimaging studies highlight atypical neural activity in brain networks involved in interoceptive awareness and reward processing. METHODS: The current study used resting-state neuroimaging to model the architecture of large-scale functional brain networks and characterize network properties of individual brain regions to clinical measures. Resting-state neuroimaging was conducted in 62 adolescents, 22 (21 female) with a history of AN and 40 (39 female) healthy controls (HCs). Sensorimotor and basal ganglia regions, as part of a 165-region whole-brain network, were investigated. Subject-specific functional brain networks were computed to index centrality. A contrast analysis within the general linear model covarying for age was performed. Correlations between network properties and behavioral measures were conducted (significance q < .05). RESULTS: Compared to HCs, AN had lower connectivity from sensorimotor regions, and greater connectivity from the left caudate nucleus to the right postcentral gyrus. AN demonstrated lower sensorimotor centrality, but higher basal ganglia centrality. Sensorimotor connectivity dyads and centrality exhibited negative correlations with body dissatisfaction and drive for thinness, two essential features of AN. CONCLUSIONS: These findings suggest that AN is associated with greater communication from the basal ganglia, and lower information propagation in sensorimotor cortices. This is consistent with the clinical presentation of AN, where individuals exhibit patterns of rigid habitual behavior that is not responsive to bodily needs, and seem "disconnected" from their bodies.}, Doi = {10.1186/s40337-022-00534-9}, Key = {fds362309} } @article{fds362310, Author = {Kim, YK and Di Martino and JM and Nicholas, J and Rivera-Cancel, A and Wildes, JE and Marcus, MD and Sapiro, G and Zucker, N}, Title = {Parent strategies for expanding food variety: Reflections of 19,239 adults with symptoms of Avoidant/Restrictive Food Intake Disorder.}, Journal = {Int J Eat Disord}, Volume = {55}, Number = {1}, Pages = {108-119}, Year = {2022}, Month = {January}, url = {http://dx.doi.org/10.1002/eat.23639}, Abstract = {OBJECTIVE: To characterize helpful parent feeding strategies using reflections on childhood eating experiences of adults with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID). METHOD: We explored a unique text-based dataset gathered from a population of N = 19,239 self-identified adult "picky eaters." The sample included adults with symptoms of ARFID as evidenced by marked interference in psychosocial functioning, weight loss/sustained low weight, and/or nutritional deficiency (likely ARFID), and non-ARFID participants. We leveraged state-of-the-art natural language processing (NLP) methods to classify feeding strategies that were perceived as helpful or not helpful. The best classifiers that distinguished helpful approaches were further analyzed using qualitative coding according to a grounded theory approach. RESULTS: NLP reliably and accurately classified the perceived helpfulness of caregivers' feeding strategies (82%) and provided information about features of helpful parent strategies using recollections of adults with varying degrees of food avoidance. Strategies perceived as forceful were regarded as not helpful. Positive and encouraging strategies were perceived as helpful in improving attitudes toward food and minimizing social discomfort around eating. Although food variety improved, adults still struggled with a degree of avoidance/restriction. DISCUSSION: Adults perceived that positive parent feeding strategies were helpful even though they continued to experience some degree of food avoidance. Creating a positive emotional context surrounding food and eating with others may help to eliminate psychosocial impairment and increase food approach in those with severe food avoidance. Nevertheless, additional tools to optimize parent strategies and improve individuals' capacity to incorporate avoided foods and cope with challenging eating situations are needed.}, Doi = {10.1002/eat.23639}, Key = {fds362310} } @article{fds349214, Author = {Zickgraf, HF and Richard, E and Zucker, NL and Wallace, GL}, Title = {Rigidity and Sensory Sensitivity: Independent Contributions to Selective Eating in Children, Adolescents, and Young Adults.}, Journal = {J Clin Child Adolesc Psychol}, Volume = {51}, Number = {5}, Pages = {675-687}, Year = {2022}, url = {http://dx.doi.org/10.1080/15374416.2020.1738236}, Abstract = {Objective: Selective or "picky" eating (SE) refers to rejection of a wide range of familiar and unfamiliar foods based on aversions to their sensory properties. When severe, SE can cause symptoms of avoidant/restrictive food intake disorder (ARFID), including weight loss, nutritional deficiencies, and/or psychosocial impairment. SE is highly prevalent in autism spectrum disorder (ASD) compared to both typical development and other developmental disorders. A possible explanation for the high prevalence of SE in ASD is the effect of core ASD symptoms, repetitive/restrictive behaviors (e.g., rigidity), and sensory sensitivity on feeding behaviors. These traits are found not only in ASD but also in other clinical groups and the general population, albeit often at subclinical levels. Identifying mechanisms of SE across various populations is critical to inform intervention approaches.Methods: In 263 unselected children ages 5-17, 534 unselected college students ages 18-22, 179 children with anxiety/obsessive spectrum disorders ages 5-17, and 185 children with ASD ages 4-17, we explored the unique contributions of sensory (i.e., oral texture and olfactory) sensitivities and rigidity as predictors of self/parent-reported SE.Results: In each sample, rigidity and oral texture sensitivity, controlling for olfactory sensitivity, age, and gender, emerged as significant, independent predictors of SE.Conclusions: This is the first study to highlight the importance of cognitive/behavioral rigidity to SE, and one of the first to illustrate the domain-specificity of the relationship between sensory sensitivity and SE.}, Doi = {10.1080/15374416.2020.1738236}, Key = {fds349214} } @article{fds362560, Author = {Neshteruk, CD and Zizzi, A and Suarez, L and Erickson, E and Kraus, WE and Li, JS and Skinner, AC and Story, M and Zucker, N and Armstrong, SC}, Title = {Weight-Related Behaviors of Children with Obesity during the COVID-19 Pandemic.}, Journal = {Child Obes}, Volume = {17}, Number = {6}, Pages = {371-378}, Year = {2021}, Month = {September}, url = {http://dx.doi.org/10.1089/chi.2021.0038}, Abstract = {Background: During the coronavirus disease 2019 (COVID-19) pandemic, children and families have had to adapt their daily lives. The purpose of this study was to describe changes in the weight-related behaviors of children with obesity after the onset of the COVID-19 pandemic. Methods: Semistructured interviews (n = 51) were conducted from April to June 2020 with parents of children with obesity. Families were participants in a randomized trial testing a clinic-community pediatric obesity treatment model. During interviews, families described their experience during the COVID-19 pandemic, with a particular emphasis on children's diet, physical activity, sleep, and screen time behaviors. Rapid qualitative analysis methods were used to identify themes around changes in children's weight-related behaviors. Results: The mean child age was 9.7 (±2.8) years and the majority of children were Black (46%) or Hispanic (39%) and from low-income families (62%). Most parent participants were mothers (88%). There were differences in the perceived physical activity level of children, with some parents attributing increases in activity or maintenance of activity level to increased outdoor time, whereas others reported a decline due to lack of outdoor time, school, and structured activities. Key dietary changes included increased snacking and more meals prepared and consumed at home. There was a shift in sleep schedules with children going to bed and waking up later and an increase in leisure-based screen time. Parents played a role in promoting activity and managing children's screen time. Conclusions: The COVID-19 pandemic has created unique lifestyle challenges and opportunities for lifestyle modification. Clinical Trials ID: NCT03339440.}, Doi = {10.1089/chi.2021.0038}, Key = {fds362560} } @article{fds350140, Author = {Schuette, SA and Zucker, NL and Smoski, MJ}, Title = {Do interoceptive accuracy and interoceptive sensibility predict emotion regulation?}, Journal = {Psychol Res}, Volume = {85}, Number = {5}, Pages = {1894-1908}, Year = {2021}, Month = {July}, url = {http://dx.doi.org/10.1007/s00426-020-01369-2}, Abstract = {INTRODUCTION: Interoception refers to awareness, interpretation, and integration of sensations in the body. While interoceptive accuracy has long been regarded as a core component of emotional experience, less is known about the relationship of interoceptive accuracy and related facets of interoception to emotion regulation deficits. This study explores how interoceptive accuracy and interoceptive sensibility relate to emotion regulation in a non-clinical sample. METHODS: Undergraduate participants completed a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness (Noticing and Body Listening sub-scales), and rated their confidence in performance on the heartbeat perception task. Participants also completed self-report measures of emotional awareness and regulation (Profile of Emotional Competence, intrapersonal emotion identification and emotion regulation sub-scales), and rated their use of different coping strategies (Brief COPE). RESULTS: Noticing predicted emotion identification, emotion regulation, and the use of adaptive but not maladaptive coping strategies. Heartbeat perception accuracy did not significantly contribute to the prediction of any outcome variables. DISCUSSION: Future work is needed to extend these findings to clinical populations. The results from this study support the use of interoceptive training interventions to promote emotional wellbeing.}, Doi = {10.1007/s00426-020-01369-2}, Key = {fds350140} } @article{fds356184, Author = {Stein, K and Warne, N and Heron, J and Zucker, N and Bould, H}, Title = {Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population-based cohort.}, Journal = {Int J Eat Disord}, Volume = {54}, Number = {6}, Pages = {915-924}, Year = {2021}, Month = {June}, url = {http://dx.doi.org/10.1002/eat.23513}, Abstract = {OBJECTIVE: Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16. METHOD: The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders. RESULTS: After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p = .197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p = .002), and after excluding those with pre-existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p = .002). DISCUSSION: Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long-term outcomes than functional impairment.}, Doi = {10.1002/eat.23513}, Key = {fds356184} } @article{fds357026, Author = {Nicholas, JK and van Tilburg, MAL and Pilato, I and Erwin, S and Rivera-Cancel, AM and Ives, L and Marcus, MD and Zucker, NL}, Title = {The diagnosis of avoidant restrictive food intake disorder in the presence of gastrointestinal disorders: Opportunities to define shared mechanisms of symptom expression.}, Journal = {Int J Eat Disord}, Volume = {54}, Number = {6}, Pages = {995-1008}, Year = {2021}, Month = {June}, url = {http://dx.doi.org/10.1002/eat.23536}, Abstract = {OBJECTIVE: Individuals with a gastrointestinal (GI) disorder often alter their diet to manage GI symptoms, adding complexity to understanding the diverse motivations contributing to food avoidance/restriction. When a GI disorder is present, the DSM-5 states that Avoidant/Restrictive Food Intake Disorder (ARFID) can be diagnosed only when eating disturbance exceeds that expected. There is limited guidance to make this determination. This study attempts to address this gap by characterizing the presentation of ARFID in adults with and without a self-reported GI disorder. METHOD: Participants were 2,610 adults ages 18-44 who self-identified as "picky eaters." Participants reported on motivations for food avoidance, affective experiences towards food, and perceived impairment. Responses were compared across four groups: GI issues and likely ARFID (L-ARFID/GI), L-ARFID-only, GI-only, and No-ARFID/No-GI. RESULTS: Groups with a GI disorder (L-ARFID/GI, GI-only) reported more fear of aversive consequences of eating than those without a GI disorder, while groups with L-ARFID (L-ARFID, L-ARFID/GI) evidenced significantly greater sensory aversion to food and indifference to food or eating, negative emotional reactions to food and overall disgust sensitivity, and eating related impairment. DISCUSSION: Consideration of the interplay of a GI disorder with ARFID can add precision to case conceptualization. Food avoidance may be attempts to manage fears of aversive consequences that are augmented by a history of GI symptoms, while sensory aversions and negative emotional reactions towards foods may be more elevated in ARFID. These findings emphasize the need to consider an ARFID diagnosis in patients with GI disorders to optimize care.}, Doi = {10.1002/eat.23536}, Key = {fds357026} } @article{fds362766, Author = {Ives, LT and Stein, K and Rivera-Cancel, AM and Nicholas, JK and Caldwell, K and Datta, N and Mauro, C and Egger, H and Puffer, E and Zucker, NL}, Title = {Children's Beliefs about Pain: An Exploratory Analysis.}, Journal = {Children (Basel)}, Volume = {8}, Number = {6}, Pages = {452}, Year = {2021}, Month = {May}, url = {http://dx.doi.org/10.3390/children8060452}, Abstract = {Functional abdominal pain (FAP) is one of the most common childhood medical complaints, associated with significant distress and impairment. Little is known about how children understand their pain. Do they attribute it to personal weakness? Do they perceive pain as having global impact, affecting a variety of activities? How do they cope with pain? We explored the pain beliefs of 5- to 9-year-old children with FAP using a novel Teddy Bear Interview task in which children answered questions about a Teddy bear's pain. Responses were analyzed quantitatively and qualitatively. Results indicate that the majority of young children with FAP are optimistic about pain outcomes. Children generated many types of coping strategies for Teddy's pain and adjusted their calibration of Teddy's pain tolerance dependent on the activity being performed. Early warning signs also emerged: a subset of children were pessimistic about Teddy's pain, and several children identified coping strategies that, while developmentally appropriate, could lead to excessive help seeking if not intervened upon (e.g., physician consultation and shot). The Teddy Bear Interview allows children to externalize their pain, making it a useful tool to access cognitive pain constructs in younger children. Thus, these findings highlight the importance of early intervention for childhood FAP.}, Doi = {10.3390/children8060452}, Key = {fds362766} } @article{fds351218, Author = {Wallace, GL and Richard, E and Wolff, A and Nadeau, M and Zucker, N}, Title = {Increased emotional eating behaviors in children with autism: Sex differences and links with dietary variety.}, Journal = {Autism}, Volume = {25}, Number = {3}, Pages = {603-612}, Year = {2021}, Month = {April}, url = {http://dx.doi.org/10.1177/1362361320942087}, Abstract = {Although "picky" eating is well documented in autism spectrum disorder, emotional eating has rarely been investigated. This study examined emotional over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder (n = 190) as compared to same-age typically developing children (n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts.}, Doi = {10.1177/1362361320942087}, Key = {fds351218} } @article{fds354551, Author = {Datta, N and Bidopia, T and Datta, S and Mittal, G and Alphin, F and Herbert, BM and Marsh, EJ and Fitzsimons, GJ and Strauman, TJ and Zucker, NL}, Title = {Internal states and interoception along a spectrum of eating disorder symptomology.}, Journal = {Physiol Behav}, Volume = {230}, Pages = {113307}, Year = {2021}, Month = {March}, url = {http://dx.doi.org/10.1016/j.physbeh.2020.113307}, Abstract = {OBJECTIVE: Recent studies on atypical interoceptive capabilities have focused on clinical populations, including anorexia nervosa[1,2]. The present exploratory study aims to characterize the influence of disordered eating symptomology on interoceptive capabilities in college students, a population for which dangerous dieting behaviors may emerge. METHOD: Ninety-nine participants were randomized to consume a blinded high calorie or low calorie midday shake. Participants reported frequency of eating disorder cognitions and behaviors; indicated changes in satiety, happiness, and energy pre- and post-consumption; and guessed the calories in their shake. Outcomes (perceived satiety, changes in mood, and caloric guess) were regressed on eating disorder symptoms scores, the high/low calorie shake condition, and the interaction between these predictors. RESULTS: Those randomized to receive the high calorie shake reported feeling fuller, but only when endorsing lower levels of eating concern. Those randomized to the high calorie shake reported greater post-meal happiness, but only at greater levels of eating concerns. Lastly, those with lower levels of eating restraint reported an expected positive association between level of fullness and calorie guess, but those with higher levels of eating restraint did not exhibit any relationship between perceived fullness and calorie guess. DISCUSSION: Results of this exploratory suggest that irregular eating habits (e.g., not eating a sufficient amount for lunch) may have direct consequences on interoceptive capabilities. Further, these capacities may be impacted by individual differences in eating concern and restraint. Preliminary findings suggest that impairment in deciphering visceral signals may be associated with the degree of eating disorder symptomology; such impairment may occur at lower levels of symptomatology than normative data would indicate.}, Doi = {10.1016/j.physbeh.2020.113307}, Key = {fds354551} } @article{fds354550, Author = {Ng, S and Liu, Y and Gaither, S and Marsan, S and Zucker, N}, Title = {The clash of culture and cuisine: A qualitative exploration of cultural tensions and attitudes toward food and body in Chinese young adult women.}, Journal = {Int J Eat Disord}, Volume = {54}, Number = {2}, Pages = {174-183}, Year = {2021}, Month = {February}, url = {http://dx.doi.org/10.1002/eat.23459}, Abstract = {OBJECTIVE: Accumulating evidence suggests that the prevalence of eating disorders among Chinese women is a public health concern. Prior studies have drawn linkages between conflicting cultural values, identity confusion, and eating disorder symptomatology, which may be relevant for understanding the rise of eating disorders amidst China's rapid economic and sociocultural transformation. Here, we explore how women's experiences with traditional eating norms and modernizing norms of femininity may shape their food and body attitudes. METHOD: Chinese young adult women (N = 34; aged 18-22 years) participated in semi-structured interviews focusing on experiences with norms surrounding eating and ideal feminine appearance, perceived conflict between these norms, and their responses to perceived conflict. Interviews were conducted via email (n = 27) or via Skype (n = 7). Participants were not asked about past or present diagnoses of eating disorders. Analysis of responses was guided by the principles of thematic analysis. RESULTS: Women reported encounters with cultural eating norms and feminine appearance norms, and described factors that motivated continued or discontinued adherence to these norms. Women reported strategies of conflict resolution, which resulted in different emotional and behavioral outcomes including eating disorder symptoms. DISCUSSION: Women's experiences with norms surrounding eating and appearance indicate the centrality of these encounters in the formation of individual and interpersonal values. Our findings suggest the importance for clinicians to assist clients in exploring the meanings behind internalized attitudes toward food and body, and to help clients balance interpersonal and individual needs.}, Doi = {10.1002/eat.23459}, Key = {fds354550} } @article{fds356954, Author = {Zelkowitz, RL and Zerubavel, N and Zucker, NL and Copeland, WE}, Title = {Longitudinal associations of trauma exposure with disordered eating: Lessons from the Great Smoky Mountains Study.}, Journal = {Eat Disord}, Volume = {29}, Number = {3}, Pages = {208-225}, Year = {2021}, url = {http://dx.doi.org/10.1080/10640266.2021.1921326}, Abstract = {Disordered eating is prevalent among trauma survivors, yet little is known about mechanisms underlying this relation. We explored cross-sectional and longitudinal associations of trauma exposure and posttraumatic stress disorder symptoms (PTSD) with disordered eating among 1,420 community-based youth participating in the Great Smoky Mountain Study. Participants were interviewed about trauma exposure, PTSD symptoms, and disordered eating at regular intervals throughout childhood, adolescence, and early adulthood. Our findings confirmed associations of all forms of trauma exposure (violent, sexual, and other) with disordered eating symptoms in childhood and adulthood, although the pattern of results varied by disordered eating symptom and trauma exposure type. Only non-sexual, non-violent trauma exposure in childhood had significant associations with any disordered eating symptoms in adulthood. Within childhood, trauma exposures but not PTSD symptoms showed significant longitudinal associations with bulimia nervosa symptoms and sustained appetite changes and preoccupation with eating. In adulthood, PTSD symptoms but not trauma exposures showed significant longitudinal associations only with bulimia nervosa symptoms. The association of specific PTSD clusters on bulimia nervosa symptoms was significant for reexperiencing, whereas hyperarousal symptoms trended toward significance. The impact of trauma exposures on disordered eating may vary by developmental period.}, Doi = {10.1080/10640266.2021.1921326}, Key = {fds356954} } @article{fds362833, Author = {Datta, N and Foukal, M and Erwin, S and Hopkins, H and Tchanturia, K and Zucker, N}, Title = {A mixed-methods approach to conceptualizing friendships in anorexia nervosa.}, Journal = {PLoS One}, Volume = {16}, Number = {9}, Pages = {e0254110}, Year = {2021}, url = {http://dx.doi.org/10.1371/journal.pone.0254110}, Abstract = {BACKGROUND: Individuals with anorexia nervosa have reported feelings of loneliness, social anhedonia, and interpersonal difficulties. This study sought to clarify the nature of interpersonal relationships in adults with anorexia, which may help improve existing interventions while also facilitating the attainment of something that might compete with the drive for thinness: friendships. METHODS: The present study used a mixed-methods approach to investigate friendship experiences in three groups: anorexia (n = 27), participants with a history of anorexia who are weight restored (n = 20), and healthy controls (n = 24). Thematic analysis was used to isolate the most prevalent themes that emerged from an open-ended interview of experiencing friendships in a subset of participants. Three self-report questionnaires investigating friendship valuation and attachment styles were also administered. RESULTS: 11 unique themes emerged in the data: social comparison, reciprocity, trust, fear of negative evaluation, perceived skills deficit, logistical barriers, reliability, identity issue, low interest, similarity, and conflict avoidance. Only 17% of those with anorexia reported experiencing friendships as positive, relative to 82% of healthy controls and 52% of weight restored participants. Lastly, on self-report measures, participants with anorexia reported greater reliance on themselves versus others, greater use of care-seeking behaviors, and more fear/anger at the thought of losing an attachment figure (p < .05 in all cases). CONCLUSION: Results suggest that individuals with anorexia have particular challenges which interfere with the formation and maintenance of friendships, such as viewing friendships negatively and struggling with social comparisons in friendships. Assessing and addressing barriers to intimacy may motivate those with anorexia to relinquish dangerous symptoms that maintain the illness.}, Doi = {10.1371/journal.pone.0254110}, Key = {fds362833} } @article{fds352420, Author = {Datta, N and Bidopia, T and Datta, S and Mittal, G and Alphin, F and Marsh, EJ and Fitzsimons, GJ and Strauman, TJ and Zucker, NL}, Title = {Meal skipping and cognition along a spectrum of restrictive eating.}, Journal = {Eat Behav}, Volume = {39}, Pages = {101431}, Year = {2020}, Month = {December}, url = {http://dx.doi.org/10.1016/j.eatbeh.2020.101431}, Abstract = {OBJECTIVE: Inadequate nutrition adversely impacts brain development and cognitive functioning (Pollitt et al., 1983). Studies examining the acute impact of eating regular meals on cognition have reported inconsistent findings, necessitating the exploration of individual differences in samples contributing to equivocal results. The present study examines the impact of skipping lunch on cognitive ability in college-aged students by including eating restraint as a moderator. METHODS: Participants were 99 college-aged students (M = 19.7 years, SD = 1.5) randomized to a blinded 'lunch' or 'lunch-omission' condition, and assessed on memory, attention, processing speed, set shifting, and eating disorder symptomology. RESULTS: Regressing long and short-term memory on the lunch manipulation, eating restraint scores, and their interaction revealed significant interactions: those who had lunch had superior memory performance, but only for those reporting lower levels of eating restraint. Regressing set shifting speed on the manipulation, those who had lunch had slower set shifting speed than those who skipped, but only for those reporting lower levels of eating restraint. CONCLUSIONS: Results suggest that skipping lunch may have immediate consequences on cognition, however, cognitive enhancing effects may be diminished in the presence of even low levels of eating restraint. Findings highlight the significance of purported subclinical levels of eating restraint and may inform health education strategies.}, Doi = {10.1016/j.eatbeh.2020.101431}, Key = {fds352420} } @article{fds352093, Author = {Reinhardt, KM and Zerubavel, N and Young, AS and Gallo, M and Ramakrishnan, N and Henry, A and Zucker, NL}, Title = {A multi-method assessment of interoception among sexual trauma survivors.}, Journal = {Physiol Behav}, Volume = {226}, Pages = {113108}, Year = {2020}, Month = {November}, url = {http://dx.doi.org/10.1016/j.physbeh.2020.113108}, Abstract = {It is well established that many female sexual trauma survivors experience dissociation, particularly disconnection from the body, in the aftermath of sexual trauma. This study aims to address the open question of how sexual trauma is associated with awareness of inner body sensations (i.e., interoception). Given the important role that interoception has in emotion regulation, a process with which survivors often struggle, it is important to understand the associations between interoception and PTSD symptoms among survivors. Through multi-methods, we assessed associations between interoception, dissociation, and PTSD symptoms among 200 female sexual trauma survivors. We assessed two components of interoception: interoceptive accuracy (IAc: accurately perceiving internal body sensations; via heartbeat perception task) and interoceptive sensibility (IS: self-report perception of sensitivity to interoceptive sensations). We hypothesized that IAc and IS would be positively correlated with PTSD, with interactions between IAc/dissociation and IS/dissociation qualifying those main effects, weakening them for survivors with higher dissociation. Results showed an opposite pattern than was predicted: although IAc did explain significant PTSD variance, as IAc increased, PTSD decreased. Although IAc did explain significant variance in PTSD symptoms, interestingly, IS did not. Consistent with extant literature, dissociation predicted significant variance in PTSD. These correlational results suggest that the ability to more accurately perceive inner body sensations is related to lower PTSD symptoms. Findings provide a foundation for future research that can assess if interventions (such as yoga or exercise) that target increasing interoceptive accuracy lead to decreases in PTSD symptoms. We discuss further clinical implications, limitations and future directions.}, Doi = {10.1016/j.physbeh.2020.113108}, Key = {fds352093} } @article{fds349215, Author = {Calland, AR and Siegler, IC and Costa, PT and Ross, LM and Zucker, N and French, R and Hauser, E and Huffman, KM}, Title = {Associations of self-reported eating disorder behaviors and personality in a college-educated sample.}, Journal = {Appetite}, Volume = {151}, Pages = {104669}, Year = {2020}, Month = {August}, url = {http://dx.doi.org/10.1016/j.appet.2020.104669}, Abstract = {OBJECTIVE: In order to better understand factors motivating eating disorder (ED) behaviors and better identify persons at-risk for these behaviors, we sought to identify which personality domains and facets were associated with behaviors for weight control. METHODS: ED behavior information was gathered from the University of North Carolina Alumni Heart Study using the question, "have you ever used any of the following to lose weight?" Respondents endorsed any combination of the following: "Vomiting," "Fasting," "Laxatives," "Excessive physical exercise." Personality was measured using the Revised NEO Personality Inventory (NEO-PI-R). One-way ANOVAs were performed comparing personality domains and facets to reported ED behaviors, computed both as separate behaviors and the number of cumulative behaviors. RESULTS: Of 3496 respondents, 9.41% endorsed ever having used at least one ED behavior, with the majority endorsing only a single ED behavior. For both sexes, endorsing greater numbers of ED behaviors was associated with higher scores on Neuroticism and Openness. For women, the strongest associations for behaviors with personality were: excessive exercise with high Impulsiveness; fasting with high Impulsiveness and low Gregariousness; laxative use/purging with high scores on Activity and Feelings. For men, the strongest associations were: excessive exercise with high Impulsiveness; fasting with high Ideas; laxative use/purging with low Modesty. DISCUSSION: Data collected from this sample showed a sex-modulated pattern of association between personality domains and facets with ED behaviors. Our findings support that obtaining personality profiles of individuals exhibiting subclinical eating behaviors will enhance our understanding of who is at risk of developing an ED diagnosis.}, Doi = {10.1016/j.appet.2020.104669}, Key = {fds349215} } @article{fds348815, Author = {Fuemmeler, BF and Sheng, Y and Schechter, JC and Do, E and Zucker, N and Majors, A and Maguire, R and Murphy, SK and Hoyo, C and Kollins, SH}, Title = {Associations between attention deficit hyperactivity disorder symptoms and eating behaviors in early childhood.}, Journal = {Pediatr Obes}, Volume = {15}, Number = {7}, Pages = {e12631}, Year = {2020}, Month = {July}, url = {http://dx.doi.org/10.1111/ijpo.12631}, Abstract = {BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) symptoms have been linked with eating behaviors and obesity adolescence and young adulthood. Yet, little is known about whether these associations occur during early childhood and few studies have examined these associations prospectively. OBJECTIVES: To assess magnitude and direction of associations between childhood ADHD symptoms and eating behaviors. METHODS: Participants were from the Newborn Epigenetics Study (N = 470, M age = 4 years). Multivariable linear regression models were used to examine cross-sectional associations between ADHD symptoms and eating behaviors. Latent Change Score (LCS) modeling was performed to examine prospective association among a subset of children with available follow-up data. (N = 100, M age = 7 years). RESULTS: The cross-sectional results showed that attention problem (AP) and hyperactivity (HY) were positively associated with food responsiveness, emotional overeating, desire to drink, and slowness in eating. AP, but not HY, was inversely associated with enjoyment of food. Results of the LCS models revealed AP and HY were both positively associated with prospective changes in emotional overeating and satiety responsiveness. AP was further positively associated with prospective changes in food responsiveness. The reverse relationship predicting changes in ADHD symptoms from earlier assessments of eating behaviors was not significant. CONCLUSION: Results suggest a link between ADHD symptoms and obesity-related eating behaviors in early childhood, highlighting the need to address self-regulation and healthy eating behaviors in the prevention of childhood obesity.}, Doi = {10.1111/ijpo.12631}, Key = {fds348815} } @article{fds354260, Author = {Armstrong, SC and Windom, M and Bihlmeyer, NA and Li, JS and Shah, SH and Story, M and Zucker, N and Kraus, WE and Pagidipati, N and Peterson, E and Wong, C and Wiedemeier, M and Sibley, L and Berchuck, SI and Merrill, P and Zizzi, A and Sarria, C and Dressman, HK and Rawls, JF and Skinner, AC}, Title = {Rationale and design of "Hearts & Parks": study protocol for a pragmatic randomized clinical trial of an integrated clinic-community intervention to treat pediatric obesity.}, Journal = {BMC Pediatr}, Volume = {20}, Number = {1}, Pages = {308}, Year = {2020}, Month = {June}, url = {http://dx.doi.org/10.1186/s12887-020-02190-x}, Abstract = {BACKGROUND: The prevalence of child and adolescent obesity and severe obesity continues to increase despite decades of policy and research aimed at prevention. Obesity strongly predicts cardiovascular and metabolic disease risk; both begin in childhood. Children who receive intensive behavioral interventions can reduce body mass index (BMI) and reverse disease risk. However, delivering these interventions with fidelity at scale remains a challenge. Clinic-community partnerships offer a promising strategy to provide high-quality clinical care and deliver behavioral treatment in local park and recreation settings. The Hearts & Parks study has three broad objectives: (1) evaluate the effectiveness of the clinic-community model for the treatment of child obesity, (2) define microbiome and metabolomic signatures of obesity and response to lifestyle change, and (3) inform the implementation of similar models in clinical systems. METHODS: Methods are designed for a pragmatic randomized, controlled clinical trial (n = 270) to test the effectiveness of an integrated clinic-community child obesity intervention as compared with usual care. We are powered to detect a difference in body mass index (BMI) between groups at 6 months, with follow up to 12 months. Secondary outcomes include changes in biomarkers for cardiovascular disease, psychosocial risk, and quality of life. Through collection of biospecimens (serum and stool), additional exploratory outcomes include microbiome and metabolomics biomarkers of response to lifestyle modification. DISCUSSION: We present the study design, enrollment strategy, and intervention details for a randomized clinical trial to measure the effectiveness of a clinic-community child obesity treatment intervention. This study will inform a critical area in child obesity and cardiovascular risk research-defining outcomes, implementation feasibility, and identifying potential molecular mechanisms of treatment response. CLINICAL TRIAL REGISTRATION: NCT03339440 .}, Doi = {10.1186/s12887-020-02190-x}, Key = {fds354260} } @article{fds349933, Author = {Zucker, NL and Hughes, SO}, Title = {The Persistence of Picky Eating: Opportunities to Improve Our Strategies and Messaging.}, Journal = {Pediatrics}, Volume = {145}, Number = {6}, Pages = {e20200893}, Year = {2020}, Month = {June}, url = {http://dx.doi.org/10.1542/peds.2020-0893}, Doi = {10.1542/peds.2020-0893}, Key = {fds349933} } @article{fds348933, Author = {Zucker, NL and Bulik, CM}, Title = {On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa.}, Journal = {Int J Eat Disord}, Volume = {53}, Number = {4}, Pages = {508-512}, Year = {2020}, Month = {April}, url = {http://dx.doi.org/10.1002/eat.23255}, Abstract = {Gastrointestinal (GI) symptoms are common in anorexia nervosa (AN), can predate illness onset, complicate renourishment, and persist after recovery. We explore how, through processes of aversive visceral conditioning, early GI pain and discomfort may increase vulnerability to AN in some individuals. Processes include enhanced preoccupation with the gut resulting from aversive visceral memories and disruptions in the typical acquisition of self-attunement when children learn to map and interpret interoceptive sensations and develop adaptive actions. We question whether a fear of weight gain, in some cases, may be an epiphenomenon of the recapitulation of actual or perceived GI symptoms that is especially relevant during puberty, especially in girls. This conceptualization has immediate clinical implications and offers ideas for future research. We propose that GI discomfort associated with renourishment may reignite prior aversive visceral experiences. We encourage development of a formulation that organizes the individual's current experience of the body with respect to these prior aversive experiences. Our conceptualization underscores the importance of assessment of GI experiences in individuals with AN; the examination of dietary strategies that minimize GI symptoms and enhance renourishment efficacy; and strategies that attempt to alter this aversive visceral conditioning by mapping sensations to meanings and adaptive actions.}, Doi = {10.1002/eat.23255}, Key = {fds348933} } @article{fds348816, Author = {Surwit, RS and Williams, RB and Siegler, IC and Lane, JD and Helms, M and Applegate, KL and Zucker, N and Feinglos, MN and McCaskill, CM and Barefoot, JC}, Title = {Erratum. Hostility, race, and glucose metabolism in nondiabetic individuals. Diabetes Care 2002;25:835-839.}, Journal = {Diabetes Care}, Volume = {43}, Number = {3}, Pages = {691}, Year = {2020}, Month = {March}, url = {http://dx.doi.org/10.2337/dc20-er03}, Doi = {10.2337/dc20-er03}, Key = {fds348816} } @article{fds347212, Author = {Amoroso, CR and Hanna, EK and LaBar, KS and Schaich Borg and J and Sinnott-Armstrong, W and Zucker, NL}, Title = {Disgust Theory Through the Lens of Psychiatric Medicine}, Journal = {Clinical Psychological Science}, Volume = {8}, Number = {1}, Pages = {3-24}, Year = {2020}, Month = {January}, url = {http://dx.doi.org/10.1177/2167702619863769}, Abstract = {The elicitors of disgust are heterogeneous, which makes attributing one function to disgust challenging. Theorists have proposed that disgust solves multiple adaptive problems and comprises multiple functional domains. However, theories conflict with regard to what the domains are and how they should be delineated. In this article, we examine clinical evidence of aberrant disgust symptoms in the contamination subtype of obsessive-compulsive disorder, blood-injury-injection phobia, and posttraumatic stress disorder to adjudicate between two prevailing theories of disgust. We argue that the pattern of disgust sensitivities in these psychiatric disorders sheds new light on the domain structure of disgust. Specifically, the supported domain structure of disgust is likely similar to an adaptationist model of disgust, with more subdivisions of the domain of pathogen disgust. We discuss the implications of this approach for the prevention and treatment of psychiatric disorders relevant to disgust.}, Doi = {10.1177/2167702619863769}, Key = {fds347212} } @article{fds345918, Author = {Bardone-Cone, AM and Johnson, S and Raney, TJ and Zucker, N and Watson, HJ and Bulik, CM}, Title = {Eating disorder recovery in men: A pilot study.}, Journal = {Int J Eat Disord}, Volume = {52}, Number = {12}, Pages = {1370-1379}, Year = {2019}, Month = {December}, url = {http://dx.doi.org/10.1002/eat.23153}, Abstract = {OBJECTIVE: This pilot study examined the validity of a comprehensive definition of recovery (physical, behavioral, and cognitive recovery indices) for the first time in men. METHOD: Men with an eating disorder history were recruited from former patients at eating disorder centers, university campuses, and fitness centers/gyms. At baseline and a 12-month follow-up, data were collected via online surveys, diagnostic interviews, and measured weight and height from men with an eating disorder history (n = 36) and men with no eating disorder history (n = 27). RESULTS: Of the men with an eating disorder history, 15 met criteria for an eating disorder, 7 met criteria for partial recovery, and 5 for full recovery. Men who met criteria for full recovery did not differ significantly from men with no eating disorder history and had significantly lower levels of broad eating pathology, thinness and restricting expectancies, body shame, difficulties in stopping thoughts about body, food, or exercise, and male body attitudes related to muscularity and body fat than men with an eating disorder. Men meeting criteria for full recovery had higher levels of body acceptance and intuitive eating than men who met criteria for partial recovery or an eating disorder. In terms of predictive validity, of those fully recovered at baseline, 60% also met full recovery criteria at follow-up. DISCUSSION: Preliminary findings suggest that a comprehensive definition of recovery applies to men. Although research with larger samples is needed, this research provides some optimism for the potential of recovery in men.}, Doi = {10.1002/eat.23153}, Key = {fds345918} } @article{fds340616, Author = {Carpenter, KLH and Baranek, GT and Copeland, WE and Compton, S and Zucker, N and Dawson, G and Egger, HL}, Title = {Sensory Over-Responsivity: An Early Risk Factor for Anxiety and Behavioral Challenges in Young Children.}, Journal = {J Abnorm Child Psychol}, Volume = {47}, Number = {6}, Pages = {1075-1088}, Year = {2019}, Month = {June}, url = {http://dx.doi.org/10.1007/s10802-018-0502-y}, Abstract = {Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.}, Doi = {10.1007/s10802-018-0502-y}, Key = {fds340616} } @article{fds341941, Author = {Harris, AA and Romer, AL and Hanna, EK and Keeling, LA and LaBar, KS and Sinnott-Armstrong, W and Strauman, TJ and Wagner, HR and Marcus, MD and Zucker, NL}, Title = {The central role of disgust in disorders of food avoidance.}, Journal = {Int J Eat Disord}, Volume = {52}, Number = {5}, Pages = {543-553}, Year = {2019}, Month = {May}, url = {http://dx.doi.org/10.1002/eat.23047}, Abstract = {BACKGROUND: Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction. METHOD: This exploratory, cross-sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self-reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering. RESULTS: A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust. CONCLUSIONS: Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment.}, Doi = {10.1002/eat.23047}, Key = {fds341941} } @article{fds341412, Author = {Katzman, DK and Norris, ML and Zucker, N}, Title = {Avoidant restrictive food intake disorder: First do no harm.}, Journal = {Int J Eat Disord}, Volume = {52}, Number = {4}, Pages = {459-461}, Year = {2019}, Month = {April}, url = {http://dx.doi.org/10.1002/eat.23021}, Abstract = {OBJECTIVE: This opinion piece offers some considerations, both medical and psychological, for the use of nasogastric tube (NGT) feedings in the treatment of avoidant restrictive food intake disorder (ARFID) in children and adolescents. METHOD: Although there is empirical support for the use of NGT feedings in the treatment of anorexia nervosa, this evidence base does not exist for the treatment of ARFID. As such, there is need to delineate pragmatic considerations in the use of this procedure. RESULTS: Issues of medical necessity notwithstanding, we advise that the use of this procedure be considered more cautiously due to the oral sensitivities inherent in many individuals with ARFID and the potential psychological consequences. These sensitivities may make the experience of NGT feedings particularly aversive, with the potential of creating iatrogenic conditioned food aversions. DISCUSSION: This article encourages clinicians to give careful thought and attention when considering NGT feedings in children and adolescents with ARFID.}, Doi = {10.1002/eat.23021}, Key = {fds341412} } @article{fds341569, Author = {Eddy, KT and Harshman, SG and Becker, KR and Bern, E and Bryant-Waugh, R and Hilbert, A and Katzman, DK and Lawson, EA and Manzo, LD and Menzel, J and Micali, N and Ornstein, R and Sally, S and Serinsky, SP and Sharp, W and Stubbs, K and Walsh, BT and Zickgraf, H and Zucker, N and Thomas, JJ}, Title = {Radcliffe ARFID Workgroup: Toward operationalization of research diagnostic criteria and directions for the field.}, Journal = {Int J Eat Disord}, Volume = {52}, Number = {4}, Pages = {361-366}, Year = {2019}, Month = {April}, url = {http://dx.doi.org/10.1002/eat.23042}, Abstract = {OBJECTIVE: Since its introduction to the psychiatric nomenclature in 2013, research on avoidant/restrictive food intake disorder (ARFID) has proliferated highlighting lack of clarity in how ARFID is defined. METHOD: In September 2018, a small multi-disciplinary pool of international experts in feeding disorder and eating disorder clinical practice and research convened as the Radcliffe ARFID workgroup to consider operationalization of DSM-5 ARFID diagnostic criteria to guide research in this disorder. RESULTS: By consensus of the Radcliffe ARFID workgroup, ARFID eating is characterized by food avoidance and/or restriction, involving limited volume and/or variety associated with one or more of the following: weight loss or faltering growth (e.g., defined as in anorexia nervosa, or by crossing weight/growth percentiles); nutritional deficiencies (defined by laboratory assay or dietary recall); dependence on tube feeding or nutritional supplements (≥50% of daily caloric intake or any tube feeding not required by a concurrent medical condition); and/or psychosocial impairment. CONCLUSIONS: This article offers definitions on how best to operationalize ARFID criteria and assessment thereof to be tested in existing clinical populations and to guide future study to advance understanding and treatment of this heterogeneous disorder.}, Doi = {10.1002/eat.23042}, Key = {fds341569} } @article{fds340793, Author = {Zucker, NL and LaVia, MC and Craske, MG and Foukal, M and Harris, AA and Datta, N and Savereide, E and Maslow, GR}, Title = {Feeling and body investigators (FBI): ARFID division-An acceptance-based interoceptive exposure treatment for children with ARFID.}, Journal = {Int J Eat Disord}, Volume = {52}, Number = {4}, Pages = {466-472}, Year = {2019}, Month = {April}, url = {http://dx.doi.org/10.1002/eat.22996}, Abstract = {OBJECTIVE: Individuals with Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing health consequences from insufficient nutritional variety and/or quantity. Early medical conditions and/or somatic symptoms such as abdominal pain may lead some with ARFID to experience somatic sensations as aversive. As such, food avoidance may be part of a broader behavioral repertoire aimed at suppressing bodily sensations. Avoiding these necessary and informative signals (e.g., growls of hunger) may subvert the emergence of healthy self-awareness and self-regulation. Teaching children with ARFID to engage adaptively with bodily sensations may help decrease aversiveness, increase self-awareness, and increase approach behaviors. METHOD: Drawing from interventions for panic disorder and irritable bowel syndrome, we developed an acceptance-based interoceptive exposure treatment for young children with ARFID, Feeling and Body Investigators (FBI)-ARFID Division. Using playful cartoons and developmentally sensitive exposures, we teach young children how to map interoceptive sensations onto meanings (e.g., emotions) and actions (e.g., if I feel nervous, I'll hold someone's hand). RESULTS: We present a case study of a 4-year old child with lifelong poor appetite/food indifference. DISCUSSION: Some individuals with ARFID may avoid food to avoid internal sensations. Developmentally appropriate interoceptive exposures may decrease ARFID symptoms while increasing more general self-regulation skills.}, Doi = {10.1002/eat.22996}, Key = {fds340793} } @article{fds340617, Author = {Katzman, DK and Norris, ML and Zucker, N}, Title = {Avoidant Restrictive Food Intake Disorder.}, Journal = {Psychiatr Clin North Am}, Volume = {42}, Number = {1}, Pages = {45-57}, Publisher = {Elsevier BV}, Year = {2019}, Month = {March}, url = {http://dx.doi.org/10.1016/j.psc.2018.10.003}, Abstract = {Avoidant restrictive food intake disorder (ARFID) is a rearticulated eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5), published in 2013. The purpose of this article is to review what is known about ARFID; specifically outline the DSM-5 diagnostic criteria; review the epidemiology; describe the clinical characteristics of patients with this disorder; and discuss evolving treatment approaches. Although this disorder occurs across the lifespan, the focus of recent research has been primarily in children and adolescents with ARFID. Therefore, most of this article is devoted to children and adolescents with ARFID.}, Doi = {10.1016/j.psc.2018.10.003}, Key = {fds340617} } @article{fds343310, Author = {Fuemmeler, BF and Zucker, N and Sheng, Y and Sanchez, CE and Maguire, R and Murphy, SK and Kollins, SH and Hoyo, C}, Title = {Pre-Pregnancy Weight and Symptoms of Attention Deficit Hyperactivity Disorder and Executive Functioning Behaviors in Preschool Children.}, Journal = {Int J Environ Res Public Health}, Volume = {16}, Number = {4}, Year = {2019}, Month = {February}, url = {http://dx.doi.org/10.3390/ijerph16040667}, Abstract = {This study examines pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG) in relation to early childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms and related executive self-regulation behaviors. The analyses sample (n = 331) included a subsample of participants from a birth cohort recruited from prenatal clinics and hospital facilities from April 2005 to June 2011 in Durham, North Carolina. Pre-pregnancy BMI was calculated from weight at the last menstrual period and height was extracted from medical records. Gestational weight gain was calculated from pre-pregnancy weight and weight measured at the time of delivery. ADHD symptoms and executive self-regulation behaviors were assessed by maternal report (mean age = 3 years). Multivariable regression methods with inverse probability weighting (IPW) were used to evaluate associations accounting for sample selection bias and confounding. Pre-pregnancy BMI at levels ≥35 was positively associated with higher ADHD symptoms and worse executive self-regulation behaviors (inhibitory control and attention). Compared to adequate GWG, less than adequate GWG was related to more ADHD hyperactive-impulsive symptoms, whereas greater than adequate GWG was related to more problematic behaviors related to working memory and planning. The findings support a link between maternal weight and child neurodevelopment. Continued research that help identify biological mechanisms are needed.}, Doi = {10.3390/ijerph16040667}, Key = {fds343310} } @article{fds338443, Author = {Do, EK and Zucker, NL and Huang, ZY and Schechter, JC and Kollins, SH and Maguire, RL and Murphy, SK and Hoyo, C and Fuemmeler, BF}, Title = {Associations between imprinted gene differentially methylated regions, appetitive traits and body mass index in children.}, Journal = {Pediatr Obes}, Volume = {14}, Number = {2}, Pages = {e12454}, Year = {2019}, Month = {February}, url = {http://dx.doi.org/10.1111/ijpo.12454}, Abstract = {BACKGROUND: Knowledge regarding genetic influences on eating behaviours is expanding; yet less is known regarding contributions of epigenetic variation to appetitive traits and body mass index (BMI) in children. OBJECTIVE: The purpose of this study was to explore relationships between methylation at differentially methylated regions (DMRs) of imprinted genes (insulin-like growth factor 2/H19 and Delta-like, Drosophila, homolog 1/maternally expressed gene 3) using DNA extracted from umbilical cord blood leucocytes, two genetically influenced appetitive traits (food responsiveness and satiety responsiveness) and BMI. METHODS: Data were obtained from participants (N = 317; mean age = 3.6 years; SD = 1.8 years) from the Newborn Epigenetic STudy. Conditional process models were implemented to investigate the associations between DMRs of imprinted genes and BMI, and test whether this association was mediated by appetitive traits and birthweight and moderated by sex. RESULTS: Appetitive traits and birthweight did not mediate the relationship between methylation at DMRs. Increased insulin-like growth factor 2 DMR methylation was associated with higher satiety responsiveness. Higher satiety responsiveness was associated with lower BMI. Associations between methylation at DMRs, appetitive traits and BMI differed by sex. CONCLUSIONS: This is one of the first studies to demonstrate associations between epigenetic variation established prior to birth with appetitive traits and BMI in children, providing support for the need to uncover genetic and epigenetic mechanisms for appetitive traits predisposing some individuals to obesity.}, Doi = {10.1111/ijpo.12454}, Key = {fds338443} } @article{fds366414, Author = {Loeb, KL and Weissman, RS and Marcus, S and Pattanayak, C and Hail, L and Kung, KC and Schron, D and Zucker, N and Le Grange and D and Lock, J and Newcorn, JH and Taylor, CB and Walsh, BT}, Title = {Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study.}, Journal = {Front Psychiatry}, Volume = {10}, Pages = {985}, Year = {2019}, url = {http://dx.doi.org/10.3389/fpsyt.2019.00985}, Abstract = {UNLABELLED: This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT00418977.}, Doi = {10.3389/fpsyt.2019.00985}, Key = {fds366414} } @article{fds336103, Author = {Brown, M and Loeb, KL and McGrath, RE and Tiersky, L and Zucker, N and Carlin, A}, Title = {Executive functioning and central coherence in anorexia nervosa: Pilot investigation of a neurocognitive endophenotype.}, Journal = {Eur Eat Disord Rev}, Volume = {26}, Number = {5}, Pages = {489-498}, Year = {2018}, Month = {September}, url = {http://dx.doi.org/10.1002/erv.2597}, Abstract = {A neurocognitive profile characterized by problems in set shifting, executive functioning, and central coherence may pre-date and maintain anorexia nervosa (AN). To test this pattern as a possible endophenotype for AN, 10 youth with current AN, 14 healthy youth, and their biological parents, participated in a neuropsychological battery. Youth with AN demonstrated significantly weaker central coherence, related to enhanced detail-focused processing. Youth with AN and their parents demonstrated significantly greater psychopathology relative to controls, and youth-parent scores were significantly correlated. The study, limited by a small sample size, found little evidence supporting a neuropsychological endophenotype for AN. Identifying a neurocognitive profile for children and adolescents with AN has important implications for the treatment of young patients.}, Doi = {10.1002/erv.2597}, Key = {fds336103} } @article{fds336102, Author = {Khalsa, SS and Adolphs, R and Cameron, OG and Critchley, HD and Davenport, PW and Feinstein, JS and Feusner, JD and Garfinkel, SN and Lane, RD and Mehling, WE and Meuret, AE and Nemeroff, CB and Oppenheimer, S and Petzschner, FH and Pollatos, O and Rhudy, JL and Schramm, LP and Simmons, WK and Stein, MB and Stephan, KE and Van den Bergh, O and Van Diest and I and von Leupoldt, A and Paulus, MP and Interoception Summit 2016 participants}, Title = {Interoception and Mental Health: A Roadmap.}, Journal = {Biol Psychiatry Cogn Neurosci Neuroimaging}, Volume = {3}, Number = {6}, Pages = {501-513}, Publisher = {Elsevier BV}, Year = {2018}, Month = {June}, url = {http://dx.doi.org/10.1016/j.bpsc.2017.12.004}, Abstract = {Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body's internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This review article presents an overview of the emerging consensus generated by the meeting.}, Doi = {10.1016/j.bpsc.2017.12.004}, Key = {fds336102} } @article{fds336104, Author = {Dozmorov, MG and Bilbo, SD and Kollins, SH and Zucker, N and Do, EK and Schechter, JC and Zhang, JJ and Murphy, SK and Hoyo, C and Fuemmeler, BF}, Title = {Associations between maternal cytokine levels during gestation and measures of child cognitive abilities and executive functioning.}, Journal = {Brain Behav Immun}, Volume = {70}, Pages = {390-397}, Year = {2018}, Month = {May}, url = {http://dx.doi.org/10.1016/j.bbi.2018.03.029}, Abstract = {Preclinical studies demonstrate that environmentally-induced alterations in inflammatory cytokines generated by the maternal and fetal immune system can significantly impact fetal brain development. Yet, the relationship between maternal cytokines during gestation and later cognitive ability and executive function remains understudied. Children (n = 246) were born of mothers enrolled in the Newborn Epigenetic Study - a prospective pre-birth cohort in the Southeastern US. We characterized seven cytokines [IL-1β, IL-4,IL-6, IL-12p70, IL-17A, tumor necrosis factor-α (TNFα), and interferon-γ (IFNγ)] and one chemokine (IL-8) from maternal plasma collected during pregnancy. We assessed children's cognitive abilities and executive functioning at a mean age of 4.5 (SD = 1.1) years. Children's DAS-II and NIH toolbox scores were regressed on cytokines and the chemokine, controlling for maternal age, race, education, body mass index, IQ, parity, smoking status, delivery type, gestational weeks, and child birth weight and sex. Higher IL-12p70 (βIL-12p70 = 4.26, p = 0.023) and IL-17A (βIL-17A = 3.70, p = 0.042) levels were related to higher DAS-II GCA score, whereas higher IL-1β (βIL-1B = -6.07, p = 0.003) was related to lower GCA score. Higher IL-12p70 was related to higher performance on NIH toolbox measures of executive functions related to inhibitory control and attention (βIL-12p70 = 5.20, p = 0.046) and cognitive flexibility (βIL-12p70 = 5.10, p = 0.047). Results suggest that dysregulation in gestational immune activity are associated with child cognitive ability and executive functioning.}, Doi = {10.1016/j.bbi.2018.03.029}, Key = {fds336104} } @article{fds333555, Author = {Loeb, KL and Radnitz, C and Keller, KL and Schwartz, MB and Zucker, N and Marcus, S and Pierson, RN and Shannon, M and DeLaurentis, D}, Title = {The Application of Optimal Defaults to Improve Elementary School Lunch Selections: Proof of Concept.}, Journal = {J Sch Health}, Volume = {88}, Number = {4}, Pages = {265-271}, Publisher = {WILEY}, Year = {2018}, Month = {April}, url = {http://dx.doi.org/10.1111/josh.12611}, Abstract = {BACKGROUND: In this study, we applied behavioral economics to optimize elementary school lunch choices via parent-driven decisions. Specifically, this experiment tested an optimal defaults paradigm, examining whether strategically manipulating the health value of a default menu could be co-opted to improve school-based lunch selections. METHODS: The design was a randomized comparison of optimal versus suboptimal (standard) default lunch menus for all first-graders in a school district for a period of 1 week. We hypothesized that making the default lunch option healthier, while providing parents the opportunity to access and choose from the standard school menu for their child, would yield more frequent selection of healthier items than when the default option was suboptimal. RESULTS: Overall, 127 (93%) first-grade children's families participated. Among those families randomized to receive the nutritionally optimized default menu, all but one remained with these options; of those parents randomized to the standard menu (suboptimal default), all parents remained with these options (Χ2 = 123.06, df = 1, p < .001). CONCLUSIONS: The mere positioning of choices, without restricting options, significantly affected which menu items the children received during the test period. Results are proof of concept for a strategy to increase health-promoting school lunch content, procedures, and policies.}, Doi = {10.1111/josh.12611}, Key = {fds333555} } @article{fds332828, Author = {Norris, ML and Spettigue, W and Hammond, NG and Katzman, DK and Zucker, N and Yelle, K and Santos, A and Gray, M and Obeid, N}, Title = {Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder.}, Journal = {Int J Eat Disord}, Volume = {51}, Number = {2}, Pages = {170-173}, Year = {2018}, Month = {February}, url = {http://dx.doi.org/10.1002/eat.22814}, Abstract = {OBJECTIVE: To examine characteristics of patients with Avoidant/Restrictive Food Intake Disorder (ARFID) in an effort to identify and describe subtypes of the disorder. METHOD: A retrospective chart review was completed for patients aged 8-17 years assessed over a 17-year period. RESULTS: Seventy-seven patients were included in the study, the majority of whom were female (n = 56, 73%). The average age of patients was 13.7 years (SD = 2.4 years). Three specific subtypes of ARFID (aligning with example presentations outlined in the DSM-5) were identified: (a) those with weight loss and/or medical compromise as a consequence of apparent lack of interest in eating (n = 30, 39%); (b) restriction arising as a result of sensory sensitivity (n = 14, 18%); and (c) restriction based upon food avoidance and/or fear of aversive consequences of eating (n = 33, 43%). Clinical characteristics of patients varied depending on the assigned subtype. DISCUSSION: Our findings highlight the need for further research into the relative merit of subtype-assignment in patients with ARFID and whether such practice would aid in the recommended treatment. Further research is required to understand whether these categories are generalizable and applicable to other samples such as young children or adults with ARFID, and how treatment options might differ according to subtype.}, Doi = {10.1002/eat.22814}, Key = {fds332828} } @article{fds331887, Author = {Egbert, AH and Wilfley, DE and Eddy, KT and Boutelle, KN and Zucker, N and Peterson, CB and Celio Doyle and A and Le Grange and D and Goldschmidt, AB}, Title = {Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Overeating with and without Loss of Control in Youth with Overweight/Obesity.}, Journal = {Child Obes}, Volume = {14}, Number = {1}, Pages = {50-57}, Year = {2018}, Month = {January}, url = {http://dx.doi.org/10.1089/chi.2017.0114}, Abstract = {BACKGROUND: There is growing evidence that attention-deficit/hyperactivity disorder (ADHD) and loss of control (LOC) eating, both prevalent in children and adolescents, may be related to one another. However, the relationship between ADHD and overeating without LOC has been largely unexamined, thus precluding an understanding of the independent contributions of LOC and episode size in these associations. The current study sought to examine associations between ADHD symptoms and maladaptive eating by evaluating three different types of eating episodes characterized by the presence/absence of LOC and the amount of food consumed: objectively large LOC episodes [objective binge eating (OBE)], subjectively large binge episodes [subjective binge eating (SBE)], and objectively large overeating episodes without LOC [objective overeating (OO)]. METHODS: Participants were 385 youth (M age = 10.89, SD = 2.25) drawn from five different research protocols at institutions across the United States. Participants and their parents completed questionnaires and semistructured interviews to assess ADHD symptoms, OBE, SBE, and OO. RESULTS: As hypothesized, negative binomial regressions revealed that ADHD symptoms were significantly associated with OBE, χ2(1) = 16.61, p < 0.001, and with OO, χ2(1) = 10.64, p < 0.01. Contrary to expectations, they were not associated with SBE. CONCLUSIONS: These results indicate the need for future studies to explore possible shared mechanisms (e.g., impulsivity) underlying associations between ADHD symptoms, OBE, and OO. Clinical implications include support for considering ADHD symptoms in programs that target both prevention of LOC eating and obesity more generally.}, Doi = {10.1089/chi.2017.0114}, Key = {fds331887} } @article{fds332386, Author = {Merwin, RM and Moskovich, AA and Honeycutt, LK and Lane, JD and Feinglos, M and Surwit, RS and Zucker, NL and Dmitrieva, NO and Babyak, MA and Batchelder, H and Mooney, J}, Title = {Time of Day When Type 1 Diabetes Patients With Eating Disorder Symptoms Most Commonly Restrict Insulin.}, Journal = {Psychosom Med}, Volume = {80}, Number = {2}, Pages = {222-229}, Year = {2018}, url = {http://dx.doi.org/10.1097/PSY.0000000000000550}, Abstract = {OBJECTIVE: Restricting insulin to lose weight is a significant problem in the clinical management of type 1 diabetes (T1D). Little is known about this behavior or how to effectively intervene. Identifying when insulin restriction occurs could allow clinicians to target typical high-risk times or formulate hypotheses regarding factors that influence this behavior. The current study investigated the frequency of insulin restriction by time of day. METHODS: Fifty-nine adults with T1D and eating disorder symptoms completed 72 hours of real-time reporting of eating and insulin dosing with continuous glucose monitoring. We used a generalized estimating equation model to test the global hypothesis that frequency of insulin restriction (defined as not taking enough insulin to cover food consumed) varied by time of day, and examined frequency of insulin restriction by hour. We also examined whether patterns of insulin restriction for 72 hours corresponded with patients' interview reports of insulin restriction for the past 28 days. RESULTS: Frequency of insulin restriction varied as a function of time (p = .016). Insulin restriction was the least likely in the morning hours (6:00-8:59 AM), averaging 6% of the meals/snacks consumed. Insulin restriction was more common in the late afternoon (3:00-5:59 PM), peaking at 29%. Insulin was restricted for 32% of the meals/snacks eaten overnight (excluding for hypoglycemia); however, overnight eating was rare. Insulin restriction was associated with higher 120-minute postprandial blood glucose (difference = 44.4 mg/dL, 95% confidence interval = 22.7-68.5, p < .001) and overall poorer metabolic control (r = 0.43-0.62, p's < .01). Patients reported restricting insulin for a greater percentage of meals and snacks for the past 28 days than during the 72 hour real-time assessment; however, the reports were correlated (Spearman's ρ = 0.46, p < .001) and accounted for similar variance in HbA1c (34% versus 35%, respectively). CONCLUSIONS: Findings suggest that insulin restriction may be less likely in the morning, and that late afternoon is a potentially important time for additional therapeutic support. Results also suggest that systematic clinical assessment and treatment of overnight eating might improve T1D management.}, Doi = {10.1097/PSY.0000000000000550}, Key = {fds332386} } @article{fds340091, Author = {Sweitzer, MM and Watson, KK and Erwin, SR and Winecoff, AA and Datta, N and Huettel, S and Platt, ML and Zucker, NL}, Title = {Neurobiology of social reward valuation in adults with a history of anorexia nervosa.}, Journal = {PLoS One}, Volume = {13}, Number = {12}, Pages = {e0205085}, Year = {2018}, url = {http://dx.doi.org/10.1371/journal.pone.0205085}, Abstract = {OBJECTIVE: Anorexia nervosa (AN) is a disorder characterized by atypical patterns of reward valuation (e.g. positive valuation of hunger). Atypical reward processing may extend into social domains. If so, such findings would be of prognostic significance as impaired social functioning predicts worse outcome. We explore neural circuits implicated in social reward processing in individuals with a history of AN who are weight-restored relative to controls and examine the effects of illness course on the experience of social value. METHOD: 20 weight-restored individuals with a history of AN (AN-WR) and 24 healthy control (HC) participants were assessed using fMRI tasks that tapped social reward: smiling faces and full human figures that varied in attractiveness and weight. RESULTS: AN-WR differed from HC in attractiveness ratings by weight (negatively correlated in AN-WR). While there were no significant differences when viewing smiling faces, viewing full figures resulted in decreased activation in regions implicated in reward valuation (the right caudate) for AN-WR and this region was negatively correlated with a sustained course of the disorder. Exploratory whole brain analyses revealed reduced activation in regions associated with social reward, self-referential processing, and cognitive reappraisal (e.g., medial prefrontal cortex, striatum, and nucleus accumbens) with sustained disorder course. DISCUSSION: The rewarding value of full body images decreases with a sustained disorder course. This may reflect an extension of atypical reward processing documented in AN-WR, perhaps as a function of starvation dampening visceral motivational signals; the deployment of cognitive strategies that lessen the experience of reward; and/or the nature of the stimuli themselves as provocative of eating disorder symptoms (e.g., thin bodies). These findings did not extend to smiling face stimuli. Advances in technology (e.g., virtual avatars, text messaging) may provide novel means to build relationships, including therapeutic relationships, to support improved social connections without threats to symptom provocation.}, Doi = {10.1371/journal.pone.0205085}, Key = {fds340091} } @article{fds336105, Author = {Shafer, A and Patel, SJ and Bulik, CM and Zucker, N}, Title = {Experimental pretesting of message framing to motivate caregiver self-care among parents of children with eating disorders}, Journal = {Journal of Applied Biobehavioral Research}, Volume = {22}, Number = {4}, Pages = {e12092-e12092}, Publisher = {WILEY}, Year = {2017}, Month = {December}, url = {http://dx.doi.org/10.1111/jabr.12092}, Abstract = {The purpose of this study was to examine the effects of message framing strategies and approach avoidance trait moderators on health communication intervention messages aimed at encouraging adaptive coping among parents of those children with eating disorders (PCEDs). Parents of children with eating disorders (N = 108) were randomly assigned in a three-condition (gain frame, loss frame, and control) online message pretesting experiment. Outcome measures included decisional balance (Transtheoretical Model) and behavioral intentions. Gain frames were more beneficial in promoting adaptive behaviors among PCEDs, as loss frames were often harmful. Findings are qualified by approach/avoidance moderator interactions. Formative research benefits from incorporating experimental pretesting methods. Interventions using framed messages should consider relevant personality traits that serve as moderators to behavior adoption.}, Doi = {10.1111/jabr.12092}, Key = {fds336105} } @article{fds328297, Author = {Zucker, N and Mauro, C and Craske, M and Wagner, HR and Datta, N and Hopkins, H and Caldwell, K and Kiridly, A and Marsan, S and Maslow, G and Mayer, E and Egger, H}, Title = {Acceptance-based interoceptive exposure for young children with functional abdominal pain.}, Journal = {Behav Res Ther}, Volume = {97}, Pages = {200-212}, Year = {2017}, Month = {October}, url = {http://dx.doi.org/10.1016/j.brat.2017.07.009}, Abstract = {UNLABELLED: Functional abdominal pain (FAP) is a common childhood somatic complaint that contributes to impairment in daily functioning (e.g., school absences) and increases risk for chronic pain and psychiatric illness. Cognitive behavioral treatments for FAP target primarily older children (9 + years) and employ strategies to reduce a focus on pain. The experience of pain may be an opportunity to teach viscerally hypersensitive children to interpret the function of a variety of bodily signals (including those of hunger, emotions) thereby reducing fear of bodily sensations and facilitating emotion awareness and self-regulation. We designed and tested an interoceptive exposure treatment for younger children (5-9 years) with FAP. Assessments included diagnostic interviews, 14 days of daily pain monitoring, and questionnaires. Treatment involved 10 weekly appointments. Using cartoon characters to represent bodily sensations (e.g., Gassy Gus), children were trained to be "FBI agents" - Feeling and Body Investigators - who investigated sensations through exercises that provoked somatic experience. 24 parent-child dyads are reported. Pain (experience, distress, and interference) and negative affect demonstrated clinically meaningful and statistically significant change with effect sizes ranging from 0.48 to 71 for pain and from 0.38 to 0.61 for pain distress, total pain: X2 (1, n = 24) = 13.14, p < 0.0003. An intervention that helps children adopt a curious stance and focus on somatic symptoms reduces pain and may help lessen somatic fear generally. CLINICAL TRIAL REGISTRATION: NCT02075437.}, Doi = {10.1016/j.brat.2017.07.009}, Key = {fds328297} } @article{fds330052, Author = {Li, D and Zucker, NL and Kragel, PA and Covington, VE and LaBar, KS}, Title = {Adolescent development of insula-dependent interoceptive regulation.}, Journal = {Dev Sci}, Volume = {20}, Number = {5}, Year = {2017}, Month = {September}, url = {http://dx.doi.org/10.1111/desc.12438}, Abstract = {Adolescence is hypothesized to be a critical period for the maturation of self-regulatory capacities, including those that depend on interoceptive sensitivity, but the neural basis of interoceptive regulation in adolescence is unknown. We used functional magnetic resonance imaging and psychophysiology to study interoceptive regulation in healthy adolescent females. Participants regulated their gut activities in response to a virtual roller coaster by deep breathing aided by visually monitoring their online electrogastrogram (EGG) activity through a virtual thermometer (i.e. gut biofeedback), or without biofeedback. Analyses focused on the insula, given its putative role in interoception. The bilateral posterior insula showed increased activation in the no-biofeedback compared to biofeedback condition, suggesting that the participants relied more on interoceptive input when exteroceptive feedback was unavailable. The bilateral dorsal anterior insula showed activation linearly associated with age during both induction and regulation, and its activation during regulation correlated positively with change of EGG in the tachygastria frequency band from induction to regulation. Induction-related activation in the bilateral ventral anterior insula was nonlinearly associated with age and peaked at mid-adolescence. These results implicate different developmental trajectories of distinct sub-regions of the insula in interoceptive processes, with implications for competing neurobiological theories of female adolescent development.}, Doi = {10.1111/desc.12438}, Key = {fds330052} } @article{fds327423, Author = {Zucker, NL and Kragel, PA and Wagner, HR and Keeling, L and Mayer, E and Wang, J and Kang, MS and Merwin, R and Simmons, WK and LaBar, KS}, Title = {The Clinical Significance of Posterior Insular Volume in Adolescent Anorexia Nervosa.}, Journal = {Psychosom Med}, Volume = {79}, Number = {9}, Pages = {1025-1035}, Year = {2017}, url = {http://dx.doi.org/10.1097/PSY.0000000000000510}, Abstract = {OBJECTIVE: The diagnostic criterion disturbance in the experience of the body remains a poorly understood and persistent feature of anorexia nervosa (AN). Increased sophistication in understanding the structure of the insular cortex-a neural structure that receives and integrates visceral sensations with action and meaning-may elucidate the nature of this disturbance. We explored age, weight status, illness severity, and self-reported body dissatisfaction associations with insular cortex volume. METHODS: Structural magnetic resonance imaging data were collected from 21 adolescents with a history of AN and 20 age-, sex-, and body mass index-matched controls. Insular cortical volumes (bilateral anterior and posterior regions) were identified using manual tracing. RESULTS: Volumes of the right posterior insula demonstrated the following: (a) a significant age by clinical status interaction (β = -0.018 [0.008]; t = 2.32, p = .02) and (b) larger volumes were associated with longer duration of illness (r = 0.48, p < .04). In contrast, smaller volumes of the right anterior insula were associated with longer duration of illness (r = -0.50, p < .03). The associations of insular volume with body dissatisfaction were of moderate effect size and also of opposite direction, but a statistical trend in right posterior (r = 0.40, p < .10 in right posterior; r = -0.49, p < .04 in right anterior). CONCLUSIONS: In this exploratory study, findings of atypical structure of the right posterior insular cortex point to the importance of future work investigating the role of visceral afferent signaling in understanding disturbance in body experience in AN.}, Doi = {10.1097/PSY.0000000000000510}, Key = {fds327423} } @article{fds322777, Author = {Moskovich, AA and Timko, CA and Honeycutt, LK and Zucker, NL and Merwin, RM}, Title = {Change in expressed emotion and treatment outcome in adolescent anorexia nervosa.}, Journal = {Eat Disord}, Volume = {25}, Number = {1}, Pages = {80-91}, Year = {2017}, url = {http://dx.doi.org/10.1080/10640266.2016.1255111}, Abstract = {Expressed emotion (EE) has been associated with poor outcomes in anorexia nervosa (AN); however, whether changes in EE predict superior treatment outcomes is unknown. The current study examined whether decreases in EE during an open trial of a novel family-based treatment for AN predicted symptoms at end of treatment. Forty-seven adolescents (12-18 years of age) with AN or sub-threshold AN and their parents (mothers: n = 47, fathers: n = 39) participated in 6 months of family treatment. Measures of AN symptomatology (Eating Disorder Examination completed by adolescent and end of treatment recovery status) and parental EE (Family Questionnaire completed by parents which measures two facets of EE: critical communication [CC] and emotional over-involvement [EOI]) were collected at baseline and end of treatment. Parental EOI, but not CC, significantly decreased during the course of treatment. Change in mothers', but not fathers', EE accounted for additional variance in AN symptomatology at end of treatment above baseline EE and baseline AN symptom levels. Findings suggest a greater emphasis on parent support during treatment may improve outcomes.}, Doi = {10.1080/10640266.2016.1255111}, Key = {fds322777} } @article{fds277578, Author = {Kerr, KL and Moseman, SE and Avery, JA and Bodurka, J and Zucker, NL and Simmons, WK}, Title = {Altered Insula Activity during Visceral Interoception in Weight-Restored Patients with Anorexia Nervosa.}, Journal = {Neuropsychopharmacology}, Volume = {41}, Number = {2}, Pages = {521-528}, Year = {2016}, Month = {January}, ISSN = {0893-133X}, url = {http://dx.doi.org/10.1038/npp.2015.174}, Abstract = {Anorexia nervosa (AN) is a devastating psychiatric illness that is associated with significant morbidity and mortality. Aberrant visceral interoceptive processing within the insula has been hypothesized to be an important mechanism in AN's pathophysiology due to the theoretical link between interoception and emotional experience. We therefore utilized functional magnetic resonance imaging (fMRI) to examine whether altered insula functioning underlies visceral interoception in AN. Fifteen females with restricting-type AN and 15 healthy control females underwent fMRI while performing an interoceptive attention task during which they focused on sensations in their heart, stomach, and bladder. Participants also performed an anxious rumination task while in the scanner. AN participants were weight-restored and free of psychotropic medications. Two distinct regions of the insula-anterior insula and dorsal mid-insula-exhibited a significant (p<0.05) interaction between group and interoceptive modality. The post hoc analyses revealed that in the dorsal mid-insula the interaction was driven by group differences during stomach interoception (p=0.002, Bonferroni corrected), whereas in the anterior insula the interaction was driven by group differences during heart interoception (p=0.03, Bonferroni corrected). In addition, individuals with AN displayed increased activation during anxious rumination in the dorsal mid-insula, and activation in this region during stomach interoception was correlated with measures of anxiety and psychopathology. This relationship between altered visceral interoception and clinical symptoms in AN suggests an important mechanism for the disorder. Additional research is needed to examine whether interventions targeting visceral interoception may increase the efficacy of treatments for AN.}, Doi = {10.1038/npp.2015.174}, Key = {fds277578} } @article{fds322778, Author = {Zucker, NL and Copeland, W and Egger, H}, Title = {Authors' Response.}, Journal = {Pediatrics}, Volume = {137}, Number = {1}, Year = {2016}, Month = {January}, url = {http://dx.doi.org/10.1542/peds.2015-3635B}, Doi = {10.1542/peds.2015-3635B}, Key = {fds322778} } @article{fds328090, Author = {Matherne, CE and Zucker, N and Bryant, EJ and Sbrocco, T and Mirza, N and Tanofsky-Kraff, M}, Title = {A feasibility study of group caregiver training for the prevention of obesity (GCT-O) in African American Preschoolers}, Journal = {Clinical Practice in Pediatric Psychology}, Volume = {4}, Number = {3}, Pages = {275-290}, Publisher = {American Psychological Association (APA)}, Year = {2016}, Month = {January}, url = {http://dx.doi.org/10.1037/cpp0000125}, Abstract = {Obesity prevention is a priority for African American (AA) children. However, effective programs are sparse. We therefore conducted a feasibility study of an 8-week group caregiver training program for obesity prevention (GCT-O) targeting parental selfefficacy in family-based lifestyle change. Twenty primary caregivers of overweight and obese (BMI z score M = 2.46, SD = .93), AA preschoolers (M = 4.10 y, SD = 1.48, 70% female) participated in an open-Trial of GCT-O within a community setting serving primarily low-income, AA families. Caregivers completed assessments of parenting and child behavior at baseline and postintervention, and feasibility/ acceptability questionnaires at postintervention. Child height and weight were measured at both time points and at 3-month follow-up. Retention through postintervention was 75%. Average attendance was M = 5.12, SD = 2.12 of 8 sessions. Caregivers reported enjoying the program (100%), and found it helpful (87%) and feasible (79%). Postintervention, caregivers reported less authoritarian (p = .02) and permissive (p = .03) parenting, improved feeding practices (p = .03), and a reduction in youth's lifestyle-related problem behaviors (p = .01). Caregiver report of children's daily caloric intake decreased from baseline to postintervention (p = .04). Parental selfefficacy did not improve postintervention (p = .23). Child BMI z score was unchanged postintervention (p = .70), but decreased significantly by 3-month follow-up (p = .02). GCT-O was feasible and acceptable to program completers. Preliminary results suggest that GCT-O may improve caregiver and child behavior and prevent excess weight gain among AA preschoolers. An adequately powered and controlled efficacy trial is warranted.}, Doi = {10.1037/cpp0000125}, Key = {fds328090} } @article{fds330053, Author = {Copeland, WE and Bulik, CM and Zucker, N and Wolke, D and Lereya, ST and Costello, EJ}, Title = {Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis.}, Journal = {Int J Eat Disord}, Volume = {48}, Number = {8}, Pages = {1141-1149}, Year = {2015}, Month = {December}, url = {http://dx.doi.org/10.1002/eat.22459}, Abstract = {OBJECTIVE: Bullying is a common childhood experience with enduring psychosocial consequences. The aim of this study was to test whether bullying increases risk for eating disorder symptoms. METHOD: Ten waves of data on 1,420 participants between ages 9 and 25 were used from the prospective population-based Great Smoky Mountains Study. Structured interviews were used to assess bullying involvement and symptoms of anorexia nervosa and bulimia nervosa as well as associated features. Bullying involvement was categorized as not involved, bully only, victim only, or both bully and victim (bully-victims). RESULTS: Within childhood/adolescence, victims of bullying were at increased risk for symptoms of anorexia nervosa and bulimia nervosa as well as associated features. These associations persisted after accounting for prior eating disorder symptom status as well as preexisting psychiatric status and family adversities. Bullies were at increased risk of symptoms of bulimia and associated features of eating disorders, and bully-victims had higher levels of anorexia symptoms. In terms of individual items, victims were at risk for binge eating, and bully-victims had more binge eating and use of vomiting as a compensatory behavior. There was little evidence in this sample that these effects differed by sex. Childhood bullying status was not associated with increased risk for persistent eating disorder symptoms into adulthood (ages 19, 21, and 25). DISCUSSION: Bullying predicts eating disorder symptoms for both bullies and victims. Bullying involvement should be a part of risk assessment and treatment planning for children with eating problems.}, Doi = {10.1002/eat.22459}, Key = {fds330053} } @article{fds277570, Author = {Cravener, TL and Schlechter, H and Loeb, KL and Radnitz, C and Schwartz, M and Zucker, N and Finkelstein, S and Wang, YC and Rolls, BJ and Keller, KL}, Title = {Feeding Strategies Derived from Behavioral Economics and Psychology Can Increase Vegetable Intake in Children as Part of a Home-Based Intervention: Results of a Pilot Study.}, Journal = {J Acad Nutr Diet}, Volume = {115}, Number = {11}, Pages = {1798-1807}, Year = {2015}, Month = {November}, ISSN = {2212-2672}, url = {http://dx.doi.org/10.1016/j.jand.2015.03.024}, Abstract = {BACKGROUND: Behavioral economics and psychology have been applied to altering food choice, but most studies have not measured food intake under free-living conditions. OBJECTIVES: To test the effects of a strategy that pairs positive stimuli (ie, stickers and cartoon packaging) with vegetables and presents them as the default snack. DESIGN: A randomized controlled trial was conducted with children who reported consumption of fewer than two servings of vegetables daily. Children (aged 3 to 5 years) in both control (n=12) and treatment (n=12) groups received a week's supply of plainly packaged (ie, generic) vegetables, presented by parents as a free choice with an alternative snack (granola bar), during baseline (Week 1) and follow-up (Week 4). During Weeks 2 and 3, the control group continued to receive generic packages of vegetables presented as a free choice, but the treatment group received vegetables packaged in containers with favorite cartoon characters and stickers inside, presented by parents as the default choice. Children in the treatment group were allowed to opt out of the vegetables and request the granola bar after an imposed 5-minute wait. STATISTICAL ANALYSIS: General Linear Model repeated measures analysis of variance was conducted to compare vegetable and granola bar intake between control and treatment groups across the 4-week study. Both within- and between-subjects models were tested. RESULTS: A time×treatment interaction on vegetable intake was significant. The treatment group increased vegetable intake from baseline to Week 2 relative to control (P<0.01), but the effects were not sustained at Week 4 when the treatment was removed. Granola bar intake decreased in the treatment group at Week 2 (P≤0.001) and Week 3 (P≤0.005) relative to baseline. CONCLUSIONS: Parents were able to administer feeding practices derived from behavioral economics and psychology in the home to increase children's vegetable intake and decrease intake of a high-energy-density snack. Additional studies are needed to test the long-term sustainability of these practices.}, Doi = {10.1016/j.jand.2015.03.024}, Key = {fds277570} } @article{fds277577, Author = {Matheson, BE and Camacho, C and Peterson, CB and Rhee, KE and Rydell, SA and Zucker, NL and Boutelle, KN}, Title = {The relationship between parent feeding styles and general parenting with loss of control eating in treatment-seeking overweight and obese children.}, Journal = {Int J Eat Disord}, Volume = {48}, Number = {7}, Pages = {1047-1055}, Year = {2015}, Month = {November}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.22440}, Abstract = {OBJECTIVE: To examine differences in parent feeding behaviors and general parenting of overweight children with and without loss of control (LOC) eating. METHOD: One-hundred-and-eighteen overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± 0.39) and their parents (42.42 ± 6.20 years; 91% female; 70% Caucasian; BMI: 31.74 ± 6.96 kg/m(2) ) were seen at a baseline assessment visit for a behavioral intervention that targeted overeating. The Eating Disorder Examination, adapted for children (ChEDE) was administered to assess for LOC eating. Parents completed the Parental Feeding Styles Questionnaire (PFSQ) and the Child Feeding Questionnaire (CFQ) to assess parent feeding styles and behaviors. Children also completed a self-report measure of general parenting (Child Report of Parent Behavior Inventory, CRPBI-30). RESULTS: Forty-three children (36.40%) reported at least one LOC eating episode in the month prior to assessment. Parents who reported greater restriction and higher levels of pressure to eat were more likely to have children that reported LOC eating (ps < 0.05). Parents who utilized more instrumental feeding and prompting/encouragement to eat techniques were less likely to have children that reported LOC eating (ps < 0.05). Child-reported parenting behaviors were unrelated to child LOC eating (ps > 0.05). DISCUSSION: Parent feeding styles and behaviors appear to be differentially and uniquely related to LOC eating in treatment-seeking overweight and obese children. Future research is needed to determine if implementing interventions that target parent feeding behaviors may reduce LOC eating, prevent full-syndrome eating disorders, and reduce weight gain in youth.}, Doi = {10.1002/eat.22440}, Key = {fds277577} } @article{fds292812, Author = {Merwin, RM and Dmitrieva, NO and Honeycutt, LK and Moskovich, AA and Lane, JD and Zucker, NL and Surwit, RS and Feinglos, M and Kuo, J}, Title = {Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology.}, Journal = {Diabetes Care}, Volume = {38}, Number = {11}, Pages = {2025-2032}, Year = {2015}, Month = {November}, ISSN = {0149-5992}, url = {http://dx.doi.org/10.2337/dc15-0753}, Abstract = {OBJECTIVE: Individuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions. RESEARCH DESIGN AND METHODS: Eighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed 3 days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction. RESULTS: Individuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual's typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., "no desserts"). CONCLUSIONS: Results suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.}, Doi = {10.2337/dc15-0753}, Key = {fds292812} } @article{fds277575, Author = {Zucker, N and Copeland, W and Franz, L and Carpenter, K and Keeling, L and Angold, A and Egger, H}, Title = {Psychological and Psychosocial Impairment in Preschoolers With Selective Eating.}, Journal = {Pediatrics}, Volume = {136}, Number = {3}, Pages = {e582-e590}, Year = {2015}, Month = {September}, ISSN = {0031-4005}, url = {http://dx.doi.org/10.1542/peds.2014-2386}, Abstract = {OBJECTIVE: We examined the clinical significance of moderate and severe selective eating (SE). Two levels of SE were examined in relation to concurrent psychiatric symptoms and as a risk factor for the emergence of later psychiatric symptoms. Findings are intended to guide health care providers to recognize when SE is a problem worthy of intervention. METHODS: A population cohort sample of 917 children aged 24 to 71 months and designated caregivers were recruited via primary care practices at a major medical center in the Southeast as part of an epidemiologic study of preschool anxiety. Caregivers were administered structured diagnostic interviews (the Preschool Age Psychiatric Assessment) regarding the child's eating and related self-regulatory capacities, psychiatric symptoms, functioning, and home environment variables. A subset of 188 dyads were assessed a second time ∼24.7 months from the initial assessment. RESULTS: Both moderate and severe levels of SE were associated with psychopathological symptoms (anxiety, depression, attention-deficit/hyperactivity disorder) both concurrently and prospectively. However, the severity of psychopathological symptoms worsened as SE became more severe. Impairment in family functioning was reported at both levels of SE, as was sensory sensitivity in domains outside of food and the experience of food aversion. CONCLUSIONS: Findings suggest that health care providers should intervene at even moderate levels of SE. SE associated with impairment in function should now be diagnosed as avoidant/restrictive food intake disorder, an eating disorder that encapsulates maladaptive food restriction, which is new to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.}, Doi = {10.1542/peds.2014-2386}, Key = {fds277575} } @article{fds277572, Author = {Winecoff, AA and Ngo, L and Moskovich, A and Merwin, R and Zucker, N}, Title = {The functional significance of shyness in anorexia nervosa.}, Journal = {Eur Eat Disord Rev}, Volume = {23}, Number = {4}, Pages = {327-332}, Year = {2015}, Month = {July}, ISSN = {1072-4133}, url = {http://dx.doi.org/10.1002/erv.2363}, Abstract = {The defining features of anorexia nervosa (AN) include disordered eating and disturbance in the experience of their bodies; however, many women with AN also demonstrate higher harm avoidance (HA), lower novelty seeking, and challenges with interpersonal functioning. The current study explored whether HA and novelty seeking could explain variation in disordered eating and social functioning in healthy control women ( n = 18), weight-restored women with a history of AN (n = 17), and women currently-ill with AN (AN; n = 17). Our results indicated that clinical participants (AN + weight-restored women) reported poorer social skills than healthy control participants. Moreover, the relationship between eating disorder symptoms and social skill deficits was mediated by HA. Follow-up analyses indicated that only the 'shyness with strangers' factor of HA independently mediated this relationship. Collectively, our results suggest a better understanding of shyness in many individuals with eating disorders could inform models of interpersonal functioning in AN.}, Doi = {10.1002/erv.2363}, Key = {fds277572} } @article{fds277576, Author = {Shanahan, L and Zucker, N and Copeland, WE and Bondy, CL and Egger, HL and Costello, EJ}, Title = {Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample.}, Journal = {Psychol Med}, Volume = {45}, Number = {8}, Pages = {1721-1730}, Year = {2015}, Month = {June}, ISSN = {0033-2917}, url = {http://dx.doi.org/10.1017/S0033291714002840}, Abstract = {BACKGROUND: Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood - and to which specific disorders - has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity. METHOD: The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4-7 times between ages 9-16 years. They were assessed again up to three times between ages 19-26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9-16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. RESULTS: Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders. CONCLUSIONS: Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.}, Doi = {10.1017/S0033291714002840}, Key = {fds277576} } @article{fds277579, Author = {Timko, CA and Zucker, NL and Herbert, JD and Rodriguez, D and Merwin, RM}, Title = {An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.}, Journal = {Behav Res Ther}, Volume = {69}, Pages = {63-74}, Year = {2015}, Month = {June}, ISSN = {0005-7967}, url = {http://dx.doi.org/10.1016/j.brat.2015.03.011}, Abstract = {Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12-18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed.}, Doi = {10.1016/j.brat.2015.03.011}, Key = {fds277579} } @article{fds277589, Author = {Kragel, PA and Zucker, NL and Covington, VE and LaBar, KS}, Title = {Developmental trajectories of cortical-subcortical interactions underlying the evaluation of trust in adolescence.}, Journal = {Soc Cogn Affect Neurosci}, Volume = {10}, Number = {2}, Pages = {240-247}, Year = {2015}, Month = {February}, ISSN = {1749-5016}, url = {http://dx.doi.org/10.1093/scan/nsu050}, Abstract = {Social decision making is guided by the ability to intuitively judge personal attributes, including analysis of facial features to infer the trustworthiness of others. Although the neural basis for trustworthiness evaluation is well characterized in adults, less is known about its development during adolescence. We used event-related functional magnetic resonance imaging to examine age-related changes in neural activation and functional connectivity during the evaluation of trust in faces in a sample of adolescent females. During scanning, participants viewed masked presentations of faces and rated their trustworthiness. Parametric modeling of trust ratings revealed enhanced activation in amygdala and insula to untrustworthy faces, effects which peaked during mid-adolescence. Analysis of amygdala functional connectivity demonstrated enhanced amygdala-insula coupling during the evaluation of untrustworthy faces. This boost in connectivity was attenuated during mid-adolescence, suggesting a functional transition within face-processing circuits. Together, these findings underscore adolescence as a period of reorganization in neural circuits underlying socioemotional behavior.}, Doi = {10.1093/scan/nsu050}, Key = {fds277589} } @article{fds277571, Author = {Boutelle, KN and Liang, J and Knatz, S and Matheson, B and Risbrough, V and Strong, D and Rhee, KE and Craske, MG and Zucker, N and Bouton, ME}, Title = {Design and implementation of a study evaluating extinction processes to food cues in obese children: the Intervention for Regulations of Cues Trial (iROC).}, Journal = {Contemp Clin Trials}, Volume = {40}, Pages = {95-104}, Year = {2015}, Month = {January}, ISSN = {1551-7144}, url = {http://dx.doi.org/10.1016/j.cct.2014.11.011}, Abstract = {Obesity and its health sequelae affect a significant portion of children in the United States. Yet, the current gold-standard family-based behavioral weight-loss treatments are only effective for one-third of children long-term. Therefore, we developed iROC (Intervention for Regulation of Cues) to specifically target a method to decrease overeating in overweight children, based on learning theory, to inform and enhance interventions targeting diet and obesity in youth. This study will rigorously test extinction processes as a method of decreasing physiological and psychological responses to food cues in overweight and obese children. Through exposing children to their highly craved foods, and 'training the brain and body' to decrease overeating, we are hoping to produce longer-lasting weight loss or weight-gain prevention over time.}, Doi = {10.1016/j.cct.2014.11.011}, Key = {fds277571} } @article{fds277582, Author = {Zucker, N and Wagner, HR and Merwin, R and Bulik, CM and Moskovich, A and Keeling, L and Hoyle, R}, Title = {Self-focused attention in anorexia nervosa.}, Journal = {Int J Eat Disord}, Volume = {48}, Number = {1}, Pages = {9-14}, Year = {2015}, Month = {January}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.22307}, Abstract = {OBJECTIVE: The clinical presentation of anorexia nervosa (AN) is characterized by preoccupation with body experience, intrusive concerns regarding shape, and pathological fears of weight gain. These symptoms are suggestive of unrelenting self-focused attention. No research to date has characterized self-focused attention (SFA) in AN nor examined neurocognitive features that may facilitate an excessive, rigid, or sustained focus on one's appearance. METHOD: This study examined SFA, body image disturbance, and executive functioning in women with current anorexia nervosa (AN-C; n = 24), a history of AN who were weight-restored at the time of the study (WR; n = 19), and healthy controls (n = 24). RESULTS: Private and public SFA were highest among WR and lowest among AN-C. Shape concerns were negatively correlated with SFA, especially among AN-C, after controlling for depression and social anxiety symptoms. DISCUSSION: Lower levels of SFA among AN-C were unexpected and suggest the acute state of AN may lessen pathological self-focus, negatively reinforcing symptoms. In addition, body image concerns may distract from general SFA. Deficits in executive attention may explain these findings, as each one unit increase in perseverative errors among AN-C participants was associated with an almost one-half unit decrease in public SFA.}, Doi = {10.1002/eat.22307}, Key = {fds277582} } @article{fds277574, Author = {Shanahan, L and Zucker, N and Copeland, WE and Costello, EJ and Angold, A}, Title = {Are children and adolescents with food allergies at increased risk for psychopathology?}, Journal = {J Psychosom Res}, Volume = {77}, Number = {6}, Pages = {468-473}, Year = {2014}, Month = {December}, ISSN = {0022-3999}, url = {http://dx.doi.org/10.1016/j.jpsychores.2014.10.005}, Abstract = {OBJECTIVE: Living with food allergy is a unique and potentially life-threatening stressor that requires constant vigilance to food-related stimuli, but little is known about whether adolescents with food allergies are at increased risk for psychopathology-concurrently and over time. METHODS: Data came from the prospective-longitudinal Great Smoky Mountains Study. Adolescents (N=1420) were recruited from the community, and interviewed up to six times between ages 10 and 16 for the purpose of the present analyses. At each assessment, adolescents and one parent were interviewed using the Child and Adolescent Psychiatric Assessment, resulting in N=5165 pairs of interviews. RESULTS: Cross-sectionally, food allergies were associated with more symptoms of separation and generalized anxiety, disorder, attention deficit and hyperactivity disorder, and anorexia nervosa. Longitudinally, adolescents with food allergy experienced increases in symptoms of generalized anxiety disorder and depression from one assessment to the next. Food allergies were not, however, associated with a higher likelihood of meeting diagnostic criteria for a psychiatric disorder. CONCLUSION: The unique constellation of adolescents' increased symptoms of psychopathology in the context of food allergy likely reflects an adaptive increase in vigilance rather than cohesive syndromes of psychopathology. Support and guidance from health care providers is needed to help adolescents with food allergies and their caregivers achieve an optimal balance between necessary vigilance and hypervigilance and unnecessary restriction.}, Doi = {10.1016/j.jpsychores.2014.10.005}, Key = {fds277574} } @article{fds277586, Author = {Merwin, RM and Moskovich, AA and Dmitrieva, NO and Pieper, CF and Honeycutt, LK and Zucker, NL and Surwit, RS and Buhi, L}, Title = {Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes.}, Journal = {Appetite}, Volume = {81}, Pages = {123-130}, Year = {2014}, Month = {October}, ISSN = {0195-6663}, url = {http://dx.doi.org/10.1016/j.appet.2014.05.028}, Abstract = {OBJECTIVE: Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c). METHODS: Two-hundred and seventy-six individuals with type 1 diabetes completed an online survey of eating behaviors, insulin dosing and most recent HbA1c. We used structural equation modeling to test the hypothesis that disinhibited eating when blood sugar is thought to be low predicts weight-related insulin mismanagement, and this, in turn, predicts higher HbA1c. RESULTS: The majority of participants endorsed some degree of disinhibition when they think their blood glucose is low (e.g., eating foods they do not typically allow) and corresponding negative affect (e.g., guilt/shame). The frequency of disinhibited eating was positively associated with weight-related insulin mismanagement. Controlling for age, sex, education, and insulin pump use, the model explained 31.3% of the variance in weight-related insulin mismanagement and 16.8% of the variance in HbA1c. CONCLUSION: Addressing antecedents to disinhibited eating that are unique to type 1 diabetes (e.g., perceived BG level) and associated guilt or shame may reduce weight-related insulin omission.}, Doi = {10.1016/j.appet.2014.05.028}, Key = {fds277586} } @article{fds277583, Author = {Pisetsky, DS and Trace, SE and Brownley, KA and Hamer, RM and Zucker, NL and Roux-Lombard, P and Dayer, J-M and Bulik, CM}, Title = {The expression of cytokines and chemokines in the blood of patients with severe weight loss from anorexia nervosa: an exploratory study.}, Journal = {Cytokine}, Volume = {69}, Number = {1}, Pages = {110-115}, Year = {2014}, Month = {September}, ISSN = {1043-4666}, url = {http://dx.doi.org/10.1016/j.cyto.2014.05.018}, Abstract = {Anorexia nervosa (AN) is a serious, potentially life-threatening disorder characterized by severe weight loss, dysregulated eating, and often excessive exercise. While psychiatric illnesses such as depression are associated with increased levels of pro-inflammatory mediators, evidence for such disturbances in patients with AN has been less clear. In an exploratory study of possible disturbances in immune responses in AN, we assayed a panel of cytokines and chemokines in the blood of patients undergoing inpatient treatment, testing the hypothesis that metabolic disturbances in this disease would lead to a pattern of immune disturbances distinct from that of other psychiatric diseases. For this purpose, we evaluated patients by the Beck Depression Inventory-II (BDI-II) and the Eating Disorders Examination-Questionnaire and assessed cytokines and chemokines by enzyme-linked immunosorbent assays. Patients reported a moderate level of depression (mean BDI-II = 22.6) but exhibited few immunologic abnormalities of the kind associated with major depressive disorder [e.g., increased interleukin (IL)-6]; RANTES showed the most frequent elevations and was increased in 4 of the patients studied. Together, these findings suggest that features of AN such as loss of adipose tissue and excessive exercise may attenuate cytokine production and thus modulate the experience of illness that impacts on core features of disease.}, Doi = {10.1016/j.cyto.2014.05.018}, Key = {fds277583} } @article{fds277584, Author = {Braden, A and Rhee, K and Peterson, CB and Rydell, SA and Zucker, N and Boutelle, K}, Title = {Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology.}, Journal = {Appetite}, Volume = {80}, Pages = {35-40}, Year = {2014}, Month = {September}, ISSN = {0195-6663}, url = {http://dx.doi.org/10.1016/j.appet.2014.04.017}, Abstract = {Emotional eating is the tendency to eat in response to negative emotions. Prior research has identified a relationship between parenting style and child emotional eating, but this has not been examined in clinical samples. Furthermore, the relationship between specific parenting practices (e.g., parent feeding practices) and child emotional eating has not yet been investigated. The current study examined relationships between child emotional eating and both general and specific parenting constructs as well as maternal symptoms of depression and binge eating among a treatment-seeking sample of overweight children. Participants included 106 mother-child dyads who attended a baseline assessment for enrollment in a behavioral intervention for overeating. Ages of children ranged from 8 to 12 years old. Mothers completed self-report measures of their child's emotional eating behavior, their own feeding practices, and symptoms of depression and binge eating. Children completed a self-report measure of their mothers' general parenting style. A stepwise regression analysis was conducted to identify the parent variable that was most strongly related to child emotional eating, controlling for child age and gender. Emotional feeding behavior (i.e., a tendency to offer food to soothe a child's negative emotions) was the parent factor most significantly related to child emotional eating. Findings suggest that emotional feeding practices in parents may be related to emotional eating in children. Treatment with overweight children who engage in emotional eating may be improved by targeting parent feeding practices.}, Doi = {10.1016/j.appet.2014.04.017}, Key = {fds277584} } @article{fds277585, Author = {Boutelle, KN and Zucker, N and Peterson, CB and Rydell, S and Carlson, J and Harnack, LJ}, Title = {An intervention based on Schachter's externality theory for overweight children: the regulation of cues pilot.}, Journal = {J Pediatr Psychol}, Volume = {39}, Number = {4}, Pages = {405-417}, Year = {2014}, Month = {May}, ISSN = {0146-8693}, url = {http://dx.doi.org/10.1093/jpepsy/jst142}, Abstract = {OBJECTIVE: This study evaluated the feasibility, acceptability, and initial efficacy of an intervention based on Schachter's externality theory; the Regulation of Cues (ROC) program. METHODS: 44 overweight and obese 8-12-year-old children and their parents were randomly assigned to a 4-month ROC program or the control group. Outcomes were assessed at baseline, posttreatment, and 4 months posttreatment and included acceptability and feasibility, body weight, and eating behaviors. RESULTS: The ROC program had moderate to high acceptability ratings. Significant improvements were found for the ROC group compared with the control group on child food responsiveness at posttreatment and eating in the absence of hunger at 4 months posttreatment. Improvements were seen for the ROC group compared with the control group on body weight measures and food responsiveness, although these only approached significance. CONCLUSION: The ROC intervention may be useful with overweight and obese children. Larger, fully powered studies are needed to further evaluate the efficacy of this model.}, Doi = {10.1093/jpepsy/jst142}, Key = {fds277585} } @article{fds277588, Author = {Boutelle, KN and Peterson, CB and Crosby, RD and Rydell, SA and Zucker, N and Harnack, L}, Title = {Overeating phenotypes in overweight and obese children.}, Journal = {Appetite}, Volume = {76}, Pages = {95-100}, Year = {2014}, Month = {May}, ISSN = {0195-6663}, url = {http://dx.doi.org/10.1016/j.appet.2014.01.076}, Abstract = {The purpose of this study was to identify overeating phenotypes and their correlates in overweight and obese children. One hundred and seventeen treatment-seeking overweight and obese 8-12year-old children and their parents completed the study. Children completed an eating in the absence of hunger (EAH) paradigm, the Eating Disorder Examination interview, and measurements of height and weight. Parents and children completed questionnaires that evaluated satiety responsiveness, food responsiveness, negative affect eating, external eating and eating in the absence of hunger. Latent profile analysis was used to identify heterogeneity in overeating phenotypes in the child participants. Latent classes were then compared on measures of demographics, obesity status and nutritional intake. Three latent classes of overweight and obese children were identified: High Satiety Responsive, High Food Responsive, and Moderate Satiety and Food Responsive. Results indicated that the High Food Responsive group had higher BMI and BMI-Z scores compared to the High Satiety Responsive group. No differences were found among classes in demographics or nutritional intake. This study identified three overeating phenotypes, supporting the heterogeneity of eating patterns associated with overweight and obesity in treatment-seeking children. These finding suggest that these phenotypes can potentially be used to identify high risk groups, inform prevention and intervention targets, and develop specific treatments for these behavioral phenotypes.}, Doi = {10.1016/j.appet.2014.01.076}, Key = {fds277588} } @article{fds277592, Author = {Madowitz, J and Liang, J and Peterson, CB and Rydell, S and Zucker, NL and Tanofsky-Kraff, M and Harnack, L and Boutelle, KN}, Title = {Concurrent and convergent validity of the eating in the absence of hunger questionnaire and behavioral paradigm in overweight children.}, Journal = {Int J Eat Disord}, Volume = {47}, Number = {3}, Pages = {287-295}, Year = {2014}, Month = {April}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.22213}, Abstract = {OBJECTIVE: This study aimed to assess the concurrent and convergent validity of the Eating in the Absence of Hunger (EAH) questionnaire parent report of child (EAH-PC) and child self-report (EAH-C) with the EAH behavioral paradigm (EAH%) and usual dietary intake. METHOD: Data were obtained at baseline assessment for 117 treatment-seeking overweight and obese (BMI > 85th percentile) 8- to 12-year old children (53% female, 54% white) and their parents. Children participated in the EAH free access paradigm after a standardized ad libitum meal. Parents and children completed EAH questionnaires, and the children completed three 24 h recalls. EAH External Eating subscale and total scores were assessed. RESULTS: EAH% was inversely associated with the EAH-PC total score (p < .04), however, it was not associated with the EAH-PC External Eating scale, EAH-C total score or EAH-C External Eating scale. Daily caloric intake was positively related to both the EAH-C total score (p < .02) and External Eating subscale (p < .007). Daily caloric intake was inversely related to EAH-PC total score (p < .05), but was not related to EAH-PC External Eating subscale or EAH%. DISCUSSION: Concurrent validity was not supported for EAH questionnaires, but convergent validity was supported for EAH-C and child daily caloric intake. Further research is warranted to assess whether EAH questionnaires and paradigm are measuring different aspects of EAH in treatment-seeking children.}, Doi = {10.1002/eat.22213}, Key = {fds277592} } @article{fds277596, Author = {Runfola, CD and Zucker, NL and Von Holle and A and Mazzeo, S and Hodges, EA and Perrin, EM and Bentley, ME and Ulman, TF and Hoffman, ER and Forsberg, S and Algars, M and Zerwas, S and Pisetsky, EM and Taico, C and Kuhns, RA and Hamer, RM and Bulik, CM}, Title = {NURTURE: development and pilot testing of a novel parenting intervention for mothers with histories of an eating disorder.}, Journal = {Int J Eat Disord}, Volume = {47}, Number = {1}, Pages = {1-12}, Year = {2014}, Month = {January}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.22178}, Abstract = {OBJECTIVE: To describe the treatment development and pilot testing of a group parenting intervention, NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating), for mothers with histories of eating disorders. METHOD: Based on focus group findings, extant research, and expert opinion, NURTURE was designed to be delivered weekly over 16 (1.5 h) sessions via an interactive web conferencing forum. It comprises four modules: (1) laying the foundation, (2) general parenting skills, (3) eating and feeding, and (4) breaking the cycle of risk. Pilot testing was conducted with three groups of 3-6 mothers (N = 13) who had children ages 0-3 years to determine feasibility (e.g., retention), acceptability (e.g., feedback questionnaire responses), and preliminary efficacy. Maternal satisfaction with NURTURE and changes in mother-child feeding relationship measures, maternal feeding style, maternal self-efficacy, and maternal psychopathology (eating disorder, depression, and anxiety symptoms) across three time points (baseline, post-treatment, 6-month follow-up) were examined. All outcomes were exploratory. RESULTS: The intervention was well tolerated with a 100% retention rate. Feedback from mothers was generally positive and indicated that the groups provided an engaging, supportive experience to participants. We observed changes suggestive of improvement in self-reported maternal self-efficacy and competence with parenting. There were no notable changes in measures of maternal feeding style or psychopathology. DISCUSSION: NURTURE is a feasible, acceptable, and potentially valuable intervention for mothers with eating disorder histories. Results of this pilot will inform a larger randomized-controlled intervention to determine efficacy and impact on child outcomes.}, Doi = {10.1002/eat.22178}, Key = {fds277596} } @article{fds277590, Author = {Patel, S and Shafer, A and Brown, J and Bulik, C and Zucker, N}, Title = {Parents of children with eating disorders: developing theory-based health communication messages to promote caregiver well-being.}, Journal = {J Health Commun}, Volume = {19}, Number = {5}, Pages = {593-608}, Year = {2014}, ISSN = {1081-0730}, url = {http://dx.doi.org/10.1080/10810730.2013.821559}, Abstract = {Parents of children with eating disorders experience extreme emotional burden because of the intensity and duration of the recovery process. While parental involvement in a child's eating disorder treatment improves outcomes, parents often neglect their own well-being, which can impede their child's recovery. This study extends the research on caregivers and on health theory in practice by conducting formative research to develop a theory-based communication intervention encouraging parents to engage in adaptive coping and self-care behaviors. The Transactional Model of Stress and Coping and the Transtheoretical Model guided qualitative assessments of the determinants of parents' coping behaviors. Three focus groups with 19 parents of children with eating disorders and 19 semi-structured interviews with experts specializing in eating disorders were conducted. Findings indicate that parents and experts see parents' need for permission to take time for themselves as the main barrier to self-care. The main motivator for parents to engage in coping behaviors is awareness of a connection between self-care and their child's health outcomes. Participant evaluation of six potential messages for main themes and effectiveness revealed that theory-based elements, such as certain processes of change within the Transtheoretical Model, were important to changing health behavior.}, Doi = {10.1080/10810730.2013.821559}, Key = {fds277590} } @article{fds277599, Author = {Merwin, RM and Zucker, NL and Timko, CA}, Title = {A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa.}, Journal = {Cogn Behav Pract}, Volume = {20}, Number = {4}, Pages = {485-500}, Year = {2013}, Month = {November}, ISSN = {1077-7229}, url = {http://dx.doi.org/10.1016/j.cbpra.2012.11.001}, Abstract = {The treatment of adolescent anorexia nervosa (AN) has improved significantly with the increased emphasis on family-based intervention. Yet despite advances, a substantial number of adolescents do not respond optimally to existing treatment models and thus there is a need for treatment alternatives that address barriers to recovery. We developed and piloted an acceptance-based separated family treatment (ASFT) with 6 adolescents with AN or subthreshold AN (eating disorder not otherwise specified, with the primary symptoms of restriction and severe weight loss). Treatment acceptability was adequate. Overall, parents rated the treatment as credible and expected improvement in their child's condition. Five of the 6 adolescents treated with ASFT restored weight to their ideal body mass index as indicated by age, height, and sex and determined by individual growth charts. Many demonstrated improved psychological health and adaptive functioning. There was evidence of broad effects, with parents reporting decreased anxiety and caregiver burden. ASFT holds promise as a treatment option for AN. The efficacy of this therapeutic approach should be tested in larger trials and compared to current family-based interventions to determine unique effects.}, Doi = {10.1016/j.cbpra.2012.11.001}, Key = {fds277599} } @article{fds277597, Author = {Østbye, T and Malhotra, R and Stroo, M and Lovelady, C and Brouwer, R and Zucker, N and Fuemmeler, B}, Title = {The effect of the home environment on physical activity and dietary intake in preschool children.}, Journal = {Int J Obes (Lond)}, Volume = {37}, Number = {10}, Pages = {1314-1321}, Year = {2013}, Month = {October}, ISSN = {0307-0565}, url = {http://hdl.handle.net/10161/11440 Duke open access}, Abstract = {BACKGROUND: The effects of the home environment on child health behaviors related to obesity are unclear. PURPOSE: To examine the role of the home physical activity (PA) and food environment on corresponding outcomes in young children, and assess maternal education/work status as a moderator. METHODS: Overweight or obese mothers reported on the home PA and food environment (accessibility, role modeling and parental policies). Outcomes included child moderate-vigorous PA (MVPA) and sedentary time derived from accelerometer data and two dietary factors ('junk' and healthy food intake scores) based on factor analysis of mother-reported food intake. Linear regression models assessed the net effect (controlling for child demographics, study arm, supplemental time point, maternal education/work status, child body mass index and accelerometer wear time (for PA outcomes)) of the home environment on the outcomes and moderation by maternal education/work status. Data were collected in North Carolina from 2007 to 2011. RESULTS: Parental policies supporting PA increased MVPA time, and limiting access to unhealthy foods increased the healthy food intake score. Role modeling of healthy eating behaviors increased the healthy food intake score among children of mothers with no college education. Among children of mothers with no college education and not working, limiting access to unhealthy foods and role modeling reduced 'junk' food intake scores whereas parental policies supporting family meals increased 'junk' food intake scores. CONCLUSIONS: To promote MVPA, parental policies supporting child PA are warranted. Limited access to unhealthy foods and role modeling of healthy eating may improve the quality of the child's food intake.}, Doi = {10.1038/ijo.2013.76}, Key = {fds277597} } @article{fds277600, Author = {Zucker, NL and Merwin, RM and Bulik, CM and Moskovich, A and Wildes, JE and Groh, J}, Title = {Subjective experience of sensation in anorexia nervosa.}, Journal = {Behav Res Ther}, Volume = {51}, Number = {6}, Pages = {256-265}, Year = {2013}, Month = {June}, url = {http://www.ncbi.nlm.nih.gov/pubmed/23523866}, Abstract = {The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diagnosed with AN (n = 20), women with a prior history of AN who were weight restored (n = 15), and healthy controls with no eating disorder history (n = 24). Levels of sensitivity to sensation and attempts to avoid sensory experience were significantly higher in both clinical groups relative to healthy controls. Sensory sensitivity was associated with body image disturbance (r(56) = .51, p < .0001), indicating that body image disturbance increased with increased global sensitivity to sensation. Sensory sensitivity was also negatively and significantly correlated with lowest BMI (r(2) = -.32, p < .001), but not current BMI (r(2) = .03, p = .18), and to the temperament feature of harm avoidance in both clinical groups. We discuss how intervention strategies that address sensitization and habituation to somatic experience via conditioning exercises may provide a new manner in which to address body image disturbance in AN.}, Doi = {10.1016/j.brat.2013.01.010}, Key = {fds277600} } @article{fds277598, Author = {Fuemmeler, BF and Lovelady, CA and Zucker, NL and Østbye, T}, Title = {Parental obesity moderates the relationship between childhood appetitive traits and weight.}, Journal = {Obesity (Silver Spring)}, Volume = {21}, Number = {4}, Pages = {815-823}, Year = {2013}, Month = {April}, url = {http://www.ncbi.nlm.nih.gov/pubmed/23712985}, Abstract = {OBJECTIVE: In this study, the independent and combined associations between childhood appetitive traits and parental obesity on weight gain from 0 to 24 months and body mass index (BMI) z-score at 24 months in a diverse community-based sample of dual parent families (n = 213) were examined. DESIGN AND METHODS: Participants were mothers who had recently completed a randomized trial of weight loss for overweight/obese postpartum women. As measures of childhood appetitive traits, mothers completed subscales of the Children's Eating Behavior Questionnaire, including Desire to Drink (DD), Enjoyment of Food (EF), and Satiety Responsiveness (SR), and a 24-h dietary recall for their child. Heights and weights were measured for all children and mothers and self-reported for mothers' partners. The relationship between children's appetitive traits and parental obesity on toddler weight gain and BMI z-score were evaluated using multivariate linear regression models, controlling for a number of potential confounders. RESULTS: Having two obese parents was related to greater weight gain from birth to 24 months independent of childhood appetitive traits, and although significant associations were found between appetitive traits (DD and SR) and child BMI z-score at 24 months, these associations were observed only among children who had two obese parents. When both parents were obese, increasing DD and decreasing SR were associated with a higher BMI z-score. CONCLUSIONS: The results highlight the importance of considering familial risk factors when examining the relationship between childhood appetitive traits on childhood obesity.}, Doi = {10.1002/oby.20144}, Key = {fds277598} } @article{fds277569, Author = {Zucker, N and Moskovich, A and Vinson, M and Watson, K}, Title = {Emotions and empathic understanding: Capitalizing on relationships in those with eating disorders}, Pages = {52-61}, Publisher = {Routledge}, Year = {2013}, Month = {March}, url = {http://dx.doi.org/10.4324/9780203816691}, Doi = {10.4324/9780203816691}, Key = {fds277569} } @article{fds277617, Author = {Bloom, T and Sharpe, L and Mullan, B and Zucker, N}, Title = {A pilot evaluation of appetite-awareness training in the treatment of childhood overweight and obesity: a preliminary investigation.}, Journal = {Int J Eat Disord}, Volume = {46}, Number = {1}, Pages = {47-51}, Year = {2013}, Month = {January}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.22041}, Abstract = {OBJECTIVE: The aim of this study was to conduct a preliminary evaluation of Children's Appetite Awareness Training (CAAT), a treatment for childhood obesity which encourages overweight children to eat in response to internal appetite cues. METHOD: Overweight children (ages 6-12 years old) were randomized to either the CAAT treatment group (N = 23), to receive 1-h treatment sessions over 6 weeks, or a wait-list group (N = 24). Weight and height of children and parents in both groups were assessed at pre- and post-treatment (or equivalent time for wait-list control) and at a 6-month follow-up for those in the CAAT group. RESULTS: The intervention had a significant, short-term effect on the BMI of children who participated. Although at 6-month follow-up, children's BMI has not increased significantly, the difference between pretreatment and follow-up BMI was no longer significant. DISCUSSION: These results are encouraging for the use of CAAT with overweight children. Long-term effectiveness could be enhanced through increasing the duration of the program, adding booster sessions and increased involvement of parents.}, Doi = {10.1002/eat.22041}, Key = {fds277617} } @article{fds277627, Author = {Zucker, N and Moskovich, A and Bulik, CM and Merwin, R and Gaddis, K and Losh, M and Piven, J and Wagner, HR and LaBar, KS}, Title = {Perception of affect in biological motion cues in anorexia nervosa.}, Journal = {Int J Eat Disord}, Volume = {46}, Number = {1}, Pages = {12-22}, Year = {2013}, Month = {January}, url = {http://www.ncbi.nlm.nih.gov/pubmed/23109257}, Abstract = {OBJECTIVE: Nonverbal motion cues (a clenched fist) convey essential information about the intentions of the actor. Individuals with anorexia nervosa (AN) have demonstrated impairment in deciphering intention from facial affective cues, but it is unknown whether such deficits extend to deciphering affect from body motion cues. METHOD: We examined the capacities of adults with AN (n = 21) or those weight restored for ≥12 months (WR; n = 20) to perceive affect in biological motion cues relative to healthy controls (HC; n = 23). RESULTS: Overall, individuals with AN evidenced greater deficit in discriminating affect from biological motion cues than WR or HC. Follow-up analyses showed that individuals with AN differed especially across two of the five conditions--deviating most from normative data when discriminating sadness and more consistently discriminating anger relative to WR or HC. DISCUSSION: Implications of these findings are discussed in relation to some puzzling interpersonal features of AN.}, Doi = {10.1002/eat.22062}, Key = {fds277627} } @article{fds277594, Author = {Østbye, T and Malhotra, R and Stroo, M and Lovelady, C and Brouwer, R and Zucker, N and Fuemmeler, B}, Title = {The effect of the home environment on physical activity and dietary intake in preschool children}, Journal = {International Journal of Obesity}, Volume = {37}, Number = {10}, Pages = {1314-1321}, Year = {2013}, ISSN = {0307-0565}, url = {http://dx.doi.org/10.1038/ijo.2013.76}, Abstract = {Background:The effects of the home environment on child health behaviors related to obesity are unclear.Purpose:To examine the role of the home physical activity (PA) and food environment on corresponding outcomes in young children, and assess maternal education/work status as a moderator.Methods:Overweight or obese mothers rePORted on the home PA and food environment (accessibility, role modeling and parental policies). Outcomes included child moderate-vigorous PA (MVPA) and sedentary time derived from accelerometer data and two dietary factors ('junk' and healthy food intake scores) based on factor analysis of mother-rePORted food intake. Linear regression models assessed the net effect (controlling for child demographics, study arm, supplemental time point, maternal education/work status, child body mass index and accelerometer wear time (for PA outcomes)) of the home environment on the outcomes and moderation by maternal education/work status. Data were collected in North Carolina from 2007 to 2011.Results:Parental policies supPORting PA increased MVPA time, and limiting access to unhealthy foods increased the healthy food intake score. Role modeling of healthy eating behaviors increased the healthy food intake score among children of mothers with no college education. Among children of mothers with no college education and not working, limiting access to unhealthy foods and role modeling reduced 'junk' food intake scores whereas parental policies supPORting family meals increased 'junk' food intake scores.Conclusions:To promote MVPA, parental policies supPORting child PA are warranted. Limited access to unhealthy foods and role modeling of healthy eating may improve the quality of the child's food intake. © 2013 Macmillan Publishers Limited.}, Doi = {10.1038/ijo.2013.76}, Key = {fds277594} } @article{fds277601, Author = {Merwin, RM and Moskovich, AA and Wagner, HR and Ritschel, LA and Craighead, LW and Zucker, NL}, Title = {Emotion regulation difficulties in anorexia nervosa: Relationship to self-perceived sensory sensitivity.}, Journal = {Cogn Emot}, Volume = {27}, Number = {3}, Pages = {441-452}, Year = {2013}, url = {http://www.ncbi.nlm.nih.gov/pubmed/22963392}, Abstract = {Changes in sensation (e.g., prickly skin) are crucial constituents of emotional experience, and the intensity of perceived changes has been linked to emotional intensity and dysregulation. The current study examined the relationship between sensory sensitivity and emotion regulation among adults with anorexia nervosa (AN), a disorder characterised by disturbance in the experience of the body. Twenty-one individuals with AN, 20 individuals with AN who were weight-restored, and 23 typical controls completed self-report measures of sensory sensitivity and emotion regulation. AN participants reported heightened sensory sensitivity and greater difficulty regulating emotions relative to controls. Self-perceived sensory sensitivity was associated with greater emotion dysregulation. Weight-restored AN participants reported greater ability to regulate emotions than their currently underweight counterparts, despite heightened sensitivity. Findings suggest that hypersensitivity may be a persisting feature in AN, and that weight restoration may involve improved ability to cope with sensation.}, Doi = {10.1080/02699931.2012.719003}, Key = {fds277601} } @article{fds277620, Author = {Østbye, T and Krause, KM and Stroo, M and Lovelady, CA and Evenson, KR and Peterson, BL and Bastian, LA and Swamy, GK and West, DG and Brouwer, RJN and Zucker, NL}, Title = {Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study.}, Journal = {Prev Med}, Volume = {55}, Number = {3}, Pages = {188-195}, Year = {2012}, Month = {September}, url = {http://www.ncbi.nlm.nih.gov/pubmed/22705016}, Abstract = {OBJECTIVE: The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2-5 years old) dyads in North Carolina (2007-2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight. METHOD: The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized. RESULTS: Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (-0.24 vs. 0.01, p<0.001) and TV snacks (-.069 vs. -0.24, p=0.001). There were also improvements in emotional feeding (p=0.03), mother's sugary beverage (p=0.03) and fruit/vegetable (p=0.04) intake, and dinners eaten in front of TV (p=0.01); these differences were not significant after adjustment for multiple comparisons. CONCLUSION: KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.}, Doi = {10.1016/j.ypmed.2012.06.005}, Key = {fds277620} } @article{fds277616, Author = {Wildes, JE and Zucker, NL and Marcus, MD}, Title = {Picky eating in adults: results of a web-based survey.}, Journal = {Int J Eat Disord}, Volume = {45}, Number = {4}, Pages = {575-582}, Year = {2012}, Month = {May}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.20975}, Abstract = {OBJECTIVE: To gather information about picky eating and its correlates in adults and to determine whether picky eating is distinct from other eating disorder symptoms. METHOD: Nearly 6,895 adults completed a web-based survey of picky eating behaviors, eating disorder symptoms, and putative associated features. Latent class analysis was used to identify groups based on picky eating and eating disorder symptoms, and groups were compared on salient demographic and clinical characteristics. RESULTS: The latent class analysis identified four distinct groups that differed in severity of clinical correlates and levels of impairment. Morbidity was highest in the comorbid picky eating/eating disorder group, followed by the eating disorder, picky eating, and low pathology groups, respectively. DISCUSSION: Future research is needed to document the continuity of picky eating from childhood, establish the epidemiology of picky eating in adults, clarify thresholds of clinical significance, and elucidate clinical features that will inform nosology.}, Doi = {10.1002/eat.20975}, Key = {fds277616} } @article{fds277614, Author = {Boutelle, KN and Zucker, NL and Peterson, CB and Rydell, SA and Cafri, G and Harnack, L}, Title = {Two novel treatments to reduce overeating in overweight children: a randomized controlled trial.}, Journal = {J Consult Clin Psychol}, Volume = {79}, Number = {6}, Pages = {759-771}, Year = {2011}, Month = {December}, ISSN = {0022-006X}, url = {http://dx.doi.org/10.1037/a0025713}, Abstract = {OBJECTIVE: Our purpose in this study was to examine 2 treatments targeted at reducing eating in the absence of hunger in overweight and obese children. METHOD: Thirty-six overweight and obese 8- to 12-year-old children (58% female; mean age = 10.3 years, SD = 1.3), with high scores on eating in the absence of hunger, and their parents were randomly assigned to an 8-week children's appetite awareness training or cue exposure treatment-food. Children completed an eating in the absence of hunger (EAH) paradigm, an Eating Disorder Examination interview for children, and three 24-hr dietary recalls, and their height and weight were measured. Parents completed the EAH Questionnaire and the Binge Eating Scale, and their height and weight were measured. Assessments were conducted at baseline, posttreatment, and 6 and 12 months posttreatment. RESULTS: Results showed that both treatments resulted in significant decreases in binge eating in children over time. Additionally, children in the food cue exposure treatment showed significant decreases in EAH posttreatment and 6 months posttreatment, but children in the appetite awareness training showed no change in EAH. Neither treatment produced significant effects on caloric intake in children or on any of the parent outcomes. CONCLUSIONS: This study demonstrates that training in food cue responsitivity and appetite awareness has the potential to be efficacious for reducing EAH and binge eating in children. Because these data are preliminary, further treatment development and randomized controlled studies are needed.}, Doi = {10.1037/a0025713}, Key = {fds277614} } @article{fds277615, Author = {Zucker, N and Moskvich, A and Soo, A}, Title = {Neuropsychological aspects of eating disorders}, Journal = {Psychiatric Annals}, Volume = {41}, Number = {11}, Pages = {539-546}, Publisher = {SLACK INC}, Year = {2011}, Month = {November}, ISSN = {0048-5713}, url = {http://dx.doi.org/10.3928/00485713-20111017-07}, Doi = {10.3928/00485713-20111017-07}, Key = {fds277615} } @article{fds277613, Author = {Goldschmidt, A and Wilfley, DE and Eddy, KT and Boutelle, K and Zucker, N and Peterson, CB and Celio-Doyle, A and Le Grange, D}, Title = {Overvaluation of shape and weight among overweight children and adolescents with loss of control eating.}, Journal = {Behav Res Ther}, Volume = {49}, Number = {10}, Pages = {682-688}, Year = {2011}, Month = {October}, ISSN = {0005-7967}, url = {http://dx.doi.org/10.1016/j.brat.2011.07.011}, Abstract = {Little is known about the phenomenology of pediatric loss of control (LOC) eating. Overvaluation of shape and weight, however, appears to be diagnostically meaningful among binge eating adults. We explored the significance of shape and weight overvaluation among children and adolescents with LOC eating. Participants (n = 526) included 149 overweight youth with LOC eating and 377 overweight controls (CON). Participants were categorized as those reporting at least moderate overvaluation (LOC-Mod, n = 74; CON-Mod, n = 106) or less than moderate overvaluation (LOC-Low, n = 75; CON-Low, n = 271), and compared on measures of eating-related and general psychopathology. LOC-Mod evidenced lower self-esteem than CON-Low, and greater behavioral problems than CON-Mod and CON-Low, but did not differ from LOC-Low in these domains. With the exception of LOC-Low and CON-Mod, all groups differed on global eating-disorder severity, with LOC-Mod scoring the highest. Overvaluation of shape and weight appears to be of questionable importance in defining subtypes of youth with LOC eating. However, as overvaluation and LOC eating each independently predicts eating-disorder onset, their confluence may confer even further risk for eating-disorder development. Longitudinal studies should address this possibility. Developmentally appropriate discussion about body image disturbance may be indicated in interventions targeting pediatric LOC eating and/or obesity.}, Doi = {10.1016/j.brat.2011.07.011}, Key = {fds277613} } @article{fds277626, Author = {Zucker, NL and Green, S and Morris, JP and Kragel, P and Pelphrey, KA and Bulik, CM and LaBar, KS}, Title = {Hemodynamic signals of mixed messages during a social exchange.}, Journal = {Neuroreport}, Volume = {22}, Number = {9}, Pages = {413-418}, Year = {2011}, Month = {June}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21602650}, Abstract = {This study used functional magnetic resonance imaging to characterize hemodynamic activation patterns recruited when the participants viewed mixed social communicative messages during a common interpersonal exchange. Mixed messages were defined as conflicting sequences of biological motion and facial affect signals that are unexpected within a particular social context (e.g. observing the reception of a gift). Across four social vignettes, valenced facial expressions were crossed with rejecting and accepting gestures in a virtual avatar responding to presentation of a gift from the participant. The results indicate that conflicting facial affect and gesture activated superior temporal sulcus, a region implicated in expectancy violations, as well as inferior frontal gyrus and putamen. Scenarios conveying rejection differentially activated the insula and putamen, regions implicated in embodied cognition, and motivated learning, as well as frontoparietal cortex. Characterizing how meaning is inferred from integration of conflicting nonverbal communicative cues is essential to understand nuances and complexities of human exchange.}, Doi = {10.1097/WNR.0b013e3283455c23}, Key = {fds277626} } @article{fds277619, Author = {Ostbye, T and Zucker, NL and Krause, KM and Lovelady, CA and Evenson, KR and Peterson, BL and Bastian, LA and Swamy, GK and West, DG and Brouwer, RJN}, Title = {Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics.}, Journal = {Contemp Clin Trials}, Volume = {32}, Number = {3}, Pages = {461-469}, Year = {2011}, Month = {May}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21300177}, Abstract = {BACKGROUND: Prevention of childhood obesity is a public health priority. Parents influence a child's weight by modeling healthy behaviors, controlling food availability and activity opportunities, and appropriate feeding practices. Thus interventions should target education and behavioral change in the parent, and positive, mutually reinforcing behaviors within the family. METHODS: This paper presents the design, rationale and baseline characteristics of Kids and Adults Now! - Defeat Obesity (KAN-DO), a randomized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight, and weight reduction in overweight children. 400 children aged 2-5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are randomized equally to control or the KAN-DO intervention, consisting of mailed family kits encouraging healthy lifestyle change. Eight (monthly) kits are supported by motivational counseling calls and a single group session. Mothers are targeted during a hypothesized "teachable moment" for health behavior change (the birth of a new baby), and intervention content addresses: parenting skills ((e.g., emotional regulation, authoritative parenting), healthy eating, and physical activity. RESULTS: The 400 mother-child dyads randomized to trial are 75% white and 22% black; 19% have a household income of $30,000 or below. At baseline, 15% of children are overweight (85th-95th percentile for body mass index) and 9% are obese (≥ 95th percentile). CONCLUSION: This intervention addresses childhood obesity prevention by using a family-based, synergistic approach, targeting at-risk children and their mothers during key transitional periods, and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change.}, Doi = {10.1016/j.cct.2011.01.017}, Key = {fds277619} } @article{fds277612, Author = {Zucker, N and Von Holle and A and Thornton, LM and Strober, M and Plotnicov, K and Klump, KL and Brandt, H and Crawford, S and Crow, S and Fichter, MM and Halmi, KA and Johnson, C and Kaplan, AS and Keel, P and LaVia, M and Mitchell, JE and Rotondo, A and Woodside, DB and Berrettini, WH and Kaye, WH and Bulik, CM}, Title = {The significance of repetitive hair-pulling behaviors in eating disorders.}, Journal = {J Clin Psychol}, Volume = {67}, Number = {4}, Pages = {391-403}, Year = {2011}, Month = {April}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21365638}, Abstract = {We studied the relation between intrusive and repetitive hair pulling, the defining feature of trichotillomania, and compulsive and impulsive features in 1,453 individuals with anorexia nervosa and bulimia nervosa. We conducted a series of regression models examining the relative influence of compulsive features associated with obsessive-compulsive disorder, compulsive features associated with eating disorders, trait features related to harm avoidance, perfectionism, and novelty seeking, and self harm. A final model with a reduced sample (n = 928) examined the additional contribution of impulsive attributes. One of 20 individuals endorsed hair pulling. Evidence of a positive association with endorsement of compulsive behavior of the obsessive-compulsive spectrum emerged. Hair pulling may be more consonant with ritualistic compulsions than impulsive urges in those with eating disorders.}, Doi = {10.1002/jclp.20770}, Key = {fds277612} } @article{fds277622, Author = {Merwin, RM and Timko, CA and Moskovich, AA and Ingle, KK and Bulik, CM and Zucker, NL}, Title = {Psychological inflexibility and symptom expression in anorexia nervosa.}, Journal = {Eat Disord}, Volume = {19}, Number = {1}, Pages = {62-82}, Year = {2011}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21181580}, Abstract = {The purpose of this article is to outline a model of anorexia nervosa (AN) as a disorder of psychological inflexibility, motivated by an insatiable desire for prediction and control with related intolerance for uncertainty. We describe preliminary data that provide initial support for this conceptualization and point to the ways in which mindfulness and acceptance-based strategies might be particularly useful for treating AN. This article is not intended to be an exhaustive literature review, rather a conceptual framework to guide future research and treatment development.}, Doi = {10.1080/10640266.2011.533606}, Key = {fds277622} } @article{fds277624, Author = {Zucker, NL and Herzog, D and Moskovich, A and Merwin, R and Lin, T}, Title = {Incorporating dispositional traits into the treatment of anorexia nervosa.}, Journal = {Curr Top Behav Neurosci}, Volume = {6}, Pages = {289-314}, Year = {2011}, ISSN = {1866-3370}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21243482}, Abstract = {We provide a general framework to guide the development of interventions that aim to address persistent features in eating disorders that may preclude effective treatment. Using perfectionism as an exemplar, we draw from research in cognitive neuroscience regarding attention and reinforcement learning, from learning theory and social psychology regarding vicarious learning and implications for the role modeling of significant others, and from clinical psychology on the importance of verbal narratives as barriers that may influence expectations and shape reinforcement schedules.}, Doi = {10.1007/7854_2010_92}, Key = {fds277624} } @article{fds277621, Author = {Merwin, RM and Zucker, NL and Lacy, JL and Elliott, CA}, Title = {Interoceptive awareness in eating disorders: Distinguishing lack of clarity from non-acceptance of internal experience}, Journal = {Cognition and Emotion}, Volume = {24}, Number = {5}, Pages = {892-902}, Publisher = {Informa UK Limited}, Year = {2010}, Month = {July}, ISSN = {0269-9931}, url = {http://dx.doi.org/10.1080/02699930902985845}, Abstract = {Poor interoceptive awareness is often cited as a key feature of eating disorders, yet the precise nature of the deficits and their relationship to eating pathology remains unclear. Interoceptive awareness includes both acceptance of affective experience and clarity regarding emotional responses. The aim of the current study was to parse these components and examine the association between these deficits and two representative eating disorder symptoms: dietary restraint and binge eating. Participants were 50 eating disorder patients who completed a medical examination, clinical interview and symptom self-report measures. Results of regression analyses controlling for BMI and illness duration indicated that non-acceptance, not lack of clarity, was significantly associated with dietary restraint. Neither predicted binge eating. Findings suggest that negative reactions to emotional responses may contribute to the development or maintenance of dietary restraint. Results highlight the need to investigate the experience of emotional arousal in individuals with eating disorders using experimental methods that deconstruct the components of interoceptive awareness, and the potential utility of treatments that increase comfort with affective experience for individuals with more restrictive patterns. © 2009 Psychology Press.}, Doi = {10.1080/02699930902985845}, Key = {fds277621} } @article{fds277611, Author = {Bravender, T and Bryant-Waugh, R and Herzog, D and Katzman, D and Kriepe, RD and Lask, B and Le Grange and D and Lock, J and Loeb, KL and Marcus, MD and Madden, S and Nicholls, D and O'Toole, J and Pinhas, L and Rome, E and Sokol-Burger, M and Wallin, U and Zucker, N and Workgroup for Classification of Eating Disorders in Children and Adolescents}, Title = {Classification of eating disturbance in children and adolescents: proposed changes for the DSM-V.}, Journal = {Eur Eat Disord Rev}, Volume = {18}, Number = {2}, Pages = {79-89}, Year = {2010}, Month = {March}, ISSN = {1072-4133}, url = {http://dx.doi.org/10.1002/erv.994}, Abstract = {Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.}, Doi = {10.1002/erv.994}, Key = {fds277611} } @article{fds277610, Author = {Treasure, J and Claudino, AM and Zucker, N}, Title = {Eating disorders.}, Journal = {Lancet}, Volume = {375}, Number = {9714}, Pages = {583-593}, Year = {2010}, Month = {February}, ISSN = {0140-6736}, url = {http://dx.doi.org/10.1016/S0140-6736(09)61748-7}, Abstract = {This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery.}, Doi = {10.1016/S0140-6736(09)61748-7}, Key = {fds277610} } @article{fds277618, Author = {Watson, KK and Werling, DM and Zucker, NL and Platt, ML}, Title = {Altered social reward and attention in anorexia nervosa.}, Journal = {Front Psychol}, Volume = {1}, Pages = {36}, Year = {2010}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21887145}, Abstract = {Dysfunctional social reward and social attention are present in a variety of neuropsychiatric disorders including autism, schizophrenia, and social anxiety. Here we show that similar social reward and attention dysfunction are present in anorexia nervosa (AN), a disorder defined by avoidance of food and extreme weight loss. We measured the implicit reward value of social stimuli for female participants with (n = 11) and without (n = 11) AN using an econometric choice task and also tracked gaze patterns during free viewing of images of female faces and bodies. As predicted, the reward value of viewing bodies varied inversely with observed body weight for women with anorexia but not control women, in contrast with their explicit ratings of attractiveness. Surprisingly, women with AN, unlike control women, did not find female faces rewarding and avoided looking at both the face and eyes - independent of observed body weight. These findings suggest comorbid dysfunction in the neural circuits mediating gustatory and social reward in anorexia nervosa.}, Doi = {10.3389/fpsyg.2010.00036}, Key = {fds277618} } @article{fds277593, Author = {Zucker, N and Merwin, R and Elliott, C and Lacy, J and Eichen, D}, Title = {Assessment of eating disorder symptoms in children and adolescents}, Pages = {401-443}, Publisher = {Springer New York}, Year = {2009}, Month = {December}, url = {http://dx.doi.org/10.1007/978-0-387-09528-8_14}, Abstract = {The most recent diagnostic classification system delineated by the American Psychiatric Association (DSM-IV; American Psychiatric Association, 2000) is not sensitive to the expression of disordered eating in children and adolescents (Cooper, Watkins, Bryant-Waugh, & Lask, 2002). The issues are complex. First, symptom expression in children and adolescents may manifest differently than in adults due to developmental influences on cognition, affect, and physical maturation. Second, children and adolescents may require different symptom thresholds for diagnosis given the sensitivity and importance of nutritional health for these age groups. Indeed, malnourishment may have permanent negative effects on cognitive and emotional functioning, sexual maturation, and physical growth, damage that may be particularly pronounced during this sensitive developmental period (Oninla, Owa, Onayade, & Taiwo, 2007). The end result of these challenges is that clinicians may fail to detect children and adolescents in need of intervention, the failure to detect lower symptom thresholds may have permanent negative health consequences, diminished sensitivity to the age-related expression of symptoms may interfere with appropriate treatment formulation, and the failure to consider developmental nuances may prevent the advance of a meaningful research agenda. This chapter is intended to address these important issues by proposing strategies for assessment that consider developmentally sensitive manifestations of eating disturbance in children and adolescents for the purposes of diagnosis and case formulation. © 2009 Springer New York.}, Doi = {10.1007/978-0-387-09528-8_14}, Key = {fds277593} } @article{fds277609, Author = {Zucker, NL and Losh, M}, Title = {Repetitive behaviours in anorexia nervosa, autism, and obsessive-compulsive personality disorder}, Journal = {Psychiatry}, Volume = {7}, Number = {4}, Pages = {183-187}, Publisher = {Elsevier BV}, Year = {2008}, Month = {April}, ISSN = {1476-1793}, url = {http://dx.doi.org/10.1016/j.mppsy.2008.02.012}, Abstract = {Restricted and repetitive behaviours and interests (RRBs) greatly contribute to the burden of psychiatric illness for the individual and his or her family. While as a class the presence of RRBs may evidence continuity, the form of the behaviour may change. Further, a given individual may exhibit a multitude of RRBs that compromise different areas of functioning. In eating disorders, individuals may exhibit RRB before eating disorder diagnosis. These behaviours may compromise or complicate treatment, and they may persist following eating disorder improvement. Strategies to organize these behaviours within an individual may facilitate the efficiency of management, while searching for parallel manifestations in RRBs across diagnostic syndromes may guide novel hypothesis generation on underlying biological mechanisms. This article illustrates this strategy by examining potential symptom overlap in the expression of RRBs in individuals with anorexia nervosa, obsessive-compulsive personality disorder, and autism. © 2008.}, Doi = {10.1016/j.mppsy.2008.02.012}, Key = {fds277609} } @article{fds277608, Author = {Bravender, T and Bryant-Waugh, R and Herzog, D and Katzman, D and Kreipe, RD and Lask, B and Le Grange and D and Lock, J and Loeb, K and Madden, S and Nicholls, D and O'Toole, J and Pinhas, L and Rome, E and Sokol-Burger, M and Wallen, U and Zucker, N and Workgroup for Classification of Eating Disorders in Children and Adolescents}, Title = {Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA).}, Journal = {Int J Eat Disord}, Volume = {40 Suppl}, Number = {7 SUPPL.}, Pages = {S117-S122}, Year = {2007}, Month = {November}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.20458}, Abstract = {OBJECTIVE: : The purpose of this article is to summarize major conceptual and clinical variables related to age-appropriate and developmentally appropriate classification of eating problems and disorders in children and adolescents. METHOD: A review of current classifications and related literature in child development is provided. Problems with current classification schemes are identified and discussed. RESULTS: Current classifications are inadequate to address the clinical and research needs of children and adolescents with eating disturbances and disorders. CONCLUSION: A range of possible changes in classification strategies for eating disorders in children and adolescents are described.}, Doi = {10.1002/eat.20458}, Key = {fds277608} } @article{fds277625, Author = {Zucker, NL and Losh, M and Bulik, CM and LaBar, KS and Piven, J and Pelphrey, KA}, Title = {Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes.}, Journal = {Psychol Bull}, Volume = {133}, Number = {6}, Pages = {976-1006}, Year = {2007}, Month = {November}, ISSN = {0033-2909}, url = {http://www.ncbi.nlm.nih.gov/pubmed/17967091}, Abstract = {Death by suicide occurs in a disproportionate percentage of individuals with anorexia nervosa (AN), with a standardized mortality ratio indicating a 57-fold greater risk of death from suicide relative to an age-matched cohort. Longitudinal studies indicate impaired social functioning increases risk for fatal outcomes, while social impairment persists following recovery. Study of social cognition in AN may elucidate impaired processes that may influence therapeutic efficacy. Symptoms of autism spectrum disorders (ASD) are overrepresented in those who evidence a chronic course. Relative to that in AN, social information processing in ASD is well characterized and may inform systematic study in AN. This article (a) reviews impaired interpersonal processes in AN, (b) compares the phenotype of AN with that of ASD, (c) highlights deficits of social cognitive disturbance in ASD relative to AN, and (d) proposes a new framework to understand the interaction of individuals with AN with their social context.}, Doi = {10.1037/0033-2909.133.6.976}, Key = {fds277625} } @article{fds277632, Author = {Georgiades, A and Zucker, N and Friedman, KE and Mosunic, CJ and Applegate, K and Lane, JD and Feinglos, MN and Surwit, RS}, Title = {Changes in depressive symptoms and glycemic control in diabetes mellitus.}, Journal = {Psychosom Med}, Volume = {69}, Number = {3}, Pages = {235-241}, Year = {2007}, Month = {April}, url = {http://www.ncbi.nlm.nih.gov/pubmed/17420441}, Abstract = {OBJECTIVE: To investigate if changes in depressive symptoms would be associated with changes in glycemic control over a 12-month period in patients with Type 1 and Type 2 diabetes. METHODS: Ninety (Type 1 diabetes, n = 28; Type 2 diabetes, n = 62) patients having Beck Depression Inventory (BDI) levels of >10 were enrolled in the study. Of those 90 patients, 65 patients completed a 12-week cognitive behavioral therapy intervention. BDI was assessed at baseline and thereafter biweekly during 12 months. Hemoglobin (HbA1c) and fasting blood glucose levels were assessed at baseline and at four quarterly in-hospital follow-up visits. Linear mixed-model analysis was applied to determine the effects of time and diabetes type on depressive symptoms, HbA1c levels, and fasting glucose levels. RESULTS: Mean and standard deviation baseline BDI and HbA1c levels were 17.9 +/- 5.8 and 7.6 +/- 1.6, respectively, with no significant difference between patients with Type 1 and Type 2 diabetes. Mixed-model regression analysis found no difference between the groups with Type 1 and Type 2 diabetes in the within-subject effect of BDI score on HbA1c or fasting glucose levels during the study. Depressive symptoms decreased significantly (p = .0001) and similarly over a 12-month period in both patients with Type 1 and Type 2 diabetes, whereas HbA1c and fasting glucose levels did not change significantly over time in either group. CONCLUSION: Changes in depressive symptoms were not associated with changes in HbA1c or fasting glucose levels over a 1-year period in either patients with Type 1 or Type 2 diabetes.}, Doi = {10.1097/PSY.0b013e318042588d}, Key = {fds277632} } @article{fds277628, Author = {Bravender, T and Kanter, R and Zucker, N}, Title = {Anorexia nervosa and second-degree atrioventricular block (Type I).}, Journal = {Int J Eat Disord}, Volume = {39}, Number = {7}, Pages = {612-615}, Year = {2006}, Month = {November}, ISSN = {0276-3478}, url = {http://dx.doi.org/10.1002/eat.20235}, Abstract = {OBJECTIVE: This is the first case report of a second-degree heart block (Mobitz Type I) described in a patient with anorexia nervosa (AN). METHOD: We present the case of a 20-year-old woman with AN and second-degree heart block. Pertinent reports in the literature regarding atrioventricular conduction abnormalities as well as cardiac rhythm disturbances are reviewed. RESULTS AND CONCLUSION: Although this patient's second-degree heart block may represent an intrinsic conduction abnormality unrelated to her AN, the importance of the validation of medical conditions during the treatment of AN is discussed.}, Doi = {10.1002/eat.20235}, Key = {fds277628} } @article{fds277607, Author = {Zucker, NL and Marcus, M and Bulik, C}, Title = {A group parent-training program: a novel approach for eating disorder management.}, Journal = {Eat Weight Disord}, Volume = {11}, Number = {2}, Pages = {78-82}, Year = {2006}, Month = {June}, url = {http://www.ncbi.nlm.nih.gov/pubmed/16809979}, Abstract = {OBJECTIVE: To describe the rationale, development, and preliminary acceptability of a Group Parent Training Program (GPT) as an alternative approach for the treatment of adolescent eating disorders. METHOD: Sixteen families participated in a 16-session group treatment. After four months, parents were administered a treatment satisfaction questionnaire. RESULTS: Parent response to the intervention was positive. All parents indicated GPT was essential for the management of their child, improved general parenting skills, improved their own self-care, and decreased the burden they experienced as a result of managing their child's illness. DISCUSSION: Given the magnitude of task demands placed on a family for the management of adolescent eating disorders, there is the need for the development of effective intervention strategies that ease the stress of illness management for parents. Preliminary satisfaction data from GPT are promising and argue for a more systematic test of this intervention.}, Doi = {10.1007/BF03327755}, Key = {fds277607} } @article{fds136118, Title = {Zucker, N.L., Marcus, M., & Bulik, C. (2006). A group parent-training program: A novel approach to eating disorder management. Eating and Weight Disorders, 11, 78-83.}, Year = {2006}, Key = {fds136118} } @article{fds277606, Author = {Zucker, N and Story, LB}, Title = {Questions & answers: Integrating academics in the context of eating disorder treatment.}, Journal = {Eat Disord}, Volume = {14}, Number = {4}, Pages = {349-352}, Year = {2006}, ISSN = {1064-0266}, url = {http://dx.doi.org/10.1080/10640260600796309}, Doi = {10.1080/10640260600796309}, Key = {fds277606} } @article{fds277630, Author = {Zucker, NL and Ferriter, C and Best, S and Brantley, A}, Title = {Group parent training: a novel approach for the treatment of eating disorders.}, Journal = {Eat Disord}, Volume = {13}, Number = {4}, Pages = {391-405}, Year = {2005}, ISSN = {1064-0266}, url = {http://www.ncbi.nlm.nih.gov/pubmed/16864353}, Abstract = {This paper describes the rationale, development, and implementation of a group parent training program designed to assist caregivers in the management of their child's eating disorder while facilitating the development of a healthy home environment for sustained change. The content of this program instructs caregivers in disorder management and capitalizes on caregivers as role models of adaptive behavior. Strategies are provided to address acute disorder management, features of caregivers that may impede task implementation, and environmental and attitudinal changes. The group format enhances social support, accountability, and self-efficacy. A preliminary qualitative evaluation and future directions are described to assist healthcare professionals in better meeting the needs of caregivers of these disorders.}, Doi = {10.1080/10640260591005272}, Key = {fds277630} } @article{fds277633, Author = {Mazzeo, SE and Zucker, NL and Gerke, CK and Mitchell, KS and Bulik, CM}, Title = {Parenting concerns of women with histories of eating disorders.}, Journal = {Int J Eat Disord}, Volume = {37 Suppl}, Pages = {S77-S79}, Year = {2005}, ISSN = {0276-3478}, url = {http://www.ncbi.nlm.nih.gov/pubmed/15852326}, Keywords = {Adult • Attitude • Child • Child of Impaired Parents • Eating Disorders • Female • Humans • Mothers • Parenting* • psychology*}, Abstract = {The current article reviews the literature on parenting among women with EDs, and outlines the process of developing an intervention addressing their parenting concerns.}, Language = {eng}, Doi = {10.1002/eat.20121}, Key = {fds277633} } @article{fds277605, Author = {Varnado-Sullivan, PJ and Zucker, N}, Title = {The Body Logic Program for Adolescents: a treatment manual for the prevention of eating disorders.}, Journal = {Behav Modif}, Volume = {28}, Number = {6}, Pages = {854-875}, Year = {2004}, Month = {November}, ISSN = {0145-4455}, url = {http://dx.doi.org/10.1177/0145445503259856}, Abstract = {The Body Logic Program for Adolescents was developed as a two-stage intervention to prevent the development of eating disorder symptoms. Preliminary results indicate that this program shows promise as an effective prevention effort. The current article provides a detailed description of the protocol for implementing Body Logic Part I, a school-based intervention. A brief review of Body Logic Part II, an intensive family-based intervention for high-risk students, is also provided. Examples of exercises are introduced and goals for practitioners are discussed. The authors hope that by providing this in-depth description of the protocol, researchers and clinicians can use this program in future prevention efforts.}, Doi = {10.1177/0145445503259856}, Key = {fds277605} } @article{fds136117, Title = {Zucker, N.L., Ferriter, C., Best, S., & Brantley, A. (in press). Group Parent Training: A Novel Approach for Eating Disorder Treatment. Eating Disorders: The Journal of Treatment and Prevention. | |
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