From MedpageToday.com

Eating regular meals with the family may keep teenage girls from extreme weight control measures such as purging, according to a longitudinal study.

Girls who ate with their family most days of the week were 29% less likely to engage in purging or to use diet pills and diuretics five years later, even after adjusting for confounding factors, Dianne Neumark-Sztainer, Ph.D., M.P.H., R.D., of the University of Minnesota here, and colleagues reported in the January issue of Archives of Pediatrics & Adolescent Medicine.

Binge eating and other disordered eating behaviors also tended to be less common for those accustomed to eating meals with their family, the researchers said.

Action Points

Explain to interested patients that this study supports the role of family meals in helping teens make healthy decisions about food.

Consider suggesting ways families can increase the number of meals they eat together, such as trying breakfast if dinner does not work because of scheduling.

The prospective findings add to a growing body of literature suggesting family meals play an important role in the health and well-being of adolescent girls.

“Health care professionals have an important role to play in reinforcing the benefits of family meals,” they said.

Without being judgmental, providers can help families set realistic goals and come up with creative ways to increase frequency of meals together, Dr. Neumark-Sztainer added.

“This may be eating breakfast together if dinner doesn’t work,” she suggested. “It can be challenging, I just think we have to put it up there with our priorities.”

The researchers’ Project EAT (Eating Among Teens) study had previously shown that extreme weight control behaviors increased in prevalence from 14.5% to 23.9% as the girls progressed from middle to late adolescence.

These behaviors can cause physical and psychological problems, including weight gain, depressive symptoms, and the onset of eating disorders, they noted.

The second, longitudinal, phase of Project EAT followed 1,386 female and 1,130 male middle and high school students from 31 Minnesota schools for eating patterns and weight-control related behaviors.

Whereas the first phase used in-class surveys and anthropometric measures during the 1998-99 school year, the second surveyed just over half of the original participants by mail during the 2003-04 academic year.

A third of the participants were in middle school (mean age 12.8) in the 1998-99 phase; the rest were high schoolers (mean age 15.8).

Disordered eating behaviors at five-year follow-up were more common among girls than boys, and the effect of baseline family meal patterns was different between genders.

In unadjusted analyses, girls who reported at least five family meals a week had significantly lower prevalence of all types of disordered eating behaviors.

Compared with girls who reported fewer than five weekly family meals, prevalence was:

17.4% versus 26% for extreme weight-control behaviors, including self-induced vomiting and use of laxatives, diet pills, or diuretics (P0.001)

57.4% versus 64.4% for unhealthy weight control behaviors, defined as fasting, eating food substitutes or “very little” food, skipping meals, and smoking more cigarettes (P0.008)

9.2% versus 12.7% for binge eating (P0.046)

13.9% versus 18.5% for chronic dieting (P0.02)

After adjustment for sociodemographics and body mass index, regular family meals were associated with lower odds of extreme weight control behaviors (odds ratio: 0.66, 95% CI: 0.49 to 0.88, P0.005) and a trend for less unhealthy behaviors (OR: 0.80, 95% CI: 0.63 to 1.02, P0.07) and chronic dieting (OR: 0.75, 95% CI: 0.55 to 1.03, P0.07).

The association with extreme weight-control behaviors remained after additional adjustment for family connectedness and parental encouragement to diet (OR: 0.69, 95% CI: 0.51 to 0.94, P0.02) and for baseline behaviors (OR: 0.71, 95% CI: 0.52 to 0.97, P0.03).

Trends for the other disordered eating behaviors continued to suggest a protective effect of family meals.

Among boys, family meals had little impact on disordered eating.

However, there was an unexpected increase in unhealthy weight control behaviors for boys who regularly had meals with family (OR: 1.73, 95% CI: 1.24 to 2.40, P0.001). This increase was limited to skipping meals (OR: 1.81, 95% CI: 1.24 to 2.63) and eating very little food (OR: 1.84, 95% CI: 1.23 to 2.69).

The gender difference could be because adolescent boys and girls have different experiences at family meals, Dr. Neumark-Sztainer and colleagues speculated.

“Family meals may offer more benefits to adolescent girls, who may be more sensitive to and likely to be influenced by interpersonal and familial relationships than are adolescent boys,” they wrote.

Another factor could simply be that disordered eating is less common among boys, Dr. Neumark-Sztainer said.

However, they cautioned, the findings could have been limited by attrition from the original study population and the use of brief measures of disordered eating behaviors and lack of clinical measures of eating disorders.

Family meals may not be the only factor that impacts development of disordered eating behaviors, Dr. Neumark-Sztainer said.

“All we can say from this is the association is very strong,” she said.

From HealthScout

Eating disorders rose significantly among American boys between 1995 and 2005, according to a study that examined weight control behaviors among high school students.

The study, based on an analysis of national data from the U.S. Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System, identified a large increase in all forms of weight control behaviors among males, including dieting, diet product use, purging, exercise and vigorous exercise.

Hispanic males were most likely to practice weight control, while white males were least likely, said the study authors, led by Y. May Chao of Wesleyan University in Middletown, Conn.

They also found a significant overall increase in dieting and diet product use among female adolescents. White females were most likely practice weight control while black females were least likely, the researchers said.

The increased weight control behavior noted in males suggests growing social pressure for males to achieve unrealistic body expectations, thus increasing the risk of body dissatisfaction and eating disorders, the study authors said.

“Considering that males have negative attitudes toward treatment-seeking and are less likely than females to seek treatment, efforts should be made to increase awareness of eating disorder symptomatology in male adolescents, and future prevention efforts should target male as well as female adolescents,” the researchers wrote.

The study was published online in the International Journal of Eating Disorders

From MedPage Today

Identifying obese patients and treating them aggressively can help prevent the constellation of diseases that accompany being overweight — a condition that now impacts 74% of Americans.

“We need to treat the cause of obesity — the patient who is overweight,” Christopher Cannon, M.D., of Harvard and Brigham and Women’s Hospital, told attendees at an industry-sponsored symposium held in conjunction with the American Heart Association meeting here.

Samuel Klein, M.D., of Washington University in St. Louis, listed the host of diseases obesity causes or to which it contributes: stroke, idiopathic intracranial hypertension, cataracts, pulmonary disease, coronary heart disease, nonalcoholic fatty liver disease, gallbladder disease, infertility, various cancers, osteoarthritis, phlebitis, and gout.

Dr. Cannon suggested that physicians need to measure both the patient’s weight and his waist, assess risk factors, and “initiate long-term treatment to achieve and maintain weight loss.”

He said that doctors can promote lifestyle intervention, treat patients with drugs that are now available and others that may become available — particularly drugs now in development that interfere with the endocannabinoid receptors — and consider that they may have to send the patient for bariatric therapy.

Dr. Cannon also reviewed studies on two of the drugs in development — rimonabant and taranabant — noting that rimonabant is stalled at the FDA. Taranabant, he said, has shown dose-dependent ability to reduce weight and waist.

“I think obesity is a disease,” said F. Xavier Pi-Sunyer, M.D., professor of medicine at Columbia University.

About treating obesity with the endocannabinoid receptor antagonists, he said that they work in the brain to reduce food intake, in adipose tissue to increase adiponectin and to reduce lipogenesis, in muscles to improve glucose uptake and oxygen consumption, in the liver to reduce lipogenesis, and in the gastrointestinal tract to promote satiety.

Dr. Klein said that the United States isn’t the fattest nation in the world — that honor goes to the island nation of Nauru where 94.5% of the population is either overweight or obese.

And, putting the recent attention on obesity into perspective, he noted that studies show that Americans have been getting fatter for more than a century — and the biggest jump in weight came in the years from 1946 through 1961.

Parents often fail to recognize children’s use of harmful venues for weight-loss tips

From HealthDay

They’re called pro-eating disorder Web sites. And many teens looking to lose weight — even those who don’t need to — are logging on to these communities of individuals who engage in dangerous eating habits.

Yet many parents aren’t aware the sites even exist and that their children are visiting them, researchers have found.

“Most parents would not endorse their child leaving the house at night, walking to an area of town that they themselves had never been in and meeting people that they themselves had never met,” said study author Dr. Rebecka Peebles, an instructor in adolescent medicine at Lucile Packard Children’s Hospital at Stanford University School of Medicine. “And I think that’s actually what a lot of kids are doing online at home from their bedrooms.”

Potentially dangerous venues include Web sites where people who engage in disordered eating gather to discuss their activities. A majority of these sites have sections where members of the community share tips and techniques “that I would consider as a physician fairly harmful,” Peebles said.

Complicating matters, “pro-recovery” sites that promote recovery from eating disorders can also be a source of weight-loss or purging techniques, the researchers found.

Peebles and her colleagues sent questionnaires regarding Internet use and eating disorder information to the parents of almost 700 people who had been evaluated for an eating disorder at Lucile Packard Children’s Hospital between 1997 and 2004. A total of 182 responded, including 76 teens and 106 parents.

Forty-one percent of the patients had visited a pro-eating disorder (pro-ED) Web site, while 36 percent had visited a pro-recovery Web site.

One of the problems, Peebles explained, is that even forums designed to disseminate helpful information are constantly changing and may contain content that wasn’t the author’s original intent. “In our study, we did find that 96 percent of patients who visited pro-ED Web sites reported learning dieting tips and purging techniques from Web sites,” she said. “However, nearly half of the people who visited pro-recovery Web sites also reported learning similar tips and techniques.”

A majority of parents (52 percent) didn’t know whether their children visited pro-eating disorder Web sites, and 62.5 percent had no knowledge of pro-recovery sites. Half of parents of users of pro-eating disorder Web sites either didn’t know whether their child visited these sites while in treatment or thought their child did not use these sites.

Peebles said the findings, published in the journal Pediatrics, underscore the need for parents to educate themselves about the Internet as a medium, so they can make consistent choices about guiding their teens’ Web activity.

“I think a lot of parents are deciding by default not to be involved in their kids online activities really, just because Google, in and of itself, is scary to them,” she said.

“Most of our kids are more savvy surfers than we are,” agreed Cynthia M. Bulik, professor of eating disorders at the University of North Carolina at Chapel Hill School of Medicine and director of the UNC Eating Disorders Program at UNC Hospitals. To stay in control, she tells parents to “hone your own surfing skills” and “keep your family-access computer in a place where everyone can see what is being surfed.”

Parents also need to talk to their child about what he or she finds on the Internet, Bulik advised. And should they learn that their child is visiting eating disorder Web sites, that’s a perfect opportunity to open a dialogue.

Bulik said, “I always tell parents, if your child comes home and says, ‘I’m going on a diet,’ or “I feel fat,’ you should take it as seriously as if they were to come home and say, ‘I’m trying my first cigarette’ or ‘I’m going to have a beer’ — time to start the conversation!”