Marian Tanofsky-Kraff, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): Obesity has reached epidemic rates in the U.S. Estimates indicate that one third of the adult population is at risk for adverse health consequences resulting from obesity and overweight. Early prevention efforts are essential because the risk of an overweight child or adolescent becoming obese as an adult increases with both age and degree of overweight. Data suggest that youth who are above average weight are at greater risk than their average weight peers for future excessive weight gain and the development of obesity-related co-morbid conditions. The most prevalent disordered eating pattern described in overweight and at-risk for overweight adolescents is loss of control (LOC) eating, during which individuals experience an inability to control the amount of food they consume. Evidence indicates that LOC eating episodes, even occurring infrequently (=1 times/month), predispose youth to gain excessive weight. Thus, LOC eating is likely to be an important contributor to obesity in susceptible individuals. Efforts to decrease LOC in adolescents are potentially preventive interventions. However, it remains unknown whether LOC eating can be decreased by preventive efforts in adolescents, or whether programs directed at reducing LOC eating affect weight gain trajectories. Interpersonal Psychotherapy (IPT) has been adapted for the treatment of eating disorders and has demonstrated efficacy in reducing binge eating episodes and inducing modest weight loss or weight stabilization among obese adults diagnosed with binge eating disorder. IPT, which targets the underlying social and interpersonal difficulties that predispose individuals to engage in LOC eating, is also well-established and effective for the treatment and prevention of depression in adolescents. In a pilot study, IPT was found to be feasible and acceptable in slowing the trajectory of weight gain in overweight or at-risk for overweight adolescents who report symptoms of LOC eating. Preliminary findings are promising and thus require an adequately powered trial to determine whether IPT is effective at preventing excessive weight gain in youth at high-risk for adult obesity who report LOC eating. Accordingly, the proposed study is a controlled trial randomizing 110 adolescent (12-17y) girls between the 75th and 97th BMI percentile to either IPT or a standard-of-care health education program. BMI will be assessed prior to and just after the prevention programs, and again at 6 and 12 month follow-up visits. Pre and post measures of LOC eating, disordered eating attitudes, and general psychopathology will be collected. Additionally, measures of actual food intake based upon laboratory test meals will be collected before and after the programs. If IPT proves effective in reducing excessive weight gain attributable to LOC eating, it may provide an important early intervention to prevent the adverse health consequences of adult obesity. PUBLIC HEALTH RELEVANCE: Preventing excessive weight gain in adolescents at high risk for adult obesity has important relevance to public health. By decreasing the number of individuals who become obese in adulthood, the economic burden of co-morbid health conditions and psychological problems may be reduced. Given that weight loss programs have been met with minimal success, prevention of excessive weight gain before adulthood must be a priority in order to reduce the epidemic rates of obesity. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Binge eating disorder is associated with significant impairment, psychiatric comorbidity, adverse health outcomes, and obesity. With the proposed inclusion of binge eating disorder as an official diagnosis in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is important to plan now for the next generation of research. There has been increasing scientific interest in binge eating disorder and many exciting new findings from researchers in the fields of eating disorders, obesity, and addictions. Moreover, the robust relationship between binge eating disorder and obesity has prompted researchers in other related fields to investigate disinhibited eating. Such disciplines include pediatrics, cardiovascular health, and research with underserved populations such as racial and ethnic minority groups. Unfortunately, there has been insufficient communication between individuals in the field of eating disorders and those involved in other areas who share an interest in binge eating disorder and related dysregulation of eating and appetite. In part because these disciplines have been largely working independently, there is little consensus as to a reasonable research agenda for binge eating disorder to guide investigators and funding agencies. This application is a proposal to hold a workshop to develop a roadmap for the next generation of binge eating disorder research. Investigators in the field of eating disorders, obesity and addictions will participate. Furthermore, Program Officers at relevant institutes at the National Institutes of Health and laypersons working with advocacy groups will be encouraged to attend. Deliverables from this meeting include a Workshop Report outlining a research agenda for binge eating disorder and a commitment from a relevant journal to publish a summary of the results from the workshop. The outcome of the proposed effort should provide a roadmap, outlining the necessary future steps for binge eating disorder research. PUBLIC HEALTH RELEVANCE: Binge eating disorder is associated with significant impairment, psychiatric comorbidity, adverse health outcomes, and obesity. With the proposed inclusion of binge eating disorder as an official diagnosis in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is important to plan now for the next generation of research. There has been increasing scientific interest in binge eating disorder and many exciting new findings from researchers in the fields of eating disorders, obesity, and addictions. Moreover, the robust relationship between binge eating disorder and obesity has prompted researchers in other related fields to investigate disinhibited eating. Such disciplines include pediatrics, cardiovascular health, and research with underserved populations such as racial and ethnic minority groups. Unfortunately, there has been insufficient communication between individuals in the field of eating disorders and those involved in other areas who share an interest in binge eating disorder and related dysregulation of eating and appetite. In part because these disciplines have been largely working independently, there is little consensus as to a reasonable research agenda for binge eating disorder to guide investigators and funding agencies. Therefore, this application is a proposal to hold a workshop to develop a roadmap for the next generation of binge eating disorder research. Investigators in the field of eating disorders, obesity and addictions will participate. Furthermore, Program Officers at relevant institutes at the National Institutes of Health and laypersons working with advocacy groups will be encouraged to attend. Deliverables from this meeting include a Workshop Report outlining a research agenda for binge eating disorder and a commitment from a relevant journal to publish a summary of the results from the workshop. The outcome of the proposed effort should provide a roadmap, outlining the necessary future steps for binge eating disorder research. Specific aims are: Aim 1. Convene a meeting to identify and propose a binge eating disorder research agenda to guide investigators. Aim 2. Topic committees will present talks on the recommendations for future binge eating disorder research in relevant disciplines. Aim 3. Publish a Workshop Report and a journal article on the results of this meeting. The proposed workshop will bring together researchers from multiple fields to collaboratively plan future research to address the problem of binge eating disorder and its comorbidities. Results from this endeavor will provide a roadmap for binge eating disorder research.

DESCRIPTION (provided by applicant): Obesity has reached epidemic rates in the U.S. Estimates indicate that one third of the adult population is at risk for adverse health consequences resulting from obesity and overweight. Early prevention efforts are essential because the risk of an overweight child or adolescent becoming obese as an adult increases with both age and degree of overweight. Data suggest that youth who are above average weight are at greater risk than their average weight peers for future excessive weight gain and the development of obesity-related co-morbid conditions. The most prevalent disordered eating pattern described in overweight and at-risk for overweight adolescents is loss of control (LOC) eating, during which individuals experience an inability to control the amount of food they consume. Evidence indicates that LOC eating episodes, even occurring infrequently (=1 times/month), predispose youth to gain excessive weight. Thus, LOC eating is likely to be an important contributor to obesity in susceptible individuals. Efforts to decrease LOC in adolescents are potentially preventive interventions. However, it remains unknown whether LOC eating can be decreased by preventive efforts in adolescents, or whether programs directed at reducing LOC eating affect weight gain trajectories. Interpersonal Psychotherapy (IPT) has been adapted for the treatment of eating disorders and has demonstrated efficacy in reducing binge eating episodes and inducing modest weight loss or weight stabilization among obese adults diagnosed with binge eating disorder. IPT, which targets the underlying social and interpersonal difficulties that predispose individuals to engage in LOC eating, is also well-established and effective for the treatment and prevention of depression in adolescents. In a pilot study, IPT was found to be feasible and acceptable in slowing the trajectory of weight gain in overweight or at-risk for overweight adolescents who report symptoms of LOC eating. Preliminary findings are promising and thus require an adequately powered trial to determine whether IPT is effective at preventing excessive weight gain in youth at high-risk for adult obesity who report LOC eating. Accordingly, the proposed study is a controlled trial randomizing 110 adolescent (12-17y) girls between the 75th and 97th BMI percentile to either IPT or a standard-of-care health education program. BMI will be assessed prior to and just after the prevention programs, and again at 6 and 12 month follow-up visits. Pre and post measures of LOC eating, disordered eating attitudes, and general psychopathology will be collected. Additionally, measures of actual food intake based upon laboratory test meals will be collected before and after the programs. If IPT proves effective in reducing excessive weight gain attributable to LOC eating, it may provide an important early intervention to prevent the adverse health consequences of adult obesity. PUBLIC HEALTH RELEVANCE: Preventing excessive weight gain in adolescents at high risk for adult obesity has important relevance to public health. By decreasing the number of individuals who become obese in adulthood, the economic burden of co-morbid health conditions and psychological problems may be reduced. Given that weight loss programs have been met with minimal success, prevention of excessive weight gain before adulthood must be a priority in order to reduce the epidemic rates of obesity.

DESCRIPTION (provided by applicant): The increased prevalence of obesity among the children of military personnel has paralleled that observed in the civilian population. Disordered eating, especially binge or loss of control (LOC) eating, is common among adolescents and is a salient risk factor for obesity and the development of exacerbated disordered eating and depressive symptoms. The goal of this proposal is to test the effectiveness of interpersonal psychotherapy (IPT) to slow the trajectory of weight gain in adolescent boys and girls at high-risk for adult obesity by virtue of elevated body mass index (BMI) percentile and LOC eating. IPT targets the difficult social functioning and stressful events that are associated with LOC and highly relevant to the adolescent youth from military families. Male and female adolescent military dependents will be randomized to receive either the IPT weight gain prevention program or a health education (HE) control condition, for 12 weekly group sessions. Adolescents' weight status, eating behaviors, and mood will be assessed at baseline, immediately following the prevention program (12-weeks), and at 1-year follow-up. At 2-year and 3-year follow-up time points, participants' BMI and physiologic data will be collected via the Military Health System's electronic medical record system. It is hypothesized that adolescents who receive the IPT group program will show significantly less weight gain (or more weight loss) relative to those randomized to HE at 3-year follow-up. Additionally, it is hypothesized that adolescents receiving IPT (as compared to HE) will demonstrate improvements on secondary outcomes of interest, including the presence and frequency of classic binge eating episodes, as well as obesity-related physiological measures of health (e.g., fasting insulin). The overall goal of the proposal is to prevent excess weight gain and adult obesity, and to prevent worsening disordered eating and metabolic functioning among overweight military dependents at risk for adult obesity and binge eating disorders.