A common issue that comes up as parents and clinicians try to help adolescents avoid both eating disorders and obesity is the concern that a conversation about obesity with a child might trigger eating disorder behaviors.  The dilemma leads to a lot of discomfort as to the best way to have this conversation, if at all.

Directly addressing this question are some new survey data from the Eating and Activity in Teens Study and the Project Families and Eating and Activities in Teens Project.  Over 2000 teens from 20 public schools around the Minneapolis/St Paul area were assessed using school based surveys while parents also completed questionnaires.  The mean age of the adolescents was 14.4 years and the sample was ethnically diverse with 81% from an ethnic minority and most coming from lower income households.

Most parents reported engaging in some kind of conversation with their children about eating behaviors.  For one-third of parents of nonoverweight teens, these discussions were focused on weight.  For parents of overweight teens, the rate rose to 60%.  Compared to conversations about healthy eating, maternal discussions focused on weight were significantly more likely to be associated with dieting and unhealthy weight control behaviors for both overweight (64% versus 40%) and nonoverweight teens (39% versus 30%). However, the difference in rate of extreme unhealthy weight control behaviors was not different among adolescents whose mothers discussed healthy eating (8.5%) versus weight (9.5%).  Similar but not identical trends emerged for fathers.

The authors concluded that parents should have conversations related to healthy eating rather than weight, particularly with adolescents who are overweight.

While this is an interesting study that offers data about a common clinical dilemma, one needs to be mindful not to overinterpret these findings.  While much of the attention for this article relates to eating disorders per se, significant associations were not generally found between the content of parental eating discussions and more extreme weight loss behavior, and eating disorders were not diagnosed directly in this sample. Furthermore, eating disorder symptoms were quite common among teens whose parents focused their discussions on healthy eating too. Parents may also have under-reported the amount of weight focus of their conversations.

That said, the study does offer some empirical support to a practice that many clinicians already advocate, namely to make weight a secondary issue and instead focus on more healthy eating.

Reference

Berge J, et al., Parent Conversations About Healthful Eating and Weight: Associations With Adolescent Disordered Eating Behaviors.  JAMA Pediatrics 2013;167(8):746-753.

The onset of puberty has been occurring earlier for unclear reasons.  Furthermore, a relatively early puberty onset has been associated with internalizing symptoms such as anxiety and depression, especially for girls.  A new study from the journal Development and Psychopathology tests the idea that the effect of this phenomenon may depend on individual attributes such as one’s temperament.

Subjects included 1,025 individuals from the age 11 to 15 who were followed longitudinally for the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD).  Temperament was measured using items from various scales, internalizing problems was assessed with the Child Behavior Checklist, while puberty timing was assessed by physical exam.  The study focused on temperament dimensions related to emotional reactivity and self-regulation. Structural equation modeling was used to predict age 15 internalizing scores from temperament, puberty timing and their interaction.

Results showed that, for girls, early onset of puberty, higher emotional reactivity, and lower self-regulation predicted internalizing symptoms at age 15.  The relation between puberty timing and internalizing problems was found be a function of temperament with the effect of early puberty strongest among subjects with lower self-regulation.  Controlling for baseline internalizing scores, however, resulted in nonsignificant associations between internalizing problems and both puberty timing and emotional reactivity. For boys, emotional reactivity and low self-regulation was again found to predict internalizing symptoms but no effect of puberty timing was found.

The authors concluded that, for girls only, early puberty is associated with increased internalizing problems, especially for those with specific temperamental vulnerabilities.  This link appears to be due to the association of puberty timing with internalizing problems at age 11 rather than later in adolescence (since controlling for age 11 internalizing problems eliminated the effect of early puberty). 

While the headline of the study was related to the effect of puberty, what stands out for both boys and girls was the association between  later psychopathology and temperament. Like many studies that examine the relations between temperament and psychiatric symptoms, however, it is important to remember that the items used to measure both constructs are often quite similar.

With apologies for the shameless plug, I invite those interested in learning more about the connection between temperament and psychiatric symptoms to check out my new book on the subject to be released next month.

Reference

Crockett LJ, et al.   The role of pubertal timing and temperametal vulnerability in adolescents’ internalizing problems.  Development and Psychopathology 2013; 25(2):377-389.