class: center, middle, inverse, title-slide .title[ # The Effects of Adaptive Eating Behaviors on Weight Loss of Physically Disabled Children and Adolescents ] .author[ ### Cui, Tianxiang (YC273132) ] .institute[ ### Department of Psychology, University of Macau ] .date[ ### 2023.04.03 ] --- class: inverse, center, middle # Introduction --- # Obesity Obesity is rapidly growing in both developed and developing countries (Arroyo-Johnson & Mincey, 2016) -- Obesity boosts the risk of developing... -- **physical health** problems - **cancer** (Calle & Kaaks, 2004) - **type 2 diabetes** (Stein & Colditz, 2004) - **cardiovascular disease** (Field et al., 2001) -- **mental health** problems - **depression** (Stunkard et al., 2003) - **low self-esteem** (Franklin et al., 2006) - **body dissatisfaction and eating disorders** (Brownell & Walsh, 2017; He et al., 2017) ??? the presentation starts from obesity --- # The prevalence of obesity Obesity has increased in over 70 countries from 1980 to 2015, and continues to rise in most countries. (The GBD 2015 Obesity Collaborators, 2017). -- China has seen a dramatic increase in obesity among adults, especially among men (Mi et al., 2015). -- - an annual cost of 24.35 billion RMB or 2.46% of the nation’s healthcare expenditure due to the increasing obesity rate (Qin & Pan, 2016). --- # Obesity & physically disabled people Physically disabled children and adolescents have a higher rate of obesity compared to their non-disabled peers (Neter et al., 2011) -- Reasons for the higher obesity rate -- - It is difficult for them to complete enough physical activities and access healthy diets and exercise facilities, as they often come from low-income families (Emerson et al., 2010; Rimmer & Rowland, 2008). -- - Their lack of social activities may lead to feelings of loneliness and result in binge eating or other **maladaptive eating behaviors**, which can trigger obesity. (Reinehr et al., 2010; Warren et al., 2017). --- # Adaptive Eating behaviors - Developing adaptive eating behaviors (e.g., mindful eating and intuitive eating) can positively address obesity-related behaviors, including binge eating and emotional eating (Warren et al., 2017). -- - Mindful eating and intuitive eating emphasize developing a good relationship with food, being aware of food choice, and recognizing feelings of hunger and fullness (Warren et al., 2017). -- - Adaptive Eating behaviors can help individuals slow down consumption of a meal and recognize feelings of fullness to better control overeating (Lofgren, 2015). --- # Why focusing on eating behaviors? - Physically disabled individuals have more difficulties doing exercises to lose weight compare to non-disabled peers (Rimmer & Rowland, 2008) -- - They may experience sense of isolation which can lead to disordered eating behaviors (Warren et al., 2017) -- - Adaptive eating behaviors focusing on internal feelings and sensations can be a feasible approach for them to reduce obesity. -- - Previous treatments for obesity in this population didn’t involve these interventions, highlighting the importance of this approach (Matizanadzo & Paudyal, 2021; McPherson et al., 2014). --- # Previous interventions Physical training, exercises, and diet education have not shown significant reductions in BMI or weight (Matizanadzo & Paudyal, 2021; McPherson et al., 2014) -- - Physical activities and dietary intervention might have failed to be optimally combined (Matizanadzo & Paudyal, 2021) -- - Studies have had small to medium sample sizes and few involved control group -- - Previous research has lacked long-term interventions, with most evaluations being conducted less than three months after the interventions (McPherson et al., 2014) -- - The importance of parental involvement in children's obesity interventions has been underestimated (Golan & Weizman, 2001) --- # The present study - To integrate the theories of mindful eating and intuitive eating, and apply them to physically disabled adolescents in China -- - This theoretical basis will inform the design of an intervention scheme and manual -- - The feasibility of the intervention scheme will be verified and revised through pretesting, leading to a final scheme -- - A cluster randomized control study will evaluate the effect of the scheme in different intervention modes -- - The short- and long-term effects of the scheme will be evaluated the short- and long-term effects of the scheme, and ultimately guide the development of an obesity intervention guide for physically disabled adolescents -- - The study hypothesizes that the intervention scheme will show positive effects on children and adolescents with physical disabilities --- class: inverse, center, middle # Methods --- # Participants Sample size estimation: G*Power -- Junior high school students from rehabilitation centers, with parents being involved -- Inclusion and exclusion criteria - Families will be excluded if the child has an intellectual disability, comorbidities or other health conditions, or is receiving other interventions. - Medical records will be examined to confirm their physical disability status - Waist circumferences will be measured to determine whether a participant is obese or not (boys: over 83cm; girls: over 78cm; Wingo et al., 2015) -- Informed consent --- # Study design Preparations -- - A comprehensive theoretical model -- - Revise and localize the model -- - Scheme and the manual for intervention -- Pilot study: 6-8 weeks -- Formal intervention: short- (after 3 months) and long-term (after 1 year) - mode 1 “regular intervention” (in addition to the health education curriculum and physical activity, intervention scheme will be given) - mode 2 “integrated intervention” (integrate the intervention scheme into the health education curriculum and physical activity) - mode 3 “indirect intervention” (adolescents will be given health education curriculum and physical activity only but parents will be given lessons) - The control group will be assigned a health education curriculum only --- # Measures Eating Disorder Symptomatology - The 12-item Eating Disorder Examination Questionnaire (EDE-QS; Gideon et al., 2016) Intuitive eating - The Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013) Mindful eating - The 17-item Mindful Eating Questionnaire adapted for Children (MEQ-C; Hart et al., 2018) Waist circumference The development stage of puberty - The Chinese version of the self-reported Pubertal Development Scale (Chan et al., 2010) --- # Data analysis - Correlational analysis - One-way analysis of variance - A repeated measures multivariate analysis of variance - Intention-to-treat analysis --- # References Arroyo-Johnson, C., & Mincey, K. 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