the "evidence" you might see that child and adolescent weight management doesn't increase disordered eating or EDs...

Everything has to be "evidence-based" these days. While in theory that is a good thing, when the "evidence" itself is poor (which it is more often than I am comfortable with*) then I would argue we are worse off. If a question is "answered," and published in a reputable journal,  many will take it for face value.  But did it really answer a question, provide clarity to difficult issues, or did it just muddy the waters? When a study is used to champion a cause, or cited by others who like the conclusion with little discussion of the merits of the study, it is lazy and possibly harmful.The following article might be a case in point.  "The Influence of a Behavioral Weight Management Program on Disordered Eating Attitudes and Behaviors in Children with Overweight." ( Follansbee-Junger, JADA  2010 1653-9) The conclusion of the study says, "These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors." (It does go on to say further study is warranted as most article do these days.)I'm throwing this out there, because this is a contentious issue. An issues that needs good science. If first we must do no harm, then this is an important question. Do current standard practices in weight management for children and teens cause an increase in disordered eating and eating disorders? (This is a separate question from does the current standard practice work, which many, including myself,  argue it does not, but I'm too tight for time to pull a bunch of references...) I argue that this study has brought us no closer to knowing the answer, but that many will take the conclusion and run with it...I worry now that every study on children and adolescents and weight, every public health initiative  forged to fight the "obesity epidemic" will cite this study as "evidence" that weight loss programs for kids do not cause a rise in disordered eating or eating disorders. It will be cited as proof that refutes and argues concerns of harm, particularly from the eating disorder community that decries the rise in eating disorders, and in younger and younger children.Here is my brief analysis of this flawed study, and why their wily conclusion, of "do not provide evidence of harm" should not be conflated with "doesn't cause harm."1) this was a NON-RANDOM sample, that means families were recruited for a weight loss behavioral program for children and teens (I would have liked the authors to have a bit more of a discussion of their study limitations as many studies do...)2) there were 68 initial families, 50 by the end of the study3) the control group was "tainted"  in that it was not a true control. It was made up of the self-selected folks on the waiting list who were presumably worried about their children and their weight4) they used what they called a "validated and reliable" child feeding questionnaire, while the author of the questionnaire herself said, "Further work with the instrument is needed to establish its reliability and validity." (Child Feeding Questionnaire, Birch and Fisher, Appetite 2001)5) they did not attempt to either validate (are you measuring what you say you will measure) or confirm reliability (consistency of the tool) though that is commonly done. What is odd is that they did test for internal consistency (a validity measure) for one of their tools, the Schwartz Peer Victimization Scale, so we can presume that they could have tested their Child Feeding Questionnaire tool...They did find that "across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices, and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up," which is consistent with past findings on the effects of worry over weight and restriction. Oh, and peer victimization, or bullying is NOT benign and is pervasive. (And they did check for validity of the peer victimization tool, so we could argue this is a more convincing finding...)The "worry over weight"  points to why the control group might be "tainted," since it is a group of parents and youngsters self-selected and already concerned, with no direction on a waiting list, which might lead to higher concern and restriction...So, alas, in my opinion, the study is of such poor design that any results are not generalizable or relevant. I just fear that in the current era of "evidence" that folks who want to say that weight loss interventions don't cause harm will use this as their "proof."What do you think? Do you work in the ED community? Keep an eye out for this paper... Remember the name Follansbee, it might just start popping up in those bibliographies...*One of the worst things I encountered while practicing medicine in the office setting was not having the time to really dig into the data and studies. So many medications were "black-boxed"(taken off the market or used only with dire safety warnings.) Meds that only a few years earlier I was told were standard of care based on the "evidence." From Tequin, Avandia, universal hormone replacement therapy, Bextra... I remember having hesitancy with Avandia, and not wanting to use it so quickly, and the company I worked for had a quality control group that said if I didn't use them with diabetics, my "report card" would show I was not in compliance with "best practice" and I would have consequences... I guess I'm just a little skeptical of the "evidence" these days. Are you?