Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment

A Longitudinal Study of Maternal and Child Internalizing Symptoms Predicting Early Adolescent Emotional Eating

Objective

To examine maternal and child internalizing symptoms as predictors of early adolescent emotional eating in a longitudinal framework spanning three critical developmental periods (preschool, elementary school, and early adolescence).

Methods

Participants were 170 children recruited at preschool age for a longitudinal study. When children were 5.25 years, their mothers completed ratings of their own internalizing symptoms. During the spring of 4th grade, children completed measures of internalizing symptoms. In early adolescence, youth completed a measure of emotional eating.

Results

Maternal and child internalizing symptoms predicted adolescent emotional eating. The results indicated that child psychopathology moderated the association between maternal psychopathology (except for maternal anxiety) and early adolescent emotional eating. There was no evidence of mediation.

Conclusions

Pediatric psychologists are encouraged to provide early screening of, and interventions for, maternal and child internalizing symptoms to prevent children's emotional eating.

Stress, overeating, and obesity: Insights from human studies and preclinical models

Eating disorders and obesity have become predominant in human society. Their association to modern lifestyle, encompassing calorie-rich diets, psychological stress, and comorbidity with major diseases are well documented. Unfortunately the biological basis remains elusive and the pharmacological treatment inadequate, in part due to the limited availability of valid animal models. Human research on binge eating disorder (BED) proves a strong link between stress exposure and bingeing: state-levels of stress and negative affect are linked to binge eating in individuals with BED both in laboratory settings and the natural environment. Similarly, classical animal models of BED reveal an association between acute exposure to stressors and binging but they are often associated with unchanged or decreased body weight, thus reflecting a negative energy balance, which is uncommon in humans where most commonly BED is associated with excessive or unstable body weight gain. Recent mouse models of subordination stress induce spontaneous binging and hyperphagia, altogether more closely mimicking the behavioral and metabolic features of human BED. Therefore the translational relevance of subordination stress models could facilitate the identification of the neurobiological basis of BED and obesity-associated disease and inform on the development of innovative therapies.

Reducing behavioural risk factors for cancer: An affect regulation perspective

Nearly half of all cancer deaths are attributable to preventable causes, primarily unhealthy behaviours such as tobacco use, alcohol use and overeating. In this review, we argue that people engage in these behaviours, at least in part, as a means of regulating their affective states. To better understand why people engage in these behaviours and how researchers might design interventions to promote the selection of healthier methods for regulating affect, we propose a conceptual model of affect regulation. We synthesise research from both the stress and coping tradition as well as the emotion and emotion regulation tradition, two literatures that are not typically integrated. In so doing, we indicate where researchers have made headway in understanding these behaviours as affect regulation and note how our model could be used to structure future work in a way that would be particularly advantageous to cancer control efforts.

Childhood drinking and depressive symptom level predict harmful personality change

Personality traits in children predict numerous life outcomes. Although traits are generally stable, if there is personality change in youth, it could affect subsequent behavior in important ways. We found that the trait of urgency, the tendency to act impulsively when highly emotional, increases for some youth in early adolescence. This increase can be predicted from the behavior of young children: alcohol consumption and depressive symptom level in elementary school children (5th grade) predicted increases in urgency 18 months later. Urgency, in turn, predicted increases in a wide range of maladaptive behaviors another 30 months later, at the end of the first year of high school. The mechanism by which early drinking behavior and depressive symptoms predict personality is not yet clear and merits future research; notably, the findings are consistent with mechanisms proposed by personality change theory and urgency theory.

Behind binge eating: A review of food-specific adaptations of neurocognitive and neuroimaging tasks

Recurrent binge eating, or overeating accompanied by a sense of loss of control, is a major public health concern. Identifying similarities and differences among individuals with binge eating and those with other psychiatric symptoms and characterizing the deficits that uniquely predispose individuals to eating problems are essential to improving treatment. Research suggests that altered reward and control-related processes may contribute to dysregulated eating and other impulsive behaviors in binge-eating populations, but the best methods for reliably assessing the contributions of these processes to binge eating are unclear. In this review, we summarize standard neurocognitive and neuroimaging tasks that assess reward and control-related processes, describe adaptations of these tasks used to study eating and food-specific responsivity and deficits, and consider the advantages and limitations of these tasks. Future studies integrating both general and food-specific tasks with neuroimaging will improve understanding of the neurocognitive processes and neural circuits that contribute to binge eating and could inform novel interventions that more directly target or prevent this transdiagnostic behavior.

Validation and Factor Structure of the French-Language Version of the Emotional Appetite Questionnaire (EMAQ)

The concept of Emotional Eating (EE) is increasingly considered to be implicated in overeating and obesity, and in different subtypes of eating disorders. Among the self-report questionnaires assessing EE, the Emotional Appetite Questionnaire (EMAQ) includes recent advances in this area: it evaluates a broad range of emotions and situations both positive and negative, and the way they modulate food intake (decrease, stability, or increase). The main objective of our study was to further investigate the psychometric properties of the French version of the EMAQ in a large sample of students. Participants completed the EMAQ (n = 679), the DEBQ (Dutch Eating Behavior Questionnaire) (n = 75) and the CIDI-eating disorders screening (Composite International Diagnostic Interview) (n = 604). Factorial structure, reliability, and validity of the EMAQ were tested. Factorial analyses supported a two-factor (Positive and Negative) structure. The internal consistency indices were satisfactory and results suggest good test–retest reliability for the scale. Convergent and discriminant validity were confirmed from the significant correlations observed between the EMAQ scores and the DEBQ-EE subscale scores. Regarding associations with weight, whereas EMAQ negative scores were positively correlated with BMI, EMAQ positive scores were negatively correlated with BMI. Finally, EMAQ scores differed significantly depending on gender and risk for bulimia nervosa. This study supports the validity and the reliability of the EMAQ, which appears to be a promising instrument to better understand individual differences that could modulate food intake.

N-of-1 study of weight loss maintenance assessing predictors of physical activity, adherence to weight loss plan and weight change

OBJECTIVE

Behaviour change interventions are effective in supporting individuals to achieve clinically significant weight loss, but weight loss maintenance (WLM) is less often attained. This study examined predictive variables associated with WLM.

DESIGN

N-of-1 study with daily ecological momentary assessment combined with objective measurement of weight and physical activity, collected with wireless devices (Fitbit™) for six months. Eight previously obese adults who had lost over 5% of their body weight in the past year took part. Data were analysed using time series methods.

MAIN OUTCOMES MEASURES

Predictor variables were based on five theoretical themes: maintenance motives, self-regulation, personal resources, habits, and environmental influences. Dependent variables were: objectively estimated step count and weight, and self-reported WLM plan adherence.

RESULTS

For all participants, daily fluctuations in self-reported adherence to their WLM plan were significantly associated with most of the explanatory variables, including maintenance motivation and satisfaction with outcomes, self-regulation, habit, and stable environment. Personal resources were not a consistent predictor of plan adherence.

CONCLUSION

This is the first study to assess theoretical predictions of WLM within individuals. WLM is a dynamic process including the interplay of motivation, self-regulation, habit, resources, and perceptions of environmental context. Individuals maintaining their weight have unique psychological profiles which could be accounted for in interventions.

Interpersonal psychotherapy for the prevention of excess weight gain and eating disorders: A brief case study

This article presents a brief case study of "Jane Doe," a 13-year-old, non-Hispanic White girl 2 participating in a clinical research trial of interpersonal psychotherapy-weight gain (IPT-WG). Girls at-risk for adult obesity and binge eating disorder (BED) were randomly assigned to take part in 12 weeks of preventative group treatment. Jane's IPT-WG group included five other early adolescent girls (mostly aged 12-13) at risk for adult obesity and BED. The case of Jane illustrates a successful example of IPT-WG for the prevention of excessive weight gain and for the prevention of BED. (PsycINFO Database Record

Negative emotions and emotional eating: the mediating role of experiential avoidance

PURPOSE

Emotional eating is a risk factor for eating pathology across the life- and weight-span. Research demonstrates that negative emotions are a precipitant of emotional eating, particularly among female college students. However, the underlying factors that explain this relationship are unclear. Experiential avoidance, a propensity toward being unwilling to remain in contact with aversive private experiences, may explain the association between negative emotions and emotional eating. The purpose of this study was to examine whether experiential avoidance would mediate the association between negative emotions and emotional eating.

METHODS

A sample of 132 women (17.4 % African American, 59.8 % White) completed measures of mood, experiential avoidance and emotional eating. Bias-corrected bootstrapping mediational analyses were conducted.

RESULTS

Experiential avoidance mediated the relationship between negative emotions and emotional eating b = -0.21, 95 % BC CI [-0.43, -0.07]. The indirect effect through experiential avoidance accounted for 9 % of the variance, which represents a medium effect (k ² = 0.09, 95 % BC CI [0.03, 0.18]).

CONCLUSIONS

Results suggest that experiential avoidance is important for understanding the relationship between negative emotions and emotional eating and may inform potential strategies for prevention and treatment.

Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample

BACKGROUND

This study examined the associations between specific dimensions of emotion dysregulation and eating disorder (ED) symptoms and behaviors, non-suicidal self-injury (NSSI), and suicide attempts in a heterogeneous ED sample.

METHODS

Participants (N=110) completed the Difficulties in Emotion Regulation Scale (DERS), the Eating Disorder Examination Questionnaire (EDE-Q), and self-reported the presence of lifetime NSSI and a lifetime suicide attempt.

RESULTS

The EDE-Q global score, a primarily cognitive measure of ED symptoms, was significantly positively correlated with DERS strategies, clarity, and awareness subscale scores and DERS total score (ps<0.01). Only the strategies subscale was uniquely positively associated with EDE-Q global score in a multivariate regression analysis. There was no association between the frequency of binge eating or frequency of driven exercise and any of the DERS subscale scores or total score (ps>0.01). Frequency of purging was significantly, positively associated with DERS impulse subscale score and total score (p<0.01). None of the DERS subscale scores were significantly different between those with and without NSSI or between those with and without a lifetime suicide attempt (ps>0.01).

CONCLUSIONS

Findings indicate that in a heterogeneous ED sample, emotion regulation deficits are more strongly associated with cognitively-oriented symptoms of EDs than behavioral symptoms such as a binge eating, purging, driven exercise, NSSI, or suicide attempts.

Fluctuations in negative emotions predict binge eating both in women and men: An experience sampling study

This study investigated the associations between emotional fluctuations and emotion regulation difficulties in predicting binge eating and overeating episodes using the experience sampling method among 97 women and 61 men. Among women, fluctuations in negative emotion, emotion regulation difficulties, restrained eating, and the interaction of negative emotion fluctuations and emotion regulation difficulties predicted binge eating. Among men, trait impulsivity and fluctuations in negative emotion predicted binge eating. However, overeating did not associate with aforementioned aspects. Results suggest that fluctuations in negative emotions should be studied in the context of emotion regulation difficulties.

Occurrence and co-occurrence of nonsuicidal self-injury and disordered eating in a daily diary study: Which behavior, when?

Although research has explored between-person traits that may account for the co-occurrence of non-suicidal self-injury (NSSI) and disordered eating (DE), little is known about within-person processes that predict when each behavior occurs. This study describes the socioemotional contexts of NSSI and DE behaviors during a two-week daily diary period. Young adults (aged 18-35) who reported ≥1 episode of NSSI and ≥1 episode of DE (binge eating, purging, or fasting) during the diary period were included (N=25). NSSI and DE co-occurred approximately one third of the time. Participants were more likely to act on NSSI thoughts following arguments and feelings of rejection. They were more likely to act on binge eating/purging thoughts after eating or watching television, and when they felt self-hatred. They were more likely to act on fasting thoughts after discussing upsetting memories, and when they were in a public setting. NSSI days were marked by more intense negative mood in the evenings relative to fasting days, and greater fatigue in the morning relative to binge eating/purging days. This study underscores the utility of using experience-sampling methods to develop and test within-person models to advance our understanding of co-occurring behaviors.

Behavioral evidence of emotion dysregulation in binge eaters

Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ² = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (r_pb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.

Validation of the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A) in the obese with and without binge eating disorder

Obesity and binge eating disorder (BED) are both associated with deficiencies in executive function. The Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A) is a self-report measure that assesses executive function. This study aimed to examine the psychometric properties of the BRIEF-A in an obese population, with and without BED, and to explore the differences on the BRIEF-A in the obese, with and without BED, compared to normative sample. 98 obese participants (70 BED) completed the BRIEF-A, DASS-21 and several performance-based measures of executive function. 30 participants completed a repeat assessment two months later. There was evidence of good internal consistency and test-retest reliability, however evidence for construct and convergent validity was mixed. Additionally, it was found that obese individuals report significantly more executive function difficulties on the BRIEF-A than the normative sample. Further, obese with BED report more executive function difficulties than those without. This study shows some evidence of sound psychometric properties of the BRIEF-A in an obese sample, however more research is required to understand the nature of executive function being measured.

Cortisol response to an induction of negative affect among adolescents with and without loss of control eating

BACKGROUND

Adults with binge eating disorder may have an exaggerated or blunted cortisol response to stress. Yet, limited data exist among youth who report loss of control (LOC) eating, a developmental precursor to binge eating disorder.

METHODS

We studied cortisol reactivity among 178 healthy adolescents with and without LOC eating. Following a buffet lunch meal adolescents were randomly assigned to watch a neutral or sad film clip. After, they were offered snacks from a multi-item array to assess eating in the absence of hunger. Salivary cortisol was collected at -80, 0, 30 and 50 min relative to film administration, and state mood ratings were reported before and after the film.

RESULTS

Adolescents with LOC had greater increases in negative affect during the experimental paradigm in both conditions (ps > 0.05). Depressive symptoms, but not LOC, related to a greater cortisol response in the sad film condition (ps > 0.05). Depressive symptoms and state LOC were related to different aspects of eating behaviour, independent of film condition or cortisol response (ps > 0.05).

CONCLUSIONS

A film clip that induced depressed state affect increased salivary cortisol only in adolescents with more elevated depressive symptoms. Adolescents with and without LOC were differentiated by greater increases in state depressed affect during laboratory test meals but had no difference in cortisol reactivity. Future studies are required to determine if adolescents with LOC manifest alterations in stress reactivity to alternative stress-inducing situations.

Association of binge eating behavior and psychiatric comorbidity in ELSA-Brasil study: Results from baseline data

OBJECTIVE

To estimate the association of binge eating behavior (BE) with common mental disorders (CMD).

METHOD

Cross sectional investigation of 14,088 adults, aged 35-74years (ELSA-Brasil study). BE was assessed with Structured Clinical Interview for DSM Disorders (SCID - DSM IV) questions, and psychiatric morbidity with CIS-R (CIS R - Clinical Interview Schedule Revised). Poisson regression was used to estimate the association of BE and psychiatric morbidity.

RESULTS

Adjusted prevalence ratios (PR) for CMD and BE were: PR=1.60 (1.34-1.91) for a CIS R score 12-18 (presence of CMD with lower clinical severity); PR=2.40 (2.06-2.80) for a CIS R score≥18 (severe symptom profile likely to require treatment); for psychiatric diagnoses: PR=2.24 (1.84-2.73) for depressive episodes; PR=1.77 (1.53-2.04) for anxiety disorders, and PR=1.42 (1.20-1.67) for mixed depressive-anxiety disorder.

CONCLUSION

BE was associated with higher prevalence of common mental disorders. Our findings highlight the need to investigate mechanisms involved in the relationship of BE, obesity and psychopathology in low/middle income countries.

Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa

Despite robust support for the role of affect in the maintenance of binge eating and purging, the relationship between affect and restrictive eating remains poorly understood. To investigate the relationship between restrictive eating and affect, ecological momentary assessment data from 118 women with anorexia nervosa (AN) were used to examine trajectories of higher-order dimensions of negative affect (NA) and positive affect (PA), as well as lower-order dimensions of NA (Fear, Guilt) and PA (Joviality, Self-Assurance) relative to restrictive eating. Affect trajectories were modeled before and after restrictive eating episodes and AN subtype was examined as a moderator of these trajectories. Across the sample, Guilt significantly increased before and decreased after restrictive eating episodes. Global NA, Global PA, Fear, Joviality, and Self-Assurance did not vary relative to restrictive eating episodes across the sample. However, significant subtype by trajectory interactions were detected for PA indices. Among individuals with AN restricting subtype, Global PA, Joviality, and Self-Assurance decreased prior to and Self-Assurance increased following restrictive eating episodes. In contrast, Global PA and Self-Assurance increased prior to, but did not change following, restrictive eating episodes among individuals with AN binge eating/purging subtype. Results suggest that dietary restriction may function to mitigate guilt across AN subtypes and to enhance self-assurance among individuals with AN restricting subtype. (PsycINFO Database Record

Prevalence and correlates of binge eating disorder related features in the community

Binge eating disorder (BED) is associated with high levels of obesity and psychological suffering, but little is known about 1) the distribution of features of BED in the general population and 2) their consequences for weight development and psychological distress in young adulthood. We investigated the prevalence of features of BED and their association with body mass index (BMI) and psychological distress among men (n = 2423) and women (n = 2825) from the longitudinal community-based FinnTwin16 cohort (born 1975-1979). Seven eating-related cognitions and behaviors similar to the defining features of BED were extracted from the Eating Disorder Inventory-2 and were assessed at a mean age of 24. BMI and psychological distress, measured with the General Health Questionnaire, were assessed at ages 24 and 34. We assessed prevalence of the features and their association with BMI and psychological distress cross-sectionally and prospectively. More than half of our participants reported at least one feature of BED; clustering of several features in one individual was less common, particularly among men. The most frequently reported feature was 'stuffing oneself with food', whereas the least common was 'eating or drinking in secrecy'. All individual features of BED and their clustering particularly were associated with higher BMI and more psychological distress cross-sectionally. Prospectively, the clustering of features of BED predicted increase in psychological distress but not additional weight gain when baseline BMI was accounted for. In summary, although some features of BED were common, the clustering of several features in one individual was not. The features were cumulatively associated with BMI and psychological distress and predicted further increase in psychological distress over ten years of follow-up.

Stress-induced eating in women with binge-eating disorder and obesity

The purpose of the current study was to investigate stress-induced eating in women with binge-eating disorder (BED) and obesity. Three groups of women [obese with BED (n=9); obese non-BED (n=11); and normal weight (NW) non-BED (n=12)], rated their levels of hunger and psychological distress before and after completing the Trier Social Stress Test, followed by food anticipation and then consumption of their preferred snack food. We differentiated between the motivational and hedonic components of eating by measuring the amount of food participants poured into a serving bowl compared to the amount consumed. Stress did not affect poured and consumed calories differently between groups. Across all subjects, calories poured and consumed were positively correlated with post-stress hunger, but calories poured was positively correlated with post-stress anxiety and negative affect. These results indicate that stress-related psychological factors may be more strongly associated with the motivational drive to eat (i.e. amount poured) rather than the hedonic aspects of eating (i.e. amount consumed) for women in general. Exploratory correlation analyses per subgroup suggest that post-stress hunger was positively associated with calories poured and consumed in both non-BED groups. In the obese BED group, calories consumed was negatively associated with dietary restraint and, although not significantly, positively associated with stress-induced changes in anxiety.These findings suggest that stress-induced snacking in obese BED women may be influenced by psychological factors more so than homeostatic hunger mechanisms. After controlling for dietary restraint and negative affect, the NW non-BED women ate a greater percentage of the food they poured than both obese groups, suggesting that obesity may be associated with a heightened motivational drive to eat coupled with a reduction in hedonic pleasure from eating post-stress. Further studies that incorporate novel approaches to measuring the motivational versus hedonic aspects of stress-induced eating may expose nuanced eating behaviors that differentiate BED and obesity. If confirmed, our findings would support prevention and treatment strategies that target subsets of women based on obesity and BED status.

Acute Stressors Reduce Neural Inhibition to Food Cues and Increase Eating Among Binge Eating Disorder Symptomatic Women

Stressors can trigger binge-eating but researchers have yet to consider their effects on both neural responses to food cues and food consumption among those at risk. In this experiment, we examined the impact of acute stressors on neural activation to food images and subsequent food consumption within binge-eating disorder (BED) and non-eating disordered control groups. Eighteen women meeting DSM-IV BED criteria and 26 women serving as non-eating disordered controls were randomly assigned to unpleasant stressor (painful cold pressor test (CPT) followed by negative performance feedback) or less unpleasant stressor (non-painful sensory discrimination task followed by positive performance feedback) conditions. Subsequently, they were scanned with functional magnetic resonance imaging (fMRI) while viewing food and neutral images. After the scans, participants completed a self-report battery in an environment conducive to snacking. During exposure to food images, BED-symptomatic women in the unpleasant stressor condition reported more liking of high calorie food images and showed less activation in one inhibitory area, the hippocampus, compared to controls in this condition. BED-symptomatic women exposed to unpleasant stressors also consumed more chocolate than any other group during the post-scan questionnaire completion. Crucially, reduced hippocampal activation to high calorie food images predicted more chocolate consumption following fMRI scans within the entire sample. This experiment provides initial evidence suggesting unpleasant acute stressors contribute to reduced inhibitory region responsiveness in relation to external food cues and later food consumption among BED-symptomatic women.

The ABBA study - approach bias modification in bulimia nervosa and binge eating disorder: study protocol for a randomised controlled trial

BACKGROUND

The core symptoms of bulimia nervosa (BN) and binge eating disorder (BED) are recurrent episodes of binge eating. Despite negative psychological and physical consequences, BN/BED patients show uncontrollable approach tendencies towards food. This cognitive bias occurs at an early stage of information processing. Cognitive bias modification (CBM) directly targets such biases and has been shown to be effective in treating several mental disorders. In alcohol addiction, automatic action tendencies towards alcohol cues and relapse rates were successfully reduced by a specific form of CBM, termed approach bias modification. Based on these findings and data from a proof-of-concept study in people with high levels of food craving, CBM is considered a promising new treatment approach for BN/BED. Given the similarities between BN/BED and addictive disorders, the rationale for using approach bias modification appears to be particularly strong. The aim of the present study is to examine whether, compared to a sham training, computerised approach bias modification (10 sessions) can reduce binge-eating episodes in BN/BED patients from pre-treatment to follow-up. Additionally, we will investigate whether this CBM programme also reduces global eating disorder psychopathology, trait and cue-elicited food craving, food intake as well as approach and attentional bias towards visual food cues. Treatment acceptance will be determined by attrition rates and responses on a feedback form.

METHODS

This is a double-blind, randomised, placebo-controlled, parallel-group superiority trial with two parallel arms. A total of 54 BN/BED patients will be recruited. Approach bias towards food will be retrained by a computer task adopting an implicit learning paradigm. Patients in the control condition (sham) will conduct a similar task but will not be trained to avoid food cues. Methods against bias include public registration, randomisation by a central study office, standardisation of the treatments and blinding of assessors. Furthermore, the session number and duration will be equivalent in the two conditions.

DISCUSSION

This is the first registered randomised controlled trial of approach bias modification in a clinical BN/BED sample. Results from this study will provide an indication of the efficacy of approach bias modification training for BN/BED and the potential mechanisms of action underlying this treatment.

TRIAL REGISTRATION

DRKS00010231 (retrospectively registered on 24 March 2016; first version).

Ecologic Momentary Assessment: Perspectives on Applications and Opportunities in Research and Practice Regarding Nutrition Behaviors

Retrospective self-reported data have limitations, making it important to evaluate alternative forms of measurement for nutrition behaviors. Ecological momentary assessment (EMA) attempts to overcome the challenges of recalled data with real-time data collection in a subject's natural environment, often leveraging technology. This perspective piece 1) introduces the concepts and terminology of EMA, 2) provides an overview of the methodological and analytical considerations, 3) gives examples of past research using EMA, and 4) suggests new opportunities (including combining assessment and intervention) and limitations (including the need for technology) for the application of EMA to research and practice regarding nutrition behaviors.

Eating, feeding, and feeling: emotional responsiveness mediates longitudinal associations between maternal binge eating, feeding practices, and child weight

Background

Although it is known that maternal disordered eating is related to restrictive feeding practices, there is little research exploring mechanisms for this association or its effects on other feeding practices. The purpose of this study was to assess whether maternal emotion responses mediate the association between maternal binge eating (BE) and child feeding practices, in order to identify potential risk factors for feeding practices that influence child weight.

Methods

This longitudinal observational study included (n = 260) mothers and children from the STRONG Kids Panel Survey. At Wave 1, children were an average of 37 months old (SD = 6.9), and at Wave 2 children were an average of 57 months old (SD = 8.3). Mothers self-reported their frequency of binge eating behavior (Wave 1), responses to children’s negative emotions (Wave 1), feeding practices (Wave 1 and Wave 2), and child height and weight were measured at both time points. Using bias-corrected bootstrapping procedures, we tested the hypothesis that longitudinal associations between maternal BE and nonresponsive parent feeding practices would be mediated by parents’ unsupportive responses to children’s negative emotion. We also tested a serial mediation model positing that maternal BE predicts child body mass index (BMI) percentile change 18-24 months later, indirectly through unsupportive responses to negative emotion and nonresponsive feeding practices.

Results

Maternal BE predicted use of more nonresponsive feeding practices (e.g. Emotion Regulation, Restriction for Health, Pressure to Eat, and Food as Reward), indirectly through more Distress responses to children’s negative emotions. In the serial mediation model, maternal BE was associated with greater use of Distress responses, which indirectly predicted higher child BMI percentile through Food as Reward feeding practices.

Conclusions

These results suggest that maternal eating and emotion responsiveness are important for understanding the interpersonal context of feeding behaviors, and child weight outcomes. Distress responses may serve as a risk factor for use of unhealthful feeding practices among mothers with BE and these responses may increase children’s risk for weight gain.

Trial registration

This study used an observational prospective design. Therefore, it has not been registered as a clinical intervention trial.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0415-5) contains supplementary material, which is available to authorized users.

Examination of body checking, body image dissatisfaction, and negative affect using Ecological momentary assessment

Research has shown that non-clinical women, particularly those with high body concern, engage in frequent body checking behaviors. The purpose of this study was to use ecological momentary assessment (EMA) to examine the frequency and correlates of body checking behavior, including its association with body image dissatisfaction and negative affect, in non-clinical women with high body concern. Undergraduate female participants with high body concern (n=22) were assessed five times per day for five days via text messages sent to their smart phones. During each assessment, participants reported the number of times they engaged in eight different body checking behaviors and their current level of negative affect and body dissatisfaction. After aggregation, a total of 3064 body checking behaviors were reported by the sample during the five-day period. All participants reported engaging in body checking at least once per day, with a mean of 27.85 checking behaviors per day. Hierarchical Linear Modeling revealed that body checking significantly predicted both body dissatisfaction and negative affect. These results provide preliminary support for the cognitive behavioral theory of eating disorders, suggesting that as women engage in more frequent body checking behaviors, they also experience higher levels of body dissatisfaction and negative affect.

Media exposure and associated stress contribute to eating pathology in women with Anorexia Nervosa: Daily and momentary associations

OBJECTIVE

We examined whether media exposure and media-induced stress contributed to eating disorder behaviors immediately and over the course of a day in women with anorexia nervosa (AN).

METHOD

Women with AN (N = 118) completed a 2-week ecological momentary assessment protocol during which they reported on exposure to food, shape, or weight-related media, associated stress, and eating behaviors.

RESULTS

Food, weight, or shape-related media exposure alone did not predict more frequent daily eating disorder behaviors. However, stress associated with media exposure was prospectively associated with a greater likelihood of binge eating and vomiting at the next assessment point. In addition, media-induced stress increased the probability of restrictive eating and fluid intake, vomiting, and laxative abuse across the day.

DISCUSSION

Media-induced stress may contribute to increased eating disorder behaviors in women with AN, as women who saw a media image and reported this experience as stressful were more likely to engage in momentary binge eating or vomiting. Reducing stress associated with viewing media images could be a potential target for therapeutic intervention with disordered eating. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:617-621).

A preliminary evaluation of the validity of binge-eating disorder defining features in a community-based sample

OBJECTIVE

Little empirical attention has been paid to the DSM-5 definition of binge-eating disorder (BED), particularly to the associated features of binge episodes. The present study sought to determine how the associated features and undue influence of weight/shape on self-evaluation contribute to evidence of a clinically significant eating disorder.

METHOD

Secondary analyses were conducted on data (N = 80; 76.3% women, 76.3% Caucasian, ages 18-43) collected through an epidemiological study of eating patterns. Descriptive statistics were used to report the sample prevalence of the features, independently and in combination. Correlations and alpha reliability were employed to examine relationships among associated features, distress regarding bingeing, and clinical diagnosis. Regression models and receiver-operating characteristic (ROC) curves were used to determine the utility of the features for explaining variance in distress.

RESULTS

Internal consistency reliability for indicators was low, and several features demonstrated low or nonsignificant associations with distress and diagnosis. Feeling disgusted/depressed/guilty was the only unique predictor of distress (p = 0.001). For the ROC curves, three features was the best threshold for predicting distress.

DISCUSSION

Results support the need to refine the features to ensure better detection of clinically significant eating pathology for research inclusion and treatment of the illness. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:524-528).

Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients

BACKGROUND

Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations.

METHOD

We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome.

RESULTS

The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression.

LIMITATIONS

The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation.

CONCLUSIONS

Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.

Reciprocal associations between negative affect, binge eating, and purging in the natural environment in women with bulimia nervosa

Although negative affect (NA) has been identified as a common trigger for bulimic behaviors, findings regarding NA following such behaviors have been mixed. This study examined reciprocal associations between NA and bulimic behaviors using real-time, naturalistic data. Participants were 133 women with bulimia nervosa (BN) according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders who completed a 2-week ecological momentary assessment protocol in which they recorded bulimic behaviors and provided multiple daily ratings of NA. A multilevel autoregressive cross-lagged analysis was conducted to examine concurrent, first-order autoregressive, and prospective associations between NA, binge eating, and purging across the day. Results revealed positive concurrent associations between all variables across all time points, as well as numerous autoregressive associations. For prospective associations, higher NA predicted subsequent bulimic symptoms at multiple time points; conversely, binge eating predicted lower NA at multiple time points, and purging predicted higher NA at 1 time point. Several autoregressive and prospective associations were also found between binge eating and purging. This study used a novel approach to examine NA in relation to bulimic symptoms, contributing to the existing literature by directly examining the magnitude of the associations, examining differences in the associations across the day, and controlling for other associations in testing each effect in the model. These findings may have relevance for understanding the etiology and/or maintenance of bulimic symptoms, as well as potentially informing psychological interventions for BN.

Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature

Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.

The relation of anxiety, depression, and stress to binge eating behavior

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.

The influence of negative urgency, attentional bias, and emotional dimensions on palatable food consumption

We tested a theoretical model concerning the role of attentional bias and negative affect in food consumption that offers important advances. We hypothesized that the effects of negative affect manipulations on food consumption vary as a function of trait levels of negative urgency (NU; tendency to act impulsively when distressed), and attentional bias and that the roles of emotional arousal and negative emotional valence differ and should be studied separately. 190 undergraduate women were randomly assigned to either an anger or neutral mood condition. Women in both conditions completed the Food Stroop, in which the presentation of food and neutral words were counterbalanced. After the task, participants were given the opportunity to eat mandarin oranges and/or chocolate candy while the experimenter was out of the room. The type and quantity of food consumed was counted after the participant departed. As hypothesized, the roles of emotional arousal and valence differed and the effect of the induced emotion was moderated by NU. Women high in NU who experienced emotional arousal were more likely to eat candy and consumed more candy than other women. Emotional valence had no effect on candy consumption. Neither increases in emotional arousal or emotional valence influenced attentional bias to food cues. Attentional bias was also unrelated to food consumption. The impact of negative mood inductions on palatable food consumption appears to operate through emotional arousal and not negative emotional valence, and it may operate primarily for women high in NU.

Family Functioning and Dysfunctional Eating Among Italian Adolescents: The Moderating Role of Gender

The first aim of this study was to examine the association between different dimensions of family functioning and dysfunctional eating in a sample of Italian adolescent boys and girls. The second aim was to investigate whether gender moderates the relationship between family functioning and dysfunctional eating. Seven hundred and twenty seven adolescents (500 boys and 227 girls) with ages ranging from 15 to 18 years completed a survey of self-report measures. Findings from hierarchical multiple regression analysis suggested that aspects of family functioning such as flexibility, cohesion, disengagement, enmeshment, rigidity and chaotic were related to dysfunctional eating in adolescents. Additionally the results indicated differences between boys and girls, in particular dysfunctional eating in adolescent boys seemed to be more affected by dimensions of enmeshment and disengagement than dysfunctional eating in girls. This research highlights the important role of various aspects of family functioning in relation to dysfunctional eating in adolescents.

Understanding the role of psychopathology in bariatric surgery outcomes

Bariatric surgery is the most effective treatment for morbid obesity; however, a subset of patients who undergo this procedure regain weight or achieve suboptimal weight loss results. A large number of studies have examined whether psychological variables play a role in weight loss surgery outcome. Although presurgical psychopathology has been found to be associated with suboptimal results in some studies, this literature is equivocal. These inconsistent findings are reviewed and considered in the context of contemporary models of psychopathology. More specifically, the review focuses on the limitations of atheoretical, descriptive diagnostic systems and examines whether comorbidity within the mood/anxiety disorders, impulse control/substance use disorders and thought disorders can account for the inconsistent findings reported to date. Contemporary models of psychopathology are highlighted and linked to the Research Domain Criteria, which have been advanced by the National Institute of Health. Means for assessing psychological constructs congruent with these models are reviewed. Recommendations are made for standardizing approaches to investigating how psychopathology contributes to suboptimal bariatric surgery outcomes.

Behavioral and hormonal responses to stress in binge-like eating prone female rats

Binge eating episodes are frequently stimulated by stress. We developed a model of binge eating proneness based on individual sensitivity of young female Sprague Dawley rats to significantly increase sucrose consumption in response to stress. The rats were subjected to unpredictable intermittent 1-h access to 10% sucrose. After the stabilization of sucrose intake, rats were assessed for consistency of higher (for binge-like eating prone, BEP) or lower (for binge-like eating resistant, BER) sucrose intake in response to unpredictable episodes of foot-shock stress. The objectives of this study included demonstrating face validity of the BEP model and determining if some of the features of this model were pre-existing before exposure to intermittent access to sucrose and repeated stress. The BEP rats consumed a larger (20%>BER) amount of sucrose in a discrete (1-h) period of time compared to the BER phenotype in non-stressful conditions and significantly increased sucrose intake (50%>BER) under stress. Conversely, stress did not affect sucrose intake in BER rats. BEP rats showed higher sucrose intake compared to BER rats at the beginning of darkness as well as during the light period when they were sated and not physically hungry. Analyses of the sucrose licking microstructure revealed that BEP rats had a high motivational drive to consume sucrose in non-stressful condition and an increased hedonic value of sucrose when they were exposed to stressful conditions. BEP rats consumed sucrose much more rapidly under stressful conditions compared to BER rats. Finally, BEP rats demonstrated compulsive-like intake of sucrose (assessed in the light-dark box) and a blunted stress-induced increase in plasma corticosterone levels. Body weight and chow intake were not different between the phenotypes. Before exposure to intermittent access to sucrose and repeated stress, the BEP rats showed no clear evidence for compulsive sucrose intake. However, from the first 1-h access to sucrose, the BEP rats exhibited sucrose overeating; and from the first exposure to stress before intermittent access to sucrose, the BEP rats showed a blunted increase in corticosterone plasma levels. Innate sucrose hyperconsumption and altered reactivity of the hypothalamo-pituitary adrenal (HPA) axis to stress may be involved in the development of binge-like eating. Increased perceived hedonic value of palatable food and an increased motivation to consume this food despite aversive conditions as well as deregulated reactivity of the HPA axis may contribute to stress-induced bingeing on sucrose in BEP rats.

Sexual violence, weight perception, and eating disorder indicators in college females

OBJECTIVE

To examine the relationships between sexual violence experiences, inaccurate body weight perceptions, and the presence of eating disorder (ED) indicators in a sample of female US college students.

PARTICIPANTS

Participants were 6,090 college females 25 years of age and younger.

METHODS

A secondary analysis of National College Health Assessment data gathered annually at one institution from 2004 to 2013 was utilized. A model predicting ED indicators was tested using logistic regression analyses with multiple categorical variables representing severity of sexual violence, accuracy of body weight perception, and an interaction between the two.

RESULTS

Sexual violence and inaccurate body weight perception significantly predicted ED indicators; sexual violence was the strongest predictor of purging behavior, whereas inaccurate body weight perception was best predicted by underweight status.

CONCLUSIONS

Findings provide support to the relationship between purging behavior and severity of sexual violence and also to the link between inaccurate body weight perception and being underweight.

Nonsuicidal Self-injury as a Risk Factor for Purging Onset: Negatively Reinforced Behaviours that Reduce Emotional Distress

Both nonsuicidal self-injury (NSSI) and purging behaviour are thought to involve harm to the self. The acquired capability for self-harm model holds that engaging in one self-harming behaviour increases the capability to tolerate harm to the self, thus increasing risk for engaging on other such behaviours. In addition, both behaviours are thought to serve the similar function of relief from distress. We thus tested whether engagement in one of these behaviours predicts the subsequent onset of the other. In a longitudinal design, 1158 first-year college women were assessed for purging and NSSI at two time points. Engagement in NSSI at time 1 predicted the college onset of purging behaviour 9 months later (OR = 2.20, p < .04, CI = 1.07-4.19) beyond prediction from time 1 binge behaviour, and purging behaviour at time 1 predicted the subsequent onset of NSSI (OR = 6.54, p < .01, CI = 1.71-25.04). These findings are consistent with the acquired capability for harm model and with the possibility that the two behaviours serve a similar function.

Shared risk factors for mood-, eating-, and weight-related health outcomes

OBJECTIVE

Given the overlap among depressive symptoms, disordered eating, and overweight, identifying shared risk factors for these conditions may inform public health interventions. This study aimed to examine cross-sectional and prospective relationships among these 3 conditions, and identify potential shared eating-related and psychosocial variable risk factors (i.e., body dissatisfaction, dieting, teasing experiences).

METHOD

A population-based sample (n = 1,902) self-reported depressive symptoms, disordered eating (binge eating, extreme weight control behaviors), weight status, and several putative risk factors (body satisfaction, dieting frequency, weight-related teasing) at 5-year intervals spanning early/middle adolescence, middle adolescence/early young adulthood, and early/middle young adulthood.

RESULTS

There was moderate overlap among depressive symptoms, disordered eating, and overweight at each time point, and moderate stability in each condition over time. Body dissatisfaction and dieting were the most potent shared risk factors for later depressive symptoms, disordered eating, and overweight among males and females (ps < .05).

CONCLUSIONS

Depressive symptoms, disordered eating, and overweight share several risk factors, including dieting and body dissatisfaction, which may be effective targets for interventions aiming to simultaneously prevent these 3 conditions.

Incidence and weight trajectories of binge eating disorder among young women in the community

OBJECTIVE

To assess the population prevalence and incidence of binge eating disorder (BED) among young women.

METHOD

In a nationwide longitudinal study of Finnish twins born 1975-1979, the women participated in five surveys from age 16 until their mid-thirties. At Wave 4 (mean age 24 years), the women (N = 2,825) underwent a 2-stage screening for eating disorders. We assessed the lifetime prevalence, incidence, and clinical characteristics of DSM-5 BED.

RESULTS

We detected 16 women who met DSM-5 criteria for BED, yielding a lifetime prevalence of 0.7% (95% confidence interval [CI] 0.4-1.2%). The incidence of BED among women between 10 and 24 years of age was 35 (95% CI 20-60) per 100,000 person-years. The mean age of onset of BED was 19 years (range 13-27 years). Of the cases, 13/16 (81%) were currently ill. Duration of illness at the time of assessment ranged from less than a year to 13 years (median 6 years). Of women with BED, only two had a history of other eating disorders, but six had lifetime major depressive disorder. Two-thirds of the women with BED belonged to the highest weight quartile at age 16, and their mean BMI at age 22-27 year was 26.2 kg/m(2) (range 22.1-32.5 kg/m(2)).

DISCUSSION

Incident BED as defined by DSM-5 was relatively rare among younger women and was often preceded by relative overweight. BED often occurred without a history of other eating disorders, but comorbidity with major depressive disorder was common.

Insights revealed by rodent models of sugar binge eating

Binge eating is seen across the spectrum of eating disorder diagnoses as well as among individuals who do not meet diagnostic criteria. Analyses of the specific types of foods that are frequently binged upon reveal that sugar-rich items feature prominently in binge-type meals, making the effects of binge consumption of sugar an important focus of study. One avenue to do this involves the use of animal models. Foundational and recent studies of animal models of sugar bingeing, both outlined here, lend insight into the various neurotransmitters and neuropeptides that may participate in or be altered by this behavior. Further, several preclinical studies incorporating sugar bingeing paradigms have explored the utility of pharmacological agents that target such neural systems for reducing sugar bingeing in an effort to enhance clinical treatment. Indeed, the translational implications of findings generated using animal models of sugar bingeing are considered here, along with potential avenues for further study.

Impulsivity and emotion dysregulation as predictors of food addiction

Food addiction is the clinical occurrence in which individuals develop physical and psychological dependencies on high fat, high sugar, and highly palatable foods. Past research has demonstrated a number of similarities between food addiction and drug use disorders including the activation of specific brain regions and neurotransmitters, disrupted neuronal circuitry, and behavioral indicators of addiction such as continued use despite negative consequences. The present study examined the role of impulsivity and emotion dysregulation in food addiction as both play salient roles in drug use disorders. Poisson regression analyses using data from 878 undergraduate students revealed negative urgency, the tendency to act impulsively when under distress, and emotion dysregulation positively predicted symptom count on the Yale Food Addiction Scale (Gearhardt, Corbin, & Brownell, 2009) whereas a lack of premeditation negatively predicted symptom count (all ps<0.05). Future research is needed to confirm precursors to eating episodes in food addiction, elucidate causal mechanisms, and support an explanatory model of food addiction.