The gender specificity of emotional, situational, and behavioral indicators of binge eating in a diet-seeking obese population

A review of sex differences in the mechanisms and drivers of overeating

Disordered eating is often associated with marked psychological and emotional distress, and severe adverse impact on quality of life. Several factors can influence eating behavior and drive food consumption in excess of energy requirements for homeostasis. It is well established that stress and negative affect contribute to the aetiology of eating disorders and weight gain, and there is substantial evidence suggesting sex differences in sub-clinical and clinical types of overeating. This review will examine how negative affect and stress shape eating behaviors, and how the relationship between the physiological, endocrine, and neural responses to stress and eating behaviors differs between men and women. We will examine several drivers of overeating and explore possible mechanisms underlying sex differences in eating behavior.

Sex differences in the relationships among weight stigma, depression, and binge eating

Weight stigma and weight discrimination are prevalent in the United States and binge eating has been found to be associated with these experiences in numerous studies. One issue with the current literature on weight stigma and binge eating, however, is that study samples are primarily female, resulting in a lack of understanding of this relationship among males. To address this gap, we examined potential sex differences in the association between weight stigma and binge eating, as well as mediators of this relationship. Specifically, we examined experiences of weight discrimination and weight stigma consciousness as predictors of binge eating, and we assessed whether these relationships were mediated by depression, perceived stress, and/or perceived control. Results showed that, among females and males, experiences of weight discrimination significantly predicted binge eating and depression mediated this relationship; perceived stress also mediated this association, but only among males, and perceived control did not mediate for either sex. Results also showed that, among males, the relationship between weight stigma consciousness and binge eating was mediated by depression and perceived control, but not perceived stress. Weight stigma consciousness was unrelated to binge eating among females. Together, these findings suggest that weight stigma constructs differentially impact females and males, thereby illuminating the possible need for consideration of sex as an important component of efforts to reduce weight stigma.

Do parental traumatic experiences have a role in the psychological functioning of early adolescents with binge eating disorder?

PURPOSE

Few studies have addressed the psychological characteristics of adolescents with binge eating disorder (BED). No research has focused on the psychological functioning of these adolescents' parents or on the prevalence of traumatic experiences among them.

METHODS

In this study, 202 adolescents aged 11-13 and their parents were recruited from mental health clinics to complete the youth self-report (YSR), the response evaluation measure for youth (REM-71), the Toronto Alexithymia Scale (TAS-20), the Symptom Check-List (SCL-90-R), and the traumatic experience checklist (TEC).

RESULTS

Female adolescents scored higher than males on withdrawal, internalizing problems, dissociation, and somatization subscales. Boys scored higher than girls on externalizing problems and acting out subscales. Maternal depression predicted withdrawal and dissociation in female adolescents. Maternal sexual abuse predicted social problems in males and self-destructive behaviors in females. Paternal physical abuse predicted delinquent behavior and acting out in males.

CONCLUSIONS

Our data suggest that parental traumatic experiences play a role in their offspring's mental health; the data also showed different psychopathological configurations in male and female adolescents with BED and their parents, suggesting the development of prevention and treatment polices specific to gender.

Differential motivational profiles following adolescent sucrose access in male and female rats

Adolescents are the highest consumers of sugar sweetened drinks. Excessive consumption of such drinks is a likely contributor to the development of obesity and may be associated with enduring changes in the systems involved in reward and motivation. We examined the impact of daily sucrose consumption in young male and female rats (N=12 per group) across the adolescent period on the motivation to perform instrumental responses to gain food rewards as adults. Rats were or were not exposed to a sucrose solution for 2 h each day for 28 days across adolescence [postnatal days (P) 28-56]. They were then trained as adults (P70 onward) to lever press for a palatable 15% cherry flavored sucrose reward and tested on a progressive ratio (PR) schedule to assess motivation to respond for reinforcement. Female rats exposed to sucrose had higher breakpoints on the PR schedule than controls, whereas male rats exposed to sucrose had lower breakpoints than controls. These results show that consumption of sucrose during adolescence produced sex-specific behavioral changes in responding for sucrose as adults.

A gender-based approach to developing a healthy lifestyle and healthy weight intervention for diverse Utah women

Utah women from some cultural minority groups have higher overweight/obesity rates than the overall population. We utilized a gender-based mixed methods approach to learn about the underlying social, cultural and gender issues that contribute to the increased obesity risk among these women and to inform intervention development. A literature review and analysis of Utah's Behavioral Risk Factor Surveillance System data informed the development of a focus group guide. Focus groups were conducted with five groups of women: African immigrants from Burundi and Rwanda, African Americans, American Indians/Alaskan Natives, Hispanics/Latinas, and Pacific Islanders. Six common themes emerged: (1) health is multidimensional and interventions must address health in this manner; (2) limited resources and time influence health behaviors; (3) norms about healthy weight vary, with certain communities showing more preference to heavier women; (4) women and men have important but different influences on healthy lifestyle practices within households; (5) women have an influential role on the health of families; and (6) opportunities exist within each group to improve health. Seeking insights from these five groups of women helped to identify common and distinct cultural and gender themes related to obesity, which can be used to help elucidate core obesity determinants.

Correlations between self-efficacy in resisting six temptations and dietary energy and macronutrient intake at each meal

Self-efficacy in relation to eating behavior for weight control is commonly defined as having the confidence to control urges to overeat in high-risk situations. Prior researchers have suggested that self-efficacy plays a mediating role in eating behavior for weight loss and maintenance. The current study examined the relationship between self-efficacy in resisting certain temptations and daily dietary intake at each meal. Participants were 83 men and 122 women registered at the health management website "Asken". They administered questionnaires about self-efficacy and dietary records. As results of multiple regression analysis, self-efficacy in resisting negative emotions was negatively related to lunch energy intake in men (β=-0.308, p=0.023) and total (β=-0.302, p=0.003), breakfast (β=-0.334, p=0.004), and snacking (β=-0.232, p=0.022) energy intake in women. Also, self-efficacy in resisting rewards was negatively related to lunch energy intake in men (β=-0.218, p=0.040). In men, self-efficacy in resisting hunger was positively related to protein intake (β=0.148, p=0.021) and relaxation was negatively related to lipid intake (β=-0.211, p=0.009). Self-efficacy in resisting some temptations, especially negative emotions, and dietary intakes were negatively related. Future research is needed to confirm these results and assess the prospective effects of self-efficacy.

Assessment tools in obesity - psychological measures, diet, activity, and body composition

The global increase in the prevalence of obesity has led to an increased need for measurement tools for research, management and treatment of the obese person. The physical size limitations imposed by obesity, variations in body composition from that of normal weight, and a complex psychopathology all pose tremendous challenges to the assessment of an obese person. There is little published research regarding what tools can be used with confidence. This review is designed to provide researchers and clinicians with a guide to the current and emerging measurement tools specifically associated with obesity research and practice. Section 1 addresses psychological measures of well being. Sections 2, 3, and 4 focus on the assessment of food intake, activity, and body composition. All sections address basic challenges involved in the study and management of obesity, and highlight methodological issues associated with the use of common assessment tools. The best available methods for use in the obese both in research and clinical practice are recommended.

Disordered eating in women: implications for the obesity pandemic

Contemporary Western society emphasizes thinness for women, and the ideal female body size has become progressively smaller over the past half century. Meanwhile, the actual female body size has increased steadily, and rates of aberrant attitudes and behaviours surrounding food and weight have risen and tend to be much more common in overweight individuals. Thus disordered eating and excess body weight may perpetuate each other's development. We have synthesized the literature concerning female body size and disordered eating within a sociocultural context. Eight cognitions and behaviours that occur in women were examined: media exposure, weight stereotypes, body dissatisfaction, dieting, "fat talk," emotional eating, perfectionism, and the "superwoman" ideal. The research literature suggests that these factors may play a role in both disordered eating and obesity. Furthermore, these factors may induce triggers, exacerbated by perfectionism and excess weight, that increase the risk of binge eating. These triggers include interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. Comprehensive interventions targeting the indicated sociocultural cognitions and behaviours, combined with healthy living education, may be the most effective strategy for reducing the prevalence of disordered eating and obesity among females.

Role of media and peers on body change strategies among adult men: is body size important?

There has been limited previous research that has examined the role of sociocultural influences on body change strategies among adult men. The current study investigated the role of specific types of messages (encouragement, teasing and modelling) from peers and the media on the strategies to change weight among adult men. Differences were evaluated between 526 men aged from 18 to 60 years from three groups (normal weight, overweight and obese) on body image, body change strategies and messages about their body received from peers and the media. Men were primarily drawn from United States, Australia and Europe. Results showed that messages received by men regarding losing weight or increasing muscle size differed according to weight. Body image and media messages were the strongest predictors of losing weight, whereas body image importance and messages from peers were the strongest predictors of increasing muscles. These findings highlight the importance of sociocultural influences on body change strategies among adult males.

Binge eating and other eating behaviors among patients on treatment for psychoses in India

OBJECTIVE

'Medication-induced eating disorder' is implicated as one of the reasons for the weight gain seen in psychotic patients. The aim of this study was to examine the prevalence of binge eating disorder (BED), binge spectrum and other eating behaviors in patients on treatment for non-affective psychoses in India.

METHOD

An outpatient cross-sectional study of 73 participants.

RESULTS

Most of the binge spectrum behaviors occurred in patients on treatment for more than 2 years and on concomitant antidepressant medication. Patients admitted to obesogenic eating behaviour more readily than actual calorie intake. BED was absent in our sample.

CONCLUSION

While binge spectrum eating behaviors were noted in many patients, the absence of BED was striking and could be due to cultural factors. Binge spectrum eating behaviors could be treatment emergent or linked particularly to the improvement from psychoses and post psychotic depression.

Comparison of obese men and women with binge eating disorder seeking weight management

OBJECTIVE

This study examined whether obese males with binge eating disorder (BED) seeking weight loss treatment differed significantly from obese females with BED seeking weight loss treatment in developmental variables, weight loss history, current and lifetime prevalence of psychiatric disorders, and metabolic abnormalities.

METHODS

Psychiatric (using the Structural Clinical Interview for DSM-IV), medical, and laboratory assessments of 44 obese males with BED were compared with assessments from 44 age- and race-matched obese females with BED seeking weight loss treatment.

RESULTS

High rates of mood disorders, anxiety disorders, and metabolic syndrome were observed in the population as a whole. Obese males with BED had attempted significantly fewer diets, medications and supplements for weight loss before seeking weight loss treatment. The two genders did not differ significantly in any other of the examined variables.

CONCLUSIONS

Our results suggest that while obese men and women with BED who present for weight management are very similar, males had fewer previous attempts at weight loss, possibly related to their less pronounced body dissatisfaction or fewer help-seeking behaviors as compared to females. Our results also support findings of substantial comorbidity among obesity, BED, mood and anxiety disorders, and metabolic syndrome in weight loss seeking populations, in men as well as women.

Ethnic and gender differences in eating attitudes among black and white college students

This study examines ethnic and gender differences in eating attitudes and behaviors among college students. Participants were 225 Black and 199 White students sampled from a historically Black university. White participants were more dissatisfied with their bodies, engaged in more self-loathing, and dieted more than Blacks. Similarly, women were more dissatisfied with their bodies, engaged in more self-loathing, dieted more, and showed a greater drive for thinness than men. White women and Blacks of either gender exhibited similar predictors of drive for thinness with each group showing some combination of dieting and self-loathing. Intrapersonal anger predicted drive for thinness in White men, adding to a growing body of research suggesting a link between anger and eating disorders. Results support a substantial body of literature showing that Black and White college students differ on their views of body image and eating. Future research should explore the role of anger as a risk factor for eating disorders among White men.

Negative emotion and disordered eating among obese college students

The present study examined the relationship between negative emotions, body dissatisfaction, exercise, and disordered eating attitudes and behaviors among obese college students. It also examined whether there were gender differences in these variables. A total of 88 males and 102 females, who reported a BMI score above 30, completed a survey. Females reported higher levels of disordered eating, body dissatisfaction, and more frequent dieting than males and as predicted, males reported higher levels of exercise behaviors. Body dissatisfaction, anger discomfort, and self dissatisfaction all correlated with drive for thinness for both genders. Anger discomfort was the only variable to predict disordered eating for both genders. The results support numerous studies that have found that females are at greater risk of disordered eating than males, and also suggest that anger management may be an important component in treatment of disordered eating among obese young adults.

Anger and bulimic psychopathology: gender differences in a nonclinical group

OBJECTIVE

The current study addressed the link between anger and bulimic psychopathology between young adult men and women.

METHOD

Volunteers (125 males and 125 females) completed two self-report questionnaires measuring anger (State Trait Anger Inventory [STAXI]) and bulimic attitudes and behaviors (Bulimic Investigatory Test, Edinburgh [BITE]).

RESULTS

Although overall levels of anger did not differ broadly across genders, bulimic attitudes were associated with state anger in men but with anger suppression in women.

DISCUSSION

Men appear to engage in bulimic behaviors to reduce anger states, whereas women appear to use such behaviors to reduce the likelihood of anger states from arising. Further experimental validation of these findings is required in both clinical and nonclinical groups.

Evaluating commercial weight loss programmes: an evolution in outcomes research

The increasing prevalence of obesity has been mirrored by a parallel increase in the number of commercial weight loss programmes. Research evaluating these programmes is meagre, however, compared to the numbers treated. Reluctance of commercial weight loss programmes to meaningfully evaluate their weight loss efficacy may arise from fear that competitors will use the results against them. Evaluation of commercial weight loss programmes usually progresses from testimonials, often by famous people who were successful, to uncontrolled studies of past participants evaluated either by the programme itself or by an outside entity. The gold standard, however, is a scientifically rigorous, controlled study of the programme conducted by an independent entity. Such a study, published in a peer-reviewed journal, can gain credibility for a programme, as it did with Slim Fast, if the results are positive, or herald the end of the programme, as it was with Simeons human chorionic gonadotropin injection clinics. This review of the evolution of the evaluation process of commercial weight loss programmes leads us to conclude that consumers are likely to demand greater scientific rigour in the future, a change that will favour informed choice and discourage the practice of unrealistic advertising that raises false hopes.

Changing eating behavior: a preliminary study to consider broader measures of weight control treatment success

This study evaluated changes in the self-reported eating behaviors (snacking, binge eating, portion sizes, and meal skipping) of 52 obese adults (33 women and 19 men) attending a residential weight loss facility on two consecutive occasions. For each of the eating patterns studied, subjects reported engaging in the behavior significantly less frequently at the time of their return visit. It is proposed that changes in eating behaviors provide a useful and appropriate nonweight based outcome measure for estimating treatment success in diet-seeking clients.

Gender differences in patients with binge eating disorder

OBJECTIVE

This study examined gender differences in patients with binge eating disorder (BED).

METHOD

Participants were 182 adults (35 male, 147 female) who were consecutively evaluated for outpatient clinical trials and met criteria for BED as outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. They were administered a battery of measures to examine developmental, eating and weight-related disturbances, and psychological features associated with BED.

RESULTS

Men and women did not differ significantly on several developmental variables (age at first overweight, age at first diet, age at onset of regular binge eating, or number of weight cycles). Men had significantly higher current body mass index (BMI), highest adult BMI, and were significantly more likely to be classified as obese. Men and women did not differ significantly on measures of current eating disorder features (binge eating, eating concerns, weight or shape concerns) but women reported significantly greater body image dissatisfaction and drive for thinness. Men and women did not differ significantly on current depression or self-esteem but men reported a greater frequency of past drug abuse problems.

DISCUSSION

Although men and women who present for treatment for BED show many similarities in current eating disorder features, we observed a number of gender differences on important developmental and physical variables as well as associated psychological features.

Body image partially mediates the relationship between obesity and psychological distress

OBJECTIVE

Body image is considered as a potential mediator of the relationship between obesity and psychological distress.

RESEARCH METHODS AND PROCEDURES

One hundred ten men and women in a residential weight control facility completed the Multidimensional Body Self-Relations Questionnaire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Binge Eating Scale.

RESULTS

For both men and women, body-image satisfaction partially mediated the relationship between degree of overweight and depression/self-esteem.

DISCUSSION

Sociodemographic factors that may influence the relationships among weight, body image, and depression/self-esteem are discussed.