Validation of eating and dieting expectancy measures in two adolescent samples

My Diet Study: protocol for a two-part observational, longitudinal, psycho-biological study of dieting in Australian youth

Introduction

Self-directed dieting (i.e., unsupervised) is very common among adolescents and young adults but has had almost no direct research. This paper describes the protocol for the My Diet Study, a two-arm observational investigation of the natural progression of dieting among young people over a period of 6-months. The study aims to examine the links between self-directed dieting, general physiological and psychological metrics of wellbeing (e.g., depressive symptoms) and biomarkers of gut-brain axis functions (e.g., microbiome and hormones) that are predicted to influence diet adherence through appetite, mood and metabolism regulation.

Methods

Young people aged 16-25, intending to start a diet will be invited to participate in this observational study. For Part 1 (psychological arm), participants will be asked to complete a set of questionnaires and diaries at the beginning of every month for 6 months, to assess overall mental (e.g., psychological distress, disordered eating) and physical (e.g., weight) health, perceived diet success, food intake and gastrointestinal movements. For Part 2 (biological arm), a subsample of 50 participants will be asked to provide feces, blood and saliva for bio-sampling each month for the first 3-months of their participation in Part 1.

Discussion

The My Diet Study will be the first longitudinal, observational study of dieting in young people combining in-depth psychological and biological data. It is anticipated that the findings will yield psychological & biological information about the impacts and effectiveness of self-directed dieting in young people, inform a framework for advice on safety in dieting among young people and help to establish the potential for biomarkers for risk management and improvement of diet-based lifestyle interventions.

The association between distress tolerance and eating expectancies among trauma-exposed college students with obesity

Objective Obesity is a significant health concern among college populations, and trauma-exposed students are particularly at risk for behaviors associated with weight gain. There is need for further understanding of factors that may contribute to increased obesity among this population. Participants: Participants included 139 trauma-exposed college students with obesity (76.3% females; M_age = 25.4 years, SD = 8.07). Method: The current cross-sectional study examined distress tolerance in terms of expectancies of eating to help manage negative affect and to lead to feeling out of control among trauma-exposed college students with obesity. Results: Results indicated that lower perceived distress tolerance was associated with greater expectancies of eating to help manage negative affect and to lead to feeling out of control. Conclusions: These findings suggest that distress tolerance may be a clinically significant target for treatment in order to better understand and treat expectancies of eating among trauma-exposed college students with obesity.

Computer-delivered intervention for individuals with obesity and elevated anxiety sensitivity: feasibility, acceptability, and initial test

Obesity is one the fastest growing public health problems related to numerous chronic diseases and frequently co-occurs with negative mood states. One promising approach to address the heterogeneity of affective vulnerabilities and obesity is to focus on processes (e.g. anxiety sensitivity [AS]) that underpin both conditions. Thus, this study aimed to evaluate the feasibility, acceptability, and initial efficacy of a brief, computer-delivered AS reduction program (AST) for adults with obesity and elevated AS. Participants were 131 individuals with obesity and elevated AS who received either AST or a health information control (HC). Latent growth curve modeling was utilized to examine the effect of treatment condition on change in AS, emotional eating, expectancies of eating to manage mood, and exercise self-efficacy from baseline to 1-week, 2-weeks, and 1-month follow-up. Results indicated it was feasible to recruit and retain individuals with obesity and elevated AS through the 1-month follow-up. Positive qualitative feedback was also provided for both AST and HC. AST was a statistically significant predictor of change in expectancies of eating to manage negative affect. No other statistically significant treatment effects were indicated. Current data provide initial empirical support for future work focused on persons with obesity and elevated AS.

The Positive Body Image among Adolescents Scale (PBIAS): Conceptualization, development, and psychometric evaluation among adolescents from Belgium

In this study, we aimed to offer a conceptualization of positive body image during adolescence and psychometrically examine a new scale developed to measure this conceptualization. A literature review on positive body image and adolescence was conducted, which shaped the development of the Positive Body Image among Adolescents Scale (PBIAS). In Study 1, four focus groups (totaling 14 adolescents) from Belgium explored the content, clarity, and applicability of the PBIAS items. In Study 2, an exploratory factor analysis (N = 565; M_age = 14.9, 63.8 % girls) revealed 4 factors: body self-appreciation, body other-appreciation, resilience against media body ideals, and resilience against negative appearance feedback. This 4-factor structure was confirmed in Study 3 (N = 718; M_age = 15.2, 50.4 % girls), and gender invariance was upheld. The test-retest reliability of the PBIAS scores was partially supported in Study 4 (N = 309, M_age = 15.3, 66.3 % girls). Across studies, internal consistency was supported and construct validity (convergent and incremental) evidence was garnered. Further, the PBIAS was translated from Dutch to English to offer researchers an option for collecting data in English-speaking countries. Overall, the PBIAS is a brief measure with psychometric support that assesses four dimensions of adolescent positive body image.

Mindful Attention and Eating Expectancies among College Students with Obesity and a History of Trauma Exposure

Objectives

Trauma exposure and obesity are highly prevalent among college students and both are associated with disordered eating. There is a need to understand psychological factors that may be related to maladaptive eating behavior among college students with obesity and a history of trauma exposure.

Methods

Participants included 139 college students with obesity (defined as a BMI ≥ 30) and a history of trauma exposure (76.3% females; M _age = 25.4 years, SD = 8.07). The current study conducted three separate two-step hierarchical regressions examining mindful attention, and its relation to eating expectancies (expectancies of eating to help manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to feeling out of control).

Results

Results indicated that lower levels of mindful attention were related to greater levels of expectancies of eating to help manage negative affect (b = -4.16, SE = 1.08, p = .023, CI_95% = -7.72, -0.60, sr² = .04), expectancies of eating to alleviate boredom (b = -1.09, SE = 0.39, p = .006, CI_95% = -1.86, -0.32, sr² = .06), and expectancies of eating to lead to feeling out of control (b = -1.62, SE = 0.40, p < .001, CI_95% = -2.41, -0.83, sr² = .11). Results were observed over, and above variance accounted for by sex (assigned at birth), body mass index (BMI), and posttraumatic stress disorder (PTSD) symptom severity.

Conclusions

Overall, the results from the present investigation suggest the potential importance and need for future research in the role of mindful attention in relation to several distinct eating expectancies associated with maladaptive eating.

Disordered eating in the postpartum period: Role of psychological distress, body dissatisfaction, dysfunctional maternal beliefs and self-compassion

The present cross-sectional study tested the affect regulation model of disordered eating for women in the postpartum period, whereby disordered eating is used to cope with psychological distress. Two hundred and two women who had given birth in the last two years completed an online survey of self-report measures of study variables. Path analyses supported the primary hypothesis: negative affect mediated relationships between body dissatisfaction, dysfunctional maternal beliefs, negative components of self-compassion and disordered eating behaviours, particularly binge eating. Results suggest that negative affect plays a central role in postpartum disordered eating. Interventions to address maladaptive emotion regulation strategies, specifically targeting body image distress and self-critical maternal thoughts may improve eating behaviours for this population.

Anxiety sensitivity in relation to eating expectancies among college students

Disordered eating is highly prevalent on college campuses and is associated with a host of negative outcomes. To better understand the nature of disordered eating, it is important to examine motivational processes that guide eating behavior. Participants: Participants were a diverse sample of 1,589 college students (80.4% females; M_age=22.2 years, SD = 5.27). Methods: This study examined anxiety sensitivity, a transdiagnostic vulnerability factor, as a predictor of eating expectancies. Results: Results indicated that higher levels of anxiety sensitivity was associated with greater levels of expectancies of eating to help manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to feeling out of control. Results were observed over and above variance accounted for by gender, race/ethnicity, and negative affectivity. Conclusions: These findings suggest that college students with higher anxiety sensitivity may have a greater risk for maladaptive eating expectancies.

Association between food addiction and body dissatisfaction among college students: The mediating role of eating expectancies

A positive association between food addiction (i.e., an addiction to compulsively overeat highly palatable foods) and body dissatisfaction in college students exists. However, little is known about the underlying mechanisms. Eating expectancies, one's learning history regarding the association between eating and its consequences, may provide potential pathways linking food addiction and body dissatisfaction. In the current study, five eating expectancies (i.e., eating helps manage negative affect, eating is pleasurable and useful as a reward, eating leads to feeling out of control, eating enhances cognitive competence, and eating alleviates boredom) were evaluated as potential mediators between food addiction and body dissatisfaction in 738 college students (mean age = 19.21 ± 1.63, 61.4% female). Students completed the Eating Pathology Symptoms Inventory, Yale Food Addiction Scale, and Eating Expectancy Inventory. Adjusting for sex, age, race, and body mass index, structural equation modeling was used to examine the bi-directional mediation effects of the eating expectancies between food addiction and body dissatisfaction. Results showed a bi-directional positive association between food addiction and body dissatisfaction (β = 0.12-0.26, standard error [SE] = 0.07-0.03, all p < 0.01) that was partially mediated by the expectancy that eating leads to feeling out of control, regardless of whether body dissatisfaction was included as the independent or dependent variable (β = 0.15-0.36, SE = 0.05-0.02, all p < 0.01). Findings suggest the need to address the influence of expecting eating to lead to feeling out of control in interventions for co-occurring food addiction and body dissatisfaction among college students.

Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.

The relationship between perfectionism and eating-related symptoms in adolescents: A systematic review

The clinical significance of two major aspects of perfectionism, perfectionistic strivings (PS) and perfectionistic concerns (PC), in eating disorders (EDs) symptoms was well-established among adults. However, no systematic review has assessed evidence examining associations between both unidimensional and multidimensional perfectionism and EDs in early and middle adolescence. For this aim, three online databases (PsycINFO, Medline and PsycArticle) were searched for articles published until January 2019, and observational studies were considered. Study quality was systematically appraised, and results were summarized using a narrative synthesis approach. Fifty-one cross-sectional and 28 longitudinal studies were included. Most studies supported the relationship between perfectionism and EDs, with the majority adopting a unidimensional approach for assessing perfectionism. Among studies that employed multidimensional measures of perfectionism, the majority (n = 11) of evidence supported the relationship between eating symptoms and PC, while fewer (n = 5) studies provided significant unique associations with PS. These findings are consistent with the body of research suggesting the strength of the relationship between PC and EDs was greater than between PS and EDs. It was recommended that preventive interventions should be primarily focused on reducing self-critical perfectionism, since it resulted to be the most relevant perfectionistic dimension in the development of eating symptoms in adolescents.

The role of emotion dysregulation in the association between subjective social status and eating expectancies among college students

Objective: Research suggests that college is a risky period for changes in eating behavior and beliefs. Although social health determinants relate to health behavior changes, research has not explored subjective social status, one's societal standing, in terms of eating expectancies among college students. The present study examined the emotion dysregulation in association between subjective social status and eating expectancies among college students. Participants: Participants were a diverse sample of 1,589 college students (80.4% females; M_age = 22.2 years, SD = 5.27) from an urban university. Results: Results showed a significant indirect association of subjective social status via emotion dysregulation in relation to expectancies of eating to help manage negative affect, to alleviate boredom, and to lead to feeling out of control. Conclusion: These findings provide evidence that college students with lower subjective social status may have a higher risk for dysregulated emotions, and consequently, expressing maladaptive eating expectancies.

Eating expectancies before bariatric surgery: assessment and associations with weight loss trajectories

BACKGROUND

While presurgical eating behaviors have demonstrated limited prognostic value, cognitions regarding the effects of eating may serve as important predictors of weight loss outcomes after bariatric surgery. The Eating Expectancies Inventory (EEI) is a commonly used, self-report measure of expected consequences of eating; however, its psychometric and predictive properties have not yet been evaluated among bariatric surgery patients.

OBJECTIVES

This study sought to examine the factor structure and internal consistency of the EEI among bariatric surgery candidates, to examine relationships between EEI factors and measures of eating psychopathology, and to explore the effects of eating expectancies on postsurgical weight loss.

SETTING

Data originated from an interdisciplinary bariatric surgery center in the Midwest United States.

METHODS

Two hundred sixty-two women completed self-report questionnaires before bariatric surgery. Presurgical data and available postsurgical weights (at 6, 12, and 18 mo) were obtained from medical records.

RESULTS

Analyses indicated that the original 5-factor model was a good-to-excellent fit for the EEI data. All EEI factors demonstrated good reliability and were significantly associated with eating disorder symptoms and behaviors at baseline. Higher scores on EEI Factor 1 (negative affect) and Factor 5 (alleviates boredom) predicted poorer weight loss at 18 months postsurgery (n = 132).

CONCLUSIONS

Findings support the reliability and validity of the EEI among female bariatric candidates. Presurgical eating expectancies were linked to pathologic eating patterns and also predicted postsurgical weight loss trajectories, suggesting that eating expectancies may have prognostic value as predictors of bariatric surgery outcomes.

Preferences for being muscular and thin in 6-year-old boys

Body dissatisfaction emerges at an early age in childhood. However, the unique experiences of young boys regarding muscularity have not been examined. Interview responses were collected from 101 6-year-old boys to examine muscularity- and thinness-oriented body dissatisfaction. Both muscularity- and thinness-oriented body dissatisfaction were evident; boys on average selected ideal figure sizes significantly more muscular and significantly thinner than current figures. In addition, a significantly greater proportion of boys wanted to be more muscular (32.6%) than less muscular (16.8%), and thinner (20.8%) rather than larger-fatter (8.9%). Further, boys perceived significantly greater rewards from muscularity than from thinness. Findings demonstrate that muscularity and thinness-oriented body dissatisfaction is present in a substantial proportion of young boys, although a greater proportion are dissatisfied with muscularity than with thinness, suggesting that examination of body image in young boys needs to focus on muscularity dimensions as well as thinness-fatness dimensions.

Insomnia and eating expectancies among college students: the role of emotion dysregulation

There is limited understanding of the relation between insomnia and aspects of eating among college students though available data suggest salient clinical relationships. The present study explored a potential transdiagnostic mechanism in the relation between insomnia symptoms and eating expectancies. Participants were a racially/ethnically diverse sample of 1589 college students (80.4% females; Mage = 22.2 years, SD = 5.27) from an urban university. Primary analysis included three regression-based models of eating expectancies. Insomnia symptoms served as the predictor, and emotion dysregulation served as the indirect (mediator) variable in all models. Results indicated that insomnia symptoms yielded a significant indirect effect through emotion dysregulation on expectancies of eating to help manage negative affect, alleviate boredom, and lead to feeling out of control. Students experiencing insomnia symptoms may be at higher risk for experiencing dysregulated emotions and consequently maladaptive eating expectancies compared to good sleepers.

Developmental trajectories of compensatory exercise and fasting behavior across the middle school years

Compensatory exercise and fasting behavior, in the absence of binge eating and purging, appear to be important eating disorder behaviors that are associated with dysfunction, but little is known about these behaviors in youth. We studied the trajectories of their development in non-binge eating and non-purging girls during early adolescence. Using a longitudinal design, we assessed 564 girls six times over the three years of middle school (grades 6 through 8) and developed trajectories specifying different developmental patterns in relation to the behaviors. Prior to this period, when the girls were in 5th grade (elementary school), we assessed risk factors to predict girls' subsequent trajectory group membership. Compensatory exercise trajectory groups included a non-engagement group, a group that increased in the behavior, and a group that decreased in the behavior. There were two fasting trajectory groups, one consistently engaging in the behavior and the other consistently not. Elementary school levels of depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership. Risk for compensatory exercise and fasting should be evaluated as early as in 5th grade. Targeted interventions should focus on girls in late elementary school or middle school, as this appears to be a critical developmental and maintenance period for compensatory exercise and fasting behavior.

Positive and negative eating expectancies in disordered eating among women and men

BACKGROUND

Deficits in emotion regulation are known to characterize disordered eating patterns including binge eating, purging, and dietary restraint, though much of this work has been conducted exclusively on women. Eating expectancies, or expectations regarding reinforcement from food and eating, constitute one cognitive mechanism that is thought to serve as a proximal influence on eating behavior. Previous research shows that eating to manage negative affect (a negative eating expectancy) is associated with eating pathology in women, but less is known about eating as a reward or for pleasure (a positive eating expectancy). In addition, no prior work has examined eating expectancies among men. This study examines the role of emotion regulation and eating expectancies on disordered eating in women and men.

MATERIALS AND METHODS

Participants were 121 female and 80 male undergraduates who completed self-report measures of emotion regulation, eating expectancies, and disordered eating.

RESULTS

In women, body mass index (BMI), emotion regulation, and eating to manage negative affect directly predicted disordered eating in the final multivariate model, whereas eating for pleasure or reward was inversely associated with disordered eating. However, in men, emotion regulation predicted disordered eating, but not when eating expectancies were added to the model. In the final model, only BMI and eating to manage negative affect contributed significantly to the variance in disordered eating.

CONCLUSIONS

These findings suggest that some correlates of eating pathology, particularly eating expectancies, may vary by gender. Future research should continue to examine gender differences in the explanatory mechanisms underlying disordered eating.

Comparability of the Eating Disorder Inventory-2 Between Women and Men

Researchers studying eating disorders in men often use eating-disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, this article reports on the validity the Eating Disorder Inventory–2 (EDI-2), one of the best-validated among women and the most widely used risk and symptom measure for women. The EDI-2 had the same, standard eight-factor structure for both genders, and tests of invariance showed that factor loadings, factor variances, and factor intercorrelations were equivalent across gender. The EDI-2 scales correlated with questionnaire measures of bulimic and anorexic symptomatology equivalently across gender. However, the EDI-2 scales were generally less reliable for men, leading to slightly lower Pearson-based estimates of correlations among the measures for men.

Bulimic symptom onset in young girls: A longitudinal trajectory analysis

To investigate whether there are different patterns of development for binge eating and purging behavior among preadolescent and early adolescent girls, we conducted trajectory analyses of those behaviors in 938 girls across 8 waves of data from the spring of 5th grade (the last year of elementary school) through the spring of 9th grade (the first year of high school). Analyses revealed 4 separate developmental trajectories for binge eating behavior (labeled none, increasing, decreasing, and high steady) and 3 separate developmental trajectories for purging behavior (labeled none, dabble, and increasing). Fifth grade scores on risk factors that were both transdiagnostic (negative affect and negative urgency) and eating disorder specific (expectancies for reinforcement from eating and from thinness) differentiated among the trajectory groups, in some cases before the groups differed in the target behaviors. These findings are the first, to our knowledge, to examine developmental trajectories for bulimic symptom onset in youth as young as elementary school. Clinical implications are discussed.

Two pathways toward impulsive action: an integrative risk model for bulimic behavior in youth

BACKGROUND

This study provides an integrative review of existing risk factors and models for bulimia nervosa (BN) in young girls. We offer a new model for BN that describes two pathways of risk that may lead to the initial impulsive act of binge eating and purging in children and adolescents.

SCOPE

We conducted a selective literature review, focusing on existing and new risk processes for BN in this select population.

FINDINGS

We identify two ways in which girls increase their risk to begin engaging in the impulsive behavior of binge eating and purging. The first is state-based: the experience of negative mood, in girls attempting to restrain eating, leads to the depletion of self-control and thus increased risk for loss of control eating. The second is personality-based: elevations on the trait of negative urgency, or the tendency to act rashly when distressed, increase risk, particularly in conjunction with high-risk psychosocial learning. We then briefly discuss how these behaviors are reinforced, putting girls at further risk for developing BN.

CONCLUSIONS

We highlight several areas in which further inquiry is necessary, and we discuss the clinical implications of the new risk model we described.

Thinness expectancies and restraint in Black and White college women: a prospective study

Despite stereotypes to the contrary, women of diverse racial backgrounds, including Black women, experience disordered eating symptoms. While there has been an increase in research comparing disordered eating symptoms across ethnic groups, there remains a dearth of research on the mechanisms of action underlying the development of these symptoms in non-White populations. Thinness expectancies prospectively predict disordered eating symptoms in adolescent girls, but the majority of research on expectancies has been conducted with White samples. Restraint, or self-initiated attempts to restrict food intake, may be precipitated by cognitive factors such as thinness expectancies. In the current study, we followed a sample of Black and White women over one semester of college to assess the influence of thinness expectancies and ethnic identity on restraint. Our sample consisted of 193 college women (93 Black women). We found that White women experienced restraint at higher levels than Black women, but both Black and White women experienced an increase in restraint across the first semester in college. The endorsement of thinness expectancies added significant incremental variance to the prediction of restraint over time, when baseline restraint was included in the model. These effects were not moderated by ethnicity nor ethnic identity. This study adds to the scarce literature on phenomenology of disordered eating in Black women.

Eating Expectancies in Relation to Eating Disorder Recovery

This study examined the relation between eating expectancies, assessed via the Eating Expectancy Inventory, and eating disorder recovery. Individuals formerly seen for an eating disorder were categorized as having an active eating disorder (n = 53), as partially recovered (n = 15), or as fully recovered (n = 20). The expectancies of these groups were compared to each other and to 67 non-eating disorder controls. Results revealed that three of the five eating expectancies differed across groups. Non-eating disorder controls and fully recovered individuals endorsed similar levels of the expectancies that eating helps manage negative affect, eating is pleasurable and useful as a reward, and eating leads to feeling out of control. Partially recovered individuals looked more similar to active eating disorder cases on these expectancies. The other two expectancies did not differ across groups. Results provide some indication that certain eating expectancies may be associated with eating disorder recovery.

Evaluating the acquired preparedness model for bulimic symptoms and problem drinking in male and female college students

Individuals who act impulsively under stress show increased risk for both problematic alcohol use and problems with food. These two issues evidence significant comorbidity; many models have explored the relation between these conditions. The current study examines the relation of trait urgency and disorder-specific expectancies to alcohol problems and eating. Previous studies have examined these variables together in females, and this investigation evaluates this model in a combined sample of men and women. The findings from this study are consistent with an acquired preparedness model, indicating that trait urgency and expectancies enhance risk for both alcohol and eating problems. Furthermore, expectancies moderate the relationship between urgency and bulimic symptoms. The relationship between urgency, expectancies, and drinking depends on gender.

Thinness expectations and weight cycling in a sample of middle-aged adults

BACKGROUND

The False Hope Syndrome suggests that unrealistic expectations of dieting and weight loss are key constructs in the prediction of behavioral failure and may exacerbate weight cycling. The objective of this study was to determine cross-sectional associations among dieting and thinness expectations and weight cycling history within the framework of the False Hope Syndrome.

METHODS

Participants were middle-aged (45±12 years) women (n=116) and men (n=98) recruited via worksite intranet distributions. Information on dieting and thinness expectations, weight loss attempts, and weight cycling history was gathered using standard questionnaires.

RESULTS

More women than men reported currently dieting (43% vs. 26%; p<0.01). Moderate [OR=2.54; 95%CI: 1.01-6.45] and higher [OR=2.70; 95%CI: 1.07-6.80] levels of the thinness expectation score were significantly associated with the greater odds of weight cycling, independent of age, sex, BMI, and weight loss attempts.

CONCLUSIONS

These data are the first to extend the pervasive and potent influence of thinness expectancy to middle-aged persons and in particular, to men.

A longitudinal transactional risk model for early eating disorder onset

The presence of binge eating behavior in early middle school predicts future diagnoses and health difficulties. We showed that this early binge eating behavior can be predicted by risk factors assessed in elementary school. We tested the acquired preparedness model of risk, which involves transactions among personality, psychosocial learning, and binge eating. In a sample of 1,906 children assessed in the spring of fifth grade (the last year of elementary school), the fall of sixth grade, and the spring of sixth grade, we found that fifth grade negative urgency (the personality tendency to act rashly when distressed) predicted subsequent increases in the expectancy that eating helps alleviate negative affect, which in turn predicted subsequent increases in binge eating behavior. This transactional risk process appeared to continue to occur at later time points. Negative urgency in the fall of sixth grade was predicted by fifth grade pubertal onset, binge eating behavior, and expectancies. In turn, it predicted increases in high-risk eating expectancies by the spring of sixth grade, and thus heightened risk.

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

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = -0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode.

A risk model for preadolescent disordered eating

OBJECTIVE

This study tested this risk model for disordered eating in preadolescent girls: pubertal onset is associated with increases in negative urgency (the personality tendency to act rashly when distressed); negative urgency influences eating disorder symptoms by shaping psychosocial learning (expectancy formation), thus indirectly influencing symptom levels; and many influences on purging are mediated by binge eating.

METHOD

Nine hundred five fifth grade girls completed questionnaire measures of eating pathology, negative urgency, and dieting/thinness and eating expectancies.

RESULTS

Binge eating and purging behaviors were present in fifth grade girls. As anticipated, pubertal status was associated with higher levels of negative urgency, negative urgency was associated with each expectancy measure, quadratic dieting/thinness and eating expectancies were associated with binge eating, and binge eating was associated with purging.

DISCUSSION

It is important and feasible to develop risk models for preadolescent eating disordered behaviors. Our model that integrates puberty, personality, and psychosocial learning appears promising.

Rating of Eating Disorder Severity Interview for Children: psychometric properties and comparison with EDI-2 symptom index

OBJECTIVE

This study aimed to evaluate the psychometrics of the Rating of Eating Disorder Severity Interview for Children (REDS-C) and compare it with the Eating Disorder Inventory-2 symptom index.

METHODS

The psychometrics of the REDS-C were analyzed utilizing data from 336 patients, of ages 8 to 18 years. Receiver operator curve analyses were performed to evaluate the ability of the REDS-C and the Eating Disorder Inventory-2 symptom index to discriminate severity of eating disorder symptoms in relationship to an objective standard, defined as hospitalisation for medical stabilisation beyond 1 week.

RESULTS

Three factors were identified using 14 of the 16 original REDS-C items. Resulting subscales demonstrated acceptable reliability and validity. The receiver operator curve results demonstrated the usefulness of the 14-item version of the REDS-C in predicting hospitalisation greater than 7 days as an indicator of symptom severity.

DISCUSSION

The 14-item REDS-C is a reliable tool to assist clinicians in evaluating the severity of eating disorder symptoms in children and adolescents.

A risk model for disordered eating in late elementary school boys

The authors tested the following risk model for disordered eating in late elementary school-age boys: Pubertal status is associated with increases in negative urgency, that is, the tendency to act rashly when distressed; high levels of negative urgency then influence binge eating through psychosocial learning; and binge eating influences purging. A sample of 908 fifth-grade boys completed questionnaire measures of puberty, negative urgency, dieting/thinness and eating expectancies, and eating pathology. Eating disorder symptoms were present in these young boys: 10% reported binge eating and 4.2% reported purging through self-induced vomiting. Each hypothesis in the risk model was supported. Boys this young do in fact engage in the maladaptive behaviors of binge eating and purging; it is crucial to develop explanatory risk models for this group. To this end, it appears that characteristics of boys, including their pubertal status, personalities, and psychosocial learning, help identify boys at risk.

The acquired preparedness model of risk for bulimic symptom development

The authors applied person-environment transaction theory to test the acquired preparedness model of eating disorder risk. The model holds that (a) middle-school girls high in the trait of ineffectiveness are differentially prepared to acquire high-risk expectancies for reinforcement from dieting or thinness; (b) those expectancies predict subsequent binge eating and purging; and (c) the influence of the disposition of ineffectiveness on binge eating and purging is mediated by dieting or thinness expectancies. In a three-wave longitudinal study of 394 middle-school girls, the authors found support for the model. Seventh-grade girls' scores on ineffectiveness predicted their subsequent endorsement of high-risk dieting or thinness expectancies, which in turn predicted subsequent increases in binge eating and purging. Statistical tests of mediation supported the hypothesis that the prospective relation between ineffectiveness and binge eating was mediated by dieting or thinness expectancies, as was the prospective relation between ineffectiveness and purging. This application of a basic science theory to eating disorder risk appears fruitful, and the findings suggest the importance of early interventions that address both disposition and learning.

Distinctions Between Two Expectancies in the Prediction of Maladaptive Eating Behavior

In this longitudinal study, the authors provide support for the validity of the claim that differences in the nature of the reinforcement that adolescent girls expect from eating contribute to the development of different forms of maladaptive eating. The learned expectancy that eating is pleasurable and rewarding predicted higher levels of social/celebratory overeating across the first year of middle school but did not predict higher levels of clinical binge eating. In contrast, the expectancy that eating helps one manage negative affect predicted higher levels of binge eating but not of social/celebratory overeating across the same time period (n = 394). The results also supported a reciprocal model in which binge eating predicted higher levels of the expectancy that eating will manage negative affect but not that eating is pleasurable and rewarding; conversely, social/celebratory overeating predicted higher levels of the expectancy that eating is pleasurable and rewarding but not that eating will manage negative affect.

Prevalence and correlates of exercise motivated by negative affect

OBJECTIVE

The purpose of this study was to determine the prevalence and correlates of exercising in response to negative affect.

METHOD

Participants (N = 177) completed questionnaires assessing affect before and after exercise, exercise quality and quantity, eating behaviors and attitudes, body image, and self-esteem.

RESULTS

Fifty-eight percent of participants endorsed ever exercising in response to negative affect. As a group, these individuals were more likely to report self-induced vomiting, binge eating, and fasting over the previous 4 weeks. They also showed poorer body image and self-esteem, and their exercise was more obligatory and impairing. Groups did not differ on body mass index or quantity of exercise.

DISCUSSION

Negative affect motivated exercise appears to be a common phenomenon that is associated with eating disordered behavior.

Implications of Emotional Eating Beliefs and Reactance to Dietary Advice for the Treatment of Emotional Eating and Outcome Following Roux-en-Y Gastric Bypass

This case describes cognitive—behavioral treatment for emotional eating, preceding and following Roux-en-Y gastric bypass, which is associated with 84.52% excess BMI (body mass index) loss 53 months after surgery. It explores the relevance of emotional eating beliefs (EEB; that is, equating food with both alleviation of negative feelings and friendship) and reactance to dietary advice (RDA; that is, rebelling against prescribed nutrition) for the deliberate use of food to feel both better and befriended. EEB and RDA motivate and justify, respectively, the conscious consumption of rich or “forbidden” foods. Simultaneous treatment of EEB and RDA is associated with the utilization of rational thinking and problem solving to cope with emotional discomfort. Remediation of equations of food with friendship engenders amelioration of distress through spousal support. Unrecognized emotional distress fueling reflexive eating and accompanying external eating are found. External eating is decreased coincident with therapy for emotional eating. Implications are discussed.

Expectancies related to thinness, dietary restriction, eating, and alcohol consumption in women with bulimia nervosa

OBJECTIVE

To investigate behavior-outcome expectancies relating to thinness, dietary restriction, eating, and alcohol consumption in women with bulimia nervosa (BN).

METHOD

Women with BN (N = 29), women with BN and a co-morbid lifetime alcohol use disorder (AUD; N = 18), and control women (N = 24), completed interviews and questionnaires assessing eating- and alcohol-related symptoms, as well as questionnaires measuring expectancies relating to thinness, dietary restriction, eating, and alcohol consumption.

RESULTS

Compared with the control group, both bulimic groups reported greater positive expectancies relating to thinness, dietary restriction and eating; expectancy endorsements were also predictive of the severity of eating-related symptoms. Compared with the other groups, the bulimic group with comorbid lifetime AUD had elevated positive alcohol-related expectancies, and alcohol expectancy endorsements predicted severity of alcohol-related symptoms.

DISCUSSION

Women with BN endorsed more positive expectancies relating to thinness, dietary restriction, and eating, whereas women with BN and a lifetime comorbid AUD endorsed more positive alcohol expectancies. The results are consistent with expectancy theory in that positive expectancy endorsements were associated with symptom severity in a syndrome-specific manner. Expectancies related to thinness, dietary restriction, eating, and alcohol consumption in women with BN.

Female emotional eaters show abnormalities in consummatory and anticipatory food reward: a functional magnetic resonance imaging study

OBJECTIVE

To test the hypothesis that emotional eaters show greater neural activation in response to food intake and anticipated food intake than nonemotional eaters and whether these differences are amplified during a negative versus neutral mood state.

METHOD

Female emotional eaters and nonemotional eaters (N = 21) underwent functional magnetic resonance imaging (fMRI) during receipt and anticipated receipt of chocolate milkshake and a tasteless control solution while in a negative and neutral mood.

RESULTS

Emotional eaters showed greater activation in the parahippocampal gyrus and anterior cingulate (ACC) in response to anticipated receipt of milkshake and greater activation in the pallidum, thalamus, and ACC in response to receipt of milkshake during a negative relative to a neutral mood. In contrast, nonemotional eaters showed decreased activation in reward regions during a negative versus a neutral mood.

DISCUSSION

Results suggest that emotional eating is related to increased anticipatory and consummatory food reward, but only during negative mood.

Methylphenidate reduces energy intake and dietary fat intake in adults: a mechanism of reduced reinforcing value of food?

BACKGROUND

Dopamine mediates the reinforcing value of food, and low concentrations of dopamine are related to increased feeding. Thus, administering a drug that increases dopamine may reduce energy intake, possibly by reducing food reinforcement.

OBJECTIVES

We tested whether short-acting methylphenidate (MPH), a drug that increases the availability of dopamine by blocking its reuptake, reduces energy intake and alters macronutrient preference and whether these effects are due to a mechanism of reduced hunger or food reinforcement.

DESIGN

Fourteen adults were given placebo or short-acting MPH (0.5 mg/kg) in a randomized, double-blind, placebo-controlled crossover fashion. One hour after ingestion, hunger and the relative reinforcing value of snack food were measured, followed immediately by energy intake and macronutrient preference during a buffet-style lunch.

RESULTS

MPH reduced energy intake by 11% (P = 0.024) as well as intake of fat by 17% (P = 0.003) relative to placebo. Despite similar levels of prebuffet hunger, subjects taking MPH reduced their energy and fat intakes more than did those taking placebo, which suggests that hunger may not mediate the effects of MPH on energy intake. MPH showed a trend toward reducing the reinforcing value of high-fat food relative to placebo, but reduced food reinforcement was not significantly correlated with energy intake.

CONCLUSION

MPH reduced overall energy intake with a selective reduction in dietary fat. Findings are consistent with a reward deficiency model of obesity whereby low brain dopamine predicts overeating and obesity, and administering agents that increase dopamine results in reduced feeding behavior.

Associations among family-of-origin food-related experiences, expectancies, and disordered eating

OBJECTIVE

The study reported here integrates research on family-of-origin learning experiences and adult eating/thinness expectancies in the study of risk for eating disordered behavior.

METHOD

A sample of women manifesting a wide range of eating disordered behaviors (n = 66) were compared in their retrospective reports of family learning, current eating and dieting expectancies, and current eating disordered behaviors.

RESULTS

History of food-related teasing from friends and family, negative maternal modeling, and friends' criticism of eating all related to both adult disordered behavior and adult eating and thinness expectancies. Tests of mediation supported the putative mediation by expectancies of the relationships between early experiences and adult disordered behavior.

CONCLUSION

Family-of-origin learning experiences may influence adult eating disordered behavior by contributing to the formation of expectancies for reinforcement from eating and from thinness.

The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders

OBJECTIVE

Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of the current study was to assess whether a stressful situation would reveal an association between perfectionism, low self-esteem, worry, and body mass index (BMI) and measures of eating disorder symptoms in female high school students.

METHOD

A sample of 145 female high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, the Penn State Worry Questionnaire, and the Self Liking and Competence Scale three times--on an average school day, on the day of an examination, and on the day the subjects received the results of that examination. Linear regression analysis was performed to verify whether the dimensions of perfectionism were associated with the measures of eating disorders.

RESULTS

Low self-esteem, worry, and parental criticism (a dimension of perfectionism) were associated with the measures of eating disorders only during the stressful situation, whereas concern over mistakes (another dimension of perfectionism) was associated in both stressful and nonstressful situations.

DISCUSSION

The results suggest that in nonclinical female individuals, stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in a predisposed personality.

Coping with distress by eating or drinking: role of trait urgency and expectancies

The authors propose that trait urgency (the tendency to act rashly when distressed) is a risk factor for both alcohol abuse and bulimic symptoms, that disorder-specific expectancies influence whether one engages in one behavior or the other, and that expectancies moderate urgency's influence on those behaviors. Cross-sectional findings were consistent with the model. Problems from alcohol use were comorbid with binge eating and purging. Trait urgency was associated with both behaviors. Alcohol expectancies were associated with drinking levels and with problem drinking, but not with eating. Eating expectancies were associated with binge eating, but not with alcohol use or problems. Urgency's effect on binge eating was moderated by expectancies, but its effect on alcohol use and problem drinking was not.

Similarities and differences between women and men on eating disorder risk factors and symptom measures

Researchers studying eating disorders in men often use eating disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, we report on the validity of doing so with a set of measures chosen to reflect a wide range of risk factors and symptoms. The Bulimia Test-revised (BULIT-R), the restraint scale (RS), the three-factor eating questionnaire (TFEQ), the Eating Expectancy Inventory, and the eating attitudes test (EAT) all had the same factor structures for both genders, and tests of invariance showed that factor loadings, factor variances, and intercorrelations among factors were equivalent across gender. A modified Structured Clinical Interview for DSM-IV anorexic symptoms questionnaire did not perform adequately for either gender. Men produced slightly less reliable scores on virtually all measures, with the result that Pearson-based estimates of correlations among the measures were slightly lower for men. Men had lower scores on symptom and risk measures, but not on other eating measures.

Measuring eating concerns in Black and White adolescent girls

OBJECTIVE

Few instruments exist to measure eating concerns in adolescent girls from diverse ethnic backgrounds.

METHODS

A Children's version of the Eating Disorder Inventory (EDI-C) has been under development for several years and was designed to be more appropriate for younger children with lower reading levels. However, little is known about the validity of this instrument. The current study reports on the factor structure of an early version of the EDI-C using nonclinical samples of 1,073 White and 1,155 Black girls (ages 11-12).

RESULTS

Factor analysis resulted in an eight-factor solution for each group that included a weight concerns factor and an emotional distress factor. For Black girls only, the positively worded items from the Body Dissatisfaction subscale loaded on a separate factor. Four of five factors were similar to the original EDI subscales (Bulimia, Interpersonal Distrust, Maturity Fears, and Perfectionism), although the latter was unique to White girls.

DISCUSSION

The factor structure was generally similar for Black and White girls, although the separate body satisfaction factor and lack of shared variance for the perfectionism factor for Black girls suggest that EDI data obtained from ethnic minority samples may need to be interpreted cautiously.