Can we apply the dual-pathway model of overeating to a population of weight-preoccupied overweight women?

Efficacy and mechanisms of change in exposure-based and cognitive stand-alone body image interventions in women with overweight and obesity

OBJECTIVE

Body dissatisfaction is highly prevalent in overweight and obesity, while evidence for the efficacy of body image interventions is still scarce. This interventional pilot study investigates the efficacy and mechanisms of change of two stand-alone body image interventions in women with overweight and obesity.

METHODS

Women with overweight and obesity (n = 76) were randomly assigned to five weekly sessions of either a mirror exposure (ME) or a cognitive restructuring intervention (CR) or to a wait-list control group (WCG). Primary outcome measures were self-reported body dissatisfaction and interview-based shape concerns; depression, self-esteem and emotional eating served as secondary outcome measures. Experimental paradigms were used prior to and after the interventions to analyze possible mechanisms of change: (a) Implicit Associations Tests to assess weight-related attitudes (b) eye-tracking experiments to assess visual processing of body pictures and (c) a thought-sampling procedure to assess body-related cognitions and arousal.

RESULTS

According to intent-to-treat analyses using linear mixed-models, both interventions lead to significant improvements in body image, while there were no changes in the WCG. Different mechanisms of change were identified.

CONCLUSIONS

Both types of interventions might be effective in the reduction of self-reported body dissatisfaction and interview-based shape concerns in overweight and obesity. However, as different mechanisms drive the effects, future research should clarify which individual might best benefit from which intervention.

Two of a Kind? Mapping the Psychopathological Space between Obesity with and without Binge Eating Disorder

(1) Background: Obesity (OB) is a frequent co-morbidity in Binge Eating Disorder (BED), suggesting that both conditions share phenotypical features along a spectrum of eating-related behaviors. However, the evidence is inconsistent. This study aimed to comprehensively compare OB-BED patients against OB individuals without BED and healthy, normal-weight controls in general psychopathological features, eating-related phenotypes, and early life experiences. (2) Methods: OB-BED patients (n = 37), OB individuals (n = 50), and controls (n = 44) completed a battery of standardized questionnaires. Responses were analyzed using univariate comparisons and dimensionality reduction techniques (linear discriminant analysis, LDA). (3) Results: OB-BED patients showed the highest scores across assessments (e.g., depression, emotional and stress eating, food cravings, food addiction). OB-BED patients did not differ from OB individuals in terms of childhood traumatization or attachment styles. The LDA revealed a two-dimensional solution that distinguished controls from OB and OB-BED in terms of increasing problematic eating behaviors and attitudes, depression, and childhood adversities, as well as OB-BED from OB groups in terms of emotional eating tendencies and self-regulation impairments. (4) Conclusions: Findings support the idea of a shared spectrum of eating-related disorders but also highlight important distinctions relevant to identifying and treating BED in obese patients.

Psychosocial factors underlying symptoms of muscle dysmorphia in a non-clinical sample of men

Muscle dysmorphia is primarily characterized by an excessive preoccupation that one's body is not muscular or lean enough. Muscle dysmorphia has shown clinical similarities with eating disorders. The present study aims to explore the psychosocial factors underlying muscle dysmorphia symptoms by referring to Stice's dual pathway model (1994), a theoretical model of eating disorders. Three hundred and eighty-six men were recruited to complete an online survey including questionnaires assessing social pressures to reach a muscular body and internalization of the muscular body, drive for muscularity, muscular-enhancing behaviors, negative affect, narcissistic traits, and symptoms of muscle dysmorphia. Path analyses showed that the original model has a good fit, without, however, confirming a significant relationship between the drive for muscularity and negative affect. Thus, social pressure to reach a muscular body and its internalization were associated to a drive for muscularity and then, to muscle dysmorphia symptoms. The drive for muscularity was indirectly related to symptoms of muscle dysmorphia through muscle-enhancing behaviors as well as negative affect (although, only for individuals with higher levels of narcissistic vulnerability). Results supported the adaptation of the Stice's model to explain muscle dysmorphia symptoms and underlined the possible influence of narcissistic vulnerability traits in this condition.

Body dissatisfaction predicts poor behavioral weight loss treatment adherence in overweight Mexican American women

Poor adherence poses a major barrier to the success of behavioral weight loss (BWL) programs, particularly for overweight Mexican American women. Given the high prevalence and costs of overweight/obesity, factors that contribute to attendance and adherence problems should be identified, especially in ethnic minority populations. The current study examined the role of pre-treatment body dissatisfaction and depression in predicting attendance and adherence in a BWL intervention. Ninety-nine overweight/obese Mexican American women enrolled in the intervention and completed baseline measures. Eighty-one of the women attended at least one treatment session and provided measures of dietary and physical activity adherence. Simultaneous linear regression analyses suggested that although higher levels of body dissatisfaction and depression each played unique roles in predicting poorer attendance, only body dissatisfaction predicted adherence. Specifically, higher body dissatisfaction predicted poorer treatment adherence. Findings highlight the importance of addressing body dissatisfaction early in BWL treatment to increase attendance and adherence.

Replication and extension of the dual pathway model of disordered eating: The role of fear of negative evaluation, suggestibility, rumination, and self-compassion

OBJECTIVE

The dual pathway model, a theoretical model of eating disorder development, suggests that thin ideal internalization leads to body dissatisfaction which leads to disordered eating via the dual pathways of negative affect and dietary restraint. While the dual pathway model has been a valuable guide for eating disorder prevention, greater knowledge of characteristics that predict thin ideal internalization is needed.

METHOD

The present study replicated and extended the dual pathway model by considering the addition of fear of negative evaluation, suggestibility, rumination, and self-compassion in a sample of community women and female university students.

RESULTS

Results showed that fear of negative evaluation and suggestibility predicted thin ideal internalization whereas rumination and self-compassion (inversely) predicted body dissatisfaction. Negative affect was predicted by fear of negative evaluation, rumination, and self-compassion (inversely).

DISCUSSION

The extended model fit the data well in both samples. Analogue and longitudinal study of these constructs is warranted in future research.

Applicability of the dual pathway model in normal and overweight binge eaters

Binge eating is a significant problem in both eating disordered and community populations alike. Extensive support exists for the dual pathway model of binge eating in both adolescent and adult clinical and nonclinical populations. However, the restrained eating pathway to binge eating in particular has failed to be confirmed in some studies. In particular, the dual pathway model may not be applicable to overweight binge eaters. The current study examined the applicability of the dual pathway model in a sample of healthy and overweight binge eaters. A total of 260 (115 healthy weight; 145 overweight or obese) adult binge eaters completed an online survey. Mediation analyses indicated support for both the dietary restraint and negative affect pathways in the healthy weight sample but only the latter pathway was supported in the overweight sample. Therefore, the full dual pathway model may only be applicable to healthy weight binge eaters.

Examining the associations between overeating, disinhibition, and hunger in a nonclinical sample of college women

BACKGROUND

Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.

PURPOSE

The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.

METHOD

Female students (n = 1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.

RESULTS

The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.

CONCLUSIONS

Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.