Elevated pre-morbid weights in bulimic individuals are usually surpassed post-morbidly: implications for perpetuation of the disorder

Physiological, body composition, and body mass measures show that a developmental measure of weight suppression is more valid than the traditional measure

OBJECTIVE

The traditional measure of weight suppression (TWS; the difference between an individual's highest past weight at adult height and current weight), has been associated with many psychological, behavioral and biological variables in those with eating disorders. A new measure of weight suppression, called developmental weight suppression (DWS), corrects two major problems in the original measure. Initial research indicates that DWS represents a superior operationalization of the construct weight suppression was originally designed to measure (Lowe [1993, Psychol Bull, 114: 100]). This study is the first to examine the relation between both WS measures and weight history, body composition and a variety of metabolic hormones.

METHODS

Data were collected in 91 women with bulimia nervosa (BN) or BN-spectrum disorders.

RESULTS

Both weight suppression indices were related to multiple hormones. However, multiple regression analyses showed that the independent effects of DWS differed from the independent effects of TWS in that only DWS was negatively related to: (1) current z-BMI, (2) body fat percentage, and (3) insulin, leptin, T3 free, and TSH. This differential pattern also occurred when results were corrected for multiple comparisons.

DISCUSSION

Findings provide stronger biological support for the construct validity of DWS than TWS and suggest that: (1) from the perspective of individuals with BN, high DWS embodies success at food restriction and weight loss, (2) elevated DWS may trap individuals with BN in a powerful biobehavioral bind, and (3) DWS is the preferred measure of weight suppression in future research on eating disorders.

PUBLIC SIGNIFICANCE

Most individuals with bulimia nervosa lose substantial weight in the process of developing their disorder. Such weight suppression is related to many characteristics of those with the eating disorder bulimia nervosa. This study shows why a new measure of weight suppression, based on an individual's growth during development, is more biologically valid than the traditional measure of weight suppression.

Weight History Correlates of Resting Energy Expenditure in Women With Bulimia Nervosa

OBJECTIVE

Among those with bulimia nervosa, weight suppression has been associated with illness severity and treatment prognosis. Although significant weight loss is known to reduce metabolic rate, the relation between weight suppression and resting energy expenditure (REE) in bulimia nervosa has not been examined. This study tested the hypothesis of an inverse relation between weight suppression and REE in a sample of women with bulimia nervosa (N = 84).

METHODS

In primary analyses, linear regressions were conducted between weight suppression and REE, corrected for fat-free mass. In follow-up, exploratory analyses, stepwise linear regressions were conducted to explore the main and interaction effects of weight history and weight suppression on REE.

RESULTS

Neither traditional (TWS) nor developmental weight suppression (DWS) correlated with REE. Results from exploratory analyses, however, revealed a medium-to-large inverse relation between several weight history variables and REE (highest past weight, sr2 = 0.05; lowest postmorbid weight, sr2 = 0.07; current weight, sr2 = 0.05). Additionally, DWS interacted with current (sr2 = 0.08) and highest premorbid (sr2 = 0.05) z-BMI to influence REE with a medium-to-large effect. For individuals low in current and premorbid z-BMIs, higher DWS associated with lower REE levels. However, for individuals at higher premorbid z-BMIs, higher DWS unexpectedly associated with greater REE levels.

DISCUSSION

In this sample of women with bulimia nervosa, reduced REE associated with higher weights across all timepoints. If the interaction effect between DWS and z-BMI history persists in future studies, this may indicate unique challenges faced by individuals low in z-BMI and high in DWS related to weight gain and normalization of eating.

Weight suppression at lowest weight as an indicator of eating disorder clinical severity: A retrospective cohort study

OBJECTIVES

Weight suppression (WS) defines the difference between the highest weight in adulthood and the current weight. WS at lowest weight is the difference between the highest and the lowest ever weight. Weight rebound is the difference between the past lowest weight and current weight. The distinction in the capacities of WS, weight rebound, and WS at the lowest weight remains unclear regarding their efficacy in forecasting clinical endpoints. This study assessed the relationship between WS, WS at lowest weight and/or weight rebound and eating disorder (ED) clinical severity.

METHODS

In this retrospective cohort study, adult participants were selected at the Outpatient Unit for multidisciplinary assessment of ED, Montpellier, France, between February 2012 and October 2014 and May 2017 and January 2020. ED clinical severity was evaluated using the Eating Disorder Examination Questionnaire (EDE-Q).

RESULTS

The sample included 303 patients: 204 with anorexia nervosa (AN) and 99 with bulimia nervosa (BN). The EDE-Q total score was positively correlated with WS at lowest weight in patients with AN (Spearman's rho = 0.181, p = 0.015) and with BN (Spearman's rho = 0.377; p < 0.001). It was also positively correlated with weight rebound (Spearman's rho = 0.319; p = 0.003) in patients with BN. In the multivariate analysis, EDE-Q total score was associated with WS at lowest weight only in patients with BN (β = 0.265; p = 0.03).

CONCLUSION

WS at lowest weight seems to be a good measure of ED clinical severity. More research is needed for better understanding WS at lowest weight in assessment and treatment of patients with ED.

A comparison of traditional and developmental measures of weight suppression in residential patients with bulimia nervosa

OBJECTIVE

Weight suppression (WS) is associated with many eating disorder (ED)-related symptoms. However, traditional calculations of WS do not consider the age or height at which one's highest past weight was reached. Lowe et al. (2022) found that developmental WS (DWS) was associated with a wider variety of ED-related symptoms compared with traditional WS (TWS). This study replicated and extended these findings in a larger sample of individuals with bulimia nervosa (BN) at a residential ED treatment center.

METHODS

Participants were 1051 female patients with BN. We examined the relations between each WS measure and ED symptoms, emotional symptoms, and weight history variables.

RESULTS

TWS and DWS showed a similar number of relations with ED-related symptoms. DWS was positively related to behavioral symptoms (e.g., vomiting), and negatively related to cognitive symptoms (e.g., weight/eating concern). TWS was positively related to highest premorbid, highest postmorbid, and lowest postmorbid weights. DWS was also positively related to highest premorbid z-scored body mass index (zBMI), but negatively related to lowest and highest postmorbid zBMI.

CONCLUSIONS

DWS, relative to TWS, may better capture the psychobiological impact of the weight discrepancy that a measure of WS is meant to reflect.

PUBLIC SIGNIFICANCE

Weight suppression, the difference between an individual's past highest weight and current weight, is significantly related to many ED-related symptoms. This study found that a new weight suppression measure, based on expected weight-for-height during physical development, relates to ED characteristics in a different manner from the traditional measure of weight suppression, showing positive associations with behavioral symptoms and negative associations with cognitive symptoms.

A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends

Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.

Traditional versus developmental measures of weight suppression: Exploring their relationships with bulimic psychopathology

OBJECTIVE

Weight suppression (WS) is related to a wide variety of eating disorder characteristics. However, individuals with eating disorders usually reach their highest premorbid weight while still developing physically. Therefore, a more sensitive index of individual differences in highest premorbid weight may be one that compares highest premorbid z-BMI to current z-BMI (called developmental weight suppression [DWS] here).

METHOD

In this exploratory study, we compared the relationships between traditional weight suppression (TWS) and DWS and a variety of measures related to bulimic psychopathology in 91 females (M age, 25.2; 60.5% White), with clinical or sub-clinical bulimia nervosa.

RESULTS

TWS and DWS were correlated (r = 0.40, p < 0.001). TWS was only significantly related to a measure of physical activity whereas DWS was related to 14 outcomes. DWS showed consistent positive relations with behavioural outcomes (e.g., binge eating) but consistent negative relations with cognitive/affective outcomes (e.g., weight concerns).

CONCLUSIONS

Findings indicated much more consistent relationships between the novel DWS measure and bulimic characteristics than with the TWS measure. DWS showed both positive and negative relations with bulimic symptoms, though these findings require replication to confirm their validity. Consistent evidence indicated that the two WS measures served as mutual suppressor variables.

An examination of the factor structure of the Goldfarb Fear of Fat Scale in clinical and non-clinical samples of Polish women

Although associations between fear of fat and eating disorders (ED) have been frequently studied, it appears that the construct of fear of fat requires in-depth understanding to determine whether it is similar in individuals diagnosed with bulimia nervosa, anorexia nervosa, and individuals from the general population. The purpose of our study was to confirm the factor structure of the Goldfarb Fear of Fat Scale (GFFS) in clinical and non-clinical settings. This issue has not yet been investigated in the literature. Data were collected from 126 female patients diagnosed with ED and a total of 581 women from the general population. Our findings are highly consistent with the original single-factor structure of GFFS but only in the clinical sample. In the non-clinical sample, a good fit to the data has been achieved with a two-factor model composed of Fear of gaining weight and Fear of losing control over eating/weight. The Polish version of GFFS demonstrated good psychometric properties. It can be used as a fast screening tool to identify individuals with eating disorders and those at risk of developing such disorders. We recommend the two-factor model for non-clinical samples and the one-dimensional model for clinical samples for both research and practice.

Within-subject weight variability in bulimia nervosa: Correlates and consequences

OBJECTIVE

The oscillations between binge eating, purging, and dieting in bulimia nervosa (BN) may produce substantial within-subject weight variability. Although weight variability has been predictive of eating- and weight-related variables in community samples, it has not been empirically examined in eating disorders. The current study examined cross-sectional and prospective associations between weight variability and BN pathology.

METHOD

Four weights were collected over an average of 42.02 days, and weight variability was calculated as the root mean square error around each individual's weight trajectory regression line. Linear regressions were performed to examine the association between weight variability and eating disorder psychopathology, cross-sectionally at baseline and prospectively at 6-month follow-up, adjusting for baseline BMI.

RESULTS

Weight variability was cross-sectionally associated with eating pathology, but these relationships became non-significant after adjusting for BMI. However, at 6-month follow-up, greater baseline weight variability predicted increases in body dissatisfaction, shape and weight concerns, and global eating pathology, even after adjusting for baseline BMI.

DISCUSSION

These findings demonstrate, for the first time, that within-subject weight variability predicts greater eating disorder pathology over time in BN. The results add to evidence that weight history variables contribute to BN psychopathology above and beyond well-documented psychological dysfunction in BN.

A new, developmentally-sensitive measure of weight suppression

OBJECTIVE

Weight suppression (WS) has demonstrated associations with numerous indices of eating behavior, psychopathology and eating disorder prognosis. However, because WS has traditionally been measured as a simple subtraction of current weight from highest past weight at adult height, this calculation is problematic for most individuals with disordered eating, who usually reach their highest past weight during adolescence. Here we propose a new method for computing WS to address this shortcoming, termed "developmental weight suppression" (DWS), and provide a web-based tool for ease of calculation.

METHOD

DWS is calculated as the difference between one's highest premorbid z-BMI (i.e., BMI z-score), and current z-BMI. z-BMIs were calculated using Cole's lambda-mu-sigma (LMS) approach, in accordance with LMS parameters publicly available from the Center for Disease Control (2010). A web-based user interface is available at https://niuxin.shinyapps.io/devws/, making its computation easier and its adoption by researchers simpler.

DISCUSSION

By using z-BMIs in place of weights, DWS is more sensitive to the developmentally-relevant factors of age, height, and sex. Preliminary findings suggest that DWS is more strongly related to measures of eating pathology and biological reactions to weight loss than traditionally-computed WS, although more research is needed to test this hypothesis.

The independent and interacting effects of weight suppression and admission body mass index on treatment weight change in patients with anorexia nervosa or bulimia nervosa

OBJECTIVE

Weight suppression (WS) and body mass index (BMI) have predicted weight change in individuals with eating disorders, but the interaction between these variables is understudied. Furthermore, WS is usually measured as absolute WS-the numeric difference between current weight and highest past weight-overlooking the potentially important influence of how much a person weighed at their highest historical weight.

METHOD

The current study investigated the independent and interacting effects of BMI and two measures of WS at admission on residential treatment weight change. WS measures included absolute WS and the relative WS index, the percentage of total body weight lost from highest past weight. Participants were women with anorexia nervosa (n = 357) or bulimia nervosa (n = 293) who provided complete data, 87% of the eligible treatment sample.

RESULTS

In both diagnostic subsamples, BMI, absolute WS, and the relative WS index all significantly predicted weight change. The interaction between BMI and WS predicted weight change, but only when the relative WS index was used.

DISCUSSION

Results highlight the potential importance of considering an individual's weight and weight history when predicting their treatment weight change and support the importance of utilizing both methods of calculating WS in future research.

Why is premorbid BMI consistently elevated in clinical samples, but not in risk factor samples, of individuals with eating disorders?

Body image disturbance is widely viewed as contributing to the development and maintenance of disordered eating. Yet this perspective is not inconsistent with the possibility that elevated premorbid BMIs also increase the risk of developing eating disorders. Research examining whether actual body size may play a role in eating disorder development reveals a curious pattern of findings. Few prospective risk factor studies conducted with community-based samples found a relationship between premorbid BMI and subsequent eating disorder pathology whereas retrospective research conducted with clinical samples indicates a consistent pattern of elevated premorbid BMIs relative to population norms or control groups. This study documents these disparate findings, considers potential explanations for them and proposes further study of premorbid BMI as a factor contributing to the psychopathology of eating disorders, particularly among those who come to the attention of treatment providers.

Weight suppression and its relation to eating disorder and weight outcomes: a narrative review

Weight suppression (WS) refers to the discrepancy between highest adult weight and current weight, and has been examined as a key construct related to both: eating pathology and weight management. However, despite increasing interest in WS, findings regarding the clinical implications of WS are often conflicting. For instance, WS has been associated with both adaptive and maladaptive outcomes across various populations. Moreover, results regarding the predictive utility of WS within clinical samples have been inconsistent. The current paper aims to provide a narrative review of existing investigation related to WS, highlight gaps in the field's understanding of this construct, and outline recommendations for future study.

Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.

The impact of weight suppression and weight loss speed on baseline clinical characteristics and response to treatment

OBJECTIVE

Growing evidence suggests an impact of weight suppression (WS) on severity and course of symptoms in patients with eating disorders (ED), but no study explored also the role of the weight loss speed (WLS) together with WS on the same clinical variables, which is the aim of the present work.

METHOD

A mixed cross-sectional and longitudinal cohort study was employed. Four hundred and fourteen patients with anorexia nervosa (AN = 208) or bulimia nervosa (BN = 206) according to DSM-5 criteria were recruited and assessed at referral by means of clinical interviews and self-reported questionnaires. Body mass index and diagnostic status were re-evaluated at the end of treatment.

RESULTS

WS was positively correlated with body dissatisfaction in patients with AN (p = .005), but negatively correlated in BN (p = .022). In contrast, WLS was significantly inversely correlated with age and duration of illness in all ED (p < .001), and positively correlated with drive for thinness in BN (p = .007). After treatment, WS at intake predicted higher BMI increase in both AN and BN (p < .03), while higher WLS was significantly associated with a lower drop-out rate in patients with BN (p = .02), and predicted BMI increase only in restricting AN patients (p = .02). In the whole group, WLS significantly predicted remission status (p = .039).

DISCUSSION

In our study, both WS and WLS were associated with baseline "core" clinical variables and provided complementary abilities to predict weight gain and remission at the end of treatment. If replicated, our data suggest the importance of considering both WS and WLS as useful clinical variables in the baseline assessment of ED.

Conceptualizing body dissatisfaction in eating disorders within a self-discrepancy framework: a review of evidence

Body dissatisfaction, the negative subjective evaluation of one's body, is associated with many negative psychological and physical health consequences. One conceptualization of body dissatisfaction includes an experience of discrepancy between perceived actual and ideal body shapes. This paper reviews the literature on three facets of body dissatisfaction from the framework of self-discrepancy theory: perceptions of current weight, ideal body weight, and the relative importance of conforming to ideals. We review components of body dissatisfaction among healthy individuals and eating-disordered individuals. We also address the conceptualization's relationship among body dissatisfaction, weight history, and dieting to expand the impact of body dissatisfaction research and to provide more information on the nature and treatment of eating disorders.

Premorbid BMI predicts binge-purge symptomatology among individuals with anorexia nervosa

OBJECTIVE

A finding consistent with the transdiagnostic approach to eating disorders is that about half of those with restricting anorexia nervosa (AN) eventually undergo a transition to the binge/purge (BP) subtype or to bulimia nervosa. Given evidence that individuals with bulimic symptoms exhibit elevated weights premorbidly, we tested the hypothesis that among those with AN, highest premorbid BMI would predict which individuals with AN would develop AN-BP.

METHOD

The current study used longitudinal data from a community sample of adolescents with AN in Sweden. Premorbid weights were obtained from growth charts, and participants were re-assessed at 6, 10, and 18 years after first presentation with AN.

RESULTS

A greater highest premorbid BMI z score predicted a greater likelihood of developing binge/purge symptoms over 18 years.

DISCUSSION

Among individuals who develop an eating disorder, premorbid BMI may be implicated in the type and course of the eating disorder that emerges.

Attitudes toward health and taste of food among women with bulimia nervosa and women of a non-clinical sample

Taste preferences and health concerns play important roles in determining eating attitudes, thus influencing food choices. Disordered eating attitudes are common among women, and can lead to the development and maintenance of eating disorders (ED). Attitudes toward health and taste of food among ED patients and its comparison with non-clinical women are not well known, and this knowledge could improve eating interventions. In this study, we compared taste preferences and health concerns in 27 women with diagnosis of bulimia nervosa (BN) and 216 women of a non-clinical sample. All participants completed the Health and Taste Attitude Scale (HTAS). Using analysis of covariance we compared the HTAS scores of the BN patients with those of the college students. Risk behaviors for ED (assessed by the Eating Attitudes Test) were identified in 54 (25%) of the non-clinical sample, all of whom were therefore excluded in comparison of BN patients. Non-clinical sample, compared to patients, scored higher on the HTAS Taste domain (p < 0.001) and its pleasure subscale (p < 0.001), whereas patients scored higher on the HTAS Health domain (p < 0.05) and its light product interest subscale (p < 0.05). Based on our data, eating attitudes of women of non-clinical sample are related to taste and pleasure, whereas women with BN are concerned with adopting a diet regarded as healthy, thus increasing their interest in "light" products. Therefore, the taste and health concerns must be considered in nutrition interventions for women in general, and prevention and treatment of ED as determinants of food choice.

Incremental validity of weight suppression in predicting clinical impairment in bulimic syndromes

Research has shown that weight suppression (WS; the difference between a person's highest and current body weight in pounds) is a robust predictor of weight gain and eating-disorder (ED) symptoms among individuals with bulimic syndromes. Given the important prognostic role that WS plays in ED course and outcome, we hypothesized that WS would represent a clinically useful indicator of impairment for bulimic syndromes. We further posited that WS would demonstrate incremental validity above-and-beyond other proposed indicators in explaining clinical impairment in bulimic syndromes. Participants were community-recruited adults (N = 101; 80.2% female) with full-threshold (n = 51) or subthreshold (n = 50) bulimia nervosa. Other indicators of impairment included body mass index, frequency of inappropriate compensatory behaviors, lifetime history of any internalizing disorder, and multiple purging. Clinical impairment was assessed with the clinical impairment assessment (CIA). Hierarchical linear regression tested whether WS added to the explanation of CIA score variance above-and-beyond other indicators of bulimic-syndrome impairment. WS was significantly associated with clinical impairment (p = .011), but did not demonstrate incremental validity over other independent variables in predicting CIA scores. WS explained an additional 1.7% of the variance in CIA scores above-and-beyond other variables and the independent effect of WS on CIA scores represented a medium-sized effect (Cohen's d = 0.521). Results suggested that WS may be an indicator of ED-related clinical impairment. Inquiring about WS could be an informative component of routine bulimic-syndrome assessment, given that WS explains some of the variance in clinical impairment in bulimic syndromes.

Childhood body mass index in adolescent-onset anorexia nervosa

OBJECTIVE

Although weight history is relevant in predicting eating disorder symptom severity, little is known about its role in the etiology of anorexia nervosa (AN). This study aimed to determine whether BMI or BMI trajectory differed between individuals who later developed adolescent-onset AN and a comparison group of HCs between school grades 1 through 6.

METHOD

This study was based on longitudinal data that identified 51 adolescents with AN and 51 matched HCs. Cases were identified through community screening in Sweden and included individuals born in 1969 through 1977. Measured weights and heights were retrieved and BMIs and weight trajectories of the AN and HC groups were compared using growth curve analysis. Main outcome measures included measured BMI and BMI trajectories from grades 1-6. Secondary outcomes examined included ponderal index at birth and maternal body weight.

RESULTS

Individuals who later developed AN had higher BMIs than HCs between grades 1 and 6, by an average of 1.42 BMI-units. There was no difference in rate of weight gain between groups. Ponderal index at birth was higher for the AN as compared with HC group. Maternal weight did not differ significantly between groups.

DISCUSSION

These findings, combined with those previously reported on the premorbid BMIs of those with bulimia nervosa, suggest that a predisposition toward elevated premorbid BMIs during childhood characterizes those who later develop anorexia or bulimia nervosa. These findings are consistent with a transdiagnostic perspective and suggest shared risk factors for AN and obesity. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1002-1009).

Eating patterns, diet quality and energy balance: from the macro- to the microscopic

As a discussant for the 2013 IBRC Symposium on Eating Patterns, Diet Quality and Energy Balance at Purdue University, I describe here several reflections I had on the papers as a whole. I initially focus on the keynote address by Dr. Leonard. His address suggested that the evolutionary development of Homo sapiens during the past 2 million years may have "prepared" humans to seek and consume food beyond their immediate energy needs, a predisposition that may have rendered humans particularly vulnerable to modern food environments. Additional observations include: 1) the importance of differentiating between a given appetitive variable (e.g., snacking) as a potential cause versus consequence of an outcome of interest (e.g., obesity), 2) the need to move beyond research on the consummatory phase of appetite to the anticipatory phase of appetite, and 3) the opportunity that exists to take the many obesogenic nutritional influences documented in the symposium and "turn them on their heads" to facilitate, rather than undermine, long-term weight control.

Assessing the three types of dieting in the Three-Factor Model of dieting. The Dieting and Weight History Questionnaire

The construct of attempted eating restriction has been measured in a number of ways in recent years. The Three-Factor Model of Dieting suggests that dieting can be subdivided into three types: (1) frequency of past dieting and overeating (i.e., history of dieting), (2) current dieting to lose weight, and (3) weight suppression, or the difference between an individual's current weight and his or her highest previous weight. The purpose of this paper is to (1) describe the Dieting and Weight History Questionnaire (DWHQ), a measure that we have used for many years to assess these three dimensions of dieting; (2) provide some recent examples of published research on each type of dieting; (3) discuss some of the nuances of assessing these dieting types; and (4) suggest directions for future research.