Predictive factors of binge eating disorder in women searching to lose weight

Associations between weight loss history and factors related to type 2 diabetes risk in the Stop Diabetes study

Background

Frequent weight loss attempts are related to maladaptive eating behaviours and higher body mass index (BMI). We studied associations of several type 2 diabetes (T2D) risk factors with weight loss history, defined as the frequency of prior weight loss attempts, among Finnish adults at increased risk for T2D.

Methods

This study (n = 2684, 80% women) is a secondary analysis of the 1-year StopDia lifestyle intervention with digital intervention group, digital intervention + face-to-face counselling group, or control group. The frequency of prior weight loss attempts was categorized into five groups: no attempts/no attempts to lose weight, but trying to keep weight stable/1–2 attempts/3 or more attempts/ continuous attempts. Data on emotional eating and social/emotional nutrition self-efficacy were collected with a digital questionnaire. We assessed baseline differences between categories of weight loss history as well as the intervention effects.

Results

Altogether 84% of participants had attempted weight loss. Those with one or more weight loss attempts had higher BMI, larger waist circumference, and more emotional eating compared to ‘no attempts’ and ‘no attempts to lose weight, but trying to keep weight stable’ categories. The ‘no attempts’ category had the highest baseline fasting insulin, whereas it showed the largest decrease in this measure with the intervention. This change in fasting insulin in the ‘no attempts’ category was significantly different from all the other categories. Emotional nutrition self-efficacy slightly improved in the ‘no attempts’ category, which was significantly different from its concomitant decrease in the categories ‘1-2 attempts’ and ‘3 or more attempts’. The intervention group assignment did not affect the results.

Conclusions

Multiple attempts to lose weight may unfavourably affect T2D risk factors as well as lifestyle intervention outcomes. More research is needed on how weight loss frequency could affect T2D risk factors and how to design lifestyle interventions for individuals with frequent previous weight loss attempts.

Eating behavior tendencies among Finnish adults in relation to previous weight loss attempts

BACKGROUND

The number of weight loss attempts may be associated with higher weight status and unfavorable health behaviors as well as dysfunctional eating behaviors. We aimed to study eating behavior tendencies, i.e., cognitive restraint, uncontrolled eating and emotional eating among a sample of Finnish adults who had engaged in a different number of attempts to lose weight during their lifetime.

METHODS

Data were collected through a web-based survey. Participants completed a background questionnaire (including questions on weight, height, number of attempts to lose weight) and the Three-Factor Eating Questionnaire (TFEQ-R18). Out of 1985 individuals, 1679 with complete data were included in the study. The TFEQ-R18 was tested for its reliability and fit to our study population using Cronbach's alpha and Confirmatory Factor Analysis (CFA).

RESULTS

Subscales of the TFEQ-R18 had acceptable reliability except for that of 'cognitive restraint', which reached acceptable reliability when three items were deleted (items 15, 16, 18). The revised version of the questionnaire was designated as the TFEQ-R15, which showed good fit based on CFA fit indices. Participants who had attempted to lose weight during their lifetime (n = 1229), especially those with ≥3 weight loss attempts (n = 499), had greater cognitive restraint, uncontrolled eating, emotional eating, and higher body mass index (BMI) than those with no previous weight loss attempts (n = 132).

CONCLUSIONS

Our findings suggest that eating behavior tendencies, i.e., decreasing tendencies of uncontrolled and emotional eating should receive more emphasis to support successful weight management.

Screening for Binge Eating Disorder in people with obesity

The Risk factors for Binge Eating Disorder in Overweight (REO) questionnaire is a screening tool for nutritionists to discriminate between individuals with obesity with and without Binge Eating Disorder (BED). The first study tested the discriminative ability of the REO and identified an optimal cut-off value. In the second study this cut-off value was used to identify individuals with and without BED from a sample of individuals with obesity visiting a nutritionist and compared clinical and personality characteristics with a group of individuals officially diagnosed with BED. Results showed that the REO has a sensitivity of 95.1%, specificity of 81.5%, a good internal consistency of α=.96, and an exploratory factor analysis showed four underlying factors of the REO that explained a total variance of 63.7%. Characteristics of individuals with BED symptoms identified by the REO and those officially diagnosed with BED were comparable and differed from individuals with obesity without BED symptoms. By screening individuals with obesity with the REO those presenting with BED symptoms are more easily identified, and can be referred to psychological treatment facilities for further assessment and appropriate treatment.

Diagnosing binge eating disorder in a primary care setting

Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that it is not merely a subtype of obesity.

Identification of psychological dysfunctions and eating disorders in obese women seeking weight loss: cross-sectional study

Objective. The aim of this study is to analyse associations between eating behaviour and psychological dysfunctions in treatment-seeking obese patients and identify parameters for the development of diagnostic tools with regard to eating and psychological disorders. Design and Methods. Cross-sectional data were analysed from 138 obese women. Bulimic Investigatory Test of Edinburgh and Eating Disorder Inventory-2 assessed eating behaviours. Beck Depression Inventory II, Spielberger State-Trait Anxiety Inventory, form Y, Rathus Assertiveness Schedule, and Marks and Mathews Fear Questionnaire assessed psychological profile. Results. 61% of patients showed moderate or major depressive symptoms and 77% showed symptoms of anxiety. Half of the participants presented with a low degree of assertiveness. No correlation was found between psychological profile and age or anthropometric measurements. The prevalence and severity of depression, anxiety, and assertiveness increased with the degree of eating disorders. The feeling of ineffectiveness explained a large degree of score variance. It explained 30 to 50% of the variability of assertiveness, phobias, anxiety, and depression. Conclusion. Psychological dysfunctions had a high prevalence and their severity is correlated with degree of eating disorders. The feeling of ineffectiveness constitutes the major predictor of the psychological profile and could open new ways to develop screening tools.

Correlates of weight instability across the lifespan in a population-based sample

OBJECTIVE

Research from overweight/obese clinical samples links weight instability to poor health. This study investigated whether negative health outcomes were associated with weight instability in a population-based sample.

METHOD

One thousand five hundred ten women and 1,111 men from the Mid-Atlantic Twin Registry completed questionnaires assessing demographics, body size in childhood, adolescence, and adulthood, health satisfaction, and disordered eating. Noneating disorder psychiatric diagnoses were assessed via clinical interviews.

RESULTS

Weight instability was related to lower health satisfaction and self-esteem, and higher body dissatisfaction, dieting, and binge eating for both sexes. Weight unstable women were more likely to meet criteria for lifetime major depressive disorder, generalized anxiety disorder, and eating disorders. Weight stable women were more likely to abuse alcohol; however, two of these associations [e.g. weight instability and generalized anxiety disorder (GAD) and weight stability and alcohol abuse] became nonsignificant once lifetime binge eating was accounted for, indicating that these forms of psychopathology are more strongly related to binge eating than weight instability itself. No associations between weight stability and psychiatric diagnoses were found in men.

DISCUSSION

Weight instability is related to mental and physical health concerns for both sexes. It was also specifically associated with depression and eating pathology in women.

Frequent intentional weight loss is associated with higher ghrelin and lower glucose and androgen levels in postmenopausal women

Population-based studies suggest that repetitive cycling of weight loss and regain may be associated with future weight gain. Therefore, to better define the relationship between weight cycling, energy homeostasis, and future weight gain, we examined associations between frequent intentional weight loss and hormonal profiles in postmenopausal women. This cross-sectional study evaluated the relationship between a history of frequent weight loss and biomarkers, including serum glucose, insulin, leptin, and ghrelin, as well as sex steroid hormones. We hypothesized that frequent intentional weight loss would be associated with changes in normal appetite and body weight regulatory hormones, favoring increased appetite and weight gain. One hundred fifty-nine healthy, weight stable, sedentary, overweight, postmenopausal women who had been recruited for an exercise intervention participated in this study. History of intentional weight loss (frequency and magnitude) was assessed by questionnaire. Hormonal assays were performed by radioimmunoassay (insulin, leptin, ghrelin, estrogens, androgens, and dehydroepiandrosterone), chemiluminescence immunoassay (insulin-like growth factor-1), and immunometric assay (sex hormone binding globulin). Analysis of variance and regression analyses were used to investigate the relationship between weight loss history and metabolic hormones. A higher degree of weight cycling, characterized by the frequency of intentionally losing more than 10 lb, was associated with an appetite-stimulating hormonal profile, including higher concentrations of ghrelin (P trend = .04), lower glucose (P trend = .047), and to some extent, lower insulin (P trend = .08). Frequent weight loss was also associated with lower androgen concentrations, including androstenedione (P trend = .02), testosterone (P trend = .04), and free testosterone (P trend = .01). No independent associations between the concentrations of leptin or estrogens and weight cycling were observed. This study suggests that frequent intentional weight loss may affect hormones involved in energy regulation.

A comparison of eating disorders among patients receiving surgical vs non-surgical weight-loss treatments

BACKGROUND

Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different clinical needs in the management of surgical compared to non-surgical WLT patients.

METHODS

Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of eating disorders in WLT. Participants filled out the Eating Disorders in Obesity Questionnaire as well as self-rating questionnaires of general psychopathology and HRQL before initiating surgical (n = 54) or non-surgical (n = 46) WLT.

RESULTS

Eating disorders were found to be more common among patients accepted for surgical treatments, whereas binge eating (as a symptom) was found to be equally common in both groups. Surgical patients also indicated higher levels of psychopathology compared to those receiving non-surgical treatment.

CONCLUSION

Patients in surgical WLT are younger, more obese, and indicate higher levels of eating disorders and psychopathology than non-surgical WLT patients. Results highlight the importance of surgical WLT units having adequate knowledge, resources, and methods for detecting and addressing issues of eating disorders and psychopathology before and during the WLT. Future longitudinal studies need to ascertain to what extent eating and general psychopathology influence the outcome of WLT in terms of lapses, complications, weight gain, quality of life, etc.

Socioeconomic differences in obese patients with and without eating disorders

OBJECTIVE

The present study aims to evaluate whether there are any socioeconomic differences in obese patients with and without eating disorders.

METHOD

567 obese participants referred to obesity treatment were divided into one eating-disordered group and one group without eating disorders. Those groups were compared regarding four socioeconomic variables: education, occupational status, daily occupation and housing area.

RESULTS

The prevalence of eating disorders in the sample was 9.8%. Female participants with an eating disorder (ED) had a higher BMI than female participants without an ED. Women with an ED were more often actively occupied, implying that they at the present time were working or studying, and they were also more frequently living in a lower income housing area. No statistically significant differences were found for education or occupational status.

CONCLUSION

Our study shows that prevalence of eating disorders does not differ as a function of education or occupational status in patients referred to obesity treatment, but that differences in daily occupation and housing area can prevail for the women in particular.