Do momentary changes in body dissatisfaction predict binge eating episodes? An ecological momentary assessment study

A naturalistic examination of feeling fat: Characteristics, predictors, and the relationship with eating disorder behaviors

OBJECTIVE

Although literature implicates feeling fat in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa, binge-ED), research in this area is small, nascent, and relies on retrospective self-report. The current study sought to understand the temporal pattern of feeling fat and its role as a precipitant and consequence of ED behaviors.

METHODS

Totally 106 treatment-seeking adults with binge-spectrum EDs completed 7-14-day ecological momentary assessments. They rated feeling fat, negative affect states, and reported on ED behaviors six times per day. Multilevel models evaluated whether feeling fat mediates prospective links between negative affect states and ED behaviors, assessed if negative affect states mediate the prospective association of feeling fat on ED behaviors, and examined the bidirectional prospective association between feeling fat and ED behaviors.

RESULTS

Feeling fat was highest in the early morning (6-8:59 a.m.). Individuals with binge-ED-spectrum EDs demonstrated greater variability in feeling fat than those with bulimia nervosa-spectrum EDs who had stable and high levels of feeling fat. Guilt, sadness, anxiety, and the overall NA at Time 2 mediated the prospective associations between at Time 1 feeling fat and Time 3 dietary restraint, actual dietary restriction, and compensatory exercise. There was a bidirectional prospective association between feeling fat and binge eating.

DISCUSSION

Feeling fat serves as a proximal predictor and mediator of the prospective association between guilt and binge eating. Feeling fat and binge eating mutually reinforce each other.

PUBLIC SIGNIFICANCE

Little is understood regarding the experience of feeling fat in natural environments among individuals with binge-spectrum eating disorders. We found that the risk for having the experience of feeling fat is high in the morning and evening. Feeling fat triggers guilt, anxiety, and sadness which in turn, increases engagement in dietary restraint/restriction and compensatory exercise. Feeling fat also triggers binge eating, and binge eating leads to feelings of fatness.

Emotional Distress and Body Dissatisfaction: The Mediating Role of Social Media and Emotional Regulation

BACKGROUND

Body dissatisfaction is defined as a negative attitude towards one's body, characterized by emotional disorders. Currently, problematic use of social media seems to be associated with an increase in body dissatisfaction and emotional distress. Therefore, the present study examined the relationship between emotional distress (i.e., depression, anxiety, and stress) and body dissatisfaction, as well as the mediating role of emotional regulation and problematic social media use in this relationship. In addition, the study aims to identify sex differences in the four research variables.

METHODS

Measures of the four variables mentioned above were administered to 2520 participants over 18 (M = 48.35; SD = 16.56, 51% females).

RESULTS

The results reveal that women reported higher levels of emotional regulation, emotional distress, body dissatisfaction, and problematic use of social media. Emotional distress correlated with problematic use of social media, emotion regulation strategies (i.e., rumination and catastrophizing), and body dissatisfaction. The relationship between emotional distress and body dissatisfaction was mediated by the problematic use of social media and emotional regulation.

CONCLUSIONS

These findings underscore the relevance of educating social media users on strategies for emotional regulation. The results highlight the clinical importance of including the emotion regulation approach to a comprehensive understanding of body dissatisfaction.

Daily instability in body dissatisfaction in individuals with and without eating disorders

Body dissatisfaction (BD) includes negative thoughts and feelings about one's body shape. Although typically assessed as a trait, BD has been found to fluctuate within a day. The present study examined whether daily instability in BD differs according to trait BD, eating disorder (ED) diagnosis, and engagement in maladaptive exercise. Participants with EDs (n = 166) and controls (n = 44) completed a self-report measure of trait BD and reported BD and engagement in maladaptive exercise five times daily for 14 days as part of an ecological momentary assessment protocol. BD instability was calculated as adjusted mean squared successive difference. On average across assessments, participants with EDs reported a 16% change in their BD ratings between consecutive assessments, which was significantly higher than the 12% change in controls. Trait BD was significantly inversely associated with BD instability in individuals with EDs, but not in controls. BD instability did not differ across ED diagnoses or between days with versus without maladaptive exercise. Findings suggest that BD is a dynamic state that varies within a day, especially in participants with EDs. Further research is needed to clarify whether this heightened instability in BD is a clinically relevant factor underlying ED symptoms.

Reward mediates the association between engagement in noneating activities and state body dissatisfaction: An ecological momentary assessment study

OBJECTIVE

Momentary worsening (i.e., greater than one's average levels) of state body dissatisfaction (BD) has been implicated as a proximal risk factor for eating disorder (ED) behaviors in binge-spectrum EDs. Yet, research exploring the prospective association between noneating activities in daily life (e.g., chores, self-care/coping) and momentary state BD remains limited. Understanding the momentary link between engagement in noneating activities and state BD, and pathways through which engagement in said activities influences momentary state BD is critical to informing treatments. The current ecological momentary assessment (EMA) study examined whether (1) engagement in noneating activities at Time 1 prospectively predicted momentary state BD at Time 2 and (2) reward drawn from noneating activities at Time 1 mediates the prospective association between engagement in noneating activities at Time 1 and momentary state BD at Time 2.

METHOD

Sixty-six adults with transdiagnostic binge eating completed an EMA protocol over 7-14 days. Participants received six EMA signals per day (total EMA observations = 4038). Multilevel modeling was used to examine the research questions.

RESULTS

Engagement in an indoor hobby, outdoor recreation, socializing, and self-care/coping strategies prospectively predicted momentary state BD improvements, while using TV/social media and cooking prospectively predicted momentary state BD worsening. Reward drawn from engagement in these noneating activities mediated the associations.

DISCUSSION

If replicated, these findings suggest that increasing the frequency of certain noneating activities and enhancing their rewarding aspects to improve state BD and decrease ED behavior risk during treatment may be worthy of further exploration.

PUBLIC SIGNIFICANCE

Momentary worsening of state body dissatisfaction (BD) is a risk factor for eating disorder behaviors in individuals with binge eating. This study found that engaging in certain noneating activities (e.g., socializing) prospectively predicted momentary improvements in state BD, while other noneating activities (e.g., cooking) predicted momentary worsening of state BD. Reward drawn from activities mediated these relations. To improve state BD, treatments should target the frequency of, and reward obtained from these noneating activities.

Social media and body dissatisfaction in young adults: An experimental investigation of the effects of different image content and influencing constructs

Research shows negative correlations between media exposure of body images in the context of hegemonic beauty ideals and body satisfaction. The present study deals with the underlying mechanisms and the effects of different exposure contents. In the online experimental study, a sample consisting of 226 individuals (82.3% female, 17.7% male) received a three-minute exposure to Instagram images of women and men in the context of either hegemonic beauty ideals in the experimental group or body diversity in the control group. A conducted Mixed ANOVA with repeated measures showed significant group differences, including an increase in body dissatisfaction in the experimental group and a reduction in the control group after exposure. Statistically significant detrimental effects of exposure to images in the experimental group on women's state mood as well as descriptive similar tendencies on men's state mood were found. Moderating effects of the tendency to make upward social comparisons and the internalization of the gender-specific beauty ideal on the relationship between exposure content and the change scores of body dissatisfaction were found. Furthermore, a mediation model was calculated to investigate the effect of exposure content on post-measurement of body dissatisfaction, using the constructs "comparison processes regarding sexual attractiveness" and "assessment of one's own sexual attractiveness" as mediators. The model did not yield significant mediation, although significant relationships were found between the model components. Exploratory analyses were conducted on the influence of the assessment of one's own sexual attractiveness on related social comparisons and the intensity of engagement with Instagram content as a predictor of body dissatisfaction. The results highlight the relevance for psychoeducational purposes of addressing a critical engagement with depicted beauty ideals in social media. Moreover, the study proposes body diversity as an alternative content that can have a positive impact on body satisfaction, which can be actively sought during the individual Instagram user experience.

Momentary predictors of binge eating episodes and heavy drinking episodes in individuals with comorbid binge eating and heavy drinking

PURPOSE

The co-morbidity of binge eating and heavy drinking (BE + HD) is a serious concern due to the high prevalence rates and associated elevated severity. Clarifying the momentary factors that increase risk for binge eating and heavy drinking among BE + HD is important for expanding theoretical models of BE + HD and informing treatment recommendations. The current study used ecological momentary assessment (EMA) to compare the momentary processes maintaining binge eating between BE + HD and individuals with binge eating only (BE-only) and to identify the momentary risk factors for binge eating episodes and heavy drinking episodes among BE + HD.

METHODS

Participants (BE + HD: N = 14; BE-only: N = 37) were adults with clinically significant binge eating who completed between 7 and 14 days of EMA prior to treatment.

RESULTS

The presence of food and within-day dietary restraint predicted higher odds of binge eating for both groups. Among BE + HD, the presence of alcohol and dietary restraint increased risk for subsequent binge eating and subsequent heavy drinking, and the absence of food increased risk for subsequent heavy drinking.

CONCLUSION

These results offer preliminary support for treatment interventions for BE + HD that focus on reducing dietary restraint and teaching strategies for urge management in situations with palatable food or alcohol. Future research should study the maintenance mechanisms of BE + HD with larger, more diverse samples and using study design approaches with more experimenter control (i.e., laboratory experiments).

LEVEL OF EVIDENCE

Level IV, multiple time series without intervention.

Rationale and Design of an Ecological Momentary Assessment Study Examining Predictors of Binge Eating Among Sexual Minority and Heterosexual Young Women: Protocol for the Health and Experiences in Real Life (HER Life) Study

BACKGROUND

Previous research has identified health disparities between sexual minority and heterosexual women, including increased rates of obesity and binge eating in sexual minority women. Established predictors of binge eating behavior include negative emotions and sociocultural processes; however, these studies are generally conducted in samples of young women where sexual identity is not known or reported. There is a dearth of research evaluating how sexual minority-specific factors (eg, minority stress and connectedness to the lesbian, gay, bisexual, transgender, and queer community) may affect binge eating in sexual minority women. In addition, no studies have examined these processes in racially diverse samples or considered how intersecting minority identities (eg, Black and sexual minority) may affect eating behaviors.

OBJECTIVE

The Health and Experiences in Real Life (HER Life) Project aims to clarify real-world predictors of binge eating in young heterosexual and sexual minority women using ecological momentary assessment. The role of affective, social, and health behavior factors in binge eating will be examined for all women (aim 1), and sexual minority-specific predictors will also be considered for sexual minority women participants (aim 2). Person-level moderators of race, body- and eating-related factors, and sexual minority-specific factors will also be examined to better understand how real-world binge eating predictors may differ for various demographic groups (aim 3).

METHODS

Researchers aim to recruit 150 sexual minority and 150 heterosexual women from across the United States, including at least 50 Black women for each group, using web-based recruitment methods. The eligibility criteria include identifying as a woman, being aged between 18 and 30 years, and having had at least two binge eating episodes in the last 2 weeks. Participants must endorse being only or mostly attracted to men (considered heterosexual) or only or mostly attracted to women or having a current or most recent female partner (considered sexual minority). Eligible participants complete an initial web-based baseline survey and then 14 days of ecological momentary assessment involving the completion of a morning and before-bed survey and 5 prompted surveys per day as well as a user-initiated survey after binge eating episodes. The data will be analyzed using a series of multilevel models.

RESULTS

Data collection started in February 2021. We have currently enrolled 129 sexual minority women and 146 heterosexual women. Data collection is expected to conclude in fall 2022.

CONCLUSIONS

The Health and Experiences in Real Life Project aims to elucidate potential differences between sexual minority and heterosexual women in within-person factors predicting binge eating and inform eating disorder interventions for sexual minority women. The challenges in recruiting sexual minority women, including the determination of eligibility criteria and considerations for remote data collection, are discussed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41199.

Understanding momentary associations between body dissatisfaction and exercise in binge-spectrum eating disorders

PURPOSE

Maladaptive exercise is common among individuals with binge-spectrum eating disorders. One mechanism that may drive engagement in exercise in this population is state body dissatisfaction. However, no studies to date have examined prospective, momentary relationships between state body dissatisfaction and exercise.

METHODS

Adults with binge-spectrum eating disorders (N = 58) completed a 7-14-day ecological momentary assessment protocol assessing exercise and state body dissatisfaction several times per day. Multilevel models were used to evaluate prospective reciprocal associations between state body dissatisfaction and exercise. Mixed models examined trajectories of change in state body dissatisfaction pre- and post-exercise. Additional models examined exercise type (maladaptive vs. adaptive) as a moderator.

RESULTS

Momentary increases (i.e., greater than one's average levels) in state body dissatisfaction at any given timepoint did not prospectively predict engagement in exercise at the next nearest timepoint. Exercise at any given timepoint did not prospectively predict momentary increases in state body dissatisfaction. State body dissatisfaction was found to increase in the initial hours preceding an exercise episode (linear estimate, β = - 0.012, p = 0.004). State body dissatisfaction did not significantly change in the hours following engagement in exercise. Exercise type did not moderate these associations.

CONCLUSION

If replicated, our results may suggest that momentary increases in state body dissatisfaction may not be associated with exercise behaviors in individuals with binge-spectrum eating disorders.

LEVEL OF EVIDENCE

Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, orreports of expert committees.

Associations between fear of weight gain and exercise in binge-spectrum eating disorders

PURPOSE

Maladaptive exercise (i.e., exercise that is either driven or compensatory) is thought to momentarily down-regulate elevated fear of weight gain (FOWG). However, little research has examined associations between FOWG and exercise, and no research has measured FOWG at a momentary level or considered exercise type (i.e., maladaptive vs. adaptive). Thus, we examined both within- and between-subject associations between FOWG and exercise among individuals with trans-diagnostic binge eating.

METHODS

We recruited treatment-seeking adults (N = 58, 82.9% female) to complete a 7-14-day ecological momentary assessment protocol which assessed levels of FOWG and exercise engagement and type. Mixed models and generalized estimating equations assessed within-subject associations, and linear regression assessed between-subject associations.

RESULTS

There was no main effect of FOWG on exercise engagement at the next survey. However, unexpectedly, exercise type moderated this relationship such that the relationship between FOWG and exercise was strongest for episodes of adaptive exercise. Overall exercise frequency accounted for 10.4% of the variance in FOWG and exercise type explained an additional 1.7% of the variance in FOWG.

CONCLUSION

The findings of the current study indicate that momentary levels of FOWG are associated with subsequent adaptive exercise episodes, while higher overall levels of maladaptive exercise were associated with higher levels of FOWG. Future treatments should place a greater emphasis on reducing the frequency of maladaptive exercise by providing strategies for reducing FOWG.

LEVEL OF EVIDENCE

Level IV: Evidence obtained from multiple time series analysis such as case studies.

Changes in affect from non-eating activity engagement as predictors of loss of control eating: an ecological momentary assessment study

PURPOSE

Loss of control eating (LOCE) is supported as a maladaptive regulation strategy for high negative affect (NA) and low positive affect (PA). Yet, little is known about the day-to-day activities outside of eating that may precipitate such changes in affect and impact risk for LOCE. The current ecological momentary assessment study sought to examine whether (1) low NA and high PA at a given survey would prospectively predict lower likelihood of a LOCE episode at the next survey, and (2) having recently engaged in various non-eating activities would be associated with changes in average NA and PA levels at the same survey.

METHODS

Data collected from 66 participants with LOCE over 7-14 days were analyzed using generalized estimating equations.

RESULTS

High NA but not low PA at a given survey prospectively predicted lower likelihood of a LOCE episode at the next survey. Having recently engaged in outdoor recreation and socializing was associated with lower than one's usual NA and higher than one's usual PA at the same survey, social media was associated with higher than one's usual NA and lower than one's usual PA, self-care was associated with higher than one's usual PA, and napping was associated with lower than one's usual PA.

CONCLUSION

Individuals may benefit from increasing the frequency of daily non-eating activities that reduce NA, since it appears to be a more salient predictor of LOCE than PA. Further research is needed to elucidate this LOCE maintenance model, particularly in regard to the role of PA.

LEVEL OF EVIDENCE

Level IV, multiple time series without intervention.

State body dissatisfaction predicts momentary positive and negative affect but not weight control behaviors: an ecological momentary assessment study

PURPOSE

Body dissatisfaction is ubiquitous in our society and leads to eating disorders. Longitudinal research suggests that higher body dissatisfaction predicts higher negative affect and unhealthy weight control behaviors over time. However, no study has assessed how body dissatisfaction impacts affect and weight control behaviors in the moment. In the current study, we examined the momentary relationships between body dissatisfaction, affect and weight control behaviors using ecological momentary assessment.

METHODS

Female college students (N = 67) completed measures of state body dissatisfaction, affect, and weight control behaviors across fourteen days using ecological momentary assessment.

RESULTS

Greater body dissatisfaction significantly predicted lower subsequent positive affect and higher subsequent negative affect, but positive and negative affect did not predict subsequent body dissatisfaction. Daily average body dissatisfaction was not significantly associated with daily engagement in either healthy or unhealthy weight control behaviors.

CONCLUSION

Short-term negative effects of body dissatisfaction on affect were apparent. Targeting body dissatisfaction may be important for improving affect.

LEVEL OF EVIDENCE

Level IV, multiple time series without intervention.

State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women

This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.