Jolly fat or sad fat?

Emotion word use patterns and eating disorder symptoms: Considering the circumplex model of affect and basic emotions theory

OBJECTIVE

No prior research has examined whether the types of emotion words individuals use to describe their affective experiences cluster along affective dimensions inherent within leading affect theories, or how such emotion word use maps onto eating disorder (ED) symptoms.

METHOD

To address these gaps, latent profile analysis was used to empirically-identify groups of young adults (N = 352) by how often they use emotion words characterized by the circumplex model of affect's valence-arousal dimensions and basic emotions theory's basic versus complex emotion word categorizations. Auxiliary analyses examined differences in groups' ED symptoms (binge eating, purging, restricting, excessive exercising, muscle building, body dissatisfaction, and cognitive restraint).

RESULTS

The 5-profile valence-arousal model and 4-profile basic-complex model were the best-fitting theoretically-supported solutions. Valence-arousal profiles with greater negative affect valence generally exhibited worse ED pathology than others, whereas profiles with greater positive affect valence produced inconsistent risk- and protective-factor relations with distinct ED symptoms. Basic-complex profiles characterized by frequent use of both basic and complex emotion words generally had the greatest ED severity, and profiles with greater basic emotion word use exhibited elevated binge eating.

DISCUSSION

Individual-differences in young adults' emotion word use patterns, versus sample-level averages only, warrant further consideration in ED prevention and research.

PUBLIC SIGNIFICANCE

The present findings suggest that young adults differ in the types of words they use to describe their emotional experiences, and that these unique emotion word use patterns are linked to distinct eating disorder symptoms. These sources of variation warrant further consideration in eating disorders prevention efforts and future research seeking to advance affect-based eating disorders theories.

Attentional processing of body images in women with overweight and obesity

PURPOSE

Despite the claim to integrate body image interventions in obesity treatment, little is known about the mechanisms involved in maintaining body dissatisfaction in persons with overweight and obesity. Therefore, the present study sought to investigate attentional processing of body stimuli in women with overweight and obesity (OW).

METHODS

Women with OW (n = 82) and normal weight controls (NW; n = 44) conducted two eye-tracking paradigms. In the first paradigm, fixation duration on the subjectively most beautiful and ugliest body part of one's own and a weight-matched control body were analyzed. In the second paradigm, picture pairs including the own and a control body or object were presented and initial fixation orientation was measured. Automatic and intentional processing of the body pictures was manipulated by either indicating on which side which stimuli would appear or not.

RESULTS

Women with OW displayed a bias towards the ugliest as opposed to the most beautiful body part, whereas women with NW showed a balanced viewing pattern. Furthermore, both groups showed a preference for bodies relative to the object. However, only women with OW preferred their own relative to the control body during intentional processing.

CONCLUSION

Taken together, results point towards a self-focused and deficit-oriented gaze pattern in women with overweight and obesity. Targeting these processes might help to improve obesity treatment outcomes.

LEVEL OF EVIDENCE

Level I, experimental study.

Psychological Profiles of Treatment-Seeking Adults with Overweight and Obesity: A Cluster Analysis Approach

BACKGROUND

Overweight and obesity are associated with depression and well-being. Some psychological characteristics play a role in explaining well-being and depression in obesity and in identifying specific patient profiles. However, subtyping individuals with overweight/obesity based on variables like self-esteem or stress has not often been done. Therefore, our objective was to explore the psychological profiles of treatment-seeking individuals overweight or with obesity and to compare their depression and well-being.

METHODS

Data regarding eating self-efficacy, well-being, depression, physical hunger, self-esteem, body satisfaction and perceived stress in individuals with overweight/obesity were collected from the ESTEAM cohort. Hierarchical cluster analysis and mean comparisons were performed on female (n = 1427) and male samples (n = 310).

RESULTS

Three psychological profiles were identified in both samples. The "High psychological concerns" profile and the "Low psychological concerns" profile were identical in both samples. The third profile, "Bodily concerns", differed by sex and was characterized by appearance dissatisfaction for women and by appearance and eating concerns for men. The "Low psychological concerns" profile presented the highest well-being and the lowest depression scores in both samples.

DISCUSSION

The findings support the hypothesis of the heterogeneity of individuals with overweight and obesity and suggest sex-related therapeutic approaches.

Psychosocial and Diet-Related Lifestyle Clusters in Overweight and Obesity

This study explored intraindividual multidimensional profiles integrating psychosocial factors, namely, body image and satisfaction, weight-related self-stigma, positivity, and happiness, and behavioural-lifestyle factors, namely, adherence to a healthy diet, among Spanish adults with overweight or obesity. We further aimed to investigate the association of excess weight (i.e., measured body mass index, BMI) with the abovementioned multidimensional configurations. A convenience sample of 100 adult individuals (60% females) with excessive weight (69% overweight; 31% obesity) was recruited. They completed self-reports regarding the study variables, and their weight and height were measured. With a perspective centered on the individual, a cluster analysis was performed. Three distinct intraindividual psychosocial and diet-related profiles were identified: a group of healthy individuals with excess weight (46%); a group of individuals who were negatively affected by their excessive weight and showed the most distressed profile (18%); and a group of dysfunctional individuals who seemed to be excessively unrealistic and optimistic regarding their excessive weight and unhealthy lifestyles, but were troubled by their weight (36%). Furthermore, individuals in the affected cluster had higher obesity (mean BMI ± SD = 32.1 ± 3.7) than those in the clusters of healthy (28.0 ± 3.0) and dysfunctional individuals (28.1 ± 3.3) (p < 0.05). The results showed that there are specific psychosocial and lifestyle profiles in the adult population with excess weight and that there are relationships among psychological, behavioural, and body-composition factors. For clinical application purposes, it is important to account for the heterogeneity within individuals who are obese and to individualize the interventions, with a focus from weight change to the individual's overall well-being.

Association of a Mediterranean Diet and Fruit and Vegetable Consumption with Subjective Well-Being among Adults with Overweight and Obesity

Recent evidence suggests that among behavioral-lifestyle factors, adherence to a healthy dietary pattern such as the Mediterranean Diet (MedDiet) is linked not only to better psychological health and mental positive status but also to increased subjective well-being (SWB). Nevertheless, this association has been unexplored among individuals with excessive weight. This study explored whether adherence to the MedDiet and the intake of healthy foods such as fruits and vegetables (FV) are associated with increased happiness and life satisfaction among Spanish adults with overweight or obesity when weight, body image, and body satisfaction are also considered. A convenience sample of adult individuals with excessive weight completed self-reports on the study variables, and weight and BMI were measured by bioimpedance. No evidence of a relationship with SWB indicators was obtained for MedDiet global indicators, probably due to the low adherence to a healthy diet by these individuals. In contrast, FV intake, as a powerful indicator of healthy eating, was associated with life satisfaction when BMI and body image dimensions were considered, among which body satisfaction had a key role. Moreover, life satisfaction fully mediated the relationship between FV consumption and happiness. Our findings are expected to make a relevant contribution to knowledge on the positive correlates or protective factors for overall well-being in obesity, including dietary habits and body appreciation. Our results may inform obesity management actions focused on inclusive, positive aesthetic models and promoting a healthy lifestyle for happiness in obesity.

Maternal Eating Behavior and Problematic Eating Behaviors of Children Undergoing Weight Loss Treatment: A Cluster Analysis

Background: Research on the interplay between mothers' and children's eating behaviors is needed to better inform sensitive and tailored interventions for treatment-seeking children with overweight/obesity. The present study aimed to identify mothers' eating behavior phenotypes, investigating their associations with problematic eating behaviors of children undergoing weight loss treatment in two central hospitals. Methods: This is a cross-sectional study evaluating 136 mother-child dyads (Mothers: age 39.58 ± 5.40 years; Children: n = 75 female; age 10.13 ± 1.37 years). Mothers' eating behavior (restraint, emotional, and uncontrolled eating) and depression/anxiety, and children's problematic eating attitudes/behaviors were assessed. A cluster analysis (K-means) was performed using mothers' eating behavior dimensions. Multivariate Analysis of Covariance investigated differences between clusters on mothers' and children's sociodemographic, anthropometric, psychological, and eating-related variables. Results: Three clusters emerged: The Disordered Eating group (n = 39) of mothers with the highest scores on emotional eating and uncontrolled eating dimensions, the Restraint Eating group (n = 48), including mothers scoring high in cognitive restraint, and the Low Disordered Eating (n = 49) group where mothers scored low in all eating behavior dimensions. Children of mothers in the Disordered Eating cluster had significantly higher emotional overeating relative to children of mothers in the other two clusters. Conclusions: Distinctive eating behavior profiles of mothers, instead of the presence of single eating behaviors, seem to be associated with specific problematic eating behaviors of children undergoing weight loss treatment. Prospective studies are essential to determine whether these profiles can predict differential weight change trajectories in pediatric obesity treatment.

Identifying stress-related eating in behavioural research: A review

Stress is a commonly reported precipitant of overeating. Understanding the relationship between stress and food intake is important, particularly in view of the increasing prevalence of obesity. The purpose of this review is to examine how stress-related eating has been defined and measured in the literature to date. There are no established diagnostic criteria or gold standards for quantification of stress-related eating. Questionnaires relying on the accuracy of self-report are the mainstay of identifying people who tend to eat in response to stress and emotions. There is a paucity of clinical research linking objective measurements of stress and appetite with self-reported eating behaviour. Limitations of the methodological approaches used and the heterogeneity between studies leave significant knowledge gaps in our understanding of the mechanism of stress related eating, and how best to identify it. These issues are discussed, and areas for further research are explored.

Body Satisfaction, Weight Stigma, Positivity, and Happiness among Spanish Adults with Overweight and Obesity

Although previous evidence suggests that happiness is lower among individuals with obesity, research on the correlates of subjective well-being (SWB) is warranted to increase our knowledge. We aim to explore excess weight (i.e., measured and self-reported body mass index (BMI)), body image and satisfaction, self-stigma, positivity, and happiness among Spanish adults with overweight or obesity. We further aim to investigate the predictors of SWB in this sample. A convenience sample of 100 individuals with excess weight completed self-reports on the study variables and were weighed and their height measured. On average, the participants reported body perceptions revealing minor excessive weight, moderate body satisfaction, low-to-moderate weight-related stigma, and elevated positivity and happiness. BMI and gender/sex independently affected these variables, but there were no significant interaction effects. Furthermore, individuals with overweight or obesity with higher body satisfaction and elevated positivity were more likely to report being happy, independent of their age, gender/sex, weight, and weight-related stigma. Mediation effects were found for body satisfaction and positivity in the relationship between weight and happiness. Moreover, positive orientation suppressed the pervasive influence of stigma on SWB. Our findings confirm the key role of body image dimensions and weight-related stigma for happiness and add support to the relevance of positivity for overall well-being of individuals with excess weight. These results may inform obesity management actions focused on inclusive aesthetic models, combating social stigmatization and enhancing positivity for a flourishing and fulfilling life.

Why some obese people become depressed whilst others do not: exploring links between cognitive reactivity, depression and obesity

Obesity and depression are two major public health concerns, particularly when they co-occur. To date, mechanisms underlying this association have not been established and it is unclear why some obese people become depressed whilst others do not. However, considering the strong association between depression and cognitive reactivity (CR), the present study explores possible associations between obesity, depression and CR in light of the scarce and conflicting nature of past literature. 254 participants were included for measures of depression, CR and obesity. Multivariate analyses of covariance examined the effects of depression and obesity as well as interaction effects of depression x obesity controlling for age and gender. Directions of effects were analysed by means of regression analyses and group contrasts. Linear analyses revealed (1) a significant effect of obesity on the rumination (RUM) and control/perfectionism subscales of CR, (2) a significant effect of depression on CR and all of its subscales, and (3) a significant interaction effect between obesity x depression on RUM. Results may support the 'Jolly Fat Hypothesis' and the existence of a psychologically protected subgroup of obese patients characterised by a lower ruminative thinking style and fewer depressive symptoms. Thus, incorporating anti-rumination therapy into treatment for obese individuals may be beneficial to prevent the development of comorbid depression.

Disordered eating in Jordanian adolescents

BACKGROUND

Disordered eating attitudes and behaviours are linked to poor physical and psychological outcomes.

AIM

To examine the individual, psychological, and socio-cultural factors associated with disordered eating attitudes among Jordanian adolescents.

METHODS

A stratified sampling method was used to select school students aged 15 to 18 years from three governates in Jordan in 2013/2014. Participants filled out questionnaires on socio-demographic variables, the Eating Attitudes Test (EAT-26; to discriminate adolescents with disordered eating); the Body Shape Questionnaire (BSQ; used to measure psychological factors associated with disordered eating); Body Mass Index was calculated and obesity evaluated according to international cut off points (to categorize normal weight, overweight, and obese adolescents, and these categories were used as individual factors associated with disordered eating).

RESULTS

A total of 963 (460 boys and 503 girls) participated in the study. Disordered eating (EAT score ≥ 20) was present in 389 (40.4%); body shape dissatisfaction (BSQ scores ≥110) was present in 161 (16.8%). Overweight and obesity were found in 332 (34.5%) participants. Unhealthy weight loss behaviours (such as self-induced vomiting, substance abuse, and smoking) were very common. Multivariate logistic regression analysis demonstrated that female sex, urban residence, distorted perceptions of weight, BMI (excess weight), body dissatisfaction, and socio-cultural variables (parents, peers and mass media) were significantly associated with disordered eating.

CONCLUSION

Jordanian urban adolescents seem to embrace Western norms to fit in with the demands of Western culture. Socio-cultural factors, particularly mass media, play a significant role in changing adolescents' norms. Prevention and intervention programs are needed to control these disorders.

Body image dissatisfaction and depression in postbariatric patients is associated with less weight loss and a desire for body contouring surgery

BACKGROUND

Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results.

OBJECTIVES

To evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS.

SETTING

Outpatient clinic.

METHODS

One thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model.

RESULTS

There was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n = 157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction.

CONCLUSIONS

There are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients.

Validity and Clinical Utility of Subtyping by the Beck Depression Inventory in Women Seeking Gastric Bypass Surgery

BACKGROUND

The Beck Depression Inventory (BDI) is commonly used in the screening and evaluation process with bariatric surgery candidates despite relatively limited psychometric evidence in this patient group. We examined the validity of the BDI and its clinical utility for subtyping women seeking gastric bypass surgery.

METHODS

One hundred twenty-four women evaluated for gastric bypass surgery were administered the Structured Clinical Interview for DSM-IV (SCID-I/P) and completed a self-report battery of psychosocial measures including the BDI.

RESULTS

Based on the SCID-I/P, 12.9 % (n = 16) met criteria for current mood disorder. Receiver operating characteristic (ROC) curve analysis revealed the BDI had a good area under the curve (0.788) for predicting SCID-I/P mood disorder diagnosis; BDI score of >15 optimized both sensitivity and specificity. Patients diagnosed with SCID-I/P mood disorders had significantly higher levels of eating disorder psychopathology, self-esteem, and shame, than those without mood disorders. Based on a BDI cut-off score of >15, 41.9 % (n = 52) were categorized as high-BDI and 58.1 % (n = 72) as low-BDI. Patients characterized as high-BDI also had significantly higher levels of all associated measures than those with low-BDI; effect sizes for the differences by BDI subtyping were generally 2-3 times greater than those observed when comparing SCID-I/P-based mood versus no mood disorder subgroups.

CONCLUSIONS

In women seeking gastric bypass surgery, the BDI demonstrated limited acceptability efficiency for identifying mood disorders with a cut-point score of >15. When identifying clinical severity, however, subtyping women by BDI scores of >15 may identify a significantly more disturbed subgroup than relying on a SCID-I/P-generated mood disorder diagnosis.

State and trait positive and negative affectivity in relation to restraint intention and binge eating among adults with obesity

Restraint and binge eating are cognitive and behavioral processes that are particularly important in the context of obesity. While extensive research has focused on negative affect (NA) in relation to binge eating, it is unclear whether affective valence (i.e., positive versus negative) and stability (i.e., state versus trait) differentially predict binge eating and restraint among individuals with obesity. Distinguishing between valence and stability helps elucidate under which affective contexts, and among which individuals, restraint and binge eating are likely to occur. Therefore, the present study examined relationships between trait and state levels of NA and positive affect (PA), binge eating, and restraint intention among 50 adults with obesity (BMI ≥ 30). Participants completed baseline assessments followed by a two-week ecological momentary assessment (EMA) protocol. Structural equation modeling assessed a trait model of person-level measures of affect in relation to overall levels of binge eating and restraint intention, while general estimating equations (GEEs) assessed state models examining relationships between momentary affect and subsequent binge eating and restraint. The trait model indicated higher overall NA was related to more binge eating episodes, but was unrelated to overall restraint intention. Higher overall PA was related to higher overall restraint intention, but was unrelated to binge eating. State models indicated momentary NA was associated with a greater likelihood of subsequent binge eating and lower restraint intention. Momentary PA was unrelated to subsequent binge eating or restraint intention. Together, findings demonstrate important distinctions between the valence and stability of affect in relationship to binge eating and restraint intention among individuals with obesity. While NA is a more salient predictor of binge eating than PA, both overall PA and momentary NA are predictors of restraint intention.

Association between depression and eating behaviors among bariatric surgery candidates in a Turkish sample

PURPOSE

The purpose of this study was to explore further whether depression is associated with problematic eating behaviors in a sample of Turkish bariatric surgery candidates.

METHODS

This descriptive study included 168 consecutively seen bariatric surgery candidates in a university bariatric surgery outpatient. Participants were asked to complete the Dutch Eating Behavior Questionnaire (DEBQ), the Beck Depression Inventory (BDI) and surveys assessing sociodemographic and clinical variables. Correlations and linear regression analyses were performed to evaluate the relationship between clinical and demographic variables.

RESULTS

Participants had a mean age 37.7 ± 11.3 years and BMI of 46.4 ± 6.7 kg/m² (SD = 6.7). According to BDI scores, 75.5 % of the patients had mild, moderate, or severe depressive symptomatology. Lower levels of depressive symptoms were associated with higher levels of restrictive eating (r = -0.17; p = 0.04), whereas higher levels of depressive symptoms were associated with more frequent eating in response to both internal (r = 0.3; p = 0.002) and external (r = 0.2; p = 0.04) cues. The BDI scores were significantly associated with increased external eating (ß = 0.03, p < 0.02) and emotional eating (ß = 0.03, p < 0.002) scores. BMI (β = -0.02, p = 0.02 > 0.1) was not associated with DEBQ total scores.

CONCLUSIONS

This research suggests that mild, moderate or severe depressive symptoms are observed in most of the bariatric surgical candidate patients. There is a positive correlation between severity of depression and emotional/external eating behaviors, and a negative correlation between severity of depression and restrictive eating behavior. Additional research is needed to determine whether treating depression preoperatively can assist with alleviating problematic eating behaviors.

Portion Size: Latest Developments and Interventions

PURPOSE OF REVIEW

The aim of this review is to provide an overview of (1) underlying mechanisms of the effect of portion size on energy intake, (2) external factors explaining the portion size effect and (3) interventions and measurements aimed at food portion size.

RECENT FINDINGS

Previous studies have shown that portion sizes have increased in recent decades. Many experimental studies have been conducted to unravel the mechanisms underlying the portion-size effect on food intake (e.g. the appropriateness mechanism, the 'unit bias' mechanism, the 'previous experience/expectation' mechanism, the 'visual cue' mechanism and the 'bite size' mechanism). In addition, external factors have been found to drive food portion selection and consumption (e.g. value for money, mindless eating, levels of awareness, estimation bias. Research on several interventions (ranging from 'providing information' to 'eliminating choice') have been conducted, but remain scarce, especially intervention studies in which portion size is a key focus in weight loss. Moreover, only three new instruments with respect to portion control behavior have been developed. There is considerable evidence for the portion-size effect on energy intake. However, the work on interventions targeting portion size and measurements for portion control behavior are limited. Moreover, from the literature it is not yet clear what type of interventions work best, for whom and in what context.

Body Weight Can Change How Your Emotions Are Perceived

Accurately interpreting other’s emotions through facial expressions has important adaptive values for social interactions. However, due to the stereotypical social perception of overweight individuals as carefree, humorous, and light-hearted, the body weight of those with whom we interact may have a systematic influence on our emotion judgment even though it has no relevance to the expressed emotion itself. In this experimental study, we examined the role of body weight in faces on the affective perception of facial expressions. We hypothesized that the weight perceived in a face would bias the assessment of an emotional expression, with overweight faces generally more likely to be perceived as having more positive and less negative expressions than healthy weight faces. Using two-alternative forced-choice perceptual decision tasks, participants were asked to sort the emotional expressions of overweight and healthy weight facial stimuli that had been gradually morphed across six emotional intensity levels into one of two categories—“neutral vs. happy” (Experiment 1) and “neutral vs. sad” (Experiment 2). As predicted, our results demonstrated that overweight faces were more likely to be categorized as happy (i.e., lower happy decision threshold) and less likely to be categorized as sad (i.e., higher sad decision threshold) compared to healthy weight faces that had the same levels of emotional intensity. The neutral-sad decision threshold shift was negatively correlated with participant’s own fear of becoming fat, that is, those without a fear of becoming fat more strongly perceived overweight faces as sad relative to those with a higher fear. These findings demonstrate that the weight of the face systematically influences how its emotional expression is interpreted, suggesting that being overweight may make emotional expressions appear more happy and less sad than they really are.

Effortful control as a dimension of temperament is negatively associated with prefrontal serotonin transporter availability in obese and non-obese individuals

There is evidence that temperamental factors are associated with obesity; however, the biological mechanism of such association remains elusive. We aimed to investigate a possible association between serotonin transmission and regulative temperament in obese and non-obese individuals by using positron emission tomography (PET) imaging of serotonin transporters (SERT) and the Adult Temperament Questionnaire. Twenty-nine obese individuals with body mass index (BMI) ≥ 35 kg/m² and 13 non-obese controls (BMI < 30 kg/m² ) underwent PET with [¹¹ C]-labeled DASB (highly selective for SERT) and self-completed the Effortful Control (EC) scale of the Adult Temperament Questionnaire-Short Form (ATQ). With the help of this questionnaire, we aimed to assess the capacity of self-regulation. Overall, for obese and non-obese individuals together, VOI-based (volume of interest) analysis showed significant negative correlations between SERT BP_ND and ATQ-EC AC (Activation Control) subscale in several brain regions (all r ≤ -0.47). Obese and non-obese individuals separated showed equally strong positive, but non-significant correlations. The analysis did not reveal any significant correlations of SERT availability and ATQ-EC IC (Inhibitory Control) or ATQ-EC AtC (Attentional Control) subscale within and between the two groups. The results indicate that regulative temperament - particularly the capacity to mitigate negatively toned impulses and to resist inappropriate avoidance behavior - might be associated with the prefrontal serotonergic system.

Obesity and emotional well-being in adolescents: Roles of body dissatisfaction, loss of control eating, and self-rated health

OBJECTIVE

Weak or inconsistent association between obesity and impairment in emotional well-being in population-based samples has led to efforts to identify mediating variables. This study examined the relative importance of body dissatisfaction (BD), loss of control (LOC) eating, and self-rated health (SRH) in mediating the association between obesity and impairment in emotional well-being in a school-based sample of adolescents (boys, n = 437; girls, n = 950).

METHODS

Moderated mediation analysis was employed to assess the relative importance of the putative mediating variables and moderation of mediation effects by sex following the methods suggested by Hayes and coworkers.

RESULTS

BD and SRH, but not LOC eating, were found to mediate the association between obesity and impairment in emotional well-being. Stronger mediation effects were observed for BD than for SRH. None of these results was moderated by sex.

CONCLUSIONS

The findings suggest that it may be important to target BD in obesity prevention and treatment programs in order to reduce the adverse impact of excess body weight on young people's emotional well-being.

Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem

BACKGROUND

Using the person-oriented approach, we determined the relationships between four indicators (restraint and eating, shape, and weight concerns) of disordered eating (DE), as measured by the self-reported Eating Disorders Examination Questionnaire (EDE-Q), to identify typical DE patterns. We then related these patterns to clinical EDE-Q cut-off scores and emotion dysregulation, depression, self-esteem, and two categories of DE behaviors (≥2 or ≤1 "yes" responses on the SCOFF questionnaire).

METHOD

Typical patterns of DE were identified in a community sample of 1,265 Swedish adolescents (M_age  = 16.19, SD = 1.21; age range 13.5-19 years) using a cluster analysis. Separate analyses were performed for girls (n = 689) and boys (n = 576).

RESULTS

The cluster analysis yielded a six-cluster solution for each gender. Four of the six clusters for girls and five for boys showed scores above the clinical cut-off on at least one of the four DE indicators. For girls, the two clusters that scored above the clinical cut-offs on all four DE indicators reported severe psychological problems, including high scores on emotion dysregulation and depression and low scores on self-esteem. In contrast, for boys, although two clusters reported above the clinical cut-off on all four indicators, only the cluster with exceedingly high scores on shape and weight concerns reported high emotion dysregulation and depression, and extremely low self-esteem. Furthermore, significantly more girls and boys in the most problematic DE clusters reported ≥2 "yes" responses on the SCOFF questionnaire (as opposed to ≤1 response), indicating clear signs of DE and severe psychological difficulties.

CONCLUSION

We suspect that the various problematic DE patterns will require different paths back to a healthy diet. However, more research is needed to determine the developmental trajectories of these DE patterns and ensure more precise clinical cut-off scores, especially for boys. Comprehensive understanding of DE patterns might be of use to healthcare professionals for detecting DE before it develops into an eating disorder.

TRIAL REGISTRATION

Lund, EPN (dnr: 2012/499).

Why weight for happiness? Correlates of BMI and SWB in Australia

Despite our best medical and behavioural strategies, the physical and mental health of the overweight and obese remains compromised. In an effort to improve treatment outcomes, research has begun to focus on (1) specific BMI categories, and (2) subjective well-being (SWB), a broad construct exploring how we evaluate and experience our lives. Positive psychology is concerned with SWB, through the application of variables associated with health, happiness and optimal functioning. To date, research exploring the relationship between BMI categories and SWB is lacking for community based Australians. This study employed a cross-sectional design using an online survey method (n=260). SWB and related variables were assessed over five BMI categories including normal, overweight, and obese classes one, two and three. Main findings suggest the class two and three obese demonstrated significantly lower scores on flourishing in comparison with the normal and overweight. The class three obese also demonstrated higher depression, and lower scores on agency and positive affect in comparison with the normal and overweight. Furthermore class two and three obese reported lower scores on pathways thinking than the overweight. Results provide preliminary support for the hypothesis that a lack of SWB may contribute to or maintain atypical BMI. Implications for treatment interventions are discussed.

Healthy or Unhealthy on Sale? A cross-sectional study on the proportion of healthy and unhealthy foods promoted through flyer advertising by supermarkets in the Netherlands

Background

It is generally assumed that supermarkets promote unhealthy foods more heavily than healthy foods. Promotional flyers could be an effective tool for encouraging healthier food choices; however, there is a lack of good-quality evidence on this topic. Therefore, the aim of this study was to determine the proportions of healthy and unhealthy foods on promotion in Dutch supermarket flyers.

Methods

Supermarket food promotions were assessed using the weekly promotional flyers of four major Dutch supermarkets over a period of eight weeks. All promotions were evaluated for healthiness,

price discount, minimum purchase amount, product category and promotion type. The level of healthiness consists of a ‘healthy’ group; products which have a positive effect on preventing chronic diseases and can be eaten every day. The ‘unhealthy’ group contain products which have adverse effects on the prevention of chronic diseases. Data were analysed using ANOVA, independent t-tests and chi-square tests.

Results

A total of 1,495 promotions were included in this study. There were more promotions in the unhealthy category; 70% of promotions were categorised as unhealthy. The price discount was greater for the healthy promotions (mean 29.5%, SD 12.1) than for the two categories of unhealthy promotions (23.7%, SD 10.8; 25.4%, SD 10.5, respectively), a tendency which was mainly due to discounts in the fruit and vegetables category. To obtain the advertised discount, a significantly higher number of products had to be purchased in the unhealthy category than in the healthier categories. Promotions in the category meat, poultry and fish category occurred frequently.

Compared to traditional supermarkets, discounter supermarkets had higher percentages of unhealthy food discounts, lower discount levels and lower minimum purchase amounts.

Conclusion

This research confirmed that unhealthy foods are more frequently advertised than healthier foods in Dutch supermarket flyers. Moreover, consumers had to buy more products to achieve the discount when the promotion was categorized as unhealthy, providing extra incentive for buying additional unhealthy products. Future research should explore the proportion of healthy and unhealthy food discounts in relation to supermarkets’ total product range, to determine if unhealthy products are over-represented in promotions or if there are more unhealthy products stocked in supermarkets overall. The findings of this study provide an important basis for future intervention and policy development aiming to achieve healthier supermarket environments.

Obesity and psychosocial impairment: mediating roles of health status, weight/shape concerns and binge eating in a community sample of women and men

OBJECTIVES

We examined the relative importance of physical health status, weight/shape concerns and binge eating as mediators of the association between obesity and psychosocial impairment in a community sample of women and men.

METHODS

Self-report measures of eating disorder features, perceived physical health and psychosocial functioning were completed by a general population sample of women and men classified as obese or non-obese (women: obese=276, non-obese=1220; men: obese=169, non-obese=769). Moderated mediation analysis was used to assess the relative importance of each of the putative mediators in accounting for observed associations between obesity and each outcome measure and possible moderation of these effects by sex.

RESULTS

Weight/shape concerns and physical health were equally strong mediators of the association between obesity and psychosocial impairment. This was the case for both men and women and for each of three measures of psychosocial functioning-general psychological distress, life satisfaction and social support-employed. The effects of binge eating were modest and reached statistical significance only for the life satisfaction measure in men.

CONCLUSIONS

A greater focus on body acceptance may be indicated in obesity prevention and weight-management programs.

Personality subtypes in female pre-bariatric obese patients: do they differ in eating disorder symptoms, psychological complaints and coping behaviour?

In the pre-bariatric psychological assessment of 102 morbidly obese women, two personality subtypes emerged: a resilient/high functioning subtype with a 'normal' personality profile and an emotional dysregulated/ undercontrolled subtype, characterized by high neuroticism and low extraversion/conscientiousness. Emotional dysregulated/ undercontrolled patients showed more concerns about eating/weight/shape, more binge eating driven by emotions and external triggers, more psychological complaints (such as depression and anxiety) and more avoidance and depressive coping reactions than resilient/high functioning patients. Further research should clarify whether these clearly different psychological profiles are related to different outcomes (weight loss or well-being) of bariatric surgery.

Associations between obesity (BMI and waist circumference) and socio-demographic factors, physical activity, dietary habits, life events, resilience, mood, perceived stress and hopelessness in healthy older Europeans

BACKGROUND

It is important to understand the psycho-social context of obesity to inform prevention and treatment of obesity at both the individual and public health level.

METHODS

Representative samples of middle-aged adults aged ≥43 years were recruited in Great Britain (GB) (n = 1182) and Portugal (n = 540) and interviewed to explore associations between body mass index (BMI), waist circumference (WC), demographic factors, physical activity, dietary habits (FFQ), life events (LES), Resilience (RS11), Mood (MS), Hopelessness (BDI) and Perceived Stress (PSS4). BMI (kg/m2) and WC (cm) were dependent variables in separate multiple linear regression models for which predictors were entered in 4 blocks: 1. demographic factors; 2. stressful life events; 3. diet/activity; and, 4. psychological measures.

RESULTS

In the GB sample, BMI (kg/m2) was predicted by less education, illness in a close friend or relative, frequent alcohol consumption and sedentary behaviour. Among the Portuguese, higher BMI (kg/m2) was predicted by lower resilience. Being male and less education were independent predictors of having a larger WC (cm) in both countries. Within GB, not working, illness in a close friend or relative, sedentary lifestyle and lower resilience were also independent predictors of a larger WC (cm).

CONCLUSIONS

These data suggest that intervention to treat and/or prevent obesity should target males, particularly those who have left education early and seek to promote resilience. In GB, targeting those with high alcohol consumption and encouraging physical activity, particularly among those who have experienced illness in a close friend or relative may also be effective in reducing obesity.

Eating and psychological profiles of women with higher depressive symptoms who are trying to lose weight

The aim of this study was to determine whether women with higher depressive symptoms differed from women with lower depressive symptoms on early weight-loss, eating behaviors and psychological profiles. Among a sample of 45 overweight/obese women who had undertaken a self-initiated weight-loss attempt, two groups were formed based on scores from the Beck Depression Inventory (BDI-II), one with lower depressive symptoms (BDI-II < 10; n = 21) and one with higher depressive symptoms (BDI ≥ 10; n = 24). Even if some women in the higher depressive symptom group did not reach the clinical cut-off for depression (BDI = 14), this group tended to lose less weight in the first two months of their weight-loss attempt and to show a more disturbed eating and psychological profile compared to the group with lower depressive symptoms. In addition, among women with higher depressive symptoms, eating and psychological variables were systematically related to one another whereas these variables were not related among the other group. Results highlight the relevance of considering the presence of depressive symptoms as a marker of clinical severity among the overweight/obese population, and suggest that the BDI-II could be an interesting screening instrument to identify this particular subgroup.

Interdisciplinary lifestyle therapy improves binge eating symptoms and body image dissatisfaction in Brazilian obese adults

INTRODUCTION: Obesity is related to numerous negative consequences for physical and mental health. It is often associated with the presence of binge eating disorder, body image dissatisfaction, and general psychopathology. OBJECTIVE: To assess the effects of an interdisciplinary lifestyle therapy on binge eating symptoms, depression, anxiety, body dissatisfaction, and quality of life in obese adults. METHODS: A total of 49 obese adults (body mass index = 37.35±5.82 kg/m²; age = 44.14±10.00 years) participated in a weight-loss program for 6 months. Symptoms suggestive of binge eating, body dissatisfaction, depression, anxiety, and quality of life were measured using self-reported questionnaires. Food intake was assessed using a 3-day dietary record. Data were analyzed using analysis of variance (ANOVA). RESULTS: ANOVA results showed a reduction in binge eating symptoms and in body dissatisfaction results. Depression and anxiety symptoms also decreased, and an increase was observed in quality of life scores. After therapy, a significant improvement was observed in dietary patterns, as well as significant weight loss. A positive correlation was found between variation of anxiety symptoms and lipid intake. Binge eating symptoms were associated with anxiety symptoms and body image dissatisfaction, and body image dissatisfaction correlated positively with anxiety symptoms in males only. In females, a positive correlation was observed between depression and binge eating symptoms. CONCLUSION: The interdisciplinary therapy was effective in promoting positive physical and psychological changes and in improving the quality of life of obese adults.

The use of negative themes in television food advertising

The ability of food advertising to trigger food consumption and influence social norms relating to food consumption has resulted in increasing attention being given to the prevalence and nature of food advertising. The present study investigated the use of negative themes in food advertisements aired on Australian television to determine the prevalence of depictions of violence/aggression, mocking, nagging, boredom, loneliness, food craving, mood enhancement, and the emotional use of food across 61 days of programming time. The results suggest that advertisers are using negative themes to capture attention and invoke an emotional response in the target audience. Sixteen percent (14,611) of the 93,284 food advertisements contained negative themes, with mood enhancement and food craving being the most commonly depicted negative themes. Advertisements with negative themes were more likely to be for non-core foods and to be aired during children's popular viewing times than at other times. The potential for negative themes in food advertising to promote unhealthy food consumption behaviors among children is likely to be of concern to policy makers. Building on this exploratory study, further research is needed to investigate how nutrition-related decision making is affected by exposure to food advertisements employing negative emotional themes.

Clarifying boundaries of binge eating disorder and psychiatric comorbidity: a latent structure analysis

Binge eating disorder (BED) presents with substantial psychiatric comorbidity. This latent structure analysis sought to delineate boundaries of BED given its comorbidity with affective and anxiety disorders. A population-based sample of 151 women with BED, 102 women with affective or anxiety disorders, and 259 women without psychiatric disorders was assessed with clinical interviews and self-report-questionnaires. Taxometric analyses were conducted using DSM-IV criteria of BED and of affective and anxiety disorders. The results showed a taxonic structure of BED and of affective and anxiety disorders. Both taxa co-occurred at an above-chance level, but also presented independently with twice-as-large probabilities. Within the BED taxon, diagnostic co-occurrence indicated greater general psychopathology, lower social adaptation, and greater premorbid exposure to parental mood and substance disorder, but not greater eating disorder psychopathology. Eating disorder psychopathology discriminated individuals in the BED taxon from individuals in the affective and anxiety disorders taxon. Diagnostic criteria of BED were more indicative of the BED taxon than were criteria of affective and anxiety disorders. The results show that at the latent level, BED was co-occurring with, yet distinct from, affective and anxiety disorders and was not characterized by an underlying affective or anxiety disorder.

Dietary restraint moderates genetic risk for binge eating

Dietary restraint is a prospective risk factor for the development of binge eating and bulimia nervosa. Although many women engage in dietary restraint, relatively few develop binge eating. Dietary restraint may increase susceptibility for binge eating only in individuals who are at genetic risk. Specifically, dietary restraint may be a behavioral exposure factor that activates genetic predispositions for binge eating. We investigated this possibility in 1,678 young adolescent and adult same-sex female twins from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Twin moderation models were used to examine whether levels of dietary restraint moderate genetic and environmental influences on binge eating. Results indicated that genetic and nonshared environmental factors for binge eating increased at higher levels of dietary restraint. These effects were present after controlling for age, body mass index, and genetic and environmental overlap among dietary restraint and binge eating. Results suggest that dietary restraint may be most important for individuals at genetic risk for binge eating and that the combination of these factors could enhance individual differences in risk for binge eating.

The role of food-cue exposure and negative affect in the experience of thought-shape fusion

Thought-shape fusion (TSF) is a cognitive distortion that can be induced by imagining eating high-caloric foods, and involves increased guilt, feelings of fatness, and perceptions of weight gain and moral wrong-doing. Two studies were conducted to further elucidate this phenomenon. Study 1 investigated whether merely being exposed to fattening foods (without being asked to think about these foods) could induce a TSF-like experience. Study 2 investigated the relationship between negative affect and TSF-like experiences. The results suggested that TSF is specific to thinking about eating fattening foods, as mere exposure to high-caloric foods did not increase state TSF scores in healthy females relative to a neutral control condition. Furthermore, susceptibility to TSF is associated with negative affect. Healthy females with low levels of negative affect appear to be protected against TSF, medium negative affect is associated with susceptibility to TSF inductions, while those with high levels of negative affect appear to be particularly vulnerable to TSF-like experiences (even after imagining a neutral situation). Overall, the studies suggest that negative affect is associated with a TSF-like experience, and that TSF is a phenomenon that is experienced (to at least some extent) by females in the general population.

Psychological distress and risk for eating disorders in subgroups of dieters

OBJECTIVE

The aim of the present study was to predict the risk of developing an eating disorder in subgroups of dieters, based on the adolescents own accounts of the reason for starting to diet.

METHOD

Eighty-one dieters from a cohort of 595 adolescents (318 boys and 288 girls) aged 15 participated in the present prospective study. Personal interviews at both base-line and follow-up were combined with questionnaire data on depression, social phobia and self-esteem.

RESULTS

Four mutually exclusive groups of dieters were identified: vanity dieters, overweight dieters, depressed dieters and feeling fat dieters. Depressed and feeling-fat dieters had a 15-fold risk of having a lifetime eating disorder at age 18 compared to vanity and overweight dieters.

CONCLUSION

Typical teenage vanity dieting and dieting among overweight adolescents appears to be a benign practice, but adolescents dieting because of psychological distress have high-risk of developing an eating disorder.

Subtyping weight-preoccupied overweight/obese women along restraint and negative affect

Previous clustering analysis performed among samples of bulimic or binge eating women have consistently yielded two subtypes (Dietary and Dietary-Depressive). The present study verifies whether this clustering solution could be replicated among weight-preoccupied overweight/obese women and compares the different clusters on personality-, eating- and weight-related variables. Cluster analysis was performed along dietary restraint and negative affect among a sample of 156 overweight/obese weight-preoccupied women. Results failed to replicate the original two-cluster solution, rather evidencing a three-cluster solution (Dietary, Depressive, Low-Dietary/Low-Depressive). Also, dietary restraint did not appear to be a core feature for all weight-preoccupied overweight/obese women as it is for eating-disordered women since only one group presented dietary restraint. The presence of a pure Depressive group and a pure Dietary group showed that dietary restraint and negative affect may act independently among our sample. In term of clinical severity, the Dietary group, even in the absence of high negative affect, occupied an intermediate position between the Low-Dietary/Low-Depressive and the Depressive group, the most impaired one, in accordance with previous studies. It thus suggests that other factors beside negative affect can contribute to eating and psychological impairment among overweight/obese women.

Food-related lifestyles and their association to obesity in five European countries

This paper's objective is to investigate the associations between obesity and Food-Related Lifestyles (FRL) in five European countries. A cross-sectional web-based survey was carried out in Belgium, Denmark, Germany, Greece and Poland, January 2008, with quota samples on gender (male, female), age categories (20-44 and 45-70 years), and locality of residence (urban, rural). A total of 2437 respondents (51% women, 49% men; mean age 41.4 years, SD 13.1) participated. Obtained data included socio-demographic information, measure of the food-related lifestyle scale and self-reported weights and heights. Body Mass Index (in kg/m(2)) was calculated as weight (in kg) divided by the squared height (in m(2)). Individuals were classified as obese if BMI > or = 30. Logistic regressions were fitted for the aggregated sample and then by country with obese as dependent and socio-demographics and FRL were included as independents. The prevalence of obesity in the five countries is 22%. Europeans giving more importance to 'self-fulfilment' (odds = 1.18), 'planning of meals' (odds = 1.15), and preferring 'snacks vs. meals' (odds = 1.24) are more likely to be obese. Respondents were less likely to be obese if they attached lower levels of importance to the use of 'shopping lists' (odds = 0.87). The overall picture is that a stronger interest in health, organic products and freshness, within the FLR domain of quality aspects, is associated with 'not being obese'. This study has identified specific FRL dimensions as potential predictors of obesity. The resulting consumers' profiling can be used for targeted interventions for weight management in Europe.

Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity

OBJECTIVE

The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment.

METHODS

Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise.

RESULTS

Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight.

CONCLUSION

Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity.