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

Potential pathways to the onset and development of eating disorders in people with overweight and obesity: A scoping review

OBJECTIVE

To describe pathways to eating disorder (ED) development that have been evaluated in people with overweight and obesity.

METHODS

Four databases were searched to identify studies testing ED development models in adolescents (10-19 years) or adults (>19 years) with overweight and obesity. Explanatory variables were thematically grouped into constructs to describe pathways to each ED outcome.

RESULTS

Of 2226 studies screened, 46 (10 adolescent; 36 adult) were included. Study samples were predominantly female, ranging from 22 to 2236 participants and mean age 12.3 to 56.0 years. In total, 207 explanatory variables were grouped into 18 constructs to summarize 107 pathways that were identified. The most common ED outcome was binge eating (n = 24 studies), followed by global ED psychopathology (n = 10 studies). Across pathways to ED development, negative affect was the most proposed construct, followed by preoccupation with weight/shape and weight stigma.

CONCLUSION

Pathways to ED development in people with overweight and obesity are complex and may include more than 18 different explanatory factors of which negative affect, preoccupation with weight/shape, and weight stigma are the most common. More research on adolescents, males, and the spectrum of ED in diverse populations is required for early identification and intervention.

Factor Structure, Reliability, and Convergent Validity of an Ecological Momentary Assessment Binge-Eating Symptoms Scale

Ecological momentary assessment (EMA) of binge-eating symptoms has deepened our understanding of eating disorders. However, there has been a lack of attention on the psychometrics of EMA binge-eating symptom measures. This paper focused on evaluating the psychometric properties of a four-item binge-eating symptom measure, including multilevel factor structure, reliability, and convergent validity. Forty-nine adults with binge-eating disorder and/or food addiction completed baseline questionnaires and a 10-day EMA protocol. During EMA, participants completed assessments of eating episodes, including four binge-eating symptom items. Analyses included multilevel exploratory factor analysis, computation of omega and intraclass correlation coefficients, and multilevel structural equation models of associations between contextual factors and binge-eating symptoms. A one within-subject factor solution fit the data and showed good multilevel reliability and adequate within-subjects variability. EMA binge-eating symptoms were associated with baseline binge-eating measures as well as relevant EMA eating characteristics: including greater unhealthful food and drink intake; higher perceived taste of food; lower likelihood to be planned eating; and lower likelihood of eating to occur at work/school and other locations and greater likelihood to occur at restaurants compared to home. In conclusion, the study findings support the psychometrics of a 4-item one-factor EMA measure of binge-eating symptoms.

Body-related self-conscious emotions, self-compassion, and dietary restraint in Canadian undergraduate university students: A multilevel mediation and moderation analysis

OBJECTIVE

Self-compassion has an inverse association with dietary restraint however, the mechanisms linking self-compassion and dietary restraint are not clear. This study aimed to determine to what extent self-compassion was inversely concurrently related to dietary restraint, indirectly through body-related self-conscious emotions, and to what extent trait self-compassion moderated the concurrent within-person association between body-related self-conscious emotions and dietary restraint.

METHOD

Data was collected from 224 Canadian university students who reported on trait self-compassion at baseline and body-related shame, guilt, envy, and embarrassment, and dietary restraint biweekly between November 2020 and August 2021.

RESULTS

Results from a 2-1-1 multilevel mediation model showed that trait self-compassion was indirectly concurrently related to dietary restraint through body-related shame, guilt, envy, and embarrassment. Results from the moderation model showed that there was a significant positive concurrent within-person association between body-related shame, envy, and embarrassment, but not guilt, with dietary restraint. These relationships were not moderated by trait self-compassion.

DISCUSSION

This study adds to our understanding of the concurrent association between body-related self-conscious emotions and dietary restraint, and the mechanisms through which self-compassion is related to dietary restraint. Given body-related self-conscious emotions were related to dietary restraint at both the within-person and between-person level, both compassion-focused interventions that aim to improve general levels of body-related self-conscious emotions and interventions that aim to overcome spikes in these emotions compared with one's usual level are warranted.

PUBLIC SIGNIFICANCE STATEMENT

Negative body-related self-conscious emotions were related to higher levels of dietary restraint both across individuals and within individuals over time; and may play a mechanistic role in linking self-compassion with dietary restraint. Interventions aimed at reducing negative body-related self-conscious emotions are warranted in the prevention of eating disorder psychopathology.

Relations between forms of dietary restraint, restriction, and loss-of-control eating among adolescents seeking weight control: An ecological momentary assessment study

OBJECTIVE

This study aimed to: 1) compare rates of dietary restraint and restriction between adolescents with and without loss-of-control (LOC) eating who were seeking weight control and 2) examine temporal relations between restraint/restriction and LOC eating.

METHOD

37 adolescents seeking weight control (mean age: 15.4 ± 1.5; 62 % White; 57 % female; mean BMI percentile = 97.3 ± 3.1) completed a one-week ecological momentary assessment protocol and reported on dietary restraint/restriction and eating behavior prior to beginning a weight control intervention. Chi-square tests examined differences in frequency of restraint/restriction between participants with and without LOC eating. Multilevel models examined associations between dietary restraint/restriction and LOC eating at the next survey and on the next day.

RESULTS

Of 37 participants, 15 (41 %) reported engaging in LOC eating. Participants with LOC eating more frequently endorsed several forms of restraint and restriction versus participants without LOC eating. Attempting to avoid enjoyable foods and attempting to limit eating at one survey predicted greater likelihood of LOC eating at the next survey.

CONCLUSIONS

Findings suggest that attempted restraint, but not actual restriction, was associated with LOC eating. Research should explore additional factors that may influence these relationships, which could inform weight control treatments that address restraint/restriction.

Ecological momentary assessment of state affect prior to and following loss of control eating in young men

OBJECTIVE

Loss of control (LOC) eating is prevalent but understudied among young men. Affect regulation models propose that LOC eating functions as a maladaptive effort to escape from distressing affective states. As such, negative affect is thought to increase before and decrease after LOC eating. However, examinations with young men are lacking and it remains unclear whether specific emotional experiences are differentially implicated in their LOC eating.

METHODS

The current study examined the temporal roles of affect in LOC eating in 31 young men (18-35 years; Mage = 25.74 ± 5.61y; 46.7 % White; 30 % Black/African American; 10 % Hispanic/Latino, 10 % South Asian) who reported engaging in recurrent LOC eating. Participants completed a 14-day ecological momentary assessment protocol and recorded all eating episodes each day and their state affect five times per day. Generalized linear mixed models were conducted to examine the trajectories of global and item-level negative and positive affect pre- and post-LOC eating episodes.

RESULTS

Negative affect did not change significantly before or after LOC eating (ps > .05). Positive affect did not change significantly before LOC eating (ps > .05). Global positive affect, excitement, and happiness decreased significantly after LOC eating (ps ≤ .001).

DISCUSSION

Study findings contradict extant theory and empirical data largely from female samples. Negative affect did not increase risk for LOC eating, nor did LOC eating function to improve participants' mood; rather, positive mood slightly decreased after LOC eating. Further investigation around the observed decline in positive affect after LOC eating will clarify if this is a relevant intervention point in this population.

Social media and dating app use are differentially related to same- and next-day disordered eating pathology in young men with loss of control eating

OBJECTIVE

To evaluate whether social networking site (SNS) and dating app use is associated with disordered eating in young men.

METHODS

42 men (18-35y) who reported ≥4 loss of control (LOC) eating episodes in the prior month completed a 14-day ecological momentary assessment (EMA) protocol. Five times throughout the day, participants responded to prompts regarding their dietary restraint, body dissatisfaction, and LOC eating. Each night at ~10 pm, participants reported their total time spent on SNSs and dating apps/websites within the last day.

RESULTS

39 out of 42 cisgender men (M_age = 25.1 ± 5.3 years; 47 % non-Hispanic White, 29 % Black or African American; 63 % non-students; 87 % heterosexual) reported using SNSs and/or dating apps. Neither SNS nor dating app use was associated with body dissatisfaction. Dating app use with associated with higher same- (r² equivalent = 0.022, p = .003) and next-day dietary restraint (r² equivalent = 0.016, p = .02); SNS use was not. More SNS use was associated with lower odds of same- (OR [95 % CI] = 0.86 [0.75, 0.99], p = .044) and next-day LOC eating (OR [95 % CI] = 0.82 [0.71, 0.96], p = .011); links with dating app use were non-significant.

DISCUSSION

Non-significant links for SNS and dating app use with body dissatisfaction, and inverse associations with LOC eating, are contrary to research conducted with girls and women. Research is needed to evaluate whether the quality of SNS and dating app engagement (e.g., specific sites) are more closely related to men's disordered eating, and this work should consider muscularity concerns.

The association between anxiety sensitivity and food cravings among individuals seeking treatment for weight-related behaviors

BACKGROUND

A better understanding of risk-factors associated with state-like food cravings may be one clinically relevant component in an effort to better understand obesity. Existing work has shown anxiety sensitivity (AS) to be a significant risk factor for increased cravings across a variety of health behaviors (e.g., smoking, alcohol use). Yet, no work has examined the relationship between AS and state-like food cravings. Therefore, the current study sought to examine the association between AS and a variety of state-like food cravings, including: (1) an intense desire to eat, (2) anticipation of relief from negative states and feelings/improvement in mood that may result from eating, (3) obsessive preoccupation with food or lack of control over eating, and (4) craving as a physiological state.

METHODS

Participants included 161 (Mage = 31.58, SD = 10.71; 60.9 % female) individuals seeking treatment for weight-related behaviors.

RESULTS

Results indicated that elevated AS was associated with reinforcement-based and physiological food cravings.

CONCLUSION

Our findings indicate that there may be clinical utility in screening for AS among individuals seeking treatment for weight-related behaviors in efforts to better understand specific types of food craving.

Trait Anxiety and Unhealthy Eating in Adult Women: The Mediating Role of Cognitive Instability

Previous studies have demonstrated the influence of affective states on unhealthy eating. Heightened impulsivity has also been recognized as a risk factor for unhealthy eating. The objective of the present study was to investigate the relationship between trait anxiety and unhealthy eating and to test whether cognitive instability (trait impulsivity component) might mediate this relationship among adult women.

METHOD

The sample was composed of 225 women (Mage = 29.70 ± 9.23; MBodyMass Index = 23.39 ± 4.43). The State-Trait Anxiety Inventory (STAI), the Food Frequency Questionnaire (FFQ), and the Barratt Impulsiveness Scale (BIS) were used. We first conducted a principal components analysis to reduce the dimensionality of the FFQ data, finding four principal components. For our primary analyses, we focused on unhealthy eating. We then conducted a mediation analysis to examine whether trait anxiety was associated with unhealthy eating and, if so, whether cognitive impulsivity mediated this relationship.

RESULTS

Trait anxiety was positively associated with cognitive instability, and cognitive instability was positively associated with unhealthy eating. Trait anxiety was also positively associated with unhealthy eating, but only when controlling for cognitive instability. Consistent with our proposed mediation model, trait anxiety was positively associated with cognitive instability, which in turn predicted unhealthy eating among adult women.

CONCLUSION

Adult women who reported higher levels of trait anxiety experienced higher levels of cognitive instability and engaged in poor dietary behaviors. Identifying the factors related to unhealthy eating represents a crucial step toward findings ways of reducing their impact on food intake and replacing them with more productive ones.

Loss of control may uniquely predict negative affect among the disinhibited eating experiences of high-risk young men

OBJECTIVE

Loss of control (LOC) eating is a disordered eating behavior that is prevalent but understudied among men. It is common for men with LOC eating to concurrently engage in diverse eating behaviors characterized as disinhibited. It remains unclear which eating qualities are most distressing for men. This study evaluated the link between disinhibited eating qualities and subsequent negative affect in young men.

METHODS

42 men (18-35 y) who reported engaging in ≥4 LOC eating episodes in the prior month completed a 14-day ecological momentary assessment protocol. For each meal and snack, participants were asked to rate the extent to which they felt they overate; lost control; ate more than planned; ate mindlessly; had concerns about wasting food; and were encouraged to eat more by others. State negative affect was evaluated during random intervals five times per day.

RESULTS

After adjusting for previous negative affect and time between ratings, five of the six eating qualities were significantly and positively associated with subsequent negative affect according to between-participant findings (ps < 0.026). In within-participant analyses, only LOC was significantly and positively associated with subsequent negative affect (p = 0.044).

DISCUSSION

While a range of disinhibited eating qualities are correlated with negative affect in a sample of young men, a sense of LOC while eating may be a promising target for interventions focused on improving the psychological functioning of high-risk young men.

Psychological inflexibility in terms of eating behaviors among individuals seeking treatment for comorbid affective vulnerabilities and weight-related behaviors

Maladaptive eating patterns and behaviors are frequently documented in relation to obesity onset and management. To better understand these occurrences, it is important to examine psychological processes that may be guiding these patterns and behaviors. The current study examined the role of psychological inflexibility on emotional eating, food cravings, and disordered eating symptoms among 161 participants (60.9% female, Mage = 31.58, SD = 10.71) who attended a baseline appointment for a larger randomized-controlled trial for individuals with elevated anxiety sensitivity and obesity. Three separate two-step hierarchal regressions were conducted. Results indicated that greater levels of psychological inflexibility were associated with greater levels of emotional eating, food cravings, and disordered eating symptoms. These findings suggest that promoting psychological flexibility may be a key factor in promoting positive changes in eating behaviors among individuals seeking treatment for comorbid affective vulnerabilities and weight-related behaviors.

Associations among affect, diet, and activity and binge-eating severity using ecological momentary assessment in a non-clinical sample of middle-aged fathers

PURPOSE

Knowledge of within-day factors associated with binge-eating severity among middle-aged fathers is limited. The purpose of the current report was to examine within-day associations of affect, diet, and activity in relation to binge-eating severity using ecological momentary assessment (EMA) in men.

METHODS

Twenty-three middle-aged fathers completed 8 days of EMA and wore accelerometers to objectively assess activity. Generalized estimating equations assessed relationships among affect, diet, and activity and binge-eating severity.

RESULTS

When positive affect was above average, men reported greater binge-eating severity in the next 2 h. Oppositely, when negative affect was above average, men reported less binge-eating severity in the next 2 h. At times when men reported consumption of sweets and fast food, they reported higher binge-eating severity during the same 2-h window. Men with greater average levels of light activity reported less overall binge-eating severity.

CONCLUSIONS

Findings show that affect, unhealthy food intake, and light activity could be targeted among middle-aged fathers to reduce binge-eating severity and prevent eating disorders.

LEVEL OF EVIDENCE

Level III: Evidence obtained from cohort or case-control analytic studies.

Food insecurity moderates the relationship between momentary affect and adherence in a dietary intervention study

OBJECTIVE

Negative affect and food insecurity have been proposed to impede adherence to weight loss interventions. Therefore, this study examined the role of these variables on dietary adherence using Ecological Momentary Assessment.

METHODS

A total of 50 participants (19 male participants; age = 49 [SD 14] years) participated in an outpatient dietary study. Lean participants (n = 22; BMI ≤ 25 kg/m² ) received a weight-maintaining energy needs (WMEN) diet, and participants with obesity (BMI ≥ 30) were randomized to receive either a WMEN diet (n = 14) or a 35% calorie-reduced diet (n = 14). Food insecurity was measured, and, twice daily, Ecological Momentary Assessment captured real-time affect ratings and adherence. Between-person (trait-level) and lagged within-person (state-level) scores were calculated.

RESULTS

Greater food insecurity and trait-level negative affect were associated with reduced adherence (p = 0.0015, p = 0.0002, respectively), whereas higher trait-level positive affect was associated with greater adherence (p < 0.0001). Significant interactions between affect and food insecurity revealed an association between higher trait positive affect and increased adherence at lower levels of food insecurity. Higher trait negative affect was more strongly associated with decreased adherence in participants with greater levels of food insecurity (-1 SD: B = -0.21, p = 0.22; mean: B = -0.46, SE = 0.13, p = 0.0004; +1 SD: B = -0.71, SE = 0.17, p < 0.0001).

CONCLUSIONS

Trait-level affect may be crucial in predicting dietary adherence, especially in those with greater food insecurity.

Exploring the role of momentary positive and negative affect in overeating and binge eating: Evidence for different associations among men and women

Momentary positive and negative emotions have shown to affect eating behaviour. In this study, we used experience sampling method (ESM) to assess how momentary positive affect (PA) and negative affect (NA) relate to overeating (OE) and binge eating (BE) episodes among men and women compared to no OE/BE episodes. We additionally looked at how situational and social context moderate these relationships. For this purpose, 87 women and 94 men participated in the study where they were instructed to rate their levels of various positive and negative emotions, situational whereabouts, and the presence of OE/BE 7 times a day for 3 consecutive days. We found that men and women greatly differed in how momentary PA and NA relate to OE and BE. In women, NA was highest before BE, followed by OE compared to no OE/BE. Further, an interaction between the type of an eating episode and situational context demonstrated that this relationship was significant when at home, but not away from home. No differences in the momentary NA between the types of eating episodes were found in men. In men, PA was significantly higher before OE compared to BE and no OE/BE. Additionally, an interaction between the type of eating episode and situational context showed that this relationship was significant when at home, but not when away from home. Our results further confirm the role of negative affect in overeating and binge eating in women, whereas also suggesting that the role of positive affect in eating behaviour is warranted more research, particularly in men.

Delineating the role of binge eating in cancer research

PURPOSE

Binge eating is defined as consumption of a large amount of food accompanied by a sense of loss of control over eating. While binge eating is associated with poor physical, behavioral, and psychosocial health, it has not been studied in cancer research. Therefore, the overarching goal of this review is to delineate the role of binge eating in cancer research and to spur new research in this area. Specifically, in this review, we outlined (1) binge eating as a possible risk factor that contributes to cancer risk, (2) how binge eating may develop after cancer diagnosis, and (3) how binge eating may be associated with health and relapse during survivorship.

CONCLUSIONS

It is critical to elucidate the role of binge eating in the prevention of cancer and long-term cancer survivorship. This review suggested a number of ways that binge eating may increase risk for cancer as well as several pathways that may lead to the development of binge eating after cancer diagnosis.

LEVEL OF EVIDENCE

Level V: narrative review.

The mediating role of self-compassion in the relationship between positive reactivity, negative reactivity, and perfectionism with disordered eating

BACKGROUND

Individuals with disordered eating are at an increased of having one or more additional risks for comorbid disorders, such as anxiety disorder, depressive disorder, and insomnia. Therefore, the present study aimed to investigate the mediating role of self-compassion in the relationship between positive reactivity, negative reactivity, and perfectionism with disordered eating.

MATERIALS AND METHODS

The study method was descriptive-correlational through structural equation modeling (SEM). The present study population included all students of the University of Tehran in the city of Tehran in 2018-2019. A total of 302 students were selected by convenience sampling method and completed questionnaires on eating attitudes test-8, self-compassion scale (short form), eating disorder inventory-perfectionism scale, and Perth emotional reactivity scale. The SEM path analysis and Pearson correlation coefficient were conducted to analyze the obtained data in SPSS-23 and Lisrel-8.80.

RESULTS

The finding of the path analysis showed that self-compassion acts as a mediating role in the relationship of disordered eating with positive and negative emotional reactivity and perfectionism. Only the direct effect coefficient of general positive reactivity on disordered eating was not significant.

CONCLUSION

Based on the results of this study, self-compassion can serve as a protective factor against negative emotional reactivity and perfectionism. Therefore, self-compassion can be considered in the development of prevention and treatment programs for disordered eating.

Descriptives and baseline ecological momentary assessed predictors of weight change over the course of psychological treatments for binge eating disorder

OBJECTIVE

The objectives were to examine individual variability in weight change across psychological treatments for binge-eating disorder (BED) and to examine baseline predictors (i.e., BED symptoms, affect, and appetite) of weight change using ecological momentary assessment (EMA).

METHOD

Adults with BED (N = 110) enrolled in a randomized clinical trial in which they received one of two psychological treatments for BED. At baseline, participants completed a 7-day EMA protocol measuring BED symptoms, affect, and appetite. Height and weight were measured at baseline, mid-treatment, end-of-treatment, and follow-up, and body mass index (BMI) was calculated.

RESULTS

On average, participants evidenced a 2% increase in BMI at end-of-treatment and a 1% increase between end-of-treatment and 6-month follow-up assessments. Although results showed that BMI increased over time, the quadratic term reflected a deceleration in this effect. There were interactions between positive affect and the linear trajectory across time predicting BMI, indicating that individuals reporting higher positive affect at baseline evidenced a flatter trajectory of weight gain. There was a main effect of overeating as assessed by EMA and interactions between overeating and linear and quadratic trajectories across time predicting BMI. Individuals who reported greater overeating at baseline had higher BMI across time. However, the BMI of individuals with lower overeating increased linearly, and increases in BMI among those with average or high rates of overeating appeared to stabilize over time.

CONCLUSION

Despite the variability in weight change, baseline positive affect and overeating may be ecological targets for improving weight outcomes in psychological treatments for BED.

Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.

The interplay between binge eating risk factors: Toward an integrated model

We aimed to assess the interplay between dietary restraint and emotion regulation (ER) difficulties as well as other well-known risk factors of binge eating in a community sample of women. Altogether 96 women (mean age 21.5 years; mean BMI 21.7) participated in the study using ecological momentary assessment. Structural equation modeling indicated that restraint and ER pathways are related yet operate independently in predicting binge eating in a unified model. ER difficulties moderated the effect of negative affect and fluctuations in negative affect in predicting binge eating while Neuroticism and preoccupation with body weight predicted binge eating indirectly.

The Many Faces of Stress: Three Factors that Predict Physical Illness in Young Adults

Three studies examined how various forms of stress uniquely contribute to physical illness. We compared negative affect and perceived stress in Study 1, neuroticism and perceived stress in Study 2, and negative affect, neuroticism, and perceived stress in Study 3. We also controlled for health-related covariates (i.e., exercise, nutrition, substance use, and BMI). In all three studies (ns = 271, 577, and 300), participants completed online surveys for course credit. The results of Study 1 demonstrated that both negative affect and perceived stress predicted physical illness. In Study 2, neuroticism and perceived stress each predicted illness symptoms, and an additional interaction between neuroticism and perceived stress, were found. In Study 3, where all three stress factors were included, only negative affect predicted illness symptoms. Taken together, these results suggest that negative affect uniquely explains most of the variance in physical illness symptoms while controlling for other forms of stress.

Emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies

Emotional eating has traditionally been defined as (over)eating in response to negative emotions. Such overeating can impact general health because of excess energy intake and mental health, due to the risks of developing binge eating. Yet, there is still significant controversy on the validity of the emotional eating concept and several theories compete in explaining its mechanisms. The present paper examines the emotional eating construct by reviewing and integrating recent evidence from psychometric, experimental and naturalistic research. Several psychometric questionnaires are available and some suggest that emotions differ fundamentally in how they affect eating (i.e. overeating, undereating). However, the general validity of such questionnaires in predicting actual food intake in experimental studies is questioned and other eating styles such as restrained eating seem to be better predictors of increased food intake under negative emotions. Also, naturalistic studies, involving the repeated assessment of momentary emotions and eating behaviour in daily life, are split between studies supporting and studies contradicting emotional eating in healthy individuals. Individuals with clinical forms of overeating (i.e. binge eating) consistently show positive relationships between negative emotions and eating in daily life. We will conclude with a summary of the controversies around the emotional eating construct and provide recommendations for future research and treatment development.

Associations between latent trait negative affect and patterns of food-intake among girls with loss-of-control eating

OBJECTIVE

Momentary negative affect (NA) has been shown to predict eating patterns in the laboratory, yet, more stable mood states have not been studied in relation to eating patterns in the laboratory among youth at high risk for binge-eating disorder and obesity.

METHOD

One-hundred-eight adolescent girls (14.5 ± 1.7 years) with BMI between the 75th-97th percentile who reported loss-of-control (LOC)-eating completed measures of trait anxiety and depressive symptoms. Food-intake patterns were measured from a laboratory test meal (9,385 kcal). Latent factor analysis of depressive symptoms and trait anxiety was used to compute latent trait NA. Multivariate general linear models predicted total energy, snacks, and macronutrient intake from trait NA, adjusting for age, race, height, lean-mass, and percentage fat-mass.

RESULTS

Trait NA was significantly positively related to total energy-intake, and, specifically, snacks, sweet snacks, and percentage sweet fats (ps ≤ .03), and negatively related to percentage protein consumed (p = .04).

DISCUSSION

Expanding on affect theory, trait NA may relate to palatable food-intake among girls with LOC-eating. Further data are needed to determine whether those with LOC-eating and trait NA are at heightened risk for the development of binge-eating disorder and obesity.

Examining associations between emotion-based rash action and dysregulated eating symptoms in men and women

Negative urgency (NU: tendency to act rashly when distressed) is the facet of impulsive personality that has been most predictive of binge eating, but less is known about the relative role of positive urgency (PU: tendency to act rashly in response to positive emotions). In addition, most studies have exclusively focused on women and the examination of pathological eating outcomes, using a dimensional symptom approach, has been somewhat limited. This study aimed to replicate and extend upon prior work. We examined the extent to which NU and/or PU are uniquely associated with dysregulated eating, using a latent factor comprised of dimensional symptoms, and directly tested whether effects differ by sex. Two independent cross-sectional samples of women and men were used (Sample 1: Midwestern university, 437 females, 348 males; Sample 2: Southwestern university, 301 females, 236 males). NU and PU were assessed with the UPPS-P Impulsive Behavior Scale, and dysregulated eating symptoms (i.e., binge eating, loss of control eating, eating concerns) were assessed with well-validated self-report questionnaires. Although both NU and PU showed significant positive associations with dysregulated eating, NU showed the strongest unique relationship with dysregulated eating in both samples. The relative role of PU was weakened in Sample 1 and completely attenuated in Sample 2 once its shared variance with NU was accounted for. All results were similar in men and women. Overall, findings continue to suggest that NU is the form of impulsivity that is most relevant to dysregulated eating in both men and women.

The Effect of a Maternal Mediterranean Diet in Pregnancy on Insulin Resistance is Moderated by Maternal Negative Affect

There is inconsistent evidence that healthy dietary interventions can effectively mitigate the risk of adverse outcomes associated with elevated insulin resistance in pregnancy, suggesting that other moderating factors may be at play. Maternal psychological state is an important factor to consider in this regard, because stress/mood state can directly influence glycemia and a bidirectional relationship may exist between nutrition and psychological state. The objective of this study was to examine the interaction between maternal negative affect and diet quality on third trimester insulin resistance. We conducted a prospective longitudinal study of N = 203 women with assessments in early and mid-pregnancy, which included an ecological momentary assessment of maternal psychological state, from which a negative affect score (NAS) was derived, and 24-h dietary recalls, from which the Mediterranean Diet Score (MDS) was computed. The homeostasis model assessment of insulin resistance (HOMA-IR) was computed from third trimester fasting plasma glucose and insulin values. Early pregnancy MDS was inversely associated with the HOMA-IR, but this did not maintain significance after adjusting for covariates. There was a significant effect of the mid-pregnancy MDS*NAS interaction term with the HOMA-IR in the adjusted model, such that a higher negative affect was found to override the beneficial effects of a Mediterranean diet on insulin resistance. These results highlight the need to consider nutrition and affective state concurrently in the context of gestational insulin resistance.

Emotional disorder symptoms, anhedonia, and negative urgency as predictors of hedonic hunger in adolescents

Affect and reward are associated with unhealthy eating and weight; however, less research has examined affective predictors of hedonic hunger (i.e., extreme reward responsivity, pleasure toward, and drive for food), particularly among adolescents. Whether symptoms indicative of emotional disturbance increase risk of adverse reward-based eating-related symptoms such as hedonic hunger, is unknown. Such evidence could explain why emotional problems increase risk of eating and weight problems among adolescents, when eating-related health problems often originate. This report examined baseline emotional disorder symptoms, negative urgency (i.e., tendency to act impulsively in response to negative affect), and anhedonia (i.e., loss of interest in activities and decreased pleasure) as prospective predictors of increases in hedonic hunger in adolescents; associations between changes in emotional disturbance problems and hedonic hunger were also examined. Ninth-grade students (N = 2598) from high schools completed paper-and-pencil surveys at baseline and a 1-year follow-up. In a multivariable model controlling for the covariance of emotional problems, higher negative urgency, general anxiety, and obsessive-compulsive symptoms, and lower anhedonia at baseline independently predicted increases in hedonic hunger one year later. Also, increases in negative urgency, general anxiety, and obsessive-compulsive symptoms and decreases in anhedonia independently predicted increases in hedonic hunger. Affect- and reward-related variables may be important contributors to risk of hedonic hunger in adolescence.

From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders

PURPOSE OF REVIEW

Ambulatory assessment methods, including ecological momentary assessment (EMA), have often been used in eating disorders (EDs) to assess the type, frequency, and temporal sequencing of ED symptoms occurring in naturalistic environments. Relatedly, growing research in EDs has explored the utility of ecological momentary interventions (EMIs) to target ED symptoms. The aims of the present review were to (1) synthesize recent literature pertaining to ambulatory assessment/EMA and EMI in EDs, and (2) identify relevant limitations and future directions in these domains.

RECENT FINDINGS

With respect to ambulatory assessment and EMA, there has been substantial growth in the expansion of constructs assessed with EMA, the exploration of state- vs. trait-level processes, integration of objective and passive assessment approaches, and consideration of methodological issues. The EMI literature in EDs also continues to grow, though most of the recent research focuses on mobile health (mHealth) technologies with relatively minimal EMI components that adapt to momentary contextual information. Despite these encouraging advances, there remain several promising areas of ambulatory assessment research and clinical applications in EDs going forward. These include integration of passive data collection, use of EMA in treatment evaluation and design, evaluation of dynamic system processes, inclusion of diverse samples, and development and evaluation of adaptive, tailored EMIs such as just-in-time adaptive interventions. While much remains to be learned in each of these domains, the continual growth in mobile technology has potential to facilitate and refine our understanding of the nature of ED psychopathology and ultimately improve intervention approaches.

A multimodal, naturalistic investigation of relationships between behavioral impulsivity, affect, and binge eating

While binge eating is associated with both emotion regulation deficits and cognitive control impairments related to impulsivity, thus far research has not examined how dimensions of behavioral impulsivity may influence momentary relationships between affect and binge-eating episodes. The present study utilized multimodal methods to examine the extent to which individual differences in impulsive choice (i.e., delay and probabilistic discounting) and impulsive action (i.e., response inhibition) moderated momentary relationships between negative and positive affect (NA and PA) and binge eating measured in the natural environment. Participants were 30 adult women with binge-eating symptoms who completed measures of behavioral impulsivity (i.e., Monetary Choice Questionnaire, Cued Go/No-Go task, Game of Dice Task), followed by a 14-day ecological momentary assessment protocol during which they reported affect levels and binge-eating episodes. Results of generalized estimating equations indicated that greater delay discounting (i.e., preference for immediate, yet smaller rewards) strengthened momentary relationships between both PA and NA and binge eating. However, and unexpectedly, the relationship between momentary PA and binge eating was negative among individuals with greater Cued Go/No-go commission errors, suggesting that higher PA actually attenuated risk of binge episode occurring in these individuals. Together these findings highlight important distinctions between facets of behavioral impulsivity as well as their relationships with affect valence and intensity in predicting binge episodes. Specifically, temporal rather than probabilistic discounting may be most relevant to momentary processes that contribute to binge eating, and promotion of momentary positive affect may be helpful for individuals with poorer response inhibition.

Pediatric Obesity and Eating Disorders Symptoms: The Role of the Multidisciplinary Treatment. A Systematic Review

The prevalence of obesity in children/adolescents has increased worldwide during the past 30 years, becoming a significant public health concern; prevention, and management of pediatric obesity onset is one of the most critical public health goals for both industrialized and developing countries. Pediatric obesity has been identified as a risk factor for various psychopathologies, including eating disorders (ED). Although it has been demonstrated that a comprehensive multidisciplinary treatment (MT), with small steps and practical approaches to lifestyle change, can be an effective treatment for children and adolescents with obesity, to the best of our knowledge, this is the first systematic review investigating the effect of MT on the development, progression or decrease of ED symptoms (EDS) in this target population. PubMed and Web of Science databases were searched (last search on 18 February 2019) according to a predetermined search strategy, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement. Original studies published in English examining the effect of MT on pediatric overweight/obesity, paying particularly attention at the development of EDS, were eligible for inclusion. Seven hundred and forty-four records have been identified; nine articles with study quality ranging from weak to moderate have been included. MTs were heterogeneous in nature including length, number, frequency and type of sessions, parent-involvement and use of technology, besides several psychometric questionnaires were used to screen for EDS, since there are no standardized criteria. In 3 studies there was a significant decrease in external and emotional eating and in four studies a significant increase in restraint eating post MT. Two studies found a significant decrease of binge eating symptoms and other two studies showed an improvement of self-perception, weight, and shape concern. A statistical significant decrease in BMI, BMIz, BMISDS, and adjusted BMI was observed after all MTs, except one. A narrative summary of the evidences reported highlighted the positive impact of MT on the EDS. Moreover, since weight loss post MTs was not necessarily related to EDS, clinicians should also look for the presence of EDS and treat them accordingly.

Momentary predictors of binge eating: An attachment perspective

INTRODUCTION

According to attachment theory, individuals who are preoccupied with the possibility of rejection are prone to emotion dysregulation, which research has found to be related to disordered eating. The current study examined naturalistic momentary relationships between binge eating, depressive symptoms, emotion dysregulation, and attachment anxiety.

METHOD

Participants were 55 undergraduate women who owned a mobile phone and who had binge eaten at least once during the past 28 days. All participants were screened to confirm the presence of binge eating and then completed trait measures of attachment anxiety. Participants then received seven text messages per day for 14 days. Texts contained links to state measures of depressive symptoms, state emotion dysregulation, and recent binge eating.

RESULTS

Momentary depressive symptoms predicted subsequent binge eating. Aspects of emotion dysregulation (i.e., nonacceptance of emotional responses and difficulty modulating one's emotions) mediated the relationship between attachment anxiety and binge eating.

DISCUSSION

Depressed mood often triggers binge eating. Additionally, attachment anxiety seems to predict binge eating through emotion dysregulation. Interventions for binge eating should address both attachment anxiety and emotion dysregulation in order to maximize therapeutic benefit.

The Association among Emotions and Food Choices in First-Year College Students Using mobile-Ecological Momentary Assessments

Background

Studies have examined the associations between emotions and overeating but have only rarely considered associations between emotions and specific food choices. The purpose of this secondary data analysis was to use mobile ecological momentary assessments (mEMAs) to examine associations between emotions and food choices among first-year college students living in residence halls.

Methods

Using an intensive repeated-measures design, mEMAs were used to assess concurrent emotions and food choices in a racially/ethnically diverse sample of first-year college students (n = 663). Emotions were categorized as negative (sad, stressed, tired), positive (happy, energized, relaxed), and apathetic (bored, meh). Assessments were completed multiple times per day on four quasi-randomly selected days (three random weekdays and one random weekend day) during a 7-day period using random prompt times. Generalized estimating equations (GEE) were used to examine between- and within-person associations of emotional status with a variety of healthy and unhealthy food choices (sweets, salty snacks/fried foods, fruits/vegetables, pizza/fast food, sandwiches/wraps, meats/proteins, pasta/rice, cereals), adjusting for gender, day of week, and time of day, accounting for within-person dependencies among repeated measurements of eating behavior.

Results

At the between-person level, participants who reported positive emotions more frequently compared to others consumed meats/proteins more often (OR = 1.8; 99% CI = 1.2, 2.8). At the within-person level, on occasions when any negative emotion was reported (versus no negative emotion reported) participants were more likely to consume meats/proteins (OR = 1.5, 99% CI = 1.0, 2.1); on occasions when any positive emotion was reported as compared to occasions with no positive emotions, participants were more likely to consume sweets (OR = 1.7, 99% CI = 1.1, 2.6), but less likely to consume pizza/fast food (OR = 0.6, 99% CI = 0.4, 1.0).

Conclusions

Negative and positive emotions were significantly associated with food choices. mEMA methodology provides a unique opportunity to examine these associations within and between people, providing insights for individual and population-level interventions. These findings can be used to guide future longitudinal studies and to develop and test interventions that encourage healthy food choices among first-year college students and ultimately reduce the risk of weight gain.