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Jenkins PE, Proctor K, Snuggs S. Dietary intake of adults with eating disorders: A systematic review and meta-analysis. J Psychiatr Res 2024; 175:393-404. [PMID: 38772131 DOI: 10.1016/j.jpsychires.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Studies have confirmed the link between altered dietary intake and eating disorders (EDs), although no systematic assessment of this research exists. Rigorous synthesis of dietary intake in anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and similar EDs is needed to explore similarities and differences. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we conducted a systematic review and quantitative synthesis of studies of dietary intake. Searches of three electronic databases resulted in thirty-nine included studies. Meta-analyses of subsets of these studies were undertaken to summarise macronutrient intake across AN, BN, and BED. Study quality was assessed using the American Academy of Nutrition and Dietetics Quality Criteria Checklist, with ratings either Positive (k = 27) or Neutral (k = 12). Adults with AN had low energy intake and those with BED reported elevated macronutrient intake. Individuals with BN reported wide variation in energy intake, including some of the highest estimates. Individuals with AN were likely to under-consume key micronutrients, with sodium potentially over-consumed in BN and BED. Vitamin D was under-consumed across all disorders. This meta-analysis highlights important diagnostic differences and synthesises dietary intake in EDs, with particular relevance to risk assessment and treatment.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom.
| | - Katy Proctor
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
| | - Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6ES, UK, United Kingdom
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2
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Mason TB, Morales JC, Smith A, Smith KE. Factor Structure, Reliability, and Convergent Validity of an Ecological Momentary Assessment Binge-Eating Symptoms Scale. Eval Health Prof 2024:1632787241249500. [PMID: 38670932 DOI: 10.1177/01632787241249500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
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.
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3
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Nechita DM, David D. Shame facets as predictors of problematic eating behaviors: An ecological momentary assessment study. Behav Res Ther 2023; 168:104381. [PMID: 37542804 DOI: 10.1016/j.brat.2023.104381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/09/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
It is well-established that negative affect acts as predictor and maintenance factor of problematic eating behaviors. However, the relevance of different facets of negative affect is unclear. While guilt was consistently shown as having a relevant contribution in relation with problematic eating patterns, shame might play a similar role. The current study used an ecological momentary assessment design to assess associations between facets of shame and subsequent disturbed eating behaviors. The study included 57 females with high levels of eating disorders (ED) symptomatology who completed five surveys per day for 14 consecutive days. Participants completed measures of facets of shame (i.e., general shame, body shame, shame around eating), negative affect and problematic eating behaviors (i.e., binge eating, restriction, weighting, body checking, purging, taking laxative/diuretics and excessive exercise). Data were analyzed using multilevel models. In general, between-subjects facets of shame were associated with more disturbed eating behaviors, with shame explaining a significantly and clinically relevant percent of the variance of these problematic eating behaviors. At the within-subject level, facets of shame predicted subsequent binge eating, body checking and excessive exercise. These findings support the role of shame in ED symptomatology and the relevance of directly tackling shame in psychological treatments.
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Affiliation(s)
- Diana-Mirela Nechita
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania
| | - Daniel David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania.
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Levine MD, Tavernier RLE, Conlon RPK, Grace JL, Sweeny GM, Wang B, Cheng Y. Loss of control eating during pregnancy is associated with excessive gestational weight gain among individuals with overweight and obesity. BMC Pregnancy Childbirth 2023; 23:340. [PMID: 37173628 PMCID: PMC10176920 DOI: 10.1186/s12884-023-05618-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) predicts negative health outcomes among individuals with overweight or obesity. Loss of control eating (LOC), the ingestion of food associated with being unable to control eating, is the core psychopathology of binge eating disorders. We evaluated the contribution of LOC to GWG among pregnant individuals with prepregnancy overweight/obesity. METHODS In a prospective longitudinal study, individuals with prepregnancy BMI ≥ 25 (N = 257) were interviewed monthly to assess LOC and reported demographic, parity, and smoking information. GWG was abstracted from medical records. RESULTS Among individuals with prepregnancy overweight/obesity, 39% endorsed LOC prior to or during pregnancy. After adjusting for factors that have previously been linked to GWG, LOC during pregnancy, uniquely predicted higher GWG and greater likelihood of exceeding GWG recommendations. Participants with prenatal LOC gained 3.14 kg (p = 0.03) more than did those without LOC during pregnancy and 78.7% (n = 48/61) exceeded IOM guidelines for GWG. The frequency of LOC episodes was also associated with greater weight gain. CONCLUSIONS Prenatal LOC is common among pregnant individuals with overweight/obesity and predicts greater GWG and increased likelihood of exceeding IOM GWG guidelines. LOC may represent a modifiable behavioral mechanism to prevent excessive GWG among individuals at risk for adverse pregnancy outcomes.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Rebecca L Emery Tavernier
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel P K Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Jennifer L Grace
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gina M Sweeny
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bang Wang
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu Cheng
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
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Moraes CEFD, Antunes MML, Mourilhe C, Sichieri R, Hay P, Appolinario JC. Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City. Nutrients 2023; 15:nu15071573. [PMID: 37049413 PMCID: PMC10096673 DOI: 10.3390/nu15071573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/11/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old-60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE.
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Affiliation(s)
- Carlos Eduardo Ferreira de Moraes
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2750, Australia
| | - Marina Maria Leite Antunes
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Carla Mourilhe
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute (IMS), State University of Rio de Janeiro (UERJ), Rio de Janeiro 28625-570, Brazil
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2750, Australia
- Mental Health Services, South West Sydney Local Health District (SWSLHD), Campbelltown, NSW 2560, Australia
| | - Jose Carlos Appolinario
- Group of Obesity and Eating Disorders (GOTA), Psychiatry Institute (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
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6
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Alshurafa NI, Stump TK, Romano CS, F. Pfammatter A, Lin AW, Hester J, Hedeker D, Forman E, Spring B. Rationale and design of the SenseWhy project: A passive sensing and ecological momentary assessment study on characteristics of overeating episodes. Digit Health 2023; 9:20552076231158314. [PMID: 37138585 PMCID: PMC10150430 DOI: 10.1177/20552076231158314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 05/05/2023] Open
Abstract
Objectives Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors (e.g., stress eating), as well as new phenotypes based on social and psychological features. Method Up to 60 adults with obesity in the Chicagoland area will be recruited for a 14-day free-living observational study. Participants will complete ecological momentary assessments and wear 3 sensors designed to capture features of overeating episodes (e.g., chews) that can be visually confirmed. Participants will also complete daily dietitian-administered 24-hour recalls of all food and beverages consumed. Analysis Overeating is defined as caloric consumption exceeding 1 standard deviation of an individual's mean consumption per eating episode. To identify features that predict overeating, we will apply 2 complementary machine learning methods: correlation-based feature selection and wrapper-based feature selection. We will then generate clusters of overeating types and assess how they align with clinically meaningful overeating phenotypes. Conclusions This study will be the first to assess characteristics of eating episodes in situ over a multiweek period with visual confirmation of eating behaviors. An additional strength of this study is the assessment of predictors of problematic eating during periods when individuals are not on a structured diet and/or engaged in a weight loss intervention. Our assessment of overeating episodes in real-world settings is likely to yield new insights regarding determinants of overeating that may translate into novel interventions.
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Affiliation(s)
- Nabil I. Alshurafa
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Tammy K. Stump
- Department of Dermatology, University
of Utah, Salt Lake City, UT, USA
| | - Christopher S. Romano
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Angela F. Pfammatter
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Annie W. Lin
- Department of Nutrition, Benedictine University, Lisle, IL, USA
| | - Josiah Hester
- Department of Electrical and Computer
Engineering, McCormick School of Engineering and
Applied Science, Northwestern University, Evanston, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences,
University of Chicago, Chicago, IL, USA
| | - Evan Forman
- Department of Psychological and Brain
Sciences, Drexel University, Philadelphia, PA, USA
- Center for Weight, Eating and Lifestyle
Sciences, Drexel University, Philadelphia, PA, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
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Wiklund CA, Igudesman D, Kuja-Halkola R, Bälter K, Thornton LM, Bulik CM. Intake and adherence to energy and nutrient recommendations among women and men with binge-type eating disorders and healthy controls. Clin Nutr ESPEN 2022; 48:186-195. [PMID: 35331490 PMCID: PMC9744359 DOI: 10.1016/j.clnesp.2022.02.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Research quantifying dietary intake in individuals with bulimia nervosa and binge-eating disorder (i.e., binge-type eating disorders) is surprisingly scant. We assessed the dietary intake of women and men with binge-type eating disorders in a large case-control study and compared them with healthy controls. We also evaluated the extent to which their dietary intake adhered to the Nordic Nutrition Recommendations. Among cases, we assessed the relationship of binge eating frequency with energy and macronutrient intake. METHODS We derived the total daily energy, macro-, and micronutrient intake of 430 cases with binge-type eating disorders (women: n = 391, men: n = 39) and 1227 frequency-matched controls (women: n = 1,213, men: n = 14) who completed the MiniMeal-Q, a validated food frequency questionnaire. We calculated mean intake for men and women and, in women, compared mean intake of energy and nutrients between cases and controls using linear regression. We calculated the proportion of women and men who met the recommended intake levels from the NNR, and compared these proportions in female cases and controls using logistic regression. We used linear regression to examine energy and macronutrient intake of women with varying frequencies of current binge-eating. RESULTS Female, but not male cases, had a higher mean intake of total energy/day compared with controls and higher intake than recommended. The majority in all groups (male and female cases and controls) exceeded saturated fat recommendations, and did not meet recommendations for omega-3 fatty acid intake. Among all groups, adherence was low for vitamin D, selenium, and salt. Iron and folate intake was low among the majority of women, especially controls. Female cases with ≥4 binge-eating episodes in the past 28 days had higher intake of energy and percent carbohydrates, and lower intake of percent fat, compared to cases with no binge-eating episodes in the past month. CONCLUSIONS Higher than recommended total daily energy intake among women with binge-type eating disorders may lead to weight gain and downstream health complications, if persistent. In most women, iron and folate intake was insufficient, which may have negative consequences for reproductive health. We found suboptimal adherence for key nutrients that are important to limit (saturated fat and salt) or meet (omega-3 fatty acids) for cardiovascular and overall health in all groups. Nutrition counseling should form an important pillar of treatment to assist with normalization of eating patterns and may also benefit individuals without eating disorders to optimize nutrient intake for long term health promotion.
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Affiliation(s)
- Camilla A. Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Katarina Bälter
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden,School of Health, Care and Social Welfare, Division of Public Health Sciences, Mälardalen University, Sweden
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden,Department of Nutrition, University of North Carolina at Chapel Hill, USA,Department of Psychiatry, University of North Carolina at Chapel Hill, USA
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8
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Mason TB, Smith KE, Anderson LM, Hazzard VM. Anhedonia, positive affect dysregulation, and risk and maintenance of binge-eating disorder. Int J Eat Disord 2021; 54:287-292. [PMID: 33295671 PMCID: PMC8673784 DOI: 10.1002/eat.23433] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 11/12/2022]
Abstract
Low positive affect has been identified as an antecedent of binge-eating episodes among individuals with binge-eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward-related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating- and weight-related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research-including methodological/measurement, theoretical, and clinical research directions.
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Affiliation(s)
- Tyler B. Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Kathryn E. Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
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9
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Mourilhe C, Moraes CED, Veiga GD, Q da Luz F, Pompeu A, Nazar BP, Coutinho ESF, Hay P, Appolinario JC. An evaluation of binge eating characteristics in individuals with eating disorders: A systematic review and meta-analysis. Appetite 2021; 162:105176. [PMID: 33639247 DOI: 10.1016/j.appet.2021.105176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 12/16/2020] [Accepted: 02/19/2021] [Indexed: 01/29/2023]
Abstract
The objective of this review is to provide an updated synthesis of studies in individuals with eating disorders that examined the following components of binge eating episodes (BEEs): caloric intake, episode duration, and also the association of BEE size with psychopathology. A systematic review and meta-analysis were performed following the PRISMA guidelines. Searches were conducted on PubMed, PsycINFO, Scopus, SciELO, ScienceDirect and ProQuest databases. Meta-analysis was performed using random effects models and meta-regression. Forty-three studies were included. There was a paucity of information regarding BEE in individuals with anorexia nervosa. The pooled caloric intake of participants with bulimia nervosa (BN) during BEE in laboratory studies was significantly greater in comparison to the caloric intake during BEE in clinical studies [(3070 (95%CI 2596, 3544) vs. 1789 (95%CI 1498, 2081)], respectively. In participants with binge eating disorder (BED), the pooled means were 2088 (95%CI 1819, 2358) kcal in laboratory studies and 1903 (95%CI 1622, 2184) kcal in clinical studies, with no statistically significant difference between groups. Overall, BEE had a mean duration of 37.3 min in participants with BN and 41.7 min in those with BED. We found a positive correlation between the average caloric intake and level of depression (β = 55.5; p = 0.019). BEE in individuals with BN or BED were characterized by the consumption of extremely large quantities of calories. This was mainly found in laboratory studies of individuals with BN. BEE had a mean duration of less than 1 h in individuals with BN or BED. BEE size was positively associated with depression severity. Future research should explore the relevance of binge size as a core component of binge eating in clinical samples, in males, and in pediatric populations.
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Affiliation(s)
- Carla Mourilhe
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Institute of Nutrition Josue de Castro, Department of Social and Applied Nutrition - Av. Carlos Chagas Filho, 373 - bloco J, 2° andar - Cidade Universitária, CEP:21941-902, Rio de Janeiro, Brazil.
| | - Carlos EduardoFerreira de Moraes
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
| | - GloriaValeria da Veiga
- Federal University of Rio de Janeiro, Institute of Nutrition Josue de Castro, Department of Social and Applied Nutrition - Av. Carlos Chagas Filho, 373 - bloco J, 2° andar - Cidade Universitária, CEP:21941-902, Rio de Janeiro, Brazil.
| | - Felipe Q da Luz
- University of São Paulo, Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), São Paulo, SP 05403-010, Brazil.
| | - Amanda Pompeu
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
| | - Bruno Palazzo Nazar
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
| | - Evandro Silva Freire Coutinho
- The State University of Rio de Janeiro, Institute of Social Medicine - R. São Francisco Xavier, 524 - Maracanã, CEP:20550-900, Rio de Janeiro, Brazil.
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, School of Medicine - David Pilgrim Avenue, Campbelltown, NSW 2560, Australia.
| | - Jose Carlos Appolinario
- Federal University of Rio de Janeiro, Institute of Psychiatry, Obesity and Eating Disorders Group - Av. Venceslau Brás, 71, Botafogo, CEP:22290-140, Rio de Janeiro, Brazil.
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10
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Dietary patterns of patients with binge eating disorders with and without night eating. Eat Weight Disord 2020; 25:321-328. [PMID: 30327996 DOI: 10.1007/s40519-018-0590-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE This study aimed to compare dietary patterns (timing and frequency of binge episodes, caloric intake and macronutrient composition) of patients with binge eating disorders (BE) with and without night eating syndrome (NES). DESIGN The study includes 59 women (18-60) who sought treatment for Eating Disorders (EDs) and were diagnosed with BED or BN (BE) with or without NES. They were divided into two groups: NES-BE and BE-only. The participants kept 7-day, 24-h food diaries and completed demographic and depression questionnaires. RESULTS NES-BE reported significantly a higher frequency of binge days and binge episodes during the week, and more energy and fat consumption than BE-only. CONCLUSIONS Individuals with NES-BE exhibit higher levels of eating pathology than individuals with BE-only. Thus, NES-BE may not be simply a variant of BED or BN but rather a separate entity that may lead to a more severe disorder and require early assessment and more intensive and suitable treatment. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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11
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Dochat C, Godfrey KM, Golshan S, Cuneo JG, Afari N. Dietary restraint and weight loss in relation to disinhibited eating in obese Veterans following a behavioral weight loss intervention. Appetite 2019; 140:98-104. [PMID: 31078701 PMCID: PMC6581621 DOI: 10.1016/j.appet.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 01/21/2023]
Abstract
Ability to restrain one's dietary intake is a necessary skill for weight loss. However, dietary restraint has been shown to paradoxically increase disinhibited eating in certain populations, thereby negatively impacting weight loss and leading to worse overall health outcomes. The aim of this study was to address gaps in the literature regarding the relationships between separate facets of dietary restraint (intention; behavior) with weight loss and various types of disinhibited eating (binge eating, external eating, emotional eating) in overweight and obese adults who recently completed a weight loss intervention. A sample of mostly male Veterans with overweight and obesity (N = 88) self-reported their dietary restraint intention, restraint behavior, and current disinhibited eating following completion of an 8-week behavioral weight loss treatment. Greater dietary restraint intention was related to greater dietary restraint behavior, p < .05. Greater dietary restraint behavior was significantly related to greater recent weight loss, p < .05, while restraint intention was not, p > .05. Greater dietary restraint intention was related to greater current binge eating and external eating, while greater self-reported restraint behavior was related to less binge eating, p < .05. Thus, dietary restraint behavior appears to be adaptive for this population, whereas rigid dietary restraint intention may increase risk for disinhibited eating. To decrease disinhibited eating and improve weight loss outcomes in Veterans, interventions might specifically address rigid rule-following associated with abandonment of weight loss goals and help Veterans develop specific yet flexible eating plans. Future research should examine whether dietary restraint intention and behavior differentially predict disinhibited eating and weight loss outcomes prospectively.
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Affiliation(s)
- Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Kathryn M Godfrey
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Jessica Gundy Cuneo
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, USA.
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12
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Abstract
The Risk factors for Binge Eating Disorder in Overweight (REO) questionnaire is a screening tool for nutritionists to discriminate between individuals with obesity with and without Binge Eating Disorder (BED). The first study tested the discriminative ability of the REO and identified an optimal cut-off value. In the second study this cut-off value was used to identify individuals with and without BED from a sample of individuals with obesity visiting a nutritionist and compared clinical and personality characteristics with a group of individuals officially diagnosed with BED. Results showed that the REO has a sensitivity of 95.1%, specificity of 81.5%, a good internal consistency of α=.96, and an exploratory factor analysis showed four underlying factors of the REO that explained a total variance of 63.7%. Characteristics of individuals with BED symptoms identified by the REO and those officially diagnosed with BED were comparable and differed from individuals with obesity without BED symptoms. By screening individuals with obesity with the REO those presenting with BED symptoms are more easily identified, and can be referred to psychological treatment facilities for further assessment and appropriate treatment.
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13
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Strahler J, Nater UM. Differential effects of eating and drinking on wellbeing—An ecological ambulatory assessment study. Biol Psychol 2018; 131:72-88. [DOI: 10.1016/j.biopsycho.2017.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/07/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
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14
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Goldschmidt AB, Crosby RD, Cao L, Pearson CM, Utzinger LM, Pacanowski CR, Mason TB, Berner LA, Engel SG, Wonderlich SA, Peterson CB. Contextual factors associated with eating in the absence of hunger among adults with obesity. Eat Behav 2017; 26:33-39. [PMID: 28131964 PMCID: PMC5735853 DOI: 10.1016/j.eatbeh.2017.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Abstract
Eating in the absence of hunger (EAH) is under-explored in adults with obesity. In this study, 50 adults with obesity recorded eating episodes and theoretically-relevant environmental, perceptual, and emotional correlates in the natural environment for 2weeks via ecological momentary assessment (EMA). Generalized linear models and mixed models were used to characterize correlates and consequences of EAH vs. non-EAH episodes/tendencies (within-subjects and between-subjects effects, respectively), time of day, and time of day×EAH interactions. Approximately 21% of EMA-recorded eating episodes involved EAH, and 70% of participants reported at least 1 EAH episode. At the within-person level, participants' EAH episodes were associated with greater self-labeled overeating than their non-EAH episodes. At the between-person level, participants who tended to engage in more EAH reported less self-labeled overeating than those who engaged in less EAH. Across EAH and non-EAH episodes, eating in the evening was associated with overeating, expecting eating to be more rewarding, greater alcoholic beverage consumption, eating alone, eating because others are eating, and eating while watching television. Significant EAH×time of day interactions were also observed but the pattern of findings was not consistent. Findings suggest that EAH may be a relevant target for reducing food intake in individuals with obesity given its high prevalence and association with perceptions of overeating, although results should be extended using objective measures of food intake. Associations between evening eating episodes and perceptual and environmental factors should be further explored.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Ross D. Crosby
- Department of Biostatistics, Neuropsychiatric Research Institute, Fargo, ND, USA,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Li Cao
- Department of Biostatistics, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Carolyn M. Pearson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Linsey M. Utzinger
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Carly R. Pacanowski
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Tyler B. Mason
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Laura A. Berner
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Scott G. Engel
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Stephen A. Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
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15
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Segura-Garcia C, Caroleo M, Rania M, Barbuto E, Sinopoli F, Aloi M, Arturi F, De Fazio P. Binge Eating Disorder and Bipolar Spectrum disorders in obesity: Psychopathological and eating behaviors differences according to comorbidities. J Affect Disord 2017; 208:424-430. [PMID: 27846411 DOI: 10.1016/j.jad.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/05/2016] [Accepted: 11/06/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity is not a mental disorder, yet DSM-5 recognizes a strong association between obesity and psychiatric syndromes. Disorders within the Bipolar Spectrum (BSD) and Binge Eating Disorder (BED) are the most frequent psychiatric disorders among obese patients. The aim of this research is to investigate the psychopathological differences and the distinctive eating behaviors that accompany these comorbidities in obese patients. METHODS One hundred and nineteen obese patients (40 males; 79 females) underwent psychological evaluation and psychiatric interview, and a dietitian evaluated their eating habits. Patients were divided into four groups according to comorbidities, and comparisons were run accordingly. RESULTS Forty-one percent of participants presented BED+BSD comorbidity (Group 1), 21% BED (Group 2) and 8% BSD (Group 3); only 29% obese participants had no comorbidity (Group 4). Female gender was overrepresented among Groups 1 and 2. BSD diagnosis varied according to comorbidities: Type II Bipolar Disorder and Other Specified and Related Bipolar Disorder (OSR BD) were more frequent in Group 1 and Type I Bipolar Disorder in Group 3. A trend of decreasing severity in eating behaviors and psychopathology was evident according to comorbidities (Group 1=Group2>Group3>Group 4). LIMITATIONS Limitations include the small sample size and the cross-sectional design of the study. CONCLUSIONS BED and BSD are frequent comorbidities in obesity. Type II Bipolar Disorder and OSR BD are more frequent in the group with double comorbidity. The double comorbidity seems associated to more severe eating behaviors and psychopathology. Distinctive pathological eating behaviors could be considered as warning signals, symptomatic of psychiatric comorbidities in Obesity.
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Affiliation(s)
| | - Mariarita Caroleo
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Barbuto
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Flora Sinopoli
- Dietetic Service, University Hospital Mater Domini, Catanzaro, Italy
| | - Matteo Aloi
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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16
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Abstract
Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that it is not merely a subtype of obesity.
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Affiliation(s)
- C Brendan Montano
- a Connecticut Clinical Research Center, Private Practice, Internal Medicine , Cromwell , CT , USA
| | - Natalie L Rasgon
- b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA
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17
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Steffen KJ, Engel SG, Wonderlich JA, Pollert GA, Sondag C. Alcohol and Other Addictive Disorders Following Bariatric Surgery: Prevalence, Risk Factors and Possible Etiologies. EUROPEAN EATING DISORDERS REVIEW 2015; 23:442-50. [DOI: 10.1002/erv.2399] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Kristine J. Steffen
- Department of Pharmaceutical Sciences, College of Pharmacy, Nursing, and Allied Sciences; North Dakota State University; Fargo ND USA
- Neuropsychiatric Research Institute; Fargo ND USA
| | | | | | | | - Cindy Sondag
- Department of Neuroscience; University of North Dakota; ND USA
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18
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Racine SE, Burt SA, Keel PK, Sisk CL, Neale MC, Boker S, Klump KL. Examining associations between negative urgency and key components of objective binge episodes. Int J Eat Disord 2015; 48:527-31. [PMID: 25865091 PMCID: PMC4478159 DOI: 10.1002/eat.22412] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Negative urgency (NU; tendency to act impulsively when experiencing negative emotions) is a risk factor for binge eating, although few studies have examined interviewer-assessed objective binge episodes (OBEs). Moreover, research has not investigated how NU relates to the core components of OBEs: loss of control (LOC) eating and objective overeating (OO). Understanding the relationship between NU and these core components will enhance etiologic models of eating disorder development. Thus, the current study examined the associations between NU, OBEs, and the components of OBEs by comparing levels of NU in women with OBEs, LOC eating only, and OO only to women with no pathological eating. METHOD Participants were 612 women who endorsed lifetime OBEs (5.4%), LOC eating outside of OBEs (5.7%), OO only (2.8%), or none of these eating episodes (85.9%). RESULTS Women with OBEs, LOC only, and OO only had significantly higher levels of NU than women without these episodes, suggesting that NU is associated with both the LOC and OO components of OBEs. DISCUSSION NU relates to the spectrum of pathology present in women with OBEs. Future research should examine the mechanisms underlying these associations, including impaired behavioral/psychological control and/or increased reward sensitivity in response to negative affect.
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Affiliation(s)
| | | | | | - Cheryl L. Sisk
- Department of Psychology, Michigan State University,Neuroscience Program, Michigan State University
| | - Michael C. Neale
- Departments of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University
| | - Steven Boker
- Department of Psychology, University of Virginia
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19
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Ranzenhofer LM, Engel SG, Crosby RD, Anderson M, Vannucci A, Cohen LA, Cassidy O, Tanofsky-Kraff M. Using ecological momentary assessment to examine interpersonal and affective predictors of loss of control eating in adolescent girls. Int J Eat Disord 2014; 47:748-57. [PMID: 25046850 PMCID: PMC4557873 DOI: 10.1002/eat.22333] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pediatric loss of control (LOC) eating is predictive of partial- and full-syndrome binge eating disorder. The interpersonal model proposes that LOC eating is used to cope with negative mood states resulting from interpersonal distress, possibly on a momentary level. We therefore examined temporal associations between interpersonal problems, negative affect, and LOC eating among overweight adolescent girls using ecological momentary assessment (EMA). METHOD Thirty overweight and obese (≥85th body mass index (BMI) percentile; BMI: M = 36.13, SD = 7.49 kg/m(2)) adolescent females (Age: M = 14.92, SD = 1.54 y; 60.0% African American) who reported at least two LOC episodes in the past month completed self-report momentary ratings of interpersonal problems, state affect, and LOC eating for 2 weeks. A series of 2-level multilevel models with centering within subjects was conducted. RESULTS Between- and within-subjects interpersonal problems (p's < .05), but not between- (p = .12) or within- (p = .32) subjects negative affect predicted momentary LOC eating. At the between-subjects level, interpersonal problems significantly predicted increases in negative affect (p < 001). DISCUSSION Naturalistic data lend support to the predictive value of interpersonal problems for LOC eating among adolescents. Interventions targeting interpersonal factors on a momentary basis may be useful during this developmental stage.
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Affiliation(s)
- Lisa M. Ranzenhofer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, Maryland,*Correspondence to: Lisa Ranzenhofer, Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology 4301 Jones Bridge Road, Bethesda, MD 20814.
| | - Scott G. Engel
- Neuropsychiatric Research Institute (NRI), Fargo, North Dakota, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Ross D. Crosby
- Neuropsychiatric Research Institute (NRI), Fargo, North Dakota, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Micheline Anderson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, Maryland
| | - Anna Vannucci
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, Maryland
| | - L. Adelyn Cohen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, Maryland
| | - Omni Cassidy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, Maryland
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, Maryland
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20
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Characterization of eating patterns among individuals with eating disorders: What is the state of the plate? Physiol Behav 2014; 134:92-109. [DOI: 10.1016/j.physbeh.2014.02.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 12/28/2022]
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21
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Engel SG, Wonderlich SA, Crosby RD, Mitchell JE, Crow S, Peterson CB, Le Grange D, Simonich HK, Cao L, Lavender JM, Gordon KH. The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 122:709-19. [PMID: 24016011 DOI: 10.1037/a0034010] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study examines the relationship of affect and eating disorder behavior in anorexia nervosa (AN) using ecological momentary assessment. Participants were 118 adult females recruited at three sites from eating disorder treatment centers and community advertisements. All participants met full Diagnostic and statistical manual of mental disorders (4th ed.) criteria or subthreshold criteria for AN. Participants were provided handheld computers and asked to report positive affect, negative affect, loss of control (LOC) eating, purging, exercise, drinking fluids to curb appetite, and weighing one's self multiple times per day as well as dietary restriction once daily over a 2-week interval. Mixed-effects models were used to examine the extent to which affective states predict dietary restriction. In addition, we used two analytic approaches to compare affect before and after other eating disorder behaviors. We found that higher daily ratings of negative affect were associated with a greater likelihood of dietary restriction on subsequent days. When examining the single rating immediately before and after behaviors, we found that negative affect increased significantly after LOC eating, purging, the combination of LOC and eating/purging, and weighing of one's self. Using this same analytic approach, we also found negative affect to decrease significantly after the consumption of fluids to curb appetite and exercise. When examining the covariation of AN behaviors and negative affect assessed multiple times in the hours and minutes before the behaviors, we found negative affect significantly increased before LOC eating, purging, the combination of LOC eating/and purging, and weighing behavior. Negative affect also significantly decreased after the occurrence of these behaviors. These findings are consistent with the idea that that negative affect is potentially a critical maintenance mechanism of some AN symptoms, but that the analytic approach used to examine affect and behavior may have significant implications on the interpretation of findings.
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22
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Schreiber-Gregory DN, Lavender JM, Engel SG, Wonderlich SA, Crosby RD, Peterson CB, Simonich H, Crow S, Durkin N, Mitchell JE. Examining duration of binge eating episodes in binge eating disorder. Int J Eat Disord 2013; 46:810-4. [PMID: 23881639 PMCID: PMC3889648 DOI: 10.1002/eat.22164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The primary goal of this article is to examine and clarify characteristics of binge eating in individuals with binge eating disorder (BED), particularly the duration of binge eating episodes, as well as potential differences between individuals with shorter compared to longer binge eating episodes. METHOD Two studies exploring binge eating characteristics in BED were conducted. Study 1 examined differences in clinical variables among individuals (N = 139) with BED who reported a short (<2 h) versus long (≥ 2 h) average binge duration. Study 2 utilized an ecological momentary assessment design to examine the duration and temporal pattern of binge eating episodes in the natural environment in a separate sample of nine women with BED. RESULTS Participants in Study 1 who were classified as having long duration binge eating episodes displayed greater symptoms of depression and lower self-esteem, but did not differ on other measures of eating disorder symptoms, compared to those with short duration binge eating episodes. In Study 2, the average binge episode duration was approximately 42 min, and binge eating episodes were most common during the early afternoon and evening hours, as well as more common on weekdays versus weekends. DISCUSSION Past research on binge episode characteristics, particularly duration, has been limited to studies of binge eating episodes in bulimia nervosa. This study contributes to the existing literature on characteristics of binge eating in BED.
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Affiliation(s)
- Deanna N. Schreiber-Gregory
- North Dakota State University, Fargo, North Dakota,Correspondence concerning this research article should be sent to:
| | | | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
| | - Steve A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
| | - Carol B. Peterson
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
| | | | - Scott Crow
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
| | - Nora Durkin
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
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Lanza ST, Vasilenko SA, Liu X, Li R, Piper ME. Advancing the understanding of craving during smoking cessation attempts: a demonstration of the time-varying effect model. Nicotine Tob Res 2013; 16 Suppl 2:S127-34. [PMID: 23975881 DOI: 10.1093/ntr/ntt128] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Advancing the understanding of smoking cessation requires a complex and nuanced understanding of behavior change. To this end, ecological momentary assessments (EMA) are now being collected extensively. The time-varying effect model (TVEM) is a statistical technique ideally suited to model processes that unfold as behavior and nicotine dependence change. Coefficients are expressed dynamically over time and are represented as smooth functions of time. METHODS The TVEM approach is demonstrated using data from a smoking-cessation trial. Time-varying effects of baseline nicotine dependence (a time-invariant covariate) and negative affect (a time-varying covariate) on urge to smoke during a quit attempt were estimated for monotherapy, combination therapy, and placebo groups. SAS syntax for conducting TVEM is provided so that readers can adapt it for their research. RESULTS During the first 2 days after quitting, the association between negative affect and craving was significantly stronger among individuals in the placebo group, suggesting an early positive impact of treatment. For the monotherapy and combination therapy groups, during the second week of the quit attempt, baseline dependence was less strongly related to craving compared with the placebo group, indicating a different positive impact of treatments later in the quit attempt. CONCLUSIONS The results reveal information about the underlying dynamics that unfold during a quit attempt and how monotherapy and combination therapy impact those processes. This suggests possible mechanisms to target in an intervention and indicates timepoints that hold the greatest promise for effective treatment. TVEM is a straightforward approach to examining time-varying processes embedded in EMA.
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Affiliation(s)
- Stephanie T Lanza
- Methodology Center, Pennsylvania State University, University Park, PA
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24
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Grenard JL, Stacy AW, Shiffman S, Baraldi AN, MacKinnon DP, Lockhart G, Kisbu-Sakarya Y, Boyle S, Beleva Y, Koprowski C, Ames SL, Reynolds KD. Sweetened drink and snacking cues in adolescents: a study using ecological momentary assessment. Appetite 2013; 67:61-73. [PMID: 23583312 DOI: 10.1016/j.appet.2013.03.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 03/14/2013] [Accepted: 03/16/2013] [Indexed: 11/19/2022]
Abstract
The objective of this study was to identify physical, social, and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods. Students were recruited from high schools with a minimum level of 25% free or reduced cost lunches. Using ecological momentary assessment, participants (N=158) were trained to answer brief questionnaires on handheld PDA devices: (a) each time they ate or drank, (b) when prompted randomly, and (c) once each evening. Data were collected over 7days for each participant. Participants reported their location (e.g., school grounds, home), mood, social environment, activities (e.g., watching TV, texting), cravings, food cues (e.g., saw a snack), and food choices. Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school, being with friends, feeling lonely or bored, craving a drink or snack, and being exposed to food cues. Surprisingly, sweet drink consumption was associated with exercising. Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks. These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions designed to disrupt these food-related, cue-behavior linked habits.
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Affiliation(s)
- Jerry L Grenard
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Blvd. Suite 310, Claremont, CA 91711-3475, USA.
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25
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Pollert GA, Engel SG, Schreiber-Gregory DN, Crosby RD, Cao L, Wonderlich SA, Tanofsky-Kraff M, Mitchell JE. The role of eating and emotion in binge eating disorder and loss of control eating. Int J Eat Disord 2013; 46:233-8. [PMID: 23109227 PMCID: PMC3570734 DOI: 10.1002/eat.22061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Binge eating, defined as the consumption of large amounts of food during which a sense of loss of control (LOC) is experienced, is associated with negative affect. However, there are no data on the experience of LOC after accounting for the effects of negative affect and caloric intake. METHOD Nine adult patients with binge eating disorder (BED) and 13 obese nonbinge eating disorder (NBED) participants carried a palmtop computer for 7 days, rating momentary mood and sense of LOC multiple times each day. Electronic food logs were collected once daily. RESULTS After removing the effects of caloric intake and negative affect, a significant group difference was observed for ratings of LOC between BED and NBED participants. DISCUSSION These findings suggest the experience of LOC in adults with BED is a salient feature of binge episodes, beyond that explained by caloric intake and momentary affect.
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26
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Tanofsky-Kraff M, Bulik CM, Marcus MD, Striegel RH, Wilfley DE, Wonderlich SA, Hudson JI. Binge eating disorder: the next generation of research. Int J Eat Disord 2013; 46:193-207. [PMID: 23354950 PMCID: PMC3600071 DOI: 10.1002/eat.22089] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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27
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Goldschmidt AB, Engel SG, Wonderlich SA, Crosby RD, Peterson CB, Le Grange D, Tanofsky-Kraff M, Cao L, Mitchell JE. Momentary affect surrounding loss of control and overeating in obese adults with and without binge eating disorder. Obesity (Silver Spring) 2012; 20:1206-11. [PMID: 21938073 PMCID: PMC3816927 DOI: 10.1038/oby.2011.286] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Research suggests that loss of control (LOC) while eating (the sense that one cannot control what or how much one is eating) is a more salient feature of binge eating than the amount of food consumed. This study examined the unique contributions of LOC and episode size to negative affect surrounding eating episodes in binge eating disorder (BED) and obesity. Twenty-two obese adults with (n = 9) and without (n = 13) BED completed daily records of eating patterns and mood using ecological momentary assessment (EMA). Linear mixed modeling revealed that across groups, greater premeal self-reported LOC was associated with higher premeal negative affect independent of episode size. For individuals with BED, greater premeal self-reported LOC was associated with higher postmeal negative affect, regardless of the amount of food eaten, whereas for obese controls, the combination of LOC and consumption of large amounts of food was associated with lower postmeal negative affect. Results indicate that LOC, but not the quantity of food consumed, is associated with momentary distress related to aberrant eating in BED. Findings also highlight the need for further research investigating the emotional context surrounding aberrant eating in obese individuals without BED.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA.
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Mitchell JE, Karr TM, Peat C, Wonderlich S, Crosby RD, Engel S, Simonich H. A fine-grained analysis of eating behavior in women with bulimia nervosa. Int J Eat Disord 2012; 45:400-6. [PMID: 21956763 PMCID: PMC4201497 DOI: 10.1002/eat.20961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In the current study, we were interested in developing a typology of eating in patients with bulimia nervosa (BN) based on the size of the eating episode, whether the episode was followed by self-induced vomiting, and the degree of loss of control (LOC) self-reported by participants. METHOD Twenty-one women with BN, purging type, were evaluated using the Nutritional Data System for Research, the Eating Disorders Examination, and the Matrix. RESULTS The most common type of episode resembled what might be termed "normal" eating, which involved the consumption of <1,000 kcal with no sense of LOC and no vomiting. There was an increase in severity of self-assessed LOC in objectively large eating episodes with vomiting. Self-reported hunger prior to eating episodes did not seem to be predictive of subsequent behavior. Most people were engaged in other behaviors while eating. DISCUSSION The results of this study suggest a typology that included primarily four types of eating episodes. The results also suggest that when LOC is assessed on a Likert-scale rather than as a dichotomous variable, there is considerable variability in self-assessed degree of LOC.
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Affiliation(s)
- James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Trisha M. Karr
- Neuropsychiatric Research Institute, Fargo, ND, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Christina Peat
- Neuropsychiatric Research Institute, Fargo, ND, Department of Psychology, University of North Dakota, Grand Forks, ND
| | - Stephen Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, ND, Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
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Masheb RM, Grilo CM, White MA. An examination of eating patterns in community women with bulimia nervosa and binge eating disorder. Int J Eat Disord 2011; 44:618-24. [PMID: 21997425 PMCID: PMC3646558 DOI: 10.1002/eat.20853] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 05/05/2010] [Accepted: 06/27/2010] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To better understand the eating patterns of persons with eating disorders. METHOD This study investigated typical eating behavior (meal frequency and snacking) and atypical eating behavior among 311 community women with on-line questionnaires. Participants were classified with bulimia nervosa (BN; n =39), binge eating disorder (BED; n = 69), or controls (CON; n = 203). RESULTS In terms of typical eating behaviors, the BN group ate significantly fewer meals, particularly lunches, than the other two groups. Atypical eating, such as nibbling, eating double meals and nocturnal eating, was significantly more common in the eating disorder groups. More frequent breakfast consumption was associated with lower BMI in the BED and CON groups, and more frequent meal consumption was associated with less binge eating in the BED group only. DISCUSSION Our study revealed differences in typical and atypical eating patterns, and associations with weight and eating disorder behaviors among eating disorder and control groups.
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Affiliation(s)
- Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
,Correspondence to: Robin M. Masheb, Ph.D., Yale University School of Medicine, PO Box 208098, 301 Cedar Street, 2nd Floor, New Haven, Connecticut 06520-8098.
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
,Department of Psychology, Yale University, New Haven, Connecticut
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Schulz S, Laessle RG. Associations of negative affect and eating behaviour in obese women with and without binge eating disorder. Eat Weight Disord 2010; 15:e287-93. [PMID: 21406953 DOI: 10.1007/bf03325311] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The present study was planned to investigate differences in psychopathological features, eating behaviour and eating habits between obese women with and without BED. It also aimed to identify specific relationships between affective symptoms and eating behaviour in obese women with BED. Eighty-four obese women were studied (40 with BED, 44 non-BED). Psychiatric comorbidities were assessed with the structured diagnostic interview for DSM-IV (SCID). Depressive symptoms were measured with the Beck Depression Inventory (BDI) and anxiety with the state-trait anxiety inventory (STAI). Eating habits (emotional and restrained eating) were assessed by the Dutch eating behaviour questionnaire (DEBQ). Food diaries were used for assessing naturalistic eating behaviour (food intake) and mood before and after food intake. BED subjects exhibited higher levels of comorbidity (in particular mood disorders, anxiety disorders and substance-related disorders), higher depressive symptoms, trait anxiety, external and emotional eating scores than non-BED subjects. Regression analyses revealed that anxiety and emotional eating were significant predictors for BED status. In the BED group, depressive symptoms were significantly related to emotional eating and food intake and negatively related to restraint. Anxiety was significantly related to emotional eating. In general, food intake significantly enhanced mood. Mood was worse on the days with self-reported binge eating episodes than on nonbinge days. These results are discussed with regard to aetiological models for BED and for BED being a distinct diagnostic category separate from obesity.
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Affiliation(s)
- S Schulz
- Department of Clinical and Physiological Psychology, University of Trier, 54286 Trier, Germany
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Sysko R, Hildebrandt T, Wilson GT, Wilfley DE, Agras WS. Heterogeneity moderates treatment response among patients with binge eating disorder. J Consult Clin Psychol 2010; 78:681-90. [PMID: 20873903 PMCID: PMC2948417 DOI: 10.1037/a0019735] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of the study was to explore heterogeneity and differential treatment outcome among a sample of patients with binge eating disorder (BED). METHOD A latent class analysis was conducted with 205 treatment-seeking, overweight or obese individuals with BED randomized to interpersonal psychotherapy (IPT), behavioral weight loss (BWL), or guided self-help based on cognitive behavioral therapy (CBTgsh). A latent transition analysis tested the predictive validity of the latent class analysis model. RESULTS A 4-class model yielded the best overall fit to the data. Class 1 was characterized by a lower mean body mass index (BMI) and increased physical activity. Individuals in Class 2 reported the most binge eating, shape and weight concerns, compensatory behaviors, and negative affect. Class 3 patients reported similar binge eating frequencies to Class 2, with lower levels of exercise or compensation. Class 4 was characterized by the highest average BMI, the most overeating episodes, fewer binge episodes, and an absence of compensatory behaviors. Classes 1 and 3 had the highest and lowest percentage of individuals with a past eating disorder diagnosis, respectively. The latent transition analysis found a higher probability of remission from binge eating among those receiving IPT in Class 2 and CBTgsh in Class 3. CONCLUSIONS The latent class analysis identified 4 distinct classes using baseline measures of eating disorder and depressive symptoms, body weight, and physical activity. Implications of the observed differential treatment response are discussed.
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Affiliation(s)
- Robyn Sysko
- Division of Clinical Therapeutics, The New York State Psychiatric Institute, New York, NY 10032, USA.
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