The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students

Do Weight Perception Transitions in Adolescence Predict Concurrent and Long-Term Disordered Eating Behaviors?

PURPOSE

Perceiving one's weight as "overweight" is associated with disordered eating in adolescence. Yet, it is unknown whether weight perceptions change during adolescence, or whether these weight perception transitions predict disordered eating. This study aims to: (1) characterize weight perception transitions from early to late adolescence among a population-based sample and (2) examine whether weight perception transitions in adolescence predict concurrent and future disordered eating into young adulthood.

METHODS

Eating and Activity in Teens and Young Adults (N = 1,414) survey data were used to examine correlates of weight perception transitions from early (Mage = 14.9 ± 1.6 years) to late adolescence (Mage = 19.4 ± 1.6 years). Adjusted generalized estimating equations were used to determine whether weight perception transitions in adolescence predicted concurrent and future disordered eating in emerging adulthood (Mage = 25.2 ± 1.6 years) and young adulthood (Mage = 31.0 ± 1.6 years).

RESULTS

Weight perceptions were stable from early to late adolescence for 77.2% of adolescents, whereas 15.5% transitioned to perceiving their weight as "overweight" and 7.3% stopped perceiving "overweight" in late adolescence. Perceived "overweight", especially in late adolescence, was associated with higher concurrent and long-term disordered eating up to 10 years later. For example, the predicted prevalence of binge eating in young adulthood among individuals who perceived their weight as "overweight" throughout adolescence was 20.1% compared to 6.6% for those who never perceived their weight as "overweight" in adolescence.

DISCUSSION

Adolescent weight perception was relatively stable in this population-based sample. However, weight perception transitions that involved perceiving "overweight", particularly in late adolescence, were associated with long-term higher risk of disordered eating.

Severity of Binge Eating Behavior among Overweight College Students in Taiwan and Associated Factors

BACKGROUND

Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors.

METHODS

This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis.

RESULTS

The average BES score was 10.67 (SD = 6.66, 0-34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman's rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (rs = -0.14-0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05-6.04 times those of male participants and those without such experiences (p < 0.05).

CONCLUSION

The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy.

A high-fat diet has sex-specific effects on nicotine vapor self-administration in mice

BACKGROUND

Previous investigations have shown that fat-rich diets increase vulnerability to drug dependence, including nicotine. Despite this knowledge, few investigations into the neurochemical mechanisms have been completed. Our objective here was to examine if high-fat diet (HFD) impacted nicotine intake and in parallel examine potential changes in dopamine signaling.

METHODS

Adult male and female C57/BL6J mice were used in nicotine e-vape® self-administration (EVSA) assays after being maintained on a standard diet or HFD for 6 weeks. In a separate cohort of mice, dopamine release in the nucleus accumbens core was examined with fast-scan cyclic voltammetry.

RESULTS

Female mice assigned to HFD exhibited increased nicotine EVSA during low-effort responding (FR1) when compared to standard-diet mice. HFD-assigned mice (male and female) also exhibited reduced active nose pokes in a progressive ratio task. Finally, HFD-mice exhibited reduced phasic dopamine release compared to standard-diet mice.

CONCLUSIONS

These show that fat-rich diets alter nicotine intake (females increase at low effort, males and females decrease at high effort) and this may occur due to HFD-induced decreases in NAc dopamine release.

Unraveling the meaning of weight misperception in a sample of college students: Unaware or body satisfied?

Weight misperception has been seen as a threat to public health. We aimed to understand the meaning of weight misperception by examining associations of weight perception with body satisfaction and body awareness along with healthy ideals and culturally normative body ideals. Undergraduates with higher weights at a Mid-South University (n = 166) completed survey measures that included: weight status perception ("How do you think of yourself in terms of weight?"), self-reported weight and height (used to indicate awareness), current and ideal body size using Figure Rating Scales (FRS), three measures of body satisfaction (difference between current and ideal figures on FRS, Appearance Evaluation subscale of the Multidimensional Body Self-Relations Questionnaire, Body Dissatisfaction subscale of the Eating Disorder Inventory-3). Height and weight were also measured. Thirty percent (n = 49) of participants perceived themselves as 'healthy' weight and 70 % (n = 117) perceived themselves as above healthy weight. In bivariate analyses, there were no significant differences in identification of healthy or culturally normative body ideals by weight perception group. A series of logistic regression models were run to examine associations between weight perception and both BMI awareness and body satisfaction. In unadjusted and adjusted models, increased body satisfaction was associated with reduced odds of perceiving oneself above healthy weight (OR: 0.25, p < 0.001); BMI awareness was not associated with weight misperception. Findings suggest that weight misperception reflects body satisfaction, and not a lack of awareness of body weight/size, definitions of healthy bodies, or culturally normative body ideals. "Correcting" individuals who perceive their bodies as about right has the potential to cause great harm and should be eliminated as a public health goal.

Alexithymia, reward sensitivity and excessive exercise in non-binge-eaters versus severe binge eaters: Implications for primary and secondary exercise dependence

A distinction has been made between primary and secondary exercise dependence, with the latter defined as excessive exercise secondary to disordered eating and weight concerns. Based on theoretical considerations from research on the roles of trait factors in addictions, the present study used validated scales to assess alexithymia, sensitivity to reward and punishment, emotion regulation and interoception in relation to exercise dependence symptoms in Australian male and female non-binge eaters (n = 228) and severe binge eaters (n = 126) aged 18-30 yr. In both groups, exercise dependence symptoms were significantly positively associated with reward sensitivity and interoceptive awareness, with the latter two variables predicting exercise dependence symptoms in hierarchical regression models; punishment sensitivity was significantly negatively related to such symptoms. Alexithymia was significantly associated with exercise dependence symptoms only in non-binge eaters; in severe binge eaters, alexithymia explained 0% of unique variance. Male sex was associated with more exercise dependence symptoms in severe binge eaters only. Participants in the severe binge group scored significantly higher on measures of exercise dependence, alexithymia, risky alcohol use, and sensitivity to reward and punishment, and significantly lower on emotion regulation, compared to those in the non-binge group. Hierarchical regression models explained 25% of variance in exercise dependence symptoms in non-binge-eaters and 43% in severe binge eaters. Findings are discussed in terms of the distinction between primary and secondary exercise dependence, the role of alexithymia, study limitations including data collection during the COVID-19 pandemic in Australia, and suggestions for future research.

Alexithymia and binge eating: Maladaptive emotion regulation strategy or deficient interoception?

Alexithymia has been linked to various excessive behaviors as a likely risk factor, including binge eating. Such relationships are often attributed to deficient emotional self-regulation in alexithymia, ostensibly leading to the use of maladaptive, externalized behaviors as strategies for coping with distress. An alternative view is that alexithymia reflects a fundamental deficit of interoceptive awareness that, in the case of binge eating, would suggest that internal satiety cues are poorly recognized, promoting overconsumption. The present study assessed the relationship between alexithymia and binge eating in the context of these competing hypotheses. A large online sample of young adults (n = 532) completed validated measures of alexithymia, emotion regulation, interoception, binge eating, emotional eating motivation, and sensitivity to reward and punishment. Correlations were as expected except for interoception, which showed minimal association with alexithymia or binge eating. In a hierarchical regression controlling for age, gender, education level and student status as covariates, binge eating was predicted by emotional eating motivation, emotion regulation (a negative predictor), alexithymia, and reward sensitivity, with the final model explaining 53% of variance in binge eating. Bootstrapped path analyses controlling for all other variables indicated that the relationship between alexithymia and binge eating was mediated by deficient emotion regulation but not deficient interoception, and that the relationships of both alexithymia and emotion regulation with binge eating were mediated by emotional eating motivation. Results are consistent with the notion that the association of alexithymia with binge eating reflects deficient emotion regulation in alexithymia, which can lead to adoption of maladaptive, externalized behaviors such as binge eating for coping with distress.

Orthorexia nervosa and substance use for the purposes of weight control, conformity, and emotional coping

PURPOSE

Orthorexia nervosa (ON), characterized by extreme behaviors driven by the goal of eating only healthy and pure foods, could plausibly be associated with avoidance of nicotine, alcohol, and illicit drugs. However, findings from the limited research on these relationships are mixed, and other eating disorders are associated with greater substance abuse.

METHOD

An online survey was completed by 471 participants (86% women, mean age = 20) recruited from undergraduate courses and through an Instagram advertisement. The questionnaires assessed ON symptomatology; frequency of smoking, alcohol consumption, and illicit drug use; abuse of these substances; and motivations for using these substances.

RESULTS

ON scores were not significantly related to the level of use or abuse of nicotine, alcohol, or most illicit drugs. Yet, ON scores were positively correlated with frequency of using illicit depressant drugs. Further, among substance users, ON scores were positively associated with smoking or vaping for the purpose of weight control, and with consuming alcohol and using illicit drugs for the purposes of conformity and coping with such negative emotions as anxiety and depression.

CONCLUSION

Although people who are high in ON symptomatology may be at least partly driven by a strong desire to be as healthy as possible, they are not less likely to use potentially harmful drugs. Instead, many of them may even turn to certain drugs for the same weight control and emotional-coping motives that guide the behaviors of individuals with other eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Direct and indirect effects of alexithymia on disordered eating in a non-clinical female sample: Determining the role of negative affect

BACKGROUND

Alexithymia is an independent predictor of symptoms of eating disorders, but also influences disordered eating in clinical samples indirectly via negative affect (depression and anxiety). The aim of the current work was to establish if alexithymia predicts disordered eating in a non-clinical sample directly and indirectly (via negative affect).

METHODS

A sample of healthy females (n = 248) completed measures of depression, anxiety, alexithymia, and disordered eating (drive for thinness, bulimia, and body dissatisfaction). Bias-corrected bootstrapping was used to conduct parallel mediation analyses to determine if negative affect (depression and anxiety) mediated the influence of alexithymia on disordered eating.

RESULTS

The relationship between alexithymia (difficulty identifying feelings) and drive for thinness was mediated by depression but not anxiety. The link between difficulty identifying feelings and bulimia was mediated by anxiety but not depression. The correlation between alexithymia (difficulty describing feelings) and body dissatisfaction was mediated by both depression and anxiety. However, after controlling for negative affect, difficulty identifying feelings remained an independent predictor of drive for thinness, and difficulty describing feelings remained an independent predictor of body dissatisfaction.

CONCLUSION

Facets of alexithymia (DIF and DDF) directly predict disordered eating in healthy participants as well as indirectly via depression and anxiety. These findings suggest that targeted interventions to improve the ability of individuals to identify and describe their feelings could be beneficial in reducing disordered eating, particularly in those "at risk" of developing eating disorders.

Weight-problem perception, depression, and emotional eating among Latinas in the U.S

Weight-problem perception is an individual's self-assessment that they are overweight or obese, and is associated with emotional eating beyond that which can be explained by self-reported weight status and depression. Extant research, however, has not examined weight-problem perception and emotional eating within Latinas in the United States. The purpose of this study was to investigate emotional eating, weight-problem perception, self-reported weight status (overweight, not overweight), depression, acculturation, and enculturation within Latinas. It was hypothesized that weight-problem perception, but not weight status, would contribute to higher levels of emotional eating after depression and an acculturation-enculturation interaction were covaried. Participants were 268 undergraduates from southeastern California who identified as female and as Latina. Participants completed questionnaires to measure the variables of interest. Results indicated that emotional eating in Latinas was correlated positively with body mass index and depression (p's ≤ .05) but not at all with acculturation nor enculturation (p's ≥ .05). Analyses of covariance revealed that neither weight-problem perception (p = .10) nor weight status (p = .05) had significant main effects on emotional eating whereas depression was a significant covariate (p ≤ .01). Limitations include correlational design and an exclusively undergraduate sample with little Latinx-subgroup variability. The inclusion of precise cultural or appearance-related variables in future research might explain why a relationship between weight-problem perception and emotional eating was not observed in this study. Implications include possible consideration of subjective distress about perceived weight, the role that treating depression might play to reduce emotional eating among Latinas, and the need to include ethnicity and culture in research about and interventions for weight-problem perception, emotional eating, and depression.

Binge Eating and Binge Drinking: A Two-Way Road? An Integrative Review

Unhealthy diet and alcohol are serious health problems, especially in adolescents and young adults. "Binge" is defined as the excessive and uncontrolled consumption of food (binge eating) and alcohol (binge drinking). Both behaviors are frequent among young people and have a highly negative impact on health and quality of life. Several studies have explored the causes and risk factors of both behaviors, and the evidence concludes that there is a relationship between the two behaviors. In addition, some research postulates that binge eating is a precipitating factor in the onset and escalation of excessive alcohol consumption, while other studies suggest that alcohol consumption leads to excessive and uncontrollable food consumption. Given that no review has yet been published regarding the directionality between the two behaviors, we have set out to provide an upto- date overview of binge eating and binge drinking problems, analyzing their commonalities and differences, and their uni- and bidirectional associations. In addition, we explore the reasons why young people tend to engage in both behaviors and consider directions for future research and clinical implications.

Binge Eating and Addictive-Like Behaviours in Males and Females

INTRODUCTION

Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences.

METHOD

A community sample (N = 500; 75% female, M_age = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption.

RESULTS

42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females.

CONCLUSIONS

The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.

The role of self-compassion and self-criticism in binge eating behaviour

Self-criticism and low self-compassion are implicated in the development and maintenance of binge eating. However, the association between these self-attitudes and binge eating symptoms remains unclear. Women with symptoms of Bulimia Nervosa (BN) or Binge Eating Disorder (BED) were randomised to either a self-compassion (n = 30) or self-critical rumination (n = 30) strategy following a negative mood induction. Responses to food cues (cue reactivity and affect) and calorie consumption in a 'taste test' were assessed. The self-compassion strategy was associated with a greater improvement in positive and negative affect following the negative mood induction. Despite the differential effects on mood, self-compassion and self-critical rumination led to similar self-reported food cravings and physiological reactivity to cues. However, participants in the self-compassion condition consumed significantly fewer calories, rated the consumed food as less pleasurable, and reported less desire to continue eating. The findings suggest that therapeutic strategies for cultivating self-compassion are associated with improved food-related self-regulation in the context of negative mood.

A longitudinal investigation of perceived weight status as a mediator of sexual orientation disparities in maladaptive eating behaviors

Sexual minority adolescents are more likely than heterosexual peers to engage in maladaptive eating behaviors such as restrictive dieting. However, prior studies relied on cross-sectional data and did not test potential mechanisms. This study examined longitudinal associations between adolescent sexual minority status and three maladaptive eating behaviors (restrictive dieting, diet pill use, and drug-related dieting) in young adulthood and tested higher perceived weight status as a mediator of observed disparities. Data were drawn from Waves 2 (11th grade in 2010/2011) to 7 (4 years post high school in 2015/2016) of the NEXT Generation Health Study, a U.S. national longitudinal cohort of adolescents (n = 1925). Logistic regression analyses revealed that, relative to heterosexual females, sexual minority females were more likely to report any restrictive dieting (extreme food intake restriction) in the past year (62.9% vs. 37.0%; Adjusted Odds Ratio = 2.26, 95% CI = 1.07, 4.76). Associations between sexual minority status and diet pills use or drug-related dieting were not found. Results from structural equation modeling indicated that higher perceived weight status was a significant mediator of the association between sexual minority status and restrictive dieting among females. These findings highlight higher perceived weight status as an important cognitive mechanism explaining why sexual minority females are at heightened risk for restrictive dieting in young adulthood. To optimally inform prevention efforts, additional research is needed to test the extent to which minority stressors may shape weight perceptions and their contribution to maladaptive and disordered eating behaviors among sexual minority adolescents.

An update on obesity: Mental consequences and psychological interventions

Besides physical consequences, obesity has negative psychological effects, thereby lowering human life quality. Major psychological consequences of this disorder includes depression, impaired body image, low self-esteem, eating disorders, stress and poor quality of life, which are correlated with age and gender. Physical interventions, mainly diet control and energy balance, have been widely applied to treat obesity; and some psychological interventions including behavioral therapy, cognitive behavioral therapy and hypnotherapy have showed some effects on obesity treatment. Other psychological therapies, such as relaxation and psychodynamic therapies, are paid less attention. This review aims to update scientific evidence regarding the mental consequences and psychological interventions for obesity.

Binge Eating and Loss of Control in College-Age Women

BACKGROUND

Loss of control (LOC) over eating is a cardinal feature of the DSM-5 definition of binge eating (BE). While this behavior is frequently reported in college-age women, there is limited research on descriptions of loss of control from first-person accounts from individuals reporting LOC associated with BE.

OBJECTIVE

The objective of this study was to investigate descriptions of LOC associated with BE episodes in college-age women who reported recent BE behavior.

STUDY DESIGN

A secondary analysis of previously collected qualitative data on BE behaviors in college students was conducted. Two hundred and twenty-one college-age women's (age = 19.77 ± 1.03) comments regarding the experiences of LOC associated with BE episodes were analyzed using conventional content analysis. Codes were inductively generated allowing categories to emerge from the data codes.

RESULTS

Three major overarching descriptive categories were identified: (1) LOC over eating, (2) feelings associated with the LOC, and (3) cognitive dispositions (thoughts) associated with LOC during a BE episode.

DISCUSSION

The findings of this study expand the current literature on LOC over eating and provide a number of potential targets for intervention with college-age women who report BE behaviors.

Impaired Conflict Monitoring to Food Cues in Women Who Binge Eat

Previous research demonstrated the associations between cognitive biases toward food cues and binge eating (BE) behavior. To determine the characteristics of conflict monitoring to food cues in women who binge eat and non-eating disordered controls, a flanker task featured high-caloric food and low-caloric food images was used to examine conflict monitoring with measures of accuracy and reaction time. Women who binge eat displayed longer reaction times (RTs) to incongruent trials (i.e., flanked by pictures from the different category) than to congruent trials (i.e., flanked by pictures from the same category), while controls showed no such difference. This finding demonstrated women who binge eat displayed a general flanker effect toward food-related stimuli compared to controls. Faster reaction times in response to high-caloric food images disturbed by low-caloric food images predicted lower self-reported motor impulsiveness in the women who binge eat, but not in controls. These data suggest a relative conflict monitoring deficit in women with BE pathology.

Weight Perception, Weight Stigma Concerns, and Overeating

OBJECTIVE

Perceiving one's own weight status as being overweight is a likely motivation for weight loss. However, self-perceived overweight status has also been found to be associated with overeating and weight gain. This study examined whether weight stigma concerns explain why individuals who perceive their weight status as overweight are at increased risk of overeating.

METHODS

We conducted two survey studies of United States adults (N = 1,236) in which we assessed whether weight stigma concerns explain the cross-sectional relationship between perceived overweight and overeating tendencies.

RESULTS

Across two studies, the cross-sectional relationship between perceived overweight and overeating tendencies was in part explained by weight stigma concerns. Participants who perceived their weight as "overweight" reported greater weight stigma concerns than participants who perceived their weight as "about right," and this explained 23.3% (Study 1) to 58.6% (Study 2) of the variance in the relationship between perceived overweight and overeating tendencies.

CONCLUSIONS

Weight stigma concerns may explain why perceiving one's own weight status as overweight is associated with an increased tendency to overeat.

Cross-sectional associations between weight-related health behaviors and weight misperception among U.S. adolescents with overweight/obesity

Background

Weight misperception occurs when there is a discrepancy between one’s actual and perceived weight status. Among adolescents with overweight/obesity, many believe that correcting weight misperception is imperative to inspire weight-related behavior change. However, past research has shown that adolescents with overweight/obesity who misperceive their weight status gain less weight over time compared to accurate perceivers. Therefore, our objective was to examine possible mechanisms underlying this relationship. Specifically, we examined the association between weight misperception and engagement in weight-related health behaviors among adolescents with overweight/obesity.

Methods

Self-reported data from the 2015 National Youth Risk Behavior Survey was used in analyses restricted to participants with overweight/obesity (n = 4383). Using multivariate logistic models correcting for sex, race/ethnicity, and grade in school, we examined the cross-sectional associations between weight misperception and engagement in weight-related health behaviors, specifically related to dietary intake, physical activity, and sleep.

Results

Adolescents with overweight/obesity who misperceived their weight status were more likely to drink 100% fruit juice two or more times per day (OR = 1.53, 95% CI: 1.20, 1.94), eat vegetables two or more times per day (OR = 1.29, 95% CI: 1.07, 1.57), be physically active for 1 hour or more per day for at least 5 days in the week prior (OR = 1.40, 95% CI: 1.15, 1.72), be on a sports team in the last year (OR = 1.55, 95% CI: 1.21, 1.97), sleep an average of at least 8 hours per school night (OR = 1.40, 95% CI: 1.15, 1.72), and less likely to be trying to lose weight (OR = 0.17, 95% CI: 0.15, 0.20). Misperceivers were more likely to consume breakfast every morning in the week prior and to drink a sports drink at least once per day, though these results were not statistically significant. We observed no difference in fruit intake, soda intake, or TV viewing between weight misperceivers and accurate perceivers.

Conclusions

Overall, weight misperception among adolescents with overweight/obesity was associated with a number of beneficial weight-related health behaviors. Engagement in these healthy weight-related behaviors may explain some of the protective effect of weight misperception on weight gain over time.

Trial registration

Not applicable.

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes

It is commonly assumed that a person identifying that they are 'overweight' is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight-related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight.

The importance of thinking styles in predicting binge eating

Impulsivity, Body Mass Index, negative emotions and irrational food beliefs are often reported as predictors of binge eating. In the current study we explored the role played by two thinking styles, namely food thought suppression and desire thinking, in predicting binge eating among young adults controlling for established predictors of this condition. A total of 338 university students (268 females) participated in this study by completing a battery of questionnaires measuring the study variables. Path analysis revealed that impulsivity was not associated with binge eating, that Body Mass Index and negative emotions predicted binge eating, and that irrational food beliefs only influenced binge eating via food thought suppression and desire thinking. In conclusion, thinking styles appear an important predictor of binge eating and they should be taken into consideration when developing clinical interventions for binge eating.

Weight misperception and disordered weight control behaviors among U.S. high school students with overweight and obesity: Associations and trends, 1999-2013

OBJECTIVE

To examine prevalence of weight misperception (incongruence between one's perceived weight status and one's actual weight status) and disordered weight control behaviors (DWCBs; unhealthy behaviors aiming to control or modify weight), associations between weight misperception and DWCBs, and temporal trends in prevalence and associations among adolescents with overweight and obesity from 1999 to 2013.

METHODS

Self-reported data from eight biennial cycles (1999-2013) of the cross-sectional national Youth Risk Behavior Survey were used in analyses restricted to respondents with overweight/obesity. Data on weight status perception, use of fasting, purging, and diet pills to control weight, sex, race/ethnicity, and grade in school were used in multivariate logistic regression models.

RESULTS

Among U.S. high school students with overweight and obesity, no linear temporal trends were detected for prevalence of weight misperception, fasting, or purging between 1999 and 2013, while a significant linear decrease was observed for prevalence of diet pill use between 1999 and 2013 (b=-0.81, p<0.01). Using data pooled across 1999-2013, weight misperception predicted lower use of all DWCBs examined in this study among females and lower use of fasting to control weight among males. No significant changes over time in associations of weight misperception with fasting or purging were observed, though the association between weight misperception and diet pill use weakened somewhat across 1999-2013.

DISCUSSION

In the context of increasing prevalence of overweight and obesity, weight misperception appears to be a robust protective factor for DWCBs.

No calorie comfort: Viewing and drawing "comfort foods" similarly augment positive mood for those with depression

Based on behavioral and neurobiological data, we tested the hypothesis that viewing/drawing visual images of comfort foods in the absence of eating will increase positive mood and that this effect is augmented for those with clinical symptoms of depression. A counterbalanced design was used for 60 participants with and without clinical symptoms in two variations: food image and food art. In each variation, participants viewed/drew foods high or low in fat/sugar; pre-post mood was recorded. Results show a consistent pattern: viewing/drawing comfort foods [food image (95% confidence interval): 2.72-4.85; food art (95% confidence interval): 2.65-4.62] and fruits [food image (95% confidence interval): 1.20-2.23; food art (95% confidence interval): 1.51-2.56] enhanced mood. For comfort foods, mood was augmented for those with clinical symptoms of depression [food image (95% confidence interval): 0.95-3.59; food art (95% confidence interval): 0.97-3.46]. Findings corroborate previous data and reveal a novel finding of augmented mood increases for those with clinical symptoms.

Weight misperception among young adults with overweight/obesity associated with disordered eating behaviors

OBJECTIVE

The purpose of this study was to examine the cross-sectional association between weight misperception among young adults with overweight/obesity and disordered eating behaviors.

METHOD

In a subsample of young adults with overweight or obesity participating in Wave III (2001-2002) of The National Longitudinal Study of Adolescent to Adult Health (n = 5,184), we examined the cross-sectional association between weight under-perception (i.e., perceiving oneself to be at a healthy body weight or underweight) and disordered eating (fasting/meal skipping for weight control, purging/pills for weight control, overeating/loss of control eating, and use of performance-enhancing products/substances).

RESULTS

About 20% of young adult females under-perceived their weight compared to 48% of males. Individuals who misperceived their weight as healthy were significantly less likely to report fasting/meal skipping (Females: OR: 0.25, 95% CI: 0.14-0.43; Males: OR: 0.31, 95% CI: 0.20-0.48) and vomiting or taking diet pills/laxatives/diuretics (Females: OR: 0.10, 95% CI: 0.04-0.25; Males: OR: 0.10, 95% CI: 0.04-0.25) for weight control. Among females, those who misperceived their weight status as healthy were also less likely to report overeating or loss of control eating (OR: 0.41, 95% CI: 0.24-0.71). Greater use of performance-enhancing products/substances was seen among males who under-perceived their weight as healthy (OR: 2.06, 95% CI: 1.57-2.72) and among both females (OR: 2.29, 95% CI: 1.40-20.0) and males (OR: 2.27, 95% CI: 1.13-4.55) who perceived themselves to be underweight.

DISCUSSION

Weight under-perception among young adults with overweight/obesity may convey some benefit related to disordered eating behaviors, but could be a risk factor for the use of performance-enhancing products/substances. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord ; 49:937-946).

Internalized weight bias mediates the relationship between depressive symptoms and disordered eating behavior among women who think they are overweight

OBJECTIVE

This study tested the potential mediating role of Internalized Weight Bias (IWB) in the relationship between depressive symptoms (DEP-SX) and disordered eating behavior. In particular, we hypothesized that IWB may be an intervening variable in the well documented association between depression and disordered eating.

METHOD

College women (N=172) who were taking undergraduate psychology courses and who endorsed thinking they were overweight completed the Patient Health Questionnaire depression screener (PHQ-9), the Weight Bias Internalization Scale (WBIS), and the Eating Disorder Examination Questionnaire (EDE-Q). Bootstrapping mediation analyses were conducted to explore the relationships between these variables.

RESULTS

IWB was significantly correlated with eating disorder symptoms and DEP-SX, but not Body Mass Index. Mediation analyses supported a model in which IWB mediated the relationship between DEP-SX and disordered eating behavior.

DISCUSSION

Results indicate that individuals with elevated DEP-SX may be likely to internalize weight bias, which may in turn lead to maladaptive approaches to eating and weight control, regardless of one's actual weight status.

Metacognitions about desire thinking predict the severity of binge eating in a sample of Italian women

In this study, our principal aim was to investigate whether metacognitions about desire thinking predict the severity of binge eating in women and, if so, whether this relationship is independent of age, self-reported body mass index (BMI), negative affect, irrational food beliefs and craving. One hundred and four women, consisting of 32 consecutive patients with binge eating disorder undergoing initial assessment for cognitive therapy for eating disorders, 39 moderate binge eaters, and 33 non-binge eaters (both from the general population), completed the following measures: Self-reported BMI, Hospital Anxiety and Depression Scale, Irrational Food Beliefs Scale, General Craving Scale, Metacognitions about Desire Thinking Questionnaire, and Binge Eating Scale. A series of Spearman's rho correlation analyses revealed that self-reported BMI, anxiety, depression, irrational food beliefs, craving, and all three factors of the metacognitions about desire thinking questionnaire were significantly associated with the severity of binge eating. A stepwise regression analysis identified self-reported BMI, craving, and negative metacognitions about desire thinking as significant predictors of the severity of binge eating. These results, taken together, highlight the possible role of metacognitions about desire thinking in predicting the severity of binge eating. The clinical implications of these findings are discussed.

Differential food intake and food choice by depression and body mass index levels following a mood manipulation in a buffet-style setting

While eating in response to emotional cues is associated with intake of unhealthy foods, less is known about the extent to which obesity and depression may differentially influence food intake in a buffet-style setting where low- and high-calorie foods are available to choose from. Using a counterbalanced design, 154 participants were grouped by depression and obesity categories, then asked to read a series of vignettes that were sad (on 1 day) and neutral (on a different day), followed by a buffet to eat until full. Food intake (in grams and calories) and food choice (number of high- or low-calorie food options) were recorded. Results showed that participants who were obese and depressed had significantly greater energy intake following the sad versus happy vignette, largely due to increased intake of high-calorie foods. The results corroborate recent theories on emotional eating and extend the ecological validity of such effects in a buffet-style setting.

A statement synthesis of emotional eating and body size recognition: advancing nursing science related to obesity research

AIM

A discussion of a statement synthesis of the relationship between the concepts of emotional eating and body size recognition.

BACKGROUND

The interrelatedness of the concepts of emotional eating and body size recognition is poorly understood; however, both factors significantly impact weight management. Nurses can be instrumental in developing more effective weight management interventions as a critical step in helping to ameliorate the public health burden of obesity.

DESIGN

This discussion article reports a literary statement synthesis.

DATA SOURCES

Five quantitative research studies from 1996 - 2014 were identified, which examined the relationship between the concepts.

IMPLICATIONS FOR NURSING

A relational statement delineating the direct association between the amount of self-reported emotional eating and an adult individual's recognition of their body size was constructed. Construction of a relational statement about emotional eating and recognition of body size is a step in the nursing theory-building process.

CONCLUSION

The constructed relational statement will guide future research and nursing theory development and may ultimately help to construct more effective weight management interventions.

Expanding binge eating assessment: Validity and screening value of the Binge Eating Scale in women from the general population

There is growing recognition that binge eating is a prevalent problem with serious implications for both clinical and nonclinical samples. The current study aimed at examining the factor structure, psychometric properties and the screening usefulness of the Binge Eating Scale (BES) in a large sample of female college students and women from the Portuguese general population. A sample of 1008 participants was collected to conduct a confirmatory factor analysis and test the BES psychometric properties; 150 participants were further evaluated through the Eating Disorder Examination 16.0D to assess the discriminant validity of the BES. Results confirmed that the BES presents a sound one-dimensional factorial structure, with very good construct reliability and convergent validity. Also, the scale presented very good retest-reliability. Findings also offered evidence that the BES is positively associated with measures of eating and general psychopathology, and BMI. Furthermore, the BES revealed an excellent performance (96.7%) on discriminating clinically significant cases of binge eating, showing a sensitivity of 81.8% and a specificity of 97.8%. Results support the validity and usefulness of the BES as an assessment and screening tool for binge eating in women from the general population.

Desire thinking: A risk factor for binge eating?

In the current study we explored the role of desire thinking in predicting binge eating independently of Body Mass Index, negative affect and irrational food beliefs. A sample of binge eaters (n=77) and a sample of non-binge eaters (n=185) completed the following self-report instruments: Hospital Anxiety and Depression Scale, Irrational Food Beliefs Scale, Desire Thinking Questionnaire, and Binge Eating Scale. Mann-Whitney U tests revealed that all variable scores were significantly higher for binge eaters than non-binge eaters. A logistic regression analysis indicated that verbal perseveration was a predictor of classification as a binge eater over and above Body Mass Index, negative affect and irrational food beliefs. A hierarchical regression analysis, on the combined sample, indicated that verbal perseveration predicted levels of binge eating independently of Body Mass Index, negative affect and irrational food beliefs. These results highlight the possible role of desire thinking as a risk factor for binge eating.

Night Eating Syndrome in Major Depression and Anxiety Disorders

INTRODUCTION

The purpose of this study is to investigate the prevalence and the clinical features of night eating syndrome (NES) in patients with depression and anxiety disorders.

METHOD

The study was conducted at Bakırköy State Hospital for Mental Health and Neurological Disorders. Three-hundred out-patients who had major depression (MD), panic disorders (PD), general anxiety disorders (GAD) and obsessive-compulsive disorders (OCD) participated in the study. The semi-structured socio-demographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Night Eating Questionnaire, and NES Evaluation Questionnaire were implemented.

RESULTS

In our sample, the prevalence of the NES was 15.7% (n=47). NES frequency was significantly higher in the patients diagnosed with major depression (MD 22%, GAD 7.8%, OCD 12.5%, PD 14%). Smoking, presence of past suicide attempts, rates of antipsychotic drugs use, and average scores of body mass index (BMI) were significantly higher in the patients who had NES. In this sample, depression, BMI, and smoking were found to be determinants of NES.

CONCLUSION

This study shows that NES may be frequently observed in patients admitted to psychiatric clinics, especially in those with major depression. Evaluation of NES in psychiatric patients may help the treatment of the primary psychopathology and prevent the adverse effects, like weight gain, which may reduce the quality of life.

Escaping from body image shame and harsh self-criticism: exploration of underlying mechanisms of binge eating

Shame has been highlighted as a key component of eating psychopathology. However, the specific impact of body image shame on binge eating and the mechanisms through which it operates remained unexplored. The current study tests a model examining the role that body image shame plays in binge eating and the mediator effect of self-criticism on this association, while controlling for the effect of depressive symptoms, in 329 women from the general population and college students. Correlation analyses showed that binge eating is positively associated with depressive symptoms, body image shame, and self-criticism, namely with a more severe form of self-criticism characterized by self-disgust, hating and wanting to hurt the self - hated self. Furthermore, results indicated that the path model explained 32% of binge eating behaviours and confirmed that body image shame has a significant direct effect on binge eating, and that this effect is partially mediated by increased hated self. These findings suggest that binge eating may emerge as a maladaptive way to cope with the threat of being negatively viewed by others because of one's physical appearance and the consequent engagement in a severe critical self-relating style marked by hatred, disgust and contempt towards the self. This study contributes therefore for the understanding of the processes underlying binge eating. Also, these findings have important research and clinical implications, supporting the relevance of developing eating disorder treatments that specifically target shame and self-criticism, through the development of self-compassionate skills.

Examining the role of distress tolerance and negative urgency in binge eating behavior among women

The current study examined whether distress tolerance and negative urgency moderate the link between depressive symptoms and binge eating frequency, and between disordered eating attitudes and binge eating frequency. Young adult women (N=186) completed questionnaires assessing depressive symptoms, cognitive restraint, eating, shape and weight concerns, distress tolerance, impulsivity (including negative urgency), and binge eating. After controlling for body mass index, race/ethnicity, and other domains of impulsivity, negative urgency was significantly associated with binge eating above and beyond the influence of disordered eating attitudes and depressive symptoms. Distress tolerance, in contrast, was not associated with binge eating. In addition, neither negative urgency nor distress tolerance moderated the associations between disordered eating attitudes and binge eating frequency, or between depressive symptoms and binge eating. Results support the additive role of difficulties responding adaptively to distress in binge eating frequency, above and beyond the influence of emotional distress. Findings highlight the potential value of focusing on negative urgency in targeted treatments for binge eating among women. Importantly, results from the current study differ from those of previous research; these discrepancies could be the result of variations in sample characteristics and approaches to the assessment of binge eating behavior. Additional research, including longitudinal studies and research using "real-time" assessment strategies, such as ecological momentary assessment, is necessary to elucidate further the role of various emotion regulation strategies in maintaining binge eating behavior in adult women.

Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population

PURPOSE

Gay, lesbian, and bisexual youth may experience significant body dissatisfaction. We examined sexual orientation differences in self-perceived weight status and the prevalence of potentially dangerous weight control behaviors in a representative sample of adolescents.

METHODS

Data were obtained from 12,984 youth between 2003 and 2009 over four cycles of the Massachusetts Youth Risk Behavior Survey, a statewide survey of ninth- through 12th-grade students. Self-perceived weight status and past-month unhealthy weight control behaviors (fasting >24 hours, using diet pills, and vomiting or using laxatives) were compared among gay/lesbian, bisexual, or self-identified heterosexual youth with same-sex partners, unsure youth, and exclusively heterosexual youth using logistic regression, adjusting for age and race/ethnicity.

RESULTS

Compared with exclusively heterosexual males, heterosexual males with prior same-sex partners and bisexual males were more likely to self-perceive as overweight despite being of healthy weight or underweight (respectively, adjusted odds ratio [AOR], 2.61; 95% confidence interval [CI], 1.68-4.05; and AOR, 2.56; 95% CI, 1.64-4.00). Compared with exclusively heterosexual females, lesbians and bisexual females were more likely to self-perceive as being of healthy weight or underweight despite being overweight or obese (respectively, AOR, 3.17; 95% CI, 1.15-8.71; and AOR, 2.00; 95% CI, 1.20-3.33). Unhealthy weight control behaviors were significantly more prevalent among sexual minority males (32.5%; AOR, 4.38; 95% CI, 3.38-5.67) and females (34.7%; AOR, 2.27; 95% CI, 1.85-2.78) when considered together relative to exclusively heterosexual males (9.7%) and females (18.8%).

CONCLUSIONS

One third of sexual minority youth engage in hazardous weight control behaviors. Future research should investigate underlying mechanisms and determine whether clinicians should routinely screen for these behaviors.

Profiles of binge eating: the interaction of depressive symptoms, eating styles, and body mass index

Binge eating is associated with depressive symptoms, eating styles, and obesity. However, less is known about interactions between these variables and binge eating. This study examined the relationship between depressive symptoms, eating styles, body mass index, and binge eating. Individuals with a higher body mass index, who reported more depressive symptoms and more external eating, reported the greatest binge eating. Similarly, individuals with a higher body mass index who reported more depressive symptoms and more emotional eating reported the greatest binge eating. These findings demonstrate possible profiles of individuals most at risk for binge eating and associated eating disorders.

The relationship between emotional eating and weight problem perception is not a function of body mass index or depression

Weight problem perception (WPP) refers to the belief that one is overweight. Previous research suggests that WPP, even in the absence of actual overweight status, is associated with disordered eating, binge eating, and body image dissatisfaction. However, the relationship between emotional eating, BMI, and WPP has not yet been explored. This investigation recruited a total of 409 college students who completed a web-based survey. An additional 76 participants were recruited to complete an identical survey with the addition of a depression measure to evaluate the contribution of this potentially important covariate. As hypothesized, WPP was associated with emotional eating, while actual BMI was not. In the second sample, WPP remained significantly associated with emotional eating, even after depression was included as a covariate. Results suggest that non-overweight young adults who express the belief that they are overweight may be at risk for emotional eating, which, over the long term, could indeed adversely impact BMI. Cognitive approaches to address disordered eating may benefit from addressing WPP.

Binge eating and weight loss behaviors of overweight and obese college students

PURPOSE

To investigate binge eating (BE) and weight-related behaviors in overweight and obese college students.

DATA SOURCES

This was a secondary analysis of data from 487 overweight and obese college-age students from a private university in the northeastern United States.

CONCLUSIONS

BE was reported by 34.9% of students. Only 6.2% of participants reported the use of compensatory behaviors (i.e., self-induced vomiting, laxative, or diuretic use) to prevent weight gain. BE was associated with smoking and exercising to lose weight. Gender differences emerged from the data as women were more likely to report being obese, the use of compensatory behaviors, and to perceive themselves as moderately or extremely overweight.

IMPLICATIONS FOR PRACTICE

BE is a significant problem on college campuses and is associated with the development of obesity and eating disorders. Nurse practitioners (NPs) are in an excellent position to effect change in this population through their frequent contact with young adults in community and school-based venues. NPs are well-prepared to identify at-risk college students and provide them with individualized care, education, and support.

Evaluating the indirect effect of self-compassion on binge eating severity through cognitive-affective self-regulatory pathways

Current theory and evidence point to disruptions in self-concept and difficulties with emotion regulation as contributing to the severity of binge eating. Alternatively, contemporary perspectives on self-compassion suggest that individual differences in this adaptive approach to self-regulation may serve to counteract these cognitive-affective triggers presumably resulting in reductions in binge eating severity. Accordingly, the present cross-sectional analysis examined an indirect effect model of positive dimensions of self-compassion on binge eating severity through both emotional tolerance and unconditional self-acceptance pathways. Two hundred fifteen undergraduate students (78% female) completed self-report measures of the variables of interest; BMI was calculated from self-reported heights and weights. Pearson's correlations revealed a positive linear association between self-compassion and unconditional self-acceptance; negative links were observed between self-compassion and emotional intolerance along with the severity of binge eating symptoms. A subsequent multiple mediator analysis utilizing both normal test theory and robust non-parametric bootstrap resampling procedures confirmed the presence of a significant total indirect effect of self-compassion on binge eating severity (-.15, p<0.001) through the combined mediators along with yielding specific indirect effects for both emotional tolerance (-.05, p<0.05) and unconditional self-acceptance (-.11, p<0.01) which were preserved in a model adjusted for BMI. Preliminary results underscore the need to further evaluate the tenability of this model in both prospective cohort and intervention-based research. Findings additionally invite considering the value of integrating self-compassion training into college health promotion efforts towards mitigating the appreciable levels of binge eating behavior prevalent in this at-risk population.

Executive functioning and behavioral impulsivity of young women who binge eat

OBJECTIVE

To examine the link between binge eating, executive functioning, and behavioral impulsivity.

METHOD

Fifty women who reported engaging in weekly binge eating in the absence of regular compensatory behaviors and 66 women with no history of binge eating completed several self-report questionnaires and a brief neuropsychological battery, including the Wisconsin Card Sorting Task and Conner's Continuous Performance Task.

RESULTS

Hierarchical regression analyses revealed that groups did not differ in executive functioning after controlling for depression, anxiety, body mass, general intelligence, and psychotropic medication use. Correlation analyses suggest that individuals who endorse more frequent binge eating might have greater difficulties thinking flexibly or shifting attention. Individuals who binge eats are also more likely to behave impulsively, but only for emotional reasons.

DISCUSSION

Although this study is unable to determine whether these cognitive and behavioral factors precede or follow binge-eating episodes, outcomes have implications for treatment and prevention.

Evaluating race/ethnicity in moderating baseline cardiometabolic risk and body composition changes in North Carolina first-year college women

The roles of race/ethnicity and geographical region in the context of first-year college weight gain remain largely under-examined. The present study evaluated whether race/ethnicity: (1) at baseline was associated with greater representation in cardiometabolic health risk categories for body mass index, percent body fat, waist circumference, and waist-to-hip ratio in the full sample of 54 Black/African American and 80 White/European American first-year female undergraduates attending a North Carolina state university; and (2) moderated body composition changes between the beginning of the fall and spring semesters among the 83 participants who completed baseline and follow-up visits (N = 39 Black/African Americans). More Black/African Americans than White/European Americans had percent body fat values ≥32% at baseline; a greater proportion of White/European Americans than Black/African Americans had a waist-to-hip ratio >0.80. Among those who completed baseline and follow-up visits, White/European Americans had higher waist-to-hip ratios (unadjusted: p <0.01, adjusted for family income: p < 0.01) and waist circumferences (adjusted for family income: p < 0.05) at both time points. No strong moderating effects of race/ethnicity were detected. Preliminary results suggested that greater consideration of racial/ethnic indicators and potential regional variation in these biometric attributes among first-year college students is warranted.

Gender differences in binge eating and behavioral correlates among college students

PURPOSE

The purpose of this study was to investigate gender differences in binge eating and associated behavioral correlates in college students.

METHODS

A webbased survey was conducted with 2073 students (mean age 19.8 yr; range 18-23 yr). Multiple logistic regression was used to calculate odds ratios and 95% confidence intervals for the factors associated with binge eating.

RESULTS

Twenty-nine percent of students reported recent bingeing. Factors associated with binge eating included being female, having a higher body mass index, current tobacco use, and exercising to lose weight. Women were more likely to binge eat (73.8%; χ(2)=32.3; p≤0.001), report loss of control (45%; χ(2)=16.3; p≤0.001), self induced vomiting (20.7%; χ(2)=15.9; p≤0.001), and laxative use (6.7%; χ(2)=8.93; p≤0.001).

CONCLUSIONS

Results generated from this study suggest that gender-disparate behaviors are potential targets for future tailored interventions.

Positive cognitive coping strategies and binge eating in college women

The current study explored whether specific cognitive coping strategies moderated the relation between global eating disorder symptomatology and binge eating frequency. Global eating disorder symptomatology and cognitive coping strategies (i.e., self-blame, acceptance, rumination, positive refocusing, refocus on planning, positive reappraisal, putting into perspective, catastrophizing, and other-blame) were evaluated in a sample of women who reported engaging in binge eating in the absence of compensatory behaviors (N=419). Moderation analyses indicated that most positive cognitive coping strategies were associated with reduced binge eating frequency; however, there was no such buffering effect among individuals who reported engaging in acceptance, or in negative coping strategies. These results suggest that focusing on specific positive cognitive coping skills might be an effective approach to decreasing binge eating frequency, although additional experimental research is needed.