Loss of Control Over Eating Scale (LOCES): Validation in undergraduate men and women with and without eating disorder symptoms

A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers

COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Loss of control as a transdiagnostic feature in obesity-related eating behaviours: A systematic review

OBJECTIVE

Emerging evidence suggests that loss of control (LOC) may present as a common feature across disordered eating behaviours. However, there has been limited research on the transdiagnostic nature of LOC in this area. The primary aim of this study was to systematically review disordered eating behaviours and measures of LOC in clinical and non-clinical populations.

METHOD

Electronic searches of the relevant databases were conducted. Selected articles were screened for eligibility and assessed for methodological quality.

RESULTS

Thirty-four studies met inclusion criteria. Findings demonstrated that LOC was associated with disordered eating behaviours across bariatric populations, eating disorder populations, and community populations. Specifically, LOC was associated with binge eating (subjective and objective episodes), grazing, night eating, and emotional or stress eating. Findings also revealed that LOC was inconsistently operationalised across studies, with varied approaches to measuring the construct.

CONCLUSION

Overall, the findings from this review provide support for LOC as a transdiagnostic feature of disordered eating behaviours. Future studies should utilise robust multi-method assessments to measure the severity of LOC, which may provide greater insight into how LOC manifests across different eating disorder presentations.

Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria

BACKGROUND

Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions.

OBJECTIVE

We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching.

METHODS

Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability.

RESULTS

A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content.

CONCLUSIONS

These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI.

Mindful eating, intuitive eating, and the loss of control over eating

BACKGROUND

The loss of control over eating (LOCE) is frequently cited as a core process of eating disturbances. In contrast, mindful eating and intuitive eating have been identified as adaptive styles of eating and have been associated with positive psychological constructs. Therefore, the present study aimed to investigate whether mindful or intuitive eating are potential protective factors for the loss of control over eating.

METHODS

1155 participants (64.2 % female) were recruited from a large university. Participants were administered select subscales of the Intuitive Eating Scale - 2nd edition (IES-2) and Mindful Eating Questionnaire (MEQ), and the brief Loss of Control over Eating Scale (LOCES-B).

RESULTS

Controlling for BMI and age, intuitive and mindful eating were significantly associated with LOCE, F (8,966) = 114.78, p < .001, R² = 0.49. Both IES-2 subscales were negatively associated with LOCE: 1) eating for physical rather than emotional reasons and 2) reliance on hunger and satiety cues, p < .001. One MEQ subscale was negatively associated with LOCE: disinhibition, p < .001. The MEQ subscales assessing awareness and external cues were not significantly associated with LOCE.

CONCLUSIONS

Results suggest that while some forms of mindful eating and intuitive eating are potential protective factors, others may be less relevant to LOCE. These findings have implications for treatment, as they suggest intuitive eating may counteract the loss of control over eating. The findings also provide evidence for convergent validity of the LOCES by clarifying positive constructs that may protect against the development of this core eating pathology.

Motivation for dietary restraint, and disordered eating among adults experiencing food insecurity in the United States

OBJECTIVE

Does engaging in dietary restraint due to weight/shape concerns versus economic hardship differentially relate to disordered eating?

METHOD

The sample consisted of 582 adults experiencing food insecurity (FI) who completed online measures assessing severity of FI, disordered eating, loss of control over eating, and dietary restraint. Participants reported their motivation for dietary restraint with options consisting of weight/shape concerns, economic hardship (i.e., insufficient funds and prioritizing others' needs), mixed reasons, and other/I do not know.

RESULTS

In the sample, 18% reported engaging in dietary restraint primarily due to weight/shape concerns, 33% due to economic hardship, 18% other/do not know, and 30% due to a mix of reasons. There were positive correlations between FI, economic hardship, dietary restraint, disordered eating, and loss of control over eating. Regression analyses revealed the association between dietary restraint and disordered eating does not differ across individuals who endorse economic hardship as a motivator for dietary restraint. Findings replicated with loss of control. However, the association between dietary restraint and disordered eating grew stronger as more dietary restraint due to weight/shape concerns was endorsed. No significant association emerged with loss of control.

DISCUSSION

Research is needed to replicate findings and examine how patterns of food scarcity impacts disordered eating in food insecure populations with and without weight/shape concerns. Findings suggest that motivation for dietary restraint may influence associations with dietary restraint and the cognitive components of disordered eating, but not the behavioral components of disordered eating.

PUBLIC SIGNIFICANCE STATEMENT

Disordered eating due to dietary restraint is most commonly associated with weight and shape concerns; however, even when dietary restraint is due to economic reasons, it can still be associated with disordered eating.

Loss-of-Control Eating and Cardiometabolic Health in Relation to Overweight and Obesity

PURPOSE OF REVIEW

Loss-of-control (LOC) eating, the subjective feeling of being unable to control what or how much is being consumed, is common. The purpose of this review was to examine the relationships among LOC eating, cardiometabolic health, and weight management intervention outcomes.

RECENT FINDINGS

In youth and adults, LOC eating is associated with and predictive of psychological symptoms, high weight, and worsened cardiometabolic health. While LOC eating pre-intervention does not appear to impact outcomes, LOC eating during or following is associated with worsened outcomes from behavioral and surgical weight management interventions. When individuals are undergoing weight management interventions, it may be important to regularly assess for LOC eating. There is limited research on the examined relationships in diverse populations (e.g., males, individuals of a lower socio-economic status, racial/ethnic minority groups). Future research should examine these relationships across the lifespan in diverse populations, with a focus on how these relationships can be impacted through targeted interventions.

Ability to tolerate distress moderates the indirect relationship between emotion regulation difficulties and loss-of-control over eating via affective lability

INTRODUCTION

Loss-of-control eating (LOCE), inability to refrain from or cease eating, may contribute to significant distress and dysfunction, yet research is lacking specificity on vulnerabilities contributing to LOCE as an independent construct. Preliminary evidence indicates potential roles of distress tolerance, emotion regulation, and affective lability, but the relationship between these variables and LOCE has been under-assessed.

MATERIAL AND METHODS

A sample (N = 3968) consisting of university students completed an assessment of pathological eating and affiliated affective vulnerabilities. A latent variable structural equation model (SEM) was generated to predict LOCE by way of affective lability and indirectly, emotion regulation difficulties and low distress tolerance, controlling for general eating pathology.

RESULTS

Findings indicated a significant direct effect of affective lability on LOCE, as well as significant indirect effects of emotion regulation difficulties and distress tolerance on LOCE, via affect lability. Additionally, distress tolerance moderated the relationship between emotion regulation difficulties and affective lability, such that lower ability to tolerate distress strengthened the relationship and higher distress tolerance capability attenuated it.

DISCUSSION

Findings suggest an influence of distress tolerance on the relationship between poor emotion regulation and affective lability, which in turn may affect LOCE. Clinical implications and suggestions for future research are discussed.

Associations of Stress and Appetite Hormones with Binge Eating in Females with Anorexia Nervosa after Weight Restoration: A Longitudinal Study

Binge eating is a transdiagnostic eating disorder symptom that can occur in patients with anorexia nervosa (AN), persisting after weight restoration, and impeding their recovery. However, little is known about the biological predictors of binge eating after AN weight restoration. The goals of this exploratory study of 73 females with AN were: (1) to examine changes in cortisol, the adrenocorticotropic hormone, norepinephrine, ghrelin (total and active), and leptin levels across the admission, discharge, and 3 months post-discharge from the inpatient AN weight restoration; and (2) to determine whether the target hormones were associated with objective or subjective binge eating (OBE or SBE). The participants completed the self-reported Eating Disorder Examination Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory-II, and provided fasting whole blood samples for hormone assays. The results showed significant changes in body mass index (BMI), cortisol, total ghrelin, and leptin levels over the three time points. The cortisol levels at admission and discharge were significantly associated with the number of SBE episodes at 3 months post-discharge. Findings suggest the need to replicate and confirm the role of cortisol in predicting the emergence of SBE and uncover the mechanisms underlying SBE and cortisol to prevent SBE and its negative consequences.

Continuous versus Intermittent Dieting for Fat Loss and Fat-Free Mass Retention in Resistance-trained Adults: The ICECAP Trial

INTRODUCTION

Can intermittent energy restriction (IER) improve fat loss and fat-free mass retention compared with continuous energy restriction (CER) in resistance-trained adults?

METHODS

Sixty-one adults (32 women) with a mean (SD) age of 28.7 (6.5) yr, body weight of 77.2 (16.1) kg, and body fat of 25.5% (6.1%) were randomized to 12 wk of 1) 4 × 3 wk of moderate (m) energy restriction interspersed with 3 × 1 wk of energy balance (mIER; n = 30; 15 wk total) or 2) 12 wk of continuous moderate energy restriction (mCER; n = 31). Analyses of all outcome measures were by intention-to-treat.

RESULTS

After accounting for baseline differences, mIER did not result in lower fat mass or body weight, or greater fat-free mass, compared with mCER after energy restriction. Mean (and 97.5% confidence interval for fat mass at the end of mIER versus mCER was 15.3 (12.5-18.0) kg versus 18.0 (14.3-21.7) kg (P = 0.321), that for fat-free mass was 56.7 (51.5-61.9) kg versus 56.7 (51.4-62.0) kg (P = 0.309), and that for body weight (with 95% confidence interval) was 72.1 (66.4-77.9) versus 74.6 (69.3-80.0) (P = 0.283). There were no differences between interventions in muscle strength or endurance or in resting energy expenditure, leptin, testosterone, insulin-like growth factor-1, free 3,3',5-triiodothyronine or active ghrelin, or in sleep, muscle dysmorphia, or eating disorder behaviors. However, participants in mIER exhibited lower hunger (P = 0.002) and desire to eat (P = 0.014) compared with those in mCER, and greater satisfaction (P = 0.016) and peptide YY (P = 0.034).

CONCLUSIONS

Similar fat loss and fat-free mass retention are achieved with mIER and mCER during 12 wk of energy restriction; however, mIER is associated with reduced appetite.

The validation of a Farsi version of the Loss of Control over Eating Scale (F-LOCES) among Iranian adolescent boys and girls

OBJECTIVE

Few studies have been conducted on disordered eating in Iran, with limited research on loss of control (LOC) eating in adolescents. The purpose of the current study was to evaluate the validation of a Farsi version of the Loss of Control over Eating Scale (F-LOCES) among Iranian adolescents.

METHOD

Participants were 504 boys (Age _mean = 15.35; Body Mass Index [zBMI] _mean = 0.01) and 607 girls (Age _mean = 15.71; zBMI _mean = -0.01) who completed a battery of questionnaires including the F-LOCES.

RESULTS

Confirmatory Factor Analysis (CFA) and bi-factor model indicated that the F-LOCES had good fit to the data and supported a three-factor model. Additionally, the scale was invariant across all the groups. Girls had higher scores than boys on the behavioral subscale. Additionally, individuals with elevated eating pathology and zBMI endorsed higher LOC eating. As expected, the F-LOCES scores were positively associated with zBMI, disordered eating symptoms, and depression, and negatively associated with self-esteem.

DISCUSSION

Findings suggest that the F-LOCES is a reliable and valid measure of LOC eating in Iranian adolescents. The availability of the F-LOCES will enable researchers to examine the developmental trajectories, predictors, and outcomes of LOC eating.

Low testosterone is associated with dysregulated eating symptoms in young adult men

OBJECTIVE

Extant animal and human data indicate that natural variation in circulating levels of testosterone may contribute to differential risk for dysregulated eating among males. Indeed, testosterone ablation in postpubertal male rodents results in stimulatory effects on sweet-taste preferences, and lower levels of circulating testosterone in adolescent boys have been found to predict dysregulated eating symptoms during mid-to-late puberty. Nonetheless, no prior study has examined whether lower testosterone is associated with dysregulated eating in adulthood. The current study examined this possibility.

METHOD

Participants were 154 young adult men (ages = 18-33) from a large Southwestern University. The Eating Disorder Examination Questionnaire, Eating Pathology Symptoms Inventory, and Loss of Control Over Eating Scale were used to assess three types of dysregulated eating symptoms: eating concerns, binge eating, and loss-of-control eating. Afternoon saliva samples were assayed for testosterone using high-sensitive enzyme immunoassays.

RESULTS

Consistent with animal data and prior research in adolescent boys, men with lower testosterone reported significantly higher levels of dysregulated eating symptoms even after controlling for depressive symptoms, body mass index, and age.

DISCUSSION

Lower testosterone concentrations might serve as a sex-specific biological factor that contributes to dysregulated eating among men.

The feasibility of a behavioral group intervention after weight-loss surgery: A randomized pilot trial

Background

Formal psychosocial support programs after weight-loss surgery are limited in scope and availability.

Objective

This randomized pilot study evaluated the feasibility of a postoperative behavioral intervention program.

Materials and methods

Postoperative weight-loss surgery patients (N = 50) were recruited from February 2017–July 2017 and randomized to a four-month behavioral program or usual care wait-list. Outcomes evaluated in addition to feasibility included health-related quality of life (Short Form -36), psychosocial functioning and adherence. Secondary outcomes included within-group changes for each outcome.

Results

Out of eight possible sessions, intervention participants attended a mean of 4.2 sessions. Intervention group participants experienced greater improvements in the social functioning domain of health-related quality of life compared to usual care. Self-reported dietary adherence in the intervention group remained stable, while usual care group dietary adherence declined. Within the intervention group, participants also reported gains in the physical function, pain and general health aspects of quality life from baseline to post-treatment. No differences in weight, mood or other eating behaviors (e.g., loss of control, emotional eating) were evident between groups.

Conclusion

Though participation in a postoperative behavioral intervention varied, the program helped participants to maintain aspects of quality of life and self-reported adherence to dietary recommendations.

Trial registration

ClinicalTrials.gov NCT03092479

Less Binge Eating and Loss of Control over Eating Are Associated with Greater Levels of Mindfulness: Identifying Patterns in Postmenopausal Women with Obesity

Obesity is a public health concern resulting in widespread personal, social, and economic burden. Many individuals with obesity report feeling unable to stop eating or to control their food intake (i.e., a loss of control over eating) despite their best efforts. Experiencing loss of control over eating predicts further eating pathology and is a key feature of binge eating. Mindfulness (i.e., awareness and acceptance of current thoughts, feelings, sensations, and surrounding events) has emerged as a potential strategy to treat such eating disorder behaviors, but it is not known whether there is merit in investigating this strategy to address binge eating in postmenopausal women with obesity. Thus, this study aimed to examine the relationships between binge eating and mindfulness in postmenopausal women with obesity seeking weight loss treatment. Participants (n = 101) were assessed with the Eating Disorder Examination Questionnaire, the Loss of Control over Eating Scale, the Five-Facet Mindfulness Questionnaire, and the Langer Mindfulness Scale. Participants´ overall scores on both mindfulness scales were significantly and negatively correlated with binge eating frequency or the severity of loss of control over eating. Moreover, participants who reported fewer binge eating episodes were significantly more mindful than those who reported greater frequencies of binge eating episodes within the past 28 days. These findings suggest a merit in investigating the use of mindfulness-based therapies to treat binge eating in postmenopausal women with obesity.

Self-report measures of loss of control over eating: Psychometric properties in clinical and non-clinical samples

OBJECTIVE

Research evidence supports the clinical significance of subjective feelings of loss of control over eating; however, limited attention has been given to how this construct is assessed. Two measures have been developed in recent years (i.e., Eating Loss of Control Scale [ELOC] and Loss of Control over Eating Scale [LOCES]), but further validation in clinical and non-clinical samples is needed.

METHOD

The current study evaluated the psychometric properties, including factor structure, criterion validity, and measurement invariance of the ELOC and LOCES across two groups: (a) a clinical sample of individuals with eating disorders (n = 106) and (b) a non-clinical sample of college students (n = 321).

RESULTS

Confirmatory factor analyses indicated that the 16-item version of the ELOC and 7-item brief version of the LOCES provided good fit to the data in both samples. These measures were highly correlated (r = .83-.87) and associated with binge-eating and related psychopathology. The ELOC demonstrated partial invariance between men and women and between the clinical and non-clinical samples. The LOCES-brief demonstrated full invariance between men and women and partial invariance between the clinical and non-clinical samples.

DISCUSSION

Findings suggest that the 16-item ELOC and 7-item LOCES are reliable measures of severity of loss of control eating in clinical and non-clinical samples. Given the brevity of the LOCES-brief and evidence for measurement invariance across sex, it is recommended over the ELOC in heterogeneous samples. Future research is needed to confirm the validity of these measures across individuals with and without eating disorders.

Psychometric properties of the brief loss of control over eating scale (LOCES-B) in early adolescents

OBJECTIVE

The purpose of this study was to evaluate the psychometric properties of the brief loss of control over eating scale (LOCES-B) in a community sample of adolescents.

METHOD

Participants were 1,116 adolescents (11-15 years; 53% girls; 53% non-Hispanic White) recruited from middle schools in the Northeast United States. Participants were administered self-report surveys during school in the fall of 2016.

RESULTS

Confirmatory factor analyses indicated that the LOCES-B total score was unidimensional, which was invariant across gender and weight status. The LOCES-B had excellent internal consistency (α = .92). The LOCES-B total score had large, positive relationships with the frequency of LOC eating episodes, objective bulimic episodes, and subjective bulimic episodes, and a small, positive relationship with objective overeating episode frequency. After adjusting for demographics, anthropometrics, and LOC eating frequency, adolescents reporting higher scores on the LOCES-B total score had greater body image dissatisfaction, more internalizing symptoms, and lower trait effortful control.

DISCUSSION

Findings suggested that the LOCES-B is a reliable and valid measure of LOC eating in early adolescents. The availability of the LOCES-B has the potential to elucidate the developmental trajectories, predictors, and outcomes of LOC eating across the full severity spectrum in large cohort studies of youth.