Exploring gender differences in the link between weight suppression and eating pathology

Preconception weight suppression predicts eating disorder symptoms in pregnancy

OBJECTIVE

Disordered eating is common in pregnancy and associated with adverse health outcomes. Weight suppression (WS), the discrepancy between highest lifetime and current weight, is a robust predictor of loss of control (LOC) and binge eating and weight gain trajectories in clinical populations. This study explored the role of preconception WS as a predictor of disordered eating and weight gain in pregnancy.

METHOD

Pregnant individuals (n = 137) reported their highest, preconception, and current weights to calculate preconception WS, actual gestational weight gain (GWG), and deviations from recommended weight gain trajectories in pregnancy. Participants also completed the Prenatal Eating Behaviours Screening (PEBS) tool, a validated measure of disordered eating specifically in pregnancy.

RESULTS

Preconception WS was a significant predictor of PEBS total scores [F(5, 122) = 2.70, p = 0.02, R2 = 0.10] and significantly and positively correlated with individual item scores quantifying restrictive eating behaviours. Preconception WS was not predictive of deviations from recommended GWG trajectories or LOC or binge eating frequency and did not interact with pre-pregnancy body mass index or GWG to predict eating disorder symptom severity.

CONCLUSIONS

Preconception WS was predictive of disordered eating, and specifically restrictive eating behaviours in pregnancy, and should be assessed as part of screening for eating disorder risk in pregnant individuals.

Personality Traits and Risk of Eating Disorders in Men: A Cross-Sectional Study

Eating disorders (EDs) have been understudied and misunderstood in men. Among the relevant factors in the risk, onset, and maintenance of EDs, personality stands out. Therefore, the aim of the study was to analyze the relationships between personality traits and risk variables for the development of EDs in men. A total of 443 male university students (mean = 22.16 years) who completed the Spanish versions of the Eating Disorder Inventory-3 (EDI-3) and the NEO Five-Factor Inventory (NEO-FFI) participated. Correlation analyses were performed, and in order to determine the predictive role of personality traits on risk scales, a hierarchical multiple regression was performed. The results showed that neuroticism was positively associated with drive for thinness, being its main predictor variable. In bulimia, the main relationships were positively associated with neuroticism and negatively with conscientiousness. As for body dissatisfaction, the main predictor variables were neuroticism and, in a negative sense, extraversion and openness to experience. In conclusion, personality traits are related to the risk of developing EDs in male university students, with neuroticism being the main associated trait.

Body Dissatisfaction and Restricted Diet in Chinese Adolescents: A Longitudinal Analysis

Background/Objective

Body dissatisfaction and restricted diet frequently co-occur among adolescents. However, the exact temporal relationship between the two is unclear. Furthermore, most relevant studies concentrate on Western cultural backgrounds, with only a few investigations conducted in many non-Western developing countries, including China. Therefore, this study aimed to investigate the mutual relationship between body dissatisfaction and restricted diet among Chinese adolescents.

Patients/Methods

We recruited a sample of 672 middle school students from China (358 females, mean age = 14.33±0.94) and collected self-reported measures of body dissatisfaction and restricted diet at three-time points (with a five-month interval between each). We used cross-lagged models to examine the bidirectional relationship between body dissatisfaction and restricted diet.

Results

(1) Both cross-sectional and cross-lagged correlation analysis showed positive correlation between body dissatisfaction and restricted diet (r=0.29-0.36; r=0.25-0.35, Ps<0.001); (2) The cross-lagged effect of body dissatisfaction on restricted diet was significant (β=0.09, 0.13, Ps<0.01), and vice versa (β=0.20, 0.18, Ps<0.001); (3) The differences in the associations between body dissatisfaction and restricted diet across gender were found.

Conclusion/Implications

There is a bidirectional relationship between adolescents' body dissatisfaction and restricted diet. Our findings enrich the existing literature on body image and dietary health, thereby contributing to the reduction of negative body image and disordered eating among adolescents.

Does suppressing weight improve body satisfaction? A longitudinal analysis in undergraduate men and women

Young adults with high body dissatisfaction may engage in disordered eating to reduce their weight, believing that weight loss will improve body satisfaction. Yet, limited research has examined whether suppressing weight contributes to improved body satisfaction in nonclinical samples. Undergraduate students (N = 661; 81.2% female) completed three surveys over a six-month period. Longitudinal mixed-effect models investigated whether weight suppression was associated with change in body dissatisfaction. Body dissatisfaction was higher on average among women, and greater weight suppression was associated with greater body dissatisfaction across genders. Among women, higher baseline weight suppression was related to higher body dissatisfaction across time; however, neither baseline weight suppression nor change in weight suppression were associated with change in body dissatisfaction. Among men, higher baseline weight suppression was related to increased body dissatisfaction over time. However, greater increases in weight suppression were associated with improvements in body dissatisfaction. Thus, the impact of weight suppression on body image outcomes may differ by gender. Findings suggest that when men become more weight suppressed, their body dissatisfaction decreases; however, changes in weight may not impact body dissatisfaction in women. Findings may inform educational programs challenging diet and weight loss myths, particularly for women.

The effect of weight suppression on eating behavior: Does the intentionality of weight loss matter?

Weight suppression (WS) has been consistently related to eating pathology. The weight loss that produces weight suppression has always been assumed to be intentional, but no study has tested whether unintentional weight loss would also be associated with eating pathology. The current study examined whether the association between WS and eating pathology may be moderated by intentionality of weight loss in a community-based sample of 520 adults. Participants were categorized into low WS (<5% weight loss from highest past weight), intentional, high WS (>5% intentional weight loss), and unintentional, high WS (>5% unintentional weight loss) groups. The intentional WS group reported greater restraint than the unintentional WS and low WS groups, and the low WS group reported greater restraint and more frequent loss-of-control (LOC) eating than those with unintentional WS. Further, WS was positively related to loss-of-control eating frequency only in the intentional WS group, and negatively associated with LOC eating frequency in the low WS group. Additionally, BMI was positively associated with LOC and binge eating frequency and restraint only in the low WS group. Given the relatively high prevalence of substantial but unintended weight loss found in this study, researchers studying weight suppression should consider asking about intentionality of weight loss and analyzing their data with and without unintentional weight suppressors included in the sample.

A prospective analysis of loss of control over eating, sociodemographics, and mental health during COVID-19 in the United States

Purpose

The study assessed the relationships between sociodemographics, mental health, and prospective changes in loss of control over eating (LOCE).

Methods

Sixty-nine participants (M_age = 39.81 years, SD = 12.25; 49.3% female) completed a survey assessing sociodemographics, mental health, and LOCE at three time points.

Results

A one-way repeated-measures ANOVA revealed statistically significant differences between the Wave 1 and Wave 3 LOCE. Mixed between-within subjects ANOVAs revealed a main effects of time, essential worker status, and mental health constructs. Interaction effects were observed for sex, anxiety, and stress with time.

Conclusion

Findings provide insight into eating behaviors during COVID-19.

Associations among weight suppression, self-acceptance, negative body image, and eating disorder behaviors among women with eating disorder symptoms

The present study aimed to clarify existing research that has inconsistently shown that weight suppression (differences between individuals' highest and current body weights) is associated with worse eating disorder (ED) behaviors and negative body image among women with lifetime EDs, by examining whether an understudied client-supported protective factor for ED pathology - self-acceptance - moderates these associations. Currently symptomatic women with lifetime EDs (N = 108) completed measures assessing self-acceptance and ED symptoms via an online survey. Moderated regressions examined whether self-acceptance moderated associations between weight suppression and both body image (weight/shape preoccupation, overvaluation, dissatisfaction) and ED behavior (dietary restraint, compensatory behaviors, binge eating) outcomes. Results indicated that weight suppression was associated with more severe negative body image and dietary restraint, but not compensatory behaviors or binge eating. In contrast, self-acceptance consistently emerged as a protective factor relative to all negative body image and ED behavior indices. This protective effect did not offset apparent risk factor associations between weight suppression, and negative body image and ED behavior outcomes. These results support further assessment of self-acceptance as an understudied protective factor for women's ED symptoms and as a mechanism of change in EDs intervention research. Women's weight suppression should be assessed during ED prevention initiatives.

Examining weight suppression as a predictor and moderator of intervention outcomes in an eating disorder and obesity prevention trial: A replication and extension study

Weight suppression (WS) predicts future weight gain and increases in eating disorder symptoms in community and clinical samples but has received minimal attention in obesity and eating disorder prevention programs. In a sample of emerging adults (N = 364) in a randomized controlled trial evaluating two obesity and eating disorder prevention interventions versus a control condition, this study aimed to replicate the findings that WS and its interaction with baseline BMI predict increases in weight and eating disorder symptoms and test a novel hypothesis that WS would moderate the effects of the interventions on change in weight and eating disorder symptoms. Participants completed assessments at baseline, post-intervention, 6-, 12-, and 24-months. WS was calculated as the difference between highest lifetime weight and baseline weight. WS interacted with baseline BMI to predict greater weight gain over 24-months, such that those with high WS and lower baseline BMI gained weight most rapidly. WS did not predict eating disorder symptom change and did not moderate the effects of the prevention programs. Given that individuals with WS are at increased risk for weight gain, expressly targeting this high-risk population with evidence-based obesity prevention programs may be useful. CLINICALTRIALS.GOV REGISTRATION: NCT01680224.

Diagnosis of Eating Disorders Among College Students: A Comparison of Military and Civilian Students

INTRODUCTION

Eating disorders are often under-detected, which poses a serious threat to the health of individuals with eating disorder symptoms. There is evidence to suggest that the military represents a subpopulation that may be susceptible to high prevalence of eating disorders and vulnerable to their underdiagnosis. Underreporting of eating disorder symptoms in the military could lead to this underdiagnosis of individuals with eating disorder symptoms. The purpose of this study was to examine the association between military affiliation and eating disorder symptoms among college students and the likelihood of eating disorder diagnosis among those with eating disorder symptoms using a large, diverse college-aged sample of both military-involved and civilian students.

MATERIALS AND METHODS

Participants for this study were from the 2015-2016, 2016-2017, and 2017-2018 Healthy Minds Study (HMS). Healthy Minds Study is a large, cross-sectional cohort study of both undergraduate and graduate students from universities and colleges across the United States and Canada. The Healthy Minds Study survey questions include assessment of demographic information, military status, self-reported eating disorder symptoms using the SCOFF questionnaire, and self-reported eating disorder diagnosis. Univariate analysis, chi-square analysis, and logistic regression with an unadjusted and covariate adjusted model were used to examine the association between eating disorder symptoms and military affiliation. These analyses were also used to examine the association between eating disorder diagnosis among those with eating disorder symptoms and military affiliation. All analyses were conducted using SPSS.

RESULTS

The prevalence of eating disorder symptoms was high among both the civilian (20.4%) and military-involved (14.4%) students. Among females, there was a significantly higher (P value = .041) prevalence of eating disorder symptoms among civilian college students (24.7%) compared to military-involved students (21.3%). Among those with eating disorder symptoms, the prevalence of diagnosis was low in both military and civilian students. Specifically, the prevalence of diagnosis was significantly lower (P value = .032) among military-involved college students (10.8%) compared to civilian college students (16.4%). Differences in sociodemographic characteristics (e.g., gender, race/ethnicity, and age) among military-involved and civilian college students appear to explain this association.

CONCLUSIONS

The underdiagnosis of eating disorders is far too common, and this represents a threat to the health of military and civilian populations alike. Underdiagnosis of eating disorders within military environments may be due to underreporting, particularly among men and racial/ethnic minority groups.

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery

BACKGROUND

Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating.

OBJECTIVES

To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients.

SETTING

Multicenter study, United States.

METHODS

This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating.

RESULTS

The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m². The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05).

CONCLUSION

Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.

The brief (seven-item) eating disorder examination-questionnaire: Evaluation of a non-nested version in men and women

OBJECTIVE

Several recent studies have examined the psychometric properties of brief measures of eating disorder attitudes based on the Eating Disorder Examination Questionnaire (EDE-Q). A seven-item version (the EDE-Q7) has been proposed but, as yet, has only been investigated by looking at the items when presented as part of the longer EDE-Q (i.e., as a nested version). The current study presented the EDE-Q7 as a standalone instrument and examined factor structure fit and measurement invariance across male and female genders.

METHODS

University students (244 women; 155 men; 1 did not identify with either gender) completed questionnaires as part of two independent studies. All individuals completed the EDE-Q7 and measures of eating disorder behaviors. In a mixed-gender subsample (n = 286), measures of depression and eating disorder-specific quality of life were also included. Confirmatory factor analysis of the EDE-Q7 was conducted on males and females independently, in addition to estimates of internal consistency reliability and validity. Measurement invariance was assessed through multigroup confirmatory factor analysis.

RESULTS

The EDE-Q7 demonstrated good internal consistency and findings supported measurement invariance by gender. In a mixed-gender subsample, the measure showed positive associations with depression and both eating disorder behaviors and eating disorder-specific quality of life.

DISCUSSION

The present study adds to the literature supporting the psychometric properties of the EDE-Q7, extending this to use of the questionnaire as a standalone instrument. Measurement invariance suggests that the measure may be appropriate for college-age men and women, although future studies should establish psychometric properties more fully.

Eating Disorders in Males: How Primary Care Providers Can Improve Recognition, Diagnosis, and Treatment

Eating disorders are complex and multifactorial illnesses that affect a broad spectrum of individuals across the life span. Contrary to historic societal beliefs, this disorder is not gender-specific. Lifetime prevalence of eating disorders in males is on the rise and demanding the attention of primary care providers, as well as the general population, in order to negate the potentially life-threatening complications. Current literature has continued to reinforce the notion that eating disorders predominately affect females by excluding males from research, thereby adding to the void in men-centered knowledge and targeted clinical care. To determine what is currently known about eating disorders among males, a scoping review was undertaken, which identified 15 empirical studies that focused on this topic. Using the Garrard matrix to extract and synthesize the findings across these studies, this scoping review provides an overview of the contributing and constituting factors of eating disorders in males by exploring the associated stigmas, risk factors, experiences of men diagnosed with an eating disorder, and differing clinical presentations. The synthesized evidence is utilized to discuss clinical recommendations for primary care providers, inclusive of male-specific treatment plans, as a means to improving care for this poorly understood and emerging men’s health issue.

Eating behavior and metabolic syndrome over time

PURPOSE

We evaluated the longitudinal associations between eating behaviors (EB) and risk of metabolic syndrome (MetS).

METHODS

We obtained complete data on EB, assessed using the Dutch Eating Behavior Questionnaire, and MetS components at baseline and follow-up. Participants included 1876 individuals (704 men, 1172 women; mean age, 45.0 ± 12.8 years) from those participating in the Korean Healthy Twin study. A generalized estimating equation model was applied, with sociodemographic factors, health-related factors, follow-up interval, and EB (baseline and changes over time) as independent factors.

RESULTS

MetS at baseline was 21.5%, while incident MetS and persistent MetS were 12.0% and 66.6%, respectively, at the 3.13 ± 1.38 years follow-up period. In men, baseline restrained EB had positive associations with concurrent MetS (odds ratio [95% confidence interval] per 1 point increase in the score, 1.55 [1.33-1.81]) and persistent MetS (1.53 [1.16-2.01]); baseline external EB and change in external EB had positive associations with persistent MetS (1.56 [1.04-2.33], 1.37 [1.01-2.22], respectively). In women, baseline restrained EB had a positive association with concurrent MetS (1.14 [1.01-1.30]); baseline external EB had an inverse association with persistent MetS (0.71[0.52-0.98]); baseline emotional EB had positive associations with concurrent, incident, and persistent MetS (1.23 [1.01-1.50], 2.14 [1.50-3.06], and 1.92 [1.40-2.64], respectively); and change in emotional EB had positive associations with incident and persistent MetS (1.50 [1.05-2.15], 1.62 [1.14-2.29], respectively).

CONCLUSION

Higher restrained and external EB, and an increase in external EB in men; and higher restrained and emotional EB, and an increase in emotional EB in women may be associated with increased risk of concurrent, incident, or persistent MetS.

LEVEL OF EVIDENCE

III, cohort study.

Weight suppression and weight maintenance following treatment of anorexia nervosa

OBJECTIVE

The value of weight suppression (WS) in predicting the course of anorexia nervosa (AN) is uncertain. The objective of this study was to determine, using data from a previously published study, whether patients who remain weight suppressed following restoration to a minimally normal weight are at greater risk for relapse.

METHOD

Following weight restoration, 93 women with AN were randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy for 1 year. WS (highest adult weight minus current weight), body mass index (BMI), and their interaction were assessed as predictors of change in weight over the first 28 days, of successful weight maintenance at 6 and 12 months, and of time to relapse.

RESULTS

Neither WS nor its interaction with BMI predicted successful weight maintenance at 6 and 12 months, time to relapse, or weight change over the first 28 days following discharge.

DISCUSSION

This study found that WS does not substantially impact the likelihood of successful weight maintenance or time to relapse following restoration to a minimally normal weight in AN.

Examining the contribution of weight-bias internalization to the associations between weight suppression and disordered eating in undergraduates

Weight suppression (WS) is consistently, positively associated with eating disorder (ED) symptoms, but variables that contribute to these associations remain understudied. The current study examined weight-bias internalization as a potential contributor to the link between weight suppression (WS) and disordered eating in an undergraduate sample. Men (n = 285) and women (n = 610) completed assessments of weight history, weight-bias internalization, and ED symptoms. Absolute (difference in highest and current BMI) and relative WS (%BMI change) were calculated. Hierarchical linear and count regression models examined whether WS contributed to ED symptoms (restraint, objective binge episodes [OBEs], loss-of-control [LOC] eating, and compensatory exercise) above and beyond weight-bias internalization. Analyses were conducted by gender. After accounting for weight-bias internalization, WS demonstrated unique associations with restraint in men (p = .01) and women (p < .001), and LOC eating frequency in men (p = .02), though effects were weaker relative to weight-bias internalization. Although WS was positively correlated with frequency of OBEs in men and LOC eating in women, these associations were no longer significant when accounting for weight-bias internalization. Weight-bias internalization was positively associated with all measured ED symptoms. Consistent with previous work, gender differences in the relations of WS and ED symptoms emerged. Results suggest weight-bias internalization might contribute to links between WS and ED symptoms, particularly binge behaviors, in non-clinical samples. Future research should explore whether decreasing weight-bias internalization could weaken the association between WS and ED symptoms.

What are you losing it for? Weight suppression motivations in undergraduates

PURPOSE

Accumulating evidence suggests weight suppression (WS) is related to disordered eating and eating disorder (ED) risk in non-clinical samples; however, research to-date has not examined the intentionality of, or motivations for, WS. The purpose of this study was to: (1) qualitatively assess WS motivation in undergraduates, and (2) explore differences in body image and eating behaviors across motivation categories.

METHODS

In the first study, responses from 192 undergraduates were evaluated using inductive content analysis; four primary motivation categories emerged: appearance, functional, sports/military, and unintentional. In a second study, 1033 undergraduates indicated their primary WS motivation, if applicable, and completed body image and eating behavior measures. Separate analyses were run by gender; covariates included current body mass index (BMI) and WS.

RESULTS

Differences in body image and eating behaviors emerged across motivation categories for both men (p < 0.001) and women (p < 0.001). Appearance-motivated WS in men, and appearance and sports/military-motivated WS in women, were related to greater body dissatisfaction, restraint, thin-ideal internalization, and ED risk. Undergraduates with intentional WS demonstrated higher body dissatisfaction and eating pathology than undergraduates with unintentional or no WS (all ps < 0.05).

CONCLUSIONS

Assessing weight history and WS motivations could be a brief, low-cost intervention to improve identification of undergraduates at greatest risk for EDs. This information could be integrated into campus marketing campaigns promoting wellness.

LEVEL OF EVIDENCE

Cross-sectional descriptive study, Level V.

Low body mass and ethnic identity exploration exacerbate the association between body image concerns and loss of control eating in Hispanic/Latino men

OBJECTIVE

Although Hispanic/Latino populations have some of the highest rates of obesity in the United States, little is known about their loss of control (LOC) eating, a robust predictor of excess weight gain. This study examined the association between body image concerns and LOC eating frequency in a sample of young Hispanic/Latino men. Body mass index (BMI), ethnic identity, and acculturation were examined as potential moderators.

METHOD

The sample included 271 Hispanic/Latino men between the ages of 18 and 30 years (M_age = 23.89 ± 3.54; M_BMI = 26.46 ± 5.82). Participants completed an online survey and reported on height, weight, and demographic characteristics; concerns with muscularity and body fat; LOC eating frequency in the last 28 days; ethnic identity; and perceived acculturation.

RESULTS

Negative binomial regression models were conducted, adjusting for BMI, income, education, and presence of a psychiatric diagnosis. Concerns with muscularity and body fat were positively associated with LOC eating frequency (ps < .001). Low BMI exacerbated the link between concerns with body fat and LOC eating frequency (p = .03). The positive association between concerns with muscularity and LOC eating frequency was exacerbated among those who reported low ethnic identity exploration (p = .01). While acculturation did not function as a moderator (ps = .14-.27), it was inversely associated with LOC eating frequency (p < .001).

DISCUSSION

BMI and ethnic identity are important individual factors to consider in the link between body image concerns and LOC eating among young Hispanic/Latino men.

Compulsive exercise and weight suppression: Associations with eating pathology in distance runners

Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.

Weight suppression and its relation to eating disorder and weight outcomes: a narrative review

Weight suppression (WS) refers to the discrepancy between highest adult weight and current weight, and has been examined as a key construct related to both: eating pathology and weight management. However, despite increasing interest in WS, findings regarding the clinical implications of WS are often conflicting. For instance, WS has been associated with both adaptive and maladaptive outcomes across various populations. Moreover, results regarding the predictive utility of WS within clinical samples have been inconsistent. The current paper aims to provide a narrative review of existing investigation related to WS, highlight gaps in the field's understanding of this construct, and outline recommendations for future study.

Weight Suppression in Eating Disorders: a Research and Conceptual Update

PURPOSE OF REVIEW

Weight suppression, the discrepancy between an individual's highest past weight at adult height and his or her current weight, is related to many characteristics of individuals with eating disorders. This paper reviews research findings from the past 5 years, draws several implications regarding the mechanism underlying these effects, and proposes new approaches to measuring weight suppression.

RECENT FINDINGS

Studies were reviewed under the categories of anorexia nervosa, bulimia nervosa, and mixed or miscellaneous samples, with more studies falling into the last category than in the first two. Recent findings have continued to show that weight suppression is related to a wide variety of biological and behavioral features in both diagnosed and sub-clinical samples. Weight suppression promotes weight gain which is anathema to individuals with eating disorders, putting them in a biobehavioral bind that appears to prolong their disorder. Priorities for future research are to understand the mechanisms underlying the effects of weight suppression, evaluate new ways of defining weight suppression, and study its implications for modifying treatment.

Relation of BMI and weight suppression to eating pathology in undergraduates

Weight suppression (WS), the difference in one's highest and current adult weight excluding pregnancy, is associated with eating disorder (ED) symptom onset and maintenance. There is increasing evidence that WS is related to ED symptoms in non-clinical samples, but there are no known studies examining the interaction of WS and current body mass index (BMI) in this group. History of overweight is common in those with EDs, and higher weight status often delays identification and treatment. This study examined the interaction of WS and current BMI on body dissatisfaction and eating pathology in undergraduate men and women. Undergraduates (N = 476) completed online surveys assessing current height and weight, weight history, and eating attitudes and behaviors. In women (n = 333), both BMI and WS were positively associated with body dissatisfaction, restraint, and global ED symptoms. In men (n = 143), there were no significant associations with BMI, but WS was related to greater body dissatisfaction, restraint, global ED symptoms, and loss-of-control eating. Moderation analyses revealed that the effect of current BMI on shape concern (p = .005), weight concern (p = .002), global ED symptoms (p = .01), and purging behaviors (p = .04) in women and restraint (p = .03) in men weakened at the highest levels of WS. Results suggest that WS is salient in a non-clinical sample and underscore the need to evaluate both weight history and the presence of disordered eating in individuals across the BMI spectrum.

The impact of weight suppression and weight loss speed on baseline clinical characteristics and response to treatment

OBJECTIVE

Growing evidence suggests an impact of weight suppression (WS) on severity and course of symptoms in patients with eating disorders (ED), but no study explored also the role of the weight loss speed (WLS) together with WS on the same clinical variables, which is the aim of the present work.

METHOD

A mixed cross-sectional and longitudinal cohort study was employed. Four hundred and fourteen patients with anorexia nervosa (AN = 208) or bulimia nervosa (BN = 206) according to DSM-5 criteria were recruited and assessed at referral by means of clinical interviews and self-reported questionnaires. Body mass index and diagnostic status were re-evaluated at the end of treatment.

RESULTS

WS was positively correlated with body dissatisfaction in patients with AN (p = .005), but negatively correlated in BN (p = .022). In contrast, WLS was significantly inversely correlated with age and duration of illness in all ED (p < .001), and positively correlated with drive for thinness in BN (p = .007). After treatment, WS at intake predicted higher BMI increase in both AN and BN (p < .03), while higher WLS was significantly associated with a lower drop-out rate in patients with BN (p = .02), and predicted BMI increase only in restricting AN patients (p = .02). In the whole group, WLS significantly predicted remission status (p = .039).

DISCUSSION

In our study, both WS and WLS were associated with baseline "core" clinical variables and provided complementary abilities to predict weight gain and remission at the end of treatment. If replicated, our data suggest the importance of considering both WS and WLS as useful clinical variables in the baseline assessment of ED.