Body image evaluations in obese females with binge eating disorder

Disgust sensitivity and behavioural inhibitory systems in binge eating disorder: associations with eating pathology

Disgust sensitivity refers to how unpleasant a disgusting experience is to an individual and is involved in the development of many psychiatric conditions. Given its link with food ingestion, there is an interest in understanding how an individual's susceptibility to disgust relates to dietary habits. One possible mechanism giving rise to this association is through the effects negative emotions have on high-order cognitive processes, but few studies take this model into account. The aim of this study was to characterize general disgust sensitivity in a clinical binge eating disorder (BED) population, and explore whether disgust sensitivity relates to inhibitory control and eating pathology. Following a case-controlled study design, our results show that: (1) disgust sensitivity and its subscales do not differ between BED and healthy controls, (2) higher disgust sensitivity in BED relates to greater behavioural inhibition, (3) inhibitory control reaction times relate to aspects of eating pathology, and (4) inhibitory control does not mediate relationships between disgust sensitivity and BMI among participants with BED. Understanding the role of disgust sensitivity in BED may allow us to understand how negative emotion systems maintain dysregulated eating behaviours with the potential to inform emotion-regulation treatment approaches. Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Comparative efficacy and acceptability of selective serotonin reuptake inhibitor antidepressants for binge eating disorder: A network meta-analysis

Background: There are several selective serotonin reuptake inhibitor (SSRI) antidepressants currently used to treat binge eating disorder (BED), but the efficacy and acceptability of these antidepressants are still controversial. Therefore, we designed a network meta-analysis (NMA) to compare the efficacy and acceptability of different SSRI antidepressants for the treatment of BED.

Methods: Four databases including PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched for the eligible randomized controlled trials (RCTs) for the treatment of patients with BED. The analysis was performed with Stata16 software.

Results: 9 RCTs were included in this NMA. The results of the study showed that compared with placebo, sertraline and fluoxetine could significantly reduce the frequency of binge eating. Fluoxetine was shown to be the drug with the greatest reduction in Hamilton Rating Scale for Depression (HAMD) score. Besides, all SSRI antidepressants were ineffective in losing weight. In addition, all the investigated antidepressants were found to be well acceptable in regards to the acceptability reflected by the dropout rate.

Conclusion: As far as both efficacy and acceptability were concerned, fluoxetine might be the best choice.

Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review

The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.

Quantitative gastrointestinal and psychological traits associated with obesity and response to weight-loss therapy

BACKGROUND & AIMS

Weight loss after pharmacotherapy varies greatly. We aimed to examine associations of quantitative gastrointestinal and psychological traits with obesity, and to validate the ability of these traits to predict responses of obese individuals to pharmacotherapy.

METHODS

In a prospective study, we measured gastric emptying of solids and liquids, fasting and postprandial gastric volume, satiation by nutrient drink test (volume to fullness and maximal tolerated volume), satiety after an ad libitum buffet meal, gastrointestinal hormones, and psychological traits in 328 normal-weight, overweight, or obese adults. We also analyzed data from 181 previously studied adults to assess associations betwecen a subset of traits with body mass index and waist circumference. Latent dimensions associated with overweight or obesity were appraised by principal component analyses. We performed a proof of concept, placebo-controlled trial of extended-release phentermine and topiramate in 24 patients to validate associations between quantitative traits and response to weight-loss therapy.

RESULTS

In the prospective study, obesity was associated with fasting gastric volume (P = .03), accelerated gastric emptying (P < .001 for solids and P = .011 for liquids), lower postprandial levels of peptide tyrosine tyrosine (P = .003), and higher postprandial levels of glucagon-like peptide 1 (P < .001). In a combined analysis of data from all studies, obesity was associated with higher volume to fullness (n = 509; P = .038) and satiety with abnormal waist circumference (n = 271; P = .016). Principal component analysis identified latent dimensions that accounted for approximately 81% of the variation among overweight and obese subjects, including satiety or satiation (21%), gastric motility (14%), psychological factors (13%), and gastric sensorimotor factors (11%). The combination of phentermine and topiramate caused significant weight loss, slowed gastric emptying, and decreased calorie intake; weight loss in response to phentermine and topiramate was significantly associated with calorie intake at the prior satiety test.

CONCLUSIONS

Quantitative traits are associated with high body mass index; they can distinguish obesity phenotypes and, in a proof of concept clinical trial, predicted response to pharmacotherapy for obesity. ClinicalTrials.gov Number: NCT01834404.

Association of Body Image and Health Beliefs With Health Behaviors in Patients With Diabetes

Purpose

The purpose of this study was to investigate relationships between body image, health beliefs, and health behavior in patients with diabetes classified according to body mass index (BMI).

Methods

A cross-sectional study was conducted in a community hospital between January and April 2010. One-hundred-sixty-eight patients with diabetes were enrolled. Main measure was the previously published and validated Health Belief Questionnaire. Data were analyzed and compared between two groups, one with BMI ≥ 24 Kg/m2 and another with BMI < 24 Kg/m2.

Results

Perceived body image affected health behavior of patients with BMI ≥ 24 Kg/m2 but did not affect health behavior in patients with BMI < 24 Kg/m2. Multivariate analysis found a positive association between health behavior and appearance evaluation and between health behavior and health evaluation in high BMI group. No significant association was found between body image and health behavior in the low BMI group. Patients with high BMI had lower body image than patients with low BMI as demonstrated by results of appearance evaluation, health evaluation, prevention behavior, and benefits.

Conclusions

Perceived body image and health beliefs are associated with self-reported health behavior among patients with diabetes with BMI measurement greater than 24 Kg/m2. Diabetes educators may apply the findings of this study and the Health Belief Questionnaire to instruct and monitor patients with diabetes about self management behaviors.

Bupropion versus sertraline in the treatment of depressive patients with binge eating disorder: retrospective cohort study

This study sought to compare Bupropion versus Sertraline in the treatment of depressed patients with Binge Eating Disorder (BED) prescribed off-label. Medical records of outpatients with diagnosis of BED and Depression (DSM-IV-TR criteria) were selected: 15 patients were treated with bupropion 150 mg/per day, and 15 with sertraline 200 mg/per day. During the screening and control visits (2°-6°-14°-24° week), the selected patients were first weighed and then evaluated using the following questionnaires: Binge Eating Disorder-Clinical Interview (BEDCI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory X (STAI-X) and Arizona Sexual Experience Scale (ASEX). Both drugs reduced anxious-depressive symptoms and binge frequency: Bupropion showed a better effectiveness in reducing weight and improving sexual performances; weight loss related to it was proportional to the body mass index. Bupropion may be associated with more weight loss in BED, depressed patients than sertraline.

Body satisfaction, weight gain and binge eating among overweight adolescent girls

Objective

To examine if body satisfaction is associated with body mass index (BMI) change and whether it protects against the development of frequent binge eating among overweight and obese adolescent girls.

Methods

We used prospective data from 9 waves of an ongoing cohort study of adolescents, the Growing Up Today Study. At enrollment in 1996, participants were 9 to 14 years old. Questionnaires were mailed to participants annually until 2001, then biennially through 2007. Girls who were overweight or obese in 1996 were included in the analysis (n=1 559). Our outcomes were annual change in BMI and incident frequent binge eating, defined as binge eating at least weekly and no use of compensatory behaviors.

Results

At baseline, 57.2% of the overweight and obese girls were at least somewhat satisfied with their bodies. During 11 years of follow-up, 9.5% (95% confidence interval (CI) [7.8, 10.8]) of the girls started to binge eat frequently. Controlling for BMI and other confounders, overweight and obese girls who reported being at least somewhat satisfied with their bodies made smaller BMI gains (β=−0.10 kg/m², 95% CI [−0.19, −0.02]) and had 61% lower odds of starting to binge eat frequently (odds ratio (OR)=0.39, 95% CI [0.24, 0.64]) than their less satisfied peers. Compared to girls who were the least satisfied with their bodies, girls who were the most satisfied had 85% lower odds of starting to binge eat frequently (OR=0.15, 95% CI [0.06, 0.37]). The association between body satisfaction and starting to binge eat frequently was stronger for younger adolescents than older adolescents.

Conclusions

While body dissatisfaction is common among overweight and obese girls, body satisfaction may protect against excessive weight gain and binge eating. Prevention of body dissatisfaction must begin early and should be considered as a component of both obesity and eating disorder prevention programs.

Race, weight, and correlates of binge eating in female college students

This study examined the correlates of race, weight status, and binge eating among 715 female undergraduate students (77% Caucasian; 13% African American) enrolled at an urban university. Approximately 21.7% of Caucasians and 36.8% of African-Americans (AA) were overweight/obese. Higher BMI was associated with BED, and severity of binge eating symptoms. After removing participants who endorsed compensatory behaviors ≥ 1×/week from the analyses, 8.4% of the sample met criteria for BED (2.4% of the AA and 9.9% of the Caucasian students) and 44% reported severe binge eating symptoms. AA students were less likely to have BED than Caucasian students and reported less severe binge eating symptomatology. For Caucasian students, mood, cognitive restraint, drive for thinness, and BMI all contributed significant individual variance in binge eating severity. For African Americans, mood, body image dissatisfaction, and drive for thinness were found to be unique contributors. For those meeting criteria for BED, retrospectively recalled predictors of binge eating included negative affect (e.g., self-anger, worry, guilt), but not hunger. Behavioral triggers for binge behavior differed by race, as well, with African American students retrospectively reporting lower levels of anxiety prior to bingeing. Results from this study suggest that there are racial differences in binge eating behaviors. Future studies are needed to examine differences in eating practices among racial groups (e.g., grazing, large portions, high fat food preparation) that may contribute to early onset weight gain and obesity. The results suggest the importance of sensitive tailored weight and disordered eating interventions for college women from diverse backgrounds.

Binge eating disorder and depression: a systematic review

The purpose of this systematic literature review is to examine previous studies that investigated the relation between depression and binge eating disorder (BED). Medline/PubMed published data from 1980 through 2006 was tracked using the following keywords: "binge eating disorder and depression", "periodic binge eating and depression", "binge eating disorder" and "periodic binge eating". The findings of 14 studies were successfully highlighted: one cohort, four cross-sectional and nine case-control studies. Most studies (7/14) were conducted in the United States, with missing data varying between 2.3 and 44.32%, and seven studies emphasizing the most important variables. The majority of the studies (10/14) showed an association between depression and binge eating disorder, but carefully designed studies are required to minimize the limitations found in these studies.

Self-efficacy after bariatric surgery for obesity. A population-based cohort study

BACKGROUND

Eating behaviors often predict outcomes after bariatric surgery, and in this regard, self-efficacy has been shown to predict long-term behavior. We examined current eating self-efficacy in post-bariatric surgery patients comparing them to obese non-surgery patients to determine whether weight loss is associated with increased self-efficacy in post-bariatric surgery patients.

METHODS

We performed a population-based study of patients evaluated for Roux-en-Y gastric bypass and administered a survey using the Weight Efficacy Lifestyle (WEL) Questionnaire. There were 148 surgical and 88 non-operative patients who responded. Overall WEL score was assessed using linear regression models. Predictors of an increased self-efficacy score were also examined.

RESULTS

Follow-up was 4.0 and 3.8 years in the operative and non-operative groups, respectively. Operative responders were slightly older and had a lesser BMI compared to non-responders, otherwise the demographics were similar. Difference in overall WEL between groups was 25.5+/-5.3 points on a 0-180 scale. A 25% change in weight was associated with a difference of 15.4 points on the total WEL between groups. Current self-efficacy scores were highly related to weight loss and correlated to quality of life at follow-up (rho=0.36).

CONCLUSION

Profound weight loss after bariatric surgery is associated with increased eating self-efficacy in a population of obese adults seeking medical treatment for obesity.

The effect of obesity management on body image in patients seeking treatment at medical centers

OBJECTIVE

Body image dissatisfaction is common in treatment-seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs.

RESEARCH METHODS AND PROCEDURES

A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 +/- standard deviation 11.0 years; BMI, 36.8 +/- 5.7 kg/m(2)) were evaluated at baseline and after a 6-month weight loss treatment. Body uneasiness, psychiatric distress, and binge eating were tested by Body Uneasiness Test (BUT, Part A), Symptom CheckList-90 (SCL-90), and Binge Eating Scale (BES), respectively.

RESULTS

At 6-month follow-up, the percentage weight loss was significantly higher in men (9.0 +/- 6.3%) than in women (6.8 +/- 7.3%; p = 0.010). Both men and women had a significant improvement in BUT Global Severity Index and in all of the BUT subscales with the exception of the Compulsive Self-Monitoring subscale. Linear regression analysis selected baseline psychological and behavioral measures (global score of BUT and SCL-90) and improved psychiatric distress and binge eating as independent predictors of changes in basal body dissatisfaction in females, whereas in males, changes were associated only with baseline BUT-Global Severity Index score, binge eating, and its treatment-associated improvement. Pre-treatment BMI and BMI changes did not enter the regression.

DISCUSSION

Obesity treatment, even with a modest degree of weight loss, is associated with a significant improvement of body image, in both females and males. This effect depends mainly on psychological factors, not on the amount of weight loss.

Psychosocial variables, eating behavior, depression, and binge eating in morbidly obese subjects

OBJECTIVES

Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among patients seeking treatment for obesity. The purpose of this study was to determine whether morbidly obese subjects with BED differ from those without BED (NBED) in terms of eating behavior, social/environmental variables, and depression.

RESEARCH METHODS AND PROCEDURES

Out of 110 morbidly obese (BMI > or = 40 kg/m2) subjects, 88 could be reliably classified as BED (19) or NBED (69). These subjects (age 42.0+/-13.4 years, BMI 47.0+/-5.7 kg/m2) were examined by a semi-structured interview and by validated questionnaires to assess depression and eating behavior.

RESULTS

Subjects with BED showed higher scores of disinhibited eating (12.3+/-2.7 vs. 9.1+/-3.6, p<0.05), were more likely to attribute obesity to their eating habits (chi2=8.4, p<0.05), and rated their social environment regarding relationships as less supportive and cohesive (chi2=10.6, p=0.001). In addition, patients with BED experienced an earlier onset of obesity (chi2=6.3, p<0.05). No relationship, however, was found between binge eating disorder and depression.

DISCUSSION

Morbidly obese patients with BED exhibit typical psychological features when compared to those without BED. Their recognition by a structured psychological evaluation in conjunction with questionnaires might be necessary to develop appropriate therapeutic strategies to facilitate weight loss.

Prevalência de compulsão alimentar entre universitárias de diferentes áreas de estudo

INTRODUÇÃO: A compulsão alimentar (CA) entre mulheres tem sido considerada fator de risco para o diagnóstico de transtornos alimentares mais graves. O objetivo do presente estudo foi investigar a prevalência de CA entre universitárias e a sua associação com IMC (índice de massa corpórea) e idade. MATERIAL E MÉTODO: Foram avaliadas 491 estudantes universitárias, com idade entre 17 e 55 anos, de três áreas de estudo (exatas, saúde e humanas) da Universidade do Vale do Rio dos Sinos (UNISINOS), situada no município de São Leopoldo (RS). Para avaliar a freqüência de CA, utilizou-se o questionário auto-aplicável Escala de Compulsão Alimentar Periódica (ECAP). As medidas de peso e estatura foram auto-informadas. RESULTADOS: A prevalência de CA entre as universitárias estudadas foi de 18,1%. A freqüência de IMC > 25 kg/m² foi de 11,4%, e 75,8% delas apresentavam mais de 20 anos. Observou-se uma associação significativa entre IMC e CA no grupo geral, sendo que 54,5% das universitárias com excesso de peso ou obesidade apresentaram CA (p < 0,001), e a idade não foi associada com a presença de CA. Porém, na área da saúde, as estudantes com idade igual ou menor a 20 anos apresentaram maior freqüência de CA (p < 0,05), e, na área de humanas, o resultado foi inverso (p < 0,05). CONCLUSÃO: O questionário auto-aplicável ECAP revelou elevada prevalência de CA entre mulheres universitárias, mostrando associação com excesso de peso. Investigações futuras são necessárias, com o objetivo de confirmar esses resultados e avaliar a presença de outros transtornos alimentares.

Body dissatisfaction and binge eating in obese women: the role of restraint and depression

OBJECTIVE

This study examined the association between body dissatisfaction and binge eating, and the mediating role of restraint and depression among obese women.

RESEARCH METHODS AND PROCEDURES

Participants were obese women taking part in a cognitive-behavioral treatment program who completed self-report measures at baseline (n = 89) and post-treatment follow-up (n = 69).

RESULTS

At baseline, body dissatisfaction was strongly correlated with binge eating score. This was partly a direct effect and partly mediated by depression. No mediating effect of restraint was observed. Over the treatment period, a reduction in body dissatisfaction was associated with a reduction in binge-eating score. As in the cross-sectional data, there was evidence for mediation by change in depression with the greatest improvement in binge eating among those who became more restrained and less depressed.

DISCUSSION

These results suggest that it would be valuable to address psychological well-being, and especially body image, as part of the management of binge-eating behavior in obesity.