A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder

Repeated binge-like eating episodes in female rats alter adenosine A2A and dopamine D2 receptor genes regulation in the brain reward system

OBJECTIVE

Binge-eating disorder is an eating disorder characterized by recurrent binge-eating episodes, during which individuals consume excessive amounts of highly palatable food (HPF) in a short time. This study investigates the intricate relationship between repeated binge-eating episode and the transcriptional regulation of two key genes, adenosine A2A receptor (A2AAR) and dopamine D2 receptor (D2R), in selected brain regions of rats.

METHOD

Binge-like eating behavior on HPF was induced through the combination of food restrictions and frustration stress (15 min exposure to HPF without access to it) in female rats, compared to control rats subjected to only restriction or only stress or none of these two conditions. After chronic binge-eating episodes, nucleic acids were extracted from different brain regions, and gene expression levels were assessed through real-time quantitative PCR. The methylation pattern on genes' promoters was investigated using pyrosequencing.

RESULTS

The analysis revealed A2AAR upregulation in the amygdala and in the ventral tegmental area (VTA), and D2R downregulation in the nucleus accumbens in binge-eating rats. Concurrently, site-specific DNA methylation alterations at gene promoters were identified in the VTA for A2AAR and in the amygdala and caudate putamen for D2R.

DISCUSSION

The alterations on A2AAR and D2R genes regulation highlight the significance of epigenetic mechanisms in the etiology of binge-eating behavior, and underscore the potential for targeted therapeutic interventions, to prevent the development of this maladaptive feeding behavior. These findings provide valuable insights for future research in the field of eating disorders.

PUBLIC SIGNIFICANCE

Using an animal model with face, construct, and predictive validity, in which cycles of food restriction and frustration stress evoke binge-eating behavior, we highlight the significance of epigenetic mechanisms on adenosine A2A receptor (A2AAR) and dopamine D2 receptor (D2R) genes regulation. They could represent new potential targets for the pharmacological management of eating disorders characterized by this maladaptive feeding behavior.

Clinical Factors Associated with Binge-Eating Episodes or Purging Behaviors in Patients Affected by Eating Disorders: A Cross-Sectional Study

The aim of the present study was to investigate the potential associations between clinical/socio-demographic variables and the presence of purging/binge-eating episodes in eating disorders (EDs). Clinical/socio-demographic variables and psychometric scores were collected. Groups of patients were identified according to the presence or absence of purging or objective binge-eating episodes (OBEs) and compared through t-test and chi-square tests. Binary logistic regression analyses were run. A sample of 51 ED outpatients was recruited. Patients with purging behaviors had a longer duration of untreated illness (DUI) (t = 1.672; p = 0.019) and smoked a higher number of cigarettes/day (t = 1.061; p = 0.030) compared to their counterparts. A lower BMI was associated with purging (OR = 0.881; p = 0.035), and an older age at onset showed a trend towards statistical significance (OR = 1.153; p = 0.061). Patients with OBEs, compared to their counterparts, were older (t = 0.095; p < 0.001), more frequently presented a diagnosis of bulimia or binge-eating disorder (χ2 = 26.693; p < 0.001), a longer duration of illness (t = 2.162; p = 0.019), a higher number of hospitalizations (t = 1.301; p = 0.012), and more often received a prescription for pharmacological treatment (χ2 = 7.864; OR = 6.000; p = 0.005). A longer duration of the last pharmacological treatment was associated with OBE (OR = 1.569; p = 0.046). In contrast to purging, OBE was associated with a more complicated and severe presentation of ED. A lower BMI and a later age at onset, as well as long-lasting previous pharmacological treatments, may predict the presence of purging/binging. Further research is needed to thoroughly characterize ED features and corroborate our preliminary findings.

Improvements in cardiovascular disease risk factors associated with modest weight loss following treatment in patients with binge-eating disorder and obesity

BACKGROUND

Modest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%).

METHOD

Of 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss.

RESULTS

At posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure).

CONCLUSIONS

Modest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes.

PUBLIC SIGNIFICANCE STATEMENT

Individuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors.

Psychosocial Factors, Technology Use, and Disordered Eating in College Students During the COVID-19 Pandemic

The current cross-sectional study aimed to evaluate the effects of psychosocial factors and technology use on disordered eating in college students (aged 18 to 23 years) during the coronavirus disease 2019 (COVID-19) pandemic. An online survey was distributed between February and April 2021. Participants completed questionnaires on eating disorder behaviors and cognitions, depressive symptoms, anxiety, impacts of the pandemic across personal and social domains, social media use, and screen time. Of all participants (N = 202), 40.1% of students reported moderate or greater depressive symptoms and 34.7% endorsed moderate or greater anxiety symptoms. Higher depressive symptoms were associated with increased odds of bulimia nervosa (BN) (p = 0.03) and binge eating disorder (p = 0.02). People with higher COVID-19 infection scores were at increased odds of reporting BN (p = 0.01). Mood disturbances and COVID-19 infection history were associated with increased eating disorder psychopathology in college students during the pandemic. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 29-38.].

Cognitive-behavioral therapy for binge-eating disorder for non-responders to initial acute treatments: Randomized controlled trial

OBJECTIVE

Certain treatments have demonstrated acute efficacy for binge-eating disorder (BED) but many patients who receive "evidence-based" interventions do not derive sufficient benefit. Given the dearth of controlled research examining treatments for patients who fail to respond to initial interventions, this study tested the efficacy of cognitive-behavioral therapy (CBT) for patients with BED who do not respond to initial acute treatments.

METHODS

Prospective randomized double-blind placebo-controlled single-site trial, conducted August 2017-December 2021, tested 16-weeks of therapist-led CBT for non-responders to initial treatment (naltrexone/bupropion and/or behavioral therapy) for BED with obesity. Thirty-one patients (mean age 46.3 years, 77.4% women, 80.6% White, mean BMI 38.99 kg/m2 ) who were non-responders to initial acute treatments were randomized to CBT (N = 18) or no-CBT (N = 13), in addition to continuing double-blinded pharmacotherapy. Independent assessments were performed at baseline, throughout treatment, and posttreatment; 83.9% completed posttreatment assessments.

RESULTS

Intention-to-treat remission rates were significantly higher for CBT (61.1%; N = 11/18) than no-CBT (7.7%; N = 1/13). Mixed models of binge-eating frequency (assessed using complementary methods) converged revealing a significant interaction between CBT and time and a significant main effect of CBT. Binge-eating frequency decreased significantly with CBT but did not change significantly with no-CBT. Since only four patients received behavioral treatment during the acute treatments, we performed "sensitivity-type" analyses restricted to the 27 patients who received pharmacotherapy during the acute treatment and found the same pattern of findings for CBT versus no-CBT.

CONCLUSIONS

Adult patients with BED who fail to respond to initial pharmacological treatments should be offered CBT.

PUBLIC SIGNIFICANCE

Even with leading evidence-based treatments for binge-eating disorder, many patients do not derive sufficient benefit. Almost no controlled research has examined treatments for patients who fail to respond to initial interventions. This study found that that cognitive-behavioral therapy was effective for patients with binge-eating disorder who did not respond to initial interventions, with 61% achieving abstinence.

Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder

BACKGROUND

Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes.

METHODS

In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes.

RESULTS

Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores.

CONCLUSIONS

Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.

Unsound sleep, wound-up mind: a longitudinal examination of acute suicidal affective disturbance features among an eating disorder sample

BACKGROUND

Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders.

METHODS

Women (N = 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment.

RESULTS

There was a significant interaction between within-person agitation and sleep quality on suicidal ideation [B(s.e.) = -0.02(0.01), p < 0.05], such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation.

CONCLUSIONS

This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.

Endocannabinoid System Regulation in Female Rats with Recurrent Episodes of Binge Eating

Recurrent Binge Eating (BE) episodes characterize several eating disorders. Here, we attempted to reassemble a condition closer to BE disorder, and we analyzed whether recurrent episodes might evoke molecular alterations in the hypothalamus of rats. The hypothalamus is a brain region which is sensitive to stress and relevant in motivated behaviors, such as food intake. A well-characterized animal model of BE, in which a history of intermittent food restriction and stress induce binge-like palatable food consumption, was used to analyze the transcriptional regulation of the endocannabinoid system (ECS). We detected, in rats showing the BE behavior, an up-regulated gene expression of cannabinoid type-1 receptor (CB1), sn-1-specific diacylglycerol lipase, as well as fatty acid amide hydrolase (Faah) and monoacylglycerol lipase. A selective reduction in DNA methylation was also observed at the promoter of Faah, which is consistent with the changes in the gene expression. Moreover, BE behavior in rats was associated with an increase in anandamide (AEA) levels. Our findings support the relevant role of the ECS in the regulation of food intake in rats subjected to repeated BE episodes, and, in particular, on AEA signaling, acting via CB1 and FAAH modulation. Notably, the epigenetic regulation of the Faah gene might suggest this enzyme as a possible target for developing new therapeutical approaches.

Self-Oriented Body Comparison and Self-Compassion: Interactive Models of Disordered Eating Behaviors Among Postpartum Women

Evidence suggests self-oriented body comparison (comparison of one's postpartum body shape and weight to one's prepregnant body shape and weight) is a critical factor associated with increased levels of disordered eating during the postpartum period. However, some postpartum women adopt a self-compassionate and acceptance-based perspective toward their body shape and weight changes. It is unclear whether self-compassion may buffer the associations between self-comparisons and disordered eating behaviors among postpartum women, which is the aim of the current study. A total of 306 postpartum women who gave birth in the past year completed an online survey asking about self-compassion, social comparison, broad eating pathology, dietary restraint, and binge eating. Results indicated that self-compassion appeared to buffer the associations between self-comparison and broad eating pathology and binge eating among postpartum women, such that for women with above-average levels of self-compassion, the associations between self-comparison and disordered eating was weaker than for women with average or below-average levels of self-compassion. Findings suggest self-compassion could be a potential target for intervention programs.

Associations between probable eating disorders and healthcare use among post-9/11 veteran men and women

OBJECTIVE

Healthcare use is elevated among individuals with eating disorders (EDs); however, most people with EDs do not receive ED-specific care, likely due to factors such as the cost and availability of treatment as well as stigma. U.S. military veterans historically have been understudied in ED research. We investigated healthcare use and barriers to care among recently separated veteran men and women.

METHOD

In this cross-sectional study, 1494 participants completed an online or paper survey assessing ED symptoms, healthcare use, and logistical and attitudinal barriers to care. We estimated logistic regression models to investigate the association of ED status with healthcare use variables and examined gender similarities and differences in barriers to care.

RESULTS

Men and women with probable EDs reported low rates of ED treatment but greater healthcare use, during military service and since separating from service, compared to veterans without probable EDs (odds ratios = 1.57-7.05). Large proportions of participants reported that they did not know where to get help for EDs and that treatment is too costly. There were few gender differences in barriers to care (Cramer's V = 0.02-0.32).

CONCLUSION

Veterans reported high healthcare use but low rates of ED treatment. Findings underscore the need to increase the reach and accessibility of ED treatment in potentially vulnerable groups.

Motivation to change predicts naturalistic changes in binge eating and purging, but not fasting or driven exercise among individuals with eating disorders

We examined the naturalistic relations between motivation to change and change in four specific eating disorder (ED) behaviors-binge eating (BE), purging, fasting, and driven exercise-in a community-based sample of individuals with EDs over two consecutive 6-week periods. We conducted cross-lagged generalized estimating equations using the transtheoretical model's four stages of change to predict changes in the ED behaviors 6 weeks later. Individuals reported lower pre-contemplation for behaviors typically associated with more distress (e.g., BE, purging) than they did for behaviors associated with less distress (e.g., fasting and driven exercise). Action predicted decreases in BE and purging frequencies but not fasting or driven exercise frequencies. Naturalistic relations between ED behavior severity/frequency and motivation to change these features can be detected over 6-week intervals; that is, attempts at change in individuals' natural environments can be successful over relatively brief periods of time, especially when individuals experience the motivation to change these features. The process of motivation to change ED behaviors is not linear, and our study highlights the movement between stages of change among individuals with EDs. Future research is needed to examine how much of the observed changes are sustained.

Binge size and loss of control as correlates of eating behavior and psychopathology among individuals with binge eating disorder and higher weight

Studies comparing individuals with loss of control (LOC) eating who do and do not have objectively large binge episodes have found that degree of LOC is more important than binge size to psychological and behavioral outcomes. However, the relative importance of these characteristics has not been investigated in a population with binge eating disorder (BED), who by definition all have objectively large binge episodes. Persons with BED and higher weight (N = 34) were enrolled in a BED treatment trial and completed the Loss of Control Over Eating Scale, the Eating Disorder Examination, and measures of eating behavior, mood, and quality of life. Body mass index (BMI) was calculated from measured height and weight. The size of the largest binge episode (measured in kilocalories) and degree of LOC were entered into multiple regression equations to determine their relationships with disordered eating symptoms, depression, quality of life, and BMI in this pilot study. Greater LOC had a stronger independent association than binge size with higher total eating psychopathology, shape dissatisfaction, hunger, food cravings and food addiction symptoms. Larger binge size had a stronger independent association than LOC with higher weight concern and lower general and social quality of life. Both characteristics were associated with higher eating concern and neither were associated with depression or BMI. Both binge size and degree of LOC are associated with important psychosocial treatment targets in patients with BED. Future research should validate the largest binge episode measurement method and replicate the present findings in a larger sample.

Assessing negative core beliefs in eating disorders: revision of the Eating Disorder Core Beliefs Questionnaire

BACKGROUND

Increased theoretical and empirical attention has been given to examining the role of core beliefs in both the development and maintenance of eating disorders (EDs). The Eating Disorder Core Beliefs Questionnaire (ED-CBQ) is self-report measure designed to assess five dimensions of core beliefs relating to eating disorders; self-loathing, unassertive/inhibited, demanding/needing help and support, abandoned/deprived, and high standards for the self. The present study aimed to evaluate the psychometric properties of the ED-CBQ and to develop a revised and improved version of the original measure after evaluating its factor structure and related properties.

METHODS

A sample of undergraduate university students (N = 763) completed an online test battery of questionnaires. Putative ED-symptomatic (n = 384) and non-ED (n = 379) subgroups were created from self-reported responses from the Eating Disorder Examination Questionnaire (EDEQ). Confirmatory factor analyses (CFAs) were performed, and internal consistency, construct validity, group differences and clinical utility was examined.

RESULTS

An initial CFA did not support the original five-factor 40-item ED-CBQ. A revised version was developed that possessed equal or superior psychometric properties to the original 40-item measure. The ED-CBQ-R demonstrated superior model fit, similar levels of reliability and construct validity, and the ability to discriminate between putative ED diagnostic groups.

CONCLUSIONS

Our results suggest that the ED-CBQ-R is a valid, reliable, but more importantly an efficient and accessible measure with the potential to be utilised both clinically and in research settings.

Efficacy and safety of dasotraline in adults with binge-eating disorder: a randomized, placebo-controlled, fixed-dose clinical trial

OBJECTIVE

The aim of this fixed-dose study was to evaluate the efficacy and safety of dasotraline in the treatment of patients with binge-eating disorder (BED).

METHODS

Patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for BED were randomized to 12 weeks of double-blind treatment with fixed doses of dasotraline (4 and 6 mg/d), or placebo. The primary efficacy endpoint was change in number of binge-eating (BE) days per week at week 12. Secondary efficacy endpoints included week 12 change on the BE CGI-Severity Scale (BE-CGI-S) and the Yale-Brown Obsessive-Compulsive Scale Modified for BE (YBOCS-BE).

RESULTS

At week 12, treatment with dasotraline was associated with significant improvement in number of BE days per week on the dose of 6 mg/d (N = 162) vs placebo (N = 162; -3.47 vs -2.92; P = .0045), but not 4 mg/d (N = 161; -3.21). Improvement vs placebo was observed for dasotraline 6 and 4 mg/d, respectively, on the BE-CGI-S (effect size [ES]: 0.37 and 0.27) and on the YBOCS-BE total score (ES: 0.43 and 0.29). The most common adverse events on dasotraline were insomnia, dry mouth, headache, decreased appetite, nausea, and anxiety. Changes in blood pressure and pulse were minimal.

CONCLUSION

Treatment with dasotraline 6 mg/d (but not 4 mg/d) was associated with significantly greater reduction in BE days per week. Both doses of dasotraline were generally safe and well-tolerated and resulted in global improvement on the BE-CGI-S, as well as improvement in BE related obsessional thoughts and compulsive behaviors on the YBOCS-BE. These results confirm the findings of a previous flexible dose study.

General impulsivity in binge-eating disorder

BACKGROUND

The nature and significance of impulse-control difficulties in binge-eating disorder (BED) are uncertain. Most emerging research has focused on food-specific rather than general impulsivity. The current study examines the clinical presentation of patients with BED categorized with and without clinical levels of general impulsivity.

METHOD

A total of 343 consecutive treatment-seeking patients with BED were categorized as having BED with general impulsivity (GI+; N = 73) or BED without general impulsivity (GI-: N = 270) based on structured diagnostic and clinical interviews. The groups were compared on demographic, developmental, and psychological features, and on rates of psychiatric and personality comorbidity.

RESULTS

Individuals with BED and general impulsivity (GI+) reported greater severity of eating-disorder psychopathology, greater depressive symptoms, and greater rates of comorbidity than those without general impulsivity (GI-).

CONCLUSIONS

A subtype of individuals with BED and general impulsivity may signal a more severe presentation of BED characterized by heightened and broader psychopathology. Future work should investigate whether these impulse-control difficulties relate to treatment outcomes.

Changes in eating and exercise behaviors during the COVID-19 pandemic in a community sample: A retrospective report

OBJECTIVE

The COVID-19 pandemic has generated extreme physical, psychological, and social consequences across the world, many of which have the potential to exacerbate disordered eating and exercise behaviors. The purpose of this study was to retrospectively assess changes in eating pathology and exercise behaviors as a result of the COVID-19 pandemic in a community sample.

METHOD

Participants (n = 159, M_age = 27.59 years, 90.6% female) were individuals in the United States surveyed during COVID-19. Participants completed measures quantifying eating pathology, exercise behaviors, and motives for exercise both prior to and during the pandemic.

RESULTS

All results compare variables prior to and during COVID-19. Overall, individuals with a prior eating disorder (ED) diagnosis did not report significantly different changes in eating or exercise pathology compared to the non-ED group. Participants had significantly fewer episodes of overeating (p < .05, d = -0.23) and eating with loss of control (p < .05, d = -0.23), but not objective binge episodes. Respondents also indicated an overall decrease in time spent on strength/weight activity (p < .05, d = -0.34) and increase in cardiovascular activity (p < .05, d = 0.19), as well as significant changes in motives for exercise.

DISCUSSION

Our results suggest that in a sample of primarily young adult females, with and without a prior ED, exercise behaviors and motives, but not eating pathology, shifted significantly in the first few months of the COVID-19 pandemic. Further longitudinal studies examining the maintenance and potential risk of these changes are warranted, particularly in individuals at high risk, as the pandemic continues.

Anti-obesity public health messages and risk factors for disordered eating: a systematic review

In response to the increasing prevalence of overweight and obesity, public health efforts to curb these conditions have been delivered in abundance. There is concern however that the messages used to target these conditions may be increasing risk factors for disordered eating. Therefore, we sought to systematically review the literature on the effects of anti-obesity public health messages on risk factors for disordered eating. Seven electronic databases were searched for articles meeting the inclusion criteria, resulting in the inclusion of 12 studies of various methodologies that measured one or more risk factors for disordered eating following exposure to public health messages. Few studies specifically and accurately measured disordered eating behaviours. Most studies found that messages were stigmatizing towards persons who are overweight/obese, and exacerbate thin ideals and drive for thinness. Interestingly, the same was not found for measures of body dissatisfaction. Messages promoting smaller meals were also thought to be potential triggers for disordered eating. Whilst the studies included in this review offered both quantitative and qualitative insights into how public health messages may have adverse effects on eating behaviours, there was a consistent lack of valid reporting measures and clear classification of outcomes overall. Hence, future research is recommended using valid reporting tools such as validated questionnaires, as well as prolonged exposure to the intervention condition to determine longer-term impact.

Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials

BACKGROUND

Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes.

METHODS

In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout, and posttreatment by doctoral research-clinicians using reliably-administered semi-structured interviews, self-report measures, and measured weight. Data were aggregated from RCTs testing cognitive-behavioral therapy, behavioral weight loss, multi-modal (combined pharmacological plus cognitive-behavioral/behavioral), and/or control conditions. Intent-to-treat analyses (all available data) tested comorbidity (mood, anxiety, 'any disorder' separately) as predictors and moderators of outcomes. Mixed-effects models tested comorbidity effects on binge-eating frequency, global eating-disorder psychopathology, and weight. Generalized estimating equation models tested binge-eating remission (zero binge-eating episodes during the past month; missing data imputed as failure).

RESULTS

Overall, 41% of patients had current psychiatric comorbidity; 22% had mood and 23% had anxiety disorders. Psychiatric comorbidity did not significantly moderate the outcomes of specific treatments. Psychiatric comorbidity predicted worse eating-disorder psychopathology and higher binge-eating frequency across all treatments and timepoints. Patients with mood comorbidity were significantly less likely to remit than those without mood disorders (30% v. 41%). Psychiatric comorbidity neither predicted nor moderated weight loss.

CONCLUSIONS

Psychiatric comorbidity was associated with more severe BED psychopathology throughout treatment but did not moderate outcomes. Findings highlight the need to improve treatments for BED with psychiatric comorbidities but challenge perspectives that combining existing psychological and pharmacological interventions is warranted. Treatment research must identify more effective interventions for BED overall and for patients with comorbidities.

Comparison of Interview to Questionnaire for Assessment of Eating Disorders after Bariatric Surgery

The Eating Disorder Examination Interview Bariatric Surgery Version (EDE-BSV) assesses eating pathology after bariatric surgery but requires significant training and time to administer. Consequently, we developed a questionnaire format called the Eating Disorders After Bariatric Surgery Questionnaire (EDABS-Q). This study evaluates the consistency of responsiveness between the two formats. After surgery, 30 patients completed the EDE-BSV and EDABS-Q in a restricted randomized design. Patient reported behavior for each item which was converted to a score following the Eating Disorder Examination-Questionnaire (EDE-Q) scoring scheme. Responses fell into three distributions: (1) dichotomous, (2) ordinal, or (3) unimodal. Distributions of items were not different between the two formats and order did not influence response. Tests of agreement (normal approximation of the binomial test) and association (χ² analyses on binary data and spearman rank order correlations on ordinal items) were performed. Percent concordance was high across items (63-100%). Agreement was significant in 31 of 41 items (Bonferroni-P < 0.001). Association was significant in 10 of 21 in χ²-appropriate items (Bonferroni-P < 0.002), and the ordinal items had highly significant correlations between formats (Bonferroni-P < 0.0125). The EDABS-Q is an adequate substitute for the EDE-BSV and may be useful for research and clinical evaluation of eating pathology after bariatric surgery.

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction

Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratified by FA status. Participants (n = 186) were assessed with the Eating Disorder Examination before and after BWL treatment. Mixed effects models examined FA (presence/absence) before and after (post-treatment and 6- and 12-month follow-up) treatment and associations with frequency of weighing and related perceptions (reactions to weighing, sensitivity to weight gain and shape/weight acceptance). Participants with FA reported more negative reactions to weighing and less acceptance of shape/weight throughout treatment and follow-ups, and both variables were associated with greater disordered eating at follow-ups among participants with FA. Sensitivity to weight gain decreased over time independent of FA status. Frequency of weighing was associated with a greater likelihood of achieving 5% weight loss only among those without FA. Reactions to weighing and sensitivity to weight gain are associated with FA and poorer treatment outcomes in individuals with BED and obesity. Targeting these features may improve BWL outcomes among individuals with BED, obesity and FA.

Naltrexone + Bupropion Combination for the Treatment of Binge-eating Disorder with Obesity: A Randomized, Controlled Pilot Study

PURPOSE

Binge-eating disorder (BED), the most prevalent eating disorder, is associated strongly with obesity and functional impairments. Few evidence-based treatments for BED exist; a pharmacotherapy effective in reducing both binge eating and weight needs to be identified. This placebo-controlled double-blind pilot RCT evaluated the acute effects of naltrexone + bupropion (NB) on BED with obesity and examined the longer-term effects through 6-month follow-up after the discontinuation of medication.

METHODS

Twenty-two adult patients with BED were randomized to receive 12 weeks of double-blind treatment with fixed-dose NB (naltrexone + bupropion XL 50/300 mg) or placebo. Independent (blinded) researcher-clinicians evaluated patients at major outcome time points (baseline, posttreatment, and 6-month follow-up after the treatment period); patients were also evaluated for the tracking of course/tolerability throughout treatments and at 3-month follow-up. Primary outcomes were changes from baseline in binge-eating frequency and percentage weight. Secondary outcomes were changes in eating-disorder psychopathology and depression.

FINDINGS

A total of 22 patients were enrolled (86.4% women; mean age, 50.4 years), with 77.3% of patients completing treatments; completion rates (NB, 83.3%; placebo, 70.0%) and adverse events did not differ significantly between NB and placebo. Analyses revealed significant reductions from baseline in binge-eating, eating-disorder psychopathology, depression, and weight during treatment, but these changes with NB did not differ significantly from those with placebo. The percentage of patients who attained 3% weight loss was significantly greater with NB than with placebo (45.5% vs 0%); weight-loss and binge-eating reductions were significantly correlated in the group that received NB. At 6-month follow-up, outcomes remained improved relative to baseline, with no significant differences between NB and placebo.

IMPLICATIONS

The findings from this pilot RCT suggest that NB was well-tolerated in these patients with BED and comorbid obesity. Most outcomes were not statistically different between NB and placebo. A larger-scale, adequately powered RCT is needed for determining the efficacy of NB in the treatment of BED. ClinicalTrials.gov identifier: NCT02317744.

Emotion and overeating behavior: effects of alexithymia and emotional regulation on overweight and obesity

PURPOSE

Obesity and overweight are significant risk factors for many serious diseases. Several studies have investigated the relationship between emotional regulation and overweight or obesity in people with eating disorders. Although a few studies have explored alexithymia in individuals with severe obesity without eating disorders, no attention has been paid to individuals with overweight and preclinical form of obesity. This study aims to assess whether overweight and obesity are related to emotional dysregulation and alexithymia.

METHODS

The study involved 111 undergraduate students who had not been diagnosed with an eating disorder. The sample was divided into two groups according to their body mass index (BMI): normal weight (N = 55) and overweight (N = 56). All of them completed the Toronto Alexithymia Scale (TAS-20), the Emotional Regulation Questionnaire (ERQ), and the Eating Disorder Inventory-2 (EDI-2).

RESULTS

Results showed higher levels of alexithymia, and specifically higher difficulty in identifying feelings and an externally oriented thought, in participants with overweight. Multiple correlation analysis highlighted the positive relations between some EDI-2 subscales and both alexithymia and emotional regulation scores. Linear regressions revealed a significant relationship between body BMI and both alexithymia and emotional regulation strategies.

CONCLUSIONS

The condition of overweight/obesity seems to be associated with higher emotional dysregulation compared to normal weight condition. It is essential to study this relationship because it could represent a risk factor for the worsening of problems related to overeating and excessive body weight. These findings suggest that an integrated approach aimed at considering the promotion of emotional regulation could contribute to the effectiveness of a program designed to reduce overweight and obesity.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Male Figural Rating Scales: A Critical Review of the Literature

Figural rating scales are tools used to measure male body dissatisfaction. The present review aimed to examine the design and psychometric properties of male figural rating scales and make recommendations based on findings. Relevant databases were systematically searched for studies that had developed and validated male figural rating scales. Twenty studies were included in this review. Figural rating scales differed in terms of the number of images represented and type of stimuli used (hand-drawn silhouettes, hand-drawn figures, computer-rendered figures, and photograph figures). Reliability and validity evidence varied greatly in strength across all scales. Four of the 20 scales included a correlational analysis between figural rating scale scores and eating disorder symptoms. Results showed the moderate to high positive correlations between eating disorder symptoms and figural rating scale perceived and index scores, suggesting that figural rating scales are sensitive to detecting eating disorder symptoms. Ideally, male figural rating scales should show strong validity and reliability, include variations in both body fat and muscularity, utilise realistic body stimuli, and be interval scales. No existing male figural rating scale meets these criteria. However, this review identifies five figural rating scales that meet the majority of the recommended criteria.

Assessing the Clinical Utility of the Eating Beliefs Questionnaire

Abstract. The Eating Beliefs Questionnaire (EBQ) is a valid and reliable self-report tool measuring positive and negative beliefs about binge eating. This study sought to further investigate the clinical utility of the EBQ using a clinical binge eating sample and a healthy control comparison group. Clinical participants were 74 individuals seeking treatment for eating disorders: 38 with bulimia nervosa and 36 with binge eating disorder. Healthy controls were 114 individuals recruited from the general community. Participants all completed a test battery that included the EBQ. Diagnoses of clinical participants were confirmed using the semi-structured interview, the Eating Disorders Examination, administered by a trained clinician. The EBQ and its subscales showed good internal consistency, and significant differences between the clinical and nonclinical groups were observed for EBQ total and subscales scores, but not between the two clinical groups. Receiver operating characteristic (ROC) curve analyses revealed optimal cutoff scores for the EBQ, which demonstrated excellent sensitivity, specificity, and positive and negative predictive values. Results from this study provide further evidence in support of the EBQ’s psychometric properties. Clinical cutoff scores can be used to assess severity of binge eating-related cognitions in both research and clinical settings.

Randomized controlled trial testing the effectiveness of adaptive "SMART" stepped-care treatment for adults with binge-eating disorder comorbid with obesity

This randomized controlled trial (RCT) tested effectiveness of adaptive SMART stepped-care treatment to "standard" behavioral weight loss (BWL [standard]) for patients with binge-eating disorder (BED) and obesity. One hundred ninety-one patients were randomly assigned to 6 months of BWL (standard; n = 39) or stepped care (n = 152). Within stepped care, patients started with BWL for 1 month; treatment responders continued BWL, whereas nonresponders switched to cognitive-behavioral therapy (CBT), and patients receiving stepped care were additionally randomized to weight-loss medication or placebo (double-blind) for the remaining 5 months. Independent assessments were performed reliably at baseline, throughout treatment, and posttreatment. Intent-to-treat (ITT) analyses of remission rates (zero binges/month) revealed that BWL (standard) and stepped care did not differ (74.4% vs. 66.5%); within stepped care, remission rates ranged 40.0% to 83.3%, with medication significantly superior to placebo (overall) and among nonresponders switched to CBT. Mixed-models analyses of binge-eating frequency revealed significant time effects, but BWL (standard) and stepped care did not differ; within stepped care, medication was significantly superior to placebo and among nonresponders switched to CBT. Mixed models revealed significant weight loss, but BWL (standard; 5.1% weight-loss) and stepped care (5.8% weight-loss) did not differ; within stepped care (range = 0.4% to 8.8% weight-loss), medication was significantly superior to placebo and among both responders continued on BWL and nonresponders switched to CBT. In summary, BWL (standard) and adaptive stepped-care treatments produced robust improvements in binge eating and weight loss in patients with BED/obesity. Within adaptive stepped care, weight-loss medication enhanced outcomes for BED/obesity. Implications for clinical practice and future adaptive designs are offered. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Randomized Controlled Trial Comparing Health Coach-Delivered Smartphone-Guided Self-Help With Standard Care for Adults With Binge Eating

OBJECTIVE

Cognitive-behavioral therapy (CBT) has shown efficacy in the treatment of eating disorders. The authors conducted a randomized controlled telemedicine trial of CBT-guided self-help (CBT-GSH) assisted with a smartphone app, Noom Monitor, for binge eating with or without purging. They hypothesized that coach-delivered CBT-GSH telemedicine sessions plus Noom Monitor would yield greater reductions in symptoms of binge eating, purging, and eating disorders compared with standard care.

METHODS

Fifty-two-week outcomes for CBT-GSH plus Noom Monitor (N=114) were compared with outcomes for standard care (N=111) among members of an integrated health care system in the Pacific Northwest. Patients in the health system who met inclusion criteria were ≥18 years old, had a body mass index ≥18.5, met criteria for DSM-5 binge eating disorder or bulimia nervosa, had 12 months of continuous health care enrollment in Kaiser Permanente Northwest, and had a personal smartphone. Participants received eight CBT-GSH telemedicine sessions over 12 weeks administered by health coaches, and outcomes were assessed at baseline and at weeks 4, 8, 12, 26, and 52. The use of available treatment offered within the Kaiser Permanente health care system was permitted for participants assigned to standard care.

RESULTS

Participants who received CBT-GSH plus Noom Monitor reported significant reductions in objective binge-eating days (β=-0.66, 95% CI=-1.06, -0.25; Cohen's d=-1.46, 95% CI=-4.63, -1.09) and achieved higher rates of remission (56.7% compared with 30%; number needed to treat=3.74) at 52 weeks compared with participants in standard care, none of whom received any eating disorder treatment during the intervention period (baseline and weeks 1-12). Similar patterns emerged for compensatory behaviors (vomiting, use of laxatives, and excessive exercise; 76.3% compared with 56.8%; number needed to treat=5.11), eating disorder symptoms (body shape, weight, eating concerns, and dietary restraint), and clinical impairment (Cohen's d=-10.07, -2.15).

CONCLUSIONS

These results suggest that CBT-GSH plus Noom Monitor delivered via telemedicine by routine-practice health coaches in a nonacademic health care system yields reductions in symptoms and impairment over 52 weeks compared with standard care.

Female Body Dissatisfaction and Attentional Bias to Body Images Evaluated Using Visual Search

One factor, believed to predict body dissatisfaction is an individual’s propensity to attend to certain classes of human body image stimuli relative to other classes. These attentional biases have been evaluated using a range of paradigms, including dot-probe, eye-tracking and free view visual search, which have yielded a range of – often contradictory – findings. This study is the first to employ a classic compound visual search task to investigate the relationship between body dissatisfaction and attentional biases to images of underweight and with-overweight female bodies. Seventy-one undergraduate females, varying their degree of body dissatisfaction and Body Mass Index (BMI), searched for a horizontal or vertical target line among tilted lines. A separate female body image was presented within close proximity to each line. On average, faster search times were obtained when the target line was paired with a uniquely underweight or with-overweight body relative to neutral (average weight only) trials indicating that body weight-related images can effectively guide search. This congruent search effect was stronger for individuals with high eating restraint (a behavioral manifestation of body image disturbance) when search involved a uniquely underweight body. By contrast, individuals with high BMIs searched for lines more rapidly when paired with with-overweight rather than underweight bodies, than did individuals with lower BMIs. For incongruent trials – in which a unique body was paired with a distractor rather than the target – search times were indistinguishable from neutral trials, indicating that the deviant bodies neither compulsorily “captured” attention nor reduced participants’ ability to disengage their attention from either underweight or with-overweight bodies. These results imply the existence of attentional strategies which reflect one’s current body and goal-directed eating behaviors.

Examining sex as a predictor and moderator of treatment outcomes for binge-eating disorder: Analysis of aggregated randomized controlled trials

OBJECTIVE

This study examined whether sex predicted and/or moderated treatment outcomes among men and women who participated in binge-eating disorder (BED) randomized controlled trials (RCTs).

METHOD

Data were aggregated from RCTs performed at one medical center. RCTs tested cognitive-behavioral therapy, behavioral weight loss, multimodal treatment, and/or control conditions. Participants were 660 adults, both men (n = 170) and women (n = 490), with Diagnostic and Statistical Manual-fourth edition (DSM-IV)-defined BED. Doctoral-level research-clinicians assessed participants using structured interviews and established self-report measures of eating-disorder psychopathology and depression, and measured height and weight. Assessments occurred at baseline, throughout treatment, and at post-treatment.

RESULTS

Sex was not a significant moderator of any treatment outcomes. Mixed models revealed sex had a main effect: men had lower eating-disorder psychopathology and lost more weight than women over the course of treatment.

DISCUSSION

Both epidemiological and RCT studies report disparities in treatment-seeking between men and women with BED. Despite this, men have comparable or better treatment outcomes compared with women, including significantly greater weight loss. Thus, disseminating evidence-based BED treatments is promising for both men and women. Additional research is necessary, however, to understand treatment effects-including other predictors and moderators of outcomes-across diverse providers, treatment settings, and patient groups.

Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.

Toward an understanding of the distinctiveness of body-image constructs in persons categorized with overweight/obesity, bulimia nervosa, and binge-eating disorder

OBJECTIVE

We examined distinctiveness of different aspects of body-image disturbance in persons categorized with eating/weight disorders. We compared dissatisfaction with weight/shape, overvaluation of weight/shape, preoccupation with weight/shape, and fear of weight gain - in three study groups of persons categorized with overweight/obesity [O/O], bulimia nervosa [BN], and binge-eating disorder [BED] and examined how each body-image construct relates to clinical measures within and between the study groups.

METHOD

1017 community volunteers completed measures of body-image, eating-disorder psychopathology, and depression. Participants were categorized into three study groups: O/O (N = 511), BN-purging type (N = 167), and BED (N = 339).

RESULTS

Groups differed significantly on the four body-image constructs (medium-to-large effect sizes) with a consistent severity gradient with BN greater than BED greater than O/O. Both within and between groups, the four body-image constructs varied in strengths of association among themselves and with clinical measures. Analyses revealed considerable variability in variance accounted for in the clinical measures; distinctive significant patterns observed across the groups included: dissatisfaction with BMI, preoccupation and fear with eating concerns and restraint, and overvaluation with depression.

CONCLUSION

Clinical manifestations of body-image disturbances are complex and show important differences across study groups defined as overweight/obesity, BN, and BED. Improved understanding of distinctions between different body-image constructs and their differential salience across different eating/weight disorders is needed to improve case conceptualization and treatment formulation.

Core psychopathology of treatment-seeking patients with binge-eating disorder: a network analysis investigation

BACKGROUND

Mental disorders may emerge as the result of interactions between observable symptoms. Such interactions can be analyzed using network analysis. Several recent studies have used network analysis to examine eating disorders, indicating a core role of overvaluation of weight and shape. However, no studies to date have applied network models to binge-eating disorder (BED), the most prevalent eating disorder.

METHODS

We constructed a cross-sectional graphical LASSO network in a sample of 788 individuals with BED. Symptoms were assessed using the Eating Disorders Examination Interview. We identified core symptoms of BED using expected influence centrality.

RESULTS

Overvaluation of shape emerged as the symptom with the highest centrality. Dissatisfaction with weight and overvaluation of weight also emerged as highly central symptoms. On the other hand, behavioral symptoms such as binge eating, eating in secret, and dietary restraint/restriction were less central. The network was stable, allowing for reliable interpretations (centrality stability coefficient = 0.74).

CONCLUSIONS

Overvaluation of shape and weight emerged as core symptoms of BED. This trend is consistent with past network analyses of eating disorders more broadly, as well as literature that suggests a primary role of shape and weight concerns in BED. Although DSM-5 diagnostic criteria for BED does not currently include a cognitive criterion related to body image or shape/weight overvaluation, our results provide support for including shape/weight overvaluation as a diagnostic specifier.

Psychometric properties of the eating loss of control scale among postbariatric patients

BACKGROUND

Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients.

OBJECTIVE

This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients.

SETTING

Academic medical center in the United States.

METHODS

One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures.

RESULTS

CFA revealed poor fit for a 1-factor structure (χ² = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ² = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors.

CONCLUSIONS

Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.

Frustration with feeling: Latent classes of non-suicidal self-injury and emotion regulation difficulties

Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.

Early Change Trajectories in Cognitive-Behavioral Therapy for Binge-Eating Disorder

Rapid response is considered the most well-established outcome predictor across treatments of binge-eating disorder (BED), including cognitive-behavioral therapy (CBT). This study sought to identify latent trajectories of early change in CBT and compare them to common rapid response classifications. In a multicenter randomized trial, 86 adults with BED (DSM-IV) or subsyndromal BED provided weekly self-reports of binge eating over the first 4 weeks of CBT, which were analyzed to predict binge eating, depression, and body mass index at posttreatment, 6-, and 18-month follow-up. Using latent growth mixture modeling, three patterns of early change-including moderate and low decreasing-as well as low stable binge eating were identified, which significantly predicted binge-eating remission at 6-month follow-up. Other classifications of rapid response based on Receiver Operating Characteristics curve analyses or on the literature (≥ 10% reduction in binge eating at week 1, ≥ 70% reduction in binge eating at week 4) only predicted posttreatment remission or overall depression, respectively. Latent change trajectories, but not other rapid response classifications, predicted binge-eating frequency over time. A fine-grained analysis of change over the first 4 weeks of CBT for BED revealed different trajectories of early change in binge eating that led to an improved prediction of binge-eating outcome, compared to that of common rapid response classifications. Thorough monitoring of early change trajectories during treatment may have clinical utility.

Momentary predictors of binge eating: An attachment perspective

INTRODUCTION

According to attachment theory, individuals who are preoccupied with the possibility of rejection are prone to emotion dysregulation, which research has found to be related to disordered eating. The current study examined naturalistic momentary relationships between binge eating, depressive symptoms, emotion dysregulation, and attachment anxiety.

METHOD

Participants were 55 undergraduate women who owned a mobile phone and who had binge eaten at least once during the past 28 days. All participants were screened to confirm the presence of binge eating and then completed trait measures of attachment anxiety. Participants then received seven text messages per day for 14 days. Texts contained links to state measures of depressive symptoms, state emotion dysregulation, and recent binge eating.

RESULTS

Momentary depressive symptoms predicted subsequent binge eating. Aspects of emotion dysregulation (i.e., nonacceptance of emotional responses and difficulty modulating one's emotions) mediated the relationship between attachment anxiety and binge eating.

DISCUSSION

Depressed mood often triggers binge eating. Additionally, attachment anxiety seems to predict binge eating through emotion dysregulation. Interventions for binge eating should address both attachment anxiety and emotion dysregulation in order to maximize therapeutic benefit.

I weigh therefore I am: Implications of using different criteria to define overvaluation of weight and shape in binge-eating disorder

OBJECTIVE

Research suggests that overvaluation of weight and shape is a clinical feature in binge-eating disorder (BED). However, this construct has been differentially defined in the literature even when using the same measure. Here we compare two cut-offs that have previously been used to differentiate clinical and subthreshold overvaluation using the EDE-Q.

METHOD

Individuals with BED (n = 72, 93% female) and no history of an eating disorder (NED; n = 21, 91% female) completed measures of eating disorder (ED) and general psychopathology online. Individuals with BED were categorized as having clinical or subthreshold overvaluation using two different cut-offs used in previous studies. The clinical, subthreshold, and NED groups were compared on ED and general psychopathology. The association between overvaluation and psychopathology was also assessed in the BED and NED groups.

RESULTS

The two cut-offs yielded identical results, with individuals in the clinical overvaluation group reporting greater ED psychopathology than those in the subthreshold and NED groups. When considered as a continuous variable, overvaluation was a significant predictor of both ED-related and general psychopathology.

DISCUSSION

The two cut-offs yielded identical results, likely due to the high internal consistency between overvaluation items. Under such circumstances, the use of either cut-off seems appropriate. However, given the associations reported in the regression analyses, we propose that considering overvaluation as a dimensional variable, rather than a categorical one, may have greater utility.

Food addiction among Spanish-speaking Latino/as residing in the United States

OBJECTIVE

This study examined food addiction, assessed by the Yale Food Addiction Scale (YFAS), and associated features among a participant group of Spanish-speaking Latino/as residing in the United States.

METHOD

Participants were 140 Spanish-speaking Latino/as (n = 77 female) who participated in an anonymous web-based survey. Mean age and body mass index (BMI) were 31.87 (SD = 9.12) years and 28.34 (SD = 7.14) kg/m², respectively. Participants completed a battery of established self-report measures assessing food addiction, binge-eating and eating-disorder psychopathology (Eating Disorder Examination-Questionnaire; EDE-Q), depressive symptoms (Patient Health Questionnaire-2; PHQ-2), and mental and physical functioning (MOS Short Form Health Survey; SF-12).

RESULTS

Of the 140 participants, 25 (17.9%) exceeded the clinical threshold of food addiction; no significant differences were observed between those categorized with versus without food addiction in age, sex, or race. YFAS scores were significantly correlated with EDE-Q overvaluation, EDE-Q dissatisfaction, BMI, SF-12, and the PHQ-2 (all p-values < .01). Categorical analyses revealed similar findings with participants categorized with clinical levels of food addiction being significantly more likely to meet clinical levels of overvaluation of weight/shape, and reporting significantly greater frequency of binge-eating, depressive symptoms, and poorer overall mental health than those not meeting food addiction criteria (all p-values < .05).

CONCLUSION

Our findings for this Spanish-speaking participant group are generally consistent with those reported in a meta-analysis of English-speaking individuals in suggesting that higher YFAS scores are associated with greater disturbances in eating psychopathology. Future studies should examine whether level of acculturation might contribute to differences in food addiction symptoms and associated psychopathology among Spanish-speaking Latino/as.

Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students

OBJECTIVE

Eating disorders (EDs) present a significant threat to the health of adolescents and young adults, yet remain under-diagnosed and under-treated at a population-level. EDs have historically been thought to afflict "skinny, white, affluent girls" (the SWAG stereotype). As such, higher-weight individuals, racial/ethnic minorities, those from socioeconomically disadvantaged backgrounds, and males may not recognize their need for treatment, may not be properly screened for EDs, and/or may not be referred to treatment.

METHOD

Using large-scale survey data from the healthy bodies study, we examined variations in prevalence of perceived need for ED treatment, ED diagnosis, past-year ED treatment, and treatment barriers according to weight status, race, socioeconomic background, and sex among undergraduate and graduate students with symptoms of an ED (N = 1,747).

RESULTS

Among students with symptoms of an ED, 30.7% perceived a need for treatment, 10.5% had received a diagnosis, and 13.6% had received treatment in the past year. Individual characteristics were highly associated with perceived need, diagnosis, and past-year treatment. Females were more likely than males to perceive a need for treatment (OR = 1.97), to be diagnosed (OR = 4.66), and to be treated (OR = 1.64) for their ED symptoms. Socioeconomic background was associated with perceived need for treatment and past-year treatment, with students from affluent backgrounds having higher odds of perceiving need (OR = 1.52) and of receiving treatment (OR = 1.89) compared with their non-affluent peers.

DISCUSSION

At a population-level, the unmet need for ED treatment disproportionately affects certain groups. Stereotypes about who develops EDs could contribute to disparities in ED treatment and outcomes.

Form and formulation: Examining the distinctiveness of body image constructs in treatment-seeking patients with binge-eating disorder

OBJECTIVE

Body-image disturbance is a core aspect of eating disorders, yet the clinical manifestations of individuals' weight and shape concerns are complex, vary considerably, and are poorly understood by clinicians and researchers. This study aimed to distinguish different aspects of body-image disturbance-including weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain-in patients with binge-eating disorder (BED). Examining how each specific body image construct relates to biopsychosocial features of BED could contribute to the refinement of conceptualization and treatment planning.

METHOD

The current study assessed body-image disturbance and eating-disorder psychopathology in 748 treatment-seeking patients with BED using established investigator-based interviews reliably administered by doctoral clinicians.

RESULTS

The 4 body image constructs, although related to one another, showed some important similarities in associations with biopsychosocial clinical features, as well as some important distinctions. The relation between overvaluation and self-esteem was, as conceptualized, more strongly negative than for other body image variables, and preoccupation was more associated than other body image variables with eating concerns. Biopsychosocial features of BED were associated with different forms of body-image disturbance, but associations of body image variables with body mass index (BMI) were not significant and associations with binge-eating frequency did not differ across body image variables.

CONCLUSION

Manifestations of body-image disturbance in BED are complex and understanding the distinctions between different body image constructs can contribute to treatment formulation. (PsycINFO Database Record

Loss-of-control eating after bariatric/sleeve gastrectomy surgery: Similar to binge-eating disorder despite differences in quantities

OBJECTIVE

To characterize loss-of-control eating following sleeve gastrectomy surgery by comparing relevant patient groups.

METHOD

Participants were 431 adults seeking treatment for eating/weight concerns categorized into one of four groups: 1) overweight/obesity (OW/OB), 2) binge-eating disorder (BED), 3) "Bariatric Binge-Eating Disorder" (Bar-BED) defined as meeting all criteria for DSM-5 binge-eating disorder, except for the requirement of an unusually large amount of food, following sleeve gastrectomy surgery, and 4) "Bariatric Loss-of-Control Eating" (Bar-LOC Only), defined as experiencing at least once weekly loss-of-control eating episodes during the past month without the other associated clinical features and distress that characterize Bar-BED, following sleeve gastrectomy surgery.

RESULTS

The Bar-BED and BED groups reported comparable levels of overall eating-disorder and depressive symptoms, and these levels were significantly higher than those levels reported by the OW/OB and Bar-LOC Only groups. Adjusting for age, body mass index, and race did not change the overall pattern of findings.

CONCLUSION

"Bariatric Binge-Eating Disorder" shares clinical features of DSM-5 binge-eating disorder, regardless of the quantity of food consumed. Careful assessment of loss-of-control eating, associated behavioral features, and distress is warranted following surgery. More broadly, our findings highlight the importance of assessing loss-of-control eating across patient groups with obesity.

The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version

PURPOSE

To examine the validity and reliability of a new Italian language version of the latest edition of the Eating Disorder Examination Questionnaire (EDE-Q 6.0).

METHODS

The sixth edition of the EDE-Q was translated into Italian and administered to 264 Italian-speaking inpatient and outpatient (257 females in their mid-20s) with eating disorder (75.4% anorexia nervosa) and 216 controls (205 females).

RESULTS

Internal consistency was high for both the global EDE-Q and all subscale scores. Test-retest reliability was good to excellent (0.66-0.83) for global and subscale scores, and for items assessing key behavioral features of eating disorders (0.55-0.91). Patients with an eating disorder displayed significantly higher EDE-Q scores than controls, demonstrating the good criterion validity of the tool. Confirmatory factor analysis revealed a good fit for a modified seven-item three-factor structure.

CONCLUSIONS

The study showed the good psychometric properties of the new Italian version of the EDE-Q 6.0, and validated its use in Italian eating disorder patients, particularly in young females with anorexia nervosa.

Australian Healthcare Professionals' Knowledge of and Attitudes toward Binge Eating Disorder

Objective: This study aimed to investigate Australian healthcare practitioners’ knowledge and attitudes toward binge eating disorder (BED).

Method: Participants were 175 healthcare professionals, who were randomized to one of two conditions that assessed diagnostic and treatment knowledge of either comorbid BED and obesity or only obesity via case vignette, as well as weight bias toward obese patients.

Results: Results suggested that participants demonstrated a reluctance to diagnose comorbid BED and obesity, that their knowledge of physical complications associated with BED was limited, and that they indicated a narrow range of evidence-based treatment options. When compared with levels of weight bias expressed by healthcare professionals in previous international studies, Australian clinicians were significantly less biased, however, still largely endorsed ‘negative’ attitudes toward obesity.

Conclusion: Findings suggest that future clinical training in eating disorders should therefore focus not only on diagnostic criteria, physical complications and treatment options, but also on practitioner attitudes toward eating and weight.

A brief screening measure for binge eating in primary care

OBJECTIVE

Binge eating disorder (BED) is associated with medical and psychiatric issues commonly seen and managed in primary care; however, the disorder typically goes undetected as there are no assessment tools feasible for use in primary care. The objective was to examine the validity of the VA Binge Eating Screener (VA-BES), a single-item screening measure for binge eating.

METHOD

The sample consisted of 116 veterans referred to a primary care-based weight management program. Participants had a mean age of 61.66years (SD=8.73) and average BMI of 37.90 (SD=7.35). Frequency of binge eating ranged from zero to 21 episodes per week. The prevalence of BED was 7.76%. All participants completed the Questionnaire of Eating and Weight Patterns - Revised (QEWP-R) to assess for BED. They also completed the VA-BES, and measures of disordered eating and depressive symptoms.

RESULTS

The VA-BES was compared to the QEWP-R to determine the sensitivity, specificity, positive predictive value, and negative predictive value for each cutpoint. Analyses revealed one cutpoint (≥2 binge eating episodes per week) maximized these values, demonstrated excellent agreement with the QEWP-R (χ²=24.79, p<0.001), and had significant associations with other variables commonly associated with binge eating.

DISCUSSION

This study demonstrates the utility and validity of a single-item measure to screen for binge eating in primary care. The item can quickly and easily identify binge eating, thus facilitating referral to treatment and potentially subsequent improvements in related medical and mental health comorbidities treated in primary care.

Mild, moderate, meaningful? Examining the psychological and functioning correlates of DSM-5 eating disorder severity specifiers

OBJECTIVE

This study evaluated the DSM-5 severity specifiers for treatment-seeking groups of participants with anorexia nervosa (AN), the purging form of bulimia nervosa (BN), and binge-eating disorder (BED).

METHOD

Hundred and sixty-two participants with AN, 93 participants with BN, and 343 participants with BED were diagnosed using semi-structured interviews, sub-categorized using DSM-5 severity specifiers and compared on demographic and cross-sectional clinical measures.

RESULTS

In AN, the number of previous hospitalizations and the duration of illness increased with severity, but there was no difference across severity groups on measures of eating pathology, depression, or measures of self-reported physical or emotional functioning. In BN, the level of eating concerns increased across the severity groups, but the groups did not differ on measures of depression, self-esteem, and most eating pathology variables. In BN, support was also found for an alternative severity classification scheme based upon number of methods of purging. In BED, levels of several measures of eating pathology and self-reported physical and emotional functioning increased across the severity groups. For BED, however, support was also found for an alternative severity classification scheme based upon overvaluation of shape and weight. Preliminary evidence was also found for a transdiagnostic severity index based upon overvaluation of shape and weight.

DISCUSSION

Overall, these data show limited support for the DSM-5 severity specifiers for BN and modest support for the DSM-5 severity specifiers for AN and BED.