Compulsive eating and dietary restraint

Effect of Lorcaserin Alone and in Combination with Phentermine on Food Cravings After 12-Week Treatment: A Randomized Substudy

OBJECTIVE

This study evaluated the effect of lorcaserin 10 mg twice daily (LOR BID), or with phentermine 15 mg once daily (LOR BID + PHEN QD) and 15 mg twice daily (LOR BID + PHEN BID), in conjunction with energy restriction on food cravings.

METHODS

Two hundred and thirty-five patients without diabetes but with obesity or overweight and ≥ 1 comorbidity received LOR BID, LOR BID + PHEN QD, or LOR BID + PHEN BID for 12 weeks in a randomized double-blind study. The Food Craving Inventory (FCI) and the Control of Eating Questionnaire (COEQ) were administered over 12 weeks.

RESULTS

The FCI total score and the subscale scores reduced from baseline in all groups. The least squares means (95% confidence intervals) for the total scores were -0.65 (-0.75 to -0.55), -0.75 (-0.84 to -0.65), and -0.84 (-0.95 to -0.74) in the LOR BID, LOR BID + PHEN QD, and LOR BID + PHEN BID groups, respectively. Cravings assessed by COEQ reduced from baseline in all groups. In general, the combination treatments were more effective than lorcaserin alone. At week 12, except for fruit juice and dairy products, general and specific cravings reduced in LOR BID + PHEN BID compared with LOR BID (P < 0.05).

CONCLUSIONS

Lorcaserin in combination with phentermine improves control of food cravings during short-term energy restriction.

Olfactory stimulation curbs food cravings

Based on the logic of mutual competition between cravings and odours for limited-capacity resources, this study investigated whether a simple olfactory task, involving a brief odour exposure, could reduce food cravings. In support, Experiment 1 showed that smelling a neutral unfamiliar odorant reduced cravings for highly desired food items, relative to a comparison auditory task and a no-task control condition. Experiment 2 replicated these findings specifically for chocolate cravings, which can be particularly problematic. Thus olfactory stimulation offers potential scope for curbing unwanted food cravings.

The nature of imagery processes underlying food cravings

OBJECTIVE

The study used a working memory approach to examine the nature of the imagery processes underlying food cravings.

DESIGN AND METHOD

A sample of 60 dieters and 60 non-dieters were asked to imagine either a food induction or a holiday induction scenario. Participants then performed 18 trials of either a visual imagery task (loading the visuo-spatial sketch pad) or auditory imagery task (loading the phonological loop). Food craving was measured before and after the induction scenario, and then after every 6 trials of the imagery task.

RESULTS

Craving intensity increased following instructions to imagine the food (but not holiday) induction scenario, especially for dieters. As predicted, the visual imagery task was superior to the auditory imagery task in reducing the level of food craving.

DISCUSSION

The results confirmed the imaginal basis of food cravings. Specifically, they demonstrated that the imagery processes involved in food cravings are predominantly visual in nature. Hence concurrent tasks that load the visuospatial sketch pad of working memory can be used to reduce food cravings. The findings have potential application in the treatment of craving episodes in clinical populations.

Eating disorders, obesity and addiction

An addiction model of both eating disorders and obesity has received increasing attention in the popular and scientific literature. The addiction is viewed as a brain disease that must be directly targeted if treatment is to succeed. Evidence from laboratory feeding studies, epidemiology, genetic and familial research, psychopathological mechanisms, and treatment outcome research on cognitive behaviour therapy (CBT) is inconsistent with the clinical validity or utility of the addiction model of eating disorders. Neurobiological research has shown commonalities in brain reward processes between obesity and substance abuse disorders. Yet emphasis on apparent similarities overlooks important differences between obesity and drug addiction. Interest in obesity as a brain disease should not detract from a public health focus on the 'toxic food environment' that is arguably responsible for the obesity epidemic and related nutrition-based chronic disease.

The FTO gene rs9939609 obesity-risk allele and loss of control over eating

BACKGROUND

Children with rs9939609 FTO variant alleles (homozygous = AA and heterozygous = AT) are predisposed to greater adiposity than are those with 2 wild-type alleles (TT).

OBJECTIVE

Because FTO is highly expressed in hypothalamic regions that are important for appetite, FTO genotype may affect energy balance by influencing eating behavior. Loss of control (LOC) eating, a behavior commonly reported by overweight youth, predicts excessive weight gain in children. However, the relation between FTO genotype and LOC eating has not been previously examined.

DESIGN

Two-hundred eighty-nine youth aged 6-19 y were genotyped for rs9939609, underwent body-composition measurements, and were interviewed to determine the presence or absence of LOC eating. A subset (n = 190) participated in a lunch buffet test meal designed to model an LOC eating episode. Subjects with AA and AT genotypes were grouped together for comparison with wild-type TT subjects.

RESULTS

Subjects with at least one A allele (67.7%) had significantly greater body mass indexes, body mass index z scores (P < 0.01), and fat mass (P < 0.05). Of the AA/AT subjects, 34.7% reported LOC compared with 18.2% of the TT subjects (P = 0.002). Although total energy intake at the test meal did not differ significantly by genotype (P = 0.61), AA/AT subjects consumed a greater percentage of energy from fat than did the TT subjects (P < 0.01).

CONCLUSIONS

Children and adolescents with 1 or 2 FTO rs9939609 obesity-risk alleles report more frequent LOC eating episodes and select foods higher in fat at a buffet meal. Both LOC eating and more frequent selection of energy-dense, palatable foods may be mechanisms through which variant FTO alleles lead to excess body weight.

Restrained Eating and Risk of Gaining Weight and Body Fat in Middle-Aged Women: A 3-Year Prospective Study

Purpose.

Examine the extent to which restrained eating (RE) and changes in RE influence the risk of weight and fat gain over 36 months in women.

Design.

Prospective cohort.

Setting.

Several communities.

Subjects.

Baseline and follow-up assessments were completed by 192 middle-aged women (ages 40.0 ± 3 years).

Measures.

Body weight was measured with an electronic scale, body fat (BF) was assessed using the Bod Pod, energy intake was evaluated using 7–day weighed food records, physical activity was measured objectively using accelerometers, and RE was indexed using the Dutch Eating Behavior Questionnaire.

Analysis.

Relative risk (RR) was calculated using incidence data.

Results.

The risk of weight gain (> 1 kg) over the 36 months was 69% greater in women who did not increase in RE compared with their counterparts (RR = 1.69, 95% confidence interval [CI] = 1.12–2.52). The risk of substantial weight gain (≥3 kg) was 138% greater in women who did not increase in RE compared with women who did (RR = 2.38, 95% CI = 1.16–4.89), and the risk of gains in BF (≥ 1% point) was 49%) greater (RR = 1.49, 95% CI = 1.02–2.17). Control of potential confounding factors, except changes in energy intake, had little influence on risk.

Conclusion.

Women who do not become more restrained in their eating over time are at much greater risk of gaining weight and BF compared with those who become more restrained.

The modified Trait and State Food-Cravings Questionnaires: development and validation of a general index of food craving

In the present study, the multidimensional Trait and State Food Cravings Questionnaires (FCQ-T and FCQ-S), as developed by Cepeda-Benito, Gleaves, Williams, and Erath, [2000. The development and validation of the State and Trait Food Cravings Questionnaires. Behavior Therapy, 31, 151-173], were modified in order to construct an index of general food craving instead of specific food craving. The factor structure, validity and reliability of the modified questionnaires, renamed as the Trait and State General Food Cravings Questionnaires (G-FCQ-T and G-FCQ-S), were investigated in three separate studies. Firstly, exploratory factor analyses were conducted, which yielded a G-FCQ-T with a four-factor structure, that was considerably shorter as compared to the original (nine-factor) FCQ-T, and a G-FCQ-S of which the factor structure was highly comparable to the original FCQ-S. Secondly, in an attempt to replicate the factor structures of the G-FCQ-T and the G-FCQ-S as found in Study 1, confirmative factor analyses were performed. Results indicated adequate fits for both questionnaires. In addition, the test-retest reliability of both versions was satisfactory and an analysis of the construct validity generally revealed the expected results. In Study 3, the validity of the state version of the G-FCQ was further investigated by relating scores on this questionnaire to indices of food deprivation and satiation. Results indicated that the G-FCQ-S indeed measures food craving as a variable state, which is influenced by situational and temporal variables. Altogether, it can be concluded that the G-FCQ-T and G-FCQ-S are both reliable and valid measures of general trait-like and state-dependent food craving.

The phenomenology of food cravings: The role of mental imagery

The study aimed to investigate the role of mental imagery in the experience of food cravings. A sample of 130 undergraduate students was first asked to recall and rate a previous food craving experience. Second, they were asked to imagine themselves eating their favourite food and to rate the involvement of different sensory modalities. It was found that mental imagery was a key element in both the retrospective craving experience and the current food induction. In particular, craving intensity was related to the vividness of the food image (r = .46). The specific sensory modalities most involved were visual (39.7%) and gustatory (30.6%), followed by olfactory (15.8%). There was little involvement of auditory or tactile modalities. It was concluded that cognitive experimental techniques aimed at reducing the vividness of visual, gustatory or olfactory imagery, might usefully be deployed to reduce unwanted food cravings.

A comparative proteomic analysis of the rat brain during rebound hyperphagia induced by space-restriction

Although neurochemical changes have been reported in the brain in animal models of binge eating, biochemical changes of specific proteins in the brain are unknown. Our aim was to elucidate brain proteins altered in rats during enhanced rebound hyperphargia. Rats were deprived of food for 22 h/day for 6 days, then allowed free access to food for 24 h in normal cages (rebound hyperphargia) or in space-restricted cages (enhanced rebound hyperphargia). Proteins extracted from the rat brain were separated by two-dimensional gel electrophoresis, and compared with those from control rats freely fed for 7 days in normal cages. Proteins expressed differently from controls were identified by N-terminal amino acid sequencing and mass fingerprinting using a MALDI-TOF mass spectrometer. Among proteins in the corpus striatum, frontal lobe, hippocampus and thalamus/hypothalamus, ubiquitin C-terminal hydrolase L1 and peroxiredoxin 2 decreased in the hippocampus and phosphatidylethanolamine-binding protein increased in the thalamus/hypothalamus of rats with the enhanced rebound hyperphargia induced by space-restriction. In this study, we first demonstrated that three brain proteins changed in rats during enhanced rebound hyperphagia. These proteins might have pathophysiologic relevance to binge eating.

Dietary Restraint, Body Dissatisfaction, and Psychological Distress: A Prospective Analysis

This study uses prospective data from a survey of 1,177 adolescent girls to examine whether emotional eating, binge eating, abnormal attitudes to eating and weight, low self-esteem, stress, and depression are associated with dietary restraint or body dissatisfaction. In analyses that included both restraint and body dissatisfaction as independent predictors, restraint was associated only with more negative attitudes to eating, whereas body dissatisfaction was significantly associated with all the adverse outcomes. These results cast doubt on the proposition that restrained eating is a primary cause of bulimic symptoms, emotional eating, and psychological distress seen in individuals who are trying to control their weight, and rather suggest that body dissatisfaction is the key factor.

Reduction of food cravings through concurrent visuospatial processing

OBJECTIVE

Two experiments adopted a working memory approach to evaluate the effectiveness of visuospatial tasks as a technique for reducing food cravings.

METHOD

Dieting and non-dieting women were asked to form images of both food-related and nonfood items, induced by either pictures (Experiment 1) or verbal cues (Experiment 2). They were required to concurrently perform one of three tasks that load on the visuospatial sketch pad of working memory: saccadic eye movements, dynamic visual noise, or spatial tapping.

RESULTS

In support of the working memory model of limited visuospatial capacity, concurrent visuospatial activity reduced the vividness of food-related images which, in turn, reduced the intensity of the associated craving. The same pattern of results was observed across dieters and non-dieters and for all stimulus types.

DISCUSSION

Visuospatial tasks may provide a useful technique for the treatment of food craving episodes in both nonclinical and clinical populations.

Women with high scores for cognitive dietary restraint choose foods lower in fat and energy

Women with high dietary restraint typically report restricting energy intake and using reduced-kilocalorie foods in an effort to achieve or maintain a certain body weight. However, previous studies of food choices associated with dietary restraint have been limited by the self-report of participants' food selections. We provided all foods consumed during a free-living 24-hour period to 62 normal-weight women with high (n=33) or low (n=29) dietary restraint, and observed choices from among similar foods varying in fat, fiber, and energy content. Women with high dietary restraint consumed less energy and chose reduced-kilocalorie and reduced-fat foods more frequently than unrestrained eaters. Group differences in choices of milk, cream cheese, mayonnaise, salad dressing, and soda were noted. Dietitians may consider frequent use of reduced-kilocalorie and reduced-fat foods a potential indicator of high dietary restraint, which may have health consequences. Accordingly, further exploration of clients' tendency to restrict dietary intake may be warranted.

Of human bondage: food craving, obsession, compulsion, and addiction

Is it more than a linguistic accident that the same term, craving, is used to describe intense desires for both foods and for a variety of drugs of abuse? There is strong evidence for common pathways that are affected by most addictive drugs. As the other contributors to this volume will indicate, a strong case can also be made for some shared substrates for food and drug rewards in animals. There has been less explicit work on this topic in humans but many lines of evidence support the common mechanism view: Opioid peptides seem to influence food palatability for humans. There is mounting evidence for comorbidity between drug/alcohol abuse and excessive craving or liking for sweets. Anecdotally, elderly individuals tend to 'age-out' of drug abuse, and the elderly also experience markedly fewer food cravings with age. If we focus on the compulsive aspects of food and drug cravings, there is also evidence for overlap: for example, activity in the orbitofrontal cortex is associated with cocaine and alcohol craving. This area is also implicated in the pathology of obsessive-compulsive disorder. Although there is no direct evidence of orbitofrontal involvement in food cravings, there is indirect evidence such as higher than expected co-occurrence of obsessive-compulsive behavior and eating disorders. As a result of bringing together evidence for common substrates for food and for drug rewards, we hope to be able to advance fundamental knowledge of motivational processes and to promote the development of better treatments for drug addiction and for eating disorders.

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.

Motives underlying food choice: dentists, porters and dietary health promotion

OBJECTIVE

Differences in dental decay and disease amongst socioeconomic groups are thought to derive, in part, from variations in dietary practices and differences in education. The aim of this exploratory study was to examine whether differences in motivating factors affecting food choice could be found in a comparison of two groups at very different ends of the social spectrum: dentists and porters/cleaners.

DESIGN

A convenience sample of 100 people (51 porters/cleaners and 49 dentists) working in the dental school at a university in the North West of England were approached to interview face-to-face and complete the Food Choice Questionnaire (FCQ), a previously validated measure designed to assess nine main factors relevant to peoples' food choices. A sample size of 100 was chosen because it was adequate to test validity (using a two-group Chi-square test with a 0.050 two sided significance).

RESULTS

Findings were analysed using independent sample t-test and multiple linear regression. Results indicated significant differences between porters/cleaners and dentists in terms of their motives for food choice on six of the nine FCQ factors. These included convenience (p < 0.001), natural content (p < 0.05), price (p < 0.005), familiarity (p < .0001), mood (p < 0.03) and ethical concern (p < 0.01). Porters/cleaners tended to rate the factors covenience, price, mood and familiarity more highly, whereas dentists did the same for natural content and ethical concern.

CONCLUSIONS

Awareness of the differences in motivational factors affecting food choice between different social groups is important to dental practitioners who are being taught to play an increasing role in health promotion. If dental practitioners are to partake meaningfully in such a role, it is necessary for them to be aware not only of their own motives in food selection, but also of the way in which those motives may differ from those of their clients.

Bulimics' responses to food cravings: is binge-eating a product of hunger or emotional state?

This study examined the roles of hunger, food craving and mood in the binge-eating episodes of bulimic patients, and identified the critical factors involved in the processes surrounding binge-eating episodes that follow cravings. This was a prospective study of the binge-eating behaviour of 15 women with bulimia nervosa. The participants used food intake diaries and Craving Records to self-monitor their nutritional behaviour, hunger levels and affective state. Cravings leading to a binge were associated with higher tension, lower mood and lower hunger than those cravings not leading to a binge. Levels of tension and hunger were the critical discriminating variables. The findings of the study support empirical evidence and models of emotional blocking in binge-eating behaviour and challenge the current cognitive starve-binge models of bulimia. The role of food cravings in the emotional blocking model is discussed in terms of a classically conditioned motivational state. Implications for treatment are addressed.

Evaluation of a modified cognitive-behavioural programme for weight management

OBJECTIVE

To evaluate a modified cognitive-behavioural treatment (M-CBT) for weight management which addresses both the psychosocial costs and the physiological health risks of obesity, without a focus on weight loss.

DESIGN

Randomized controlled trial comparing M-CBT with standard cognitive-behavioural therapy (S-CBT).

SUBJECTS

Sixty-three overweight women with body mass index (BMI) > or = 28 kg/m2, mean age = 47.5 and mean BMI = 35.4.

MEASURES

Weight, waist and hip circumference, blood lipids, blood glucose, blood pressure, psychological well-being, depression, self esteem, stress, binge eating, eating style, body image, nutrient intake, aerobic fitness, activity levels, patient satisfaction with treatment.

RESULTS

Both M-CBT and S-CBT achieved improvements in a broad range of physical, psychological and behavioural variables. Weight loss in the S-CBT group was greater than in the M-CBT group immediately after treatment, but both groups lost weight. Participants in the M-CBT group continued to lose weight up to the 1 y follow-up. M-CBT was evaluated positively by participants.

CONCLUSIONS

Both M-CBT and S-CBT programmes were successful at inducing modest weight loss, as well as improving emotional well-being, reducing distress, increasing activity and fitness, improving dietary quality and reducing cardio-vascular disease risk factors. The improvements were maintained or continued at 1 y follow-up. These results suggest that treatment based on the new weight-control paradigm which emphasizes sustained lifestyle change without emphasis on dieting, can produce modest benefits to health and well-being.

Outcomes of a traditional weight control program and a nondiet alternative: a one-year comparison

The purpose of this study was to evaluate the effectiveness of a traditional weight control program and nondiet alternative in improving behavioral (e.g., restrained, emotional, and external eating), psychological (e.g., body preoccupation, physical self-esteem), and biomedical (e.g., body weight, blood pressure, cholesterol) outcomes. There were 2 intervention groups--traditional weight control (TWC) and Diet Free Forever (DFF); a nonvolunteer comparison group; and a control group, all made up of employees of 3M (N = 357). The 2 intervention groups participated in 10-week eating programs. Outcome variables were assessed at baseline, at 10 weeks for the intervention groups only, and again at 1 year. At baseline, the 2 intervention groups had higher restrained, external, and emotional eating scores, greater body preoccupation, and lower physical self-esteem than the comparison and control groups. They also weighed more. At 1 year, both intervention groups had decreased their body preoccupation and increased their physical self-esteem. Participants in the DFF program reduced their restrained eating, whereas those in the TWC program increased their restrained eating. Neither eating program had an impact on the biomedical outcomes.

Treatment of obesity: theory into practice

The purpose of the present paper is to outline the current situation in the management of obesity in adults, and to make some suggestions as to how health professionals involved in obesity treatment can best address this growing problem. Dietitians and nutritionists have long been involved in the treatment of obesity, and have a vital role to play in the battle to reverse the increasing prevalence of this major public health problem. However, the current management of obesity is far from ideal. There is evidence to suggest that in general health care, even when there are clearly effective clinical interventions, health professionals may not practise in the best way. Furthermore, some professionals may also hold negative attitudes towards the obese. These are the subject of a systematic review on improving health professionals' practice and organization of care in obesity treatment, the preliminary findings of which will be discussed in the present paper (Harvey et al. 1998a,b). A new approach to obesity is required, encompassing effective treatment and prevention strategies. A greater understanding of the problems faced by the obese individual in attempting to lose weight is also needed, with a range of treatment approaches on offer to acknowledge the heterogeneity of obesity. Those health professionals involved in obesity treatment must consider the impact of dietary advice given in a consultation against the impact of environmental cues that assail the patient as soon as they leave the room. Tackling the obesity epidemic requires action at the individual and population level if we are to see any reduction in prevalence.

Prefrontal and striatal dopamine metabolism during enhanced rebound hyperphagia induced by space restriction--a rat model of binge eating

BACKGROUND

Several lines of evidence indicate that abnormalities in brain dopamine and serotonin metabolism may play an important role in bulimia nervosa. However, the regional neurochemical mechanism of the binge eating is poorly understood. Our purpose was to elucidate brain neurochemical mechanisms of binge eating using a rat model.

METHODS

The dopamine release and metabolism in the prefrontal cortex (PFC) and in the ventrolateral striatum (VLS) of rats were studied using microdialysis during enhanced rebound hyperphagia induced by space restriction (an animal model of binge eating).

RESULTS

The rats showed rebound hyperphagic state when they were released from scheduled feeding (2 hours/day feeding for 7 days). The hyperphagia was further enhanced when they were put in a space-restricted cage where their mobility was restricted. Dopamine release and metabolism were increased both in the PFC and in the VLS during the enhanced rebound hyperphagia.

CONCLUSIONS

These results tentatively suggest that increased dopamine release and metabolism in the PFC and in the VLS may be related to space restriction and to activation of motor function involved in feeding behavior, respectively. The enhanced rebound hyperphagia induced by space restriction may be useful as an animal model of binge eating.

Food cravings, endogenous opioid peptides, and food intake: a review

Extensive research indicates a strong relationship between endogenous opioid peptides (EOPs) and food intake. In the present paper, we propose that food cravings act as an intervening variable in this opioid-ingestion link. Specifically, we argue that altered EOP activity may elicit food cravings which in turn may influence food consumption. Correlational support for this opioidergic theory of food cravings is provided by examining various clinical conditions (e.g. pregnancy, menstruation, bulimia, stress, depression) which are associated with altered EOP levels, intensified food cravings, and increased food intake.

Locating reward cue at response manipulandum (CAM) induces symptoms of drug abuse

Appetitive instrumental discrimination learning procedures provide for CAM (cue and manipulandum) when the reward cue (discriminative stimulus positively correlated with positive reinforcement) is located at the response manipulandum (object that when contacted or manipulated defines the performance of the instrumental response). Evidence reviewed shows that CAM induces excessive and compulsive instrumental responding relative to otherwise comparable non-CAM control procedures. In humans, symptoms of drug abuse are particularly likely when the drug-taking implement (response manipulandum at which instrumental drug-taking is directed) is also predictive of the drug's rewarding effects (reward cue). Evidence that the predictive relationship between a drug-taking implement and drug reward relates to drug abuse is reviewed, and implications for treatment and prevention are considered. CAM is related to neurobiological models of drug abuse that emphasize the role of the neurotransmitter dopamine (DA). CAM produces convergence of DA-mediated responding for conditioned reinforcement with DA mediation of psychomotor activation and incentive-motivational processes to yield reflexive cue-directed responding not observed in non-CAM controls.

The correlates of binge eating in two nonpatient samples

Binge eating in two nonpatient samples was examined as a function of actual body weight (expressed as BMI), attempts to control eating, food/weight preoccupation, and neuroticism. All of these factors were univariately associated with binge eating, but multivariate analyses indicated that food/weight preoccupation was the most powerful predictor, accounting for much of the common variance shared by the various correlates. This replicates previous work and suggests that the dynamics of subclinical bingeing are substantially similar to that found in the full DSM-III-R syndrome of bulimia nervosa.

The experience of food craving: a prospective investigation in healthy women

This study aimed to provide a detailed analysis of the experience of food craving in a healthy, non-clinical group of women. Twenty-five women who reported food cravings prospectively recorded their experiences over a period of 5 weeks using a Food Craving Record. The average number of cravings recorded was just under 2 per week. Craving for chocolate amounted to 49% of all the food cravings. Subtle differences in the change in arousal and hunger were noted between chocolate cravings and those for other sweet foods. Additional differences were found between these cravings and those for savoury foods, in their situational circumstances and speed of disappearance. There was a premenstrual increase in food cravings but no selective change in the types of food craved. Overall, the food cravings reported by these women were hunger-reducing, mood-improving experiences, directed at wanting to consume highly pleasant tasting food. This analysis should serve as a template against which other subject groups and other forms of craving may be explored.

Restraint and perception of body weight among British adults

A sample of 533 adults (268 women and 265 men) representative of the general population of Great Britain were interviewed so that the extent and effects of restraint, using the Dutch Eating Behaviour Questionnaire (DEBQ; Van Strien, Frijters, Bergers, & Defares, 1986) and the extent of overestimation of body weight could be examined. High-restraint subjects reported more guilt about food and eating and a greater likelihood of overeating in reaction to dysphoric mood, and they were more apt to overestimate their body size. Women reported significantly higher restraint, more guilt after eating in various types of social situations, and more overeating in reaction to dysphoric mood. Higher social class was associated with reports of guilt about a greater number of foods and with reports of more overeating when under stress or tired. Age was positively associated with guilt and negatively associated with overeating in reaction to being under stress, tired, or depressed.

Eating style and eating behaviour in adolescents

The relationship between eating style, attitudes towards food and food intake was investigated in 846 British adolescent schoolchildren. Eating style was assessed with the Dutch Eating Behaviour Questionnaire, attitudes towards food with a series of specially prepared questions, and food intake with a diet history taken by a dietitian. The results showed that restraint, external and emotional eating were associated with very different profiles of attitudes and behaviour. Restrained subjects had a higher body weight, more negative attitudes towards food, a lower likelihood of overeating and a lower overall energy intake. External eaters had a lower body weight, positive attitudes to food, and reported a higher energy intake. Emotional eaters fell in between in some ways, with some signs of situational loss of control combined with a negative attitude towards overeating. While external eating appeared to be attenuated by restraint, emotional eating was enhanced by it. The implications of these eating styles for later patterns of eating and weight are discussed.

Body size perception and body satisfaction in restrained and unrestrained eaters

In 21 restrained and 20 unrestrained eaters body size perception was measured using the video distortion technique (VDT), the image marking procedure (IMP) and the kinesthetic size estimating apparatus (KSEA). Body satisfaction was assessed by questionnaires (Body Shape Questionnaire, Dieting scale of the Eating Attitudes Test). Restrained eaters showed no systematic over- or underestimation of the body size but less perceptual accuracy (in VDT and KSEA). Furthermore, they were clearly more dissatisfied with their bodies than unrestrained eaters. Both findings were unrelated to each other. In both groups depressive mood or thoughts seemed to be associated with body dissatisfaction but not with body size misperception. Objective body measures (body mass index, body fat content) were not related to either body size perception or body satisfaction. The findings suggest that a perceptual uncertainty in regard to body size (either for visual or for somatosensory aspects) has already developed in restrained eaters, which may constitute a predisposition for more overt forms of body size misperception as found in eating disorder patients.

Cue-exposure vs self-control in the treatment of binge eating: a pilot study

From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS-US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. The present authors treated six obese bulimics with cue exposure and response prevention. Six other patients learned to avoid or escape the binge-related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the 1 yr follow-up. In contrast to the 100% binge-free subjects treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the subjects.

Food craving, dietary restraint and mood

A common assumption is that dieting causes food cravings, probably as a result of food energy deprivation. This issue was investigated in a two-phase study. In phase one, 206 women completed the Dutch Eating Behaviour Questionnaire, the Three-Factor Eating Questionnaire and a food craving scale. A correlational analysis showed food craving to be only weakly related to dietary restraint, but highly and significantly correlated with external eating, emotional eating and susceptibility to hunger. In phase two, ten women who regularly experienced food cravings and ten who rarely craved food kept prospective records of their food intake, daily mood and food craving episodes. There were few differences in eating behaviour, although the cravers tended to consume slightly more daily energy than the non-cravers. The cravers had higher ratings of boredom and anxiety during the day, and dysphoric mood was prominent prior to the cravings themselves. Food deprivation does not appear to be a necessary condition for food cravings to occur. Rather, food cravings are closely associated with mood, in particular as an antecedent to craving and also as a consequence of craving.

Dietary restraint and disinhibition: is restraint a homogeneous construct?

The homogeneity of the restraint construct is investigated in a study of 54,525 subjects participating in a weight reduction program. Using the German version of the TFEQ (Stunkard & Messick, 1985, Journal of Psychosomatic Research, 29, 71-83; Pudel & Westenhoefer 1989a, Fragebogen zum Essverhalten; Handanweisung), it is shown that different types of relations exist between the items measuring dietary restraint and the disinhibition scale. A discriminant analysis in a subgroup of moderately highly restrained eaters with either low or high disinhibition (n = 1759) reveals different sets of restraint behaviours and cognitions that differentiate between high and low disinhibition. These findings are replicated in an independent validation sample (n = 1693). Two restraint subscales are constructed, one associated with increasing disinhibition, the other with decreasing disinhibition. It is argued that different sets of restrained behaviours and cognitions should be differentiated when looking at the causal link between restraint and disturbances of eating behaviour.

The phenomenology of food cravings

A craving for specific foods represents one of the most common and intense experiences surrounding eating. This paper explores the phenomenology of food craving by discussing the properties, origins and determinants of the craving state. The discussion includes consideration of the use of the craving concept in the drug literature and a review of the food craving literature. It is suggested that advances in the understanding of food cravings must address the problem of the definition and measurement of the craving state and proceed with recognition of the inadequacies of the ubiquitous assumption that cravings serve to identify and redress bodily needs.

A psychometric investigation of the Rigorous Eating Scale

A psychometric analysis of the Rigorous Eating Scale was carried out based on data of Smead from 1986 and also from 1987 by Smead and Boyd. This 13-item scale was designed to measure hunger, deprivation, and restraint in eating style and used in both of the foregoing studies to investigate the relationship between dieting and eating style and scoring higher on measures of subclinical symptoms of anorexia and bulimia. This brief report highlights internal consistency reliability, factor structure, and item-criterion correlations. Results indicate appropriately high reliability, but inadequate factor structure. Item-criterion correlations suggest several aspects of eating style which may be important to include in similar scales of the future.

Is anorexia nervosa an obsessive-compulsive disorder?

Although anorexia nervosa may vary widely in its severity and outcome, it is usually regarded as an illness in its own right, as patients do not display major changes in the form of the illness over time (Russell, 1970). It readily lends itself to being accorded clear-cut diagnostic criteria (Russell, 1977) and this is reflected in ICD–10 (World Health Organization, 1987). However, the nosological independence of anorexia nervosa has undergone vigorous assault since its classic description by William Gull (1874). For example, the psychological nature of anorexia nervosa was obscured for 30 years by Simmond's (1914) description of anterior pituitary lesions and cachexia, and Kay & Leigh's (1954) influential study of anorexia nervosa concluded with their doubts about its status as a ‘psychiatric entity’.

Endocrine findings in restrained eaters

Restrained (n = 9) and unrestrained eaters (n = 13) were selected from a group of healthy young women. Blood samples were collected overnight at half-hour intervals. Levels of cortisol, growth hormone, and glucose in both groups did not differ, while restrained eaters had significantly lower insulin values. After a standardized test meal of 500 kcal, restrained eaters had significantly lower norepinephrine values while insulin and glucose values did not differ from those of the unrestrained group. These findings indicate that restrained eating may have a biological basis.

From dietary restraint to binge eating: some theoretical considerations

A correlation between dietary restraint and the occurrence of binge eating has been convincingly shown in several investigations. However, the mediating mechanisms have not yet been elaborated in detail nor linked to empirical evidence. This theoretical gap is addressed in the following. After a short review of behavioral and metabolic correlates of dietary restraint, potential effects of restrained eating on the psychophysiological regulation of food intake are described. These effects may lead to the disruption of intake regulation and therefore can be regarded as direct causes of binge eating.