Are loss of control while eating and overeating valid constructs? A critical review of the literature

Evaluating the predictions of an interoceptive inference model of bulimia nervosa

OBJECTIVE

Bulimia nervosa (BN) is associated with loss-of-control (LOC) eating episodes that frequently occur in response to negative emotions. According to recent neurocomputational models, this link could be explained by a failure to accurately update beliefs about the body in states of high arousal. Specifically, these interoceptive inference models suggest that under-relying on signals from one's body about sensory experience ("low sensory precision") and/or over-relying on previously held beliefs ("excessively precise priors") lead to inaccurate perception and maladaptive behaviors. We conducted an initial test of these core predictions of the interoceptive inference model in BN using self-report measures.

METHODS

We compared women with BN (n = 30) and age-, BMI-, and full-scale IQ-matched controls (n = 31) on trust in sensory information from the body and two types of beliefs about what can be done to regulate high negative affect. Within the BN group, we tested interrelations among these measures and explored their associations with LOC eating frequency.

RESULTS

Compared with healthy controls, the BN group reported lower levels of trust in sensory information and stronger beliefs that once upset, there is little one can do, apart from eating, to self-regulate. These beliefs were associated with each other and with lower body trust. Beliefs about the uncontrollability of emotion were associated with more frequent subjective binge-eating episodes.

CONCLUSIONS

Findings provide initial support for the core predictions of an interoceptive inference account of BN: low trust in sensory information ("sensory precision") may promote an overreliance on maladaptive "prior beliefs" about the effects of eating on negative emotions, ultimately interfering with accurate updating of beliefs about other strategies that could regulate emotions and maintain LOC eating. Low body trust, strong expectations about emotions, and their neurocomputational underpinnings could be promising combined treatment targets for BN.

Changes in evening-shifted loss of control eating severity following treatment for binge-eating disorder

BACKGROUND

Loss of control eating is more likely to occur in the evening and is uniquely associated with distress. No studies have examined the effect of treatment on within-day timing of loss of control eating severity. We examined whether time of day differentially predicted loss of control eating severity at baseline (i.e. pretreatment), end-of-treatment, and 6-month follow-up for individuals with binge-eating disorder (BED), hypothesizing that loss of control eating severity would increase throughout the day pretreatment and that this pattern would be less pronounced following treatment. We explored differential treatment effects of cognitive-behavioral guided self-help (CBTgsh) and Integrative Cognitive-Affective Therapy (ICAT).

METHODS

Individuals with BED (N = 112) were randomized to receive CBTgsh or ICAT and completed a 1-week ecological momentary assessment protocol at baseline, end-of-treatment, and 6-month follow-up to assess loss of control eating severity. We used multilevel models to assess within-day slope trajectories of loss of control eating severity across assessment periods and treatment type.

RESULTS

Within-day increases in loss of control eating severity were reduced at end-of-treatment and 6-month follow-up relative to baseline. Evening acceleration of loss of control eating severity was greater at 6-month follow-up relative to end-of-treatment. Within-day increases in loss of control severity did not differ between treatments at end-of-treatment; however, evening loss of control severity intensified for individuals who received CBTgsh relative to those who received ICAT at 6-month follow-up.

CONCLUSIONS

Findings suggest that treatment reduces evening-shifted loss of control eating severity, and that this effect may be more durable following ICAT relative to CBTgsh.

Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study

OBJECTIVE

This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE).

METHOD

Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion.

RESULTS

The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up.

DISCUSSION

Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE.

PUBLIC SIGNIFICANCE

This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.

Loss of control eating in children is associated with altered cortical and subcortical brain structure

Introduction

Loss of control (LOC) eating is the perceived inability to control how much is eaten, regardless of actual amount consumed. Childhood LOC-eating is a risk factor for the development of binge-eating disorder (BED), but its neurobiological basis is poorly understood. Studies in children with BED have shown both increased gray matter volume in regions related to top-down cognitive control (e.g., dorsolateral prefrontal cortex) and reward-related decision making (e.g., orbital frontal cortex) relative to healthy controls. However, no studies have examined brain structure in children with LOC-eating. To identify potential neurobiological precursors of BED, we conducted secondary analysis of five studies that conducted T1 MPRAGE scans.

Methods

A total of 143, 7-12-year-old children (M = 8.9 years, 70 boys) were included in the study, 26% of which (n = 37) reported LOC-eating (semi-structured interview). Age, sex, and obesity status did not differ by LOC-eating. Differences between children with and without LOC were examined for gray matter volume, cortical thickness, gyrification, sulci depth, and cortical complexity after adjusting for age, sex, total intercranial volume, weight status, and study.

Results

Children with LOC, relative to those without, had greater gray matter volume in right orbital frontal cortex but lower gray matter volume in right parahippocampal gyrus, left CA4/dentate gyrus, and left cerebellar lobule VI. While there were no differences in cortical thickness or gyrification, children with LOC-eating had great sulci depth in left anterior cingulate cortex and cuneus and greater cortical complexity in right insular cortex.

Discussion

Together, this indicates that children with LOC-eating have structural differences in regions related to cognitive control, reward-related decision-making, and regulation of eating behaviors.

Independent associations of food addiction and binge eating measures with real-time eating behaviors and contextual factors: An exploratory ecological momentary assessment study

Food addiction (FA) is a concept centered around the addictive potential of highly palatable processed foods, though there is debate over the discriminative validity of FA as a distinct construct from binge-eating symptomatology. This study explored how trait measures of FA and binge-eating symptoms independently and interactively predicted eating behaviors and posited correlates of FA and binge eating measured via ecological momentary assessment (EMA). Adult participants (N = 49) who met the criteria for FA and/or binge-eating disorder completed baseline measures of FA (Yale Food Addiction Scale [YFAS 2.0]) and binge-eating symptoms (Eating Pathology Symptom Inventory [EPSI] binge eating scale) followed by a 10-day EMA protocol. Generalized linear mixed models examined the independent effects of YFAS 2.0, EPSI, and their interaction predicting EMA outcomes. Higher YFAS 2.0 symptom count scores were uniquely related to greater EMA-measured overeating, loss of control eating, negative and positive affect, and impulsivity when controlling for EPSI scores. Conversely, higher EPSI scores were uniquely related to greater EMA-measured eagerness and urge to eat, and expectancies that eating would improve mood. No interaction effects were significant. These results highlight potential distinctions between phenomena captured by FA and other measures of binge eating, in that FA symptoms may be a marker of heightened binge-eating severity, emotional arousal, and impulsivity.

Loss of control eating exhibits an evening diurnal shift among females with bulimia nervosa and binge-eating disorder

Loss of control (LOC) is a hallmark feature of binge eating that is associated with significant distress and impairment. Despite the central role diurnal rhythms may play in the development and maintenance of LOC eating, diurnal patterns of LOC remain understudied and poorly characterised. We assessed the diurnal timing of LOC in a sample of females with bulimia nervosa and binge-eating disorder who participated in a study assessing the impact of bright light exposure on binge eating, hypothesising that higher ratings of LOC would be more likely to occur later in the day. Participants (N = 34) completed a 22-day protocol during which they provided LOC ratings six times daily. Kernel density estimates describing LOC ratings across times of day were compared using permutation tests of equality. Results demonstrated an evening shift in LOC, wherein higher LOC was more likely to occur later in the day and lower LOC was more likely to occur earlier in the day. This study is the first to clearly depict the phenomenon that the likelihood of experiencing higher LOC increases throughout the day, pointing to the potential role diurnal rhythms, such as disrupted appetitive rhythms or mood variations, may play in maintaining binge eating.

State-level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study

BACKGROUND

Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait-level working memory (WM), which may limit adaptive responding to intra- and extra-personal cues related to eating. Understanding of how WM performance relates to eating behavior in real-time is currently limited.

METHODS

We studied 32 youth (ages 10-17 years) with LOC eating and overweight/obesity (LOC-OW; n = 9), overweight/obesity only (OW; n = 16), and non-overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone-based ecological momentary assessment. Linear mixed effects models estimated group-level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating.

RESULTS

LOC-OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between-subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within-subject effects (reflecting variations in moment-to-moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05).

CONCLUSIONS

Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory-based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal-weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment-to-moment basis.

Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating

BACKGROUND

Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT).

METHODS

Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design).

RESULTS

The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up.

CONCLUSIONS

This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level.

TRIAL REGISTRATION

The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).

Unequivocally large, but not enormous: An examination of the nutritional content of objective and subjective binge-eating episodes using ecological momentary assessment data

OBJECTIVE

This study compared the macronutrient profiles of subjective binge-eating episodes (SBEs), objective binge-eating episodes (OBEs), and typical eating episodes.

METHOD

Twenty-one adults with binge eating completed ecological momentary assessment of all eating episodes for 2 weeks, including detailed monitoring of food types and portions. Binge-eating episodes (N = 237) were coded as OBEs (n = 76) or SBEs (n = 161). Calories and macronutrients were computed using manufacturer information and USDA Food and Nutrient Database for Dietary Studies. Multilevel regression models compared the eating episode types on caloric and macronutrient content.

RESULTS

OBEs contained an average of 121.5 (95.1) g fat, 363.7 (289.1) g carbohydrates, 65.2 (38.2) g protein, 20.9 (16.4) g fiber, and 2856.2 (1869.2) calories. SBEs contained 31.6 (30.5) g fat, 76.5 (54.0) g carbohydrates, 20.5 (21.6) g protein, 5.3 (5.9) g fiber, and 695.1 (505.9) calories. Although OBEs contained significantly more calories and grams of all macronutrients than SBEs (p < .001), the macronutrient proportions of OBEs and SBEs did not differ. The proportions of carbohydrates (p = .005) and protein (p < .001) in SBEs significantly differed from typical eating episodes.

DISCUSSION

Our findings offer preliminary evidence that OBEs and SBEs are more comparable in macronutrient profile than typical eating episodes.

PUBLIC SIGNIFICANCE STATEMENT

The present study compared the calories and grams of macronutrients in objectively large binge-eating episodes, subjectively large binge-eating episodes, and typical meals and snacks. Results suggest that objectively and subjectively large binge-eating episodes demonstrate similar profiles of macronutrients, which are different from the macronutrient profile of meals and snacks. These results may help the eating disorder field better study the impact of subjectively large binge-eating episodes.

The association between preconception loss of control over eating and depressive symptom trajectories from childhood through first pregnancy

OBJECTIVE

Loss of control over eating (LOC) during pregnancy impacts prenatal health and often co-occurs with depressive symptoms. However, the role of depression history as a risk factor for LOC prior to pregnancy is unclear; information that is essential for effective prenatal health promotion. We examined the association between trajectories of depressive symptoms from childhood to first pregnancy and preconception LOC.

METHOD

Participants (N = 1031) were predominantly Black, first-time mothers enrolled in the population-based Pittsburgh Girls Study. LOC and depressive symptoms were measured annually. Pre-pregnancy height and weight, and gestational weight gain data were abstracted from medical records.

RESULTS

There was a significant difference in age of first conception for Black and White individuals (t = 8.73, df = 976, p < .001). Latent class analysis revealed four and three classes of depressive symptom trajectories for Black and White individuals, respectively. In the entire sample, the high-changing and moderate-decreasing classes of depressive symptoms were each associated with lifetime, in preconception year and not in preconception year, LOC (X2  = 56.7, p < .001).

DISCUSSION

High levels of lifetime depressive symptoms may increase vulnerability to future LOC prior to first pregnancy, suggesting potential targets for interventions to improve maternal health.

PUBLIC SIGNIFICANCE

Both depression history and disordered eating behaviors are known to influence prenatal health. The present study revealed associations between high levels of depressive symptoms from childhood through first pregnancy and loss of control over eating that included the year prior to conception. Results highlight potential targets for preconception interventions with relevance for future prenatal health.

Disordered Eating and Eating Disorders in Pediatric Obesity: Assessment and Next Steps

While the exact prevalence of disordered eating in youth who are overweight and have obesity has not been determined, studies show that the odds of a young adult (18-24 years) with obesity engaging in disordered eating behaviors is 2.45 times more likely to occur than in young adults with Body Mass Indexes (BMI) in the normative range. The purpose of this review is to highlight the role that disordered eating and eating disorders may play in pediatric obesity and the importance of screening for these conditions. The ability to identify and assess disordered eating alters the course of treatment. Without an understanding of the intersection of obesity and disordered eating, medical providers may continue treatment-as-usual. Doing so may inadvertently contribute to internalized weight bias in patients with obesity and exacerbate their disordered eating symptoms and behaviors. In addition, understanding the spectrum of disordered eating in pediatric patients with obesity allows providers to tailor treatments, discuss food and physical activity differently, and know when to refer patients to eating-disorder-specific providers for continued treatment.

Loss of Control over Eating, Inhibitory Control, and Reward Sensitivity in Children and Adolescents: A Systematic Review

OVERVIEW

In recent years, there has been increasing clinical and empirical interest in the concept of pediatric loss of control over eating, particularly about its link with the executive functions related to the concept of impulsivity, such as inhibitory control and reward sensitivity. However, there has yet to be a comprehensive literature synthesis about the associations between these variables. A comprehensive literature synthesis would help identify future research directions to advance the field in this area. Therefore, this systematic review aimed to synthesize evidence concerning the associations between loss of control over eating, inhibitory control, and reward sensitivity in children and adolescents.

METHODS

The systematic review was conducted according to the guidelines proposed by PRISMA in Web of Science, Scopus, PubMed, and PsycINFO. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias.

RESULTS

Twelve studies met the selection criteria and were included in the final review. Overall, methodological heterogeneity, variability in assessment methods, and the age of participants make it difficult to draw general conclusions. Nevertheless, most studies with community samples of adolescents indicate that inhibitory control difficulties are linked to the concept of loss of control eating. The presence of obesity seems to be associated with inhibitory control difficulties, regardless of the presence of loss of control eating. Studies on reward sensitivity are scarcer. However, it has been suggested that higher reward sensitivity is related to loss of control eating behaviors in young people, particularly binge eating.

CONCLUSIONS

The literature on the link between loss of control eating and trait-level facets of impulsivity (low inhibitory control and higher reward sensitivity) among young people remains limited, and more studies on children are needed. Findings from this review may make healthcare professionals more aware of the potential clinical importance of targeting the trait-level facets of impulsivity and help to inform existing and future weight-loss/maintenance interventions in childhood and adolescence.

Altered prefrontal activation during the inhibition of eating responses in women with bulimia nervosa

BACKGROUND

The sense of 'loss of control' (LOC), or a feeling of being unable to stop eating or control what or how much one is eating, is the most salient aspect of binge eating. However, the neural alterations that may contribute to this experience and eating behavior remain poorly understood.

METHODS

We used functional near-infrared spectroscopy (fNIRS) to measure activation in the prefrontal cortices of 23 women with bulimia nervosa (BN) and 23 healthy controls (HC) during two tasks: a novel go/no-go task requiring inhibition of eating responses, and a standard go/no-go task requiring inhibition of button-pressing responses.

RESULTS

Women with BN made more commission errors on both tasks. BN subgroups with the most severe LOC eating (n = 12) and those who felt most strongly that they binge ate during the task (n = 12) showed abnormally reduced bilateral ventromedial prefrontal cortex (vmPFC) and right ventrolateral prefrontal cortex (vlPFC) activation associated with eating-response inhibition. In the entire BN sample, lower eating-task activation in right vlPFC was related to more frequent and severe LOC eating, but no group differences in activation were detected on either task when this full sample was compared with HC. BN severity was unrelated to standard-task activation.

CONCLUSIONS

Results provide initial evidence that diminished PFC activation may directly contribute to more severe eating-specific control deficits in BN. Our findings support vmPFC and vlPFC dysfunction as promising treatment targets, and indicate that eating-specific tasks and fNIRS may be useful tools for identifying neural mechanisms underlying dysregulated eating.

Patterns of Eating Behavior among 13-Year-Old Adolescents and Associated Factors: Findings from the Generation XXI Birth Cohort

Eating behavior adopted during adolescence may persist into adulthood. The aims of this study were to identify eating behavior patterns among Portuguese adolescents and to explore whether groups differ in terms of early life and family characteristics, severity of depressive symptoms, and body mass index (BMI) z-score. Participants were 3601 13-year-olds enrolled in the birth cohort Generation XXI. Eating behavior was assessed using the self-reported Adult Eating Behavior Questionnaire (AEBQ), validated in this sample. The severity of depressive symptoms was measured through the Beck Depression Inventory (BDI-II), and data on sociodemographic and anthropometrics were collected at birth and 13-years-old. Latent class analysis was conducted, and associations were estimated using multinomial logistic regression models. Five patterns of individuals were identified: "Picky eating", "Disinterest towards food", "Food neophilia", "Emotional eating", and "Food attractiveness". The adolescents' sex, maternal education, BMI z-score, and severity of depressive symptoms were significantly associated with the identified patterns. In particular, adolescents with a higher BMI z-score were more likely in "Food neophilia" while individuals with more severe depressive symptoms were in the "Picky eating", "Emotional eating", and "Food attractiveness" patterns. These findings suggest a starting point for the development and planning of targeted public health interventions.

Social media and dating app use are differentially related to same- and next-day disordered eating pathology in young men with loss of control eating

OBJECTIVE

To evaluate whether social networking site (SNS) and dating app use is associated with disordered eating in young men.

METHODS

42 men (18-35y) who reported ≥4 loss of control (LOC) eating episodes in the prior month completed a 14-day ecological momentary assessment (EMA) protocol. Five times throughout the day, participants responded to prompts regarding their dietary restraint, body dissatisfaction, and LOC eating. Each night at ~10 pm, participants reported their total time spent on SNSs and dating apps/websites within the last day.

RESULTS

39 out of 42 cisgender men (M_age = 25.1 ± 5.3 years; 47 % non-Hispanic White, 29 % Black or African American; 63 % non-students; 87 % heterosexual) reported using SNSs and/or dating apps. Neither SNS nor dating app use was associated with body dissatisfaction. Dating app use with associated with higher same- (r² equivalent = 0.022, p = .003) and next-day dietary restraint (r² equivalent = 0.016, p = .02); SNS use was not. More SNS use was associated with lower odds of same- (OR [95 % CI] = 0.86 [0.75, 0.99], p = .044) and next-day LOC eating (OR [95 % CI] = 0.82 [0.71, 0.96], p = .011); links with dating app use were non-significant.

DISCUSSION

Non-significant links for SNS and dating app use with body dissatisfaction, and inverse associations with LOC eating, are contrary to research conducted with girls and women. Research is needed to evaluate whether the quality of SNS and dating app engagement (e.g., specific sites) are more closely related to men's disordered eating, and this work should consider muscularity concerns.

The psychometric properties of Binge Eating Scale among overweight college students in Taiwan

BACKGROUND

The Binge Eating Scale (BES) is a widely used measuring tool to assess binge eating problems in Western countries. However, the psychometric properties of such scales among cross-cultural youth groups are insufficient, and the factor structure continues to be debated; therefore, further research is needed. The aim of this study was to examine the properties of BES among overweight college students in Taiwan.

METHODS

A cross-sectional design and convenience sampling were adopted to recruit 300 overweight students from five universities. A translated Traditional Chinese version of BES was used for the survey, and the validity of the scale was tested using the Confirmatory Factor Analysis (CFA) and Bulimic Investigatory Test, Edinburgh (BITE). The reliability was evaluated using internal consistency and test-retest reliability.

RESULTS

The CFA results showed a reasonable model fit. The first-order two-factor model was consistent with that of the original BES and significantly correlated with the criterion of BITE score. Cronbach's α value, representing internal consistency reliability, and the intraclass correlation coefficient of repeated measures made one month apart were both 0.83, indicating good reliability and stability. Significant correlations were observed between the BES score and sex and BMI; however, no correlation was observed between BES scores and age.

CONCLUSION

The BES presents sound psychometric properties, has good cross-cultural applicability, and can be used as a first-line screening tool by mental health professionals to identify the severity of binge eating behavior among overweight college students in Taiwan. It is recommended that participant diversity and obesity indicators be incorporated into the scale in the future to establish a universal psychometric tool.

Daily weight stigma experiences, and disordered and intuitive eating behaviors among young adults with body dissatisfaction

OBJECTIVE

The present study aimed to extend naturalistic weight stigma research by examining the following aims among young adults with body dissatisfaction and varied body mass indices (BMIs): (1) characterize the frequency of individuals' daily weight stigma experiences, and contextual variations, over a 14-day period; (2) examine whether BMI moderated daily associations between weight stigma experiences relative to eating disorder symptoms and intuitive eating behaviors.

METHOD

Women (n = 174) and men (n = 24) completed a 14-day daily diary protocol. Concurrent and time-lagged multilevel models examined associations between daily weight stigma, and eating disorder and intuitive eating behaviors among women only due to the small subsample of men.

RESULTS

Over the 14-day assessment, 43.94% (n = 87) of participants experienced weight stigma. Weight stigma rates varied based on how, where, and by whom weight stigma was expressed, and via BMI. Further, among women, multiple concurrent within-person associations were identified between women's daily weight stigma experiences and daily eating disorder symptoms (skipping meals, binge eating, and body dissatisfaction). Time-lagged associations also showed that women's weight stigma experiences on a given day were associated with a greater likelihood that they would limit the amount of food they consumed the next day. These associations did not differ via women's BMIs.

DISCUSSION

Collectively, these findings provide important information on how weight stigma experiences unfold in daily life among individuals with body dissatisfaction and varied BMIs, and the proximal and more enduring impact of women's daily weight stigma experiences on their use of multiple adverse eating behaviors that can promote poor health.

PUBLIC SIGNIFICANCE

The present findings provide important information on how, where, and by whom weight stigma experiences unfold in daily life among young adults with body dissatisfaction and varied body weights, as well as the proximal and more enduring impact of women's daily weight stigma experiences on their use of a variety of adverse eating behaviors that can promote poor health.

Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach

BACKGROUND

People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight.

OBJECTIVE

The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations.

METHODS

A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight.

RESULTS

Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape.

CONCLUSIONS

In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.

Experiences of loss of control eating in women after bariatric surgery: A qualitative study

OBJECTIVE

Loss of control (LOC) eating following bariatric surgery remains insufficiently understood, reflected in a lack of clear conceptualization, valid measurements, and effective treatments. This study explored patients' perspectives on LOC eating post-bariatric surgery, focusing on the relevance of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) indicators of impaired control, and patients' experiences before (precipitating factors), during (eating patterns, perpetuating factors), and after the episodes (strategies used to stop eating).

METHODS

This was a qualitative study using descriptive phenomenology. Participants were adults who have undergone gastric bypass or sleeve gastrectomy and self-reported recent LOC eating. Data were collected by semi-structured interviews and analyzed using a combined inductive and deductive approach.

RESULTS

Participants were all women (N = 15; age: 34.5 ± 9.2 years). Results suggested that (1) except for feeling disgusted, guilty, or depressed after eating, other DSM-5 indicators did not seem to be highly relevant to this bariatric cohort; (2) LOC eating could occur across contexts, with food access, boredom, and food craving being consistent triggers; (3) the food amount consumed during a LOC episode was not necessarily considered excessive; (4) "mindlessness" and "satisfying hedonic, physiological, and mental needs" were the main perpetuating factors of LOC eating; and (5) self-talk and distracting attention were the most adopted strategies to stop eating.

DISCUSSION

Study findings have implications concerning the conceptualization, measurement, and intervention of LOC eating among bariatric patients. For example, results suggested the need for more data to determine the appropriate indicators of LOC eating and the inclusion of boredom as an intervention target in bariatric patients.

PUBLIC SIGNIFICANCE

Loss of control (LOC) eating is characterized by a sense of being unable to stop while eating. LOC eating is prevalent in patients who have undergone weight loss surgery and is associated with worse surgical outcomes. This qualitative study that explored post-bariatric surgery patients' experiences of LOC eating will inform efforts to better assess and intervene in this disordered eating behavior, thus ultimately optimizing patients' health following weight loss surgery.

Real-time versus retrospective self-report assessment of loss-of-control eating in adults undergoing bariatric surgery

OBJECTIVE

Loss-of-control (LOC) eating is common in adults undergoing bariatric surgery. Agreement between real-time and retrospective assessment methods is unclear.

METHODS

Adults with severe obesity reported on LOC eating over the preceding 28 days via Eating Disorder Examination-Questionnaire (EDE-Q) items and in near real time over 10 days via ecological momentary assessment (EMA; involving daily repeated surveys delivered via smartphone in the natural environment), with both assessment forms completed before surgery and at 3, 6, and 12 months after surgery. Wilcoxon signed rank tests and generalized linear mixed models were used to compare participants' EDE-Q and EMA reports of subjectively and objectively large LOC episodes across time points.

RESULTS

Participants reported subjectively large LOC episodes more frequently via EMA than EDE-Q across time points, although differences did not reach statistical significance (all p > 0.05). Conversely, objectively large LOC episodes were more frequently reported via EDE-Q than EMA, with differences reaching significance at 6 months post surgery only (p = 0.03).

CONCLUSIONS

Agreement between real-time and retrospective assessments of LOC eating varied by episode size and time elapsed in the year following surgery. These findings should be considered when designing assessment batteries for bariatric surgery-seeking adults and when extrapolating research findings across studies with diverging methods of real-time versus retrospective self-report assessment of LOC eating in adults undergoing bariatric surgery.

Severity of Binge Eating Behavior among Overweight College Students in Taiwan and Associated Factors

BACKGROUND

Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors.

METHODS

This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis.

RESULTS

The average BES score was 10.67 (SD = 6.66, 0-34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman's rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (r_s = -0.14-0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05-6.04 times those of male participants and those without such experiences (p < 0.05).

CONCLUSION

The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Eating to cope: Advancing our understanding of the effects of exposure to racial discrimination on maladaptive eating behaviors

OBJECTIVE

Racial discrimination is a stressor for young Black women that leads to poor health outcomes, including maladaptive eating. This study presents findings on racial discrimination and maladaptive eating behaviors (overeating, LOC eating) using ecological momentary assessment (EMA).

METHODS

Black emerging adult women (N = 27) with overweight or obesity participated in a 14-day EMA study examining exposure to racial discrimination, eating behaviors, and racial identity. Frequencies and chi-square tests were used to characterize the type of racial discrimination experienced and frequency of overeating. Mixed effect ordinal logistic regression models were used to assess the relation between racial discrimination and maladaptive eating. Moderation analysis was conducted by creating interaction terms for discrimination and racial identity variables.

RESULTS

81.5% of participants reported experiencing racial discrimination. Young Black women reporting exposure to racial discrimination were more likely to endorse higher levels of both overeating and LOC eating compared to times when discrimination was not experienced (p < .0001). Racial identity moderated the link between racial discrimination and maladaptive eating (overeating, LOC) such that reporting greater levels of private regard buffered the deleterious effect of racial discrimination. Higher levels of public regard exacerbated the association between racial discrimination and both overeating, and LOC. Higher centrality worsened the relation between racial discrimination and LOC.

CONCLUSION

Young Black women might use maladaptive eating to cope with exposure to racial discrimination, which underscores the importance of examining the link between racism and disordered eating, particularly among Black women submerged in a society that continuously exposes them to racial discrimination.

PUBLIC SIGNIFICANCE

Emerging adult Black women are exposed to racial discrimination daily. In theory, exposure to racial discrimination could contribute to overeating and loss of control eating in this population. Using ecological momentary assessment, to capture experiences and eating behaviors in the moment they occur, this project quantified the magnitude of racial discrimination and how it was associated with maladaptive eating behaviors. Further, it examined ways in which racial identity was linked to this association.

The roles of negative emotion intensity, negative emotion differentiation, and self-compassion in loss of control eating

OBJECTIVE

Negative affect intensity is robustly related to binge eating, but the relationship between negative emotion differentiation (i.e., the ability to differentiate negatively-valenced emotions) and binge eating is unclear. Further, little is known about factors that might reduce emotion intensity and/or enhance emotion differentiation, thereby reducing binge eating. Self-compassion is consistently linked to less binge eating, which may be due to decreased negative affect and/or an enhanced ability to differentiate emotions. The current study examined the roles of negative emotion intensity, negative emotion differentiation, and self-compassion in binge eating using ecological momentary assessment.

METHOD

Participants were 201 university students (52.2% female) who completed questionnaires assessing affect seven times a day, and engagement in loss of control (LOC) eating episodes at the end of each day, for 10 days. The average of sadness, fear, guilt, and hostility subscales represented negative emotion intensity; intraclass correlations across negative affect subscales defined negative emotion differentiation. Both daily (i.e., within-person) and trait (i.e., between-person) emotion variables were examined as predictors.

RESULTS

Between-person negative emotion intensity, but not negative emotion differentiation, significantly predicted LOC eating occurrence. Self-compassion had a significant effect on LOC eating frequency, and this relationship was partially mediated via negative emotion intensity, but not via negative emotion differentiation.

DISCUSSION

Lower levels of negative emotion intensity partially account for the relationship between greater self-compassion and less frequent LOC eating. These findings highlight the importance of cultivating self-compassion to down-regulate negative emotions and to reduce LOC eating.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that university students who approach their limitations compassionately experience fewer negative emotions in daily life and engage in less loss of control eating. Lower levels of negative affect partially explain this relationship between self-compassion and loss of control eating. These results highlight the importance of cultivating an understanding and a compassionate attitude toward oneself for reducing eating pathology.

The Role of Affective Instability in Loss of Control Eating in Youth with Overweight/Obesity Across Development: Findings from Two EMA Studies

Affective instability is common during adolescence, but at high levels it is associated with a variety of internalizing and externalizing disorders, including eating disorders. Although most models focus on affective intensity as a mechanism for explaining eating disorders in adults, affective instability may be more developmentally relevant at predicting eating behaviors in youth. Using ecological momentary assessment, this manuscript explored the association between loss of control over eating (LOC), a key component of dysregulated eating in youth, and affective instability in youth with overweight/obesity in two separate studies, one with youth in middle childhood and early adolescence (Study 1: ages eight to 13) and one in youth in early through middle adolescence (Study 2: ages 12-17). Overall, there was no association between affective instability and LOC in Study 1, but in Study 2, age moderated the association between positive affective instability and LOC, such that greater between-person positive affective instability (i.e., relative to peers) was associated with lower average LOC for youth earlier in adolescence and higher average LOC for those later in adolescence. Negative affective instability was also associated with LOC in Study 2, such that on days when youth reported less within-person negative affective instability (i.e., relative to their own average), they also reported greater average LOC. Findings across the two studies indicate that the association between affective instability and LOC may not emerge until adolescence, and when it does, both positive and negative affective instability may be important to consider.

Changes in the prevalence and sociodemographic correlates of eating disorder symptoms from 2013 to 2020 among a large national sample of U.S. young adults: A repeated cross-sectional study

OBJECTIVE

The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population.

METHOD

Participants included a large national sample of U.S. college students (N = 286,720) who completed the repeated cross-sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time-trends in participants' ED symptoms and past 12-month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics.

RESULTS

Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12-months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12-month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time.

DISCUSSION

These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities.

PUBLIC SIGNIFICANCE

Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non-linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time.

Mindful acceptance, not awareness, associated with lower food susceptibility

PURPOSE

Food susceptibility refers to an individual's thoughts, feelings, and motivations when highly palatable foods are available. Mindfulness, or the practice of paying attention, non-judgmentally, in the present moment, is a key element in acceptance-based programs, which have been shown to benefit those with high food susceptibility. This study examined the relationship between food susceptibility and (1) trait mindfulness and (2) mindfulness facets (i.e., awareness, acceptance) in daily life.

METHODS

Participants were 108 adults with overweight/obesity (45.56 ± 11.41 years old, 75.9% white, 72.2% female) enrolled in a weight loss trial (Clinical Trials.gov Identifier: NCT02786238). Food susceptibility was measured with the Power of Food Scale (PFS). Mindfulness was assessed using the Philadelphia Mindfulness Scale (PHMS) and its two subscales: PHMS-Awareness and PHMS-Acceptance. Two regressions examined the associations of (1) total PHMS on PFS, and (2) simultaneous PHMS subscales on PFS. Covariates were age, sex, race, and education.

RESULTS

Regression results revealed, after adjustment for covariates, that Total PHMS was significantly negatively associated with PFS scores (β = - 0.258, p = 0.001), but only one of the PHMS subscales, Acceptance, was significantly associated with PFS scores (β = - 0.328, p < 0.001). PHMS-Awareness was not related to PFS scores.

CONCLUSION

Greater levels of mindfulness were associated with lower food susceptibility in treatment-seeking adults with overweight/obesity. Mindful acceptance may be the driving factor in this relationship, suggesting that awareness alone is not sufficient for promoting healthier appetite regulation. Interventions aimed to reduce food susceptibility and improve coping with cravings may benefit from an enhanced focus on teaching mindful-acceptance skills.

LEVEL OF EVIDENCE

Level III, observational cohort study.

Pediatric weight management interventions improve prevalence of overeating behaviors

OBJECTIVE

To examine changes in prevalence of overeating behaviors in a comparative effectiveness study of two pediatric weight management interventions.

METHODS

Four-hundred and seven children, ages 6-12 years, with a BMI ≥ 85th percentile were enrolled in a comparative effectiveness trial of two pediatric weight management interventions. Prevalence of "sneaking, hiding or hoarding food", and 'eating in the absence of hunger' was evaluated at baseline and 12 months. Statistical methods included McNemar's test and longitudinal logistic regression.

RESULTS

Prevalence of "sneak, hide, or hoard food" significantly decreased in all participants from 29.1% to 20.7% at 12 months. The prevalence of "eating in the absence of hunger" decreased in all participants from 46.7% to 22.4% at 12 months. Use of SNAP benefits, free/reduced meals at school, parental stress, housing, and food insecurity at baseline were associated with an increased likelihood of endorsing overeating behaviors at 12 months. Conversely, those who engaged in at least one session of the pediatric weight management intervention were significantly less likely to endorse "eating in the absence of hunger" at 12 months.

CONCLUSIONS

Participation in pediatric weight management interventions improves the prevalence of overeating behaviors and is associated with participant engagement and social determinants of health, specifically food security status. Efforts to engage populations impacted by food insecurity and other social determinants of health risk factors will be critical for success of weight management interventions.

CLINICAL TRIAL REGISTRATION

This trial has been registered at ClinicalTrials.gov (identifier: NCT03012126).

Exploring Correlates of Loss of Control Eating in a Nonclinical Sample

Objective

Loss of control (LOC) eating has been directly related to the core aspects of the psychopathology of eating disorders and to different dimensions of emotion and behavior regulation and self-criticism. This study investigates a model representing the interplay between these dimensions to understand LOC eating among a nonclinical sample.

Methods

A total of 341 participants, recruited in a college campus (mean age 23.21, SD = 6.02), completed a set of self-report measures assessing LOC eating, weight suppression, psychopathology of eating disorders, depression, negative urgency, emotion regulation difficulties, and self-criticism. Path analysis modeling tested a hypothesized model with 3 paths for LOC eating as follows: (1) psychopathology of eating disorders; (2) emotion and behavior regulation; and (3) interplay between these paths.

Results

We found goodness-of-fit indexes to our data: χ2 = 17.11, df = 10, Comparative Fit Index (CFI) = 0.99, Tucker-Lewis index (TLI) = 0.98, Root Mean Square Error Approximation (RMSEA) = 0.045, Standardized Root Mean Square Residual (SRMR) = 0.041, suggesting that: (1) participants with higher weight suppression showed higher degrees of the psychopathology of eating disorders, which was linked to higher levels of LOC eating; (2) self-criticism was a mediator between emotion regulation and depression/negative urgency; (3) self-criticism was a mediator between emotion regulation and disorder eating, which was significantly associated with LOC eating via increased negative urgency.

Conclusion

Our model shows that LOC eating occurs for individuals with the psychopathology of higher eating disorders who experience depressive symptoms and act rashly under distress for their inability to cope adequately with negative feelings of self-devaluation. These findings point to the importance of negative self-evaluations and feelings of inadequacy or worthlessness to understand LOC eating among college students.

Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12-20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.

Cognitive function in binge eating disorder and food addiction: A systematic review and three-level meta-analysis

BACKGROUND

An extensive body of recent research has focused on the contribution of cognitive functioning to eating behaviors. In binge eating disorder (BED) and food addiction (FA), the extent of cognitive impairment is still unclear. This study aimed to characterize, among those with BED and FA, neurocognitive functions using performances based on neuropsychological tasks in the context of neutral stimuli in adults.

METHOD

MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and gray literature (ProQuest and OpenGrey) were used to identify studies that reported neurocognitive assessments in BED or FA up to December 2019. A three-level meta-analysis was conducted.

RESULTS

A significant overall effect was found for global cognitive impairments, suggesting that individuals with BED or FA have poorer performances when completing cognitive tasks. Analyses for specific cognitive domains revealed that individuals with BED showed poorer performances at tasks assessing cognitive flexibility, inhibitory control, attention and planning. Analyses regarding FA were inconclusive due to a lack of studies. Thus, the results were described qualitatively.

CONCLUSION

Our meta-analysis highlighted the cognitive weaknesses that seem to come with BED and the necessity to integrate them in the assessment and treatment of this condition. It also stressed the lack of quality studies surrounding the cognitive features of FA.

Lived experiences of subjective binge eating: An inductive thematic analysis

OBJECTIVE

Growing evidence suggests that subjective binge eating (SBE; loss of control eating involving subjectively, but not objectively, large quantities of food) is clinically concerning even though it is not currently considered a diagnostic criterion for eating disorders. However, the lived experience of SBEs has not been examined in a systematic, and data-driven way.

METHOD

The current study used a qualitative, inductive interview approach to further define SBEs as described by individuals who experience them. Participants (N = 14; 11 cisgender women, M_age  = 35.29, 12 White/non-Latinx) reported SBEs that occurred at least twice per week over the prior 3 months. We completed semi-structured qualitative phone interviews with participants regarding their most recent SBE and objective binge-eating episode (OBE) if applicable, as well as broader experiences and attitudes regarding non-binge eating.

RESULTS

Inductive, reflexive, thematic coding yielded descriptive and interpretive codes regarding SBEs. Main themes regarding SBE experience included: (a) SBEs Occur Across Contexts and Food Types, (b) SBEs Are Contrasts to General Over-Control, (c) SBEs Are Distress- and Disconnection-Inducing, Not Relieving, (d) SBEs Are Responses to Hunger and Restriction, and (e) SBEs Can Be "Echoes" of OBEs.

DISCUSSION

The current study explored the lived experiences of those who report SBEs and provides an important foundation for hypothesis generation for future research on and clinical interventions for SBEs.

Gut hormones, adipokines, and pro- and anti-inflammatory cytokines/markers in loss of control eating: A scoping review

Loss of control (LOC) eating is the defining feature of binge-eating disorder, and it has particular relevance for bariatric patients. The biomarkers of LOC eating are unclear; however, gut hormones (i.e., ghrelin, cholecystokinin [CCK], peptide YY [PYY], glucagon-like peptide 1 [GLP-1], and pancreatic polypeptide [PP]), adipokines (i.e., leptin, adiponectin), and pro- and anti-inflammatory cytokines/markers (e.g., high-sensitivity C-reactive protein [hsCRP]) are candidates due to their involvement in the psychophysiological mechanisms of LOC eating. This review aimed to synthesize research that has investigated these biomarkers with LOC eating. Because LOC eating is commonly examined within the context of binge-eating disorder, is sometimes used interchangeably with subclinical binge-eating, and is the latent construct underlying disinhibition, uncontrolled eating, and food addiction, these eating behaviors were included in the search. Only studies among individuals with overweight or obesity were included. Among the identified 31 studies, 2 studies directly examined LOC eating and 4 studies were conducted among bariatric patients. Most studies were case-control in design (n = 16) and comprised female-dominant (n = 13) or female-only (n = 13) samples. Studies generally excluded fasting total ghrelin, fasting CCK, fasting PYY, and fasting PP as correlates of the examined eating behaviors. However, there was evidence that the examined eating behaviors were associated with lower levels of fasting acyl ghrelin (the active form of ghrelin) and adiponectin, higher levels of leptin and hsCRP, and altered responses of postprandial ghrelin, CCK, and PYY. The use of GLP-1 analog was able to decrease binge-eating. In conclusion, this review identified potential biomarkers of LOC eating. Future studies would benefit from a direct focus on LOC eating (especially in the bariatric population), using longitudinal designs, exploring potential mediators and moderators, and increased inclusion of the male population.

Exploring the role of momentary positive and negative affect in overeating and binge eating: Evidence for different associations among men and women

Momentary positive and negative emotions have shown to affect eating behaviour. In this study, we used experience sampling method (ESM) to assess how momentary positive affect (PA) and negative affect (NA) relate to overeating (OE) and binge eating (BE) episodes among men and women compared to no OE/BE episodes. We additionally looked at how situational and social context moderate these relationships. For this purpose, 87 women and 94 men participated in the study where they were instructed to rate their levels of various positive and negative emotions, situational whereabouts, and the presence of OE/BE 7 times a day for 3 consecutive days. We found that men and women greatly differed in how momentary PA and NA relate to OE and BE. In women, NA was highest before BE, followed by OE compared to no OE/BE. Further, an interaction between the type of an eating episode and situational context demonstrated that this relationship was significant when at home, but not away from home. No differences in the momentary NA between the types of eating episodes were found in men. In men, PA was significantly higher before OE compared to BE and no OE/BE. Additionally, an interaction between the type of eating episode and situational context showed that this relationship was significant when at home, but not when away from home. Our results further confirm the role of negative affect in overeating and binge eating in women, whereas also suggesting that the role of positive affect in eating behaviour is warranted more research, particularly in men.

Grazing's frequency and associations with obesity, psychopathology, and loss of control eating in clinical and community contexts: A systematic review

The term grazing is generally described as the repetitive and nonplanned consumption of small amounts of food, not in response to hunger/satiety sensations. The present study aims to identify and critically review studies examining the frequency of grazing in both clinical and community samples, as well as, to investigate its relationship with eating disorder psychopathology, Loss of Control eating (LOC), psychological impairment, and weight-related variables. This systematic review followed the PRISMA recommendations for reporting systematic reviews and meta-analysis. A total of 138 articles were initially retrieved from the database search. In the end, 18 articles were considered for this systematic review. The results were separated in Grazing and Grazing-like behavior (picking and nibbling). Results of studies of grazing-like behaviors displays that, in these studies, the results are sometimes inconsistent and controversial. On the other hand, studies of Grazing behavior showed more consistent results. These results show that the use of different definitions across the literature makes it difficult to establish comparisons across studies. In this literature review, the studies selected used five different definitions of grazing and five different instruments to assess this eating behavior which reinforces the requirement for standardized definition and evaluation. More, the studies hereby revised suggested that LOC eating was considered in association with grazing, being significantly associated with higher levels of psychopathology and psychological impairment. In accordance, a growing body of research argues that LOC eating was a stronger predictor of eating disorder psychopathology than the amounts of food consumed. Furthermore, the results found by studies show an advance to literature with an accordance about LOC, supported by evidences in studies of this review.

Weight teasing experienced during adolescence and young adulthood: Cross-sectional and longitudinal associations with disordered eating behaviors in an ethnically/racially and socioeconomically diverse sample

OBJECTIVE

This study assessed cross-sectional and longitudinal relationships between weight teasing and disordered eating in an ethnically/racially and socioeconomically diverse sample of young people and examined these relationships across sociodemographic characteristics.

METHOD

The EAT 2010-2018 study surveyed adolescents (n = 1,534) in the Minneapolis/St. Paul public schools (mean age = 14.4 years) and 8 years later (mean age = 22.2 years).

RESULTS

Weight teasing was prevalent in adolescence (34.1%) and young adulthood (41.5%). In analyses adjusted for sociodemographic characteristics and body mass index, weight teasing was cross-sectionally associated with a higher prevalence of all disordered eating behaviors during both adolescence and young adulthood. For example, 64.5% of young adults who reported being teased about their weight engaged in unhealthy weight control behaviors, compared with 47.9% among those not teased (p < .001). There were fewer observed associations in longitudinal analyses, although weight teasing still predicted prevalent overeating and both prevalent and incident dieting (incident dieting-teased: 48.4% vs. not teased: 38.0%, p = .016). Weight teasing and disordered eating were more prevalent among Black, Indigenous, and People of Color (BIPOC) young people and those from low socioeconomic backgrounds, and the relationship between weight teasing and disordered eating was similar across ethnic/racial, socioeconomic, and gender demographic groups.

DISCUSSION

Results indicate that weight teasing is strongly correlated with disordered eating in both adolescence and young adulthood regardless of ethnicity/race, socioeconomic status, or gender. Finding suggest that future research and policy interventions should address weight stigma and prioritize the needs of BIPOC young people and young people from low socioeconomic backgrounds.

Pain, eating behavior, and weight outcomes in adolescent girls

OBJECTIVE

In adults, pain is prospectively associated with overweight/obesity and concurrently associated with dysregulated eating, with evidence for stronger associations in women than men. This study aimed to evaluate whether similar associations among pain response, BMI, and loss of control (LOC) eating are also evident in adolescent girls.

METHOD

Girls (n = 202) completed the cold pressor test (CPT) at age 10, and BMI and LOC eating were assessed annually from ages 10-16 years. Generalized linear models were used to test associations between pain tolerance (total immersion time) and threshold (latency to highest pain rating), and changes in BMI and LOC eating.

RESULTS

Lower pain tolerance and threshold at age 10 were associated with increases in LOC eating from age 10 to 16 (tolerance: B < -.01, SE < .01, p = .005; threshold: B = -.03, SE = .01, p = .0118). No significant associations were observed between pain tolerance/threshold and increasing BMI.

DISCUSSION

Pain responsivity in childhood is associated with increases in dysregulated eating from childhood to adolescence. These findings provide support for the early development of an interface between pain and eating behaviors.

Descriptives and baseline ecological momentary assessed predictors of weight change over the course of psychological treatments for binge eating disorder

OBJECTIVE

The objectives were to examine individual variability in weight change across psychological treatments for binge-eating disorder (BED) and to examine baseline predictors (i.e., BED symptoms, affect, and appetite) of weight change using ecological momentary assessment (EMA).

METHOD

Adults with BED (N = 110) enrolled in a randomized clinical trial in which they received one of two psychological treatments for BED. At baseline, participants completed a 7-day EMA protocol measuring BED symptoms, affect, and appetite. Height and weight were measured at baseline, mid-treatment, end-of-treatment, and follow-up, and body mass index (BMI) was calculated.

RESULTS

On average, participants evidenced a 2% increase in BMI at end-of-treatment and a 1% increase between end-of-treatment and 6-month follow-up assessments. Although results showed that BMI increased over time, the quadratic term reflected a deceleration in this effect. There were interactions between positive affect and the linear trajectory across time predicting BMI, indicating that individuals reporting higher positive affect at baseline evidenced a flatter trajectory of weight gain. There was a main effect of overeating as assessed by EMA and interactions between overeating and linear and quadratic trajectories across time predicting BMI. Individuals who reported greater overeating at baseline had higher BMI across time. However, the BMI of individuals with lower overeating increased linearly, and increases in BMI among those with average or high rates of overeating appeared to stabilize over time.

CONCLUSION

Despite the variability in weight change, baseline positive affect and overeating may be ecological targets for improving weight outcomes in psychological treatments for BED.

Documenting the course of loss of control over eating prior to, during and after pregnancy among women with pre-pregnancy overweight and obesity

OBJECTIVE

Loss of control over eating (LOC) is common among women, particularly those with overweight and obesity (OV/OB), and predicts weight gain. Given the importance of understanding weight and eating behaviors during pregnancy, we sought to characterize LOC across pregnancy and the postpartum period among women with pre-pregnancy OV/OB.

METHODS

Pregnant women (N = 257; 28.44 ± 5.48 years old) with self-reported OV/OB prior to pregnancy were interviewed using a pregnancy-adapted version of the Eating Disorder Examination (EDE-PV). Pre-pregnancy LOC was retrospectively assessed during the first trimester and then prospectively assessed monthly throughout pregnancy and postpartum over the course of seven assessments.

RESULTS

Rates of LOC were significantly higher during pregnancy compared to prior to ( χ12 =44.845, p < .01) and after ( χ12 =36.379, p < .01) pregnancy, with 37% (n = 95) of women reporting ≥1 LOC episode during pregnancy. LOC during pregnancy was associated with higher likelihood of LOC postpartum. Higher age (OR = 1.084, p = .04) and identifying as a minority (OR = 0.344, p = .02) was associated with greater likelihood of experiencing LOC during pregnancy only.

DISCUSSION

LOC during pregnancy is common among women with pre-pregnancy OV/OB, suggesting that screening and intervention for LOC during pregnancy may be warranted. Future research is necessary to examine the relationship between LOC during pregnancy and maternal and infant health outcomes.

Loss of Control Eating and Health Indicators Over 6 Years in Adolescents Undergoing Metabolic and Bariatric Surgery

OBJECTIVES

The aim of this study was to assess associations between loss of control (LOC) eating and health outcomes among adolescents undergoing metabolic and bariatric surgery.

METHODS

A total of 234 adolescents were studied before and up to 6 years after surgery in a prospective, observational cohort design. Adolescents provided self-reports of LOC eating, pain severity, sleep quality, polycystic ovary syndrome, gastroesophageal reflux disease, and medication usage and objective measures of fasting glucose, serum insulin, glycohemoglobin A1c , cholesterol, triglycerides, and blood pressure. χ2 tests, Wilcoxon rank sums, and generalized linear mixed models were used to assess concurrent and prospective associations between LOC eating and health indicators.

RESULTS

LOC eating presented in 32.5% of adolescents before surgery and was positively associated with sleep disturbances and psychiatric medication usage. After surgery, LOC eating presented in 7.9% to 14.6% of participants and was correlated with improved low- and high-density lipoprotein cholesterol levels and greater back pain. LOC eating was inversely associated with low-density lipoprotein cholesterol at the next consecutive time point.

CONCLUSIONS

LOC eating was unexpectedly associated with improved low- and high-density lipoprotein cholesterol in adolescents undergoing metabolic and bariatric surgery. Deleterious effects of LOC eating on obesity-related health conditions, aside from back pain, were not detected. Metabolic and other weight-independent health benefits of surgery may persist postoperatively despite LOC eating and associated weight regain.

Using association rules mining to characterize loss of control eating in childhood

Childhood loss of control (LOC)-eating, the perceived inability to stop or control eating, is associated with increased risk for binge-eating disorder and obesity. However, the correlates of LOC-eating in childhood remain unclear. A secondary analysis of 177, 7-12-year-old children from five laboratory feeding studies was performed to investigate potential family (e.g., frequency of meals together, feeding practices), parental (e.g., education, weight status), and child (e.g., weight status, appetite traits) correlates of LOC-eating. Association rules mining (ARM¹), a data-driven approach, was used to examine all characteristics that were common across studies to identify which were associated with LOC-eating. Results showed LOC-eating was characterized by a combination of child appetitive behaviors and parental feeding practices. In particular, LOC-eating was associated with low parental pressure to eat in combination with a high propensity to want to eat all the time and frequent refusal or dislike of novel foods. This pattern of both food approach (i.e., wanting to eat all the time) and avoidant behaviors (i.e., food fussiness) highlights the need for more research to characterize the complex patterns of appetitive traits associated with LOC-eating. In contrast, the absence of LOC-eating was associated with a low propensity to want to eat all the time, greater family income, and infrequent emotional overeating. Therefore, propensity to want to eat all the time, a single question from the Children's Eating Behavior Questionnaire, characterized both the presence and absence of LOC-eating, highlighting the need for more research to determine if this question captures clinically relevant individual differences. Future studies addressing these questions will advance our understanding of pediatric LOC-eating and may lead to interventions to reduce risk for more severe eating disorder symptomology.

Binge Eating After Bariatric Surgery in Patients Assisted by the Reference Service in a Brazilian Hospital and the Correlation with Weight Loss

PURPOSE

Identify, 18 months after bariatric surgery, the binge eating variation and its relation with weight regain or loss.

MATERIALS AND METHODS

Cross-sectional, retrospective study with 108 patients, assisted by an obesity walk-in clinic of a specialized hospital in São Paulo (Brazil), who had undergone bariatric surgery a minimum of 18 months previously. The anthropometric and clinic data were collected from medical records, and binge eating symptoms were evaluated with the application of the Binge Eating Scale (BES). Scale outcomes were related to weight regain and loss at the application moment.

RESULTS

The average age (standard error) of the sample was 47 years (±0.91) and 93% were female. Patients had lost 52.2% of their body weight and regained 4.7% of their weight 18 months after the surgery. The elapsed surgical time (> 50 months) was associated with a higher gross weight (p<0.0001).

CONCLUSIONS

Bariatric surgery has been shown to be effective for improving diabetes mellitus as well as for controlling obesity. The variation in binge eating intensity 18 months after bariatric surgery is a factor that interferes in the amount of weight regained. The presence of binge eating symptoms negatively affects the % total weight loss (%TWL).

Gender identity, race/ethnicity and eating pathology in a treatment-seeking community sample

Despite the wide-reaching impact of eating disorders (EDs), less is known about eating pathology among individuals across racial/ethnic groups whose gender identity differs from the binary categorization. Examining ED pathology both across binary and minority-gender groups, and relative to racial/ethnic identification is necessary to inform screening and culturally-sensitive intervention efforts. This study investigated patterns of ED symptomology among youth and adults (N = 13658) who telephoned treatment centers in the United States when seeking clinical support for ED symptoms. Analyses examined data from participants who completed a semi-structured clinical interview. Results indicated that Anorexia nervosa was the most common diagnosis in each gender category and for a majority of race/ethnic groups; Black individuals had elevated rates of binge eating disorder. Compared to females, males were less likely to endorse all ED symptoms (ps < .001); gender minority status was also associated with decreased report of a majority of ED symptoms. Asian and Black individuals were less likely than Whites to endorse most ED symptoms. When compared to Whites, Hispanic/Latinx and Bi/Multi-racial participants did not demonstrate significant differences in presentation across a majority of ED symptoms. Overall findings suggest individuals with female gender and White race may seek treatment from an ED treatment facility with greater frequency than other demographic groups. Noted exceptions include Hispanic/Latinx and Bi/Multi-racial individuals, for whom ED pathology may be represented comparably to Whites. While findings confirm traditional patterns in gender and racial/ethnic representation in EDs, current study findings also underscore that EDs are not culture bound.

A systematic review of neural correlates of dysregulated eating associated with obesity risk in youth

Dysregulated eating among children and adolescents is associated with a wide range of negative mental and physical health outcomes, including obesity. However, less is known regarding underlying neural mechanisms underlying such behaviors. Therefore, the present manuscript systematically reviewed neuroimaging research examining dysregulated eating behavior linked to excess weight in children and adolescents. A systematic literature search identified 23 eligible studies, the majority of which were cross-sectional functional magnetic resonance imaging (fMRI) studies and excluded participants with psychiatric disorders. Dysregulated eating was captured by measures of eating styles and eating self-regulation, eating disorder behaviors, food addiction, objective measures of non-homeostatic eating and caloric restriction. While preliminary, findings suggested eating dysregulation was related to aberrant functioning within the frontostriatal and frontoparietal regions involved in self-regulatory processes, as well as regions involved in satiety signaling and interoception. This heterogeneous body of research is continually growing and may have potential to inform future prevention and intervention approaches. Results also identified several important limitations to consider and highlight key areas for future research.

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

BACKGROUND

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

OBJECTIVES

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

SETTING

Multicenter study, United States.

METHODS

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

RESULTS

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

CONCLUSION

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

Problematic eating behaviors in patients undergoing bariatric surgery: Studying their relationship with psychopathology

This study explored the associations between individuals presenting different problematic eating behaviors (Objective/Subjective binge-eating-OBE/SBE-and Compulsive/Non-compulsive grazing-C_Grazing/NC_Grazing) and eating disorder related symptoms. About 163 pre- and 131 post-bariatric patients were assessed. Assessment included: Face-to-face clinical interview to assess binge-eating and grazing episodes, and self-report measures to assess eating disorder symptomatology, psychological distress, and negative urgency. OBE and NC_Grazing were the problematic eating behaviors most and least associated with psychopathology, respectively. OBE and C_Grazing uniquely accounted for the significant variance in the most disordered eating variables. Our findings emphasize the need for the conceptualization of grazing behavior in the spectrum of disordered eating.

Examination of momentary maintenance factors and eating disorder behaviors and cognitions using ecological momentary assessment

The integrative cognitive-affective therapy (ICAT) momentary maintenance model proposes a number of situational factors that precipitate eating disorder (ED) behaviors and cognitions. The current study examines momentary situational triggers in relation to a broad range of ED symptoms in a diagnostically heterogeneous sample of individuals with ED psychopathology. In the current study, 30 women with binge eating pathology completed a 14-day ecological momentary assessment (EMA) protocol during which they responded to five random signals throughout the day. During signaled assessments, participants completed measures of self-criticism, interpersonal problems, self-regulation of binge eating, appearance concerns, and cognitive and behavioral ED symptoms. Multilevel models were used to examine prospective associations between hypothesized ICAT maintenance factors and ED symptoms. Within-subjects self-criticism prospectively predicted vomiting, restriction, preoccupation with thoughts of food, and urges to eat. Within-subjects interpersonal problems prospectively predicted vomiting, and within-subjects appearance concerns prospectively predicted preoccupation with thoughts of food. There were no significant predictors of binge eating. These results provide some support for hypothesized momentary situational triggers of ED symptoms in the momentary maintenance model of ICAT using naturalistic, momentary assessment. Specifically, it may be particularly useful for interventions such as ICAT to address momentary self-criticism when targeting a range of ED symptoms.

Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.