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Sundbom M, Järvholm K, Sjögren L, Nowicka P, Lagerros YT. Obesity treatment in adolescents and adults in the era of personalized medicine. J Intern Med 2024; 296:139-155. [PMID: 39007440 DOI: 10.1111/joim.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has "tried everything"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.
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Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, University Hospital, Uppsala, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Lovisa Sjögren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine (Solna), Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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2
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Tsompanaki E, Aveyard P, Park RJ, Koutoukidis DA. The impact of low-energy total diet replacement with behavioural support for remission of type 2 diabetes on disordered eating (ARIADNE): Protocol for a non-inferiority randomised controlled trial. Contemp Clin Trials 2024; 142:107542. [PMID: 38685400 DOI: 10.1016/j.cct.2024.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The National Health Service (NHS) in England is currently piloting a weight loss programme for remission of newly diagnosed type 2 diabetes (T2D), where participants replace all food with low-energy nutritionally complete formula products for 12 weeks (total diet replacement, TDR) and receive behavioural support. In a clinical trial, this programme led to remission in nearly half the participants. However, this weight loss programme might also worsen disordered eating and prompt eating disorders in susceptible people. We aim to investigate if the TDR programme is non-inferior to standard care in terms of disordered eating in susceptible individuals. METHODS Fifty six people with newly diagnosed T2D, BMI ≥ 27 kg/m2, and medium to high scores of disordered eating based on the Eating Disorders Examination questionnaire (EDE-Q) will be randomised 1:1 to TDR receiving remote weekly/bi-weekly dietetic support or standard care. Participants will be re-assessed remotely at 1, 3, 4, 6, and 12 months. The primary outcome will be the between-group difference in the score of the EDE-Q. If the sample size can be expanded to 150, we will reduce the non-inferiority boundary. Weight, glycated haemoglobin (HbA1c), impairment from disordered eating, and distress will be secondary outcomes. Using the recorded consultations, we will evaluate the process in observed changes in eating behaviour and disordered eating. CONCLUSIONS If TDR for T2D remission is deemed non-inferior to standard care, more people may enrol and benefit from T2D remission. If TDR exacerbates disordered eating, screening may reduce unintended harm. TRIAL REGISTRATION NCT05744232 (ClinicalTrials.gov, prospectively registered).
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Affiliation(s)
- E Tsompanaki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R J Park
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - D A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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3
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Irish LA, Bottera AR, Manasse SM, Christensen Pacella KA, Schaefer LM. The Integration of Sleep Research Into Eating Disorders Research: Recommendations and Best Practices. Int J Eat Disord 2024. [PMID: 38937938 DOI: 10.1002/eat.24241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/01/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Sleep disturbance is common among individuals with eating disorders (EDs), with approximately 50% of patients with EDs reporting sleep disturbance. Sleep problems may promote, exacerbate, or maintain ED symptoms through a variety of hypothesized mechanisms, such as impaired executive function, increased negative affect, and disruptions to appetitive rhythms. Although research investigating the role of sleep in EDs is growing, the current literature suffers from methodological limitations and inconsistencies, which reduce our ability to translate findings to improve clinical practice. The purpose of this forum is to propose a coordinated approach to more seamlessly integrate sleep research into ED research with particular emphasis on best practices in the definition and assessment of sleep characteristics. METHODS In this article, we will describe the current status of sleep-related research and relevant gaps within ED research practices, define key sleep characteristics, and review common assessment strategies for these sleep characteristics. Throughout the forum, we also discuss study design considerations and recommendations for future research aiming to integrate sleep research into ED research. RESULTS/DISCUSSION Given the potential role of sleep in ED maintenance and treatment, it is important to build upon preliminary findings using a rigorous and systematic approach. Moving forward as a field necessitates a common lens through which future research on sleep and EDs may be conducted, communicated, and evaluated.
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Affiliation(s)
- Leah A Irish
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota, USA
| | | | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychological Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Lauren M Schaefer
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota, USA
- Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
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Sjunnestrand M, Neuman N, Järvholm K, Ek A, Nordin K, Salas XR, Eli K, Nowicka P. "A balancing act": parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment. BMC Public Health 2024; 24:1695. [PMID: 38918803 PMCID: PMC11202376 DOI: 10.1186/s12889-024-19195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.
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Affiliation(s)
- My Sjunnestrand
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Nicklas Neuman
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | | | - Anna Ek
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karin Nordin
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ximena Ramos Salas
- European Association for the Study of Obesity, United Kingdom and Bias 180, Ottawa, Canada
| | - Karin Eli
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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5
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Smith KE, Goldschmidt AB. Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research. Curr Obes Rep 2024; 13:195-202. [PMID: 38363468 PMCID: PMC11150297 DOI: 10.1007/s13679-024-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions. RECENT FINDINGS Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.
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Affiliation(s)
- Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA, 90033, USA.
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Clarke ED, Stanford J, Gomez-Martin M, Collins CE. Revisiting the impact of Health at Every Size® interventions on health and cardiometabolic related outcomes: An updated systematic review with meta-analysis. Nutr Diet 2024; 81:261-282. [PMID: 38563692 DOI: 10.1111/1747-0080.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024]
Abstract
AIMS To (1) synthesise evidence from Health at Every Size® interventions on physical and psychological health in people with overweight and obesity and (2) report between-group differences within interventions evaluating the impact of Health at Every Size® interventions on health and health-related outcomes. METHODS Six databases (Medline, Embase, Cochrane, PsychInfo, CINAHL, and Scopus) were searched from inception until November 2022. Included studies were conducted in adults with overweight or obesity, used Health at Every Size®-based interventions compared with control interventions and reported dietary, physical and/or psychological outcomes, including diet quality, anthropometry, or quality of life. Data on between-group differences were extracted. Risk of bias was assessed using ROB2. Random-effects meta-analyses were undertaken for outcomes with at least three studies reporting the same or comparable data. RESULTS From 128 studies identified, 19 full-text articles (10 unique studies, 6 published since 2017), were included. Meta-analysis found a significant reduction for susceptibility to hunger in Health at Every Size® intervention groups relative to controls (p = 0.005), with no significant difference (p > 0.05) between Health at Every Size® interventions and control groups for anthropometric, psychological or cardiometabolic outcomes (total cholesterol, HDL cholesterol, triglycerides, systolic or diastolic blood pressure). CONCLUSION Health at Every Size® interventions had similar results compared with weight-based interventions on anthropometric outcomes and cardiometabolic outcomes. Health at Every Size® interventions had a significant benefit for reducing susceptibility to hunger. The decision to use a Health at Every Size®-based intervention should be personalised to individual needs. Further research in more diverse populations is required using standardised outcome measures to facilitate future meta-analyses.
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Affiliation(s)
- Erin D Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jordan Stanford
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Maria Gomez-Martin
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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7
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Brewerton TD, Dennis K, Wiss DA. Dismantling the myth of "all foods fit" in eating disorder treatment. J Eat Disord 2024; 12:60. [PMID: 38760858 PMCID: PMC11102136 DOI: 10.1186/s40337-024-01017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Kim Dennis
- SunCloud Health, Chicago, IL, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
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Skinner JA, Leary M, Whatnall M, Collins RA, Pursey KM, Verdejo-Garcia A, Hay PJ, Baker AL, Hides L, Paxton SJ, Wood LG, Colyvas K, Collins CE, Burrows TL. A three-arm randomised controlled trial of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program). Appetite 2024; 195:107211. [PMID: 38215944 DOI: 10.1016/j.appet.2024.107211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
There is a substantial research base for addictive eating with development of interventions. The current 3-arm RCT aimed to investigate the efficacy of the TRACE (Targeted Research for Addictive and Compulsive Eating) program to decrease addictive eating symptoms and improve mental health. Participants (18-85 yrs) endorsing ≥3 addictive eating symptoms were randomly allocated to 1) active intervention, 2) passive intervention, or 3) control group. Primary outcome was change in addictive eating symptoms 3-months post-baseline measured by the Yale Food Addiction Scale. Depression, anxiety and stress were also assessed. A total of 175 individuals were randomised. Using Linear Mixed Models, from baseline to 3-months, there was significant improvement in symptom scores in all groups with mean decrease of 4.7 (95% CI: -5.8, -3.6; p < 0.001), 3.8 (95% CI: -5.2, -2.4; p < 0.001) and 1.5 (95% CI: -2.6, -0.4; p = 0.01) respectively. Compared with the control group, participants in the active intervention were five times more likely to achieve a clinically significant change in symptom scores. There was a significant reduction in depression scores in the active and passive intervention groups, but not control group [-2.9 (95% CI: -4.5, -1.3); -2.3 (95% CI: -4.3, -0.3); 0.5 (95% CI: -1.1, 2.1), respectively]; a significant reduction in stress scores within the active group, but not passive intervention or control groups [-1.3 (95% CI: -2.2, -0.5); -1.0 (95% CI: -2.1, 0.1); 0.4 (95% CI: -0.5, 1.2), respectively]; and the reduction in anxiety scores over time was similar for all groups. A dietitian-led telehealth intervention for addictive eating in adults was more effective than a passive or control condition in reducing addictive eating scores from baseline to 6 months. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12621001079831.
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Affiliation(s)
- Janelle A Skinner
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Mark Leary
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Rebecca A Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Kirrilly M Pursey
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, 3800, Australia
| | - Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2751, Australia; Mental Health Services, South Western Sydney Local Health District, Camden and Campbelltown Hospitals, NSW, 2560, Australia
| | - Amanda L Baker
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Leanne Hides
- School of Psychology, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Susan J Paxton
- Department of Psychology and Counselling, Latrobe University, Melbourne, VIC, 3086, Australia
| | - Lisa G Wood
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia; School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kim Colyvas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Tracy L Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia.
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Herb Neff KM, Buta E, Fenn LM, Ramsey CN, Snow JL, Haskell SG, Masheb RM. Distinguishing probable atypical anorexia nervosa from weight loss alone in a national sample of U.S. Military Veterans: Disentangling the roles of weight suppression and cognitive concerns. Int J Eat Disord 2024; 57:827-838. [PMID: 38129986 DOI: 10.1002/eat.24116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Veterans are at high risk for eating disorders (EDs), and specifically for atypical anorexia nervosa (atypical AN). The current study aimed to better understand this under-studied disorder and how it differs from weight loss without ED cognitive features. METHOD Secondary analyses were conducted with data from a national study of Veterans (N = 882, 49.4% women). Participants were categorized into four mutually exclusive groups using the Eating Disorder Diagnostic Scale 5: probable atypical AN, a cognitive concerns group (Cog Only), a weight suppressed group (WS Only), and a no ED control group. Adjusted regression models were used to compare groups on measures of eating pathology and mental health. Three weight suppression thresholds (5%, 10%, and 15%) for probable atypical AN were also tested. RESULTS The sample was comprised of 12% probable atypical AN, 23.6% Cog Only, 16.3% WS Only, and 48.1% Control. The probable atypical AN group was most like the Cog Only group except for higher levels of dietary restraint. Atypical AN fared worse and was least like the Control group followed by the WS Only group. All weight suppression thresholds significantly predicted dietary restraint, with 5% being the best predictor. DISCUSSION Results found that probable atypical AN is a distinct clinical entity and that the exact weight suppression threshold associated with atypical AN is less important than having any weight suppression. Findings highlight the clinical significance of atypical AN and the importance of gaining a better understanding of how to address this clinical entity. PUBLIC SIGNIFICANCE Atypical anorexia nervosa is a relatively underexamined but highly prevalent eating disorder in the Veteran population. Results show that ED cognitive features are more closely linked to clinically significant eating pathology and poor mental health than weight suppression alone suggesting that negative thinking about weight gain and appearance, regardless of the presence or severity of weight loss, may signal the need for specialized intervention.
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Affiliation(s)
| | - Eugenia Buta
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Lindsay M Fenn
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Christine N Ramsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
- University of Texas at Austin, Austin, Texas, USA
| | - Jennifer L Snow
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
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Raynor HA, Morgan-Bathke M, Baxter SD, Halliday T, Lynch A, Malik N, Garay JL, Rozga M. Position of the Academy of Nutrition and Dietetics: Medical Nutrition Therapy Behavioral Interventions Provided by Dietitians for Adults With Overweight or Obesity, 2024. J Acad Nutr Diet 2024; 124:408-415. [PMID: 38040115 DOI: 10.1016/j.jand.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031.
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Affiliation(s)
- Hollie A Raynor
- College of Education, Health, and Human Sciences, University of Tennessee Knoxville, Knoxville, Tennessee
| | - Maria Morgan-Bathke
- Department of Nutrition and Dietetics, Viterbo University, La Crosse, Wisconsin
| | | | - Tanya Halliday
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah
| | - Amanda Lynch
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan
| | - Neal Malik
- Department of Health Science and Human Ecology, California State University, San Bernardino, San Bernardino, California
| | - Jessica L Garay
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, New York
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Chicago, Illinois.
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11
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Brodosi L, Stecchi M, Marchignoli F, Lucia E, Magnani L, Guarneri V, Petroni ML, Marchesini G, Pironi L. Risk of binge eating disorder in patients with metabolic dysfunction-associated steatotic liver disease. Eat Weight Disord 2023; 28:100. [PMID: 38055131 DOI: 10.1007/s40519-023-01628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE Very few data exist on the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and eating disorders. The study aimed to evaluate the presence of binge eating disorder (BED), in MASLD subjects. METHODS Demographic, clinical investigation, anthropometric measurements and laboratory were collected in 129 patients with MASLD (34.1% males; age, 53.7 years; BMI, 34.4 kg/m2) addressed by general practitioners to a hospital-based unit of metabolic disorders. The risk of binge eating was tested by the binge eating scale (BES); values in the range 17-26 were considered "possible" BED, values > 26 were considered "probable" BED. Hepatic steatosis and fibrosis were tested by surrogate biomarkers and imaging (transient elastography). Calorie intake and lifestyle were self-assessed by questionnaires. RESULTS Possible BED was present in 17.8% of cases, probable BED in another 7.6%, and were neither associated with gender, obesity class, diabetes, features of metabolic syndrome, nor with presence and severity of hepatic steatosis and fibrosis. Also steatosis grade by CAP and fibrosis stage by liver stiffness did not correlate with BES. However, an association was present between the daily caloric intake and "possible" BED (odds ratio, 1.14; 95% confidence interval, 1.05-1.24; "probable" BED, 1.21; 1.07-1.37), after adjustment for confounders. CONCLUSION Binge eating, as scored by BES, is present in a significant proportion of MASLD cases screened for metabolic disorders in a specialized center. It may impact behavioral treatment, reducing the chance of weight loss without systematic psychological support. LEVEL OF EVIDENCE Level III, cohort analytic study.
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Affiliation(s)
- Lucia Brodosi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
- Clinical Nutrition and Metabolism Unit, IRCCS-Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Michele Stecchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Marchignoli
- Clinical Nutrition and Metabolism Unit, IRCCS-Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Elisabetta Lucia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Lucia Magnani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valeria Guarneri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Letizia Petroni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Clinical Nutrition and Metabolism Unit, IRCCS-Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Clinical Nutrition and Metabolism Unit, IRCCS-Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
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Hagerman CJ, Ehmann MM, Taylor LC, Forman EM. The role of self-compassion and its individual components in adaptive responses to dietary lapses. Appetite 2023; 190:107009. [PMID: 37619622 PMCID: PMC10543633 DOI: 10.1016/j.appet.2023.107009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
Dietary lapses (i.e., instances of dietary non-adherence) are common during weight loss attempts, and compromise success in two ways: increasing caloric intake and demoralizing the participant, sometimes leading them to abandon their weight control goals altogether. Efforts to understand and prevent demoralization have received almost no research attention. Self-compassion has high potential to promote adaptive responses to these setbacks because it reframes "failure" and promotes self-improvement. Past research shows that when participants experience a lapse, those practicing higher self-compassion report higher self-efficacy and intentions to continue dieting. The current study extended this literature to examine whether self-compassion in response to a lapse would predict lower likelihood of a subsequent same-day lapse and greater reports of perceived control over weight management behaviors. We also examined whether the individual facets of self-compassion, including self-kindness (treating oneself the way one would a friend); common humanity (the understanding that everyone has struggles); and mindfulness (non-judgmental awareness of thoughts and feelings) are associated with these outcomes. Participants (N = 140) enrolled in a behavioral weight loss trial completed 6 ecological momentary assessment (EMA) surveys a day for seven days. Total self-compassion and each facet of self-compassion individually were all associated with less negative affect after a lapse. None of the self-compassion variables predicted the likelihood of participants reporting a lapse again that day. However, higher total self-compassion and higher self-kindness after a lapse were both associated with greater perceived self-control over weight management behaviors in the hours following. Common humanity and mindfulness, respectively, were not associated with reports of perceived control. Results suggest that self-compassion following dieting setbacks may prevent goal disengagement, and that self-kindness is the facet most strongly associated with adaptive responses to these setbacks.
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Affiliation(s)
- Charlotte J Hagerman
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Marny M Ehmann
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Lauren C Taylor
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Evan M Forman
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
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13
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Grilo CM, Lydecker JA, Jastreboff AM, Pittman B, McKee SA. Naltrexone/bupropion for binge-eating disorder: A randomized, double-blind, placebo-controlled trial. Obesity (Silver Spring) 2023; 31:2762-2773. [PMID: 37751990 PMCID: PMC10600891 DOI: 10.1002/oby.23898] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Binge-eating disorder (BED) is a prevalent psychiatric disorder associated with obesity. Few evidence-based treatments exist for BED, particularly pharmacological options. This study tested the efficacy of naltrexone/bupropion for BED. METHODS A randomized, double-blind, placebo-controlled, 12-week trial tested naltrexone/bupropion for BED with and without obesity. Eighty-nine patients (70.8% women, 69.7% White, mean age 45.7 y, mean BMI 35.1 kg/m2 , 77.5% with BMI ≥ 30 kg/m2 ) were randomized to placebo (n = 46) or naltrexone/bupropion (n = 43), with randomization stratified by obesity status and gender; 92.1% completed post-treatment assessments. RESULTS Mixed models of binge-eating frequency revealed significant reductions that did not differ significantly between naltrexone/bupropion and placebo. Logistic regression of binge-eating remission rates revealed that naltrexone/bupropion and placebo did not differ significantly. Obesity status did not predict, or moderate, binge-eating outcomes considered either continuously or categorically. Mixed models revealed that naltrexone/bupropion was associated with significantly greater percentage weight loss than placebo. Logistic regression revealed that naltrexone/bupropion had significantly higher rates of attaining ≥5% weight loss than placebo (27.9% vs. 6.5%). Obesity status did not predict or moderate weight-loss outcomes. CONCLUSIONS Naltrexone/bupropion did not demonstrate effectiveness for reducing binge eating relative to placebo but showed effectiveness for weight reduction in patients with BED. Obesity status did not predict or moderate medication outcomes.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janet A Lydecker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ania M Jastreboff
- Department of Medicine (Endocrinology and Metabolism), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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14
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Lobo I, da Luz FQ, Hay P, Gaeta TL, Teixeira PC, Cordás TA, Sainsbury A, Salis Z. Is binge eating associated with poor weight loss outcomes in people with a high body weight? A systematic review with meta-analyses. Eat Weight Disord 2023; 28:89. [PMID: 37889364 PMCID: PMC10611631 DOI: 10.1007/s40519-023-01613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES This systematic review aimed to compare the weight change in people with or without binge eating who underwent various weight loss treatments. METHODS We searched for studies in PubMed, American Psychological Association, and Embase from inception to January 2022. The studies selected included assessment of binge eating and body weight before and after weight loss treatment in people of any age. The meta-analyses were conducted using Comprehensive Meta-Analysis (CMA). We used Egger's regression test, the funnel plot, and the Trim and Fill test to assess the risk of publication bias. RESULTS Thirty-four studies were included in the systematic review, with a total of 10.184 participants. The included studies were divided into three categories according to types of weight loss treatments, namely, (1) bariatric surgery; (2) pharmacotherapy isolated or combined with behavioral interventions; and (3) behavioral and/or nutritional interventions. The meta-analyses showed no significant difference in weight loss between people with or without binge eating engaged in weight loss treatments, with an overall effect size of - 0.117 (95% CI - 0.405 to 0.171; P = 0.426). CONCLUSIONS Our findings showed no difference in weight loss in people with or without pre-treatment binge eating who received various weight loss treatments. Weight loss treatments should not be withheld on the basis that they will not be effective in people with pre-treatment binge eating, albeit their safety and longer term impacts are unclear. LEVEL OF EVIDENCE Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.
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Affiliation(s)
- Isabella Lobo
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Felipe Q da Luz
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Tamiris L Gaeta
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Paula Costa Teixeira
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Táki Athanássios Cordás
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Zubeyir Salis
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia.
- Faculty of Medicine, School of Public Health, Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia.
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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15
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Grilo CM, Juarascio A. Binge-Eating Disorder Interventions: Review, Current Status, and Implications. Curr Obes Rep 2023; 12:406-416. [PMID: 37439970 PMCID: PMC10528223 DOI: 10.1007/s13679-023-00517-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW Binge-eating disorder (BED) is a serious psychiatric problem associated with substantial morbidity that, unfortunately, frequently goes unrecognized and untreated. This review summarizes the current status of behavioral, psychological, pharmacological, and combined treatments for BED in adults with a particular focus on recent findings and advances. RECENT FINDINGS Certain specific psychological treatments, notably CBT and IPT, and to some extent DBT, have demonstrated efficacy and are associated with durable benefits after treatment. Certain specific lower-cost scalable interventions, notably CBTgsh, have demonstrated efficacy and have potential for broader uptake. An important advance is the emerging RCT data indicating that BWL, a generalist and available behavioral lifestyle intervention, has effectiveness that approximates that of CBT for reducing binge eating and eating-disorder psychopathology but with the advantage of also producing modest weight loss. There exists only one pharmacological agent (LDX) with approval by the FDA for "moderate-to-severe" BED. Research with other "off label" medications has yielded modest and mixed outcomes with a few medications statistically superior to placebo over the short-term and almost no longer-term data. Nearly all research combining medications and psychological treatments has failed to enhance outcomes (combined appears superior to pharmacotherapy-only but not to psychotherapy-only). Many people with BED suffer in silence and shame, go untreated, and rarely receive evidence-based treatments. Patients and practitioners need to recognize that research has identified several effective interventions for BED, and these can work quickly for many patients. Future research should identify treatments for those who do not derive benefit from initial interventions, identify additional pharmacological options, test agents with relevant mechanisms of action, and utilize innovative adaptative "SMART" designs to identify treatments to enhance outcomes among initial responders and to test alternative treatments to assist initial non-responders.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Yale Program for Obesity Weight and Eating Research (POWER), New Haven, CT, USA.
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
- Drexel University Center for Weight, Eating and Lifestyle Science (WELL), Philadelphia, PA, USA
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16
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Forney KJ, Rogers ML, Grillot CL, Pucci G, Joiner TE, Keel PK. Testing replicability of the relationship between weight suppression and binge eating in three non-clinical samples varying in lifetime weight history. Eat Behav 2023; 50:101784. [PMID: 37515999 DOI: 10.1016/j.eatbeh.2023.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Increased weight suppression, the difference between an individual's highest and current weight at present height, predicts binge eating among eating disorder samples. Less is known about this relationship in non-clinical samples of individuals with a history of higher weight. METHODS Lifetime highest BMI was tested as a moderator of the relationship between weight suppression and binge eating in three independent samples (N = 1740). RESULTS At the bivariate level, weight suppression was not associated with binge eating in any sample (p's ≥ 0.20). Lifetime highest BMI moderated the relationship between weight suppression and binge eating in Sample 1 (p = .04), such that greater weight suppression was associated with lower binge eating among those with a history of higher weight (i.e., BMI = 40 kg/m2). In Samples 2 and 3, the lifetime highest BMI by weight suppression interaction term was not significant and dropped from the model (p's = 0.10-0.12). Accounting for age, gender, and lifetime highest BMI, greater weight suppression was associated with lower binge eating scores (p's < 0.04). A meta-analysis combining results revealed a small but significant interaction effect (r = 0.07, p = .02). CONCLUSIONS Findings highlight the importance of investigating the generalizability of eating disorder risk and maintenance theories across the weight spectrum. Weight loss may not increase risk for binge eating among those with a history of higher weight. Future work should replicate and extend this finding using longitudinal designs. More research is needed to elucidate which weight loss motivations and/or behaviors are most closely linked to binge eating.
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Affiliation(s)
- K Jean Forney
- Department of Psychology, Ohio University, Athens, OH, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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