Associations between Posttraumatic Stress Disorder and Diabetes in Vietnam-Era Women Veterans in the HealthViEWS Study

Background: Posttraumatic stress disorder (PTSD) is associated with incident diabetes. However, past studies have often included predominantly male samples, despite important sex and gender differences in diabetes. To address this limitation, this study examined the association between PTSD and diabetes in older Veteran women, a population with a high burden of PTSD. Materials and Methods: Data were collected from 4,105 women (Mage = 67.4 years), participating in the Health of Vietnam-Era Veteran Women's Study (HealthViEWS; Department of Veterans Affairs Cooperative Studies Program #579). Participants completed self-report measures of demographics, health conditions, and health behaviors. Information on military service was obtained through service records. A structured clinical interview was conducted by telephone to assess current and lifetime PTSD and other mental health disorders. Weighted descriptive and logistic regression analyses were used to examine associations between PTSD and diabetes. Results: The prevalence of diabetes was 28.4% among women with current full PTSD compared to 23.4%, 17.6%, and 17.5% for current subthreshold, remitted, and no PTSD. In unadjusted analyses, women with current full and subthreshold PTSD were 1.87 [1.49; 2.33] and 1.44 [1.11; 1.85] times more likely to have diabetes compared to women with no PTSD. Remitted PTSD was not associated with increased odds of diabetes. Effects were attenuated but remained significant after adjustment for relevant covariates. Conclusions: Vietnam-era women with current PTSD, including subthreshold symptoms, had a greater likelihood of diabetes compared to women without PTSD. These findings suggest that women with PTSD may benefit from increased diabetes prevention efforts.

Identifying candidate mechanisms of comorbidity in disordered eating and posttraumatic stress disorder symptoms among U.S. veterans: A network analytic approach

OBJECTIVE

Comorbidity between posttraumatic stress disorder (PTSD) and disordered eating (DE) symptoms is common, reflecting a possible reciprocal relationship between these disorders. Network analysis may reveal candidate mechanisms underlying their comorbidity and highlight important treatment targets.

METHOD

Two national samples of U.S. veterans endorsing trauma exposure self-reported PTSD and DE symptoms. The discovery sample included veterans from all service eras (n = 434). The validation sample included recently separated post-9/11 veterans (n = 507). We fit graphical lasso models to evaluate the network structure of PTSD factors based on the seven-factor "hybrid" model and DE symptoms within each sample. We used strength scores to identify the most central symptoms within the networks and identified bridge symptoms connecting PTSD and DE features. We tested for network invariance between self-identified men and women within each sample and across the studies.

RESULTS

PTSD and DE symptoms clustered as expected within networks for each sample. The strongest nodes in the networks included both PTSD and DE features. The strongest bridge symptoms in both studies included overevaluation of shape and weight, negative affect, and avoidance. Networks were invariant across men and women in each sample and largely invariant across samples.

CONCLUSIONS

Cross-sectional network models of PTSD and DE symptoms largely replicated across national samples of U.S. veterans and between men and women within samples. Cognitive features of both disorders, along with avoidance, may partially underlie comorbidity and represent potential treatment targets. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The impact of stress and well-being during the COVID-19 pandemic on mental health in U.S. veterans

The COVID-19 pandemic disrupted life around the globe and negatively impacted mental health (MH), including among military veterans. Building on previous research with U.S. veterans, the present study examined the association between a broad array of pandemic stressors and well-being on MH outcomes. A total of 372 veterans (51.3% women) from all service eras completed measures of posttraumatic stress disorder and depression during early (timepoint 1 [T1]) and peri-pandemic (timepoint 2 [T2]) periods. Pandemic-related stressors and well-being (satisfaction in life domains) were assessed at the peri-pandemic timepoint (T2). Logistic regression analyses were used to investigate associations between stressors and well-being with the likelihood of a probable MH diagnosis at T2 controlling for T1 MH status. More negative physical and MH impacts of the pandemic in addition to fewer positive consequences and lower satisfaction with paid work, finances, health, romantic relationships, and social life were associated with a higher likelihood of a probable T2 MH diagnosis. COVID infection was associated with lower odds of a probable T2 MH diagnosis. There were significant indirect effects, such that physical and MH impacts of the pandemic were associated with T2 MH via well-being. Overall, these findings highlight the role of stress and well-being on MH during a global pandemic. Interventions to address well-being may be important to address veteran MH during other periods of stress. Future research should examine the generalizability of study findings and further investigate factors that contribute to veterans' MH resilience during stressful life experiences.

Gender similarities and differences in associations between weight discrimination, shape/weight concerns, and eating disorder symptoms among post-9/11 veterans

OBJECTIVE

Weight discrimination, defined as mistreatment of people based on body weight, is associated with body image concerns and eating disorder (ED) symptoms. Military veterans are particularly vulnerable to developing ED symptoms, which may be due to experiences of weight discrimination resulting from the military's strict weight and fitness requirements. However, no previous study has examined these associations among veterans. We investigated relationships between weight discrimination during and after military service and shape/weight concerns and ED symptoms in post-9/11 veterans. Based on evidence for gender differences in weight discrimination, body image, and ED symptoms, we also examined whether gender moderated these associations.

METHOD

Participants were randomly selected from the population of post-9/11 U.S. veterans who had been discharged from the military within the previous 18 months. A total of 1494 veterans completed the Everyday Discrimination Scale, Eating Disorders Examination-Questionnaire, and the Eating Disorder Diagnostic Scale-5.

RESULT

Women were more likely to report weight discrimination and had higher levels of ED symptoms and shape/weight concerns than men. Weight discrimination in and after leaving the military were positively associated with shape/weight concerns and ED symptoms in the full sample and among men and women. Gender moderated the association between weight discrimination after leaving the military and shape/weight concerns such that the association was stronger among men.

DISCUSSION

Both male and female veterans may be vulnerable to developing ED symptoms, in part due to weight discrimination experienced during and after military service. Our findings emphasize the need to address weight discrimination and its consequences in veterans.

Examining the individual and relational impacts of varying responses to negative body talk within college women's female friendships

Many college women make self-disparaging comments about their appearance to others. This "fat talk" (negative body talk) is a causal risk factor for body image disturbance, which in turn predicts eating disorders and depression. Research is needed to identify effective responses to negative body talk; namely, those that reduce negative body talk without shaming its initiator or damaging the relationship. The current study examined the impact of different responses to negative body talk on the likelihood of future negative body talk and on individual and relationship factors. College women (N = 160) recalled a situation using negative body talk with a female friend. Participants listened to audio recordings of four responses (Deny/Reassure, Challenge, Empathize/Reciprocate, Ignore) and rated appearance satisfaction, shame, friendship support, and likelihood of future negative body talk after each. Linear mixed models indicated that the Deny/Reassure response followed closely by the Challenge response were most beneficial for individual and relationship factors; however, participants reported being least likely to use future negative body talk after the Ignore response. Recommendations for developing promising responses to negative body talk include combining responses to balance validation (Deny/Reassure) and change (Challenge), and studying the contribution of other relationships and varying body dissatisfaction levels.

The Posttraumatic Cognitions Inventory (PTCI): Psychometric evaluation in veteran men and women with trauma exposure

The Posttraumatic Cognitions Inventory (PTCI) is a self-report measure of negative posttraumatic cognitions, which is an important construct in the development and maintenance of posttraumatic stress disorder (PTSD). Evidence for the most appropriate PTCI item and factor structure is mixed, and this measure has not been extensively studied in veterans. The present study examined the psychometric properties of the PTCI in two national samples of veteran men and women. Participants in Sample 1 (veterans from all service eras) and Sample 2 (recently separated veterans) completed the PTCI and additional measures of mental health symptoms. Confirmatory factor analyses indicated that a brief version of the PTCI (PTCI-9; 3-factor, nine-item) was a superior fit relative to other examined factor structures. Consistent with the original conceptualization of the measure, these factors were labeled: Negative cognitions about self, negative cognitions about the world, and self-blame. Scores on the PTCI-9 were differentially associated with the PTSD symptom clusters and with scores on self-report measures of external comorbidities. PTCI-9 scores were higher among individuals with trauma exposure and with a probable PTSD diagnosis. There was evidence of full (Sample 1) and partial (Sample 2) scalar invariance across men and women. Overall, the present study supports the use of the PTCI-9 as a measure of negative cognitions; however, scores may not be specific to PTSD and may represent a global negative thinking style. Even so, the PTCI-9 appears to be a suitable and abbreviated measure that could be used with veterans in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing hedonic hunger among Chinese adults using the Power of Food Scale: Psychometric properties and cross-cultural invariance between China and the US

Hedonic hunger refers to food consumption for pleasure without biological energy deficits. The Power of Food Scale (PFS) is a well-developed self-report instrument assessing hedonic hunger. The present study aimed to translate and validate the PFS into simplified Chinese (C-PFS) and examine its psychometric properties among Chinese adults. A total of 773 participants (51.1 % men, M age = 24.98 years, SD = 6.10) were recruited in the present study from college and community populations. Consistent with the previous studies, confirmatory factor analysis showed that the C-PFS had three factors: food present, food available, and food tasted. In addition, a Cronbach's alpha of 0.92 and an ICC of 0.86 suggested that the C-PFS has good internal consistency and test-retest reliability. In terms of convergent validity, the scores of C-PFS correlated significantly with disordered eating symptomatology and loss of control over eating. Measurement invariance tests showed that the C-PFS was invariant across gender and sample source groups in the Chinese sample. In addition, a U.S. sample of 490 college students (26.6 % men, M age = 21.41 years, SD = 5.45) was used to test the measurement invariance across countries, and results suggested a partial invariance across college students from China and those from the U.S. In conclusion, the C-PFS can be a useful tool for measuring hedonic hunger among adults in China, and there may be cultural differences in the measurement of the PFS in college students across China and the U.S.

Using Exploratory Structural Equation Modeling (ESEM) To Examine the Factor Structure and Measurement Invariance of the Farsi Version of the Children's Eating Attitudes Test (F-ChEAT) among Iranian Preadolescents Across Gender and Age

Despite considerable examination of the Children's Eating Attitudes Test (ChEAT) in Western societies, there is no study about the ChEAT in Iran. The purpose of the current study was to translate and examine the factor structure and measurement invariance of the Farsi version of the ChEAT (F-ChEAT) among Iranian preadolescents. Iranian preadolescents (N = 717) completed the F-ChEAT and demographic information. Exploratory structural equation modeling (ESEM) was used to examine the factor structure and measurement invariance across gender and age. A 5-factor, 15-item ESEM model showed an excellent fit of the data. Tests of measurement invariance suggested that scores on the latent means could be meaningfully compared across gender and age. Girls had higher latent means on the Food Preoccupation and Caloric Awareness and Control factors, and older preadolescents had higher latent means on all the F-ChEAT factors, except for the Dieting factor. Findings suggest that a 5-factor, 15-item ESEM model of the F-ChEAT was a useful assessment tool to understand disordered eating symptoms in Iranian preadolescents.

Factor analytic support for the EDE-Q7 among American Indian/Alaska Native undergraduate women

OBJECTIVE

American Indian/Alaska Native (AI/AN) people have historically been excluded from eating disorder research. Consequently, not much is known about the validity of eating disorder assessment measures in this group. The purpose of the current study was to examine the factor structure of a short measure for eating pathology, the seven-item Eating Disorder Examination Questionnaire (EDE-Q7), in AI/AN undergraduate women. Exploratory analyses examined the measurement invariance of the EDE-Q7 across AI/AN, White, and Latinx undergraduates.

METHODS

A sample of 150 AI/AN undergraduate women completed the full EDE-Q (28 items) as part of two larger studies. The seven items comprising the EDE-Q7 were selected from the full measure to test the factor structure. Random samples of White and Latinx women of equal sample size were chosen from the larger studies to test measurement invariance.

RESULTS

Confirmatory factor analyses found support for the EDE-Q7 factor structure in AI/AN undergraduate women, and scores were strongly positively correlated with the original EDE-Q global scale and disordered eating behaviors. Exploratory analyses found support for the measurement invariance of the EDE-Q7 across AI/AN, White, and Latinx women. One-way ANOVAs showed no significant racial and ethnic differences on the EDE-Q7.

DISCUSSION

The current study found psychometric support for the EDE-Q7 in AI/AN undergraduate women and provided preliminary evidence that the EDE-Q7 can be meaningfully compared across AI/AN, White, and Latinx undergraduate women. Further research should continue to investigate the EDE-Q7 and other eating disorder measures in AI/AN and other historically excluded groups.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Development and psychometric evaluation of an empirically-derived daily checklist of weight control: Consumption-reduction strategies and health-focused strategies in college students

Objective: Many college women report engaging in weight control strategies, yet little is known about which strategies are used and how often. The current study's goal was to evaluate the factor structure of a comprehensive list of weight control behaviors used in the previous 24-hours. Participants: Undergraduate women (N = 286) were recruited from a southwestern university. Methods: Participants reported their weight control strategies for the previous 24 hours on a checklist compiled from previous studies. Results: Exploratory and confirmatory factor analyses indicated that a 14-item, 2-factor ("Consumption-reduction", "Health-focused" Strategies) structure was a good fit of the data. Tests of longitudinal measurement invariance found support for using the checklist to make meaningful comparisons across time. Conclusions: This study developed a checklist of past 24-hour weight-control strategy usage, thereby providing a step toward developing an instrument that may be used for weight control or early intervention for disordered eating.

Disordered eating in sexual minority post-9/11 United States veterans

OBJECTIVE

It is well documented that sexual minority individuals are more likely to report disordered eating (DE) than those identifying as heterosexual. Although DE is prevalent in veterans, investigation of potential disparities in DE among sexual minority veterans is limited. This study examined rates of DE in post-9/11 United States (U.S.) veterans identifying as sexual minorities and explored their association with discrimination because of marginalized identities.

METHODS

A national sample of recently separated post-9/11 U.S. veterans were recruited. Women (N = 805; heterosexual [n = 656]; lesbian [n = 51]; bisexual [n = 98]) and men (N = 558; heterosexual [n = 540]; gay [n = 11]; bisexual [n = 7]) completed a survey assessing eating behaviors, mental health, and military experiences. Weighted correlational and regression analyses were conducted. Analyses in men were exploratory.

RESULTS

DE was prevalent across gender and sexual orientation identity groups. Women identifying as bisexual and men identifying as gay reported higher rates of DE and consequent impairment compared to veterans who identified as heterosexual. There were no differences in DE between heterosexual and lesbian female veterans, but lesbian women reported lower DE-related impairment. Experiencing any discrimination in the military was positively related to DE.

DISCUSSION

This study found evidence of disparities in DE among sexual minority U.S. military veterans. While the factors contributing to these differences, such as the role of discrimination, are not completely understood, DE is a health concern for sexual minority veterans and requires continued investigation.

PUBLIC SIGNIFICANCE

Sexual minority individuals experience disparities in disordered eating; yet, this has not been explored in military veterans. This study found that disordered eating is a significant health concerns for veteran women and men, especially among those identifying as sexual minorities. More research is needed to explore why these disparities exist, such as the role of minority stress, in order to address the unique healthcare needs of these veterans.

What Is Healthy Eating? Exploring Profiles of Intuitive Eating and Nutritionally Healthy Eating in College Women

PURPOSE

Research suggests that food's nutritional content and the feelings and behaviors associated with eating contribute to overall health, yet these constructs are rarely considered simultaneously. The current cross-sectional study investigated healthy eating profiles in college women that included both nutritional quality and intuitive eating (IE), with IE being an eating style that prioritizes physiological hunger/satiety cues and minimizes dieting and emotional eating.

DESIGN/SETTING/SUBJECTS

Undergraduate women (n=352) completed an online assessment and daily diaries (80% retention).

MEASURES

Nutritionally healthy eating, IE, dieting, body dissatisfaction, disordered eating, and psychological health were examined.

ANALYSIS

Latent profile analysis explored patterns of nutritionally healthy eating and IE, and determined how these patterns related to psychological and eating disorder outcomes.

RESULTS

A four-profile solution emerged: 1) Dieting (high nutritionally healthy eating + intermediate IE), 2) Unhealthy Eating (low nutritionally healthy eating + low IE), 3) Intuitive Eating (moderately high nutritionally healthy eating + high IE), and 4) Non-Dieting (low nutritionally healthy eating + intermediate IE). These profiles significantly differed from one another, such that the Intuitive Eating and Non-Dieting profiles reported lower psychological distress, BMI, and eating disorder symptoms compared to other profiles, while the Dieting and Unhealthy Eating profiles showed the healthiest and poorest nutritional eating, respectively.

CONCLUSION

These findings suggest that IE and nutritionally healthy eating are distinct factors in conceptualizing the eating patterns of college women, and both should be considered when developing interventions. Future research should replicate these findings in larger/more diverse samples and examine eating profiles longitudinally.

Integrative data analysis of self-efficacy in 4 clinical trials for alcohol use disorder

BACKGROUND

Self-efficacy has been proposed as a key predictor of alcohol treatment outcomes and a potential mechanism of success in achieving abstinence or drinking reductions following alcohol treatment. Integrative data analysis, where data from multiple studies are combined for analyses, can be used to synthesize analyses across multiple alcohol treatment trials by creating a commensurate measure and controlling for differential item functioning (DIF) to determine whether alcohol treatments improve self-efficacy.

METHOD

The current study used moderated nonlinear factor analysis (MNLFA) to examine the effect of treatment on self-efficacy across four different treatment studies (N = 3720; 72.5% male, 68.4% non-Hispanic white). Self-efficacy was measured using the Alcohol Abstinence Self-Efficacy Scale (AASE) in the COMBINE Study (n = 1383) and Project MATCH (n = 1726), and the Drug Taking Confidence Questionnaire (DTCQ) in two studies of Telephone Continuing Care (TEL Study 1: n = 303; TEL Study 2: n = 212). DIF was examined across time, study, treatment condition, marital status, age, and sex.

RESULTS

We identified 12 items from the AASE and DTCQ to create a commensurate measure of self-efficacy using MNLFA. All active treatments, including cognitive-behavioral treatment, a combined behavioral intervention, medication management, motivation enhancement treatment, telephone continuing care, twelve-step facilitation, and relapse prevention, were associated with significant increases in self-efficacy from baseline to posttreatment that were maintained for up to a year. Importantly, treatment as usual in community settings, which consisted of weekly group therapy that included addiction counseling and twelve-step recovery support, was not associated with significant increases in self-efficacy.

CONCLUSIONS

Alcohol self-efficacy increases following treatment and numerous evidence-based treatments are associated with significant increases in self-efficacy, which are maintained over time. Community treatment that focuses solely on addiction counseling and twelve-step support may not promote increases in self-efficacy.

The Bulimia Test-Revised (BULIT-R): Psychometric properties in a non-clinical sample of White and Latina college women

The Bulimia Test-Revised (BULIT-R) is a measure of bulimia nervosa and binge eating disorder symptoms. While this measure can serve as a useful screening tool, the validity of the BULIT-R in White and Latina samples is uncertain. Previous research has proposed several different BULIT-R factor structures, but has yet to find consistent support for a measurement model or to test measurement invariance. To address this gap, the current study attempted to examine the factor structure and measurement invariance of the BULIT-R among 699 non-clinical White (40.9%) and Latina (59.1%) undergraduate women. Analyses indicated that none of the previously published factor structures in adult samples of the BULIT-R were an acceptable fit in either Latina or White undergraduates. These findings further underscore difficulties in replicating the BULIT-R factor structure, even when using similar sample characteristics to those in the literature. Given the lack of an adequate fitting measurement model, tests of measurement invariance were not conducted. In the absence of measurement invariance of the BULIT-R, there is uncertainty regarding group comparisons, such as whether group differences reflect true differences or are artifacts of measurement error. This study highlights the need for additional psychometric investigation of the BULIT-R. The focus should be on diverse groups as well as non-clinical samples, with the latter being less likely to endorse extreme eating behaviors. Special consideration should be given to the number of items included in the measurement model and the number of indicators per latent factor. Caution should be exercised when interpreting scores on this instrument.

The Condom Use Self-Efficacy Scale in Substance Use Disorder Treatment-Seeking American Indian Adults

American Indians (AIs) experience substance use disorder and sexual risk related inequities with elevated rates of sexually transmitted infections, unintended pregnancy, and fetal alcohol spectrum disorders. Substance misuse is associated with risky sexual behaviors including condomless sex. Objectives: The current study aimed to test the validity of the Condom Use Self-Efficacy Scale (CUSES) and the relationship between self-efficacy and condom use behaviors in AI individuals with substance use disorders (SUDs). Exploratory analyses also examined changes in condom use self-efficacy across SUD treatment. Methods: As part of a larger randomized controlled trial, AI individuals (N = 79) seeking SUD treatment completed baseline measures of condom use self-efficacy and sexual risk behaviors. Results: Confirmatory factor analysis (CFA) indicated that a 3-factor, 10-item version of the CUSES was a reliable and valid measure in this population. Condom use self-efficacy was associated with condom use behavior and increased during SUD treatment. Conclusions: Overall, it appears that the CUSES is a valid measure in AI individuals, is related to condom use behavior, and increases with SUD treatment. There is a need for future research to integrate these findings into AI cultural values. Addressing sexual risk behaviors in SUD treatment may be an important target and future research is needed to understand predictors of condom use self-efficacy and determine potential intervention targets to reduce sexual risk behaviors and related health inequities.

Evaluation of the relationships between dietary restraint, emotional eating, and intuitive eating moderated by sex

Intuitive eating involves attention to feelings putatively related to hunger and satiety to guide eating choices. This adaptive eating style has been linked to a number of positive physical and psychological outcomes. Interestingly, women tend to report lower levels of intuitive eating compared to men. It has been hypothesized that sociocultural pressures or dieting could be contributing factors to this sex discrepancy. The current study aimed to explore whether sex moderates the relationship between either dietary restraint and intuitive eating, or between emotional eating and intuitive eating. Assessments were administered to a sample of college males and females (N = 478) as part of a larger study of eating behaviors. Moderation analyses indicated that higher dietary restraint was more strongly associated with lower levels of intuitive eating in women than in men. Emotional eating also had a stronger negative association with intuitive eating in women compared to men. Additionally, relationships between dietary restraint/emotional eating and a component of intuitive eating, "eating for physical rather than emotional reasons", was stronger for women compared to men. These findings suggest that dietary restraint and emotional eating may serve as barriers in the implementation of an intuitive eating style, especially for women. Prevention and intervention efforts should target those high in dietary restraint and emotional eating.

Psychometric evaluation of the power of food scale in a diverse college sample: Measurement invariance across gender, ethnicity, and weight status

The Power of Food Scale (PFS) is an instrument designed to examine individual differences in the drive to eat for pleasure (as opposed to in response to physiological hunger) and the effect of living in an obesogenic environment. Previous research supports the validity and reliability of the PFS, however, it had yet to be validated in an ethnically diverse college sample. The purpose of the current study was to test the factor structure and measurement invariance of the PFS across gender, ethnicity, and weight status. A sample of 432 college students completed the PFS (males=113, females = 319; non-Hispanic white=181, Hispanic=251; non-overweight=302, overweight=130). Confirmatory factor analysis was used to test a second-order, 3-factor (food available, food present, food tasted) structure of the PFS in each group separately (males, females, Hispanic, non-Hispanic white, non-overweight, and overweight) and tests of measurement invariance were conducted to test the equivalency of the measure across gender, ethnicity, and weight status. Results supported the measure's original factor structure (second-order, 3-factor model) and indicated that the measure is equivalent across each of these groups, respectively. Although the small, unbalanced groups may impact the stability of the findings, the results nonetheless suggest that the PFS is a psychometrically valid measure in a diverse college sample, and that mean comparisons on this measure are meaningful across gender, ethnicity, and weight status. Given the measurement invariance of the PFS, there is support for use of the PFS among diverse college students in future work.

Perceived Conflict and Support Among Women with Bulimia Nervosa Compared to Women with Depression and Healthy Controls: An Experimental Manipulation

Objective: Women with bulimia nervosa (BN) often present with interpersonal difficulties. It is unknown whether these difficulties primarily are based on distorted social perceptions, and whether they are unique to BN. The current study used a repeated-measures design to compare perceptions of interpersonal interactions for participants with BN, depression (DEP), and healthy controls (HCs). We hypothesized that women with BN would perceive more conflict and less support than HCs. Analyses comparing BN and DEP were exploratory.

Method: Participants with BN (n = 27) or DEP (n = 26) and HCs (n = 27) rated perceived conflict and support for 24 vignettes depicting social interactions that varied in levels of these two constructs. Participants also completed relationship quality/satisfaction questionnaires.

Results: Multilevel model analyses revealed that the BN group perceived greater conflict relative to HCs. There also were significant interactions, with BN participants more greatly impacted by high support. There were no differences between DEP and BN groups.

Discussion: Overall, BN participants perceived more conflict than HCs, but differences were attenuated when level of social support was high. Helping women with BN tolerate discomfort associated with any amount of perceived conflict and/or low support may be an important treatment target.

Confirmatory factor analysis and measurement invariance of the Eating Disorder Examination Questionnaire (EDE-Q) in a non-clinical sample of non-Hispanic White and Hispanic women

OBJECTIVE

Body dissatisfaction and eating disorder rates have increased in racial and ethnic minority groups, yet the validity of various commonly-used eating disorder instruments has not been established in these populations. One way to establish validity is to test for measurement invariance; namely, that the same constructs are being measured across groups. This study tested the measurement invariance of the Eating Disorder Examination Questionnaire (EDE-Q) across non-Hispanic White and Hispanic women.

METHOD

Female undergraduates (n = 561) were recruited from a southwestern U.S. university. Confirmatory factor analysis (CFA) and measurement invariance of the EDE-Q were tested in non-Hispanic White and Hispanic samples.

RESULTS

CFA analyses revealed that the original four-factor structure did not fit the data in either group. Only a modified 7-item, three-factor structure of the EDE-Q provided an acceptable fit in both non-Hispanic White and Hispanic women. Thus, this modified EDE-Q factor structure was used to test the equivalence of the measure between groups. Results found that the factor structure was similar across groups, but the factor loadings and intercepts differed across non-Hispanic White and Hispanic women.

DISCUSSION

A modified 7-item, three-factor structure of the EDE-Q provided an acceptable fit of the data, which is supported by previous research. However, the lack of measurement invariance suggests that researchers should be cautious when using this modified EDE-Q to make explicit comparisons between non-Hispanic White and Hispanic women. Future research should further examine the psychometric properties of the EDE-Q in ethnically diverse groups, specifically the role of dietary restraint among Hispanic women.

What does self-reported "dieting" mean? Evidence from a daily diary study of behavior

Dieting is often recommended as a means of weight loss, yet research consistently shows that self-reported dieting does not result in weight loss. Toward resolving this discrepancy, this study assessed the daily dietary intake and weight control strategies of people who self-identified as dieting. College women (N = 266) provided a report of their eating pattern (dieting, "watching what I eat," and/or "eating healthy") followed by three daily diaries (24-hour recalls of dietary intake and weight control strategies) elicited on randomly selected days during a one-month period. Dieters were expected to report fewer daily calories, more daily exercise, and more daily weight control strategies than non-dieters. At baseline, 122 participants (45.9%) endorsed both "watching" and "eating healthy" ("Concerned Eaters") while 55 (20.7%) endorsed current dieting along with "watching" and "eating healthy" ("Dieters"). Just 3 (1.1%) endorsed dieting only, and 31 (11.7%) endorsed no eating pattern ("Unconcerned Eaters"). Dieters' mean BMI was in the overweight range; the mean BMIs of other groups were in the normal weight range. Dieters did not consistently endorse dieting across diaries. Nevertheless, Dieters reported fewer daily calories, and more overall weight control strategies, including more healthy weight control strategies, than Concerned Eaters. Across groups, participants' weights did not change significantly during the study. Dieters appear to engage in weight control strategies which could result in weight loss; however, their reports of whether they are dieting vary across days, suggesting a need for more consistent behavior. These results have clinical and research implications in the area of weight loss.

Obligatory exercise and coping in treatment-seeking women with poor body image

PURPOSE

Obligatory exercise is characterized by continued exercise despite negative consequences, and intense negative affect when unable to exercise. Research suggests psychosocial differences between individuals that exercise in an obligatory manner and those that do not. It also has been speculated that obligatory exercise may serve coping and affect regulation functions, yet these factors have not been routinely examined in community women with poor body image. The purpose of the current study was to investigate psychosocial differences between obligatory and non-obligatory exercisers, and to examine the use of obligatory exercise as an avoidant coping strategy in a sample of women with poor body image.

METHODS

Women (n = 70) seeking treatment for body dissatisfaction were divided into obligatory and non-obligatory exercise groups based on their scores on the Obligatory Exercise Questionnaire. Participants then completed an assessment battery about eating pathology, body image, reasons for exercise, coping strategies, and negative affect.

RESULTS

Independent t test analyses indicated that obligatory exercisers had significantly greater eating disorder symptomatology, avoidant coping, and appearance- and mood-related reasons for exercise than non-obligatory exercisers. Multiple regression analyses revealed that eating disorder symptomatology and avoidant coping were significant predictors of obligatory exercise.

CONCLUSIONS

There are distinct psychosocial differences between women with poor body image who exercise in an obligatory fashion and those who do not. The current study suggests that obligatory exercise may serve as an avoidant coping strategy for women with poor body image. Enhancing healthy coping strategies may be an important addition to body image improvement programs.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Body dissatisfaction predicts poor behavioral weight loss treatment adherence in overweight Mexican American women

Poor adherence poses a major barrier to the success of behavioral weight loss (BWL) programs, particularly for overweight Mexican American women. Given the high prevalence and costs of overweight/obesity, factors that contribute to attendance and adherence problems should be identified, especially in ethnic minority populations. The current study examined the role of pre-treatment body dissatisfaction and depression in predicting attendance and adherence in a BWL intervention. Ninety-nine overweight/obese Mexican American women enrolled in the intervention and completed baseline measures. Eighty-one of the women attended at least one treatment session and provided measures of dietary and physical activity adherence. Simultaneous linear regression analyses suggested that although higher levels of body dissatisfaction and depression each played unique roles in predicting poorer attendance, only body dissatisfaction predicted adherence. Specifically, higher body dissatisfaction predicted poorer treatment adherence. Findings highlight the importance of addressing body dissatisfaction early in BWL treatment to increase attendance and adherence.

The role of familism in weight loss treatment for Mexican American women

Mexican American women are disproportionately affected by overweight/obesity and the health complications accompanying them, but weight loss treatments are less successful in this ethnic group. High levels of familism, a value reflecting obligation to family that supersedes attention to oneself, interfere with weight loss for Mexican American women. This mixed methods study investigated overweight Mexican American women’s beliefs about how familism, and Mexican American culture, might hinder weight loss success, and how treatments might be culturally adapted. Results suggest a need to support women in their commitment to family while also helping them make changes. Recommendations for culturally adapted treatments are made.