The impact of fitspiration comments on adult women's body dissatisfaction and negative affect

The present study examined the impact of writing different types of comments in response to fitspiration (fitness inspiration) images on women's body dissatisfaction and negative affect. Women (N = 256) from the general population (age range: 18 to 49) were randomized to write one of three types of comments on the same fitspiration images: appearance (comment on the woman's appearance), functionality (comment on what the woman's body can do), or background (comment on the image background). Participants completed measures of state body dissatisfaction and negative affect pre- and post-exposure and measures of appearance comparison and functionality appreciation post-exposure. After controlling for pre-body dissatisfaction due to a baseline difference among groups, there was no difference among groups in body dissatisfaction at post-exposure. Negative affect decreased from pre- to post-exposure across all groups, but there was no difference by group or interaction by time and group. The background group reported lower state appearance comparison than the appearance group. There were no group differences in functionality appreciation. Our results suggest that commenting on image backgrounds might decrease appearance comparison relative to making appearance comments and that writing comments on appearance, functionality, or the background in response to fitspiration may be beneficial for mood.

Dissemination of a dissonance-based body image promotion program for mothers and daughters in church settings: A controlled pilot study of Reclaiming Beauty

This proof of concept, controlled pilot study expands on existing dissonance-based body image promotion programs by testing a modified version of the Body Project for 136 mothers and daughters aged 11-18 years old in church settings called Reclaiming Beauty. Mothers (n = 30) and their daughters (n = 35) who participated in Reclaiming Beauty were compared to mothers (n = 32) and daughters (n = 39) in a waitlist, assessment-only, control group on body image, eating psychopathology, and risk factor measures (thin-ideal internalization, physical appearance comparison) at pre-, post-, and 6-month-follow-up assessments. Intent-to-treat, multilevel modeling indicated that mothers and daughters in the Reclaiming Beauty group experienced significant improvement in body appreciation, body shape concerns, eating psychopathology, thin-ideal internalization, and physical appearance comparison over a six-month period compared to control participants. Changes in thin-ideal internalization and appearance comparison did not predict body image and eating psychopathology at follow-up. Baseline levels of body satisfaction did not moderate the effect of the program, except for its effect on body shape concerns. Findings provide preliminary support for delivering a dissonance-based body image promotion intervention to mothers and their daughters and the feasibility of leveraging the mother-daughter relationship as well as delivering interventions in church settings.

Assessing the need for pre-mental health competencies in undergraduate education: insights from graduate faculty surveys

Introduction

Despite the value of clinical competencies for masters- and doctoral-level practitioners as well as the tremendous variability in preparedness for graduate school and at graduation from graduate school, there are no competency standards for students pursuing mental healthcare careers prior to graduate study. This study aimed to identify potential pre-mental health competency standards for undergraduates pursuing mental healthcare careers.

Methods

Faculty at masters and doctoral programs in a range of mental healthcare fields were asked to rate their expectations of entry-level competence and the perceived entry-level competence of their first-year, bachelor-level graduate students on 42 sub-competencies derived from the APA's Competency Benchmarks in Professional Psychology.

Results

Faculty of both masters (N = 320) and doctoral (N = 220) programs reported high expectations of first-year graduate students for 11 competency categories (professional values/attitudes; relationships; management-administration; interdisciplinary systems; individual/cultural diversity; advocacy; scientific knowledge and methods; reflective practice, self-assessment, and self-care; ethical standards and policy; supervision, and research/evaluation) and 25 sub-competencies. Faculty in masters programs rated students as not meeting their expectations in 28 sub-competencies, while faculty in doctoral programs rated students as not meeting their expectations in 17 sub-competencies. Faculty recommended internships as well as improvement in writing, counseling skills, professional behavior, diversity, equity, and inclusion, cultural competence and humility, research methods, reading research, connecting research to practice, and education about the different mental healthcare professions.

Discussion

Our findings suggest that students would benefit from intentional training in multiple pre-mental health competency areas at the undergraduate level to facilitate graduate-level training in mental healthcare and to better prepare our future clinicians.

Evidence-based policy solutions to prevent eating disorders: Do disclaimer labels on fashion advertisements mitigate negative impact on adult women?

Exposure to media images portraying the thin ideal is associated with increased body dissatisfaction and disordered eating in women. Organizations and policymakers globally have proposed polices requiring warning or disclaimer labels on altered images. Research examining efficacy of disclaimer labels is growing but has largely overlooked adult women. This study extends current research by exploring novel disclaimer labels in a sample of adult women. Women (N = 872) recruited via Amazon's MTurk were randomly assigned to view 20 fashion advertisements with one of five labels: 1) no label; 2) general-digital-alteration label; 3) health-warning label; 4) specific-weight label; or 5) facial features/cosmetic label. Results revealed a significant increase in body dissatisfaction after advertisement exposure, irrespective of label group. Women who viewed advertisements with labels and recalled the labels reported lower body satisfaction and intention to purchase products compared to those who viewed advertisements with no label. Age appears to play an important role in how disclaimer labels affect women. Younger women of color appear to be more negatively impacted by the facial features/cosmetic label than older women of color. Findings are consistent with previous studies indicating no protective effect of disclaimer labels suggesting the need for more effective preventive strategies.

Psychometric properties of the Farsi version of the Eating Pathology Symptoms Inventory (F-EPSI) among Iranian University men and women

BACKGROUND

Limited research has validated eating pathology assessments in Iranian men and women. The purpose of the current study was to translate and validate a Farsi version of the Eating Pathology Symptoms Inventory (F-EPSI) in Iranian university students.

METHODS

Men (n = 279) and women (n = 486) completed questionnaires including the F-EPSI.

RESULTS

Confirmatory factor analysis (CFA) indicated that the F-EPSI had an acceptable fit to the data and supported the eight-factor model. The scale was partially invariant across genders. Men reported higher scores on Excessive Exercise and Muscle Building subscales, and women reported higher scores on Body Dissatisfaction and Restricting subscales. The F-EPSI subscales had good 5- to 6-month test-retest reliability. The F-EPSI demonstrated convergent validity with clinical impairment, eating pathology, and body mass index (BMI). Finally, individuals scoring above the Clinical Impairment Assessment (CIA) cutoffs reported higher scores on the F-EPSI subscales, further supporting convergent validity of the scale.

CONCLUSION

Findings suggest that the F-EPSI will enable researchers to examine eating pathology symptoms among men and women in Iran.

The validation of a Farsi version of the Clinical Impairment Assessment (F-CIA) among Iranian adolescent boys and girls

PURPOSE

Although some studies have been conducted to examine general psychosocial impairment in Iran, there is no research to date on clinical impairment secondary to disordered eating in Iranian adolescents. The purpose of this study was to evaluate the Farsi version of the Clinical Impairment Assessment (F-CIA) among Iranian adolescents.

METHODS

A total of 1112 adolescents (age_{M [SD]} = 15.55 [1.59], body mass index [zBMI] _{M [SD]} = - 0.00 [1.0]; 54.6% girls) were recruited from four cities (Tehran [Capital], Tabriz [North-Western], Kurdistan [West], and Rasht [North]) in Iran. After translation and back-translation procedures, the F-CIA, Eating Disorder Examination Questionnaire (EDE-Q), and Beck Depression Inventory-Second Edition (BDI-II) were administered to adolescents. We used confirmatory factor analysis (CFA), measurement invariance, independent samples t tests, Pearson correlation, chi-square tests, and internal consistency to test validity and reliability.

RESULTS

CFA indicated that F-CIA demonstrated good fit to the data and supported a three-factor model. The scale was invariant across gender and zBMI. The F-CIA had good internal consistency (αs = 0.76-0.93) and positive associations (rs = 0.13-0.62; p < 0.001) with zBMI, disordered eating symptoms, and binge/purge symptoms. We found no gender differences across mean scores on the F-CIA, but adolescents with higher zBMI reported higher scores on the F-CIA relative to those with lower zBMIs. Finally, adolescents scoring above CIA cutoffs reported higher zBMI, disordered eating outcomes, and depression.

CONCLUSION

Findings suggested that the F-CIA is a reliable and valid measure of clinical eating disorder-related impairment in Iranian adolescents.

LEVEL OF EVIDENCE

III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.

The effect of misgendering on body dissatisfaction and dietary restraint in transgender individuals: Testing a Misgendering-Congruence Process

OBJECTIVE

Despite research findings that transgender individuals have higher rates of body dissatisfaction and disordered eating than their cisgender peers, reasons for greater eating pathology remain unclear. We propose a Misgendering-Congruence Process by which being misgendered (i.e., labeled a gender other than that with which one identifies) could lead transgender individuals to feel greater incongruence between their bodies and internal identities, which in turn leads to body dissatisfaction and efforts to bring one's body in line with one's identified gender by engaging in weight and shape control behaviors such as dietary restraint.

METHOD

One hundred and thirty transgender individuals completed measures of misgendering frequency, transgender congruence, body dissatisfaction, and dietary restraint.

RESULTS

Mediation analyses provided preliminary support for the Misgendering-Congruence Process when conducted with the overall sample as well as with transgender subgroups: transgender women (n = 41), transgender men (n = 42), and nonbinary transgender individuals (n = 47).

DISCUSSION

Social recognition of transgender people's gender identities appears to play a unique role in their body satisfaction and restrained eating behaviors.

The validation of a Farsi version of the Loss of Control over Eating Scale (F-LOCES) among Iranian adolescent boys and girls

OBJECTIVE

Few studies have been conducted on disordered eating in Iran, with limited research on loss of control (LOC) eating in adolescents. The purpose of the current study was to evaluate the validation of a Farsi version of the Loss of Control over Eating Scale (F-LOCES) among Iranian adolescents.

METHOD

Participants were 504 boys (Age _mean = 15.35; Body Mass Index [zBMI] _mean = 0.01) and 607 girls (Age _mean = 15.71; zBMI _mean = -0.01) who completed a battery of questionnaires including the F-LOCES.

RESULTS

Confirmatory Factor Analysis (CFA) and bi-factor model indicated that the F-LOCES had good fit to the data and supported a three-factor model. Additionally, the scale was invariant across all the groups. Girls had higher scores than boys on the behavioral subscale. Additionally, individuals with elevated eating pathology and zBMI endorsed higher LOC eating. As expected, the F-LOCES scores were positively associated with zBMI, disordered eating symptoms, and depression, and negatively associated with self-esteem.

DISCUSSION

Findings suggest that the F-LOCES is a reliable and valid measure of LOC eating in Iranian adolescents. The availability of the F-LOCES will enable researchers to examine the developmental trajectories, predictors, and outcomes of LOC eating.

Dissemination of a dissonance-based body image promotion program in church settings: A preliminary controlled pilot study with adult women

Adult women report significant body dissatisfaction yet are often overlooked in body image promotion programs. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many in the South of the United States. This study tested a dissonance-based body image program, Reclaiming Beauty (RB), adapted for adult women in church settings. Six groups (n = 30) were led by two trained church leaders (peer-led) and three groups (n = 21) were led by a trained peer leader and a researcher (researcher-co-led). RB participants, aged 30-77 years (M = 53.1 ± 12.7), completed assessments pre-intervention, immediately post-intervention, and 6 months post-intervention. Waitlist-controls (n = 31) completed assessments at time intervals consistent with intervention participants. RB participants reported significantly decreased thin-ideal internalization, body surveillance, and eating psychopathology at post-intervention and at 6 months post-intervention relative to controls. RB participants also reported significantly increased body satisfaction immediately post-intervention relative to controls, but this was not significant at 6 months post-intervention. Peer-led groups outperformed researcher-co-led groups on body surveillance at 6 months, but RB conditions did not otherwise differ. Our findings provide preliminary support for the dissemination of a culturally-modified dissonance-based body image program to adult women in church settings.

A longitudinal study of weight and shape concerns and disordered eating groups by gender and their relationship to self-control

PURPOSE

Weight/shape concerns and disordered eating are common among young adults. Minimal research has examined these variables longitudinally by gender and in connection to self-control. The present study examined the level of weight/shape concerns and disordered eating at the end of the first and fourth year of college separately by gender and explored differences in self-control.

METHODS

Participants included 394 female and 157 male undergraduates (N = 551; 40% non-white) who were categorized into three groups using a cluster analysis by gender: low weight/shape concerns and low disordered eating (LowWS-LowDE group), high weight/shape concerns and low disordered eating (HighWS-LowDE group), and high weight/shape concerns and high disordered eating (HighWS-HighDE group).

RESULTS

Approximately, 62% of women and 54% of men reported having weight/shape concerns and/or disordered eating at the end of the first year of college, and around 51% of women and 44% of men reported having weight/shape concerns and/or disordered eating at the end of the fourth year. Results indicated that those in the HighWS-HighDE group had lower self-control compared to those in the LowWS-LowDE group at the end of the first and fourth year in both women and men. Women, but not men, who worsened in weight/shape concerns and/or disordered eating over time also reported significantly decreased self-control from their first to their fourth year.

CONCLUSION

Findings support the role of self-control in the maintenance of weight/shape concerns and disordered eating for both women and men.

LEVEL III

Evidence obtained from well-designed cohort or case-control analytic studies.

What happens when you compare yourself to a model eating a cheeseburger? An experiment testing the impact of models promoting calorie-dense foods on beliefs about weight maintenance, body satisfaction, and purchase intent

BACKGROUND

Ads depicting models promoting calorie-dense foods and beverages are ubiquitous and no known research has examined their effects on consumers. Drawing from social comparison theory, we hypothesized that participants who viewed ads with models (versus without models) would be more likely to rate models and less likely to rate themselves as able to consume the calorie-dense foods regularly and still maintain their weight/shape. We also hypothesized that participants who viewed ads with models (versus without models) would report more body dissatisfaction and, consistent with consumer research, a greater intention to purchase the product.

METHODS

Participants (N = 168) were randomly assigned to view food or beverage ads with models or without models and completed self-report measures.

RESULTS

Participants who viewed ads without models were more likely to rate themselves and most people as able to consume calorie-dense foods regularly and maintain their weight/shape and reported a greater intention to purchase the product. Consistent with our hypotheses, participants who viewed ads with models reported increased body dissatisfaction.

CONCLUSIONS

Results indicate that consumers' perceptions of their own and others' abilities to regularly consume calorie-dense foods and maintain their weight/shape change based on whether (or not) the calorie-dense foods are promoted by a model. Our findings reveal the nuanced negative effects of calorie-dense food ads with and without models and give insight into the psychological and potential physical health consequences that food ads can have on consumers.

Community-Based Prevention Programs for Disordered Eating and Obesity: Updates and Current Limitations

PURPOSE OF REVIEW

To review the status of community-based disordered eating and obesity prevention programs from 2014 to 2019.

RECENT FINDINGS

In the last 5 years, prevention programs have found success in intervening with children and parental figures in wellness centers, physical activity centers, childcare centers, workplaces, online, and over-the-phone through directly reducing disordered eating and obesity or by targeting risk factors of disordered eating and obesity. Community-based prevention programs for disordered eating and programs targeting both disordered eating and obesity were scarce, highlighting the critical need for the development of these programs. Qualities of the most effective programs were those in which parents and children were educated on physical activity and nutrition via multiple group-based sessions. Limitations of current prevention programs include few programs targeting high-risk populations, a dearth of trained community members serving as facilitators, inconsistent reporting of adherence rates, and few direct measurements of disordered eating and obesity, as well as few long-term follow-ups, precluding the evaluation of sustained effectiveness.

Warning labels on fashion images: Short- and longer-term effects on body dissatisfaction, eating disorder symptoms, and eating behavior

OBJECTIVE

Fashion warning labels that caution readers about digitally altered images have been recommended and adopted by several countries to prevent body dissatisfaction and eating disorders. This study investigated the short- and longer-term influence of fashion warning labels on affect, body dissatisfaction, eating disorder symptoms, and snack consumption using a randomized-controlled experiment.

METHOD

Female undergraduates (n = 118) were randomized to view and rate responses to fashion images either with or without a warning label. They then consumed snacks and completed questionnaires. Sixty-four participants (54%) completed follow-up online surveys asking them to view and rate new fashion images with or without warning labels once per week for 4 weeks. Primary outcomes were affect, body dissatisfaction, eating disorder symptoms, and kilocalories consumed.

RESULTS

Overall, fashion warning labels had no short-term effects on affect, body dissatisfaction, or kilocalories consumed in the lab. However, individuals who reported engaging in restrictive eating consumed fewer kilocalories when exposed to advertisements with warning labels (M = 170.33, SD = 120.78) versus no labels (M = 286.46, SD = 166.30), p = .008. Warning labels also had no protective effects after repeated exposure over 4 weeks on affect or eating disorder symptoms, and significantly increased appearance orientation (p = .001).

DISCUSSION

Warning labels on media images are unlikely to be an effective policy tool to prevent negative affect, body dissatisfaction, and eating disorder symptoms, and, in some cases, may exacerbate these concerns.

The moderating role of self-compassion on weight and shape concerns and eating pathology: A longitudinal study

OBJECTIVE

The present study employed a longitudinal design to examine the moderating role of self-compassion in the relationship between weight/shape concerns and the outcomes of eating pathology and stress in a diverse college student population.

METHOD

Participants were 765 students who completed measures of self-compassion, weight/shape concerns, eating pathology, and stress over their first 2 years of college. We tested whether self-compassion attenuated the relation between weight/shape concerns at the beginning of college and eating pathology, and stress later in college.

RESULTS

For the first year of college, self-compassion significantly moderated the relationship of weight/shape concerns and eating pathology. For participants who were low in self-compassion, there was a stronger relationship between weight/shape concerns and disordered eating; whereas, for individuals high in self-compassion, there was a weaker relationship between weight/shape concerns and disordered eating. However, these findings did not replicate for the second year of college. Self-compassion also significantly moderated the relationship between weight/shape concerns and stress for the first year of college, though the relationship was complex and warrants further research.

DISCUSSION

Our findings suggest that high self-compassion may reduce the likelihood that undergraduate students with weight/shape concerns will engage in disordered eating behavior in the first year of college. They also highlight the influence of self-compassion on general stress.

Family histories of anxiety in overweight men and women with binge eating disorder: A preliminary investigation

OBJECTIVE

A preliminary examination of the significance of family histories of anxiety in the expression of binge eating disorder (BED) and associated functioning.

METHODS

Participants were 166 overweight patients with BED assessed using diagnostic interviews. Participants were administered a structured psychiatric history interview about their first-degree relatives (parents, siblings, children) (N=897) to determine lifetime diagnoses of DSM-IV anxiety disorders and completed a battery of questionnaires assessing current and historical eating and weight variables and associated psychological functioning (depression).

RESULTS

BED patients with a family history of anxiety disorder were significantly more likely than BED patients without a family history of anxiety disorder to have lifetime diagnoses of anxiety disorders and mood disorders but not substance use disorders. A family history of anxiety was not significantly associated with timing or sequencing of age at onset of anxiety disorder, binge eating, dieting, or obesity, or with variability in current levels of binge eating, eating disorder psychopathology, or psychological functioning.

CONCLUSIONS

Although replication with direct interview method is needed, our preliminary findings suggest that a family history of anxiety confers greater risk for comorbid anxiety and mood disorders but is largely unrelated to the development of binge eating, dieting, or obesity and unrelated to variability in eating disorder psychopathology or psychological functioning in overweight patients with BED.

Development and validation of the eating loss of control scale

Recurrent objective bulimic episodes (OBE) are a defining diagnostic characteristic of binge eating disorder (BED) and bulimia nervosa (BN). OBEs are characterized by experiencing loss of control (LOC) while eating an unusually large quantity of food. Despite nosological importance and complex heterogeneity across patients, measurement of LOC has been assessed dichotomously (present/absent). This study describes the development and initial validation of the Eating Loss of Control Scale (ELOCS), a self-report questionnaire that examines the complexity of the LOC construct. Participants were 168 obese treatment-seeking individuals with BED who completed the Eating Disorder Examination interview and self-report measures. Participants rated their LOC-related feelings or behaviors on continuous Likert-type scales and reported the number of LOC episodes in the past 28 days. Principal component analysis identified a single-factor, 18-item scale, which demonstrated good internal reliability (α = .90). Frequency of LOC episodes was significantly correlated with frequency of OBEs and subjective bulimic episodes. The ELOCS demonstrated good convergent validity and was significantly correlated with greater eating pathology, greater emotion dysregulation, greater depression, and lower self-control but not with body mass index. The findings suggest that the ELOCS is a valid self-report questionnaire that may provide important clinical information regarding experiences of LOC in obese persons with BED. Future research should examine the ELOCS in other eating disorders and nonclinical samples.

Interpersonal problems and developmental trajectories of binge eating disorder

OBJECTIVE

The aim of the present study was to explore associations between specific interpersonal constructs and the developmental progression of behaviors leading to binge eating disorder (BED).

METHOD

Eighty-four consecutively evaluated, treatment-seeking obese (body mass index ≥30 kg/m(2)) men and women with BED were assessed with structured diagnostic and clinical interviews and completed a battery of established measures to assess the current and developmental eating- and weight-related variables as well as interpersonal functioning.

RESULTS

Using the interpersonal circumplex structural summary method, amplitude, elevation, the affiliation dimension, and the quadratic coefficient for the dominance dimension were associated with eating- and weight-related developmental variables. The amplitude coefficient and more extreme interpersonal problems on the dominance dimension (quadratic)-that is, problems with being extremely high (domineering) or low in dominance (submissive)-were significantly associated with a younger age at onset of binge eating, BED, and overweight as well as accounted for significant variance in age at binge eating, BED, and overweight onset. Greater interpersonal problems with having an overly affiliative interpersonal style were significantly associated with and accounted for significant variance in a younger age at diet onset.

DISCUSSION

Findings provide further support for the importance of interpersonal problems among adults with BED and converge with recent work highlighting the importance of specific types of interpersonal problems for understanding heterogeneity and different developmental trajectories of individuals with BED.

Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology

OBJECTIVE

Research has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED.

METHODS

Participants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures.

RESULTS

Social anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint.

DISCUSSION

Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.

Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning

OBJECTIVE

Widespread bias against obese individuals may lead to the internalization of weight bias in obese persons. This study examined correlates of internalized weight bias (IWB) in obese patients with binge eating disorder (BED).

METHOD

One hundred treatment-seeking obese patients with BED were administered with the eating disorders examination interview and questionnaires assessing IWB, fat phobia, depression, and self-esteem.

RESULTS

The mean IWB score in this group of patients with BED was significantly greater than the mean IWB score observed previously in a community sample of overweight adults. IWB was positively associated with eating disorder psychopathology, fat phobia, and depression, and negatively associated with self-esteem. IWB made significant independent contributions to the variance in eating disorder psychopathology even after accounting for fat phobia, depression, and self-esteem.

DISCUSSION

Treatment-seeking obese patients with BED demonstrate high levels of IWB. IWB may contribute to the variance in eating disorder psychopathology in BED patients, beyond the contributions of fat phobia, depression, and self-esteem.

Parental substance use history of overweight men and women with binge eating disorder is associated with distinct developmental trajectories and comorbid mood disorder

OBJECTIVE

To examine the significance of parental histories of substance use disorders (SUDs) in the expression of binge eating disorder (BED) and associated functioning.

METHOD

Participants were 127 overweight patients with BED assessed using diagnostic interviews. Participants were administered a structured psychiatric history interview about their parents (N = 250) and completed a battery of questionnaires assessing current and historical eating and weight variables and associated psychological functioning (depression and self-esteem).

RESULTS

Patients with BED with a parental history of SUD were significantly more likely to start binge eating before dieting, had a significantly earlier age at BED onset, and reported less time between binge eating onset and meeting diagnostic criteria for BED than did patients without a parental history of SUD. For psychiatric comorbidity, patients with BED with a parental history of SUD were significantly more likely to meet the criteria for a mood disorder. A parental history of SUD was not significantly associated with variability in current levels of binge eating, eating disorder psychopathology, or psychological functioning.

DISCUSSION

Our findings suggest that a parental history of SUD is associated with certain distinct trajectories in the development of binge eating (earlier binge onset predating dieting onset) and with elevated rates of comorbidity with mood disorders in patients with BED.

Predictive significance of changes in dietary restraint in obese patients with binge eating disorder during treatment

OBJECTIVE

To examine whether changes in different aspects of dietary restraint in obese patients with binge eating disorder (BED) participating in a treatment study predict outcomes.

METHOD

Fifty obese patients with BED in a randomized controlled study of orlistat administered with cognitive-behavioral therapy, guided-self-help (CBTgsh) completed dietary restraint measures at baseline, during- and post-treatment, and three-month follow-up.

RESULTS

Change in the restraint scale of the Eating Disorder Examination-Questionnaire did not predict binge abstinence or 5% weight loss. Increased flexible restraint subscale of the Three Factor Eating Questionnaire (TFEQ) during treatment significantly predicted binge abstinence at post-treatment and three-month follow-up and 5% weight loss at post-treatment. Change in the rigid restraint subscale of the TFEQ predicted binge abstinence at post-treatment.

DISCUSSION

Our findings clarify further pathologic and adaptive aspects of restraint and suggest the importance of enhancing flexible restraint in order to improve both binge eating and weight loss outcomes.

Exploring weight gain in year before treatment for binge eating disorder: a different context for interpreting limited weight losses in treatment studies

OBJECTIVE

To examine weight changes in obese patients with binge-eating disorder (BED) during the year before seeking treatment and to explore correlates of weight changes.

METHOD

Seventy-eight consecutive, treatment-seeking, obese BED patients were assessed with structured interviews and self-report questionnaires.

RESULTS

Overall, participants reported a mean weight gain of 15.1 pounds during the 12 months before treatment. This overall weight gain comprised remarkable heterogeneity, ranging from a 30-pound loss to a 53-pound gain. The subgroup of participants who reported gaining weight (76% of sample) reported gaining an average of 22.2 pounds during the 12 months before treatment. Weight change was associated with significantly more frequent binge eating and overeating during breakfasts.

DISCUSSION

Treatment-seeking obese patients with BED reported having gained substantial amounts of weight during the previous year. These findings provide an important context for interpreting the modest weight losses typically reported by treatment studies of BED.

Exploring pretreatment weight trajectories in obese patients with binge eating disorder

Treatments for obese patients with binge eating disorder (BED) typically report modest weight losses despite substantial reductions in binge eating. Although the limited weight losses represent a limitation of existing treatments, an improved understanding of weight trajectories before treatment may provide a valuable context for interpreting such findings. The current study examined the weight trajectories of obese patients in the year before enrollment in primary care treatment for BED. Participants were a consecutive series of 68 obese patients with BED recruited from primary care centers. Doctoral-level clinicians administered structured clinical interviews to assess participants' weight history and eating behaviors. Participants also completed a self-report measure assessing eating and weight. Overall, participants reported a mean weight gain of 9.5 lb in the past year, although this overall average comprised remarkable heterogeneity in patterns of weight changes, which ranged from losing 40 lb to gaining 62 lb. Most participants (65%) gained weight, averaging 22.5 lb. Weight gain was associated with more frequent binge eating episodes and overeating at various times. Most obese patients with BED who present to treatment in a primary care setting reported having gained substantial amounts of weight during the previous year. Such weight trajectory findings suggest that the modest amounts of weight losses typically reported by treatment studies for this specific patient group may be more positive than previously thought. Specifically, although the weight losses typically produced by treatments aimed at reducing binge eating seem modest, they could be reinterpreted as potentially positive outcomes given that the treatments might be interrupting the course of recent and large weight gains.