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Haderlein TP, Hamilton AB, Masheb RM, Mullur R, Lam CA, Washington DL. Racial and Ethnic Variation in Healthcare Utilization Before and During the COVID-19 Pandemic: Differential Effects for Overall Versus Telehealth Care. J Gen Intern Med 2024; 39:886-888. [PMID: 38228985 PMCID: PMC11043243 DOI: 10.1007/s11606-023-08592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Taona P Haderlein
- VHA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, 11301 Wilshire Blvd, Bldg 206 (151), Los Angeles, CA, 90073, USA.
- Veterans Emergency Management Evaluation Center, U.S Department of Veterans Affairs, North Hills, CA, USA.
| | - Alison B Hamilton
- VHA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, 11301 Wilshire Blvd, Bldg 206 (151), Los Angeles, CA, 90073, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rashmi Mullur
- Telehealth Service, VA Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | | | - Donna L Washington
- VHA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, 11301 Wilshire Blvd, Bldg 206 (151), Los Angeles, CA, 90073, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Siegel SE, Ranney RM, Masheb RM, Huggins J, Maguen S. Associations between posttraumatic stress disorder and eating disorder symptoms among women veterans. Eat Behav 2024; 52:101851. [PMID: 38324959 DOI: 10.1016/j.eatbeh.2024.101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Recent research suggests high rates of posttraumatic stress disorder (PTSD) and eating disorder (ED) comorbidity in women veterans. This study aims to expand the literature by examining associations between PTSD and ED diagnoses and symptoms in this population. We assessed probable PTSD diagnosis and symptom clusters (intrusion, avoidance, arousal and reactivity, and negative alterations in cognition and mood [NACM]), as well as probable Binge Eating Disorder (BED) diagnosis and ED subscales (dietary restraint, shape/weight overvaluation, and body dissatisfaction) in a sample of women veterans (N = 371). We investigated significance at the standard p < .05, and the Bonferroni-corrected p < .005 cut-off to adjust for experiment-wise error. Overall, we found that probable PTSD was associated with provisional BED (p < .001) using logistic regression at both cut-offs. Probable PTSD was associated with all ED subscales (all p's < 0.003) using linear regression models also at both cut-offs. Provisional BED was associated with NACM at p < .05 (p = .046), though it did not meet significance at our conservative cut-off. NACM was also associated with shape/weight overvaluation (p = .02) and a global ED score (p = .01) at p < .05, but not at our conservative cut-off; arousal was associated with shape/weight overvaluation (p = .04) and the global ED score (p = .02) at p < .05, but not at our conservative cut-off. Our findings may further guide how ED-related topics can be integrated in PTSD treatment for women veterans with comorbid PTSD and ED.
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Affiliation(s)
- Sarah E Siegel
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA.
| | - Rachel M Ranney
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, 4150 Clement St, San Francisco, CA 94121, USA
| | - Robin M Masheb
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Yale School of Medicine, New Haven, CT, USA
| | - Joy Huggins
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA
| | - Shira Maguen
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA
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Maguen S, Batten A, Siegel SE, Huggins J, Snow JL, Fenn LM, Dick AM, Zenteno C, West AC, Masheb RM. Validation of the EDDS-5 self-report survey against the SCID-5 diagnostic interview in US veterans. Eat Behav 2024; 52:101846. [PMID: 38335645 DOI: 10.1016/j.eatbeh.2024.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
The aim of our study was to validate the Eating Disorder Diagnostic Scale (EDDS-5) updated for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with a diverse veteran population against a clinician-administered interview based on the Structured Clinical Interview for DSM-5 (SCID-5). Our sample included 343 veterans, 18-75 years, recruited April 2019 to December 2022 who completed the EDDS-5 as well as other eating disorder and mental health measures. A subsample of these veterans received clinical interviews (n = 166), which were used to validate the EDDS-5. We found that despite multiple proposed modifications, the EDDS-5 performed poorly at correctly identifying diverse veterans who were diagnosed as having eating disorders through clinician-administered interviews. The sensitivity was very low, indicating that using the EDDS-5 did not identify many true positives and may also over diagnose those without true eating disorders. The EDDS-5 may not be the best for screening or diagnostic purposes among diverse samples like veterans.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA.
| | - Adam Batten
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | - Sarah E Siegel
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | - Joy Huggins
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | | | | | | | | | | | - Robin M Masheb
- VA Connecticut Healthcare System, USA; Yale School of Medicine, New Haven, CT, USA
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Masheb RM, Vernarelli JA, Snow JL, Marsh AG, Ciszewski S, Dudley B, White CA, Purcell SA, Lutes L. The 24-hour food frequency assessment screening tool (FAST24): Development and evaluation of a novel dietary screener to identify foods associated with weight change. Clin Nutr ESPEN 2023; 57:735-738. [PMID: 37739731 DOI: 10.1016/j.clnesp.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Brief screening questionnaires can identify 'at risk' behaviors in clinical settings. However, there is currently no screener for dietary intake specifically developed using foods associated with body weight change and increased risk for multiple chronic conditions and diseases. METHODS We developed a novel brief dietary screener, the 24-Hour Food Frequency Assessment Screening Tool Questionnaire (FAST24), to identify intake of foods associated with weight change. University students completed the FAST24 and the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) at two time points to assess acceptability and determine preliminary criterion validity against food categories from the United States Department of Agriculture (USDA) Food Patterns Equivalents Database (FPED). RESULTS 202 individuals (age 20.4 ± 3.6 years; 65.7% females) completed the FAST24 in an average time of 2 min compared to 24 min for the ASA24. Over half of the food items from the FAST24 were matched to, and correlated with, standard USDA food pattern components (r's ranging from .15 to .58, p's < .05). Food items from the dietary data from the FAST24 were also highly correlated with the more intensive ASA24 application (r's ranging from .23 to .82, p's < .01), and were less time-consuming and burdensome to complete (p's < .0001). CONCLUSIONS Findings support the continued refinement of the FAST24 as a rapid, valid primary care assessment tool for measuring USDA dietary intake patterns. Use of a short, simple screener such as the FAST24 has the potential for integration into large healthcare delivery settings to help establish a baseline for promoting relative behavior changes critical for long-term health and well-being.
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Affiliation(s)
- Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs, West Haven, CT, USA.
| | | | | | - Alison G Marsh
- U.S. Department of Veterans Affairs, West Haven, CT, USA
| | - Stefanie Ciszewski
- Department of Psychology, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Brooke Dudley
- Department of Psychology, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Carmela A White
- Department of Psychology, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Sarah A Purcell
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Biology, Irving K. Barber Faculty of Science, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Lesley Lutes
- Department of Psychology, University of British Columbia, Okanagan, Kelowna, BC, Canada
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Carr MM, Lou R, Macdonald-Gagnon G, Peltier MR, Funaro MC, Martino S, Masheb RM. Weight change among patients engaged in medication treatment for opioid use disorder: a scoping review. Am J Drug Alcohol Abuse 2023; 49:551-565. [PMID: 37200510 PMCID: PMC10840392 DOI: 10.1080/00952990.2023.2207720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
Background: Medication treatment for opioid use disorder (MOUD) is an instrumental tool in combatting opioid use and overdose. Excess weight gain associated with MOUD initiation is a potential barrier that is not well understood.Objectives: Conduct a scoping review of available studies investigating the effect of MOUD on weight.Methods: Included studies consisted of adults taking any type of MOUD (e.g. methadone, buprenorphine/naloxone, naltrexone) with data on weight or body mass index for at least two time points. Evidence was synthesized using qualitative and descriptive approaches, and predictors of weight gain including demographics, comorbid substance use, and medication dose were examined.Results: Twenty-one unique studies were identified. Most studies were uncontrolled cohort studies or retrospective chart reviews testing the association between methadone and weight gain (n = 16). Studies examining 6 months of methadone treatment reported weight gain ranging from 4.2 to 23.4 pounds. Women appear to gain more weight from methadone than men, while patients using cocaine may gain less. Racial and ethnic disparities were largely unexamined. Only three case reports and two nonrandomized studies examined the effects of either buprenorphine/naloxone or naltrexone, and potential associations with weight gain were not clear.Conclusion: The use of methadone as an MOUD appears to be associated with mild to moderate weight gain. In contrast, there is little data supporting or refuting weight gain with buprenorphine/naloxone or naltrexone. Providers should discuss the potential risk for weight gain with patients as well as prevention and intervention methods for excess weight gain.
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Affiliation(s)
- Meagan M. Carr
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Raissa Lou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - MacKenzie R. Peltier
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Melissa C. Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Steve Martino
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robin M. Masheb
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Ramsey CM, Gaffey AE, Brandt CA, Haskell SG, Masheb RM. Depression, Insomnia, and Obesity Among Post-9/11 Veterans: Eating Pathology as a Distinct Health Risk Behavior. Mil Med 2023; 188:921-927. [PMID: 35726626 DOI: 10.1093/milmed/usac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 05/27/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Understanding the interrelationships between co-occurring chronic health conditions and health behaviors is critical to developing interventions to successfully change multiple health behaviors and related comorbidities. The objective of the present study was to examine the effects of depression, insomnia, and their co-occurrence on risk of obesity and to examine the role of health risk behaviors as potential confounders of these relationships with an emphasis on eating pathologies. METHODS Iraq and Afghanistan conflict era veterans (n = 1,094, 51.2% women) who participated in the Women Veterans Cohort Study between July 2014 and September 2019 were categorized as having depression, insomnia, both, or neither condition. Logistic regression models were used to examine group differences in the risk of obesity. Health risk behaviors (i.e., eating pathology, physical activity, smoking, and hazardous drinking) were then assessed as potential confounders of the effects of depression and insomnia on the likelihood of obesity. RESULTS Obesity was most prevalent in individuals with co-occurring insomnia and depression (53.2%), followed by depression only (44.6%), insomnia only (38.5%), and neither condition (30.1%). Importantly, maladaptive eating behaviors confounded the depression-obesity association but not the insomnia-obesity association. There was no evidence that insufficient physical activity, smoking, or hazardous drinking confounded the effects of insomnia or depression on obesity. CONCLUSIONS These findings exemplify the complex relationships between multiple health conditions and behaviors that contribute to obesity. Elucidating these associations can enhance the precision with which interventions are tailored to efficiently allocate resources and reduce the severe health impact of obesity among veterans.
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Affiliation(s)
- Christine M Ramsey
- Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19130, USA
| | - Allison E Gaffey
- PRIME Center of Innovation, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Cynthia A Brandt
- PRIME Center of Innovation, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Sally G Haskell
- PRIME Center of Innovation, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Robin M Masheb
- PRIME Center of Innovation, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
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Crosky S, McFarlin M, Sullivan N, Winograd D, Litke D, Masheb RM, Lu SE, Costanzo M, Anastasides N, Gonzalez C, Doshi J, Graff F, Khatib L, Thien S, McAndrew LM. Randomized controlled trial protocol of health coaching for veterans with complex chronic pain. Trials 2023; 24:239. [PMID: 36997946 PMCID: PMC10061706 DOI: 10.1186/s13063-023-07113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Pain predominant multisymptom illness (pain-CMI) refers to symptom-based conditions where pain is a primary symptom. There is initial evidence that health coaching may be efficacious in treating pain-CMI because it can be tailored to the veteran's goals and emphasizes long-term behavior change, which may indirectly impact the maintaining factors of pain-CMI (e.g., catastrophizing, poor pain control, and limited activity). This paper describes the study protocol and rationale of a randomized controlled trial that will compare the efficacy of remote-delivered health coaching in reducing disability and pain impairment for veterans with pain-CMI to remote-delivered supportive psychotherapy. METHODS This randomized controlled trial will consist of two treatment arms: remote-delivered health coaching and remote-delivered supportive psychotherapy, the active control. Each treatment condition will consist of twelve, weekly one-on-one meetings with a study provider. In addition to the baseline assessment, participants will also complete 6-week (mid-treatment), 12-week (post-treatment), and 24-week (follow-up) assessments that consist of questionnaires that can be completed remotely. The primary aims for this study are to determine whether health coaching reduces disability and pain impairment as compared to supportive psychotherapy. We will also examine whether health coaching reduces physical symptoms, catastrophizing, limiting activity, and increasing pain control as compared to supportive psychotherapy. DISCUSSION This study will contribute to the existing literature on pain-CMI and report the effectiveness of a novel, remote-delivered behavioral intervention.
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Affiliation(s)
- Sarah Crosky
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, USA
| | - Mikhaela McFarlin
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, USA
| | - Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Darren Winograd
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, USA
| | - David Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06610, USA
| | - Shou-En Lu
- Epidemiology and Statistics, School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| | - Michelle Costanzo
- War Related Illness and Injury Study Center, Washington DC VA Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Christina Gonzalez
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Jaineel Doshi
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Fiona Graff
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Linda Khatib
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Scott Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA.
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Masheb RM, Snow JL, Fenn LM, Antoniadis NE, Raffa SD, Ruser CB, Buta E. Development and Psychometric Assessment of the Weight and Eating Quality of Life (WE-QOL) Scale in US Military Veterans. J Gen Intern Med 2023:10.1007/s11606-023-08132-4. [PMID: 36973571 PMCID: PMC10361921 DOI: 10.1007/s11606-023-08132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The Veterans Health Administration (VHA) is in need of population health approaches to address overweight and obesity-related diseases. BMI serves as a simple, blunt metric to monitor these efforts. However, emerging research has demonstrated that healthcare weigh-ins contribute to weight stigma which paraodoxically is associated with weight gain. An alternative metric is urgently needed for VHA's MOVE!® Weight Management Program and other eating- and weight-related services. OBJECTIVE To develop a brief population health metric called the Weight and Eating Quality of Life (WE-QOL) Scale and assess its psychometric properties. DESIGN The literature was reviewed for relevant weight- and eating-specific QOL measures to identify unique and overlapping constructs. Eight items, representing these constructs, comprised the new brief WE-QOL Scale. A survey study was conducted with data analyzed in STATA. PARTICIPANTS A total of 213 consecutively evaluated US Veterans attending an orientation session for MOVE!. MAIN MEASURES The WE-QOL Scale, as well as a widely used generic health-related QOL measure, the European Quality of Life Screener (EQ-ED-5L), and relevant validated measures. KEY RESULTS WE-QOL descriptive findings demonstrated severe impacts on physical activity and physical discomfort for approximately 30% of the sample each; moderate-to-severe impacts on daily responsibilities, emotional distress, and shame and guilt for one-third of the sample each and public distress for one-fourth of the sample. The WE-QOL Scale performed as well as, or better than, the EQ-ED-5L for internal consistency (Cronbach's alpha = 0.91) and associations to relevant constructs (BMI, eating pathology, and physical activity). CONCLUSIONS Findings support the reliability and construct validity of the WE-QOL Scale. The WE-QOL Scale has potential to provide a standardized population health metric that could be used as a screening tool and clinical reminder to identify, refer, and assess outcomes for Veterans with weight and disordered eating issues. Future research could be targeted at using this measure to improve patient care and quality of care.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System West Haven VA Medical Center, West Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
| | - Jennifer L Snow
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System West Haven VA Medical Center, West Haven, CT, USA
| | - Lindsay M Fenn
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System West Haven VA Medical Center, West Haven, CT, USA
| | - Nicole E Antoniadis
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System West Haven VA Medical Center, West Haven, CT, USA
| | - Susan D Raffa
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Christopher B Ruser
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System West Haven VA Medical Center, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
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Carr MM, Serowik KL, Na PJ, Potenza MN, Martino S, Masheb RM, Pietrzak RH. Co-occurring alcohol use disorder and obesity in U.S. military veterans: Prevalence, risk factors, and clinical features. J Psychiatr Res 2022; 150:64-70. [PMID: 35358833 DOI: 10.1016/j.jpsychires.2022.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Obesity and alcohol use disorder (AUD) are two of the most prevalent and costly clinical conditions among U.S. military veterans, and these conditions often co-occur. However, little is known about the clinical correlates of co-occurring obesity and AUD, which is critical to informing effective interventions. The current study analyzed data from a nationally representative sample of 4069 (3463 males, 479 females) veterans, who completed an online survey. The Alcohol Use Disorder Identification Test was used to identify veterans who screened positive for probable AUD (pAUD) and self-reported height and weight was used to calculate body mass index and identify veterans with obesity. Multinomial logistic regression was used to examine differences between four groups: controls (no current AUD or obesity), pAUD only, obesity only, and pAUD + obesity. A total of 1390 (36.1%) veterans had obesity, 10.5% (n = 359) had pAUD, and 3.7% (n = 124) had pAUD and obesity. Relative to veterans without AUD, Veterans with pAUD were less likely to have normal/lean weight (14.6% versus 21.4%) and more likely to have overweight (49.6% versus 41.7%). Veterans with pAUD + obesity were nearly twice as likely than veterans with pAUD to report three or more adverse childhood experiences. The results of this study help inform the clinical presentation and needs of veterans with co-occurring obesity and AUD. They also underscore the importance of regularly monitoring weight among veterans with AUD, and considering the role of childhood adversity as a risk factor for co-occurring AUD and obesity.
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Affiliation(s)
- Meagan M Carr
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA.
| | - Kristin L Serowik
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; Department of Neuroscience, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; Child Study Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Steve Martino
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Robin M Masheb
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave., New Haven, CT, 06516, USA; Department of Social and Behavioral Sciences, Yale School of Medicine, 60 College St., New Haven, CT, 06510, USA
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11
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Etuk R, Shirk SD, Klein KM, Masheb RM, Potenza MN, Park CL, Keeler K, Kraus SW. Examining the Clinical Correlates of Overeating and Binge-Eating Behaviors Among U. S. Veterans. Mil Med 2021; 187:297-303. [PMID: 34962274 DOI: 10.1093/milmed/usab533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/26/2021] [Accepted: 12/15/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Pressure to meet U.S. military weight requirements during service may predispose some service members to develop psychiatric disorders such as eating disorders or unhealthy eating behaviors, which may persist after military discharge. Specifically, research examining U.S. military veterans has found that in weight management programs, veterans with binge-eating behaviors have shown poor treatment outcomes. Overall, previous research suggests that veterans experience considerable and persistent disordered eating problems, and in addition may experience a higher prevalence of disordered eating in comparison to the general U.S. population. Research on Post-9/11 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans is needed as this group frequently presents with high rates of medical and psychiatric disorders. The current study used clinician-administered structured interviews to examine relationships between psychiatric, health, and demographic variables in a sample of Post-9/11 OEF/OIF/OND veterans with binge-eating or overeating behavior or neither. MATERIALS AND METHODS This article presents secondary analyses of the baseline phase from data obtained for the Survey of the Experiences of Returning Veterans. Using structured phone interviews, we cross-sectionally examined patterns of medical comorbidities between sociodemographic, health, eating, and psychiatric variables in 846 recently deployed U.S. veterans with binge-eating behaviors (reporting both overeating and loss of control [LOC] eating), overeating behaviors (overeating without LOC), or healthy controls (absence of any disordered eating). Study procedures were approved by the Department of Veterans Affairs (VA) Institutional Review Boards, and informed consent was obtained from the participants. A series of chi-square and analysis of variance tests revealed significant bivariate between-group differences in sociodemographic, health, eating, and psychiatric variables. Variables with significant group differences (P < .05) were entered into a multinomial logistic regression to examine relationships between psychiatric, health, and eating factors and binge-eating severity. RESULTS Results of the multinomial logistic regression analysis showed that women relative to men were less likely to overeat. When comparing the binge-eating group and controls, higher body mass index was associated with higher odds of binge eating. Furthermore, for the overeating group in comparison to controls, fasting behavior was associated with higher odds of overeating. For the psychiatric variables, the binge-eating and overeating groups were associated with higher rates of compulsive buying when compared to healthy controls. Additionally, the overeating group was associated with higher rates of alcohol dependence. Lastly, binge-eating and overeating behaviors were positively associated with specific psychiatric and health comorbidities. CONCLUSIONS Further research is needed to inform the development of effective treatments for disordered eating problems, as evidenced by an anticipated increase of veterans entering the VA healthcare system and the high rate of binge eating observed in our study and prior research in Post-9/11 veterans. Moreover, our study findings suggest the relevance of screening veterans for compulsive buying. This study was limited by its relatively small sample which only examined disordered eating behaviors. Future studies could simultaneously explore binge-eating behaviors and binge-eating disorder diagnoses in larger samples. Study strengths include a diverse sample of Post-9/11 veterans with sizable female representation.
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Affiliation(s)
- Repairer Etuk
- Department of Psychology, University of Nevada, Las Vegas, NV 89154-5030, USA
| | - Steven D Shirk
- VISN 1 New England MIRECC, Bedford Healthcare System, Bedford, MA 01730, USA.,Department of Psychiatry and Population and Quantitative Health Sciences Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Kelly M Klein
- Department of Veterans Affairs, Brockton Division, VA Boston Healthcare System, Boston, MA 02301, USA.,Department of Psychiatry, Harvard University Medical School, Boston, MA 02215, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA.,Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Crystal L Park
- Department of Psychological Science, University of Connecticut, Storrs, CT 06269, USA
| | - Kerri Keeler
- Department of Veterans Affairs, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV 89154-5030, USA
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12
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Masheb RM, Ramsey CM, Marsh AG, Decker SE, Maguen S, Brandt CA, Haskell SG. DSM-5 eating disorder prevalence, gender differences, and mental health associations in United States military veterans. Int J Eat Disord 2021; 54:1171-1180. [PMID: 33665848 DOI: 10.1002/eat.23501] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Little is known about prevalence estimates of new and revised DSM-5 eating disorders diagnoses in general, and especially among high-risk, underserved and diverse eating disorder populations. The aim of the current study was to determine prevalence, gender differences and correlates of DSM-5 eating disorders in veterans. METHOD Iraq and Afghanistan war era veterans (N = 1,121, 51.2% women) completed the Eating Disorder Diagnostic Scale-5 and validated measures of eating pathology and mental health between July 2014 and September 2019. RESULTS Overall more women than men (32.8% vs. 18.8%, p < .001) reported symptoms consistent with a DSM-5 eating disorder. Prevalence estimates (women vs. men) for the specific diagnoses were: Anorexia Nervosa (AN; 0.0% vs. 0.0%), Bulimia Nervosa (BN; 6.1% vs. 3.5%), Binge-Eating Disorder (BED; 4.4% vs. 2.9%), Atypical AN (AAN; 13.6% vs. 4.9%), Subclinical BN (0.0% vs. 0.2%), Subclinical BED (1.4% vs. 0.6%), Purging Disorder (2.1% vs. 0.7%), and Night Eating Syndrome (NES; 5.2% vs. 6.0%). Women were more likely to have BN or AAN, and there was no difference for BED or NES among genders. The eating disorder group had a higher mean BMI, and significantly greater eating pathology and mental health symptoms than the non-eating disorder group. DISCUSSION Approximately one-third of women, and one-fifth of men, reported symptoms consistent with a DSM-5 eating disorder diagnosis. These high prevalence estimates across genders, and associated mental health concerns, suggest an urgent need to better understand and address eating disorders in military and veteran populations.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Christine M Ramsey
- Yale School of Medicine, New Haven, Connecticut, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Alison G Marsh
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Suzanne E Decker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Shira Maguen
- University of California San Francisco Medical School, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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13
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Masheb RM, Ramsey CM, Marsh AG, Snow JL, Brandt CA, Haskell SG. Atypical Anorexia Nervosa, not so atypical after all: Prevalence, correlates, and clinical severity among United States military Veterans. Eat Behav 2021; 41:101496. [PMID: 33711788 DOI: 10.1016/j.eatbeh.2021.101496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/11/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE DSM-5 Atypical Anorexia Nervosa (AAN), a new eating disorder diagnosis, presents similarly to Anorexia Nervosa (AN) in the absence of severe underweight. The prevalence of AAN and other DSM-5 eating disorders was estimated in a sample of Veterans. Sociodemographic, mental health, and eating behavior correlates were examined. METHOD Iraq and Afghanistan war era Veterans (N = 1137, 51.6% female) completed the Eating Disorder Diagnostic Scale-5 for probable AAN diagnosis, and validated measures of eating pathology and mental health, between February 2016 and October 2019. Multivariate analyses compared Veterans with AAN to those with and without any DSM-5 eating disorder. RESULTS Among completers, 13.6% of women and 4.9% of men in the sample met criteria for probable AAN and 19.2% of women and 13.9% of men for another eating disorder. Mean age was 41 years, and on average BMIs were classified as overweight (BMI = 28.8, SD = 5.6) despite being at least 10% lower than their lifetime highest weight. Two-thirds reported dietary restraint on more than half the days in the past month. On measures of mental health, the AAN group had worse functioning than the no eating disorder group, similar functioning to Veterans with Binge Eating Disorder (BED), and better functioning than Veterans with Bulimia Nervosa (BN). DISCUSSION Results support AAN as a highly prevalent and clinically significant diagnosis. Findings highlight the need to identify and address eating disorders, particularly other specified eating disorders not meeting criteria for AN, BN, or BED, in active military and Veteran, and other high-risk and underserved, populations.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America.
| | - Christine M Ramsey
- Yale School of Medicine, New Haven, CT, United States of America; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
| | - Alison G Marsh
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Jennifer L Snow
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America
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14
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Grilo CM, White MA, Masheb RM, Ivezaj V, Morgan PT, Gueorguieva R. Randomized controlled trial testing the effectiveness of adaptive "SMART" stepped-care treatment for adults with binge-eating disorder comorbid with obesity. ACTA ACUST UNITED AC 2021; 75:204-218. [PMID: 32052995 DOI: 10.1037/amp0000534] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This randomized controlled trial (RCT) tested effectiveness of adaptive SMART stepped-care treatment to "standard" behavioral weight loss (BWL [standard]) for patients with binge-eating disorder (BED) and obesity. One hundred ninety-one patients were randomly assigned to 6 months of BWL (standard; n = 39) or stepped care (n = 152). Within stepped care, patients started with BWL for 1 month; treatment responders continued BWL, whereas nonresponders switched to cognitive-behavioral therapy (CBT), and patients receiving stepped care were additionally randomized to weight-loss medication or placebo (double-blind) for the remaining 5 months. Independent assessments were performed reliably at baseline, throughout treatment, and posttreatment. Intent-to-treat (ITT) analyses of remission rates (zero binges/month) revealed that BWL (standard) and stepped care did not differ (74.4% vs. 66.5%); within stepped care, remission rates ranged 40.0% to 83.3%, with medication significantly superior to placebo (overall) and among nonresponders switched to CBT. Mixed-models analyses of binge-eating frequency revealed significant time effects, but BWL (standard) and stepped care did not differ; within stepped care, medication was significantly superior to placebo and among nonresponders switched to CBT. Mixed models revealed significant weight loss, but BWL (standard; 5.1% weight-loss) and stepped care (5.8% weight-loss) did not differ; within stepped care (range = 0.4% to 8.8% weight-loss), medication was significantly superior to placebo and among both responders continued on BWL and nonresponders switched to CBT. In summary, BWL (standard) and adaptive stepped-care treatments produced robust improvements in binge eating and weight loss in patients with BED/obesity. Within adaptive stepped care, weight-loss medication enhanced outcomes for BED/obesity. Implications for clinical practice and future adaptive designs are offered. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
| | - Marney A White
- Department of Social and Behavioral Sciences, Yale University School of Public Health
| | - Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine
| | | | - Peter T Morgan
- Department of Psychiatry, Yale University School of Medicine
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15
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Masheb RM, Sala M, Marsh AG, Snow JL, Kutz AM, Ruser CB. Associations between adverse childhood experiences and weight, weight control behaviors and quality of life in Veterans seeking weight management services. Eat Behav 2021; 40:101461. [PMID: 33352386 DOI: 10.1016/j.eatbeh.2020.101461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A neglected area of trauma research with Veterans is the study of Adverse Childhood Experiences (ACEs). The present study aimed to examine the prevalence of ACEs, and to explore relationships between ACEs and measures of weight, eating behaviors and quality of life in weight loss seeking Veterans. METHODS Participants were 191 Veterans [mean age 58.9 (SD = 12.8), mean Body Mass Index (BMI) 35.4 (SD = 6.1), 86.9% male, 33.7% racial/ethnic minority] receiving care at VA Connecticut Healthcare System (VA CT) who attended an orientation session of VA's behavioral weight management program. Participants completed a measure of ACEs and measures related to weight, eating and health. RESULTS Among completers, 68.6% endorsed at least one ACE. The average number of reported ACEs was 2.2 (SD = 2.5), with 48.7% of Veterans reporting more than one type of ACE. Women were more likely to report any ACE (88.0% vs. 65.6%, p = .025) and reported significantly more ACEs compared to males (4.2 vs. 1.9, p < .001). ACEs were associated with lower physical activity (p = .05), lower quality of life (p's < 0.05), and lower weight-related quality of life (p < .01), but not weight, weight control strategies, binge eating, or alcohol use. CONCLUSION ACEs are common among weight loss seeking Veterans, particularly among female Veterans. Findings suggest that there is a high rate of ACEs in Veterans, which are associated with exercise and quality of life outcomes, but not diet and weight outcomes.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America; Yale University School of Medicine, 333 Cedar St., New Haven, CT 06610, United States of America.
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, United States of America.
| | - Alison G Marsh
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America.
| | - Jennifer L Snow
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America.
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States of America.
| | - Christopher B Ruser
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America; Yale University School of Medicine, 333 Cedar St., New Haven, CT 06610, United States of America.
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16
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Casu G, Gremigni P, Masheb RM. Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight. Eat Weight Disord 2020; 25:1747-1754. [PMID: 31782027 DOI: 10.1007/s40519-019-00821-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/15/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight. MATERIALS AND METHODS Participants were 314 Italian adults (72.6% females, aged 18-76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald's ω and ordinal α coefficients for internal consistency and Cohen's weighted Kappa coefficient (Kw) for test-retest reliability. RESULTS Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; Kw= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity. CONCLUSIONS EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level. LEVEL OF EVIDENCE Level V, cross-sectional, descriptive study.
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Affiliation(s)
- Giulia Casu
- Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127, Bologna, Italy
| | - Paola Gremigni
- Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127, Bologna, Italy.
| | - Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, 300 George St, New Haven, CT, 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
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17
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Kutz AM, Marsh AG, Gunderson CG, Maguen S, Masheb RM. Eating Disorder Screening: a Systematic Review and Meta-analysis of Diagnostic Test Characteristics of the SCOFF. J Gen Intern Med 2020; 35:885-893. [PMID: 31705473 PMCID: PMC7080881 DOI: 10.1007/s11606-019-05478-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Eating disorders affect upwards of 30 million people worldwide and often go undertreated and underdiagnosed. The purpose of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the Sick, Control, One, Fat and Food (SCOFF) questionnaire for DSM-5 eating disorders in the general population. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. A PubMed search was conducted among peer-reviewed articles. Information regarding validation of the SCOFF was required for inclusion. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS The final analysis included 25 studies. The validity of the SCOFF was high across samples with a pooled sensitivity of 0.86 (95% CI, 0.78-0.91) and specificity of 0.83 (95% CI, 0.77-0.88). Subgroup analyses were conducted to examine the impact of methodology, study quality, and clinical characteristics on diagnostic accuracy. Studies with the highest sensitivity tended to be case-control studies of young women with anorexia nervosa (AN) and bulimia nervosa (BN). Studies which included more men, included those diagnosed with binge eating disorder, and recruited from large community samples tended to have lower sensitivity. Few studies reported on BMI and race/ethnicity; thus, subgroups for these factors could not be examined. No studies used reference standards which assessed all DSM-5 eating disorders. CONCLUSION This meta-analysis of 25 validation studies demonstrates that the SCOFF is a simple and useful screening tool for young women at risk for AN and BN. However, there is not enough evidence to support utilizing the SCOFF for screening for the range of DSM-5 eating disorders in primary care and community-based settings. Further examination of the validity of the SCOFF or development of a new screening tool, or multiple tools, to screen for the range of DSM-5 eating disorders heterogenous populations is warranted. TRIAL REGISTRATION This study is registered online with PROSPERO (CRD42018089906).
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Affiliation(s)
- Amanda M Kutz
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | | | - Craig G Gunderson
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shira Maguen
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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18
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Masheb RM, Douglas ME, Kutz AM, Marsh AG, Driscoll M. Pain and emotional eating: further investigation of the Yale Emotional Overeating Questionnaire in weight loss seeking patients. J Behav Med 2020; 43:479-486. [PMID: 32107681 DOI: 10.1007/s10865-020-00143-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
Providers frequently report pain as a barrier to weight loss yet the relationship between the pain experience and eating behavior is poorly understood. The current study examines overeating in response to physical pain (Pain Overeating). Weight-loss seeking Veterans (N = 126) completed the Yale Emotional Overeating Questionnaire, a measure used to assess the frequency of overeating in response to a range of emotions that was adapted to include a Pain Overeating item, and validated measures of pain, eating pathology, and mental health. Fifty-one participants (42.5%) engaged in at least one Pain Overeating episode in the past month, and 14.2% engaged in this behavior daily. Pain Overeating was significantly related to pain intensity and interference, and accounted for statistically significant variance in predicting BMI, eating pathology and depression. Findings suggest eating in response to physical pain is common among weight-loss seeking Veterans and may have important implications for weight management treatment.
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Affiliation(s)
- Robin M Masheb
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA. .,Yale School of Medicine, 333 Cedar St., New Haven, CT, 06510, USA.
| | - Megan E Douglas
- Baylor Scott & White Institute for Rehabilitation, 909 N. Washington Ave, Dallas, TX, 75246, USA
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Alison G Marsh
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Mary Driscoll
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale School of Medicine, 333 Cedar St., New Haven, CT, 06510, USA
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19
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Masheb RM, Kutz AM, Marsh AG, Min KM, Ruser CB, Dorflinger LM. "Making weight" during military service is related to binge eating and eating pathology for veterans later in life. Eat Weight Disord 2019; 24:1063-1070. [PMID: 31471885 DOI: 10.1007/s40519-019-00766-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE "Making weight" behaviors are unhealthy weight control strategies intended to reduce weight in an effort to meet weight requirements. This study aimed to examine a brief measure of making weight and to investigate the relationship between making weight and weight, binge eating, and eating pathology later in life. METHODS Participants were veterans [N = 120, mean age 61.7, mean body mass index (BMI) 38.0, 89.2% male, 74.2% Caucasian] who were overweight/obese and seeking weight management treatment. Participants completed the making weight inventory (MWI), a measure of making weight behaviors engaged in during military service, and validated measures of eating behavior. Analyses compared participants who engaged in at least one making weight behavior (MWI+) versus those who did not (MWI-). RESULTS The MWI had good internal consistency. One-third of participants were MWI+ and two-thirds were MWI-. The most frequently reported behavior was excessive exercise, reported in one-quarter of the sample, followed by fasting/skipping meals, sauna/rubber suit, laxatives, diuretics, and vomiting. MWI+ participants were significantly more likely to be in a younger cohort of veterans, to be an ethnic/racial minority, and to engage in current maladaptive eating behaviors, including binge eating, vomiting, emotional eating, food addiction, and night eating, compared to the MWI- group. Groups did not differ on BMI. CONCLUSIONS One-third of veterans who were overweight/obese screened positive for engaging in making weight behaviors during military service. Findings provide evidence that efforts to "make weight" are related to binge eating and eating pathology later in life. Future research and clinical efforts should address how to best eliminate unhealthy weight control strategies in military service while also supporting healthy weight management efforts.
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Affiliation(s)
- Robin M Masheb
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Alison G Marsh
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Kathryn M Min
- Graduate Institute of Professional Psychology, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Christopher B Ruser
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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Dorflinger LM, Masheb RM. PTSD is associated with emotional eating among veterans seeking treatment for overweight/obesity. Eat Behav 2018; 31:8-11. [PMID: 30048898 DOI: 10.1016/j.eatbeh.2018.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022]
Abstract
Both obesity and post-traumatic stress disorder (PTSD) are common among veterans. Veterans with PTSD are at higher risk for obesity and have poorer outcomes in obesity treatment. We examined emotional eating among veterans presenting for obesity treatment, and its relationship with PTSD. Veterans completed questionnaire batteries before initiating treatment. Participants were 120 veterans with a mean age of 62 years and mean BMI of 38. A positive PTSD screen was associated with significantly higher scores on the Yale Emotional Overeating Questionnaire (YEOQ) overall, as well as higher scores on each individual item, which includes anxiety, sadness, loneliness, tiredness, anger, happiness, boredom, guilt, and physical pain (all p < 0.005). Higher scores on the PTSD screener were associated with more frequent emotional eating for all emotions as well. Findings suggest that emotional eating is common among veterans reporting PTSD symptoms, and that any degree of PTSD symptom severity is associated with more frequent emotional eating. Veterans with PTSD may need specific attention given to alternative coping strategies when facing difficult emotions as part of weight loss treatment.
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Affiliation(s)
| | - Robin M Masheb
- Yale School of Medicine, VA Connecticut Healthcare System, United States of America
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Godfrey KM, Bullock AJ, Dorflinger LM, Min KM, Ruser CB, Masheb RM. Pain and modifiable risk factors among weight loss seeking Veterans with overweight. Appetite 2018; 128:100-105. [PMID: 29885382 DOI: 10.1016/j.appet.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Overweight/obesity and chronic pain frequently co-occur and demonstrate a bidirectional relationship. Modifiable risk factors, such as eating behaviors and mental health symptoms, may be important to understand this relationship and improve interventions in Veterans. DESIGN Cross-sectional. SETTING Veterans Health Administration Medical Center outpatient clinic. SUBJECTS The sample of Veterans (N = 126) was mostly male (89.7%), White (76%), and non-Hispanic (94%) with average age of 61.9 years (SD = 8.5) and average body mass index (BMI) of 38.5 (SD = 7.5). METHODS Veterans referred for weight loss treatment (MOVE!) at VA Connecticut completed self-report questionnaires, and electronic medical records were reviewed. RESULTS Mean self-reported pain rating was 4.5 out of 10 (SD = 2.3). Moderate to severe pain was endorsed by 60% of the sample. Veterans with higher pain intensity and interference reported higher global eating disorder symptoms, emotional overeating, night eating, insomnia severity, and mental health symptoms (all p's < 0.01). However, pain intensity and interference were not associated with BMI. CONCLUSIONS For Veterans seeking behavioral weight loss treatment, higher pain intensity and interference were associated with more severe eating disorder, sleep, and mental health symptoms. A better description of the clinical characteristics of Veterans with pain who participate in MOVE! highlights their unique needs and may improve treatments to address pain in the context of weight loss treatment.
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Affiliation(s)
- Kathryn M Godfrey
- The Drexel University Center for Weight, Eating and Lifestyle Science, Philadelphia, PA, USA
| | | | | | - Kathryn M Min
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher B Ruser
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA.
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Masheb RM, Ruser CB, Min KM, Bullock AJ, Dorflinger LM. Does food addiction contribute to excess weight among clinic patients seeking weight reduction? Examination of the Modified Yale Food Addiction Survey. Compr Psychiatry 2018; 84:1-6. [PMID: 29654930 DOI: 10.1016/j.comppsych.2018.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite controversy surrounding the construct of food addiction, its relationship with obesity and the validity of the Yale Food Addiction Scale (YFAS), have become emerging fields of study. No prior research has examined the prevalence and correlates of food addiction, and validation of the Modified Yale Food Addiction Scale (mYFAS), in a non-research based weight management clinic setting. OBJECTIVE The current study sought to examine the validity of a brief version of the Yale Food Addiction Scale in weight loss seeking patients, and to determine whether food addiction contributes to excess weight in this patient population. PARTICIPANTS The sample consisted of 126 Veterans with overweight/obesity who attended an orientation session for a weight management program. Participants (mean age = 61.8 years, mean BMI = 38.0, male = 89.7%, Caucasian = 76.0%) completed questionnaires related to food addiction, weight and eating, and mental health and behavior. RESULTS Ten percent of the sample met diagnostic threshold for food addiction. Correlational analysis revealed that food addiction was significantly and highly correlated with BMI, emotional eating, night eating and screens for depression and insomnia (p's < 0.001); significantly correlated with eating pathology, and screening for PTSD (p's < 0.05); and inversely correlated with screening for alcohol use disorders (p < 0.01). The prevalence of food addiction was significantly higher in participants with Binge Eating Disorder (75%) compared to participants without (5.4%; p < 0.001). Food addiction uniquely accounted for 15% of the variance of BMI, almost three times more than general eating disorder pathology. DISCUSSION This study provides further evidence for the validity of the mYFAS, and clinical significance of the food addiction construct among weight loss seeking patients in non-research based weight management settings. Findings confirm that food addiction contributes to excess weight among clinic patients seeking weight reduction above and beyond the effects of disordered eating. It is recommended that clinicians and researchers consider an addiction framework for addressing comorbid overweight and food addiction among afflicted individuals seeking weight loss.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States.
| | - Christopher B Ruser
- VA Connecticut Healthcare System, West Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - Kathryn M Min
- VA Connecticut Healthcare System, West Haven, CT, United States
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Dorflinger LM, Ruser CB, Masheb RM. Night eating among veterans with obesity. Appetite 2017; 117:330-334. [DOI: 10.1016/j.appet.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022]
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Abstract
OBJECTIVE Binge eating disorder (BED) is associated with medical and psychiatric issues commonly seen and managed in primary care; however, the disorder typically goes undetected as there are no assessment tools feasible for use in primary care. The objective was to examine the validity of the VA Binge Eating Screener (VA-BES), a single-item screening measure for binge eating. METHOD The sample consisted of 116 veterans referred to a primary care-based weight management program. Participants had a mean age of 61.66years (SD=8.73) and average BMI of 37.90 (SD=7.35). Frequency of binge eating ranged from zero to 21 episodes per week. The prevalence of BED was 7.76%. All participants completed the Questionnaire of Eating and Weight Patterns - Revised (QEWP-R) to assess for BED. They also completed the VA-BES, and measures of disordered eating and depressive symptoms. RESULTS The VA-BES was compared to the QEWP-R to determine the sensitivity, specificity, positive predictive value, and negative predictive value for each cutpoint. Analyses revealed one cutpoint (≥2 binge eating episodes per week) maximized these values, demonstrated excellent agreement with the QEWP-R (χ2=24.79, p<0.001), and had significant associations with other variables commonly associated with binge eating. DISCUSSION This study demonstrates the utility and validity of a single-item measure to screen for binge eating in primary care. The item can quickly and easily identify binge eating, thus facilitating referral to treatment and potentially subsequent improvements in related medical and mental health comorbidities treated in primary care.
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Affiliation(s)
- Lindsey M Dorflinger
- VA Connecticut Healthcare System, United States; Yale School of Medicine, United States.
| | - Christopher B Ruser
- VA Connecticut Healthcare System, United States; Yale School of Medicine, United States
| | - Robin M Masheb
- VA Connecticut Healthcare System, United States; Yale School of Medicine, United States
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Janney CA, Masheb RM, Lutes LD, Holleman RG, Kim HM, Gillon LR, Damschroder LJ, Richardson CR. Mental health and behavioral weight loss: 24-month outcomes in Veterans. J Affect Disord 2017; 215:197-204. [PMID: 28340446 DOI: 10.1016/j.jad.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/30/2017] [Accepted: 03/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals with mental health (MH) disorders have an increased risk of being overweight/obese; however research on behavioral weight loss interventions has been limited. A priori hypothesis was that Veterans with serious mental illness (SMI) and/or affective disorders (AD) would lose significantly less weight and have a different pattern of weight loss than Veterans without these diagnoses. METHODS Secondary data analysis of ASPIRE-VA study, three-arm randomized, effectiveness weight loss trial among Veterans (n=409) categorized by MH diagnoses: 1) SMI, 2) AD without SMI, or 3) No SMI/No AD. Linear mixed-effects model analyzed weight changes from baseline thru 24 months. RESULTS SMI and AD were diagnosed in 10% (n=41) and 31% (n=125). Participants attended approximately 15 sessions from baseline to 24 months. On average, participants lost a modest amount of weight over 24 months regardless of MH diagnosis. Longitudinally, no statistically significant differences were found in weight loss patterns by MH diagnosis. Unadjusted average weight loss (kg) was 1.6±4.0 at 3 months (n=373), 1.9±6.5 at 12 months (n=361), 1.5±7.8 at 18 months (n=289), and 1.4±8.0 at 24 months (n=279). LIMITATIONS ASPIRE-VA study was not designed or powered to detect weight loss differences among MH diagnostic groups. CONCLUSIONS Veterans achieved and maintained modest weight loss, through 24 months, with the three behavioral weight loss interventions. Contrary to our hypotheses, the amount and pattern of weight loss did not differ by MH diagnosis. Greater inclusion of individuals with MH diagnoses may be warranted in behavioral weight loss interventions not specifically tailored for them.
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Affiliation(s)
- Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Michigan State University College of Human Medicine - Midland Regional Campus Center, 4611 Campus Ridge Drive, Midland, MI 48670, United States.
| | - Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, PRIME Center/11ACSLG, 950 Campbell Avenue, West Haven, CT 06516, United States.
| | - Lesley D Lutes
- Department of Psychology, University of British Columbia Okanagan, 3187 University Way, Kelowna, BC, Canada V1V 1V7.
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States.
| | - Leah R Gillon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Caroline R Richardson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.
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Masheb RM, Chan SH, Raffa SD, Ackermann R, Damschroder LJ, Estabrooks PA, Evans-Hudnall G, Evans NC, Histon T, Littman AJ, Moin T, Nelson KM, Pagoto S, Pronk NP, Tate DF, Goldstein MG. State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions. J Gen Intern Med 2017; 32:74-78. [PMID: 28271431 PMCID: PMC5359158 DOI: 10.1007/s11606-016-3965-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone- and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016. The work group agreed that there is strong evidence for efficacy and effectiveness of core behavioral intervention components and processes, but insufficient evidence to determine the comparative effectiveness of multiple clinician-delivered weight management modalities, as well as technologies that may or may not supplement clinician-delivered treatments. Effective strategies for implementation of weight management services in VHA were identified. The SOTA work group's foremost policy recommendations are to establish a system-wide culture for weight management and to identify a population-level health metric to measure the impact of weight management interventions that can be tracked and clearly communicated throughout VHA. The work group's top research recommendation is to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans.
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Affiliation(s)
- Robin M Masheb
- Yale School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave Psychology Service, 116B, West Haven, CT, 06516, USA.
| | - Stephanie H Chan
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Susan D Raffa
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Ronald Ackermann
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Neil C Evans
- VA Office of Connected Care, Washington, DC, USA
| | - Trina Histon
- Kaiser Permanente Care Management Institute, Washington, DC, USA
| | | | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Tacoma, WA, USA
- University of Washington, Seattle, WA, USA
| | - Sherry Pagoto
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Michael G Goldstein
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
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Hoerster KD, Wilson S, Nelson KM, Reiber GE, Masheb RM. Diet quality is associated with mental health, social support, and neighborhood factors among Veterans. Eat Behav 2016; 23:168-173. [PMID: 27816854 DOI: 10.1016/j.eatbeh.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 12/13/2022]
Abstract
United States Veterans have a higher prevalence of overweight and related chronic conditions compared to the general population. Although diet is a primary and modifiable contributor to these conditions, little is known about factors influencing diet quality among Veterans. The goal of this study is to examine individual, social environment, and physical environment correlates of general diet quality among Veterans. Study participants (N=653) received care at an urban VA Medical Center in Seattle, WA and completed a mailed survey in 2012 and 2013. Diet quality was assessed with Starting the Conversation, an instrument that measures consumption of unhealthy snacks, fast food, desserts, sugar-sweetened beverages, and fats; fruits and vegetables; and healthy proteins. Variables significantly (p<0.05) associated with diet quality in bivariate analyses were included in a multivariate regression. In the multivariate model, higher level of depressive symptom severity (Diff=0.05; CI=0.01, 0.09; p=0.017); not having others eat healthy meals with the Veteran (Diff=-0.81; CI=-1.5, -0.1; p=0.022); and reduced availability of low-fat foods in neighborhood stores where the Veteran shops (Diff=-0.37; CI=-0.6, -0.2; p<0.001) were associated with poorer diet quality. Consistent with prior research in the general population, this study identified multiple domains associated with Veterans' diet quality, including psychological comorbidity, the social environment, and the physical environment. Findings from this study suggest that interventions aimed at mental health, social support, and neighborhood access to healthy foods are needed to improve Veteran diet quality.
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Affiliation(s)
- Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Seattle, WA 98195, United States.
| | - Sarah Wilson
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, 508 Fulton Street (Mail Stop: MIRECC), Durham, NC 27705, United States; Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, United States.
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States.
| | - Gayle E Reiber
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; University of Washington School of Public Health, Departments of Health Services and Epidemiology, 1959 NE Pacific St, Seattle, WA 98195, United States.
| | - Robin M Masheb
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, United States; Yale School of Medicine, 301 Cedar Street, New Haven, CT 06520, United States.
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Masheb RM, Dorflinger LM, Rolls BJ, Mitchell DC, Grilo CM. Binge abstinence is associated with reduced energy intake after treatment in patients with binge eating disorder and obesity. Obesity (Silver Spring) 2016; 24:2491-2496. [PMID: 27797154 PMCID: PMC5172456 DOI: 10.1002/oby.21664] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/09/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Binge eating disorder (BED) is strongly associated with obesity and related medical and psychiatric morbidities. Cognitive behavioral therapy (CBT) has consistently been shown to reduce binge eating frequency and improve psychological functioning, as well as to produce abstinence rates of roughly 50%. This study examined the relationship between binge abstinence and dietary and psychological outcomes after CBT for BED. METHODS Fifty adult patients with BED received 6-month treatments using a combination of CBT and dietary counseling. Trained interviewers conducted two 24-hour dietary recall interviews on randomly selected days at baseline and at 6 months. RESULTS Participants had significant reductions in energy, macronutrient, and sugar intake and an increase in fruit intake. They reported significant reductions in BMI and binge eating frequency (from mean = 14.24 to mean = 1.90 binge eating episodes during the previous 28 days), as well as improvements in psychological functioning. Those who became binge abstinent reported eating roughly 400 fewer calories per day and experienced greater improvements in psychological functioning than those who did not. CONCLUSIONS Findings from this study suggest that individuals who achieve complete cessation from binge eating have significantly improved dietary and psychological outcomes that could potentially improve weight status, compared with those who continue to binge eat post-treatment.
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Affiliation(s)
- Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Lindsey M Dorflinger
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Barbara J Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, Pennsylvania, USA
| | - Diane C Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, Pennsylvania, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Haibach JP, Haibach MA, Hall KS, Masheb RM, Little MA, Shepardson RL, Dobmeyer AC, Funderburk JS, Hunter CL, Dundon M, Hausmann LRM, Trynosky SK, Goodrich DE, Kilbourne AM, Knight SJ, Talcott GW, Goldstein M. Erratum to: Military and veteran health behavior research and practice: challenges and opportunities. J Behav Med 2016; 40:227-228. [PMID: 27757768 DOI: 10.1007/s10865-016-9801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jeffrey P Haibach
- Health Services Research and Development Service, U.S. Department of Veterans Affairs, 810 Vermont Avenue NW (10P9H), Washington, DC, 20420, USA.
| | | | - Katherine S Hall
- Durham VA Medical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Melissa A Little
- Center for Population Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robyn L Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Anne C Dobmeyer
- Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Deployment Health Clinical Center, Bethesda, MD, USA
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Christopher L Hunter
- Patient-Centered Medical Home Branch, Clinical Support Division, Defense Health Agency, Washington, DC, USA
| | - Margaret Dundon
- National Center for Health Promotion and Disease Prevention, U.S. Department of Veterans Affairs, Durham, NC, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephen K Trynosky
- Office of Academic Affiliations, U.S. Department of Veterans Affairs, Washington, DC, USA
- Medical Service Corps, U.S. Army Reserve, Washington, DC, USA
| | - David E Goodrich
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Amy M Kilbourne
- Health Services Research and Development Service, U.S. Department of Veterans Affairs, 810 Vermont Avenue NW (10P9H), Washington, DC, 20420, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sara J Knight
- Birmingham VA Medical Center, Birmingham, AL, USA
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald W Talcott
- Center for Population Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael Goldstein
- National Center for Health Promotion and Disease Prevention, U.S. Department of Veterans Affairs, Durham, NC, USA
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30
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Haibach JP, Haibach MA, Hall KS, Masheb RM, Little MA, Shepardson RL, Dobmeyer AC, Funderburk JS, Hunter CL, Dundon M, Hausmann LR, Trynosky SK, Goodrich DE, Kilbourne AM, Knight SJ, Talcott GW, Goldstein MG. Military and veteran health behavior research and practice: challenges and opportunities. J Behav Med 2016; 40:175-193. [DOI: 10.1007/s10865-016-9794-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
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White MA, Kalarchian MA, Levine MD, Masheb RM, Marcus MD, Grilo CM. Prognostic Significance of Depressive Symptoms on Weight Loss and Psychosocial Outcomes Following Gastric Bypass Surgery: A Prospective 24-Month Follow-Up Study. Obes Surg 2016; 25:1909-16. [PMID: 25720515 DOI: 10.1007/s11695-015-1631-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study examined the prognostic significance of depressive symptoms in bariatric surgery patients over 24 months of follow-ups. METHODS Three hundred fifty-seven patients completed a battery of assessments before and at 6, 12, and 24 months following gastric bypass surgery. In addition to weight loss and depressive symptoms, the assessments targeted eating disorder psychopathology and quality of life. RESULTS Clinically significant depressive symptoms, defined as a score of 15 or greater on the Beck Depression Inventory, characterized 45% of patients prior to surgery, and 12% at 6-month follow-up, 13% at 12-month follow-up, and 18% at 24-month follow-up. Preoperative depressive symptoms did not predict postoperative weight outcomes. In contrast, postsurgery depressive symptoms were predictive of weight loss outcomes. Higher postsurgery depressive symptoms at each time point predicted a greater degree of concurrent and subsequent eating disorder psychopathology and lower quality of life. CONCLUSIONS The frequency of elevated depressive symptoms decreases substantially following gastric bypass surgery but increases gradually over 24 months. Postoperative depressive symptoms are significantly associated with poorer weight outcomes at 6 and 12 months following surgery but do not predict longer-term weight outcomes at 24 months. Postoperative depressive symptoms prospectively predict greater eating disorder psychopathology and poorer quality of life through 24 months. Elevated depressive symptoms, readily assessed by self-report, may signal a need for clinical attention after surgery.
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Affiliation(s)
- Marney A White
- Program for Obesity Weight and Eating Research, Department of Psychiatry, Yale University School of Medicine, PO Box 208098, New Haven, CT, 06520, USA,
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Masheb RM, White MA, Grilo CM. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder. Eur Eat Disord Rev 2016; 24:247-50. [PMID: 26841114 DOI: 10.1002/erv.2432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 11/10/2022]
Abstract
Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED.
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Affiliation(s)
- Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Marney A White
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Udo T, White MA, Barnes RD, Ivezaj V, Morgan P, Masheb RM, Grilo CM. Psychosocial and metabolic function by smoking status in individuals with binge eating disorder and obesity. Addict Behav 2016; 53:46-52. [PMID: 26451703 DOI: 10.1016/j.addbeh.2015.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/29/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
Individuals with binge eating disorder (BED) report smoking to control appetite and weight. Smoking in BED is associated with increased risk for comorbid psychiatric disorders, but its impact on psychosocial functioning and metabolic function has not been evaluated. Participants were 429 treatment-seeking adults (72.4% women; mean age 46.2±11.0years old) with BED comorbid with obesity. Participants were categorized into current smokers (n=66), former smokers (n=145), and never smokers (n=218). Smoking status was unrelated to most historical eating/weight variables and to current eating disorder psychopathology. Smoking status was associated with psychiatric, psychosocial, and metabolic functioning. Compared with never smokers, current smokers were more likely to meet lifetime diagnostic criteria for alcohol (OR=5.51 [95% CI=2.46-12.33]) and substance use disorders (OR=7.05 [95% CI=3.37-14.72]), poorer current physical quality of life, and increased risk for metabolic syndrome (OR=1.80 [95% CI=0.97-3.35]) and related metabolic risks (reduced HDL, elevated total cholesterol). On the other hand, the odds of meeting criteria for lifetime psychiatric comorbidity or metabolic abnormalities were not significantly greater in former smokers, relative to never smokers. Our findings suggest the importance of promoting smoking cessation in treatment-seeking patients with BED and obesity for its potential long-term implications for psychiatric and metabolic functioning.
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Affiliation(s)
- Tomoko Udo
- School of Public Health, University at Albany, State University of New York, Rensselaer, NY, United States.
| | - Marney A White
- Yale University School of Medicine, New Haven, CT, United States
| | - Rachel D Barnes
- Yale University School of Medicine, New Haven, CT, United States
| | - Valentina Ivezaj
- Yale University School of Medicine, New Haven, CT, United States
| | - Peter Morgan
- Yale University School of Medicine, New Haven, CT, United States
| | - Robin M Masheb
- Yale University School of Medicine, New Haven, CT, United States
| | - Carlos M Grilo
- Yale University School of Medicine, New Haven, CT, United States; CASAColumbia, New Haven, CT, United States
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Higgins DM, Buta E, Dorflinger L, Masheb RM, Ruser CB, Goulet JL, Heapy AA. Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans. ACTA ACUST UNITED AC 2016; 53:71-82. [PMID: 26933823 DOI: 10.1682/jrrd.2014.10.0251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/08/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Diana M. Higgins
- Department of Veterans Affairs (VA) Boston Healthcare System, Boston, MA, and Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Eugenia Buta
- VA Connecticut Healthcare System, West Haven, CT;Department of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Lindsey Dorflinger
- VA Connecticut Healthcare System, West Haven, CT;Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Robin M. Masheb
- VA Connecticut Healthcare System, West Haven, CT;Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Christopher B. Ruser
- VA Connecticut Healthcare System, West Haven, CT;Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Joseph L. Goulet
- VA Connecticut Healthcare System, West Haven, CT;Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Alicia A. Heapy
- VA Connecticut Healthcare System, West Haven, CT;Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Udo T, White MA, Lydecker JL, Barnes RD, Genao I, Garcia R, Masheb RM, Grilo CM. Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings. Eur Eat Disord Rev 2015; 24:181-6. [PMID: 26640009 DOI: 10.1002/erv.2417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/13/2015] [Accepted: 10/26/2015] [Indexed: 11/08/2022]
Abstract
This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients.
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Affiliation(s)
- Tomoko Udo
- School of Public Health, University at Albany, State University of New York, USA
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Masheb RM, Lutes LD, Kim HM, Holleman RG, Goodrich DE, Janney CA, Kirsh S, Higgins DM, Richardson CR, Damschroder LJ. Weight loss outcomes in patients with pain. Obesity (Silver Spring) 2015; 23:1778-84. [PMID: 26237112 DOI: 10.1002/oby.21160] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/27/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether the presence or severity of pain is predictive of suboptimal weight loss outcomes in behavioral weight management programs. METHODS This is a secondary data analysis comparing weight loss among participants with overweight/obesity who participated in a 12-month randomized controlled trial. Of the 481 participants randomized, 394 (81.9%) had available pain data and were categorized by Pain Type (back pain, arthritis pain, both, or neither) and Pain Severity (no pain, moderate pain, or severe pain). Dietary and physical activity outcomes were also explored. RESULTS High rates of moderate and severe (80.2%), and back and arthritis (72.6%), pain were observed. Linear mixed models showed significant differences in % weight loss among Pain Severity, but not Pain Type, groups. Patients with severe pain lost significantly less weight (-0.1 kg, 95% CI = -1.5, -1.2) compared to those with either moderate or no pain (-1.9 kg, 95% CI = -2.5, -1.3; -2.1 kg, 95% CI = -3.3, -1.0, respectively). Patients with arthritis pain lost a significant amount of weight despite only minor improvements in walking distance. CONCLUSIONS Pain severity, but not pain type, is predictive of suboptimal weight loss outcomes.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lesley D Lutes
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Susan Kirsh
- Office of Primary Care, VA Central Office, Washington, DC, and Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Diana M Higgins
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Caroline R Richardson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Grilo CM, White MA, Masheb RM, Gueorguieva R. Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response. J Consult Clin Psychol 2015; 83:387-94. [PMID: 25622201 DOI: 10.1037/a0038635] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. METHOD One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes. RESULTS Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss. DISCUSSION Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. CLINICAL TRIAL REGISTRATION clinicaltrials.gov: NCT00537810 (PsycINFO Database Record
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
| | - Marney A White
- Department of Psychiatry, Yale University School of Medicine
| | - Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine
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Masheb RM, Lutes LD, Kim HM, Holleman RG, Goodrich DE, Janney CA, Kirsh S, Richardson CR, Damschroder LJ. High-frequency binge eating predicts weight gain among veterans receiving behavioral weight loss treatments. Obesity (Silver Spring) 2015; 23:54-61. [PMID: 25385705 DOI: 10.1002/oby.20931] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/22/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess for the frequency of binge eating behavior and its association with weight loss in an overweight/obese sample of veterans. METHODS This study is a secondary analysis of data from the ASPIRE study, a randomized effectiveness trial of weight loss among veterans. Of the 481 enrolled veterans with overweight/obesity, binge eating frequency was obtained by survey for 392 (82%). RESULTS The majority (77.6%) reported binge eating, and 6.1% reported high-frequency binge eating. Those reporting any binge eating lost 1.4% of body weight, decreased waist circumference by 2.0 cm, and had significantly worse outcomes than those reporting never binge eating who lost about double the weight (2.7%) and reduced waist circumference by twice as much (4.2 cm). The high-frequency binge group gained 1.4% of body weight and increased waist circumference by 0.3 cm. CONCLUSIONS High rates of binge eating were observed in an overweight/obese sample of veterans enrolled in weight loss treatment. The presence of binge eating predicted poorer weight loss outcomes. Furthermore, high-frequency binge eating was associated with weight gain. These findings have operational and policy implications for developing effective strategies to address binge eating in the context of behavioral weight loss programs for veterans.
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Affiliation(s)
- Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA; VA Connecticut Healthcare System, West Haven, Connecticut, USA
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Higgins DM, Buta E, Dorflinger L, Heapy AA, Ruser CB, Goulet JL, Masheb RM. Psychometric properties of a MOVE!23 subscale: Perceived Contributors to Weight Change in a national sample of veterans. J Health Psychol 2014; 21:1394-403. [PMID: 25293969 DOI: 10.1177/1359105314554530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The MOVE!23, a questionnaire to assess weight-related domains in veterans, was examined. Factor analysis of Perceived Contributors to Weight Change revealed three factors (psychosocial, eating behavior, and medical) that were positively correlated with body mass index, and psychiatric and medical comorbidity (p's < 0.001). Multivariable cumulative logit models modeling the factor scores indicated that women were more likely than men to endorse psychosocial (odds ratio = 2.15, confidence interval = 2.04-2.27) and medical (odds ratio = 1.69, confidence interval = 1.59-1.79) items. The MOVE!23 Perceived Contributors to Weight Change subscale is a reliable and valid measure that is associated with body mass index and may assist in tailoring treatments according to gender and comorbidity.
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Affiliation(s)
| | - Eugenia Buta
- VA Connecticut Healthcare System, USA Yale University, USA
| | | | - Alicia A Heapy
- VA Connecticut Healthcare System, USA Yale University, USA
| | | | | | - Robin M Masheb
- VA Connecticut Healthcare System, USA Yale University, USA
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Grilo CM, Masheb RM, White MA, Gueorguieva R, Barnes RD, Walsh BT, McKenzie KC, Genao I, Garcia R. Treatment of binge eating disorder in racially and ethnically diverse obese patients in primary care: randomized placebo-controlled clinical trial of self-help and medication. Behav Res Ther 2014; 58:1-9. [PMID: 24857821 DOI: 10.1016/j.brat.2014.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Abstract
The objective was to determine whether treatments with demonstrated efficacy for binge eating disorder (BED) in specialist treatment centers can be delivered effectively in primary care settings to racially/ethnically diverse obese patients with BED. This study compared the effectiveness of self-help cognitive-behavioral therapy (shCBT) and an anti-obesity medication (sibutramine), alone and in combination, and it is only the second placebo-controlled trial of any medication for BED to evaluate longer-term effects after treatment discontinuation. 104 obese patients with BED (73% female, 55% non-white) were randomly assigned to one of four 16-week treatments (balanced 2-by-2 factorial design): sibutramine (N = 26), placebo (N = 27), shCBT + sibutramine (N = 26), or shCBT + placebo (N = 25). Medications were administered in double-blind fashion. Independent assessments were performed monthly throughout treatment, post-treatment, and at 6- and 12-month follow-ups (16 months after randomization). Mixed-models analyses revealed significant time and medication-by-time interaction effects for percent weight loss, with sibutramine but not placebo associated with significant change over time. Percent weight loss differed significantly between sibutramine and placebo by the third month of treatment and at post-treatment. After the medication was discontinued at post-treatment, weight re-gain occurred in sibutramine groups and percent weight loss no longer differed among the four treatments at 6- and 12-month follow-ups. For binge-eating, mixed-models revealed significant time and shCBT-by-time interaction effects: shCBT had significantly lower binge-eating frequency at 6-month follow-up but the treatments did not differ significantly at any other time point. Demographic factors did not significantly predict or moderate clinical outcomes. Our findings suggest that pure self-help CBT and sibutramine did not show long-term effectiveness relative to placebo for treating BED in racially/ethnically diverse obese patients in primary care. Overall, the treatments differed little with respect to binge-eating and associated outcomes. Sibutramine was associated with significantly greater acute weight loss than placebo and the observed weight-regain following discontinuation of medication suggests that anti-obesity medications need to be continued for weight loss maintenance. Demographic factors did not predict/moderate clinical outcomes in this diverse patient group.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, United States.
| | - Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Marney A White
- Department of Psychiatry, Yale University School of Medicine, United States
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Public Health, United States
| | - Rachel D Barnes
- Department of Psychiatry, Yale University School of Medicine, United States
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University School of Medicine, United States
| | - Katherine C McKenzie
- Department of General Internal Medicine, Yale University School of Medicine, United States
| | - Inginia Genao
- Department of General Internal Medicine, Yale University School of Medicine, United States
| | - Rina Garcia
- Department of General Internal Medicine, Yale University School of Medicine, United States
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Udo T, McKee SA, White MA, Masheb RM, Barnes RD, Grilo CM. Menopause and metabolic syndrome in obese individuals with binge eating disorder. Eat Behav 2014; 15:182-5. [PMID: 24854801 PMCID: PMC4032475 DOI: 10.1016/j.eatbeh.2014.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/26/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
Menopausal transition has been associated with the emergence of metabolic abnormalities, which may increase risk for chronic medical conditions in women. This study compared metabolic function between premenopausal women (n = 152), postmenopausal women (n = 88), and men (n =9 8) recruited for treatment studies for obesity co-occurring with binge eating disorder (BED), a high-risk population for developing metabolic syndrome (MetS). Postmenopausal women were more likely than premenopausal women to show elevated total cholesterol (OR = 2.75; 95% CI = 1.56-4.80) and poor glycemic control (OR = 2.92; 95% CI = 1.32-6.33) but were more likely to have lower HDL levels (OR = 0.36; 95% CI = 0.19-0.68). These became non-significant after adjusting for age. Both pre- and postmenopausal women were less likely than age-matched men to show elevated levels of triglycerides (OR = 0.27; 95% CI = 0.13-0.53 [postmenopausal], OR = 0.29; 95% CI = 0.16-0.53 [premenopausal]), blood pressure (OR = 0.48; 95% CI = 0.25-0.91 [postmenopausal], OR=0.40; 95% CI = 0.23-0.69 [premenopausal]), and less likely to have MetS (OR = 0.41; 95% CI = 0.21-0.78 [postmenopausal], OR = 0.46; 95% CI = 0.27-0.79 [premenopausal]). Premenopausal women were also less likely to have elevated fasting glucose level (OR = 0.50; 95% CI = 0.26-0.97) than age-matched men. Among obese women with BED, aging may have a more profound impact on metabolic abnormalities than menopause, suggesting the importance of early intervention of obesity and symptoms of BED. The active monitoring of metabolic function in obese men with BED may also be critical.
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Affiliation(s)
- Tomoko Udo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rachel D. Barnes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
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.
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Affiliation(s)
| | | | - Rachel D Barnes
- Department of Psychiatry, School of Medicine, Yale University
| | - Marney A White
- Department of Psychiatry, School of Medicine, Yale University
| | - Robin M Masheb
- Department of Psychiatry, School of Medicine, Yale University
| | - Carlos M Grilo
- Department of Psychiatry, School of Medicine, Yale University
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Abstract
OBJECTIVE The goal of this study was to examine the clinical utility of nibbling behavior, defined as eating in an unplanned and repetitious manner between meals and snacks without a sense of loss of control, in obese patients with Binge Eating Disorder (BED). METHODS Two-hundred seventeen (N = 217) consecutive, treatment-seeking, obese patients with BED were assessed with the Eating Disorder Examination (EDE). Nibbling frequency was examined in relation to current weight, eating disorder psychopathology and eating patterns. RESULTS Results found that nibbling/picking was not related to body mass index, objective bulimic, subjective bulimic, or overeating episodes, food avoidance, sensitivity to weight gain, or any subscales of the EDE. However, nibbling/picking was significantly related to frequency of morning and afternoon snacking (r = .21, p = .002; r = .27, p < .001). DISCUSSION The assessment of nibbling/picking behaviors among individuals with BED might not provide clinically significant information.
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Affiliation(s)
- Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine
| | - Christina A. Roberto
- Christina A. Roberto is an RWJF Health & Society Scholar at Harvard University, Department of Social and Behavioral Sciences, Harvard School of Public Health
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine,Yale University School of Public Health,Department of Psychology, Yale University
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Grilo CM, White MA, Gueorguieva R, Barnes RD, Masheb RM. Self-help for binge eating disorder in primary care: a randomized controlled trial with ethnically and racially diverse obese patients. Behav Res Ther 2013; 51:855-61. [PMID: 24189569 DOI: 10.1016/j.brat.2013.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center. METHOD 48 obese patients with BED were randomly assigned to either shCBT (N = 24) or UC (N = 24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment. RESULTS Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition. CONCLUSIONS Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, USA.
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Barnes RD, Masheb RM, White MA, Grilo CM. Examining the relationship between food thought suppression and binge eating disorder. Compr Psychiatry 2013; 54:1077-81. [PMID: 23751246 PMCID: PMC3779532 DOI: 10.1016/j.comppsych.2013.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 03/15/2013] [Accepted: 04/15/2013] [Indexed: 11/28/2022] Open
Abstract
Food thought suppression, or purposely attempting to avoid thoughts of food, is related to a number of unwanted eating- and weight-related consequences, particularly in dieting and obese individuals. Little is known about the possible significance of food thought suppression in clinical samples, particularly obese patients who binge eat. This study examined food thought suppression in 150 obese patients seeking treatment for binge eating disorder (BED). Food thought suppression was not associated with binge eating frequency or body mass index but was significantly associated with higher current levels of eating disorder psychopathology and variables pertaining to obesity, dieting, and binge eating.
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Affiliation(s)
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine,Department of Psychology, Yale University,Department of Chronic Disease Epidemiology, School of Public Health, Yale University
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine,Department of Psychology, Yale University
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Gianini LM, White MA, Masheb RM. Eating pathology, emotion regulation, and emotional overeating in obese adults with Binge Eating Disorder. Eat Behav 2013; 14:309-13. [PMID: 23910772 PMCID: PMC4015336 DOI: 10.1016/j.eatbeh.2013.05.008] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/25/2013] [Accepted: 05/08/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the current study was to examine the relationship among emotional regulation, emotional overeating, and general eating pathology in a treatment seeking sample of adults with Binge Eating Disorder (BED). METHOD The sample was composed of 326 adults (248 women, 78 men) who were obese and met DSM-IV-TR criteria for BED. Prior to treatment, participants completed the Difficulties in Emotion Regulation Scale (DERS), Emotional Overeating Questionnaire (EOQ), Beck Depression Inventory (BDI), and Eating Disorder Examination-Questionnaire (EDE-Q) as part of a larger assessment battery. RESULTS A series of hierarchical regression analyses indicated that difficulties with emotion regulation accounted for unique variance in both emotional overeating and general eating pathology above and beyond sex and negative affect. DISCUSSION Emotion regulation may play a significant role in the maintenance of emotional overeating and eating pathology in obese adults with BED.
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Affiliation(s)
| | | | - Robin M. Masheb
- Correspondence to: Robin M. Masheb, Ph.D., Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, P.O. Box 208098, New Haven, CT 06520-8090,
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Gearhardt AN, White MA, Masheb RM, Grilo CM. An examination of food addiction in a racially diverse sample of obese patients with binge eating disorder in primary care settings. Compr Psychiatry 2013; 54:500-5. [PMID: 23332551 PMCID: PMC3638060 DOI: 10.1016/j.comppsych.2012.12.009] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The concept of food addiction in obesity and binge eating disorder (BED) continues to be a hotly debated topic yet the empirical evidence on the relationship between addictive-like eating and clinically relevant eating disorders is limited. The current study examined the association of food addiction as assessed by the Yale Food Addiction Scale (YFAS) with measures of disordered eating, dieting/weight history, and related psychopathology in a racially diverse sample of obese patients with binge eating disorder (BED). METHOD A consecutive series of 96 obese patients with BED who were seeking treatment for obesity and binge eating in primary care were given structured interviews to assess psychiatric disorders and eating disorder psychopathology and a battery of self-report measures including the YFAS to assess food addiction. RESULTS Classification of food addiction was met by 41.5% (n=39) of BED patients. Patients classified as meeting YFAS food addiction criteria had significantly higher levels of negative affect, emotion dysregulation, and eating disorder psychopathology, and lower self-esteem. Higher scores on the YFAS were related to an earlier age of first being overweight and dieting onset. YFAS scores were also significant predictors of binge eating frequency above and beyond other measures. DISCUSSION Compared to patients not classified as having food addiction, the subset of 41.5% of BED patients who met the YFAS food addiction cut-off appears to have a more severe presentation of BED and more associated pathology.
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Affiliation(s)
- Ashley N. Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI,Correspondence to: Ashley N. Gearhardt, University of Michigan, Department of Psychology, 2268 East Hall, 530 Church St., Ann Arbor, MI, 48109,
| | - Marney A. White
- Department of Psychology, Yale University, New Haven, CT,Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Chronic Disease Epidemiology, Yale School of Public Health
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Carlos M. Grilo
- Department of Psychology, Yale University, New Haven, CT,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Grilo CM, White MA, Gueorguieva R, Wilson GT, Masheb RM. Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychol Med 2013; 43:1335-1344. [PMID: 22967857 PMCID: PMC3666331 DOI: 10.1017/s0033291712002097] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undue influence of body shape or weight on self-evaluation - referred to as overvaluation - is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This study examined the concurrent and predictive significance of overvaluation of shape/weight in obese patients with BED participating in a randomized clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method A total of 90 participants were randomly assigned to 6-month group treatments of CBT or BWL. Assessments were performed at baseline, throughout- and post-treatment, and at 6- and 12-month follow-ups after completing treatments with reliably administered semi-structured interviews and established measures. RESULTS Participants categorized with overvaluation (n = 52, 58%) versus without overvaluation (n = 38, 42%) did not differ significantly in demographic features (age, gender and ethnicity), psychiatric co-morbidity, body mass index or binge eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology and poorer psychological functioning (higher depression and lower self-esteem) than the non-overvaluation group. Overvaluation of shape/weight significantly predicted non-remission from binge eating and higher frequency of binge eating at the 12-month follow-up, even after adjusting for group differences in depression and self-esteem levels. CONCLUSIONS Our findings suggest that overvaluation does not simply reflect concern commensurate with being obese or more frequent binge eating, but also is strongly associated with heightened eating-related psychopathology and psychological distress, and has negative prognostic significance for longer-term treatment outcomes. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity and treatment outcome.
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Affiliation(s)
- C M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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Grilo CM, White MA, Barnes RD, Masheb RM. Psychiatric disorder co-morbidity and correlates in an ethnically diverse sample of obese patients with binge eating disorder in primary care settings. Compr Psychiatry 2013; 54:209-16. [PMID: 22943959 PMCID: PMC3515704 DOI: 10.1016/j.comppsych.2012.07.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/13/2012] [Accepted: 07/09/2012] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine DSM-IV lifetime/current psychiatric disorder co-morbidity and correlates in ethnically-diverse obese patients with binge eating disorder (BED) seeking treatment for obesity and binge eating in primary care. METHOD A consecutive series of 142 participants (43% Caucasian, 37% African-American, 13% Hispanic-American, and 7% "other" ethnicity) were evaluated with semi-structured interviews. RESULTS 67% of BED patients had at least one additional lifetime psychiatric disorder, with mood (49%), anxiety (41%), and substance-use (22%) disorders most common. In terms of current co-morbidity, 37% had at least one other psychiatric disorder, with anxiety (27%) and mood (17%) most common. Few gender differences were observed but psychiatric co-morbidity rates differed across ethnic/racial groups with larger differences for current diagnoses. African-American and Hispanic groups were more than twice as likely as the Caucasian group to have additional current psychiatric disorders, mood disorders, and anxiety disorders. Psychiatric co-morbidity was associated with greater eating-disorder psychopathology and poorer functioning, but not with binge-eating or BMI. CONCLUSION Our study presents new findings suggesting that among obese BED patients in primary care, ethnic/racial minority groups are more likely than Caucasian groups to present with psychiatric co-morbidity. Within BED, psychiatric co-morbidity shows few gender differences but is associated with greater eating-disorder psychopathology and poorer functioning.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,Corresponding Author: Carlos M. Grilo, Ph.D., Department of Psychiatry, Yale University School of Medicine, 301 Cedar St., 2 Floor, New Haven, CT 06519,
| | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Rachel D. Barnes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Barnes RD, Sawaoka T, White MA, Masheb RM, Grilo CM. Factor structure and clinical correlates of the Food Thought Suppression Inventory within treatment seeking obese women with binge eating disorder. Eat Behav 2013; 14:35-9. [PMID: 23265399 PMCID: PMC3670144 DOI: 10.1016/j.eatbeh.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 06/28/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
Prior research on the relations among eating behaviors and thought suppression is limited to a measure of general thought suppression, the White Bear Suppression Inventory. To address this limitation, researchers recently validated the Food Thought Suppression Inventory (FTSI). Analyses using this measure suggest that food thought suppression is distinct from and is more predictive of eating disorder psychopathology than is general thought suppression. The FTSI, however, has not yet been validated in clinical samples. The purpose of the current study is to examine the factor structure and clinical correlates of the FTSI within treatment seeking obese women with binge eating disorder (BED; N=128). Analyses revealed a valid and reliable one-factor measure of food thought suppression that was related to higher levels of eating and general psychopathology. The findings provide evidence for the use of the FTSI with obese women with BED. Future research should examine the psychometric properties of the FTSI within larger and more diverse samples.
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Affiliation(s)
- Rachel D. Barnes
- Department of Psychiatry, Yale University School of Medicine, USA,Corresponding author at: Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, P.O. Box 208098, New Haven, CT 06520-8098, USA. Tel.:+1 203 785 6395; fax: +1 203 785 7855
| | | | - Marney A. White
- Department of Psychiatry, Yale University School of Medicine, USA,Department of Psychology, Yale University, USA,Department of Chronic Disease Epidemiology, Yale School of Public Health, USA
| | - Robin M. Masheb
- Department of Psychiatry, Yale University School of Medicine, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, USA,Department of Psychology, Yale University, USA
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