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Which Dieters Are at Risk for the Onset of Binge Eating? A Prospective Study of Adolescents and Young Adults
Abstract
Dieting is a well-established risk factor for binge eating, yet the majority of dieters do not develop binge eating problems. The purpose of the current study was to examine psychosocial factors involved in the relation between dieting and binge eating over a 10-year follow-up period.
A population-based sample (n = 1,827) completed surveys assessing eating habits, psychological functioning, and weight status at 5-year intervals spanning early/middle adolescence (time 1), late adolescence/early young adulthood (time 2), and early/middle young adulthood (time 3). Dieting, along with depression symptoms, self-esteem, and teasing experiences at time 1 and time 2, was used to predict new onset binge eating at time 2 and time 3, respectively. Interactions between dieting status and varying degrees of these psychosocial factors in relation to binge eating onset were also tested.
Dieters were two to three times more likely than nondieters to develop binge eating problems over 5-year follow-ups. At most time points, depression symptoms and self-esteem predicted binge eating onset beyond the effects of dieting alone. Detrimental levels of these factors among dieters (relative to nondieters) increased the likelihood of binge eating onset only during the later follow-up period.
Depression and self-esteem appear to be particularly salient factors involved in the relation between dieting and binge eating onset among adolescents and young adults. Early identification of these factors should be a priority to prevent the development of binge eating problems among already at-risk individuals.
... Longitudinal studies in this area suggest a possible bi-directional relationship between depression and EDs. Several studies have found depression to be a risk factor for EDs and ED symptoms (e.g., Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012;Johnson, Cohen, Kotler, Kasen, & Brook, 2002;McCabe & Ricciardelli, 2006;Sharpe et al., 2018) while others have found EDs (i.e., Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder) and sub-clinical ED symptoms to be a risk factor for depression (e.g., Micali et al., 2015;Stice, Hayward, Cameron, Killen, & Taylor, 2000). However, the majority of these studies have focused on ED total scores rather than individual ED symptoms. ...
... In this context, it is often suggested that shape and weight dissatisfaction precedes depressive symptoms and individuals respond to depressive symptoms by engaging in maladaptive eating practices (Stice et al., 2021;Stice & Van Ryzin, 2019). Studies have found depression to precede the onset of ED symptoms including binge eating (Allen, Crosby, Oddy, & Byrne, 2013;Goldschmidt et al., 2012;Liechty & Lee, 2013), dietary restriction, purging (Johnson et al., 2002) and extreme weight change behaviours (e.g., exercise dependence, use of food supplements, drive for thinness) (McCabe & Ricciardelli, 2006) in community samples of female and male adolescents and young adults. However, these studies conceptualised depression as a risk factor and ED symptoms as the outcome factor(s) and did not consider the reciprocal relationship between depression and ED symptoms. ...
... As exemplified by the aforementioned studies (e.g., Allen et al., 2013;Goldschmidt et al., 2012;Lee & Vaillancourt, 2018;Marmorstein et al., 2008;McCabe & Ricciardelli, 2006;Sharpe et al., 2018), a relationship between depression and EDs in adolescence is well-established. However, a comprehensive understanding of their temporal sequencing at a symptom-level remains elusive. ...
Despite frequently co-occurring, the temporal relationship between depression and eating disorder symptoms remains poorly understood. This exploratory study sought to investigate the reciprocal relationship between depressive symptoms and (1) shape and weight dissatisfaction, (2) shape and weight overvaluation, (3) preoccupation with shape or weight, (4) preoccupation with food, (5) dietary restraint and (6) binge eating in early adolescence. Adolescents (N = 1393) aged between 11.4 and 13.9 years (M = 12.50, SD = 0.38) completed the Centre for Epidemiological Depression Scale-Revised and Eating Disorder Examination Questionnaire-Adolescent version at the beginning of secondary school (T1) and 12-months later (T2). Cross-lagged models were created to assess the reciprocal relationship between depressive symptoms and ED symptoms. Depressive symptoms at T1 predicted shape and weight dissatisfaction, shape and weight overvaluation, preoccupation with shape or weight, preoccupation with food, dietary restraint and binge eating at T2. Shape and weight dissatisfaction and binge eating were the only ED symptoms at T1 to predict depressive symptoms at T2. Findings suggest young adolescents who experience depressive symptoms in their first year of secondary school are at-risk of developing ED symptoms over the subsequent 12-month period.
... Specifically, hyperinsulinemia and hyperandrogenism can predispose individuals to binging episodes, and binge eating behaviors may contribute to weight increase, hyperinsulinemia, and hyperandrogenism [107]. In addition, androgen excess, causing hirsutism and weight gain, may cause important body dissatisfaction, and dieting behaviors are often adopted to improve body image, cope with body dissatisfaction, and compensate for binge episodes [109]. The cycle of dieting-cravings promotes further binge episodes, which increase the risk of weight gain and dissatisfaction and may cause insulin unbalances [109]. ...
... In addition, androgen excess, causing hirsutism and weight gain, may cause important body dissatisfaction, and dieting behaviors are often adopted to improve body image, cope with body dissatisfaction, and compensate for binge episodes [109]. The cycle of dieting-cravings promotes further binge episodes, which increase the risk of weight gain and dissatisfaction and may cause insulin unbalances [109]. ...
Polycystic ovary syndrome (PCOS) is a multifaceted and heterogeneous disorder, linked with notable reproductive, metabolic, and psychological outcomes. During adolescence, key components of PCOS treatment involve weight loss achieved through lifestyle and dietary interventions, subsequently pursued by pharmacological or surgical therapies. Nutritional interventions represent the first-line therapeutic approach in adolescents affected by PCOS, but different kinds of dietary protocols exist, so it is necessary to clarify the effectiveness and benefits of the most well-known nutritional approaches. We provided a comprehensive review of the current literature concerning PCOS definition, pathophysiology, and treatment options, highlighting nutritional strategies, particularly those related to high-fat diets. The high-fat nutritional protocols proposed in the literature, such as the ketogenic diet (KD), appear to provide benefits to patients with PCOS in terms of weight loss and control of metabolic parameters. Among the different types of KD studies, very low-calorie ketogenic diets (VLCKD), can be considered an effective dietary intervention for the short-term treatment of patients with PCOS. It rapidly leads to weight loss alongside improvements in body composition and metabolic profile. Even though extremely advantageous, long-term adherence to the KD is a limiting factor. Indeed, this dietary regimen could become unsustainable due to the important restrictions required for ketosis development. Thus, a combination of high-fat diets with more nutrient-rich nutritional regimens, such as the Mediterranean diet, can amplify positive effects for individuals with PCOS.
... Recurrent binge eating, an eating disorder behavior characterized by a subjective sense of loss of control while eating a large amount of food in a discrete period of time, characterizes binge-spectrum eating disorders (e.g., bulimia nervosa, binge-eating disorder; APA, 2022; Claudino et al., 2019). Importantly, subjective loss of control (i.e., feeling as if one cannot stop eating once started) distinguishes binge eating from overeating and is associated with significant distress above and beyond quantity consumed (Goldschmidt et al., 2012;Latner et al., 2007;Wolfe et al., 2009), emphasizing its clinical significance. In fact, quantity consumed may be less clinically relevant given that individuals with binge-spectrum eating disorders report experiencing loss of control eating both with and without objectively large quantities of food (Wolfe et al., 2009). ...
... It is also possible that the consumption patterns of college students differ from those of non-college students, necessitating future investigations within community samples. However, understanding the diurnal appetitive rhythms and consumption patterns of college students with loss of control eating, regardless of size, is important given the high rates of eating disorders among college students (Eisenberg et al., 2011) and the degree of distress associated with loss of control (e.g., Goldschmidt et al., 2012;Latner et al., 2007;Wolfe et al., 2009). ...
Binge eating demonstrates an evening diurnal shift among individuals with eating disorders. Disruptions to diurnal appetitive rhythms may be somewhat chronic and set the stage for additional disruptions to prompt binge eating. Despite known diurnal shifts in binge eating and related constructs (e.g., mood) and detailed characterizations of binge-eating episodes, no findings to date describe the naturalistic diurnal timing and composition of energy and nutrient intake on days with and without loss of control eating. We aimed to characterize eating behaviors (i.e., meal timing, energy intake, and macronutrient composition) across seven days in individuals with binge-spectrum eating disorders, assessing differences between eating episodes and days with and without loss of control eating. Undergraduate students (N = 51; 76.5% female) who endorsed past 28-day loss of control eating completed a 7-day naturalistic ecological momentary assessment protocol. Participants completed daily food diaries and reported instances of loss of control eating across the 7-day period. Results indicated that episodes of loss of control were more likely to occur later in the day, but overall meal timing did not differ across days with and without loss of control. Similarly, greater caloric consumption was more likely for episodes with loss of control, but overall caloric consumption did not differ between days with and without loss of control. Analysis of nutritional content demonstrated differences between both episodes and days with and without loss of control for carbohydrates and total fats, but not for protein. Findings provide support for the hypothesized role disruptions in diurnal appetitive rhythms play in maintaining binge eating via consistent irregularities, underscoring the importance of examining treatment adjuncts that intervene on the regulation of meal timing to enhance eating disorder treatment outcomes.
... Body dissatisfaction occurs when individuals feel that their internal view of self-body image does not align with what they perceive as an 'ideal body' and is frequently associated with a drive for thinness. Therefore, body dissatisfaction is seen as a risk factor for disordered eating patterns [105,106], and is common among athletes who present with disordered eating patterns. Body dissatisfaction can often lead to an intentional restriction of food intake or excessive exercising in an effort to alter body appearance [106,107]. ...
... Therefore, body dissatisfaction is seen as a risk factor for disordered eating patterns [105,106], and is common among athletes who present with disordered eating patterns. Body dissatisfaction can often lead to an intentional restriction of food intake or excessive exercising in an effort to alter body appearance [106,107]. ...
Relative Energy Deficiency in sport is experiencing remarkable popularity of late, particularly among female athletes. This condition is underpinned by low energy availability, which is a byproduct of high energy expenditure, inadequate energy intake, or a combination of the two. Several contributing factors exist that may predispose an athlete to low energy availability, and therefore a holistic and comprehensive assessment may be required to identify the root causes. The focus of the current narrative review is to discuss the primary contributing factors as well as known risk factors for low energy availability among female athletes to help practitioners increase awareness on the topic and identify future areas of focus.
... On a mechanistic level, depression is associated with reduced cognitive and affective flexibility [87], which are critical in effective emotional regulation [84]. Relatedly, deficiencies in emotional awareness and regulation have been associated with Uncontrolled Eating [88] and are particularly evident in adolescence where coping skills are still developing [89]. Thus, depressive symptoms may have possibly increased vulnerability to engaging in binge eating tendencies in the current sample as a means to cope with feelings of negative affect [88]. ...
... Relatedly, deficiencies in emotional awareness and regulation have been associated with Uncontrolled Eating [88] and are particularly evident in adolescence where coping skills are still developing [89]. Thus, depressive symptoms may have possibly increased vulnerability to engaging in binge eating tendencies in the current sample as a means to cope with feelings of negative affect [88]. ...
Plain English Summary Binge eating tendencies have become an increasingly common phenomenon in adolescent populations. These behaviours involve consuming large amounts of food in a short period of time, during which one feels out of control and unable to stop. Episodes are often followed by marked emotional distress that can serve to perpetuate and maintain these tendencies. The current study examined a group of adolescents aged 13 to 16 over three testing periods spaced 12 to 18 months apart, to investigate whether high levels of anxiety and stress interacted to increase likelihood of binge eating tendencies in individuals over time. Results revealed that participants who experienced higher anxiety and stress than usual were more likely to score highly on binge eating tendencies measures, compared to when they experienced lower levels of anxiety and stress. Correspondingly, we recommend raising greater awareness in parents, educators, and health professionals of the link between high anxiety and stress and increased risk of binge eating tendencies, in order to facilitate better prevention, detection, and early intervention.
... Restricting food intake has also been shown to increase food-related preoccupations, placing individuals at increased risk of engaging in overeating and binge eating (Coscina and Dixon 1983;Keys et al 1950;Polivy and Herman 1985;Wardle 1987). Similarly, studies have shown that self-reported dieting predicts onset of binge eating or certain eating disorders in community and clinical samples (e.g., Goldschmidt et al 2012;Liechty and Lee 2013;Patton et al 1999;Stice et al 2017;Stice and Agras 1998;Stice et al 2002). However, criticisms of the theory suggest that it is overly simplified (Burton and Abbott 2017;Schaumberg et al 2016;Waller 2002). ...
... In particular, the majority of individuals who engage in dieting or participate in weight-loss treatments do not develop binge eating, and dieting does not always precede the development of binge-eating disorder. Findings suggest that certain subgroups of those who report dietary restraint and/or dieting, such as individuals who also report negative mood or engage in more severe weight control methods, may be at elevated risk of developing binge eating (Goldschmidt et al 2012;Neumark-Sztainer et al 1995;Stice and Agras, 1998). However, the core original theory does not directly address biological or psychological vulnerabilities that would potentially account for this discrepancy across individuals (Masheb and Grilo 2000;Mussell et al 1995;Patton et al 1990;Wilson 1993). ...
Numerous conceptualizations addressing the onset or persistence of binge-eating behaviors have been proposed within the literature. This chapter provides an overview of a wide range of theories addressing the development or maintenance of binge eating. The models vary across a number of features, and this chapter is generally organized based on these features: (1) the focus on binge eating as an independent behavior versus in conjunction with other eating disorder behaviors (e.g., restriction and purging) or within a certain diagnostic class (e.g., bulimia nervosa and binge-eating disorder); (2) the explicit association with a specific psychotherapeutic intervention; and (3) the nature of the variables within the model, including cognitive, affective, interpersonal, sociocultural, and/or biological variables. We also acknowledge the range of the types of variables included within each conceptualization reviewed within this chapter. Notably, various risk or maintenance factors are shared across multiple models (e.g., restraint, affect regulation, and self-oriented cognitions), and the more complex conceptualizations often integrate elements or processes from other models.
... 한 가지 주목할 만한 것은 다이어트가 폭식의 위험 요인 이라는 것이다 (Goldschmidt et al., 2012). 폭식은 일정 시간 동안 대부분의 사람이 유사한 상황에서 동일한 시간 동안 먹는 것보다 분명하게 많은 양의 음식을 먹는 것으로 음식 섭취를 참을 수 없거나 한번 먹기 시작하면 멈출 수 없게 되는 것을 말한다(American Psychiatric Association, 2013). ...
... 섭식 절제 이론에 따르면, 폭식은 지속적이 고 엄격한 식이 억제로부터 비롯된 박탈감에 대한 반응이 다 (Polivy et al., 1985). 회피이론에서는 (Goldschmidt et al., 2012). 이를 뒷받침하듯 많 은 연구에서 우울이라는 부정적인 정서가 폭식과 관련이 있다고 보고되었다 (Herzog et al., 1988;Wolff et al., 2000;McCabe et al., 2003;Park HR, 2014;Jeong MS et al., 2016: Lee Sh et al., 2018 (Lee SH et al., 2018). ...
Background: This study has been carried out in order to investigate the mediating effect of depression on the relationship of self discouragement and binge eating behaviour of university female students with diet experience. Methods: The data of diet experience existence, depression, binge eating behavior and self discouragement were obtained. Lastly, the total data of 296 undergraduate female students were analyzed. Results: The results of this study were as follows. First, 76% of college women reported a Diet experience. This figure was more than three times the female students reported that this diet experience. Second, In college students with diet experience, the variables of depression, binge eating behavior and self-disappointment were all significantly correlated. Third, binge eating behavior partially mediated the relation between depression and self discouragement. Conclusions: Binge eating behavior mediated the relation between depression and self discouragement of University female students with diet experience.
... Similarly, Dakanalis et al. [27] found that internalized body shame correlated with disordered eating attitudes and behaviors in collegiate men. This is not surprising as within the core of internalized shame is self-esteem [28], and self-esteem, in previous studies, has been found to be salient in predicting eating disorders in adolescents and young adult men and women [29,30]. However, no research has examined drive for muscularity, disordered eating, self-blame, and internalized shame together to determine how they may be interconnected in collegiate men. ...
... Although research has examined the interplay of internalized shame and self-blame in their relationships to disordered eating and body dissatisfaction in collegiate women [33], to our knowledge, no studies have examined the relationships between disordered eating, self-blame, and internalized shame at the same time in collegiate men. In Dakanalis et al.'s study of adult men [27] and in support of the findings from the Project EAT studies in adolescents [29,30], internalized shame significantly predicted disordered eating in collegiate men. In our study, self-blame accounted for a greater percentage of the variance in disordered eating attitudes and behaviors than did internalized shame. ...
Purpose
The purpose of the present study was to explore the relative contributions of self-blame and internalized shame to variability in disordered eating and drive for muscularity scores in collegiate men.
Method
One hundred and sixty-eight male college students in the Rocky Mountain region of the USA completed valid and reliable self-report survey measures: the Drive for Muscularity Scale, the Internalized Shame Scale, the Shame and Guilt Eating Scale to assess self-blame, and the Eating Attitudes Test. Cross-sectional data were analyzed through descriptive, correlation, and regression statistics.
Results
Men who reported higher levels of self-blame, r = 0.39, p < 0.001, and internalized shame, r = 0.38, p < 0.001, also reported higher levels of eating disorder symptomology. Similarly, men who scored higher on internalized shame, r = 0.20, p < 0.01, reported higher scores on drive for muscularity. Regression analyses revealed that internalized shame was the sole contributor to variability in drive for muscularity scores, β = 0.20, p < 0.01, whereas both self-blame, β = 0.27, p < 0.001, and internalized shame, β = 0.24, p < 0.001, contributed to scores on disordered eating attitudes and behaviors in men.
Conclusions
Our study was the first to examine how internalized shame and self-blame relate to drive for muscularity and disordered eating in collegiate men. Our results suggest that both self-blame and internalized shame may contribute to disordered eating in men. Additionally, internalized shame appears to relate to drive for muscularity in men. Clinicians may wish to consider how they approach treatment given the potential contributions of internalized shame and self-blame to disordered eating in their male clients.
Level of evidence
Level V, cross-sectional descriptive study.
... Similar dichotomous yes/no questions to determine dieting status have been used in previous studies of undergraduates (e.g. Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012;Lowe & Timko, 2004). For ease of presentation in this paper, those who reported dieting to lose weight are referred to as dieters, those who selected dieting to maintain weight are referred to as maintainers, and those who answered "no" to both questions are referred to as non-dieters. ...
... health benefits and social engagement), but were comparable to dieters in the use of exercise for appearance and weight control. Dieters' constellation of goals and motivations indicates risk for reduced exercise engagement in the long term (Silva et al., 2011;Teixeira et al., 2012;Vlachopoulos & Neikou, 2007), as well as risk for disordered eating, particularly if these behaviours do not result in progress toward weight-loss goals (Goldschmidt et al., 2012;Neumark-Sztainer, Wall, Larson, Eisenberg, & Loth, 2011). Dieters engaging in weight-loss goals are more likely to gain weight and ultimately consume more calories than their non-dieting peers (Lowe, 2015). ...
Attempts at weight control are common in university students. Two of the most commonly cited methods of weight control are dieting and exercise. The purpose of this study was to assess if different dieting identities/motives predicted exercise goals, motivations, and frequency/intensity of exercise in undergraduate women. Participants were 117 women from a large university in the United States. Participants completed a set of empirically supported questionnaires inquiring about dieting identity (weight loss, weight maintenance, or non-dieting), exercise frequency and intensity, exercise goals (e.g. health vs. weight loss), and exercise motivations. Women were also asked to self-identify as dieting to lose weight, dieting to maintain weight, or not dieting. Non-dieters and women dieting for weight loss were more likely to engage in exercise for extrinsic and aesthetic reasons. Women dieting for weight maintenance were more likely to report intrinsic goals and motivation for exercise. Consistent with previous work, weight loss as a goal was associated with unhealthy dieting and exercise participation. Individuals dieting for weight loss are at increased risk for discontinuing exercise. Health benefits, and not weight loss, should be emphasised for exercise interventions for undergraduates.
... In this sample, current dieting was not associated with total energy intake or percentage intake from macronutrients. This finding is in contrast with longitudinal studies that have implicated self-reported dieting in the development of LOC-eating (Goldschmidt et al., 2012;Neumark-Sztainer et al., 2011;Stice et al., 2002). However, our findings are consistent with laboratory-based studies of other eating behavior (e. g. snacking, during a dinner meal) among youth (Bennett & Blissett, 2020;Daniel et al., 2015). ...
... Binge eating behavior in adolescents who are on dietary restraint can be influenced by several other factors, such as psychological factors (Goldschmidt et al., 2012). People on a controlled diet are less likely to experience decreased self-control when they encounter stressors, whether they come from external factors such as social pressures or life problems or internal factors such as negative feelings about themselves (Dovey, 2016;Kukk & Akkermann, 2022;Yau & Potenza, 2013). ...
... Dietary restriction is a known maintaining factor in the transdiagnostic ED model (e.g., Fairburn, 2008) and has consistently been linked to ED symptoms (e.g., pathological weight loss, binge eating; Goldschmidt et al., 2012). In general, GLP-1As can increase satiety and decrease hunger, which may lead to dietary restriction (Shah & Vella, 2014). ...
Glucagon‐like peptide‐1 receptor agonists (GLP‐1As) are being used as approved or off‐label treatments for weight loss. As such, there has been increasing concern about the potential for GLP‐1As to impact eating disorder (ED) symptomatology. This article seeks to (1) review the current state of knowledge regarding GLP‐1As and ED symptomatology; (2) provide recommendations for future research; and (3) guide ED clinicians in how to discuss GLP‐1As in clinical practice. Although evidence is limited, it is possible that GLP‐1As could exacerbate, or contribute to the development of, ED pathology and negatively impact ED treatment. Preliminary research on the use of GLP‐1As to treat binge eating has been conducted; however, studies have design limitations and additional research is needed. Therefore, at the current time there is not sufficient evidence to support the use of GLP‐1s to treat ED symptoms. In summary, more research is required before negative or positive conclusions can be drawn about the impact of GLP‐1As on EDs psychopathology. Herein, we provide specific recommendations for future research and a guide to help clinicians navigate discussions with their clients about GLP‐1As. A client handout is also provided.
Public Significance
Despite glucagon‐like peptide‐1 receptor agonists (GLP‐1As; e.g., semaglutide) increasingly being the topic of clinical and public discourse, little is known about their potential impact on ED symptoms. It is possible that GLP‐1As could maintain, worsen, or improve ED symptoms. This article reviews the limited literature on GLP‐1As and ED symptoms, recommends future research, and provides clinicians with a guide for discussing GLP‐1As with ED clients.
... For example, unhealthy behaviors such as skipping meals, using food substitutes, and diet pills in an attempt to lose weight have been shown to predict higher BMI over time in adolescents [39]. Furthermore, longitudinal studies have shown that dieting predicts the occurrence of binge eating [40], especially when dieting is accompanied by depressive symptoms and impaired self-esteem [41]. These findings support the idea that dieting increases the risk of losing control over food. ...
This study aimed to investigate the role of the psychological impact of environments rich in palatable foods on three aspects of eating behavior: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). The hypotheses were as follows: (a) The psychological impact (i.e., motivation to eat) of an environment rich in palatable foods will positively predict CR, UE, and EE; (b) dieting will predict CR, UE, and EE; and (c) CR, UE, and EE will positively predict body mass index (BMI). This study had a cross-sectional design in which data were collected online from 413 subjects. The psychological impact of food-rich environments (food available, food present, and food tasted) was assessed using the Power of Food Scale (PFS), and CR, UE, and EE were assessed using the Three-Factor Eating Questionnaire (TFEQ-R18). Both instruments were tested for confirmatory factor analysis. The relationship between constructs was measured using partial least-square structural equation modeling (PLS-SEM). “Food available” positively predicted all TFEQ-R18 factors (p < 0.01). “Food present” positively predicted UE (p < 0.001) and EE (p = 0.01). People currently on a diet showed higher levels of CR (p < 0.001) and EE (p = 0.02). UE and EE positively predicted BMI. Thus, CR, UE, and EE were positively predicted by the motivation to consume palatable foods in varying proximity, suggesting that the presence of food and, more importantly, its general availability may be important determinants of eating behavior, particularly UE and EE. Health strategies should consider the influence of the food environment to prevent and better manage impairments in eating behavior. Sex differences suggest that special attention should be paid to women. Furthermore, dieting was associated with higher levels of EE, which in turn was associated with higher BMI. Weight loss interventions should consider this vulnerability.
... A Meta-analysis of the general population in China investigating symptoms of EDs during the COVID-19 pandemic supports such an opinion [11]. Adolescents are particularly at risk [12], giving rise to habits of overeating and other conditions [13]. Scholars have also found that EDs are prospectively related to depression in most patients in the later stages of various illnesses. ...
Background
Depression is being increasingly acknowledged as a global public health concern, and following this trend, attention towards eating disorders (EDs) has surged within China’s national consciousness. EDs symptoms frequently coexist with various mental health conditions, including depression. However, research focusing on EDs symptoms and depressive symptoms among Tibetan students in China remains scant. This study employs network analysis to estimate the relational network between EDs and depressive symptoms.
Methods
Tibetan (n = 2,582) and Han (n = 1,743) students from two universities in the Xizang Autonomous Region, China, completed the Eating Attitude Test-26 (EAT-26) and the Patient Health Questionnaire-9 (PHQ-9). We estimated the network structure of EDs symptoms and depressive symptoms, identified central and bridge symptoms, and examined whether network characteristics differed by gender and ethnic.
Results
The core symptoms identified within this study were Calorie_awareness, Desire_to_thin and Fatigue. Conversely, bridge symptoms included Appetite, Suicide, Anhedonia, Guilty, Body_fat_awareness, and Food_preoccupation. The study also revealed no significant gender differences within the network model. However, disparities among ethnic groups were observed within the network structure.
Conclusions
Our study examined the correlation between EDs symptoms and depressive symptoms in Tibetan college students. Focusing on the individual's quest for the perfect body shape and some Tibetan students' appetite problems – potentially stemming from transitioning to a new university environment, adapting to the school canteen's diet, or being away from their hometown – could aid in the prevention and management of EDs and depression symptoms. It could reduce the incidence of complications by helping students maintain good physical and mental health. Concurrently, our research provides insights into the relatively higher levels of depression triggered by the unique plateau environment.
... However, this suggestion should be made with caution as the adverse effects of LCDs and their potential risks for overweight or obese populations have not yet been systematically investigated. Moreover, dietary restrictions may be a contraindication for certain individuals, such as geriatric populations (Volkert et al., 2022) or people with or at risk of developing an eating disorder (Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012). One problem is the experience that may people regain weight quickly after strict weight loss, described as weight cycling, which might cause fluctuations in cardiovascular risk factors such as blood pressure, heart rate, sympathetic activity, and circulating levels of glucose, lipids, and insulin (Rhee, 2017). ...
Background
Individuals with overweight or obesity are at a high risk for so-called ‘atypical’ or immunometabolic depression, with associated neurovegetative symptoms including overeating, fatigue, weight gain, and a poor metabolic profile evidenced e.g. by dyslipidemia or hyperglycemia. Research has generated preliminary evidence for a low-calorie diet (LCD) in reducing depressive symptoms. The aim of the current systematic review and meta-analysis is to examine this evidence to determine whether a LCD reduces depressive symptoms in people with overweight or obesity.
Methods
Eligible studies were identified through PubMed, ISI Web of Science, and PsycINFO until August 2023. Standardized mean differences (SMDs) were derived using random-effects meta-analyses for (1) pre-post LCD comparisons of depression outcomes, and (2) LCD v. no-diet-control group comparisons of depression outcomes.
Results
A total of 25 studies were included in the pre-post meta-analysis, finding that depression scores were significantly lower following a LCD (SMD = −0.47), which was not significantly moderated by the addition of exercise or behavioral therapy as a non-diet adjunct. Meta-regressions indicated that a higher baseline BMI and greater weight reduction were associated with a greater reduction in depression scores. The intervention-control meta-analysis ( n = 4) found that overweight or obese participants adhering to a LCD showed a nominally lower depression score compared with those given no intervention (SMD = −0.29).
Conclusions
There is evidence that LCDs may reduce depressive symptoms in people with overweight or obesity in the short term. Future well-controlled intervention studies, including a non-active control group, and longer-term follow-ups, are warranted in order to make more definitive conclusions.
... Dietary restraint and restriction have been empirically linked to increased LOC eating in some contexts. Self-directed dieting (i.e., outside of the context of structured lifestyle modification programs), which encompasses both attempted restraint and actual restriction, has longitudinally predicted binge eating among adolescents in numerous studies (Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012;Neumark-Sztainer et al., 2007;Neumark-Sztainer, Wall, Larson, Eisenberg, & Loth, 2011;Neumark-Sztainer, Wall, Story, & Sherwood, 2009). However, findings have not consistently supported this relationship. ...
Objective:
This study aimed to: 1) compare rates of dietary restraint and restriction between adolescents with and without loss-of-control (LOC) eating who were seeking weight control and 2) examine temporal relations between restraint/restriction and LOC eating.
Method:
37 adolescents seeking weight control (mean age: 15.4 ± 1.5; 62 % White; 57 % female; mean BMI percentile = 97.3 ± 3.1) completed a one-week ecological momentary assessment protocol and reported on dietary restraint/restriction and eating behavior prior to beginning a weight control intervention. Chi-square tests examined differences in frequency of restraint/restriction between participants with and without LOC eating. Multilevel models examined associations between dietary restraint/restriction and LOC eating at the next survey and on the next day.
Results:
Of 37 participants, 15 (41 %) reported engaging in LOC eating. Participants with LOC eating more frequently endorsed several forms of restraint and restriction versus participants without LOC eating. Attempting to avoid enjoyable foods and attempting to limit eating at one survey predicted greater likelihood of LOC eating at the next survey.
Conclusions:
Findings suggest that attempted restraint, but not actual restriction, was associated with LOC eating. Research should explore additional factors that may influence these relationships, which could inform weight control treatments that address restraint/restriction.
... Various cognitive, behavioral, and emotional risk factors, such as low self-esteem, internalizing or externalizing behaviors during adolescence, risky dieting, shaperelated attitudes, behaviors consistent with restraint or disinhibition, and depressive symptoms have been identified as potential precursors of the later development of an ED [27,28]. ...
Purpose:
This article provides an overview of current treatment options for adults and adolescents suffering from eating disorders (ED).
Views:
ED are prevalent public health problems that considerably impair physical health and disrupt psychosocial functioning. In primary care settings, anorexia nervosa, bulimia nervosa, and binge eating disorder represent the most frequently seen types of eating disorders, in both adults and adolescents. To address these maladaptive eating-related behaviors and concurrent psychiatric symptoms, various pharmacological interventions and specialized psychological treatments have been evaluated and received support to varying degrees by controlled research.
Conclusions:
The current literature regarding children and adolescents with eating disorders mainly supports the use of psychological interventions, such as family-based treatment and cognitive behavioral therapy. Due to the lack of robust evidence, the use of psychotropic medications is neither recommended nor approved in this population. For adults with eating disorders, an array of behaviorally focused psychotherapies, along with integrative and interpersonal approaches, can lead to the improvement of symptoms and the achievement of a healthy weight. Moreover, aside from psychotherapy, several pharmacological agents can contribute to the alleviation of eating disorders' clinical characteristics in the adult population. At the moment, the recommended psychotropic medication for eating disorders is represented by fluoxetine for bulimia nervosa and lisdexamfetamine for binge eating disorder.
... Fatores de predisposição -que incluem os biológicos, psicológicos, familiares e socioculturais -, associados a fatores precipitadores e mantenedores, contribuem para o desenvolvimento dos quadros completos de TAs 5 . A restrição alimentar, ou as dietas, aparece como preditor de uma patologia alimentar em estudos que a relacionam com um maior risco de desenvolver a forma completa e subclínica da AN 3 , da BN 6 e do TCA 6,7 . ...
Objectives
To assess whether parental modeling, regarding the practice and/or encouragement of diets, can predict risk behaviors related to eating disorders (EDs) in children and adolescents.
Methods
A systematic review of studies published until June 2022, available in indexed databases – such as PubMed, Virtual Health Library, SciELO and Cochrane Library, was carried out. Cross-sectional and longitudinal studies in Portuguese, Spanish and English were included and assessed for risk of bias according to the NewCastle – Ottawa Quality Assessment Scale.
Results
Fourteen studies were considered in the review. Most of them are cross-sectional (71.4%), coming from the United States and European countries (57.1%), in addition to presenting a low risk of bias (85.7%). Most of the studies found associations between parental encouragement of diets (direct modeling) and risk behaviors in children and adolescents, such as the use of weight control methods, body dissatisfaction and food restriction. Few studies have related the father’s habit of dieting (indirect modeling) with these behaviors.
Conclusions
Data support the idea that direct modeling, that is, verbal encouragement to use diets, can be very harmful, especially to individuals who are excessively concerned about weight and food. Future research is needed to assess the impact of parental eating practices and the development of possible actions to prevent weight-related problems.
KEYWORDS
Eating disorders; disordered eating; risk behavior; paternal; child; adolescent
... Importantly, mainstream, or weight-normative health interventions encourage weight loss for higher-weight individuals, and by doing so prescribe varying means of restricting intake to achieve negative energy balance (Freire, 2020). A series of studies over the past several decades have demonstrated that dieting and restrictive eating precipitate binge eating episodes (e.g., Goldschmidt et al., 2012;Polivy & Herman, 1985;Stice et al., 2002). Similarly, Derks et al. (2022) recently found early adolescents who endorsed loss of control and binge eating were more likely to have been engaging in restrained eating and other unhealthy weight control behaviors as well as have high BMI at preceding timepoints. ...
Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30–45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = −3.76, SE = 0.64, p < .0001) and emotional eating (b = −1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.
... Dietary restraint (i.e., attempted or actual restriction of caloric intake) is widely considered the primary maintaining factor for B-EDs and reducing dietary restraint is a key treatment target within enhanced cognitive behavior therapy for B-EDs (Fairburn et al., 2009). While a robust body of literature has linked the occurrence and severity of dietary restraint to binge eating (Goldschmidt et al., 2012;Linardon, 2018a) and extreme weight control behaviors (Liechty & Lee, 2013), little is known about the contributions of specific forms of dietary restraint to severity of binge eating and overall eating pathology. Different forms of dietary restraint may differentially contribute to restricted energy consumption (e.g., fasting or restriction of caloric content may yield substantially restricted energy intake, whereas avoidance of specific foods may not) and therefore to binge eating. ...
Objective:
The relationship of dietary restraint in increasing risk for binge eating among individuals with binge-spectrum eating disorders (B-EDs) is well established. However, previous research has not yet identified whether these individuals exhibit heterogeneous profiles of dietary restraint and whether these profiles are associated with differences in eating pathology.
Methods:
Individuals with B-EDs (N = 290) completed the Eating Disorder Examination. Latent profile analysis was conducted on dietary restraint frequency data, including restriction of overall amount of food consumed, avoidance of eating, desire for an empty stomach, food avoidance, and dietary rules. Identified latent profiles were compared on binge eating frequency, compensatory behaviors frequency, and ED pathology using the three-step procedure.
Results:
A four-class model of dietary restraint best fit the data. Classes significantly differed in frequency of compensatory behaviors (F[3, 286] = 31.01, p < .001), EDE Eating Concern (F[3, 286] = 14.36, p < .001), EDE Shape Concern (F[3, 286] = 7.06, p < .001), EDE Weight Concern (F[3, 286] = 6.83, p < .001), and ED Pathology (F[3, 286] = 12.86, p < .001), but did not differ in frequency of objective (F[3, 286] = 2.45, p = .06) or subjective binge episodes (F[3, 286] = 1.87, p = .14).
Discussion:
Individuals with B-EDs exhibit distinct profiles of dietary restraint, which are associated with frequency of compensatory behaviors and severity of ED pathology.
Public significance statement:
Individuals with binge-spectrum eating disorders have different patterns of restrictive eating symptoms. These profiles of restrictive eating behaviors are associated with differences in severity of compensatory behaviors and cognitive eating disorder symptoms, like shape and weight dissatisfaction. Understanding the relationships between profiles of restrictive eating behaviors and other eating disorder symptoms may allow for personalization of treatment and improvements in treatment efficacy.
... Further, LOC has been associated with poor quality of life, problematic weight control behaviours, low self-esteem, disinhibition while eating, emotion dysregulation, depressive symptoms, and general distress in people with EDs or obesity as well as subclinical and community populations (Colles et al., 2008a;Goldschmidt et al., 2015;Latner et al., 2007). In addition, LOC has been evidenced to independently contribute to negative affect and is a better predictor of distress experienced before and after an overeating episode than the amount of food consumed (Goldschmidt et al., 2012;Kelly et al., 2018). Thus, when individuals engage in disordered eating behaviours, it is the sense of LOC with eating that is more strongly related to psychopathology than the amount consumed. ...
Objective:
Emerging evidence suggests that loss of control (LOC) may present as a common feature across disordered eating behaviours. However, there has been limited research on the transdiagnostic nature of LOC in this area. The primary aim of this study was to systematically review disordered eating behaviours and measures of LOC in clinical and non-clinical populations.
Method:
Electronic searches of the relevant databases were conducted. Selected articles were screened for eligibility and assessed for methodological quality.
Results:
Thirty-four studies met inclusion criteria. Findings demonstrated that LOC was associated with disordered eating behaviours across bariatric populations, eating disorder populations, and community populations. Specifically, LOC was associated with binge eating (subjective and objective episodes), grazing, night eating, and emotional or stress eating. Findings also revealed that LOC was inconsistently operationalised across studies, with varied approaches to measuring the construct.
Conclusion:
Overall, the findings from this review provide support for LOC as a transdiagnostic feature of disordered eating behaviours. Future studies should utilise robust multi-method assessments to measure the severity of LOC, which may provide greater insight into how LOC manifests across different eating disorder presentations.
... This theory hypothesizes that sociocultural pressure for obtaining the thin beauty ideal increases the risk for body dissatisfaction, which increases the risk for negative affect and dietary restriction, which then increases the risk of the onset of eating disorder symptoms, e.g., binge eating. This model was supported in other research by Goldschmidt and colleagues [30,31]. Furthermore, other longitudinal studies by Stice and colleagues [32] suggested that successful dietary restraint (actual self-regulation of food intake) might result in reduced binge eating. ...
The origins of theories specifying dietary restraint as a cause of eating disorders can be traced to the 1970s. This paper will present an overview of the origins of dietary restraint theories and a brief historical review of evidence will be summarized. Recent research will be presented, including the results from the CALERIE Phase 1 study, as well as CALERIE Phase 2, which were NIH-sponsored randomized controlled trials. CALERIE 2 provided a test of the effect of two years of caloric restriction (CR) on the development of eating disorder syndromes and symptoms in comparison to a control group that did not alter eating behavior or body weight. The intervention was effective for inducing a chronic (two-year) reduction in total energy expenditure and increased dietary restraint but did not increase symptoms of eating disorders. The results of this recent investigation and other studies have not provided experimental support for conventional dietary restraint theories of eating disorders. These findings are discussed in terms of potential revisions of dietary restraint theory, as well as the implications for a paradigm shift in public health messaging related to dieting.
... Negative affect (NA) is widely recognized as a maintenance factor for loss of control eating (LOCE) [1], i.e., eating either an unambiguously large amount of food or an amount of food deemed large only by the individual combined with a sense of lack of control over eating [2]. The affect regulation model conceptualizes the significant relationship between NA and LOCE in binge eating spectrum disorders [3,4] as LOCE being maladaptively intended to alleviate, control, or avoid experiencing NA [1,[5][6][7]. Ecological momentary assessment (EMA) studies have supported this model by indicating that momentary NA is an antecedent to LOCE, such that high NA prospectively predicts the near-time occurrence of a LOCE episode [8][9][10]. ...
PurposeLoss of control eating (LOCE) is supported as a maladaptive regulation strategy for high negative affect (NA) and low positive affect (PA). Yet, little is known about the day-to-day activities outside of eating that may precipitate such changes in affect and impact risk for LOCE. The current ecological momentary assessment study sought to examine whether (1) low NA and high PA at a given survey would prospectively predict lower likelihood of a LOCE episode at the next survey, and (2) having recently engaged in various non-eating activities would be associated with changes in average NA and PA levels at the same survey.Methods
Data collected from 66 participants with LOCE over 7–14 days were analyzed using generalized estimating equations.ResultsHigh NA but not low PA at a given survey prospectively predicted lower likelihood of a LOCE episode at the next survey. Having recently engaged in outdoor recreation and socializing was associated with lower than one’s usual NA and higher than one’s usual PA at the same survey, social media was associated with higher than one’s usual NA and lower than one’s usual PA, self-care was associated with higher than one’s usual PA, and napping was associated with lower than one’s usual PA.Conclusion
Individuals may benefit from increasing the frequency of daily non-eating activities that reduce NA, since it appears to be a more salient predictor of LOCE than PA. Further research is needed to elucidate this LOCE maintenance model, particularly in regard to the role of PA.Level of evidenceLevel IV, multiple time series without intervention.
... Stice, Gau, Rohde & Shaw (2017) found dieting predicted full criteria and subclinical presentations of AN, BN, and BED three years later among adolescent girls. Similary, adolescent girls who were on a diet to lose weight were at increased risk of binge eating up to five years later when compared to non-dieting peers (Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012). From the patient perspective two thirds of women with AN report that dieting had been the onset of their eating disturbance (Hilbert et al., 2014). ...
Evidence-based eating disorder prevention programs are aimed at reducing established risk factors; however, controversy exists on whom preventive efforts should be targeted. The aim of this study was to compare the impact of a prevention program for eating disorders on female adolescents with and without dieting behavior. This program is a three-session, weekly intervention based on the principles of media-literacy and cognitive dissonance. Eighty-eight female adolescents aged 12-17 years from Buenos Aires participated in this uncontrolled trial. The adolescents completed a pre- and post-intervention assessment and a six-month follow-up. General linear models were computed for those with complete data. A significant decrease across time was observed in Drive for Thinness and Thin-ideal Internalization scores across all participants. However, a significant decrease in Bulimic Attitudes was only observed among those who reported dieting to lose weight. Furthermore, no significant changes were observed on Body Dissatisfaction scores. Thus, Dieting Behavior partially moderated the effect of the intervention. These mixed results support the effects of the prevention program while suggesting continued work is needed to improve the intervention.
... 13 In the literature, self-esteem is often considered a risk factor for the development of eating disorders. 14 Prospective studies suggest that high self-esteem provides protection against unhealthy weight control behaviors, 15 binge eating, 16 and purging behaviors. 17 In addition, higher self-esteem predicts the cessation of unhealthy weight control behaviors 15 and binge eating. ...
Objective:
To explore the role of body-esteem and self-esteem in the occurrence of academic functioning problems associated with eating disturbances. Participants: 330 university students (aged 16-53 years) in Finland in 2016. Method: Interference with academic functioning measured with the Eating and Body Image Academic Interference Scale. Multivariable logistic regression analyses were performed to describe the relationship of body-esteem, global self-esteem, and age with academic functioning problems associated with eating disturbances. Results: The level of academic functioning problems was low. High appearance-esteem (OR = 0.26; 95% CI [0.14-0.48]) and a five-year increase in age (OR = 0.68; 95% CI [0.52-0.89]) provided protection against academic functioning problems, whereas high evaluations attributed to others about one's body and appearance increased the odds of such problems (OR = 2.25; 95% CI [1.41-3.59]). Conclusion: Problems in academic functioning may relate to problems in eating behavior, body image, and feelings about appearance.
... La autoestima se ha considerado un mediador de la depresión (Nima, Rosenberg, Archer & García, 2013), y en conjunto aumentan el riesgo de presentar conducta de atracón entre personas que hacen dieta restringida (Goldschmidt, Wall, Loth, Grange & Neumark-Sztainer, 2012). Stice, Marti & Durant (2011) mostraron que los sujetos con las puntuaciones más altas de síntomas depresivos, el riesgo de TCA aumentaba casi tres veces. ...
El presente trabajo tiene como objetivo conocer la prevalencia de conductas alimentarias de riesgo y de síntomas depresivos, así como su relación con autoestima, interiorización del ideal estético de la delgadez y relación con el padre y la madre. La muestra (N = 892: 501 mujeres y 390 hombres), con edades entre 16 y 41 años (X = 19.7; DE = 2.9), se obtuvo de un censo realizado a los estudiantes de primer ingreso a una universidad pública en la Ciudad de México. Los resultados muestran una prevalencia de conductas alimentarias de riesgo (CAR) en el nivel moderado de 15.1% en los varones y de 19.5% en las mujeres, y del 4.1% y 6.1% para riesgo alto, respectivamente. Entre las mujeres, la depresión subumbral y el riesgo alto de un episodio depresivo mayor se encontró en conjunto 6.7%. Entre los hombres la frecuencia fue 3.3%. Se encontró que los sujetos con algún grado de depresión y preocupación por la figura corporal tienen mayor riesgo de CAR.
... Moreover, conventional behavioral treatments mostly fail in long-term weight reduction: Dieters struggle to maintain new eating patterns, give in to food cravings, and consequently regain most of their weight after a year (Butryn, Webb, & Wadden, 2011). In certain individuals, weight-loss programs might actually favor weight problems and pathological eating patterns, such as binge eating and bulimic symptoms (Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012). ...
Objective:
Conventional weight-loss programs that induce a calorie deficit mostly fail in long-term weight reduction and disadvantageous eating styles often remain unchanged. Mindfulness interventions therefore redirect the focus away from the weight-loss goal and toward the process of eating itself. By eating more mindfully, at a slower pace, and with an enhanced focus on bodily sensations, participants might not only indirectly reduce their daily calorie intake but also eat less craving and stress driven.
Method:
This study randomized participants to either intervention (n = 23) or waitlist group (n = 23) to investigate the effectiveness of a 4-session mindfulness and prolonged chewing intervention. Dependent variables were body mass index and food craving as well as emotional, external, and intuitive eating.
Results:
Across the 8 weeks of intervention, significant Group × Measurement time interactions pointed to decreases in body mass index and disadvantageous eating styles (food cravings, emotional and external eating) and an increase in intuitive eating in the intervention group. Weight loss in the intervention group was maintained after a 4-week follow up.
Conclusion:
A combination of mindfulness and a specific chewing training that increases awareness of satiety strongly impacted energy intake and related eating styles. Such interventions obviate loss-oriented calorie reduction and foster enjoyment and focused tasting of foods. Conventional weight-loss diets might incorporate such brief interventions in more long-term dieting trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
... The association between depression and binge eating has also been studied extensively and predicts binge eating symptoms among White females (Mitchell & Mazzeo, 2004), middle school students (Pearson, Zapolski, & Smith, 2015), adolescent girls (Skinner, Haines, Austin, & Field, 2012), and dieting young adults (Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012). One recent study found that greater depression predicted increased reports of binge eating behaviors more strongly among female participants; however, the mediational path from weight stigma to depression to binge eating and the possible moderation of this pathway by sex were not examined (Brechan & Kvalem, 2015). ...
Weight stigma and weight discrimination are prevalent in the United States and binge eating has been found to be associated with these experiences in numerous studies. One issue with the current literature on weight stigma and binge eating, however, is that study samples are primarily female, resulting in a lack of understanding of this relationship among males. To address this gap, we examined potential sex differences in the association between weight stigma and binge eating, as well as mediators of this relationship. Specifically, we examined experiences of weight discrimination and weight stigma consciousness as predictors of binge eating, and we assessed whether these relationships were mediated by depression, perceived stress, and/or perceived control. Results showed that, among females and males, experiences of weight discrimination significantly predicted binge eating and depression mediated this relationship; perceived stress also mediated this association, but only among males, and perceived control did not mediate for either sex. Results also showed that, among males, the relationship between weight stigma consciousness and binge eating was mediated by depression and perceived control, but not perceived stress. Weight stigma consciousness was unrelated to binge eating among females. Together, these findings suggest that weight stigma constructs differentially impact females and males, thereby illuminating the possible need for consideration of sex as an important component of efforts to reduce weight stigma.
... It is possible that other factors besides dieting need to be present in order to increase the risk for eating disorder behaviors. For example, a prospective study with a population-based sample of 1827 adolescents and young adults and a 10-year follow-up period, found that symptoms of depression and low self-esteem in dieters were important elements increasing the risk of binge eating [31]. Moreover, a narrative review concluded that while dieting may contribute to eating disorders, other factors mediate this relationship, namely a family history of eating disorders, mood disorders, problems with substance/alcohol use, personality characteristics, problematic family interactions, and biological vulnerability [32]. ...
Obesity and eating disorders are each associated with severe physical and mental health consequences, and individuals with obesity as well as comorbid eating disorders are at higher risk of these than individuals with either condition alone. Moreover, obesity can contribute to eating disorder behaviors and vice-versa. Here, we comment on the health complications and treatment options for individuals with obesity and comorbid eating disorder behaviors. It appears that in order to improve the healthcare provided to these individuals, there is a need for greater exchange of experiences and specialized knowledge between healthcare professionals working in the obesity field with those working in the field of eating disorders, and vice-versa. Additionally, nutritional and/or behavioral interventions simultaneously addressing weight management and reduction of eating disorder behaviors in individuals with obesity and comorbid eating disorders may be required. Future research investigating the effects of integrated medical, psychological and nutritional treatment programs addressing weight management and eating disorder psychopathology in individuals with obesity and comorbid eating disorder behaviors—such as binge eating—is necessary.
... Evidence suggests that high scores on dietary restraint scales predict the development of eating pathology (Polivy & Heatherton, 2015;Schaumberg & Anderson, 2016). Recent studies suggest that there is a relation between scores on dietary restraint scales and disordered eating behaviours in adolescents (Goldschmidt, Wall, Loth, Le Grange, & Neumark-Sztainer, 2012) and young adults (Liechty & Lee, 2013). Dieting in adolescence is related to binge eating and behaviours such as laxative use, vomiting and use of diet pills in subsequent years (Liechty & Lee, 2013). ...
The present study examined the factorial structure and construct validity of the Greek version of the 10-item Restraint Scale (RS). One hundred and fifty-three Cypriot university students were administered the RS and other measures. An oblique two-factor model with the Concern for Dieting (CD) and Weight Fluctuation (WF) factors, with Item 6 removed, fitted adequately to the data. The two subscales were found to correlate differentially with other measures. CD had strong correlations with dieting and dieting behaviour, and WF had a moderate association with weight. None of the subscales correlated with measures of exercising and perceived stress. A multidimensional structure of the scale for this sample and the consideration of two subscores instead of a single total score were suggested.
... In part because of the association with having excess weight, youths with LOC eating are particularly vulnerable to forms of social stress such as weight-related teasing and social isolation [17]. Not surprisingly, these factors have been suggested to influence the onset and course of LOC eating [32][33][34][35][36]. Indeed, results from longitudinal studies indicate that family weight-based teasing [37,38] and impaired interpersonal functioning [39] predicts increases in and the onset of future disordered eating behaviors. ...
Background:
The interpersonal model of loss of control (LOC) eating proposes that interpersonal problems lead to negative affect, which in turn contributes to the onset and/or persistence of LOC eating. Despite preliminary support, there are no data examining the construct validity of the interpersonal model of LOC eating using temporally sensitive reports of social stress, distinct negative affective states, and laboratory energy intake.
Method:
117 healthy adolescent girls (BMI: 75th-97th %ile) were recruited for a prevention trial targeting excess weight gain in adolescent girls who reported LOC eating. Prior to the intervention, participants completed questionnaires of recent social stress and consumed lunch from a multi-item laboratory test meal. Immediately before the test meal, participants completed a questionnaire of five negative affective states (anger, confusion, depression, fatigue, anxiety). Bootstrapping mediation models were conducted to evaluate pre-meal negative affect states as explanatory mediators of the association between recent social stress and palatable (desserts and snack-type) food intake. All analyses adjusted for age, race, pubertal stage, height, fat mass percentage, and lean mass.
Results:
Pre-meal state anxiety was a significant mediator for recent social stress and palatable food intake (ps<.05). By contrast, pre-meal state anger, confusion, depression, and fatigue did not mediate the relationship between social stress and palatable food intake (ps>.05).
Discussion:
Pre-meal anxiety appears to be the salient mood state for the interpersonal model among adolescent girls with LOC eating. Interventions that focus on improving both social functioning and anxiety may prove most effective at preventing and/or ameliorating disordered eating and obesity in these adolescents.
... Overall, results suggest that opportunities to Our finding that children, but not adolescents, who endorsed secretive eating were more 301 likely to endorse depressive symptomatology than children who did not endorse secretive eating 302 is in contrast to past literature showing an association between adolescent secretive eating and 303 depression (9). It is possible that, among children, low mood precipitates this problematic eating 304 behavior, or that engaging in secretive eating leads to feelings of low mood (e.g., guilt), which 305 can increase risk for other problematic eating behaviors such as binge eating (43)(44)(45)(46). Although Note: LOC = Loss of control eating (objective binge eating + subjective binge eating); Purging = vomiting, laxative misuse, and diuretic misuse; Linear regression and logistic regression analyses were conducted controlling for study site and age. ...
Purpose:
Secretive eating, characterized by eating privately to conceal being seen, may reflect eating- and/or body-related shame, be associated with depression, and correlate with binge eating, which predicts weight gain and eating disorder onset. Increasing understanding of secretive eating in youth may improve weight status and reduce eating disorder risk. This study evaluated the prevalence and correlates of secretive eating in youth with overweight or obesity.
Methods:
Youth (N?=?577) presented to five research/clinical institutions. Using a cross-sectional design, secretive eating was evaluated in relation to eating-related and general psychopathology via linear and logistic regression analyses.
Results:
Secretive eating was endorsed by 111 youth, who were, on average, older than youth who denied secretive eating (mean age?=?12.07???2.83 versus 10.97???2.31). Controlling for study site and age, youth who endorsed secretive eating had higher eating-related psychopathology and were more likely to endorse loss of control eating and purging than their counterparts who did not endorse secretive eating. Groups did not differ in excessive exercise or behavioral problems. Dietary restraint and purging were elevated among adolescents (?13y) but not children (<13y) who endorsed secretive eating; depression was elevated among children, but not adolescents, who endorsed secretive eating.
Conclusions:
Secretive eating may portend heightened risk for eating disorders, and correlates of secretive eating may differ across pediatric development. Screening for secretive eating may inform identification of problematic eating behaviors, and understanding factors motivating secretive eating may improve intervention tailoring.
Objective
The aim of this study was to identify naturally occurring groups of individuals experiencing binge eating (BE) symptoms based on their endorsement of varied functions of BE.
Method
Adults (N = 646) with self-reported BE symptoms were examined using latent profile analysis to identify differentiated profiles based on eight established functions of BE. Profiles were also compared on measures of BE symptoms, eating disorder psychopathology, internal shame, body shame, psychological distress, adverse childhood experiences, and demographic variables.
Results
A four-profile solution was selected balancing goodness-of-fit and interpretability. Profiles identified were Emotion Avoidance, Classic, Emotion Reactivity, and Complex, with profiles differing primarily on emotion- and trauma-related functions of BE, and varying on all associated characteristics examined, with the Complex profile showing the most adverse associations.
Discussion
The identification of these distinct profiles suggests that individuals present with differentiated, inter-related patterns or reasons for BE. These clinically relevant profiles may inform binge-eating disorder intervention choice and the targeting of specific maintenance factors within profiles. Further research is needed to examine the clinical utility of these profiles in informing the most suitable psychological treatment for an individual.
Binge eating disorder is characterized by excessive food consumption, which is accompanied by a sense of loss of control and occurs at least once a week. This study compared maladaptive schemas, stress coping strategies and two emotional disorders in two groups of gym-going women (a group at risk for binge eating disorder and a group not at risk) and analyzed which variables were predictors of binge eating disorder risk in this group of women. The variables included as predictors explained 55 % of the risk of BPD: two maladaptive schemas, two coping strategies, one measure of obesity, one psychopathological personal history, one psychopathological family history, and one measure of frequency of gym attendance. The importance of these variables in the genesis and maintenance of binge eating disorder is discussed.
Objective:
Loss of control (LOC) eating is prevalent but understudied among young men. Affect regulation models propose that LOC eating functions as a maladaptive effort to escape from distressing affective states. As such, negative affect is thought to increase before and decrease after LOC eating. However, examinations with young men are lacking and it remains unclear whether specific emotional experiences are differentially implicated in their LOC eating.
Methods:
The current study examined the temporal roles of affect in LOC eating in 31 young men (18-35 years; Mage = 25.74 ± 5.61y; 46.7 % White; 30 % Black/African American; 10 % Hispanic/Latino, 10 % South Asian) who reported engaging in recurrent LOC eating. Participants completed a 14-day ecological momentary assessment protocol and recorded all eating episodes each day and their state affect five times per day. Generalized linear mixed models were conducted to examine the trajectories of global and item-level negative and positive affect pre- and post-LOC eating episodes.
Results:
Negative affect did not change significantly before or after LOC eating (ps > .05). Positive affect did not change significantly before LOC eating (ps > .05). Global positive affect, excitement, and happiness decreased significantly after LOC eating (ps ≤ .001).
Discussion:
Study findings contradict extant theory and empirical data largely from female samples. Negative affect did not increase risk for LOC eating, nor did LOC eating function to improve participants' mood; rather, positive mood slightly decreased after LOC eating. Further investigation around the observed decline in positive affect after LOC eating will clarify if this is a relevant intervention point in this population.
Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals’ diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.
Objective:
Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary restraint results in successful dietary restriction, or which types of restraint/restriction confer highest risk for LOC eating. Furthermore, little research has evaluated momentary, temporal associations between dietary restraint and LOC eating. Thus, the present study aimed to (1) characterize dietary restraint and restriction, among individuals with LOC eating, and (2) examine temporal relationships between restraint/restriction and LOC eating within- and between-subjects.
Method:
The current study recruited adults with binge spectrum EDs (n = 96, 80.4% female) to complete a 7-14-day ecological momentary assessment protocol assessing ED symptoms. Multilevel models and linear regression evaluated within- and between-subjects associations between momentary restraint/restriction and LOC eating, respectively.
Results:
Attempted avoidance of enjoyable foods, limiting the amount eaten, and any restraint predicted greater likelihood of LOC eating at the next survey. Attempts to delay eating predicted reduced likelihood of LOC eating at the next survey, though this effect was no longer statistically significant after correcting for multiple comparisons. Diagnostic presentation moderated the association between attempted avoidance of enjoyable foods and LOC eating such that this association was significantly stronger for those on the BN-spectrum.
Discussion:
Dietary restraint seems to be more predictive of LOC eating than dietary restriction both within- and between-subjects. Future treatments should target dietary restraint to reduce LOC eating.
Public significance:
Some research suggests that dietary restriction (i.e., reduced calorie intake) and restraint (i.e., attempted restriction) may not be linked to LOC eating in all contexts. We found that dietary restraint is more predictive of LOC eating than dietary restriction both within and between individuals. Future treatments should target dietary restraint to reduce LOC eating.
Objective
Binge eating, loss of control eating and overeating often develop during late childhood or early adolescence. Understanding the presentation of binge eating as early as symptoms manifest and its preceding and concurrent factors is essential to hamper the development of eating disorders. This study examined the prevalence, concurrent and preceding factors (e.g. compensatory behaviors, emotional and behavioral problems) of subclinical binge eating symptoms in early adolescence.
Methods
Data from the population-based Generation R Study were used (n = 3595). At 10 years and 14 years, preceding and concurrent factors including eating behaviors, body dissatisfaction, emotional and behavioral problems and body composition were assessed. At 14 years, 3595 adolescents self-reported on binge eating symptoms in the past 3 months and were categorized into four groups: no symptoms (n = 3143, 87.4%), overeating only (n = 121, 3.4%), loss of control (LOC) eating only (n = 252, 7.0%) or binge eating (i.e. both, n = 79, 2.2%).
Results
In total, 452 (12.6%) young adolescents reported subclinical binge eating symptoms. Those who reported LOC eating and binge eating showed most compensatory behaviors (e.g. hide or throw away food, skipping meals). Concurrent emotional and behavioral problems, body dissatisfaction, more emotional-, restrained- and uncontrolled eating, and a higher BMI were associated with subclinical binge eating symptoms. Preceding self-reported emotional and behavioral problems, body dissatisfaction, more restrained eating and higher BMI (both fat mass and fat-free mass) at 10 years were associated with LOC eating and binge eating, but not with overeating.
Discussion
Among young adolescents, subclinical binge eating symptoms were common. Considering the high prevalence of LOC eating, and the overlapping preceding and concurrent factors of LOC eating and binge eating compared to overeating, LOC eating seems to be a key symptom of binge eating in early adolescence.
Intuitive eating (IE) emphasizes relying on hunger and satiety cues to guide eating, and is associated with positive mental health and health-promoting behaviors. Although parents' own eating patterns often shape those of their children, no known research has explored familial associations of IE. The purpose of this cross-sectional, population-based study was to examine IE concordance between emerging adults and their parents, and whether concordance differed across sociodemographic characteristics and weight perceptions. The analytic sample included 891 emerging adults (M age = 22.0) and their primary parent (M age = 50.4) who participated in the population-based, longitudinal EAT and F-EAT 2010-2018 studies. Parents and emerging adults were grouped into dyads based on IE concordance: (1) neither are intuitive eaters; (2) only the emerging adult is an intuitive eater; (3) only the parent is an intuitive eater; (4) both are intuitive eaters. Dyads differed across socioeconomic status (SES), race/ethnicity, and weight perceptions. Concordant dyads who ate intuitively were more likely to be at higher SES and perceive their weight as "about right" than concordant dyads who did not eat intuitively. Asian emerging adults were most likely to belong to concordant non-intuitive eater dyads. Emerging adults who shared their parent's perception their weight was "overweight" were less likely to be intuitive eaters (even if their parents were). In this sample, sociodemographic characteristics and weight perceptions were related to IE concordance among emerging adults and their parents. Lower SES might be an intergenerational barrier to IE disproportionately impacting communities of color, though longitudinal data are needed. Results also suggest rather than motivating healthful eating, perceiving one's weight as "overweight" could hinder IE. Differences across sociodemographic variables likely intersect in meaningful ways, which is an important future research direction.
Compulsive eating is an overlapping construct with binge eating and shares many characteristics with substance abuse disorders. Compulsive eating may impact millions of Americans; presenting in some cases of binge eating disorders, overweight/obesity, and among individuals who have not yet been diagnosed with a recognized eating disorder. To study the behavioral and neurobiological underpinnings of compulsive eating, we employ a published rodent model using cyclic intermittent access to a palatable diet to develop a self-imposed binge-withdrawal cycle. Here, we further validated this model of compulsive eating in female Wistar rats, through the lens of behavioral economic analyses, and observed heightened demand intensity, inelasticity and essential value as well as increased food-seeking during extinction. Using electrophysiological recordings in the anterior insular cortex, a region previously implicated in modulating compulsive-like eating in intermittent access models, we observed functional adaptations of pyramidal neurons. Within the same neurons, application of leptin led to further functional adaptations, suggesting a previously understudied, extrahypothalamic role of leptin in modulating feeding-related cortical circuits. Collectively, the findings suggest that leptin may modulate food-related motivation or decision-making via a plastic cortical circuit that is influenced by intermitted access to a preferred diet. These findings warrant further study for whether the behavioral economics of compulsive eating behavior can impact disordered eating outcomes in humans, and whether there is translational relevance of a leptin-sensitive anterior insular circuit implicated in these behaviors.
Objective:
Intuitive eating is an adaptive style of eating that has generated significant research attention. Theoretically, intuitive eating is a core construct that features prominently in the Acceptance Model of Intuitive Eating, a framework that explains how positive environmental influences can foster intuitive eating practices via body appreciation. Empirically, intuitive eating has been connected to a broad range of adaptive mental health indices. At present, a quantitative synthesis of intuitive eating and its correlates has yet to be conducted. This was the objective of the current meta-analysis.
Method:
Ninety-seven studies (89% cross-sectional) were included. Random effects meta-analyses were conducted on 23 psychological correlates, divided into three clusters: eating behavior and body image disturbances, positive body image and other adaptive factors, and general psychopathology. Meta-analytic path analyses were also computed to test the validity of the Acceptance Model.
Results:
Intuitive eating was inversely associated with multiple indices of eating pathology, body image disturbances, and psychopathology (rs = -.23 to -.58). Intuitive eating was positively associated with numerous positive psychological constructs, such as positive body image, self-esteem, and wellbeing (rs = .20 to .58). Men reported higher levels of intuitive eating than women (d = 0.39), with differences being largest in Caucasian samples. Meta-analytic path analyses strongly supported the hypothesized pathways specified in the Acceptance Model of Intuitive Eating.
Conclusions:
There is a strong evidence base for intuitive eating's connection to numerous adaptive psychological constructs. Attention should now shift toward prospective and experimental designs so that the temporal nature of these relationships can be identified.
Compulsive eating is prevalent in binge-type eating disorders, present in some obese individuals, and often conceptualized in relation to the recently operationalized construct of food addiction. Compulsive eating putatively involves escalated intake of highly preferred foods, finickiness toward otherwise acceptable alternatives, increased effort and time spent to obtain preferred foods, eating behavior despite incorrect or adverse outcomes, and eating of palatable food in order to soothe abstinence- and stress-induced negative emotional states. We review theoretical and empirical bases for an opponent-process affective dysregulation model of compulsive eating, adapted from the addiction field, whereby intermittent, extended access to palatable food progressively dampens reward circuitry and potentiates activation of stress circuitry. We then detail corresponding protocols for two rodent models of intermittent, extended access to palatable food, describe methods for assessing compulsive-like outcomes, and discuss possible adaptations that can be used to understand better the prevention, biology, and treatment of compulsive eating.
Wellness in health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. Obese adolescents are at particular risk for low wellness due to weight stigma, weight-based teasing/bullying and increased risk of metabolic syndrome, social isolation, avoidance of health care, depression, anxiety, substance use, low self-esteem, self-harm, poor body image, and suicide. The appropriate identification of teens experiencing excessive weight gain and potential comorbidities is important to make sure helpful services can be offered, ideally by an interdisciplinary team with adolescent expertise. Nutrition providers play an important role in helping teens to improve their relationship with food, prevent disordered eating and promote whole-person health.
Binge eating, defined as the consumption of an objectively large amount of food accompanied by a sense of loss of control (LOC) while eating, is a transdiagnostic feature of eating disorders and often presents outside the context of full syndrome eating disorder diagnoses. Individuals with binge eating often report lower levels of psychosocial functioning than those who do not endorse binge eating. This chapter provides a comprehensive review of the existing literature on the relation between binge eating and psychosocial functioning in youth and adults, including cross-sectional, longitudinal, and momentary studies. Overall, the evidence suggests that individuals who endorse binge eating also experience higher levels of psychiatric comorbidity, lower quality of life, and increased internalizing and externalizing symptoms than the general population. Additionally, in some cases, the relation between binge eating and psychosocial impairment may be bidirectional in nature. This evidence underscores the importance of addressing psychosocial impairment in the context of binge eating treatment, as well as the need to assess binge eating symptoms among individuals with heightened psychosocial impairment in clinical settings.
The transition from casual drug use to dependence involves a shift from positive to negative reinforcement. This “dark side” shift also is implicated in food addiction. Palatable food intake initially has pleasurable and comforting effects that can normalize stress responses. But, repeated, intermittent intake can downregulate brain reward pathways and recruit brain circuitry, yielding negative emotional behavior when the food is not eaten, tolerance, palatable food-seeking despite aversive consequences, and heightened stress-induced relapse to palatable food-seeking. The results support an affective dysregulation model whereby intake becomes obligatory to prevent negative emotions, which show high comorbidity with addiction-like eating. Such negative emotions also may trigger impulsive palatable food intake via negative urgency. Neurobiological changes resemble many from substance-use disorders, including corticotropin-releasing factor, hypocretin, dopamine, opioid, and endocannabinoid systems in mesolimbic, extended amygdala and inhibitory frontal circuitry. We synthesize conceptual and empirical contributions to illuminate the “dark side” in food addiction.
Binge eating disorder (BED) is the most common eating disorder and is accompanied by multiple medical comorbidities, many of which are associated with obesity-related diseases. However, the BED itself is likely to confer additional risk factors. BED presents with medical symptoms in virtually every body system and can have devastating consequences on both quality and length of life. This review covers the major comorbidities of BED and highlights areas of ongoing research in this disorder.
Many people restrict their palatable food intake. In animal models, time-limiting access to palatable foods increases their intake while decreasing intake of less preferred alternatives; negative emotional withdrawal-like behavior is sometimes reported. In drug addiction models, intermittent extended access drives greater changes in use than brief access. When it comes to palatable food, the impact of briefer vs. longer access durations within intermittent access conditions remains unclear. Here, we provided male rats with chow or with weekday access to a preferred, sucrose-rich diet (PREF) (2, 4, or 8 h daily) with chow otherwise available. Despite normal energy intake, all restricted access conditions increased weight gain by 6 weeks and shifted diet acceptance within 1 week. They increased daily and 2-h intake of PREF with individual vulnerability and decreased chow intake. Rats with the briefest access had the greatest binge-like (2-h) intake, did not lose weight on weekends despite undereating chow, and were fattier by 12 weeks. Extended access rats (8 h) showed the greatest daily intake of preferred food and corresponding undereating of chow, slower weight gain when PREF was unavailable, and more variable daily energy intake from week to week. Increased fasting glucose was seen in 2-h and 8-h access rats. During acute withdrawal from PREF to chow diet, restricted access rats showed increased locomotor activity. Thus, intermittent access broadly promoted weight gain, fasting hyperglycemia and psychomotor arousal during early withdrawal. More restricted access promoted greater binge-like intake and fat accumulation, whereas longer access promoted evidence of greater food reward tolerance.
Compulsive binge eating is a hallmark of binge eating disorder and bulimia nervosa and is implicated in some obesity cases. Eating disorders are sexually dimorphic, with females more often affected than males. Animal models of binge-like eating based on intermittent access to palatable food exist; but, little is known regarding sex differences or individual vulnerability in these models with respect to the reinforcing efficacy of food, the development of compulsive- and binge-like eating, or associated changes in whole-body metabolism or body composition. Adolescent male (n = 24) and female (n = 32) Wistar rats were maintained on chow or a preferred, high-sucrose, chocolate-flavored diet in continuous or intermittent, extended access conditions. Body weight and composition, intake, fixed- and progressive-ratio operant self-administration, and whole body energy expenditure and respiratory exchange ratios were measured across an 11-week study period. Subgroup analyses were conducted to differentiate compulsive-like "high responder" intermittent access rats that escalated to extreme progressive-ratio self-administration performance vs. more resistant "low responders." Female rats had greater reinforcing efficacy of food than males in all diet conditions and were more often classified as "high responders". In both sexes, rats with intermittent access showed cycling of fuel substrate utilization and whole-body energy expenditure. Further, "high-responding" intermittent access female rats had especially elevated respiratory exchange ratios, indicating a fat-sparing phenotype. Future studies are needed to better understand the molecular and neurobiological basis of the sex and individual differences we have observed in rats and their translational impact for humans with compulsive, binge eating disorders.
IN BRIEF Although the Look AHEAD (Action for Health in Diabetes) trial, which spanned more than 8 years, did not find significant differences in cardiovascular morbidity and mortality between study groups, it did demonstrate significant differences in weight loss and maintenance. Using lessons learned from the Look AHEAD protocol, clinicians can help people with type 2 diabetes lose weight, improve glucose management, increase physical activity, alter eating patterns, and support long-term positive health outcomes. It remains important, however, to avoid assigning a higher priority to weight loss goals than to improvements in glucose management, long-term health outcomes, and quality of life.
Background:
Palatable food access promotes obesity leading some to diet. Here, we modeled the roles of duration, intermittency and choice of access in bingeing, escalation of daily intake, and underacceptance of alternatives.
Method:
Female rats with ("Choice") or without continuous chow access, received chow or continuous (Chocolate), intermittent (MWF) long (24h, Int-Long), or intermittent short (30min, Int-Short) access to a sucrose-rich, chocolate-flavored diet (CHOC).
Results:
Int-Long rats showed cycling body weight; they overate CHOC, had increased feed efficiency on access days and underate chow and lost weight on non-access days, the latter correlating with their reduced brown fat. Int-Short rats had the greatest 30-min intake upon CHOC access, but did not underaccept chow or weight cycle. Individual vulnerability for intermittent access-induced feeding adaptations was seen. Continuous access rats gained fat disproportionate, but in direct relation, to their normalized energy intake and persistently underaccepted chow despite abstinence and return to normal weight. Abstinence reduced the binge-like CHOC intake of Int-Short rats and increased that of continuous access rats, but not to levels associated with intermittent access history. Choice increased daily CHOC intake under Continuous access and binge-like intake under Int-Short access.
Conclusions:
Intermittency and duration of past access to palatable food have dissociable, individually-vulnerable influences on its intake and that of alternatives. With extended access, daily intake reflects the palatability of available food, rather than metabolic need. Ongoing restrictedness of access or a history of intermittency each drive binge-like intake. Aspects of palatable food availability, similar and different to drug availability, promote disordered eating.
Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N = 231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model.
Numerous longitudinal studies have identified risk factors for the onset of most eating disorders (EDs). Identifying women at highest risk within a high-risk sample would allow for focusing of preventive resources and also suggests different etiologies.
A longitudinal cohort study over 3 years in a high-risk sample of 236 college-age women randomized to the control group of a prevention trial for EDs. Potential risk factors and interactions between risk factors were assessed using the methods developed previously. Main outcome measures were time to onset of a subthreshold or full ED.
At the 3-year follow-up, 11.2% of participants had developed a full or partial ED. Seven of 88 potential risk factors could be classified as independent risk factors, seven as proxies, and two as overlapping factors. Critical comments about eating from teacher/coach/siblings and a history of depression were the most potent risk factors. The incidence for participants with either or both of these risk factors was 34.8% (16/46) compared to 4.2% (6/144) for participants without these risk factors, with a sensitivity of 0.75 and a specificity of 0.82.
Targeting preventive interventions at women with high weight and shape concerns, a history of critical comments about eating weight and shape, and a history of depression may reduce the risk for EDs.
We first establish the association between binge eating and dieting and present sequence data indicating that dieting usually precedes binging, chronologically. We propose that dieting causes binging by promoting the adoption of a cognitively regulated eating style, which is necessary if the physiological defense of body weight is to be overcome. The defense of body weight entails various metabolic adjustments that assist energy conservation, but the behavioral reaction of binge eating is best understood in cognitive, not physiological, terms. By supplanting physiological regulatory controls with cognitive controls, dieting makes the dieter vulnerable to disinhibition and consequent overeating. Implications for therapy are discussed, as are the societal consequences of regarding dieting as a "solution" to the problem of binging.
Terms such as risk, risk factors, and especially the term cause are inconsistently and imprecisely used, fostering scientific miscommunication and misleading research and policy. Clarifying such terms is the essential first step. We define risk and a risk factor (protective factor) and their potency, set out the conceptual basis of the methods by which risk factors are identified and potency demonstrated, and propose criteria for establishing the status of a risk factor as a fixed or variable marker or a causal risk factor. All definitions are based on the state of scientific knowledge (empirical documentation), rather than on hypotheses, speculations, or beliefs. We discuss common approaches and pitfalls and give a psychiatric research example. Imprecise reports can impede the search for understanding the cause and course of any disease and also may be a basis of inadequate clinical or policy decision-making. The issues in risk research are much too important to tolerate less than precise terminology or the less than rigorous research reporting that results from imprecise and inconsistent terminology.
This study examined the prospective relations of naturalistic weight-reduction efforts to growth in relative weight and onset of obesity with data from a community study of female adolescents (N = 692). Initial self-labeled dieting, appetite suppressant/laxative use, incidental exercise, vomiting for weight-control purposes, and binge eating predicted elevated growth in relative weight over the 4-year period. Dietary restraint, self-labeled dieting, exercise for weight-control purposes, and appetite suppressant/laxative use predicted an increased risk for obesity onset. Data imply that the weight-reduction efforts reported by adolescents are more likely to result in weight gain than in weight loss and suggest the need to educate youth on more effective weight-control strategies.
This report presents the revised growth charts for the United States. It summarizes the history of the 1977 National Center for Health Statistics (NCHS) growth charts, reasons for the revision, data sources and statistical procedures used, and major features of the revised charts.
Data from five national health examination surveys collected from 1963 to 1994 and five supplementary data sources were combined to establish an analytic growth chart data set. A variety of statistical procedures were used to produce smoothed percentile curves for infants (from birth to 36 months) and older children (from 2 to 20 years), using a two-stage approach. Initial curve smoothing for selected major percentiles was accomplished with various parametric and nonparametric procedures. In the second stage, a normalization procedure was used to generate z-scores that closely match the smoothed percentile curves.
The 14 NCHS growth charts were revised and new body mass index-for-age (BMI-for-age) charts were created for boys and girls (http://www.cdc.gov/growthcharts). The growth percentile curves for infants and children are based primarily on national survey data. Use of national data ensures a smooth transition from the charts for infants to those for older children. These data better represent the racial/ethnic diversity and the size and growth patterns of combined breast- and formula-fed infants in the United States. New features include addition of the 3rd and 97th percentiles for all charts and extension of all charts for children and adolescents to age 20 years.
Created with improved data and statistical curve smoothing procedures, the United States growth charts represent an enhanced instrument to evaluate the size and growth of infants and children.
To assess weight-related concerns and behaviors in a population-based sample of adolescents and to compare these concerns and behaviors across sex and weight status.
The study population included 4746 adolescents from St Paul or Minneapolis, Minn, public schools who completed surveys and anthropometric measurements as part of Project EAT (Eating Among Teens), a population-based study focusing on eating patterns and weight concerns among teenagers.
Measured weight status, weight-related concerns (perceived weight status, weight disparity, body satisfaction, and care about controlling weight), and weight-related behaviors (general and specific weight control behaviors and binge eating).
Weight-related concerns and behaviors were prevalent among the study population. Although adolescents were most likely to report healthy weight control behaviors (adolescent girls, 85%; and adolescent boys, 70%), also prevalent were weight control behaviors considered to be unhealthy (adolescent girls, 57%; and adolescent boys, 33%) or extreme (adolescent girls, 12%; and adolescent boys, 5%). Most overweight youth perceived themselves as overweight and reported the use of healthy weight control behaviors during the past year. However, the use of unhealthy and extreme weight control behaviors and binge eating were alarmingly high among overweight youth, particularly adolescent girls. Extreme weight control practices (taking diet pills, laxatives, or diuretics or vomiting) were reported by 18% of very overweight adolescent girls, compared with 6% of very overweight adolescent boys (body mass index, > OR = 95th percentile).
Prevention interventions that address the broad spectrum of weight-related disorders, enhance skill development for behavioral change, and provide support for dealing with potentially harmful social norms are warranted in light of the high prevalence and co-occurrence of obesity and unhealthy weight-related behaviors.
Because little is known about the predictors of binge eating (a risk factor for obesity), a set of putative risk factors for binge eating was investigated in a longitudinal study of adolescent girls. Results verified that binge eating predicted obesity onset. Elevated dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, body mass, and low self-esteem and social support predicted binge eating onset with 92% accuracy. Classification tree analysis revealed an interaction between appearance overvaluation, body mass, dieting, and depressive symptoms, suggesting qualitatively different pathways to binge eating and identifying subgroups at extreme risk for this outcome. Results support the assertion that these psychosocial and biological factors increase risk for binge eating.
To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later.
Population-based 5-year longitudinal study.
Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).
Weight status, binge eating, extreme weight control, and self-reported eating disorder.
Multiple linear and logistic regressions.
Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors.
Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.
The article describes a 20-year longitudinal study of body weight, dieting, and disordered eating in women and men. Body weight increased significantly over time in both women and men. However, women's weight perception and dieting frequency decreased over time, whereas men's weight perception and dieting frequency increased, and disordered eating declined more in women than in men from late adolescence to midlife. In both women and men, changes in weight perception and dieting frequency were associated with changes in disordered eating. In addition, adult roles such as marriage and parenthood were associated with significant decreases in disordered eating from late adolescence to midlife in women, whereas few associations were observed in men. Despite different developmental trajectories, women demonstrated more weight dissatisfaction, dieting, and disordered eating compared with men across the period of observation.
Binge and loss of control eating are among the most common disordered eating behaviors reported by children and adolescents. Given their associations with overweight and elevated eating-related and general psychopathology, binge and loss of control eating are clearly significant problems warranting empirical and clinical attention. The past several years have seen dramatic advances in research on the development and correlates of pediatric binge and loss of control eating, yet important work remains to be done. The purpose of this paper is to review the current state of the field as it concerns research on binge and loss of control eating in children and adolescents. Extant literature on the classification, measurement, prevalence, distribution, correlates, etiology, and treatment of binge and loss of control eating in youth will be reviewed and consolidated in order to make clinical recommendations for healthcare providers. The current literature suggests that early detection of binge and loss of control eating in youth should be a priority in order to provide appropriate intervention, thereby helping to slow the trajectory of weight gain and prevent or reduce associated long-term negative consequences. Future research is required to explicate developmental pathways, and to develop novel prevention and treatment interventions for youth exhibiting binge and loss of control eating patterns.
This study examined the role of media body comparison as a mediator of the relationships between psychological factors and sociocultural pressures to be thin and body dissatisfaction in both females and males. Participants were 1,386 females (mean age = 19.37 years) and 1,130 males (mean age = 19-46) from diverse backgrounds who completed a self-report questionnaire. Path analysis was used to test a cross-sectional model in which media body comparison mediated the impact of self-esteem, depressive mood, parent dieting environment, friend dieting, TV exposure, magazine message exposure, weight teasing and body mass index (BMI) on body dissatisfaction. In females, media body comparison partially or fully mediated relationships between self-esteem, depressive mood, friend dieting, magazine message exposure and BMI, and body dissatisfaction. In males, media body comparison was not a significant predictor of body dissatisfaction. This research particularly highlights the need to further examine processes that are involved in the development of body dissatisfaction in males.
How are teenagers' feelings of failure related to dieting and concern about weight and compulsive eating? Subjects were 405 high school students, who completed a 59-item, multiple-choice questionnaire. For 19 areas of achievement, subjects indicated how successful they felt they were in living up to their own expectations and to the perceived expectations of their parents. Compulsive eating and dieting behaviors were assessed with self-report scales developed and tested by the researchers in prior studies. Among boys, dieting and compulsive eating both were directly related to feelings that they had failed to meet the perceived expectations of their parents. In contrast, the amount of compulsive eating reported by girls depended upon the perceived power structure of the family. Girls from families perceived to be mother-dominated reported more compulsive eating, a feeling of failure to meet mother's standards, and a higher need for social approval than did girls from families in which mother and father were perceived to rule equally, or families in which the children were perceived to share equally with parents in making major decisions.
Objective
The study objectives were to assess (1) the prevalence of dieting and disordered eating among adolescents; (2) the sociodemographic, anthropometric, psychosocial, and behavioral correlates of dieting and disordered eating; and (3) whether adolescents report having discussed weight-related issues with their health care providers.
Design
Cross-sectional school-based survey.
Study Population
A nationally representative sample of 6728 adolescents in grades 5 to 12 who completed the Commonwealth Fund surveys of the health of adolescent girls and boys.
Main Outcome Measures
Dieting and disordered eating (binge-purge cycling).
Results
Approximately 24% of the population was overweight. Almost half of the girls (45%) reported that they had at some point been on a diet, compared with 20% of the boys. Disordered eating was reported by 13% of the girls and 7% of the boys. Strong correlates of these behaviors included overweight status, low self-esteem, depression, suicidal ideation, and substance use. Almost half of the adolescents (38%-53%) reported that a health care provider had at some point discussed nutrition or weight with them. Discussions on eating disorders were reported by lower percentages of girls (24%) and boys (15%).
Conclusions
The high prevalence of weight-related concerns suggests that all youth should be reached with appropriate interventions. Special attention needs to be directed toward youth at greatest risk for disordered eating behaviors, such as overweight youth, youth engaging in substance use behaviors, and youth with psychological concerns such as low self-esteem and depressive symptoms.
Theoretical properties of nonresponse adjustments based on adjustment cells are studied, for estimates of means for the whole population and in subclasses that cut across adjustment cells. Three forms of adjustment are considered: weighting by the inverse response rate within cells, post-stratification on known population cell counts, and mean imputation within adjustment cells. Two dimensions of covariate information x are distinguished as particularly useful for reducing nonresponse bias: the response propensity p̂(x) and the conditional mean ŷ(x) of the outcome variable y given x. Weighting within adjustment cells based on p̂(x) controls bias, but not necessarily variance. Imputation within adjustment cells based on ŷ(x) controls bias and variance. Post-stratification yields some gains in efficiency for overall population means, and smaller gains for means in subclasses of the population. A simulation study similar to that of Holt & Smith (1979) is described which explores the mean squared error properties of the estimators. Finally, some modifications of response propensity weighting to control variance are suggested. /// L'estimation de moyennes de la population et de sous-populations pour une enquête soumise à nonréponse est discutée. Trois méthodes d'ajustement pour nonréponse sont comparés: le weighting, la post-stratification et l'imputation de moyennes en classes d'ajustement. Deux dimensions des covariates x sont distinguées pour la réduction du biais de nonréponse, la tendence de réponse p̂(x) et la moyenne conditionnelle E(yǀx) du variable y sujet à nonréponse. Les caractéristiques de méthodes qui font usage de ces dimensions pour la création de classes d'ajustement sont recherchées au moyen de théorie et de simulation.
How are teenagers' feelings of failure related to (1) dieting and concern about weight and (2) compulsive eating? Subjects were 405 high school students, who completed a 59-item, multiple-choice questionnaire. For 19 areas of achievement, subjects indicated how successful they felt they were in living up to their own expectations and to the perceived expectations of their parents. Compulsive eating and dieting behaviors were assessed with self-report scales developed and tested by the researchers in prior studies. Among boys, dieting and compulsive eating both were directly related to feelings that they had failed to meet the perceived expectations of their parents. In contrast, the amount of compulsive eating reported by girls depended upon the perceived power structure of the family. Girls from families perceived to be mother-dominated reported more compulsive eating, a feeling of failure to meet mother's standards, and a higher need for social approval than did girls from families in which mother and father were perceived to rule equally, or families in which the children were perceived to share equally with parents in making major decisions.
To describe the development and psychometric properties of survey measures relevant to eating, physical activity, and weight-related behaviors among young adults.
Focus groups and reliability testing guided the development of the Project EAT-III survey. The final survey was completed by 2287 young adults.
The systematic process employed led to a psychometrically sound and developmentally appropriate survey. Test-retest reliabilities for items included on the final survey were mostly moderate to good, and Cronbach alphas were >0.7 for 83% of developed scales.
Future studies may find the systematic process used to be helpful in creating other weight-related surveys.
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
To examine 5-year longitudinal and secular trends in weight-related teasing among adolescents.
Project EAT-II (Eating Among Teens-II) followed 2,516 adolescents (females = 1,386, 55.1%) prospectively from 1999 to 2004. EAT-II included two cohorts allowing the observation of longitudinal changes in reported weight-related teasing as participants transitioned from early to mid-adolescence (middle school to high school) and from mid- to late-adolescence (high school to post-high school). EAT-II also allowed the examination of secular trends in reported teasing among middle adolescents in 1999 and 2004.
In 1999, approximately one-quarter of adolescents in the total sample (including both overweight and nonoverweight youth) reported being teased about their weight in early adolescence and mid-adolescence. Prevalence rates of teasing were higher among overweight youth (early adolescence: females 42.4%, males 44.6%; mid-adolescence: females 31.2%, males 40.8%). Longitudinal trends suggest that weight-related teasing decreased among overweight males and females in the younger cohort as they transitioned from early adolescence to mid-adolescence. In the older cohort of youth, teasing decreased in the total sample of females as they transitioned from mid-adolescence to older adolescence. Analyses of age-matched secular trends among middle adolescents showed that the prevalence of weight-related teasing remained stable among most adolescent subgroups and declined among overweight males between 1999 and 2004.
Weight-related teasing is prevalent through the various stages of adolescence. Our findings point to a need for ongoing interventions, throughout adolescence, which focus on reducing weight-related teasing and improving social supports for affected youth.
Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood.
To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood.
Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010).
The study population included 2,287 young adults (55% girls, 52% nonwhite). The sample included a younger group (mean age 12.8±0.7 years at baseline and 23.2±1.0 years at follow-up) and an older group (mean age 15.9±0.8 at baseline and 26.2±0.9 years at follow-up).
Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline.
In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors 10 years later. Tracking was particularly consistent for the older girls and boys transitioning from middle adolescence to middle young adulthood.
Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts before the onset of harmful behavioral patterns as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.
Weight teasing is common among adolescents, but less is known about the continuation of this experience during young adulthood. The present study uses survey data from a diverse sample of 2287 young adults, who participated in a 10-year longitudinal study of weight-related issues to examine hurtful weight comments by family members or a significant other. Among young adults, 35.9% of females and 22.8% of males reported receiving hurtful weight-related comments by family members, and 21.2% of females and 23.8% of males with a significant other had received hurtful weight-related comments from this source. Hispanic and Asian young adults and overweight/obese young adults were more likely to report receiving comments than those in other groups. Weight teasing during adolescence predicted hurtful weight-related comments in young adulthood, with some differences by gender. Findings suggest that hurtful weight talk continues into young adulthood and is predicted by earlier weight teasing experiences.
The objective of this study was to determine whether obesity prevalence and weight-related behaviors (e.g., diet, physical activity) differ among students enrolled in 2-year community/technical colleges and those attending 4-year colleges/universities. This information could inform the development of intervention strategies. Through an existing surveillance system of Minnesota postsecondary education institutions, survey data were collected from 16,539 students from 27 campuses (14 two-year college campuses, 13 four-year college/university campuses; 2007-2008), including self-reported physical activity, media use, dietary patterns, weight control behaviors, height, and weight. Unadjusted analyses indicated that students enrolled in 2-year colleges, particularly females, had a higher prevalence of overweight/obesity, lower levels of physical activity, more television viewing, higher intakes of soda, fast food, and diet pills compared to students attending 4-year colleges (P < 0.05). Females attending 4-year colleges were more likely to engage in certain unhealthy weight control behaviors (taking diet pills, binge eating, self-induced vomiting) compared to females attending 2-year institutions. Among male students there were fewer differences between 2-year and 4-year colleges. Controlling for sociodemographic factors (e.g., race/ethnicity, age), most disparities in prevalence estimates remained, though many were attenuated. Overall, few young adults engage in weight-related behaviors consistent with national recommendations. Two-year college students may represent a particularly at-risk group. Disparities between 2- and 4-year college students exist beyond the sociodemographic differences in these populations. Effective weight-related interventions are needed for young adults, particularly females attending 2-year colleges and all males attending postsecondary institutions.
Introduction General Conditions for the Randomization-Validity of Infinite-m Repeated-Imputation Inferences Examples of Proper and Improper Imputation Methods in a Simple Case with Ignorable Nonresponse Further Discussion of Proper Imputation Methods The Asymptotic Distribution of (Q̄m, Ūm, Bm) for Proper Imputation Methods Evaluations of Finite-m Inferences with Scalar Estimands Evaluation of Significance Levels from the Moment-Based Statistics Dm and Δm with Multicomponent Estimands Evaluation of Significance Levels Based on Repeated Significance Levels
The objective of this article was to investigate the prevalence and psychological correlates of binge eating among adolescents. Self-report questionnaires were administered to a community sample of 708 adolescents (M(age) = 14 years). Adolescents reporting loss of control over eating (17% of the sample) reported more eating pathology and more general maladjustment compared to those without loss of control. The combined presence of subjective and objective binge episodes was related to the most severe pattern of eating pathology. The results suggest that loss of control over eating is a relatively frequent experience among adolescents from the general population and it is related to eating pathology and maladjustment.
The epidemiology and correlates of depressive mood were measured in a representative sample of public high school students in New York State and a subsample matched to their parents. Depressive mood was measured by a self-reported scale validated in a clinical sample. Adolescents with a diagnosis of major depressive disorder scored higher than those with other psychiatric diagnoses. In the general adolescent sample, ex differences in depressive mood paralleled those previously reported for adults, with girls scoring higher than boys. Adolescents reported higher depressive mood than their parents, with the differences greater in daughter-mother than in son-father pairs. If judged by mood differences, adolescence was a stressful period in the life cycle. Lowest levels of adolescent depressive mood correlated with high levels of attachment both to parents and to peers. Sex differences in depressive mood in adolescents may be accounted for by masked depression and increased delinquency among boys as compared with girls.
A combined survey and interview study was conducted to validate a categorical Dieting and Bingeing Severity Scale (DBSS), and to estimate the prevalence of eating disorders in young women. We hypothesized that assignment to the DBSS categories would be confirmed by clinical interviews such that interview-diagnosed eating disorders would be found with increasing frequency and severity at the upper end of the DBSS. Freshmen college women (n = 1367) completed a survey instrument addressing the frequency and severity of dieting, binge-eating, and other behaviors and attitudes related to weight control. Random stratified sampling procedures were used to select a subset of women (n = 306) from each DBSS category for structured clinical interviews for DSM-III-R (SCID). Survey respondents were assigned to one of six mutually exclusive DBSS categories: non-dieters (9% of sample), casual dieters (26%), moderate dieters (23%), intense dieters (21%), dieters at-risk (19%), and probable bulimia nervosa (2%). The DBSS effectively rank-ordered subjects according to the risk of having interview-diagnosed eating disorders. Women in the three most severe DBSS categories were significantly more likely to have current subthreshold and threshold level eating disorders, in particular bulimia nervosa and eating disorder not otherwise specified (EDNOS). The estimated prevalence of current bulimia nervosa was approximately 2% by both survey and interview methods. The prevalence of current EDNOS was 13%, more than six times greater than the prevalence of bulimia nervosa. The DBSS was found to be a reliable and valid measure of dieting and bingeing severity. The survey instrument may be useful in measuring the extent of, and changes in, pathological dieting in community-based samples of young women, and in studying comorbidity of dieting and bingeing severity with other psychiatric conditions including depression and substance use. The DBSS may also be useful in identifying risk factors associated with the onset of eating disorders.
One hundred obese women with a mean age of 39.2 years, and a mean body mass index (BMI) of 35.9 kg/m2 were evaluated before entering a treatment study for weight reduction. According to the results of a structured interview, subjects were divided into four groups: (1) no overeating episodes, (2) episodic overeating episodes without the feeling of loss of control, (3) overeating plus the sense of loss of control (binge eating), and (4) full diagnostic criteria for binge eating disorder (BED). One-way analyses of variance (ANOVAs) revealed significant positive associations between binge eating and eating/weight-related characteristics such as a history of frequent weight fluctuations, the amount of time spent dieting, drive for thinness, and a tendency for disinhibition of eating. Furthermore, subjects exhibited more feelings of ineffectiveness, stronger perfectionistic attitudes, more impulsivity, less self-esteem, and less interoceptive awareness the more problems with binge eating they reported. The results support the idea that binge eaters might be a distinct subgroup among the obese population, and corroborate the utility of a diagnosis of BED in identifying the most disturbed obese subjects with regard to the variables tested.
In examining individuals with binge eating disorder (BED), we aimed to determine whether their binge eating preceded their first diet or their first diet preceded their binge eating, the age of their first diet, the age of their first binge, and the age when they met DSM-IV criteria for BED. Additionally, we aimed to identify psychological factors that may distinguish the two groups.
Eighty-seven individuals with BED (19 men and 68 women) were administered the Eating Disorders Examination, the Structured Clinical Interview for DSM-III-R, and several other measures of psychological functioning and psychiatric disturbance.
Forty-five percent of the subjects reported that dieting preceded their first binge episode (dietfirst) and 55% reported that binge eating preceded their first diet (bingefirst). There were no significant differences in current eating disturbance, body mass index (BMI), or age for these two groups, but they differed on the age of the first episode of binge eating and the age when binging met BED criteria. The group reporting having binged first had a younger age of onset of binge eating and a younger age at which binge eating met diagnostic criteria than the dietfirst group. The bingefirst group also had a history of more psychiatric problems and were more likely to have an Axis II personality disorder.
Age of onset of the first binge and BED is markedly different depending on whether an individual began dieting or binging first. These findings suggest that there may be important etiological differences between individuals who binge first and those who diet first. Moreover, individuals who binge first may be at greater risk for psychiatric disturbance.
The present study was designed to test whether dietary restraint mediates the relationship between body dissatisfaction and bulimic eating patterns in a sample of 172 university females. Contrary to what was expected the results showed that body dissatisfaction mediated the relationship between dietary restraint and bulimic patterns of eating. Thus the results highlight the primary importance of body dissatisfaction as a predictor of bulimic behavior. Body dissatisfaction encompasses a broad array of dimensions such as self-perceptions, cognitions, affect and behavior and it carries enormous explanatory power but its different components remain largely unexplored.
Although laboratory experiments suggest that negative affect inductions potentiate the relation between dieting and disinhibited eating, little research has tested whether this finding generalizes to binge eating in the natural environment. Thus, we assessed whether negative affect moderated the relation between dieting and binge eating in a passive-observational study.
This aim was addressed with longitudinal data from a community sample of adolescents (N = 631).
For females, dieting and negative affect predicted binge eating in cross-sectional and prospective analyses, but negative affect potentiated the relation between dieting and binge eating only in the cross-sectional analyses. Similar, but attenuated results were found for males.
Findings converge with those from laboratory studies in suggesting that negative affect moderates the relation between dieting and binge eating, but also imply that dieting and negative affect constitute independent risk factors for binge eating. The lack of prospective effects may suggest that the interactive relations have a short time lag or are difficult to detect prospectively.
The study objectives were to assess (1) the prevalence of dieting and disordered eating among adolescents; (2) the sociodemographic, anthropometric, psychosocial, and behavioral correlates of dieting and disordered eating; and (3) whether adolescents report having discussed weight-related issues with their health care providers.
Cross-sectional school-based survey.
A nationally representative sample of 6728 adolescents in grades 5 to 12 who completed the Commonwealth Fund surveys of the health of adolescent girls and boys.
Dieting and disordered eating (binge-purge cycling).
Approximately 24% of the population was overweight. Almost half of the girls (45%) reported that they had at some point been on a diet, compared with 20% of the boys. Disordered eating was reported by 13% of the girls and 7% of the boys. Strong correlates of these behaviors included overweight status, low self-esteem, depression, suicidal ideation, and substance use. Almost half of the adolescents (38%-53%) reported that a health care provider had at some point discussed nutrition or weight with them. Discussions on eating disorders were reported by lower percentages of girls (24%) and boys (15%).
The high prevalence of weight-related concerns suggests that all youth should be reached with appropriate interventions. Special attention needs to be directed toward youth at greatest risk for disordered eating behaviors, such as overweight youth, youth engaging in substance use behaviors, and youth with psychological concerns such as low self-esteem and depressive symptoms.
Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N = 231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model.
This study determined the prevalence of Minnesota urban youths reaching the Healthy People 2010 objectives for obesity and intake of fat, calcium, fruits, vegetables, and grains and compared prevalence rates across sociodemographic characteristics.
The study sample included 4746 adolescents (aged 11-18 years) from the Minneapolis/St. Paul area who completed dietary surveys and participated in anthropometric measurements as part of a school-based population study.
Considerable gaps were seen between the existing prevalence rates for obesity and nutrient and food patterns and the targeted Healthy People 2010 prevalence rates. For example, 12.5% of the girls and 16.6% of the boys had body mass index values at or greater than the 95th percentile (target = 5%). Only 29.5% of the girls and 42.5% of the boys were meeting the daily recommended intakes for calcium (target = 75%). Similarly, percentages of youths consuming the recommended amounts of fat, fruits, vegetables, and grains were lower than the targeted percentages. There were large sociodemographic disparities in obesity and eating patterns, particularly across race/ethnicity and socioeconomic status.
Concerted public health efforts are needed to achieve the Healthy People 2010 objectives for obesity and nutrition and to reduce racial/ethnic and socioeconomic disparities.
Eating disorders are an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. They are much less frequent in men. Eating disorders are divided into three diagnostic categories: anorexia nervosa, bulimia nervosa, and the atypical eating disorders. However, the disorders have many features in common and patients frequently move between them, so for the purposes of this Seminar we have adopted a transdiagnostic perspective. The cause of eating disorders is complex and badly understood. There is a genetic predisposition, and certain specific environmental risk factors have been implicated. Research into treatment has focused on bulimia nervosa, and evidence-based management of this disorder is possible. A specific form of cognitive behaviour therapy is the most effective treatment, although few patients seem to receive it in practice. Treatment of anorexia nervosa and atypical eating disorders has received remarkably little research attention.
The aims of the study were to identify the characteristics of the dieters most at risk of subsequently developing an eating disorder and to evaluate the feasibility of using a brief questionnaire to identify such dieters in advance.
A general population cohort of 2,992 young women who were dieting was identified. On four occasions over the subsequent 2 years, this cohort was sent a questionnaire concerning eating habits and attitudes. Participants whose responses suggested that they had developed an eating disorder were interviewed to establish their true case status. The baseline questionnaires of those who did and did not subsequently develop an eating disorder were compared to identify features that predicted future case status.
One hundred four of the dieters developed an eating disorder of clinical severity during the 2 years of follow-up. Their baseline questionnaire scores differed in many respects from those who had not developed an eating disorder. Items associated with developing an eating disorder were selected by using three different statistical methods. A simple case-predicting instrument based on one of five items scoring above an optimal cut point had a sensitivity of 71% and a specificity of 72% (overall efficiency of 72%).
Dieters who will develop an eating disorder within the next 2 years have distinctive features. It is feasible to identify them in advance with reasonable efficiency with a brief questionnaire. This questionnaire could be incorporated into routine health assessments, thereby identifying those at high risk.
This article describes the development and validation of a revised measure for the assessment of history of being teased about physical appearance. Study 1 involved the preliminary psychometric evaluation of the questionnaire on a sample of 227 college women, Two factors emerged: Weight-Related Teasing (WT) and Teasing About Abilities/Competencies (Competency Teasing; CT). The integrity of the factor structure of these two scales was established in Study 2 with a sample of 87 college women. Internal consistency ratios in this sample were also found to be acceptable. In Study 3, 92 college women were administered measures of body image, eating disturbance, and self-esteem to test for convergence with the Perception of Teasing Scale. Subjects also rated teasing items for frequency and effect (e.g., how upset they were by the teasing). Two-week test-retest reliabilities for these measures were acceptable. Weight-Related Teasing correlated to a greater degree with other measures than Competency Teasing. Regression analyses revealed the importance of a frequency versus effect dimension. Findings are discussed in light of recent research on developmental factors in body image and eating disturbance.
To examine correlates of dieting behavior in overweight and non-overweight youth.
Data came from Project EAT (Eating Among Teens), a study of eating and weight-related attitudes, behaviors, and psychosocial variables among 4746 adolescents in public schools. Logistic regression was used to compare dieters and non-dieters, and to examine interactions of dieting and overweight status.
Approximately one third (31.8%) of the sample was overweight. Dieting in the previous year was reported by 55.2% of girls and 25.9% of boys. Dieting was associated with similarly elevated rates of extreme weight control behaviors, body dissatisfaction, and depression in both the non-overweight and overweight groups for both boys and girls. Girls reporting dieting behavior in both the non-overweight and overweight groups had similarly elevated risk for cigarette use, alcohol use, and marijuana use.
The negative correlates of dieting are similarly common among teens of varying weight status. These data suggest that dieting may not be a preferred method of weight management, even for overweight adolescents. Regardless of weight status, dieting may be a marker for other unhealthy behaviors and depressed mood in adolescents.
This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents.
Project EAT-II followed 2516 adolescents from Minnesota longitudinally from 1999 to 2004. The population included two cohorts allowing for the observation of transitions from early to middle adolescence (junior high school to high school) and from middle to late adolescence (high school to post-high school).
The prevalence of overweight (females: 28.7%; males: 28.0%) was high in early adolescence and remained high throughout adolescence. In females, between early and middle adolescence, there were steep longitudinal increases in the use of unhealthy weight control behaviors (48.6% to 58.8%, P = 0.001) and extreme weight control behaviors (9.4% to 17.9%, P < 0.001), and between middle and late adolescence, extreme weight control behaviors increased from 14.5% to 23.9% (P < 0.001). In males, extreme weight control behaviors doubled from middle to late adolescence (3.4% to 6.3%, P = 0.023). Use of diet pills doubled from 7.5% to 14.2% from 1999 to 2004 (P = 0.004) in high school females. One fifth (19.9%) of females in late adolescence reported taking diet pills.
Overweight status and unhealthy weight control behaviors in adolescents are major public health concerns that warrant interventions addressing both problems.
Preliminary research suggests that pediatric overweight is associated with increased eating disorder pathology, however, little is known about which overweight youth are most vulnerable to eating disorder pathology. We therefore investigated 122 overweight treatment-seeking youth to describe eating disorder pathology and mental health correlates, and to identify psychopathological constructs that may place overweight youth at increased risk for eating disorder pathology. Youth participated in a comprehensive assessment of eating disorders, mood and anxiety disorders, general psychopathology, and risk variables involving semi-structured clinical interviews and self- and parent-report questionnaires prior to the initiation of weight-loss treatment. Ten youth met criteria for an eating disorder, and over one-third endorsed recent binge eating. Eating disorder pathology was associated with depressive and anxious symptoms (p's<0.001). Structural equation modeling indicated increased negative affect, teasing experience, and thin-ideal internalization, and decreased perfectionism were associated with increased eating disorder pathology. Findings corroborate earlier work indicating that eating disorder pathology is elevated and clinically significant in overweight treatment-seeking youth, bolstering the need for mental health assessment of such individuals. Cross-sectional modeling proposed key variables that relate to eating disorder pathology in overweight treatment-seeking youth, which following prospective replication, may inform the development of effective interventions for overweight and eating disorders.
Prospective studies suggest that dieting increases risk for bulimic symptoms, but experimental trials indicate dieting reduces bulimic symptoms. However, these experiments may be unrepresentative of real-world weight loss dieting. In addition, the fact that most dieters do not develop eating disorders suggests moderating factors may be important. Accordingly, we randomly assigned 157 female intermittent dieters to either diet as they usually do for weight loss or eat as they normally do when not dieting for 4 weeks. Naturalistic dieting halted the weight gain shown by controls, but did not result in significant weight loss. Although there was no main effect of the dieting manipulation on bulimic symptoms, moderation analyses indicated that naturalistic dieting decreased bulimic symptoms among participants with initially low depressive symptoms. Results suggest that self-initiated weight loss dieting is not particularly effective, which appears to explain several discrepancies in the literature. Additionally, depressive symptoms may be an important determinant of bulimic symptoms that eclipses the effects of naturalistic dieting on this outcome.
In 2005, the format for assessing race/ethnicity on the national Youth Risk Behavior Survey (YRBS) was changed from one to two questions. The 2005 Chicago YRBS included the single-question and two-question formats, providing an opportunity to identify how the change affects reporting of race/ethnicity.
Students in grades 9-12 (n = 808) were asked at the beginning of a 91-item questionnaire, "How do you describe yourself?" with "Hispanic or Latino" as one of several response options. At the end of the questionnaire, students were asked, "Are you Hispanic or Latino?" and then "What is your race?"
Using standard algorithms to categorize students, 10.6% were classified as White, 46.2% as Black, 33.2% as Hispanic/Latino, 9.2% as other, and .9% as missing based on the single-question format. The two-question format yielded a similar distribution: 10.3% White, 41.1% Black, 34.8% Hispanic/Latino, 8.2% other, and 5.7% missing. The difference between these distributions was explained by the disproportionate number of Black students who left multiple questions blank at the end of the questionnaire. Regardless of whether the single-question or two-question format was used, 92.0% of students were classified the same (kappa = .85) when comparing distributions of the four-category race/ethnicity variable.
These results suggest self-reported race/ethnicity among high school students is similar regardless of which question format is used, and the changed format will not affect the ability of YRBS data users to conduct trend analysis by race/ethnicity.
This study examined the role of media body comparison as a mediator of the relationships between psychological factors and sociocultural pressures to be thin and body dissatisfaction in both females and males. Participants were 1,386 females (mean age = 19.37 years) and 1,130 males (mean age = 19.46) from diverse backgrounds who completed a self-report questionnaire. Path analysis was used to test a cross-sectional model in which media body comparison mediated the impact of self-esteem, depressive mood, parent dieting environment, friend dieting, TV exposure, magazine message exposure, weight teasing and body mass index (BMI) on body dissatisfaction. In females, media body comparison partially or fully mediated relationships between self-esteem, depressive mood, friend dieting, magazine message exposure and BMI, and body dissatisfaction. In males, media body comparison was not a significant predictor of body dissatisfaction. This research particularly highlights the need to further examine processes that are involved in the development of body dissatisfaction in males.