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[Display omitted] • Intermittent sucrose/fasting protocol led to overeating behavior. • Animals with loss-control eating also showed depressive-like behavior. • Fasting itself did not induce depressive-like or sucrose overeating behavior. • Activity of monoamine oxidases was disrupted in overeating mice. • Sucrose-exposed mice tend to exhibit increased risk behavior after 20 h-fasting. Binge eating disorder is the most prevalent eating disorder, affecting both sexes but more commonly found in women. Given the frequent co-occurrence of psychiatric disorders, this study aimed to establish a standardized experimental intermittent protocol to investigate overeating associated with depression. A 10-day protocol induced uncontrolled eating behavior in C57BL/6J female mice. The first experiment included the following groups: naive group (chow ad libitum), control group (chow and sucrose solution ad libitum), and fasting groups (16 and 20 h) exposed to an intermittent sucrose solution (10 %) and chow regimen. Subsequently, the feeding test, open field test, elevated plus maze test, tail suspension test, and light/dark conflict test were conducted. Furthermore, monoamine oxidase (MAO) A and B activities in brain structures and plasma corticosterone levels were assessed. Food overconsumption and depressive-like behavior were observed in both sucrose fasting groups, while risk-taking behaviors were specifically observed in the 20-hour fasting sucrose group. While both fasting sucrose groups caused reduced hippocampal MAO-A activity, only the F20 sucrose group inhibited MAO-B in the cortex and hypothalamus. Moreover, both fasting sucrose groups exhibited elevated corticosterone levels. In a separate design (Experiment 2), groups with 16 and 20 h of fasting alone (without sucrose) did not show the same behavioral results as the intermittent fasting sucrose groups, thus avoiding fasting bias. Based on these results, the 20-hour sucrose fasting group was chosen as the ideal protocol for mimicking overeating behavior associated with depression to investigate future therapeutic approaches for this comorbidity. [ABSTRACT FROM AUTHOR]

Research shows eating disorders increase the mortality rate: anorexia nervosa has the highest mortality rate and yet an accurate morbidity rate of bulimia nervosa remains hidden. However, research on the endopsychic structural dynamics that perpetuate in patients with eating disorders is scant. This essay depicts the use of Fairbairn's theory of endopsychic personality structure in understanding anorexia nervosa, binge eating disorder and bulimia nervosa. Fairbairn, of the independent group of British object relations theorists, provides a picture of the endopsychic structure based on the conscious and unconscious psychodynamics between partial ego/part‐object dyads. Using three case histories, the following pages illustrate the incessantly present endopsychic permutations of the aforementioned dynamics and the possibility of the entrapment in one of these or swinging from one to the other in eating disorders. The essay also shows that early traumatic experiences are present in the case history of individuals with any one of these eating disorders and despite their manifested behavioural differences, they result from the widening of fissures in the universal split in the psyche due to emotional and/or physical abuse. Finally, using Fairbairn's theory, the analysis in the essay explains the comorbidity of certain eating disorders and borderline personality structure. [ABSTRACT FROM AUTHOR]

This article discusses a study on the real-life use of the weight loss medication liraglutide (Saxenda) in patients with obesity in France. The study found that patients who started treatment were generally less socially disadvantaged than those who did not start treatment, possibly due to the higher cost of the medication. The primary reasons for not initiating Saxenda were cost and concerns about side effects. Patients who continued treatment for more than 6 months achieved greater weight loss, and the cost of the medication varied widely. The study suggests that social factors and cost play a significant role in adherence to anti-obesity treatment. [Extracted from the article]

Few studies have considered the neural underpinnings of binge eating disorder (BED) in children, despite clinical and subclinical symptom presentation occurring in this age group. Symptom presentation at this age is of clinical relevance, as early onset of binge eating is linked to negative health outcomes. Studies in adults have highlighted dysfunction in the frontostriatal reward system as a potential candidate for binge eating pathophysiology, although the exact nature of such dysfunction is currently unclear. Data from 83 children (mean age 9.9 years, SD = 0.60) with symptoms of BED (57% girls) and 123 control participants (mean age 10.0 years, SD = 0.60) (52% girls) were acquired from the 4.0 baseline release of the Adolescent Brain Cognitive Development Study. Task-based graph theoretic techniques were used to analyze data from anticipation trials of the monetary incentive delay task. Network and nodal properties were compared between groups. The BED-S group showed alterations in topological properties associated with the frontostriatal subnetwork, such as reduced nodal efficiency in the superior frontal gyrus, nucleus accumbens, putamen, and in normal sex-difference patterns of these properties, such as diminished girls-greater-than-boys pattern of betweenness-centrality in nucleus accumbens observed in controls. Distinct network properties and sex-difference patterns in preadolescent children with BED-S suggest dysregulation in the reward system compared to those of matched controls. For the first time, these results quantify this dysregulation in terms of systems-level properties during anticipation of monetary reward and significantly inform the early and sex-related brain markers of BED symptoms. Binge eating disorder is the most common eating disorder. One factor that may contribute to binge eating is dysregulation of the reward system in the brain. This study analyzed brain activity during anticipation of monetary rewards in 83 youth with and 123 children without binge eating disorder symptoms from the Adolescent Brain Cognitive Development Study. The authors found specific alterations in the frontostriatal system, responsible for reward processing, in children with binge eating disorder symptoms, compared to the control group, suggesting dysregulation of the reward system. [ABSTRACT FROM AUTHOR]

Objective Method Results Conclusions In the Diagnostic and Statistical Manual of Mental Disorders‐5, severity of bulimia nervosa (BN) is defined by the frequency of purging behaviour. Previous research suggests the number of purging methods as an alternative rating. The current analysis investigated characteristics (sociodemographic and treatment‐related variables, body mass index [BMI], eating disorder‐specific and general psychopathology) of persons with BN as a function of purging frequency and number of purging methods in order to examine which approach might be better suited for indicating severity of BN.Two‐hundred and sixty‐one persons (98.5% female; mean age 25.2 years, SD = 9.41; mean BMI 22.0 kg/m2, SD = 3.79) with BN completed self‐report questionnaires on eating disorder‐specific and general psychopathology at admission to inpatient (n = 214) or daypatient (n = 47) treatment.Higher severity based on either purging frequency or number of purging methods tended to relate to lower BMI and higher eating disorder‐specific and general psychopathology. In addition, binge‐eating frequency differentially related to eating disorder‐specific and general psychopathology as a function of severity groups.This study partially supports the utility of both purging frequency and the number of purging methods as indicators of severity in persons with BN. However, focussing only on purging behaviours may be short‐sighted as it appears necessary to consider the number of binge‐eating episodes as well when evaluating severity of BN. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion To compare all other specified feeding or eating disorders (OSFED) groups (atypical anorexia nervosa [AN], purging disorder [PD], night eating syndrome [NES], subthreshold bulimia nervosa [sub‐BN], and subthreshold binge‐eating disorder [sub‐BED]) to threshold eating disorders (EDs [AN, BN, and BED]) and control groups (CGs) on measures of eating and general psychopathology.We conducted a comprehensive search in PsycINFO, Medline, Embase, and CINAHL on all published studies from January 2013 to February 2024 using DSM‐5 diagnostic criteria via clinical interviews or well‐established diagnostic tools. We also undertook a quality appraisal using an adapted version of the Downs and Black criteria and registered the review with PROSPERO (ID: CRD42022314495).Overall, our meta‐analyses (n = 33 eligible studies) indicated that the combined OSFED and several specific OSFED subtypes displayed comparable levels of eating psychopathology to full‐threshold EDs. Our systematic review (n = 33 eligible studies) found individuals with OSFED to have comparable levels of eating and general psychopathology to full‐threshold EDs, but higher levels of eating and general psychopathology than CGs. These findings were specifically attributed to atypical AN and NES. There was a lack of evidence available for sub‐BN and sub‐BED. Studies mainly met the quality appraisal criteria. The main limitations identified in the included studies were insufficient reporting of their statistical power (78%) and no adjusting for potential confounding factors (67%).Findings support the conceptualization of atypical AN, and NES as clinically significant EDs with similar severity to full‐threshold EDs. [ABSTRACT FROM AUTHOR]

ABSTRACT The results of Dang et al.'s recent systematic review and meta‐analysis suggested that individuals diagnosed with other specified feeding or eating disorder (OSFED) and those diagnosed with specified eating disorders (EDs, such as bulimia nervosa) endorse similar, elevated levels of ED‐related cognitions (but not behaviors). The DSM has traditionally conceptualized EDs primarily as disturbances in eating behavior, and the diagnostic boundaries for EDs are based on objective markers, such as behavioral frequencies and weight. Although focusing on objective markers for ED diagnoses and severity indices has advantages (e.g., clinical communication, measurement), pitfalls include diagnostic migration and low emphasis on ED cognitions. Dang et al.'s findings provide a basis for rethinking DSM's conceptualization of EDs as primarily behavioral. This commentary discusses the potential merits and challenges of emphasizing subjective cognitions when assigning ED diagnoses. We explore how objective markers (e.g., behavioral frequency, weight) and subjective experience (e.g., fear of weight gain) may be balanced to improve the clinical utility of ED diagnoses. In all, research that more deeply phenotypes the subjective experiences of people with EDs across contexts, identities, and cultures will enrich our understanding of eating pathology and may inform diagnostic revisions. [ABSTRACT FROM AUTHOR]

ABSTRACT Dang et al.'s review concludes that atypical anorexia nervosa (atypical AN), purging disorder (PD), and night eating syndrome (NES) are clinically significant and severe eating disorders (EDs). However, findings are unlikely to alter their status in future editions of the DSM due to limitations in the literature to date. Guidelines are offered to promote rigorous and reproducible research on other specified feeding or eating disorder OSFED. First, published research diagnostic criteria for atypical AN, PD, and NES should be consistently used to ensure findings across studies reflect the same conditions. Second, operational definitions are recommended for “recurrent” as at least twice within a 3‐month period, minimum duration as at least 1 month, and “significant weight loss” as >5% BMI reduction within 1 month. Third, Thomas's and Gydus's trumping scheme for differential diagnosis of OSFED subcategories is endorsed but should prioritize identifying treatment targets based on medical morbidity over mirroring existing diagnostic algorithms. Fourth, a systematic approach for establishing clinical significance is recommended that explicitly notes medical risk associated with malnutrition, purging and nonpurging behaviors, and relevance of marked distress related to binge eating and body image disturbance. Adoption of these guidelines will facilitate necessary research on clinical utility. [ABSTRACT FROM AUTHOR]

Leading treatments for binge eating target dietary restraint, but up to 35% of the people with binge eating report low restraint. This study examined the roles of reward sensitivity and emotion dysregulation in relation to low-restraint binge eating. Women with binge eating (low-restraint: n = 22; high-restraint: n = 69) and controls (n = 49) completed self-report measures of generalized reward sensitivity and emotion dysregulation and a picture-viewing task assessing craving and pleasure for high-calorie food. As expected, food-related craving and emotion dysregulation were greater in the clinical than in the control group, but no differences emerged between high- and low-restraint binge eating groups. However, correlational analyses found that, within the clinical group, the number of restraint days related to greater anticipatory sensitivity for generalized rewards and lower pleasure ratings of food. Results suggest that emotion dysregulation characterizes both high- and low-restraint binge eating. As self-reported food liking was linked with lower restraint, greater enjoyment of palatable foods may uniquely contribute to low-restraint binge eating. Increasing emphasis on emotion regulation and food-related reward sensitivity may enhance treatment outcomes for individuals with low-restraint binge eating. [ABSTRACT FROM AUTHOR]

Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events. Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis. In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD. DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability. • In our sample of 17,505 trauma exposed participants, 13 % had PTSD and 42 % had distressing memories without PTSD. • Distressing memories represent an intermediate state between well-being and post-traumatic stress disorder. • Distressing memories are transdiagnostic psychiatric symptoms useful in identifying psychiatric vulnerability. [ABSTRACT FROM AUTHOR]

Summary Objective Methods Results Conclusion To describe pathways to eating disorder (ED) development that have been evaluated in people with overweight and obesity.Four databases were searched to identify studies testing ED development models in adolescents (10–19 years) or adults (>19 years) with overweight and obesity. Explanatory variables were thematically grouped into constructs to describe pathways to each ED outcome.Of 2226 studies screened, 46 (10 adolescent; 36 adult) were included. Study samples were predominantly female, ranging from 22 to 2236 participants and mean age 12.3 to 56.0 years. In total, 207 explanatory variables were grouped into 18 constructs to summarize 107 pathways that were identified. The most common ED outcome was binge eating (n = 24 studies), followed by global ED psychopathology (n = 10 studies). Across pathways to ED development, negative affect was the most proposed construct, followed by preoccupation with weight/shape and weight stigma.Pathways to ED development in people with overweight and obesity are complex and may include more than 18 different explanatory factors of which negative affect, preoccupation with weight/shape, and weight stigma are the most common. More research on adolescents, males, and the spectrum of ED in diverse populations is required for early identification and intervention. [ABSTRACT FROM AUTHOR]

Background: Online content can inform the personal risk of developing an eating disorder, and it can influence the time and motivation to seek treatment. Patients routinely seek information online, and access to information is crucial for both prevention and treatment. The primary aim of the current study was to quantify the readability scores of online content on eating disorders using natural language processing algorithms, across two languages: English and Italian. Methods: Unique terms related to single diagnoses were searched using Google®. The content available on Wikipedia was also assessed. Readability was defined according to the Flesch Readability Ease (FRE) and the Rate Readability Index (RIX). The scientific support of retrieved content and the authoritativeness of sources were measured through standardized variables. Results: In Italian, online content was more likely published by private psychotherapy institutes or by websites that promote diet-advice or weight-loss. In both languages, the most readable content was on Anorexia Nervosa (RIX 4.18, FRE-en 59.6, FRE-it 41.69), Bulimia Nervosa (RIX 3.99, FRE-en 66.27, FRE-it 39.66) or Binge Eating (RIX 4.01, FRE-en 68.10, FRE-it 38.62). English sources consistently had more references than Italian pages (range 35–182, vs 1–163, respectively). and had a higher percentage of citations available in the target language. The content of these references was mainly reflective of peer-reviewed or clinical manuals. Conclusion: Attention should be given to developing online content for Muscle Dysmorphia and Orthorexia Nervosa, as well as improving the overall readability of online content on eating disorders, especially for languages other than English. [ABSTRACT FROM AUTHOR]

Yoga is effective in binge eating disorder (BED) treatment, but it does not seem effective enough to improve low physical fitness. In contrast, high-intensity interval training (HIIT) is effective in improving physical fitness but has never been studied in the context of BED. In the study, 47 young inactive females with mild to moderate BED were recruited and randomly assigned to a HIIT group (HIIT), a Yoga group (YG), or a control group (CG; age, 19.47 ± 0.74, 19.69 ± 0.874, and 19.44 ± 0.63 years; BMI, 21.07 ± 1.66, 21.95 ± 2.67, and 20.68 ± 2.61 kg/m2, respectively). The intervention groups participated in 8-week specific exercises, while the CG maintained their usual daily activity. Before and after the training, participants were evaluated for BED using the binge eating scale (BES) and for physical fitness. The obtained data were compared within groups and between groups, and a correlation analysis between BES and physical fitness parameters was performed. After the training, the YG presented significant improvements in BES (− 20.25%, p = 0.006, ηp2 = 0.408), fat mass (FM, − 3.13%, p = 0.033, ηp2 = 0.269), and maximal oxygen consumption (VO2max, 11.51%, p = 0.000, ηp2 = 0.601), whereas the HIIT showed significant improvements in body weight (BW, − 1.78%, p = 0.006, ηp2 = 0.433), FM (− 3.94%, p = 0.033, ηp2 = 0.285), and BMI (− 1.80%, p = 0.006, ηp2 = 0.428), but not in BES. Comparisons between groups revealed that both HIIT and YG had significantly higher VO2max levels than CG (HIIT 12.82%, p = 0.006, ηp2 = 0.088; YG: 11.90%, p = 0.009, ηp2 = 0.088) with no difference between HIIT and YG. Additionally, YG presented significantly lower BES than both HIIT (15.45%, p = 0.02, ηp2 = 0.03) and CG (11.91%, p = 0.022, ηp2 = 0.03). In conclusion, Yoga is an effective treatment for BED, but HIIT is not, despite its high efficacy in improving physical fitness. [ABSTRACT FROM AUTHOR]

The Barratt Impulsiveness Scale–short form (BIS–15) is a questionnaire used to measure impulsivity as a trait. It is a shorter version of the BIS–11. There is no specific cut-off score for the BIS–15 because impulsivity is not a mental disorder and cannot be classified into categories. However, mean scores on the BIS–15 in different samples ranged between 29 and 42, with higher scores seen in samples with conditions associated with elevated impulsivity. The author suggests that scores around 40-45 can be considered "moderately impulsive," while scores above 45 can be seen as "markedly impulsive." It is important to use BIS–15 scores as continuous variables and further research is needed to validate the interpretation guidelines provided. [Extracted from the article]

Summary: Episodic future thinking (EFT) strengthens self‐regulation abilities by increasing the perceived value of long‐term reinforcements and reducing impulsive choice in delay discounting tasks. As such, EFT interventions have the potential to improve dietary and eating‐related decision‐making in individuals with obesity or binge eating symptoms, conditions associated with elevated delay discounting. Here, we meta‐analyzed evidence from 12 studies that assessed whether EFT interventions improve delay discounting and real‐world food choice compared to control interventions. Included studies involved 951 adults with overweight or obesity (body mass index [BMI] ≥25). There were no studies involving participants with binge eating disorder. EFT intervention pooled effects were significant, improving delay discounting with a medium effect, g = 0.55, p < 0.0001, and subsequent food choice outcomes with a small effect, g = 0.31, p < 0.01. Notably, our review is the first to analyze mechanisms of effect in this population, demonstrating that improvements were greater when temporal horizons of EFT episodes were aligned with delay discounting tasks and more distant horizons predicted far‐transfer to subsequent dietary and eating‐related choices. Our findings thus show that EFT is an effective intervention for individuals with higher weight at risk of adverse health consequences. [ABSTRACT FROM AUTHOR]

Objective. To compare the prevalence and trajectories of risky health behaviors in sexual minority (SM; lesbian/gay/bisexual/questioning/asexual) versus heterosexual undergraduates across their first year of post-secondary. Participants. First-year undergraduates (N = 704, Mage=17.97 years, 24% SM) from a midsized Canadian university. Methods. Students completed monthly (September-April) online questionnaires assessing substance use (binge drinking, tobacco, cannabis, illicit drug use) and disordered eating (binge eating, fasting, purging). Results. At the outset of the academic year, SM students endorsed more frequent cannabis use, illicit drug use, fasting, and binge eating, but less frequent tobacco use, versus heterosexual students. Over the year, SM students' binge drinking frequency declined less than that of heterosexual students, but their illicit drug use decreased while that of their heterosexual peers increased, and all students reported declining disordered eating frequency. Conclusions. Campus wellness initiatives for SM students should offer prevention and harm-reduction strategies prior to or shortly after their arrival on campus. [ABSTRACT FROM AUTHOR]

Exposure to persistent mild stress is a frequently encountered chronic challenge in a rapidly evolving society. Depending on various factors including sex, the response to stressors varies and is closely linked to the phenomenon of resilience. Depression and anxiety can be considered maladaptive responses to such stress. In this rat study, we investigated the sex-dependent effects of low-grade systemic inflammation during 1 week in combination with chronic unpredictable mild stress during the following 4 weeks on anxiety-like behavior and episodic feeding behavior. Increased anxiety-like behavior and increased sucrose intake were identified in stressed compared to control animals regardless of sex. Interestingly, two nearly equally distributed subpopulations were found in the stressed groups within each sex at the end of the 5-week protocol of combined stress exposure: the resistant and the susceptible, which were characterized by unchanged and increased sucrose intake, respectively. This difference in susceptibility to protracted combined mild stress and ensuing response to a sucrose eating binge demonstrates the complexity of the underlying regulatory mechanisms associated with emotional hyperreactivity. This model carries the potential for further investigation of the molecular basis of resilience and susceptibility to combined stressors and for testing treatments with potential preventive or therapeutic effects. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion “Feeling fat”, the somatic experience of being overweight not fully explained by objective body weight, is considered to be an eating pathology maintenance factor. The traditional clinical understanding of “feeling fat” is based on the body displacement hypothesis, which suggests that negative emotions are projected onto the body and experienced as “feeling fat” in lieu of adaptive emotion regulation. A more recent theory suggests that “feeling fat” occurs in response to thought‐shape fusion (TSF), a cognitive distortion in response to the imagined consumption of perceived fattening food. The present experimental study compared the roles of these two proposed mechanisms of “feeling fat” using self‐report and psychophysiological measures.Eighty‐two women (41 with binge eating, 41 control participants) self‐reported “feeling fat” and had their heart rate variability (HRV), a physiological index of emotion regulation, measured before and after imagined inductions. Participants imagined either a personalized negative affective experience or consuming a preferred, so‐called ‘fattening’ food.The TSF induction increased self‐reports of “feeling fat” among participants with binge eating but not among control women. The negative affect induction did not increase self‐reported “feeling fat” in either group. HRV did not significantly change in response to either induction for either group.TSF may be a more potent precursor to “feeling fat” than negative affect for individuals with binge eating. This may suggest new treatment directions, such as cognitive defusion from TSF when patients experience “feeling fat.” The utility of HRV in monitoring “feeling fat” is questionable. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposure to fitspiration/thinspiration on Instagram.We evaluated a hypothesized pathway from exposure to fitspiration/thinspiration (i.e., ED‐salient content) on Instagram to disordered eating mediated by negative affect and tested individual differences in weight bias internalization, trait self‐esteem, and trait self‐comparison as moderators. We recruited 173 undergraduate women who reported engaging in DEBs on average at least once per week over the past 3 months. Participants completed a seven‐day ecological momentary assessment protocol, during which they reported their ED‐salient content exposure on Instagram, affect, and engagement in DEBs.Multilevel modeling was used to assess moderated mediation. Negative affect partially mediated associations between viewing ED‐salient content and subsequent engagement in objective binge eating and restricting but did not mediate the pathway to purging or excessive exercise. Higher weight bias internalization intensified the association between viewing ED‐salient content and negative affect.The association between viewing ED‐salient content and engaging in objective binge eating and restricting may be a partial consequence of elevated negative affect; however, effects were small. Individuals with higher weight bias internalization may be more vulnerable to negative consequences from viewing ED‐salient content. Findings suggested that reducing negative affect responses (e.g., via emotion regulation) could reduce negative consequences of viewing ED‐salient content. [ABSTRACT FROM AUTHOR]

Introduction: Bulimia nervosa (BN) is a disorder primarily affecting adolescent females, characterized by episodes of binge eating followed by inappropriate compensatory behaviors aimed at preventing weight gain, including self-induced vomiting and the misuse of diuretics, laxatives, and insulin. The precise etiology of BN remains unknown, with factors such as genetics, biological influences, emotional disturbances, societal pressures, and other challenges contributing to its prevalence. First-line treatment typically includes pharmacotherapy, which has shown moderate effectiveness. Neuroimaging evidence suggests that altered brain activity may contribute to the development of BN, making interventions that directly target the brain extremely valuable. One such intervention is repetitive transcranial magnetic stimulation (rTMS), a non-invasive stimulation technique that has been garnering interest in the medical community for many years. Methods: This review explores the use of rTMS in the treatment of BN. Searches were conducted in the PubMed/Medline, ResearchGate, and Cochrane databases. Results: Twelve relevant studies were identified. Analysis of the results from these studies reveals promising findings, particularly regarding key parameters in the pathophysiology of BN. Several studies assessed the impact of rTMS on binge episodes. While some studies did not find significant reductions, most reported decreases in binge eating and purging behaviors, with some cases showing complete remission. Reductions in symptoms of depression and food cravings were also demonstrated. However, results regarding cognitive improvement were mixed. The discussion focused heavily on potential mechanisms of action, including neuromodulation of brain networks, induction of neuroplasticity, impact on serotonergic dysfunction, anti-inflammatory action, and HPA axis modulation. rTMS was found to be a safe intervention with no serious side effects. Conclusions: rTMS in the treatment of BN appears to be a promising intervention that alleviates some symptoms characteristic of the pathophysiology of this disorder. An additional effect is a significant reduction in depressive symptoms. However, despite these findings, further research is required to confirm its effectiveness and elucidate the mechanisms of action. It is also recommended to further investigate the potential mechanisms of action described in this review. [ABSTRACT FROM AUTHOR]

Internet-Based Cognitive Behavioral Therapy (iCBT) is an innovative modality of cognitive-behavioral intervention that presents a promising therapeutic strategy for individuals diagnosed with binge spectrum eating disorders. This study employed a meta-analysis methodology to assess the clinical effectiveness and acceptability of iCBT. We conducted searches in databases such as PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO, collecting literature that met the inclusion criteria until August 5, 2023. A comprehensive analysis was conducted, encompassing a total of 11 randomized controlled studies that satisfied the predetermined criteria for inclusion. The summary results demonstrated that iCBT could significantly improve the pathological features related to eating in patients with binge spectrum eating disorders and also significantly reduce the frequency of binge episodes. Additionally, iCBT could ameliorate the depressive and anxious emotions of patients with binge spectrum eating disorders and boost their self-esteem. Furthermore, a notable disparity in dropout rates was seen in comparison to the control group. Heterogeneity across studies，limitations of self-assessment scales and potential publication bias. iCBT can effectively assist patients with binge spectrum eating disorders in improving clinical symptoms. However, it is important to use caution when interpreting the findings of this study, as there are limitations pertaining to the quantity and quality of the included studies. • Patients with binge spectrum eating disorders face challenges in accessing standardized treatment. • iCBT markedly ameliorated clinical symptoms associated with binge spectrum eating disorders. • Our meta-analysis illustrates the clinical efficacy and acceptability of iCBT for binge spectrum eating disorders. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Discussion To explore dietary‐restraint as a mediator of binge eating and weight‐loss outcomes within a randomized controlled trial comparing cognitive‐behavioral therapy (CBT) and behavioral weight loss (BWL) for binge‐eating disorder (BED) with obesity.Ninety participants were randomly assigned to CBT or BWL and assessed by evaluators blinded to conditions at pretreatment, throughout‐, and post‐treatment (6 months). Three dietary‐restraint measures (Eating Disorder Examination‐Questionnaire [EDE‐Q]‐Restraint, Three‐Factor Flexible‐Restraint and Rigid‐Restraint) were administered at pretreatment and after 2 months of treatment. Regression models examined whether changes at 2‐months in the restraint scales mediated the effects of treatment (CBT versus BWL) on binge eating and weight‐loss outcomes at post‐treatment.CBT and BWL had similar binge‐eating outcomes and similar changes in EDE‐Q‐restraint and flexible‐restraint. BWL had greater 2‐month increases in rigid‐restraint and greater weight‐loss at posttreatment than CBT, with results suggesting 2‐month changes in rigid‐restraint mediated the greater difference (>7 pounds) in weight‐loss. The observed mediation effect of 2.92 suggests 39% of total treatment‐effect on weight‐loss was mediated through 2‐month increases in rigid‐restraint.This secondary analysis within a trial comparing CBT and BWL for BED suggests early‐change in rigid‐restraint has a mediating effect of BWL on weight‐loss. Findings indicate that BWL improves binge eating and challenge views that dietary‐restraint might exacerbate binge eating in BED with obesity. Findings require confirmation using hypothesis‐testing in future trials.Trial Registration: Clinicaltrials.gov: NCT00537758 (“Treatment for Obesity and Binge Eating Disorder”) [ABSTRACT FROM AUTHOR]

Background: Weight stigma refers to the social rejection, discrimination, and ideological devaluation of individuals because of body size and is a direct result of weight bias and anti-fat attitudes. Individuals with higher weight may be less likely to seek healthcare due to weight stigma, and if or when they do present for care, medical providers with weight bias may fail to provide high quality care. Little, however, is known about the intersectionality of weight stigma and perceptions of healthcare interactions as experienced by individuals who also binge eat. Methods: Community-based adults completed online self-report questionnaires regarding generalized weight stigma (Attitudes Towards Obese Persons1), healthcare interaction quality (Patient Perceptions of Healthcare Provider Interaction Quality; PPH), and disordered eating (Eating Disorder Examination-Questionnaire) via Amazon's Mechanical Turk platform. For this cross-sectional study, participants were categorized by the presence and absence of regular binge episodes. Pearson's correlations, T-tests, ANOVA/ANCOVA, and a multivariate regression were used to examine relationships among demographic variables, weight stigma, disordered eating, and the PPH. Results: Participants (N = 648) primarily identified as female (65.4%) and White, non-Hispanic (72.7%). Participants' average age and body mass index (BMI) were 37.5 (SD = 12.3) years old and 27.3 (SD = 6.9) kg/m2, respectively. Higher healthcare provider interaction quality ratings (PPH) were significantly related to lower BMI (r(648)=-0.098,p = 0.012), less weight stigma (r(648) = 0.149,p < 0.001), and identifying as a woman (t(514) = 2.09, p = 0.037, Cohen's d = 0.165) or White, non-Hispanic (t(646)=-2.73, p = 0.007, Cohen's d=-0.240). Participants reporting regular binge eating endorsed significantly worse perceptions of healthcare provider quality than those who did not, even after accounting for BMI, F(1, 645) = 8.42, p = 0.004, η2 = 0.013. A multivariate linear regression examining the PPH as dependent, and weight stigma and binge eating as independent, variable/s, was significant even after accounting for covariates (sex, race, BMI), F(95, 640) = 7.13,p < 0.001, R2 = 0.053 (small effect). Conclusions: More negative experiences with healthcare providers was associated with worse weight stigma, higher BMI, regular binge eating and overall disordered eating, and for participants identifying as male or a Person of Color. These data have implications for non-clinical community populations and are particularly important as experiencing poorer quality of interactions with healthcare providers may decrease individuals' likelihood of seeking needed care for both disordered eating and health-related concerns. Trial Registration: N/A. Plain English summary: Weight stigma refers to the discrimination towards individuals because of body size. Individuals who identify as a Person of Color and who experience binge eating may experience additional discrimination, resulting in barriers to receiving healthcare. To examine these relationships, a community-based sample (N = 648) completed health- and eating-related questionnaires online. Participants who had higher weight rated their perceptions of their interactions with healthcare providers as lower quality. People of Color and men reported lower quality of perceptions of their healthcare provider interactions compared to White, non-Hispanic and female participants, respectively. Participants reporting less weight stigma also reported more positive interactions with their healthcare providers. Participants who reported regular binge eating episodes reported worse quality of interactions with their healthcare providers compared to those who did not report regular binge eating, regardless of their weight. Participants endorsing more stigmatizing views of individuals with higher weight and those reporting regular binge eating were more likely to report poorer perceived quality of interactions with healthcare providers, regardless of their weight, race/ethnicity, or sex. These findings are of particular importance as experiencing poor quality interactions with healthcare providers may be a barrier to receiving needed healthcare. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions In cross‐sectional and retrospective research, parental binge eating is associated with their children's eating psychopathology. The current study extended the evidence by cross‐sectionally and longitudinally examining the relation between parental binge eating and binge eating and weight‐control behaviors in the next generation of their adolescent children and young adult children in a population‐based sample.Adolescents (Time 1: M = 14.5, SD = 2.0 years) (n = 2367), followed into adulthood (Time 2: M = 22.1, SD = 2.0 years), and their parents (n = 3664) were enrolled in EAT 2010–2018 and Project F‐EAT 2010. The current study examined parental binge eating, and child binge eating and weight‐control behaviors. Adjusted models covaried for child gender, age, and race/ethnicity.Approximately 7% of adolescents at Time 1 had at least one parent who reported binge eating with no differences by child's age, gender, or race/ethnicity. Having at least one parent experiencing binge eating at Time 1 (vs. not) was associated cross‐sectionally with adolescent children's use of extreme weight‐control behaviors (9.6% vs. 4.8%; Risk Difference [RD] = 4.9%) and associated longitudinally with binge eating during young adulthood (21.1% vs. 11.6%; RD = 9.5%). Other associations did not reach statistical significance.Children of parents with binge eating appear to have elevated risk of extreme weight‐control behaviors during adolescence and binge eating in young adulthood. Clinicians should assess whether eating psychopathology extends to other family members, and offer additional support to parents with binge eating. Further research is needed to identify risk factors in the children of parents with binge eating and to assess strategies for prevention. [ABSTRACT FROM AUTHOR]

Objective: Binge‐eating disorder (BED) is a strongly stigmatized condition and is often complicated by weight stigma. Research on the intersection between BED and weight stigma is scarce especially in Chinese populations. The present study examined BED stigma in Chinese, whether BED stigma was independent from weight stigma, and whether diagnostic labeling and etiological explanations influenced the degree of BED stigma. Method: Using a between‐subject experimental vignette study, 642 participants (mean age = 29.74 years, SD = 11.34) were randomly assigned to read one of the 18 vignettes, describing a character with information on BED symptoms, weight status, diagnostic labeling, and etiological explanations, followed by measures of stigma and help‐seeking intentions. Results: The character with BED symptoms was ascribed more negative personality characteristics, elicited more negative affective reactions, and triggered greater desired social distance compared to the character without BED symptoms. No evidence for weight stigma was found nor for its interaction with BED stigma. The Cantonese diagnostic label of BED, kwong sik zing, was associated with lower levels of volitional stigma and greater help‐seeking intentions than the diagnostic label of eating disorders, jam sik sat tiu, and the absence of labeling. The effect of etiological explanations was only significant in the univariate test, indicating that providing either a psychosocial or a biogenetic etiological explanation lessened the negative evaluations of personality characteristics. Discussion: The present study provided first evidence for BED stigma in Chinese. BED stigma appeared to be attributable to the presence of disordered eating behavior rather than the BED diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Adults with binge‐eating disorder (BED), compared with those without BED, demonstrate higher blood‐oxygen–level‐dependent (BOLD) response to food cues in reward‐related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge‐eating cues following CBT versus wait‐list control (WLC). Method: Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (fMRI) to measure BOLD response while listening to personalized scripts of binge‐eating and neutral‐relaxing cues. Data were analyzed using general linear models with mixed effects. Results: Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge‐eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge‐eating stimuli during the fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward‐based eating drive, disinhibition, and hunger as assessed by questionnaires (ps < 0.05). Discussion: CBT was effective in reducing binge eating, but, contrary to our hypothesis, CBT did not improve BOLD response to auditory binge‐eating stimuli in reward regions of the brain. Further studies are needed to assess mechanisms underlying improvements with CBT for BED. Trial Registration: ClinicalTrials.gov identifier: NCT03604172 [ABSTRACT FROM AUTHOR]

Objective: Binge eating has adverse health effects and may be 10 times more common in people with type 2 diabetes (T2D) than in the general population. Still, binge eating is not consistently addressed in diabetes treatment. People with T2D and binge eating may, therefore, seek guidance on the topic on social media. The study objective was to explore discussions about binge eating among members of a T2D‐specific Facebook group. Method: Interactions among members of the Facebook group were observed over 8 months and supplemented by keyword searches within group content. The data were imported into NVivo12 and analyzed using Interpretive Description. Results: The overarching theme described how group members exchanged guidance concerning co‐existing T2D and binge eating based on personal experiences while trying to resolve co‐members' misapprehensions regarding binge eating. Two subthemes were generated, describing frequently discussed topics relating to binge eating triggers and inhibitors. Triggers were confusion about the health impacts of carbohydrates and encounters with unsupportive clinicians, while inhibitors included the possibility of speaking openly about binge eating with peers and hunger cues being suppressed by glucagon‐like peptide 1 receptor agonists. Discussion: Social media may constitute an important source of support for people with T2D and binge eating, as the topic is typically not addressed in routine care. Besides being aware of the extent of binge eating in people with T2D and the health risks involved, clinicians should keep in mind that people with both conditions may seek information on social media that can affect diabetes management. [ABSTRACT FROM AUTHOR]

Objective: Food insecurity is associated with eating disorder psychopathology. This Spotlight describes why food pantries could be promising partners for disseminating and implementing eating disorder interventions. Method: Researchers are increasingly collaborating with community‐based organizations to improve access to health interventions, because community‐based organizations overcome structural barriers to traditional healthcare by being embedded physically in the communities they serve, convenient to visit, regularly frequented, and led by trusted community members. Results: We describe strategies we have identified with our partner to disseminate and implement our digital intervention for binge eating; we also discuss ways we support the pantry's needs to improve the mutuality of the partnership. Discussion: The potential benefits of partnerships with food pantries make this an area to explore further. Future research directions include deeply engaging with food pantries to determine how pantries benefit from disseminating and implementing eating disorder interventions and how to intervene in non‐stigmatizing ways, what resources they need to sustainably support these efforts, what eating disorder intervention modalities guests are willing and able to engage with, what intervention adaptations are needed so individuals with food insecurity can meaningfully engage in eating disorder intervention, and what implementation strategies facilitate uptake to intervention sustainably over time. [ABSTRACT FROM AUTHOR]

Objective: Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision‐making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents. Methods: Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self‐induced vomiting episodes (SVEs) at baseline and end‐of‐treatment (EOT). Results: Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (훽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11–0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (훽 = 0.05, p = 0.005, 95% CI = [0.01–0.08]) positively associated with SVE frequency at EOT. Discussion: The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes. Public Significance: Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom‐level outcomes. However, less flexible thinking at the start of treatment predicted self‐induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN. [ABSTRACT FROM AUTHOR]

Objective: Understanding the perspectives of behavioral weight loss (BWL) participants could inform whether, how, and for whom BWL should be offered. Method: All 126 participants in a clinical trial of BWL for adults with binge‐eating disorder (BED) and overweight/obesity were contacted about a qualitative study. 45 participants, 11 of whom had dropped out of the parent study, completed qualitative interviews. The interview guide was developed using data from a survey of providers who offer Health at Every Size and other weight‐neutral lifestyle interventions. Questions were phrased to invite even the most negative responses. Questions focused on participants' experiences of weight stigma during treatment, perceptions of BWL's calorie and WL goals, and opinions of BWL and weight‐neutral interventions. Results: We identified four themes using thematic analysis: (1) BWL did not perpetuate weight stigma. (2) Calorie and WL goals did not exacerbate participants' binge eating. (3) Patients should have the right to pursue any treatment that aligns with their personal goals. (4) BWL can improve participants' overall health. Discussion: BWL participants with BED and overweight/obesity want others to have access to a program that can reduce both weight and binge eating. Participants emphasized that no treatment works for everyone, and they all agreed that BWL had not perpetuated weight stigma. Fewer than 20% of participants considered the program's calorie and WL goals to be harmful; most participants viewed those goals as achievable and helpful, and many asserted that their participation in BWL had improved their overall health. Public Significance: We interviewed adults with binge‐eating disorder and overweight/obesity who had participated in a behavioral weight loss (BWL) program. Our participants wanted others in their position to have access to BWL because it aims to reduce both weight and binge‐eating frequency. Efforts should be made to provide patients, clinicians, and policymakers with the knowledge that supervised, evidence‐based BWL is an effective and desired treatment choice for this population. [ABSTRACT FROM AUTHOR]

Eating disorders continue to impact youth at staggering rates, with 13.2% of adolescents meeting DSM-5 criteria for an eating disorder by age 20. Integrating narrative therapy expressive art interventions with the healing power of group can meet the layered developmental needs of adolescents battling anorexia, bulimia, binge eating disorder, or nonspecific eating disorders. This conceptual manuscript pulls from literature on expressive arts, adolescent eating disorders, group counseling, and residential treatment considerations using a narrative therapy theoretical approach. Expressive art interventions appropriate for serving adolescents with eating disorders in a residential treatment setting are provided. [ABSTRACT FROM AUTHOR]

Background: Psychiatric symptoms are highly prevalent in patients with severe obesity, often representing pivotal factors in the development and progression of this condition. This study examines the association between negative emotional dysregulation (NED) and weight loss following bariatric surgery. Methods: Ninety-nine patients were consecutively enrolled at the Obesity Center of the Pisa University Hospital between March 2019 and February 2021, during a routine psychiatric evaluation before bariatric surgery. Psychopathological dimensions were assessed using the Mini-International Neuropsychiatric Interview (MINI), the Reactivity, Intensity, Polarity, and Stability questionnaire in its 40-item version (RIPoSt-40), the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and the Barratt Impulsiveness Scale (BIS-11). Based on a RIPoSt-40 cut-off score of 70, subjects were divided into two groups: with (NED+) and without (NED−) NED. Results: NED+ subjects had a higher rate of psychiatric comorbidities and eating disorders than NED− patients. Of the total sample, 76 underwent bariatric surgery, and 65 of them were re-evaluated one-year after surgery. Among them, 10 of 28 NED+ subjects (37.5%) had inadequate weight loss one year after surgery compared to 5 of 37 NED− subjects (13.5%) (p = 0.035, OR 3.55, 95%, C.I. 1.05–12.03). Conclusions: Our results suggest a significant association between NED and inadequate weight loss at one-year post surgery. [ABSTRACT FROM AUTHOR]

Binge eating disorder (BED) is the most common specific eating disorder (ED). It is frequently associated with attention deficit hyperactivity disorder (ADHD), depression, bipolar disorder (BD), anxiety disorders, alcohol and nicotine use disorder, and obesity. The aim of this narrative review was to summarize the evidence for the pharmacological treatment of BED and its comorbid disorders. We recommend the ADHD medication lisdexamfetamine (LDX) and the antiepileptic and antimigraine drug topiramate for the pharmacological treatment of BED. However, only LDX is approved for the treatment of BED in some countries. Medications to treat diseases frequently comorbid with BED include atomoxetine and LDX for ADHD; citalopram, fluoxetine, sertraline, duloxetine, and venlafaxine for anxiety disorders and depression; aripiprazole for manic episodes of BD; lamotrigine, lirasidone and lumateperone for depressive episodes of BD; naltrexone for alcohol use disorder; bupropion for nicotine use disorder; and liraglutide, semaglutide, and the combination of bupropion and naltrexone for obesity. As obesity is a frequent health consequence of BED, weight gain-inducing medications, such as the atypical antipsychotics olanzapine or clozapine, the novel antidepressant mirtazapine and tricyclic antidepressants, and the mood stabilizer valproate should be avoided where possible. It is currently unclear whether the novel and promising glucagon, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like peptide 1 (GLP-1) receptor agonists like tirzepatide and retatrutide help with BED and its comorbidities. However, these compounds have been reported to reduce binge eating in individuals with obesity or overweight. [ABSTRACT FROM AUTHOR]

• We assessed clinician attitudes toward the use of guided self-help (GSH) • A minority of clinicians had ever used or received training in GSH. • Given a mock patient with moderate symptoms, likelihood of GSH use was 53.62% • Openness to evidence-based practices and prior GSH use predicted hypothetical use. • Lack of training was a frequently endorsed barrier to GSH use. The current study evaluated knowledge of and attitudes toward guided self-help (GSH) among clinicians who use evidence-based practices to treat one or more of the following: panic disorder, major depressive disorder, bulimia nervosa, binge-eating disorder, and generalized anxiety disorder. A total of 153 of 256 individuals recruited online and at professional conferences were eligible. This study assessed prior experience with and knowledge of GSH, as well as hypothetical use with a mock patient. Less than 20% of clinicians had ever used GSH, and fewer had used it as a stand-alone treatment. Given a mock patient reporting moderate symptoms, clinicians indicated a 53.62% likelihood that they would use GSH. Exploratory analyses indicated that hypothetical use was predicted by prior use of GSH as well as the Openness subscale of the Evidence-Based Practice Attitude Scale. Study findings suggest that clinicians using evidence-based practices do not uniformly know of or endorse the use of GSH. Lack of training in GSH was one of the most frequently endorsed barriers to implementing GSH in clinical practice (n = 99, 64%). These findings have implications for the use of therapy formats that scale evidence-based treatments in the United States. [ABSTRACT FROM AUTHOR]

Background: The practice of sports is not always associated with the concept of health. Rhythmic gymnastics often witnesses athletes adopting unhealthy eating habits. This may lead to eating disorders. Aims: This study aims to evaluate a sample of rhythmic gymnasts from Southern Italy in terms of eating habits, eating disorders, and menstrual cycles disorders. Methods: Girls under 19 years of age who practice rhythmic gymnastics answered two questionnaires: the Eating Attitudes Test-26 (EAT-26); and the Bulimic Investigatory Test Edinburgh (BITE). An health questionnaire was also proposed. Results: The participants had a mean body mass index of 17.9 ± 2.2 kg/m2; 33.33% of the gymnasts reported a score ≥ 20 in the EAT, indicating a possible eating disorder. On the BITE Symptom subscale, 6.7% of the gymnasts had a score between 10 and 19 (abnormal eating habits); 10% scored ≥ 20 (highly disordered eating possible binge eating). Some gymnasts presented altered menstrual cycle. Conclusion: the findings emphasize the need for special attention to eating disorders, menstrual alteration, and education among rhythmic gymnasts. Coaches and team managers should institute monitoring and preventive measures to address these issues as athletes transition into adulthood. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full‐threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. Method: We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM‐5 (Diagnostic and Statistical Manual of Mental Disorders). Results: SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full‐threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. Conclusions: OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full‐threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice. Highlights: Those with OSFED and bulimia nervosa (BN) presented with comparable lifetime suicidal ideation (SI) and attempts, underlining need for universal suicide risk assessment in all individuals with Eating disorders (EDs).Non‐diagnostic clinical features, such as number of purging methods used, predicted suicidal attempts, and may be considered during ED‐informed suicide risk assessments.Frequency of loss of control (LOC) and eating episode size did not predict suicide attempts (SA) when other clinical features were taken into account. [ABSTRACT FROM AUTHOR]

Objective: Negative urgency (i.e., acting rashly when experiencing negative affect; NU), is a theorised maintenance factor in binge‐eating type eating disorders. This study examined the association between trait NU and eating disorder severity, momentary changes in state NU surrounding episodes of binge eating, and the momentary mechanistic link between affect, rash action, and binge‐eating risk. Methods: Participants were 112 individuals with binge‐eating disorder (BED). Baseline measures included the UPPS‐P Impulsive Behaviour Scale to assess trait NU and the Eating Disorders Examination to assess binge‐eating frequency and global eating disorder severity. Ecological momentary assessment captured real‐time data on binge eating, negative affect, and state NU. Results: Multiple regression analysis revealed a strong association between trait NU and eating disorder severity. Generalised estimating equations showed that state NU increased before and decreased after binge‐eating episodes, and that this pattern was not moderated by trait‐level NU. Finally, a multilevel structural equation model indicated that increases in rash action mediated the momentary relationship between states of high negative affect and episodes of binge eating. Conclusion: These findings underscore the importance of both trait and state NU in binge‐eating type eating disorders, and suggest NU as a potential key target for intervention. Highlights: Trait negative urgency (tNU) appears to be a marker of disorder severity, potentially above and beyond binge frequencyState urgency significantly increased prior to binge eating and decreased following binge eating, regardless of tNUMoments of high negative affect predict increases in subsequent rash action, and that this impulsivity is predictive of a greater likelihood of a binge‐eating episode [ABSTRACT FROM AUTHOR]

Purpose: Migrants may have elevated exposure to stressors, which can affect their physical and mental well-being. However, migrants often experience a healthy immigrant effect, the applicability of this phenomena to eating disorders is unknown. We aimed to synthesize the available literature and estimate a summary measure of prevalence odds ratio for eating disorders in migrant populations compared to local populations. Methods: A literature search was conducted using MEDLINE, Embase, PsycINFO, and Web of Science with keywords on migration and eating disorders. Inclusion criteria involved using a validated eating disorder scale and having a comparator group. Two independent reviewers performed study screening and data extraction. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. Random-effects models of meta-analysis were applied to compare eating disorder prevalence between migrants and local populations. Results: There were 10 studies included in our review (meta-analysis = 6, narrative synthesis = 4). Studies provided prevalence estimates for: any eating disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa. Among studies with a diagnostic instrument, the pooled prevalence odds ratio (POR) between migrants and local populations for any eating disorder was 0.45 (95%CI: 0.35–0.59). However, a subgroup analysis of eating disorder instruments among studies using risk assessment tools demonstrated inconsistent findings, with both increases and decreases in prevalence. Conclusion: Migrants were found to have a lower prevalence of eating disorders compared to local populations, supporting the healthy immigrant hypothesis. However, this effect differs between diagnostic and risk assessment tools. [ABSTRACT FROM AUTHOR]

Exposure therapy has been examined as a treatment for eating disorders, but research has yet to determine how to adapt these approaches for those in larger bodies who experience weight stigma. This case study reports on the use of values-based exposure interventions to reduce body dissatisfaction and body-related concerns in a woman with binge eating disorder in a larger body. We used a values-based approach to mirror and body image exposure that focused on fear tolerance and valued actions, as opposed to belief disconfirmation or habituation-based approaches to exposure, which may invalidate weight stigmatizing experiences. The client was a white cisgender woman in her late 20's with binge eating disorder and major depressive disorder enrolled in trial of Transdiagnostic Network-Informed Personalized Treatment for eating disorders. Symptoms were assessed at pre-, mid-, post-treatment and one-month follow-up. The client was highly satisfied with treatment and experienced clinically significant reductions in eating disorder symptoms and shape and weight concerns. Decreases in body dissatisfaction, feeling fat, and overvaluation of weight and shape were large. Clinical impairment decreased, and quality of life increased. A detailed description of the approach to body image exposure for those in larger bodies is provided. Using a values-based approach to body image exposures may help account for weight stigma experienced by those in larger bodies while decreasing avoidance of personally meaningful experiences, body dissatisfaction, and eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Summary Problematic eating behaviours are prevalent in individuals living with obesity and have been linked to weight gain over time. Furthermore, there is evidence that heightened negative emotionality is common in a subset of individuals living with obesity and that negative emotions often precede problematic eating behaviours. Consequently, several theories have highlighted emotion dysregulation as a potential explanatory mechanism of this relationship. However, to date, no comprehensive review has compiled the specific ways in which individuals living with obesity exhibit emotion dysregulation. The present review utilizes Gratz and Roemer's (2004) multidimensional conceptualization of emotion regulation and dysregulation as a framework to summarize the extant literature on emotion dysregulation in obesity. Specifically, this review examines research related to: (1) awareness and clarity of emotions; (2) acceptance of, and willingness to experience, emotion; (3) the ability to remain goal directed and inhibit impulsive behaviour when distressed; and (4) access to emotion regulation strategies. Overall, findings from the present review demonstrate that individuals living with obesity exhibit deficits in emotion clarity, and experience difficulty inhibiting impulsive behaviour and remaining goal directed when experiencing emotion. Strengths and limitations of the literature are reviewed, and future research directions and clinical implications are discussed in light of these findings. [ABSTRACT FROM AUTHOR]

Background: Weight-related self-monitoring (WRSM) apps are used by millions, but the effects of their use remain unclear. This study examined longitudinal relationships between WRSM and disordered eating among a population-based sample of emerging adults. Methods: Participants (n = 138) were recruited from EAT 2010–2018 (Eating and Activity over Time study) to participate in a mixed-methods (quantitative and qualitative) longitudinal study to understand the impacts of WRSM. In 2018, participants (Mage=21.7 ± 1.9 years) reported motivations for use and types of WRSM apps used. Dependent variables collected in 2022 (Mage=25.7 ± 1.9 years) included past year total number of disordered weight control behaviors, disordered muscle building behaviors, compulsive exercise, and binge eating. Linear and logistic regressions were used adjusting for sociodemographics, body mass index, and baseline disordered eating. Semi-structured interviews (n = 25) were analyzed using inductive thematic analysis. Results: Participants using WRSM apps for weight management demonstrated an increase in disordered weight control behaviors over time (β = 0.894, p =.012). Using WRSM apps for "healthy" eating was marginally associated with an increase in disordered weight control behaviors. (β = 0.673, p =.052). Qualitatively, participants reported varied temporality between WRSM and disordered eating, but believed that app use encouraged restriction/binge cycles and normalized disordered eating. Conclusions: Findings suggest there may be individual variation in the relationships between WRSM and disordered eating, but that using WRSM apps with the motivation of managing eating or weight may increase disordered eating in some. Additionally, WRSM apps may normalize or encourage disordered eating. Therefore, safeguards, including screening and monitoring, are needed to ensure WRSM does not cause or escalate harm among WRSM users. Plain English summary: For some, weight-related self-monitoring apps, like MyFitnessPal and Fitbit, may cause or worsen disordered eating over time among emerging adults. However, it seems as though the motivation for self-monitoring (e.g., for managing eating or weight) may be more important than what they are monitoring when it comes to disordered eating risk. [ABSTRACT FROM AUTHOR]

The development of social media and the internet has redefined beauty standards, creating pressure to conform and leading to an increase in eating disorder behaviours such as anorexia nervosa, bulimia nervosa and binge eating disorder. This study aims to examine the relationship between body appreciation, psychological well-being and eating disorder behaviours among students at Universiti Kebangsaan Malaysia (UKM). This quantitative study employs a survey method with simple random probability sampling to obtain 388 UKM students, consisting of 127 male and 261 female students. The Body Appreciation Scale-2 (BAS2) was used to measure the level of body image appreciation, the Psychological Well-being Scale (PWBS) was used to measure psychological well-being and the Eating Disorder Examination Questionnaire 6.0 (EDEQ 6.0) was used to measure eating disorder behaviours. The results show that body image appreciation as well as psychological well-being had a significant negative relationship with eating disorder behaviour. Overall, this study is important for educational institutions and policymakers as it provides empirical findings on body image issues among students. These findings can be used to develop interventions to enhance positive body image acceptance and reduce eating disorder behaviours. Furthermore, stakeholders such as university counselling services and policymakers can utilize these study results to implement more effective programs and policies that support student mental health and well-being. [ABSTRACT FROM AUTHOR]

Food addiction (FA) is associated with greater severity on many eating-related correlates when comorbid with binge eating disorder (BED) but no study has established this relation across the whole spectrum of binge eating, i.e., from no BED to subthreshold BED to BED diagnosis. This study aims to examine the effect of the presence of FA on the severity of eating behaviors and psychological correlates in patients without BED, subthreshold BED or BED diagnosis. Participants (n = 223) were recruited at a university center specialized in obesity and eating disorder treatment and completed a semi-structured diagnostic interview and questionnaires measuring eating behaviors, emotional regulation, impulsivity, childhood interpersonal trauma, and personality traits. They were categorized by the presence of an eating disorder (no BED, subthreshold BED, or BED) and the presence of FA. Group comparisons showed that, in patients with BED, those with FA demonstrated higher disinhibition (t(79) = −2.19, p = 0.032) and more maladaptive emotional regulation strategies (t(43) = −2.37, p = 0.022) than participants without FA. In patients with subthreshold BED, those with FA demonstrated higher susceptibility to hunger (t(68) = −2.55, p = 0.013) and less cooperativeness (t(68) = 2.60, p = 0.012). In patients without BED, those with FA demonstrated higher disinhibition (t(70) = −3.15, p = 0.002), more maladaptive emotional regulation strategies (t(53) = −2.54, p = 0.014), more interpersonal trauma (t(69) = −2.41, p = 0.019), and less self-directedness (t(70) = 2.14, p = 0.036). We argue that the assessment of FA provides relevant information to complement eating disorder diagnoses. FA identifies a subgroup of patients showing higher severity on many eating-related correlates along the binge eating spectrum. It also allows targeting of patients without a formal eating disorder diagnosis who would still benefit from professional help. [ABSTRACT FROM AUTHOR]

Objective: Although literature implicates feeling fat in the maintenance of binge‐spectrum eating disorders (EDs; e.g., bulimia nervosa, binge‐ED), research in this area is small, nascent, and relies on retrospective self‐report. The current study sought to understand the temporal pattern of feeling fat and its role as a precipitant and consequence of ED behaviors. Methods: Totally 106 treatment‐seeking adults with binge‐spectrum EDs completed 7–14‐day ecological momentary assessments. They rated feeling fat, negative affect states, and reported on ED behaviors six times per day. Multilevel models evaluated whether feeling fat mediates prospective links between negative affect states and ED behaviors, assessed if negative affect states mediate the prospective association of feeling fat on ED behaviors, and examined the bidirectional prospective association between feeling fat and ED behaviors. Results: Feeling fat was highest in the early morning (6–8:59 a.m.). Individuals with binge‐ED‐spectrum EDs demonstrated greater variability in feeling fat than those with bulimia nervosa‐spectrum EDs who had stable and high levels of feeling fat. Guilt, sadness, anxiety, and the overall NA at Time 2 mediated the prospective associations between at Time 1 feeling fat and Time 3 dietary restraint, actual dietary restriction, and compensatory exercise. There was a bidirectional prospective association between feeling fat and binge eating. Discussion: Feeling fat serves as a proximal predictor and mediator of the prospective association between guilt and binge eating. Feeling fat and binge eating mutually reinforce each other. Public Significance: Little is understood regarding the experience of feeling fat in natural environments among individuals with binge‐spectrum eating disorders. We found that the risk for having the experience of feeling fat is high in the morning and evening. Feeling fat triggers guilt, anxiety, and sadness which in turn, increases engagement in dietary restraint/restriction and compensatory exercise. Feeling fat also triggers binge eating, and binge eating leads to feelings of fatness. [ABSTRACT FROM AUTHOR]

Objective: Despite unique experiences that may increase eating disorder risk, U.S. military service members are an understudied population. The current study examined incidence and prevalence of eating disorder diagnoses in U.S. military personnel. Method: This retrospective cohort study utilized Military Health System Data Repository (MDR) data on eating disorder diagnoses (2016–2021). Active duty, Reserve, and National Guard U.S. military service members who received care via TRICARE Prime insurance were identified by ICD‐10 eating disorder diagnostic codes. Results: During the 6‐year surveillance period, 5189 Service members received incident eating disorders diagnoses, with a crude overall incidence rate of 6.2 cases per 10,000 person‐years. The most common diagnosis was other/unspecified specified eating disorders, followed by binge‐eating disorder, bulimia nervosa, and anorexia nervosa. There was an 18.5% overall rise in total incident cases across the surveillance period, but this trend was not statistically significant (p = 0.09). Point prevalence significantly increased across the 6‐year timeframe for total eating disorders (p < 0.001). Period prevalence for 6‐year surveillance period was 0.244% for total eating disorders, 0.149% for other/unspecified eating disorder, 0.043% for bulimia nervosa, 0.038% for binge‐eating disorder, and 0.013% for anorexia nervosa. Discussion: Overall crude incidence estimates for total eating disorders were higher than reported in prior research that included only active duty Service members and required an eating disorder diagnosis code in the first or second diagnostic position of the medical record. Comprehensive and confidential studies are needed to more thoroughly characterize the nature and scope of eating disorder symptomatology within U.S. military personnel. Public Significance: U.S. military service members are a vulnerable population with regard to eating disorder symptoms. Previously reported incidence and prevalence estimates using data from the Military Health System may have been underestimated due to overly stringent case definitions. Given personal and occupational barriers (e.g., career consequences), confidential studies of military personnel may provide more complete data on the scope of eating disorders to inform screening and clinical practice guidelines for military populations. [ABSTRACT FROM AUTHOR]

Objective: Although rates of weight discrimination are on‐par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight‐based discrimination in youth, including on disordered eating. Knowing whether experiences of weight‐based discrimination, including in youth with multiply‐marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts. Method: Youth (N = 11,875) ages 10–11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross‐sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge‐eating, vomiting, weight‐gain fear, weight self‐worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used. Results: Rates of weight‐based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight‐based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination. Discussion: Weight‐based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight‐based discrimination, is a critical intervention target to prevent and treat eating disorders. Public Significance: Experiences of discrimination contribute to poorer health; however, weight‐based discrimination is relatively understudied. Data from a large sample of youth ages 10–11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply‐marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight‐based discrimination is a critical target to prevent and treat eating disorders, especially in multiply‐marginalized youth. [ABSTRACT FROM AUTHOR]

Disordered eating behaviors consistently associated with emotion regulation difficulties. However, most studies have focused on affect intensity without considering dynamic affective patterns. We examined these patterns in relation to daily overeating, loss of control eating (LOCE), dietary restraint, and food craving in young adults using ecological momentary assessment (EMA). Adults (N = 24) completed a 10-day EMA protocol during which they reported momentary affect and eating patterns. Generalized linear mixed-models examined each index in relation to eating variable. Higher PA instability (within-person) was associated with higher ratings of binge-eating symptoms (B = 0.15, SE = 0.06, p = 0.007). Lower NA differentiation (within-person) was associated with higher levels of food craving (B = −10.11, SE = 4.74, p = 0.033). Our results support previous findings suggesting that acute fluctuations in PA may increase risk of binge-eating symptoms. Further, inability to differentiate between momentary states of NA was associated with cravings. This study highlights the importance of examining multiple facets of NA and PA in relation to eating regulation. Trial registration: ClinicalTrials.gov identifier: NCT02945475. [ABSTRACT FROM AUTHOR]

AbstractMigration poses a myriad of challenges to migrants’ mental well-being, including eating disorders (EDs) and body image dissatisfaction (BID). This review aims to explore the prevalence and characteristics of EDs and BID among migrant populations. A comprehensive search of PubMed/MEDLINE and Web of Science databases was conducted from inception to January 2023. Using search terms encompassing ED/BID and migrant populations, 11 studies were selected from an initial pool of 899 records. Epidemiological studies demonstrate varying prevalence rates of ED among migrant groups, presenting mixed data. In certain populations, the global prevalence of EDs was reported at 5.8%, with binge eating disorder specifically observed at a rate of 1.7%. Clinical cases reveal how the migratory route, culture and psychopathology intersect in ED presentations. Cultural practices and ethnic identity can influence ED development, often exacerbated by biases related to food and body image. Conversely, cultural heritage may serve as a mitigating factor. Studies on BID reveal a prevalent preference for thinner bodies among migrants in Western nations, likely influenced by exposure to Western cultural norms and ideals. The present findings underscore the complex phenomenology of ED and BID in migrant populations, influenced by a multitude of factors including migration-related stress and cultural constructs. [ABSTRACT FROM AUTHOR]

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time. Examine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating. In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives. Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking. Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women. • College women are at high risk for both problematic alcohol use and binge eating. • The longitudinal relationship between them is less studied among college women. • Problematic alcohol use prospectively predicted greater binge eating. • The relationship was stronger at higher levels of shame. [ABSTRACT FROM AUTHOR]

Background: The recurrence of weight gain is attributed to the homeostatic regulation of hunger and satiety signals, influenced by metabolic state, nutrient availability, and non-homeostatic mechanisms shaped by reinforced consequences from experiences. In response, Evelyn Tribole and Elyse Resch proposed Intuitive Eating (IE) in 1980, countering restrictive diets. IE, inversely correlated with Body Mass Index (BMI), binge eating, and anxiety/depression symptoms, fosters mind–body-food harmony by recognizing hunger and satiety cues. IE encourages meeting physiological, not emotional, needs, permitting unconditional eating, and relying on internal signals for food decisions. Amidst university students' stress, exacerbated during the COVID-19 pandemic, understanding their eating behavior, particularly intuitive eating levels, becomes crucial. Objective: This study aimed to assess the IE level of Brazilian students during the COVID-19 pandemic. Methods: This cross-sectional study, the first to analyze the Intuitive Eating of students in Brazil during the pandemic, was conducted using an online questionnaire. Results: The sample comprised 1335 students, most of whom were women (82.17%), with a mean age of 26.12 ± 7.9 years, and a healthy nutritional status (57.58%). The mean IE score was 3.2 ± 0.6. A significant association was found between the confinement situation, the type of housing unit, and the IE subscale-Unconditional Permission to Eat (p = 0.043). However, there was no association between the other subscales and the total IE scale. Regarding self-reported mental and eating disorders, the most frequent were anxiety (21.2%), depression (6.5%), and binge eating disorder (BED) (4.7%). IE was negatively associated with BED (B = − 0.66; p <.001), bulimia nervosa (B = − 0.58; p <.001), body mass index (BMI) (p <.001) and self-reported anxiety (B = −.102; p = 0.16). The male sex showed a higher IE score compared with the female sex (p <.001). Conclusion: While no significant association was found between IE and the confinement situation, a significant association was found between housing type and the Unconditional Permission to Eat subscale. [ABSTRACT FROM AUTHOR]