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Objective: Deterioration rate among patients with bulimia‐spectrum eating disorders (BN‐EDs) after receiving enhanced cognitive‐behavioral therapy (CBT‐E) remains high. Previous studies identified body image concerns, environmental triggers, lack of social support, lack of resources, comorbidity, and discontinued skill use as predictors of deterioration. However, no studies have qualitatively explored patients' perceptions of how these factors influenced their skill use and led to deterioration after receiving outpatient CBT. Methods: This study aimed to qualitatively explore (1) what post‐treatment factors patients believe contributed to deterioration, and (2) whether patients continued to practice the CBT skills they learned from treatment and identify motivators and barriers to post‐treatment skill use. Twelve participants who had previously completed 16 sessions of CBT for their BN‐EDs and experienced at least modest treatment responses participated in the qualitative interviews. Results: Four themes were identified from the qualitative interviews. Post‐treatment deterioration was primarily driven by decreased skill use due to a perceived sudden loss of accountability and continued body dissatisfaction after treatment ended. Discontinued practice of binge analysis led to decreased awareness of the relationship between poor skill use and ED behaviors. Difficulty accessing resources impeded participants from receiving external help to address challenges in skill practice, thus also contributing to deterioration. Discussion: Findings suggested that outpatient treatment for BN‐EDs patients should emphasize more on body image concern, and deterioration prevention for outpatient CBT‐E should focus on building self‐accountability to keep practicing skills after treatment ends. Public significance: This study was the first to qualitatively explore post‐treatment factors influencing skill use and deterioration in patients with bulimia‐spectrum eating disorders after they completed outpatient CBT. Findings indicated that decreased skill use was a primary driver of post‐treatment deterioration, and that relapse prevention for outpatient CBT for BN‐EDs should focus on enhancing patients' self‐accountability to continue practicing therapeutic skills independently after treatment ended. [ABSTRACT FROM AUTHOR]

Background: Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait‐level working memory (WM), which may limit adaptive responding to intra‐ and extra‐personal cues related to eating. Understanding of how WM performance relates to eating behavior in real‐time is currently limited. Methods: We studied 32 youth (ages 10–17 years) with LOC eating and overweight/obesity (LOC‐OW; n = 9), overweight/obesity only (OW; n = 16), and non‐overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone‐based ecological momentary assessment. Linear mixed effects models estimated group‐level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating. Results: LOC‐OW were less accurate on numerical WM tasks compared to OW and NW (ps <.01); groups did not differ on spatial task accuracy (p =.41). Adjusting for between‐subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within‐subject effects (reflecting variations in moment‐to‐moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p =.013). There were no associations between WM performance and LOC eating severity (ps >.05). Conclusions: Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory‐based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored. Public significance statement: Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal‐weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment‐to‐moment basis. [ABSTRACT FROM AUTHOR]

Objective: Theories propose that low self‐esteem and problematic eating behaviors (PEBs) negatively impact each other. While previous studies suggested bidirectional associations between self‐esteem and PEBs, they did not separate within‐person from between‐person associations. Therefore, this prospective study investigated the within‐person bidirectional associations between self‐esteem and four PEBs in adolescence, while accounting for between‐person differences. Method: We used two independent longitudinal samples of Dutch adolescents, each including three annually collected waves of data. Sample 1 consisted of 1856 adolescents (Baseline: 50.4% males; Mage = 13.79 years, SDage = 0.72), with measures of self‐esteem, emotional eating, restrained eating, and loss of control (LOC) while overeating. Sample 2 consisted of 555 adolescents (Baseline: 49.7% males; Mage = 13.13 years, SDage = 0.68), with measures of self‐esteem and LOC eating. The data were analyzed using random intercept cross‐lagged panel models (CLPMs). Results: Within persons, lower self‐esteem was associated with higher emotional and restrained eating (both Sample 1) one year later, and vice versa. Self‐esteem did not predict, nor was predicted by, LOC while overeating (Sample 1) or LOC eating (Sample 2). Between persons, self‐esteem was negatively correlated with all PEBs (Samples 1 and 2). Discussion: We found within‐person bidirectional associations between low self‐esteem and emotional and restrained eating (but not LOC while overeating/LOC eating), and between‐person correlations between low self‐esteem and all PEBs. These results have theoretical and practical implications. Within‐person processes clarify underlying mechanisms that explain the occurrence of PEBs; between‐person associations are important to identify adolescents at risk of PEBs. Public Significance: While theories indicate that low self‐esteem and PEBs are inversely associated within individuals, empirical studies have not disentangled within‐person processes from between‐person differences. This study addressed this disparity, finding that lower self‐esteem was bidirectionally associated with higher emotional and restrained eating (but not LOC eating) within persons. These findings suggest that enhancing self‐esteem is a viable option for prevention and intervention. [ABSTRACT FROM AUTHOR]

Objective: Loss of control over eating (LOC) during pregnancy impacts prenatal health and often co‐occurs with depressive symptoms. However, the role of depression history as a risk factor for LOC prior to pregnancy is unclear; information that is essential for effective prenatal health promotion. We examined the association between trajectories of depressive symptoms from childhood to first pregnancy and preconception LOC. Method: Participants (N = 1031) were predominantly Black, first‐time mothers enrolled in the population‐based Pittsburgh Girls Study. LOC and depressive symptoms were measured annually. Pre‐pregnancy height and weight, and gestational weight gain data were abstracted from medical records. Results: There was a significant difference in age of first conception for Black and White individuals (t = 8.73, df = 976, p <.001). Latent class analysis revealed four and three classes of depressive symptom trajectories for Black and White individuals, respectively. In the entire sample, the high‐changing and moderate‐decreasing classes of depressive symptoms were each associated with lifetime, in preconception year and not in preconception year, LOC (X2 = 56.7, p <.001). Discussion: High levels of lifetime depressive symptoms may increase vulnerability to future LOC prior to first pregnancy, suggesting potential targets for interventions to improve maternal health. Public Significance: Both depression history and disordered eating behaviors are known to influence prenatal health. The present study revealed associations between high levels of depressive symptoms from childhood through first pregnancy and loss of control over eating that included the year prior to conception. Results highlight potential targets for preconception interventions with relevance for future prenatal health. [ABSTRACT FROM AUTHOR]

Objective: Loss‐of‐control and overeating are common in adolescents with high body mass index (BMI). Mindfulness may affect negative affect, and both may relate to loss‐of‐control and overeating. Yet, there is limited understanding of these associations in adolescents' daily lives. Methods: Forty‐five adolescents (77% female; Mage = 14.4 years, SDage = 1.7 years) with high weight (92% with BMI [kg/m2] ≥85th percentile for age/sex) provided daily, repeated measurements of mindfulness, negative affect, loss‐of‐control, and overeating for ~7 days (M = 5.6 days; range = 1–13). Multilevel mixed modeling was conducted to test within‐person (intraindividual) and between‐person (interindividual) associations for the same‐day (concurrent) and next‐day (time‐ordered/prospective). Results: There were within‐person and between‐person associations of higher mindfulness with lower negative affect on the same‐day and next‐day. Greater between‐person mindfulness related to lower odds of adolescents' loss‐of‐control occurrence (same‐day) and conversely, more perceived control over eating (same‐day and next‐day). Greater within‐person mindfulness related to less odds of next‐day overeating. Discussion: Dynamic relations exist among mindfulness, negative affect, and eating in adolescents at‐risk for excess weight gain. Mindfulness may be an important element to consider in loss‐of‐control and overeating. Future work using momentary‐data within an experimental design would help disentangle the intraindividual effects of increasing mindfulness/decreasing negative affect on disordered eating. Public Significance: Loss‐of‐control and overeating are common in teenagers with high weight. Greater mindfulness—present‐moment, non‐judgmental attention—and less negative emotions may relate to healthier eating, but we do not know how these processes play out in teenagers' daily lives. Addressing this knowledge gap, the current findings showed that greater daily mindfulness, but not negative affect, related to less loss‐of‐control/overeating, suggesting the importance of mindfulness for eating patterns in teenagers' daily lives. [ABSTRACT FROM AUTHOR]

Objective: The daily biobehavioral factors that precipitate loss of control eating (LOCE) in adolescent girls are not well known. Ovarian hormone levels are key biological factors associated with the etiology of eating disorders in adolescent girls. Yet, models on how daily ovarian hormone exposure predicts LOCE in adolescent girls are underdeveloped. The goal of this study is to examine the daily patterns and mechanisms of ovarian hormone levels on LOCE across the menstrual cycle in adolescent girls and the mediating roles of food‐related reward anticipation and response inhibition. Ecological momentary assessment (EMA) paired with daily hormonal sampling will be used to examine (1) daily associations between within‐person hormones and LOCE, and (2) the mediating role of within‐person food‐related reward anticipation and response inhibition. Methods: Normally cycling adolescent girls who have reached menarche will provide daily saliva samples for hormone analysis and complete EMA for 35 days. During EMA, girls will report LOCE and will complete task‐based and self‐report measures of food‐related response inhibition and reward anticipation. Discussion: This work has implications for the development of new real‐world biobehavioral models of LOCE in adolescent girls, which will guide theory improvements and treatment for LOCE. Results will provide preliminary evidence for treatment targets for novel interventions for adolescent girls—for example, a response inhibition intervention. Public Significance: Adolescent eating disorders are severe mental health conditions, often marked by loss of control eating. Estrogen and progesterone play a role in the development and persistence of loss of control eating. The current study will examine how daily exposure to estrogen and progesterone predicts loss of control eating in adolescent girls and identify possible daily mechanisms linking estrogen and progesterone exposure and loss of control eating. [ABSTRACT FROM AUTHOR]

Objective: Binge‐eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or "resigned" to LOC. This study examined differences in psychopathology among treatment‐seeking patients with binge‐eating disorder categorized with fear of LOC, resignation to LOC, and no fear/resignation of LOC. Method: Doctoral research clinicians administered diagnostic and semistructured interviews to characterize psychopathology and establish a diagnosis of binge‐eating disorder in participants (N = 382). The interview assessed fear of LOC in the past month. Further queries assessed whether, in the absence of fear of LOC, patients were resigned to LOC or had no fear/resignation. Results: Patients with fear of LOC and resigned to LOC endorsed significantly greater global eating‐disorder psychopathology than patients with no fear/resignation. Patients with fear of LOC reported greater distress about binge eating and greater depression than those with no fear/resignation. Patients resigned to LOC reported significantly more frequent binge‐eating episodes than those with fear of LOC and no fear/resignation. Black individuals and men were more likely to report no fear/resignation than other demographic groups. Discussion: This study describes a novel clinical aspect of binge‐eating disorder: resignation to LOC. Findings highlight the importance of including anticipatory cognitive‐affective experiences in treatment formulations and planning. Future research should examine co‐occurrence of these experiences and their association with impairment. Future research should also examine how fear of LOC and resignation to LOC change during treatment and whether they predict or moderate treatment outcomes. Public Significance: Adults with binge‐eating disorder have anticipatory cognitive‐affective experiences about loss of control (LOC) over eating (i.e., fear of LOC, resigned to LOC, no fear nor resignation of LOC). Individuals who experience fear of LOC and those who are resigned to LOC had more severe psychopathology than those without fear/resignation. Binge‐eating disorder has the highest prevalence of the eating disorders; thus, findings have high public significance in guiding clinicians' treatment planning. [ABSTRACT FROM AUTHOR]

Objective: Loss of control (LOC) eating following bariatric surgery remains insufficiently understood, reflected in a lack of clear conceptualization, valid measurements, and effective treatments. This study explored patients' perspectives on LOC eating post‐bariatric surgery, focusing on the relevance of the Diagnostic and Statistical Manual of Mental Disorders‐5 (DSM‐5) indicators of impaired control, and patients' experiences before (precipitating factors), during (eating patterns, perpetuating factors), and after the episodes (strategies used to stop eating). Methods: This was a qualitative study using descriptive phenomenology. Participants were adults who have undergone gastric bypass or sleeve gastrectomy and self‐reported recent LOC eating. Data were collected by semi‐structured interviews and analyzed using a combined inductive and deductive approach. Results: Participants were all women (N = 15; age: 34.5 ± 9.2 years). Results suggested that (1) except for feeling disgusted, guilty, or depressed after eating, other DSM‐5 indicators did not seem to be highly relevant to this bariatric cohort; (2) LOC eating could occur across contexts, with food access, boredom, and food craving being consistent triggers; (3) the food amount consumed during a LOC episode was not necessarily considered excessive; (4) "mindlessness" and "satisfying hedonic, physiological, and mental needs" were the main perpetuating factors of LOC eating; and (5) self‐talk and distracting attention were the most adopted strategies to stop eating. Discussion: Study findings have implications concerning the conceptualization, measurement, and intervention of LOC eating among bariatric patients. For example, results suggested the need for more data to determine the appropriate indicators of LOC eating and the inclusion of boredom as an intervention target in bariatric patients. Public Significance: Loss of control (LOC) eating is characterized by a sense of being unable to stop while eating. LOC eating is prevalent in patients who have undergone weight loss surgery and is associated with worse surgical outcomes. This qualitative study that explored post‐bariatric surgery patients' experiences of LOC eating will inform efforts to better assess and intervene in this disordered eating behavior, thus ultimately optimizing patients' health following weight loss surgery. [ABSTRACT FROM AUTHOR]

Objective: Racial discrimination is a stressor for young Black women that leads to poor health outcomes, including maladaptive eating. This study presents findings on racial discrimination and maladaptive eating behaviors (overeating, LOC eating) using ecological momentary assessment (EMA). Methods: Black emerging adult women (N = 27) with overweight or obesity participated in a 14‐day EMA study examining exposure to racial discrimination, eating behaviors, and racial identity. Frequencies and chi‐square tests were used to characterize the type of racial discrimination experienced and frequency of overeating. Mixed effect ordinal logistic regression models were used to assess the relation between racial discrimination and maladaptive eating. Moderation analysis was conducted by creating interaction terms for discrimination and racial identity variables. Results: 81.5% of participants reported experiencing racial discrimination. Young Black women reporting exposure to racial discrimination were more likely to endorse higher levels of both overeating and LOC eating compared to times when discrimination was not experienced (p <.0001). Racial identity moderated the link between racial discrimination and maladaptive eating (overeating, LOC) such that reporting greater levels of private regard buffered the deleterious effect of racial discrimination. Higher levels of public regard exacerbated the association between racial discrimination and both overeating, and LOC. Higher centrality worsened the relation between racial discrimination and LOC. Conclusion: Young Black women might use maladaptive eating to cope with exposure to racial discrimination, which underscores the importance of examining the link between racism and disordered eating, particularly among Black women submerged in a society that continuously exposes them to racial discrimination. Public Significance: Emerging adult Black women are exposed to racial discrimination daily. In theory, exposure to racial discrimination could contribute to overeating and loss of control eating in this population. Using ecological momentary assessment, to capture experiences and eating behaviors in the moment they occur, this project quantified the magnitude of racial discrimination and how it was associated with maladaptive eating behaviors. Further, it examined ways in which racial identity was linked to this association. [ABSTRACT FROM AUTHOR]

Background: Loss‐of‐control (LOC)‐eating postoperatively predicts suboptimal longer‐term outcomes following bariatric surgery. This study examined longer‐term effects through 24‐month follow‐ups after completing treatments in a randomized controlled trial testing guided‐self‐help treatments (cognitive‐behavioral therapy [gshCBT] and behavioral weight‐loss [gshBWL]) and control (CON) delivered postoperatively for LOC‐eating. Methods: 140 patients with LOC‐eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3‐months of gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24) delivered by trained allied‐health clinicians. Independent assessments were performed throughout/after treatments and at 6‐, 12‐, 18‐, and 24‐month follow‐ups; 83% of patients were assessed at 24‐month follow‐up. Results: Intention‐to‐treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC‐eating abstinence at posttreatment (30%, 27%, 38%), 12‐month follow‐up (34%, 32%, 42%), and 24‐month follow‐up (45%, 32%, 38%) revealed no significant differences. Mixed‐models revealed significantly reduced LOC‐eating frequency through posttreatment, no significant changes in LOC‐eating frequency during follow‐up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow‐ups, with no differences between groups. Conclusions: Overall, the 12‐week scalable guided‐self‐help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC‐eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24‐month follow‐up. Weight gain was substantial and nearly universal whereas the frequency of LOC‐eating did not change over time (i.e., LOC‐eating reductions and abstinence rates were well maintained through 24‐moth follow‐ups). Patients with postoperative LOC‐eating require more intensive adjunctive treatments. Public significance: Loss‐of‐control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer‐term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24‐month follow‐up of a controlled study of scalable guided‐self‐help treatments and a control condition, improvements in LOC‐eating frequency, eating‐disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC‐eating at the 24‐month follow‐up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24‐month follow‐ups, with no differences between the three groups. Findings suggest LOC‐eating following bariatric surgery might represent a "marker" for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low‐intensity scalable treatments and may require more intensive specialist treatments. [ABSTRACT FROM AUTHOR]

Objective: Individuals with eating disorders (EDs) demonstrate difficulties with emotion regulation, and these difficulties have been associated with severity and maintenance of ED symptoms. Although emotion reactivity (i.e., the strength and duration of emotional experiences) is distinct from emotion regulation, few studies have examined emotion reactivity in the context of EDs. The purpose of the current study was to examine longitudinal associations between emotion reactivity and ED symptoms and impairment in individuals with EDs. Method: Individuals seeking outpatient ED treatment (N = 265) completed questionnaires assessing ED symptoms and severity, emotion reactivity, and emotion regulation difficulties at treatment intake and bi‐monthly during treatment. Results: Individuals with anorexia nervosa or binge eating or purging presentations had higher emotion reactivity scores than a non‐ED comparison group. Controlling for age, diagnosis, and emotion regulation difficulties, emotion reactivity was positively associated with ED severity, ED‐related impairment, and loss of control eating severity. Moreover, emotion reactivity, but not emotion regulation difficulties, was associated with change in ED symptoms during treatment. Discussion: Findings support that emotion reactivity may differ based on ED presentations and may be an important correlate of ED symptom severity. Public Significance: Emotion reactivity refers to the strength and duration of an emotional experience. This study found that higher emotion reactivity was related to greater eating disorder symptom severity and eating disorder‐related impairment. It may be beneficial to consider the role of emotion reactivity in conceptualizations of eating disorders, particularly those characterized by binge eating or purging. [ABSTRACT FROM AUTHOR]

Objective: Does engaging in dietary restraint due to weight/shape concerns versus economic hardship differentially relate to disordered eating? Method: The sample consisted of 582 adults experiencing food insecurity (FI) who completed online measures assessing severity of FI, disordered eating, loss of control over eating, and dietary restraint. Participants reported their motivation for dietary restraint with options consisting of weight/shape concerns, economic hardship (i.e., insufficient funds and prioritizing others' needs), mixed reasons, and other/I do not know. Results: In the sample, 18% reported engaging in dietary restraint primarily due to weight/shape concerns, 33% due to economic hardship, 18% other/do not know, and 30% due to a mix of reasons. There were positive correlations between FI, economic hardship, dietary restraint, disordered eating, and loss of control over eating. Regression analyses revealed the association between dietary restraint and disordered eating does not differ across individuals who endorse economic hardship as a motivator for dietary restraint. Findings replicated with loss of control. However, the association between dietary restraint and disordered eating grew stronger as more dietary restraint due to weight/shape concerns was endorsed. No significant association emerged with loss of control. Discussion: Research is needed to replicate findings and examine how patterns of food scarcity impacts disordered eating in food insecure populations with and without weight/shape concerns. Findings suggest that motivation for dietary restraint may influence associations with dietary restraint and the cognitive components of disordered eating, but not the behavioral components of disordered eating. Public Significance Statement: Disordered eating due to dietary restraint is most commonly associated with weight and shape concerns; however, even when dietary restraint is due to economic reasons, it can still be associated with disordered eating. [ABSTRACT FROM AUTHOR]

Objective: Sexual minoritized persons evidence higher prevalence of eating disorders than heterosexual persons, yet it is unclear which specific symptoms drive these disparities. Empirical evidence also documents the importance of considering subclinical eating disorder presentations, as well as potential differentiation in expression of eating disorder symptoms based on gender. The current study complements that of Kamody et al. (2020), who examined sexual orientation‐based disparities in eating disorder diagnoses using a nationally representative sample of the US adult population. Method: Using the National Epidemiologic Survey on Alcohol and Related Conditions‐III (NESARC‐III), we compared the prevalence of eating disorder symptoms across sexual minority status separately for men and women. Results: Sexual minoritized men were more likely than heterosexual men to report body mass index (BMI) < 18.5 kg/m2 (odds ratio [OR] = 1.76), thus, being screened into questions about restrictive eating. Sexual minoritized women were more likely than heterosexual women to endorse ever engaging in a binge‐eating episode (OR = 2.25) and engaging in weekly binge eating for at least 3 months (OR = 1.58), thus, being screened into follow‐up questions about binge eating. Sexual minoritized men were more likely than heterosexual men to fear gaining weight even when at their lowest weight (OR = 4.35) and experience a loss of control when overeating (OR = 3.13). Discussion: Sexual orientation‐based disparities in eating disorder symptom endorsement were nuanced when stratifying the entire sample by gender. Findings expand previous research on disparities in clinical/diagnosed eating disorders, highlighting the importance of assessing symptomology beyond diagnosis, as well as the intersectional influence of sexual orientation and gender, in both research and practice. [ABSTRACT FROM AUTHOR]

Objective: In adults, pain is prospectively associated with overweight/obesity and concurrently associated with dysregulated eating, with evidence for stronger associations in women than men. This study aimed to evaluate whether similar associations among pain response, BMI, and loss of control (LOC) eating are also evident in adolescent girls. Method: Girls (n = 202) completed the cold pressor test (CPT) at age 10, and BMI and LOC eating were assessed annually from ages 10–16 years. Generalized linear models were used to test associations between pain tolerance (total immersion time) and threshold (latency to highest pain rating), and changes in BMI and LOC eating. Results: Lower pain tolerance and threshold at age 10 were associated with increases in LOC eating from age 10 to 16 (tolerance: B < −.01, SE <.01, p =.005; threshold: B = −.03, SE =.01, p =.0118). No significant associations were observed between pain tolerance/threshold and increasing BMI. Discussion: Pain responsivity in childhood is associated with increases in dysregulated eating from childhood to adolescence. These findings provide support for the early development of an interface between pain and eating behaviors. [ABSTRACT FROM AUTHOR]

Objective: Loss of control over eating (LOC) is common among adolescents and is associated with negative developmental outcomes. Low self‐regulation, and specifically low inhibitory control, is increasingly emphasized as an underlying factor in LOC. However, the specific context in which these capacities fail remains unclear. The affect regulation model proposes that negative affect may trigger LOC; however, research has mostly assessed trait negative affect using questionnaires, whereas measuring state negative affect is needed to determine its triggering role. Therefore, this study examined the interaction between inhibitory control and state negative affect in predicting LOC among adolescents using an experimental mood‐induction design. Method: Participants were 50 adolescents (10–18 years; 76% girls) from the general community. Participants first reported on their self‐regulatory and inhibitory control capacities. They were then assigned to a sad or neutral mood‐induction (using a film clip), followed by a multi‐item food buffet from which they could eat as much as they liked. Finally, participants reported on their experience of loss of control while eating. Results: Inhibitory control (but not self‐regulation in general) interacted with the mood‐induction to predict LOC. Adolescents with low inhibitory control experienced significantly more LOC, but only in the sad mood condition. Discussion The experience of negative affect appears to be an important trigger for LOC in adolescents with low inhibitory control. With a view to prevention and early intervention of LOC, inhibitory control training may be most effective in contexts where adolescents experience high levels of negative affect. [ABSTRACT FROM AUTHOR]

Objective: Hedonic hunger (i.e., the motivation to consume palatable foods in the absence of an energy deficit) has been associated with the onset and maintenance of loss of control (LOC) eating. However, it remains underexplored as a mechanism of action in outpatient cognitive behavioral therapy (CBT) for bulimia nervosa (BN). In the present study, we hypothesized that reductions in hedonic hunger would significantly mediate reductions in overall eating pathology and LOC episodes in two samples (N1 = 28, N2 = 23) of 20 and 16 sessions, respectively. Method: Participants completed the Eating Disorder Examination (EDE) and Power of Food Scale (PFS) at pre‐ and post‐treatment. Results: In both samples, EDE Global scores, LOC episodes, and PFS Total scores significantly improved over the course of treatment. In Sample 1, significant indirect effects of PFS Total scores on EDE Global scores and LOC episodes were observed. In Sample 2, the indirect effect of PFS Total scores was significant on EDE Global scores and nonsignificant on LOC episodes though it followed a similar pattern of change. Discussion: Results suggest that reductions in hedonic hunger are associated with better outcomes in CBT for BN. Replication and further research is needed to elucidate the treatment components driving these reductions. [ABSTRACT FROM AUTHOR]

Objective: Parental factors have been linked to weight‐related outcomes in children, though less is known regarding the role of parental self‐efficacy (PSE) for promoting healthy dietary behaviors (HDBs). This study examined associations between PSE for promoting HDBs and child reports of craving, overeating, and loss of control eating in daily life. The interactive effects of PSE and child eating style (emotional eating, external eating, and restraint) were also explored. Method: Thirty‐eight youth (ages 8–14; 55.3% female) with overweight/obesity and their parents completed the Dutch Eating Behavior Questionnaire for Children (DEBQ‐C) and Parental Self‐Efficacy for Healthy Dietary and Physical Activity Behaviors Scale, respectively. Youth completed ecological momentary assessment (EMA) to report craving, overeating, and loss of control eating. Results: Generalized estimating equations indicated no consistent main effects of PSE on EMA outcomes, but PSE interacted with DEBQ‐C child eating styles to predict each EMA outcome. Among children of parents with lower PSE, (a) higher emotional eating was associated with greater overeating and loss of control eating; (b) higher external eating was associated with greater craving; and (c) higher restraint was associated with greater loss of control eating and craving. Conversely, these associations were attenuated among children of parents with higher PSE. Discussion: Together findings suggest the interplay of child characteristics and PSE regarding children's eating behaviors warrants future investigation in the context of eating and weight disorders. In particular, further research is needed to examine the directionality of effects and mechanisms underlying these associations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate two questionnaires, an updated youth version of the questionnaire on eating and weight patterns (Questionnaire on Eating and Weight Patterns‐5 Children/Adolescent [QEWP‐C‐5]) and the Loss‐of‐Control (LOC) Eating Disorder Questionnaire (LOC‐ED‐Q), against the Eating Disorder Examination (EDE) interview to assess the presence of LOC‐eating among youth. Method: Two‐hundred and eighteen youths (12.8 ± 2.7 years) completed the QEWP‐C‐5, LOC‐ED‐Q, and EDE, depressive and anxiety questionnaires, and adiposity assessment. Sensitivity, specificity, positive‐predictive value, negative‐predictive value, and diagnostic accuracy were calculated; Cochran's Q and McNemar's tests were used to compare measures. Receiver operating characteristic area under the curve (AUC) analyses were performed. Mood and adiposity based on LOC‐eating presence and absence based on each measure were examined. Results: The QEWP‐C‐5 and LOC‐ED‐Q demonstrated poor sensitivity (33%; 30%) and high specificity (95%; 96%) compared with the EDE. The AUCs suggested neither the QEWP‐C‐5 (0.64) nor the LOC‐ED‐Q (0.62) demonstrated acceptable diagnostic accuracy. Comparing distributions of LOC‐eating presence between assessments, the QEWP‐C‐5 and EDE did not differ significantly (p =.10), while the LOC‐ED‐Q and EDE had significantly different distributions (p =.03). LOC‐eating presence was associated with higher depressive and anxiety symptoms across all measures (ps <.02). Greater adiposity (ps <.02) was associated with LOC‐eating presence on the EDE and LOC‐ED‐Q, and higher BMI z‐score (p =.02) on the LOC‐ED‐Q. Discussion Neither the QEWP‐C‐5 nor the LOC‐ED‐Q was sensitive for identifying LOC‐eating presence as determined by the EDE, although both were associated with greater mood symptoms. Research is needed to improve self‐report questionnaires to better screen for LOC‐eating presence among pediatric populations. [ABSTRACT FROM AUTHOR]

Objective: The network theory of psychopathology has been described as an "innovative framework" that may "transform" clinical psychological science. Several network studies have identified central eating disorder (ED) symptoms, yet studies have been comprised primarily of women. Using two large samples, we constructed ED symptom networks among men to identify central symptoms. Method: Participants were recruited from three universities and using Amazon's Mechanical Turk. Participants completed the Eating Disorder Examination‐Questionnaire (EDE‐Q), Male Body Attitudes Scale, and Drive for Muscularity Scale. ED symptom networks were jointly estimated among men with (n = 248) and without core ED symptoms (n = 902). Core ED symptoms were defined by (a) scoring above a suggested male EDE‐Q clinical cutoff and (b) reporting symptoms consistent with probable ED diagnoses. Expected influence and predictability (proportion of each node's variance explained by other nodes in the network) were calculated for each node. Results: Shape overvaluation, desiring weight loss, fear of losing control over eating, feeling guilty for missing weight training, and using supplements had the greatest expected influence and predictability. Network structures did not significantly differ between participants with versus without core ED symptoms. Discussion: The centricity of body dissatisfaction items in the networks supports some components of cognitive behavioral theories of EDs. However, the findings also suggest the importance of muscularity‐ and leanness‐oriented concerns, which have been traditionally neglected from leading ED theories that tend to focus on thinness pursuits as a main driver of body dissatisfaction. [ABSTRACT FROM AUTHOR]

Objective: Some individuals eat furtively and conceal evidence of eating, and this seems to occur beyond binge‐eating episodes. This type of secretive eating is common among youth and emerging evidences suggests that it is a relevant marker of eating disorder psychopathology among adults with significant eating and weight concerns. Method: We assessed secretive eating, loss‐of‐control (LOC) eating, and eating disorder psychopathology using investigator‐based interviews among treatment‐seeking adults experiencing LOC eating following bariatric surgery (N = 168). Participants also completed an established depression measure; height and weight were measured. Results: Overall, 37% of patients reported secretive eating: 54% of patients who met criteria for binge‐eating disorder except for the size criterion ("bariatric BED") and 25% of patients with subthreshold bariatric BED reported secretive eating. Many clinical variables were higher among patients with secretive eating compared to those without secretive eating; however, only eating disorder psychopathology severity and body dissatisfaction remained significantly higher among patients with secretive eating compared to those without when bariatric BED status was also included as a variable in the model. Discussion: Findings suggest that among post‐bariatric surgery patients with LOC eating, secretive eating signals more severe eating disorder psychopathology overall and specifically related to dissatisfaction with weight and shape. Bariatric BED status, however, has a stronger association than secretive eating with many clinical variables. Secretive eating should be assessed and considered when addressing weight and shape concerns among patients experiencing LOC eating after bariatric surgery. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to evaluate whether children with overweight or obesity participating in an evidence‐based treatment, family‐based behavioral treatment (FBT) for obesity, or a parent‐only variant of FBT (PBT), experience an increase of eating disorder (ED) symptoms during and following treatment. Method: Children (N = 150) participating in a randomized controlled trial of FBT or PBT completed measures of EDs attitudes and behaviors at baseline, following 6‐months of treatment, 6 months, and 18 months after treatment. Results: Linear‐mixed effects models suggest that ED attitudes did not significantly increase. Rather, significant decreases of shape, weight, and eating concerns were shown following treatment. Loss of control over eating significantly decreased over treatment and follow‐up. No participant endorsed purging at any time point. Discussion: Results confirm the hypothesis that ED symptoms do not increase after participating in FBT or a FBT‐based treatment. These findings should help assuage fears of parents that enrolling their child will exacerbate ED symptoms and aid children to access evidence‐based treatments that may help reduce significant physical and psychosocial complications of childhood obesity. [ABSTRACT FROM AUTHOR]

According to Self‐Determination Theory, when motivation to reach an objective is fully internal, it is said to be "autonomous"; when driven by external incentives, it is said to be "controlled". Previous research has indicated that autonomously motivated individuals show better response to treatments for eating disorders. Objective: In individuals undergoing different intensities of outpatient treatment for an eating disorder, we sought to assess associations between autonomous and controlled motivations and response to treatment on the one hand, and likelihood of dropping out of treatment, on the other. Method: Seven hundred seventy adults meeting DSM‐5 criteria for an eating disorder (216 with Anorexia Nervosa, 282 with Bulimia Nervosa, and 272 with Other Specified Feeding or Eating Disorder) were included in this study. Before an interval of outpatient treatment, individuals completed the Eating Disorder Examination Questionnaire and the Autonomous and Controlled Motivations for Treatment Questionnaire. Participants completed the Eating Disorder Examination Questionnaire again at one or two subsequent timepoints. Results: After controlling for diagnosis, treatment intensity, and number of previous treatments, analyses showed that higher autonomous motivation was associated with better response on eating‐disorder overall symptoms and lower likelihood of dropping out of treatment. In contrast, controlled motivation was not associated with response to treatment. Discussion Our results suggest that autonomous motivation has trans‐diagnostic influence upon response to various intensities of treatment for an eating disorder. In support of an autonomy supportive approach to treatment, findings link autonomous motivation with more favorable outcome. [ABSTRACT FROM AUTHOR]

Objective: Impaired decision‐making and inhibitory control may be involved in the pathophysiology of psychiatric disorders like bulimia nervosa (BN). Their improvement after neuromodulation may underpin clinical improvement. We assessed the effects of rTMS on these cognitive functions in a sample of women with BN. Methods: Thirty‐nine participants (22 in a sham group and 17 in an rTMS group) were assessed before and after 10 high frequency rTMS sessions over the left dorsolateral prefrontal cortex (DLPFC). Results: The between‐group analyses revealed no differences in the final neuropsychological performances. The within‐group analyses showed that inhibitory control improved in both the go/no‐go task (p = .03) and the BIS cognitive impulsivity subscale (p = .01) in the rTMS group only. Switches toward good choices on the Iowa gambling task significantly improved in the rTMS group only (p = .002), and understanding of the task contingencies increased between the two assessments, also in the rTMS group only (p = .03). Discussion: This preliminary evidence suggests that modulation of left DLPFC might improve two putative cognitive biomarkers of BN. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge‐eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. Method: This cross‐sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face‐to‐face assessment: Eating Disorders Examination for binge‐eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5‐point Likert scale. Self‐report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Results: OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self‐report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. Discussion: There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Pediatric loss of control (LOC) eating prospectively predicts the worsening of metabolic syndrome components. However, it is unknown if remission of LOC eating is associated with improvements in metabolic health. Therefore, we conducted a secondary analysis of a trial that enrolled adolescent girls with LOC eating, examining whether LOC remission (vs. persistence) at end‐of‐treatment was associated with changes in metabolic syndrome components at 6‐month follow‐up. Method: One hundred three adolescent girls (age 14.5 ± 1.7 years; BMI‐z 1.5 ± 0.3; 56.3% non‐Hispanic White, 24.3% non‐Hispanic Black) with elevated weight (75th–97th BMI %ile) and reported LOC eating were assessed for metabolic syndrome components at baseline and again six months following the interventions. The main effects of LOC status at end‐of‐treatment (persistence vs. remission) on metabolic syndrome components (waist circumference, lipids, glucose, and blood pressure) at 6‐month follow‐up were examined, adjusting for baseline age, depressive symptoms, LOC frequency, fat mass, and height, as well as race, change in height, change in fat mass, and the baseline value of each respective component. Results: Youth with LOC remission at end‐of‐treatment had lower glucose (83.9 ± 6.4 vs. 86.5 ± 5.8 mg/dL; p = .02), higher high‐density lipoprotein cholesterol (50.3 ± 11.8 vs. 44.8 ± 11.9 mg/dL; p = .01), and lower triglycerides (84.4 ± 46.2 vs. 96.9 ± 53.7 mg/dL; p = .02) at 6‐month follow‐up when compared with youth with persistent LOC, despite no baseline differences in these components. No other component significantly differed by LOC eating status (ps > .05). Discussion: Reducing LOC eating in adolescent girls may have a beneficial impact on some components of the metabolic syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Contextual factors related to maladaptive eating behavior in youth with overweight/obesity are poorly understood. This pilot study sought to elucidate immediate internal and external cues related to perceptions of overeating and loss of control (LOC) over eating in a heterogeneous sample of children and adolescents with overweight/obesity assessed in their natural environments. Method: Community‐based youth [N = 40; 55% female (n = 22)], aged 8–14 y (M age = 11.2 ± 1.9 y), with overweight/obesity (M z‐BMI = 2.07 ± 0.49) reported on all eating episodes and their physiological, environmental, affective, and interpersonal antecedents and correlates via ecological momentary assessment over a 2‐week period. Generalized estimating equations were used to assess the relationship between contextual variables and degree of overeating and LOC. Results: Eating occasions involving greater food hedonics (i.e., perceived palatability of food being consumed) were associated with greater LOC severity (within‐subjects effect: B = 0.01, p = .015), although youth with lower overall levels of food hedonics reported higher LOC severity ratings on average (between‐subjects effect: B = –0.04, p = .005). Youth reporting higher overall cravings reported higher average ratings of LOC severity (between‐subjects effect: B = 0.20, p = .001). Finally, youth reporting greater overall influence of others on eating behavior evidenced greater average levels of overeating severity (between‐subjects effect: B = 0.17, p < .001). Discussion: Eating‐related factors appear to be most strongly associated with LOC severity, while environmental factors were most associated with overeating severity. Interventions targeting maladaptive eating in youth with overweight/obesity may benefit from helping youth incorporate palatable foods and satisfy cravings in a planned and controlled manner, and enhancing awareness of social‐contextual effects on eating. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Childhood loss of control (LOC) eating and attention‐deficit/hyperactivity disorder (ADHD) are highly comorbid conditions and present with disordered eating behaviors, such as overeating. This study sought to delineate shared and specific abnormalities in physiological, cognitive‐motivational, and behavioral components of food‐specific impulsivity in children with LOC eating and ADHD. Specifically, children's reactivity and habituation to food and eating in the absence of hunger were examined. Methods: Within this community‐based study, four groups of 8–13‐year‐old children with LOC eating (n = 24), ADHD (n = 32), comorbid LOC eating/ADHD (n = 9), and matched controls (n = 34) received a standard laboratory test meal to establish satiety and were then exposed to their favorite snack food in a cue exposure/reactivity trial, while salivation and desire to eat were repeatedly assessed. Subsequently, they were offered a variety of snack foods ad libitum. Results: Children with LOC eating, ADHD, and LOC/ADHD did not differ from controls in salivary reactivity and habituation to food cues. Children with LOC eating and ADHD showed greater cue reactivity of the desire to eat than controls, but groups did not differ in its longer‐term increments. At free access, only children with LOC/ADHD consumed significantly more energy than controls. Longer‐term increments of desire to eat predicted greater energy intake beyond LOC/ADHD group status. Discussion: Desire to eat among children with comorbid LOC eating and ADHD was associated with overeating in the absence of hunger, which may contribute to excess weight gain. Delineation of the specific features of childhood LOC eating versus ADHD warrants further study. [ABSTRACT FROM AUTHOR]

Objective There are a subset of individuals with eating disorders (EDs) who do not overevaluate body shape/weight (i.e., nonfat phobic ED; NFP-ED). According to the transdiagnostic cognitive-behavioral conceptualization of EDs, a need for control, in general, is hypothesized as the core psychopathology of NFP-EDs, with shape- and weight-related motivations for ED behavior merely superimposed in FP-ED presentations. This study tested the need for control as motivation for restriction in NFP-ED, using items aimed at assessing control from the Eating Disorder Examination (EDE) Restraint scale. Method Females ages 13-27 years consecutively admitted to residential treatment completed the EDE, Eating Disorder Inventory-3 Drive for Thinness subscale (EDI-DFT), and other self-report measures of psychopathology. We included patients with DSM-5 EDs, but excluded patients with avoidant/restrictive food intake disorder. Twenty participants had NFP-ED (≤14 on EDI-DFT) and 124 had fatphobic ED (FP-ED; >14 on EDI-DFT). Results NFP-ED scored significantly lower than FP-ED on EDE Restraint scale shape/weight [χ2(1) = 10.73-35.62, p's < .01] and on control items [χ2(1) = 10.72-20.62, p's < .01], in addition to scoring lower on measures of general psychopathology and impairment. Discussion Findings suggest those with NFP-ED report lower psychopathology overall and the new EDE Restraint scale control items do not capture additional motivation for restriction beyond that captured in the original Restraint scale shape/weight items. Future research should examine whether this latter finding is due to a minimizing response style in NFP-ED, an incomplete capture of desire for control by the EDE assessment method, or indeed reflects that need for control does not motivate restriction in NFP-EDs. [ABSTRACT FROM AUTHOR]

Objective: Binge-eating disorder (BED) in adults is associated with alterations in executive functions (EF) and obesity. Much less is known about these relationships in adolescents, including whether poor EF are associated with eating disorder psychopathology and/or elevated body mass index. This study examined EF in response to neutral stimuli in youth with BED. Method: Adolescents with BED and obesity (n = 22), individually matched adolescents with obesity (n = 22), and normal weight (n = 22) completed neuropsychological tests targeting inhibition (Color-Word Interference Test), sustained attention (D2 Concentration Endurance Test), cognitive flexibility (Comprehensive Trail Making Test), and decision-making (Iowa Gambling Task). Results: Adolescents with BED and obesity displayed significantly poorer inhibitory control compared to normal-weight adolescents. This effect persisted after controlling for the level of secondary education. However, initial differences between adolescents with obesity and normalweight controls regarding inhibitory control and sustained attention vanished after controlling for education. The three groups did not differ regarding cognitive flexibility and decision-making. Moreover, adolescents with BED and obesity did not perform worse than adolescents with obesity on any of the neuropsychological tests. Discussion: Overall, our results indicate that adolescent BED is associated with only a few alterations in general EF, specifically inhibitory control, and underline BED and educational level as confounding factors in neuropsychological research on obesity. To further delineate EF profiles of adolescents with BED, future research should focus on EF in response to disorder-related stimuli and experimental settings with high ecological validity. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study examined the prevalence of and changes in loss of control over eating (LOC) among pregnant women with overweight/obesity, along with associations between LOC and depressive symptoms and stress. Method Community women ( N = 200; body mass index ≥ 25; 12-20 weeks gestation) reported LOC before and during early pregnancy using the Eating Disorder Examination, which was adapted for administration in pregnancy. Women self-reported depressive symptoms and stress during early pregnancy. Results Twenty-eight percent ( n = 56) of women reported LOC before or during early pregnancy: 14.5% ( n = 29) reported LOC incidence during early pregnancy, 9.5% ( n = 19) reported LOC persistence from prepregnancy to early pregnancy, and 4.0% ( n = 8) reported LOC prepregnancy only. Women with LOC reported more depressive symptoms and stress than did those without. Women with LOC persistence reported clinically significant depressive symptoms and elevated stress. Levels of depressive symptoms and stress differed between women with LOC persistence and those without LOC ( ps < 0.05). Discussion LOC during pregnancy was prevalent and associated with distress, particularly when present before and during pregnancy. Among women with LOC, few reported remission, but one-half reported onset during early pregnancy. Longitudinal studies are needed among mothers with overweight/obesity to identify patterns of LOC throughout pregnancy and how LOC affects perinatal outcomes. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:582-586) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Eating disorder diagnostic criteria were revised from the fourth to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and −5, respectively). This study examines the impact of these revisions on rates of eating disorder diagnoses in treatment-seeking youth. Method Participants were 651 youth, ages 7-18 years, presenting to an outpatient eating disorders program who met criteria for a DSM-IV eating disorder diagnosis on intake. Patients completed well-validated semi-structured interviews to assess eating disorder psychopathology and psychiatric comorbidity. Results Participants were predominantly female ( n = 588; 90.3%) with an average age of 15.28 years (SD = 2.21), mean percent of median Body Mass Index (mBMI) of 101.91 (SD = 31.73), and average duration of illness of 16.74 months (SD = 17.63). Cases of DSM-IV Eating Disorder Not Otherwise Specified (EDNOS), now most consistent with DSM-5 Other Specified Feeding or Eating Disorder, decreased from 47.6% to 39.0%, Anorexia Nervosa increased from 29.6% to 33.5%, and Bulimia Nervosa increased from 22.7% to 24.7%. Discussion Consistent with previous studies, and in keeping with the aims of the DSM-5 for eating disorders, the revised diagnostic criteria reduced cases of DSM-IV EDNOS and increased cases of specified eating disorders. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:578-581) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Bariatric surgery results in significant long-term weight loss, albeit with considerable variability. This study examines the prognostic significance of eating pathology as determined by a structured interview, the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV). Method Participants ( N = 183) in this substudy of the Longitudinal Assessment of Bariatric Surgery (LABS) Research Consortium were assessed using the EDE-BSV, independent of clinical care, presurgery and annually postsurgery. We examined eating pathology and experiences at several frequency thresholds (present, ≥ monthly, ≥ weekly) over 3 years, and utilized mixed models to test their associations with percentage weight loss from baseline at years 1, 2, and 3. Results The prevalence of several forms of eating pathology declined pre- to 1-year postsurgery, including ≥weekly objective bulimic episodes (11.6-1.3%), loss of control (LOC) eating (18.3-6.2%) and picking/nibbling (36.0-20.2%) ( P for all <0.01), and regular evening hyperphagia (16.5-5.0%, P = 0.01), but not cravings ( P = 0.93). Mean EDE global score, and hunger and enjoyment scores, also declined ( P for all <0.01). These metrics remained lower than baseline through year-3 ( P for all <0.01). Presurgery eating variables were not related to weight loss ( P for all ≥0.05). However, postsurgery higher EDE global score and greater hunger were independently associated with less weight loss postsurgery ( P for both ≤0.01), while cravings were associated with greater weight loss ( P = 0.03). Discussion Pathological eating behaviors and experiences are common presurgery and improve markedly following surgery. Postsurgery pathological eating-related experiences and attitudes and hunger may contribute to suboptimal weight loss. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1058-1067) [ABSTRACT FROM AUTHOR]

The article discusses the relationship between resource depletion model of self-control and binge eating. It notes that binge eating is characterized by overeating and a sense of loss of control that leads to adverse health conditions like excess weight gain and development of full-syndrome eating disorders. It stresses the need to better characterize momentary factors involved in binge eating and recommends further research to test depletion model for those engaged in binge eating.

ABSTRACT Objective The purpose of this study was to examine the cross-sectional association between weight misperception among young adults with overweight/obesity and disordered eating behaviors. Method In a subsample of young adults with overweight or obesity participating in Wave III (2001-2002) of The National Longitudinal Study of Adolescent to Adult Health ( n = 5,184), we examined the cross-sectional association between weight under-perception (i.e., perceiving oneself to be at a healthy body weight or underweight) and disordered eating (fasting/meal skipping for weight control, purging/pills for weight control, overeating/loss of control eating, and use of performance-enhancing products/substances). Results About 20% of young adult females under-perceived their weight compared to 48% of males. Individuals who misperceived their weight as healthy were significantly less likely to report fasting/meal skipping (Females: OR: 0.25, 95% CI: 0.14-0.43; Males: OR: 0.31, 95% CI: 0.20-0.48) and vomiting or taking diet pills/laxatives/diuretics (Females: OR: 0.10, 95% CI: 0.04-0.25; Males: OR: 0.10, 95% CI: 0.04-0.25) for weight control. Among females, those who misperceived their weight status as healthy were also less likely to report overeating or loss of control eating (OR: 0.41, 95% CI: 0.24-0.71). Greater use of performance-enhancing products/substances was seen among males who under-perceived their weight as healthy (OR: 2.06, 95% CI: 1.57-2.72) and among both females (OR: 2.29, 95% CI: 1.40-20.0) and males (OR: 2.27, 95% CI: 1.13-4.55) who perceived themselves to be underweight. Discussion Weight under-perception among young adults with overweight/obesity may convey some benefit related to disordered eating behaviors, but could be a risk factor for the use of performance-enhancing products/substances. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord ; 49:937-946) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study assessed loss of control (LOC) eating and eating disorders (EDs) in adolescents undergoing bariatric surgery for severe obesity. Method Preoperative baseline data from the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) multisite observational study ( n = 242; median BMI = 51 kg/m2; mean age= 17; 76% female adolescents; 72% Caucasian) included anthropometric and self-report questionnaires, including the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R), the Night Eating Questionnaire (NEQ), the Beck Depression Inventory (BDI-II), and the Impact of Weight on Quality of Life-Kids (IWQOL-Kids) Results LOC eating (27%) was common and ED diagnoses included binge-eating disorder (7%), night eating syndrome (5%), and bulimia nervosa (1%). Compared to those without LOC eating, those with LOC eating reported greater depressive symptomatology and greater impairment in weight-related quality of life. Discussion Before undergoing bariatric surgery, adolescents with severe obesity present with problematic disordered eating behaviors and meet diagnostic criteria for EDs. LOC eating, in particular, was associated with several negative psychosocial factors. Findings highlight targets for assessment and intervention in adolescents before bariatric surgery. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:947-952) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Although many individuals with purging disorder (PD) report loss of control (LOC) eating, it is unclear whether they differ from those who do not, or from other eating disorders involving purging and/or LOC. Method We compared PD with LOC (PD-LOC), PD without LOC (PD-noLOC), bulimia nervosa (BN), and anorexia nervosa-binge/purge subtype (AN-B/P) on measures of eating-related and general psychopathology in treatment-seeking adolescents. Results PD-LOC comprised ∼30% of PD diagnoses. PD-LOC and PD-noLOC did not differ from one another, or from BN and AN-B/P, on most measures of psychopathology, with some exceptions. PD-noLOC was similar to AN-B/P ( p = 0.99) and significantly different from BN on eating concerns ( p < 0.001), while PD-LOC was similar to BN, AN-B/P, and PD-noLOC on this measure ( ps ≥ 0.06). PD-LOC reported higher self-esteem than BN, AN-B/P, and PD-noLOC ( ps < 0.001). Discussion PD was largely similar to other eating disorders characterized by purging, regardless of whether LOC eating was present. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:801-804) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Research in individuals with bulimia nervosa has highlighted the clinical significance of weight suppression (WS), defined as the difference between one's highest and current weight. More recently, studies have suggested that WS also may play a role in symptom maintenance and weight gain during treatment in anorexia nervosa (AN) and that the influence of WS on AN outcomes may depend on an individual's body mass index (BMI). However, no study has investigated whether WS or the interaction between WS and BMI is associated with the longer-term course of eating pathology following treatment discharge in patients with AN. Method The current study examined a sample of females with AN ( N = 180) who completed interviews and self-report questionnaires at discharge from intensive treatment and at 3, 6, and 12-months after discharge. Latent growth curve models tested whether WS, BMI, or the WS by BMI interaction significantly predicted the trajectory of eating disorder symptoms (i.e., Eating Disorder Examination global score, BMI, frequency of loss of control eating, frequency of purging) over the year following discharge. Results WS at discharge predicted change in BMI, and the interaction between WS and BMI predicted growth in eating disorder severity and purging frequency over time. Neither WS nor its interaction with BMI predicted growth in loss of control eating frequency. Discussion Results provide further support for the clinical significance of WS in AN symptom maintenance, but suggest that the influence of WS likely depends on an individual's BMI as well as the outcome being measured. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:753-763) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Of the two primary features of binge eating, loss of control (LOC) eating is well validated while the role of eating episode size is less clear. Given the ICD-11 proposal to eliminate episode size from the binge-eating definition, the present study examined the incremental validity of the size criterion, controlling for LOC. Method Interview and questionnaire data come from four studies of 243 women with bulimia nervosa ( n = 141) or purging disorder ( n = 102). Hierarchical linear regression tested if the largest reported episode size, coded in kilocalories, explained additional variance in eating disorder features, psychopathology, personality traits, and impairment, holding constant LOC eating frequency, age, and body mass index (BMI). Analyses also tested if episode size moderated the association between LOC eating and these variables. Results Holding LOC constant, episode size explained significant variance in disinhibition, trait anxiety, and eating disorder-related impairment. Episode size moderated the association of LOC eating with purging frequency and depressive symptoms, such that in the presence of larger eating episodes, LOC eating was more closely associated with these features. Neither episode size nor its interaction with LOC explained additional variance in BMI, hunger, restraint, shape concerns, state anxiety, negative urgency, or global functioning. Discussion Taken together, results support the incremental validity of the size criterion, in addition to and in combination with LOC eating, for defining binge-eating episodes in purging syndromes. Future research should examine the predictive validity of episode size in both purging and nonpurging eating disorders (e.g., binge eating disorder) to inform nosological schemes. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:651-662) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Interpersonal psychotherapy (IPT) is aimed at improving negative affect that is purported to contribute to the development and maintenance of loss-of-control (LOC) eating. Although youth who report LOC over eating tend to consume more snack-foods than those without LOC, it is unknown if IPT impacts objective energy intake. Methods To test if IPT improves mood and eating in the laboratory, we examined a sample of 88 girls with LOC eating who were randomized to either IPT ( n = 46) or a standard-of-care health education (HE) group program. At baseline, and 6-month (follow-up 1) and 1-year (follow-up 2) following the initiation of the groups, girls consumed lunch from a multi-item meal with an instruction designed to model a LOC episode. Girls also reported mood state immediately before each meal. Results Girls in IPT experienced no significant changes in pre-meal state depressive affect, while girls in HE experienced a non-significant improvement by follow-up 1 and then returned to baseline by follow-up 2 ( p < .04). We found no significant group difference for changes in total intake relative to girls' daily energy needs ( p's ≥ .25). However, IPT reduced, while HE increased, the percentage of daily energy needs consumed from snack-foods by follow-up 2 ( p = .04). Within-groups, HE increased their snack food intake from follow-up 1 to follow-up 2 ( p = .01). Conclusions In adolescent girls with LOC, IPT did not change total intake at the test meal and was associated with reduced snack-food intake. Data are required to determine if IPT effectively prevents excess weight gain in the longer-term. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:490-498) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Loss of control (LOC) eating is a salient indicator of eating disorder psychopathology in adolescents and is associated with marked distress. While research has focused on the relevance of episode size, clinical significance of LOC eating frequency has rarely been explored. Therefore, this study aimed at identifying LOC eating prevalence with respect to its recurrence and associated variables in a community-based sample. Method Participants were 1,643 adolescents, aged 12-20 years (62.4% female). Based on EDE-Q self-report, participants were categorized as those reporting recurrent ( N = 156; 9.5%), nonrecurrent ( N = 226; 13.8%), and no LOC eating ( N = 1261; 76.7%). Results Adolescents with recurrent LOC eating reported clinically relevant and significantly greater eating disorder psychopathology, functional impairment, and distress because of LOC eating, and a significantly higher body mass index (BMI, kg/m2) than adolescents with nonrecurrent and those without LOC eating. Discussion These results underline that LOC eating is a common eating behavior among adolescents in the community associated with clinical characteristics of eating disorders, and could therefore be a risk factor for developing full- or partial-syndrome eating disorders. Further research on the classification of eating disorders in adolescents with LOC eating and severity indicators is warranted. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:413-420). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The use of coercion in the treatment for anorexia nervosa (AN) is controversial and the limited studies to date have focused on involuntary treatment. However, coercive pressure for treatment that does not include legal measures is common in voluntarily admitted patients with AN. Empirical data examining the effect of non-legal forms of coerced care on hospital outcomes are needed. Method Participants ( N = 202) with AN, Avoidant/Restrictive Food Intake Disorder (ARFID), or subthreshold AN admitted to a hospital-based behavioral specialty program completed questionnaires assessing illness severity and perceived coercion around the admissions process. Hospital course variables included inpatient length of stay, successful transition to a step-down partial hospitalization program, and achievement of target weight prior to program discharge. Results Higher perceived coercion at admission was associated with increased drive for thinness and body dissatisfaction, but not with admission BMI. Perceived coercion was not related to inpatient length of stay, rate of weight gain, or achievement of target weight although it was predictive of premature drop-out prior to transition to an integrated partial hospitalization program. Discussion These results, from an adequately powered sample, demonstrate that perceived coercion at admission to a hospital-based behavioral treatment program was not associated with rate of inpatient weight gain or achieving weight restoration, suggesting that coercive pressure to enter treatment does not necessarily undermine formation of a therapeutic alliance or clinical progress. Future studies should examine perceived coercion and long-term outcomes, patient views on coercive pressures, and the effect of different forms of leveraged treatment. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:407-412). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The purpose of this review is to provide an overview of possible medical complications of binge-eating disorder (BED). Method Literature on BED, both in obese and nonobese patients, was reviewed. Results A growing literature suggests that BED independently may increase the likelihood of developing components of the metabolic syndrome, and that LOC eating in children may contribute to weight gain and metabolic disturbances. Limited evidence suggests that other organ systems may be affected by BED as well. Discussion Additional prospective studies are needed. Although the results of the available studies are not definitive and provide somewhat mixed results, there does appear to be a clear suggestion of an increased risk for the development of components of the metabolic syndrome in adults and children. [ABSTRACT FROM AUTHOR]

Objective: The relative importance of loss of control and overeating in the relationship between binge eating and eating-related and general psychopathology has been debated in the literature. This study assessed the prevalence and correlates of overeating with and without loss of control within a diverse, population-based sample of adolescents. Method: A highly diverse (81.1% non- White) sample of adolescents (n 5 2,793) from EAT-2010 (Eating and Activity in Teens) completed self-report questionnaires assessing eating-related psychopathology, substance use, nonsuicidal self-injury, depressive symptoms, and self-esteem. Results: Overeating without loss of control was reported by 6.9% of girls and 5.0% of boys, while 9.6% of girls and 6.3% of boys reported overeating with loss of control (binge eating). Overall, overeating (with or without loss of control) was positively associated with unhealthy or extreme weight control behaviors, dieting, nonsuicidal self-injury, lower body satisfaction, and self-esteem, and higher depressive symptoms relative to no overeating. Among girls, binge eating was associated with unhealthy or extreme weight control behaviors, lower self-esteem, and higher depressive symptoms relative to overeating without loss of control, while in boys, binge eating was associated with greater cigarette usage, lower body satisfaction, and greater depressive symptoms than overeating without loss of control (although cigarette usage was comparable in boys reporting binge eating and no overeating). Discussion: Any overeating, with or without loss of control, was associated with multiple adverse correlates among adolescents. Loss of control was uniquely associated with multiple health indicators, further highlighting its importance as a marker of severity of overeating. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To examine differences in parent feeding behaviors and general parenting of overweight children with and without loss of control (LOC) eating. Method One-hundred-and-eighteen overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI- z: 2.06 ± 0.39) and their parents (42.42 ± 6.20 years; 91% female; 70% Caucasian; BMI: 31.74 ± 6.96 kg/m2) were seen at a baseline assessment visit for a behavioral intervention that targeted overeating. The Eating Disorder Examination, adapted for children (ChEDE) was administered to assess for LOC eating. Parents completed the Parental Feeding Styles Questionnaire (PFSQ) and the Child Feeding Questionnaire (CFQ) to assess parent feeding styles and behaviors. Children also completed a self-report measure of general parenting (Child Report of Parent Behavior Inventory, CRPBI-30). Results Forty-three children (36.40%) reported at least one LOC eating episode in the month prior to assessment. Parents who reported greater restriction and higher levels of pressure to eat were more likely to have children that reported LOC eating ( ps < 0.05). Parents who utilized more instrumental feeding and prompting/encouragement to eat techniques were less likely to have children that reported LOC eating ( ps < 0.05). Child-reported parenting behaviors were unrelated to child LOC eating ( ps > 0.05). Discussion Parent feeding styles and behaviors appear to be differentially and uniquely related to LOC eating in treatment-seeking overweight and obese children. Future research is needed to determine if implementing interventions that target parent feeding behaviors may reduce LOC eating, prevent full-syndrome eating disorders, and reduce weight gain in youth. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1047-1055) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Deficits in executive function (EF)-including inhibitory control, cognitive flexibility, decision-making, and working memory-may be risk or maintenance factors for binge eating disorder (BED). However, there is mixed evidence regarding EF deficits in individuals with BED. Significant methodological weaknesses (e.g., use of a single EF measure, omission of relevant covariates) in the current literature represent one reason for lack of consensus. Method This study compared EF in a sample of overweight women with ( n = 31) and without ( n = 43) full or subthreshold BED, with the aim of conducting a multifaceted investigation of the neurocognitive profile of BED. A neuropsychological battery of EF was administered to all participants. Results After controlling for IQ and age, individuals with binge eating displayed significantly poorer performance on tasks of problem-solving and inhibitory control, and displayed higher prioritization of immediate versus delayed rewards, but the two groups did not appear to differ on set-shifting, working memory, and risk taking. Differences in inhibitory control were no longer statistically significant when depressive symptomology was added as a covariate and correction for multiple comparisons was applied. Exploratory analyses indicated that full and sub-threshold BED groups did not differ in EF. Discussion Results partially support the hypothesis of relative EF deficits in individuals with BED, suggesting that binge eating may be maintained by cognitive factors distinct from those of obesity. Future research should aim to replicate with a larger sample, control for a wider range of psychiatric comorbidities, and examine whether EF deficits predict treatment outcome. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:677-683) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The objective was to examine the trajectory of five types of negative affect (global negative affect, fear, guilt, hostility, sadness) prior to and following three types of eating episodes (overeating in the absence of loss of control [OE-only], loss of control eating in the absence of overeating [LOC-only], and binge eating) among obese adults using ecological momentary assessment (EMA). Method Fifty obese adults (84% female) completed a two-week EMA protocol during which they were asked to record all eating episodes and rate each episode on continua of overeating and loss of control. Momentary measures of global negative affect, fear, guilt, hostility, and sadness were assessed using an abbreviated version of the Positive and Negative Affect Schedule (PANAS). Trajectories for each of the five types of negative affect were modeled prior to and following episodes of OE-only, LOC-only, and binge eating. Results Consistent with previous findings, global negative affect and Guilt increased prior to and decreased following binge eating episodes (all ps < .05). Guilt also decreased following OE-only episodes ( p < .05). Discussion These results are consistent with the affect regulation model of binge eating and suggest that binge eating may function to regulate global negative affect, and more specifically, guilt among obese adults. These data suggest that the relationship between negative affect and binge eating may not be unique to individuals with clinical eating disorders and indicate that targeting negative affect may be an effective strategy for the treatment of binge eating in the context of obesity. © 2015 Wiley Periodicals, Inc (Int J Eat Disord 2015; 48:641-653) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Limited data suggest that the children of U.S. service members may be at increased risk for disordered-eating. To date, no study has directly compared adolescent military-dependents to their civilian peers along measures of eating pathology and associated correlates. We, therefore, compared overweight and obese adolescent female military-dependents to their civilian counterparts along measures of eating-related pathology and psychosocial functioning. Method Adolescent females with a BMI between the 85th and 97th percentiles and who reported loss-of-control eating completed interview and questionnaire assessments of eating-related and general psychopathology. Results Twenty-three military-dependents and 105 civilians participated. Controlling for age, race, and BMI-z, military-dependents reported significantly more binge episodes per month ( p < 0.01), as well as greater eating-concern, shape-concern, and weight-concern ( p's < 0.01) than civilians. Military-dependents also reported more severe depression ( p < 0.05). Discussion Adolescent female military-dependents may be particularly vulnerable to disordered-eating compared with civilian peers. This potential vulnerability should be considered when assessing military-dependents. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:790-794) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Negative urgency (NU; tendency to act impulsively when experiencing negative emotions) is a risk factor for binge eating, although few studies have examined interviewer-assessed objective binge episodes (OBEs). Moreover, research has not investigated how NU relates to the core components of OBEs: loss of control (LOC) eating and objective overeating (OO). Understanding the relationship between NU and these core components will enhance etiologic models of eating disorder development. Thus, the current study examined the associations between NU, OBEs, and the components of OBEs by comparing levels of NU in women with OBEs, LOC eating only, and OO only to women with no pathological eating. Method Participants were 612 women who endorsed lifetime OBEs (5.4%), LOC eating outside of OBEs (5.7%), OO only (2.8%), or none of these eating episodes (85.9%). Results Women with OBEs, LOC only, and OO only had significantly higher levels of NU than women without these episodes, suggesting that NU is associated with both the LOC and OO components of OBEs. Discussion NU relates to the spectrum of pathology present in women with OBEs. Future research should examine the mechanisms underlying these associations, including impaired behavioral/psychological control and/or increased reward sensitivity in response to negative affect. © 2015 Wiley Periodicals, Inc.© 2015 Wiley Periodicals, Inc (Int J Eat Disord 2015; 48:527-531). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Motivational Interviewing (MI) is a collaborative therapy that focuses on strengthening a person's internal motivation to change. Research suggests that MI may be helpful for treating binge eating; however, findings are limited and little is known about how MI for binge eating compares to active therapy controls. The present study aimed to build on current research by comparing MI as a prelude to self-help treatment for binge eating with psychoeducation as a prelude to self-help treatment for binge eating. Method Participants with full or subthreshold DSM-IV Binge Eating Disorder or nonpurging Bulimia Nervosa were randomly assigned to receive either 60 minutes of MI followed by a self-help manual ( n = 24) or 60 minutes of psychoeducation followed by a self-help manual ( n = 21). Questionnaires were completed pre- and postsession, and at 1 and 4 months postsession. Results MI significantly increased readiness to change and confidence in ability to control binge eating, whereas psychoeducation did not. No group differences were found when changes in eating disorder attitudes and behaviors were examined. Discussion MI offers benefits for increasing motivation and self-efficacy. However, it may not be a uniquely effective treatment approach for reducing binge eating. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:328-332) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The current study examined behavioral, emotional, and situational factors involved in purging among women with anorexia nervosa (AN). Method Women with AN ( n=118) completed a two-week ecological momentary assessment protocol involving daily reports of eating disorder behaviors, mood, and stressful events. Generalized estimating equations examined the likelihood and context of purging following eating episodes involving both overeating and loss of control (binge eating; BE); loss of control only (LOC); overeating only (OE); and neither loss of control nor overeating (non-pathological eating; NE). Results Relative to NE, purging was more likely to occur following BE, LOC, and OE (Wald chi-square = 18.05; p < .001). BE was more strongly associated with subsequent purging than LOC but not OE; the latter two did not differ from one another. Negative affect predicted purging following NE (Wald chi-square = 7.71; p = .005). Discussion Binge eating involving large amounts of food was the strongest predictor of purging in AN, which challenges the notion that loss of control is the most salient aspect of experiencing distress in bulimia nervosa and BE disorder. Parallel to findings from the BE literature, negative affect strongly predicted purging following NE. Further research should clarify the function and triggers of purging in AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:341-344) [ABSTRACT FROM AUTHOR]