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Elevated glucose variability may be one mechanism that increases risk for significant psychological and physiological health conditions among individuals with binge-spectrum eating disorders (B-EDs), given the impact of eating disorder (ED) behaviors on blood glucose levels. This study aimed to characterize glucose variability among individuals with B-EDs compared with age-matched, sex-matched, and body mass index-matched controls, and investigate the association between frequency of ED behaviors and glucose variability.Participants were 52 individuals with B-EDs and 22 controls who wore continuous glucose monitors to measure blood glucose levels and completed ecological momentary assessment surveys to measure ED behaviors for 1 week. Independent samples t-tests compared individuals with B-EDs and controls and multiple linear regression models examined the association between ED behaviors and glucose variability.Individuals with B-EDs demonstrated numerically higher glucose variability than controls (t = 1.42, p = .08, d = 0.43), although this difference was not statistically significant. When controlling for covariates, frequency of ED behaviors was significantly, positively associated with glucose variability (t = 3.17, p = .003) with medium effect size (fGlucose variability among individuals with B-EDs appears to be positively associated with engagement in ED behaviors, particularly binge eating. Glucose variability may be an important mechanism by which adverse health outcomes occur at elevated rates in B-EDs and warrants future study.This study suggests that some individuals with binge ED and bulimia nervosa may experience elevated glucose variability, a physiological symptom that is linked to a number of adverse health consequences. The degree of elevation in glucose variability is positive associated with frequency of eating disorder behaviors, especially binge eating.

OBJECTIVE. Fear of weight gain (FOWG) is increasingly implicated in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa (BN), binge eating disorder (BED)) through the pathway of increased dietary restriction. However, particularly in binge-spectrum EDs, research is nascent and based on retrospective self-report. To improve treatment outcomes, it is critical to better understand the momentary relations between FOWG and dietary restriction. METHOD. Sixty-seven adults with binge spectrum EDs completed a 7–14-day ecological momentary assessment protocol that included items regarding FOWG, ED behaviors, and types of dietary restriction (e.g., attempted restraint vs actual restriction) several times per day. Multilevel models were used to evaluate reciprocal associations between FOWG and dietary restriction, and to evaluate the indirect of effects of dietary restriction on the relation between FOWG and binge eating. RESULTS. While main effects were not statistically significant, ED presentation significantly moderated the association between increases in FOWG at time1 and both attempted and actual avoidance of enjoyable foods at time2 such that those with BN-spectrum EDs were more likely to avoid enjoyable foods following increased FOWG compared to those with BED-spectrum EDs. Engagement in restriction at time1 was not associated with decreased FOWG at time2. DISCUSSION. Prospective associations between FOWG and restriction suggest that individuals with BN may be more likely to restrict their eating following increased FOWG. These findings suggest FOWG may be an important target for future treatments.

OBJECTIVE Binge planning (BP; i.e., preparatory thoughts and actions to facilitate future binge-eating episodes) is hypothesized to distract individuals from negative affect and increase the salience of food. Thus, individuals who engage in BP may report greater positive eating expectancies (i.e., beliefs about the outcomes of eating) and hedonic hunger (i.e., desire to eat for pleasure), as BP may increase the likelihood of obtaining these expected outcomes; but empirical tests of this possibility are needed. METHOD Prior to starting treatment, adults (N = 86) with bulimia-spectrum eating disorders were assessed for engagement in BP and self-reported on eating expectancies and hedonic hunger. RESULTS Twenty-nine participants (33.7%) reported planning at least one binge-eating episode in the previous 28 days. Compared to individuals who did not report BP, individuals who reported BP had greater expectancies that eating would alleviate negative affect (t = -2.54, p = .013) and boredom (U = 503.50, p = .006). Groups did not differ on levels of hedonic hunger (t = -1.68, p = .096). DISCUSSION These findings suggest that BP status is linked to expectancies that eating will reduce negative affect. However, more data are needed to determine the temporal relationships among eating expectancies, hedonic hunger and BP. TRIAL REGISTRATION NUMBERS NCT02716831, NCT03673540.

Objective Although existing research supports the efficacy of mindfulness- and acceptance-based treatments (MABTs) for eating disorders (EDs), few studies have directly compared outcomes from MABTs to standard CBT. Method Participants (N = 44), treatment-seeking adults with bulimia-spectrum EDs, were screened for eligibility, consented, and randomized to receive 20 sessions of outpatient, individual CBT or MABT treatment. Treatment outcomes (binge eating and compensatory behavior episodes, global ED severity, depressive symptoms, quality of life, emotional awareness/clarity, distress tolerance, values-based decision-making, and emotion modulation) were measured at pre-treatment, post-treatment, and 6-month follow up. Data on feasibility and acceptability are also presented. Results Treatment and assessment retention rates were comparable between MABT and CBT (p range = .51-.73) and between-group differences on acceptability measures were very small (d range = 0.03-0.19). Both conditions produced notable and generally comparable changes in most treatment outcomes at post-treatment (within group d range = 0.06-1.77). Discussion The MABT and CBT conditions demonstrated comparable degrees of feasibility, acceptability, and symptom improvement, suggesting that MABTs warrant further evaluation as ED treatments.

OBJECTIVE: Existing screening tools are inadequate in differentiating binge eating from normative overeating in treatment-seeking individuals with overweight or obesity, as these individuals tend to overendorse loss-of-control (LOC; the hallmark characteristic of binge eating) on self-report measures. In order for treatment centers to efficiently and accurately identify individuals who would benefit from specialized treatment, it is critical to develop effective brief screening tools. This study examined the sensitivity and specificity of a self-report screener designed to be used by an outpatient treatment center on a large scale. METHODS: Participants were treatment-seeking individuals (N = 364) with overweight or obesity who were administered the screener and who completed a subsequent interview assessing for LOC and binge eating. RESULTS: Discriminant analyses revealed that the screener achieved 77.6% sensitivity and 77.0% specificity in predicting clinician-assessed LOC and 75.2% sensitivity and 74.1% specificity in predicting “full-threshold” binge eating (i.e., ≥12 objectively large binge-eating episodes within the past 3 months). Post hoc analyses indicated that male participants were more likely to be misclassified with the screener. CONCLUSIONS: The self-report screener demonstrated satisfactory predictive ability, which is notable given the challenges of discriminating between LOC and normative overeating. However, room for improvement remains. In particular, the inclusion of additional screener items that more fully capture the binge-eating experience in males is warranted.

Objective Although current treatments are effective for some patients with eating disorders, a large number of patients remain partially or fully symptomatic post-treatment. This may be related to poor utilization of treatment skills outside of the therapy office. Smartphone applications that can detect and intervene during moments of need could facilitate such skill use between sessions. Method Individuals (N = 16) participated in a small pilot open trial where they received 21 sessions of in-person Integrative Cognitive-Affective Therapy (ICAT) therapy an app (iCAT+) that delivers ecological momentary interventions (EMI) in response to user-entered data. Data were collected on the feasibility and acceptability of this treatment approach and on preliminary indicators of treatment outcomes. Results Participants found iCAT+ as a treatment augmentation acceptable and indicated it had clinical utility as an adjunct to in-person therapy, although analyses indicated poor compliance with data entry needed to trigger EMI delivery. This suggests that long-term use of EMI requiring ongoing data entry is infeasible. Conclusions We describe lessons learned from our initial pilot trial and future directions for the development of impactful EMI systems that can be used to augment in-person therapies.

Outcomes from cognitive behavioral therapy (CBT) for bulimia nervosa (BN) and binge-eating disorder (BED) are suboptimal. One potential explanation is that CBT fails to adequately target inhibitory control (i.e., the ability to withhold an automatic response), which is a key maintenance factor for binge eating. Computerized inhibitory control training (ICT) is a promising method for improving inhibitory control but is relatively untested in BN/BED. The present study will evaluate a computer-based ICT as an adjunct to CBT for BN/BED. Participants with BN (n = 30) or BED (n = 30) will be randomized to 12 weeks of either CBT + ICT or CBT + a sham training. Trainings will be completed daily for 4 weeks and weekly for 8 weeks. Primary aims include the following: (a) confirm target engagement (evaluate whether ICT improves inhibitory control), (b) test target validation (evaluate whether improvements in inhibitory control are associated with improvements in binge eating), and (c) evaluate the incremental efficacy of ICT on binge eating. Secondary aims include the following: (a) evaluate ICT feasibility and acceptability and (b) assess the moderating effects of approach tendencies on highly palatable food, dietary restraint, and diagnosis. Data will be used to shape a fully powered clinical trial designed to assess efficacy and dose-response effects of ICT for BN/BED.

Objective Affect regulation, eating expectancies, and attention toward food-related cues are interrelated constructs that have been implicated in the maintenance of binge eating. While these processes show considerable temporal variability, the momentary associations between these domains have not been elucidated. This study examined a model that posited momentary fluctuations in affect, eating expectancies, and attention bias (AB) would interact to predict subsequent binge eating. Method Forty women who endorsed recurrent binge eating completed a 10-day ecological momentary assessment protocol with ambulatory measures of AB (i.e., dot-probe task with palatable food and neutral cues) and self-report assessments of positive and negative affect, eating expectancies (i.e., the belief that eating would improve one's mood), and binge-eating symptoms. Results Generalized linear mixed models indicated higher momentary AB toward palatable food was associated with increased risk of subsequent binge eating, and a two-way interaction showed that moments of higher eating expectancies and negative affect were associated with increased likelihood of subsequent binge eating. Also, a three-way interaction emerged, in that the association between eating expectancies and subsequent binge eating was strongest at lower levels of positive affect and higher AB. Discussion Together, findings partially supported hypotheses and demonstrate meaningful within-person fluctuations in AB that precede binge eating. Further, results demonstrate that the momentary influence of eating expectancies on binge eating depends on both affective state and attentional processes.

Objective Despite calls for routine use of progress and outcome monitoring in private and intensive treatment centres for eating disorders (EDs), existing measures have limited relevance to these supervised treatment settings. This study sought to develop and validate the progress monitoring tool for eating disorders, a multidimensional measure for progress monitoring in the context of intensive ED treatment. Method Thirty-seven items were generated by a team of content experts, clinicians, and administrative staff from the target treatment setting. Adolescent and adult females (N = 531) seeking residential ED treatment completed the items at admission as part of the clinic's routine assessment battery; 83% were retained for repeat assessment at discharge. Exploratory factor analysis was conducted for preliminary measure development. Results Results yielded a five-factor, 26-item structure explaining 50% of total variance. Final construct domains included weight and shape concern, ED behaviours and urges, emotion avoidance, adaptive coping, and relational connection. The measure demonstrated adequate internal consistency, sensitivity to change during treatment, and convergence with validated assessment measures. Conclusions Preliminary data support the progress monitoring tool for eating disorders as a novel and valid multidimensional measure of treatment-relevant constructs. This measure may have utility in measuring treatment progress for patients receiving intensive treatment for EDs.

In recent years, ecological momentary assessment (EMA) has been used to repeatedly assess eating disorder (ED) symptoms in naturalistic settings, which has allowed for increased understanding of temporal processes that potentiate ED behaviors. However, there remain notable limitations of self-report EMA, and with the rapid proliferation of technology there are ever-increasing possibilities to improve ambulatory assessment methods to further the understanding and treatment of EDs. Therefore, the purpose of this review was to (a) systematically review the studies in EDs that have utilized ambulatory assessment methods other than self-report, and (b) provide directions for future research and clinical applications.A systematic literature search of electronic databases was conducted, and data regarding study characteristics and methodological quality were extracted.The search identified 17 studies that used ambulatory assessment methods to gather objective data, and focused primarily on autonomic functioning, physical activity, and cognitive processes in ED and control groups.Together the literature demonstrates the promise of using a range of ecologically valid ambulatory assessment approaches in EDs, though there remains limited research that has utilized methods other than self-report (e.g., wearable sensors), particularly in recent years. Going forward, there are several technology-enhanced momentary assessment methods that have potential to improve the understanding and treatment of EDs.En años recientes, la evaluación momentánea ecológica (en inglés, ecological momentary assessment (EMA)) ha sido utilizada repetidamente para evaluar los síntomas de trastorno de la conducta alimentaria (TCA) en ambientes naturalistas, lo que ha permitido un incremento en el entendimiento de los procesos temporales que potencían las conductas de trastornos alimentarios. Sin embargo, todavía hay notables limitaciones del autoreporte EMA y con la rápida proliferación de la tecnología hay todavía mayores posibilidades de mejorar los métodos de evaluación ambulatoria para avanzar el entendimiento y el tratamiento de los TCAs. Objetivo: Por lo tanto, el propósito de esta revisión fue 1) revisar sistemáticamente los estudios en TCAs que han utilizado métodos de evaluación ambulatoria además del auto-reporte, y 2) proveer las pautas para futuras investigaciones y aplicaciones clínicas. Método: Se realizó una búsqueda sistemática de la literatura en las bases de datos electrónicas, y los datos con las características del estudio y calidad metodológica fueron extraídos. Resultados: La búsqueda identificó 17 estudios que utilizaron métodos de evaluación ambulatoria para recopilar datos objetivos y se centraron principalmente en el funcionamiento autónomo, la actividad física y los procesos cognitivos en los grupos de control y de TCA. Discusión: En conjunto, la literatura demuestra la promesa de utilizar una variedad de abordajes de evaluación ambulatoria ecológicamente válidos en los TCA, aunque sigue habiendo investigaciones limitadas que han utilizado métodos distintos al autoinforme (por ejemplo, sensores portátiles), particularmente en los últimos años. En el futuro, hay varios métodos de evaluación momentánea mejorados con tecnología que tienen potencial para mejorar la comprensión y el tratamiento de los TCA.

Objective Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. Methods We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. Results Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. Discussion Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.

Objective: The most widely researched treatment for bulimia nervosa (BN) and binge-eating disorder (BED) is cognitive behavioral therapy (CBT), a present-focused, active, skill-oriented treatment. However, despite the success of CBT, many patients fail to achieve sufficient rates of skill utilization (i.e., the frequency with which a patient practices or uses therapeutic skills) or adequate skill acquisition (i.e., the ability to successfully perform a skill learned in treatment) by the end of treatment and outcomes suffer as a result. One method for improving skill acquisition and utilization in patients with BN or BED could be the augmentation of in-person treatment with just-in-time adaptive interventions (JITAIs), which use smartphone technology to deliver real-time interventions during app-identified moments of need. The current article discusses how novel JITAI systems that utilize machine learning or other predictive algorithms could be used to detect momentary risk for eating disordered behavior and provide tailored interventions to enhance outcomes. We will consider technologies that may help reduce patient burden and suggest avenues for future research on developing acceptable and effective JITAIs that can be used as an adjunct to CBT protocols.

OBJECTIVE Individuals with overweight/obesity and loss-of-control eating (LOC) may experience poorer outcomes from behavioural weight loss due to reactivity to internal (e.g., affective and physical) states that impact treatment adherence (e.g., dietary lapses). This study examined (a) whether the presence of LOC increased risk for dietary lapses and (b) the moderating role of LOC on the relation between internal states and dietary lapses. METHOD Individuals (n = 189) with overweight and obesity completed ecological momentary assessment early in behavioural weight loss. RESULTS LOC was positively associated with dietary lapse. LOC did not moderate the relation between momentary changes in internal states and dietary lapses. However, the effect of average levels of internal states on lapses was attenuated for those with LOC. DISCUSSION Results suggest that those with LOC are at higher risk of dietary lapse, whereas elevated average levels of internal states may contribute to early inadherence for those without LOC.

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.

mHealth tools may be a feasible modality for delivering evidence-based treatments and principles (EBPs), and may enhance treatment for eating disorders (EDs). However, research on the efficacy of mHealth tools for EDs and the extent to which they include EBPs is lacking. The current study sought to (i) review existing apps for EDs, (ii) determine the extent to which available treatment apps utilize EBPs, and (iii) assess the degree to which existing smartphone apps utilize recent advances in smartphone technology. Overall, existing ED intervention apps contained minimal EBPs and failed to incorporate smartphone capabilities. For smartphone apps to be a feasible and effective ED treatment modality, it may be useful for creators to begin taking utilizing the abilities that set smartphones apart from in-person treatment while incorporating EBPs. Before mHealth tools are incorporated into treatments for EDs, it is necessary that the feasibility, acceptability, and efficacy be evaluated.

Objective: The current study sought to examine executive function (EF) in overweight individuals with and without loss-of-control (LOC) eating. Method: Eighty overweight and obese individuals entering a behavioural weight loss trial with (n=18) and without (n=62) LOC eating were administered a clinical interview and neuropsychological battery designed to assess self-regulatory control, planning, delayed discounting and working memory. Results: After controlling for age, IQ and depression, individuals with LOC eating performed worse on tasks of planning and self-regulatory control and did not differ in performance on other tasks. Discussion: Results indicate that overweight individuals with LOC eating display relative deficits in EF compared with overweight individuals without LOC eating. Planning and self-regulatory control deficits in particular may contribute to dysregulated eating patterns, increasing susceptibility to LOC episodes. Future research should examine how EF deficits relate to treatment outcome. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

ABT. Results: Both groups produced significant weight loss, and when administered by experts, weight loss was significantly higher in ABT than SBT at post-treatment (13.17% vs. 7.54%) and 6-month follow-up (10.98% vs. 4.83%). Moreover, 64% of those receiving ABT from experts (vs. 46% for SBT) maintained at least a 10% weight loss by follow-up. Moderation analyses revealed a powerful advantage, at followup, of ABT over SBT in those potentially more susceptible to eating cues. For participants with greater baseline depression symptomology, weight loss at follow-up was 11.18% in ABT versus 4.63% in SBT; other comparisons were 10.51% versus 6.00% (emotional eating), 8.29% versus 6.35% (disinhibition), and 9.70% versus 4.46% (responsivity to food cues). Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action. Conclusions: Results offer strong support for the incorporation of acceptance-based skills into behavioral weight loss treatments, particularly among those with greater levels of depression, responsivity to the food environment, disinhibition, and emotional eating, and especially when interventions are provided by weight-control experts.

Weight suppression, which is the discrepancy between a patient’s highest weight and current weight, may be an important factor in the course and outcome of bulimia nervosa (BN). Individuals who are weight suppressed weigh less than they once did. Because patients with BN usually present for treatment at a normal weight, the fact that many were once overweight or obese is often overlooked (1). The average weight suppression for BN patients is high, with those in outpatient or residential treatment having average levels of 9.6 kg and 12.0 kg, respectively (2,3). Healthy college students, by comparison, have a mean weight suppression of 2.7 kg (4). The perpetual dieting and/or compensatory behaviors that are needed to maintain a suppressed weight could maintain binge eating and purging. This large reduction in weight also could make patients with BN more susceptible to weight gain (possibly due to reduced metabolic rate, increased overeating, or both), leading to even greater dietary restriction, which maintains the binge/purge cycle (2, 5). Two studies have found that weight suppression predicted weight gain in patients with BN (β = .21, p = .03, 4.7% of variability in weight gain (3); B = 0.100, SE = 0.04, p =.01, Exp (B) = 1.11, R2= 0.06 (6)). This weight gain could cause increased body image dissatisfaction and lead to higher rates of disordered eating in an effort to avoid future weight gain or to lose the undesired weight. Additionally, since many individuals with BN were previously overweight, they may have an even greater fear of weight gain because they have previously seen those fears realized. This fear of weight gain could also contribute to greater levels of dieting and compensatory behaviors. Research has shown that patients who are high in weight suppression, compared to their peers with lower weight suppression, have a higher frequency of objective binge eating ((β = .319, p< .05), a higher probability of maintaining a bulimic syndrome over 10 years (7), a higher risk of dropping out of treatment (B = −0.37, SE = 0.07, p =.01, Exp(B) = 0.69) (2), and a lower chance of abstaining from binge eating and purging by treatment completion (2, 6, 8). Weight suppression is calculated by two factors: current weight and highest weight. Research has examined whether either factor is predictive above and beyond weight suppression. To date, highest weight has not been predictive of BN symptoms or treatment outcome (2, 8). However, current weight is independently predictive of BN symptoms and outcome, with those who have lower weights demonstrating higher rates of BN pathology (9) and higher risk of treatment dropout (10). Despite research suggesting that both current relative weight and weight suppression are predictive of bulimic pathology, no study has investigated the potential interaction between current weight and weight suppression. Individuals who have high weight suppression and low current weight might have the greatest motivation to stay thin, and may engage most in unhealthy eating behaviors. Individuals who are high in weight suppression and have a relatively high weight or those who are thin but not weight suppressed may have less severe symptoms, possibly because these individuals are not as afraid of weight gain or experience less biological pressures toward weight gain. In addition, the combination of high weight suppression and low weight could engage defensive biological mechanisms that could induce more binge eating and metabolic efficiency and therefore predispose these individuals towards weight gain. To test this hypothesis, the current study examined weight suppression, body mass index (BMI), and the interaction between weight suppression and BMI as predictors of bulimic symptoms upon admission to treatment. It was hypothesized that weight suppression and BMI would be independent predictors of bulimic symptoms, and that the interaction would be significant, with patients who have high weight suppression and low BMI demonstrating the most bulimic symptoms.