Search

Objective: Cognitive‐behavioural therapy (CBT) delivered face‐to‐face and via the internet reduces bulimia nervosa (BN) symptoms. However, our empirical understanding of factors affecting patient outcomes is limited. Method: Using data from a randomised, controlled trial comparing internet‐based (CBT4BN, n = 78) with face‐to‐face (CBTF2F, n = 71) group CBT (97% female, M = 28 years), we examined general treatment (across conditions) and modality‐specific predictors of end‐treatment and 1‐year outcomes (abstinence, binge‐eating frequency, purging frequency). Results: Improved eating disorder‐related quality of life (EDQOL) during treatment and follow‐up predicted abstinence at end‐treatment and 1‐year assessments. Improved EDQOL, disordered eating cognitions, and anxiety symptoms predicted less frequent binge eating and purging. Previous CBT and being employed predicted more frequent binge eating and purging at both assessments. Higher self‐transcendence and self‐directedness predicted less frequent binge eating. More severe binge eating and purging at baseline and end‐treatment predicted more frequent binge eating and purging at subsequent assessments. Improved EDQOL was more strongly associated with positive outcome in CBT4BN; improved depressive symptoms and health‐related QOL predicted positive outcome in CBT4BN but not CBTF2F. Discussion: Symptom improvement and certain character traits predicted positive outcome, whereas more severe presentation and prior CBT experience predicted poorer outcome. Consideration of intreatment symptom improvement may facilitate care recommendations, particularly for internet‐based modalities. Highlights: This study examined predictors of end‐treatment and 1‐year outcome from a randomised controlled trial comparing internet‐based (CBT4BN) with face‐to‐face (CBTF2F) cognitive‐behavioural therapy (CBT) for bulimia nervosa.Improvement in eating disorder‐related quality of life, disordered eating cognitions, and anxiety symptoms were the most consistent predictors of positive response to treatment.Relations between associated symptom improvement, namely general‐ and eating disorder‐related quality of life and depressive symptoms, and positive outcome were most evident in CBT4BN.Being employed, greater binge‐eating and purging severity, and a previous course of CBT most consistently predicted poor outcome.The character traits self‐directedness and self‐transcendence predicted less frequent binge eating at both outcome assessments. [ABSTRACT FROM AUTHOR]

Objective: To characterize helpful parent feeding strategies using reflections on childhood eating experiences of adults with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID). Method: We explored a unique text‐based dataset gathered from a population of N = 19,239 self‐identified adult "picky eaters." The sample included adults with symptoms of ARFID as evidenced by marked interference in psychosocial functioning, weight loss/sustained low weight, and/or nutritional deficiency (likely ARFID), and non‐ARFID participants. We leveraged state‐of‐the‐art natural language processing (NLP) methods to classify feeding strategies that were perceived as helpful or not helpful. The best classifiers that distinguished helpful approaches were further analyzed using qualitative coding according to a grounded theory approach. Results: NLP reliably and accurately classified the perceived helpfulness of caregivers' feeding strategies (82%) and provided information about features of helpful parent strategies using recollections of adults with varying degrees of food avoidance. Strategies perceived as forceful were regarded as not helpful. Positive and encouraging strategies were perceived as helpful in improving attitudes toward food and minimizing social discomfort around eating. Although food variety improved, adults still struggled with a degree of avoidance/restriction. Discussion: Adults perceived that positive parent feeding strategies were helpful even though they continued to experience some degree of food avoidance. Creating a positive emotional context surrounding food and eating with others may help to eliminate psychosocial impairment and increase food approach in those with severe food avoidance. Nevertheless, additional tools to optimize parent strategies and improve individuals' capacity to incorporate avoided foods and cope with challenging eating situations are needed. [ABSTRACT FROM AUTHOR]

Objective: Individuals with a gastrointestinal (GI) disorder often alter their diet to manage GI symptoms, adding complexity to understanding the diverse motivations contributing to food avoidance/restriction. When a GI disorder is present, the DSM‐5 states that Avoidant/Restrictive Food Intake Disorder (ARFID) can be diagnosed only when eating disturbance exceeds that expected. There is limited guidance to make this determination. This study attempts to address this gap by characterizing the presentation of ARFID in adults with and without a self‐reported GI disorder. Method: Participants were 2,610 adults ages 18–44 who self‐identified as "picky eaters." Participants reported on motivations for food avoidance, affective experiences towards food, and perceived impairment. Responses were compared across four groups: GI issues and likely ARFID (L‐ARFID/GI), L‐ARFID‐only, GI‐only, and No‐ARFID/No‐GI. Results: Groups with a GI disorder (L‐ARFID/GI, GI‐only) reported more fear of aversive consequences of eating than those without a GI disorder, while groups with L‐ARFID (L‐ARFID, L‐ARFID/GI) evidenced significantly greater sensory aversion to food and indifference to food or eating, negative emotional reactions to food and overall disgust sensitivity, and eating related impairment. Discussion: Consideration of the interplay of a GI disorder with ARFID can add precision to case conceptualization. Food avoidance may be attempts to manage fears of aversive consequences that are augmented by a history of GI symptoms, while sensory aversions and negative emotional reactions towards foods may be more elevated in ARFID. These findings emphasize the need to consider an ARFID diagnosis in patients with GI disorders to optimize care. [ABSTRACT FROM AUTHOR]

Background: Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction. Method: This exploratory, cross‐sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self‐reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering. Results: A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust. Conclusions: Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment. [ABSTRACT FROM AUTHOR]

Objective: This study examines the course of eating pathology and its associations with change in weight and health‐related quality of life following bariatric surgery. Method: Participants (N = 184) completed the eating disorder examination‐bariatric surgery version (EDE‐BSV) and the medical outcomes study 36‐Item short form health survey (SF‐36) prior to and annually following Roux‐en‐Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for up to 7 years. Results: The prevalence of ≥ weekly loss of control (LOC) eating, picking/nibbling, and cravings declined post‐RYGB and remained lower through 7 years (LOC: 5.4% at Year‐7 vs. 16.2% pre‐RYGB, p = .03; picking/nibbling: 7.0% vs. 32.4%, p < .001; and cravings: 19.4% vs. 33.6%, p = .02). The prevalence of picking/nibbling was significantly lower 7 years following LAGB vs. pre‐LAGB (29.4% vs 45.8%, p = .049), while cravings (p = .13) and LOC eating (p = .95) were not. EDE‐BSV global score and ratings of hunger and enjoyment of eating were lower 7 years following both RYGB and LAGB versus pre‐surgery (p's for all <.05). LOC eating following RYGB was associated with less long‐term weight loss from surgery (p < .01) and greater weight regain from weight nadir (p < .001). Higher post‐surgery EDE‐BSV global score was associated with less weight loss/greater regain (both p < .001) and worsening/less improvement from surgery in the SF‐36 mental component summary scores (p < .01). Discussion: Initial improvements in eating pathology following RYGB and LAGB were sustained across 7 years of follow‐up. Individuals with eating pathology post‐RYGB, reflected by LOC eating and/or higher EDE‐BSV global score, may be at risk for suboptimal long‐term outcomes. [ABSTRACT FROM AUTHOR]

Objective: This virtual issue of the International Journal of Eating Disorders (IJED) is presented in conjunction with The Obesity Society (TOS) to coincide with Obesity Week held in Nashville, TN November 11‐15, 2018. Methods: We present selected articles published in IJED in 2017‐2018 that are relevant to scholars who focus on obesity, eating disorders (EDs), or both areas of inquiry. Discussion: We hope to promote discussion and collaboration between the obesity and ED fields, and stimulate additional work, including submissions to IJED. [ABSTRACT FROM AUTHOR]

Eating disorders and related symptoms occur during midlife; however, little is known about their aetiology. It has been hypothesised that perimenopause represents a window of vulnerability for the development or exacerbation of eating disorder symptomatology because, like puberty, perimenopause is a period of reproductive hormone change. We compared symptoms of bulimia nervosa (bulimic symptomatology) assessed via mean scores on a self-report questionnaire in premenopausal and perimenopausal women. We also examined the association between hormone concentrations (reproductive/appetite) and bulimic symptomatology. No mean differences in bulimic symptomatology were observed between premenopause and perimenopause. However, there was a significant positive association between leptin and binge eating. Although no significant associations between reproductive hormones and bulimic symptomatology were observed, additional research is needed to provide definitive information. It is essential to learn more about the aetiology of eating disorders and related symptomatology across the lifespan in order to develop age-relevant treatment and prevention programs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. Method Participants ( N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. Results Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). Discussion Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577) [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]

Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicators of severity and chronicity in eating disorders. Patients with AN ( N = 355) completed interviews and questionnaires at treatment admission and discharge; height and weight were assessed to calculate body mass index (BMI). Structural equation mixture modeling was used to test whether associations among potential indicators of SE-AN (illness duration, treatment history, BMI, binge eating, purging, quality-of-life) formed distinct subgroups, a single group with one or more dimensions, or a combination of subgroups and dimensions. A three-factor (dimensional), two-profile (categorical) mixture model provided the best fit to the data. Factor 1 included eating disorder behaviors; Factor 2 comprised quality-of-life domains; Factor 3 was characterized by illness duration, number of hospitalizations, and admission BMI. Profiles differed on eating disorder behaviors and quality-of-life, but not on indicators of chronicity or BMI. Factor scores, but not profile membership, predicted outcome at discharge from treatment. Data suggest that patients with AN can be classified on the basis of eating disorder behaviors and quality-of-life, but there was no evidence for a chronic subgroup of AN. Rather, indices of chronicity varied dimensionally within each class. Given that current definitions of SE-AN rely on illness duration, these findings have implications for research and clinical practice. [ABSTRACT FROM AUTHOR]

The article discusses the lack of consistency of outcome measures in eating disorder treatment program in the U.S., focusing on an initiative proposed by the authors to encourage systematic collection of data regarding treatment outcomes across an array of settings. It discusses the data that should be collected including patient characteristics, clinical diagnosis, and core features of illness, along with the required and optional data to be gathered.

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]

Objective: To evaluate the potential utility of a structured dietary intervention to assist bariatric surgery patients with weight management.Methods: Participants who underwent Roux-en-Y gastric bypass surgery 1 year previously were randomly assigned to a structured dietary intervention incorporating portion-controlled foods (intervention, n = 20) or a comparison group (control, n = 20). Both groups received instruction in behavioral weight loss (one 60-min session) followed by four monthly coaching telephone calls. Assessments were conducted at baseline, 4 months (post-intervention), and 6 months.Results: Participants were 85% female and 80% White. Average age was 46.9 (11.1) years, and body mass index was 31.3 (5.4) kg/m(2) at enrollment. Percent weight change from enrollment was significantly greater for intervention compared with control participants at 4 months [-4.56% vs. -0.13%, t(30)  = -3.29, P = 0.003] and 6 months [-4.07% vs. -0.14%, t(31)  = -2.03, P = 0.05]. Change in average daily calorie intake was greater among intervention compared with control [-108 vs. 116, t(30)  = -2.01, P = 0.05] at 4 months only.Conclusions: A structured dietary intervention increased weight loss and reduced calorie intake when initiated 1 year following Roux-en-Y gastric bypass. This approach holds promise for optimizing postsurgery lifestyle change. [ABSTRACT FROM AUTHOR]

Objective: This study examined the effect of a behavioral weight loss intervention (BWLI) on young adults (age = 18-35 years).Methods: Participants (N = 470) enrolled in a 6-month BWLI that included weekly group sessions, a prescribed energy-restricted diet, and moderate to vigorous physical activity (MVPA). Assessments included weight, body composition, fitness, lipids, glucose, insulin, resting blood pressure and heart rate, physical activity, and dietary intake. Data are presented as median [25th, 75th percentiles].Results: Retention was 90% (N = 424; age: 30.9 [27.8, 33.7] years; BMI: 31.2 [28.4, 34.3] kg m(-2) ). Participants completed 87.5% [76.1%, 95.5%] of scheduled intervention contacts. Weight and body fat decreased while fitness increased (P < 0.0001). MVPA in bouts ≥10 min increased (P < 0.0001), though total MVPA did not change significantly. Sedentary time decreased (P = 0.03). Energy and percent fat intake decreased, while percent carbohydrate and protein intake increased (P < 0.0001). Systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, glucose, and insulin decreased (P < 0.0001).Conclusions: A 6-month BWLI produced favorable changes in dietary intake and physical activity and elicited favorable changes in weight and other health outcomes in young adults. MVPA performed in bouts of ≥10 min was associated with greater weight loss, but sedentary behavior was not. [ABSTRACT FROM AUTHOR]

Despite positive results overall, a substantial number of patients experience poor long-term outcomes following bariatric surgery. One reason for variability in weight loss may be difficulty in making and sustaining changes in dietary intake and physical activity; post-surgery binge eating has also been associated with poorer weight outcomes. In this paper, we review available evidence on adjunctive psychosocial interventions for bariatric surgery patients. Although the literature is limited, evidence suggests that bariatric surgery patients may benefit from a comprehensive approach targeting diet, activity and psychological factors. We think the optimal time to initiate adjunctive intervention is after surgery, but before significant weight regain has occurred. Adaptive interventions incorporating advances in technology may prove to be effective for promoting behavioural self-management and psychosocial adjustment following bariatric surgery. For some patients, pharmacotherapy and reoperation may also play a role in a personalized approach to post-surgery care. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. Method The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from six clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days before their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1,875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal p-values ( p < .05). Holm's-adjusted p-values were also reported. Results After adjusting for age, sex, education, and body mass index, BED status was found to be independently associated with four of the 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR] = 1.45 (95% confidence interval [CI]: 1.12-1.87)), high triglycerides (OR = 1.28 (95% CI: 1.002-1.63)), and urinary incontinence (OR = 1.30 (95% CI: 1.02-1.66)), all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR = 0.53 (95% CI: 0.29-0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with three comorbidities (impaired glucose levels (OR = 1.36 (95% CI: 1.04-1.79)), cardiovascular disease (OR = 0.50 (95% CI: 0.30-0.86)), and severe walking limitations (OR = 0.38 (95% CI: 0.19-0.77)). However, Holm's-adjusted p-values for all variables were greater than .05. Discussion The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:471-476) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study aimed to evaluate the preliminary effectiveness of Emotion Acceptance Behavior Therapy (EABT), an outpatient psychotherapeutic intervention for anorexia nervosa (AN) based on a disorder-specific model of symptom maintenance that emphasizes emotion avoidance. EABT combines standard behavioral interventions that are central to the clinical management of AN with evidence-supported strategies to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Method Twenty-four individuals aged ≥17 years with AN were treated using the EABT manual. EABT was delivered in 33-58 individual sessions provided over 38-53 weeks. Assessments were conducted before and after treatment, and at 3- and 6-month follow-ups. Results Thirteen patients (54.2%) completed EABT; 11 (45.8%) dropped out or were withdrawn. EABT was associated with significant improvements in weight, disordered eating symptoms, and emotion avoidance that were maintained over 6-month follow-up. The majority of EABT completers achieved a body mass index >18.5 ( n = 9/13) or had a normal Eating Disorder Examination Global score ( n = 10/13) at post-treatment. Discussion Preliminary data suggest that EABT may have utility for a subset of adults with AN. Future research will focus on improving outcomes in EABT nonresponders and identifying of mechanisms that drive treatment response. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:870-873) [ABSTRACT FROM AUTHOR]

Objective To examine changes in depressive symptoms and treatment in the first 3 years following bariatric surgery. Methods The longitudinal assessment of bariatric surgery-2 (LABS-2) is an observational cohort study of adults ( n = 2,458) who underwent a bariatric surgical procedure at 1 of 10 US hospitals between 2006 and 2009. This study includes 2,148 participants who completed the Beck depression inventory (BDI) at baseline and ≥ one follow-up visit in years 1-3. Results At baseline, 40.4% self-reported treatment for depression. At least mild depressive symptoms (BDI score ≥ 10) were reported by 28.3%; moderate (BDI score 19-29) and severe (BDI score ≥30) symptoms were uncommon (4.2 and 0.5%, respectively). Mild-to-severe depressive symptoms independently increased the odds (OR = 1.75; P = 0.03) of a major adverse event within 30 days of surgery. Compared with baseline, symptom severity was significantly lower at all follow-up time points (e.g., mild-to-severe symptomatology was 8.9%, 6 months; 8.4%, 1year; 12.2%, 2 years; 15.6%, 3 years; ps < 0.001), but increased between 1 and 3 years postoperatively ( P < 0.01). Change in depressive symptoms was significantly related to change in body mass index ( r = 0.42; P < 0001). Conclusion Bariatric surgery has a positive impact on depressive features. However, data suggest some deterioration in improvement after the first postoperative year. LABS-2, #NCT00465829, . [ABSTRACT FROM AUTHOR]

Objective To examine the stability of severe pediatric obesity relative to moderate obesity and associated changes in cardiometabolic risk from the beginning of 6th to the end of 8th grade. Methods Participants in HEALTHY, a multi-site, cluster randomized school-based study designed to mitigate risk for type 2 diabetes, completed standardized assessments of height, weight, glucose, insulin, lipids, and blood pressure at the beginning of 6th grade and the end of 8th grade. Youth were classified as moderately obese (100-119% of the 95th percentile of BMI for age and gender) or severely obese (≥120% of the 95th percentile of BMI for age and gender). Generalized linear mixed models (GLMM) that controlled for relevant covariables were used to examine the relation between baseline demographic and cardiometabolic risk factors and BMI status, as well as changes in relative weight category and risk factors during middle school. Results Severe obesity was more likely to endure over the course of middle school than was moderate obesity, and was associated with significantly higher levels of cardiometabolic risk. Conclusions Research with a specific focus on understanding, preventing, and treating severe obesity in children is warranted. [ABSTRACT FROM AUTHOR]

The article argues that research with includes measures of attentional set-shifting and reversal learning will promote understanding of the role of cognitive flexibility in the expression, course and treatment of eating disorders (ED). Topics covered include definition of cognitive flexibility and how attentional and set-shifting and reversal learning be discriminated and measured. Also mentioned are ED's phenotypic heterogeneity and cognitive flexibility in adolescents with eating disorders.

Objective: Given renewed interest in dimensional approaches in psychiatric nosology, we review evidence for the utility of including dimensions of eating disorder (ED) psychopathology, comorbid psychopathology, and neurobiology in the classification of EDs. Method: We searched on-line databases and reference lists of published papers for articles on dimensional methods in psychiatric classification, with an emphasis on EDs. Results: ED classification may be enhanced by including dimensional assessments. Specifically, some ED features appear to exist on a continuum with normality, and dimensional measures of ED severity are likely to have utility in clinical contexts. Furthermore, accumulating data support the validity of ED classification schemes that incorporate dimensions of comorbid psychopathology. Finally, neurobiological dimensions have gained increasing notice across the psychiatric literature and may be particularly salient to the classification of EDs. Discussion: An approach to ED classification that incorporates multiple dimensional measures may have the greatest utility for advancing ED treatment. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:396-403) [ABSTRACT FROM AUTHOR]

The article discusses the paper ``Binge Eating Disorder: The Next Generation of Research'' by Marian Tanofsky-Kraff and colleagues. It reports the inclusion of binge eating disorder (BED) as an official diagnosis in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and discusses various aspects including risk factors, assessment, and comorbidity and consequences of BED.

Objective: To evaluate the effect of negative emotion on self-reported eating disorder symptoms and objectively-measured eating behavior in patients with anorexia nervosa (AN). Method: Twenty-eight females with AN were randomized to a negative or neutral mood induction followed by a test meal. Participants completed assessments one week before the experimental session, before (pretest) and after (posttest) the mood induction, and after the test meal. Results: Participants in the negative emotion condition had an increase in negative affect from pretest to posttest that was accompanied by significantly greater increases in self-reported eating disorder symptoms than were exhibited by participants in the neutral emotion condition, who had no increase in negative affect. There was no effect of emotion condition on eating behavior. Discussion: Results suggest that negative emotions influence the expression of cognitive eating disorder symptoms in individuals with AN, which may have implications for the identification of treatment targets. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;45:876-882) [ABSTRACT FROM AUTHOR]

Objective: To gather information about picky eating and its correlates in adults and to determine whether picky eating is distinct from other eating disorder symptoms. Method: Nearly 6,895 adults completed a web-based survey of picky eating behaviors, eating disorder symptoms, and putative associated features. Latent class analysis was used to identify groups based on picky eating and eating disorder symptoms, and groups were compared on salient demographic and clinical characteristics. Results: The latent class analysis identified four distinct groups that differed in severity of clinical correlates and levels of impairment. Morbidity was highest in the comorbid picky eating/eating disorder group, followed by the eating disorder, picky eating, and low pathology groups, respectively. Discussion: Future research is needed to document the continuity of picky eating from childhood, establish the epidemiology of picky eating in adults, clarify thresholds of clinical significance, and elucidate clinical features that will inform nosology. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five patients with AN aged 17-43 years were offered a 24-session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2011 [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group. Method: Seventy-five patients with AN completed questionnaires to assess study variables. Rates of emotion avoidance were compared to published data, and regression models were used to test the hypothesis that emotion avoidance mediates the relation between depressive and anxiety symptoms and ED psychopathology in AN. Results: Patients with AN endorsed levels of emotion avoidance that were comparable to or higher than other psychiatric populations and exceeded community controls. As predicted, emotion avoidance significantly explained the relations of depressive and anxiety symptoms to ED psychopathology. Discussion: Findings confirm that emotion avoidance is present in patients with AN and provide initial support for the idea that anorexic symptoms function, in part, to help individuals avoid aversive emotional states. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [ABSTRACT FROM AUTHOR]

Objective: Using Wakefield's conceptualization of mental disorder as “harmful mental dysfunction” (Wakefield, Am Psychol, 47, 373–388, 1992), we examined the evidence for including obesity as a mental disorder in DSM-V. Method: We searched computer databases and examined reference lists from review articles published in the last 10 years to identify empirical papers relevant to the present review. Results: Obesity is a condition of heterogeneous etiology that is harmful for most individuals. However, there is scant evidence that obesity, in general, is caused by mental dysfunction. Although recent work examining the neurocircuitry of energy balance has suggested that mental dysfunction may be involved in the etiology of specific obesity phenotypes, findings are too preliminary to support classification of obesity as a mental disorder. Nevertheless, there is evidence that obesity is related to mental disorder and many of the medications used to treat psychiatric illness. Discussion: There is little evidence for including obesity as a mental disorder in DSM-V. However, results confirm the importance of monitoring adiposity routinely among patients with psychiatric illness. © 2009 American Psychiatric Association. (Int J Eat Disord 2009) [ABSTRACT FROM AUTHOR]

Objective: Inpatient hospitalization has been a mainstay of treatment for anorexia nervosa (AN), but decreasing lengths of inpatient stay have prompted the development of alternative care-continuum models. This study characterizes the 6-month outcomes of 71 patients with AN who completed an inpatient-treatment protocol (∼5 weeks), followed by a day-hospital program (DHP) (∼3 weeks). Method: Data were derived from chart reviews and questionnaire data were collected during routine clinical care. Results: On discharge from DHP, 35.2% of patients showed excellent outcomes, whereas 23.9% exhibited poor outcomes. At 6 months after DHP discharge, 47.9% of the patients were successful in maintaining outpatient treatment status. Patients with successful 6-month outcomes were admitted to inpatient at a higher weight, had fewer previous hospitalizations, were younger, were rated by inpatient staff as more committed to treatment, endorsed less AN psychopathology during inpatient admission, and showed greater weight gain during DHP. Number of previous hospitalizations and weight gain immediately after inpatient discharge predicted 89.2% of outcome classifications 6 months after DHP discharge. Conclusion: These findings highlight both the potential benefits of this care-continuum model for patients who previously have not been hospitalized and the pressing need to develop alternative treatment strategies for patients with more chronic AN. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008 [ABSTRACT FROM AUTHOR]

Objective: Women 25 to 45 years old are at risk for weight gain and future obesity. This trial was designed to evaluate the efficacy of two interventions relative to a control group in preventing weight gain among normal or overweight women and to identify demographic, behavioral, and psychosocial factors related to weight gain prevention.Research Methods and Procedures: Healthy women (N = 284), ages 25 to 44, with BMI < 30 were randomized to one of three intervention conditions: a clinic-based group, a correspondence course, or an information-only control. Intervention was provided over 2 years, with a follow-up at Year 3. BMI and factors related to eating and weight were assessed yearly.Results: Over the 3-year study period, 40% (n = 114) of the women remained at or below baseline body weight (+/-2 lbs), and 60% gained weight (>2 lbs). Intervention had no effect on weight over time. Independently of intervention, women who were older, not actively dieting to lose weight, and who reported less perceived hunger at baseline were more likely to be successful at weight maintenance. Weight maintenance also was associated with increasing dietary restraint (conscious thoughts and purposeful behaviors to control calorie intake) and decreasing dietary disinhibition (the tendency to lose control over eating) over time.Discussion: This study raises concern about the feasibility and efficacy of weight gain prevention interventions because most women were interested in weight loss, rather than weight gain prevention, and the interventions had no effect on weight stability. Novel approaches to the prevention of weight gain are needed. [ABSTRACT FROM AUTHOR]

Objective: Binge eating disorder (BED) may manifest itself differently in children than adults. Recently researchers have proposed provisional criteria for measuring BED in children. The purpose of this study was to develop a brief, simple, structured, interviewer-administered scale (C-BEDS) to measure BED in children according to the provisional criteria and to compare diagnostic results with SCID diagnoses. Method: A total of 55 children between the ages of 5 and 13 were interviewed with both the SCID and the C-BEDS. Results: There was a significant association between the two measures (p = .001). Both measures adequately identified children with binge eating behaviors. Conclusion: Both the provisional criteria and the C-BEDS may be developmentally appropriate for use with children, although the C-BEDS may be a better screening instrument as it quickly identified children with subsyndromal BED. If used by physicians and other health providers, this brief measure may assist with identifying early onset binge eating behaviors and avoiding the associated consequences, including adult BED, obesity, and other comorbidities. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [ABSTRACT FROM AUTHOR]

Objective We sought to examine rates of eating disorder symptoms among seriously overweight children seeking treatment using the Eating Disorder Examination for Children (ChEDE) and to provide initial data about their association with treatment outcome. Method Overweight children (N = 27) 8–13 years old were interviewed using the ChEDE before participating in a family-based behavioral treatment program. Height and weight were measured pretreatment, posttreatment, and approximately 8 months posttreatment. Results Fifteen percent of children reported subjective bulimic episodes (SBE). Weight loss did not differ for children with and without SBEs, but concerns about body shape were related to larger weight losses during treatment. Conclusion A considerable minority of treatment-seeking overweight children report an episodic sense of loss of control over eating. Loss of control is related to other disordered eating attitudes and behaviors, but does not appear to affect treatment outcome. Future studies are needed to replicate these initial findings. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective The current study describes the short-term outcome of 61 inpatients with anorexia nervosa (AN), utilizing a standardized protocol that could be completed by most patients within the typical length of stay (LOS) in an academic medical center in our geographic area. Method Patients were placed on disorder-specific and medication clinical pathways and completed questionnaires at admission and discharge. Diagnostic, historical, demographic, and treatment-related information was obtained. Results Treatment was sufficient to resolve acute medical problems, initiate refeeding, and interrupt compensatory behaviors, but continued intensive treatment will be critical to full recovery. Patients were discharged at an average of 85% of ideal body weight (IBW). Twenty patients were discharged against medical advice (AMA). Clinical and demographic variables poorly predicted AMA status. Discussion Attainable inpatient treatment goals in our care environment appear to be ≥80% IBW at discharge, resolution of acute medical problems, and interruption of compensatory behaviors. Future research should examine whether shorter LOS increases readmission rates or long-term costs. © 2005 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective The goals of this study were to assess eating disorder symptoms in depressed women with no history of eating disturbance and to evaluate the clinical significance of these symptoms relative to those reported by women with bulimia spectrum disorder. Method Participants were 63 women with major depressive disorder (MDD) (n = 19), bulimia spectrum disorder (n = 20), or no history of MDD or eating disorder (n = 24). Measures included diagnostic interviews and self-report questionnaires designed to assess diagnostic criteria for bulimia nervosa, subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction. Results There were no significant differences between depressed and bulimic women on shape concerns, appearance overvaluation, or body dissatisfaction. Depressed women endorsed significantly more subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction than did control subjects. Discussion Eating disorder symptoms may be associated with depression in women in the absence of comorbid eating disorder diagnoses. © 2005 by Wiley Periodocals, Inc. [ABSTRACT FROM AUTHOR]

Objective We examined differences in the onset pattern of comorbid disorders in eating-disordered women with and without a history of parasuicide to elucidate potential etiologic differences between the two groups. Methods Fifty-four women with a current or past eating disorder partcipated. Of these women, 27 had a history of suicide attempts and self-injury and 27 had no history of suicide attempts or self-injury. The age and pattern of onset for the eating disorder relative to comorbid major depression, anxiety disorder, and substance use disorder were compared between the groups. Results The onset of major depression and anxiety disorders occurred at a younger age in the parasuicidal group. In addition, the onset of major depression in the parasuicidal group occurred significantly more often before the onset of the eating disorder. Discussion The eating disorder may be secondary to a mood disturbance in women with parasuicidal histories. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 190–197, 2004. [ABSTRACT FROM AUTHOR]

Presents a study which evaluated the acceptability and feasibility of a family-based behavioral weight control for severely obese children. Method; Results; Discussion.

Provides information on a study which conducted control trials to test the efficacy of antidepressants in eating disorders. Use of selective serotonin reuptake inhibitors in clinical practice; Reported cases of underweight women with binge eating/purging-type eating disorders; Patient response to sertraline.

The article presents the revised and updated Questionnaire on Eating and Weight Patterns (QEWP) developed for use in the original field trials of the proposed criteria for binge eating disorder (BED). Topics discussed include the background for the development and use of the questionnaire and description of the modifications made to accommodate the DSM-5 criteria and findings from a multisite field trial that BED was common in those attending specialized obesity treatment programs.

In this study, we examined the effects of an exercise intervention in the treatment of obese women with binge eating disorder (BED). Women who received active treatment reported significantly greater increases in their weekly exercise frequency than did control subjects. At posttreatment, 87.4% of subjects who had received treatment were abstinent from binge eating. Compared to women who were not abstinent at posttreatment, abstinent women evidenced significant changes in exercise frequency and caloric expenditure. However, weight loss and improvements in depressive symptomatology were not related to exercise participation. These results suggest that exercise may be an important aspect of BED treatment and useful in promoting abstinence from binge eating. [ABSTRACT FROM AUTHOR]

Binge eating is a common problem among obese individuals, and a simple, accurate way to identify obese binge eaters is needed. This study measured the concordance of the Binge Eating Scale (BES) and the Eating Disorder Examination (EDE). Women seeking obesity treatment (N = 126) were identified as binge eaters or nonbinge eaters using the BES, and then interviewed by clinicians blind to BES score using the EDE, a semistructured interview considered to be ‘gold standard” for eating disorder diagnosis. The BES accurately identified nonbinge eaters; 39 of 42 (92.9%) BES-identified nonbinge eaters were confirmed by the EDE. However, the BES did not accurately identify binge eaters; only 43 of the 83 (51.8%) BES-identified binge eaters were confirmed by the EDE. Reasons for the discrepancy between the BES and the EDE in the identification of binge eaters were explored, and modifications to the BES that might improve its accuracy were considered. [ABSTRACT FROM AUTHOR]

It has been noted that women with insulin-dependent diabetes mellitus (100M) may be at increased risk to develop disordered eating because their medical regimen requires an intense focus on diet. Thus the goal of the present study was to determine the prevalence of eating disorders symptomatology in a registry-based sample of women with IDDM and to assess the relationship between eating disorders symptomatology and blood sugar control. One hundred eighty-eight women with IDDM completed the Bulimia Test (BULIT) and the Eating Disorders Inventory (EDI). BULIT and EDI scores of diabetic subjects were comparable to those of nondiabetic subjects in standardization samples. However, eating disorders symptomatology among IDDM women was significantly associated with poorer control of diabetes. This study suggests that diabetic women are not more likely than nondiabetic women to report eating disorders symptomatology, but converging evidence indicates that these symptoms arts associated with poorer control of diabetes. [ABSTRACT FROM AUTHOR]

Obese binge eaters may benefit from cognitive-behavioral treatment (CBT) approaches that target binge eating. In the present study, eight overweight women participated in a 16-week group CBT program. The Eating Disorder Examination (EDE), a clinical interview designed to assess the psychopathology specific to eating disorders, was administered pre- and post-treatment. Frequency of bulimic episodes during the 28 days prior to assessment was substantially reduced following treatment. Total days with bulimic episodes decreased from 13.4 to 1.2, with a mean reduction of 81%. As assessed by the EDE, dysfunctional concern for body shape and weight and disturbed attitudes about eating markedly diminished. Mood similarly improved. These finding confirm that obese bingers improve after a CBT program designed to ameliorate binge eating and indicate the utility of the EDE in assessing treatment outcome with these patients. [ABSTRACT FROM AUTHOR]

In the present study, the Eating Disorder Examination (EDE), a clinical interview designed to characterized the psychopathology specific to eating disorders, was administered to 17 obese women seeking treatment for binge eating problems. Subjects also completed questionnaires to assess binge severity, depression, and weight history. Obese binge eaters obtained EDE subscale scores that did not differ from those reported for normal weight bulimia nervosa patients on the Overeating, Shape Concern, Weight Concern, and Eating Concern Subscales of the EDE; however, bulimia nervosa patients had higher scores on the EDE Restraint Subscale. Questionnaire data indicated that obese binge eaters had considerable depressive symptomatology and that early onset obesity, frequent weight losses, and family histories of obesity were common. These findings suggest that obese binge eaters and bulimia nervosa patients have similar levels of eating disorders psychopathology, but that future research directly comparing overweight and normal weight patients is needed. [ABSTRACT FROM AUTHOR]

This study compared the prevalence of psychiatric disorders among obese binge eaters (n = 25) and obese non-binge eaters (n = 25) of similar age and weight. Subjects were interviewed by clinicians who were blind to the patients' binge status using the Diagnostic Interview Schedule. Sixty percent of bingers met criteria for one or more psychiatric disorders, compared with 28% of nonbingers, with differences most apparent in affective disorder; 32% of obese bingers reported a history of affective disorder versus only 8% of nonbingers. Obese binge eaters also reported significantly more psychiatric symptoms, especially symptoms of depression, anxiety, and sexual dysfunction. [ABSTRACT FROM AUTHOR]

Previous studies suggest that binge eating occurs frequently in adolescents with type I diabetes and seriously affects glycemic control. However, there have been no studies to date to examine the effect of binge eating in patients with type II diabetes. The present study assessed binge eating severity in 98 obese type II diabetic patients who were participating in a behavioral weight-control program. Patients completed the Binge Eating Scale, a self-report instrument developed to assess binge eating in obese patients, at pre- and posttreatment, and at I year follow-up. The average score on the BES at pretreatment was 18, with females scoring significantly higher than males. Twenty-one percent of the females and 9% of the males met criteria for a serious binge-eating problem. Pretreatment scores on the BES were not related to weight or to glycemic control; however, binge-eating severity was strongly associated with depressive symptomatology. Scores on the binge eating scale decreased significantly during the weight control program. Decreases in binge eating severity were associated with improvements in mood but not with weight loss or improvements in glycemic control. Thus, binge eating is a common problem in obese type II diabetic patients that is related to symptoms of depression. However, binge eating is not related to glycemic control in these patients. [ABSTRACT FROM AUTHOR]

To examine the association of nocturnal eating getting up out of bed to eat with overweight, binge eating, and negative mood or anxiety. Forty overweight women diagnosed with binge eating disorder (BED) and 39 overweight controls monitored their nocturnal eating for an average of eight nights. Seven instances of nocturnal eating were recorded by 6 patients, all of whom were binge eaters. Foods consumed nocturnally tended to be selected form those favored for binge episodes, and reported control over nocturnal eating episodes. In this sample, nocturnal eating was associated more with eating diorder than overweight. This report should provide the basis of future work to determine wether nocturnal eating should be evaluted and treated among eating disordered or overweight groups of patients. [ABSTRACT FROM AUTHOR]

Extensive recent research supports a proposal that a new eating disorder, binge eating disorder (BED), be included in DSM-IV. BED criteria define a relatively pure group of individuals who are distressed by recurrent binge eating who do not exhibit the compensatory features of bulimia nervosa. This large number of patients currently can only be diagnosed as eating disorder not otherwise specified (EDNOS). Recognizing this new disorder will help stimulate research and clinical programs for these patients. Fairburn et al.'s critique of BED fails to acknowledge the large body of knowledge that indicates that BED represents a distinct and definable subgroup of eating disordered patients and that the diagnosis provides useful information about psychopathology, prognosis, and outcome (Fairburn, Welch, & Hay [in press]). The classification of recurrent overeating: The ‘binge eating disorder’ proposal. International Journal of Eating Disorders.) Against any reasonable standard for adding a new diagnosis to DSM-IV, BED meets the test. [ABSTRACT FROM AUTHOR]

Binge eating (BED) is a new eating disorder that describes the eating disturbance of a large number of individuals who suffer from recurrent binge eating but who do not regularly engage in the compensatory behaviors to avoid weight gain seen in bulimia nervosa. This multistate study of BED involved 1,785 subjects drawn from 18 weight control programs, 942 subjects from five nonpatient community samples, and 75 patients with bulimia nervosa. Approximately 29% of subjects in weight control programs met the criteria for BED. In the nonpatient community samples BED was more common than purging bulimia nervosa. The validity of BED was supported by its strong association with (1) impairment in work and social functioning, (2) overconcern with body/shape and weight, (3) general psychopathology, (4) significant amount of time in adult life on diets, (5) a history of depression, alcohol/drug abuse, and treatment for emotional problems. [ABSTRACT FROM AUTHOR]

Postpartum weight retention contributes to obesity risk in women. Given that most women who quit smoking as a result of pregnancy will resume smoking within 6 months postpartum and that there is a robust association between smoking and weight, we sought to evaluate postpartum weight retention as a function of postpartum smoking status among women who had quit smoking during pregnancy. Women (N = 183) with biochemically confirmed cigarette abstinence at the end of pregnancy were recruited between February 2003 and November 2006. Women self-reported demographic information and weight before pregnancy. Smoking status and weight were documented at the end of pregnancy and at 6, 12, and 24 weeks postpartum. Breastfeeding was reported at 6 weeks postpartum. Differences in weight retention by relapse status at each assessment were evaluated. To examine weight retention in the presence of conceptually relevant covariates, mixed models with log-transformed weight data were used. At 24 weeks postpartum, 34.6% of women remained abstinent. Women who remained abstinent throughout the 24-week period retained 4.7 ± 2.1 kg more than did women who had relapsed by 6 weeks postpartum, P = 0.03. This difference in postpartum weight retention was significant after controlling for relevant covariates (age, race, breastfeeding, and pregravid BMI). Resumption of smoking within the first 6 weeks following childbirth is associated with decreased postpartum weight retention, even after controlling for breastfeeding and pregravid weight. Interventions to sustain smoking abstinence postpartum might be enhanced by components designed to minimize weight retention. [ABSTRACT FROM AUTHOR]

Training of new investigators is critical to promoting research in anorexia nervosa. Obstacles to training are noted, examples of current research training and early career funding opportunities are discussed, and suggestions to support training are offered. [ABSTRACT FROM AUTHOR]