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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.

PURPOSE: Maladaptive exercise (i.e., exercise that is either driven or compensatory) is thought to momentarily down-regulate elevated fear of weight gain (FOWG). However, little research has examined associations between FOWG and exercise, and no research has measured FOWG at a momentary level or considered exercise type (i.e., maladaptive vs. adaptive). Thus, we examined both within- and between-subject associations between FOWG and exercise among individuals with transdiagnostic binge eating. METHODS: We recruited treatment-seeking adults (N = 58, 82.9% female) to complete a 7–14-day ecological momentary assessment protocol which assessed levels of FOWG and exercise engagement and type. Mixed models and generalized estimating equations assessed within-subject associations, and linear regression assessed between-subject associations. RESULTS: There was no main effect of FOWG on exercise engagement at the next survey. However, unexpectedly, exercise type moderated this relationship such that the relationship between FOWG and exercise was strongest for episodes of adaptive exercise. Overall exercise frequency accounted for 10.4% of the variance in FOWG and exercise type explained an additional 1.7% of the variance in FOWG. CONCLUSION: The findings of the current study indicate that momentary levels of FOWG are associated with subsequent adaptive exercise episodes, while higher overall levels of maladaptive exercise were associated with higher levels of FOWG. Future treatments should place a greater emphasis on reducing the frequency of maladaptive exercise by providing strategies for reducing FOWG. LEVEL OF EVIDENCE: Level IV: Evidence obtained from multiple time series analysis such as case studies.

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 Dietary lapses drive weight loss failure, and specific factors influence risk of lapse. Physical activity (PA) may be one such risk factor, though whether PA increases or decreases appetite, and thus risk of lapse, is unclear. In fact, most studies examining the relation between PA and energy intake are limited by use of laboratory-based settings, intensive PA manipulations, and healthy-weight samples. This study aimed to maximize ecological validity by examining the extent to which free-living PA of various intensities prospectively predicts same-day dietary lapses among individuals enrolled in a weight loss program. Method Participants were 130 adults with overweight/obesity in a behavioral weight loss treatment instructed to follow a PA and dietary prescription. At midtreatment, moderate-to-vigorous PA (MVPA) and light PA were measured using hip-worn Actigraph GT3X+ accelerometers (Actigraph, Pensacola, FL). Lapses were assessed using ecological momentary assessment. Within-subject total PA (b = -0.012, SE = 0.005, p = .01) and light PA (b = -0.014, SE = 0.006, p = .01) negatively predicted lapse. MVPA followed the same pattern, but the effect was not statistically significant (b = -0.013, SE = 0.009, p = .12). Conclusion This study was the first to investigate if objectively measured PA prospectively predicts lapse from a weight loss program. Results suggested that for every additional 10 min of total PA one engaged in, the risk of lapse decreased by 1%. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Emotion regulation (ER) deficits are associated with illness severity in individuals with bulimia nervosa. We examined whether baseline ER abilities are associated with remission following enhanced cognitive behavioural therapy for eating disorders (CBT-E).Participants (N = 50, 85.0% female) receiving CBT-E completed a measure (yielding a global score and six subscale scores) of ER pre-treatment. Remission was assessed by the Eating Disorder Examination at post-treatment and follow-up. Analyses tested associations between baseline ER and behavioural, cognitive, or full remission at post-treatment and three-month follow-up.Lower global ER abilities, measured by the Difficulties in Emotion Regulation Scale, were associated with lower likelihood of behavioural and full, but not cognitive, remission at post-treatment. Specifically, individuals low in emotional clarity and impulse control were less likely to be behaviourally remitted. Those low in emotional acceptance, awareness, clarity, or strategies to manage emotion were less likely to be fully remitted. Global ER scores were not associated with any remission type at follow-up.Baseline ER deficits were associated with lower likelihood of behavioural or full remission at post-treatment. However, ER was less associated with remission at follow-up, indicating that ER is most important during treatment. Findings highlight a need for targeted treatments aimed at improving ER.

Maladaptive exercise is common among individuals with binge-spectrum eating disorders. One mechanism that may drive engagement in exercise in this population is state body dissatisfaction. However, no studies to date have examined prospective, momentary relationships between state body dissatisfaction and exercise.Adults with binge-spectrum eating disorders (N = 58) completed a 7-14-day ecological momentary assessment protocol assessing exercise and state body dissatisfaction several times per day. Multilevel models were used to evaluate prospective reciprocal associations between state body dissatisfaction and exercise. Mixed models examined trajectories of change in state body dissatisfaction pre- and post-exercise. Additional models examined exercise type (maladaptive vs. adaptive) as a moderator.Momentary increases (i.e., greater than one's average levels) in state body dissatisfaction at any given timepoint did not prospectively predict engagement in exercise at the next nearest timepoint. Exercise at any given timepoint did not prospectively predict momentary increases in state body dissatisfaction. State body dissatisfaction was found to increase in the initial hours preceding an exercise episode (linear estimate, β = - 0.012, p = 0.004). State body dissatisfaction did not significantly change in the hours following engagement in exercise. Exercise type did not moderate these associations.If replicated, our results may suggest that momentary increases in state body dissatisfaction may not be associated with exercise behaviors in individuals with binge-spectrum eating disorders.Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, orreports of expert committees.

Binge eating (BE) often develops during adolescence and is associated with deleterious psychological and physical consequences. Current treatments for adolescents achieve suboptimal results, likely due to failure to adequately address fear of weight gain (FOWG) which maintains BE. Thus, exposure treatment (the most powerful intervention for fear) may be a promising approach. However, exposure treatment has only minimally tested in adults with BE and never tested in adolescents. Thus, the current study is the first to evaluate a 4-session exposure module within a 12-session standard cognitive behavioral therapy for adolescents with BE. We recruited adolescents with BE ( N = 5) and examined treatment feasibility, acceptability, and preliminary effects on FOWG and eating pathology. Overall, the 4-session exposure module was feasible and acceptable and showed preliminary evidence that it could reduce FOWG. However, several participants did not endorse significant fears of weight gain; rather, these participants reported that fears of deprivation or social judgment were more related to their BE. Future research should test higher doses of exposure and further examine the role of fear of deprivation/social judgment. Finally, future iterations of this treatment could include more parent involvement or test exposure in combination with treatments other than cognitive behavioral therapy, such as family-based treatment.

Ecological momentary assessment (EMA) studies preliminarily support the transactional model of emotion regulation in eating disorders, such that heightened stress appraisal (i.e., the cognitive evaluation of an event's demands) results in increased negative affect (NA) and subsequent binge eating (BE). However, the temporal relationships between these variables and the magnitude of stress appraisal that is clinically significant require clarification. The current study aimed to extend previous research by (1) examining the temporal relationship between stress appraisal, changes in NA, and BE using three timepoints, (2) exploring what magnitude of momentary stress appraisal results in clinically significant increases in NA and BE, and (3) characterizing what stressors are associated with clinically significant stress appraisal.37 adult females completed an EMA protocol assessing momentary stressors, stress appraisal, NA, and BE over 2 week duration. Multilevel mediation models were used to test the study aims.Momentary increases in stress appraisal significantly predicted binge eating through increases in NA. Stress appraisal ratings of 0.50 SD higher relative to one's average stress appraisal began to significantly predict the likelihood of BE through increases in NA, and the likelihood of BE occurrence increased with every 0.25 increments in momentary stress appraisal. Work/school stressors and interpersonal stressors were the most commonly endorsed stressors of clinically significant stress appraisal.The current study supported the transactional model of emotion dysregulation in a binge eating sample and supports the use of momentary interventions at times of clinically significant stress appraisal to reduce BE risk.Level II, controlled trial without randomization.

Although 40–60% of individuals with eating disorders (EDs) report engaging in maladaptive exercise, self-reported reasons for engaging in exercise vary. Further, no studies have examined momentary reasons for exercise and whether reasons for exercising could be both adaptive and maladaptive for any episode. Examining reasons for exercise can inform interventions which more effectively target maladaptive exercise. The current study recruited adults with binge-spectrum EDs (N = 58, 89.2% Female) and assessed self-reported reasons for exercise using ecological momentary assessment over 7–14 days. Exercise episodes were categorized as maladaptive if the participant endorsed exercising to compensate for eating or feeling driven to exercise. On average, participants reported exercising 8 times (SD = 8) over the 7–14 days. On average, 73% of exercise episodes were maladaptive. Participants most frequently stated exercising to control shape or weight (67.2% of episodes), feeling driven (62.9%), and exercising as part of a routine (52.9%). Participants least endorsed exercising so that they could eat more later (9.8%). Participants reported a mean of 3.6 reasons for exercising at each episode (SD = 1.85, mode = 1.0). As hypothesized, individuals with EDs were exercising for several reasons at each exercise episode. Further, the extent to which each exercise episode is maladaptive varied between participants and even within a single participant's exercise episodes. These findings underscore the importance of research evaluating when, and for whom, exercise becomes maladaptive, as well as research examining other characteristic features of maladaptive and adaptive exercise in EDs.