The assessment of dietary habits in obese women: influence of eating behavior patterns

The objective of this cross-sectional, observational study was to compare the dietary history and the 7-day record method to assess dietary habits in obese women. The second goal was to investigate whether eating behavior characteristics influence self-reported dietary intake. The study took place at the Obesity Outpatient Clinic, University Hospital Gasthuisberg, Leuven, Belgium. Subjects were 137 obese women with a mean age of 40 ± 12 years and a mean body mass index of 38.2 ± 6.0 kg/m².

Dietary intake was assessed both by the dietary history and by the 7-day record method. Resting energy expenditure was measured by continuous indirect calorimetry. Physical activity level was estimated using the Baecke questionnaire. To study different aspects of eating behaviour, the “Dutch Eating Behaviour Questionnaire” was used.

Absolute energy intake, as assessed by the 7-day record, was consistently lower than with the dietary history method. Sixteen percent of the obese women were overreporters while 66% clearly underreported energy intake, using dietary history as standard method. Restrained eating was associated with underreporting, while all aspects of emotional and external eating behavior were significantly higher in the group of overreporters. No relationship could be observed between the degree of underreporting and age, body weight or body mass index.

Energy intake, as assessed by the dietary history method, correlated better with measured energy expenditure in obese subjects than the 7-day record. Eating behavior characteristics influence the accuracy of self-reported dietary intake in obese women.     

Yoga Workshop Impacts Psychological Functioning and Mood of Women With Self-Reported History of Eating Disorders

Eating disorders can lead to severe medical and psychological consequences. Traditional interventions may neglect some of the crucial elements of eating disorders, specifically mood and body awareness. Other modalities, particularly yoga, should be considered as an adjunct to traditional treatments. This pilot study explored the benefits of a 6-day yoga workshop for women with a history of eating disorders. Results indicated improvements in mood, psychological adjustment, physical and emotional awareness, and eating disorder symptoms. This study concluded that other modalities, such as yoga, may be efficacious in improving mood and psychological functioning for those with a self-reported history of eating disorders.     

Prevention series introduction

Abstract

A group of 29 obese women with Binge Eating Disorder (OB-BED) and 35 obese subjects without this disorder (OB) were compared on the presence or absence of traumatic experiences and dissociative symptoms with the Dissociation Questionnaire (DIS-Q). OB-BED subjects showed significantly higher scores on two subscales of the DIS-Q (identity confusion and loss of control). They also reported significantly more traumatic experiences than the OB sample. These data further support the assumption that among eating disorder patients, both traumatic experiences and dissociative symptoms are more prevalent when patients show serious binge eating.     

Is obesity an eating disorder?

Obesity arises when energy intake exceeds energy expenditure over a long period. Excess weight has an energy value of 7000 kcal/kg. Theoretically excess weight might be gained either because energy expenditure was too low or energy intake was too high. Many studies have shown that on average obese people expend more energy than normal so, notwithstanding dietary histories to the contrary, they must on average have a higher energy intake to maintain body weight. However it is not possible to show that obese people have any significant defect in short-term regulation of energy intake. The likeliest hypothesis is that obesity is a disorder arising from a failure of the long-term regulation of energy intake, in which cognitive factors play an important part.     

The possible influence of impulsivity and dietary restraint on associations between serotonin genes and binge eating

Although serotonin (5-HT) genes are thought to be involved in the etiology of bulimia nervosa and binge eating, findings from molecular genetic studies are inconclusive. This may be due to limitations of past research, such as a failure to consider the influence of quantitative traits and gene–environment interactions. The current study investigated these issues by examining whether quantitative traits (i.e., impulsivity) and environmental exposure factors (i.e., dietary restraint) moderate 5-HT gene/binge eating associations in a sample of young women (N = 344). Binge eating was assessed using the Minnesota Eating Behavior Survey and the Dutch Eating Behavior Questionnaire (DEBQ). Impulsivity was assessed with the Barratt Impulsiveness Scale-Version 11. Dietary restraint was measured with a factor score derived from common restraint scales. Saliva samples were genotyped for the 5-HT2a receptor T102C polymorphism and 5-HT transporter promoter polymorphism. As expected, impulsivity and dietary restraint were associated with binge eating. Although the T allele of the 5-HT2a receptor gene and the s allele of the 5-HTT gene were associated with higher levels of impulsivity, there were no main effects of 5-HT genotypes on any binge eating measure, and interactions between genotypes, impulsivity, and dietary restraint were non-significant. In conclusion, we found no evidence to suggest that dietary restraint or impulsivity moderate associations between binge eating and these 5-HT genes. Future research should continue to explore interaction effects by examining larger samples, assessing dietary intake directly, and investigating other genes, traits, and environmental factors that may be related to binge eating and bulimia nervosa.     

Impact of binge eating disorder in the psychopathological profile of obese women

Objective

Our objective was to evaluate the psychopathological profile of obese women with binge eating disorder (BED) using the Symptom Checklist-90 (SCL-90).

Methods

Two hundred twelve obese women who seek for weight loss treatment were sequentially selected to participate in the study. Binge eating disorder was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Binge eating disorder severity was assessed using Binge Eating Scale. Depressive symptoms were assessed using Beck Depression Inventory. The psychopathological profile was assessed using the SCL-90.

Results

Binge eating disorder was diagnosed in 54 patients (26.6%). Obese patients with BED presented significant higher scores in all domains of SCL-90 (P < .05 for all) in comparison with obese patients without BED. A significant relationship was found among Binge Eating Scale, Beck Depression Inventory, and all domains of the SCL-90 (P < .05 for all). After linear regression, obsessivity-compulsivity (P = .03), interpersonal sensitivity (P = .0064), paranoid ideas (P = .03), and psychoticism (P = .01) were independently related to the severity of BED.

Conclusion

Obese women with BED presented a more severe psychopathological profile than obese controls. Among all, obsessivity-compulsivity, interpersonal sensitivity, paranoid ideas, and psychoticism seem to be strongly linked to BED severity.     

Nutrient intake and anthropometry in children and adolescents with Down syndrome–a preliminary study

Objective: To assess nutrient intake and anthropometrical characteristics of children and adolescents with DS, in Northern Greece.

Study design: Cross-sectional study of 34 youngsters with DS. The sample was divided into two age groups, children aged 2–9 years and adolescents aged 10–18 years old. A 3-day food record was used to assess dietary intake. Body weight, height, WHR,% body fat, BMI, FMI, FFMI and z-scores were recorded for each participant.

Results: All participants exhibited a high CHO and low fat diet. More than half of the participants reported having five meals daily and the majority exercised twice a week. A great majority was stunted and overweight according to general population growth charts and 22% of the adolescents were also obese. %Body fat, BMI, FMI and FFMI was higher in adolescents. Generally, younger participants presented lower overweight rates and consumed a diet more sufficient in micronutrients; however, WHR was similar in both age-groups, indicating a constant trend in weight distribution of DS patients.

Conclusions: Although children with DS are born with a genetic predisposition to become overweight, obesity is actually nurtured throughout childhood when they develop food choices and become more independent.     

A review of energy intake measures used in young children with cerebral palsy

The aim of this review was to evaluate the psychometric properties and clinical utility of energy intake measures used in young children with cerebral palsy (CP). Five databases were searched for relevant literature, and measures were included if they (1) directly measured energy intake in kilojoules/kilocalories per day; (2) had published data in kilojoules/kilocalories per day for children with CP from birth to 5 years; and (3) at least 40% of participants had a diagnosis of CP. Three measures met criteria: a 3-day weighed food record, a 3-day estimated food record, and a 7-day estimated food record. Included measures were evaluated on their characteristics, intended outcome, and validity. Reliability and responsiveness were not reported for any measure. Currently there is no dietary methodology that has proven reliability or repeated validity in young children with CP. Clinicians and researchers should not rely on current methodologies until further evaluation.     

Body dissatisfaction and socio-cultural factors in women with and without BED: Their relation with eating psychopathology

The goal of the present study was to assess the role of body dissatisfaction and socio-cultural factors on eating psychopathology in women with Binge Eating Disorder (BED) and women without BED. Seventy obese women consecutively evaluated participated: 35 with BED and 35 without BED who attended for the first time in a weight loss program. All participants completed a battery of questionnaires, including: Body Shape Questionnaire, Questionnaire of Influences on the Aesthetic Body Shape Model, Questionnaire on Eating and Weight Patterns, Three Factor Eating Questionnaire, and they were interviewed with the Interview for the Diagnosis of Eating Disorder-IV. The Body Mass Index, Waist-to-Hip Ratio and Body Fat were calculated. The results showed that 21% of obese women who participated in a weight reduction program met BED criteria. The scores of body dissatisfaction, influences of socio-cultural factors and eating psychopathology were higher in women with BED compared with women without BED. In the same way, significantly stronger correlations were found among influences of socio-cultural factors, specifically, influence of advertisement, social relations and eating psychopathology in women with BED than women without BED. It is concluded that the high body dissatisfaction as well as stronger associations among influence of socio-cultural factors and eating psychopathology could play an important role in women with BED.     

Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology

ObjectiveResearch has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED.MethodsParticipants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures.ResultsSocial anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint.DiscussionOur findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.     

女性静息能量消耗与肥胖相关指标相关性的研究

目的：分析女性静息能量消耗与肥胖相关指标的关系,比较肥胖女性与正常体质量女性静息能量消耗、公斤体质量静息能量消耗的差异。 方法：选择2004/2008在北京妇产医院内分泌科就诊或体检的健康女性565例,对其进行身高、体质量测量,使用人体代谢仪测定静息能量消耗,计算体表面积、体质量指数、公斤体质量静息能量消耗,按体质量指数肥胖诊断标准,分为两组：肥胖组女性179例,正常体质量女性240例,对其测量结果进行正态性检验、相关性分析和两独立样本秩和检验或t检验。 结果：565例健康女性静息能量消耗为正态性资料,测量值为(5.793±0.940) kJ/d,静息能量消耗与体质量、身高、体质量指数、体表面积呈正相关关系(P < 0.05),与年龄无明显相关性(P > 0.05),肥胖组与正常体质量组年龄、身高之间的差异无显著性意义(P > 0.05),静息能量消耗、公斤体质量静息能量消耗差异均有显著性意义(P < 0.05)。 结论：女性静息能量消耗与其身高、体质量、体质量指数、体表面积存在正相关关系,以体质量指数诊断的肥胖女性静息能量消耗高于正常体质量女性,公斤体质量静息能量消耗肥胖组小于正常体质量组。     

Starvation symptoms in patients with anorexia nervosa: a longitudinal study

ABSTRACT

Objective. The aim of this study was to evaluate the change in starvation symptoms over time and their role as potential predictors of change in eating disorder and general psychopathology in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioral therapy (ICBT-E).

Method. Ninety adult female patients with anorexia nervosa (63 restricting type and 27 binge-eating/purging type) were recruited. Body mass index (BMI), Eating Disorder Examination (EDE) interview, Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI) and Starvation Symptoms Inventory (SSI) scores were recorded at admission, at the end of treatment, and at 6-month follow-up. All tests, except for the EDE, were also administered after 4 weeks of treatment to assess the role of refeeding on these variables.

Results. At baseline, starvation symptoms were correlated with measures of eating disorder and general psychopathology. The treatment was associated with a significant increase in BMI, improvement in eating disorder and general psychopathology, and a significant reduction in starvation symptoms. The change in SSI scores from baseline to 4 weeks predicted the improvement in EDE eating concern subscale and global BSI scores. Among patients who had restored their body weight by the end of treatment, dietary restraint and eating concern EDE-Q subscales, global EDE-Q and SSI scores showed greater improvement in the first 4 weeks than in the remaining 16 weeks of treatment.

Discussion. The findings underline the close relationship between improvements in both starvation symptoms and eating disorder and general psychopathology and indicate the important role of refeeding in ameliorating both.     

Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study

Reduced-caloric intake lowers blood pressure through sympathetic inhibition, and worsens orthostatic tolerance within days. Conversely, hypercaloric nutrition augments sympathetic activity and blood pressure. Because dietary interventions could be applied in patients with syncope, we tested the hypothesis that short-term hypercaloric dieting improves orthostatic tolerance. In a randomized crossover trial, 20 healthy individuals (7 women, 26.7 ± 8 years, 22.6 ± 2 kg/m²) followed a 4-day hypercaloric (25% increase of energy intake by fat) or normocaloric nutritional plan, with a washout period of at least 23 days between interventions. We then performed head-up tilt table testing with incremental lower body negative pressure while recording beat-by-beat blood pressure and heart rate. The primary endpoint was orthostatic tolerance defined as time to presyncope. Time to presyncope during combined head-up tilt and lower body negative pressure did not differ between hypercaloric and normocaloric dieting (median 23.19 versus 23.04 min, ratio of median 1.01, 95% CI of ratio 0.5–1.9). Heart rate, blood pressure, heart rate variability, and blood pressure variability in the supine position and during orthostatic testing did not differ between interventions. We conclude that 4 days of moderate hypercaloric nutrition does not significantly improve orthostatic tolerance in healthy individuals. Nevertheless, given the important interaction between energy balance and cardiovascular autonomic control in the brain, caloric intake deserves more attention as a potential contributor and treatment target for orthostatic intolerance.

     

Binge-eating episodes are not characteristic of carriers of melanocortin-4 receptor gene mutations

Recently, Branson and coworkers reported a strong association between binge-eating disorder (BED) and variants in the melanocortin-4 receptor gene (MC4R). In the current study, we compared the eating behavior of 43 obese probands with functionally relevant MC4R mutations and of 35 polymorphism carriers (V103I or I251L) with wild-type carriers. The module for eating disorders of the Composite International Diagnostic Interview was used to identify binge-eating behavior. The Three-Factor Eating Questionnaire and the Leeds Food Frequency Questionnaire were used to assess restrained eating, disinhibition, hunger and percent total energy intake as fat. No significant differences between carriers of MC4R variants and wild-type carriers were detected. In particular, we found no evidence for an increased rate of binge-eating behavior in obese carriers of MC4R variants. Our findings do not support the strong association between BED and MC4R carrier status.     

Obesity and eating behaviour in children and adolescents: contribution of common gene polymorphisms

The prevalence of childhood obesity is increasing in many countries and confers risks for early type 2 diabetes, cardiovascular disease and metabolic syndrome. In the presence of potent 'obesogenic' environments not all children become obese, indicating the presence of susceptibility and resistance. Taking an energy balance approach, susceptibility could be mediated through a failure of appetite regulation leading to increased energy intake or via diminished energy expenditure. Evidence shows that heritability estimates for BMI and body fat are paralleled by similar coefficients for energy intake and preferences for dietary fat. Twin studies implicate weak satiety and enhanced food responsiveness as factors determining an increase in BMI. Single gene mutations, for example in the leptin receptor gene, that lead to extreme obesity appear to operate through appetite regulating mechanisms and the phenotypic response involves overconsumption and a failure to inhibit eating. Investigations of robustly characterized common gene variants of fat mass and obesity associated (FTO), peroxisome proliferator-activated receptor (PPARG) and melanocortin 4 receptor (MC4R) which contribute to variance in BMI also influence the variance in appetite factors such as measured energy intake, satiety responsiveness and the intake of palatable energy-dense food. A review of the evidence suggests that susceptibility to childhood obesity involving specific allelic variants of certain genes is mediated primarily through food consumption (appetite regulation) rather than through a decrease in activity-related energy expenditure. This conclusion has implications for early detection of susceptibility, and for prevention and management of childhood obesity.     

Effect of Ethnic Identity on Attitudes,Feelings, and Behaviors Toward Food

Abstract

A nationwide study examined differences in attitudes, feelings, and behaviors of African-American and White female college students toward food. The study also explored the relationship between eating disorder symptoms and ethnic identity among the two groups. All subjects completed the Eating Disorder Inventory-2 (EDI-2), a demographic questionnaire, and the Multi-Group Ethnic Identity Scale (MGEI). Analyses of variance and unpaired t-test revealed that White women exhibited significantly greater disordered eating behaviors and attitudes than African-American women. After controlling for degree of overweight, differences in disordered eating symptomology between the two groups became even greater. In contrast to White women, African-American women's dissatisfaction with body weight and shape was related to actual weight problems. Furthermore, degree of ethnic identity was greater among African-American women. Nonetheless, regression analysis revealed that ethnic identity was a predictor of drive for thinness, bulimia, and body dissatisfaction for White but not African-American women.     

Food choice in disorders of eating behavior: Correlations with the psychopathological aspects of the diseases

Eating disorders (ED) are characterized by alterations in food choice and in the quantity and quality of nutrient intake. In a population of 124 female patients with ED (anorexia nervosa restricting subtype [AN-R, n = 37]; AN bingeing-purging subtype [AN-BP, n = 18]; bulimia nervosa purging subtype [BN-P, n = 40]; and binge eating disorder [BED, n = 29]) and healthy age-matched controls ([C], n = 20) we compared food choice and macronutrient intake with psychopathologic symptoms of the disorders. Data were collected from the probands’ 7-day food diaries and the scores from two assessment scales (Eating Disorder Inventory-2 [EDI-2] and Temperament and Character Inventory-revised [TCI-R]) that measure symptom domains, dimensions of personality and character dimensions, respectively. Multiple regression analysis was applied to the nutritional data and scale scores. When compared to the values for the control group, intake of animal proteins (grams) was significantly lower for all patient groups, intake of lactoproteins was lower for the AN-R and AN-BP than BN-P and BED groups, intake of vegetal proteins was higher for the AN-R, AN-BP, BN-P and BED groups, intake of dietary fats was lower for the AN-R and AN-BP subtype groups, and intake of total carbohydrates and oligosaccharides was lower for the AN-R and AN-BP groups, and oligosaccharides also for the BED, when calculated in grams but not when expressed in percent. When studied as percent values animal proteins were lower in patients than in controls, lactoprotein in BN-P and BED, vegetal proteins higher in all the patients, fat lower in AN-R and AN-BP, while carbohydrates did not differ between patients and controls.     

Validation de la version française de la Binge Eating Scale : étude de sa structure factorielle,de sa consistance interne et de sa validité de construit en population clinique et non clinique

ObjectiveThe Binge Eating Scale is a widely used scale to assess binge eating disorder in obese patients. Until now, this scale has not been validated on a French population, and no psychometrically sound tool assesses binge eating disorder in the French. This study aimed to test the psychometric properties of a French version of the Binge Eating Scale by establishing its factor structure, internal consistency, and construct validity in both a non-clinical population and a clinical population (obese patients who are candidates for bariatric surgery).MethodsA total of 553 non-clinical subjects and 63 morbidly obese patients who were candidates for bariatric surgery were assessed with the BES and the Bulimic Investigatory Test, Edinburgh or BITE (which assesses both binge eating behaviours and use of inappropriate compensatory behaviours). We tested the factor structure of the instrument, its internal consistency, its construct validity with measures of binge eating, and its construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In 47 out of the 63 obese patients, we assessed binge eating disorder (SCID).ResultsIn the non-clinical population, the BES had a one-factor structure (which accounted for 61% of the variance), excellent internal consistency (α = 0.93), and high construct validity with measures of binge eating. In this population, construct validity with measures of inappropriate compensatory behaviours was confirmed in overweight and obese subjects (P = 0.42), but not in underweight and optimal weight subjects (P < 0.001). In obese patients candidates for bariatric surgery, we demonstrated that the BES had a one-factor structure (which accounted for 46% of the variance), had high internal consistency (α = 0.88) and high construct validity with measures of binge eating and good construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In the subpopulation of 47 obese patients, sensitivity, specificity, positive predictive value and negative predictive value were respectively 75%, 88.4%, 37.5% and 97.4% (BES threshold = 18).DiscussionIn this study, we validated a psychometrically sound French version of the Binge Eating Scale, both in a non-clinical and a clinical sample. The psychometric properties of the French version of the BES are comparable to its original version with a one-factor structure. The BES is a useful tool to assess binge eating disorder in obese patients (e.g., bariatric surgery candidates), but might not differentiate between binge eating disorder and bulimia nervosa in underweight and optimal weight subjects.     

Rate of intake, bites, and chews-the interpretation of lean-obese differences

The microstructure of eating behavior reflects physical properties of food. Responses of lean and obese subjects to these physical properties are similar. For example, eating smaller bite-sized food units reduces initial ingestion rate and mean and local ingestion rate for the entire meal, but does not affect total intake in either lean or obese women. On the other hand, analysis of the microstructure of eating behavior also suggests that obese subjects are less hungry and are more motivated by food preferences than lean subjects. For example, in meals of bite-sized food units, initial ingestion rate is less affected by deprivation and more affected by food preference in obese than lean women. In buffet meals with a variety of foods, obese men eat dessert earlier in the meal, and eat more dessert and other energy dense foods than lean men. The research reviewed here suggests that treatments for obesity should not focus on modifying bite size and ingestion rate and other microstructural variables, which are largely determined by the physical properties of food. Instead, treatment should focus on food selection and the stimulatory effects of palatability on intake.     

Stories I Tell My Patients

Excessive diet soda intake is common in eating disorders. The present study examined factors contributing to excessive intake in a sample of individuals with lifetime eating disorders based on proposed DSM-5 criteria (n?=?240) and non-eating disorder controls (n?=?157). Individuals with eating disorders, particularly bulimia nervosa, consumed more diet soda than controls. Eating disorder symptoms that reflect increased appetitive drive or increased weight concerns were associated with increased diet soda intake. Increased weight concerns were associated with increased diet soda intake when levels of appetitive drive were high, but not when they were low. Results highlight the importance of monitoring diet soda intake in individuals with eating disorders and may have implications for the maintenance of dysregulated taste reward processing in bulimia nervosa.