Emotional awareness and core beliefs among women with eating disorders

Patients with eating disorders have been shown to experience the emotional components of alexithymia—difficulties in identifying and describing emotions. In keeping with cognitive theories, which stress the role of schema‐level beliefs in understanding emotions, this study examined the core beliefs that are associated with this difficulty in women with eating disorders. Seventy eating‐disordered women completed standardised measures of core beliefs and alexithymia. There were no differences in alexithymia between diagnostic groups, so the women were treated as a single, transdiagnostic group. Multiple regression analyses showed specific patterns of association between the core beliefs and the emotional elements of alexithymia. Difficulties in identifying emotions were associated with entitlement beliefs, while difficulties in describing emotions were associated with both abandonment and emotional inhibition beliefs. These findings suggest that it may be necessary to work with core beliefs in order to reduce levels of alexithymia, prior to addressing the emotions that drive and maintain pathological eating behaviours. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention

The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self‐esteem and self‐worth, negative emotions, negative self‐belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho‐emotional overload, triggering a cascade of weight gain‐inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up‐regulation, low‐grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.     

Exploring pregnancy-related changes in alcohol consumption between black and white women

Background: Although epidemiological data indicate that White women are more likely to drink and binge drink before pregnancy, fetal alcohol syndrome (FAS) is more common in the Black population than among Whites in the United States. Differences in drinking cessation between Black and White women who become pregnant may help explain the disparity in FAS rates. Methods: The study sample was comprised of 280,126 non‐Hispanic Black and White women, ages 18 to 44, from the Behavioral Risk Factor Surveillance System (BRFSS) 2001 to 2005 data sets. Predictors of reduction in alcohol consumption (in drinks per month) and binge drinking (>4 drinks on one occasion) by pregnant and non‐pregnant women were identified with logistic regression. The effect of interactions of pregnancy status with age, education, and Black or White race on drinks per month and binge occasions were explored using analysis of variance (ANOVA). Results: Pregnant White women averaged 79.5% fewer drinks per month than non‐pregnant White women (F = 1250.1, p < 0.001), and 85.4% fewer binge drinking occasions (F = 376, p < 0.001). Pregnant Black women averaged 58.2% fewer drinks per month than non‐pregnant Black women (F = 31.8, p < 0.001) and 64.0% fewer binge occasions (F = 13.8, p < 0.001). Compared to Black women, White women appear to make a 38% greater reduction in drinks per month, and a 33% greater reduction in binge occasions. Conclusions: Non‐Hispanic White women appear more likely to reduce drinks per month and binge drinking occasions than non‐Hispanic Black women during pregnancy. These findings may help explain disparities in FAS in the United States, though this cross‐sectional sample does not permit claims of causation. To better describe the impact of differential drinking reduction on FAS rates, future studies of longitudinal data should be done.     

Eating behaviors in relation to gestational weight gain and postpartum weight retention: A systematic review

Preventing obesity is of utmost public health importance. This paper systematically reviews associations between eating behaviors and peripartum weight change. This knowledge is crucial in the development of interventions that reduce long‐term obesity, often triggered and boosted in the peripartum. Through MEDLINE, EMBASE, and Web of Science, we identified 20 studies that fulfilled inclusion criteria: studies on food cravings, disinhibition, restrained, external, emotional, uncontrolled, intuitive, or mindful eating in relation to gestational or postpartum weight among adult women. Higher gestational weight gain was associated with lower intuitive eating (in 3/3 studies) and higher restrained eating (in 4/11 studies), external eating (in 2/2 studies), emotional eating (in 3/4 studies), food cravings (in 3/3 studies), and disinhibition (in 1/3 studies). No association with uncontrolled eating was found (in one study). No studies on mindful eating and gestational weight were identified. Higher postpartum weight loss was associated with higher restrained (in 2/4 studies) and intuitive eating (in 1/1 study). No associations between postpartum weight and food cravings, disinhibition, and mindful eating were found. No studies on external, emotional and uncontrolled eating, and postpartum weight were identified. Concluding, certain eating behaviors might be related to peripartum weight change.     

Preventing excessive gestational weight gain: a systematic review of interventions

Women who gain excessive weight during pregnancy have an increased risk of post‐partum obesity, and retention of gestational weight gain (GWG) post birth is a strong predictor of maternal overweight/obesity a decade or more after the birth. The aim of the current review was to identify, and evaluate the effect of key variables designed to modify risk factors for excessive weight gain in pregnant women that have been targeted in interventions over the last decade. The 10 interventions focused primarily on behavioural changes in relation to physical activity and/or to eating. While six studies reported significantly less weight gain in the intervention women, only three showed that women in the intervention were significantly more likely to gain within recommended guidelines. GWG was reduced in only normal‐weight, low‐income, obese, or overweight women, or not at all. Only one study reported a reduction in GWG in women with body mass indexes spanning the normal, overweight and obese categories. The findings were inconsistent in relation to what factors need to be targeted in intervention programmes to reduce GWG. Consideration of psychological factors relevant to pregnancy, in addition to behavioural changes in relation to eating and physical activity, is suggested for future intervention studies.     

Loss of control over eating in overweight youngsters: The role of anxiety,depression and emotional eating

The current study investigated loss of control (LC) over eating and the role of anxiety, depression and emotional eating in a sample of both treatment seeking (N = 115) and non‐treatment seeking (N = 73) overweight youngsters (aged 8–18) using a semi‐structured clinical interview and self‐report questionnaires. It was found that treatment seekers reported twice as much LC (40%) compared to non‐treatment seekers (21%). Cross‐sectional prediction models indicated that increased anxiety was associated with emotional eating and LC. Emotional eating tended to mediate the relationship between anxiety and LC. Increased depression was associated with emotional eating but not with LC. Especially overweight treatment seekers turn out to be at risk for LC. Because LC may develop as a result of inadequate coping with negative emotions like anxiety, obesity treatment should focus on teaching more effective coping strategies. Longitudinal research is recommended to further elaborate affect regulation and LC. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

Why young women gain weight: A narrative review of influencing factors and possible solutions

Significant weight gain occurs in women during young adulthood, which increases risk of diseases such as diabetes, cardiovascular disease, and many cancers. This review aims to inform future individually targeted weight gain prevention programmes and summarizes possible targets: key life events, mediators that influence energy intake and physical activity levels, and moderators that could identify groups of women at greatest risk. Life events affecting weight include pregnancy and motherhood, smoking cessation, marriage and cohabiting, attending university, and possibly bereavement. Research has identified successful methods for preventing weight gain associated with pregnancy and motherhood, which could now be used in practice, but evidence is inconclusive for preventing weight gain around other life events. Weight gain is mediated by lack of knowledge and skills around food and nutrition, depression, anxiety, stress, satiety, neural responses, and possibly sleep patterns and premenstrual cravings. A paucity of research exists into altering these to limit weight gain. Moderators include socioeconomic status, genetics, personality traits, and eating styles. More research is required to identify at‐risk females and engage them in weight gain prevention. There is a need to address evidence gaps highlighted and implement what is currently known to develop effective strategies to limit weight gain in young women.     

The association between emotions and eating behaviour in an obese population with binge eating disorder

There is utility in understanding the antecedents of binge eating (BE), with a view to explaining poorer weight loss treatment responses in this subgroup. A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines with the aim of exploring associations between emotions and eating behaviour in a population affected by obesity and binge eating disorder (BED). A comprehensive literature search of four electronic databases (2004–2014) yielded 15 studies for inclusion. Included studies performed poorly on data quality analysis with respect to controlling for confounding variables, and sample size. Included papers largely focused on negative emotions as antecedents of BE; depression was consistently associated with a BED‐obese classification and BE. Negative mood, sadness, tension and instability of emotions were found to be antecedents of BE in an adult BED‐obese sample. However, findings were mixed regarding the role of stress, anger and positive emotions within the BED‐obese population. Recommendations are presented for the identification of BED, and ecologically valid experimental designs that further understanding of the complex and varied emotions that associate with BE. The implications of these and other limitations for both researchers and practitioners are discussed. The paper concludes with recommendations for future research alongside suggestions for practitioners. © 2015 World Obesity     

Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review

Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long‐term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty‐eight studies met inclusion criteria. Findings suggested that most patients experience a short‐term reduction in anxiety and depression symptoms from pre‐surgery. Over time, however, these symptoms increase and may even return to pre‐surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer‐term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer‐term follow‐up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long‐term success of patients with obesity.     

Efficacy and safety of liraglutide,a once‐daily human glucagon‐like peptide‐1 analogue,in Latino/Hispanic patients with type 2 diabetes: post hoc analysis of data from four phase III trials

The aim of the present analysis was to evaluate the efficacy of the glucagon‐like peptide‐1 receptor agonist liraglutide in Latino/Hispanic individuals with type 2 diabetes, in addition to comparing its treatment effects with those observed in non‐Latino/Hispanic individuals. Analyses were performed on patient‐level data from a subset of individuals self‐defined as Latino/Hispanic from four phase III studies, the LEAD‐3, LEAD‐4, LEAD‐6 and 1860‐LIRA‐DPP‐4 trials. Endpoints included change in glycated haemoglobin (HbA1c) and body weight from baseline. In Latino/Hispanic patients (n = 505; 323 treated with liraglutide) after 26 weeks, mean HbA1c reductions were significantly greater with both liraglutide 1.2 and 1.8 mg versus comparator or placebo in the LEAD‐3 and LEAD‐4 studies, and with 1.8 mg liraglutide in the 1860‐LIRA‐DPP‐4 trial. In LEAD‐3 both doses led to significant differences in body weight change among Latino/Hispanic patients versus the comparator. With 1.8 mg liraglutide, difference in weight change was significant only in the 1860‐LIRA‐DPP‐4 trial versus sitagliptin. For both endpoints Latino/Hispanic and non‐Latino/Hispanic patients responded to liraglutide similarly. In summary, liraglutide is efficacious for treatment of type 2 diabetes in Latino/Hispanic patients, with a similar efficacy to that seen in non‐Latino/Hispanic patients.     

Behavioural implications of traditional treatment and closed‐loop automated insulin delivery systems in Type 1 diabetes: applying a cognitive restraint theory framework

As the prevalence of obesity in Type 1 diabetes rises, the effects of emerging therapy options should be considered in the context of both weight and glycaemic control outcomes. Artificial pancreas device systems will ‘close the loop’ between blood glucose monitoring and automated insulin delivery and may transform day‐to‐day dietary management for people with Type 1 diabetes in multiple ways. In the present review, we draw directly from cognitive restraint theory to consider unintended impacts that closed‐loop systems may have on ingestive behaviour and food intake. We provide a brief overview of dietary restraint theory and its relation to weight status in the general population, discuss the role of restraint in traditional Type 1 diabetes treatment, and lastly, use this restraint framework to discuss the possible behavioural implications and opportunities of closed‐loop systems in the treatment of Type 1 diabetes. We hypothesize that adopting closed‐loop systems will lift the diligence and restriction that characterizes Type 1 diabetes today, thus requiring a transition from a restrained eating behaviour to a non‐restrained eating behaviour. Furthermore, we suggest this transition be leveraged as an opportunity to teach people lifelong eating behaviour to promote healthy weight status by incorporating education and cognitive reappraisal. Our aim was to use a transdisciplinary approach to highlight critical aspects of the emerging closed‐loop technologies relating to eating behaviour and weight effects and to promote discussion of strategies to optimize long‐term health in Type 1 diabetes via two key outcomes: glycaemic control and weight management.     

Night eating and weight change in middle-aged men and women

OBJECTIVE: To examine the association between the habit of eating at night, and the 5-y preceding and 6-y subsequent weight changes in a middle-aged population, with particular focus on the obese. DESIGN: Prospective study with initial examination of the cohort in 1982-83, re-examination in 1987-88 and a third examination in 1992-93. SUBJECTS: The Danish MONICA cohort includes an age- and sex-stratified random sample of the population from the Western part of the Copenhagen County. Out of 2,987 subjects participating in 1987-88, a total of 1,050 women and 1,061 men had been examined in 1982-83, and 1993-94 too. Subjects working night shifts were excluded. MEASUREMENTS: Night eating in 1987-88, 5-y preceding and 6-y subsequent weight change. RESULTS: In total, 9.0% women and 7.4% men reported 'getting up at night to eat'. Obese women with night eating experienced an average 6-y weight gain of 5.2 kg (P=0.004), whereas only 0.9 kg average weight gain was seen among obese women who did not get up at night to eat. No significant associations were found among all women, or between night eating and the 5-y preceding weight change for women. Night eating and weight change were not associated among men. CONCLUSION: Night eating was not associated with later weight gain, except among already obese women, suggesting that getting up at night to eat may be a contributor to further weight gain among the obese.     

Associations between parent–child relationship quality and obesogenic risk in adolescence: a systematic review of recent literature

Adolescence is a period of significant cognitive, social and physiological change, presenting unique risk factors for weight gain. Childhood obesity research has traditionally focused on the influence of parent‐level factors on children's eating and weight status. Increasingly, emphasis is turning towards the reciprocal nature of the parent–child relationship and its influence on health behaviour. A systematic literature review was conducted to investigate the relationship between parent–child relationship quality (defined as the felt emotional bond between parent and child) and obesogenic risk (weight status, eating attitudes and behaviours, level of physical activity and sedentary behaviour) in adolescence; 26 papers were included in the review. The results neither support nor challenge an association between parent–child relationship quality and weight, with study design flaws and limited measurement of the parent–child relationship precluding robust conclusions. The review does however suggests that several aspects of the parent–child relationship are important in understanding eating attitudes and behaviours, including the felt emotional bond between the parent and child, the child's perception of how much the parent cares for them and the mother's sensitivity towards the child. The need for further longitudinal research into the association between parent–child relationship quality and obesity risk across this developmental period is discussed.     

Content of Children's Loss of Control Eating Episodes Assessed by Self‐Report and Laboratory Test Meal

Pediatric loss of control (LOC) eating heightens risk for excessive weight gain and further disordered eating. Assessment of LOC typically involves self‐report interview or laboratory test meal, although no study has concurrently examined data from both methods. We gathered eating episode data via interview (Child Eating Disorder Examination; ChEDE) and a laboratory test meal, among 22 overweight girls (aged 7–12 years) reporting LOC eating. Children consumed more energy during ChEDE episodes, although ChEDE and test meal episodes did not differ in macronutrient content. Episodes' correlation for amount consumed (grams) did not reach significance, p = .076. In exploratory analyses among the seven children reporting LOC during the test meal, episodes were significantly correlated for grams consumed. Findings provide preliminary data to suggest that semi‐structured interviews accurately capture children's LOC episode quantity. Episodes did not qualitatively differ, although children reported consuming more energy during self‐reported episodes. Replication is warranted in larger studies. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Sexual orientation, substance use behaviors and substance dependence in the United States

Aims To assess past‐year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction and behavior) in a large national sample of adult women and men in the United States. Design Data were collected from structured diagnostic face‐to‐face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM‐IV version IV (AUDADIS‐IV). Setting Prevalence estimates were based on data collected from the 2004–2005 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Participants A large national sample of 34 653 adults aged 20 years and older: 52% female, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American. Findings Approximately 2% of the population self‐identified as lesbian, gay or bisexual; 4% reported at least one life‐time same‐sex sexual partner and 6% reported same‐sex sexual attraction. Although non‐heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM‐IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men. Conclusions Results support previous research findings of heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines the reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for more effective prevention and intervention efforts that target subgroups at greatest risk.     

Mindfulness‐based interventions for obesity‐related eating behaviours: a literature review

Mindfulness‐based interventions (MBIs) targeting eating behaviours have gained popularity in recent years. A literature review was conducted to determine the effectiveness of MBIs for treating obesity‐related eating behaviours, such as binge eating, emotional eating and external eating. A search protocol was conducted using the online databases Google Scholar, PubMed, PsycINFO and Ovid Healthstar. Papers were required to meet the following criteria to be included in this review: (i) describe a MBI or the use of mindfulness exercises as part of an intervention; (ii) include at least one obesity‐related eating behaviour as an outcome; (iii) include quantitative outcomes; and (iv) be published in English in a peer‐reviewed journal. A total of N = 21 papers were included in this review. Interventions used a variety of approaches to implement mindfulness training, including combined mindfulness and cognitive behavioural therapies, mindfulness‐based stress reduction, acceptance‐based therapies, mindful eating programmes, and combinations of mindfulness exercises. Targeted eating behaviour outcomes included binge eating, emotional eating, external eating and dietary intake. Eighteen (86%) of the reviewed studies reported improvements in the targeted eating behaviours. Overall, the results of this first review on the topic support the efficacy of MBIs for changing obesity‐related eating behaviours, specifically binge eating, emotional eating and external eating.     

Insulin resistance and weight gain in postmenopausal women of diverse ethnic groups

OBJECTIVE: This study was conducted to examine the influence of insulin resistance on weight change in postmenopausal women of various ethnic groups. SUBJECTS: Data were obtained from 3389 women (60% White, 20% Black, 12% Hispanic, and 8% Asian/Pacific Islander), ages 50-79, enrolled in either the Women's Health Initiative Clinical trial or Observational Study, whose blood samples were selected randomly from the full cohort of 161 809 women for analyses. MEASUREMENTS: Glucose, insulin, and lipids were measured on fasting serum samples drawn at baseline and after 3 y of follow-up. Weight, height, waist circumference, and blood pressure were measured. Physical activity and energy intake were assessed via questionnaire. Insulin resistance was estimated using the HOMA (homeostasis model) calculation. RESULTS: Average age was 62 y, average BMI (body mass index) was 27.4 kg/m2, and average weight change was a gain of 0.4 kg in 3 y. In a multivariate analysis, insulin resistance and insulin concentrations were independent predictors of increases in weight in White women (P=0.002 and 0.004, respectively) and in the combined group (P=0.027 and 0.039). For the whole group, after adjustment for other covariates, those in the highest quartile of insulin resistance gained 0.4 kg in 3 y, whereas those in the lowest quartile lost 0.06 kg. Similar trends were found for insulin resistance and weight gain in Hispanic and Asian/Pacific Islander women, but they did not reach statistical significance. In Black women, no relation was seen between either insulin or insulin resistance and weight change. A significant interaction between obesity and insulin resistance was observed (P=0.002 for White women and 0.032 for the whole group), so that there is weight gain with increasing insulin resistance in the leaner women, but weight loss with increasing insulin resistance in the most obese. CONCLUSION: Insulin resistance appears to be a predictor of weight gain in postmenopausal women, except for the most obese women. The effect is more pronounced in women who have a lower BMI, and the effect was not seen in the Black women who as a group had a higher BMI.     

A Meta‐Analysis Examining the Influence of Pro‐Eating Disorder Websites on Body Image and Eating Pathology

Previous research has indicated that exposure to pro‐eating disorder websites might increase eating pathology; however, the magnitude of this effect is unknown. This study aimed to conduct a systematic review and meta‐analysis to examine the effect of exposure to pro‐eating disorder websites on body image and eating pathology. Studies examining the relationship between exposure to pro‐eating disorder websites and eating pathology‐related outcomes were included. The systematic review identified nine studies. Findings revealed significant effect sizes of exposure to pro‐eating disorder websites on body image dissatisfaction (five studies), d = .41, p = .003; dieting (six studies), d = .68, p < .001, and negative affect (three studies), d = 1.00, p < .001. No effect emerged for bulimic symptoms (four studies), d = .22, p = .73. Findings confirmed the effect of pro‐eating disorder websites on body image and eating pathology, highlighting the need for enforceable regulation of these websites. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Post‐partum weight retention in women in Asia: a systematic review

Obesity is a health issue for people in Asia, and many studies support that childbearing may contribute to women's obesity. However, most studies of post‐partum weight retention (PWR) focus on Western countries. This paper aimed to review recent data on PWR and discuss the related factors of PWR for women in Asia. Three electronic databases – MEDLINE, CINAHL and PsycINFO – were searched for data from January 1990 to August 2010. Twelve studies were identified as containing information related to PWR. Chinese, Taiwanese and Korean women tend to have higher gestational weight gain and PWR than women in other Asian countries in this review. The average reported gestational weight gain in these studies ranged from 8.3 kg to 18.0 kg, and the average weight retention at 6 months post partum in various countries ranged from 1.56 kg to 4.1 kg. Gestational weight gain had a positive effect on PWR, but there were no consistent conclusions for other factors. Only a few psychosocial and behavioural factors have been studied. Moreover, no one has assessed changes in waist circumference and waist‐to‐hip ratio for measuring central obesity and ensuring risk of chronic disease. Focusing on changes in maternal weight and body composition, and considering the impact of psychological and behavioural factors are suggested for future studies in Asia.