Relationship between dietary restraint, binge eating, and leptin in obese women

OBJECTIVE: To describe some biological, behavioural and psychological correlates of the Three-Factor Eating Questionnaire, and to determine the relationship between dietary restraint, binge eating, and leptin among obese women seeking treatment. DESIGN: Consecutive series of obese women enrolled in a clinical program for weight reduction treatment. SUBJECTS: Forty-two obese women. Eight participants met the criteria for 'severe binge eating' as measured by the Binge Eating Scale. MEASUREMENTS: Energy intake, resting energy expenditure, body composition, leptin, restraint, disinhibition, hunger and binge eating were assessed before starting the treatment. RESULTS: In this sample both higher disinhibition and hunger scores were associated with greater binge eating severity. Obese women with severe binge eating had lower restraint, higher disinhibition and hunger scores, as well as higher daily fat intake, when compared with obese non-binge-eaters. Interestingly, restraint scores were negatively associated with leptin levels among subjects with severe binge eating. CONCLUSION: In obese women with severe binge eating, the negative relationship between dietary restraint and serum leptin concentrations seems mediated by a greater fat intake. These findings need to be verified in further human studies.     

The impact of pregnancy on eating behaviour and aspects of weight concern

BACKGROUND: Excessive weight gain in pregnancy and retention of this weight gain is a well known problem. How women with a history of dietary restraint adjust to being pregnant, is of interest, as pregnancy epitomises many of the factors known to trigger overeating. OBJECTIVE: To examine the impact of pregnancy on eating behaviour and weight concern and the role of dietary restraint in mediating any changes. METHODS: Primigravid (n = 50) and non-pregnant nulliparous (n = 50) women completed a questionnaire to describe their profile characteristics, current health behaviours, eating behaviour and weight concern. The pregnant women completed additional retrospective items relating to these factors for the period prior to their pregnancy. RESULTS: The pregnant women reported eating more, showed lower levels of dietary restraint, were less dissatisfied with their body shape and showed higher eating self efficacy than non-pregnant women. Compared to the months prior to their pregnancy, the pregnant women rated themselves as less restrained in their eating behaviour and nearly half stated that they were eating more. In terms of the impact of pre pregnancy levels of dietary restraint, the results showed a significant interaction between restrained eating and pregnancy for both hunger and eating self efficacy. The results showed that the restrained eaters, when pregnant, rated themselves as significantly less hungry and reported less difficulty controlling their food intake than the non pregnant restrained eaters but showed comparable hunger and eating control to the other groups. The results showed no effect of restrained eating on weight change. CONCLUSION: The results suggest that pregnancy both legitimises increased food intake and removes any previous intentions to eat less.     

Eating Disorder Examination Questionnaire (EDE‐Q): Norms for Undergraduate Japanese Women

The aim of the present study was to provide normative data for the Eating Disorder Examination Questionnaire (EDE‐Q) among undergraduate Japanese women and to compare these data to norms obtained from previous studies. Undergraduate Japanese women (n = 289), aged 18–24 years, were administered the EDE‐Q. The mean global score in the present study was 1.55 (SD = 1.03). Japanese women reported significantly higher scores of shape concern and weight concern in spite of lower body mass index but a significantly lower score of restraint, compared with women in other normative studies. There were significant differences with respect to the occurrence of some specific eating disorder behaviours between Japanese women and women in the previous studies. Differences in normative data for the EDE‐Q between young Japanese women and young women in the previous studies suggest that there may be certain cultural differences in eating disorder psychopathology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Predictors of improved eating behaviour following body image therapy: A pilot study

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the ‘Eating Disorder Cognition Questionnaire’ both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to ‘body and self‐esteem’, ‘dietary restraint’, ‘eating and loss of control’, as well as ‘internalisation and social comparison’. Furthermore, the changes in dysfunctional cognitions were associated with a reduction in eating disorder psychopathology. Body image therapy is a worthy complementation to standardised eating disorder treatment programmes as it reduces negative eating related thoughts and changes attitudes towards the body. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

The association of parental characteristics and psychological problems in obese youngsters

OBJECTIVE: The aim of the present study was to examine to what extent parental psychological characteristics and parental behavior are related to psychological problems in obese youngsters. RESEARCH METHODS: Data were collected from 196 families having an overweight youngster (range 10-16 years old) (mean body mass index (BMI)=31.2; s.d.=5.3) seeking weight-loss treatment and compared with data from normal weight samples. Behavior problems were measured using the Child Behavior Checklist; the Child version of the Eating Disorder Examination was used to assess eating disorder psychopathology. Parental psychopathology was measured using the Symptom Checklist-90; parenting behavior was assessed with the Ghent Parental Behavior Scale. RESULTS: Parental psychopathology was prevalent in 59.6% of mothers and 35.7% of fathers. Youngsters exceeding the cutoff for problem behavior ranged between 41.4 and 53.1%. Children's problem behavior was most associated with psychopathology in the mother (r=0.40 for Internalizing and r=0.37 for Externalizing; both P<0.01). The research findings further revealed that the effects of maternal psychopathology were partly mediated by a specific form of parenting behavior, namely Inconsistent discipline, although the effect was stronger for Externalizing behavior (explained variance: 10%) than for Internalizing behavior (explained variance: 4%). No evidence was found for a mediator effect from parenting behavior on the eating disorder symptoms of the obese youngsters. However, several direct relations emerged, suggesting a negative association between a child's eating disorder symptoms and Positive parenting behavior by the mother (r= -0.20 for Eating concern; r= -0.18 for Restraint eating; r= -0.16 for Shape concern; all P<0.05) as well as by the father (r= -0.25 for Eating concern; r= -0.25 for Weight concern; both P<0.01; r= -0.21 for Shape concern; P<0.05). DISCUSSION: Parental characteristics were associated with psychological problems in obese youngsters, not only in a direct way but also indirectly. The effects were partly mediated by a particular ineffective parenting style, namely inconsistent discipline on the part of the mother. Pediatric obesity treatments should focus more on parenting behaviors and parental characteristics.     

Eating disorders in adolescents with type 1 diabetes mellitus

Although the causes of eating disorders remain unclear, epidemiological evidence suggests that peripubertal changes in body shape and weight predispose young women to develop unhealthy eating attitudes. A psychiatric diagnosis of an eating disorder can be made in up to 10% of young women with insulin-dependent diabetes mellitus (type 1 diabetes). Eating disorders, anorexia nervosa and bulimia nervosa, pose a particularly serious risk to health in young diabetic people. Several features associated with type 1 diabetes and its treatment, such as weight gain, dietary restraint and food preoccupation, may predispose young diabetic women to develop a clinical or subclinical eating disorder. The coexistance of these conditions could lead to poor metabolic control and an increased risk of microvascular complications. Received: 25 May 1998 / Accepted in revised form: 23 April 1999     

Quality of life,course and predictors of outcomes in community women with EDNOS and common eating disorders

We investigated the 2‐year course and putative predictors of outcome of 87 young community women with common eating disorders (n = 59, 68% with Eating Disorder not Otherwise Specified) following a health literacy (informational) intervention. Participants were recruited in 3‐phases: community survey, interview and then invitation to a longitudinal study. The health literacy intervention was provided randomly to half participants at baseline and half at 1 year. Eating disorder symptoms and mental health related quality of life (MHQoL), general psychological function, help‐seeking, and defence style were assessed at baseline, and after 2 years by questionnaire. Multiple linear regression analyses were used to identify features predictive of eating disorder symptom levels and MHQoL. Eating disorder psychopathology remained high and MHQoL remained poor. In the multivariate models, a higher baseline level of immature defence style significantly predicted higher levels of eating disorder symptoms, poorer MHQoL and more disability as measured by ‘days out of role’. In addition, higher educational attainment, baseline general psychological disturbance, lower BMI and having main work outside the home were associated with poorer MHQoL. Women with common eating disorders followed to 2 years continued to be highly symptomatic and have poor quality of life. Psychological features important to outcome included an immature coping style and higher general psychological distress. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Binge eating disorder: a review

Binge eating disorder (BED) is a new proposed eating disorder in the DSM-IV. BED is not a formal diagnosis within the DSM-IV, but in day-to-day clinical practice the diagnosis seems to be generally accepted. People with the BED-syndrome have binge eating episodes as do subjects with bulimia nervosa, but unlike the latter they do not engage in compensatory behaviours. Although the diagnosis BED was created with the obese in mind, obesity is not a criterion. This paper gives an overview of its epidemiology, characteristics, aetiology, criteria, course and treatment. BED seems to be highly prevalent among subjects seeking weight loss treatment (1.3-30.1%). Studies with compared BED, BN and obesity indicated that individuals with BED exhibit levels of psychopathology that fall somewhere between the high levels reported by individuals with BN and the low levels reported by obese individuals. Characteristics of BED seemed to bear a closer resemblance to those of BN than of those of obesity.A review of RCT's showed that presently cognitive behavioural treatment is the treatment of choice but interpersonal psychotherapy, self-help and SSRI's seem effective. The first aim of treatment should be the cessation of binge eating. Treatment of weight loss may be offered to those who are able to abstain from binge eating.     

Who will lose weight on sibutramine and orlistat? Psychological correlates for treatment success

Aim:  To study the associations between weight loss with sibutramine and orlistat with psychological aspects that may interact with patients' response to these drugs.
Methods:  A total of 478 obese patients with a mean body mass index of 42 ± 12 kg/m² gave self-reported, retrospective data on different types of previous weight loss treatments (sibutramine and orlistat, and Weight Watchers used as a control condition) including the amount of weight lost with these treatments, eating behaviour (Dutch Eating Behaviour Questionnaire) and personality (NEO Personality Inventory – Revised).
Results:  Greater weight loss with sibutramine was associated with lower levels of restrained eating and higher levels of 'neuroticism', in particular 'anxiety' and 'depression'. Greater weight loss with orlistat was associated with aspects of the personality dimension 'conscientiousness' (e.g. 'order' and 'deliberation').
Conclusion:  Sibutramine may exert its greatest effect in patients whose eating is a 'natural' response to hunger rather than regulated by cognitions and conscious controls. Patients with low levels of restraint could be more sensitive to the satiety-enhancing effect of sibutramine. They may be able to reduce their food intake without cognitive interference and/or start to control their eating most radically in response to enhanced satiety. Enhanced satiety may also help patients withstand a wish to eat triggered by psychological distress. Possible central nervous system effects on mood could also have reduced eating, which was related to distress. The administration regimen of orlistat is more demanding, requiring greater adherence. This can account for the finding that personality attributes such as conscientiousness are important for success.     

Disinhibition, as assessed by the Three-Factor Eating Questionnaire, is inversely related to psychological well-being in postmenopausal women

Psychological correlates of obesity remain under controversy. As eating behaviors and dieting history have been previously related to obesity status, these dietary variables may contribute to identify overweight and obese individuals who are at higher risk of having an impaired psychological well-being. OBJECTIVE: The main purpose of this cross-sectional study was to verify the hypothesis of a relationship between weight status and psychological well-being, and to examine whether cognitive dietary restraint, disinhibition, susceptibility to hunger and dieting history could be related to psychological well-being. DESIGN AND SUBJECTS: In a sample of 101 postmenopausal women, we performed anthropometric measurements (weight, height and body mass index (BMI)), and measured psychological well-being (PER Questionnaire). The Three-Factor Eating Questionnaire (TFEQ) and a questionnaire about dieting history (dieters: had already been on a diet; non-dieters: had never been on a diet) were also administrated. RESULTS: A trend for a significant relationship was observed between BMI and psychological well-being (r=-0.17; P=0.08). Significant negative relationships were observed for disinhibition, susceptibility to hunger and all their subscales with psychological well-being (-0.28相似文献   

Disturbances of weight control behaviours and psychological functioning in individuals presenting to an outpatient eating disorder unit: A descriptive study

The behavioural, psychological and demographic characteristsics of a sample of 169 patients presenting to a speciality eating disorder outpatient clinic are described. While disturbances of weight control involving restrictive eating are common within the sample, overeating and behaviours compensating for dietary failures are distributed more variably. The severity of these behavioural disturbances suggest that approximately 50 per cent of these patients would be currently classified as subclinical. Despite this, the psychological profile of the sample is equivalent to diagnosed eating disordered samples and identifies significant amounts of psychopathology. The study argues for a broadening of the empirical approaches to the understanding and treatment of all patients with disorders of eating and weight control.     

Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings

This study examined racial differences in eating‐disorder psychopathology, eating/weight‐related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating‐disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Possible risk factors in the development of eating disorders in overweight pre-adolescent girls

OBJECTIVES: To investigate concerns about weight, shape and eating, dietary restraint, self-esteem and symptoms of depression in overweight girls. To investigate the relationship between concerns and self-esteem and depressive symptoms in this group. METHOD: Eighteen overweight girls and 18 average-weight girls completed the child version of the Eating Disorders Examination, the Harter Self-Perception Profile and the Short Moods and Feelings Questionnaire. RESULTS: Overweight girls had more concerns about weight, shape and eating and attempted dietary restraint more often. They had more negative self-esteem related to their athletic competence, physical appearance and global self-worth and more symptoms of depression. There was an association between concerns and self-esteem based on physical appearance in the overweight group. CONCLUSION: Overweight girls show some of the psychological features associated with the development of eating disorders, including a link between concerns and self-esteem based on physical appearance. This may help to explain why childhood obesity increases the risk of a later eating disorder.     

Disinhibition: its effects on appetite and weight regulation

Over the past 30 years, the understanding of eating behaviour has been dominated by the concept of dietary restraint. However, the development of the Three Factor Eating Questionnaire introduced two other factors, Disinhibition and Hunger, which have not received as much recognition in the literature. The objective of this review was to explore the relationship of the Disinhibition factor with weight regulation, food choice and eating disorders, and to consider its aetiology. The review indicates that Disinhibition is an important eating behaviour trait. It is associated not only with a higher body mass index and obesity, but also with mediating variables, such as less healthful food choices, which contribute to overweight/obesity and poorer health. Disinhibition is also implicated in eating disorders and contributes to eating disorder severity. It has been demonstrated that Disinhibition is predictive of poorer success at weight loss, and of weight regain after weight loss regimes and is associated with lower self-esteem, low physical activity and poor psychological health. Disinhibition therefore emerges as an important and dynamic trait, with influences that go beyond eating behaviour and incorporate other behaviours which contribute to weight regulation and obesity. The characteristics of Disinhibition itself therefore reflect many components representative of a thrifty type of physiology. We propose that the trait of Disinhibition be more appropriately renamed as 'opportunistic eating' or 'thrifty behaviour'.     

Subtyping Children and Adolescents Who Are Overweight Based on Eating Pathology and Psychopathology

Children and adolescents who are overweight can differ on dimensions measuring dietary restraint and psychopathology. Classifying clinical obese children and adolescents based on these psychological characteristics is shown to be useful in making differential prognoses. The present study aimed to research the validity of subtyping children and adolescents with overweight (N = 138) in a non‐clinical sample. Using cluster analysis, results revealed three subtypes: a dietary restraint/internalizing group (DR + IN; n = 41), a pure internalizing group (IN; n = 20) and a non‐symptomatic group (NS; n = 77). The DR + IN group outscored both other groups on measures of eating pathology, whereas the IN group outscored both other groups on measures of negative offect. Interestingly, the three groups did not differ on degree of overweight. The results seem to suggest that different psychological mechanisms can be observed in subgroups of young overweight adolescents. Further research should explore how individual psychological characteristics can be helpful when stipulating weight loss treatment programmes. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Who changes body mass between adolescence and adulthood? Factors predicting change in BMI between 16 year and 30 years in the 1970 British Birth Cohort

OBJECTIVE: To examine whether factors common to obesity prevention programmes in adolescence, namely exercise, sedentary activities, eating behaviours and psychological factors, predict change in BMI in 'free-living' adolescents followed into adulthood. DESIGN: Longitudinal national birth cohort study. SUBJECTS: 1970 British Birth Cohort: 4461 subjects with data on BMI at 16 years (1986) and 30 years (2000). MEASUREMENTS AND ANALYSIS: BMI z-score (zBMI) at 16 years (measured) and 30 years (self-reported). Obesity defined as BMI exceeding 95th British centile and 28.5 kg/m2, respectively. Self-report data on exercise, eating behaviours, dieting and measures of psychological function (depression, psychological distress, self-esteem) at 16 years. Models were produced for the regression of zBMI at 30 years on each variable at 16 years, adjusted for socioeconomic status, sex and zBMI at 16 years. RESULTS: In all, 467 (8.2%) were obese at 16 years and 730 (16.4%) were obese at 30 years. Of those obese at 16 years, 60.7% were also obese at 30 years. Loss of zBMI between 16 and 30 years was predicted by female sex (P=0.01), higher social class (P<0.0001) and higher frequency of playing sport, although this was of borderline significance (P=0.05). Increase in zBMI between 16 and 30 years was predicted by 4 or more hours per day of sedentary activities (P=0.01), eating takeaway meals twice or more per week (P=0.009), consuming two or more carbonated drinks per day (P=0.04) and a history of dieting to lose weight (P=0.04). CONCLUSION: These data from 'free-living' adolescents followed into adult life support the importance of known risk factors such as reduction of sedentary behaviours and reduction of unhealthy eating patterns (consumption of carbonated drinks and takeaway foods, dieting) in the prevention of the persistence of obesity from childhood into adult life.     

Psychological correlates of obesity in women

Psychological comorbidity is high in patients with obesity and is associated with a variety of medical and dietary problems as well as demographic, social and cognitive risk factors. Young overweight and obese women are at particular risk for developing sustained depressive mood, which is an important gateway symptom for major depressive disorder. Increased knowledge of behavioural risk factors has enabled patients with obesity to be classified on a psychological basis and this needs to be considered as part of a patient's clinical assessment and treatment strategy. Increased awareness of abnormal eating behaviour, together with profiling of personality traits, could improve treatment selection for obese women and improve the outcome of weight-loss programmes. Individualised antiobesity drug therapy may be required depending on the patient's psychological characteristics.     

Weight maintenance and relapse in obesity: a qualitative study

OBJECTIVE: To investigate, among women with obesity who have lost weight, the psychological factors associated with successfully maintaining the new lower weight, as opposed to weight regain. DESIGN: Qualitative research methods (in-depth individual interviews and group interviews) were used to assess the characteristics of successful weight maintainers, as compared with weight regainers and healthy-weight women. SUBJECTS: In all, 76 females were recruited from the community, comprising 28 formerly obese women who had lost weight and maintained their new lower weight for at least 1 y; 28 obese women who had lost weight but regained the weight that they had lost; and 20 women with a stable weight in the healthy range. RESULTS: Certain psychological factors were identified which characterised the regainers but not the maintainers. These factors were: failure to achieve weight goals and dissatisfaction with the weight achieved; the tendency to evaluate self-worth in terms of weight and shape; a lack of vigilance with regard to weight control; a dichotomous (black-and-white) thinking style; and the tendency to use eating to regulate mood. CONCLUSION: The results suggest that psychological factors may provide some explanation as to why many people with obesity regain weight following successful weight loss. The factors identified in this study need to be examined further using prospective designs.     

The correlates of long-term weight loss: a group comparison study of obesity

OBJECTIVE: Although the majority of weight loss attempts are unsuccessful, a small minority succeed in both weight loss and maintenance. The present study aimed to explore the correlates of this success. METHOD: A group comparison design was used to examine differences between women who were classified as either weight loss maintainers (had been obese (body mass index, BMI=30+ kg/m2) and had lost weight to be considered non-obese (BMI<30 kg/m2) and maintained this weight loss for a minimum of 3 y; n=44), stable obese (maintained an obese weight (BMI=30+ kg/m2) for longer than 3 y; n=58), and weight loss regainers (been obese (BMI=30+ kg/m2), lost sufficient weight to be considered non-obese (BMI<30 kg/m2) and regained it (BMI=30+ kg/m2), n=40). In particular, the study examined differences in profile characteristics, historical factors, help-seeking behaviours and psychological factors. RESULTS: The results showed that in terms of profile and historical factors, the weight loss maintainers had been lighter, were currently older and had dieted for longer than the other groups but were matched in terms of age, class and ethnic group. In terms of help-seeking behaviours, the weight loss maintainers reported having tried healthy eating more frequently but were comparable to the other subjects in terms of professionals contacted. Finally, for psychological factors the weight loss maintainers reported less endorsement for medical causes of obesity, greater endorsement for psychological consequences and indicated that they had been motivated to lose weight for psychological reasons. CONCLUSIONS: Weight loss and maintenance is particularly correlated with a psychological model of obesity. This has implications for improving the effectiveness of interventions and the potential impact of current interest in medical approaches to obesity.     

Rumination in Patients with Binge‐Eating Disorder and Obesity: Associations with Eating‐Disorder Psychopathology and Weight‐bias Internalization

Overvaluation of shape and weight in binge‐eating disorder (BED) is associated with greater eating‐disorder psychopathology and greater weight‐bias internalization, which are—in turn—associated with poorer mental and physical health. Little is known, however, about the significance of other cognitive processes, such as rumination, in BED. This study examined rumination and overvaluation of shape/weight with eating‐disorder psychopathology and weight‐bias internalization among 237 treatment‐seeking patients with BED and comorbid obesity. Hierarchical multiple regressions indicated that rumination was associated with eating‐disorder psychopathology and weight‐bias internalization above and beyond the influence of overvaluation of shape/weight. Findings suggest that, among patients with BED/obesity, rumination is an important cognitive process associated with severity of eating‐disorder psychopathology even after accounting for overvaluation of shape/weight. Patients with greater rumination might be more likely to dwell on weight‐based discrimination experiences and internalize these negative attitudes. Additional controlled examination could determine whether rumination represents another potential target for BED/obesity treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.