Symptom severity in obese women with binge eating disorder as a function of smoking history

OBJECTIVE: To compare obese female former smokers with binge eating disorder (BED) to women with BED with no smoking history in the severity of binge eating and associated symptoms. METHOD: A consecutive series of 91 obese women with current diagnoses of BED were administered structured diagnostic and investigator-based interviews and self-report questionnaires to assess symptoms associated with eating disorders. Participants were classified as "never" or "former" smokers and symptom profiles were compared across smoking groups. RESULTS: Former and never-smoking groups did not differ in age, body mass index, or current binge frequency. Former smokers reported significantly higher levels of dietary restraint, rigid dieting strategies, and avoidance of eating. CONCLUSION: Former smokers were significantly more likely than never-smokers to endorse specific symptoms of eating pathology (i.e., rigid dieting strategies). Despite the average 15-year interval since smoking cessation, the former smokers in this patient group resembled current smokers with other eating disorders in terms of rigid and restrictive weight control methods. Obese patients with a smoking history may benefit from treatment to address rigid/pathological dieting and strategies.     

On the relation of flexible and rigid control of eating to body mass index and overeating in patients with binge eating disorder

OBJECTIVE: To examine the relationship of flexible and rigid dimensions of restrained eating to body mass index (BMI) and overeating in outpatients with binge eating disorder (BED). METHOD: Participants were 148 consecutive outpatients who met criteria for BED. The Three-Factor Eating Questionnaire (TFEQ) was administered to assess Cognitive Restraint, Hunger, and Disinhibition. The TFEQ also contains two Cognitive Restraint subscales--Flexible Control and Rigid Control. The Eating Disorder Examination-Questionnaire version (EDE-Q) was administered to assess frequency of different forms of overeating during the past 28 days and the attitudinal features of eating disorders. RESULTS: Flexible Control and Rigid Control were significantly correlated with each other. They were both negatively correlated with BMI, but neither was significantly correlated with the frequency of binge eating or other forms of overeating. In addition, Flexible Control and Rigid Control predicted almost the same amount of variance in BMI. DISCUSSION: BED patients exhibit flexible and rigid control of eating that is related to BMI, but not to the frequency of binge eating or other forms of overeating. Results of the present study provide preliminary evidence that flexible and rigid control of eating may not be a useful distinction in BED patients. However, increased restraint, regardless of type, may prove to be of benefit with regard to weight control and may not have adverse effects on binge eating in obese BED patients.     

Assumptions and beliefs, dieting, and predictors of eating disorder-related symptoms in young women and young men

Differences between assumptions and beliefs related to eating disorders were investigated in young women and young men, with and without a history of dieting. The unique predictive power of these assumptions and beliefs was also assessed, compared to generic assumptions and beliefs. Both women and men with a history of dieting scored more highly than those who had never dieted on assumptions related to weight, shape, and eating, but did not differ from this group in negative self-beliefs. Assumptions and beliefs related to eating disorders, as well as female gender, but not body mass index (BMI), history of dieting, or generic assumptions and beliefs, predicted eating disorder-related symptoms. The findings add to knowledge about the relationship between assumptions and beliefs, gender, dieting, and eating disorder-related symptoms. They also support the usefulness of the Eating Disorder Belief Questionnaire (EDBQ), a new measure of eating disorder-specific assumptions and beliefs.     

Binge eating and binge eating disorder in a small-scale, indigenous society: the view from Fiji

OBJECTIVE: Although the cross-cultural prevalence of anorexia and bulimia nervosa has been investigated in multiple studies, little is known about the prevalence and correlates of binge eating and binge eating disorder (BED) cross-culturally. No published studies to date have explored BED in small-scale, indigenous, or developing societies. The current study investigated the prevalence and correlates of binge eating in a community sample of Fijian women living in rural Fiji. METHODS: Fifty ethnic Fijian women completed a self-report measure developed for this study on dieting and attitudes toward body shape and change, a Nadroga-language questionnaire on body image, and the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Their height and weight were also measured. Patterns of dieting, high body mass index (BMI), and attitudes toward eating and body image were compared between women with and without a history of binge eating. RESULTS: Ten percent of respondents reported at least weekly episodes of binge eating during the past 6 months and 4% endorsed symptoms consistent with BED. Binge eating in this sample was associated significantly with a BMI value above 35, a history of dieting, and a high concern with body shape. Binge eating was not associated with several markers of acculturation in this sample, although it was associated with a key, nontraditionally Fijian (i.e., acculturated) attitude toward the body. DISCUSSION: Binge eating occurred in a social context with traditions concerning weight and diet widely disparate from Western populations. However, correlates of binge eating in this sample suggest that nontraditional Fijian attitudes toward weight and body shape play a contributory role.     

Disordered eating and the transition to college: a prospective study

OBJECTIVE: A longitudinal study was conducted to examine whether the transition to college changed eating disorder symptoms and related attitudes. METHOD: Participants were 342 women who completed an in-depth survey in the spring of their senior year of high school and again during their first year of college. We assessed changes in body self-perception, eating-related attitudes, and disordered eating classification (nondieter, dieter, problem dieter, subclinical eating disordered, or eating disordered on the basis of criteria for bulimia nervosa in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders). RESULTS: Although participants viewed themselves as significantly heavier in their first year of college, dieting frequency and disordered eating classification in college did not differ from high school assessment. DISCUSSION: Evidence from this study indicates that disordered eating symptoms and attitudes are established before college. However, our findings also reveal that poor self-image, dieting behaviors, and eating disorder symptoms are common among many young women, both before and during college.     

Food cravings mediate the relationship between rigid, but not flexible control of eating behavior and dieting success

Both food cravings and rigid dietary control strategies have been implicated in low dieting success while flexible control often is associated with successful weight loss. An online survey was conducted (N = 616) to test the mediational role of food cravings between dietary control strategies and self-perceived dieting success. Food cravings fully mediated the inverse relationship between rigid control and dieting success. Contrarily, flexible control predicted dieting success independently of food cravings, which were negatively associated with dieting success. Differential mechanisms underlie the relationship between rigid and flexible control of eating behavior and dieting success.     

A preliminary controlled evaluation of an eating disturbance psychoeducational intervention for college students

OBJECTIVE: Because conventional preventive interventions have had little success in reducing eating pathology, we developed and evaluated a more intensive psychoeducational intervention. METHOD: Female college students who underwent this intervention and a matched control sample of students (N = 66) completed pretest and posttest surveys. RESULTS: Intervention participants showed significant decreases in thin-ideal internalization, body dissatisfaction, dieting, eating disorder symptoms, and weight over the 4-month study period, whereas matched control participants did not show changes in these outcomes with the exception that they gained weight. DISCUSSION: These preliminary findings suggest that this intervention may prove useful in reducing eating disturbances and overweight among college students, as well as the risk factors for this serious mental and physical health problem.     

Timing and sequence of the onset of overweight, dieting, and binge eating in overweight patients with binge eating disorder

OBJECTIVE: To examine the self-reported sequence and timing of onset of overweight, binge eating, and dieting in adult patients diagnosed with binge eating disorder (BED). METHOD: Participants were 284 treatment-seeking adults (73 men and 211 women) who met DSM-IV research criteria for BED. Patients were interviewed with structured diagnostic interviews and were queried regarding history of overweight, dieting, and binge eating behaviors. Questionnaires were also administered to assess current eating disturbances, body dissatisfaction, and general functioning. Participants were classified as Overweight First, Binge First, or Diet First, and the three groups were compared on developmental sequence and using the battery of measures. RESULTS: Sixty-three percent of the 284 participants reported becoming overweight prior to the onset of dieting or binge eating. Participants who reported they were overweight first had significantly greater BMI at the time of assessment. The 16% of the participants who reported binge eating first were significantly younger at the onset of BED diagnosis and reported significantly less dietary restraint. Onset order differed significantly by gender; proportionally more women (25%) than men (11%) reported that dieting preceded overweight or binge eating. CONCLUSION: Weight problems preceded dieting and binge eating behaviors for a majority of treatment-seeking overweight participants diagnosed with BED.     

Flexible vs. Rigid Dieting Strategies: Relationship with Adverse Behavioral Outcomes

This study was designed to test the hypothesis that different types of dieting strategies are associated with different behavioral outcomes by investigating the relationship of dieting behaviors with overeating, body mass and mood. A sample of 223 adult male and female participants from a large community were studied. Only a small proportion of the sample (18%) was seeking weight loss treatment, though almost half (49.3%) of the subjects were significantly overweight (body mass index, BMI>30). Subjects were administered questionnaires measuring dietary restraint, overeating, depression and anxiety. Measurements of height and weight were also obtained in order to calculate BMI. Canonical correlation was performed to evaluate the relationship of dietary restraint variables with overeating variables, body mass, depression and anxiety. The strongest canonical correlation (r=0.65) was the relationship between flexible dieting and the absence of overeating, lower body mass and lower levels of depression and anxiety. The second strongest canonical correlation (r=0.59) associated calorie counting and conscious dieting with overeating while alone and increased body mass. The third canonical correlation (r=0.57) found a relationship between low dietary restraint and binge eating. The results support the hypothesis that overeating and other adverse behaviors and moods are associated with the presence or absence of certain types of dieting behavior.     

Tests of an extension of the dual pathway model of bulimic symptoms to the state-based level

The dual pathway model proposes that trait body dissatisfaction leads to bulimic symptoms via two distinct pathways: dieting and trait negative affect. As many of these modelled variables have state-based equivalents, the present study evaluated the generalisability of this model to predict associations between state body dissatisfaction and instances of disordered eating. 124 women aged 18 to 40 years completed an online survey (accessed via a mobile phone device with web access) over a 7-day period. The mobile phone device prompted participants at random intervals seven times daily to self-report their state body dissatisfaction, current mood experiences, dieting attempts, and disordered eating practices. Multi-level mediation modelling revealed that both negative mood states and dieting significantly mediated the state body dissatisfaction–disordered eating relationships, although the strength of these associations depended on the aspect of disordered eating measured and individual differences in trait body dissatisfaction, internalization of appearance standards, tendency towards dieting, and BMI. Collectively, these results not only support adapting the dual pathway model to the state-level, but also suggest that several of the model implied pathways may be more relevant for individuals with more pathological eating- and body-related concerns and behaviours.     

Trial of a psychoeducational eating disturbance intervention for college women: a replication and extension

OBJECTIVE: We conducted a controlled trial of a psychoeducational eating disturbance intervention to replicate the positive findings observed in the preliminary evaluation of this intervention and to determine whether the effects persist for a longer follow-up period. METHOD: College women who took the psychoeducational class and a matched control sample of students (N = 95) completed pretest, posttest, and 6-month follow-up surveys. RESULTS: Intervention participants showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, dieting, and eating disorder symptoms, as well as significantly less weight gain, relative to matched controls over the study period. Intervention effects tended to be larger at 6-month follow-up than at posttest. CONCLUSION: These findings suggest that the intervention effects for eating disorder risk factors and eating disorder symptoms, as well as the weight gain prevention effects, are reproducible and persist over time. This intervention has both mental health and public health significance.     

“Restrained Eating” vs “Trying to Lose Weight”: How Are They Associated with Body Weight and Tendency to Overeat among Postmenopausal Women?

In an effort to control body weight, many women diet or adopt a restrained approach to eating. Although common, dieting and dietary restraint remain poorly understood. Clarification of their association with health-related factors, such as body weight and overeating, is required. In this study, we explored how dieting and dietary restraint were associated with body mass index (BMI; calculated as kg/m²) and disinhibition (tendency to overeat) in a sample of 1,071 postmenopausal women aged 45 to 75 years. In a survey of dietary attitudes and body image, we asked about current dieting status and measured restrained eating and disinhibition. Self-reported height and weight were used to calculate BMI, which was confirmed in a subset. Participants were classified by dieting status (yes/no) and level of dietary restraint (high/low by median split).We examined the independent effects of dieting and restrained eating on BMI and disinhibition. More than half of the sample (53%) reported current dieting. Dieting and dietary restraint showed opposite associations with BMI. Among dieters, BMI was 4.1 higher (95% confidence interval: 3.6 to 4.6) than among nondieters. In contrast, BMI of restrained eaters was 1.0 lower (95% confidence interval: −1.6 to −0.5) than unrestrained eaters. Dieters had higher scores for disinhibition, but disinhibition scores of restrained eaters did not differ from those of unrestrained eaters. Our results suggest that dieting and dietary restraint are not equivalent. Finding that dietary restraint is associated with lower BMI (when considered independently of dieting) suggests that restrained eating, rather than dieting, may contribute to successful weight management.     

Eating behaviors and indexes of body composition in men and women from the Québec family study

OBJECTIVE: To put into relationship the dietary and anthropometric profile of men and women with their eating behaviors (cognitive dietary restraint, disinhibition, and susceptibility to hunger) and to assess whether gender and obesity status influence these associations. RESEARCH METHODS AND PROCEDURES: Anthropometric measurements (including visceral adipose tissue accumulation), dietary profile (3-day food record), and eating behaviors (Three-Factor Eating Questionnaire) were determined in a sample of 244 men and 352 women. RESULTS: Women had significantly higher cognitive dietary restraint and disinhibition scores than men (p < 0.0001). In both genders, scores for disinhibition and susceptibility to hunger, but not for cognitive dietary restraint, were higher in obese subjects than in overweight and nonobese subjects (p < 0.05). Positive correlations were observed between rigid restraint and most of the anthropometric variables studied (0.12 相似文献   

Intentional mis-reporting of food consumption and its relationship with body mass index and psychological scores in women

BACKGROUND: The reasons for mis-reporting food consumption warrant investigation. OBJECTIVE: To document intention to mis-report food consumption and its associations with psychological measures in women. DESIGN: A total of 184 female volunteers aged 18-65 years, comprising 50 seeking help in primary care to lose weight with a body mass index (BMI) >/=30 kg m(-2) (obese-clinical group) and 134 nurses (nonclinical groups) (BMI <25 kg m(-2), n = 52; BMI 25-29.9 kg m(-2), n = 45; BMI >/=30 kg m(-2), n = 37) were studied. A questionnaire was administered containing three psychological tests (self-esteem, psychological well-being and Stunkard's three-factor eating questionnaire) and new items to address food intake mis-reporting. RESULTS: Overall, 68% of participants declared an inclination to mis-report (64% nonclinical, 78% clinical). Inclination to under-report was 29, 33 and 51% in the three nonclinical groups; and 46% among the obese clinical patients. Among the same groups, inclination to over-report were 39, 29, 11 and 32%. After adjusting for social deprivation and BMI, women inclined to mis-report had higher hunger (P = 0.008) and disinhibition (P = 0.005) scores than those intending to report accurately. These variables were associated with current dieting, frequency of dieting, self-reported bingeing and dissatisfaction with body weight. CONCLUSIONS: These findings indicate that intentional under-reporting and over-reporting of food consumption are common in women of all BMI categories and are associated with eating behaviour. Current dieting, frequency of dieting in the past, self-reported bingeing and dissatisfaction with body weight seem to mediate this relationship.     

A randomized trial of a dissonance-based eating disorder prevention program

OBJECTIVE: As psychoeducational eating disorder prevention programs have not been shown to reduce bulimic pathology, we developed and evaluated a dissonance-based intervention for high-risk populations. METHOD: Young women (N = 87) with body image concerns were randomized to this intervention, which involves verbal, written, and behavioral exercises requiring them to critique the thin-ideal, or to a healthy weight management control group. Participants completed a baseline, termination, and 4-week follow-up survey. RESULTS: Participants in the dissonance intervention reported decreased thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms at termination and at 4-week follow-up. Unexpectedly, participants in the healthy weight management control group also reported some benefits. DISCUSSION: Taken in conjunction with past findings, these preliminary results suggest that the dissonance intervention, and to a lesser extent the healthy weight management intervention, may reduce bulimic pathology and risk factors for eating disturbances.     

Psychological stress, coping, and symptoms of disordered eating in a community sample of young Australian women

OBJECTIVE: To investigate the relationships among stress, coping, and symptoms of disordered eating in a community sample of young Australian women. METHOD: A longitudinal study design was employed. Two mail-out surveys, assessing perceived psychological stress, coping strategies, body weight dissatisfaction, dieting, and disordered eating behaviors, were completed 6 months apart by 415 young women selected from a cohort of the Women's Health Australia Study. RESULTS: Strong cross-sectional relationships among the study variables were found. Results of longitudinal analyses, however, demonstrated only tenuous relationships among stress, coping, and later symptoms of disordered eating. DISCUSSION: These results did not support the hypothesis that stress and coping strategies would predict disordered eating over time. Some evidence was found for a modest reverse relationship between stress and disordered eating. Although contrary to generally accepted theoretical models of disordered eating, these findings are consistent with those of the few previous longitudinal studies reported. Theoretical implications are discussed.     

Subtyping binge eating-disordered women along dieting and negative affect dimensions.

OBJECTIVE: Because etiologic and maintenance models of binge eating center around dieting and affect regulation, this study tested whether binge eating-disordered (BED) individuals could be subtyped along dieting and negative affect dimensions and whether subtypes differed in eating pathology, social functioning, psychiatric comorbidity, and response to treatment. METHOD: Three independent samples of interviewer-diagnosed BED women (N = 218) were subtyped along dieting and negative affect dimensions using cluster analysis and compared on the outcomes of interest. RESULTS: Cluster analyses replicated across the three independent samples and revealed a dietary subtype (63%) and a dietary-depressive subtype (37%). The latter subtype reported greater eating and weight obsessions, social maladjustment, higher lifetime rates of mood, anxiety, and personality disorders, and poorer response to treatment than did the dietary subtype. DISCUSSION: Results suggest that moderate dieting is a central feature of BED and that affective disturbances occur in only a subset of cases. However, the confluence of dieting and negative affect signals a more severe variant of the disorder marked by elevated psychopathology, impaired social functioning, and a poorer treatment response.     

Eating disturbances in women of color: an exploratory study of contextual factors in the development of disordered eating in Mexican American women

The relationship between ethnocultural identity, eating practices, and cultural expectations is complex. When there are conflicting cultural demands, eating disturbances can occur. These disturbances affect many aspects of a woman's life, including her quality of life, health, relationships, and academic/career success. Contextual variables that may influence eating disorders in women of color include (a) level of acculturation, (b) socioeconomic status (SES), (c) peer socialization, (d) family structure, and (e) immigration status. This study examined these variables in a college sample of 115 Mexican American women. Each completed a demographic questionnaire and standardized instruments to measure acculturation, eating disorder symptoms, and family issues. Multiple regression analysis indicated that family rigidity contributes to an increased susceptibility for bulimic symptoms (p < .0001). Poor peer socialization and family rigidity were related to the preoccupation with body size and slimness, thus placing young Mexican American women at greater risk for developing self-destructive eating patterns such as severe weight control and dieting behaviors (p < .0001). Implications for health, quality of life, and appropriate therapeutic care are discussed.     

Perfectionism and symptoms of eating disturbances in female college students: considering the role of negative affect and body dissatisfaction

This study examined body dissatisfaction and negative affect in understanding the link between perfectionism and dieting and bulimic symptoms in a sample of 307 female college students. Perfectionism was found to be associated with dieting and bulimic symptoms. Body dissatisfaction was found to interact with socially prescribed perfectionism in predicting both dieting and bulimic symptoms. Support for a prediction model involving negative affect as a mediator between socially prescribed perfectionism and bulimic symptoms was found only among those who reported a moderate level of body dissatisfaction. For those who reported a high level of body dissatisfaction, socially prescribed perfectionism was the only significant predictor of bulimic symptoms. Implications of the present findings for future research and for working with female college students at risk for eating disturbances are discussed.     

A prospective study of disordered eating among sorority and nonsorority women

OBJECTIVE: The current study examined disordered eating prospectively among sorority and nonsorority women. METHOD: University women were surveyed during their first, second, and third undergraduate years. Disordered eating, depression, self-esteem, body mass index (BMI), and ideal weight were measured. RESULTS: Disordered eating did not differ between the groups before women joined sororities. By Time 3, sorority women reported higher Eating Disorder Inventory (EDI) Drive for Thinness subscale scores than nonsorority women, but the EDI Bulimia and Body Dissatisfaction subscales did not differ. BMI, ideal weights, depression, and self-esteem did not differ. CONCLUSIONS: Women who join sororities are similar to those who do not in their baseline levels of disordered eating, but they maintain more rigorous attitudes and behaviors regarding dieting over the course of their higher education.