Dieting in bulimia nervosa is associated with increased food restriction and psychopathology but decreased binge eating

The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the maintenance of binge eating. However, correlational and experimental studies suggest that additional clarification is needed about the nature of this relationship. Dieting, weight, eating disorder psychopathology, and depression were assessed at admission among 166 patients with BN presenting for residential treatment. As in past research, a significant fraction (43%) of patients with BN reported not currently dieting. A comparison of weight loss dieters and non-dieters found greater food restriction and eating disorder psychopathology among weight loss dieters. However, dieters reported less frequent binge eating. There were no significant group differences in depression. Results suggest that 1) while many individuals with BN are attempting to restrict their food intake, the goal of losing weight fundamentally alters the effect of such restriction on binge eating, and 2) treatment may benefit from helping patients to establish a healthier approach to achieving long-term weight stability.     

Eating behaviours, dietary profile and body composition according to dieting history in men and women of the Québec Family Study

The purpose of the present cross-sectional study was to compare eating behaviours (cognitive dietary restraint, disinhibition and susceptibility to hunger), dietary profile and physiological variables according to the practice of dieting: current dieting; history of dieting in the 10-year period that preceded the study; no dieting during the same period. Dieting history, anthropometric markers of adiposity, RMR, dietary profile (3 d food record) and eating behaviours (three-factor eating questionnaire) were determined in a sample of 244 men and 352 women. A greater proportion of women (31.8 %) than men (16.8 %) reported that they had been on a diet over the past 10 years (P=0.0001). In both genders, current and past dieters had a higher BMI (P<0.05) than non-dieters and current dieters had lower reported energy intakes than past dieters and non-dieters (only in women) (P<0.05). Current and past dieters also had higher scores for all eating behaviours and their subscales (P<0.05; except for susceptibility to hunger in men) compared with non-dieters (adjusted for age, reported energy intake, percentage of dietary fat, BMI and RMR). Moreover, for each dieting-history category, women had significantly higher scores for cognitive dietary restraint than men (P<0.05). In conclusion, the present study showed that current and past dieters had higher scores for cognitive dietary restraint and disinhibition compared with non-dieters. As disinhibition has previously been associated with a greater risk of subsequent weight gain, interventions aimed at preventing an increase in disinhibition may be promising for long-term weight maintenance.     

Food craving, dietary restraint and mood

A common assumption is that dieting causes food cravings, probably as a result of food energy deprivation. This issue was investigated in a two-phase study. In phase one, 206 women completed the Dutch Eating Behaviour Questionnaire, the Three-Factor Eating Questionnaire and a food craving scale. A correlational analysis showed food craving to be only weakly related to dietary restraint, but highly and significantly correlated with external eating, emotional eating and susceptibility to hunger. In phase two, ten women who regularly experienced food cravings and ten who rarely craved food kept prospective records of their food intake, daily mood and food craving episodes. There were few differences in eating behaviour, although the cravers tended to consume slightly more daily energy than the non-cravers. The cravers had higher ratings of boredom and anxiety during the day, and dysphoric mood was prominent prior to the cravings themselves. Food deprivation does not appear to be a necessary condition for food cravings to occur. Rather, food cravings are closely associated with mood, in particular as an antecedent to craving and also as a consequence of craving.     

Weight satisfaction and dieting practices among college males in Taiwan.

OBJECTIVE: To obtain baseline data regarding body mass index (BMI), weight satisfaction and weight perception in male college students. Approaches used to lose weight and characteristics of dieters were also investigated. METHODS: Written questionnaires and height and weight measurements were used to collect data. Nine-hundred thirty male college students selected by multiple stage sampling among colleges in Taiwan participated in this study. Simple frequency and ANOVA were used to analyze data. Post hoc analyses were performed with the LSD test when the F ratio for the ANOVA was significant at p<0.05. RESULTS: The mean BMI for all subjects was 21.7. Males with a BMI < or =22.5 are considered thin by Taiwanese and world standards. Yet 34% of these males were attempting to lose weight and 14% percent perceived themselves as either overweight or obese. Exercise was the main approach to losing weight for subjects in all weight categories. Subjects in the dissatisfied/dieting group tended to measure body weight more frequently (p<0.05), spent more time exercising and reading nutrition information (p<0.05) and skipped breakfast and lunch more frequently (p<0.05) than non-dieters. Male dieters ate fewer vegetables and less meat than non-dieters. CONCLUSIONS: Male college students had frequent misconceptions and dissatisfaction with their body weight. Behavioral characteristics among those dissatisfied with their weight indicate they are at risk for developing eating disorders.     

How visual images of chocolate affect the craving and guilt of female dieters

This study asks whether exposure to images of chocolate induces cravings and guilty feelings in females. A further aim was to examine whether these effects are heightened in the case of dieters. The participants, 85 females, saw a series of enticing media images, either of chocolate or of non-food products. Two thirds of the sample were dieting or had dieted in the past; 15% had been on seven or more diets. After viewing the images all participants completed the Attitudes to Chocolate Questionnaire (ACQ) [Benton, Greenfield, & Morgan (1998). The development of the attitudes to chocolate questionnaire. Personality and Individual Differences, 24(4), 513-520]. The different conditions affected only those who dieted. Dieters had significantly higher ACQ scores after viewing the chocolate images than the non-dieters. It is suggested that dietary restriction increases desire for forbidden foods, in the form of craving, and may induce negative affect such as guilt, anxiety and depression.     

Differentiating between successful and unsuccessful dieters. Validity and reliability of the Perceived Self-Regulatory Success in Dieting Scale

Dieting and the wish to lose weight are ubiquitous in our society. Only few people, however, are successful in long-term weight loss and -maintenance. The Perceived Self-Regulatory Success in Dieting Scale (PSRS) is a succinct 3-item measure that can be used to differentiate between successful and unsuccessful dieters. However, psychometric properties of the scale have not yet been investigated. We re-analyzed data from several studies and demonstrate validity and reliability of the PSRS. Internal consistency was reasonably high (Cronbach's alpha=.72-.79). Item means were medium and item-total-correlations were high. Validity of the scale was demonstrated such that it correlated negatively with body-mass-index (BMI), concern for dieting, rigid dietary control, food cravings, food addiction symptoms, and binge eating. Flexible dietary control was positively associated with the PSRS. We conclude that the PSRS constitutes a valid and reliable measure to efficiently assess dieting success.     

The psychology of food craving

Cravings are hedonic responses to food, characterised by their intensity and their specificity. Food cravings are extremely common, reported by the majority of young adults. They are closely associated with liking but not synonymous with increased intake. Structured interviews and prospective incident accounts of food cravings have succeeded in revealing a richness of information about their character, their antecedents and their consequences. In addition, laboratory investigations are adding to what is being learned from field and clinical studies. Taking dieting as an example of an assumed influence on food craving, the outcomes of cross-sectional studies are mixed and unconvincing. Prospective and experimental research shows a clearer relationship. Dieting or restrained eating generally increase the likelihood of food craving while fasting makes craving, like hunger, diminish. Attempted restriction or deprivation of a particular food is associated with an increase in craving for the unavailable food. This relationship suggests a variety of underlying cognitive, conditioning and emotional processes, of which ironic cognitive processes, conditioned cue reactivity and dysphoric mood are prominent. Food cravings may also be self-attributions, accounting for why a highly-palatable but self-restricted food is (over-)consumed. Overall, the popularised account of cravings as elicited by specific nutritional need is having to give way to a more subtle and complex appreciation of human eating behaviour.     

The nutrient and food intakes of 16–17 year old female dieters in the UK

A group of female teenage dieters was isolated from a larger national dietary survey of teenagers at 16–17 years of age. The dieting group included girls who both claimed to be dieting and who had energy intakes which were considered appropriate for weight loss, based on calculated reported energy intake to estimated basal metabolic rate cut-off points. The nutrient intakes and food choices of dieters (n= 204) were compared with a similar sample of non-dieters (n= 226) from the same cohort group. The mean reported energy intake of the dieters was 1604 kcals/day compared to 2460 kcals/day amongst non-dieters. The intakes of all the macronutrients in g/day were considerably lower amongst dieters, allowing for differences in region and social class, but when expressed as a percentage of energy intake, dieters had significantly lower intakes of fat and higher intakes of protein and intrinsic sugars, milk sugars and starch. No differences were seen in the percentage of energy provided by non-milk extrinsic sugars between the two groups. The intake of all micronutrients was substantially lower amongst dieters, allowing for regional and social class differences, and more than twice as many dieters as non-dieters failed to achieve the reference nutrient intake (RNI) for retinol equivalents, thiamin, riboflavin, folates, vitamin B12, vitamin B₆, zinc, copper and selenium. Reported food intake data for the two groups suggest that dieters consumed smaller quantities of most foods, although intakes of items associated with dieting such as low calorie soft drinks, low fat spread, skimmed milk, cottage cheese, yoghurt, salad vegetables, fruit and fruit juice were consumed in equal or greater amounts by dieters. Teenage dieters should be encouraged to include more nutrient-dense foods in their diets such as fortified breakfast cereals and low fat dairy products in order to obtain sufficient micronutrients from a lower calorie intake.     

Food cravings discriminate differentially between successful and unsuccessful dieters and non-dieters. Validation of the Food Cravings Questionnaires in German

Food cravings have been strongly associated with triggering food consumption. However, definitions and measurements of food cravings are heterogeneous. Therefore, [Cepeda-Benito et al., 2000] and [Cepeda-Benito et al., 2000] have suggested the Food Cravings Questionnaires (FCQs) to measure food cravings as a multidimensional construct at trait- and state-level. In the current study, we validated a German version of the FCQs in an online study (N = 616). The factor structure of the state and trait versions could partially be replicated, but yielded fewer than the originally proposed factors. Internal consistencies of both versions were very good (Cronbach’s α > .90), whereas retest reliability of the state version was expectedly lower than that of the trait version. Construct validity of the trait version (FCQ-T) was demonstrated by high correlations with related eating behavior questionnaires and low correlations with questionnaires unrelated to eating. Most importantly, FCQ-T-subscales were able to discriminate between successful and unsuccessful dieters and non-dieters. Validity of the state version was supported by positive relations with food deprivation and current negative affect. Taken together, the German version of the FCQs has good psychometric properties. Moreover, this study provided first evidence that distinct dimensions of food cravings are differentially related to success and failure in dieting.     

The nutrient and food intakes of British male dieters aged 16–17 years

Background : There is little information available about the dieting habits of teenage boys. This study aimed to examine the food and nutrient intake of male teenage dieters and compare these with the patterns reported among female dieters. Method : Male dieters aged 16–17 years were isolated from the 1970 Longitudinal Birth Cohort study group. Five hundred and one males who provided a 4-day unweighed dietary diary, height and weight measurements and appropriate background information. Results : Thirty-nine subjects (7.8%) both reported dieting and had a ratio of reported energy intakes to estimated basal metabolic rate measurements of less than 1.35. Dieters were taller and heavier than non-dieters, with mean BMIs of 24.6 and 20.0, respectively, for the two groups. Dieters reported average energy intakes of 9.16 MJ/day compared to intakes of 12.83 MJ/day among non-dieters, and the percentage of energy provided by protein was higher and that provided by NMES lower among dieters. Reported micronutrient intakes were lower among dieters, with calcium, magnesium, zinc, selenium, iodine, vitamin B ₆, vitamin C and retinol equivalents the nutrients most vulnerable to reduction in energy intakes. Dieters reported lower intakes of most food groups, but reported intakes of alcohol and meat and meat products were not reduced among dieters. Conclusion : Dieters clearly reported energy intakes which were unlikely to represent levels of intake sufficient to maintain existing weight. The nutrient and food intakes reported by the dieters were likely to reflect either true dieting behaviour during the study period, under-reporting or a combination of these effects.     

The effect of self-initiated weight-loss dieting on working memory: the role of preoccupying cognitions

This study investigated the effects of weight loss dieting on the components of working memory and the extent to which these effects were mediated by preoccupying cognitions concerning food, diet and body shape. A dual task paradigm was used in which dieters (n=20) and non-dieters (n=20) completed mental arithmetic problems concurrently with suppression tasks designed to engage the central executive, phonological loop, and visuo-spatial sketchpad components of working memory. In addition, tasks reflecting the articulatory control process and phonological store sub-components of the phonological loop were also completed. Results showed that dieters performed more poorly on measures of the central executive and the phonological loop compared with non-dieters. Dieters reported higher levels of preoccupying cognitions which mediated the relationship between dieting status and functioning of the central executive and phonological loop, and the phonological store in particular.     

Multiple types of dieting prospectively predict weight gain during the freshman year of college

The freshman year of college is a period of heightened risk for weight gain. This study examined measures of restrained eating, disinhibition, and emotional eating as predictors of weight gain during the freshman year. Using Lowe's multi-factorial model of dieting, it also examined three different types of dieting as predictors of weight gain. Sixty-nine females were assessed at three points during the school year. Weight gain during the freshman year averaged 2.1 kg. None of the traditional self-report measures of restraint, disinhibition, or emotional eating were predictive of weight gain. However, both a history of weight loss dieting and weight suppression (discrepancy between highest weight ever and current weight) predicted greater weight gain, and these effects appeared to be largely independent of one another. Individuals who said they were currently dieting to lose weight gained twice as much (5.0 kg) as former dieters (2.5 kg) and three times as much as never dieters (1.6 kg), but the import of this finding was unclear because there was only a small number of current dieters (N = 7). Overall the results indicate that specific subtypes of dieting predicts weight gain during the freshman year better than more global measures of restraint or overeating.     

Reduction of food cravings through concurrent visuospatial processing

OBJECTIVE: Two experiments adopted a working memory approach to evaluate the effectiveness of visuospatial tasks as a technique for reducing food cravings. METHOD: Dieting and non-dieting women were asked to form images of both food-related and nonfood items, induced by either pictures (Experiment 1) or verbal cues (Experiment 2). They were required to concurrently perform one of three tasks that load on the visuospatial sketch pad of working memory: saccadic eye movements, dynamic visual noise, or spatial tapping. RESULTS: In support of the working memory model of limited visuospatial capacity, concurrent visuospatial activity reduced the vividness of food-related images which, in turn, reduced the intensity of the associated craving. The same pattern of results was observed across dieters and non-dieters and for all stimulus types. DISCUSSION: Visuospatial tasks may provide a useful technique for the treatment of food craving episodes in both nonclinical and clinical populations.     

Food perception in dieters and non-dieters

Two studies examined dieter-non-dieter differences in food perception. There were two specific questions. First, do dieters spontaneously categorize foods in terms of emotions (e.g., guilt) more than do non-dieters? Second, do dieters perceive foods in a more complex manner than do non-dieters? Female undergraduates (N = 50 and N = 46 in the two studies) were given cards containing the names of randomly-selected generic foods (e.g., cakes, melons) and were asked to "group the foods according to how you think about them when it comes to eating them". Herman and Polivy's Restraint Scale was used to classify subjects as dieters and non-dieters. Cluster analyses of the labels used by subjects to name their groups revealed six clusters in both studies. Four of these clusters showed substantial similarity across the two studies. These were an Enjoyment Cluster, a Sensory Qualities Cluster, a No Guilt Cluster and a Nutritional Qualities Cluster. One major finding was that, in both studies, dieters had significantly higher scores on the No Guilt Cluster than did non-dieters. Thus dieters thought of food in terms of absence of guilt more than did non-dieters. With respect to the issue of complexity in perception, the findings clearly contradicted the notion that dieters simply dichotomize food into "good" and "bad" categories.     

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.     

"Chocolate Addiction": a Preliminary Study of its Description and its Relationship to Problem Eating

Definitions of chocolate addiction and its potential relationship to dieting and problem eating were investigated in 50 individuals who identified themselves as "chocoholics". Respondent were interviewed and completed a battery of questionnaires on food cravings, eating, weight, dieting and depression. On average this sample consumed about 12 (60-g) bars of chocolate per week and craved chocolate about six times per week. Cravings and amount consumed were not significantly related but amount consumed was significantly correlated with disinhibition (r=0·3). Most (76%) respondents had definition of chocolate addiction that centred on a lack of control around chocolate and regarded the "addictive" factor in chocolate as orosensory (i.e. taste, smell, texture). Unlike most others, dieters and secret eaters experienced negative affect following consumption of chocolate. Consumers who preferred to eat in secret reported a higher degree of aberrant eating. The extent to which the behaviour of "chocolate addicts" resembles that of eating disordered individuals and other addictions remains to be clarified.     

Consumer views of hunger and fullness. A qualitative approach

The objective of this study was to gain a better understanding of the complex ideas of hunger and fullness from consumers through the use of focus groups. We report results of 4 focus group interviews with (1) female normal weight dieters, (2) female normal weight non-dieters, (3) female overweight dieters and non-dieters, and (4) male normal weight dieters and non-dieters. Hunger and fullness sensations were described as having both physical and psychological components that were divided into two groups: typical and extreme. Overall, hunger was described as the presence of stomach growls, stomach hunger pains, emptiness, focus on eating, loss of energy, and desire to eat. Fullness was described as a feeling of food in the stomach, stomach stretch, satisfaction, contentment, energized, focused, and lack of the desire to eat. Typical fullness was described with many psychological components while typical hunger was primarily physical in nature. Participants described situations where sensations of mental hunger and physical fullness overlapped, which provided evidence that the overall constructs of hunger and fullness may not be simple, polar opposites.     

Relationship between dieting to lose weight and the functioning of the central executive

The study investigated the impact of weight-loss dieting on the four identified functions of the central executive of working memory: dual-task performance, random generation, task switching and activation of long-term memory. Participants were 32 female current dieters and 32 female non-dieters who completed four well-established cognitive tasks designed to tap each specific function. Participants also completed tasks designed to load on the phonological loop and visuo-spatial sketch pad working memory systems, as well as self-report measures of depressed affect and preoccupying cognitions. Dieters performed more poorly than non-dieters on all central executive measures except random generation. These dieting-related differences were most evident on moderately complex trials, and were partially mediated by preoccupying thoughts about food, weight and body shape, but not by BMI or depressed affect. It was concluded that weight-loss dieting has a relatively global impact on central executive functioning and thus has wide-ranging cognitive consequences.     

The influence of restrained and external eating patterns on overeating

Eating in response to an increasingly obesogenic environment has been strongly implicated as a salient aspect of eating behaviour, arguably influenced by learning and experience. Interindividual differences in susceptibility to weight gain may be due, in part, to variability in response to environmental triggers. The phenomenon of food craving may also be an important factor influencing appetite control. The present study tested a model, in which food craving was hypothesised to be an intervening causal variable, on a causal pathway between responsivity to environmental cues and the development of obesity. One hundred and twenty four participants (aged 21-71 years, 83 females and 41 males) completed the study. Participants completed the Dutch eating behaviour questionnaire (DEBQ), measuring external eating (externality), emotional eating (emotionality) and restrained eating behaviour (restraint), and an adapted form of the food craving inventory (FCI), assessing cravings for carbohydrate, fats, sweets and fast food fats, in addition to total food cravings. Initial analysis showed positive correlations between FCI-tot and body mass index (BMI), FCI-fats and BMI and FCI-fast food fats and BMI in both men and women, and between FCI-carbohydrates and BMI in men only. Multiple regression analyses showed externality as the principal predictor of food craving, which was greater in males compared to females, but differential for different food groups between genders. Restrained eating and cravings for fats and fast food fats were negatively associated in women only. As predicted, total cravings, and cravings for fats and fast food foods mediated the positive association between external eating and BMI. It is concluded that appetitive response to external cues as an important risk factor in appetite control is mediated through cravings for particular food groups and is gender-dependent.     

Dieting status and its relationship to weight, dietary intake, and physical activity changes over two years in a working population

The present study prospectively examined changes in dietary intake, physical activity and weight associated with self-reported efforts to lose weight in a cohort of 3671 men and women sampled from the general population. Dieting efforts, dietary intake, physical activity and weight were measured at two points in time, 24 months apart. At baseline, current dieters reported consuming fewer dairy products, sweets, meat, soft drinks and fried potatoes (all p's < .0001), and engaging more frequently in high-intensity physical activity (p < .0001) than those not currently dieting. At follow-up, current dieters reported consuming fewer sweets (p < .0001) and fried potatoes (p < .0008), and engaging more frequently in moderate-intensity physical activity (p < .02) than those not currently dieting. Prospectively, those who initiated weight-loss diets showed the largest decrease in consumption of sweets (p < .0001), soft drinks (p < .0001), and fried potatoes (p < .01), and increase in frequency of high-intensity physical activity (p < .0001) and moderate-intensity physical activity (p < .007). Those initiating weight-loss diets were the only group to lose weight (1 lb.). Those dieting at baseline but not at follow-up gained the most weight (4 lbs.). Self-reports of current dieting correspond to reported changes in dietary intake and physical activity, and to measured changes in weight over the same time period. Individuals who report dieting to lose weight have healthier eating and exercise patterns than those who do not report dieting.