Biomedical subjects

W S Agras

Publications and source records attributed to W S Agras.

At least 37 records · Page 2Linked to original sources

PubMed1999

Natural history of disordered eating attitudes and behaviors over a 6-year period.

OBJECTIVE: This study investigated the course of eating attitudes and eating-disordered behaviors in a community sample of adult women. METHOD: Participants (N = 166; mean age = 32.8 years) completed the Eating Disorder Inventory (EDI), the Three-Factor Eating Questionnaire (TFEQ), and a questionnaire assessing bulimic behaviors at two time points, 6 years apart. RESULTS: Correlations for rank ordering of scores on these measures were all significant, indicating high rank stability over time. Although rates of specific bulimic behaviors decreased over time, mean scores on eating disorder attitude scales tended to increase. DISCUSSION: Findings challenge the commonly held belief that disturbed eating attitudes decline with age.

Adult↗

PubMed1999

Subtyping bulimic women along dietary restraint and negative affect dimensions.

Etiologic models of bulimia center on dieting and negative affect, yet no research has subtyped bulimic individuals according to whether they fit dietary versus negative affect profiles. This study subtyped 265 bulimic women along dieting and depressive dimensions and tested whether subtypes showed differences in eating pathology, clinical correlates, and treatment response. Cluster analysis revealed a pure dietary subtype (62%) and a mixed dietary-depressive subtype (38%). Whereas dietary and dietary-depressive bulimic women showed similar levels of bulimic behaviors, the latter reported more eating and weight obsessions; social maladjustment; higher rates of mood, anxiety, eating, impulse control, and personality disorders; and poorer treatment response. Results suggest dieting is a central feature of bulimia, but depressive affect occurs in only a subset of cases. However, the combination of dieting and depressive affect seems to signal a more severe variant of bulimia.

Adolescent↗

PubMed1999

Can mothers influence their child's eating behavior?

This study examined the relationship between general maternal parenting style, maternal eating cues, and a child's eating behavior during mealtime. We expected that the general style would relate to the number of specific eating cues and that mothers who used more eating prompts would have children that ate more and at a faster rate. Seventy-seven children (39 girls, 38 boys), aged 3.5 years, visited the laboratory with their mothers for a videotaped lunch. Videotapes of each laboratory visit were coded for the child's eating rate and maternal parenting style, which was measured as the level of maternal control and support and the number and type of eating prompts given during a meal. Caloric intake was also calculated. The number and rate of verbal and physical encouragements and discouragements were significantly related to measures of general maternal parenting style and meal duration. The rates of food offers, food presentations, and total prompts were all significantly related to the child's rate of calorie intake. However, a mother's level of support or control was not related to the child's eating behavior. Although general maternal parenting style did not predict the child's eating behavior, these behaviors were related to the frequency of maternal eating prompts, which in turn were significantly related to the number of calories eaten and the time spent eating by the child. Children who ate the fastest had mothers who delivered eating prompts at a higher frequency. These findings may have implications for the development of obesity later in childhood, as a function of rapid eating or of poor self-regulation.

Child Behavior↗

PubMed1998

Does the size of a binge matter?

OBJECTIVE: The aim of this study was to examine whether objective and subjective binges differ significantly from each other in relation to measures of psychopathology in a sample of women who meet DSM-IV diagnostic criteria for bulimia nervosa. METHOD: Baseline data from the Eating Disorder Examination (EDE) were analyzed and the average of the sum of and the difference between objective and subjective binge episodes were converted to z scores. Regressions were run with other baseline measures including the Structured Clinical Interview for Diagnosis of DSM-III-R (SCID) I and II disorders, EDE subscales, and psychological measures. RESULTS: We found no significant difference between the two types of binges on all but one measure, the "Can Do" subscale of the Self-Efficacy Questionnaire, in a regression with the z score of total binges. DISCUSSION: The lack of significant findings questions the diagnostic validity of the "large amount of food" criterion used to define binge eating in the DSM-IV.

Adult↗

PubMed1997

Eating and general psychopathology in a sample of Caucasian and ethnic minority subjects.

OBJECTIVE: Most research on eating disorders (ED) has been conducted on Caucasian women. Considerable uncertainty remains as to the presentation of ED in ethnic minorities. The primary aim of this study was to investigate whether or not Caucasian and minority eating disorder subjects differ on key ED symptomatology and general psychopathology. METHOD: This descriptive investigation examined the separate and combined influences of ED diagnosis (bulimia nervosa, binge eating disorder, or overweight subjects with no eating disorder) and ethnicity (Caucasian vs. minority) on ED symptomatology and general psychopathology. Suitable subjects, 109 Caucasian and 40 minority women, attended a clinical interview and completed several ED and general psychopathology questionnaires. RESULTS: Clear differences were shown in terms of ED and general psychopathology between the ED groups, with bulimia nervosa subjects scoring consistently higher than the other two diagnostic groups. However, Caucasian and minority subjects scored similarly on the eating disorder and general psychopathology measures. DISCUSSION: Therefore, the findings suggest that current ED treatment protocols found to be effective with Caucasian subjects may not need to be modified before application to minority patients with ED.

Adolescent↗

PubMed1997

The relationship between perceived evaluation of weight and treatment outcome among individuals with binge eating disorder.

OBJECTIVE: This study was designed to explore among individuals with binge eating disorder (BED) perceptions of others' evaluation of their weight-related behavior and affect aroused by such. METHOD: Prior to treatment for binge eating and weight loss, 47 subjects diagnosed with BED completed a questionnaire designed to assess the perceived evaluation of an understanding and a critical individual in both positive and negative weight-related situations and subjects' affective responses to being evaluated. RESULTS: Subjects exhibited characteristic patterns of affective response to perceived evaluation of their weight-related behavior, with negative situations and critical evaluators evoking greater degrees of negative affect. Negative affect in response to perceived evaluation was associated with poor outcome with weight loss but not binge eating. However, this finding was due to the correlation between negative affect in response to perceived evaluation and global severity of psychopathology (SCL-90-R). DISCUSSION: The results suggest that psychopathology in this population predicts poor outcome with weight loss, and further that independent of its relationship with depression, psychopathology is strongly associated with a tendency to experience negative affect in response to perceived evaluation by others of weight-related behavior.

Adult↗

PubMed1997

Subjective or objective binge: is the distinction valid?

OBJECTIVE: The aim of this study was to examine the validity of the distinction between objective and subjective binge episodes. METHOD: Data were analyzed from 101 women who received 12 weeks of cognitive-behavioral therapy (CBT) for binge eating in a previous treatment study. Binges recorded by participants on daily food records were rated as either subjective or objective according to the Eating Disorder Examination rating guidelines. Unpaired t tests were performed to determine the relationship between type of binge, psychopathology, and other descriptive measures, including response to treatment. RESULTS: These analyses revealed no significant differences between types of binge episodes. Of note is the observation that objective binge episodes appeared to decrease more rapidly than subjective episodes during treatment. DISCUSSION: Future research should continue to investigate whether "large amount of food" is an appropriate criterion for the diagnosis of binge eating.

Adult↗

PubMed1997

One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder.

The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive-behavioral therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight loss of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss in BED.

Analysis of Variance↗

PubMed1997

Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes.

The longer-term effects of antidepressant medication, with and without the addition of psychotherapy, for the treatment of bulimia nervosa and binge eating disorder are reviewed. The use of a single antidepressant agent results in recovery of about 25 percent of patients entering treatment; continued treatment is accompanied by relapse in about one-third of these patients. Substituting one or more antidepressants for the initial agent in patients who fail to improve or cannot tolerate side effects improves long-term maintenance. Adding cognitive-behavioral therapy (CBT) may prevent relapse once medication is discontinued, and the combination of CBT and antidepressant treatment is more effective than a single medication. There is also evidence that antidepressant treatment combined with CBT is more effective than placebo plus CBT. The problem of how to sequence medication and CBT has not been resolved, although a recent study demonstrating that pharmacotherapy is more cost-effective than CBT suggests that treatment might begin with medication.

Antidepressive Agents↗

PubMed1996

Weight and shape overconcern and emotional eating in binge eating disorder.

OBJECTIVE: This study investigated two issues: the level of weight and shape concerns, and the self-reported tendency to eat in response to negative emotions among obese individuals with binge eating disorder (BED), eating disorder not otherwise specified (EDNOS), and no eating disorder (CONTROL). METHOD: On the basis of demographic and diagnostic surveys, 156 participants in a weight loss program were categorized on two dimensions, eating disorder category and weight (BED vs. EDNOS vs. CONTROL/low vs. high body mass index), yielding a 2 x 3 experimental design. RESULTS: Individuals with BED reported a greater tendency to eat in response to negative mood states than CONTROL subjects and low weight EDNOS subjects, but not high weight EDNOS subjects. Weight did not influence self-reported weight and shape concerns. Individuals with BED expressed greater concern for weight and shape than non-eating disordered CONTROLs. DISCUSSION: The findings suggest that overconcern with weight and shape be further investigated as a diagnostic feature of BED and that emotional eating is associated with BED but not obesity per se.

Adult↗

PubMed1996

Burned out binge eaters: a preliminary investigation.

OBJECTIVE: The purpose of this study was to compare individuals who meet all the diagnostic criteria for binge eating disorder (BED), except loss of control, to individuals with BED and eating disorder not otherwise specified (EDNOS) on weight history variables. METHOD: Subjects were solicited among new participants in weight loss programs, with 35 meeting BED criteria, 47 meeting criteria for EDNOS, and 6 meeting criteria for BED without loss of control. RESULTS: Groups were not found to differ on age of onset of overweight or dieting, age of first binge, rate of largest weight loss, or number of times of losing 10 + lb. Groups did differ on highest weight ever and current body mass index (BMI). Subjects with BED without loss of control had a significantly higher highest weight and current BMI than both BED and EDNOS subjects. DISCUSSION: The results suggest that individuals reporting all the symptoms of BED except loss of control may be "former" BEDs who have "given up" on efforts to control their binge eating.

Adult↗

PubMed1996

Do emotional states influence binge eating in the obese?

OBJECTIVE: The purpose of this experimental investigation was to test the hypothesis that negative affective states trigger disinhibited eating in the form of binge eating in subjects with binge eating disorder (BED). METHOD: BED subjects and weight-matched non-eating disordered subjects (NED) attended a laboratory experiment during which they were randomly assigned to a negative or neutral mood induction procedure prior to being served a multi-item buffet. The dependent variable of interest was postmood induction caloric intake. RESULTS: There were no significant differences in caloric intake between subjects in the negative and neutral mood conditions. However, negative affect was associated with eating episodes labeled binges, and associated with loss of control. DISCUSSION: Our findings suggest that mood may be an important factor that discriminates overeating and binge eating.

Analysis of Variance↗

PubMed1996

The effects of short-term food deprivation on caloric intake in eating-disordered subjects.

The primary aim of this experimental investigation was to examine the effects of short-term dietary restriction on caloric consumption in eating disordered subjects. Subjects with bulimia nervosa, binge eating disorder, and overweight non-eating disordered subjects, attended a laboratory experiment during which they were randomly assigned to either a 1 h or a 6 h food deprivation condition prior to being served a multi-item buffet. The primary measure of interest was calories consumed during the laboratory experiment. Subjects deprived of food for 6 h consumed significantly more calories at the buffet compared to subjects in the 1 h food deprivation condition. However, caloric intake during the entire laboratory day was not affected by the experimental manipulation. Subjects in the longer deprivation condition apparently compensated at the buffet for the caloric restriction, but did not overcompensate.

Adult↗

PubMed1996

Maintenance following a very-low-calorie diet.

The authors posed 2 questions in this randomized study of maintenance procedures in which participants were followed for 15 months after completion of a very-low-calorie diet: Would stimulus narrowing during the reintroduction of solid food, achieved by the use of prepackaged foods, improve weight losses and the maintenance of those losses as compared with the use of regular food? Would reintroduction of foods dependent on progress in losing or maintaining weight be superior to reintroduction on a time-dependent basis? Neither the stimulus narrowing condition nor the reintroduction procedure enhanced either maximum weight loss or maintenance of those losses. The stimulus narrowing condition appeared to be poorly tolerated; compliance and attendance were poorer in this condition than in the regular food condition.

Adult↗

PubMed1996

The aversiveness of specific emotional states associated with binge-eating in obese subjects.

OBJECTIVE: The aim of this study was to examine the hypothesis that non-purge-related binge-eating in obesity is maintained by a 'trade-off' in which a highly aversive emotional state is exchanged for a less aversive state. METHOD: Ninety-eight obese binge-eaters meeting the DSM-IV criteria for binge-eating disorder were contrasted with 65 non-binge-eating controls on their perceived distress associated with negative mood states usually experienced before and after binges. RESULTS: Binge-eaters reported significantly greater distress and lower tolerance of negative mood compared to controls. Furthermore, when compared with controls, binge-eaters reported that emotions typically reported before binges (e.g. anger) were more aversive than those reported after (e.g. guilt). CONCLUSIONS: These results were interpreted as supporting the 'trade-off' theory and have implications for the treatment of binge-eating disorder.

Adult↗

PubMed1995

Comparing the cost effectiveness of psychiatric treatments: bulimia nervosa.

We conducted an exploratory post hoc study that compared the cost effectiveness of five treatments for bulimia nervosa: 15 weeks of cognitive behavioral therapy (CB) followed by three monthly sessions, 16 weeks (Med16) and 24 weeks (Med24) of desipramine (< or = 300 mg/day), and CB combined with desipramine for those durations (Combo16 and Combo24). We illustrate how a treatment's cost effectiveness varies according to when evaluation is done and how effectiveness and cost are defined. At 32 weeks, Med16 appears the most cost-effective treatment, and Combo16 appears the least. At 1 year, Med24 appears the most cost-effective treatment, and Combo16 appears the least. Using this post hoc analysis as an example, we discuss the pitfalls and limitations of cost-effectiveness analysis of psychiatric treatments.

Adolescent↗

PubMed1995

The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating.

The development of the Emotional Eating Scale (EES) is described. The factor solution replicated the scale's construction, revealing Anger/Frustration, Anxiety, and Depression subscales. All three subscales correlated highly with measures of binge eating, providing evidence of construct validity. None of the EES subscales correlated significantly with general measures of psychopathology. With few exceptions, changes in EES subscales correlated with treatment-related changes in binge eating. In support of the measure's discriminant efficiency, when compared with obese binge eaters, subscale scores of a sample of anxiety-disordered patients were significantly lower. Lack of correlation between a measure of cognitive restraint and EES subscales suggests that emotional eating may precipitate binge episodes among the obese independent of the level of restraint.

Adaptation, Psychological↗

PubMed1995

General population-based epidemiological study of eating disorders in Norway.

In a questionnaire-based study of eating disorders in a representative sample of the general female population of Norway, the lifetime prevalence of eating disorders was 8.7% with a point prevalence of 3.8%. The lifetime prevalence of binge eating disorder (BED) was 3.2%, bulimia nervosa (BN) 1.6%, and anorexia nervosa (AN) 0.4%. Eating disorders not otherwise specified (EDNOS) had a lifetime prevalence of 3.0%. Point prevalence of BED was 1.5%, BN 0.7%, AN 0.3%, and EDNOS 1.3%.

Adolescent↗