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PubMed2026

Genomic meta-analyses of binge-eating behavior and anorexia nervosa yield insights into the unique and shared biology of eating disorder phenotypes.

Eating disorders-including anorexia nervosa (AN), bulimia nervosa and binge-eating disorder-are clinically distinct but exhibit symptom overlap and diagnostic crossover. Genomic analyses have mostly examined AN. Here we conducted a genomic meta-analysis of case-control studies of binge-eating behavior (BE; 39,279 cases, 1,227,436 controls), alongside analyses of AN (24,223 cases, 1,243,971 controls) and its subtypes (all European ancestries). We identified six BE-associated loci, including loci associated with a higher body mass index and impulse-control behaviors. AN genome-wide association studies yielded eight loci, validating six loci. Subsequent polygenic risk score analysis demonstrated an association with AN in two East Asian ancestry studies. BE and AN exhibited similar positive genetic correlations with psychiatric disorders but opposing genetic correlations with anthropometric traits. Most of the genetic signal in BE and AN was not shared with body mass index. We have extended eating disorder genomics beyond AN; future work will incorporate multiple diagnoses and global ancestries.

Behavioural genetics↗

PubMed1993

No major differences in energy metabolism between matched and unmatched groups of 'large-eating' and 'small-eating' men.

Rates of energy expenditure (J/kg fat-free mass (FFM) per min) in normal weight, 'small-eating' men were compared with those obtained for normal weight (n 8) and underweight (n 5) 'large-eating' men. For the matched groups of 'large-' and 'small-eaters' there were no differences in resting metabolic rate (RMR) measurements but during controlled daily activities there was a small but significant increase (P < 0.05) in energy expenditure in the 'large-eaters'. These results contrast with those obtained for the unmatched groups where energy requirements were about 10% (P < 0.01) higher in the underweight 'large-eaters' at rest but were not different during the more energetic (walking) activities. However, after adjustment for differences in FFM between these two groups, the resting energy expenditures of the 'large-eaters' (82.54 (SE 1.51) J/kg FFM per min) were similar to those of the 'small-eaters' (81.87 (SE 1.51) J/kg FFM per min). Oral temperatures were significantly higher in the matched (0.35-0.65 degrees) and unmatched (0.7-0.9 degrees) 'large-eaters' both at rest and during the different activities, but the thermic effect of food (50 kJ/kg FFM) was one fifth lower (not significant) in both groups of 'large-eaters'. These results provide little evidence for any major metabolic differences between groups of 'large-eating' and 'small-eating' men.

Adult↗

PubMed2002

Incidence of chaotic eating behaviors in binge-eating disorder: contributing factors.

Because dieting is not as common in patients with binge-eating disorder (BED) as among patients with bulimia or anorexia nervosa, the authors assessed the incidence, frequency, and contributing factors of semistarvation-like eating patterns in BED patients in this study, the first to explore such behaviors in a clinical population. They administered the Semistarvation-Associated Behaviors Scale (SSABS) to 54 women seeking BED treatment and to 29 controls. The aberrant eating behaviors among BED clients were associated with current dieting and certain BED criteria, (p < .05). The strongest contributor to chaotic eating patterns was negative affect preceding BED (r = .45, p < .001). This finding highlights the behavioral psychopathology of BED and strengthens the role of negative affect in precipitating binge episodes associated with the disorder. These behaviors may help maintain BED by creating a binge-negative affect cycle. The SSABS is a tool that may help break this cycle.

Adolescent↗

PubMed2003

The relationship between eating pathology and perceived family functioning in eating disorder patients in a day treatment program.

This study examines the perceived levels of family functioning and their relationships with eating pathology across three eating disorder diagnostic groups. Charts of 65 day treatment female patients, ranging in age from 12 to 27 years, were studied by diagnosis and assessed using the FACES-II and EDI-2. Using multiple regression analyses, it was determined that perceived family functioning yielded significant predictions for various EDI-2 subscales within both Anorexia Nervosa and Eating Disorder Not Otherwise Specified diagnoses. Significant correlations were found between FACESII and the EDI-2 for all three diagnostic groups. Using ANOVA analyses and Bonferroni comparisons, significant differences among diagnoses on the EDI-2 subscales were obtained when studying patients within different family types as defined by FACES-II. These data support previous findings that suggest that as family functioning is perceived to be more dysfunctional the severity level of eating pathology increases.

Journal Article↗

PubMed2003

Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder.

This study compared patients with bulimia nervosa (BN), obese patients with binge eating disorder (BED), and nonobese patients with BED. One hundred sixty-two adult women consecutively evaluated for outpatient clinical trials who met DSM-IV criteria for BN, purging type (N = 46) or for BED (N = 79 obese and N = 37 nonobese) were compared using the Eating Disorder Inventory (EDI). The three groups differed significantly on two (drive for thinness and body dissatisfaction) of the three eating-related scales and on all five of the general personality scales of the EDI. When age and depression level were controlled, findings for the eating-related scales did not change, whereas four of the five general personality scales were no longer significant. Post hoc analyses revealed that the BN group and the nonobese BED group had significantly higher drive for thinness than the obese BED group. The nonobese and the obese BED groups did not differ from each other in any area (other than drive for thinness), including body dissatisfaction. The nonobese and the obese BED groups had significantly lower maturity features than the BN group. Our findings suggest that when the effects of age and depression levels are controlled, treatment-seeking women with BN and BED are generally similar. Certain differences that do exist between women with BN and BED are associated with obesity status (drive for thinness), whereas others are associated with diagnosis (body dissatisfaction, maturity fears).

Adolescent↗

PubMed2025

Genome-wide association studies of binge eating behaviour and anorexia nervosa yield insights into the unique and shared biology of eating disorder phenotypes.

Eating disorders -including anorexia nervosa (AN), bulimia nervosa, and binge eating disorder-are clinically distinct but exhibit symptom overlap and diagnostic crossover. Genomic analyses have mostly examined AN. We conducted the first genomic meta-analysis of binge eating behaviour (BE; 39,279 cases, 1,227,436 controls), alongside new analyses of AN (24,223 cases, 1,243,971 controls) and its subtypes (all European ancestries). We identified six loci associated with BE, including loci associated with higher body mass index (BMI) and impulse-control behaviours. AN GWAS yielded eight loci, validating six loci. Subsequent polygenic risk score analysis demonstrated an association with AN in two East Asian ancestry cohorts. BE and AN exhibited similar positive genetic correlations with psychiatric disorders, but opposing genetic correlations with anthropometric traits. Most of the genetic signal in BE and AN was not shared with BMI. We have extended eating disorder genomics beyond AN; future work will incorporate multiple diagnoses and global ancestries.

Journal Article↗

PubMed2003

Academy for Eating Disorders International Conference on Eating Disorders. Denver, CO, USA, May 29-31, 2003.

The focus of this meeting was the interface between eating disorders and obesity. A symposium at this meeting dealt with advances in treatment for bulimia nervosa (BN) and binge eating disorder. There were two presentations in this symposium that addressed pharmacological treatments. One reviewed drug treatments for BN, which included reviewing the evidence for the efficacy of tricyclic antidepressants, monoamine oxidase inhibitors and selective serotonin inhibitors in the treatment of BN. All drug studies demonstrated greater reduction in binge eating and purging than with placebo. Other medications studied without evidence of efficacy for BN include opiate antagonists, lithium and anticonvulsants. Two promising agents for BN that require further study are odansitron and topiramate. For binge eating disorder, studies have examined the efficacy of antidepressants (tricyclic antidepressants, selective serotonin re-uptake inhibitors and serotonin/noradrenaline re-uptake inhibitors), antiobesity agents (sibutramine) and antiepileptics associated with weight loss (topiramate), with some evidence of efficacy for these agents.

Anti-Obesity Agents↗

PubMed2003

Stages of change for healthy eating in diabetes: relation to demographic, eating-related, health care utilization, and psychosocial factors.

OBJECTIVES: To identify diabetes-related characteristics of individuals at different stages of readiness to change to healthy, low-fat eating. RESEARCH DESIGN AND METHODS: Stage-based differences in demographic, eating-related, health care utilization, and psychosocial factors were examined in a sample of 768 overweight (BMI >27 kg/m(2)) individuals with diabetes enrolled in a randomized behavioral intervention trial. RESULTS: Stage-based differences occurred for type 1 diabetic participants on percent of calories from fat and number of daily vegetable servings. For type 2 diabetic participants, sex, disease-specific quality of life, percent calories from fat, and number of daily vegetables servings differed across stages. Those in action stages were more likely to be female and have a better quality of life and healthier eating habits. Type 2 diabetic insulin-requiring participants in action stages were more likely to be married. Social support was highest for those in the contemplation stage and lowest for those in the action stage. Type 2 diabetic participants on pills in the action stages were older, had a lower BMI, ate more fruit, were nonsmokers, recently attended diabetes education, had a better quality of life and social support, and had less stress. One anomalous finding for type 2 diabetic participants was that precontemplators scored similarly to those in action stages. CONCLUSIONS: These data validate the Transtheoretical Model, where those in the action stages displayed healthier eating. They also indicate that demographic and psychosocial factors may mediate readiness to change diet. Precontemplators were a heterogeneous group and may need individually tailored interventions.

Analysis of Variance↗

PubMed1996

Effect of oral sensorimotor treatment on measures of growth and efficiency of eating in the moderately eating-impaired child with cerebral palsy.

Thirty-five children with cerebral palsy and moderate eating impairment were studied to determine the effect of oral sensorimotor treatment (OST) on eating efficiency and measures of growth (weight gain). After taking effects of maturation into account, 11 children who received OST (group A) exceeded their expected centile line by 1.7 percentile points after 10 weeks of treatment. Chewing exercises alone (group B) had no effect on weight gain. Although small decreases occurred in the time needed to eat three standard textures of food (solid, viscous, puree) in groups A and B, these were not significant. Children maintained their weight-for-age percentile line although at the lower end of expected norms. These children will be at risk of growth failure because of the increased energy demands once they enter their teenage growth spurt. The clinical implications of these findings are that prolonged mealtime and oral-motor therapies may be adequate through the childhood years. Thereafter, children's growth must be monitored carefully, and oral caloric supplementation is suggested to provide the necessary energy for growth.

Adolescent↗

PubMed2000

Subliminal activation of abandonment- and eating-related schemata: relationship with eating disordered attitudes in a nonclinical population.

OBJECTIVE: Previous research has demonstrated that subliminal abandonment cues can facilitate eating behavior. It is believed that such eating is a response to the activation of specific core schemata. However, the precise nature of those schemata has not been established. This study examined whether the presentation of subliminal abandonment and food/shape cues results in the activation of abandonment-related or food-related schemata. METHOD: Eighty-two women were exposed to one of three subliminal cues- an abandonment cue ("lonely"), an appetitive cue ("hungry"), and a neutral cue ("gallery"). They subsequently completed Stroop tasks to measure activation of relevant schemata. RESULTS: Subliminal presentation of abandonment cues led to the activation of food- and shape-related schemata. In contrast, subliminal appetitive cues resulted in an activation of abandonment-related schemata. CONCLUSIONS: The results show preliminary support for a multilevel cognitive model, involving indirect links between subliminal cue type and the activation of eating-related cognitions.

Adult↗

PubMed1995

The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology.

Anorectic and bulimic patients (n = 100) were interviewed using the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). All patients reported preoccupations and rituals related to their eating disorder ranging from mild to severe symptomatology, with mean scores in the moderate range. The preoccupations were more severe than the rituals; however, the rituals were still time-consuming, distressing, and interfered with functioning. Both preoccupations and rituals were largely ego syntonic. The YBC-EDS is an easy to administer interview which characterizes and quantifies preoccupations and rituals associated with eating disorders. It is useful both for research and clinical purposes.

Adaptation, Psychological↗

PubMed2005

Interpretation and use of weight information in the evaluation of eating disorders: counselor response to weight information in a National Eating Disorders Educational and Screening Program.

OBJECTIVE: Eating disorders are frequently undetected and inadequately treated in clinical settings. The current study investigated whether weight data were used appropriately in making recommendations for further care in the first National Eating Disorders Screening Program (NEDSP). METHOD: Accuracy of counselors' assessment of appropriateness of weight for height and adherence to an algorithm using weight to determine need for further evaluation were assessed for the 5,684 adult participants in a two-stage screening program held on college campuses. RESULTS: In 95% of cases, the counselors correctly used the algorithm developed for the NEDSP to assign participants to weight categories ranging from normal to extremely underweight. However, counselors were poorly adherent to an algorithm directing them to recommend urgent evaluation to all extremely underweight participants--that is, those with a weight at or below 75% of expected weight. Of the extremely underweight participants (n = 32), only 25.0% (n = 8) received an appropriate recommendation for urgent evaluation, whereas 59.4% (n = 19) received a recommendation for further (but nonurgent) evaluation, and 15.6% (n = 5) did not receive a recommendation to seek any evaluation. DISCUSSION: Clinicians appeared not to use weight data appropriately to make clinical recommendations for extremely underweight individuals. These results suggest that further specific emphasis on the health risks of extreme underweight may be helpful in training clinicians to manage patients with eating disorders.

Adolescent↗

PubMed2004

[Eating disorders in childhood and adolescence. Anorexia nervosa, bulimia nervosa, binge eating disorder].

The most important eating disorders are anorexia and bulimia, which most frequently occur for the first time during adolescence and continue into adulthood. Medical complications and accompanying psychological disturbances cause a significant mortality rate of up to 6% in anorexia and up to 3% in bulimia. The pathogenesis of eating disorders is still unclear. Current etiological concepts are multidimensional including biological, individual, familial, and sociocultural factors. In spite of a great variety of therapeutic possibilities, the prognosis for eating disorders is quite poor. In the long term, only about 50% of the persons affected overcome their illness. Preventive measures are therefore indispensable.

Adolescent↗

PubMed1990

You are what you eat--what you eat is what you are.

Eating disorders among adolescents in the United States constitute the most frequent nutritional problems in this age group, and their prevalence appears to be increasing. A causal relationship of television viewing to obesity is strongly suggested for children and adolescents. Perhaps as much as 25% of the recent increase in obesity among adolescents may be attributable to increases in television viewing. Associations between television viewing and anorexia and bulimia are less explicit than they are for obesity. Nonetheless, because children and adolescents spend more time viewing television than they do in any activity other than sleep, the world shown on television may acquire a greater reality than the world that is experienced. The low frequency of obesity among televised characters, combined with the frequent food-related references that are contained in both commercials and programming, may promote unrealistic conclusions regarding eating and body weight. Television reflects a cultural contradiction by promoting food consumption and leanness. In this context, bulimia may be viewed as an adaptive response, because only bulimics can eat everything they wish and remain thin.

Adolescent↗

PubMed2004

Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples.

In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.

Adolescent↗

PubMedDate not supplied

[Eating psychopathology and personality in eating disorders].

OBJECTIVE: The question of how many psychopathologic factors are involved in Anorexia Nervosa (AN) and Bulimia Nervosa (BN) has no definite answer. The combination of psychopathology and personality research may shed a light upon the determinants of eating pathology. METHODS: The study consists in the administration of the Temperament and Character Inventory (TCI) and the Eating Disorder Inventory 2 (EDI-2) to 95 outpatient anorectic women (50 restrictive and 45 binge-purging) and to 92 bulimic outpatient women (78 with and 14 without purging behaviours). The respective scores of each DCA subgroup are compared. RESULTS: Restricter anorectics are characterised by lower novelty seeking on respect to all the other groups and by a higher self-directedness on respect to bingeing-purging anorectics and purging bulimics. Also psychopathologic differences between restricter anorectics and the other groups are extensive. Bingeing-purging anorexia shares many traits with bulimia. CONCLUSIONS: In their complex, data suggest and in-deep study aimed to a possible re-classification of EDs which would take impulsiveness in greater consideration. The differences in temperament and character traits may partially be responsible of the repression or discontrol of impulsive eating behaviours in different ED subtypes.

Adolescent↗

PubMed2004

Circadian eating and sleeping patterns in the night eating syndrome.

OBJECTIVE: To compare the eating and sleep-wake patterns of persons with the night eating syndrome (NES) with those of matched control subjects. RESEARCH METHODS AND PROCEDURES: Forty-six overweight/obese NES subjects (mean age 43.3 +/- 9.8 years; 32 women) and 43 similar controls (mean age 39.0 +/- 11.0 years; 28 women) wore wrist actigraphs for 7 days and completed sleep and food diaries at home. RESULTS: There was no difference between the total energy intake of the NES and the control subjects, but the pattern of energy intake differed greatly. Relative to control subjects, the temporal pattern of food intake of night eaters was delayed. Food intake after the evening meal, as a proportion of the 24-hour intake, was more than 3-fold greater in NES subjects than in controls (34.6 +/- 10.1% vs. 10.0 +/- 6.9%, p = 0.001). NES subjects had sleep onset, offset, and total sleep duration times comparable with those of controls. NES subjects reported more nocturnal awakenings than did controls (1.5 +/- 1.0 per night vs. 0.5 +/- 0.5; p < 0.001), and their actigraphically monitored arousals occurred earlier during sleep (at 128 minutes after sleep onset vs. 193 minutes, p = 0.01). NES subjects consumed food on 74% of the awakenings vs. 0% for the controls. DISCUSSION: The pattern of cumulative energy intake of the night eaters suggests a phase delay in energy consumption relative to sleep-wake times. NES may involve a dissociation of the circadian control of eating relative to sleep.

Activity Cycles↗

PubMed2006

Maternal restriction of children's eating and encouragements to eat as the 'non-shared environment': a pilot study using the child feeding questionnaire.

OBJECTIVE: This pilot study tested whether maternal feeding attitudes and styles towards children are part of the 'shared' or 'non-shared' home environment. A secondary aim was to test whether within-family differences in maternal feeding attitudes and styles relate to within-family differences in child weight status. METHODS: Mothers of 3- to 7-year-old sibling pairs (N=15 pairs) completed the Child Feeding Questionnaire (CFQ), which assessed feeding attitudes (perceived responsibility, perceived child overweight and child weight concern) and feeding styles (monitoring, restriction and pressure to eat) towards children. Mothers rated each sibling separately. Child weight and height were measured and converted to body mass index (BMI) z-scores. Intraclass correlations tested the familial associations for each CFQ subscale. Pearson's correlations tested whether within-family differences in CFQ subscales were related to within-family differences in child BMI z-scores. RESULTS: Perceived responsibility (rho=0.77, P=0.0004), perceived child overweight (rho=0.99, P<0.0001) and monitoring (rho=0.57, P=0.01) showed significant familial correlations. Mothers reported significantly greater weight concern (r=0.85, P=0.02) and reduced pressure to eat (r=-0.80, P=0.03) towards heavier than thinner children within families. CONCLUSION: Whether or not maternal feeding practices are shared or non-shared components of the home environment depends on the specific feeding domain being measured. Restrictive feeding practices and encouragements to eat by mothers might be tested as non-shared environmental variables in genetics studies of childhood obesity.

Adult↗