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PubMed2002

A survey of anorexia nervosa using the Arabic version of the EAT-26 and "gold standard" interviews among Omani adolescents.

OBJECTIVE: The purpose of this study was to assess the validity of the Eating Attitude Test (EAT) in identifying the presence and severity of eating pathology in male and female Omani urban adolescents and to establish cut-off scores that matched those of anorexia identified by gold standard interviews without fear of fatness criteria. METHODS: Both females (n=126) and males (n=136) were screened using the Arabic version of the EAT-26 and interviewed using a semi-structured, Composite International Diagnostic Interview (CIDI) in order to investigate the relationship between false positives and false negatives at various EAT-26 cut-off points. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the EAT-26 for every possible threshold score. RESULTS: The EAT-26 identified 29% of the subjects as probable anorexic cases as against 9.5% identified during the structured interview based on the anorexia gold standard (32% males and 68% females). The sensitivity and specificity of the EAT-26 were respectively 24% and 69.6%. When using the ROC curve, a cut-off score of 10 gave the best compromise between sensitivity (64%) and specificity (38%). DISCUSSION: Although the EAT-26 is the most widely used screening instrument in cross-cultural studies, it does not appear to be reliable in identifying probable cases of anorexia among Omani adolescents. The use of a gold standard interview without fat phobia criteria indicated that the rate of anorexia nervosa may be more prevalent among males than previously estimated. This intriguingly high preponderance of males is discussed in terms of prevailing demographic trends in Oman.

Adolescent↗

PubMed1998

Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger.

This study investigated the association of dietary restraint and disinhibition with self-reported and actual eating behavior, body mass, and hunger. A sample of 124 women were categorized into one of four groups based upon high and low scores on measures of Dietary Restraint and Disinhibition using the Three Factor Eating Questionnaire. Half of the participants in each group consumed a high sugar/high fat chocolate pudding as a dietary preload. All participants were given a meal comprised of a standard macaroni and beef product. The interaction of Dietary Restraint and Disinhibition was related to differences in body mass. The Dietary Restraint factor was related to self-reported pathological eating behavior and influenced both perceived hunger and subjective hunger ratings. However, actual eating behavior measured by calories consumed and rate of intake was unrelated to the Dietary Restraint factor. Disinhibition was associated with excessive eating, an increased rate of eating, self-reports of eating disorder symptomatology, and perceived hunger. Hence, actual eating behavior was significantly influenced by the ingestive motivational factor, Disinhibition, but not by the cognitive factor, Dietary Restraint. These data also suggest that the Disinhibition construct is measuring overeating rather than disinhibited eating which implies the disruption of Dietary Restraint.

Adolescent↗

PubMed1986

Laboratory studies of eating behavior in women with bulimia.

This report describes a standard procedure for studying the disordered eating behavior of bulimic patients in a laboratory setting. Test meals were given to eight normal weight women with bulimia under four different conditions on non-consecutive days. On day 1 they were asked to consume as much as they "would normally eat" by means of a straw from an opaque container holding 1500 g of a palatable liquid food. An eating monitor recorded the pattern of consumption. Five patients showed abnormalities of either excessive eating or acceleration of the rate of eating. On the second and third days they were given standardized amounts of an array of foods. They were instructed to eat normally on one of these days and to eat as much as they could on the other, in counterbalanced order. All patients ate to excess when they were asked, over a 28 to 90 min period, and consumed a mean of 4477 kcal (range 2083-8499 kcal) with a macronutrient composition similar to that of the typical American diet. They all vomited afterwards. On the day they were asked to eat normally, five patients overate and vomited, two ate very little, and one refused to participate. On the fourth day patients were asked to eat as much as they could of a single item, ice cream. Six patients consumed a mean of 1545 kcal (range 741-2919 kcal); one patient ate only 85 kcal; and one patient refused to participate. There were large and significant correlations among the sizes of the various meals consumed in excess.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

A comparison of the effects of bilateral sections of the chorda tympani nerve and extirpation of the submaxillary and sublingual salivary glands on the eating and drinking patterns of the rat.

The chorda tympani nerve (CT) innervates the fungiform papillae on the tip of the tongue and has been considered an important nerve for the sense of taste. The CT also contains the parasympathetic supply to the submaxillary and sublingual salivary glands. Therefore, changes in taste or feeding behavior following bilateral sections of CT are caused by both degeneration of fungiform papillae and the inevitable partial desalivation of the rat. In the present experiments we compared the effects of bilateral chorda tympani nerve sections with extirpation of submaxillary and sublingual glands on daily home cage eating and drinking patterns in the rat. Before and after surgery we analyzed the daily eating and drinking patterns, including such measures as intake, bout number, bout length, interbout interval and rate of consumption during bouts. The results of desalivation and bilateral CT sections were indistinguishable. The most profound change was that eating bout duration was increased following surgery. Since food intake did not increase, the results indicate a marked loss in eating efficiency over the daily ingestion periods. Although the eating patterns of desalivated and chorda tympani sectioned rats are quite similar, the evidence is not compelling that they have the same physiological basis. A second experiment was designed to test the hypothesis that the atypical eating patterns observed following bilateral sectioning of CT were the direct result of partial desalivation resulting from the denervation of the salivary glands. In this experiment a unilateral section was made of one CT and it was shown that the eating behavior was not affected. Then the contralateral submaxillary and sublingual salivary glands were removed. This resulted in a six-fold increase in feeding bout length. In all cases a unilateral CT section combined with extirpation of the contralateral salivary glands resulted in rats whose eating behavior was indistinguishable from the earlier data following either the bilateral CT sections or bilateral desalivations. The conclusion is drawn that the eating irregularities noted following bilateral CT sections result from this partial desalivation. CT sections were verified by taste bud counts in the fungiform papillae and histological examinations were made of salivary glands in rats receiving CT sections.

Animals↗

PubMed1996

The psychobiology of eating behavior in anorexia nervosa.

Two models for conceptualizing eating behavior are presented and the development of the experimental methodology to examine eating behavior is described in historical context. Specific studies of eating behavior in eating disorder patients are described with emphasis on how these studies examine aspects of the two hypothetical models that are presented on eating behavior. The studies present and focus on hunger and satiety perceptions, cognitive sets, and the neurotransmitter associated with satiety, serotonin. Unfortunately, no single investigation can encompass all of the variables that need to be measured that affect eating behavior. The studies described of both acutely ill and short-term recovered eating disorder patients indicate there may be some perceptual and physiological traits that are present in anorexia nervosa and bulimia nervosa. Studies over a longer period of time are needed to substantiate this. An eventual integrative explanation of disturbed eating behavior that is documented in eating disorder patients will be possible only after extensive investigations of the components.

Animals↗

PubMed1982

The assessment of binge eating severity among obese persons.

The purpose of this study was to conduct an assessment of binge eating severity among obese persons. Two questionnaires were developed. A 16-item Binge Eating Scale was constructed describing both behavioral manifestations (e.g., eating large amounts of food) and feeling/cognitions surrounding a binge episode (e.g., guilt, fear of being unable to stop eating). An 11-item Cognitive Factors Scale was developed measure two cognitive phenomena thought to be related to binge eating: the tendency to set unrealistic standards for a diet (e.g., eliminating "favorite foods") and low efficacy expectations for sustaining a diet. The results showed that the Binge Eating Scale successfully discriminated among persons judged by trained interviewers to have either no, moderate or severe binge eating problems. Significant correlation between the scales were obtained such that severe bingers tended to set up diets which were unrealistically strict while reporting low efficacy expectations to sustain a diet. The discussion highlighted the differences among obese persons on binge eating severity and emphasized the role of cognitions in the relapse of self control of eating.

Adult↗

PubMed2004

Assessment of eating disorder psychopathology in obese children and adolescents: interview versus self-report questionnaire.

The present study compared two methods for assessing binge eating and related eating disorder psychopathology in obese children and adolescents. A comparison was made between the child version of the Eating Disorder Examination (ChEDE) and the self-report version of the interview (ChEDE-Q). A total of 139 children and adolescents (aged 10-16 years) seeking inpatient treatment for obesity completed the ChEDE questionnaire and were administered the ChEDE interview afterwards. The ChEDE and ChEDE-Q were significantly correlated for the four subscales: restraint, eating concern, weight concern and shape concern. The ChEDE-Q generated consistently higher levels of eating disorder psychopathology. There was a significant discrepancy for the assessment of a more complex feature such as binge eating. Overall, the current study found lower levels of agreement between the EDE and EDE-Q than previously reported in adult samples. It appears that children and adolescents have difficulties in identifying binge-eating episodes when they receive no detailed instruction. It is concluded that a clinical interview is necessary to identify eating disorders in obese children and that a self-report questionnaire can only be used as a screening tool. Even then, thorough clarification of the definition of the eating disorder features is needed when using a self-report questionnaire.

Adolescent↗

PubMed2005

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates.

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.

Adult↗

PubMed1999

Dietary advice to reduce fat intake is more successful when it does not restrict habitual eating patterns.

OBJECTIVE: To determine the relative and combined effects of dietary advice to lower fat intake and alter eating frequency on nutrient intake and plasma lipid levels in men with recently diagnosed hyperlipidemia. DESIGN: In this 4-week dietary intervention trial, a 7-day food diary was used in the week preceding the intervention and on the third week of the intervention to determine eating frequency. A 7-day dietary history and lipid profile (after subjects had fasted) were taken at baseline and at the end of the 4 weeks of dietary intervention. SUBJECTS: Eighty nonobese, free-living men with newly diagnosed primary hypercholesterolemia. INTERVENTION: Group 1: fat intake was reduced and eating frequency decreased. Group 2: Fat intake was reduced and eating frequency maintained. Group 3: Fat intake was maintained and eating frequency decreased. Group 4: Fat intake was maintained and eating frequency increased. MAIN OUTCOME MEASURES: Changes in lipid profiles of the subjects and evaluation of subjects' perception of the dietary advice they received. STATISTICAL ANALYSES PERFORMED: Baseline and intervention values were compared using a paired t test; 2-way analysis of variance was used across treatment groups. RESULTS: Dietary advice to lower fat intake significantly lowered total and low-density lipoprotein cholesterol levels; this advice also decreased intake of total fat and saturated fatty acids significantly, but less so in the group asked to restrict eating occasions to 3 per day. Advice to alter eating frequency was found to be difficult to follow. APPLICATIONS: Lipid-lowering dietary advice should be incorporated into the existing eating frequency pattern of each person.

Adult↗

PubMedDate not supplied

Onset of binge eating and dieting in overweight women: implications for etiology, associated features and treatment.

This study investigated differences between overweight binge eating women who reported the onset of binge eating prior to or following the onset of dieting (binged first [BF], or dieted first [DF]). Of overweight binge eating subjects enrolled in a treatment study, 38.7% indicated binge eating first, and 48.1% dieting first. The mean age of onset of binge eating differed significantly between the two groups (11.8 years vs. 25.7 years). More of the BF group (82.5%) satisfied proposed binge eating disorder (BED) criteria than did the DF group (52.0%), although short of significantly. The results suggest that: (a) the leading hypothesis concerning dieting as a cause of binge eating does not apply to a substantial number of individuals who binge eat; (b) there may be an early pattern and a late pattern in the development of binge eating among overweight individuals; and (c) the early or binge first pattern may be more likely to result in BED.

Adolescent↗

PubMed1997

Covariations of eating behaviors with other health-related behaviors among adolescents.

PURPOSE: The study objectives are: (1) to examine and compare patterns of covariation of a wide range of health behaviors among adolescent boys and girls; (2) to determine whether eating behaviors are part of a larger construct of health-related behaviors and to identify the behaviors with which they share underlying similarities; and (3) to determine whether youth engaging in other health-compromising behaviors are at risk for unhealthy eating. METHODS: Data were analyzed from the Minnesota Adolescent Health Survey, a classroom-administered questionnaire, completed by 36,284 adolescents, in grades 7-12 from 1986-87. RESULTS: Among boys, factor analysis revealed five factors: (1) risk-taking behaviors, (2) school-related behaviors, (3) "quietly" disturbed behaviors (e.g., frequent dieting, self-induced vomiting, suicide attempts), (4) health-promoting behaviors; and (5) exercise. Eating behaviors loaded on the construct of health-promoting behaviors with brushing teeth and seat belt use. Among girls, four similar factors emerged; however, exercise loaded on the construct of health-promoting behaviors. Therefore, eating behaviors loaded with brushing teeth, seat belt use, and exercise among girls. Logistic regression analyses, controlling for sociodemographic and personal variables, revealed that boys and girls engaging in health-promoting behaviors were less likely to have unhealthy eating behaviors, while those engaging in quietly disturbed behaviors, risk-taking behaviors, and problematic school behaviors were more likely to have unhealthy eating behaviors. CONCLUSIONS: Eating behaviors appear to be part of a health-promoting behavioral construct and should not be viewed in isolation from other behaviors. Although eating behaviors do not appear to be part of the "problem behavior syndrome," youth engaging in a wide range of health-compromising behaviors are at risk for unhealthy eating; emphasizing the need to target high-risk youth with health promotion programs.

Adolescent↗

PubMed2001

Which factors do provoke binge-eating? An exploratory study in female students.

To study the different factors (external, emotional, cognitive, and physiological) which may trigger binge-eating in young females. A total of 110 female students (between 14 and 25 years of age) filled out the Eating Disorder Inventory (EDI) and the Binge Eating Trigger Checklist (BETCH), a new screening device to evaluate the type of situations (and their experienced discomfort) which subjects identify as antecedents of a binge-eating episode. Approximately 41% of the female students reported binge-eating and 15% admitted they have daily binges. The binge-eating triggers most frequently reported and at the same time having the highest level of discomfort were emotional triggers (feeling bored, depressed, anxious, tense, and sad) and physiological triggers (being hungry and feeling an urge to eat sweets). Fewer food-related cues have been reported whereas dysfunctional cognitions were rarely mentioned as antecedents of binge-eating. Binge-eating, as perceived and reported by female students, seems to be provoked by a combination of different antecedents, both emotional and physiological.

Journal Article↗

PubMed2001

Exercise and eating disorders: a 3-year inpatient hospital record analysis.

The purpose of this study was to describe the exercise behavior across the DSM-IV eating disorder diagnosis (anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS)) and determine if differences exist among exercise category (high level and low level), type of exercise (aerobic, strength, and total), Eating Attitudes Test (EAT), Eating Disorders Inventory (EDI-2), and the length of inpatient hospitalization. This study was a retrospective analysis of 199 inpatient hospital records of female patients (age M=20.6, S.D.=7.03) in the following diagnostic categories: AN (n=115, 58%), BN (n=38, 19%), and EDNOS (n=46, 23%). Patients were also grouped by a median split into low- and high-level exercise categories based on their total amount of weekly exercise. No significant relationship was found between diagnosis and exercise category (high and low) or diagnosis and exercise type (total, aerobic, and strength exercise). This is valuable because exercise specialist may be a worthwhile addition to treatment teams working with all eating disorder diagnostic groups. The high-level exercisers showed significantly greater scores on the EAT [F(2,1,110)=5.117, P<.05] and weight preoccupation [F(1,1010)=4.861, P<.05] than the low-level exercise groups. There were significant relationships between total exercise and EAT (r=.354, P<.01), drive for thinness (r=.262, P<.01), and body dissatisfaction (r=.312, P<.001). Total aerobic exercise was significantly related to EAT (r=.352, P<.001), drive for thinness (r=.272, P<.01), and body dissatisfaction (r=.268, P<.01). Finally, total strength exercise was related to body dissatisfaction (r=.249, P<.05). A significant difference was found among exercise group and length of hospitalization [F(1,155)=14.384, P<.000]. The high-level exercisers were in treatment for 3 weeks longer than their low-level exercisers. A forced stepwise multiple linear regression was calculated to predict the length of hospitalization. At Step 1, diagnosis and Body Mass Index (BMI) on admission explained 27% of the variance in length of inpatient hospitalization [F(4,154)=18.08, P<.004, r(2)=.273]. When two exercise variables were included, aerobic activity explained an additional 5% of variance, whereas strength activity explained an additional 0.3% of the variance. Three-fourths of the predictors explained significant components of the total 32% variance. The present study demonstrates that patients with greater total exercise and a greater total aerobic exercise show a significantly greater drive for thinness and require a longer length of hospitalization. This association was not present with total strength exercise levels. Effective clinical methods to modify total aerobic exercise levels need to be determined with inpatient populations.

Journal Article↗

PubMed2003

The relationship between eating behaviors and obesity in African American and Caucasian women.

The primary goal of this study was to determine the relevance of four self-reported eating behaviors (eating before bedtime, eating between meals, feeling hungry within 3 h of eating, and eating beyond satiation) as risk factors for overweight and obesity. The sample consisted of 35- to 49-year-old, premenopausal African American (n=580) and Caucasian (n=398) women, randomly selected from the membership of a large urban prepaid health plan. Eating beyond satiation was the only behavior associated with body mass index (BMI). The odds of becoming obese increased 6-fold for Caucasian women and 15-fold for African American women who ate beyond satiation everyday compared to those who rarely or never ate beyond satiation. Additionally, eating beyond satiation was also the only eating behavior associated with the age of obesity onset. Focusing on this eating behavior in weight loss programs may be important.

Journal Article↗

PubMed1995

The relationship of partial syndrome eating disorders to anorexia nervosa and bulimia nervosa.

A variety of sociocultural, familial and individual features associated with the eating disorders were examined in subjects with full syndrome (FS) and partial syndrome (PS) eating disorders and in normal high school students. The EAT-26 was administered to 995 high school students. This was followed by individual interviews with those who scored in the symptomatic range. Fifty-one students with PS eating disorders, 57 students without eating disorders (normal controls) and 30 hospital patients with FS, anorexia nervosa or bulimia nervosa were compared on subscales of the Eating Disorder Inventory, the Diagnostic Survey for Eating Disorders and the Beck Depression Inventory. The three groups displayed statistically significant differences on dimensions of EDI subscales Ineffectiveness and Interoceptive Awareness and also with respect to depression, history of being overweight and past history of emotional problems, as well as having mothers with medical illnesses. On these characteristics, the FS subjects displayed higher levels than the PS subjects, who in turn were higher than the NC subjects. The PS subjects displayed elevations on Body Dissatisfaction (EDI subscale), past medical illnesses, and mother's over-concern with eating and weight. These data support a continuum model of the eating disorders, but a continuum of multiple associated features rather than of dieting.

Adolescent↗

PubMed1996

The classification of bulimic eating disorders: a community-based cluster analysis study.

There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for other of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme. A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity. The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.

Adolescent↗

PubMed2004

Personality characteristics of women before and after recovery from an eating disorder.

BACKGROUND: Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology. METHOD: Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN + BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology. RESULTS: Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women. CONCLUSIONS: Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.

Adult↗

PubMed2002

The impact on eating habits of temporary translocation from a Mediterranean to a Northern European environment.

OBJECTIVE: To assess the effect of temporary translocation from a Mediterranean to a Northern European environment on the eating habits of a group of foreign students. DESIGN: Cross-sectional survey of eating habits before and after moving from Greece to Glasgow, Scotland. SETTING: University of Glasgow. SUBJECTS: Eighty post-graduate Greek students. INTERVENTIONS: A self-administered questionnaire comprising of three major sections: (1) general eating habits; (2) frequency of eating selected food items; (3) opinion of food availability in Glasgow. RESULTS: After moving to Glasgow, significant decreases were reported in the frequency of consuming fresh fruit, raw vegetables, fish, legumes, meat, poultry and fresh fruit juice. The frequency of eating biscuits, savoury snacks, soft/fizzy drinks, alcoholic drinks and mayonnaise, dips and sauces increased. The estimated median daily consumption of fruit and vegetables decreased from 363 g in Greece to just 124 g in Glasgow, well below the Scottish and WHO dietary target of 400 g/day. The main perceived barriers to maintaining customary eating habits were the price of food, the lack of familiar tastes, the greater availability of convenience food and the limited variety of food available in Glasgow, when compared to Greece. CONCLUSIONS: These findings highlight the difficulties that migrant populations face in retaining traditional, often healthier, eating habits when migrating to a foreign country. Barriers of high cost, limited availability and poor quality of familiar foods, need to be addressed in order for migrants to maintain their customary eating patterns. Furthermore, these barriers need to be addressed before nutritionists can expect to see the widespread adoption of the Mediterranean diet by Western populations less familiar with this eating pattern.

Adult↗