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PubMed2001

Metabolic correlates of eating behavior in severe obesity.

BACKGROUND: The benefit of spreading energy intake over many small meals ('nibbling') rather than few large ones ('gorging') for control of blood glucose, serum lipids and body fat accretion has been known for 60 y, but the mechanisms are poorly understood. Men exhibit more of a gorging eating pattern than women and are also more prone to the metabolic complications of obesity, as are women with a 'male', central distribution of adipose tissue. We have shown correlations between central fat distribution, and other components of the metabolic 'Syndrome X' and fatty infiltration of the liver. Here we study relationships between eating rate and fat distribution and test the hypothesis that gorging might be associated with fatty liver. SUBJECTS AND METHODS: In 30 non-alcoholic, non-diabetic, severely obese women (body mass index, BMI=47+/-1 kg/m(2); mean+/-s.e.m.) with a mean age of 36+/-1 y and 16 men (BMI: 52+/-3) age 38+/-2 y, who were candidates for anti-obesity surgery, we measured eating rate using an eating monitor, and fat distribution by the waist-hip circumference ratio (WHR). In addition in the 17 women and 11 men who had surgery, serum lipids were analyzed and routine liver biopsies were evaluated for steatosis by a pathologist blinded to the conditions of the study. RESULTS: Men ate significantly faster than women (188+/-28 vs 123+/-9 g/min; P<0.01), and had more liver fat (score: 2.7+/-03 vs 1.5+/-0.3; P<0.01), with no statistically significant sex differences in s-cholesterol or s-triglycerides. Eating rate correlated with WHR (r=0.46; P<0.01, n=46), liver fat (r=0.55; P<0.01), and s-triglycerides (r=0.42; P<0.05) adjusting for sex. Liver fat correlated with WHR (r=0.50; P<0.05), s-triglycerides (r=0.70; P<0.01) and s-cholesterol (r=0.50; P<0.05), while there were no significant correlations with BMI or body weight. In multivariate analysis eating rate (32%), meal size (8%) and WHR (6%) contributed 46% of the variance in liver fat. CONCLUSION: We showed increased eating rates in severely obese men and women with central fat distribution. Furthermore, increased eating rates were associated with fatty liver and elevated serum lipids. Eating rate in severely obese women and men may be a determinant of the metabolic syndrome.

Adipose Tissue↗

PubMed2001

Relationship between dietary restraint, binge eating, and leptin in obese women.

OBJECTIVE: To describe some biological, behavioural and psychological correlates of the Three-Factor Eating Questionnaire, and to determine the relationship between dietary restraint, binge eating, and leptin among obese women seeking treatment. DESIGN: Consecutive series of obese women enrolled in a clinical program for weight reduction treatment. SUBJECTS: Forty-two obese women. Eight participants met the criteria for 'severe binge eating' as measured by the Binge Eating Scale. MEASUREMENTS: Energy intake, resting energy expenditure, body composition, leptin, restraint, disinhibition, hunger and binge eating were assessed before starting the treatment. RESULTS: In this sample both higher disinhibition and hunger scores were associated with greater binge eating severity. Obese women with severe binge eating had lower restraint, higher disinhibition and hunger scores, as well as higher daily fat intake, when compared with obese non-binge-eaters. Interestingly, restraint scores were negatively associated with leptin levels among subjects with severe binge eating. CONCLUSION: In obese women with severe binge eating, the negative relationship between dietary restraint and serum leptin concentrations seems mediated by a greater fat intake. These findings need to be verified in further human studies.

Bulimia↗

PubMed2004

Night eating and weight change in middle-aged men and women.

OBJECTIVE: To examine the association between the habit of eating at night, and the 5-y preceding and 6-y subsequent weight changes in a middle-aged population, with particular focus on the obese. DESIGN: Prospective study with initial examination of the cohort in 1982-83, re-examination in 1987-88 and a third examination in 1992-93. SUBJECTS: The Danish MONICA cohort includes an age- and sex-stratified random sample of the population from the Western part of the Copenhagen County. Out of 2,987 subjects participating in 1987-88, a total of 1,050 women and 1,061 men had been examined in 1982-83, and 1993-94 too. Subjects working night shifts were excluded. MEASUREMENTS: Night eating in 1987-88, 5-y preceding and 6-y subsequent weight change. RESULTS: In total, 9.0% women and 7.4% men reported 'getting up at night to eat'. Obese women with night eating experienced an average 6-y weight gain of 5.2 kg (P=0.004), whereas only 0.9 kg average weight gain was seen among obese women who did not get up at night to eat. No significant associations were found among all women, or between night eating and the 5-y preceding weight change for women. Night eating and weight change were not associated among men. CONCLUSION: Night eating was not associated with later weight gain, except among already obese women, suggesting that getting up at night to eat may be a contributor to further weight gain among the obese.

Anthropometry↗

PubMedDate not supplied

A cross-cultural study of disordered eating attitudes among Filipino and Caucasian Americans.

The present study examines the symptom levels of eating disorders among Filipino and Caucasian college students residing in Hawaii. The study also examines what variables are associated with disordered eating. A self-report questionnaire that included measures of anger discomfort, self-dissatisfaction, body dissatisfaction, and symptoms of eating disorders was administered to Filipino and Caucasian college students. As predicted, females reported higher eating disorder symptom scores than males. However, Filipino males reported higher levels of disordered eating, dieting, and body dissatisfaction than Caucasian males. No association was found between disordered eating and anger discomfort among Filipinos. The results support previous findings of females reporting higher disordered eating attitudes than males, however, Filipino males reported higher disordered attitudes than Caucasian males. Anger discomfort was not associated with disordered eating among Filipinos, supporting past studies that suggest anger management may not be an appropriate treatment for disordered eating among some Asian groups.

Journal Article↗

PubMed2006

Effects of binge eating on satiation, satiety, and energy intake of overweight children.

BACKGROUND: Children who report episodes of binge eating gain more weight than do children not reporting binge eating. However, how binge eating affects children's food intake at meals is unknown. OBJECTIVE: We compared the energy intake and postmeal satiety of children with and without a history of binge eating during buffet meals. DESIGN: Sixty overweight children aged 6-12 y were categorized into those reporting past binge-eating episodes (n = 10) and those reporting no such episodes (n = 50). Children selected lunch twice from a multiple-item, 9835 kcal, buffet meal: after an overnight fast and after a standardized breakfast. Children ate ad libitum, until they reported they were full. The main outcome measures were energy intake during meals and duration of postmeal satiety, after adjustment for covariates, including age, race, sex, socioeconomic status, and body composition. RESULTS: After the overnight fast, children in the binge-eating group consumed more energy [x (+/-SD): 1748 +/- 581 compared with 1309 +/- 595 kcal; P = 0.04] and exhibited a shorter satiety duration (194 +/- 84 compared with 262 +/- 89 min; P = 0.03) than did children in the non-binge-eating group. After the standardized breakfast, binge-eating children reported a shorter satiety duration (75 +/- 62 compared with 132 +/- 62 min; P = 0.01) and consumed more energy at the postbreakfast meal (1874 +/- 560 compared with 1275 +/- 566 kcal; P = 0.004). CONCLUSION: The ability to consume large quantities of palatable foods, coupled with decreased subsequent satiety, may play a role in the greater weight gain found in binge-eating children.

Bulimia↗

PubMed2006

Adolescents' eating, exercise, and weight control behaviors: does peer crowd affiliation play a role?

OBJECTIVE: To examine the association between peer crowd affiliation (e.g., Jocks, Populars, Burnouts, Brains) and adolescents' eating, exercise, and weight control behaviors. The roles of gender and ethnicity were also examined. METHOD: Ethnically diverse adolescents (N = 705; 66% girls) completed the Peer Crowd Questionnaire, eating and exercise items from the Youth Risk Behavior Surveillance System, and weight control behaviors from the Eating Attitudes Test-12. RESULTS: Controlling for gender and ethnicity, adolescents affiliating with the Burnouts reported more unhealthful eating and more bulimic behaviors than others; adolescents affiliating with the Brains reported more healthful eating, less unhealthful eating, and more dieting; those affiliating with Jocks and Populars reported engaging in more exercise; and Populars also reported more unhealthful eating. In addition, boys exercised more than girls; girls reported more dieting and bulimic behaviors. Black adolescents reported more unhealthful eating and less dieting than other adolescents. CONCLUSIONS: Along with gender and ethnicity, peer crowd affiliation is related to adolescents' eating, exercise, and weight control behaviors. Prevention programs should consider adolescent peer crowds in developing health promotion and obesity prevention programs.

Adolescent↗

PubMed2002

Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer's disease.

BACKGROUND: Despite numerous reports of changes in satiety, food preference, and eating habits in patients with frontotemporal dementia, there have been few systematic studies. OBJECTIVES: To investigate the frequency of changes in eating behaviours and the sequence of development of eating behaviours in frontotemporal dementia and Alzheimer's disease, using a caregiver questionnaire. METHODS: Three groups of patients were studied: frontal variant frontotemporal dementia (fv-FTD) (n = 23), semantic dementia (n = 25), and Alzheimer's disease (n = 43). Level of education and dementia severity was similar in the three groups. The questionnaire consisted of 36 questions investigating five domains: swallowing problems, appetite change, food preference, eating habits, and other oral behaviours. RESULTS: The frequencies of symptoms in all five domains, except swallowing problems, were higher in fv-FTD than in Alzheimer's disease, and changes in food preference and eating habits were greater in semantic dementia than in Alzheimer's disease. In semantic dementia, the developmental pattern was very clear: a change in food preference developed initially, followed by appetite increase and altered eating habits, other oral behaviours, and finally swallowing problems. In fv-FTD, the first symptom was altered eating habits or appetite increase. In Alzheimer's disease, the pattern was not clear although swallowing problems developed in relatively early stages. CONCLUSIONS: Change in eating behaviour was significantly more common in both of the frontotemporal dementia groups than in Alzheimer's disease. It is likely that the changing in eating behaviours reflects the involvement of a common network in both variants of frontotemporal dementia-namely, the ventral (orbitobasal) frontal lobe, temporal pole, and amygdala.

Aged↗

PubMed1996

Characteristics of eating disorders among young ballet dancers.

The characteristics of anorexia nervosa and bulimia nervosa were studied in ballet dancers in full-time training and compared with other young women at school. Dancers had higher scores on the Eating Attitudes Test. Dancers were more likely to have an eating disorder when strict modified DSM-3-R criteria were applied. Currently 1 dancer (1.6%) and no student had anorexia nervosa, 1 dancer (1.6%) and 3 students (1.3%) had bulimia nervosa and 5 dancers (8.3%) and 9 students (4.2%) had an unclassified eating disorder. Another dancer had been treated for anorexia nervosa in the past. One dancer was treated for bulimia nervosa and 6 for weight loss. Dancers were more likely to have been told to increase their body weight. Dancers were not more likely to be afraid of losing control of their weight and becoming obese if they attempted weight gain, to ignore the advice to gain weight or resist gaining weight. Regular self-induced vomiting was reported by 4% of women. Dancers are at risk for the development of eating disorders. Ballet dancers are under pressure to maintain low body weight. The low body weight and menstrual disturbance found among young dancers during training are two of the characteristics of anorexia nervosa Ballet dancers use behaviours aimed at weight control and weight loss. In dancers and professional groups under intense pressure to diet, low body weight and amenorrhoea are not sufficient criteria to diagnose anorexia nervosa. These behaviours can result in binge eating and multiple behaviours aimed at preventing binge eating. Whether the characteristics of bulimia among dancers are sufficient for a diagnosis of bulimia nervosa to be made is unknown. The aim of this paper is to study the characteristics of the eating disorders anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified among young ballet dancers in full-time ballet training and to provide information about the risk of development of eating disorders among young women required to maintain below average body weight while continuing above average exercise.

Anorexia Nervosa↗

PubMed2001

A comparison of black and white women with binge eating disorder.

OBJECTIVE: Binge eating disorder was introduced in DSM-IV as a psychiatric disorder needing further study. This community-based study describes the relationship between race and clinical functioning in black and white women with and without binge eating disorder. METHOD: A group of 150 women with binge eating disorder (52 black, 98 white) and a race-matched group of 150 healthy comparison subjects were recruited from the community. Eating and psychiatric symptoms were assessed through interviews and self-report. RESULTS: Black and white women with binge eating disorder differed significantly on numerous eating disorder features, including binge frequency, restraint, history of other eating disorders, treatment-seeking behavior, and concerns with eating, weight, and shape. Black and white healthy comparison subjects differed significantly in obesity rates. CONCLUSIONS: For both black and white women, binge eating disorder was associated with significant impairment in clinical functioning. Yet, racial differences in clinical presentation underscore the importance of considering race in psychopathology research.

Acculturation↗

PubMed1990

Covert multiple personality underlying eating disorders.

Frequently, MPD patients present themselves to the clinician with a variety of psychophysiological symptoms. Eating-disorder symptoms may be one of these, and may include the following: binge eating, self-induced vomiting, laxative abuse, excessive exercising, body image distortion, self-starvation, fluctuations in body weight, and nausea. Following are five cases in whom the pathological eating behavior was a manifestation of an underlying multiple personality disorder. The pathological eating behavior was so severe that some patients matched DSM-III-R diagnostic criteria for an eating disorder. Clinicians dealing with eating disorders should be aware that some patients may represent a subgroup in whom the underlying cause for the eating disorder may be MPD. These patients seldom respond to conventional treatment modalities used in eating-disorders programs, and only when the underlying multiplicity is identified and treated by a trained clinician, will the patient's eating-disorder symptoms improve.

Adult↗

PubMed1995

Maternal eating patterns and birth weight of Mexican American infants.

Eating patterns of 549 Mexican American mothers were identified using dietary data from the United States Hispanic Health and Nutrition Examination Survey. These eating patterns were then used to investigate the relationship between maternal diet and infant birth weight. Principle components factor analysis was used to determine the structure of the maternal eating patterns. Seven distinct eating patterns were identified: nutrient dense, traditional, transitional, nutrient dilute, protein rich, high fat dairy, and mixed dishes. Stepwise multiple regression analysis was used to identify those eating patterns associated with birth weight. In addition to eating patterns, regression variables included body mass index, hemoglobin, gestational age at delivery, maternal age, infant gender, acculturation, marital status, income, education, and smoking during pregnancy. Regression results indicated that the nutrient dense (fruits, vegetables, low fat dairy, etc.) and protein rich (low fat meats, processed meats, and dairy desserts, etc.) eating patterns were associated with increased birth weight and that the transitional eating pattern (fats and oils, breads and cereals, high fat meats, sugar, etc.) was associated with decreased birth weight. Study findings suggest that the eating pattern methodology may be an appropriate tool for analyzing food frequency data in the investigation of diet and health relationships and for targeting dietary interventions.

Acculturation↗

PubMed2003

Microstructure of eating behavior associated with Rorschach characteristics in obesity.

The relationship between the microstructure of eating behavior and personality aspects according to the Rorschach Comprehensive System (Exner, 1991, 1993) was investigated among obese participants (N = 32). Eating behavior was measured using a computerized eating monitor, VIKTOR (Cabmek, Stockholm, Sweden), calculating initial eating rate and the eating curve. A higher initial eating rate reflecting eating drive was associated with Rorschach signs of stress overload according to the D Score and higher affective responsiveness to external stimuli seen in the Affective ratio. The stress overload may prompt eating, and affective responsiveness may be linked to appetite through a higher sensitivity to food stimuli, thus increasing eating drive. An accelerating rate of consumption during the meal was associated with intense emotionality and oral dependency, suggested by Pure C and Food responses.

Adult↗

PubMed1999

Binge eating in gastric bypass patients before surgery.

BACKGROUND: Binge eating in the obese, specifically those undergoing bariatric surgery, has only recently been investigated. This study is a continuation of a long-term effort to determine the impact of eating disorders on the outcome of bariatric surgery. METHODS: Self-report questionnaires (Binge Eating Scale, Beck Depression Inventory, Questionnaire on Weight and Eating Patterns) were completed by 125 patients preparing to undergo gastric bypass surgery. RESULTS: Binge eating was clearly a problem in this population, with 33.3% showing severe binge eating problems on the Binge Eating Scale. Over half of patients engaged in bingeing or grazing, most reporting a frequency of two or more times per week. A high level of depression was associated with binge eating. CONCLUSIONS: Because postsurgical long-term weight loss maintenance is contingent on modifying eating behavior, the identification and treatment of such disorders may be critical to successful long-term outcome in these patients.

Adolescent↗

PubMed2001

Healthy eating in European elderly: concepts, barriers and benefits.

BACKGROUND: The promotion of healthy eating is more likely to be effective if based on the understanding of how the elderly perceive their own diets and healthy eating. OBJECTIVES: The objectives of this study were to identify in the elderly European population, the attitudes to food, nutrition and health, in order to define adequate strategies of health promotion. DESIGN: Cross-sectional survey using a face-to-face interview-assisted questionnaire. This project belongs to the multicentric Pan-EU Survey on Consumer Attitudes to Food, Nutrition and Health under the leadership of the Institute of European Food Studies - Dublin with the cooperation of members from all EU countries. 1843 European citizens, aged > or = 65, were interviewed. The data's descriptive analysis, was followed by univariate analysis to characterise the study's sample according to the defined objectives. RESULTS: The most important factors influencing elderly's food choice were quality and freshness (54%), trying to eat healthy and price (8%). Healthy eating was defined as "less fat" (37%) "more fresh vegetables and fruit" (34%), and "natural foods" (11%). To stay healthy (36%), to prevent disease (26%) and to promote quality of life (10%) were the major benefits associated to healthy eating. However several barriers to the adoption of healthy eating were identified, namely self-control (27%), the resistance to change (23%) and price (15%). 86% of the elderly people believe they don't need to change their eating habits as they already eat healthily. CONCLUSION: Results of this study will help to improve eating habits in the elderly, as health professionals will be able to choose the most appropriate strategies for the different groups and settings, and provide a base for future interventions in European countries for this growing age group.

Aged↗

PubMedDate not supplied

[Eating disorders in school children].

OBJECTIVE: To determine the prevalence of possible eating disorders and inappropriate eating behaviors in school children from six municipalities in the state of Minas Gerais, Brazil. METHODS: Cross-sectional study. The Bulimic Investigatory Test of Edinburgh (BITE), Eating Attitude Test (EAT), and Body Image Test were applied to 1,807 public school students with age ranging from 7 to 19 years. RESULTS: According to the EAT, 241 students (13.3%), mostly females, had inappropriate eating behaviors. Nineteen students (1.1%) had a BITE score indicating a possible diagnosis of bulimia nervosa. We found that 1,059 students (59%) were unhappy with their body image; 731 students (40%) were on a diet; and 1,014 (56%) exercised to loose weight. In addition, 218 students (12%) presented binge-eating and 175 students (10%) used purgative methods to control weight. CONCLUSIONS: We observed a high prevalence of possible eating disorders and inappropriate eating behaviors in the study population, especially among female adolescents. These results are similar to those reported for developed countries. The present findings are relevant for the clinical care of children and adolescents and can serve as the basis for future works aimed at increasing our understanding of the risk factors for these illnesses.

Adolescent↗

PubMed2004

Collegiate Athletic Trainers' Confidence in Helping Female Athletes With Eating Disorders.

OBJECTIVE: To examine college athletic trainers' confidence in helping female athletes who have eating disorders. DESIGN AND SETTING: We mailed a 4-page, 53-item survey to head certified athletic trainers at all National Collegiate Athletic Association Division IA and IAA institutions (N = 236). A 2- wave mailing design was used to increase response rate. SUBJECTS: A total of 171 athletic trainers returned completed surveys for a response rate of 77%. Eleven institutions either did not identify their head athletic trainer or did not have an identifiable mailing address. Two surveys were undeliverable because of incorrect mailing addresses. MEASUREMENTS: The survey consisted of 4 subscales: (1) efficacy expectation, (2) outcome expectation, (3) outcome value, and (4) experience in dealing with eating disorders. Content validity was established by review from a national panel of experts. Reliability ranged from.66 to.73 for the subscales. RESULTS: Although virtually all athletic trainers (91%) had dealt with a female athlete with an eating disorder, only 1 in 4 (27%) felt confident identifying a female athlete with an eating disorder, and only 1 in 3 (38%) felt confident asking an athlete if she had an eating disorder. One in 4 athletic trainers (25%) worked at an institution that did not have a policy on handling eating disorders. Almost all athletic trainers (93%) felt that increased attention needs to be paid to preventing eating disorders among collegiate female athletes. CONCLUSIONS: Collegiate athletic programs are encouraged to develop and implement eating-disorder policies. Continuing education on the prevention of eating disorders among athletes is also strongly recommended.

Journal Article↗

PubMed2005

Prevalence of Disordered-Eating Behaviors in Undergraduate Female Collegiate Athletes and Nonathletes.

Context: As the number of female college students participating in athletics has grown dramatically in the last few decades, sports medicine health care providers have become more aware of the unique health concerns of athletic women. These concerns include disordered eating, amenorrhea, and osteoporosis: the female athlete triad. Disordered eating appears to be central in the triad, and the literature has conflicting data regarding the influence of athletic participation on disordered-eating behaviors.Objective: To compare disordered-eating symptoms between collegiate athletes (in lean and non-lean sports) and nonathletes.Design: A volunteer, cross-sectional cohort study of female students during the 2002-2003 academic year.Setting: A National Collegiate Athletic Association Division I institution.Patients or Other Participants: Undergraduate females, including 84 collegiate athletes and 62 nonathletes.Main Outcome Measure(s): Symptoms associated with disordered eating were assessed using the Eating Disorders Inventory-2, a self-report measure of 91 items, and self-reported weight and menstrual function.Results: The athletes had significantly lower scores in body dissatisfaction (P = .01) and ineffectiveness (P = .002). No difference in mean body weight was noted between the 2 groups, but the nonathlete group had a significantly lower desired body weight (P = .004). Lean-sport athletes had a higher score on body dissatisfaction (P = .008) and lower actual (P = .024) and desired body weight (P = .002) than non-lean-sport athletes. A total of 7.1% of the collegiate athletes and 12.9% of the nonathletes were classified as having a high risk for disordered eating. Within the athlete sample, the high-risk group included 2.9% of the non-lean-sport athletes and 25% of the lean-sport athletes.Conclusions: In our study, female athletes did not exhibit more disordered-eating symptoms than women who did not participate in collegiate sports. However, our data suggest that lean-sport athletes are at greater risk for disordered eating than athletes in non-lean sports.

Journal Article↗

PubMedDate not supplied

On the relationship between emotional and external eating behavior.

Although there is a strong relationship between emotional and external eating, separate subscales for these behaviors have been constructed in the Dutch Eating Behavior Questionnaire. This study tries to establish whether this distinction is justified. We studied relationships among self-reported ( 1) degree of emotional and external eating behavior and (2) problems with (a) emotional distress and relationships, (b) stimulus-boundness (inappropriate amounts of either too much or too little exercise, work, leisure activities, and spending money), and (c) problems with substance use (alcohol, illicit drugs, nicotine, or caffeine) in a sample of female students. No relationships were found between either type of eating behavior and problems with substance use. Furthermore, the significant relationship between emotional and external eating behavior and stimulus-boundness disappeared in the subsample who had problems with overeating. The fact that in all samples emotional eating was significantly related to problems with emotional distress and relationships (anxiety, depression, phobias, suicidal acts or ideations, intimate relations, and sexual contacts) but external eating was not, suggests that the two types of eating behaviors refer to independent constructs. Thus, the use of separate scales to measure these theoretically different aspects of overeating seems warranted.

Adult↗