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PubMed2006

Relations between negative affect, coping, and emotional eating.

The study was designed to examine the relations between negative affect, coping, and emotional eating. It was tested whether emotion-oriented coping and avoidance distraction, alone or in interaction with negative affect, were related to increased levels of emotional eating. Participants were 125 eating-disordered women and 132 women representing a community population. Measures included the Positive and Negative Affectivity Schedule (PANAS), the Coping Inventory for Stressful Situations (CISS), and the Dutch Eating Behavior Questionnaire (DEBQ). Both emotion-oriented coping and avoidance distraction were related to emotional eating, while controlling for levels of negative affect. Negative affect did not have a unique contribution to emotional eating over and above emotion-oriented coping or avoidance distraction. The findings suggest that emotional eating is related to reliance on emotion-oriented coping and avoidance distraction in eating-disordered women as well as in relatively healthy women.

Adaptation, Psychological↗

PubMed2006

Psychological traits and platelet monoamine oxidase activity in eating disorder patients: their relationship and stability.

Self-reported behavior and attitudes towards eating [Eating Disorder Inventory-2; Garner DM (1991). Eating Disorder Inventory-2: Professional Manual. Odessa, Fl.: Psychological Assessment Resources; Estonian version Podar I, Hannus A, Allik J (1999). Personality and Affectivity Characteristics Associated With Eating Disorders: a Comparison of Eating Disordered, Weight-Preoccupied, and Normal Samples. J Pers Assess; 73(1), 133-147] and the activity of platelet monoamine oxidase (MAO) was studied in 11 patients with anorexia nervosa (AN), 43 patients with bulimia nervosa (BN) and a healthy control group (n=138). Nineteen patients filled in the EDI-2 questionnaire and donated blood samples three times with three month intervals in order to determine platelet MAO activity. Eating disordered (ED) patients scored higher on all EDI-2 subscales and had lower MAO activity compared to the control group. They also scored higher than the control group on the Neuroticism domain but lower on the Extraversion, Openness, and Conscientiousness domains of the NEO-PI-R questionnaire. The average stability of MAO on different occasions (r=.56) was slightly smaller than the stability of the EDI-2 scores (r=.70). The lack of correlations between personality dispositions and MAO activity indicates that they have independent influence on eating disorders. A possible relationship between neurochemical mechanisms and psychological symptoms of eating disordered behavior is discussed.

Adolescent↗

PubMed2003

Self-reported vegetarianism may be a marker for college women at risk for disordered eating.

The purpose of this study was to determine whether differences exist in eating attitudes and behaviors of vegetarian and nonvegetarian college women. The Eating Attitudes Test (EAT) and a questionnaire were used to gather information on eating attitudes and behaviors of 143 female college students. Thirty participants were self-reported vegetarians, and 113 participants were nonvegetarians. There was no significant difference between the vegetarians and nonvegetarians in height, weight, age, or body mass index. The median EAT score of the vegetarians (16.5) was significantly higher (P<.0001) than that of the nonvegetarians (9.0). A significantly higher (P<.0001) proportion of the vegetarians (37%) compared with nonvegetarians (8%) had EAT scores greater than 30 (indicating eating disorder risk). There was no difference in supplement use or meal skipping between the two groups. In conclusion, self-reported vegetarian college women may be more likely to display disordered eating attitudes and behaviors than nonvegetarians.

Adult↗

PubMed2004

Neuromedin beta: a strong candidate gene linking eating behaviors and susceptibility to obesity.

BACKGROUND: Obesity is frequently associated with eating disorders, and evidence indicates that both conditions are influenced by genetic factors. However, little is known about the genes influencing eating behaviors. OBJECTIVE: The objective was to identify genes associated with eating behaviors. DESIGN: Three eating behaviors were assessed in 660 adults from the Quebec Family Study with the use of the Three-Factor Eating Questionnaire. A genome-wide scan was conducted with a total of 471 genetic markers spanning the 22 autosomes to identify quantitative trait loci for eating behaviors. Body composition and macronutrient and energy intakes were also measured. RESULTS: Four quantitative trait loci were identified for disinhibition and susceptibility to hunger. Of these, the best evidence of linkage was found between a locus on chromosome 15q24-q25 and disinhibition (P <0.0058) and susceptibility to hunger (P <0.0001). After fine-mapping, the peak linkage was found between markers D15S206 and D15S201 surrounding the neuromedin beta (NMB) gene. A missense mutation (p.P73T) located within the NMB gene showed significant associations with eating behaviors and obesity phenotypes. The T73T homozygotes were 2 times as likely to exhibit high levels of disinhibition (odds ratio: 1.8; 95% CI: 1.07, 2.89; P=0.03) and susceptibility to hunger (odds ratio: 1.9; 95% CI: 1.15, 3.06; P=0.01) as were the P73 allele carriers. Six-year follow-up data showed that the amount of body fat gain over time in T73T subjects was >2 times that than in P73P homozygotes (3.6 compared with 1.5 kg; P <0.05). CONCLUSION: The results suggest that NMB is a very strong candidate gene of eating behaviors and predisposition to obesity.

Adult↗

PubMed1999

Impact of binge eating on metabolic and leptin dynamics in normal young women.

Well defined eating disorders such as anorexia nervosa and bulimia are associated with significant known health risks. Although binge eating behavior is increased in unsuccessfully dieting obese women, other health implications of this common eating pattern are unknown. We hypothesized that ingestion of an entire day's calories at one time in the evening, a common eating practice among Americans, would lead to disruptions in glucose, insulin, and leptin metabolism and in menstrual cyclicity, even in healthy young women. Seven lean women without a history of eating disorders were studied on two occasions separated by one or two menstrual cycles. During one admission, they ate three regular meals plus a snack on each of 3 days. On the other admission, they ate the same number of calories, macronutrient matched to the normal diet, in a single evening meal. Glucose, insulin, and leptin were measured frequently for 12-14 h beginning at 0800 h on the third day of each diet, and an insulin tolerance test was performed while the subjects were fasting on the fourth day. Daily blood samples were obtained until ovulation was documented to assess any impact on menstrual function. Ingestion of an entire day's calories at dinner resulted in a significant increase in fasting glucose levels and a dramatic increase in insulin responses to the evening meal. The diurnal pattern of leptin secretion was altered, such that the gradual rise in leptin from 0800 h observed during the normal diet was abolished, and leptin did not begin to rise during the binge diet until at least 2 h after the evening meal. No changes were demonstrated in insulin sensitivity, follicular growth, or ovulation between the two diets. We conclude that 1) ingestion of a large number of calories at one time (binge eating) impacts metabolic parameters even when total calories and macronutrients are appropriate for weight; 2) the timing of energy intake is an independent determinant of the diurnal rhythm of leptin secretion, indicating a relatively acute affect of energy balance on leptin dynamics; 3) the mechanism of exaggerated insulin secretion after a binge meal remains to be determined, but may be related to the altered diurnal pattern of leptin secretion; and 4) as most binge eating episodes in the population are associated with the ingestion of excess calories, it is hypothesized that binge eating behavior is associated with even greater metabolic dysfunction than that described herein.

Adult↗

PubMed1998

Eating and weight changes following chemoradiation therapy for advanced head and neck cancer.

OBJECTIVE: To describe the functional outcomes of weight loss and eating following a targeted chemoradiation protocol consisting of a selective supradose of intra-arterial cisplatin (150 mg/m2 per week for 4 weeks) with parenteral sodium thiosulfate and external-beam irradiation (1.8-2.0 Gy per fraction per day for 35 days). SUBJECTS AND DESIGN: Forty-seven patients with advanced head and neck cancer treated with a targeted chemoradiation protocol were monitored for weight and eating status before treatment and as long as 18 months after treatment. RESULTS: A statistically significant weight loss (P<.001) occurred during the targeted chemoradiation protocol, with a mean weight ratio of 90% of the starting weight. The ability to eat also declined, with an increase in reported swallowing difficulties and a need for percutaneous endoscopic gastrostomy tubes from 4 (9%) to 12 (26%). There were no significant changes in weight after the initial weight loss. Tumor stage and nodal involvement had no effect on weight loss. At the start of treatment, 18 patients (38%) reported normal eating and 4 (8%) required a feeding tube. By 18 months after treatment, 41 (87%) were eating normally, 34 (72%) reported normal eating, and 6 (13%) required a percutaneous endoscopic gastrostomy tube. CONCLUSIONS: Patients undergoing a targeted chemoradiation protocol for head and neck cancer lost about 10% of their pretreatment weight and had a decline in eating ability. Difficulty swallowing during the treatment may be due to adverse effects such as mucositis and nausea. By 18 months after therapy, most were able to eat normally and maintain their weight.

Adult↗

PubMed1996

Validity of the Arabic version of the Eating Attitude Test.

OBJECTIVES: To assess the validity of the Eating Attitude Test (EAT-26) in Arabic as a screening instrument in nonclinical populations. METHODS: A representative sample of Grade 7-12 female students in Riyadh, Saudi Arabia, was selected randomly but proportional to various social classes. The girls were independently assessed by the EAT-26 and a structured clinical interview. RESULTS: One hundred twenty-nine subjects were included. Twenty-five were identified by EAT-26 as having abnormal eating attitudes. One case was identified as anorexia nervosa by the interview and no cases of bulimia were found. DISCUSSION: EAT-26 was found to be highly sensitive and reasonably specific. Like some other studies in non-Western populations, it yielded a high false positive rate and a low positive predictive value. Because of its low cost and practicality, EAT-26 might be a useful tool in screening large populations for eating disorders.

Adolescent↗

PubMed1996

Testing a dual-process family model in understanding the development of eating pathology: a structural equation modeling analysis.

OBJECTIVE: The present study tested a dual-process family model in understanding the relationships among dysfunctional family relationships, family preoccupation with weight and appearance, and body- and self-esteem problems in the development of eating and psychiatric symptoms. METHOD: Subjects, 918 adolescent girls from eight high schools, completed measures assessing familial factors, body- and self-esteem problems, and eating and general psychiatric symptoms. RESULTS: Structural equation analyses suggested that family environment contributed to the development of eating and psychiatric symptoms through two interrelated pathways. On one hand, family preoccupation with weight and appearance had direct effects on body dissatisfaction and eating symptoms. Body dissatisfaction had direct effects on self-esteem deficit and eating symptoms, and indirect effects mediated by self-esteem deficit on eating and psychiatric symptoms. On the other hand, general family dysfunction had direct effect on negative self-esteem, and indirect effects through negative self-esteem on eating and psychiatric symptoms. DISCUSSION: Findings are discussed in relation to the possible mechanisms by which dysfunctional family relationships and family preoccupation with weight may predispose girls to eating pathology.

Adolescent↗

PubMed1997

Characteristics of interview refusers: women who decline to participate in interviews relating to eating.

OBJECTIVES: The aim of this study was to compare the eating habits and weight ranges of 27 women who refused to participate in a semistructured interview on eating with 25 women who agreed to participate, to determine if there were any systematic differences between the two groups. METHOD: The women had previously completed a general psychiatric interview that also included a lifetime DSM-III-R diagnosis of eating disorders. About 2 years after this interview, the women were asked to participate in an interview that would specifically examine eating behaviors. RESULTS: In contrast to the results of previous studies, this study found that there was no difference between women who refused or agreed to participate in an interview about eating, in terms of their eating problems or weight ranges. CONCLUSIONS: It seems that eating or weight problems need not be overrepresented in groups who refuse to participate in surveys about eating, thereby undermining the accuracy of prevalence rates in the general population. Suggestions for achieving this representation are discussed.

Adult↗

PubMed1998

The comorbidity of depression and eating dysregulation processes in a diet-seeking obese population: a matter of gender specificity.

OBJECTIVE: To explore gender differences in depression vulnerability among an obese, treatment-seeking population and to discern those components of eating-related phenomena that discriminate the depression-comorbid obese from their noncomorbid counterparts. METHOD: This sample consisted of 1,184 self-admitted patients enrolled in a residential weight loss program between 1990 and 1995. Subjects were administered several questionnaires including (a) the Beck Depression Inventory, (b) 5-point scales of eating-related foci, and (c) 7-point scales of subject's confidence in their eating control under various circumstances. Data were analyzed via analyses of variance (ANOVAs) and stepwise regression. RESULTS: Greater depression was accompanied by more disruptive, dysregulatory eating tendencies, and stronger inclination to engage in affectively and socially disrupted eating. Regression results revealed gender-specific predictors of comorbid depression. For obese females, negative-emotion disrupted eating and binge-purge behaviors were prominent predictors of depression. For males, eating induced by experiences of social or physical inadequacy and fasting relating to eating behaviors were the depression-relevant variables. DISCUSSION: These results are discussed in terms of their theoretical implications for gender-mediated models of obesity-depression comorbidity, and in terms of their clinical significance.

Adolescent↗

PubMed1998

Eating disorders among female adolescents in Switzerland: prevalence and associations with mental and behavioral disorders.

OBJECTIVES: To measure the prevalence of eating disorders in a national representative sample of adolescent girls and association of eating disorders with other behavioral/mental problems in Switzerland. METHODS: As part of a national health survey, a subsample of 1,084 15 to 20-year-old female students attending school aged filled in a self-administered anonymous questionnaire focusing on eating behavior and body image. Factor analysis made on these specific questions reveals two major dimensions: weight and image concern (WIC) and problematic eating conduct (PEC). The correlates of these two dimensions were measured using bivariate analyses. RESULTS: Among girls, 62% say they want to lose weight, 36% feel too fat, 37% report fasting episodes, 18.9% fear not to be able to stop eating, 9.1% engage in binge eating at least once a week (1.9% daily), 1.6% self-induced vomit at least once a week (0.2% daily). Girls who exhibit high WIC (N = 198) or high PEC (N = 75) scores report significantly more mood problems (p < .05), suicidal conducts (p < .05), or violent and aggressive behaviors (p < .05). No association is found with substance use. Associations with acting-out behavior are stronger among high PEC subjects, whereas those with mood disorders are stronger among high WIC subjects. CONCLUSION: A large proportion of adolescent girls show concerns regarding their weight and body image whereas a less important proportion exhibit dysfunctional eating behavior. The results confirm the associations between eating disorder and mood, suicide, and conduct problems but infirm the association with substance use. Girls who exhibit problematic conducts appear to require more attention from health resources.

Adolescent↗

PubMed1999

Eating pathology before and after bariatric surgery: a prospective study.

OBJECTIVE: The objectives of the study were (1) to determine the prevalence of eating pathology in patients before bariatric surgery and at follow-up; (2) to assess the relationship of presurgical eating pathology to various measures of psychopathology; and (3) to assess the relationship between presurgical eating pathology and outcome. METHOD: One hundred sixteen patients were evaluated prior to surgery and at follow-up an average of 5.5 years after surgery. RESULTS: Preoperative binge eating occurred in 52% of patients, 16% met criteria for binge eating disorder, and 10% had the night eating syndrome. All three forms of presurgical eating pathology were statistically associated with cognitive distortions. At follow-up, 33% of patients were vomiting at least weekly. There was no relationship between presurgical eating pathology and weight outcome or presence of vomiting at follow-up. DISCUSSION: Although postoperative vomiting usually does not represent purge behavior, it may represent failed attempts to binge.

Adult↗

PubMed2000

Acculturation and disordered eating patterns among Mexican American women.

OBJECTIVE: This quantitative study examined the relationship between acculturation and disordered eating patterns among different generations of Mexican American women. METHOD: Participants included 139 Mexican American women (mean age = 29.1) drawn from local undergraduate courses and community agencies. The posttest-only design included a demographic measure, Acculturation Rating Scale for Mexican Americans (ARSMA), and the Eating Attitudes Test (EAT-26). RESULTS: Of the five generations studied, second-generation women endorsed the most disordered eating patterns and the highest degrees of concurrent acculturation. Moreover, there was a significant, positive correlation between acculturation and Factor III of the EAT which highlights control of eating and perceived pressure from others to gain weight. Participants scoring beyond the EAT cut-off score endorsed bulimic symptoms. DISCUSSION: Differing intergenerational ideals regarding weight may create special strains for second-generation Mexican American women. Criteria for disordered eating in a population previously not considered at risk should be further assessed and clinicians should be careful not to underdiagnose among this group.

Acculturation↗

PubMed2000

Psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community.

OBJECTIVE: This study investigates psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. METHOD: Four hundred three adolescents in the community were administered structured clinical interviews to assess mood, anxiety, eating, substance use, and personality disorders. RESULTS: Adolescents with dysthymia, panic and major depressive disorder were significantly more likely than those without these disorders to have an eating disorder. After controlling for the effects of other Axis I disorders and personality disorders, only dysthymia independently predicted the presence of an eating disorder. Several personality disorders were also associated with eating disorder symptoms. However, only obsessive-compulsive personality disorder predicted eating disorder symptoms after controlling for other personality disorders. CONCLUSION: Although previous research on adults has focused on the association between major depressive disorder and eating disorders, dysthymia may be more strongly associated with eating disorders among adolescents in the community. This association is not accounted for by psychiatric comorbidity.

Adolescent↗

PubMed2000

Disordered eating among adolescents: associations with sexual/physical abuse and other familial/psychosocial factors.

OBJECTIVE: To examine associations between disordered eating behaviors and a range of familial/psychosocial factors, including sexual and physical abuse experiences, among adolescent girls and boys. METHOD: A statewide representative sample of 9,943 students in Grades 7, 9, and 11 in Connecticut completed a comprehensive survey on adolescent health within their schools. The present analysis focused on measures of disordered eating, sexual and physical abuse, familial factors, peer support, and depressive symptoms. RESULTS: Youth at increased risk for disordered eating included those who perceived family communication, parental caring, and parental expectations as low and those who reported sexual or physical abuse experiences. After adjusting for differences in familial/psychosocial factors, associations between abuse experiences and disordered eating were weakened. However, youth who reported sexual abuse were still at increased risk for disordered eating, even after adjusting for physical abuse, sociodemographics, and familial/psychosocial factors (girls: odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.51, 2.64; boys: OR = 4.88, 95% CI = 2.94, 8.10). Youth reporting physical abuse were also at increased risk for disordered eating after adjusting for sexual abuse, sociodemographics, and familial/psychosocial factors (girls: OR = 2. 00, 95% CI = 1.52, 2.62; boys: OR = 1.95, 95% CI = 1.26, 3.04). DISCUSSION: The findings suggest that strong familial relationships may decrease the risk for disordered eating among youth reporting abuse experiences, but both sexual and physical abuse are strong independent risk factors for disordered eating among both adolescent girls and boys.

Adolescent↗

PubMed2002

Disordered eating and substance use in an epidemiological sample: I. Associations within individuals.

OBJECTIVE: This study examined the strength of associations between disordered eating and eating disorders and substance use and substance use disorders (SU/SUDs) in an epidemiological sample. METHODS: 672 adolescent girls and 718 women completed structured interviews of lifetime eating disorders and substance use and misuse, as well as self-reported current disordered eating attitudes and behaviors. RESULTS: Although effect sizes were small, eating attitudes and disorders were associated modestly with nicotine, alcohol, and drug use, and with nicotine dependence in adolescent girls. Alcohol use and misuse were related to eating attitudes and pathology in women. SU/SUDs were associated with restricting and bulimic behaviors and no prominent differences in associations were observed between substance classes. In contrast to findings in clinical populations, these community-based results were positive but generally weak, suggesting there is no strong, overarching relationship between eating and substance use problems. DISCUSSION: These results have implications for the addiction model of eating disorders.

Adolescent↗

PubMed2002

Fear, disgust, and abnormal eating attitudes: a preliminary study.

OBJECTIVE: Clinical descriptions of eating disorders emphasize the role of fear (e.g., fear of weight gain, weight phobia, morbid dread of fatness). The present study explored whether disgust, an emotion that is linked intimately with food, may also be an important emotional response to eating and weight-related issues in women with abnormal eating attitudes. METHOD: Forty nonclinical female participants were presented with a series of food, drink, body shape, and emotion-related stimuli. They were asked to rate each on a number of responses associated with fear and disgust. In addition, participants completed standard questionnaire measures of eating attitudes, phobias, and disgust sensitivity. RESULTS: Ratings of fear and disgust were higher in women with abnormal eating attitudes than in those without for high-calorie foods and for overweight body shapes, but not for drinks and slim body shapes. In response to fear and disgust relevant images, women with abnormal eating attitudes also rated emotional responses higher, but this was restricted to the appropriate emotion (i.e., higher levels of fear in response to fear stimuli and higher levels of disgust in response to disgust stimuli). CONCLUSION: In women with abnormal eating attitudes, both disgust and fear responses to food and body shape issues are equally salient. Thus, an emphasis on fear in eating disorders, to the exclusion of disgust, may be unwarranted.

Adult↗

PubMed2002

The impact of racial stereotypes on eating disorder recognition.

OBJECTIVE: Eating disorders are commonly believed to affect Caucasian women more so than other women. The authors examined whether participants recognize disturbed eating symptoms to a lesser degree in an African American or Hispanic female compared with a Caucasian female. METHOD: A sample of 160 undergraduate students of different ethnic backgrounds read a passage about an adolescent girl who displayed eating disorder symptoms. Participants received one of three passages; the passages differed only regarding the girl's race (African American, Caucasian, or Hispanic). Participants completed questionnaires used to reveal possible racial stereotypes about eating disorders. RESULTS: The study found that the race of the adolescent girl had a significant impact on detection of disturbed eating patterns, such that participants recognized the eating disorder more when they read about a Caucasian girl than when they read about a minority girl (Hispanic or African American). DISCUSSION: The results have implications for public awareness of eating disorders, as well as clinical implications for work with eating disorder patients from various ethnic backgrounds.

Adolescent↗