Construct validity of the Three-Factor Eating Questionnaire: flexible and rigid control subscales

Evening types as determined by subjective and objective measures are more emotional eaters

OBJECTIVE

This study aimed to determine the association between being an evening type (ET; defined subjectively by the Morning-Evening Questionnaire or objectively by the dim-light melatonin onset [DLMO] timing) and reporting emotional eating (EE) behaviors.

METHODS

Cross-sectional analyses were conducted in 3964 participants (four international cohorts: ONTIME and ONTIME-MT [both Spain], SHIFT [the US], and DICACEM [Mexico]), in which chronotype (Morning-Evening Questionnaire), EE behaviors (Emotional Eating Questionnaire), and dietary habits (dietary records or food-frequency questionnaire) were assessed. Among 162 participants (ONTIME-MT subsample), additional measures of DLMO (physiological gold standard of circadian phase) were available.

RESULTS

In three populations, ETs presented with a higher EE score than morning types (p < 0.02); and they made up a higher proportion of emotional eaters (p < 0.01). ETs presented with higher scores on disinhibition/overeating as well as food craving factors and experienced these behaviors more frequently than morning types (p < 0.05). Furthermore, a meta-analysis showed that being an ET was associated with a higher EE score by 1.52 points of a total of 30 points (95% CI: 0.89-2.14). The timing of DLMO in the early, intermediate, and late objective chronotypes occurred at 21:02 h, 22:12 h, and 23:37 h, with late types showing a higher EE score (p = 0.043).

CONCLUSIONS

Eveningness associated with EE in populations with different cultural, environmental, and genetic backgrounds. Individuals with late DLMO also showed more EE.

Validation of the Flexible and Rigid Cognitive Restraint Scales in a General French Population

Distinguishing between flexible and rigid cognitive restraint (CR) may be useful for understanding the role of CR in dietary behavior and weight status. This study aimed to translate and adapt the flexible and rigid CR scales to the French context and test their psychometric properties. Construct validity, internal consistency, and test-retest reliability were examined in a sample of 620 individuals. Confirmatory factor analysis of the scales found a two-factor structure (flexible CR: 12 items; rigid CR: 15 items) that provided a good fit and supported the initial solution (χ² = 584.7, df = 322, CFI = 0.96, RMSEA = 0.052 [0.045, 0.059], TLI = 0.95). Higher flexible and rigid CR were associated with higher CR overall, emotional eating (TFEQ-R21) and eating disorders (SCOFF), and lower intuitive eating (IES-2). In addition, higher flexible CR was associated with lower impulsivity (BIS-11) while higher rigid CR was associated with higher uncontrolled eating (TFEQ-R21) and lower self-esteem (RSES), satisfaction with life (SWLS), and optimism (LOT-R). Flexible and rigid CR internal consistency was satisfactory (McDonald ω = 0.77 and 0.74, respectively) and test-retest reliability was good (ICC = 0.81 and 0.79, respectively). This study validated a flexible and rigid CR tool in a French population and confirmed that these two types of CR represent distinct eating behaviors.

Prisoners of Addictive Cues: Biobehavioral Markers of Overweight and Obese Adults with Food Addiction

Obesity is associated with food and eating addiction (FA), but the biobehavioral markers of this condition are poorly understood. To characterize FA, we recruited 18 healthy controls and overweight/obese adults with (n = 31) and without (n = 17) FA (H-C, FAOB, NFAOB, respectively) to assess alpha brain asymmetry at rest using electroencephalogram; event-related potentials following exposure to high-calorie food (HCF), low-calorie food (LCF), and nonfood (NF) images in a Stroop paradigm; reaction time reflective of the Stroop bias; and symptoms of depression and disordered eating behavior. The FAOB group had the greatest emotional and uncontrollable eating, depressive, and binge-eating symptoms. The FAOB group displayed lower resting left alpha brain asymmetry than that of the NFAOB group. Differently from the other groups, the FAOB group presented attenuated Stroop bias following exposure to HCF relative to NF images, as well as a lower late positive potential component (LPPb; 450-495 ms) in both frontal and occipital regions. In the total cohort, a correlation was found between the Stroop bias and the LPPb amplitude. These results point to biobehavioral hypervigilance in response to addictive food triggers in overweight/obese adults with FA. This resembles other addictive disorders but is absent in overweight/obesity without FA.

Nutritional Recommendations for Physique Athletes

The popularity of physique sports is increasing, yet there are currently few comprehensive nutritional guidelines for these athletes. Physique sport now encompasses more than just a short phase before competition and offseason guidelines have recently been published. Therefore, the goal of this review is to provide an extensive guide for male and female physique athletes in the contest preparation and recovery period. As optimal protein intake is largely related to one’s skeletal muscle mass, current evidence supports a range of 1.8-2.7 g/kg. Furthermore, as a benefit from having adequate carbohydrate to fuel performance and activity, low-end fat intake during contest preparation of 10-25% of calories allows for what calories remain in the “energy budget” to come from carbohydrate to mitigate the negative impact of energy restriction and weight loss on training performance. For nutrient timing, we recommend consuming four or five protein boluses per day with one consumed near training and one prior to sleep. During competition periods, slower rates of weight loss (≤0.5% of body mass per week) are preferable for attenuating the loss of fat-free mass with the use of intermittent energy restriction strategies, such as diet breaks and refeeds, being possibly beneficial. Additionally, physiological and psychological factors are covered, and potential best-practice guidelines are provided for disordered eating and body image concerns since physique athletes present with higher incidences of these issues, which may be potentially exacerbated by certain traditional physique practices. We also review common peaking practices, and the critical transition to the post-competition period.

Towards a Sustainable Nutrition Paradigm in Physique Sport: A Narrative Review

Physique athletes strive for low body fat with high lean mass and have higher body image and eating disorder rates than the general population, and even other weightlifting populations. Whether athletes with a background or tendency to develop these issues are drawn to the sport, or whether it drives these higher incidences, is unknown. However, the biological drive of cyclical energy restriction may contribute to binge-eating behavior. Additionally, requisite monitoring, manipulation, comparison, and judgement of one's physique may contribute to body image concerns. Contest preparation necessitates manipulating body composition through energy restriction and increased expenditure, requiring dietary restraint and nutrition, exercise, and physique assessment. Thus, competitors are at mental health risk due to (1) pre-existing or predispositions to develop body image or eating disorders; (2) biological effects of energy restriction on eating psychology; and (3) dietary restraint attitudes and resultant physique, exercise, and nutrition monitoring behavior. In our narrative review we cover each factor, concluding with tentative best-practice recommendations, including dietary flexibility, slower weight loss, structured monitoring, gradual returns to offseason energy intakes, internal eating cues, appropriate offseason body compositions, and support from nutrition and mental health professionals. A mental health focus is a needed paradigm shift in bodybuilding nutrition practice and research.

Long-Term Follow-up of the Mind Your Health Project: Acceptance-Based versus Standard Behavioral Treatment for Obesity

OBJECTIVE

In the Mind Your Health Trial, acceptance-based behavioral treatment (ABT) for obesity outperformed standard behavioral treatment (SBT) at posttreatment. This trial compared effects over 2 years of follow-up.

METHODS

Participants with overweight or obesity (n = 190) were randomized to 25 sessions of SBT or ABT over 1 year and assessed at months 12 (i.e., posttreatment), 24 (1 year posttreatment), and 36 (2 years posttreatment).

RESULTS

Weight-loss differences previously observed at 12 months attenuated by follow-up, though a large difference was observed in the proportion of treatment completers who maintained 10% weight loss at 36 months (SBT = 17.1% vs. ABT = 31.6%; P = 0.04; intent-to-treat: SBT = 14.4% vs. ABT = 25.0%; P = 0.07). The amount of regain between posttreatment and follow-up did not differ between groups. ABT produced higher quality of life at 24 and 36 months. Autonomous motivation and psychological acceptance of food-related urges mediated the effect of condition on weight. No moderator effects were identified.

CONCLUSIONS

Overall, results suggest that infusing SBT for weight loss with acceptance-based strategies enhances weight loss initially, but these effects fade in the years following the withdrawal of treatment. Even so, those receiving ABT were about twice as likely to maintain 10% weight loss at 36 months, and they reported considerably higher quality of life.

Brain and behavioral correlates of insulin resistance in youth with depression and obesity

Depression, together with insulin resistance, is increasingly prevalent among youth. These conditions have traditionally been compartmentalized, but recent evidence suggests that a shared brain motivational network underlies their co-occurrence. We posit that, in the context of depressive symptoms, insulin resistance is associated with aberrant structure and functional connectivity in the Anterior Cingulate Cortex (ACC) and hippocampus. This motivational neural circuit underlies dysfunctional behavioral responses and increased sensitivity to rewarding aspects of ingesting high calorie food that lead to disinhibition of eating even when satiated. To investigate this shared mechanism, we evaluated a sample of forty-two depressed and overweight (BMI > 85th%) youth aged 9 to 17. Using ACC and hippocampus structural and seed-based regions of interest, we investigated associations between insulin resistance, depression, structure (ACC thickness, and ACC and hippocampal area), and resting-state functional connectivity (RSFC). We predicted that aberrant associations among these neural and behavioral characteristics would be stronger in insulin resistant compared to insulin sensitive youth. We found that youth with greater insulin resistance had higher levels of anhedonia and more food seeking behaviors, reduced hippocampal and ACC volumes, and greater levels of ACC and hippocampal dysconnectivity to fronto-limbic reward networks at rest. For youth with high levels of insulin resistance, thinner ACC and smaller hippocampal volumes were associated with more severe depressive symptoms, whereas the opposite was true for youth with low levels of insulin resistance. The ACC-hippocampal motivational network that subserves depression and insulin resistance separately, may represent a critical neural interaction that link these syndromes together.

Tulsa 1000: a naturalistic study protocol for multilevel assessment and outcome prediction in a large psychiatric sample

INTRODUCTION

Although neuroscience has made tremendous progress towards understanding the basic neural circuitry underlying important processes such as attention, memory and emotion, little progress has been made in applying these insights to psychiatric populations to make clinically meaningful treatment predictions. The overall aim of the Tulsa 1000 (T-1000) study is to use the NIMH Research Domain Criteria framework in order to establish a robust and reliable dimensional set of variables that quantifies the positive and negative valence, cognition and arousal domains, including interoception, to generate clinically useful treatment predictions.

METHODS AND ANALYSIS

The T-1000 is a naturalistic study that will recruit, assess and longitudinally follow 1000 participants, including healthy controls and treatment-seeking individuals with mood, anxiety, substance use and eating disorders. Each participant will undergo interview, behavioural, biomarker and neuroimaging assessments over the course of 1 year. The study goal is to determine how disorders of affect, substance use and eating behaviour organise across different levels of analysis (molecules, genes, cells, neural circuits, physiology, behaviour and self-report) to predict symptom severity, treatment outcome and long-term prognosis. The data will be used to generate computational models based on Bayesian statistics. The final end point of this multilevel latent variable analysis will be standardised assessments that can be developed into clinical tools to help clinicians predict outcomes and select the best intervention for each individual, thereby reducing the burden of mental disorders, and taking psychiatry a step closer towards personalised medicine.

ETHICS AND DISSEMINATION

Ethical approval was obtained from Western Institutional Review Board screening protocol #20101611. The dissemination plan includes informing health professionals of results for clinical practice, submitting results to journals for peer-reviewed publication, presenting results at national and international conferences and making the dataset available to researchers and mental health professionals.

TRIAL REGISTRATION NUMBER

NCT02450240; Pre-results.

Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns

This study aimed to replicate and extend from Tylka, Calogero, and Daníelsdóttir (2015) findings by examining the relationship between rigid control, flexible control, and intuitive eating on various indices of disordered eating (i.e., binge eating, disinhibition) and body image concerns (i.e., shape and weight over-evaluation, body checking, and weight-related exercise motivations). This study also examined whether the relationship between intuitive eating and outcomes was mediated by dichotomous thinking and body appreciation. Analysing data from a sample of 372 men and women recruited through the community, this study found that, in contrast to rigid dietary control, intuitive eating uniquely and consistently predicted lower levels of disordered eating and body image concerns. This intuitive eating-disordered eating relationship was mediated by low levels of dichotomous thinking and the intuitive eating-body image relationship was mediated by high levels of body appreciation. Flexible control predicted higher levels of body image concerns and lower levels of disordered eating only when rigid control was accounted for. Findings suggest that until the adaptive properties of flexible control are further elucidated, it may be beneficial to promote intuitive eating within public health approaches to eating disorder prevention. In addition to this, particular emphasis should also be made toward promoting body acceptance and eradicating a dichotomous thinking style around food and eating.

Changes in body composition in women using long-acting reversible contraception

OBJECTIVE

Users of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users.

STUDY DESIGN

We performed a prospective cohort study of a subgroup of women enrolled in the Contraceptive CHOICE Project who initiated the LNG-IUS, copper IUD or ENG implant. Inclusion criteria included lack of metabolic and eating disorders or change in body weight of more than 5% in the 6 months before enrollment. We measured changes in weight and body composition (body fat percentage, total body fat mass, total lean mass and total body mass) in women who continued their method for 12 months.

RESULTS

We analyzed data from 149 participants: 85 LNG-IUS users, 31 copper IUD users and 33 ENG implant users. The mean age was 25.9 years, 56.4% were White, 82.5% had some college education and 67.6% were nulliparous. Although lean body mass increased over 12 months in LNG-IUS and copper IUD users but not in ENG implant users, changes in body weight and body composition did not differ between the groups. In the adjusted model, Black race was associated with change in total body mass (p<.05).

CONCLUSIONS

Among those who continued the method for 12 months, changes in body weight and composition did not differ between copper IUD, LNG-IUS and ENG implant users.

IMPLICATIONS STATEMENT

Changes in body weight and composition over 12 months did not differ between copper IUD users and LNG-IUS and ENG implant users among those with 12 months of continuous use.

Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial

OBJECTIVE

To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT).

METHODS

Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session.

RESULTS

Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges.

CONCLUSIONS

Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making.

Emotional eating and routine restraint scores are associated with activity in brain regions involved in urge and self-control

Researchers have proposed a variety of behavioral traits that may lead to weight gain and obesity; however, little is known about the neurocognitive mechanisms underlying these weight-related eating behaviors. In this study, we measured activation of reward circuitry during a task requiring response and inhibition to food stimuli. We assessed participants' emotional eating, external eating, and two subscales of dietary restraint-routine restraint and compensatory restraint-using the Weight-Related Eating Questionnaire. For routine restraint, we found positive associations with activation in the insula, dorsolateral prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex and ventromedial prefrontal cortex in response to high-calorie versus low-calorie foods. For emotional eating, we found positive associations with insula and dorsolateral prefrontal cortex activation in response to high-calorie versus low-calorie foods. We also found positive associations between emotional eating and dorsolateral prefrontal cortex activation in response to approach versus inhibition towards high-calorie foods. Thus, our results demonstrate an increase in activation across brain regions related to self-control and urges in response to high-calorie food associated with both emotional eating and routine restraint. Overall, these results support the construct validity of both emotional eating and routine restraint and provide preliminary evidence that these subscales have similar neural correlates.

Psychometric evaluation of self-report measures of binge-eating symptoms and related psychopathology: A systematic review of the literature

OBJECTIVE

Binge eating is a symptom common to bulimia nervosa, anorexia nervosa (binge/purge subtype), and binge eating disorder. There are many self-report measures available to aid the assessment of eating disorders symptoms, but there has not yet been a systematic review of the literature to identify the most valid and reliable measures for use in assessment and treatment of binge eating.

METHOD

A systematic review of the psychometric properties of self-report measures that assess binge eating symptoms and psychopathology was conducted. Two independent raters assessed the psychometric properties of each measure using a standardized quality analysis tool.

RESULTS

Of the 2,927 studies identified, 72 studies met the inclusion criteria and described the psychometric properties of 29 different self-report measures, and nine specific subscales within these. Results from the quality analysis tool utilized in this study indicated that none of the included measures currently meet all nine criteria of adequate psychometric properties.

DISCUSSION

Most of the included measures had evidence for some adequate psychometric properties. Two measures received six out of nine positive ratings for the assessed psychometric properties, the BITE and the BULIT-R, and thus appear to be the measures with the most evidence of their validity and reliability. Overall, our findings implicate a need for further investigation of the psychometric properties of the available self-report questionnaires in this field.

Stressful task increases drive for thinness and bulimia: a laboratory study

The scientific literature has suggested that stress undergirds the development of eating disorders (ED). Therefore, this study explored whether laboratory induced stress increases self-reported drive for thinness and bulimic symptoms measured via self-report. The relationship between control, perfectionism, stress, and cognition related to ED was examined using correlational methodology. Eighty-six participants completed an experimental task using a personal computer (PC). All individuals completed a battery of tests before and after the stressful task. Analyses showed a significant statistical increase in average scores on the drive for thinness and bulimia measured before and after a stressful task, and path analysis revealed two different cognitive models for the mechanism leading to drive for thinness and bulimia. These findings suggest that stress is an important factor in the development of the drive for thinness and bulimia.

Genetic variants in AKR1B10 associate with human eating behavior

BACKGROUND

The human Aldoketoreductase 1B10 gene (AKR1B10) encodes one of the enzymes belonging to the family of aldoketoreductases and may be involved in detoxification of nutrients during digestion. Further, AKR1B10 mRNA (messenger ribonucleic acid) expression was diminished in brain regions potentially involved in the regulation of eating behavior in rats which are more sensitive to cocaine and alcohol. We hypothesized that the human AKR1B10 gene may also play a role in the regulation of human eating behavior.

RESULTS

We investigated the effects of 5 genetic variants of AKR1B10 on human eating behavior among 548 subjects from a German self-contained population, the Sorbs, and in 350 subjects from another independent German cohort. Among the Sorbs, we observed nominal associations with disinhibition at the 5' untranslated region (5' UTR) variant rs10232478 and the intragenic variants rs1834150 and rs782881 (all P ≤ 0.05). Further, we detected a relationship of rs1834150 and rs782881 with waist, smoking consumption (rs782881) and coffee consumption (rs1834150) (all P ≤ 0.05). Albeit non-significant, replication analyses revealed similar effect directions for disinhibition at rs1834150 (combined P = 0.0096). Moreover, in the replication cohort we found rs1834150 related to increased restraint scores with a similar direction as in the Sorbs (combined P = 0.0072).

CONCLUSION

Our data suggest that genetic variants in the AKR1B10 locus may influence human eating behavior.

Eating behavior in Portuguese higher education students: the effect of social desirability

OBJECTIVES

The aim of this study was to relate social desirability with eating behavior dimensions among higher education students in Portugal, and to assess the effect of social desirability on the association between pairs of eating behavior dimensions.

METHODS

Data from 266 higher education students (62.8% women) aged between 18 and 27 y were evaluated. Social desirability and several eating behavior dimensions (emotional and external eating, flexible and rigid restraint, binge eating, and eating self-efficacy) were assessed.

RESULTS

In both women and men, social desirability showed negative associations with emotional, external, and binge eating, and positive associations with eating self-efficacy. For the majority of the correlations, the control for social desirability led to a decrease in the strength of the association: Social desirability showed a greater effect on the associations between external and binge eating, external eating and eating self-efficacy, binge eating and eating self-efficacy, and emotional and external eating.

CONCLUSION

This study demonstrated that social desirability should be considered when assessing the dimensions of eating behavior, namely eating self-efficacy and dimensions related to overeating.

Dietary habits and weight maintenance success in high versus low exercisers in the National Weight Control Registry

BACKGROUND

The National Weight Control Registry (NWCR) was established to examine characteristics of successful weight loss maintainers. This study compares the diet and behavioral characteristics and weight regain trajectories of NWCR members with differing physical activity (PA) levels at baseline.

METHODS

Participants (n = 3591) were divided into 4 levels of self-reported PA at registry entry (< 1000, 1000 to < 2250, 2250 to < 3500, and ≥ 3500 kcals/week). We compared self-reported energy intake (EI), macronutrient composition, eating behaviors (dietary restraint, hunger, and disinhibition), weight loss maintenance strategies, and 3 year weight regain between these 4 activity groups.

RESULTS

Those with the highest PA at registry entry had lost the most weight, and reported lower fat intake, more dietary restraint, and greater reliance on several specific dietary strategies to maintain weight loss. Those in the lowest PA category maintained weight loss despite low levels of PA and without greater reliance on dietary strategies. There were no differences in odds of weight regain at year 3 between PA groups.

CONCLUSIONS

These findings suggest that there is not a "one size fits all strategy" for successful weight loss maintenance and that weight loss maintenance may require the use of more strategies by some individuals than others.

Eating behaviour patterns and BMI in Portuguese higher education students

Our aim was to determine prototypical patterns of eating behaviour among Portuguese higher education students, and to relate these patterns with BMI. Data from 280 higher education students (63.2% females) aged between 18 and 27 years were analysed. Several eating behaviour dimensions (emotional and external eating, flexible and rigid restraint, binge eating, and eating self-efficacy) were assessed, and eating styles were derived through cluster analysis. BMI for current, desired and maximum self-reported weights and the differences between desired and current BMI and between maximum and current BMI were calculated. Women scored higher in emotional eating and restraint, whereas men showed higher eating self-efficacy. Men had higher current, desired and maximum BMI. Cluster analysis showed three eating styles in both male and female subsamples: "Overeating", "High self-efficacy" and "High restraint". High self-efficacy women showed lower BMI values than the others, and restrictive women had higher lost BMI. High self-efficacy men showed lower desired BMI than overeaters, and lower maximum and lost BMI than highly restrictive ones. Restrictive women and men differ on important eating behaviour features, which may be the cause of differences in the associations with BMI. Eating self-efficacy seems to be a central variable influencing the relationships between other eating behaviour dimensions and BMI.

Parental eating behavior traits are related to offspring BMI in the Québec Family Study

OBJECTIVE

Parental eating behavior traits have been shown to be related to the adiposity of their young children. It is unknown whether this relationship persists in older offspring or whether rigid or flexible control are involved. The objective of this study was to test the hypothesis that parental eating behavior traits, as measured by the Three-Factor Eating Questionnaire (TFEQ), are related to offspring body weight.

METHODS

Cross-sectional anthropometric and TFEQ data from phase 2 and 3 of the Québec Family Study generated 192 parent-offspring dyads (offspring age range: 10-37 years). Relationships were adjusted for offspring age, sex and reported physical activity, number of offspring per family and parent body mass index (BMI).

RESULTS

In all parent-offspring dyads, parental rigid control and disinhibition scores were positively related to offspring BMI (r=0.17, P=0.02; r=0.18, P<0.01, respectively). There were no significant relationships between cognitive restraint (P=0.75) or flexible control (P=0.06) with offspring BMI. Regression models revealed that parent disinhibition mediated the relationship between parent and offspring BMI, whereas rigid control of the parent moderated this relationship. The interaction effect between parental rigid control and disinhibition was a significant predictor of offspring BMI (β=0.13, P=0.05).

CONCLUSION

Family environmental factors, such as parental eating behavior traits, are related to BMI of older offspring, and should be a focus in the prevention of obesity transmission within families.

"Mind the trap": mindfulness practice reduces cognitive rigidity

Two experiments examined the relation between mindfulness practice and cognitive rigidity by using a variation of the Einstellung water jar task. Participants were required to use three hypothetical jars to obtain a specific amount of water. Initial problems were solvable by the same complex formula, but in later problems ("critical" or "trap" problems) solving was possible by an additional much simpler formula. A rigidity score was compiled through perseverance of the complex formula. In Experiment 1, experienced mindfulness meditators received significantly lower rigidity scores than non-meditators who had registered for their first meditation retreat. Similar results were obtained in randomized controlled Experiment 2 comparing non-meditators who underwent an eight meeting mindfulness program with a waiting list group. The authors conclude that mindfulness meditation reduces cognitive rigidity via the tendency to be "blinded" by experience. Results are discussed in light of the benefits of mindfulness practice regarding a reduced tendency to overlook novel and adaptive ways of responding due to past experience, both in and out of the clinical setting.

Association of cognitive dietary restraint and disinhibition with prediabetes – cross-sectional and longitudinal data of a feasibility study in German employees

Objective

To investigate the impact of eating behaviour traits on central obesity, prediabetes and associated major dietary food patterns.

Design

Assessment of eating behaviour was based on the revised German version of the Three-Eating Factor Questionnaire using cross-sectional and longitudinal data of a feasibility study in employees. Data on lifestyle and nutrition were obtained by validated self-administered questionnaires. Baseline characteristics were analysed by the univariate χ2 test or the Mann–Whitney test. To quantify correlations linear regression analysis was used.

Setting

The Delay of Impaired Glucose Tolerance by a Healthy Lifestyle Trial (DELIGHT), which investigated measures to prevent type 2 diabetes mellitus in 2004–2008.

Subjects

Employees (21–64 years, 127 men, 157 women) with elevated waist circumference (men ≥94 cm, women ≥80 cm) of five medium-sized companies in northern Germany.

Results

At baseline (T0), BMI but particularly waist circumference showed a strong inverse correlation with flexible control (P < 0·0001) and a positive correlation with disinhibition (P < 0·0001) and rigid control (P = 0·063). Flexible control was also significantly inversely related to fasting plasma glucose (P = 0·040), energy intake (P < 0·0001), intake of meat and meat products (P = 0·0001), and positively associated with intake of fruit and vegetables (P < 0·0001) at baseline (T0). Changes in flexible control within the first year of intervention (T1 v. T0) predicted changes in central obesity (P < 0·0001) and fasting plasma glucose (P = 0·025).

Conclusions

DELIGHT shows that flexible control characterizes individuals with a higher dietary quality, a lower waist circumference and a lower glucose level. Enhancing flexible control more than rigid control, and decreasing disinhibition, seems beneficial in terms of central adiposity and glucose levels.

Influence of Physical Activity Participation on the Associations between Eating Behaviour Traits and Body Mass Index in Healthy Postmenopausal Women

Available data reveals inconsistent relationships between eating behaviour traits and markers of adiposity level. It is thus relevant to investigate whether other factors also need to be considered when interpreting the relationship between eating behaviour traits and adiposity. The objective of this cross-sectional study was thus to examine whether the associations between variables of the Three-Factor Eating Questionnaire (TFEQ) and adiposity are influenced by the level of physical activity participation. Information from the TFEQ and physical activity was obtained from 113 postmenopausal women (56.7 ± 4.2 years; 28.5 ± 5.9 kg/m(2)). BMI was compared between four groups formed on the basis of the physical activity participation and eating behaviour traits medians. In groups of women with higher physical activity participation, BMI was significantly lower in women who presented higher dietary restraint when compared to women who had lower dietary restraint (25.5 ± 0.5 versus 30.3 ± 1.7 kg/m(2), P < .05). In addition, among women with lower physical activity participation, BMI was significantly lower in women presenting a lower external hunger than in those with a higher external hunger (27.5 ± 0.8 versus 32.4 ± 1.1 kg/m(2), P < .001). Our results suggest that physical activity participation should also be taken into account when interpreting the relationship between adiposity and eating behaviour traits.

The relationship between executive function, AD/HD, overeating, and obesity

Attention-deficit/hyperactivity disorder (AD/HD) and obesity are complex, costly disorders affecting physical, emotional, and social well-being. Executive function (EF), the cognitive ability for self-understanding and regulation, is often impaired in AD/HD, yet rarely considered in treatment of obese individuals with AD/HD. The hypothesis for this study is that low EF is seen in individuals with 4 or more symptoms of adult AD/HD and is associated with overeating behaviors leading to obesity. A nonexperimental single group design was used. A volunteer convenience sample (n = 125) completed EF, AD/HD, eating, and BMI measures. Path analysis tested the hypothesized/ modified model. Chi square (χ(2) = 6.15, df = 6, p = .4) and RMSEA (0.014) indicated a very good fit for the data. Assessment of EF and AD/HD symptoms in obese individuals is supported. Further study is needed to more fully understand this relationship and to develop strategies to address overeating behaviors in obese individuals with AD/HD.

Hungarian adaptation of Three-Factor Eating Questionnaire Revised 21-item

A vizsgálat során magyar nyelvre adaptáltuk a 21 tételes Háromfaktoros Evési Kérdőívet (Three-Factor Eating Questionnaire Revised 21-item; TFEQ-R21). Fő célkitűzésünk a kérdőív eredeti faktorstruktúrájának alátámasztása és pszichometriai elemzése volt. Célul tűztük ki továbbá az evési magatartás egyes determinánsainak vizsgálatát. Keresztmetszeti, kérdőíves kutatásunkban az ELTE PPK hallgatónői (n=262; átlagéletkor 21,7 év, szórás: 2,78; testtömeg-index (BMI) átlaga 20,8 kg/m 2 , szórás: 2,93) vettek részt. Az alábbi mérőeszközöket alkalmaztuk: a TFEQ-R21 magyar nyelvű változata, Vonásszorongás skála, Testi Attitűdök Tesztje. Az elemzés konfirmatív faktoranalízissel (CFA; MIMIC) és többjellemzős-többtételes elemzéssel történt. A CFA alátámasztotta a TFEQ-R21 eredeti faktoriális struktúráját. Skálák: kontrollálatlan evés, kognitív korlátozás, érzelmi evés. A skálák belső konzisztenciája (Cronbach α: 0,82–0,93) és kéthetes intervallumban vizsgált teszt-reteszt reliabilitása (r s : 0,79–0,91) kiváló. A többjellemzős-többtételes elemzés eredményei alátámasztják a tételek konvergens és diszkrimináns validitását. Az evési magatartás potenciális determinánsainak vizsgálata (MIMIC modell) azt az eredményt hozta, hogy a három táplálkozási viselkedés közül csak az érzelmi evés mutat szignifikáns, pozitív irányú kapcsolatot a tápláltsági állapottal. A testképpel való elégedetlenség szignifikáns magyarázó változója az étrendi korlátozásra való törekvésnek; a vonásszorongás pedig a kontrollálatlan evés és az érzelmi evés előrejelzője.

The Three-Factor Eating Questionnaire and BMI in adolescents: results from the Québec family study

Eating behaviour traits are associated with body weight variations in adults. The Three-Factor Eating Questionnaire (TFEQ) measures cognitive restraint, disinhibition and hunger, as well as their corresponding subscales, e.g. rigid and flexible control. The TFEQ has not been widely used in adolescents to investigate eating behaviour traits associated with body weight. The aim of the present study was to assess whether eating behaviour traits were associated with BMI in male and female adolescents. Sixty adolescents (thirty females and thirty males; mean age 15.0 (sd 2.4) years) from the Québec Family Study completed the TFEQ and 3 d dietary records. There were no sex differences in the TFEQ scores. Rigid control, disinhibition and emotional susceptibility (to overeat) were positively related to BMI z-scores for the entire sample (r 0.3, P < 0.05). There was a positive relationship between BMI z-scores and rigid control (r 0.39, P < 0.05) in females, while BMI z-scores were positively related to emotional susceptibility (r 0.42, P < 0.02) and disinhibition (r 0.41, P < 0.03) in males. Adolescents characterised by both high disinhibition and high rigid control had significantly higher BMI z-scores than those by both low disinhibition and low rigid control. There were no significant differences in BMI z-scores between the flexible control categories. Dietary macronutrient content was not consistently related to eating behaviour traits. These results show that the eating behaviour traits of disinhibition and rigid control are independently related to BMI z-scores in this group of adolescents.

Mediators of weight loss and weight loss maintenance in middle-aged women

Long-term behavioral self-regulation is the hallmark of successful weight control. We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a randomized controlled 12-month weight management intervention. Overweight and obese women (N = 225, BMI = 31.3 +/- 4.1 kg/m(2)) were randomly assigned to a control or a 1-year group intervention designed to promote autonomous self-regulation of body weight. Key exercise, eating behavior, and body image variables were assessed before and after the program, and tested as mediators of weight loss (12 months, 86% retention) and weight loss maintenance (24 months, 81% retention). Multiple mediation was employed and an intention-to-treat analysis conducted. Treatment effects were observed for all putative mediators (Effect size: 0.32-0.79, P < 0.01 vs. controls). Weight change was -7.3 +/- 5.9% (12-month) and -5.5 +/- 5.0% (24-month) in the intervention group and -1.7 +/- 5.0% and -2.2 +/- 7.5% in controls. Change in most psychosocial variables was associated with 12-month weight change, but only flexible cognitive restraint (P < 0.01), disinhibition (P < 0.05), exercise self-efficacy (P < 0.001), exercise intrinsic motivation (P < 0.01), and body dissatisfaction (P < 0.05) predicted 24-month weight change. Lower emotional eating, increased flexible cognitive restraint, and fewer exercise barriers mediated 12-month weight loss (R(2) = 0.31, P < 0.001; effect ratio: 0.37), but only flexible restraint and exercise self-efficacy mediated 24-month weight loss (R(2) = 0.17, P < 0.001; effect ratio: 0.89). This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance, in a large sample of overweight women. Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss. For long-term success, interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy.

Restraint, hunger, and disinhibition following treatment for binge-eating disorder

OBJECTIVE

To examine changes in total, flexible and rigid restraint, hunger, and disinhibition in obese individuals with Binge-Eating Disorder (BED), and assess whether these variables are associated with binge abstinence at post-treatment and during two-year follow-up.

METHOD

A total of 116 obese individuals with BED were randomized to a 20-week treatment trial plus two-year follow-up. Using the Eating Inventory (EI), we assessed these factors at pretreatment, post-treatment, and follow-up time-points and examined their relationship to binge abstinence at post-treatment, 12- and 24-month follow-up.

RESULTS

Low disinhibition and high-total restraint are associated with post-treatment binge abstinence. There are no significant relationships between post-treatment EI variables and binge abstinence at 12- and 24-month follow-up.

DISCUSSION

Reducing disinhibition as well as increasing EI dietary restraint during BED treatment may be important for short-term success.

Development and validation of a weight-related eating questionnaire

The objective of this study was to develop an improved weight-related eating questionnaire (WREQ) that reflects recent advancements in the assessment and understanding of theory-based eating behaviors. A sequential process of measurement development was used to construct this brief but comprehensive questionnaire. By factor analysis and structural equation modeling, a 16-item, four-factor structure was found to best fit the data. This newly developed questionnaire measures two constructs of dietary restraint (routine and compensatory restraint), susceptibility to external cues (external eating), and emotional eating. The WREQ demonstrated good preliminary construct validation against similar psychometrics, BMI, and measures of fruit and vegetable and dietary fat intake. Further validation analyses, particularly against other energy intake measures, are justified. Successful development and preliminary validation of this updated weight-related eating behavior questionnaire provides support for the WREQ as an improvement over existing eating behavior measures and warrants its use in future research.

Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem

OBJECTIVE

There is a large body of research about perfectionism and low self-esteem in eating disorders (ED). However, little is known about the influence in ED of a distorted cognition in the domain of control: the perception of low control. The present study examined the main and interactive effects of concern over mistakes (an important dimension of perfectionism), self-esteem, and perception of control on drive for thinness, bulimia, and body dissatisfaction.

METHOD

Forty individuals with ED and 55 controls completed the Multidimensional Perfectionism Scale, the Anxiety Control Questionnaire, the Rosenberg self-esteem scale, and the three symptomatic scales of the Eating Disorder Inventory, which are drive for thinness, bulimia and body dissatisfaction. Multiple linear regression was used to test the hypothesis that perception of low control has a significant effect on the symptomatic scales of the EDI.

RESULTS

The ED group had significantly lower perception of control and self-esteem and higher concern over mistakes, drive for thinness, bulimia, and body dissatisfaction than the control group. Analysis of interactive effects suggested that a combination of a low perception of control and a low self-esteem seems to moderate the effects of concern over mistakes on drive for thinness, bulimia, and body dissatisfaction.

DISCUSSION

ED are associated with a tendency to worry about mistakes, a low sense of self-esteem, and a low perception of control over internal feelings and external events. Perception of control and self-esteem seems to moderate the predictive power of concern mistakes on symptoms of ED. The results suggest that a low perception of control is an important cognitive factor in ED.

Association between chronotype and the constructs of the Three-Factor-Eating-Questionnaire

The aim of this study was to explore associations between chronotype and the Three-Factor-Eating-Questionnaire. We found a positive association between morningness and dietary restraint and negative correlations between morningness and disinhibition and perceived hunger. Further, there was an association between morningness and flexible control. BMI tended to be negatively associated with morningness and correlated with disinhibition and with the sub-scale RC7. No association was found between BMI and cognitive restraint, hunger and flexible control. Also, no relationships existed between sleep length on weekdays or on weekends and BMI or eating.

Aspects of eating behaviors "disinhibition" and "restraint" are related to weight gain and BMI in women

OBJECTIVE

The causes of adult weight gain leading to obesity are uncertain. We examined the association of adult weight gain and obesity with subscales of eating behavior characteristics in older women.

METHODS AND PROCEDURES

Current height and weight, eating behavior subscales (disinhibition subscales-habitual, situational, and emotional; restraint subscales-flexible and rigid; hunger subscales-internal and external) as assessed using the Eating Inventory (EI), and self-reported body weight at six prior age intervals were reported by 535 women aged 55-65 years. Multiple regression analysis was used to examine the relationships between EI subscale scores and weight change from the age interval of 30-39 to 55-60 years and current BMI.

RESULTS

The strongest correlate of weight gain over 20 years was susceptibility to overeating in response to everyday cues within the environment (habitual disinhibition; partial correlation coefficient (r) = 0.25, P < 0.001); susceptibility to overeating in response to emotional states such as depression (emotional disinhibition) was a quantitatively weaker but significant correlate (partial r = 0.17, P < 0.001), and susceptibility to overeating in response to specific situations such as social occasions (situational disinhibition) was not associated with weight gain. Flexible control of dietary restraint attenuated the influence of habitual disinhibition in particular on weight gain and BMI, and was less effective in attenuating associations of emotional or situational disinhibition.

DISCUSSION

Lifestyle modification programs for prevention and treatment of adult-onset obesity currently focus on reducing situational and emotional overeating; the results of this study suggest that a stronger emphasis on strategies that target habitual overeating may be warranted.

Dietary restraint: Intention versus behavior to restrict food intake

The Dutch Eating Behavior Questionnaire Restraint Scale (DEBQ-R) assesses both intentions to restrict food intake (3 items) and actual behavioral restraint (7 items). Studies in general population's samples have shown that the DEBQ-R is a reliable instrument with all items loading highly on a single factor. The purpose of the present study was to examine the psychometric properties of a two-factor intention-versus-behavior structure of the DEBQ-R in 3 different weight-concerned samples with people from different (over)weight categories (total N=790) using confirmatory factor analysis. A robust two-factor structure emerged in the various samples, generally supporting a distinction between DEBQ-R questions relating to intentions to restrict food intake and actual restrictive behavior. Results obtained in this study are important, because they suggest that a distinction between restrained intention and behavior could help to explain the relation between dietary restraint and external overeating tendencies. Future longitudinal research should examine whether the newly developed dietary restraint scales predict changes in overeating and Body Mass Index (BMI).

Psychometric properties of the State and Trait Food Cravings Questionnaires among overweight and obese persons

A crucial problem in studies involving food cravings is the lack of a psychometrically sound measure for use among overweight and obese populations. The degree to which the Food Cravings Questionnaires-Trait (FCQ-T) and State (FCQ-S) evidenced acceptable psychometric properties among overweight and obese participants was assessed. In study 1, 109 participants completed the FCQ-T and FCQ-S. Item-total correlations, test-retest reliability, internal consistency, and factor structures were examined. Results indicate good internal consistency and partially support the factor structures. In study 2, the construct and predictive validity of the FCQ-S were examined. Twenty-eight women completed the FCQ-S 15 min after finishing a standardized breakfast and then twice more, 90 min apart. Subsequent ad libitum food intake was recorded. Results suggest that the FCQ-S is sensitive to state changes in food cravings, but that the magnitude of the changes was moderate. The FCQ-S was not a good predictor of subsequent food intake. The FCQ-T and FCQ-S may be useful in studies that examine triggers of and interventions for excessive food intake.

Construct validation of the Restraint Scale in normal-weight and overweight females

The Restraint Scale (RS) is a widely used measure to assess restrained eating. The purpose of this study was to examine the construct validity of the RS in a sample of normal-weight (n=349) and overweight (n=409) females using confirmatory factor analyses of the RS in relation to other measures for dieting, overeating and body dissatisfaction. Following Laessle et al. [(1989a). A comparison of the validity of three scales for the assessment of dietary restraint. Journal of Abnormal Psychology, 98, 504-507], we assumed a three-factor structure: (1) overeating and disinhibitory eating, (2) dieting and restriction of food intake, and (3) body dissatisfaction and drive for thinness. Analyses revealed that the RS loaded significantly on all three factors for both samples, confirming its multifactorial structure. However, the RS appears to capture these constructs differently in overweight and normal-weight females such that the RS may overestimate restraint in overweight individuals. This may explain the greater effectiveness of the RS in predicting counter-regulation in normal-weight than in overweight samples of dieters.

Relations between dietary restraint, depressive symptoms, and binge eating: A longitudinal study

OBJECTIVE

Temporal relations between dietary restraint, depressive symptoms, and binge eating were tested by means of three competing models positing that (1) dietary restraint and depressive symptoms predict future increases in binge eating, (2) binge eating predicts future increases in dietary restraint and depressive symptoms, and (3) binge eating is reciprocally related to these two factors.

METHOD

Longitudinal data from a community sample of Dutch females (N = 143; M age = 19.6) was used to test these relations while controlling for initial levels of these factors.

RESULTS

Dietary restraint did not predict future increases in binge eating, nor did binge eating predict future increases in dietary restraint. Depressive symptoms predicted future increases in binge eating, but binge eating did not predict future increases in depressive symptoms.

CONCLUSION

Although this study had limited statistical power, the pattern of relations and effect sizes suggest that depressive symptoms, but not dietary restraint, increase risk of binge eating for late adolescent females.

Personality correlates of obese eating behaviour: Swedish universities Scales of Personality and the Three Factor Eating Questionnaire

OBJECTIVE

To study the relationship between personality characteristics and eating behaviour in obese patients.

METHOD

The participants were 45 patients with a mean body mass index (BMI) of 39 kg/m2. Eating behaviour was measured with the Three Factor Eating Questionnaire (TFEQ) also taking the subscales Flexible Control and Rigid Control into account, and Personality was assessed with the Swedish universities Scales of Personality (SSP).

RESULTS

In linear regression analyses the personality characteristic greater Lack of Assertiveness could explain 17% of Disinhibited eating and 13% of Hunger scores, whereas less Lack of Assertiveness could explain 12% of Flexible Control. BMI was negatively related to one of the personality characteristics, Adventure Seeking.

DISCUSSION

A lacking ability to be socially self-assertive and confident characterized obese patients with more problematic eating behaviours that imply a risk for over consumption of food. A greater self-assertiveness was found in patients with a relatively more efficient eating strategy such as flexible control over eating.

The Stice model of overeating: Tests in clinical and non-clinical samples

The present study tested the dual pathway model of Stice [. A review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633-661 and . A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124-135.] in a non-clinical sample of female adolescents and a clinical sample of female eating disorder patients. The model assumes that negative affect and restrained eating mediates the link between body dissatisfaction and overeating. We also tested an extended version of the model postulating that negative affect and overeating are not directly related, but indirectly through lack of interoceptive awareness and emotional eating. Structural equation modelling was used to test our models. First, in the two samples, body dissatisfaction and drive for thinness were associated with overeating/binge eating. In both clinical and adolescent sample, we found support for the negative affect pathway and not for the restraint pathway. Lack of interoceptive awareness and emotional eating appear to (partly) explain the association between negative affect and overeating. Emotional eating was much more strongly associated with overeating in the clinical than in the adolescent sample. In sum, we found substantial evidence for the negative affect pathway in the dual pathway model. The link between body dissatisfaction and overeating in this respect might be explained by the fact that negative affect, due to body dissatisfaction, is related to a lack of awareness of personal feelings and to eating when dealing with negative emotions, which on its turn is associated with overeating.

Rigid and flexible control of eating behavior in a college population

The objective of this study was to explore the relationship between rigid control (RC) and flexible control (FC) of eating behavior and their relationship to traditional weight, eating, and affective measurements in a large heterogeneous population. Participants were 639 underweight to obese male and female college students. Multiple regression analyses (MRA) revealed that high RC was associated with high Body Mass Index (BMI) and high Disinhibition (DIS), and high FC was associated with low BMI and low DIS in women. In men, high RC was associated with high BMI and high DIS, whereas FC was not related to BMI or DIS. Multiple regression analyses of BMI on RC and FC in the female subsample revealed that the control variables interact in such a way that the relationship between RC and BMI is stronger when FC is lower. In men, there was no interaction between these variables. This study is the first full replication of Westenhoefer's Gezugeltes Essen und Storbarkeit des Ebetaverhaltens: 2. Auflage. Gottingen: Verlag fur Psychologie () findings regarding RC and FC and their relationship to weight (BMI) and Disinhibition (DIS) in women. This is also the only second study to use the expanded, more reliable versions of the RC and FC scales. Overall, high RC in women and men was associated with greater eating and affective pathology.

What a difference a diet makes: towards an understanding of differences between restrained dieters and restrained nondieters

Restrained eaters who are and are not dieting to lose weight have shown opposite eating regulation patterns in past research. To better understand these differences, restraint theory and the Three-Factor Model of Dieting was used to generate differential predictions about the mean and variability of restrained dieters (RDs) and restrained nondieters (RNDs) on the eating inventory Cognitive Restraint (CR) scale and the Restraint Scale (RS). Unrestrained nondieters served as a reference group. Eighty normal-weight female college students completed the CR, RS, and a measure of weight cycling. RDs, relative to RNDs, obtained higher and more homogeneous scores on the Cognitive Restraint, and higher and more heterogeneous scores on the RS. A post hoc analysis found that RDs had a much greater weight cycling history than RNDs. These findings are most consistent with the Three-Factor Model of Dieting, but also point to needed revisions both in this model and in traditional restraint theory.

Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA)

OBJECTIVE

To identify risk factors for weight gain and explore body composition and eating behaviors among adolescent females initiating depot medroxyprogesterone acetate (DMPA).

METHODS

A longitudinal study was conducted in 43 adolescent females beginning DMPA. Data collection at baseline, 3, and 6 months included structured interview; measurement of height, weight, and percent body fat; and assessment of dietary restraint, disinhibition, and appetite.

RESULTS

Black and white subjects did not differ in baseline weight or body composition. At 6 months, black subjects had a 4.2% increase in weight (mean weight gain=2.9 kg; P=0.003) and a 12.5% increase in body fat (mean fat gain =2.5 kg; P<0.001). In contrast, white subjects had a 1.2% increase in weight (mean weight gain=0.9 kg; P=0.32) and a 1.2% increase in body fat (mean fat gain of 0.5 kg; P=0.54). Baseline weight (P<0.001), study visit (P=0.005), age (P=0.006), eating restraint (P=0.005), eating disinhibition (P<0.001), and other medications (P<0.001) were predictive of weight gain in black subjects. Only baseline weight (P<0.001) was predictive in white subjects. Higher baseline weight (adjusted odds ratio (AOR)=1.2, 95% confidence interval (CI)=1.1,1.3) was a risk factor for gaining >2.2 kg the first 3 months. Black race (AOR=7.8, 95% CI=1.5, 66.2) and younger age at menarche (AOR=0.6, 95% CI=0.3, 0.9) were risk factors for gaining >2.2 kg the second 3 months. Appetite decreased in the study sample reaching statistical significance in black subjects.

CONCLUSIONS

Our data suggest that black and white adolescents differ in the quantity, timing, and predictors of weight gain on DMPA. DMPA-associated weight gain is paralleled by increases in total body fat, while appetite decreases on DMPA.

Rigid vs. flexible dieting: association with eating disorder symptoms in nonobese women

The correlates of rigid and flexible dieting were examined in a sample of 188 nonobese women recruited from the community and from a university. The primary aim of the study was to test the hypothesis that women who utilize rigid versus flexible dieting strategies to prevent weight gain report more eating disorder symptoms and higher body mass index (BMI) in comparison to women who utilize flexible dieting strategies. The study sample included women who were underweight (29%), normal weight (52%), and overweight (19%). None of the women were obese, as defined by BMI>30. Participants were administered a questionnaire that measures Rigid Control and Flexible Control of eating. Body weight and height were measured and measures of eating disorder symptoms and mood disturbances were administered. Our results indicated that BMI was significantly correlated with rigid dieting and flexible dieting. BMI was controlled statistically in other analyses. The study found that individuals who engage in rigid dieting strategies reported symptoms of an eating disorder, mood disturbances, and excessive concern with body size/shape. In contrast, flexible dieting strategies were not highly associated with BMI, eating disorder symptoms, mood disturbances, or concerns with body size. Since this was a cross sectional study, causality of eating disorder symptoms could not be addressed. These findings replicate and extend the findings of earlier studies. These findings suggest that rigid dieting strategies, but not flexible dieting strategies, are associated with eating disorder symptoms and higher BMI in nonobese women.

The cognitive-behavioral model of bulimia nervosa: a direct evaluation

OBJECTIVE

This study represented the first attempt to directly evaluate Fairburn et al's (1986) cognitive-behavioral model of bulimia nervosa--the model on which the most widely used treatment for bulimia nervosa is based.

METHOD

The major predictions of the model were tested using structural equation modeling. Data were collected from the responses of 526 subjects to a number of self-report measures.

RESULTS

The factors of self-esteem, overconcern with weight and shape, and dietary restraint accounted for a large proportion of the variance in binge eating and purging. The key pathway in the model was the link between overconcern with weight and shape and the adoption of purgative behaviors, which then fed into a vicious cycle of binge eating and purging. Contrary to Fairburn's hypothesis, high levels of dietary restraint did not predict increased binge eating.

DISCUSSION

The results suggest that the components of Fairburn's model may operate to maintain the bulimic cycle in a slightly different way to that originally proposed.

On the relation of flexible and rigid control of eating to body mass index and overeating in patients with binge eating disorder

OBJECTIVE

To examine the relationship of flexible and rigid dimensions of restrained eating to body mass index (BMI) and overeating in outpatients with binge eating disorder (BED).

METHOD

Participants were 148 consecutive outpatients who met criteria for BED. The Three-Factor Eating Questionnaire (TFEQ) was administered to assess Cognitive Restraint, Hunger, and Disinhibition. The TFEQ also contains two Cognitive Restraint subscales--Flexible Control and Rigid Control. The Eating Disorder Examination-Questionnaire version (EDE-Q) was administered to assess frequency of different forms of overeating during the past 28 days and the attitudinal features of eating disorders.

RESULTS

Flexible Control and Rigid Control were significantly correlated with each other. They were both negatively correlated with BMI, but neither was significantly correlated with the frequency of binge eating or other forms of overeating. In addition, Flexible Control and Rigid Control predicted almost the same amount of variance in BMI.

DISCUSSION

BED patients exhibit flexible and rigid control of eating that is related to BMI, but not to the frequency of binge eating or other forms of overeating. Results of the present study provide preliminary evidence that flexible and rigid control of eating may not be a useful distinction in BED patients. However, increased restraint, regardless of type, may prove to be of benefit with regard to weight control and may not have adverse effects on binge eating in obese BED patients.

The measurement of dietary restraint, disinhibition and hunger: an examination of the factor structure of the Three Factor Eating Questionnaire (TFEQ)

OBJECTIVE

To conduct separate factor analyses of the Three Factor Eating Questionnaire (TFEQ-R, TFEQ-D and TFEQ-H) scales and provide initial evidence of the construct validity of the obtained solutions.

DESIGN

A cross-sectional survey with a 12 month retest of a subsample of subjects.

SUBJECTS

A total of 553 undergraduate university women with a mean age of 25.0 y. The retest sample comprised 64 subjects with a mean age at retest of 25.7 y.

MEASUREMENTS

In addition to the TFEQ, age, body mass index (BMI), satisfaction with current weight, nutrition knowledge and current exercise level were recorded.

RESULTS

Three restraint (strategic dieting behaviour, attitude to self-regulation, avoidance of fattening foods), three disinhibition (habitual susceptibility, emotional susceptibility, situational susceptibility) and two hunger constructs (internal locus for hunger, external locus for hunger) were identified. Initial evidence of the validity of these constructs was provided.

CONCLUSION

The explanation of disordered eating behaviour is likely to be refined more by specific constructs, such as those presented, rather than by the more general constructs measured by the original TFEQ-R, TFEQ-D and TFEQ-H scales. Further examination of the factor structures presented is therefore encouraged.