A novel classification paradigm for understanding the positive and negative outcomes associated with dieting

Prepregnancy dieting and obstetrical and neonatal outcomes: Findings from a national surveillance project in the United States

PROBLEM AND BACKGROUND

Women with overweight or obesity are recommended to lose weight before pregnancy. Dieting is one of the most used weight control strategies. However, the health implications of dieting before pregnancy remain unclear.

AIM

To evaluate the associations of dieting during the year before pregnancy with obstetrical and neonatal outcomes, including gestational weight gain (GWG), gestational diabetes, low birthweight, macrosomia, small-for-gestational-age infants (SGA), large-for-gestational-age infants (LGA), and preterm birth.

METHODS

This study analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a surveillance project in the United States that collects data on maternal health before, during, and after pregnancy. Women who participated in PRAMS phase 7 with a prepregnancy body mass index ≥25 kg/m2 and a singleton birth were eligible. Statistical analyses included logistic regressions and post-hoc mediation analysis (Sobel Test).

FINDINGS

A total number of 51,399 women were included in the analysis. Women who self-reported prepregnancy dieting (42.8 %) had lower odds of SGA (adjusted odds ratio [aOR]: 0.87; 95 % CI: 0.79-0.97), and higher odds of excessive GWG vs adequate GWG (aOR: 1.42; 95 % CI: 1.32-1.52), gestational diabetes (aOR: 1.12; 95 % CI: 1.02-1.22), and LGA (aOR: 1.18; 95 % CI: 1.08-1.28). Furthermore, the association between prepregnancy dieting and LGA was mediated by excessive GWG (Sobel Test z-value = 5.72, p < 0.01).

DISCUSSION AND CONCLUSION

This analysis revealed that prepregnancy dieting was associated with several adverse consequences, including excessive GWG, gestational diabetes, and LGA infants. Findings contribute to an improved understanding of the perinatal implications of prepregnancy dieting.

Youth's energy intake during a laboratory-based loss-of-control eating paradigm: Associations with reported current dieting

Dieting is theorized as a risk factor for loss-of-control (LOC)-eating (i.e., feeling a sense of lack of control while eating). Support for this association has largely relied on retrospective self-report data, which does not always correlate with objectively assessed eating behavior in youth. We hypothesized that during a laboratory-based LOC-eating paradigm, children and adolescents who reported current (at the time of the visit) dieting would consume meals consistent with LOC-eating (greater caloric intake, and intake of carbohydrates and fats, but less intake of protein). Participants were presented with a buffet-style meal and instructed to "Let yourself go and eat as much as you want." Current dieting (i.e., any deliberate change to the amount or type of food eaten to influence shape or weight, regardless of how effective the changes are) was assessed via interview. General linear models were adjusted for fat mass (%), lean mass (kg), height, sex, protocol, race and ethnicity, pre-meal hunger and minutes since consumption of a breakfast shake. Of 337 participants (Mage 12.8 ± 2.7y; 62.3 % female; 45.7 % non- Hispanic White and 26.1 % non-Hispanic Black; MBMIz 0.78 ± 1.11), only 33 (9.8 %) reported current dieting. Current dieting was not significantly associated with total energy intake (F = 1.63, p = .20, ηp2 = 0.005), or intake from carbohydrates (F = 2.45, p = .12, ηp2 = 0.007), fat (F = 2.65, p = .10, ηp2 = 0.008), or protein (F = 0.39, p = .53, ηp2 = 0.001). Contrary to theories that dieting promotes LOC-eating, current dieting was not associated with youth's eating behavior in a laboratory setting. Experimental approaches for investigating dieting are needed to test theories that implicate dieting in pediatric LOC-eating.

Relations between forms of dietary restraint, restriction, and loss-of-control eating among adolescents seeking weight control: An ecological momentary assessment study

OBJECTIVE

This study aimed to: 1) compare rates of dietary restraint and restriction between adolescents with and without loss-of-control (LOC) eating who were seeking weight control and 2) examine temporal relations between restraint/restriction and LOC eating.

METHOD

37 adolescents seeking weight control (mean age: 15.4 ± 1.5; 62 % White; 57 % female; mean BMI percentile = 97.3 ± 3.1) completed a one-week ecological momentary assessment protocol and reported on dietary restraint/restriction and eating behavior prior to beginning a weight control intervention. Chi-square tests examined differences in frequency of restraint/restriction between participants with and without LOC eating. Multilevel models examined associations between dietary restraint/restriction and LOC eating at the next survey and on the next day.

RESULTS

Of 37 participants, 15 (41 %) reported engaging in LOC eating. Participants with LOC eating more frequently endorsed several forms of restraint and restriction versus participants without LOC eating. Attempting to avoid enjoyable foods and attempting to limit eating at one survey predicted greater likelihood of LOC eating at the next survey.

CONCLUSIONS

Findings suggest that attempted restraint, but not actual restriction, was associated with LOC eating. Research should explore additional factors that may influence these relationships, which could inform weight control treatments that address restraint/restriction.

Evaluation of a combined, online intervention for binge-type eating disorders and high body weight in young adults

BACKGROUND

Binge-type eating disorders (EDs; i.e., bulimia nervosa, binge eating disorder) are common among young adults with high body weight, yet few interventions target both conditions. This study tested an online guided self-help intervention that provided cognitive behavioral therapy (CBT) tools for EDs and behavioral weight loss (BWL) content to young adults with binge-type EDs and high body weight.

METHOD

60 adults aged 18-39 with clinical/subclinical binge-type EDs and high body weight were randomized to a combined condition or a CBT-only condition. Participants received self-help content for 8 weeks and self-reported ED attitudes, frequency of binge eating and compensatory behaviors, and weight at baseline, 4-weeks, and 8-weeks. Linear mixed models and negative binomial models compared changes between conditions in ED attitudes, ED behaviors, and weight at each timepoint. Chi-square test and independent samples t-test compared program completion and session engagement between conditions.

RESULTS

No significant differences in weight change or ED symptom change emerged between the conditions. Both conditions achieved significant reductions in ED attitudes, binge episodes, and compensatory behaviors from baseline to 8-weeks (ps < .05). Neither condition demonstrated significant weight loss from baseline to 8-weeks. Program completion (47 %) and session engagement (57 %) were equally high across conditions.

DISCUSSION

Both conditions achieved ED symptom change; however, neither condition was associated with weight change. Research is needed to identify the types of strategies and doses of BWL that promote clinically significant weight and ED symptom change in young adults.

The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment

In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.

Learned industriousness as a translational mechanism in anorexia nervosa

It remains unexplained why some behaviours persist despite being non-hedonic and ostensibly aversive. This phenomenon is especially baffling when such behaviours are taken to excess in the form of psychopathology. Anorexia nervosa is one psychiatric disorder in which effortful behaviours that most people find unpleasant (suchas restrictive eating) are persistently performed. We propose thatthe social psychology theory of learned industriousness providesa novel mechanistic account for such phenomena. This theoryposits that high-effort behaviour can be conditioned to acquire secondary reinforcing properties through repeated pairing with reward. Accordingly, effort sensations become less aversive andmore appetitive, increasing willingness to engage in effortful behaviour. In this Perspective, we review pre-clinical behaviouraland biological data that support learned industriousness, contrast learned industriousness with other models of non-hedonic persistence (such as habit learning), highlight evidence that supports learned industriousness in individuals with anorexia nervosa and consider implications of the model, including translation to other psychiatric presentations.

Restrained eating behaviour, anorexia nervosa and food consumption between children and adolescents: a scoping review

Anorexia nervosa (AN) and restrained eating behaviour (REB) are characterised by reduced food intake to achieve body weight loss. This scope review aimed to describe the existing evidence on the association between AN, restrictive eating behaviour and food consumption. Studies with children and adolescents of both sexes of all races and ethnicities were included. Experimental and observational studies, systematic reviews, meta-analysis, case reports or series, conference abstracts, dissertations and theses were also included. The search was conducted in ten electronic databases and grey literature without language restriction on 14 November 2020. Twenty-four studies met the inclusion criteria. Most studies included girls and identified lower intake of energy content, fat and certain micronutrients. There was also a higher intake of caffeine, fibre, vegetables, legumes and fruits and a lower intake of low-quality snack, fast food, sweets and foods with high carbohydrate and fat contents. The need to improve the quality of the diet among study participants was also identified. Thus, it is recommended that the evaluation of food consumption be careful to develop effective prevention strategies for the development of AN/REB and minimise nutritional deficiencies in these individuals.

Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision-Making in Anorexia Nervosa

PURPOSE OF REVIEW

Despite decades of research, knowledge of the mechanisms maintaining anorexia nervosa (AN) remains incomplete and clearly effective treatments elusive. Novel theoretical frameworks are needed to advance mechanistic and treatment research for this disorder. Here, we argue the utility of engaging a novel lens that differs from existing perspectives in psychiatry. Specifically, we argue the necessity of expanding beyond two historically common perspectives: (1) the descriptive perspective: the tendency to define mechanisms on the basis of surface characteristics and (2) the deficit perspective: the tendency to search for mechanisms associated with under-functioning of decision-making abilities and related circuity, rather than problems of over-functioning, in psychiatric disorders.

RECENT FINDINGS

Computational psychiatry can provide a novel framework for understanding AN because this approach emphasizes the role of computational misalignments (rather than absolute deficits or excesses) between decision-making strategies and environmental demands as the key factors promoting psychiatric illnesses. Informed by this approach, we argue that AN can be understood as a disorder of excess goal pursuit, maintained by over-engagement, rather than disengagement, of executive functioning strategies and circuits. Emerging evidence suggests that this same computational imbalance may constitute an under-investigated phenotype presenting transdiagnostically across psychiatric disorders. A variety of computational models can be used to further elucidate excess goal pursuit in AN. Most traditional psychiatric treatments do not target excess goal pursuit or associated neurocognitive mechanisms. Thus, targeting at the level of computational dysfunction may provide a new avenue for enhancing treatment for AN and related disorders.

Machine learning to advance the prediction, prevention and treatment of eating disorders

Machine learning approaches are just emerging in eating disorders research. Promising early results suggest that such approaches may be a particularly promising and fruitful future direction. However, there are several challenges related to the nature of eating disorders in building robust, reliable and clinically meaningful prediction models. This article aims to provide a brief introduction to machine learning and to discuss several such challenges, including issues of sample size, measurement, imbalanced data and bias; I also provide concrete steps and recommendations for each of these issues. Finally, I outline key outstanding questions and directions for future research in building, testing and implementing machine learning models to advance our prediction, prevention, and treatment of eating disorders.

Weight Goals, Disordered Eating Behaviors, and BMI Trajectories in US Young Adults

BACKGROUND

Community sample data indicate that weight control efforts in young adulthood may have associations with greater increases in body mass index (BMI) over time.

OBJECTIVE

To determine the prospective associations between weight goals and behaviors in young adults and BMI trajectories over 15-year follow-up using a nationally representative sample.

DESIGN

Longitudinal cohort data collected from 2001 to 2018 of the National Longitudinal Study of Adolescent to Adult Health.

PARTICIPANTS

Young adults aged 18-26 years old at baseline stratified by gender and BMI category.

MAIN MEASURES

Predictors: weight goals, any weight loss/maintenance behaviors, dieting, exercise, disordered eating behaviors.

OUTCOMES

BMI at 7- and 15-year follow-up.

KEY RESULTS

Of the 12,155 young adults in the sample (54% female, 32% non-White), 33.2% reported a goal to lose weight, 15.7% to gain weight, and 14.6% to maintain weight. In unadjusted models, all groups have higher mean BMI at 7- and 15-year follow-up. In mixed effect models, goals to lose weight in men with BMI < 18.5 (5.94 kg/m²; 95% CI 2.58, 9.30) and goals to maintain weight in men with BMI ≥ 25 (0.44; 95% CI 0.15, 0.72) were associated with greater BMI increase compared to no weight goal. Engaging in disordered eating behaviors was associated with greater BMI increase in men with BMI < 18.5 (5.91; 2.96, 8.86) and women with 18.5 ≤ BMI < 25 (0.40; 0.16, 0.63). Dieting (- 0.24; - 0.41, - 0.06) and exercise (- 0.31; - 0.45, - 0.17) were associated with lower BMI increase in women with 18.5 ≤ BMI < 25. In women with BMI < 18.5, dieting was associated with greater BMI increase (1.35; 0.33, 2.37).

CONCLUSIONS

Weight control efforts may have variable effects on BMI over time by gender and BMI category. These findings underscore the need to counsel patients on the effectiveness of weight control efforts and long-term weight management.

Adapted emotion skills training group for young people with anorexia nervosa : A mixed-methods evaluation

BACKGROUND

Brief interventions focused on emotion processing are needed to support young people (YP) in inpatient treatment programmes to manage emotions. Cognitive Remediation and Emotion Skills Training (CREST) has been found beneficial in adult anorexia nervosa (AN) groups. An initial case series found that CREST is a feasible intervention for YP with AN. Further age-appropriate adaptations were needed to improve YP's engagement. Following qualitative feedback on the original CREST manual, a second case series was conducted in an inpatient unit with age-appropriate adaptations to evaluate its feasibility in a YP inpatient setting.

METHODS

A mixed-methods methodology was used to evaluate the intervention. A total of 30 YP were asked to write a feedback letter about their experience of the group and to complete the Emotion Skills Scale (ESS), an ad hoc 12-item self-report Likert scale assessing emotional functioning. The ESS was also completed by a member of the multidisciplinary team for an external assessment.

RESULTS

Quantitative results showed no statistically significant changes in YP's emotional functioning, while qualitative results showed that YP found it helpful to learn about emotion processes, acknowledging their need to be supported to express them and understand the link with AN symptoms. Four high-order themes were identified: Helpfulness of CREST Group for Young People (CREST-GYP), Perception of contents, Challenges of group therapy, Suggestions for improvement.

CONCLUSIONS

Pilot findings suggest that CREST-GYP is an acceptable intervention for YP with AN. Clinical and research studies are needed to clarify whether CREST-GYP can produce more beneficial treatment results than treatment as usual.

Perceptions of non-successful families attending a weight-management clinic

OBJECTIVE

This study seeks to understand family's perceptions of their care at a paediatric weight management service, with a view to informing service improvement.

DESIGN

A qualitative service review conducted via semistructured interviews with parents (n=11) and children (n=3) who attended the clinic. The recruitment was open to all, but those who were not succeeding in their weight-loss goals self-selected to participate. Self-Determination Theory was used as a framework to explore families' experiences of the clinic.

SETTING

Recruitment occurred during clinical appointments and interviews were conducted over the phone in the days following the appointments.

PATIENTS

The service sees paediatric patients with a body mass index >99th percentile, with comorbidities or safeguarding concerns.

INTERVENTIONS

The clinic's service includes appointments typically every 2 months, with a multidisciplinary team including consultant endocrinologists, a dietician, a clinical psychologist, a social worker and a clinical nurse specialist.

MAIN OUTCOME MEASURES

Families' feedback on the multi-disciplinary team (MDT) clinic, and their perceptions of how improvements could be made.

RESULTS

Families perceive a lack of autonomy, competency and feel a lack of connectivity both in their lives broadly and within their experience at the clinic.

CONCLUSIONS

Interventions in families struggling with weight improvements should see the clinical team placing more emphasis on working alongside parents to develop young people's sense of self-determination. Expectations must be set that success originates from changes outside of clinical appointments and that the clinical team is in place to support the family's development of sustainable, self-determined lifestyle habits.

Hubungan Perilaku Diet Dengan Massa Lemak Tubuh Pada Remaja Putri Di SMA Negeri 5 Surabaya

Background: The fat body mass can be increased especially in adolescent girl. When fat body mass increased it can affect the nutritional status and body image. If someone wants to have the ideal body imaged, they can try to do diet to decreased fat body mass. Objectives:  This study aimed to analyze a relationship of dieting behavior with fat body mass at SMA Negeri 5 Surabaya.Methods: The design of the study was cross sectional involving 76 selected samples in the simple random sampling. The aimed of measuring body height, weight and body fat mass for scoring the nutritional status and percentage of fat body mass. Some characteristic of the respondents were age, amount of pocket money, physical activity and nutritional status. The data were analyzed by using Chi-Square correlation test with p<0.05.Results: The averaged of respondents age was 16 years old, most of all the amounted of pocket money from the respondents approximately IDR 25,000-75,000 (35.5%). The category of physical activity was mild (42.1%), and the nutritional status of respondents was normal (61.3%). Some of the respondents was doing a healthy diet (61.8%) with averaged score was 39.8. The averaged of body fat mass from the respondents was 25.24%. The result showing there was no relationship between diet behavior with fat body mass in girl adolescent (p>0.060).Conclusions: Diet behavior was not founded to be related to the fat body mass in female adolescent. Therefore the students needed to get more information about dieting behavior and fat body mass to prevented more nutritional problems.ABSTRAKLatar Belakang: Peningkatan massa lemak tubuh biasa dialami oleh remaja putri. Massa lemak tubuh yang berlebih akan berdampak pada status gizi serta bentuk tubuh. Diet merupakan salah satu cara untuk menurunkan massa lemak tubuh tersebut agar bentuk tubuh menjadi ideal.Tujuan:menganalisis hubungan antara perilaku diet dengan massa lemak tubuh remaja putri di SMA Negeri 5 Surabaya.Metode: Penelitian ini menggunakan desain studi cross sectional dan melibatkan 76 responden yang dipilih secara simple random sampling. Data dikumpulkan dengan melakukan pengukuran berat badan dan tinggi badan untuk menilai status gizi serta pengukuran persentase massa lemak tubuh menggunakan BIA (Bioelectrical Impedance Analysis). Wawancara dan pengisian kuesioner untuk mengetahui karakteristik dan perilaku diet responden. Teknik analisis data yang digunakan adalah uji korelasi chi-square dengan p<0,05.Hasil: rata-rata usia subyek 15,93±0,64 tahun dengan rerata besar uang saku harian sebesar Rp 22.474±12.62i, Aktivitas fisik tingkat ringan sebanyak 42,1% siswi, dan status gizi responden berdasarkan IMT/U didominasi oleh kategori normal sebanyak 80,3%. Sebagian besar responden menjalankan diet sehat sebanyak 61,8% dengan rata-rata nilai sebesar 39,8.Sebanyak 31,6% subyek dengan kategori massa lebih lebihHasil analisis menunjukkan tidak adanya hubungan antara perilaku diet dengan persen lemak tubuh remaja putri (p>0,06).Kesimpulan: Perilaku diet tidak memiliki hubungan yang bermakna dengan massa lemak tubuh remaja putri. Diperlukan penelitian lebih lanjut untuk menganalisis faktor lain yang berhubungan dengan perilaku diet dan massa lemak tubuh pada remaja putri.    

Effects of Palatable Food Versus Thin Figure Conflicts on Responses of Young Dieting Women

Many young women use dieting to achieve a thinner figure yet most tend to fail as a result of heightened responsiveness to palatable food environments and increases in hedonic cravings. In this preliminary study, we developed a novel palatable food vs. thin figure conflict task to assess conflicting motives associated with eating among young women. Forty young dieting women [mean body mass index (BMI) = 22.98 kg/m², SD = 3.81] completed a food vs. figure conflict task within a 2 (distractor image: food vs. figure) × 2 (word-image congruence: congruent vs. incongruent) within-subjects design. Results supported the view that this new task could effectively capture conflict costs. Dieting young women displayed stronger food conflicts than figure conflicts based on having longer response delays and higher error rates in the food conflict condition than the figure conflict condition. Although young women often proclaimed "dieting" to achieve or maintain a good figure, dieters appeared to exhibit stronger preferences for palatable food cues relative to thin figure cues. These results provide important information for understanding automatic processing biases toward palatable foods and underscore the need for research extensions in other cultural contexts to determine whether such biases are universal in nature.

Is #cleaneating a healthy or harmful dietary strategy? Perceptions of clean eating and associations with disordered eating among young adults

BACKGROUND

Although "clean eating" is widely propagated through social media and anecdotal reports in the popular press, there is almost no scientific research on this potentially risky dietary strategy. The current investigation explored definitions and perceptions of "clean eating" and its associations with indicators of disordered eating among diverse U.S.-based undergraduates.

METHOD

Undergraduates (N = 148, M age = 19.41 years, 70.3% women) were asked to define "clean eating" via an open-ended question and then read vignettes featuring five "clean" diets, all of which caused mild functional impairment across multiple domains. Participants rated the extent to which they believed the diet was 1) "healthy," 2) reflective of "clean eating," and 3) likely to be adopted by them. Finally, participants completed questionnaires to assess body appearance evaluation, obsessive-compulsive symptoms, eating disorder symptoms, and symptoms of orthorexia nervosa.

RESULTS

Open-ended responses indicated that participants defined "clean eating" in varied but overwhelmingly positive terms. Repeated measures ANOVAs indicated that the "meal substitution" vignette was perceived as the least healthy, least "clean," and least likely to be adopted, whereas the "new" (balanced) diet vignette was rated the highest on these domains. Correlations among diet perceptions and indicators of disordered eating were positive and significant.

CONCLUSIONS

"Clean eating" is likely a heterogeneous phenomenon that is viewed favorably by U.S.-based college students even when it is linked with functional impairment and emotional distress. Ongoing examination of "clean eating" could clarify the potential benefits and risks posed by this dietary strategy and thus inform eating disorder prevention efforts.

Patterns of weight control behavior persisting beyond young adulthood: Results from a 15-year longitudinal study

OBJECTIVE

Dieting and unhealthy weight control behaviors have been associated with negative outcomes. Most research has examined the prevalence of these behaviors in adolescence and young adulthood. Less is known about whether they persist further into adulthood. We examined patterns of weight control behaviors beyond young adulthood using data from 1,455 males and females participating in Project EAT (Eating and Activity in Teens and Young Adults), a 15-year population-based, longitudinal study.

METHOD

Participants completed surveys assessing dieting, high-frequency dieting (i.e., 5+ times/year), unhealthy weight control (e.g., fasting), and extreme weight control (e.g., vomiting) at each 5-year assessment (Waves 1-4). Longitudinal logistic regression models tested trends in weight control behaviors across the waves. Likelihood of persisting or discontinuing each behavior from Wave 3 to Wave 4 was examined through cross tabulations.

RESULTS

Between Waves 3 and 4 in adulthood, dieting increased for both genders (Women: p < .001; Men: p = .004) and high-frequency dieting (p < .001) and unhealthy weight control behaviors (p = .011) increased for men. For both genders, dieting and unhealthy weight control patterns initiated in prior to young adulthood were more likely to persist than cease in adulthood (ps < .001).

DISCUSSION

Weight control behaviors continue to be prevalent in adulthood, and to especially increase among men. Research is needed to understand the consequences of weight control behaviors in different life stages; however, the results suggest that interventions to decrease unhealthy weight management practices may be needed well into adulthood.

Disordered Eating Attitudes and Behaviors in Youth with Overweight and Obesity: Implications for Treatment

PURPOSE OF THE REVIEW

Children with obesity experience disordered eating attitudes and behaviors at high rates, which increases their risk for adult obesity and eating disorder development. As such, it is imperative to screen for disordered eating symptoms and identify appropriate treatments.

RECENT FINDINGS

Family-based multicomponent behavioral weight loss treatment (FBT) is effective at treating childhood obesity and demonstrates positive outcomes on psychosocial outcomes, including disordered eating. FBT utilizes a socio-ecological treatment approach that focuses on the development of individual and family healthy energy-balance behaviors as well as positive self- and body esteem, supportive family relationships, richer social networks, and the creation of a broader environment and community that facilitates overall physical and mental health. Existing literature suggests FBT is an effective treatment option for disordered eating and obesity in children. Future work is needed to confirm this conclusion and to examine the progression and interaction of obesity and disordered eating across development to identify the optimal time for intervention.

Restrictive eating and nonsuicidal self-injury in a nonclinical sample: Co-occurrence and associations with emotion dysregulation and interpersonal problems

Disordered eating frequently co-occurs with nonsuicidal self-injury (NSSI), and evidence suggests that the co-occurrence of these behaviors is associated with heightened emotion dysregulation. However, little is known about the relationship between restrictive eating and NSSI, and the significance of their co-occurrence. This study examined cross-sectional associations between self-reported restrictive eating, NSSI, and putative mechanisms of emotion regulation and interpersonal problems in a non-clinical sample of undergraduate students (N = 98, 80.6% female), using the Dietary Restriction Screener (Haynos & Fruzzetti, 2015), Deliberate Self-Harm Inventory (Gratz, 2001), Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2006), and Inventory of Interpersonal Problems-Personality Disorders-25 (Kim & Pilkonis, 1999). Hierarchical logistic regression analyses indicated that restrictive eating was associated with NSSI above and beyond the influence of binge eating, purging, and relevant covariates (B = 2.04, p < 0.001). In addition, multivariate analyses of variance revealed that the co-occurrence of restrictive eating and NSSI was associated with greater difficulties accessing and implementing effective, rather than impulsive, emotion regulation strategies when distressed than either behavior alone (p < 0.001). Findings highlight the seriousness of restrictive eating even within a nonclinical sample, as it is associated with heightened probability of NSSI and clinical severity among those who engage in co-morbid NSSI. Healthcare providers are encouraged to screen for NSSI among individuals with restrictive eating. In addition, a focus on improving emotion regulation and interpersonal skills may enhance prevention and intervention efforts for individuals with co-occurring restrictive eating and NSSI behaviors.

Restrictive eating is associated with emotion regulation difficulties in a non-clinical sample

The relationship between emotion regulation difficulties and restrictive eating has not been established in non-clinical samples. In this study, undergraduates (n = 98) provided information regarding general and specific emotion regulation difficulties on the Difficulties in Emotion Regulation Scale (DERS) and whether they had engaged in recent restrictive eating. Generalized linear models were used to determine if individuals endorsing versus denying recent restrictive eating differed on emotion regulation problems. Results indicated that individuals endorsing restrictive eating had elevated DERS Total (p < .001), Goals (p = .001), Impulse (p < .001), and Strategies (p < .001) scores. Results remained primarily unchanged after controlling for the related construct of dietary restraint. Findings indicate that endorsement of restrictive eating among non-clinical individuals is uniquely associated with emotion regulation deficits, especially those reflecting emotional under-control. Interventions targeting emotion regulation may enhance prevention and treatment of restrictive eating across severity.

Measurement invariance of the Eating Disorder Examination in black and white children and adolescents

OBJECTIVE

The Eating Disorder Examination (EDE) was originally developed and validated in primarily white female samples. Since data indicate that eating pathology impacts black youth, elucidating the psychometric appropriateness of the EDE for black youth is crucial.

METHODS

A convenience sample was assembled from seven pediatric obesity studies. The EDE was administered to all youth. Confirmatory factor analyses (CFA) were conducted to examine the original four-factor model fit and two alternative factor structures for black and white youth. With acceptable fit, multiple-group CFAs were conducted. For measurement invariant structures, the interactive effects of race with sex, BMIz, adiposity, and age were explored (all significance levels p < .05).

RESULTS

For both black and white youth (N = 820; 41% black; 37% male; 6-18 years; BMIz -3.11 to 3.40), the original four-factor EDE structure and alternative eight-item one-factor structure had mixed fit via CFA. However, a seven-item, three-factor structure reflecting Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction had good fit and held at the level of strict invariance. Girls reported higher factor scores than boys. BMIz and adiposity were positively associated with each subscale. Age was associated with Dietary Restraint and Body Dissatisfaction. The interactional effects between sex, BMIz, and age with race were not significant; however, the interaction between adiposity and race was significant. At higher adiposity, white youth reported greater pathology than black youth.

CONCLUSION

An abbreviated seven-item, three-factor version of the EDE captures eating pathology equivalently across black and white youth. Full psychometric testing of the modified EDE factor structure in black youth is warranted.

Initial evaluation of a single-item screener to assess problematic dietary restriction

PURPOSE

Existing measures to assess restrictive eating conflate both problematic and healthy restrictive practices, and perceived restriction without reduced caloric intake. In this study, we devised and tested the utility of a single-item screener, the Dietary Restriction Screener (DRS), to assess problematic restriction.

METHODS

94 individuals completed the DRS and measures assessing eating disorder symptoms, preoccupations, and rituals. Participants were given access to an ad libitum single-item test snack. Linear regressions were conducted to evaluate whether the DRS predicted eating disorder symptoms and snack intake after controlling for relevant covariates and a commonly used restraint scale.

RESULTS

The DRS significantly predicted eating disorder symptoms (p < 0.001), preoccupations (p < 0.001), rituals (p = 0.001), and snack intake (p = 0.017) above covariates and an existing restraint scale.

CONCLUSIONS

The DRS may offer added utility in predicting problematic dietary restriction over existing measures and is beneficial due to its brevity and low burden.