Prevalence of binge eating disorder, obesity, and depression in a biracial cohort of young adults

Adherence to 24-Hour Movement Guidelines Among Chinese Older Adults: Prevalence, Correlates, and Associations With Physical and Mental Health Outcomes

BACKGROUND

It is known that 24-hour movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are crucial components affecting older adults' health. Canadian 24-hour movement guidelines for older adults were launched in 2020, emphasizing the combined role of these 3 movement behaviors in promoting older adults' health. However, research on the prevalence and correlates of guideline adherence and its associations with health-related outcomes is limited, especially among Chinese older adults.

OBJECTIVE

This study aimed to investigate the prevalence and correlates of meeting 24-hour movement guidelines among Chinese older adults. Furthermore, this study aimed to examine the associations of guideline adherence with older adults' physical and mental health outcomes.

METHODS

Using a stratified cluster random sampling approach, a total of 4562 older adults (mean age 67.68 years, SD 5.03 years; female proportion: 2544/4562, 55.8%) were recruited from the latest provincial health surveillance of Hubei China from July 25 to November 19, 2020. Measures included demographics, movement behaviors (PA, SB, and sleep), BMI, waist circumference, waist-hip ratio (WHR), percentage body fat (PBF), systolic and diastolic blood pressure, physical fitness, depressive symptoms, and loneliness. Generalized linear mixed models were employed to examine the associations between variables using SPSS 28.0 (IBM Corp).

RESULTS

Only 1.8% (83/4562) of participants met all 3 movement guidelines, while 32.1% (1466/4562), 3.4% (155/4562), and 66.4% (3031/4562) met the individual behavioral guidelines for PA, SB, and sleep, respectively. Participants who were older, were female, and lived in municipalities with lower economic levels were less likely to meet all 3 movement guidelines. Adhering to individual or combined movement guidelines was associated with greater physical fitness and lower values of BMI, waist circumference, WHR, PBF, depressive symptoms, and loneliness, with the exception of the relationship of SB+sleep guidelines with loneliness. Furthermore, only meeting SB guidelines or meeting both PA and SB guidelines was associated with lower systolic blood pressure.

CONCLUSIONS

This is the first study to investigate adherence to 24-hour movement guidelines among Chinese older adults with regard to prevalence, correlates, and associations with physical and mental health outcomes. The findings emphasize the urgent need for promoting healthy movement behaviors among Chinese older adults. Future interventions to improve older adults' physical and mental health should involve enhancing their overall movement behaviors and should consider demographic differences.

Managing type 2 diabetes or prediabetes and binge eating disorder: a qualitative study of patients' perceptions and lived experiences

BACKGROUND

The overlap in prevalence between type 2 diabetes and binge eating disorder is substantial, with adverse physical and mental health consequences. Little is known about patients' efforts at managing these two conditions simultaneously. The research objective was to explore patients' experiences managing co-existing type 2 diabetes or prediabetes and binge eating disorder.

METHODS

This is a qualitative descriptive study using semi-structured interviews. Participants included 21 women with type 2 diabetes or prediabetes (90% non-Hispanic White; mean age 49 ± 14.8 years, mean BMI 43.8 ± 8.4; 48% with type 2 diabetes and mean HbA1c was 8.4%). Interviews were analyzed using thematic analysis and NVivo software.

RESULTS

Qualitative analysis revealed that participants reported binge episodes frequently started in childhood or adolescence and went undiagnosed for decades; notably, they recalled that diabetes diagnosis preceded the binge eating disorder diagnosis. They also described trying to lose weight throughout their lives and how feelings of deprivation, shame, and failure exacerbated binge eating. Participants further reported how binge eating made diabetes self-care and outcomes worse. Finally, participants observed that when binge eating disorder treatment and diabetes management were synergistically integrated, they experienced improvements in both binge eating and glycemic outcomes. This integration included reframing negative thoughts surrounding binge eating disorder and diabetes self-management and increasing their understanding of how the two disorders were inter-related.

CONCLUSION

Findings highlight the importance of increasing healthcare providers' awareness of and screening for binge eating disorder in the treatment of diabetes and inform specific integrated interventions that address both diagnoses. From this study where we interviewed 21 women with binge eating disorder (BED) and type 2 diabetes/prediabetes, we learned how binge eating impacted diabetes management and how diabetes impacted BED. Most participants reported receiving the diabetes diagnosis before being diagnosed with BED despite the earlier onset of binge eating, pointing to the need for BED screening. Participants described trying to lose weight throughout their lives and reported feelings of failure and shame, which made binge eating worse. Binge eating made diabetes management harder, but when diabetes and BED treatment were aligned, participants experienced improvements in binge symptoms and diabetes outcomes.

Identification of Mood and Body Mass Index as Modifiable Factors for Health Improvement in Spinal Cord Injury

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Higher body mass index (BMI) is associated with lower positive affect in individuals with spinal cord injury (SCI).

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Women with SCI are at higher risk of developing increased negative affect than men.

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Older individuals with SCI have a greater chance of developing higher BMI.

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Premorbid personality traits with respect to mood and BMI are essential to interpret the association of BMI and positive affect.

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

The economic cost of bulimia nervosa and binge eating disorder: a population-based study

BACKGROUND

The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level.

METHOD

Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia.

RESULTS

The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively.

CONCLUSIONS

The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.

Binge eating and binge-eating disorder in Black women: A systematic review

OBJECTIVE

Although several effective behavioral treatments for binge-eating disorder (BED) exist, there are racial disparities in treatment access, with African-Americans and/or Black individuals having some of the lowest rates of access to care. Little is known about the experience and treatment of binge eating (BE) and BED among Black women.

METHOD

This systematic review, conducted according to PRISMA guidelines, synthesizes information related to BE and BED in Black women.

RESULTS

A total of N = 38 studies met our eligibility criteria. We did not identify any systematic risk of bias across studies. The majority of included studies used cross-sectional survey methodology, and relied on interview (EDE) and self-report measures (particularly the Binge Eating Scale, BES) for the assessment of BE. Outcomes were inconsistently measured across trials, and there are limited data on the results of evidence-based treatments for BE/BED in Black women.

DISCUSSION

Although Black women have similar or higher rates of BE than White women, most research on BE and BED has focused on White women, with Black individuals underrepresented in clinical trials. Future research should examine evidence-based treatments to prevent and treat BED in this population.

OBJETIVO

Aunque existen varios tratamientos conductuales que son efectivos para el Trastorno de Atracones (BED, por sus siglas en inglés), existen disparidades raciales en el acceso a tratamiento, con individuos Afroamericanos y/o personas de color teniendo algunas de las tasas más bajas de acceso al cuidado de la salud. Se sabe muy poco acerca de la experiencia y tratamiento del comer en atracones (BE, por sus siglas en inglés) y BED entre mujeres afroamericanas y/o de color. MÉTODO: Esta revisión sistemática, realizada bajo lineamientos de las guías PRISMA, sintetiza información relacionada con BE y BED en mujeres afroamericanas y/o de color.

RESULTADOS

Un total de N = 38 estudios cumplieron con nuestros criterios de elegibilidad. No identificamos ningún riesgo sistemático de sesgo entre los estudios. La mayoría de los estudios incluidos utilizaron una metodología de encuesta transversal y se basaron en la entrevista (EDE) y las medidas de autoinforme (en particular, la Binge Eating Scale, BES) para la evaluación de BE. Los resultados se midieron de manera inconsistente entre los ensayos, y hay datos limitados sobre los resultados de los tratamientos basados en la evidencia para BE/BED en mujeres afroamericanas y/o de color. DISCUSIÓN: Aunque las mujeres afroamericanas y/o de color tienen tasas similares o más altas de BE que las mujeres blancas, la mayoría de las investigaciones sobre BE y BED se han centrado en las mujeres blancas, con individuos afroamericanos y/o de color subrepresentados en ensayos clínicos. La investigación futura debería examinar los tratamientos basados en la evidencia para prevenir y tratar el BED en esta población.

Mindfulness in Eating Is Inversely Related to Binge Eating and Mood Disturbances in University Students in Health-Related Disciplines

The purpose of the study was to investigate the relationship between mindful eating, disordered eating and mood in university students in health-related disciplines. A total of 221 university students participated in the study; 102 students studied sport and exercise science (SS), 54 students pharmacy sciences (PS), and 65 students health sciences (HS). Participants completed the Binge Eating Scale (BES), the Mindful Eating Questionnaire (MEQ), and the Profile of Mood State questionnaire (POMS). 41% of the students were classified as binge eaters and 57% were above the POMS threshold of depression. Binge eaters were found to have significantly lower MEQ score and significantly higher total mood disturbance scores (TMD) compared to non-binge eaters (p < 0.01). Students with a high depression score exhibited no differences in the MEQ score but a significantly higher BES score compared to non-depressed students (p < 0.01). Gender differences were found in the MEQ with females exhibiting significantly higher scores in the MEQ score and in all MEQ subscales compared to males, with the exception of the emotional subscale that females were noted to have a lower score compared to males (p < 0.01). The MEQ score was inversely related to the BES score (r = −0.30, p < 0.01) and TMD (r = −0.21, p < 0.05). The MEQ score was a significant negative predictor of the variance of the binge eating behavior of the students (B = −3.17, p < 0.001). In conclusion, mindfulness in eating is inversely related to the binge eating behavior and mood state of university students studying health-related subjects and is a significant negative predictor of disordered eating behavior in this high risk population.

A developmental framework of binge-eating disorder based on pediatric loss of control eating

Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, suggesting that a developmental perspective of binge eating may be warranted. Thus, loss of control eating may be a marker of prodromal binge-eating disorder among certain susceptible youth. The present article offers a broad developmental framework of binge-eating disorder and proposes areas of future research to determine which youths with loss of control eating are at risk for persistent and exacerbated behavior that may develop into binge-eating disorder and adult obesity. To this end, this article provides an overview of loss of control eating in childhood and adolescence, including its characterization, etiology, and clinical significance, with a particular focus on associations with metabolic risk, weight gain, and obesity. A conceptual model is proposed to further elucidate the mechanisms that may play a role in determining which youths with loss of control are at greatest risk for binge-eating disorder and obesity. Ways in which treatments for adult binge-eating disorder may inform approaches to reduce loss of control eating and prevent excess weight gain in youth are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Prevalence and Associated Factors of Eating Disorders in Weight Management Centers in Tanta, Egypt

BACKGROUND

Eating disorders (EDs) are serious illnesses associated with medical complications and have been increased, especially among societies with an excessive concern about weight, shape, or appearance. This study aimed to investigate the prevalence of EDs among the individuals attending weight management centers and its associated factors.

METHODS

A cross-sectional study was carried out among individuals attending four weight management centers in Tanta, Gharbia Governorate, Egypt during the period from July to December 2016. Precoded interview questionnaires were used to identify the following data: sociodemographic characteristics and medical history of depression or psychological disorders and the Eating Attitude Test (EAT-40) was used to assess the attitudes, behavior, and traits associated with the EDs.

RESULTS

A total of 400 participants (112 males and 288 females) were included in the study. According to EAT-40 questionnaires, the prevalence of positive and negative EDs was 65.0% (n = 260) and 35.0% (n = 140), respectively. EDs were more likely reported by females, married singles, rural residents, those with higher education, and nonworking or part-time working patients, those who were overweight or obese, and who were suffering from depression or any psychological problems. Logistic regression analysis revealed that the independent predictors of EDs were age (adjusted odds ratio [OR]: 1.06), nonworking (adjusted OR: 2.32) or part-time working (adjusted OR: 2.18), increased body weight (adjusted OR: 2.66 for overweight and adjusted OR: 1.24 for obese), and having a history of depression or any psychological problem (adjusted OR: 2.76). Factor analysis of EAT-40 revealed four factors (eating behavior, diet-related lifestyle, weight concern, and food preoccupation) that were responsible for 33.2% of the total variance.

CONCLUSIONS

EDs are prevalent among individuals attending the weight management centers in a northern city in Egypt. Specific management strategies are warranted to address this commonly prevalent disease.

Evaluation of Weigh Forward: A group intervention delivered by dietitians and psychologists within a National Health Service specialist weight management service

There is limited evidence of the effectiveness of non-surgical interventions for severe obesity. Our aim was to evaluate a group intervention delivered by a National Health Service (NHS) specialist weight management service to contribute to the evidence base and inform the development of future services. Participants in this prospective cohort study were patients attending NHS Grampian Specialist Weight Management Services. The intervention was an interactive 12-session group programme based on evidence-based psychological model, with combined dietetic and psychological knowledge and support provided. The primary outcome was mean weight change at the end of the intervention and for 12-mo follow-up (including programme completers, baseline observation carried forward [BOCF], last observation carried forward). Secondary outcome measures included mood, anxiety, binge eating and quality of life. A total of 166 patients accepted a place on the group programme, mean body mass index was 48.9 kg/m² . Mean weight loss at 6 mo was 5.6 kg and 35.2% of those who completed the group (n = 88) lost ≥5%. Using BOCF, 18.7% lost ≥5% at 6 mo. Those who remained in the programme maintained their weight loss 12 and 18 mo after the start of the intervention. Significant improvements were also found in psychological variables, including reduced depression, anxiety, binge eating and improved emotion regulation. This real-world evaluation of an NHS intervention for patients with severe obesity suggests that individuals who engage achieve a moderate weight loss, which most maintain a year later, although further research is needed to strengthen this conclusion.

A narrative review of the construct of hedonic hunger and its measurement by the Power of Food Scale

INTRODUCTION

The term 'hedonic hunger' refers to one's preoccupation with and desire to consume foods for the purposes of pleasure and in the absence of physical hunger. The Power of Food Scale (PFS) was developed as a quantitative measure of this construct in 2009. Since then, over 50 published studies have used the PFS to predict appetite-related outcomes including neural, cognitive, behavioural, anthropometric and clinical measures.

OBJECTIVE

This narrative review evaluates how closely the PFS captures the construct it was originally presumed to assess and to more clearly define hedonic hunger itself.

METHODS

The measure's relationship to four domains is reviewed and summarized: motivation to consume palatable foods; level of actual consumption of such foods; body mass; and subjective loss-of-control over one's eating behaviour. Findings are synthesized to generate a more accurate understanding of what the PFS measures and how it may relate to the broader definition of hedonic hunger.

RESULTS

Results suggest that the PFS is closely related to motivation to consume palatable foods and, in extreme cases, occurrence of loss-of-control eating episodes. PFS scores are not consistently predictive of amount of food consumed or body mass.

CONCLUSIONS

Implications of these findings are discussed in the context of behavioural health, and avenues for further inquiry are identified.

Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders

The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001⁻2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs.

Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review

Depression is the most commonly experienced mental health condition in adults with autism spectrum conditions (ASC). However, it is unclear what tools are currently being used to assess depression in ASC, or whether tools need to be adapted for this group. This systematic review therefore aimed to identify tools used to assess depression in adults with and without ASC, and then evaluate these tools for their appropriateness and measurement properties. Medline, PsychINFO and Web of Knowledge were searched for studies of depression in: (a) adults with ASC, without co‐morbid intellectual disability; and (b) adults from the general population without co‐morbid conditions. Articles examining the measurement properties of these tools were then searched for using a methodological filter in PubMed, and the quality of the evidence was evaluated using the COSMIN checklist. Twelve articles were identified which utilized three tools to assess depression in adults with ASC, but only one article which assessed the measurement properties of one of these tools was identified and thus evaluated. Sixty‐four articles were identified which utilized five tools to assess depression in general population adults, and fourteen articles had assessed the measurement properties of these tools. Overall, two tools were found to be robust in their measurement properties in the general population—the Beck Depression Inventory (BDI‐II), and the patient health questionnaire (PHQ‐9). Crucially only one study was identified from the COSMIN search, which showed weak evidence in support of the measurement properties of the BDI‐II in an ASC sample. Implications for effective measurement of depression in ASC are discussed. Autism Res2018, 11: 738–754. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.

Lay Summary

Depression is the most common mental health problem experienced by adults with autism. However, the current study found very limited evidence regarding how useful tools developed for the general population are for adults with autism. We therefore suggest how these tools could be adapted to more effectively assess depression in adults with autism, and improve these individuals access to mental health assessment and support.

Binge eating behaviours in bipolar disorders

BACKGROUND

Recent research, especially from the USA, suggests that comorbid binge eating (BE) behaviour and BE disorder are frequent in individuals with Bipolar Disorder (BD). Although basic clinical associations between BD and BE have been investigated, less is known about psychological or temperamental dimensions and qualitative aspects of eating habits. In a French cohort of patients with BD, we investigated the prevalence of BE behaviour and any associations with illness characteristics, anxiety, impulsivity, emotional regulation and eating habits.

METHODS

145 outpatients with BD (I and II) were assessed for the presence of BE behaviour using the Binge Eating Scale (BES). Characteristics identified in univariate analyses as differentiating BD cases with and without BE behaviour were then included in a backward stepwise logistic regression (BSLR) model.

RESULTS

In this sample, 18.6% of BD patients met criteria for BE behaviour. Multivariate analysis (BSLR) indicated that shorter duration of BD, and higher levels of anxiety and emotional reactivity were observed in BD with compared to BD without BE behaviour.

LIMITATIONS

Relatively small sample referred to specialist BD clinics and cross-sectional evaluation meant that it was not possible to differentiate between state and trait levels of impulsivity, emotional instability and disinhibition. These dimensions may also overlap with mood symptoms.

CONCLUSION

BE behaviour is common in females and males with BD. Emotional dysregulation and anxiety may represent important shared vulnerability factors for worse outcome of BD and increased likelihood of BE behaviour.

Review: Prevalence and co-occurrence of addictions in US ethnic/racial groups: Implications for genetic research

BACKGROUND AND OBJECTIVES

We conducted a review of the prevalence and co-occurrence of 12 types of addictions in US ethnic/racial groups and discuss the implications of the results for genetic research on addictions.

METHODS

We utilized MEDLINE and PsycINFO databases to review the literature on alcohol, tobacco, marijuana, illicit drugs, gambling, eating/food, internet, sex, love, exercise, work, and shopping. We present results for each addiction based on total US prevalence, prevalence within ethnic groups, and co-occurrence of addictions among ethnic groups when available.

RESULTS

This review indicates very little research has examined the interrelationships of addictive behaviors among US ethnic groups. The studies that exist have focused nearly exclusively on comorbidity of substances and gambling behaviors. Overall findings suggest differences among US ethnic groups in prevalence of addictions and in prevalence of addiction among those who use substances or engage in gambling. Almost no ethnic group comparisons of other addictive behaviors including eating/food, internet, love, sex, exercise, work, and shopping were identified in the literature.

CONCLUSIONS

Despite large-scale research efforts to examine alcohol and substance use disorders in the United States, few studies have been published that examine these addictive behaviors among ethnic groups, and even fewer examine co-occurrence and comorbidity with other addictions.

SCIENTIFIC SIGNIFICANCE

Even with the limited studies, these findings have implications for genetic research on addictive behaviors. We include a discussion of these implications, including issues of population stratification, disaggregation, admixture, and the interplay between genetic and environmental factors in understanding the etiology and treatment of addictions. (Am J Addict 2017;26:424-436).

A Preliminary Study of the Effects of a Modified Mindfulness Intervention on Binge Eating

The purpose of this study was to explore the feasibility of a modified mindfulness intervention for reducing binge eating. Participants ( n = 25) were recruited from the general public for a Mindfulness-Based Stress Reduction (MBSR) course. The standard MBSR format was modified to include brief eating exercises. There was no control group. Participants completed the Binge Eating Scale and other self-report measures before and after the course. There was a decline in binge eating as well as state anxiety and depressive symptoms. Reduced binge eating was related to increased self-acceptance and reduced state anxiety. The results are discussed with regard to laying the foundation for future research on the effects of mindfulness on eating.

African American Women and Eating Disturbances: A Meta-Analysis

Eating disturbances are often portrayed as a problem found mainly among White women and nearly absent among African American women. The relationship between ethnicity and eating disturbances is examined using meta-analysis. Data from 18 studies were included to examine the overall relationship between ethnicity and eating disturbances and the specific relationship between African American women and White women. Although White women had a greater risk of eating disturbances than African American women as a group, the effect size was notably small. Specifically, White women had a slightly greater risk for all eating disturbances combined than African American women. African American women did not differ significantly from White women in their risk for bulimia and binge-eating disorder. Implications are discussed.

Assessment of Eating Disorders in Women

This article reviews current eating disorder self-report and interview measures and makes recommendations for choosing assessment devices for practice and research. The authors also incorporate overviews of related measures, such as body satisfaction and restrained eating. The presentation of women with eating disorders on measures of general psychological functioning (such as the Minnesota Multiphasic Personality Inventory) is also discussed. Implications and recommendations for practice are presented, as are recommendations for future research. The lack of validation of, and urgent need for, eating disorder assessment measures with ethnic minority women is discussed throughout.

Treatment of Eating Disorders in Women

This article reviews the most recent treatment literature for anorexia nervosa, bulimia nervosa, and binge eating disorder and serves as a guide for recommended readings and therapist resources. The primary focus is on empirically tested treatment modalities; for each of these approaches reviewed, the theoretical background, nature of the intervention, and existing empirical support are summarized. The article also presents less researched, albeit promising, approaches to eating disorder treatment, describing the rationale and available research. A focus on multicultural issues, including the paucity of eating disorder treatment research among participants of color, and suggestions for building research and enhancing treatment effectiveness with ethnic minority clients, is incorporated throughout. Recommendations concerning pressing research needs are made, and a summary of clinical recommendations for each disorder is formulated.

Food cravings, binge eating, and eating disorder psychopathology: Exploring the moderating roles of gender and race

OBJECTIVE

To examine the moderating effects of gender and race on the relationships among food cravings, binge eating, and eating disorder psychopathology in a community sample.

METHODS

Data were collected from a convenience sample of 320 adults (53% male; mean age 28.5±8.2years; mean BMI 27.1±5.2kg/m(2); mean education 15.1±2.2years; 64% white, 24% black, and 13% other race) participating in a cross-sectional study examining the interactions between stress, self-control and addiction. Participants completed a comprehensive assessment panel including a demographic questionnaire, the Food Craving Inventory, and Eating Disorder Examination Questionnaire. Data were analyzed using multiple logistic regression for binge eating behavior and multiple linear regression for eating disorder psychopathology.

RESULTS

Overall, food cravings demonstrated significant main effects for binge eating behavior (adjusted OR=2.65, p<.001) and global eating disorder psychopathology (B=.47±.09, p<.001). Females had a stronger relationship between food cravings and eating disorder psychopathology than males; there were no statistically significant differences by race.

CONCLUSION

These findings, based on a diverse sample recruited from the community, suggest that food cravings are associated with binge eating and eating disorder psychopathology and may represent an important target for interventions.

Binge Eating and Overweight and Obesity Among Young Adult Lesbians

PURPOSE

Lesbians are more likely to be obese compared to heterosexual women, but little research has examined correlates of obesity among lesbians. The purpose of this study was to examine the association of binge eating and overweight and obesity among lesbians.

METHODS

Self-identified lesbians (N = 377) between the ages of 18-30 completed an online survey.

RESULTS

Binge eating was a salient predictor of both overweight and obesity after controlling for demographic variables, outness, diet, and physical activity.

CONCLUSION

Health promotion and weight loss intervention programs for lesbians should assess binge eating behaviors as a possible contributor to overweight and obesity.

The relation of anxiety, depression, and stress to binge eating behavior

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.

Pharmacological approaches to the management of binge eating disorder

In the USA, binge eating disorder (BED) is the most common eating disorder, with a lifetime prevalence of ~3.5 % in adult women, 2.0 % in adult men, and 1.6 % in adolescents. BED is characterized by frequent episodes of binge eating that are accompanied by a sense of loss of control over eating and result in marked psychological distress. BED is highly co-morbid with obesity and with depression and other psychiatric conditions, and it is associated with substantial role impairment. Currently, there are no US FDA-approved pharmacological treatments for BED. Animal and human studies implicate underlying dysregulation in dopamine, opioid, acetylcholine, and serotonin neurocircuitry within brain reward regions in the pathogenesis and maintenance of BED. To date, the efficacy of various agents that target these and other neurotransmitter systems involved in motivated feeding behavior, mood regulation, and impulse control have been investigated in the treatment of BED. Several antidepressant and anticonvulsant agents have demonstrated efficacy in reducing binge eating frequency, but only in limited cases have these effects resulted in patients achieving abstinence, which is the primary goal of treatment; they also range from less (fluvoxamine) to more (topiramate) effective in achieving weight loss that is both clinically meaningful and significantly greater than placebo. Collectively, the literature on pharmacological treatment approaches to BED is limited in that very few agents have been studied in multiple, confirmatory trials with adequate follow up, and almost none have been evaluated in large patient samples that are diverse with respect to age, sex, and ethnicity. In addition, prior trials have not adequately addressed, through study design, the high placebo response commonly observed in this patient population. Several novel agents are in various phases of testing, and recent animal studies focusing on glutamate-signaling circuits linking the amygdala to the lateral hypothalamus offer new avenues for exploration and potential therapeutic development. Studies of newly FDA-approved medications for long-term obesity treatment and further explorations of dietary supplements and neutraceuticals with appetite- and mood-altering properties may also be worthwhile.

A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior

This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. (PsycINFO Database Record

Appetite sensations, appetite signaling proteins, and glucose in obese adolescents with subclinical binge eating disorder

Objective. This study aimed to investigate potential differences in appetite sensations, ghrelin, peptide YY, and glucose and their relationship with energy and macronutrient intake in obese adolescents with subclinical binge eating disorder. Methods. Fifteen obese adolescents (six and nine individuals with and without subclinical binge eating disorder, resp.) qualified for this study. Visual analog scales and Three-Factor Eating Questionnaires were used to assess eating behaviours. Circulating ghrelin, peptide YY, and glucose were measured after fasting and at multiple time points postprandially following a standardized breakfast meal. Energy and macronutrient intake were measured with an ad libitum lunch buffet. Results. Emotional eating scores were significantly higher in obese adolescents with subclinical binge eating disorder. Hunger levels rose and satiety levels fell significantly over the course of the monitoring period but there was no difference between the two groups. Obese adolescents with subclinical binge eating disorder did not have significantly different levels of appetite signaling proteins or glucose. Obese adolescents with subclinical binge eating disorder had a nonsignificantly higher energy and macronutrient intake. Conclusions. A significant difference between the two groups in terms of their emotional eating scores highlights the important role that psychological factors play in relation to eating behaviours.

The prevalence of binge eating disorder in a sample of college students in the north of Portugal

Binge eating disorder (BED) has important associated comorbidities and has been recently considered as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition. This study investigates the prevalence of BED in a sample of college students using a two-stage design. Between October 2008 and July 2009, 805 students attending a public college campus completed the Questionnaire on Eating and Weight Patterns - Revised to screen for possible cases. Eighty-five students meeting key criteria for BED were invited for a second stage interview using the Eating Disorder Examination. At stage 1, 9.6% of the subjects reported binge eating episodes. At stage 2, a prevalence rate of 0.5% for BED was found, and 1% if the criterion for large amount of food was excluded.

To eat or not to eat; is that really the question? An evaluation of problematic eating behaviors and mental health among bariatric surgery candidates

Problematic eating behaviors, such as emotional eating, and food addiction, may affect weight; however, little is known about these eating behaviors, especially among those seeking bariatric surgery. Therefore, the purpose of this study was to estimate the prevalence of problematic eating behaviors and to investigate their relationship with other eating behaviors, body mass index (BMI), and psychiatric symptoms. There were 142 patients who completed a required psychiatric evaluation prior to bariatric surgery. Of these, 16.9 % met criteria for a food addiction and 25.4-40.7 % endorsed emotional eating, depending on type of emotional eating. The number of food addiction symptoms endorsed was related to emotional eating. Both food addiction and emotional eating were related to anxiety and depressive symptoms. However, surprisingly, BMI was not related to a food addiction diagnosis, emotional eating scores, or psychiatric symptoms. Results from this study suggest that problematic eating behaviors are occurring among bariatric surgery candidates. Furthermore, this study may help to address the conflicting research regarding the effects of psychiatric symptoms on weight-loss outcomes. Perhaps it is the problematic eating behaviors (e.g., food addiction and emotional eating) that are associated with psychiatric symptoms that could be influencing outcomes. Future research should evaluate treatments for problematic eating behaviors and whether treatments improve weight-loss success.

Thinness expectancies and restraint in Black and White college women: a prospective study

Despite stereotypes to the contrary, women of diverse racial backgrounds, including Black women, experience disordered eating symptoms. While there has been an increase in research comparing disordered eating symptoms across ethnic groups, there remains a dearth of research on the mechanisms of action underlying the development of these symptoms in non-White populations. Thinness expectancies prospectively predict disordered eating symptoms in adolescent girls, but the majority of research on expectancies has been conducted with White samples. Restraint, or self-initiated attempts to restrict food intake, may be precipitated by cognitive factors such as thinness expectancies. In the current study, we followed a sample of Black and White women over one semester of college to assess the influence of thinness expectancies and ethnic identity on restraint. Our sample consisted of 193 college women (93 Black women). We found that White women experienced restraint at higher levels than Black women, but both Black and White women experienced an increase in restraint across the first semester in college. The endorsement of thinness expectancies added significant incremental variance to the prediction of restraint over time, when baseline restraint was included in the model. These effects were not moderated by ethnicity nor ethnic identity. This study adds to the scarce literature on phenomenology of disordered eating in Black women.

A double-blind, randomized pilot trial of chromium picolinate for binge eating disorder: results of the Binge Eating and Chromium (BEACh) study

OBJECTIVE

Chromium treatment has been shown to improve mood, appetite, and glucose regulation in various psychiatric and medical patient populations. The authors propose that chromium may be useful in the treatment of binge eating disorder (BED).

METHOD

Twenty-four overweight adults with BED were enrolled in a 6-month double-blind placebo-controlled trial and randomly assigned to receive either 1000mcg chromium/day ("high dose"; n=8) or 600mcg chromium/day ("moderate dose"; n=9) as chromium picolinate or placebo (n=7). Mixed linear regression models were used to estimate mean change in binge frequency and related psychopathology, weight, symptoms of depression, and fasting glucose.

RESULTS

Fasting glucose was significantly reduced in both chromium groups compared to the placebo group; similarly, numerically, but not significantly, greater reductions in binge frequency, weight, and symptoms of depression were observed in those treated with chromium versus placebo, although statistical power was limited in this pilot trial. For fasting glucose, the findings suggest a dose response with larger effects in the high dose compared to moderate dose group.

CONCLUSION

These initial findings support further larger trials to determine chromium's efficacy in maintaining normal glucose regulation, reducing binge eating and related psychopathology, promoting modest weight loss, and reducing symptoms of depression in individuals with BED. Studies designed to link the clinical effects of chromium with changes in underlying insulin, serotonin, and dopamine pathways may be especially informative. If efficacious, chromium supplementation may provide a useful, low-cost alternative to or augmentation strategy for selective serotonin reuptake inhibitors, which have partial efficacy in BED. ClinicalTrials.gov NCT00904306.

The Role of Anxiety in Binge Eating Behavior: A Critical Examination of Theory and Empirical Literature

The purpose of this manuscript is to expand the understanding of binge eating by reviewing the role of aspects of negative affect. Specifically, this paper will present evidence for further investigation of the bearing that anxiety may have in binge eating development and maintenance. A comprehensive review of the literature regarding the relation of binge eating and anxiety was performed. Valuable contributions have been made to the binge eating literature regarding some aspects of negative affect (i.e., depression); however, outside of bulimia nervosa studies, much of the theoretical and empirical binge eating research to date has not directly addressed the role of anxiety. Research supports expansion of investigations of negative emotionality and binge eating to include specific study of anxiety. Greater inclusivity and specificity in the unique contributions of various negative emotions may further the development of temporal models and intervention efforts.

Integrative Response Therapy for Binge Eating Disorder

Binge Eating Disorder (BED), a chronic condition characterized by eating disorder psychopathology and physical and social disability, represents a significant public health problem. Guided Self Help (GSH) treatments for BED appear promising and may be more readily disseminable to mental health care providers, accessible to patients, and cost-effective than existing, efficacious BED specialty treatments which are limited in public health utility and impact given their time and expense demands. No existing BED GSH treatment has incorporated affect regulation models of binge eating, which appears warranted given research linking negative affect and binge eating. Integrative Response Therapy (IRT), a new group-based guided self-help treatment, based on the affect regulation model of binge eating, that has shown initial promise in a pilot sample of adults meeting DSM IV criteria for BED, is described. Fifty-four% and 67% of participants were abstinent at post-treatment and three month follow-up respectively. There was a significant reduction in the number of binge days over the previous 28 days from baseline to post-treatment [14.44 (±7.16) to 3.15 (±5.70); t=7.71, p<.001; d=2.2] and from baseline to follow-up [14.44 (±7.16) to 1.50 (±2.88); t=5.64, p<.001; d=1.7]. All subscales from both the Eating Disorder Examination - Questionnaire and Emotional Eating Scale were significantly lower at post-treatment compared to baseline. 100% of IRT participants would recommend the program to a friend or family member in need. IRT's longer-term efficacy and acceptability are presently being tested in a National Institute of Mental Health funded randomized controlled trial.

Race, ethnicity, and eating disorder recognition by peers

We investigated racial/ethnic stereotyping in the recognition and referral of eating disorders with 663 university students. We explored responses to problem and eating disorder recognition and health care referrals after subjects read a vignette concerning a patient of a different race/ethnic background presenting with eating disorders. A series of three 4 × 3 ANOVAs revealed significant main effects for eating disorders across all three outcome variables. There were no significant main effects across the four different race/ethnicity conditions and no significant race by condition interactions. Lack of general eating disorder recognition and health care referrals by student participants were found. [Supplemental files are available for this article. Go to the publishers's online edition of Eating Disorders for the following free supplemental resource: online appendix containing vignettes 1-3, as described in the "Methods" section].

Psychosocial Characteristics and Gestational Weight Change among Overweight, African American Pregnant Women

Objectives. To describe psychosocial factors identified as contributors of weight gain in the general population and to examine the relationship between these factors and gestational weight gain among low socioeconomic status, African American, overweight pregnant women. Methods. African American women (n = 120) with a pregravid body mass index ≥25 kg/m² completed measures of eating, sleep, and depressed mood between 14 and 24 weeks of gestation. Weight was tracked. Descriptive statistics, correlations, and linear regression modeling were used to characterize the sample and examine predictors of gestational weight gain. Results. Four percent screened positive for night eating syndrome, with 32% consuming at least 25% of their daily caloric intake after dinner (evening hyperphagia). None met criteria for binge eating disorder; 4% reported occasional binge episodes. Cognitive restraint over eating was low. Participants slept 7.1 (SD = 1.9) h per night and reported 4.3 (SD = 3.6) awakenings per week; 18% reported some level of depressed mood. Night and binge eating were related to each other, sleep quality, and depressed mood. Eating due to cravings was the only psychosocial variable to predict gestational weight gain. Conclusions. Depressed mood, night eating, and nighttime awakenings were common in this cohort, while cognitive restraint over eating was low. Most psychosocial variables were not predictive of excess gestational weight gain.

Changes in depression and quality of life in obese individuals with binge eating disorder: bariatric surgery versus lifestyle modification

BACKGROUND

Obese individuals with binge eating disorder frequently experience impairments in mood and quality of life, which improve with surgical or behavioral weight loss interventions. It is unclear whether these improvements are due to weight loss itself or to additional aspects of treatment, such as group support, or acquisition of cognitive-behavioral skills provided in behavioral interventions. The objective of the study was to compare changes in weight, symptoms of depression, and quality of life in extremely obese individuals with binge eating disorder undergoing bariatric surgery or a lifestyle modification intervention. The study setting was University Hospital.

METHODS

Symptoms of depression and quality of life were assessed at baseline and 2, 6, and 12 months in participants undergoing bariatric surgery but no lifestyle intervention (n = 36) and in nonsurgery participants receiving a comprehensive program of lifestyle modification (n = 49).

RESULTS

Surgery participants lost significantly more weight than lifestyle participants at 2, 6, and 12 months (P<.001). Significant improvements in mood (as measured by the Beck Depression Inventory-II [BDI-II]) and quality of life (as measured by the Short Form-36) were observed in both groups across the year, but there were no differences between the groups at month 12 (even when controlling for reductions in binge eating). A positive correlation was observed between the magnitude of weight loss and change in BDI-II score when collapsing across groups. Moreover, weight loss at one time point predicted BDI-II score at the next time point, but BDI-II score did not predict subsequent weight loss.

CONCLUSIONS

We conclude that similar improvements in mood and quality of life can be expected from either bariatric surgery or lifestyle modification treatments for periods up to 1 year.

Ethnic Differences in Correlates of Obesity between Latin-American and Black Women

OBJECTIVE

To date, no studies have examined dietary intake, physical activity, and body image in a large sample of Latin-American and black women recruited using the same methodology. The aim of this study was to examine three potential correlates of obesity (dietary intake, body image, and physical activity) in a large sample of Latin-American and black women across the weight spectrum.

RESEARCH METHODS AND PROCEDURES

Participants were black (n = 271) and Latin-American (n = 234) adult women who completed a 24-hour dietary recall and physical activity and body image questionnaires.

RESULTS

After controlling for BMI, education, marital status, and number of children, black women consumed more kilocalories, dietary fat (grams), and percent calories from fat than Latin-American women, who consumed more carbohydrates (grams) and dietary fiber (total and soluble). Black women engaged in more sedentary behavior than Latin-American women. Although Latin-American women weighed less than black women, they perceived their current body image as heavier and reported greater body image dissatisfaction than black women. Black women also reported a higher ideal body image than Latin-American women.

DISCUSSION

The combined effect of a diet higher in calories and fat, increased sedentary behavior, and more accepting body image could account for higher rates of obesity among black women. Future studies should further explore cultural attitudes and beliefs related to weight that could provide information for the development of culturally competent obesity interventions.

Psychological treatments for binge eating disorder

Binge eating disorder (BED) is the most prevalent eating disorder in adults, and individuals with BED report greater general and specific psychopathology than non-eating disordered individuals. The current paper reviews research on psychological treatments for BED, including the rationale and empirical support for cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), dialectical behavior therapy (DBT), behavioral weight loss (BWL), and other treatments warranting further study. Research supports the effectiveness of CBT and IPT for the treatment of BED, particularly for those with higher eating disorder and general psychopathology. Guided self-help CBT has shown efficacy for BED without additional pathology. DBT has shown some promise as a treatment for BED, but requires further study to determine its long-term efficacy. Predictors and moderators of treatment response, such as weight and shape concerns, are highlighted and a stepped-care model proposed. Future directions include expanding the adoption of efficacious treatments in clinical practice, testing adapted treatments in diverse samples (e.g., minorities and youth), improving treatment outcomes for nonresponders, and developing efficient and cost-effective stepped-care models.

Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study

OBJECTIVE

The comorbidity of posttraumatic stress disorder (PTSD) and eating disorders (EDs) is high among women but has been understudied in men. Little is known about the association between partial or subthreshold PTSD and EDs among women or men.

METHOD

This study included PTSD and ED data from male (n = 2,382) and female (n = 3,310) National Comorbidity Survey-Replication study participants.

RESULTS

The vast majority of women and men with anorexia nervosa, bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with BN and BED. Subthreshold PTSD was more prevalent than threshold PTSD among women with BN and women and men with BED.

DISCUSSION

Interpersonal forms of trauma, PTSD, and subthreshold/partial PTSD, were prevalent among men and women with EDs. Findings highlight the importance of assessing for trauma and PTSD in ED patients.

Why men should be included in research on binge eating: results from a comparison of psychosocial impairment in men and women

OBJECTIVE

Prevalence of binge eating has been shown to be as common in men as in women, yet few studies have included men. Men are especially underrepresented in treatment studies, raising the question of whether men who binge eat experience less distress or impairment than women. This study compared demographic and clinical correlates of binge eating in a large employee sample of men and women.

METHOD

Cross-sectional data from 21,743 men and 24,608 women who participated in a health risk self assessment screening were used. Group differences in obesity, hypertension, dyslipidemia, Type 2 diabetes, depression, stress, sleep, sick days, work impairment, and nonwork activity impairment were tested using chi-square tests (categorical variables) and independent sample t-tests (continuous variables).

RESULTS

Effect size estimates indicate that men (n = 1,630) and women (n = 2,754) who binge eat experience comparable levels of clinical impairment. They also report substantially greater impairment when compared with men and women who do not binge eat.

DISCUSSION

The underrepresentation of men in treatment-seeking samples does not appear to reflect lower levels of impairment in men versus women. Efforts are needed to raise awareness of the clinical significance of binge eating in men so that this group can receive appropriate screening and treatment services.

Eating disorders and obesity

In conclusion, 2 types of disordered eating behaviors affect some overweight and obese persons. BED and NES present an excellent opportunity to recognize, treat, and prevent these disorders that, at the least, maintain, and at worst, promote, overweight and obesity. Articles in this volume by Wilson and co-workers and Allison and colleagues discuss current treatment options for BED and NES, respectively. Clinicians are encouraged to evaluate the presence of BED and NES in all patients who seek treatment for their obesity. Although the prevalence of these 2 eating disorders is relatively low, both are associated with significant distress and dysfunction that can be ameliorated with effective treatment.

Revisiting the relationship between eating disturbances and cultural origin: a focus on adult women in 14 community studies

Are there differences in prevalence and predictors of eating disturbances among adult women (age 30+) from diverse cultural backgrounds? Most research has explored these issues with young age groups, although the results may also be relevant to adults. Fourteen community-based studies with culturally diverse samples are examined. A majority of studies (70%) reveals no significant group differences in prevalence rates. In contrast, significantly different clinical predictors emerge from multivariate analyses despite groups having similar frequency rates. Collectively, findings offer a complex, sometimes contradictory and inconclusive picture. Additional research is warranted for developing evidence-based interventions sensitive to adults from diverse cultural traditions.

Race, weight, and correlates of binge eating in female college students

This study examined the correlates of race, weight status, and binge eating among 715 female undergraduate students (77% Caucasian; 13% African American) enrolled at an urban university. Approximately 21.7% of Caucasians and 36.8% of African-Americans (AA) were overweight/obese. Higher BMI was associated with BED, and severity of binge eating symptoms. After removing participants who endorsed compensatory behaviors ≥ 1×/week from the analyses, 8.4% of the sample met criteria for BED (2.4% of the AA and 9.9% of the Caucasian students) and 44% reported severe binge eating symptoms. AA students were less likely to have BED than Caucasian students and reported less severe binge eating symptomatology. For Caucasian students, mood, cognitive restraint, drive for thinness, and BMI all contributed significant individual variance in binge eating severity. For African Americans, mood, body image dissatisfaction, and drive for thinness were found to be unique contributors. For those meeting criteria for BED, retrospectively recalled predictors of binge eating included negative affect (e.g., self-anger, worry, guilt), but not hunger. Behavioral triggers for binge behavior differed by race, as well, with African American students retrospectively reporting lower levels of anxiety prior to bingeing. Results from this study suggest that there are racial differences in binge eating behaviors. Future studies are needed to examine differences in eating practices among racial groups (e.g., grazing, large portions, high fat food preparation) that may contribute to early onset weight gain and obesity. The results suggest the importance of sensitive tailored weight and disordered eating interventions for college women from diverse backgrounds.

Prevalence of the addictions: a problem of the majority or the minority?

An increasing number of research studies over the last three decades suggest that a wide range of substance and process addictions may serve similar functions. The current article considers 11 such potential addictions (tobacco, alcohol, illicit drugs, eating, gambling, Internet, love, sex, exercise, work, and shopping), their prevalence, and co-occurrence, based on a systematic review of the literature. Data from 83 studies (each study n = at least 500 subjects) were presented and supplemented with small-scale data. Depending on which assumptions are made, overall 12-month prevalence of an addiction among U.S. adults varies from 15% to 61%. The authors assert that it is most plausible that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors.

Social marketing-based communications to integrate and support the HEALTHY study intervention

The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the communications strategies. The HEALTHY experience provides practical considerations for systematically incorporating a social marketing-based communications approach within future school-based health behavior interventions.