Restrained eating among adolescents: dieters are not always bingers and bingers are not always dieters

Eating Disorders in the Adolescent Population:

Although eating disorders often begin during adolescence, characteristics of this population can complicate early detection by clinicians. The purpose of this article is to selectively review the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and International Classification of Diseases (10th ed.). The prevalence and course of eating disorders, theories regarding their etiology, and issues of comorbidity and differential diagnosis are also discussed.

Determinants of appetite ratings: the role of age, gender, BMI, physical activity, smoking habits, and diet/weight concern

Background

Appetite measures are often recorded by visual analogue scales (VAS), and are assumed to reflect central nervous system (CNS) perceptions and sensations. However, little is known about how physiological, psychological, social, and cultural factors influence VAS.

Objective

To investigate whether age, gender, body mass index (BMI), smoking habits, physical activity, diet behaviour, and menstruation cycle are determinants of appetite ratings.

Design

We investigated appetite ratings in different groups of a population during a single meal test, including 178 healthy women (98) and men (80), aged 20–60 years with a BMI of 18.5–35.0 kg/m². Subjects consumed an evening meal composed to meet individual requirements of energy content and recommendations regarding macronutrient composition. Before and every half hour until 3 hours after the meal, subjects filled out VAS for satiety, fullness, hunger, and prospective food intake. They also filled in a questionnaire on eating/slimming behaviour.

Results

Multiple linear regression analyses showed that gender and age were the most powerful predictors of postprandial satiety (p<0.001, adj. R²=0.19) and hunger (p<0.001, adj. R²=0.15). Repeated measures general linear model (GLM) analyses revealed that women felt more satisfied than men (p<0.001) and older subjects felt more satisfied than younger (p<0.01). Furthermore, light/no exercisers felt more satisfied and less hungry than hard/moderate exercisers (p<0.05), but these differences disappeared after adjusting for age and gender. Smokers rated their prospective consumption lower than non-smokers (p<005) and women in the ovulation phase felt less hungry than women in the menstruation phase (p<005). Neither BMI nor diet/weight concern were significantly associated with appetite ratings.

Conclusions

Appetite ratings differed according to age, gender, and physical activity and to a lesser degree for smoking habits and menstruation cycle. Appetite ratings were not influenced by BMI and diet/weight concern. These factors should be considered when planning studies and analysing data concerning appetite sensations.

Cue reactivity in male restrained eaters: the role of negative cognitions as predictors of food intake

OBJECTIVE

While restrained eating is one of the most well-established risk factors of eating disorders in females, its role for eating disturbances in males remains largely unclear. The present study investigates eating behaviour in response to food cues and negative cognitions in male restrained eaters.

METHODS

Twenty-four restrained eaters and 21 unrestrained eaters volunteered in a cue reactivity experiment consisting of two exposure trials with and without response prevention. Food and macronutrient intake were monitored, and negative cognitions were assessed using a self-report cognition inventory.

RESULTS

Male restrained eaters consumed a larger amount of food, specifically carbohydrates, than unrestrained eaters. This greater food intake was predicted by negative cognitions about self-esteem and occurred in restrained eaters who had reported binge eating episodes in the diagnostic interview.

DISCUSSION

Results suggest marked cue reactivity in male restrained eaters with an increased risk of overeating in those who experience low situational self-esteem and who are binge eaters.

Meals with similar energy densities but rich in protein, fat, carbohydrate, or alcohol have different effects on energy expenditure and substrate metabolism but not on appetite and energy intake

BACKGROUND

It has been suggested that the satiating power of the 4 macronutrients follows the oxidation hierarchy: alcohol > protein > carbohydrate > fat. However, the experimental evidence for this is still scarce.

OBJECTIVE

The goal was to investigate the effects on appetite, energy intake and expenditure, and substrate metabolism of meals rich in 1 of the 4 macronutrients.

DESIGN

Subjective appetite sensations, ad libitum food intake, energy expenditure, substrate metabolism, and hormone concentrations were measured for 5 h after breakfast meals with similar energy density and fiber contents but rich in either protein (32% of energy), carbohydrate (65% of energy), fat (65% of energy), or alcohol (23% of energy). Subjects were normal-weight, healthy women (n = 9) and men (n = 10) studied in a crossover design.

RESULTS

There were no significant differences in hunger or satiety sensations or in ad libitum energy intake after the 4 meals. Diet-induced thermogenesis was larger after the alcohol meal (by 27%; P < 0.01), whereas protein produced an intermediary response (17%; NS) compared with carbohydrate and fat (meal effect: P < 0.01). After the alcohol meal, fat oxidation and leptin concentrations were greatly suppressed (meal effects, P < 0.0001 and P < 0.05) and triacylglycerol concentrations were as high as after the fat meal.

CONCLUSION

Intake of an alcohol-rich meal stimulates energy expenditure but suppresses fat oxidation and leptin more than do isoenergetically dense meals rich in protein, carbohydrate, or fat. Despite differences in substrate metabolism and hormone concentrations, satiety and ad libitum energy intake were not significantly different between meals. Our data, therefore, do not support the proposed relation between the macronutrient oxidation hierarchy and the satiety hierarchy.

Multidimensionality in adolescent eating problems. A two-phase measurement study

The aims of this study were, firstly, to examine the factor structure of single items from several self-report methods used to measure eating disorder symptoms, and secondly, in search for a short assessment instrument to reduce the number of items within each factor. Factor analyses were employed to identify and confirm the constructs measured by a total of sixty items drawn from these assessment methods. In phase one, 508 secondary school pupils were recruited as subjects, and principal factor analysis identified three factors; body concern, dieting, and loss of control over eating. Twenty-nine items were retained, and in phase two subjected to a second data collection among 4129 secondary school pupils. Confirmatory factor analysis was employed to cross-validate the factor structure from phase one. The three-factor structure was confirmed satisfactorily for boys, but not for girls aged 12-14 years. For girls aged 14-16 years, it was confirmed when a number of items were omitted. The findings are discussed in relation to restraint theory and the continuum hypothesis.