Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology

The weight of stigma: pressures for a healthy weight from health professionals can predict binge eating symptoms through the mediation of internalised weight stigma

BACKGROUND

This study explored the mediating role of internalised weight stigma in the relationship between the pressures exerted by health professionals to maintain a healthy weight and the symptoms of binge eating disorder (BED).

METHODS

A sample of 114 participants who screened positive for eating disorder symptoms, with a BMI of 28 kg/m2 or higher, primarily female, were enrolled at the Integrated Service for Eating Disorders at Sapienza University of Rome. BED symptoms, sociocultural influences on weight, internalised weight stigma, and psychological distress were assessed using report measures.

RESULTS

Our findings show that pressures from health professionals were significantly associated with binge eating symptoms through an indirect pathway via internalised weight stigma, controlling for patients' BMI. This mediation effect lessens when exposure to general conversations about healthy weight is included as the independent variable.

CONCLUSIONS

These findings contribute to a deeper understanding of the complex dynamics at play in obesity management and highlight the potential implications of healthcare communication strategies in overweight and obesity care. The study advocates for further research into developing more empathetic and effective approaches to obesity care.

Is there harm in behavioral lifestyle weight management for binge-eating disorder in patients with obesity: Findings from a randomized controlled trial

OBJECTIVE

Trials of behavioral lifestyle weight management (BLWM) for binge-eating disorder (BED) with obesity have documented significant broad benefits. Heated debate has surfaced concerning whether BLWM interventions might exacerbate eating-disorder psychopathology and therefore be contraindicated for patients with BED. This secondary analysis of a randomized controlled trial (RCT) testing BLWM examined heterogeneity of outcomes to identify frequency of individuals who experienced increased symptoms.

METHODS

Sixty-nine participants with BED with obesity in an RCT were assessed for binge-eating, eating-disorder psychopathology, and weight at baseline and posttreatment. Thirty-four were randomized to placebo and 35 to BLWM+placebo. Changes were examined at the individual level to identify cases of any increased features.

RESULTS

At posttreatment, 3.7 % (N = 1) of participants in BLWM+placebo versus 17 % (N = 5) in placebo reported increased binge-eating frequency, and 7.4 % (N = 2) versus 18 % (N = 5) had increased eating-disorder psychopathology. Overall, a total of 7.4 % (N = 2) of participants who received BLWM+placebo had any increase on binge-eating and/or eating-disorder psychology (one participant increased both). Increased symptoms had mostly small magnitudes and did not differ significantly between interventions.

CONCLUSION

In this controlled trial for BED with obesity, the frequency of cases with any increased symptoms of binge eating and/or eating-disorder psychopathology was rare, most increases had small magnitudes, and rates did not differ significantly between BLWM+placebo versus placebo. While any worsening in even one individual is not an optimal outcome, these participant-level findings for patients with BED with obesity address concerns that BLWM exacerbates eating-disorder psychopathology and provide further clinical context regarding overall effectiveness of BLWM.

CLINICALTRIALS

govregistration:NCT03045341 (Behavioral and Pharmacologic Treatment of Binge Eating and Obesity: Acute Treatment).

The science behind the lifesum app: an intervention design analysis

Wellness is an increasingly important part of public health and can prevent both disease and death. Diet and nutrition are important factors that contribute to wellness and predict health outcomes. Adhering to healthy diets is notoriously difficult for many, and some support is often required. Increasingly, that support may be found in the shape of an app in a smartphone. One such app is Lifesum, with some 65 million users worldwide. Lifesum adopts a more holistic approach to nutrition and well-being, and adopted an evidence-based approach to its development. The aim of this study was to describe the scientific, theoretical basis for the Lifesum app and contribute to advancing science in the field of wellness app development. This was an intervention design analysis, designed to describe the theoretical model and intervention theory used to create the Lifesum app in its current embodiment. A pragmatic theoretical model describing behaviour change in the context of healthy eating was devised based on findings in literature. Factors that drive unhealthy eating behaviours, but that were malleable and whose mechanisms of change were feasible to implement, were identified and used to form an intervention theory. The theoretical model and the intervention theory could then guide the implementation of the Lifesum app, illustrated by a logic model. The theoretical model emphasizes personal goal-attainment and motivation as keys to establishing and maintaining healthy eating behaviours, with proximal outcomes being nutrition knowledge, mindfulness about eating and macro-nutrient balance. Nutrition knowledge is achieved through the provision of nutrition information from a vast database on food items, easily available. Continuous feedback on food choices made will enhance this knowledge and a greater awareness of the impact of nutrition on health remains desirable. A more mindful disposition regarding foods is achieved through support in terms of tracking food intake continuously, as well as recommending meals or recipes. After collecting user preferences on health status, biometrics and goals, these meal plans and recipes can be made to offer the optimal macro-nutrient distribution for each individual user. A theoretical model for diet-related behavior change was developed and key dietary issues were identified, outlining mechanisms for positive impact. These insights informed a mechanistic description of the Lifesum app, providing a foundation for future research on intervention outcomes.

Unhealthy app use and dietary restraint among young adults: The moderating role of body appreciation

OBJECTIVE

Health and fitness apps that integrate wearable-device data have increased in popularity for self-monitoring of body appearance and weight goals. However, limited research has explored their potential to promote unhealthy eating behaviors. This study assessed body appreciation as a moderator of the relationship between health and fitness app use and dietary restraint.

METHODS

A total of 126 young adults (Mage = 20.8 ± 2.2 years, 65.9 % women) completed an online survey incorporating the Three-Factor Eating Questionnaire (TFEQ), Body Appreciation Scale (BAS) and frequency of app usage.

RESULTS

Hierarchical regression analysis revealed that app use significantly and positively predicted dietary restraint, explaining 33.2 % of the variance (R2= 0.33, p < .001), with a combined large effect (f2 = 0.50). Body appreciation moderated this relationship, accounting for an additional 3.2 % of the variance (p = .018). Further analysis indicated for individuals with higher levels of body appreciation (above 2.95; 70.6 % of the sample), app use was significantly associated with dietary restraint.

CONCLUSIONS

Results indicate that dietary restraint was associated with one-third of young adults who use health and fitness apps. Unexpectedly, young adults with high body appreciation who actively engage with these apps report intentions to restrict food intake. It remains unclear whether app-related goal-setting features influence caloric restriction. Incorporating health warnings in apps and personalizing app interactions to discourage extreme goal setting may help protect those individuals at risk of developing eating disorders.

Turkish version of the German Eating Behavior Scale (SEV-Tr): a study of reliability and construct validity

This two-phase study aims to develop the Turkish version of the German Eating Behavior Scale (SEV-Tr), and to investigate the potential associations of health-conscious and weight-controlling eating behaviors with nutritional and health status. In the first phase, the original scale was adapted to the Turkish language and its validity and reliability were assessed in 299 healthy individuals aged 19-64 years. In the second phase, the SEV-Tr was retested in a study population of 110 healthy individuals, aged 19-64 years, and the potential associations between the SEV-Tr score, anthropometrical and biochemical measurements, and other eating behaviors assessed by the Three-Factor Eating Questionnaire (TFEQ-Tr21) were examined. Statistical analyses were performed using AMOS 20.00 and SPSS 22.0 software packages. A two-dimensional structure was identified for the SEV-Tr, and named 'health-conscious eating behavior' and 'weight- controlling eating behavior'. In the second phase, participants were clustered based on their weight-controlling and health-conscious eating behaviors (F = 59.46, p = 0.01). Participants with lower health-conscious and weight-controlling eating behaviors had higher lean body mass (p = 0.03), serum triglyceride levels (p = 0.01), emotional eating behavior (p = 0.03), and lower cognitive restraint behavior (p = 0.01, p < 0.05). Furthermore, participants with high levels of health-conscious eating behavior had higher serum HDL cholesterol (r = 0.23, p = 0.02). Regression models suggested that lower levels of emotional eating and higher levels of cognitive restraint were associated with increased weight-controlling and health-conscious eating behaviors. This study provided a valid and reliable version of the SEV to assess the health-conscious and weight-controlling eating patterns in people from Turkish culture.

An Acceptance-Based Guided Self-Help Program for Weight Loss Maintenance in Adults Who Have Previously Completed a Behavioral Weight Loss Program: The SWiM Feasibility Study

Background

Most weight lost during weight-loss programmes is eventually regained. Interventions based on Acceptance and Commitment Therapy (ACT) demonstrate good evidence for long-term weight loss, but are often costly and difficult to scale up. Guided self-help programmes delivered using technology and non-specialist coaches could increase scalability, but it is unclear whether delivering ACT-based interventions in this way is feasible and acceptable.

Methods

In this feasibility study, 61 people who recently completed a behavioral weight management intervention (BWMI) for weight management were randomly allocated to SWiM ("Supporting Weight Management": 4-month digital guided self-help ACT-based intervention for weight loss maintenance) or a standard care group (leaflet about maintaining weight loss) using a 2:1 allocation ratio. At baseline and 6 months, participants completed measures of weight, mental health, eating behavior, and other psychosocial variables. Participants completed an intervention evaluation questionnaire. At 3 and 6 months, qualitative interviews were conducted with participants from both trial arms and SWiM coaches. The analysis integrated statistics and thematic analysis, informed by the Medical Research Council (MRC) framework for process evaluations. Since this was a feasibility study, analyses focused on process outcomes instead of interpreting statistical significance.

Results

Eighty-eight percent (36/41) of participants allocated to SWiM completed at least the first session and 22 (54%) completed all sessions. At 6 months, mean weight change was -2.2 (+/-6.4 SD) kg in SWiM participants and +2.2 (+/-6.6) kg in standard care participants. Descriptively, eating behavior and mental health scores improved in SWiM participants but not in standard care participants. In interviews, SWiM participants noted that they reinforced their existing knowledge while acquiring new skills and strategies, which were felt to contribute to positive behavioral changes.

Conclusion

The SWiM intervention is practical and well-received, and shows promise in supporting weight loss maintenance, though evaluation in a larger trial is needed to assess effectiveness.

Trial Registration

ISRCTN12685964.

The invisible connection of mothers' BMI, emotional appetite, and food choices with childhood obesity

BACKGROUND

This study examined the effects of mothers' body mass index (BMI), emotional appetite, and food choices on children's growth curves and adiposity.

METHODS

Data was collected from 492 mothers. The demographic characteristics and anthropometric measurements were obtained using a questionnaire. The mothers' food choices and emotional appetites were assessed using scales. BMI for age Z score and tripoderal index (TMI) were used in the evaluation of children's anthropometric measurements and adiposity.

RESULTS

The mean age of mothers' was 39.10 ± 0.26 and BMI was 25.08 ± 0.21. Among the mothers, 54.5% were classified as normal, 28.4% as pre-obese, and 14.7% as obese. Among the children, 31.5% were overweight or obese. There was a strong positive correlation between the mean BMI of the mothers and the mean TMI and BMI of the children (p < 0.001). The "convenience" food choice factor of mothers had negative correlation with childiren's BMI for age (p < 0.005).

CONCLUSIONS

This study emphasizes the invisible connection between mothers' emotional appetite and food choices and children's BMI and TMI and highlights the importance of paying attention to mothers' eating habits for children's health outcomes. These findings will be informative in the formulation of future health policies.

IMPACT

This research revealed the relationship between mothers' food choices and emotional appetites, and their children's growth curves and adiposity. The study proposes the Triponderal Index as an alternative approach to evaluating growth, introducing a novel perspective in growth monitoring. By highlighting the impact of mothers' emotional appetites and food choices on children's dietary habits and weight status, the research emphasizes the significance of family eating habits. The findings support the promotion of healthy dietary practices within families as a crucial measure in preventing and managing childhood obesity, conveying a significant message to parents and healthcare professionals for a healthier future.

Association between healthy neuroticism and eating behavior as revealed by the NKI Rockland Sample

Trait neuroticism predicts an increased risk of mortality. However, high levels of both neuroticism and conscientiousness (i.e., healthy neuroticism) are associated with various positive health behaviors. Eating behavior is a modifiable risk factor for obesity and metabolic diseases. This study investigated the cross-sectional and longitudinal associations between healthy neuroticism and eating behaviors. The data from the Nathan Kline Institute for Psychiatric Research-Rockland Sample included 712 adults with complete assessments of personality, eating behaviors, and metabolic markers. Linear and mixed linear regression models were used to examine cross-sectional and longitudinal associations of eating behaviors and personality traits, adjusting for sociodemographics, sleep quality, and body mass index (BMI). Healthy neuroticism cross-sectionally predicted the disinhibition and hunger dimensions of eating behavior, a result that withstood the inclusion of disease burden, clinical metabolic markers, and other personality traits. Longitudinally, healthy neuroticism did not predict changes in eating behavior. Greater conscientiousness scores were associated with increased restraint. These findings provide the first evidence that neuroticism is associated with less maladaptive eating behavior when modulated by conscientiousness. The implications of these associations for the relationships between eating behavior, metabolic health, and personality are discussed.

Emotional Eating Interventions for Adults Living With Overweight and Obesity: A Systematic Review and Meta-Analysis of Behaviour Change Techniques

BACKGROUND

Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes.

METHODS

This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted.

RESULTS

In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = -0.99 [95% CI: -0.73 to -1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (-4.09 kg [95% CI: -2.76 to -5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE ('incompatible beliefs', 'goal setting outcome'. 'review outcome goals', 'feedback on behaviour' and 'pros/cons').

CONCLUSION

Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.

Enhancing Motivation to Reduce Restrictive Eating: A Novel Approach

OBJECTIVE

Despite growing interest in leveraging motivational techniques to address restrictive eating, it is not yet clear how to most effectively promote motivation to reduce this behavior. Drawing from a behavioral economic framework, the present study evaluates a novel approach for increasing motivation to address disordered eating by amplifying the potential benefits of reducing dietary restriction and the consequences of maintaining disordered behaviors.

METHOD

A sample of 126 undergraduate students engaging in restrictive eating participated in a 7-day online experiment. Participants were randomized to one of four conditions: Amplified Benefits and Consequences, Amplified Benefits, Amplified Consequences, or a control condition. Growth curve models were estimated to examine the extent to which experimental conditions led to changes in eating pathology and motivation over the study period.

RESULTS

Initial reductions in dietary restraint were observed in conditions where the benefits of reducing restriction were amplified; however, these reductions were not sustained over the 7-day study period. The greatest increases in motivation were observed when both the benefits of reducing restriction and the consequences of maintenance were amplified.

DISCUSSION

Interventions designed to enhance motivation alone are unlikely to yield sustained reductions in eating disorder symptoms and therefore should be accompanied or followed by targeted interventions which directly address restrictive eating behaviors and maladaptive cognitions about shape and weight.

Emotion regulation as a transdiagnostic construct across the spectrum of disordered eating in adolescents: A systematic review

OBJECTIVE

This systematic review aimed to understand the role of emotion regulation (ER) across the spectrum of disordered eating behaviors and attitudes in adolescents.

METHOD

A literature search was conducted using the PubMed, Scopus, and Web of Science databases, and 8381 articles were extracted. After removing duplicates and screening, data from 50 articles involving 31,591 participants from 18 countries were included.

RESULTS

Consistent associations between difficulties in ER/maladaptive ER and overeating (but not restrictive) behaviors/attitudes were found among adolescents without an eating disorder diagnosis. In contrast, in adolescents with eating disorders, ER difficulties were associated with restrictive-, compensatory- and overeating-type eating disorders. More difficulties in ER were found among adolescents with eating disorder diagnoses (i.e., anorexia nervosa, bulimia nervosa, or binge eating disorder) than among their healthy/normal-weight peers. Nonetheless, difficulties in ER abilities and in the implementation of ER strategies were greater in adolescents with anorexia nervosa or bulimia nervosa than in adolescents with binge eating disorder. Finally, concerning the role of adaptive ER, although fewer adaptive ER strategies were consistently found in adolescents with a diagnosis of anorexia nervosa than in healthy controls, the results in community samples were less consistent.

DISCUSSION

Overall, ER was associated with disordered eating behaviors/attitudes and eating disorder diagnoses, supporting the transdiagnostic role of ER in the spectrum of eating psychopathology. Fewer consistent findings were found across the weight spectrum, specifically at the higher end (overweight/obesity). These results highlighted the role of different ER abilities and strategies and the relevance of maladaptive (vs. adaptive) ER in understanding disordered eating. The findings also set the context for developing specific ER-based interventions across the spectrum of disordered eating behaviors and attitudes.

The impact of behavioral weight management interventions on eating behavior traits in children with overweight or obesity: Systematic review and meta-analysis

INTRODUCTION

Behavioral weight management interventions (BWMIs) are an evidence-based strategy for addressing childhood obesity. Targeting eating behavior traits (EBTs; individual tendencies determining food intake/occasions) could play a pivotal role in improving the effectiveness of these behavioral interventions. The present study describes a systematic review and meta-analysis of the impact of BWMIs on eating behavior traits in children with overweight or obesity.

METHODS

Seven databases were searched, and eligible studies included randomized controlled trials reporting EBT outcomes following BWMIs delivered to children with overweight or obesity (<18 years of age). Random effects meta-analyses were conducted to compare EBT outcomes for intervention and control groups. Synthesis without meta-analysis (SWiM) was applied for EBTs where meta-analysis was not feasible.

RESULTS

The review identified eight trials characterizing the impact of BWMIs on 15 EBTs. Meta-analyses of data from three trials at intervention completion and post-intervention (average of 28 weeks [±8]) revealed positive short-term increases in dietary restraint (SMD random effect 0.42 [95% CI 0.13, 0.70]). However, these effects were not sustained at follow-up. Improvements in emotional eating, external eating, food responsiveness, and enjoyment of food were shown in studies which could not be pooled quantitatively.

CONCLUSION

BWMIs in children living with overweight/obesity are beneficial for the improvement of some EBTs at intervention completion including dietary restraint, emotional eating, external eating, food responsiveness, and enjoyment of food. However, this remains a relatively unexplored area and more research is needed to strengthen understanding of the multifaceted impact of child BWMIs on a comprehensive range of EBTs.

Low Overlap and High Heterogeneity Across Common Measures of Eating Disorder Pathology: A Content Analysis

This study evaluated symptoms assessed in common measures of eating disorder pathology and tested overlap to evaluate the extent to which measures may be interchangeable. Six measures were included: Bulimia Test-Revised, Eating Attitudes Test-26, Eating Disorder Diagnostic Scale, Eating Disorder Examination Questionnaire, Eating Pathology Symptoms Inventory, and Questionnaire for Eating Disorder Diagnoses. Content overlap was quantitatively estimated using the Jaccard Index. Mean overlap was low (.195), likely due to the wide range of symptoms (87) assessed. The mean overlap of each measure with all others was .117 - .267, and the overlap among individual measures was .083 - .382. Implications of low overlap among measures include variable characterization of eating disorder phenotypes and the risk for lower generalizability of findings due to measurement variability.

Cognitive restraint and body dissatisfaction are more strongly related to muscle building behaviors for men than women

Muscle building behaviors are an understudied eating disorder (ED) symptom increasing in prevalence, especially among men. However, little is known about the cognitive ED correlates that may underlie muscle building behaviors and whether these associations differ by gender. We examined associations between cognitive ED symptoms and muscle building behaviors, and whether these associations differ between men and women. In a sample of college students (N = 258), we investigated cross-sectional associations between two core cognitive ED symptoms, body dissatisfaction and cognitive restraint, with muscle building behaviors, and whether binary gender moderated these associations. Data were analyzed using two linear regression models in which muscle building behaviors was entered as the outcome variable. In Model 1, body dissatisfaction, BMI, gender, and the interaction term of body dissatisfaction by gender were entered as predictors. In Model 2, cognitive restraint, BMI, gender, and the interaction term of cognitive restraint by gender were entered as predictors. Results of Model 1 indicated that muscle building behaviors were significantly and independently associated with body dissatisfaction and gender and the association between muscle building and body dissatisfaction was stronger for men. Results of Model 2 indicated that muscle building behaviors were significantly and independently associated with cognitive restraint and gender and the association between muscle building and cognitive restraint was stronger for men. Findings suggest that cognitive restraint and body dissatisfaction may be important prevention and intervention targets for maladaptive muscle building behaviors, particularly among men.

Eating disorder risk among Australian youth starting a diet in the community

Dieting is a potent risk factor for eating disorder (ED) symptoms and development, which typically occur in late adolescence. However, as diets are often motivated by body image concerns (another core ED risk factor), dieters may already carry heightened ED risk. Thus, the current study aimed to document ED risk among young people starting a diet in the community. Young people (16-25 years) starting or intending to start a self-initiated diet (N = 727) provided data via a screener questionnaire, assessing containing sociodemographic factors, past and current ED symptoms and behaviours. Over a third (36.9%) screened using a validated instrument were found to be at-risk of a current ED, with 10% above the clinical cut-off. Consistent with this finding, over 10% of the sample self-reported experiencing a lifetime ED, while nearly a quarter reported symptoms consistent with an ED diagnosis with no reported formal diagnosis. Findings suggest a high level of ED risk among young people starting a diet in the community and point to the need for more proactive measures targeted at this cohort (e.g., screening, monitoring). Further education on the risks of dieting and encouragement for help-seeking in young people is indicated.

Efficacy of a cognitive training based on inhibitory spillover and attribute conditioning: No weight and food intake reductions in adults with overweight and obesity

BACKGROUND

Overeating and obesity have been linked to deficient self-control and recent evidence suggests that the inhibitory spillover effect (ISE) may be an effective means to improve self-control. Specifically, it was shown that the ISE increases self-control by transfer of self-control capacity from one domain to another unrelated domain. Against this backdrop, our aim was to reduce hedonic food intake and body weight in non-dieting participants with overweight and obesity by transferring inhibitory control abilities from a food-unrelated domain to the food domain by means of an attribute conditioning procedure in a novel cognitive training (vs. a placebo training) comprising 8-sessions delivered over four weeks.

METHOD

In total, 93 adults with overweight and obesity were included in a two-arm randomized controlled trial and assigned to the computerized cognitive training or a placebo training (active control condition). Food intake in a bogus taste test and body weight were assessed prior to and after the training. Weight was additionally assessed at 3-months follow-up.

RESULTS

There was no improvement in food intake and weight reduction.

DISCUSSION

The cognitive training based on the ISE and attribute conditioning (ISAC) is not yet ready for application. Future studies need to identify the factors critical for a successful implementation of conditioning procedures aiming to associate food stimuli with self-control in overweight and obesity.

Management of a Dual Low Sodium and Diabetic Diet by Patient-Caregiver Dyads: A Qualitative Descriptive Study

PURPOSE

The purpose of the study was to explore factors surrounding management of simultaneous dietary recommendations for heart failure and type 2 diabetes among patient-caregiver dyads.

METHODS

Qualitative description was used to explore dyad experiences managing a dual diet. Semi-structured interviews were conducted with patients with a concurrent diagnosis of type 2 diabetes and heart failure and their family caregiver. Each 60-minute interview was conducted virtually. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted with coding used for themes at dyadic-and individual levels.

RESULTS

Twelve patient-caregiver dyads (N = 24) were interviewed. The mean age was 57 years (±15 years). Most participants were white (75%); patients were predominantly male, and caregivers were predominantly female (83.3% for both). Dyadic-level themes that emerged included factors that influence simultaneous management of dual diet recommendations. Themes included shared barriers, facilitators, motivators, and strategies for dual diet management. Individual-level themes discussed by patients were barriers and motivators to dual diet management, and caregivers discussed barriers to supporting dual diet management.

CONCLUSIONS

Findings from the study highlight that patients and caregivers often work together and share similar barriers, facilitators, motivators, and strategies for adhering to a dual diet. The results provide insight into chronic disease management at the family level and can guide health care providers' efforts to promote family involvement with dietary recommendations for patients with multiple comorbidities.

Exploring Dietary Restraint as a Mediator of Behavioral and Cognitive-Behavioral Treatments on Outcomes for Patients With Binge-Eating Disorder With Obesity

OBJECTIVE

To explore dietary-restraint as a mediator of binge eating and weight-loss outcomes within a randomized controlled trial comparing cognitive-behavioral therapy (CBT) and behavioral weight loss (BWL) for binge-eating disorder (BED) with obesity.

METHODS

Ninety participants were randomly assigned to CBT or BWL and assessed by evaluators blinded to conditions at pretreatment, throughout-, and post-treatment (6 months). Three dietary-restraint measures (Eating Disorder Examination-Questionnaire [EDE-Q]-Restraint, Three-Factor Flexible-Restraint and Rigid-Restraint) were administered at pretreatment and after 2 months of treatment. Regression models examined whether changes at 2-months in the restraint scales mediated the effects of treatment (CBT versus BWL) on binge eating and weight-loss outcomes at post-treatment.

RESULTS

CBT and BWL had similar binge-eating outcomes and similar changes in EDE-Q-restraint and flexible-restraint. BWL had greater 2-month increases in rigid-restraint and greater weight-loss at posttreatment than CBT, with results suggesting 2-month changes in rigid-restraint mediated the greater difference (>7 pounds) in weight-loss. The observed mediation effect of 2.92 suggests 39% of total treatment-effect on weight-loss was mediated through 2-month increases in rigid-restraint.

DISCUSSION

This secondary analysis within a trial comparing CBT and BWL for BED suggests early-change in rigid-restraint has a mediating effect of BWL on weight-loss. Findings indicate that BWL improves binge eating and challenge views that dietary-restraint might exacerbate binge eating in BED with obesity. Findings require confirmation using hypothesis-testing in future trials.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT00537758 ("Treatment for Obesity and Binge Eating Disorder").

A cross-sectional study on the prevalence of eating disorders in liver transplanted patients with type 2 diabetes and/or overweight/obesity

Liver transplantation (LT) associates with weight gain and metabolic complications. However, risk of eating disorders post-transplantation and factors influencing their onset remain poorly understood. This study aimed to fill this knowledge gap by characterizing the risk of having eating disorders or Orthorexia Nervosa (ON) according to the EAT-26, BES and Bratman screening questionnaires in 104 liver transplant recipients (mean age 62.5 years; median time from LT 6 years) with type 2 diabetes and/or overweight/obesity. Eighty-two patients (78.9 %) had diabetes; mean BMI was 30.1 ± 5.9 kg/m2. Risk of eating disorders was observed in 6.9 %-10.8 % and the risk of orthorexia (Bratman test score > 4) was observed in 60.5 % of patients. A significant association was found between BMI and the likelihood of having eating disorders considering EAT-26 (OR = 0.17, p = .009). The absence of a direct link between diabetes and the risk of having eating disorders suggest multifactorial influences on post-transplant eating behaviors. The study highlights the importance of proactive screening to evaluate eating behaviors in liver transplant recipients to define tailored interventions and optimize post-transplant outcomes. Limitations refer to the observational nature of the study and the absence of pre-transplant data. Further research is warranted to validate these findings, elucidate temporal relationship between transplantation and the onset of eating disorders, and explore potential mechanisms underlying these associations. Such insights are crucial for developing effective strategies to mitigate the impact of eating disorders on post-transplant health and well-being.

Relationships between restrained eating and personality and self-esteem

We examined relationships between restrained eating and personality and self-esteem in a sample of 4382 undergraduates attending a university in the US, Mage = 18.9, SD = 1.42. Restrained eating was measured using the Dutch Eating Behavior Questionnaire, personality was measured using the BFI-44, and self-esteem was measured using the Rosenberg self-esteem scale. Restrained eating scores were regressed onto the five personality traits of the BFI-44 using ordinary least squares multiple linear regression. These analyses found that restrained eating was significantly and positively related to extraversion, conscientiousness, and neuroticism. Restrained eating was not significantly related to agreeableness and openness. Moderation analyses suggested that restrained eating was not related to neuroticism for women with obesity, but it was related for women without obesity. Restrained eating was negatively correlated with self-esteem, and this relationship was stronger for women than it was for men. These findings contribute to our understanding about the personality factors associated with restrained eating, which may help us better understand individual differences in dietary behaviors.

Associations Between Body Weight Dissatisfaction and Diet Quality in Women With a Body Mass Index in the Healthy Weight Category: Results From the 2014-2015 Swiss National Nutrition Survey

BACKGROUND

Few studies have examined whether diet quality is lower in women with body weight dissatisfaction compared with women without body weight dissatisfaction.

OBJECTIVES

(1) Examine the association between body weight dissatisfaction and diet quality among women (18-65 years old) in the healthy weight body mass index (BMI) category, and (2) explore dietary and behavioral patterns among women with body weight dissatisfaction.

DESIGN

Data were extracted from the cross-sectional 2014-2015 Swiss National Nutrition Survey.

PARTICIPANTS/SETTING

Population-based sample of 507 women with BMI ≥ 18.5 and < 25.

OUTCOME MEASURES

Dietary intakes assessed by registered dietitians using 2 nonconsecutive computer-assisted multi-pass 24-hour dietary recalls. Diet quality was measured with a slightly modified version of the Healthy Eating Index (HEI)-2020.

STATISTICAL ANALYSES PERFORMED

Multiple linear regressions were performed to test the association between body weight dissatisfaction and total HEI-2020 score. Hierarchical cluster analysis was used to identify subgroups of women with body weight dissatisfaction.

RESULTS

Body weight dissatisfaction was not found to be associated with diet quality (β = -1.73 [-4.18; 0.71], P = .16). However, women who were dissatisfied with their body weight had lower scores for the HEI-2020 total fruits (P = .050) and whole grains (P = .014) components than women who were satisfied with their body weight. Four profiles with different dietary patterns were identified among women with body weight dissatisfaction: "Unhealthy diet with dairy," "Protein and fat," "Vegetables without protein," and "Healthier diet without dairy."

CONCLUSIONS

Among women with a BMI in the healthy weight category, overall diet quality was not observed to differ between those with or without body weight dissatisfaction. More research is needed to explore the different profiles of dietary intake in women with body weight dissatisfaction.

Restrained Eating and Disinhibited Eating: Association with Diet Quality and Body Weight Status Among Adolescents

Background/Objectives: Problematic eating behaviours may affect food consumption and, therefore, body weight. However, these associations have not been well understood, especially among adolescents. The aim of the study was to evaluate the associations of restrained eating and disinhibited eating with diet quality and body weight status among adolescents. Methods: A cross-sectional study was conducted among 1450 primary school students aged 11-13 years (52% girls). Dietary data were collected using the food frequency questionnaire (SF-FFQ4PolishChildren®). Two diet quality scores were evaluated: (i) the pro-Healthy Diet Index (pHDI), which included vegetables, fruit, dairy products, and fish, and (ii) the non-Healthy Diet Index (nHDI), which included fast food, sweets, sweetened beverages, and energy drinks. Based on the Three-Factor Eating Questionnaire, two eating styles were identified: restrained eating (RE) and disinhibited eating (DE). Body weight status was evaluated using the body mass index (BMI) z-score and the waist-to-height ratio (WHtR). Spearman's correlation coefficient and logistic regression analysis were used to assess the association between eating styles, diet quality, and body weight status. Results: Restrained eating was negatively correlated with nHDI (r = -0.178, p < 0.001) and positively correlated with the BMI z-score (r = 0.253, p < 0.001) and WHtR (r = 0.197, p < 0.001). Disinhibited eating was positively correlated with nHDI (r = 0.232, p < 0.001). Among adolescents with different RE and DE levels, significant differences in the mean nHDI, BMI z-score, and WHtR were found. Compared to adolescents with 'low RE & DE', those with 'low RE & higher DE' were more likely to fall in the upper than bottom tertile of nHDI (odds ratio (OR) =1.90, 95% CI: 1.29-2.81). Adolescents with 'higher RE & low DE' were less likely to be underweight (OR = 0.17, 95% CI: 0.06-0.49) and more likely to be overweight (OR = 2.02, 95% CI: 1.41-2.91) and to have abdominal obesity (OR = 1.79, 95% CI: 1.13-2.82). Conclusions: The findings suggest that both eating styles may be predictors of diet quality among adolescents. Body weight status was related to restrained eating, which seems to characterise mainly adolescents with overweight or obesity.

Improving adult eating behaviours by manipulating time perspective: a systematic review and meta-analysis

There is a growing body of research on improving health behaviours through future thinking but that in improving eating behaviour remains unclear. Hence, we conducted a systematic review and meta-analysis on the effectiveness of time perspective manipulation in improving adult eating behaviours. Articles published from inception through 17 March 2022 were retrieved from eight databases (CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, The Cochrane library, and Web of Science). Meta-analysis was conducted using random effects models with effect sizes reported in Hedges' g. Sixteen experimental studies were included, representing 1,914 participants with mean ages ranging from 20.5 to 44.1 years old and mean baseline BMI of 22.0 kg/m2 to 37.2 kg/m2. The interventions included were episodic future thinking (EFT; n = 12), message framing (n = 2), and varying inter-meal intervals (IMI; n = 2) in improving food choices, food intake and portion size. Two studies reported significant interventional effectiveness for domain-specific EFT while all studies on message framing and IMI reported significant interventional effectiveness. Message framing seemed to be more effective when both temporal distance and valence frames were manipulated. However, the pooled effect sizes of all the interventions did not result in a significant interventional effect (n = 5; g = -0.49; 95% confidence interval (CI) = -1.44, 0.47; p = 0.23; I2=87.2%). More rigorous research is needed to ascertain the effectiveness of manipulating time perspective in improving eating behaviours before such interventions are more widely used.

Anxiety and restrained eating in everyday life: An ecological momentary assessment study

BACKGROUND

Restrained eating has been related to psychological distress like anxiety and eating disorder symptomatology, but little is known about this relationship in daily life in non-clinical populations. We aimed to understand concurrent and temporal associations between momentary anxiety and restrained eating in everyday life within and across persons in a non-clinical sample, and examined whether this association remains after controlling for eating disorder symptomatology.

METHODS

We used a 10-day ecological momentary assessment (EMA) protocol. Participants (n = 123) completed a baseline survey with demographics and eating disorder symptomatology questions, and three EMA surveys per day reporting anxiety and restrained eating intentions. We applied mixed-effects and random intercept cross-lagged models to analyze the data.

RESULTS

Momentary anxiety and restrained eating were concurrently significantly positively associated within and between persons. When participants had more anxiety than was typical for them, they were more likely to intend to restrain eating, and people with overall higher anxiety symptoms tended to report greater restrained eating over the study period. These associations remained significant after adjusting for eating disorder symptomatology. There were no significant temporal cross-lagged effects. Anxiety-restrained eating association did not spill over into the next assessment window.

LIMITATIONS

The time window between prompts may have been too long to capture potential temporal effects, and we did not examine actual behavioral food restrictions.

CONCLUSION

Daily-life anxiety may be related to concurrent restrained eating intentions, above and beyond baseline eating disorder symptomatology. Research is needed exploring daily-life anxiety as a potential intervention target to address restrained eating.

A latent profile analysis based on diet quality and eating behaviours in participants of the PREDISE study characterized by a higher BMI

The aim of this study was to identify eating-related latent profiles based on diet quality and eating behaviours within a population characterized by a body mass index (BMI) of at least 25 kg/m2, and to compare metabolic variables between profiles. This analysis was conducted in a sample of 614 adults (45.6% women; 44.8 ± 12.9 years) from the cross-sectional PREDISE study. Participants completed the Three-Factor Eating Questionnaire, the Intuitive Eating Scale-2, the Regulation of Eating Behavior Scale, and three self-administered 24 h food recalls. Waist circumference, blood lipids, blood pressure, and fasting glucose were measured to identify carriers of the metabolic syndrome. A latent profile analysis was performed, and cases of metabolic syndrome were compared between profiles. A three-profile solution was found. Profile 1 (22.8%) was characterized by lower diet quality, lower self-determined motivation for eating, lower restraint, and higher intuitive eating. Profile 2 (44.5%) was characterized by higher diet quality, higher self-determined motivation for eating, higher restraint, lower disinhibition, and higher intuitive eating. Profile 3 (32.7%) was characterized by intermediate diet quality, higher non-self-determined motivation for eating, higher restraint and disinhibition, and lower intuitive eating. We found fewer cases of metabolic syndrome among participants in profile 2 than in the other profiles (p = 0.0001). This study suggests that a profile characterized by a lower disinhibition and higher levels of restraint, intuitive eating, self-determined motivation, and diet quality is associated with a better metabolic health among individuals with a higher BMI.

Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research

PURPOSE OF REVIEW

The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions.

RECENT FINDINGS

Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.

A Systematic Review of Moderators of the Association between Dietary Restraint and Binge Eating

Obesity interventions typically involves some form of dietary restraint (i.e., intentional limiting of food intake), yet the restraint model of binge eating proposes that engaging in dietary restraint is a causal factor for binge-eating symptoms. Evidence for this model has been mixed and differs by measures, study design, and sample. Further, there also may be moderators of the association of dietary restraint and binge eating. The purpose of this systematic review was to compile the current evidence on moderators of the association of dietary restraint and binge eating. A literature search was conducted across electronic databases, resulting in inclusion of 16 papers (with 15 different samples). Reviewed studies were primarily heterosexual White college student females and were primarily cross-sectional studies with self-report measures. There were no consistent moderators across the studies. Yet, there was some evidence for interactions between affective constructs and dietary restraint in relation to binge eating as well as three-way interactions between affect, cognitive constructs, and dietary restraint. Although there were few studies, there was little current evidence for social, biological, and demographic factors as moderators. Overall, our systematic review shows a need for further research to clarify and validate moderators, and to understand complex interactions as well as potential causal relationships between restraint and binge-eating behaviors.

Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design

The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.

Risk factors for momentary loss of control and subsequent abandonment of self-devised dietary restraint plans in adults with weight-loss goals: a behaviour sequence analysis approach

OBJECTIVE

The current study aims to improve understanding of events leading to lapses of dietary restraint, and to identify pathways to perseverance or abandonment of weight loss efforts in response to lapses. In addition, Behaviour Sequence Analysis (BSA) was also evaluated as an analytical tool in dietary behaviour.

DESIGN

A sample of 176 adults who were engaging in self-imposed dietary restraint for weight loss were recruited to participate.

MAIN OUTCOME MEASURES

Participants were instructed to provide a detailed written timeline of an episode where they lapsed in their dietary restraint plan. They were instructed to report their preceding behaviours and internal states, and social and environmental contexts, leading up to and after their lapse in dietary restraint.

RESULTS

Lapses in dietary restraint were precipitated by negative internal states in the presence of cues for highly palatable foods. In addition, abandonment of weight loss efforts after lapsing was preceded by dichotomous thinking, whereas perseverance was preceded by a more neutral, flexible interpretation of the lapse in self-control.

CONCLUSION

BSA has identified that neutral evaluation of inevitable lapses in dietary restraint are predictive of continuation with weight loss efforts, highlighting the importance of individual tolerance of lapses in self-regulation.

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.

Interoception and self-regulation of eating behaviors and weight status in college students

OBJECTIVE

To determine the associations between interoception, self-regulation, eating behaviors, and weight status among college students.

PARTICIPANTS

229 female undergraduates, predominantly classified as Juniors (51.1%) and identified as Hispanic/Latinx (75%) with a mean age of 23.4 (SD = 6.3), were examined.

METHODS

Cross-sectional data using baseline measures from a larger, longitudinal study, were examined. Confirmatory factor analyses and structural equation modeling were conducted to test hypotheses.

RESULTS

Interoception was directly associated to self-regulation. Interoception and self-regulation were inversely associated with non-purposeful eating. Non-purposeful eating was directly associated with weight status.

CONCLUSION

This study provided empirical evidence on the associations between interoception, self-regulation, eating behaviors, and weight status. Our results support the need for programs that target college students' cognitive skills to reduce unhealthy eating behaviors and optimize weight status. Future interventions are needed to enhance interoception and self-regulation skills so that college students can be more purposeful in their eating habits.

Independent associations of food addiction and binge eating measures with real-time eating behaviors and contextual factors: An exploratory ecological momentary assessment study

Food addiction (FA) is a concept centered around the addictive potential of highly palatable processed foods, though there is debate over the discriminative validity of FA as a distinct construct from binge-eating symptomatology. This study explored how trait measures of FA and binge-eating symptoms independently and interactively predicted eating behaviors and posited correlates of FA and binge eating measured via ecological momentary assessment (EMA). Adult participants (N = 49) who met the criteria for FA and/or binge-eating disorder completed baseline measures of FA (Yale Food Addiction Scale [YFAS 2.0]) and binge-eating symptoms (Eating Pathology Symptom Inventory [EPSI] binge eating scale) followed by a 10-day EMA protocol. Generalized linear mixed models examined the independent effects of YFAS 2.0, EPSI, and their interaction predicting EMA outcomes. Higher YFAS 2.0 symptom count scores were uniquely related to greater EMA-measured overeating, loss of control eating, negative and positive affect, and impulsivity when controlling for EPSI scores. Conversely, higher EPSI scores were uniquely related to greater EMA-measured eagerness and urge to eat, and expectancies that eating would improve mood. No interaction effects were significant. These results highlight potential distinctions between phenomena captured by FA and other measures of binge eating, in that FA symptoms may be a marker of heightened binge-eating severity, emotional arousal, and impulsivity.

State-level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study

BACKGROUND

Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait-level working memory (WM), which may limit adaptive responding to intra- and extra-personal cues related to eating. Understanding of how WM performance relates to eating behavior in real-time is currently limited.

METHODS

We studied 32 youth (ages 10-17 years) with LOC eating and overweight/obesity (LOC-OW; n = 9), overweight/obesity only (OW; n = 16), and non-overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone-based ecological momentary assessment. Linear mixed effects models estimated group-level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating.

RESULTS

LOC-OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between-subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within-subject effects (reflecting variations in moment-to-moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05).

CONCLUSIONS

Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory-based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal-weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment-to-moment basis.

Parent involvement approach and changes in eating pathology within an adolescent obesity intervention

BACKGROUND

Although adolescents with obesity have heightened risk for eating pathology, the impact of differential parent involvement on eating pathology after obesity treatment is unknown. We examined differences in eating pathology in adolescents whose parents were randomized to distinct interventions within adolescent obesity treatment.

METHODS

Participants were 82 adolescent/parent dyads (adolescents: 63 % female; 55 % racial/ethnically marginalized) enrolled in TEENS+, a 4-month behavioral weight loss intervention. Parents were randomized to either a parent weight loss treatment (TEENS+PWL) or parent skills training (TEENS+PAC). Adolescents completed the Eating Disorder Examination-Questionnaire with Instructions (EDE-Q-I) and Child Depression Inventory (CDI) at baseline, 4 m, and 7 m. Group differences in eating pathology (global score; eating concern, weight concern, shape concern, restraint) and depression across time points were evaluated with linear mixed models.

RESULTS

No significant differences were observed between TEENS+PAC and TEENS+PWL in eating pathology or depression, nor were there group by time interactions. Time point differences were observed for all EDE-Q-I and CDI outcomes, except eating concerns; pairwise contrasts revealed a variety of change patterns. Weight and shape concerns decreased from 0 to 4 m; observed reductions were maintained at 7 m. Restraint was highest at 4 m and decreased at 7 m but did not return to baseline. EDE-Q-I global scores significantly declined over time. Depression decreased over time, but a significant difference was only observed between 0 and 7 m.

CONCLUSIONS

Neither parent intervention yields harm related to eating pathology in adolescents engaged in obesity treatment. Obesity treatment does not appear to have iatrogenic effects on eating pathology in adolescents.

Reduction in eating disorder symptoms among adults in different weight loss interventions

Restriction of food intake and counting calories as part of weight loss programs are thought to trigger eating behaviors and attitudes which can lead to eating disorders. We have developed a treatment model, Regulation of Cues (ROC), that targets appetitive traits, including food responsiveness and satiety responsiveness, which could address overeating at an implicit level and reduce risk of detrimental behaviors and attitudes. This manuscript evaluates eating disorder symptoms, attitudes, and behaviors among adults with overweight or obesity randomized to ROC, behavioral weight loss (BWL), a combination of ROC + BWL (ROC+) and an active comparator (AC). Participants included 271 adults with a body mass index of 25 to 45, age 18 to 65 years, and a lack of comorbidities that could interfere with participation. Assessments occurred at baseline, mid-treatment (6 months), post-treatment (12-months) and 6- and 12-month follow-up. During treatment, participants in all four arms showed decreases in Eating, Weight, and Shape concerns on the Eating Disorder Examination-Questionnaire and binge eating symptoms on the Binge Eating Scale which were maintained at 6-month follow-up but increased at the 12-month follow-up. Both the ROC+ and BWL arms showed increases in Restraint during treatment which dissipated after treatment ended. This study contributes to a growing body of literature demonstrating that weight loss programs are not associated with increases in eating disorder symptoms. Future studies should evaluate interventions to maintain improvements in eating disorder symptoms following weight loss programs.

Relationships Between Three Eating Behaviors and Nine Motives for Food Choices Among Brazilian Adults: A Structural Equation Model

We examined the relationships between three eating behaviors and nine motives underlying food choices made by Brazilian adults. Using participant responses to the short version of the Three-Factor Eating Questionnaire and the Food Choice Questionnaire, we investigated eating behaviors (cognitive restriction, uncontrolled eating, and emotional eating) and motives for food choices (health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern). We used a structural equation model to test relationship pathways (β), with eating behaviors as independent variables and motives for food choices as dependent variables. Participants were 1297 individuals (69.5% female) with a mean age of 25.0 years (SD = 5.8). We confirmed the validity and reliability of the questionnaires in this sample. Restrictive eating behavior was significantly related to motives of health (β = .415), mood (β = .127), natural content (β = .364), weight control (β = .681), and ethical concern (β = .161). Emotional eating behavior was related to motives of mood (β = .277), health (β = -.137), and natural content (β = -.136). Uncontrolled eating behavior was related to motives of convenience (β = .226), sensory appeal (β = .121), price (β = .153), and familiarity (β = .090). We believe these findings can now help design future research and clinical interventions for managing people's risky eating behaviors and promoting beneficial food choices.

Body-related self-conscious emotions, self-compassion, and dietary restraint in Canadian undergraduate university students: A multilevel mediation and moderation analysis

OBJECTIVE

Self-compassion has an inverse association with dietary restraint however, the mechanisms linking self-compassion and dietary restraint are not clear. This study aimed to determine to what extent self-compassion was inversely concurrently related to dietary restraint, indirectly through body-related self-conscious emotions, and to what extent trait self-compassion moderated the concurrent within-person association between body-related self-conscious emotions and dietary restraint.

METHOD

Data was collected from 224 Canadian university students who reported on trait self-compassion at baseline and body-related shame, guilt, envy, and embarrassment, and dietary restraint biweekly between November 2020 and August 2021.

RESULTS

Results from a 2-1-1 multilevel mediation model showed that trait self-compassion was indirectly concurrently related to dietary restraint through body-related shame, guilt, envy, and embarrassment. Results from the moderation model showed that there was a significant positive concurrent within-person association between body-related shame, envy, and embarrassment, but not guilt, with dietary restraint. These relationships were not moderated by trait self-compassion.

DISCUSSION

This study adds to our understanding of the concurrent association between body-related self-conscious emotions and dietary restraint, and the mechanisms through which self-compassion is related to dietary restraint. Given body-related self-conscious emotions were related to dietary restraint at both the within-person and between-person level, both compassion-focused interventions that aim to improve general levels of body-related self-conscious emotions and interventions that aim to overcome spikes in these emotions compared with one's usual level are warranted.

PUBLIC SIGNIFICANCE STATEMENT

Negative body-related self-conscious emotions were related to higher levels of dietary restraint both across individuals and within individuals over time; and may play a mechanistic role in linking self-compassion with dietary restraint. Interventions aimed at reducing negative body-related self-conscious emotions are warranted in the prevention of eating disorder psychopathology.

Body image profiles combining body shame, body appreciation and body mass index differentiate dietary restraint and exercise amount in women

This project aimed to establish whether meaningful body image profiles (BIPs) could be identified across measures of body shame, body appreciation, and body mass index (BMI), and whether these profiles could differentiate key health behaviours. Data came from 1200 adult women who responded to an online body image survey. Latent profile analysis was used to identify BIPs based on relative levels of body shame, body appreciation and BMI. Differences in dietary restraint and weekly exercise amount were investigated according to BIP membership. Latent profile analysis revealed four unique BIPs; 1. Appreciative BIP (AP-BIP); 2. Medium Shame BIP (MS-BIP); 3. High Shame BIP (HS-BIP) and 4. Average BIP (AV-BIP). Dietary restraint and exercise amount differed significantly according to BIP in most comparisons. Women in the High Shame BIP exhibited the highest dietary restraint and lowest exercise. Women in the Appreciative BIP exhibited the lowest dietary restraint and highest exercise. Body shame and body appreciation intersect with BMI to form unique profiles (BIPs) that differentiate dietary restraint and exercise. Using BIPs to tailor interventions designed to promote healthful diet and exercise should be considered in public health initiatives.

Stability and longitudinal association between Body Mass Index and maladaptive eating behaviors in older adults: Results from the NutriAct Family Study (NFS)

PURPOSE

Due to the increasing prevalence of overweight and obesity with age and associated health risks, older adults are an important target group to promote healthy weight. Evidence indicates that maladaptive eating behaviors are associated with higher BMI. However, older adults are often neglected in this research field. This prospective study aims to clarify the temporal relationship between BMI and maladaptive eating behaviors among older adults.

METHODS

In total, 964 participants of the NutriAct Family Study (Mage = 63.34 years) completed web-based questionnaires two times (M = 3.33 years apart). BMI was assessed via self-reported height and weight, and maladaptive eating behaviors with the Dutch Eating Behavior Questionnaire (DEBQ). The stability and longitudinal associations were analyzed using cross-lagged models.

RESULTS

Cross-sectional analysis showed positive correlations between BMI and emotional (r = 0.218), external (r = 0.101), as well as restrictive eating (r = 0.160). All maladaptive eating behaviors (β > 0.684) and BMI (β > 0.922) were longitudinally stable. No significant bidirectional relationships were found between BMI and maladaptive eating behaviors over time, except for BMI predicting restrictive eating (β = 0.133).

CONCLUSION

The observed cross-sectional, but not longitudinal associations between BMI and maladaptive eating behaviors underline the need for prospective study designs to deepen the understanding of the role of maladaptive eating behaviors in weight management among the general population. Maladaptive eating behaviors among older adults may have already consolidated and play a smaller role in explaining weight course, compared to early life like childhood.

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.

Psychometric properties of an Arabic translation of the Inflexible Eating Questionnaire (IEQ) in a non-clinical sample of adults

BACKGROUND

The Inflexible Eating Questionnaire (IEQ) is an 11-item instrument designed to evaluate the behavioural and psychological components of inflexible eating. However, the psychometric properties of the instrument have been infrequently examined, and no previous work has examined its utility in the context of the Middle East.

METHODS

A total of 826 Lebanese citizens and residents completed a novel Arabic translation of the IEQ, as well as previously validated measures of body appreciation, functionality appreciation, and disordered eating.

RESULTS

The unidimensional factor structure of the IEQ was upheld through both exploratory and confirmatory factor analyses, with all 11 items retained. We obtained evidence of scalar invariance across gender and found that there were no significant differences in observed IEQ scores between men and women. IEQ scores were also found to have adequate composite reliability and adequate patterns of concurrent validity.

CONCLUSION

The present findings provide support for the psychometric properties of the Arabic version of the IEQ in examining inflexible eating in Arabic-speaking adults in Lebanon. Inflexible or rigid dietary restraint reflects an all-or-none approach that encompasses feeling compelled to obey a set of self-imposed dieting rules (e.g., avoiding high-calorie food, calorie counting, fasting to lose weight and/or skipping meals), having a sense of self-control and feeling empowered when adhering to these rules, and not respecting or following internal/external cues of hunger, satiety, and appetite. Therefore, the inflexible eating construct is composed of two dimensions, the first one is behavioural (i.e., obeying restrictive dietary rules) and the second one is psychological (i.e., the belief that following these rules is a consistent must). Until recently, the measures designed to assess inflexible eating focused on the behavioral dimension, while omitting to account for the psychological processes underlying the construct. To bridge this gap, the Inflexible Eating Questionnaire (IEQ), an 11-item self-report measure, was developed to assess both the behavioural and psychological components of dietary restraint. To date, the IEQ is not yet validated in Arabic. Through the present study, we aimed to examine the psychometric properties of an Arabic translation of the IEQ, which would in turn facilitate improved research and clinical practices related to dietary restraint in Arabic-speaking nations. Overall, findings provided support for the good psychometric qualities of the Arabic version of the IEQ, which suggests its utility for detecting inflexible eating in Arabic-speaking adults.

From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients

Liver transplantation (LT) is a complex surgical procedure requiring thorough pre- and post-operative planning and care. The nutritional status of the patient before, during, and after LT is crucial to surgical success and long-term prognosis. This review aims to assess nutritional status assessment and management before, during, and after LT, with a focus on patients who have undergone bariatric surgery. We performed a comprehensive topic search on MEDLINE, Ovid, In-Process, Cochrane Library, EMBASE, and PubMed up to March 2023. It identifies key factors influencing the nutritional status of liver transplant patients, such as pre-existing malnutrition, the type and severity of liver disease, comorbidities, and immunosuppressive medications. The review highlights the importance of pre-operative nutritional assessment and intervention, close nutritional status monitoring, individualised nutrition care plans, and ongoing nutritional support and monitoring after LT. The review concludes by examining the effect of bariatric surgery on the nutritional status of liver transplant recipients. The review offers valuable insights into the challenges and opportunities for optimising nutritional status before, during, and after LT.

To Eat or Not to Eat-A Qualitative Exploration and Typology of Restrictive Dietary Practices among Middle-Aged and Older Adults

Favorable diets often include restrictive practices that have proven health benefits, even if initiated later in life. The aim of this qualitative study is to gain a comprehensive understanding of Restrictive Dietary Practices (RDPs) among a sample of middle-aged and older German adults (aged 59-78 years). We conducted 24 narrative in-depth interviews and analyzed the data using qualitative content analysis (Kuckartz). Following an inductive thematic approach, a typology was reconstructed comprising four typical RDP characteristics: I. The Holistically Restraining Type, II. The Dissonant-savoring Restraining Type, III. The Reactively Restraining Type, and IV. The Unintentionally Restraining Type. These types differed regarding the practical implementation of, e.g., restrictive food choice into everyday routines, barriers to do so, as well as with respect to attitudes and motives underlying RDPs. The major motives for adopting a RDP involved health, well-being, ethical, and ecological concerns. The most prominent barriers to a 'successful' adoption of RDPs were the enjoyment of food and the desire for spontaneity and freedom of (food) choice. Our study offers an in-depth understanding of the aspects that shape the widespread practice of dietary restriction among middle-aged and older adults. Lifeworld-related changes in RDPs and possible 'type shiftings' are discussed as well as the meaning and chances of RDPs for public health promotion.

Low eating self-efficacy is associated with unfavorable eating behavior tendencies among individuals with overweight and obesity

Success in long-term weight management depends partly on psychological and behavioral aspects. Understanding the links between psychological factors and eating behavior tendencies is needed to develop more effective weight management methods. This population-based cross-sectional study examined whether eating self-efficacy (ESE) is associated with cognitive restraint (CR), uncontrolled eating (UE), emotional eating (EE), and binge eating (BE). The hypothesis was that individuals with low ESE have more unfavorable eating behavior tendencies than individuals with high ESE. Participants were classified as low ESE and high ESE by the Weight-Related Self-Efficacy questionnaire (WEL) median cut-off point. Eating behavior tendencies were assessed with Three Factor Eating Questionnaire R-18 and Binge Eating Scale, and additionally, by the number of difficulties in weight management. The difficulties were low CR, high UE, high EE, and moderate or severe BE. Five hundred and thirty-two volunteers with overweight and obesity were included in the study. Participants with low ESE had lower CR (p < 0.03) and higher UE, EE, and BE (p < 0.001) than participants with high ESE. Thirty-nine percent of men with low ESE had at least two difficulties in successful weight control while this percentage was only 8% in men with high ESE. In women, the corresponding figures were 56% and 10%. The risk of low ESE was increased by high UE [OR 5.37 (95% CI 1.99-14.51)], high EE [OR 6.05 (95% CI 2.07-17.66)], or moderate or severe BE [OR 12.31 (95% CI 1.52-99.84)] in men, and by low CR [OR 5.19 (95% CI 2.22-12.18)], high UE [OR 7.20 (95% CI 2.41-19.22)], or high EE [OR 23.66 (95% CI 4.79-116.77)] in women. Low ESE was associated with unfavorable eating behavior tendencies and multiple concomitant difficulties in successful weight loss promotion. These eating behavior tendencies should be considered when counseling patients with overweight and obesity.

The association between mental health and Bulimia Nervosa among a sample of Lebanese young adults: the indirect effect of difficulties in emotion regulation

BACKGROUND

Bulimia nervosa (BN) is defined as repeated episodes of binge eating, followed by compensatory behaviors such as self-induced vomiting. BN has been shown to be associated with many co-morbidities including depression and anxiety. BN has also been associated with stress, which was shown to trigger binge eating episodes in BN. Furthermore, difficulties in emotion regulation have been seen to play an important role in the psychopathology of eating disorders, including BN. Seeing that BN is the most prevalent eating disorder in Lebanon, which is linked to the stressful events the country has been through, the study aims to examine the indirect effect of emotional dysregulation on this relationship between mental health issues (stress, anxiety and depression) and bulimia nervosa among young adults. We hypothesize that difficulties in emotion regulation would have an indirect effect in the relationship between mental health and BN.

METHODS

This was a cross-sectional observational study, based on an online anonymous survey, which was carried out between September and December of 2020. Participants were all 18 years and above, recruited from all Lebanese governorates (n = 1175).

RESULTS

Difficulties in emotion regulation mediated the association between anxiety/stress/depression and bulimia. Higher mental health issues were significantly associated with more difficulties in emotion regulation; higher difficulties in emotion regulation were significantly associated with more bulimia. Finally, higher anxiety and higher stress, but not depression, were significantly and directly associated with higher bulimia.

CONCLUSION

Results of this study could be used by mental health professional to shed light on the difficulties in emotion regulation in patients with BN and try to use therapeutic strategies to help them better regulate their emotions.

Characterizing the Course of Loss of Control Eating and Prognostic Factors Following Bariatric Surgery: an Exploratory Analysis

PURPOSE

Postoperative loss of control eating (LOCE) has detrimental associations with weight outcomes and mental health following bariatric surgery. However, little is known regarding LOCE course following surgery and preoperative factors that predict remittance, continuance, or development of LOCE. The present study aimed to characterize LOCE course in the year following surgery by identifying four groups: individuals with (1) postoperative de novo LOCE, (2) maintained LOCE (endorsed at pre- and post-surgery), (3) remitted LOCE (endorsed only at pre-surgery), and (4) those who never endorsed LOCE. Exploratory analyses examined group differences in baseline demographic and psychosocial factors.

MATERIALS AND METHODS

A total of 61 adult bariatric surgery patients completed questionnaires and ecological momentary assessment at pre-surgery and 3-, 6-, and 12-month postoperative follow-ups.

RESULTS

Results showed that 13 (21.3%) never endorsed LOCE prior to or after surgery, 12 (19.7%) developed LOCE after surgery, 7 (11.5%) evidenced remittance from LOCE after surgery, and 29 (47.5%) maintained LOCE prior to and after surgery. Relative to those who never endorsed LOCE, all groups who evidenced LOCE before and/or after surgery reported greater disinhibition; those who developed LOCE reported less planned eating; and those with maintained LOCE reported less satiety sensitivity and greater hedonic hunger.

CONCLUSION

These findings highlight the importance of postoperative LOCE and need for longer-term follow-up studies. Results also suggest a need to examine the longer-term impact of satiety sensitivity and hedonic eating on LOCE maintenance, and the extent to which meal planning may buffer risk for de novo LOCE following surgery.

The role of mothers' involvement in their daughters' self-esteem and dieting behaviors

This study presents an initial effort to develop disordered eating pathology (DEP) prevention program with an emphasis on maternal involvement. Disordered eating pathology representing a range of behaviors and attitudes, from negative body image to full-blown eating disorder. It appears mainly in adolescent females and related to psychological and familial factors, including maternal modeling of thinness. A sample of 118 Israeli girls (11-12) was divided into three groups: participants in the program in parallel with their mothers, participants without their mothers, and control. Participants completed self-report questionnaires. Groups were tested three times: pre-intervention, post-intervention, and follow-up. For those girls who participated in parallel with their mothers, higher self-esteem was associated with fewer pathological diet behaviors. Findings deepen understanding of the risk factors involved in the development of DEP. The main study contribution is the important role mothers play in preventing DEP among their daughters.

Deconstructing Complex Interventions: Piloting a Framework of Delivery Features and Intervention Strategies for the Eating Disorders in Weight-Related Therapy (EDIT) Collaboration

(1) Background: weight-management interventions vary in their delivery features and intervention strategies. We aimed to establish a protocol to identify these intervention components. (2) Methods: a framework was developed through literature searches and stakeholder consultation. Six studies were independently coded by two reviewers. Consensus included recording conflict resolutions and framework changes. (3) Results: more conflicts occurred for intervention strategies compared to delivery features; both required the updating of definitions. The average coding times were 78 min (SD: 48) for delivery features and 54 min (SD: 29) for intervention strategies. (4) Conclusions: this study developed a detailed framework and highlights the complexities in objectively mapping weight-management trials.

Prevalence of dietary supplement consumption among CrossFit practitioners

Purpose

We aimed to verify the prevalence of dietary supplements among CrossFit practitioners (CFPs), considering gender and training status. Still, we aimed to determine the type, reasons, and associated factors of dietary supplement utilization among CFPs.

Methods

This is a cross-sectional, exploratory, and descriptive study with the snowball sampling method. Data were collected through online questionnaires using the Google Forms® tool. We included CFPs aged 18-64 years, from Aug 1, 2020, to Sept 31, 2020. The questionnaire contained questions to assess the prevalence, type, and reasons for supplement use; also, we assessed information about sociodemographic variables and the prevalence of the main chronic morbidities. To analyze aspects of eating behavior and sleep-related parameters, we applied the three-factor eating questionnaire (TFEQ)-R21 and the Pittsburgh Sleep Quality Index questionnaire (PSQI), respectively.

Results

We assessed one hundred twelve (n = 112; 57 men; 55 women) CFPs (28.9 ± 7.64 years old; body mass index (BMI), 25.5 ± 4.83 kg/m2). Eighty-seven (50 men; 37 women; 28.2 ± 6.66 years old; BMI, 25.4 ± 4.55 kg/m2) reported using dietary supplements. Whey protein was the most used supplement (n = 70), followed by creatine (n = 54). Cognitive restraint (a dimension of eating behavior) score was higher in supplement users than in non-users (51.7 ± 18.6 vs. 42.6 ± 20.5; p = 0.040). Sleep-related parameters did not differ between supplement users and non-users. The most associated factors to supplement use were sex (being man; OR, 7.99; p = 0.007), sleep quality (poor; OR, 5.27; p = 0.045), CrossFit level (as prescribed (RX); OR, 4.51; p = 0.031), and cognitive restraint (OR, 1.03; p = 0.029).

Conclusion

The CFPs, especially RX and Elite ones, showed a higher prevalence of supplement utilization. Anabolic-related supplements (i.e., whey protein and creatine) were the most used; moreover, several CFPs used supplements not supported by scientific evidence. Cognitive restraint score was higher in supplement users than in non-users. RX level, being men, and poor sleep quality were associated with supplement utilization. These data draw attention to the necessity of nutritional education for CrossFit coaches and athletes. Broader studies are necessary to confirm our findings.

A survey of eating styles in eight countries: Examining restrained, emotional, intuitive eating and their correlates

INTRODUCTION

Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample.

METHOD

Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey.

RESULTS

Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries.

CONCLUSION

Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.