Moderating effect of self-esteem between perfectionism and avoidant restrictive food intake disorder among Lebanese adults

BACKGROUND

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis added to the DSM-5 characterized by pathological eating habits without body image disturbances. Previous findings demonstrated a general association between high levels of perfectionism and low levels of self-esteem in association with general eating disorders. However, research is scant when it comes to ARFID specifically. Subsequently, although self-esteem is seen to moderate the association between perfectionism and general eating disorders, this research study aims to explore the same moderation but with ARFID specifically.

METHODS

For this study, 515 Lebanese adults from the general Lebanese population were recruited from all over Lebanon, 60.1% of which were females. The Arabic version of the Big Three Perfectionism Scale- Short Form (BTPS-SF) was used to measure self-critical, rigid and narcissistic perfectionism; the Avoidant/Restrictive Food Intake Disorder screen (NIAS) was used to score the ARFID variable; the Arabic-Single Item Self-Esteem (A-SISE) was the scale used to measure self-esteem.

RESULTS

Across the different perfectionism types, self-esteem was seen to moderate the association between narcissistic perfectionism and ARFID (Beta = - 0.22; p =.006). At low (Beta = 0.77; p <.001), moderate (Beta = 0.56; p <.001) and high (Beta = 0.36; p =.001) levels of self-esteem, higher narcissistic perfectionism was significantly associated with higher ARFID scores.

CONCLUSION

This study brought to light some crucial clinical implications that highlight the need for interventions that help in the enhancement of self-esteem in patients with high perfectionism and ARFID. This study suggests that clinicians and healthcare professionals should focus more on risk factors influencing the development and maintenance of ARFID-like symptoms.

Intuitive eating and its influence on self-reported weight and eating behaviors

Intuitive eating (IE) is an adaptive eating behavior that involves paying attention to the body's physiological signals, including eating when hungry and stopping when feeling full. A growing body of literature has examined the effect of IE on the development of maladaptive eating behaviors and body weight, even though IE is not centered around the latter. However, longitudinal observation studies among the general population are still rare. Therefore, this study aimed to longitudinally examine the links between IE and changes in body weight, maladaptive eating behaviors (reward, external, restrained eating), and overeating frequency over time. For this purpose, we used data from the first (2017) and the fourth waves (2020) of the Swiss Food Panel 2.0 survey, which included 1821 randomly selected Swiss participants. The same participants completed a self-administered questionnaire annually, measuring their self-reported eating behaviors and weight status. IE was measured with the Intuitive Eating Scale-2. Results showed that women with high IE scores were more likely to maintain their body weights (within ±2 kg) and less likely to gain weight (>2 kg) than women with low IE scores. No such effects were found for men. Furthermore, IE was linked to a reduction in maladaptive eating behaviors and overeating frequency over time in both genders. Results suggest that IE may counteract maladaptive eating behaviors, which can promote weight stability over time. Therefore, the encouragement of IE patterns seems to be a promising strategy to address problematic eating behaviors and the challenges associated with controlling food intake and prevention of overeating.

Emotional eating: elusive or evident? Integrating laboratory, psychometric and daily life measures

PURPOSE

Emotional eating (EE) refers to eating in response to (negative) emotions. Evidence for the validity of EE is mixed: some meta-analyses find EE only in eating disordered patients, others only in restrained eaters, which suggest that only certain subgroups show EE. Furthermore, EE measures from lab-based assessments, ecological momentary assessment (EMA), and psychometric measures often diverge. This paper tested whether the covariance of these three different EE methods can be modeled through a single latent variable (factorial validity), and if so, how this variable would relate to restrained eating (construct validity), Body-Mass-Index (BMI), and subclinical eating disorder symptomatology (concurrent validity).

METHODS

102 non-eating disordered female participants with a wide BMI range completed EE measures from three methods: psychometric questionnaires, a laboratory experiment (craving ratings of food images in induced neutral vs. negative emotion) and EMA questionnaires (within-participant correlations of momentary negative emotions and momentary food cravings across 9 days). Two measures for each method were extracted and submitted to confirmatory factor analysis.

RESULTS

A one-factor model provided a good fit. The resulting EElat factor correlated positively with subclinical eating disorder symptoms and BMI but not with restrained eating.

CONCLUSIONS

The one-factor solution shows that the EE construct can validly be assessed with three different methods. Individual differences in EE are supported by the data and are related to eating and weight problem symptomatology but not to restrained eating. This supports learning accounts of EE and underscores the relevance of the EE construct to physical and mental health.

LEVEL OF EVIDENCE

II (Evidence obtained from well-designed controlled trials without randomization).

Depressive symptoms among a sample of Lebanese adolescents: Scale validation and correlates with disordered eating

BACKGROUND

Adolescence is a transitional phase that brings many psychological and physiological challenges that increase emotional vulnerability and threaten the adolescent's mental well-being. Indeed, mental illnesses, such as depression and eating disorders, show an alarming increase in prevalence after puberty. Adolescent depression is particularly concerning owing to the fact that it is a principal cause of disability among adolescents, an important risk factor for suicidality, and is associated with higher risks of present and subsequent morbidity. Our study aimed at (1) examining the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and (2) evaluating the correlation between depression, eating disorders, stress, and other variables in a sample of Lebanese adolescents.

METHODS

This cross-sectional research enlisted 555 Lebanese teenagers (15-18 years) from all Lebanese governorates (May-June 2020). The confirmatory factor analysis of the PHQ-9 scale items was carried out using the SPSS AMOS program v.24. The relative chi-square, the root mean square error of approximation (RMSEA), Tucker Lewis Index (TLI) and the comparative fit index (CFI) were all utilized as goodness-of-fit indexes.

RESULTS

The median age of the participants was 16.66 ± 1.00 years, with 75.7% females. Among these 555 adolescents, 62.9% had mild-to-moderate depression and 14% reported moderately severe-to-severe depression, while only 23.1% were classified as not suffering from depression. Confirmatory factor analysis of the PHQ-9 scale was conducted using the one-factor structure that is described in the literature; the fit indices obtained were acceptable as follows: χ²/df= 136.26/27 =5.05, CFI=0.92, TLI=0.90 and RMSEA=0.085 [0.072-0.100]. However, the modification indices between items 6 and 9 were high; after correlating these two items, the fit indices improved more as follows: χ²/df= 105.59/26=4.06, CFI=0.94, TLI=0.92 and RMSEA=0.074 [0.060-0.089]. The multivariable analysis results showed that more stress (β=0.59), female sex (β=1.54), and more binge eating (β=0.16) were significantly associated with more depression.

CONCLUSION

This study supports the validity of the PHQ-9, which presents as a reliable tool for the evaluation of depression in future epidemiological studies of Lebanese adolescents. It also elucidates the high level of depression among this age group and its correlation with modifiable and unmodifiable factors.

Anodal stimulation of inhibitory control and craving in satiated restrained eaters

OBJECTIVES

Eating and weight disorders are severe and complex clinical conditions which, among other behaviors, include (attempts at) restrained eating, food avoidance, following dietary rules, and overeating. Comparable to women with obesity, restrained eaters (RE) without formal eating disorder diagnosis are worse at inhibiting their motor responses than unrestrained eaters (URE). According to neuroimaging studies, the right inferior frontal gyrus (rIFG) is involved in inhibitory control which, in turn, could be improved by neuromodulation such as anodal transcranial direct current stimulation (tDCS) across rIFG.

METHODS

This double-blind sham-controlled cross-over study was conducted after a standardized breakfast. Normal-weight female RE und URE performed a stop-signal task (SST) with food and non-food stimuli during sham or anodal tDCS. Food craving, hunger, and satiety were self-reported before and after tDCS. We employed a mixed between-subjects (group: RE vs. URE) and within-subjects factorial design (tDCS: anodal tDCS vs. sham; stimuli: food vs. control pictures).

RESULTS

Breakfast consumption was comparable for RE and URE, as well as craving, hunger, and thirst. Regarding inhibitory control, a significant two-way interaction between group and tDCS ermerged: RE had longer stop-signal reaction times (SSRTs) during sham tDCS, but they improved to the level of URE by application of anodal tDCS.

DISCUSSION

Results replicated an inhibitory control deficit in RE with longer SSRTs compared to URE without stimulation. During anodal tDCS to the rIFG, reduced SSRTs in RE indicated an improvement in inhibitory control. The findings suggest a specificity of rIFG stimulation in at-risk groups with regards to inhibitory control irrespective of craving.

Body talk on social networking sites and restrained eating among adolescents: A test of a multiple mediation model

The present study aimed to examine the link between body talk on social networking sites (SNS body talk) and restrained eating as well as the mediating roles of fear of negative appearance evaluation (FNAE) and body shame in this relationship. Furthermore, the moderating role of gender in the mediation model was also examined. A sample of 1481 Chinese middle and high school students (720 girls, mean age = 15.49 ± 1.84) completed self-reported measures of SNS body talk, FNAE, body shame, and restrained eating. Results showed that SNS body talk was positively associated with restrained eating. FNAE and body shame mediated the association between SNS body talk and restrained eating, separately and serially. Furthermore, gender difference emerged in the path from SNS body talk to body shame and the path from FNAE to body shame. Findings of the present study enrich the literature on social media and body image and eating behaviors, and have important implications for reducing negative body image and disordered eating among adolescents.

Could implementation intentions improve the efficacy of behavioral weight-loss treatment?

Although behavioral weight loss treatment can result in health benefits, the effects on weight loss are generally disappointing, with lost weight regained within a few years. Because these problems appear to be due to a failure to execute the strong weight control intentions formed during treatment, the use of implementation intentions has been suggested to bridge that intention-behavior gap. In contrast to behavioral intentions, implementation intentions specify the situation in which the behavior should be enacted. Although implementation intentions have generally been very effective in increasing the likelihood of goal attainment for a wide range of behaviors, results with regard to eating have been mixed. Especially disappointing have been the findings of a large study that added implementation intentions to a clinical weight loss treatment and found no effects either on weight loss or on weight loss maintenance (Knäuper et al., 2018). I argue that this failure is due to the use of implementation intentions that target specific eating behaviors. According to the goal conflict model of eating, implementation intentions are most effective if they prime the weight control goal; implementation intentions targeting specific behaviors do not reliably do that. I review evidence that the implementation intention to think of dieting when confronted with palatable food items primes weight control thoughts. It also reduces eating of primed foods and even result in weight loss.

Popularity Status Insecurity as a Risk Factor for Adolescents' Maladaptive Weight-Related Cognitions and Behaviors: Examining a Moderated Mediation Model

Previous studies have identified popularity as a risk factor for adolescents' body image concerns and disordered eating behaviors, yet little is known about how adolescents' insecure feelings about their popularity status may be associated with these outcomes. To address this gap, this study examined whether popularity status insecurity was linked to weight-related cognitions and behaviors one year later and whether these links were mediated by body dissatisfaction and moderated by popularity status. A total of 233 Chinese 10th and 11th grade adolescents (41% girls; M_age = 15.81 years, SD = 0.68) participated in the study. The results showed that adolescents' popularity status insecurity was positively and indirectly related to greater future drive for thinness and restrained eating through the mediation of dissatisfied feelings about their own body shape only among those with average and low popularity, and these indirect effects were strengthened as adolescents' popularity decreased. Implications for prevention and intervention of eating disturbances for adolescents are discussed.

Are depression, resilience and fear of COVID-19 related to eating behavior and nutrition status of university students?

OBJECTIVES

This study was designed to examine eating behaviors and their association with fear and depression states concerning COVID-19 among students in Turkey.

METHODS

A total number of 499 students, 336 (67.3%) female and 163 (32.7%) male, participated in an online-based cross-sectional study. The survey collected data on the Dutch eating behavior questionnaire (DEBQ), along with measuring psychological effect by using the Fear of COVID-19 Scale, Beck Depression Inventory, and Brief Resilience Scale. In addition, 24-h dietary records were used to calculate the daily energy and macronutrient intakes in the study.

RESULTS

A negative correlation between brief resilience and fear of COVID-19 was found. Total and subdomain DEBQ scores were positively correlated with fear of COVID-19; conversely, there was a negative correlation with brief resilience (P < 0.05). More than half (58.9%) of students had depression, and students who had moderate and severe depression had higher total DEBQ and emotional eating scores. Students with severe depression had the highest levels of fear of COVID-19. Students having higher daily energy intake had greater fear concerning COVID-19, and the daily energy intake was negatively correlated with restrained and external eating.

CONCLUSIONS

During the pandemic, negative psychological effects resulted in unfavorable dietary behavioral consequences, depending on the increasing levels of stress.

Peer Appearance Teasing and Restrained Eating Among Chinese Adolescent Girls: A Mediation Model of Fear of Negative Appearance Evaluation and Body Surveillance

Restrained eating is becoming widespread recently. The present study aimed to examine whether peer appearance teasing was positively associated with restrained eating among Chinese adolescent girls and whether this association was mediated by fear of negative appearance evaluation (FNAE) and body surveillance. A sample of 720 Chinese adolescent girls completed questionnaires on peer appearance teasing, FNAE, body surveillance, and restrained eating. Peer appearance teasing was significantly and positively related to girls' restrained eating. FNAE mediated the relationship between peer appearance teasing and restrained eating. Furthermore, the association between peer appearance teasing and restrained eating was sequentially mediated by FNAE and body surveillance. The findings of this study provide new insights into the development of restrained eating among adolescent girls, and highlight peer appearance teasing and body surveillance as potential targets for intervention programs regarding body image concerns and eating disorders.

Vegetarianism and weight status: What are the differences in eating styles, impulsivity, and emotional competences? A preliminary study

Recent studies suggest that vegetarian diets may be recommended to promote weight loss in individuals living with obesity. However, limited studies have examined psychological factors (e.g., eating styles, impulsivity) among individuals who have adopted this type of diet, even though these factors are known to play a role in being overweight. The primary objective of the present study was to compare these characteristics in participants living with obesity or those with normal-weight across diet types. Participants were recruited from two hospital nutrition departments and the general population. They completed a diagnostic interview assessing the presence of an eating disorder, followed by self-administered questionnaires measuring dysfunctional eating styles (DEBQ), impulsivity (UPPS), and emotional competence (PEC). Vegetarian participants living with obesity engaged in more dysfunctional eating styles than did normal-weight omnivores and experienced more emotional difficulties than did both normal-weight omnivores and vegetarians. In contrast, there were no significant differences between omnivore participants living with obesity and those in the other groups. Moreover, participants living with obesity had comparable emotion regulation abilities to normal-weight participants. These results suggest that emotion regulation deficits can more likely be explained by the presence of psychopathological traits than by being overweight or one's choice of diet.

The dynamic network associations of food craving, restrained eating, hunger and negative emotions

OBJECTIVE

Food craving, restrained eating, hunger, and negative emotions may predict and reinforce one another. However, less is known about how they interact together as a complex system in daily life. Therefore, we used a dynamic network approach to examine the associations between food craving, restrained eating, hunger and negative emotions in daily life.

METHODS

Food craving, restrained eating, hunger and negative emotions were measured using ecological momentary assessment three times a day over ten days in a community sample in Israel (n = 123). A two-step multilevel vector auto-regression network analysis was used to estimate temporal, contemporaneous and between-persons networks.

RESULTS

In the temporal network, restrained eating was the most central predictor of eating behaviors and negative emotions, predicting food craving and hunger as well as sadness and loneliness. Food craving was also predicted by hunger and stress, and hunger predicted loneliness. In the contemporaneous network, food craving was associated with hunger and feeling bored, and higher anger was associated with lower restrained eating. Stress and sadness were central negative emotions in the models.

DISCUSSION

This study suggests possible temporal and contemporaneous relationships between food craving, restrained eating, hunger and negative emotions, emphasizing their complex interactions in daily life. Restrained eating and stress should be investigated as potential targets for interventions addressing food craving and overeating.

Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women

Objectives

The objective of our study was to evaluate the association between the transition to menopause, body dissatisfaction, and abnormal eating habits (restrained eating, binge eating, and orthorexia nervosa) in a sample of middle-aged Lebanese women.

Methods

A cross-sectional study conducted between July 2019 and January 2020 enrolled 1001 women aged 40 years and above from all Lebanese governorates. Data were collected by face-to-face interviews with all participants. The Body dissatisfaction subscale of the Eating Disorder Inventory‑second version was used to assess body dissatisfaction, whereas the Binge Eating Scale, Dutch Restrained Eating Scale, ORTO-15, Dusseldorf Orthorexia Scale (DOS), and Teruel Orthorexia Scale (TOS) were used to assess eating disorders (binge eating, restrained eating and orthorexia nervosa respectively. Multivariable analysis of covariance (MANCOVA) was used to compare multiple measures among the three menopausal phases, after adjustment over potential confounding variables (age, monthly income, body mass index, marital status, education level, and body dissatisfaction).

Results

Postmenopause was significantly associated with more orthorexia nervosa tendencies (lower ORTO-15 scores) than premenopause (β = − 1.87; p = 0.022). Perimenopause was associated with more binge eating (β = 1.56; p = 0.031), and less orthorexia nervosa (as measured by the DOS) than premenopause, with this association tending to significance (β  = − 1.10; p = 0.051). Furthermore, higher body dissatisfaction was significantly associated with higher restrained eating (β = 0.02; p < 0.001), binge eating (β = 0.48; p < 0.001), and orthorexia nervosa as measured by ORTO-15 (β = − 0.17; p < 0.001) and TOS (β = 0.08; p = 0.002), but not DOS.

Conclusion

Our study showed that menopausal stages are associated with some disordered eating behaviors (binge eating and orthorexia nervosa) among middle-aged women. Those results may serve as a first step towards spreading awareness among women within this age group regarding eating attitudes. Moreover, healthcare professionals should screen for the presence of disordered eating during those women’s routine visits to the clinics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01738-6.

Enhanced capacity to switch but not to maintain: The basis of attentional bias to high calorie foods in restrained eaters

It has been argued that high restrained eaters (i.e., people who fluctuate between restrictive food intake and overeating) are characterised by a heightened attentional bias to high calorie foods. However, the validity of this hypothesis has not yet been convincingly established. The current study sought to empirically evaluate this hypothesis using two directional measures of attentional bias: the well-established dot probe bias assessment task and the more novel Chase the Food bias assessment task. The latter attentional assessment approach has the capacity to differentiate between attentional switching and attentional maintenance within a complex and dynamic food environment. Participants (61 high restrained eaters and 38 low restrained eaters) completed the dot probe task and the Chase the Food task. Findings obtained on the dot probe task did not reveal a group difference in terms of biased attentional responding towards high calorie vs. low calorie food. Conversely, the two groups were found to differ on one of the measures obtained on the Chase the Food task. Specifically, high restrained eaters, as compared to low restrained eaters, demonstrated speeded attentional switching to high calorie foods, rather than a greater ability to maintain attention on high calorie foods when required to do so. These novel findings imply that high restrained eaters are potentially characterised by facilitated attentional switching towards high calorie foods. Implications are discussed including the possibility of targeting biased attentional switching using training variants of the Chase the Food task in interventions designed to reduce maladaptive eating behaviours.

Exploring mediation pathways on the relationship between acculturation and binge eating among Latino adolescents

The objective of this study was to explore the mediating effects of emotional eating, restrained eating, and external eating on the relationship between acculturation and binge eating among Latino adolescents. Adolescents who self-identified as Latino (N = 285) at public high schools in Southern California were recruited and completed a self-report survey. Acculturation was assessed using the 8-item Acculturation, Habits, Interests for Multicultural Adolescents (AHIMSA) scale for adolescents, mediators were assessed using Dutch Eating Behavior Questionnaire (DEBQ), and binge eating was assessed using a 13-item Eating Disorder Diagnostic Scale. A bootstrapped multiple mediation model was used to test mediation pathways. Findings suggest that individually each eating style-emotional, restrained and external eating pathway did not reach significance singly, but that jointly, their combined effect was significant with a total indirect effect (B = 0.15, CI 0.01-0.30) indicating an additive effect of the three eating styles. Future research should examine additional mediators of the relationship between acculturation and binge eating.

Risk factors for binge eating severity among adolescent girls and boys. A structural equation modeling approach

OBJECTIVE

Parental bonding, low self-esteem, emotion dysregulation, and eating style are correlated with each other and are associated with binge eating among adolescents. However, no studies have yet examined all these variables simultaneously. In the current study, the independent and combined influences of such constructs on binge eating were tested with structural equation modeling.

METHOD

A sample of 973 students aged between 12 and 16 (M = 14.17, SD = 1.25) years was screened by means of self-report measures assessing parental bonding, self-esteem, emotion dysregulation, eating styles and binge eating severity.

RESULTS

Self-esteem (β = -0.205) and eating styles (emotional β = 0.313, external β = 0.133, and restrained β = 0.178) had a direct effect on binge eating severity. The model (χ²₍₂₂₎ = 57.679; RMSEA = 0.041; CFI = 0.987; TLI = 0.949; SRMR = 0.024) revealed that the paths from both maternal and paternal care and maternal overprotection to binge eating were mediated through low self-esteem, emotion dysregulation and each eating style, explaining 35% of the variance.

DISCUSSION

Findings provide support for a comprehensive theoretical-based model of risk factors for binge eating and suggest the possible mechanisms through which the quality of early parental relationships contribute to developing dysfunctional eating patterns. Treatment and prevention efforts should improve self-esteem and emphasize emotion regulation capabilities.

The food restriction wars: Proposed resolution of a primary battle

Research regarding the definition and consequences of dieting has generated controversy for years. This controversy has spilled over into the public domain, especially as eating disorders and obesity have become more prevalent. One of the earliest and longest-lasting controversies involves the restrained eating framework, which was originally developed by Herman and Polivy and also strongly influenced the development of the cognitive-behavioral model of bulimia nervosa. An alternative framework for understanding the role of dieting in nonclinical and clinical groups, called the Three-Factor Model of Dieting, took a sharply different approach to defining, and understanding the impact of, dieting. This paper provides a brief historical review of the development of these divergent perspectives and updates the Three Factor Model's critical distinction between restraining eating to prevent over-consumption and dieting to lose weight. We suggest that three historical trends impacted the development of Restraint Theory in ways that unfairly impugned dieting for weight control: the emergence of the new eating disorders of bulimia nervosa and binge eating disorder, a population-based increase in loss of control eating and a population-based increase in obesity. This update is aimed in part at encouraging new research to reconcile ongoing, unresolved issues between Herman and Polivy's restrained eating model and the Three-Factor model of Dieting model. Such research might also contribute to the public's understanding of the pros and cons of dieting and to new approaches to treating eating disorders and obesity.

Associations of somatic depressive symptoms with food attentional bias and eating behaviors

Recent evidence suggests that atypical major depressive disorder (MDD) - whose key features include the reversed somatic symptoms of hyperphagia (increased appetite) and hypersomnia (increased sleep) - is a stronger predictor of future obesity than other MDD subtypes. The mechanisms underlying this relationship are unclear. The present study sought to elucidate whether the individual symptoms of hyperphagia, hypersomnia, poor appetite, and disturbed sleep have differential relationships with food attentional bias, emotional eating, external eating, and restrained eating. This cross-sectional laboratory study involved 103 young adults without obesity (mean age = 20 years, 79% female, 26% non-White, mean BMI = 23.4 kg/m²). We measured total depressive symptom severity and individual symptoms of hyperphagia, poor appetite, and disturbed sleep using the Hopkins Symptom Checklist-20 (SCL-20) and added an item to assess hypersomnia; food attentional bias using a Food Stroop task; and self-reported eating behaviors using the Dutch Eating Behavior Questionnaire. Hyperphagia was positively associated with emotional eating but negatively associated with food attentional bias. Hypersomnia was negatively associated with emotional eating. Poor appetite was negatively associated with emotional eating. Disturbed sleep was positively associated with food attentional bias and emotional eating. An aggregate of the remaining 15 depressive symptoms (SCL-15) was positively associated with emotional and restrained eating. Our findings highlight the importance of examining the direction of somatic depressive symptoms, and they set the stage for future research to identify subgroups of people with depression at greatest risk for obesity (e.g., those with hyperphagia and/or disturbed sleep) and the mechanisms responsible for this elevated risk (e.g., emotional eating).

Restrained eating in Lebanese adolescents: scale validation and correlates

BACKGROUND

Restrained eating disorder is prevalent worldwide across both ethnic and different cultural groups, and most importantly within the adolescent population. Additionally, comorbidities of restrained eating present a large burden on both physical and mental health of individuals. Moreover, literature is relatively scarce in Arab countries regarding eating disorders, let alone restrained eating, and among adolescent populations; hence, the aim of this study was to (1) validate the Dutch Restrained Eating Scale in a sample of Lebanese adolescents and (2) assess factors correlated with restrained eating (RE), while taking body dissatisfaction as a moderator between body mass index (BMI) and RE.

METHODS

This cross-sectional study, conducted between May and June 2020 during the lockdown period imposed by the Lebanese government, included 614 adolescents aged between 15 and 18 years from all Lebanese governorates (mean age of 16.66 ± 1.01 years). The scales used were: Dutch Restrained Eating Scale, body dissatisfaction subscale of the Eating Disorder Inventory-Second version, Rosenberg Self-Esteem Scale, Beirut Distress Scale (for psychological distress), Hamilton Anxiety Rating Scale and Patient Health Questionnaire (for depression).

RESULTS

The factor analysis yielded a one-factor solution with Eigen values > 1 (variance explained = 59.65 %; α_Cronbach = 0.924). Female gender (B = 0.19), higher BMI (B = 0.49), higher physical activity index (B = 0.17), following a diet to lose weight (B = 0.26), starving oneself to lose weight (B = 0.13), more body dissatisfaction (B = 1.09), and higher stress (B = 0.18) were significantly associated with more RE, whereas taking medications to lose weight (B=-0.10) was significantly associated with less RE. The interaction body mass index (BMI) by body dissatisfaction was significantly associated with RE; in the group with low BMI, higher body dissatisfaction was significantly associated with more RE.

CONCLUSIONS

Our study showed that the Dutch Restrained Eating scale is an adapted and validated tool to be used among Lebanese adolescents and revealed factors associated with restrained eating in this population. Since restrained eating has been associated with many clinically-diagnosed eating disorders, the results of this study might serve as a first step towards the development of prevention strategies targeted towards promoting a healthy lifestyle in Lebanese adolescents.

Differences in the Associations between Body Dissatisfaction and Eating Outcomes by Gender? A Lebanese Population Study

BACKGROUND

The objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6±11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.

RESULTS

Body dissatisfaction was positively correlated to restrained eating (r=0.293, P<0.001), emotional eating (r=0.073, P=0.042) and binge eating (r=0.250, P<0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta=0.01, P<0.001) and orthorexia nervosa (Beta=-0.09, P<0.001), but not with emotional (Beta=-0.43, P=0.103) and binge eating (Beta=-0.08, P=0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only.

CONCLUSION

The interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.

Resting state differences between successful and unsuccessful restrained eaters

Restrained eating is a popular weight loss strategy for young women that tends to have limited effectiveness over extended periods of time. Although previous studies have explored and identified possible personality and behavior differences between successful and unsuccessful restrained eaters (REs), there has been a paucity of research on neurophysiological differences.Towards addressing this gap, we assessed brain resting state (Rs) differences in groups of unsuccessful REs (N = 39) and successful REs (N = 31). In line with hypotheses, unsuccessful REs displayed reduced regional homogeneity in brain regions involved in cognitive control (inferior parietal lobe) compared to successful REs. Regions involved in conflict monitoring (anterior cingulate cortex) were also observed to be comparatively less active in the unsuccessful RE group. Finally, based on analyses of independent components and seed-based functional connectivity, regions involved in conflict monitoring and cognitive control, especially those localized within the frontoparietal network, showed weaker connectivities among unsuccessful REs compared to their successful counterparts.These results underscore specific brain Rs differences between successful REs and unsuccessful REs in regions implicated in cognitive control and conflict monitoring.

Commentary on: "What is restrained eating and how do we identify it?": Unveiling the elephant in the room

This paper is a commentary on Polivy, Herman and Mills' (2020) article, entitled "What is restrained eating and how do we identify it?". Polivy et al.'s paper makes a useful contribution by providing guidelines to researchers for choosing the most appropriate measure of restraint for their research questions. However, the authors assume that restrained eating can be appropriately conceptualized as a trait, an assumption I question. They also assume that restrained eating has a causal influence on the outcomes (e.g., counterregulatory eating, negative affect eating, binge eating) with which it has been associated, which I also question. Finally, they ignored a second prominent model for conceptualizing dieting behavior, the Three-Factor Model of Dieting. The Three-Factor Model decomposes the construct of restrained eating into two types of dieting (current weight loss dieting and weight suppression) that do appear to be causally related to eating control and one type (restrained eating to avoid excessive consumption) that modulates likelihood of overeating but does not cause it. I conclude by noting that scientific progress is best served by promoting, not avoiding, discussion and debate about a multiplicity of perspectives on topics of interest, especially when incompatible hypotheses and data exist on such topics.

Dysfunctional Eating Behaviour and Leptin in Middle-Aged Women: Role of Menopause and a History of Anorexia Nervosa

BACKGROUND

Weight gain is common as women approach mid-life. Reduced levels of leptin, an anorexigenic hormone, may facilitate this. Studies in middle-aged women with obesity have shown that dysfunctional eating behaviour, such as restrained eating, is linked to lower leptin. Furthermore, states of low oestradiol signalling, as are found in post-menopause or anorexia nervosa, have been found to impact leptin levels. The aim of this study was to investigate, for the first time, how different aspects of dysfunctional eating, menopausal status, and a history of anorexia nervosa relate to leptin levels in normal-weight middle-aged women.

METHODS

A total of N = 57 women were recruited. Thirty-one were post-menopausal, and 27 had a history of anorexia nervosa. Dysfunctional eating behaviour was measured by the Three-Factor Eating Questionnaire, which contains three subscales: susceptibility/responsiveness to hunger, restraint, and disinhibition. Body composition was assessed by bioelectrical impedance analysis. A fasting blood sample was obtained to determine leptin.

RESULTS

Controlling for age, body mass index, and fat mass, susceptibility/responsiveness to hunger was positively associated with leptin (β = 0.267, p = 0.031), whereas restrained eating (β = - 0.183, p = 0.079) and a history of anorexia nervosa (β = - 0.221, p = 0.059) were, by trend, negatively associated with leptin. Neither disinhibited eating nor menopausal status was related to leptin.

CONCLUSIONS

Leptin may decline as a response to repeated states of a negative energy balance. A possible implication is that mid-life weight management should avoid extreme changes in eating behaviour and instead focus on the macronutrient composition of diet and physical activity. Further, longitudinal enquiries are warranted to investigate these relationships.

Problematic usage of the internet and eating disorder and related psychopathology: A multifaceted, systematic review and meta-analysis

Eating disorders are widespread illnesses with significant impact. There is growing concern about how those at risk of eating disorders overuse online resources to their detriment. We conducted a pre-registered systematic review and meta-analysis of studies examining Problematic Usage of the Internet (PUI) and eating disorder and related psychopathology. The meta-analysis comprised n = 32,295 participants, in which PUI was correlated with significant eating disorder general psychopathology Pearson r = 0.22 (s.e. = 0.04, p < 0.001), body dissatisfaction r = 0.16 (s.e. = 0.02, p < 0.001), drive-for-thinness r = 0.16 (s.e. = 0.04, p < 0.001) and dietary restraint r = 0.18 (s.e. = 0.03). Effects were not moderated by gender, PUI facet or study quality. Results are in support of PUI impacting on eating disorder symptoms; males may be equally vulnerable to these potential effects. Prospective and experimental studies in the field suggest that small but significant effects exist and may have accumulative influence over time and across all age groups. Those findings are important to expand our understanding of PUI as a multifaceted concept and its impact on multiple levels of ascertainment of eating disorder and related psychopathology.

Binge eating, orthorexia nervosa, restrained eating, and quality of life: a population study in Lebanon

OBJECTIVES

To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL.

METHODS

This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment.

RESULTS

Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors.

CONCLUSION

When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The effect of restrained eating on acute stress-induced food intake in people with obesity

Restrained eating, defined as a form of intense dieting or restrictive food intake of specific macronutrients or types of food with sporadic episodes of overeating, results in an increased risk of overweight and obesity. Acute stress situations cause irregular eating patterns and are connected to restrained eating. Therefore, the present study investigates the effect of high/low restrained eating on eating behavior in people with obesity after standardized acute stress induction as well as resting condition. Fifty men and women with obesity (BMI: 33.62 ± 3.93 kg/m²) were categorized into high restrained eaters (HRE) and low restrained eaters (LRE). The total energy intake was measured during a standardized laboratory meal after a resting and stress condition (Trier Social Stress Test) on two separate days. HRE and LRE showed differences in the total energy intake in response to acute stress but not after resting condition (F_{(1, 47)} = 9.188, p = .004, η2 = 0.164). Lower total energy intake after stress compared to resting condition could be observed in HRE (t (23) = -2.617, p = .015). LRE showed higher total energy intake after stress than after resting condition (t (25) = 2.155, p = .041). The present data suggest that restrained eating behavior might be an influencing factor for stress-induced eating in obesity. It is highly necessary to understand the association between restrained eating behavior, acute stress and obesity for the improvement of the behavioral intervention of dietary restriction.

More restriction, more overeating: conflict monitoring ability is impaired by food-thought suppression among restrained eaters

Numerous studies have shown that restrained eating is not an effective weight loss strategy. Restrained eaters often suppress their desires and thoughts about tasty food, which makes it more difficult to control themselves in subsequent eating behavior. The ego depletion impairs conflict monitoring abilities. Therefore, this study explored the effects of food thoughts suppression on restrained eaters' conflict monitoring. Therefore, this study used functional magnetic resonance imaging (fMRI) methods to explore changes in the activity of brain regions involved in conflict monitoring when restrained eaters choose between high- and low-calorie foods after either suppressing or not suppressing thoughts about food. The results showed that, compared to the control condition, after suppression of such thoughts, restrained eaters chose more high-calorie foods and displayed decreased activity in the dorsal anterior cingulate cortex-an important region in charge of conflict monitoring. At the same time, the functional coupling of the dorsal anterior cingulate cortex and the precuneus increased. Our findings suggest that restrained eaters' suppression of thoughts about tasty food could lead to a decline in their ability to monitor conflicts between current behaviors and goals, which in turn leads to unhealthy eating behavior.

Eating behaviour styles in Irish teens: a cross-sectional study

OBJECTIVES

To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles.

DESIGN

Cross-sectional data from the Irish National Teens' Food Survey (2005-2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups.

SETTING

The Republic of Ireland.

PARTICIPANTS

Nationally representative sample of teens aged 13-17 years (n 441).

RESULTS

The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r -0·343, P < 0·001) and Emotional scales (r -0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02).

CONCLUSIONS

External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat.

Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial

OBJECTIVE

Depression and obesity are bi-directionally related, eating styles and diet quality are two important factors associated with both. It remains uncertain if and how these two factors can be modified. Therefore the current study aims to investigate whether food-related behavioral activation therapy (F-BA), targeting mood, dietary habits and food related behavior, can improve eating styles, and diet quality and reduce body weight in adults with overweight or obesity and subsyndromal depressive symptoms.

METHODS

Data were derived from the MooDFOOD prevention trial, a 2x2 factorial RCT investigating the effect of nutritional strategies on prevention of depression. Changes in emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised), Mediterranean Diet Score (MDS), and body weight were analyzed among 1025 adults who either received F-BA or no intervention for 12 months. Intervention effect was tested by longitudinal analysis of covariance using mixed model analysis.

RESULTS

The F-BA group showed a small decrease in emotional (β=-5.68, p<.001) and uncontrolled eating (β=-4.05, p=.03), and increase in cognitive restrained eating (β=5.53, p<.01), compared to no F-BA. The effect of the F-BA therapy on emotional and uncontrolled eating was stronger in those with higher baseline depressive symptoms (IDS-SR). The F-BA did also lead to small improvements in MDS (β=1.95, p<.001), but not to change in body weight.

CONCLUSION

Our trial showed no reduction in bodyweight, but provides support for the possibility to improve both unhealthy eating styles and diet quality using an intervention targeting these specifically, although effects were small [Trial registration: clinicaltrials.gov NCT02529423].

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

Delineating the psychological and behavioural factors of successful weight loss maintenance

Overweight and obesity present alarming global health problems including detrimental health risks that call for effective interventions. Considerable research has examined behavioural and psychological factors associated with weight loss to advance the field of obesity and overweight. In line with the literature, this study aimed to develop a behavioural and psychological profile based on factors of personality, eating behaviours, emotional functioning, physical well-being, and psychopathology. The sample consisted of 105 community participants who had reduced their bodyweight by at least 10% and had either successfully maintained their weight loss for a minimum 12-month period (n = 41) or had regained their weight loss within 12 months (n = 64). Participants completed an online survey comprising demographic items and four empirical measures (Mini Marker Personality Scale, Patient Health Questionnaire, Three-Factor Eating Questionnaire-Revised, and a food screening tool). Based on significant bivariate correlations results, four factors (fat intake, restrained eating, uncontrolled eating, and emotional eating) were entered into a binary logistic regression. Restrained eating was the only factor that significantly increased the likelihood of predicting successful long-term weight loss. Findings have implications for overweight and obesity future research, which may guide the direction of obesity and overweight treatments.

Fear of fat and restrained eating: negative body talk between female friends as a moderator

PURPOSE

This study examined whether engagement in negative body talk would moderate the association between fear of fat and restrained eating among female friend dyads.

METHODS

Female friends (N_pairs = 130) were recruited from a Midwestern university in the United States. The dyadic data were examined with an Actor-Partner Interdependence Model (APIM).

RESULTS

Results showed that women's fear of fat was significantly related to their own restrained eating behaviors. In contrast, women's fear of fat was not significantly related to their friends' restrained eating behaviors. Negative body talk was significantly related to restrained eating, as reported by both friends. The interaction between negative body talk and women's own fear of fat was found to be significant. Although women with less fear of fat showed less restrained eating, engaging in more negative body talk with a friend increased their engagement in restrained eating. Women with more fear of fat engaged in more restrained eating, regardless of their engagement in negative body talk.

CONCLUSION

Given the detrimental role of body talk between fear of fat and restrained eating, interventions may target reducing body talk among young women.

NO LEVEL OF EVIDENCE FOR

Basic science, Animal study, Cadaver study, and Experimental study articles.

Eating behaviors and weight loss outcomes in a 12-month randomized trial of diet and/or exercise intervention in postmenopausal women

Background

Certain eating behaviors are common among women with obesity. Whether these behaviors influence outcomes in weight loss programs, and whether such programs affect eating behaviors, is unclear.

Methods

Our aim was to examine the effect of baseline eating behaviors on intervention adherence and weight among postmenopausal women with overweight or obesity, and to assess intervention effects on eating behaviors.

Four hundred and 39 women (BMI ≥25 kg/m²) were randomized to 12 months of: i) dietary weight loss with a 10% weight loss goal (‘diet’; n = 118); ii) moderate-to-vigorous intensity aerobic exercise for 225 mins/week (‘exercise’; n = 117); iii) combined dietary weight loss and exercise (‘diet + exercise’; n = 117); or iv) no-lifestyle change control (n = 87). At baseline and 12 months, restrained eating, uncontrolled eating, emotional eating and binge eating were measured by questionnaire; weight and body composition were assessed. The mean change in eating behavior scores and weight between baseline and 12 months in the diet, exercise, and diet + exercise arms were each compared to controls using the generalized estimating equation (GEE) modification of linear regression adjusted for age, baseline BMI, and race/ethnicity.

Results

Baseline restrained eating was positively associated with change in total calories and calories from fat during the dietary intervention but not with other measures of adherence. Higher baseline restrained eating was associated with greater 12-month reductions in weight, waist circumference, body fat and lean mass. Women randomized to dietary intervention had significant reductions in binge eating (− 23.7%, p = 0.005 vs. control), uncontrolled eating (− 24.3%, p < 0.001 vs. control), and emotional eating (− 31.7%, p < 0.001 vs. control) scores, and a significant increase in restrained eating (+ 60.6%, p < 0.001 vs. control); women randomized to diet + exercise reported less uncontrolled eating (− 26.0%, p < 0.001 vs. control) and emotional eating (− 22.0%, p = 0.004 vs. control), and increased restrained eating (+ 41.4%, p < 0.001 vs. control). Women randomized to exercise alone had no significant change in eating behavior scores compared to controls.

Conclusions

A dietary weight loss intervention helped women modify eating behaviors. Future research should investigate optimal behavioral weight loss interventions for women with both disordered eating and obesity.

Trial registration

NCT00470119 (https://clinicaltrials.gov). Retrospectively registered May 7, 2007.

Associations among eating behaviour traits, diet quality and food labelling: a mediation model

OBJECTIVE

To assess the associations among eating behaviour traits, food label use and diet quality and to evaluate if the association between eating behaviour traits and diet quality is mediated by food label use.

DESIGN

Eating behaviour traits were assessed using the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale and the Intuitive Eating Scale, whereas food label use was measured with the Label Reading Survey. Diet quality (Canadian Healthy Eating Index) was assessed with an FFQ.

SETTING

Cross-sectional study.

PARTICIPANTS

Adults (n 385; mean (sd): BMI = 26·0 (4·9) kg/m2, age = 41·1 (15·0) years) involved in two previous experimental studies.

RESULTS

When controlling for potential covariates, general food label use (β = 1·18 (se 0·26), P < 0·0001) was the main determinant of diet quality, explaining 6·7 % of its variance. General food label use partly mediated the association between TFEQ-cognitive restraint and diet quality; the indirect effect (βindirect (se); 95 % CI) was stronger in men (0·32 (0·10); 0·15, 0·55) than women (0·16 (0·05); 0·08, 0·27). General food label use also partly mediated the negative association between unconditional permission to eat and diet quality; the indirect effect (βindirect (se); 95 % CI) was also stronger in men (-1·88 (0·55); -3·11, -0·96) than women (-1·03 (0·33); -1·81, -0·49).

CONCLUSIONS

General food label use was the main determinant of diet quality and partly mediated the association between eating behaviour traits and diet quality. The stronger mediating effect observed in men suggests they rely more on food labelling when attempting to restrained themselves, which translates into better diet quality.

Dietary restraint and weight loss in relation to disinhibited eating in obese Veterans following a behavioral weight loss intervention

Ability to restrain one's dietary intake is a necessary skill for weight loss. However, dietary restraint has been shown to paradoxically increase disinhibited eating in certain populations, thereby negatively impacting weight loss and leading to worse overall health outcomes. The aim of this study was to address gaps in the literature regarding the relationships between separate facets of dietary restraint (intention; behavior) with weight loss and various types of disinhibited eating (binge eating, external eating, emotional eating) in overweight and obese adults who recently completed a weight loss intervention. A sample of mostly male Veterans with overweight and obesity (N = 88) self-reported their dietary restraint intention, restraint behavior, and current disinhibited eating following completion of an 8-week behavioral weight loss treatment. Greater dietary restraint intention was related to greater dietary restraint behavior, p < .05. Greater dietary restraint behavior was significantly related to greater recent weight loss, p < .05, while restraint intention was not, p > .05. Greater dietary restraint intention was related to greater current binge eating and external eating, while greater self-reported restraint behavior was related to less binge eating, p < .05. Thus, dietary restraint behavior appears to be adaptive for this population, whereas rigid dietary restraint intention may increase risk for disinhibited eating. To decrease disinhibited eating and improve weight loss outcomes in Veterans, interventions might specifically address rigid rule-following associated with abandonment of weight loss goals and help Veterans develop specific yet flexible eating plans. Future research should examine whether dietary restraint intention and behavior differentially predict disinhibited eating and weight loss outcomes prospectively.

Brain structures associated with eating behaviors in normal-weight young females

Eating behaviors play an important role in individuals' development, and restrained eaters have a higher risk of obesity in the future. In the present study, we used the Three-Factor Eating Questionnaire to measure restrained eating, uncontrolled eating, and emotional eating in 158 young, normal-weight, Chinese women. We developed a multiple linear regression model to identify significant structural brain changes associated with the above-mentioned eating behaviors. Uncontrolled eating scores were positively associated with the gray matter volume (GMV) of the cerebellum, and negatively associated with the GMV on the left side of the anterior cingulate cortex, middle cingulate cortex, and supplementary motor areas, indicating that uncontrolled eating behaviors not only are less inhibitory but also appear to be associated with the low-level processing of appetite. Increased GMV on the right side of the precuneus was associated with a higher level of restrained eating, which might be thus related to a lower sensitivity to behavioral inhibition in young females who follow a diet. In addition, we did not find a relationship between emotional eating behavior and GMV. Our findings show that eating-behavior-related structural brain changes may lead to a decrease in inhibition and an increase in food sensitivity.

Stress-Induced Release of Eating-Related Hormones in Young Women Classified as Restrained and Unrestrained Eaters

BACKGROUND/AIMS

Restrained eating has been linked to binge eating under disinhibited circumstances and is therefore considered a risk factor to develop clinical eating disorders such as bulimia nervosa or binge eating disorder. The present study investigated the release of gastrointestinal peptides such as ghrelin and PYY after stress, as well as cortisol in young females classified as restrained and unrestrained eaters.

METHODS

The study was done in the laboratory of the Department for Biological and Clinical Psychology at the University of Trier. The sample consisted of 48 females, and the stressor was the Trier Social Stress Test. Blood samples for peptides and salivary cortisol were taken.

RESULTS

Higher ghrelin, but lower cortisol after stress was obtained for restrained eaters; no stress-related changes for PYY were observed.

CONCLUSION

Restrained eaters suffer from a possible stress-related biological dysregulation of eating, posing them at risk for eating and weight disorders.

Personality, emotion-related variables, and media pressure predict eating disorders via disordered eating in Lebanese university students

PURPOSE

Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students.

METHODS

The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions.

RESULTS

In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating.

DISCUSSION

Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

Prospective relations among internalization of beauty ideals, body image concerns, and body change behaviors: Considering thinness and muscularity

Common models propose that the internalization of societal beauty ideals influences disordered eating behaviors and muscularity-oriented behaviors via body image concerns. However, previous studies addressing these pathways have been mainly cross-sectional and primarily included female samples. We investigated these pathways prospectively in male and female adolescents and young adults, examining two pathways: a 'weight/shape pathway,' linking thin-ideal internalization, weight/shape concern, and restrained eating, and a 'muscularity pathway,' linking athletic-ideal internalization, muscularity concern, and muscularity-oriented behavior. Across three time points, 973 participants from the German general population were assessed. Although the hypothesized pathways could not be supported in their complete temporal sequence, several hypothesized pathways occurred across two time points. Among others, weight/shape concern predicted restrained eating and the athletic ideal played a prominent role in the prediction of muscularity-oriented behavior in both genders.

Factors associated with restrained eating and validation of the Arabic version of the restrained eating scale among an adult representative sample of the Lebanese population: a cross-sectional study

BACKGROUND

Previous research suggests that restrained eating is problematic in Lebanon and is associated with the occurrence of clinically diagnosed eating disorders. Because of the alarming prevalence and severity of these disorders, the aim of this study is to investigate factors that may contribute to restrained eating in adults among a representative sample of the Lebanese population.

METHODS

This is a cross-sectional study conducted between January and May 2018; 811 adult participants were enrolled from all Lebanese districts. The Dutch Restrained Eating scale was used to measure body disturbance. The factors that were assessed in the questionnaire were body dissatisfaction, self-esteem, perceived stress, anxiety, depression, emotion regulation, emotional eating and adult attachment styles.

RESULTS

The mean age of the participants was 27.59 ± 11.76 years, and included 66.5% females. In the absence of a cutoff value for the Dutch Restrained Eating scale, we took the median (2.6) as the cutoff value. The results showed that 391 (48.3%) had restrained eating. The Dutch Restrained Eating scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 60.69% of the variance (Cronbach's alpha was high =0.928). The linear regression results, taking the Dutch restrained eating scale as the dependent variable, showed that being a female (Beta = 0.31), increased age (Beta = 0.01), higher body mass index (Beta = 0.01), an intermediate monthly income (Beta = 0.25), higher body dissatisfaction scores (Beta = 0.03), higher adult anxiety attachment style (Beta = 0.008), higher emotion regulation cognitive reappraisal facet (Beta = 0.01), feeling pressure from TV/magazine to lose weight (Beta = 0.45) and practicing sport activities (Beta = 0.41) were associated with higher restrained eating scores.

CONCLUSION

Our findings show that numerous factors are associated with restrained eating in the Lebanese community. They include body dissatisfaction, cognitive reappraisal, female gender, eating attitudes, social media pressure and adult attachment. Therefore, the development of prevention strategies directed at an improved body image perception and increasing knowledge about factors that might influence this body image and critical thinking regarding media images is warranted, with the ultimate goal of promoting healthier choices in the Lebanese population.

Depression and eating styles are independently associated with dietary intake

Depression and eating styles are two important, interrelated factors associated with dietary intake. However, it remains unclear whether depression and eating styles are independently associated with dietary intake, and whether associations between depression and dietary intake are mediated by eating styles. Therefore, the aim of the current study was to investigate the associations of, and interplay between depression and eating styles in relation to different aspects of dietary intake. Cross-sectional data from 1442 participants (healthy controls (22.7%), remitted (61.0%) and current patients (16.3%)) from the Netherlands Study of Depression and Anxiety were used. Linear regression analyses were used to determine associations of depressive disorders (DSM-IV based psychiatric interview), self-reported depressive symptoms (Inventory of Depressive Symptomatology), emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) with 4 measures of dietary intake (total energy intake (kcal/d), Mediterranean diet score (MDS), intake of sweets foods (g/d), and snack/fast-food (g/d)) measured with a 238-item food frequency questionnaire. Statistical mediation analyses were used to study whether associations between depression and dietary intake were mediated by eating styles. Current depression diagnosis and severity were associated with lower MDS and higher intake of sweet foods and snack/fast-food. Emotional and external eating were associated with higher intakes of snack/fast-food; external eating was also associated with higher total energy intake. Restrained eating was associated with lower total energy and intake of sweet foods, and higher MDS. Associations between current depression or severity and intake of snack/fast-food were mediated by external eating. In general, depression and eating styles contributed independently to poorer diet quality and higher intake of sweet and snack/fast-food. The association between depression and higher intake of snack/fast-food was mediated by external eating.

Reinforcement sensitivity and restrained eating: the moderating role of executive control

PURPOSE

As the prevalence of overweight and obesity are still increasing, it is important to help individuals who encounter difficulty with losing weight. The current study was set out to further investigate characteristics of individuals who are highly motivated to restrict their food intake to lose weight, but fail to do so (i.e., restrained eaters). The motivation to lose weight might stem from high punishment sensitivity, whereas the failure to succeed in restricting food intake might be the result of high reward sensitivity. Thus, it was examined whether restrained eaters are characterized by both high reward sensitivity and high punishment sensitivity. Additionally, this is the first study to examine executive control as a potential moderator of this relationship.

METHODS

Female undergraduates (N = 60) performed a behavioral measure of executive control, and completed the Restraint Scale to index level of restrained eating as well as two questionnaires on reinforcement sensitivity; the Behavioral Inhibition Scale/Behavioral Activation Scale, and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire.

RESULTS

There was a positive relationship between restrained eating and punishment sensitivity as indexed by both questionnaires. Reward sensitivity as measured by both indices was not directly related to restrained eating. Executive control moderated the relation between reward responsivity (but not reward-drive) and restrained eating; specifically in women with relatively weak executive control there was a positive relationship between reward responsivity and restrained eating behavior.

CONCLUSION

In women with low executive control, restrained eating is associated with both heightened sensitivity to punishment and heightened responsivity to reward.

Orthorexic and restrained eating behaviour in vegans, vegetarians, and individuals on a diet

PURPOSE

Orthorexic eating behaviour, restrained eating, and veganism/vegetarianism are food selection strategies sharing several characteristics. Since there are no studies investigating their interrelationships, aim of the present study was to analyse orthorexic and restrained eating behaviour in (1) a sample of vegans and vegetarians and (2) a sample of individuals on a diet to lose weight.

METHOD

Division of samples according to pre-defined criteria in (1) vegans (n = 114), vegetarians (n = 63), individuals with rare meat consumption (n = 83) and individuals with frequent meat consumption (n = 91) and in (2) participants on a diet with dietary change (n = 104), without dietary change (n = 37) and a control group of individuals not on a diet (n = 258). Orthorexic eating behaviour was assessed with the Düsseldorfer Orthorexie Skala and restrained eating was assessed with the Restraint Eating Scale.

RESULTS

Vegans and vegetarians do not differ in orthorexic eating behaviour, but both groups score higher in orthorexic eating behaviour than individuals consuming red meat. There are no differences regarding restrained eating. Individuals on a diet with dietary change score higher in both orthorexic and restrained eating, than individuals without dietary change and individuals not on a diet.

CONCLUSIONS

Individuals who restrict their eating behaviour, either predominantly due to ethical reasons or with the intention to lose weight, display more orthorexic eating behaviour than individuals not limiting their food consumption. Further research is needed to investigate whether veganism, vegetarianism, or frequent dieting behaviour serve as risk factors for orthorexia.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

How brain response and eating habits modulate food energy estimation

The estimates we do of the energy content of different foods tend to be inaccurate, depending on several factors. The elements influencing such evaluation are related to the differences in the portion size of the foods shown, their energy density (kcal/g), but also to individual differences of the estimators, such as their body-mass index (BMI) or eating habits. Within this context the contribution of brain regions involved in food-related decisions to the energy estimation process is still poorly understood. Here, normal-weight and overweight/obese women with restrained or non-restrained eating habits, received anodal transcranial direct current stimulation (AtDCS) to modulate the activity of the left dorsolateral prefrontal cortex (dlPFC) while they performed a food energy estimation task. Participants were asked to judge the energy content of food images, unaware that all foods, for the quantity presented, shared the same energy content. Results showed that food energy density was a reliable predictor of their energy content estimates, suggesting that participants relied on their knowledge about the food energy density as a proxy for estimating food energy content. The neuromodulation of the dlPFC interacted with individual differences in restrained eating, increasing the precision of the energy content estimates in participants with higher scores in the restrained eating scale. Our study highlights the importance of eating habits, such as restrained eating, in modulating the activity of the left dlPFC during food appraisal.

The role of craving in emotional and uncontrolled eating

This study presents a novel application of the cognitive processing model of alcohol craving (CPMA) from the addictions field to the role of food craving in the well-established restrained eating-overeating relationship associated with binge eating disorder (BED). A community sample (N = 1058, ages 18-66) completed an online survey assessing four core domains: restrained eating, trait food craving, uncontrolled eating, and emotional eating. In accordance with the CPMA, food craving emerged as a significant indirect effect of the association between restrained eating and both uncontrolled and emotional eating. Gender did not significantly moderate any direct or indirect associations, suggesting that gender may not change the pattern of association between restrained eating and different facets of overeating. Results suggest that treatments targeting binge eating behaviors may benefit from 1) explicitly addressing the activation of food craving rather than concentrating on reducing restrained eating and 2) recognizing that food craving may be an important gender-neutral target with the potential to reduce binge and overeating behaviors. Future research should extend these preliminary findings by examining the application of the CPMA to eating behaviors while jointly investigating antecedents and contextual factors.

Stress-related cortisol response and laboratory eating behavior in obese women

Stress-related cortisol secretion has been linked to increased appetite and subsequent food intake in overweight individuals. The present study addresses this relationship in a repeated-measures randomized controlled laboratory experiment. Nineteen obese women were compared to 36 normal weight controls with respect to stress-induced salivary cortisol and laboratory eating behavior, measured by a universal eating monitor. The trier social stress test served as stressor. Stress-induced cortisol levels were significantly higher in the obese compared to the normal weight controls. Unexpectedly, a corresponding increase in laboratory food intake was not detected. The results are interpreted and discussed with regard to restrained eating, which was found to be present to a significant degree in the obese women.

Impulse control and restrained eating among young women: Evidence for compensatory cortical activation during a chocolate-specific delayed discounting task

Theory and associated research indicate that people with elevated restrained eating (RE) scores have higher risk for binge eating, future bulimic symptom onset and weight gain. Previous imaging studies have suggested hyper-responsive reward brain area activation in response to food cues contributes to this risk but little is known about associated neural impulse control mechanisms, especially when considering links between depleted cognitive resources related to unsuccessful RE. Towards illuminating this issue, we used a chocolate-specific delayed discounting (DD) task to investigate relations between RE scores, behavior impulsivity, and corresponding neural impulse control correlates in a functional magnetic resonance imaging (fMRI) study of 27 young women. Specifically, participants were required to choose between more immediate, smaller versus delayed, larger hypothetical chocolate rewards following initial consumption of a chocolate. As predicted, RE scores were correlated positively with behavior impulse control levels. More critically, higher RE scores were associated with stronger activation in impulse control region, the dorsal-lateral prefrontal cortex (DLPFC) during the completion of difficult decision trials reflecting higher cognitive demands and resource depletion relative to easy decision trials. Exploratory analyses revealed a positive correlation between RE scores and activity in a reward system hub, the right striatum. Moreover, a positive correlation between left DLPFC and striatum activation was posited to reflect, in part, impulse control region compensation in response to stronger reward signal among women with RE elevations. Findings suggested impulse control lapses may contribute to difficulties in maintaining RE, particularly when cognitive demands are high.

Impact of Perceived Healthiness of Food on Food Choices and Intake

Healthy eating is an important determinant of health, but adherence to dietary guidelines remains a public health concern. Identifying factors that impact dietary habits is therefore important to facilitate healthy eating. One widely used strategy to help consumers make healthier food choices is nutrition information, such as labeling and claims. Despite the intention of these strategies to improve decision making, they can also be misunderstood or misinterpreted by consumers. The aim of this review is to explore food perceptions by examining how cognitive factors influence perceived healthiness of food, and the impact of perceived healthiness of food on food choices and intake. Overall findings of this review suggest that cognitive factors, such as type of food and branding, significantly contribute to judgmental bias and have an impact on perceived healthiness while not consistently or systematically influencing choice and intake.

Stress-induced release of GUT peptides in young women classified as restrained or unrestrained eaters

Basal release of GUT peptides has been found to be altered in restrained eaters. Stress-induced secretion, however, has not yet been described, but could be a biological basis of overeating that exposes restrained eaters to a higher risk of becoming obese. The aim of the present study was to compare restrained and unrestrained eaters with respect to stress-induced release of the GUT peptides ghrelin and PYY. 46 young women were studied. Blood sampling for peptides was done before and after the Trier Social Stress Test. Ghrelin secretion after stress was significantly elevated in the restrained eaters, whereas no significant differences were detected for PYY. Stress-induced release of GUT peptides can be interpreted as a cause as well as a consequence of restrained eating.

Restrained eating predicts effortful self-control as indicated by heart rate variability during food exposure

When confronted with food, restrained eaters have to inhibit the pursuit of the short-term goal of enjoying their food for the sake of the long-term goal of controlling their weight. Thus, restrained eating creates a self-control situation. In the present study we investigated the initiation of effortful self-control by food cues in accordance with the level of restrained eating. We expected that a preceding act of self-control would moderate the association between restrained eating and effortful self-control initiated by food cues. Participants (N=111) were randomly assigned to a task requiring self-control or a task not requiring self-control. Subsequently, participants were exposed to palatable food, and effortful self-control was measured via heart rate variability (HRV). Restrained eating was associated with enhanced HRV during food exposure after exercising self-control but not after not exercising self-control. The results indicate that maintaining dieting goals results in food cues initiating effortful self-control after a preceding act of self-control. We suggest considering the effect of acts of self-control when modeling the initial steps on the path from food cues to unsuccessful restrained eating.