Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study

Objectives

Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical.

Methods

An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated.

Results

A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies.

Conclusion

Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.

Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up

OBJECTIVE

To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice.

METHOD

Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month follow-up using generalized linear models with multiple imputation.

RESULTS

Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = -.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant).

DISCUSSION

Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice.

PUBLIC SIGNIFICANCE

In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder. Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder psychopathology faster, there was a trend toward relapse in CBT at 6-month follow-up. Therefore, the less costly DBT-program can be considered a relevant treatment in clinical practice.

Application of three different coaching strategies through a virtual coach for people with emotional eating: a vignette study

BACKGROUND

Around 13% of the world's population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to more effective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one - the latter being a synthesis of the first two strategies.

METHODS

A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies.

PARTICIPANTS

71 adult women (Mage 44.4/years, range 19-70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69-4.92, SD = .69) with mean BMI 30.1 (range 18-46, SD = 6.53). They were recruited via dieticians' practices, were randomly assigned to the conditions and asked how they would face and react to the presented coaching strategies. Data were transcribed and a thematic analysis was conducted.

RESULTS

Qualitative results showed that participants valued both the validating coaching strategy and the focus-on-change strategy, but indicated that a combination of validation and focus-on-change provides both mental support and practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills.

CONCLUSION

The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.

Gender‐schematic processing: An extended replication of the Larsen and Seidman study

This study is an extended replication of the Larsen and Seidman study (1986) on the Bem Sex‐Role Inventory (BSRI) as a measurement instrument for gender‐schematic processing. Using a Dutch sample and the GRAS (Groninger Androgyny Scale)—a Dutch sex‐role inventory—responses to this inventory were factor‐analysed separately for sex‐typed and non‐sex‐typed groups. The extremity of response style on GRAS items and the degree of self‐indicated cross‐situational variability on GRAS items were used as additional indices for gender‐schematic processing. Similar to Larsen and Seidman's (1986) study, bipolar factors were found for the sex‐typed groups and unipolar factors for the non‐sex‐typed groups. Similar to a study conducted by Bem (1981) into differences among the sex‐types in their response latencies to the attributes of the BSRI, sex‐typed subjects showed more extremity of response style on attributes of the GRAS when making schema‐consistent judgements about themselves, and showed less extremity of response style when making schema‐inconsistent judgements about themselves. The data on cross‐situational variability were less equivocal. It is concluded that the degree of gender‐schematic processing in individuals can be well measured by means of a sex‐role inventory.

Intuitive Eating

Abstract. Intuitive eating is defined as an adaptive way of eating that maintains a strong connection with the internal physiological signs of hunger and satiety. It has four elements: unconditional permission to eat whenever and whatever food is desired, eating for physical rather than for emotional reasons, reliance on hunger and satiety cues to determine when and how much to eat, and body-food choice congruence. In this study, we assessed the differences and similarities between intuitive eating, as measured with the Intuitive Eating Scale-2 (IES-2), and eating styles (restrained, emotional, and external eating), assessed with the Dutch Eating Behavior Questionnaire (DEBQ). Using a Spanish sample of mainly university students ( n = 1,095) we found that (a) unconditional permission to eat presented a large negative correlation with restrained eating, r = –.82; (b) eating for physical reasons had a large negative correlation with emotional eating, r = –.70; (c) the dimensions of intuitive eating only showed very small correlations with positive and negative affect, satisfaction with life, body dissatisfaction or weight control behavior after restrained, emotional, and external eating had been partialled out. Altogether, the present results suggest that two of the dimensions of intuitive eating as assessed with the IES-2 are not very new or innovative. The most promising new dimension of intuitive eating seems to be body-food choice congruence.

Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study

BACKGROUND

Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating.

METHODS

Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation.

RESULTS

Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen's d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%).

CONCLUSIONS

The results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome.

TRIAL REGISTRATION

Nederlands Trial Register: NL3982 (NTR4154). Date of registration: 2013 August 28, retrospectively registered.

Parenting quality in infancy and emotional eating in adolescence: Mediation through emotion suppression and alexithymia

This study assessed the association between parenting quality at age 15 and 28 months and emotional eating (EE) at age 12 and 16 years through serial mediation by suppression of emotions and alexithymia at 12 years. The sample included 129 children and their parents. Lower parental quality in infancy was related to more suppression of emotions, which in turn was related to more difficulty identifying emotions, and in turn to higher EE in adolescence. This serial mediation model was significant for EE at 12 years, and for EE at 16 years. If future studies reveal converging findings, this knowledge points to the need for programs preventing the development of EE in adolescence through increasing the quality of parenting in infancy.

Depression, emotional eating and long-term weight changes: a population-based prospective study

Background

Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations.

Methods

Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline (n = 5024), height, weight and WC were measured in a health examination. At follow-up (n = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses.

Results

Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI (R² = 0.048) and WC (R² = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI (P = 0.007 for the interaction) and WC (P = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI (P < 0.001 for the interaction) and WC (P = 0.065, respectively) increase in younger participants, but not in older participants.

Conclusions

Our findings offer support for the hypothesis that emotional eating is one behavioural mechanism between depression and development of obesity and abdominal obesity. Moreover, adults with a combination of shorter night sleep duration and higher emotional eating may be particularly vulnerable to weight gain. Future research should examine the clinical significance of our observations by tailoring weight management programs according to these characteristics.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0791-8) contains supplementary material, which is available to authorized users.

Duration of breastfeeding is associated with emotional eating through its effect on alexithymia in boys, but not girls

Emotional eating (EE), or eating in response to negative emotions, was earlier shown to be associated with difficulty in identifying emotions (alexithymia). To improve our understanding of possible causes of alexithymia and EE, we assessed possible associations with duration of breastfeeding in infancy. The aim of the present study was to examine in a prospective, longitudinal study whether duration of breastfeeding is associated with EE in adolescence, through its effect on alexithymia difficulty identifying emotions, and whether this mediation effect is contingent on gender. Our hypothesis was that longer duration of breastfeeding would be associated with lower EE in adolescence through its effect on lower alexithymia difficulty identifying feelings in boys but not in girls (Moderated mediation). The sample included 129 children and their families (67 boys and 62 girls). Duration of breastfeeding was reported by the mother when the infant was 15 months old. Alexithymia difficulty identifying feelings (Toronto Alexithymia Scale) and EE (Dutch Eating Behavior Questionnaire) were reported by the child at 12 years of age. EE was also reported by the child at 16 years of age. Moderated mediation was significant for EE at 12 years, and borderline significant for EE at 16 years. As hypothesized, for boys but not for girls, longer duration of breastfeeding was related to less difficulties in identifying feelings, resulting in lower degrees of EE in adolescence. It is concluded that breastfeeding in infancy may protect boys against EE through its positive association with better ability to identify feelings.

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.

Causes of Emotional Eating and Matched Treatment of Obesity

PURPOSE OF THE REVIEW

Eating in response to negative emotions (EE) may be an explanatory factor of the weight regain of many dieters. This narrative review presents evidence on possible causes of EE and the association of EE with depression and obesity and discusses implications of these findings for the treatment of obesity.

RECENT FINDINGS

Possible causes of EE are high dietary restraint, poor interoceptive awareness, alexithymia, emotion dysregulation and a reversed hypothalamic pituitary adrenal (HPA) stress axis. EE may be the outcome of inadequate parenting or depressive feelings in interaction with genetic susceptibility. There is also robust evidence that EE is a mediator between depression and obesity. The association of EE with depression and poor emotion regulation skills suggests that the treatment of obese people with high EE should not focus on calorie-restricted diets but on emotion regulation skills. The DEBQ (Dutch Eating Behavior Questionnaire) enables such a matched treatment of obesity.

Eating styles in major depressive disorder: Results from a large-scale study

Depressed persons have been found to present disturbances in eating styles, but it is unclear whether eating styles are different in subgroups of depressed patients. We studied the association between depressive disorder, severity, course and specific depressive symptom profiles and unhealthy eating styles. Cross-sectional and course data from 1060 remitted depressed patients, 309 currently depressed patients and 381 healthy controls from the Netherlands Study of Depression and Anxiety were used. Depressive disorders (DSM-IV based psychiatric interview) and self-reported depressive symptoms (Inventory of Depressive Symptomatology) were related to emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) using analyses of covariance and linear regression. Remitted and current depressive disorders were significantly associated with higher emotional eating (Cohen's d = 0.40 and 0.60 respectively, p < 0.001) and higher external eating (Cohen's d = 0.20, p = 0.001 and Cohen's d = 0.32, p < 0.001 respectively). Little differences in eating styles between depression course groups were observed. Associations followed a dose-response association, with more emotional and external eating when depression was more severe (both p-values <0.001). Longer symptom duration was also associated to more emotional and external eating (p < 0.001 and p = 0.001 respectively). When examining individual depressive symptoms, neuro-vegetative depressive symptoms contributed relatively more to emotional and external eating, while mood and anxious symptoms contributed relatively less to emotional and external eating. No depression associations were found with restrained eating. Intervention programs for depression should examine whether treating disordered eating specifically in those with neuro-vegetative, atypical depressive symptoms may help prevent or minimize adverse health consequences.

A systematic review and secondary data analysis of the interactions between the serotonin transporter 5-HTTLPR polymorphism and environmental and psychological factors in eating disorders

OBJECTIVES

To summarize and synthesize the growing gene x environment (GxE) research investigating the promoter region of the serotonin transporter gene (5-HTTLPR) in the eating disorders (ED) field, and overcome the common limitation of low sample size, by undertaking a systematic review followed by a secondary data meta-analysis of studies identified by the review.

METHOD

A systematic review of articles using PsycINFO, PubMed, and EMBASE was undertaken to identify studies investigating the interaction between 5-HTTLPR and an environmental or psychological factor, with an ED-related outcome variable. Seven studies were identified by the systematic review, with complete data sets of five community (n = 1750, 64.5% female) and two clinical (n = 426, 100% female) samples combined to perform four secondary-data analyses: 5-HTTLPR x Traumatic Life Events to predict ED status (n = 909), 5-HTTLPR x Sexual and Physical Abuse to predict bulimic symptoms (n = 1097), 5-HTTLPR x Depression to predict bulimic symptoms (n = 1256), and 5-HTTLPR x Impulsiveness to predict disordered eating (n = 1149).

RESULTS

Under a multiplicative model, the low function (s) allele of 5-HTTLPR interacted with traumatic life events and experiencing both sexual and physical abuse (but not only one) to predict increased likelihood of an ED and bulimic symptoms, respectively. However, under an additive model there was also an interaction between sexual and physical abuse considered independently and 5-HTTLPR, and no interaction with traumatic life events. No other GxE interactions were significant.

CONCLUSION

Early promising results should be followed-up with continued cross-institutional collaboration in order to achieve the large sample sizes necessary for genetic research.

Predictors of outcome for cognitive behaviour therapy in binge eating disorder

The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients.

Cortisol reactivity and distress-induced emotional eating

Animal studies suggest a relationship between blunted HPA-axis stress reactivity and increased stress-induced food intake in chronically stressed animals. Such a relationship can potentially explain the underlying mechanisms of emotional eating in humans. However, no studies have experimentally tested the relationship between stress-induced cortisol responses and acute food intake in high and low emotional eaters. We studied these effects in 46 female students that were preselected on the basis of extremely high (HEE) or low (LEE) scores on an emotional eating questionnaire. Using a within subject design we measured the difference of actual food intake after a control or a stress task (Trier Social Stress Test). The HEE and LEE groups did not differ in their cortisol stress reactivity but emotional eating significantly moderated the relationship between cortisol stress reactivity and the difference of food intake after stress vs control. Whereas HEE participants with a blunted cortisol stress response ate more food after distress than those with an elevated cortisol stress response, LEE participants showed no such relationship. These findings support the relevance of an animal based model on the relationship between a blunted cortisol stress response and increased stress-induced food intake for human high emotional eaters.

The predictive validity of the DEBQ-external eating scale for eating in response to food commercials while watching television

OBJECTIVE

To challenge the conclusion by Jansen et al., Int J Eat Disord 2011; 44:164-168, that the widely used Dutch Eating Behavior Questionnaire (DEBQ) External Eating subscale (DEBQ-EX) lacks validity for external eating, because of limitations of that study.

METHOD

In a seminaturalistic setting we measured participants' intake of crisps and M&Ms while they watched food commercials or neutral commercials spliced into a film. To avoid misclassification due to the use of median splits we used extreme scores on the DEBQ-ex (n = 60) in addition to the full range of scores (n = 125).

RESULTS

As was expected, high external eaters in the food commercial condition ate more crisps than did high external eaters in the neutral commercial condition, whereas low external eaters did not eat more crisps in one condition than in the other. No such moderator effect was found for emotional eating. No significant moderator effect was found for external eating in the original sample (n = 125) using the median-split procedure.

DISCUSSION

The DEBQ scale for external eating has validity and specificity for external eating provided that the participants have sufficiently extreme external eating scores and a natural setting is used.

Emotional eating in adolescents: a gene (SLC6A4/5-HTT) - depressive feelings interaction analysis

Eating in response to distress--i.e. emotional eating--is highly prevalent in (female) adults with binge eating, but has only a very low prevalence in young children. The present study addresses the emergence of emotional eating in adolescence in relation to depressive feelings. Because a reduction of food intake is considered the biologically natural response to distress, we tested whether the a-typical stress-response of emotional eating develops in interaction with genetic vulnerability. We hypothesized that the short allele of the 5-HTTLPR polymorphism in the serotonin transporter gene, which is associated with lower serotonin activity, would moderate the relation between depressive feelings and the increase in emotional eating, particularly in females. A sample of Dutch families with two adolescents was included in a longitudinal study with a four-year follow-up. A moderator effect of 5-HTTLPR genotype on the relation between depressive feelings and the increase in emotional eating was found in both sexes in the youngest siblings (n = 286). In the older siblings (n = 298), this specific moderator effect was only found in the girls. Younger adolescents and older adolescent girls showed a higher increase in emotional eating if they carried the 5-HTTLPR short allele. This is the first study that found support for a gene × depressive feelings interaction on emergence of emotional eating in (female) adolescents.

Comparison of the eating disorder inventory (EDI) in the Netherlands, Austria and Italy

OBJECTIVE

Comparison of scores of the Eating Disorder Inventory (EDI) in non-clinical females aged 15-35 years (total n = 2402) in three European countries with North-South variation.

METHODS

Participants were high school girls from the Netherlands (n = 642), Austria (n = 544) and Italy (n = 359), and college students from the Netherlands (n = 348), Austria (n = 114) and Italy (n = 395).

RESULTS

Age-dependent differences of EDI subscale scores were observed. Whereas in Dutch females weight and body shape concerns had a peak between 16 and 19 years, these concerns remained relatively constant in Italy and Austria. The Italian scores were significantly higher than the Dutch scores on almost all EDI subscales whereby effects were small or medium.

CONCLUSIONS

The scores may be influenced by socio-cultural factors, cultural traits, culture-specific social demands on young adults and differences in maturation between North and South Europe. National norms are necessary for different age, weight and sex groups.

The children's DEBQ for assessment of restrained, emotional, and external eating in 7- to 12-year-old children

OBJECTIVE

Construct an age adapted version of the Dutch Eating Behaviour Questionnaire (DEBQ) for measurement of restrained, emotional and external eating in 7- to 12-year-old children: the DEBQ-C.

METHOD

The DEBQ-C was constructed and tested for its reliability, factorial validity, factorial invariance for sex, overweight (BMI-status), and age, and correlations with measures for unhealthy life style in one sample (382 boys and 387 girls). In a second sample (252 boys and 263 girls) correlations were obtained with measures for body dissatisfaction and parental feeding styles. Single and multigroup confirmatory factor analyses were used.

RESULTS

The fit measures for the three factor model and the factorial invariance models with respect to sex, BMI-status, and age were satisfactory. In the (sub) samples of the 7- to 12-year-olds Cronbach's alpha's ranged from .73 to .82 and there were satisfactory correlations (p < .01) with other measures.

CONCLUSION

The DEBQ-C should provide a useful measure for young children's emerging dietary restraint and overeating tendencies. The low prevalence of emotional eating indicates that most young children show the natural reaction to emotional stressors (loss of appetite when feeling lonely, depressed or afraid) and that emotional (over) eating at this age is quite abnormal.

Perceived parental control of food intake is related to external, restrained and emotional eating in 7–12-year-old boys and girls

This study examined the prevalence of external, restrained and emotional eating and the relationship of these disturbed types of eating behaviours with perceived parental control of food intake (pressure to eat and restriction) in a group of 7- to 12-year-old boys and girls (n = 596). External eating turned out to be the most prevalent disturbed eating behaviour for boys and girls, followed by restrained eating and emotional eating. Sex differences were found in external and restrained eating. For the boys, perceived pressure to eat was positively related to emotional and external eating. For both sexes, perceived restriction to eat was negatively related to emotional and external eating and positively related to restrained eating. This led to the conclusion that perceived pressure to eat has a disruptive effect on a child's self-regulating mechanism of food intake, particularly so for boys, whereas perceived restriction can also have a positive effect.

Parental behaviour and adolescents’ emotional eating

Parents can influence their children's emotional eating behaviour through modelling processes and parenting. In this study, data on parenting (support, behavioural control and psychological control), emotional eating, and demographic variables were gathered among both parents and two adolescent children of 428 Dutch families. Structural equation modelling showed positive associations between parents' emotional eating and adolescents' emotional eating. Adolescent's reports of low maternal support and of high psychological control for younger adolescents and low behavioural control for older adolescents were associated with higher emotional eating. Parents' reports of parenting were not significantly associated with adolescent's emotional eating. Multi-group analyses revealed no significant differences in associations between modelling and parenting factors on the one hand, and adolescent emotional eating on the other, by sex of the older or younger adolescent.

Dietary restraint: Intention versus behavior to restrict food intake

The Dutch Eating Behavior Questionnaire Restraint Scale (DEBQ-R) assesses both intentions to restrict food intake (3 items) and actual behavioral restraint (7 items). Studies in general population's samples have shown that the DEBQ-R is a reliable instrument with all items loading highly on a single factor. The purpose of the present study was to examine the psychometric properties of a two-factor intention-versus-behavior structure of the DEBQ-R in 3 different weight-concerned samples with people from different (over)weight categories (total N=790) using confirmatory factor analysis. A robust two-factor structure emerged in the various samples, generally supporting a distinction between DEBQ-R questions relating to intentions to restrict food intake and actual restrictive behavior. Results obtained in this study are important, because they suggest that a distinction between restrained intention and behavior could help to explain the relation between dietary restraint and external overeating tendencies. Future longitudinal research should examine whether the newly developed dietary restraint scales predict changes in overeating and Body Mass Index (BMI).

Effects of distress, alexithymia and impulsivity on eating

OBJECTIVE

To improve our understanding of possible mechanisms underlying emotional overeating this study examined the effects of a distress manipulation on food intake in relation to alexithymia and impulsivity.

METHOD

Participants were 86 females who were subjected to a distress manipulation (the anticipation of a public speaking task) prior to an ad lib taste task and filled out questionnaires on impulsivity and the alexithymia constructs difficulty identifying and describing feelings.

RESULTS

Alexithymia significantly (p<.05) moderated the relationship between food consumption and distress. Instead of eating less in the distress condition, alexithymic females ate the same or even more, this showing a 'biological unnatural' and 'inapt' response.

CONCLUSION

Findings suggest that for the 'natural' distress response (reduction of food intake) good ability to identify and describe feelings to others is required, and that the presence or absence of these abilities may predict which people respond to distress by undereating or by overeating. The results provide empirical support for Bruch's conceptualisation of poor interoceptive awareness as possible predictive factor for emotional overeating.

Emotional, external, restrained eating and overweight in Dutch adolescents

The purpose of this study was to determine how emotional, external and restrained eating behavior and other health-related lifestyle factors were associated with being overweight in adolescents. Moreover, demographic and ethnic differences in eating behavior have been examined. The respondents were 10,087 Dutch adolescents aged 11-16 years (M= 13.0, SD= 0.8). Self-reported eating behavior was measured with the DEBQ. Health-related lifestyle was determined by physical activity, breakfasting, fruit consumption and snacking. High restrained, and low external eating were positively associated with being overweight, whereas no significant association between emotional eating and being overweight was found for girls, and a negative association for boys. Adolescents who ate breakfast on a daily basis were less likely to be overweight than those who ate breakfast irregularly or never. Being overweight was positively associated with fruit consumption for girls and negatively with physical activity for boys.

Construct validation of the Restraint Scale in normal-weight and overweight females

The Restraint Scale (RS) is a widely used measure to assess restrained eating. The purpose of this study was to examine the construct validity of the RS in a sample of normal-weight (n=349) and overweight (n=409) females using confirmatory factor analyses of the RS in relation to other measures for dieting, overeating and body dissatisfaction. Following Laessle et al. [(1989a). A comparison of the validity of three scales for the assessment of dietary restraint. Journal of Abnormal Psychology, 98, 504-507], we assumed a three-factor structure: (1) overeating and disinhibitory eating, (2) dieting and restriction of food intake, and (3) body dissatisfaction and drive for thinness. Analyses revealed that the RS loaded significantly on all three factors for both samples, confirming its multifactorial structure. However, the RS appears to capture these constructs differently in overweight and normal-weight females such that the RS may overestimate restraint in overweight individuals. This may explain the greater effectiveness of the RS in predicting counter-regulation in normal-weight than in overweight samples of dieters.

The dieting dilemma in patients with newly diagnosed type 2 diabetes: Does dietary restraint predict weight gain 4 years after diagnosis?

OBJECTIVE

To examine whether dieting--restriction of food intake for the purpose of weight control--suppresses or promotes excessive food intake and weight gain.

DESIGN

A 4-year follow-up study of a dietary intervention in a sample of 97 patients with newly diagnosed Type 2 diabetes.

MAIN OUTCOME MEASURES

Weight gain, change in body mass index (measured weight in kilograms divided by measured height squared), and intake of energy, as measured with a food frequency questionnaire, were assessed in relation to dietary restraint and tendency to overeat (emotionally or externally induced overeating), as assessed with the Dutch Eating Behaviour Questionnaire.

RESULTS

Tendency to overeat at diagnosis and not dietary restraint was associated with weight gain and intake of energy 4 years after diagnosis.

CONCLUSION

These findings suggest that the success of a dietary intervention can be predicted by a subject's tendency toward overeating. The possibility of matched treatment of obesity is discussed on the basis of the distinction between patients with a low versus a high tendency to overeat.

The effect of television viewing on adolescents' snacking: individual differences explained by external, restrained and emotional eating

In a nationwide sample of 10,087 Dutch adolescents aged 11-16 years (M = 13.0, SD = .8), on average, 25% of the respondents watched more than three hours of television per day. Lowest levels of television viewing (TVV) were found in Dutch adolescents as compared to other ethnic groups, and in higher compared to lower educational levels. Snacking was negatively associated with physical activity and positively associated with TVV. For both boys and girls, the positive association between TVV and snacking was stronger in adolescents who scored high on external and (only for boys) emotional eating, whereas restrained eating attenuated this association.

Gender differences in the association between alexithymia and emotional eating in obese individuals

OBJECTIVE

Women have been reported to use more emotion-regulation strategies than do men and to have more abilities to regulate their emotions in a different way. The aim of the present study was to examine gender differences in the relationships of alexithymia, negative mood, and the combination of alexithymia and negative mood with emotional eating in obese persons.

METHODS

Four hundred thirteen obese individuals [343 females and 70 males, aged 18-60 years, mean=43.6 years, body mass index (BMI)=38.4+/-6.6 kg/m2] completed self-report questionnaires, including the Symptom Checklist-90 (SCL-90) questionnaire, the Dutch Eating Behavior Questionnaire (DEBQ), and the Toronto Alexithymia Scale (TAS).

RESULTS

Hierarchical regression analysis showed a significant interaction between gender and alexithymia. More difficulty in identifying or describing feelings was specifically associated with more emotional eating in men.

CONCLUSION

These findings suggest that alexithymia is more strongly involved in emotional eating of obese men than women. This offers indications for designing gender-specific treatments for emotional eating among obese persons.

The validity of Dietary Restraint Scales: Comment on Stice et al. (2004)

In 4 empirical studies, E. Stice, M. Fisher, and M. R. Lowe calculated the correlations between some widely used dietary restraint scales and food intake. Failing to find substantial negative correlations, they concluded that these scales were invalid. The current article challenges this conclusion. For one thing, there is some evidence that restrained eaters do eat less than do unrestrained eaters under controlled experimental conditions favoring self-control. Dietary restraint is also associated with tendencies toward disinhibition under conditions favoring loss of self-control; such disinhibition often masks (but does not invalidate) the construct of dietary restraint. For these and other reasons, the assessment of food intake at a single eating episode may not capture overall dietary restriction. Finally, how much one eats does not necessarily indicate whether one has eaten less than one desired to eat. The authors suggest that the existing restraint scales do in fact validly assess restriction of food intake, albeit in a more complex fashion than is evident from simple correlations in single episodes.

Absence of a disinhibition effect of alcohol on food consumption

Alcohol is frequently mentioned as a disinhibitor of restrained eating behavior although only a small number of studies have investigated this disinhibition effect. The present study was conducted to fill this gap. A total of 116 female college students participated in a questionnaire-based assessment and a taste-test experiment. Before the taste test, half of the participants consumed a preset amount of alcohol-laced orange juice, the other half were given plain orange juice. The dependent variable was the amount of savory crackers eaten during the taste test. The Dutch Eating Behavior Questionnaire (DEBQ), the Three-Factor Eating Questionnaire (TFEQ), and the Restraint Scale (RS) were used to measure eating behavior dimensions, which formed the independent variables in various regression analyses. No disinhibition effect was found. On the contrary, participants scoring high on restraint (DEBQ, TFEQ) proved to consume even less food than those having lower scores. Participants that rated high on the scales measuring tendency toward overeating consumed more food than participants with low scores. These results support earlier contentions that the validity of the Restraint Theory's statement that dieting leads to overeating is questionable.

Tendency toward overeating and restraint as predictors of food consumption

Restrained eaters have repeatedly been found to overeat following a preload, which phenomenon is called the disinhibition effect. Remarkably, the disinhibition effect is only found when the restraint scale (RS) is used, and never when other measures of restraint, like the three-factor eating questionnaire (TFEQ) or the Dutch eating behavior questionnaire (DEBQ) are applied. Recent research has shown that tendency toward overeating appears to be a better predictor of food consumption than dietary restraint. The present study examines the predictive value of preload, tendency toward overeating and dietary restraint. An experiment was carried out with 209 female participants with the aim to evaluate whether the results of the study [Int J Eating Disorders 28 (2000) 333] are robust. In addition to the RS, the TFEQ and DEBQ were used to measure restraint and tendency toward overeating. Again, no disinhibition effect occurred, confirming the results of the previous study. Restraint, as measured by the three questionnaires, was not related to food consumption. In contrast, tendency toward overeating was significantly related to food consumption. Restraint theory's contentions that dieting leads to overeating might be valid for only some dieters, namely those with a high tendency toward overeating.

Validation of the Dutch EDI-2 in One Clinical and Two Nonclinical Populations1

Summary The present study establishes the validity of the Dutch translation of the EDI-2 by determining its factor structure, construct validity and its effectiveness for screening using a clinical and two nonclinical populations. An earlier study had shown that item transformation damaged the validity of the EDI-1 in a nonclinical population of female high-school students. Therefore, the issue of the use of transformed (0-3) versus untransformed (1-6) item responses was addressed first. The present study replicated the earlier finding for the EDI-2 in the same population and similar results were also found in another nonclinical population of female college students. Furthermore, untransformed responses were found to also work well in a clinical population of female patients suffering from eating disorders. Accordingly, further analyses were based on untransformed responses. The factorial integrity of the original 64-item EDI-1 was best supported in the clinical group and the nonclinical group of college students, but the three provisional scales performed poorly in terms of internal consistency and factorial integrity. In all three populations, the EDI-2 was shown to be specific for eating-disorder pathology, and to have good construct validity. It is concluded that the EDI-2 is a suitable screening tool to identify those cases in large populations that warrant more thorough examination.