Onset of binge eating and dieting in overweight women: implications for etiology, associated features and treatment

This study investigated differences between overweight binge eating women who reported the onset of binge eating prior to or following the onset of dieting (binged first [BF], or dieted first [DF]). Of overweight binge eating subjects enrolled in a treatment study, 38.7% indicated binge eating first, and 48.1% dieting first. The mean age of onset of binge eating differed significantly between the two groups (11.8 years vs. 25.7 years). More of the BF group (82.5%) satisfied proposed binge eating disorder (BED) criteria than did the DF group (52.0%), although short of significantly. The results suggest that: (a) the leading hypothesis concerning dieting as a cause of binge eating does not apply to a substantial number of individuals who binge eat; (b) there may be an early pattern and a late pattern in the development of binge eating among overweight individuals; and (c) the early or binge first pattern may be more likely to result in BED.     

An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms

PURPOSE: Food preferences, eating patterns, and physical activity patterns were examined in a cohort of adolescent females and males participating in a longitudinal study of the developmental antecedents of eating disorders. METHODS: All adolescents (n = 1494) in grades seven through ten in an entire school district completed a survey about their dieting behaviors, eating, and exercise patterns. RESULTS: Principal components analysis showed similar factor structures for food preferences and eating patterns among males and females. Gender differences were present in physical activity patterns. Sports participation was correlated with healthy food preference and was a significant predictor of eating disorders symptoms. Junk food preference was marginally inversely related to eating disorders symptoms in females. Preference for other types of foods and reported intake of foods were not related to eating disorders symptoms. The percent of variance in risk score accounted for by dietary intake and physical activity patterns was small. CONCLUSIONS: Psychological and social/environmental variables may explain a larger proportion of the variance in eating disorders risk than the dietary and physical activity variables examined in this study. Implications for understanding the etiology and behavioral expression of eating disorders are discussed.     

Tetralogy of Fallot with flap valve ventricular septal defect producing suprasystemic right ventricular pressure: echocardiographic observations

The study objectives were to gain insight into how the terms "dieting" and "binge eating" are understood and used by adolescents and to assess whether interpretations of these terms are consistent across age and gender. Twenty-five focus groups were conducted with 203 adolescents (138 girls and 65 boys) in urban public junior and senior high schools. Respondents were asked questions about dieting and binge eating behaviors. In the majority of groups (n=19), healthful eating behaviors, such as eating less fat or more fruits and vegetables, were mentioned in reference to dieting. However, in many of the groups (n=13) unhealthful eating behaviors, such as skipping meals or "starvation," were also described. Dieting was frequently described as an umbrella term for different behaviors aimed at weight control (ie, physical activity) or in nonbehavioral terms (ie, as a desire or plan for weight loss). Although binge eating was described as overeating by many participants, often it was not clear if youth were referring to uncontrolled overeating. In nearly half of the groups, participants indicated unfamiliarity with the term "binge eating." There was some confusion between binge eating and other forms of disordered eating. The findings suggest that prevalence rates of self-reported dieting and binge eating behaviors should be interpreted with caution and it should not be assumed that the majority of adolescents who self-report dieting are engaging in unhealthful behaviors. In providing nutrition counseling to youth, and in assessing dieting and binge eating behaviors in clinical settings and in research studies, specific behaviors should be defined.     

Binge eating onset in obese patients with binge eating disorder

In this study we examined whether obese women with binge eating disorder (BED) reporting earlier onset binge eating differed from those with later onset binge eating on salient clinical parameters. Subjects were 112 women who sought treatment for BED. Subjects with early (< or = age 18) and later onset (> age 18) did not differ in age, weight, body mass index, or severity of binge eating. Participants were interviewed using the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM-III-R, and completed a weight and diet history questionnaire. Early-onset binge eaters were more likely than those with later-onset to binge-eat before dieting, to have early onset of obesity and dieting, to have longer binge-free periods, and more paternal obesity and binge eating. Early-onset binge eaters also reported more eating-disorders psychopathology, and they were more likely to report a lifetime history of bulimia nervosa and DSM-III-R mood disorder. These data suggest that there are marked differences among BED patients presenting for treatment. Further research is needed to determine whether these differences reflect a different etiology or have implications for treatment.     

Weight-related attitudes and behaviors of black women

Weight-related attitudes and practices of women who attended health department clinics or who worked for a health and human services agency were assessed by means of an anonymous, self-administered questionnaire. Black women who were 25 to 64 years old and were not pregnant or had not given birth within the past year were included in this analysis (n = 500). The overweight women perceived themselves as being overweight. They were less likely to be satisfied with their weight and more likely to have dieted and to be currently dieting than nonoverweight women. Awareness of obesity-related health risks was high, but the perceived psychosocial consequences of being overweight were somewhat limited. Approximately 40% of moderately and severely overweight women considered their figures to be attractive or very attractive, which indicates a relatively positive body image. The overweight women were less likely to exercise, less likely to skip meals, and more likely to eat between meals than the nonoverweight women. Among the subset who had ever attempted to lose weight (n = 368), the overweight women were significantly more likely to have regained all or more of the weight lost during their most recent attempt. The findings of this exploratory survey suggest that although overweight black women are weight conscious, the absence of strong negative social pressure combined with a relatively positive body image may limit the extent to which weight loss efforts are sustained. Findings about eating and exercise patterns suggest some specific factors that may interfere with the effectiveness of weight control among black women.     

Interactive effects of menarcheal status and dating on dieting and disordered eating among adolescent girls.

The effects of menarcheal status and opposite-sex socializing (mixed-sex social activity, dating, and noncoital sexual involvement with boyfriends) on dieting and disordered eating among early adolescent girls are examined. In all, 89 12- and 13-year-old girls reported their menarcheal status, dieting behaviors and attitudes, and involvement in dating and other heterosocial activities. Girls who are more involved in mixed-sex social activities are more likely to exhibit disordered eating tendencies, and this effect is stronger among girls who have experienced menarche. Also, girls who are dating and are more physically involved with boyfriends are more likely to report dieting and disordered eating than are their peers. An interaction between dating and menarcheal status was observed in the prediction of dieting and disordered eating, with dating more strongly linked to dieting and disordered eating among girls who have recently experienced menarche. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mouse complement component C4 is devoid of classical pathway C5 convertase subunit activity

OBJECTIVE: The purpose of this research was to empirically develop the Cognitive Behavioral Dieting Scale (CBDS), a measure of current dieting. METHOD: The first study involved item generation and a procedure to boost internal consistency while reducing scale length. Study 2 involved a factor analysis and measures of scale reliability. The third study evaluated the ability of the CBDS to predict calorie intake and negative calorie balance from a 24-hr diet recall. Study 4 evaluated construct validity by comparing the CBDS to dietary restraint, body image, and health behavior self-efficacy. RESULTS: The CBDS is a 14-item scale which measures current dieting behavior and related thoughts within the past 2 weeks. Internal consistency was alpha = .95 and 2-day test-retest reliability was r = .95. This scale provides a method for operationalizing dieting, provides a construct that is different from restraint, and assess dieting behavior on a continuum. Additionally, this scale was able to predict calorie intake and negative calorie balance above and beyond the predictive ability of physical variables (i.e., body mass index BMI] and exercise calories). An additional study of construct validity showed the CBDS was related to poor body image esteem and dietary restraint, but minimally related to healthy eating self-efficacy. DISCUSSION: In conclusion, the CBDS shows promise as a valid and reliable measure of dieting behavior. This scale should have utility in future research on how current dieting relates to eating disorders, dietary restraint, and obesity.     

Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs.

The authors investigated mediators hypothesized to account for the effects of 2 eating disorder prevention programs using data from 355 adolescent girls who were randomized to a dissonance or a healthy weight intervention or an active control condition. The dissonance intervention produced significant reductions in outcomes (body dissatisfaction, dieting, negative affect, bulimic symptoms) and the mediator (thin-ideal internalization), change in the mediator correlated with change in outcomes and usually occurred before change in outcomes, and intervention effects became significantly weaker when change in the mediator was partialed, providing support for the hypothesized mediators and this new approach to testing mediation in randomized trials. Findings provide somewhat less support for the hypothesis that change in healthy eating and exercise would mediate the healthy weight intervention effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiologic aspects of the burnout syndrome in hospital personnel

The long-term effects of a 12- and 26-day residential weight control program on weight change were determined in 187 men and women, 1 to 5 years after treatment. Subjects completed a paper/pencil questionnaire assessing current diet, weight control techniques, exercise behaviors, behavior modification techniques, binge eating, and dieting behavior. General linear modeling was used to investigate the association between behaviors maintained posttreatment and current weight among subjects who demonstrated behaviors indicative of binge traits (BT) and nonbinge traits (NBT). Results indicate that dissimilar variables are predictive of weight change in the BT and NBT groups. Engaging in exercise behaviors and reduced attempts at dieting lead to greater weight loss in NBT individuals. The use of preplaning techniques was found to be indicative of greater weight loss in BT individuals. These findings suggest the importance of identifying individuals who indulge in binge-eating behaviors prior to intervention in order to deliver the appropriate treatment methods.     

A controlled evaluation of an elementary school primary prevention program for eating problems

Researchers have recently called for the development of primary prevention of eating disorders programs aimed at elementary school students. The present study reports on the development of a curriculum for fifth graders designed to encourage healthy eating, exercise, and body image while discouraging calorie-restrictive dieting, exercising for weight loss, and the development of body dissatisfaction. The program consisted of ten lessons taught by the classroom teachers. The influence of the curriculum on (1) knowledge about nutrition, body fat, and dieting; (2) attitudes about fat people and own body (body esteem); and (3) behaviors, including attempts at weight reduction, consumption of fruits and vegetables, and exercising, were evaluated in a pre-post controlled experimental design. There were 222 white public school children who participated in both the pre- and posttesting, 167 of whom were in the classrooms receiving the curriculum. Results indicated that knowledge was broadly improved by the curriculum. There were information improvements in terms of nutrition, effects of dieting, and causes of body fat. Attitudinal changes were less pronounced, although the curriculum did positively affect attitudes about fat people. Behavior, including eating patterns, exercise patterns, weight reduction attempts, and teasing of fat children, was not changed by participation in the curriculum.     

Dieting behaviors and weight change history in female adolescents.

The prevalence of dieting, weight change history, and specific weight loss behaviors was examined in a population-based sample of 1,015 female 9th–12th graders. Healthy weight loss behaviors were reported much more frequently than unhealthy weight loss behaviors (e.g., healthy behaviors: exercise?=?32.4%, decrease fat intake?=?26.0%, reduce snacks?=?25.0%, reduce kilocalorie intake?=?22.4%; unhealthy behaviors: fasting?=?8.1%, diet pills?=?5.4%, vomiting?=?4.4%). Obesity status and restrained eating scores were positively related to greater history of weight loss episodes, pounds lost, and weight fluctuations and to greater use of healthy weight loss methods and weight loss programs. Implications for public health recommendations regarding dieting and its associated behaviors in female adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consequences of dieting to lose weight: Effects on physical and mental health.

Concern has been raised that negative physiological and psychological effects of dieting may outweigh aesthetic and health benefits. This review of the literature concludes the following: (1) The measurement of dieting is an important unresolved issue; (2) current dieting, chronic dieting, desire to lose weight, specific weight control behaviors, and weight changes may have different effects on health and need to be distinguished; (3) dieting is usually not associated with nutritional deficiencies, adverse physiologic adaptations, severe psychological reactions, or the development of eating disorders; and (4) recommendations against weight loss efforts involving moderate changes in eating and exercise habits are not warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Plasma endothelin-1 levels during transient acute myocardial ischaemia in men: effects of coronary revascularization

The endothelium-derived peptide endothelin-1 (ET-1) was evaluated in 14 male patients [mean age 52.74 years (SEM 1.10)] affected by coronary artery disease during a bicycle electrocardiographic stress test and dipyridamole echocardiogram. Both tests were performed before and after coronary revascularization. Fourteen healthy male subjects served as controls [mean age 53.21 years (SEM 1.63)]. Baseline plasma endothelin-1 levels were higher (P < 0.0001) in ischaemic patients [1.81 pg mL-1 (0.15, n = 14)] than in control subjects [0.61 pg mL-1 (0.03, n = 14)], but did not increase with exercise in both groups. Similar results were obtained with dipyridamole infusion. Endothelin-1 levels significantly decreased after coronary revascularization [before: mean 1.81 pg mL-1 (SEM 0.15, n = 14); after: mean 1.16 pg mL-1 (SEM 0.11), P < 0.002], without changes in the peptide response to both tests. In conclusion, elevated plasma endothelin-1 concentrations were found in patients with stable angina compared with non-ischaemic subjects. No changes were observed during exercise or dipyridamole infusion in both groups. Coronary revascularization was followed by a significant decrease in plasma endothelin-1 levels.     

The relation of job satisfaction and degree of openness about one''s sexual orientation for lesbians and gay men

Previous studies have shown that cardiovascular patients benefit from exercise. The explanations are partly physical and partly psychological, yet evidence for the latter is contradictory, possibly because only selected samples start and maintain prolonged exercising. The authors examined psychological effects of short-term exercise started as soon as possible after myocardial infarction, focusing on the motivation for health of 62 male and female patients who had had a myocardial infarction 7 to 10 days earlier. Patients were divided into those who exercised for a week in a recovery camp, those who merely stayed for a week in the camp, and those who did not stay in the camp. Results of before and after tests indicated that two scores of the motivation for health (goals and norms) of patients in the exercise group increased, even when complications, former exercising, and infarct location were considered. A month later, 53 of the patients completed a cardiological adjustment questionnaire. The exercise group scored higher than the others on 8 of 9 domains, including subjective health state, sexuality, and work. Even short-term supervised exercise, if done immediately after infarction, has a great potential for beneficial psychological effects, the authors concluded.     

Effects of dietary restraint, obesity, and gender on holiday eating behavior and weight gain.

This investigation evaluated the impact of dietary restraint, relative weight, and gender on holiday eating behavior and weight gain. 65 Ss (31 men and 34 women) completed detailed food records for the 2 days before, the 4 days during, and the 2 days after the Thanksgiving weekend. Results indicated increased eating during the Thanksgiving holiday, with men eating more than women and the obese eating less than the nonobese. There was also a significant Total Restraint?×?Weight?×?Time interaction, with unrestrained normal-weight subjects behaving similarly to high-restrained overweight subjects over time. There was also a highly reliable Total Restraint?×?Sex?×?Time interaction. The most striking finding from this interaction was that high-restrained women displayed decreases in their dietary intake over time. Correlational analyses revealed that restraint scores were negatively associated with dietary intake over the 8-day period but were positively associated with weight gain. The implications for dieting, eating behavior, and energy balance are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of intermittent food restriction and refeeding on energy efficiency and body fat deposition in sedentary and exercised rats

The effects of body weight cycling on energy metabolism and body fat accumulation were examined in sedentary and exercised rats. Ten rats were sacrificed before the experiment to obtain basal data, and then 90 rats were divided into three groups; control (CN), food restricted (FR) and weight cycling (WC). Food intake in rats of the FR group was restricted constantly to 70% of the intake of the CN group. The rats of WC group were subjected to four bouts of weight cycling consisting of 7-days food restriction followed by 7-days refeeding, but were fed the same total amount of dietary energy as that of the FR group throughout the experimental period. The rats of all groups were meal-fed twice a day. Half of the rats in each group were exercised by running on a treadmill (30 min/day) throughout the experimental period. The body weight, abdominal adipose tissue weight, body fat, body protein and energy restoration for the study in both sedentary and exercised groups were greater in the WC group than in the FR group. The resting metabolic rate of the WC group after four bouts of weight cycling was lower than that of the FR group in the sedentary rats, but this difference was not observed in the exercised rats. Also, the thermic effect of food (TEF) in the sedentary rats for 6 h after a meal was significantly less in the WC group as compared to that of the FR group. However, the TEF for the exercised rats was not different between the two groups. The serum insulin level, activities of lipogenic enzymes and lipoprotein lipase in adipose tissue for the sedentary rats of the WC group were higher than those of the FR group, but did not differ in the exercised rats. These results suggest that weight cycling increases body fat deposition and energy efficiency by decreasing energy expenditure, particularly the TEF, and that exercise training can alleviate the effects of weight cycling on the energy metabolism.     

Obesity and the unbalanced energy equation: Exercise versus eating habit change.

Compared the relative effectiveness of exercise and eating habit change individually and in combination for weight loss and physical conditioning. 44 female volunteers aged 17–46 yrs were randomly assigned to 1 of 4 groups: exercise, eating habits, combination, and delay-of-treatment control. Each group met for 8 1-hr sessions. Ss were assessed at pretreatment, posttreatment, and follow-up using measures of weight, physical fitness, and personal adjustment. After the 1 8-wk period, the control group was treated using the same procedures as employed for the combination group. Results indicate significant improvement for all treatment groups in comparison with the delay-of-treatment control on body weight and most measures of physical fitness and personal adjustment. Groups who exercised showed the most improvement in physical fitness. The combination group demonstrated the most improvement in weight and body circumference. At 8-wk follow-up, only the combination group continued to lose weight. Once treated, the delay-of-treatment control group demonstrated results similar to those of the combination group. Results suggest the necessity of combining exercise and eating habit change in dealing with obesity. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Normal bone mass in bulimic women

The aim of this study was to examine the relationship among exercise, menstrual function, and bone mineral density (BMD) in different groups of age-matched patients with eating disorders. Dieting and eating disorder history, physical activity history, and menstrual history were assessed by clinical interview in 43 bulimic and 13 anorectic young women as well as in 17 healthy control subjects (18-29 yr). BMD was assessed by dual x-ray absorptiometry. All the anorectics but only 30% of the bulimics exercised regularly from the onset of their eating disorder (P < 0.01), mainly using aerobic dancing and running. All of the anorectics had been amenorrheic since the start of their symptoms, and 68% of the bulimics had a history of menstrual dysfunction. Within the exercise subgroups of bulimic patients, there was no significant relationship between BMD and current or previous menstrual function. Anorectic patients had lower BMD than bulimics and controls in all skeletal regions studied (P < 0.01). Bulimic patients who had exercised regularly during their illness had higher total body BMD than bulimics classified as sedentary (P < 0.01). Bulimics who had exercised regularly or intermittently since the onset of their eating disorder had higher BMD than sedentary bulimics in the lumbar vertebrae, femoral neck, and legs (P < 0.05). It appears that weight-bearing exercise can prevent or attenuate bone loss at specific skeletal sites in normal weight bulimic patients, but not in anorectics.     

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

This study examined individual differences in the relationships among 3 constructs relevant to restrained eating theory—cognitive restraint (dieting), disinhibition (bingeing), and hunger. Participants were 421 adolescents (158 male, 255 female, and 8 not indicated). Comparisons among subgroups based on scores on the 3 constructs indicated that there were (a) 2 types of frequent dieters—those who follow theoretical predictions and become disinhibited and those who maintain their restraint; (b) 2 types of bingers—those who engage in dieting-induced bingeing and those who are hungry and disinhibited; and (c) 2 types of low-hunger eaters—those who suppress their hunger and those who eat before they experience much hunger. Implications of the results for restrained eating theory are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)