Overweight or obesity management by therapists of the obesity and overweight think thank group (G.R.O.S.). Pilot study comparing its effects with standard nutritional management

IntroductionCurrently, international recommendations for obese and overweight people that explicitly target weight loss and are based on qualitative and/or quantitative nutritional counseling and increased physical activity do not appear to be effective in the long term. In contrast, intuitive eating seems to be an interesting alternative to dieting. The G.R.O.S., a French non-profit organization, offers tri-axial management that would enable overweight or obese individuals to acquire this flexible and adaptive behavior that consists of eating naturally according to one's physiological and emotional needs.ObjectiveAfter describing the three axes of management by G.R.O.S., a pilot study is presented to evaluate the efficacy of this management type in overweight or obese subjects compared to a standard diet (DIET).MethodThirty-five subjects were divided into two groups (G.R.O.S. and DIET), and their weight, body mass index, cognitive restraint scores, emotional eating, intuitive eating, and depressive symptomatology were measured at the beginning of the study and three months later.ResultsThis pilot study showed the positive effect of weight management, body mass index, intuitive eating, and emotional eating compared with standard dietary management, which only affects the depressive symptomatology.ConclusionsThe G.R.O.S. management style seems to be an interesting and effective alternative to slimming diets. However, this study presented a number of limitations, including the sample size, nonrandomization of subjects in groups, and non-standardization of care.     

Weight stigmatization and disordered eating in obese women: The mediating effects of self-esteem and fear of negative appearance evaluation

ObjectiveThe aim of this study is to examine whether self-esteem and fear of negative appearance evaluation are significant mediators in the association between weight-related self-devaluation and disordered eating.MethodA sample of obese Canadian women (N = 111, M age = 40.9, SD = 10.2) completed the Weight Self-Stigma Questionnaire (WSSQ), the Rosenberg Self-Esteem Scale (RSES), the Fear of Negative Appearance Evaluation Scale (FNAES), and the Eating Disorder Examination Questionnaire (EDE-Q).ResultsSelf-esteem mediated the relationship between weight-related self-devaluation and restraint and weight concerns, whereas fear of negative appearance evaluation mediated the relationship with weight, shape and eating concerns.ConclusionSince, for obese women, self-esteem and fear of negative appearance evaluation are likely to maintain disordered eating, they should be more frequently taken into consideration by researchers, health professionals and public policy stakeholders.     

Differential association between food craving,food addiction and eating-related characteristics in persons at risk for eating disorders

IntroductionFood craving is a key feature of eating disorders, but its association with medical and psychological outcome might depend on the type of eating disorder.ObjectivesThis study investigated the factors associated with food craving in individuals at risk for DSM-5 eating disorder.MethodSeventy-six women were recruited from a non-clinical population (n = 372) based on their positive screening (EDDS, QEWP-R) for binge eating disorder (BED; n = 29), anorexia nervosa (AN; n = 28) or bulimia nervosa (BN; n = 19). They completed self-administered questionnaires assessing food craving (FCQ- T-r), Body Mass Index (BMI), eating behaviour (DEBQ), food addiction (YFAS 2.0), and anxiety and depressive symptoms (HADS).ResultsIndividuals at risk for BED or BN had higher food craving than those at risk for AN. Food craving was associated with BMI only in the BED group. Food craving was positively correlated with external eating in all groups, and with emotional eating in the AN and BED groups and correlated with anxiety only in BN. Food addiction prevalence was higher in the BN group than in the AN or BED groups (respectively 94.7%, 46.4% and 65.5%; p < 0.01). In this non-clinical population, we demonstrated that food craving was differentially associated with BMI and eating-related characteristics according to the type of eating disorder.ConclusionThis suggests that food craving is a transdiagnostic dimension that should be differentially targeted depending on the type of eating disorder; future studies should test this hypothesis in clinical populations.     

Achievement goal theory and disordered eating: Relationships of disordered eating with goal orientations and motivational climate in female gymnasts and dancers

ObjectivesTo examine the relationships between disordered eating in female gymnasts and dancers and their perspective towards achievement in sport and dance, respectively. With an emphasis on outperforming others (ego involvement), more disordered eating was expected than when personal progress (task involvement) was emphasized.MethodsNinety-four aesthetic performers from gymnastics (n = 59) and dance (n = 35) completed questionnaires measuring ego and task involvement (individual orientation and motivational climate), dieting, self-esteem, perfectionism and weight-related peer and coach pressure.ResultsPartial correlations indicated that a stronger ego orientation was related to more dieting, greater perfectionism, more weight-related peer pressure, and lower self-esteem. Similar relationships were found for performance climate. Mastery climate on the other hand was negatively related to dieting, and coach and peer pressure, suggesting that when performers perceived the motivational climate as mastery, less frequent dieting was reported and less weight-related coach and peer pressure was perceived. No relationships were found between task orientation and disordered eating. Most importantly, regression analysis showed that after controlling for BMI, both ego orientation and mastery climate made a unique significant contribution to explaining dieting variance.ConclusionsGoal achievement theory is an important framework for explaining disordered eating in female aesthetic performers. Both ego orientation and mastery climate play a role in dieting of gymnasts and dancers. Aesthetic performers who are strongly ego-oriented tend to display more disordered eating correlates. Furthermore, it seems that to protect against disordered eating, coaches and teachers should create a mastery climate and target self-improvement and self-referenced comparisons over interpersonal competitiveness.     

Parental Support and Adolescent Motivation for Dieting: The Self-Determination Theory Perspective

This article focuses on parents’ role in overweight adolescents’ motivation to diet and successful weight loss. The study employed Self-Determination Theory (SDT) as the theoretical framework (Deci & Ryan, 2000, 2011). Ninety-nine participants (ages 20–30) who had been overweight during adolescence according to their Body Mass Index (BMI mean = 25, SD = 1.6), completed retrospective questionnaires about their motivation to diet and their parents’ behavior in the context of dieting. Findings from a structural equation modeling analysis suggested that participants who viewed their parents’ as more need-supportive demonstrated more autonomous motivation to diet, which, in turn, contributed to their successful weight loss. The findings highlight the importance of parental support of adolescents’ psychological needs in the quality of their motivation to diet. This is an important insight for parents and professionals who aim to encourage more constructive parent involvement in adolescents’ dieting and well-being.     

A structural equation model of intuitive eating with adolescents

IntroductionThe tendency to eat by paying attention and respecting the body's hunger and satiety cues is called intuitive eating. This eating behavior has been linked to positive health and well-being outcomes.ObjectiveThe purpose of this study was to test a global model linking intuitive eating with self-esteem, body esteem, media influence and including fear of negative appearance evaluation in adolescents’ boys and girls.MethodIn total, 740 adolescent high school students (51.5% girls; M age = 14, SD = 1.5) completed self-report questionnaires with measures of intuitive eating, body esteem, self-esteem, media influence and fear of negative appearance evaluation.ResultsStructural equation modeling revealed an overall excellent fit for the final four-variable model excluding the fear of negative appearance evaluation variable. Mediation analyses showed an indirect relationship between intuitive eating and body esteem via media influence, for girls but not for boys. Body esteem mediated the relationship between intuitive eating and self-esteem, for girls and boys.ConclusionA new model is proposed where intuitive eating is associated with self-esteem through body esteem and media influence. These findings suggest that regulating attitudes and behaviors toward food may be related to higher psychological well-being.     

Problematic eating behaviors and nutritional status in 7 to 12 year-old Chilean children

Overweight and obesity are medical conditions that require a multidisciplinary analysis of their causes and treatment. In Chile a sustained increase in the presence of obesity and excess weight has been observed in children. However, the amount and the dynamics of the aforementioned problematic eating behaviours in Chilean children are unknown. The aim of this study was to assess the relationship between restrained, external, and emotional eating, and variations in body mass index (BMI) in Chilean children. Consequently, 453 children from 7 to 12 years of age responded to the Children's Dutch Eating Behaviour Questionnaire, Spanish version. In addition, their anthropometric data were obtained. A positive association was found between restrained eating and BMI, and a negative correlation between external eating and BMI. Emotional eating demonstrated a modest inverse relationship with BMI. A significant interaction between problematic behaviour and nutritional status (normal-weight, overweight, obese) was revealed. Restrained eating was characteristic of obese children whereas external eating of normal-weight children. These results suggest that problematic eating behaviours and their relationship with body weight are similar to those described in studies in Europe.     

Towards Individual Profile Analysis for Obesity Treatment: Actual and Self-Judged Knowledge of Nutrition and Dieting and Perceived Self-Efficacy

Abstract

This paper describes the first stage in the development of a diagnostic instrument for the individualization of obesity treatment, focused on cognitive and motivational factors likely to be relevant for successful and maintained weight reduction. A 145-item questionnaire was completed by 44 overweight subjects. The results indicate that most subjects were convinced that their knowledge of nutritional basics and physiology of dieting was sufficient or high, while in most cases it was actually low. Most subjects had strong self-percepts of efficacy. Another conspicuous finding was the great interindividual variability, frequently reflecting a lack of correspondence between the actual knowledge level, the self-judgement of it, and the perceived self-efficacy. The results support the idea of a diagnostic instrument yielding individual patient profiles including the factors mentioned above.     

Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study

Objective

Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways.

Method

Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years.

Results

Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%).

Conclusion

This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.     

Weight-based discrimination,body dissatisfaction and emotional eating: The role of perceived social consensus

Objective: Discrimination can have a negative impact on psychological well-being, attitudes and behaviour. This research evaluates the impact of experiences of weight-based discrimination upon emotional eating and body dissatisfaction, and also explores whether people's beliefs about an ingroup's social consensus concerning how favourably overweight people are regarded can moderate the relationship between experiences of discrimination and negative eating and weight-related cognitions and behaviours.

Research methods and procedures: 197 undergraduate students completed measures about their experiences of weight-based discrimination, emotional eating and body dissatisfaction. Participants also reported their beliefs concerning an ingroup's attitude towards overweight people.

Results: Recollections of weight-based discrimination significantly contributed to emotional eating and body dissatisfaction. However, the relationships between experiencing discrimination and body dissatisfaction and emotional eating were weakest amongst participants who believed that the ingroup held a positive attitude towards overweight people.

Discussion: Beliefs about ingroup social consensus concerning overweight people can influence the relationships between weight-based discrimination and emotional eating and body dissatisfaction. Changing group perceptions to perceive it to be unacceptable to discriminate against overweight people may help to protect victims of discrimination against the negative consequences of weight-based stigma.     

Psychosocial moderators of the relationship between body dissatisfaction and symptoms of eating disorders: A look at a sample of young Italian women

IntroductionVarious psychosocial variables may affect the strength of the relationship between body image dissatisfaction and women's eating disorder symptomatology.ObjectiveInformed by Tylka (2004) and Brannan and Petrie (2011) research, the current study examined body surveillance and self-esteem as well as three additional theoretically relevant variables (social interaction anxiety, internalization of media ideals and attachment anxiety) as potential moderators of this relationship.MethodA cross-sectional design was used. A sample of 538 young Italian women completed self-report questionnaires.ResultsHierarchical moderated regression indicated that self-esteem buffered the deleterious effects of body dissatisfaction, whereas social interaction anxiety, body surveillance, internalization of media ideals and attachment anxiety intensified the primary body dissatisfaction-eating disorder symptomatology relationship.ConclusionSeveral risk and protective factors were found to interact with body dissatisfaction to influence its relation to women's eating disorder symptomatology. Practical implications and directions for future research are discussed.     

The Process by Which Relative Autonomous Motivation Affects Intentional Behavior: Comparing Effects Across Dieting and Exercise Behaviors

A motivational model integrating self-deter-mination theory and the theory of planned behavior was tested in two samples for exercise and dieting behavior respectively. Relative autonomous motivation from self-determination theory was hypothesized to predict intentions to exercise or diet via the mediation of attitudes and perceived behavioral control (PBC) from the theory of planned behavior. It was also expected that attitudes and PBC would predict actual levels of exercise and dieting behavior via the mediation of intentions. Relations in the proposed model were expected to be invariant across the behaviors. Two samples of participants (N = 511) completed measures of the autonomous motives, attitudes, subjective norms, PBC, and intentions with respect to exercise and dieting behavior. Four weeks later, participants self-reported their behavior. Structural equation models supported the replicability of the proposed model in both behaviors. Findings supported the majority of the hypothesized effects in the proposed model across the two health behaviors. However, four effects were significantly different across the two behaviors: the effect of autonomous motives on intentions, subjective norms and PBC on intentions, and intentions on behavior. Findings extend knowledge of the processes by which psychological antecedents from the theories affect health behaviors integral to the maintenance of energy balance.

Executive function and weight status in children: A one-year longitudinal perspective

There is considerable evidence for an association between obesity and impaired executive function (EF) in adolescents and adults. However, little research has examined EF in overweight or obese children. Furthermore, data on EF in underweight individuals is lacking. In addition, there is no consensus on the directionality of the relationship between Body Mass Index (BMI) and EF, and longitudinal studies are rare. Thus, the present study examined whether children differ in their performance on a battery of EF tasks depending on their weight status (underweight, normal-weight, overweight), and investigated the longitudinal cross-lagged associations between EF and BMI. Hot EF (delay of gratification, affective decision-making), cool EF (attention shifting, inhibition, working memory [WM] updating), and BMI were assessed in 1,657 German elementary-school children at two time points, approximately one year apart. Overweight children exhibited slightly poorer attention shifting, WM updating, and affective decision-making abilities as compared to normal-weight children. Unexpectedly, they did not show any deficits in inhibition or delay of gratification. EF levels of underweight children did not differ significantly from those of normal-weight children. Furthermore, poor attention shifting and enhanced affective decision-making predicted a slightly higher BMI one year later, and a higher BMI also predicted poorer attention shifting and WM updating one year later. The latter association between BMI and subsequent EF scores, however, diminished when controlling for socioeconomic status. Results indicate that hot and cool EF plays a role in the weight development of children, and might be a promising factor to address in preventive interventions.     

Current and vestigial effects of overweight among women: Fear of fat,attitudinal body image,and eating behaviors

College females completed multiple, standardized measures of their fear of fat, attitudinal body image, and binge eating and dieting. Situational weigh-in measures were taken, including latency to get on the scale and anxiety while being weighed. Based on current weight and a structured weight history questionnaire, three groups were constructed: normal-weight subjects without an overweight history (NW; n=24), normal-weight subjects who were formerly overweight (FOW; n=16), and those currently overweight (OW; n=24). Group comparisons revealed, as expected, that OW females, relative to their NW peers, had more weight-related anxieties, more negative body experiences, and more frequent past-year dieting. Consistent with Stunkard's original proposition, the FOW group regarded their bodies as fatter and less affectively satisfying and expressed more weigh-in anxiety than NW participants. Currently normal-weight FOW subjects seldom differed from the currently OW individuals. Clinical and research implications are considered, particularly with regard to the psychological sequelae of weight loss.     

The motivation to diet in young women: Fear is stronger than hope

This research examined the relative impact of a hoped‐for, thin body and a feared, overweight body on weight‐loss dieting (WLD) motivation. We hypothesised that the women most motivated to engage in WLD would report a higher similarity to, and a higher cognitive availability of, a feared, overweight body. In study 1, WLD motivation was operationalized as WLD intention and in study 2 as a food choice (chocolate bar versus low‐fat snack bar). As expected, those most similar to the feared body and who had a highly available overweight body had the greatest intention to engage in WLD, and were more likely to choose a low‐fat snack over a chocolate bar. The implications of our findings for future research as well as the development of eating pathology in college women are discussed. Copyright © 2011 John Wiley & Sons, Ltd.     

Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility

The current study examined whether self-compassion, the tendency to treat oneself kindly during distress and disappointments, would attenuate the positive relationship between body mass index (BMI) and eating disorder pathology, and the negative relationship between BMI and body image flexibility. One-hundred and fifty-three female undergraduate students completed measures of self-compassion, self-esteem, eating disorder pathology, and body image flexibility, which refers to one's acceptance of negative body image experiences. Controlling for self-esteem, hierarchical regressions revealed that self-compassion moderated the relationships between BMI and the criteria. Specifically, the positive relationship between BMI and eating disorder pathology and the negative relationship between BMI and body image flexibility were weaker the higher women's levels of self-compassion. Among young women, self-compassion may help to protect against the greater eating disturbances that coincide with a higher BMI, and may facilitate the positive body image experiences that tend to be lower the higher one's BMI.     

Defining features of unhealthy exercise associated with disordered eating and eating disorder diagnoses

ObjectivesThe current study sought to compare different features of unhealthy exercise on associations with disordered eating and their ability to identify individuals with eating disorders. A secondary aim of the study was to compare prevalence and overlap of different aspects of unhealthy exercise and potential differences in their gender distribution.DesignCross-sectional epidemiological study.MethodsA community-based sample of men (n = 592) and women (n = 1468) completed surveys of health and eating patterns, including questions regarding exercise habits and eating disorder symptoms.ResultsCompulsive and compensatory features of exercise were the best predictors of disordered eating and eating disorder diagnoses compared to exercise that was excessive in quantity. Further, compulsive and compensatory aspects of unhealthy exercise represented overlapping, yet distinct qualities in both men and women.ConclusionsIncluding the compulsive quality among the defining features of unhealthy exercise may improve identification of eating disorders, particularly in men. Results suggest that the compensatory aspect of unhealthy exercise is not adequately captured by the compulsive aspect of unhealthy exercise. Thus, interventions that target unhealthy exercise behaviors among high-risk individuals, such as athletes, may benefit from addressing both the compulsive and compensatory aspects of unhealthy exercise. Future prospective longitudinal studies will aid in determining the direction of the association between these features of unhealthy exercise and the onset of eating pathology.     

Behaviour change among overweight and socially disadvantaged adults: A longitudinal study of the NHS Health Trainer Service

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre–post changes in Body Mass Index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008–2009; N?=?4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change.