Biased perception of overeating in bulimia nervosa and compulsive binge eaters

This study investigated the relationship between caloric intake and perceived overeating in subjects with and without a history of problematic binge eating. Eighty subjects (20 in four groups: bulimia nervosa, compulsive binge eaters, obese, and normal controls) self-monitored eating for 2 weeks. The regression slopes for self-reported overeating as a function of caloric intake were contrasted across the four groups. At higher caloric levels, bulimics and binge eaters reported overeating at a significantly higher rate compared to obese and normal control groups. These data were interpreted as a type of cognitive bias whereby subjects with a history of binge eating distorted their perception of overeating at progressively higher caloric levels. It was proposed that excessive concern about eating and dieting may cause such cognitive biases. A parallel was drawn with body image distortion, which appears to be associated with overconcem with body size and shape.     

Perceptions of women related to food choice

Male and female subjects (predominately white) provided impression ratings of body shape, personality traits, and total caloric consumption for a female target based on her preference for a low fat or high fat diet. Results showed that meal type significantly affected impression ratings: the target who preferred low fat foods was viewed more favorably than the one who preferred high fat fare. Compared with male subjects, female subjects perceived the target who preferred a high fat diet to be significantly less conscientious. Males were significantly more accurate than females in their caloric estimations of targets' total daily consumption. The results will be discussed in terms of the social pressure on women to restrict not only their weight to acceptable levels, but their food consumption as well.Portions of this paper were presented at the meeting of the Eastern Psychological Association, Providence, Rhode Island, April 14–17, 1994.The authors wish to thank Justina Bradley, Loraina Ghiraldi, and two anonymous reviewers for their thoughtful comments on an earlier version of this paper. Melissa Van Brocklin's help during the data collection was also greatly appreciated.     

“Clean up your plate”: Effects of child feeding practices on the conditioning of meal size

To obtain information on the development of the learned control of food intake, preschool children (N = 22) participated in conditioning and extinction trials to determine whether meal size could be conditioned. Each trial consisted of a two-part snack in which consumption of a fixed amount of a distinctively flavored high (145 kcal) or low (60 kcal) caloric density preload was followed by ad lib consumption of snacks. Following the pairs of conditioning trials, extinction test trials were given in which the flavors previously paired with either high or low caloric density were presented in intermediate, isocaloric preloads. Conditioning occurred in one of two child feeding contexts: one that focused children on internal cues of hunger and satiety, or one that focused the children on external cues, including the amount of food remaining on the plate. The external group also could receive rewards for eating. Only the children in the internal context showed evidence of responsiveness to caloric density cues and associative conditioning, eating more ad lib following the low-density preload than following the high density preload during conditioning, and eating more during extinction following the flavor previously paired with low caloric density. Children in the external context showed no evidence of responsiveness to caloric density cues, but increased in ad lib consumption across the conditioning trials.     

Conditioned and unconditioned caloric compensation: Evidence for self-regulation of food intake in young children

The purpose of these two experiments was to determine (a) whether young children can be responsive to caloric density cues in regulating their food intake, (b) whether such cues can be associatively conditioned to organoleptic cues in foods, and (c) to obtain evidence regarding which of the many cues available are involved as conditioned stimuli. In Experiment 1 participants were eighteen 3- to 5-year-old children, who were seen for a series of pairs of conditioning trials, followed by extinction test trials. Each trial consisted of a two-part snack: approximately 100 ml of a pudding preload (chocolate or vanilla; high or low caloric density) followed after a delay by ad-lib consumption of snack foods (cookies and crackers). In extinction trials, flavors previously paired with high- or low-caloric density preloads during conditioning were presented in isocaloric intermediate density preloads. Results indicated that 14 of 18 children showed unconditioned caloric compensation on the first pair of conditioning trials; 16 of 18 children showed compensation following the second pair of trials, and 12 of these 16 subjects continued to show this consumption pattern during extinction. Consumption was significantly greater following the low calorie paired flavor than following the high calorie paired flavor during extinction. Experiment 2 (N = 10) replicated these findings, and uncorrelating preload and snack food flavors indicated that flavor cues in the preloads can serve as conditioned stimuli. Children showed both initial responsiveness to caloric density and evidence for associative conditioning of food cues to the physiological consequences of eating. These results provide initial evidence for a mechanism allowing the child to learn to anticipate the caloric consequences of familiar foods and regulate food intake accordingly.     

The environment influences whether high-fat foods are associated with palatable or with unhealthy

This study investigated whether relatively automatic evaluations of food differ between situations and between obese people and lean controls. These evaluations were assessed in the affective priming paradigm (APP) -- a response latency based measure for associations. In Experiment 1, we either focused participants (33 obese and 26 lean controls) on the palatability (restaurant condition) or on the healthiness (health condition) of food, prior to the APP. Independent of weight-status, relatively automatic evaluations of food were based on palatability in the restaurant condition, and on health in the health condition. So, the current focus of attention can shape the way foods are evaluated relatively automatically. In Experiment 2, craving was induced in participants (27 obese and 29 lean controls). Unexpectedly, the craving induction did not achieve its goal of focusing on the palatability of food in general, but just for low-fat foods, possibly because of the health-emphasizing environment -- a hospital. Interestingly, obese people showed a stronger palatability priming effect with increasing levels of initial craving. For normal weight controls the effect was in the same direction, but missed significance. In our environment, palatability of food may be too salient, and health may not be salient enough, influencing automatic food-evaluations.     

Obsessive-compulsive symptoms in eating disorders

Obsessive-compulsive symptoms were measured in a consecutive series of new referrals with anorexia nervosa (n = 29) and bulimia nervosa (n = 77). In contrast with previous reports, there was no significant difference on MOCI scores between eating disorder groups and normal controls. A consecutive series of 38 patients with bulimia nervosa then entered a structured treatment programme. Poor outcome cases had a higher score on the MOCI-doubting sub-scale. However, there was no significant difference in obsessive-compulsive scores between those who were binge-free and those who were bingeing daily at the end of treatment and there was no significant in outcome between high and low-scorers on the MOCI. This study fails to support the view that the eating disorders are a subtype of OCD. Previous conflicting results are attributed to selection bias and the effects of low body weight.     

Dietary restraint of bulimic subjects following cognitive-behavioral or pharmacological treatment

The pre and posttreatment self-monitored caloric intake of bulimic subjects treated with either cognitive-behavioral therapy or imipramine was compared. Results indicated that both groups equally and successfully reduced purged calories but that only cognitive-behaviorally treated subjects increased non-purged caloric intake. These results show that cognitive-behavioral treatment lessens dietary restraint whereas imipramine treatment of bulimia nervosa does not. These findings are discussed and it is suggested that they may account for the superior therapeutic maintenance following cognitive-behavioral treatment when compared with pharmacological treatment of bulimia nervosa.     

Effects of a short-term exercise program on caloric consumption

The present study investigated the effects of a short-term exercise program on caloric intake. Thirty-three women were randomly assigned to either a high-intensity exercise group (80% maximum heart rate), low-intensity exercise group (55% maximum heart rate), or waiting list control group. Exercisers were required to ride ergometer bicycles three times per week for 7 weeks, expending 200 kilocalories of energy per exercise session. All participants recorded food intake during specified weeks before, during, and following the exercise program. Results showed no significant caloric intake differences among the three groups, but a trend toward reduction in food intake with increased exercise intensity was found. Interestingly, comparisons between caloric intake on exercise and nonexercise days revealed that both exercise groups consumed significantly less on exercise days. Additionally, the control group evidenced a larger caloric intake level than did the two exercise groups on exercise days. These results suggest that exercisers do not compensate for energy expenditure by increasing caloric intake and that choosing between low- and high-intensity exercise does not differentially alter caloric intake. Nevertheless, maximization of negative energy balance or weight loss may be best achieved by exercise programs of high frequency and intensity.     

THEORETICAL,PRACTICAL, AND SOCIAL ISSUES IN BEHAVIORAL TREATMENTS OF OBESITY

Although showing superior maintenance, behavioral treatments of obesity typically produce small weight losses at a decelerating rate. Rather than reflecting poor compliance with treatment, these findings are consistent with known compensatory metabolic changes that operate to slow weight loss and promote regain. Other problems associated with dieting include failure of caloric regulation, hyper-responsivity to food palatability, and hunger, which is greatest under conditions of moderate restriction and unpredictability of access to food. The inevitability of treatment failure in many instances must be faced and efforts made to prevent further worsening of the obese patient's self-esteem. Prognosis and treatment planning may be aided by consideration of the historical difficulties of weight loss, the degree of hunger experienced on diets, which may reflect important physiological differences among individuals, and the use of food to optimize arousal level. Full involvement of the patient in setting goals and planning treatment is recommended.     

Reduced automatic motivational orientation towards food in restricting anorexia nervosa

A striking and characteristic feature of the restricting subtype of anorexia nervosa (AN) is that they are extremely successful in regulating their food intake in a destructive manner. A possible explanation for the persistent character of their restricted food intake could be a loss of the motivational saliency of food in restricting AN patients. The present study aimed to investigate motivational orientation for food in the restricting subtype of anorexia nervosa with an indirect performance-based measure and a self-report measure of craving. An indirect approach avoidance task was administered to measure automatic approach tendencies for high-fat and low-fat food in restricting adolescent AN-like patients (n=89) and a group of healthy adolescents (n=76). As predicted, restricting AN-like patients showed less automatic motivational orientation toward food than healthy controls. In a similar vein, AN-like patients reported less craving for food than the group of healthy controls. The loss of an automatic motivational orientation toward food together with the deliberate strategy to avoid food might help explain the ability of restricting AN-like patients to regulate their food intake.     

A comparison of two psychological treatments for bulimia nervosa

Two standardized psychological treatments for bulimia nervosa were studied. A cognitive behavioural approach was compared with a form of short-term focal psychotherapy. Twenty-four patients who met strict diagnostic criteria for bulimia nervosa were randomly allocated to the two treatments. All the interviews were tape-recorded so that checks on their content could be made. Assessments took place at the beginning and end of treatment, and at 4-, 8- and 12-month follow-up. None of the patients dropped out of treatment or follow-up, but 1 patient from each treatment group had to be withdrawn on clinical grounds. Patients in both groups made substantial improvements which were well maintained over the 12-month treatment-free follow-up period. The cognitive behavioural approach was superior to short-term focal psychotherapy in terms of its effect on the patients' overall clinical state, their general psychopathology and social adjustment, and their assessment of their outcome.     

Predictors of short-term treatment outcome in bulimia nervosa inpatients.

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.     

An experimental study of the relationship between thoughts and eating behaviour in bulimia nervosa

This study tested the hypothesis that cognitive disturbance has a causal role in the maintenance of disturbed eating in bulimia nervosa. Thoughts about eating, weight and shape were activated in one group of patients with bulimia nervosa (the experimental group) but not in another (the control group). There was an increase in negative self-statements in the experimental group following the experimental manipulation. Food consumption was then measured in a taste test. As predicted, the experimental group ate less in the short term than the control group. Contrary to expectations, they did not subsequently report more objective bulimic episodes as a consequence of this decreased food intake. They did, however, report significantly fewer subjective bulimic episodes.     

Relations among premorbid weight,referral weight,and psychological test scores for patients with anorexia nervosa

The purpose of this study was to test the hypothesis that, in anorexia nervosa, patients with a low premorbid weight are associated with a low weight at referral and that premorbid weight, referral weight, and weight loss are associated with mood states. The changes of Body Mass Index from premorbid to referral, the duration of illness, and the psychological scores on the Profile of Mood States and the Cornell Medical Index-Health Questionnaire were examined in 49 anorexia nervous patients. Body Mass Index at referral of patients with lower premorbid Body Mass Index was significantly lower than that of patients with higher premorbid level. For patients with a larger relative decrease, scores on depressive mood were lower. These findings suggested that in anorexia nervosa patients, lower premorbid Body Mass Index was associated with lower Body Mass Index at referral, and that the patients with higher relative decrease in Body Mass Index might be satisfied with their weight loss.     

Approach bias for food cues in obese individuals

This study aimed to investigate the existence of an approach bias for food cues in obese individuals. A community sample of 56 obese women and 56 normal weight controls completed an approach–avoidance variant of the implicit association task. The obese participants were faster to respond to trials that paired food words with approach words, and trials that paired non-food words with avoid words, than the converse pairings, thus, demonstrating an approach bias for food. This bias was evident for both high caloric and low caloric food words, and was not attributable to a state of deprivation or feelings of hunger. By contrast, the normal weight controls did not show any such bias. The results are consistent with recent neurocognitive perspectives of obesity. At a practical level, approach biases for food may present a potential target for modifying (excessive) food intake.     

Microstructural analysis of ingestive behaviour reveals no contribution of palatability to the incomplete extinction of a conditioned taste aversion

An analysis of the microstructure of licking responses was used to investigate the effects of conditioning and extinguishing a taste aversion. Rats received a single pairing of 8% fructose with lithium chloride (LiCl) while controls received unpaired exposure to fructose and LiCl. Pairing fructose with LiCl produced a reduction both in consumption and in the size of licking clusters. Subsequent exposure to fructose in the absence of LiCl produced some extinction of the taste aversion although at asymptote there was a residual difference in consumption between the taste aversion group and unpaired controls. In contrast the reduction in lick cluster size did completely extinguish. Previous analyses of licking microstructure indicate that lick cluster size is related to the palatability of the ingested solution. Thus these results indicate that although taste aversion learning initially reduces the palatability of the cue solution this reduction is not permanent. These results are discussed with reference to the possibility that preparatory behaviours are more resistant to extinction than are consummatory behaviours.     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

The impact of exposure to images of ideally thin models in TV commercials on eating behavior: an experimental study with women diagnosed with bulimia nervosa

This study investigates whether eating behavior in women with diagnosed bulimia nervosa is influenced by prior exposure to images of ideally thin models. Twenty-six participants diagnosed with bulimia nervosa (BN) and 30 normal controls (NC) were exposed to body-related and neutral TV commercials; then food that typically triggers binge eating was provided, and the amount of food eaten was measured. No significant difference for food intake between NC and BN could be found, but food intake for BN was predicted by the degree of thoughts related to eating behaviors during exposure to the thin ideal. No impact of general body image or eating pathology on food intake could be found. The results emphasize the importance of action-relevance of dysfunctional cognitions for the maintenance of eating-disordered behaviors in women with bulimia nervosa, when exposed to eating-disorder-specific triggers.     

Cigarette Smoking and Food Consumption in the United States1

Correlations were computed between United States per capita consumption of cigarettes and 41 different foods for the years 1964–1977 and 1968–1973. There were significant negative correlations between consumption of cigarettes and sugar. Few other foods showed any relationship to cigarette consumption. These findings corroborate the results of a recent human laboratory study of cigarette smoking and food consumption and a recent animal study of the effects of nicotine on food consumption, taste preferences, and body weight. Taken together, these studies suggest that the inverse relationship between cigarette smoking and body weight may be partially explained by changes in consumption of sweet-tasting high caloric foods.     

Action monitoring and perfectionism in anorexia nervosa

To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP component. Questionnaire and behavioral results indicated increased perfectionism in patients with anorexia nervosa. In line with their perfectionism and controlled response style patients made significantly less errors than controls. However, when controlling for this difference in error rates, the EEG results demonstrated a reduced error-related negativity in the patient group. These seemingly contradictory outcomes of improved performance and reduced error monitoring are discussed in relation with indications of anterior cingulate cortex hypoactivity in anorexia nervosa patients.