High self-reported rates of neglect and emotional abuse, by persons with binge eating disorder and night eating syndrome

This study compared rates of self-reported childhood maltreatment in three groups diagnosed using semi-structured interviews: binge eating disorder (BED; n=176), night eating syndrome (NES, n=57), and overweight/obese comparison (OC, n=38). We used the Childhood Trauma Questionnaire (CTQ) to assess childhood maltreatment and the Beck Depression Inventory-II to assess depression levels. Reports of maltreatment were common in patients with BED (82%), NES (79%), and OC (71%). The BED group reported significantly more forms of maltreatment above clinical cut-points (2.4) than the OC (1.4) group but not the NES (1.8) group. The BED and NES groups reported more emotional abuse than the OC group. A higher proportion of the BED group reported emotional neglect and a higher proportion of the NES group reported physical neglect. Depression levels, which were higher in BED and NES than OC, were associated with higher levels of physical and emotional abuse and neglect. In conclusion, reported rates of physical and sexual abuse differed little across groups, whereas reports of neglect and emotional abuse were higher in the BED and NES groups than in the OC group and were associated with elevated depression levels.     

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.     

Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study

Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.     

Effects of Participant’s Choice of Different Digital Interventions on Outcomes for Binge-Spectrum Eating Disorders: A Pilot Doubly Randomized Preference Trial

It is unclear whether offering individuals a choice between different digital intervention programs affects treatment outcomes. To generate initial insights, we conducted a pilot doubly randomized preference trial to test whether offering individuals with binge-spectrum eating disorder a choice between two digital interventions is causally linked with superior outcomes than random assignment to these interventions. Participants with recurrent binge eating were randomized to either a choice (n = 77) or no-choice (n = 78) group. Those in the choice group could choose one of the two digital programs, while those in the no-choice group were assigned a program at random. The two digital interventions (a broad and a focused program) took 4 weeks to complete, were based on cognitive-behavioral principles and have demonstrated comparable efficacy, but differ in scope, content, and targeted change mechanisms. Most participants (79%) allocated to the choice condition chose the broad program. While both groups experienced improvements in primary (Eating Disorder Examination Questionnaire global scores and number of binge eating episodes over the past month) and secondary outcomes (dietary restraint, body image concerns, etc.), no significant between-group differences were observed. The two groups did not differ on dropout rates, nor on most indices of intervention engagement. Findings provide preliminary insights towards the role of client preferences in digital mental health interventions for eating disorders. Client preferences may not determine outcomes when digital interventions are based on similar underlying principles, although larger trials are needed to confirm this.     

Sharing food with infants in Hadza communities in Tanzania

By analyzing mealtime interactions of Tanzanian Hadza infants with their interactional partners, we explored how two foundational schemas, namely giving/sharing and autonomy are realized and fostered in infants. We focused on three aspects of the mealtime interactions, namely how the infants’ share was protected, whether independent eating was fostered by the infants’ interactional partners, and how infants were encouraged to share food. To answer these questions, we also considered the settings that were created for infant eating, persons involved, and characteristics of the foods. Hadza infants (N = 24) between the ages of approximately 6 and 27 months were video recorded in mealtime situations. The videos were analyzed qualitatively and revealed the following patterns: First, infants’ shares were protected by eating meals in secluded places or providing infants with separate dishes. Second, independent eating was situational. It can be limited according to the child’s interest in the food or by the interactional partner. Some caregivers subtly enhanced independence by appearing unaware of infants’ signals. Third, sharing was encouraged and supported when it occurred spontaneously. Infants were also asked to share and occasionally tricked into sharing. Tolerated scrounging seemed to be generally accepted by both infants and caregivers. However, we also observed conflicts in competitive situations and somewhat overwhelmed infants. These results are discussed in light of hunter-gatherers’ foundational schemas and livelihood changes observed in the Hadza.     

Functional Analysis and Treatment of Mealtime Problem Behavior for a Person with Developmental Disabilities

We conducted a functional analysis of problem behaviors (spitting and whining) during meals and tested an intervention based on that analysis. The participant was a 13-year-old young woman with severe mental retardation and cerebral palsy. She ate all food presented to her, and the hypotheses were tested that the problem behaviors were maintained either by contingent access to trainer attention or the pace of eating. An attention analysis examined the relationship between problem behavior and trainer attention during the meal. The effect of attention following problem behavior versus ignoring was inconclusive. An analysis of the effects of teacher paced eating, student paced eating (reinforce spoon grasping) and food presented for problem behavior was conducted next. Problem behavior rates were highest when access to food was made contingent on the performance of problem behavior and lowest when spoon grasping resulted in a bite of food. Following analysis, an intervention was designed to reduce the frequency of targeted problem behaviors during mealtime. Reinforcing spoon grasping and a 10s removal of food following problem behavior dramatically reduced spitting and whining during meals. The study provides a demonstration of an extended functional analysis and treatment of a complex behavior pattern.     

IMPROVING DIETARY PRACTICES OF ELDERLY INDIVIDUALS: THE POWER OF PROMPTING,FEEDBACK, AND SOCIAL REINFORCEMENT

Three intervention packages consisting of (a) enhanced prompts, feedback, and social reinforcement; (b) a lottery; and (c) serving as a confederate were added and removed in sequence as adjacent conditions in an extended withdrawal design to assess their effects on the dietary choices of elderly persons. Participants were 3 elderly residents of an independent living facility who were identified as making consistently poor dietary choices and who had medical conditions that necessitated changes in their eating habits. All 3 participants demonstrated a marked increase in healthy choices of food items in response to the package of enhanced prompts, feedback, and social reinforcement. No additional increase occurred with the introduction of the lottery and serving as a confederate. Food-choice data indicated that most of these improvements could be attributed to healthier entree and dessert choices. Group data for all residents suggested small improvements in dietary practices during the three intervention conditions, with the largest proportion of the group's healthy choices occurring when the lottery was added to enhanced prompts, feedback, and social reinforcement. Food-choice data indicated that most of these improvements could be attributed to healthier dessert choices alone.     

Body Image Testing System: A microcomputer program for assessing body image

An interactive computer program, the Body Image Testing System (BITS), was developed to assess different components of the body image construct. The BITS program displays a frontal and side view of a human body. Subjects can change the size of each of nine body parts independently (face, neck, shoulders, arms, chest, breasts, stomach, hips, and thighs). Subjects interact with the program until satisfied that the image created matches the instructions. Subjects also provide satisfaction ratings for the nine body segments. To validate BITS, a variety of body image and eating disturbance measures was obtained from over 500 subjects. A factor analysis of actual-ideal differences and a perceptual distortion measure, derived using multiple regression, resulted in five orthogonal factors. Factor 1 measured actual-ideal discrepancy for weight-sensitive body parts. Factor 2 measured the perceptual distortion of weight-sensitive body parts. Additional factors measured perception of face and neck, shoulders, and breasts. The five factor scores plus the satisfaction ratings were strongly associated with actual body size, body fat percentage, and circumference of specific body parts. In addition, there were strong associations between the BITS and other measures of body image. Finally, BITS scores accounted for between 15 and 60% of the variance in measures of eating disturbance.     

Associations Between Peer Pressure and Adolescents’ Binge Behaviors: The Role of Basic Needs and Coping

Framed from a framework based on the integration of self-determination theory (Ryan &; Deci, 2000 Ryan, R. M., &; Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. doi:10.1037/0003-066X.55.1.68[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and Endler and Parker’s (1990) conception of coping strategies, the authors analyzed the relationships between peer pressure and binge behaviors (binge eating and binge drinking) in adolescence. Moreover, the authors explored the mediating role of satisfaction/frustration of basic psychological needs and coping strategies in these associations. Participants were 570 high school students (M?=?15.75 years, SD?=?1.14 years) living in Italy. The study design was cross-sectional and adolescents were administered self-report questionnaires. Path analysis showed significant and positive direct associations of peer pressure with both binge eating and binge drinking. Moreover, findings show that there is an indirect path in which peer pressure is positively associated with need frustration that is related to the use of emotion-oriented coping strategies that, on their turn, are associated with binge eating. Differently, binge drinking seems to be only directly related to peer pressure. The authors put light to the complex nature of the relationships between peer pressure and binge behaviors in adolescence, taking into account the separate contribution of need satisfaction and need frustration, as well as of coping strategies. Finally, practical implications of the study are discussed.     

Validation of the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Chinese adolescents

We sought to validate the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Chinese adolescents and investigate differences in eating behaviors among Chinese normal weight, overweight, and obese adolescents. Chinese middle and high school students completed the DEBQ, Eating Disorder Inventory-1, and the Self-Control Scale. Result showed that the DEBQ had good internal consistency, test–retest reliability and criterion validity. Furthermore, the obese and overweight adolescents scored significantly higher than normal weight adolescents on three subscales. The DEBQ is effective for assessing eating behaviors in Chinese adolescents.