Eating disorders in the course of life: A qualitative approach to vital change

Eating disorders (EDs) have become one of the biggest mental-health problems in the last decades, especially among youth and women. The present study aims to analyse the suitability of Prochaska and DiClemente’s Transtheoretical Model of Change when applied to the living experiences of people diagnosed with ED and their carers. For this purpose, we applied a narrative biographic approach to the ways in which people face their problems and vital development in the ED domain. Through the narrative analysis of these autobiographies, we aimed to study the patients’ own notions of ‘change’, ‘problem’ and ‘vital trajectory’. We focused on five autobiographic interviews of persons diagnosed as ED (four women and a man). The analysis yields three discourses which organize and give sense to our participants’ vital transitions: a discourse of functional adaptation to events and experiences; one that pays attention to random events and people entering your life; and one that has the personal initiative and agency of an individual agent at its core. It also illuminates particular ways of understanding determination, contemplation and pre-contemplation. These ways of understanding change are shown to extend the possible ways of thinking about people’s lives and ED patients’ perspectives.     

Conscientiousness and (un)healthy eating: The role of impulsive eating and age in the consumption of daily main meals

The present study aims to explore the relationship between conscientiousness and the consumption of healthy versus unhealthy main meals. Impulsive eating was tested as a mediator in this relationship, as well as direct effects of age on those constructs. A nationwide representative sample of 1,006 Norwegian adults (18–70 years) within a prospective design was used to test a theoretical model. The structural equation model (SEM), in combination with bootstrapping procedures in AMOS, was the principal analytical method. Conscientiousness was negatively associated with unhealthy and impulsive eating. Impulsive eating was a partial mediator between conscientiousness and unhealthy eating and a full mediator between conscientiousness and healthy eating. Age was positively correlated with conscientiousness and this relationship had an inverted U‐shape form. Finally, age was negatively associated with unhealthy and impulsive eating, and positively associated with healthy eating. This study confirmed the relevance of conscientiousness for healthy, unhealthy, and impulsive eating.     

Can we link emotional eating with the emotion regulation skills of adolescents?

Objective: A recent cross-sectional study showed that maternal rejection is associated with emotional eating of obese youngsters seeking treatment, and that this relation is mediated by maladaptive emotion regulation (ER) of the youngsters. We wanted to build on this study and investigate the relation between parental rejection, maladaptive ER and emotional eating in a community sample using longitudinal data.

Design: Participants were 81 youngsters between the ages of 10 and 16 years. Participants completed questionnaires assessing maternal and paternal rejection, ER strategies and emotional eating, at two time moments (M = 71 days between time moments). Latent change models were used to estimate level and change of each variable.

Results: Results showed that the levels of maternal rejection, maladaptive ER and emotional eating were related. The indirect effect of the level of maternal rejection on the level of emotional eating through the level of maladaptive ER was marginally significant. On average, maternal rejection showed no change over time, whereas the other variables decreased. The changes in the variables were not related.

Conclusion: The findings highlight the importance of assessing the emotional bond between mother and youngster and the ER of youngsters with an emotional eating style.     

Moderators and predictors of response to eating disorder risk factor reduction programs in collegiate female athletes

ObjectiveThe primary aim of this paper was to investigate moderators and predictors of response to two programs designed to reduce eating disorder risk factors in collegiate female athletes. This study served as an ancillary study to a parent trial that investigated the feasibility of an athlete modified cognitive dissonance-based program (AM-DBP) and an athlete modified healthy weight intervention program (AM-HWI).Design157 female collegiate athletes were randomized to either the AM-DBP or the AM-HWI program. Participants completed surveys at baseline, post-intervention, 6 weeks, and 1 year.MethodsAfter classifying sports as either lean or non-lean, we investigated if sport type acted as a moderator of program response to AM-DBP and AM-HWI using ANOVAs. Next, we examined whether baseline thin-ideal internalization, weight concern, shape concern, bulimic pathology, dietary restraint, and negative affect acted as predictors of changes in bulimic pathology using linear regression models.ResultsAthletes in non-lean sports who received AM-DBP showed more improvement in negative affect versus non-lean sport athletes in AM-HWI. Higher baseline scores of bulimic pathology predicted greater response in bulimic pathology to both programs at 6-weeks. In contrast, athletes with higher dietary restraint and negative affect baseline scores showed decreased response to both interventions at 6-weeks. Finally, athletes with higher baseline shape concern showed a decreased response to the AM-HWI intervention at the post intervention time point.ConclusionResults from the present study indicate that lean/non-lean sport may not play a strong role in determining response to efficacious programs. Further, factors such as pre-existing bulimic pathology, dietary restraint, negative affect, and shape concern may affect general response to intervention versus specific responses to specific interventions.     

Empowerment,feminism, and self-efficacy: Relationships to body image and disordered eating

Sociocultural norms pertaining to an ideal of thinness for women likely play a role in the development and maintenance of disturbance in body image, and by extension, disordered eating. However, competing norms associated with feminism may buffer women from pressures associated with achieving the thin ideal. The present study explored the relationship between feminist ideology, empowerment, and self-efficacy relative to body image and eating behavior with a sample of U.S. undergraduate women (N = 318) attending a southeastern U.S. mid-sized university. In planned hierarchical multiple regression analyses, endorsement of feminist ideology predicted perceptions of positive body image, but did not appear to predict disordered eating. Self-efficacy emerged as a robust predictor of positive body image and lower disordered eating even after controlling for perceptions of personal empowerment and feminism. Results, although limited by correlational data, suggest that self-efficacy may protect college-aged women from disordered eating and negative body image.     

Parenting to prevent body dissatisfaction and unhealthy eating patterns in preschool children: A Delphi consensus study

Interventions to prevent body dissatisfaction and unhealthy eating patterns are needed in early childhood. Identifying effective parenting strategies would be useful for parents and prevention researchers. To develop expert consensus, an online Delphi study was conducted with experts (N = 28, M_age = 44.34) who rated statements describing potential parenting strategies gleaned from a systematic literature search. If 90–100% rated a statement as either Essential or Important, it was endorsed as a guideline. From a total of 335 statements 153 were endorsed. Despite some areas of disagreement, including whether parents should weigh their child or discourage weighing, experts were able to reach consensus on a wide range of issues, such as how to discuss healthy eating with children. The developed guidelines provide a novel and required resource for parents, and a framework for researchers developing interventions to prevent the onset of body dissatisfaction and unhealthy eating patterns in early childhood.     

Fathers,daughters, and self-objectification: Does bonding style matter?

As women are exposed to objectification and the “male gaze,” they self-objectify, which predicts negative psychological outcomes. Given the centrality of the “male gaze,” positive father/child relationships may have a buffering effect. In this study, women (N = 447) completed a survey measuring paternal bonding (care and overprotection), self-objectification, negative eating attitudes, and depression. Women were categorized into four groups based on bonding style. Analyses indicated an interaction such that women who reported high care and low overprotection reported the fewest negative eating attitudes. A path model was tested for each group. The fit of the high care/high overprotection group's model significantly differed from that of the high care/low overprotection group. The relationships between body surveillance and shame as well as between shame and negative eating attitudes were stronger in the former group. These findings suggest that caring but overprotective fathers may exacerbate the negative effects of body surveillance and shame.     

Impaired configural body processing in anorexia nervosa: Evidence from the body inversion effect

Patients with anorexia nervosa (AN) suffer from severe disturbances of body perception. It is unclear, however, whether such disturbances are linked to specific alterations in the processing of body configurations with respect to the local processing of body part details. Here, we compared a consecutive sample of 12 AN patients with a group of 12 age‐, gender‐ and education‐matched controls using an inversion effect paradigm requiring the visual discrimination of upright and inverted pictures of whole bodies, faces and objects. The AN patients presented selective deficits in the discrimination of upright body stimuli, which requires configural processing. Conversely, patients and controls showed comparable abilities in the discrimination of inverted bodies, which involves only detail‐based processing, and in the discrimination of both upright and inverted faces and objects. Importantly, the body inversion effect negatively correlated with the persistence scores at the Temperament and Character Inventory, which evaluates increased tendency to convert a signal of punishment into a signal of reinforcement. These results suggest that the deficits of configural processing in AN patients may be associated with their obsessive worries about body appearance and to the excessive attention to details that characterizes their general perceptual style.     

A Network Analysis Investigation of Disordered Eating Across Demographic and Developmental Subpopulations Using a National Epidemiological Sample of High School Students

Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographics influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nationally representative epidemiological sample of high school students (Youth Risk Behavior Survey, United States; n = 59,582) to identify the most important symptoms and symptom relationships among six DE behaviors. We compared networks by sex, grade, and race to identify differences in symptom networks. Dieting for weight loss was highly central across networks. Networks significantly differed across sex, grade, and race. Our results suggest that dieting for weight loss may be an early intervention target for eating disorders, regardless of demographic and developmental factors. In addition, sex, race, and age should be accounted for when researching and developing prevention programs for DE and eating disorders. Public health officials, as well as mental health professionals, should present a more balanced message about dieting and weight loss to high school students to prevent the detrimental impact of DE on physical and mental health. Notably, this study is the first large, nationwide epidemiological sample using DE symptoms in network analysis.     

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1–9, and sessions 10–16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.