Cortney S. Warren

Eating Disorder Prevention Research: A Meta-Analysis

Eating disorder prevention programs have yielded mixed results and are somewhat controversial, primarily because of claims they may produce iatrogenic effects. We used meta-analysis to evaluate the effectiveness of eating disorder prevention programs and investigate moderators of intervention effects. Overall, prevention programs had large effects on improving knowledge and small net effects on reducing maladaptive eating attitudes and behaviors. Studies targeting participants at a relatively higher risk for developing an eating disorder produced greater benefits. Concerns about iatrogenic effects of including psychoeducational material on eating disorders were not supported by the data. These findings challenge conclusions drawn in previous review articles regarding the ineffectiveness of prevention programs and support the ability of eating disorder prevention programs to demonstrate behavioral improvements. Portions of this paper were presented at the 2003 convention for the Association for Advancement of Behavior Therapy.

Food cravings discriminate between anorexia and bulimia nervosa. Implications for success versus failure in dietary restriction

Food cravings are subjective, motivational states thought to induce binge eating among eating disorder patients. This study compared food cravings across eating disorders. Women (N=135) diagnosed with anorexia nervosa, restrictive (ANR) or binge-purging (ANBP) types, or bulimia nervosa, non-purging (BNNP) or purging (BNP) types completed measures of food cravings. Discriminant analysis yielded two statistically significant functions. The first function differentiated between all the four group pairs except ANBP and BNNP, with levels of various food-craving dimensions successively increasing for ANR, ANBP, BNNP, and BNP participants. The second function differentiated between ANBP and BNNP participants. Overall, the functions improved classification accuracy above chance level (44% fewer errors). The findings suggest that cravings are more strongly associated with loss of control over eating than with dietary restraint tendencies.

Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders?

Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of ones appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N=236; N=136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.

The relationship between quality of life, binge-eating disorder, and obesity status in an ethnically diverse sample.

This study examined the relationship between obesity status, binge‐eating disorder (BED), and quality of life (QOL) in a large, ethnically diverse community sample of adult men and women. Using data from the Collaborative Psychiatric Epidemiological Surveys (N = 20,013), individuals were categorized into four groups: nonobese with BED (n = 142), nonobese without BED (n = 14,301), obese with BED (n = 136), and obese without BED (n = 4,863). Results indicated obese individuals with BED consistently reported the poorest QOL. Findings suggested that obesity status was more strongly related to physical health‐related QOL variables (e.g., number of physical conditions, mobility impairment) whereas diagnostic status was more predictive of mental health and social functioning QOL variables (e.g., cognitive impairment, social interaction impairment, time out of role). The degree to which lifetime BED diagnosis was associated with impairment in social interaction differed across ethnic groups. For black individuals, the number of physical health conditions was associated with BED presence moreso than weight status.

Adaptation of the food-craving questionnaire trait for the assessment of chocolate cravings : Validation across British and Spanish Women

English and Spanish versions of the FCQ-T [Cepeda-Benito, A., Gleaves, D. H., Williams, T. L., & Erath, S. A. (2000). The development and validation of the state and trait food-cravings questionnaires. Behavior Therapy, 31, 151-173] were adapted to create the food chocolate-craving questionnaire trait (FCCQ-T). Female college students from England (N=293), and Spain (N=373) completed the FCCQ-T. Good and similar measurement fits for the English and Spanish versions were found. In concordance with the higher consumption of chocolate in Britain, British women reported greater chocolate cravings than Spanish women. Overall, the FCCQ-T appears a well-suited instrument to investigate chocolate cravings in English- and Spanish-speaking populations.

The Continuity/Discontinuity Models of Eating Disorders A Review of the Literature and Implications for Assessment, Treatment, and Prevention

Are the eating disorders discrete diagnostic entities or do they fall along one or more continua ranging from normal body weight, eating behavior, and weight concerns to severely disturbed patterns? Researchers have debated this question for at least 30 years and have used numerous creative strategies to examine this and related questions. This body of research is reviewed with particular attention to the more recent use of taxometric methods. Although somewhat mixed, much of the earlier research has been interpreted as supporting the continuity model. However, more recent taxometric research suggests the presence of one or more latent discontinuities, particularly with disorders associated with binge eating. These findings have implications for assessment, treatment, and possible prevention of eating disorders, and may ultimately allow us to better predict who will or will not develop an eating disorder in response to dieting, as well as who will or will not respond to particular treatments for an existing eating disorder.

Self-objectification, body self-consciousness during sexual activities, and sexual satisfaction in college women

Few studies examine the mechanisms that link body image to sexual satisfaction in women. Using the tenets of objectification theory, this study investigated the relationships between body surveillance, body shame, body self-consciousness during sexual activities, and sexual satisfaction in an ethnically diverse sample of American female college students (N=368), while controlling for relationship status and body mass index. Results based on self-report measures of these constructs suggested that body shame and body self-consciousness during sexual activity were negatively correlated with sexual satisfaction. Additionally, path analysis indicated that body surveillance predicted increased body self-consciousness during sexual activity, partially mediated by body shame. Body self-consciousness, in turn, predicted decreased sexual satisfaction. Overall, study findings highlight the negative consequences of body image concerns for womens sexual satisfaction.

The sociocultural model of eating disorders in Mexican American women: behavioral acculturation and cognitive marginalization as moderators.

White American cultural values of appearance are implicated in the development of body dissatisfaction. This study examined whether the relationships between awareness of White American appearance ideals, internalization of such ideals, and body dissatisfaction are moderated by behavioral acculturation and attitudinal marginalization in a sample of 94 Mexican American women. Results indicated that behavioral acculturation moderated the relationship between awareness and internalization and cognitive marginalization moderated the relationship between internalization and body dissatisfaction. Body size was positively correlated with body dissatisfaction and negatively correlated with behavioral acculturation. These findings have important implications for clinical practice and research with Mexican American women.

Binge Eating Disorder Mediates Links between Symptoms of Depression, Anxiety, and Caloric Intake in Overweight and Obese Women

Despite considerable comorbidity between mood disorders, binge eating disorder (BED), and obesity, the underlying mechanisms remain unresolved. Therefore, the purpose of this study was to examine models by which internalizing behaviors of depression and anxiety influence food intake in overweight/obese women. Thirty-two women (15 BED, 17 controls) participated in a laboratory eating-episode and completed questionnaires assessing symptoms of anxiety and depression. Path analysis was used to test mediation and moderation models to determine the mechanisms by which internalizing symptoms influenced kilocalorie (kcal) intake. The BED group endorsed significantly more symptoms of depression (10.1 versus 4.8, P = 0.005 ) and anxiety (8.5 versus 2.7, P = 0.003). Linear regression indicated that BED diagnosis and internalizing symptoms accounted for 30% of the variance in kcal intake. Results from path analysis suggested that BED mediates the influence of internalizing symptoms on total kcal intake (empirical P < 0.001 ). The associations between internalizing symptoms and food intake are best described as operating indirectly through a BED diagnosis. This suggests that symptoms of depression and anxiety influence whether one engages in binge eating, which influences kcal intake. Greater understanding of the mechanisms underlying the associations between mood, binge eating, and food intake will facilitate the development of more effective prevention and treatment strategies for both BED and obesity.

The relationships between fat talk, body dissatisfaction, and drive for thinness: perceived stress as a moderator.

Although body dissatisfaction and drive for thinness are commonplace in college-aged women, their relationships with fat talk and stress are understudied. This study examined (a) whether fat talk predicts body dissatisfaction and drive for thinness and (b) whether stress moderates these relationships. Results from self-report questionnaires completed by 121 female college students revealed that fat talk and perceived stress were significantly positively correlated with body dissatisfaction and drive for thinness. Although fat talk was a significant independent predictor of body dissatisfaction and drive for thinness, stress moderated these relationships such that they were stronger at lower stress levels. Although contrary to predictions, these results are logical when means are considered. Results suggest that fat talk positively predicts body dissatisfaction and drive for thinness in students with relatively lower stress levels, but does not for students under high stress because mean levels of these constructs are all already high.