Deborah J. Wallis

Stress and eating: the effects of ego-threat and cognitive demand on food intake in restrained and emotional eaters

Restrained and emotional eaters overeat in response to stress. To compare differential effects of cognitive demand and ego-threatening stressors on subsequent chocolate intake, 38 females completed a neutral (control), an ego threatening and an incongruent Stroop colour-naming task on three separate occasions. Participants were assigned to four groups based on median-split scores on the restrained and emotional eating scales of the Dutch Eating Behaviour Questionnaire-high restraint/high emotional, high restraint/low emotional, low restraint/high emotional and low restraint/low emotional. Higher response latencies were observed in the incongruent task, confirming its greater cognitive (attentional) demand. Overall intake was enhanced by 23% after ego-threat and 15% after the incongruent Stroop task relative to control. Restraint was associated with greater intake after both ego-threat and the incongruent task than in the control condition. In contrast, emotional eating was associated with greater intake after only the ego-threat, relative to control. A positive association between reaction time and subsequent intake in all conditions for high restraint/low emotional eaters provided support for the limited capacity hypothesis. Enhanced intake in emotional eaters is proposed to relate to escape from self-awareness. These findings demonstrate differential effects of threat and demand on stress-related eating in restrained and emotional eaters.

Stimulation of appetite by alcohol

To investigate the effects of alcohol on appetite and food intake, 26 males attended the laboratory on three occasions. On each occasion, they were given a standard breakfast. Visual analog scale ratings of hunger, desire to eat and fullness (appetite ratings) were recorded from before breakfast until their return to the laboratory for lunch. Thirty minutes before lunch, subjects either rested (baseline), were given 330 ml of a no-alcohol lager (264 kJ: no-alcohol condition) or 330 ml of the same lager spiked with 3 units of alcohol (24 g ethyl alcohol; total energy=969 kJ: alcohol condition). Ratings of appetite were taken before and after the preload or baseline rest period and again before and hourly after lunch. The test meal at lunch consisted of a buffet-style array of foods and chilled water. Ad libitum intake at lunch (excluding energy from alcohol) was significantly higher following alcohol (7301+/-442 kJ) compared to both baseline (6365+/-334 kJ) and the no-alcohol conditions (6479+/-289 kJ). Appetite ratings failed to demonstrate any differences between alcohol and the no-alcohol condition. Total energy intake (including energy from alcohol) was enhanced in the alcohol condition by 30%, suggesting that energy from alcohol is not compensated in the short-term and may even have a stimulatory effect on food intake.

Emotion recognition and alexithymia in females with non-clinical disordered eating

OBJECTIVES The aims were to determine if emotion recognition deficits observed in eating disorders generalize to non-clinical disordered eating and to establish if other psychopathological and personality factors contributed to, or accounted for, these deficits. DESIGN Females with high (n=23) and low (n=22) scores on the Eating Disorder Inventory (EDI) were assessed on their ability to recognise emotion from videotaped social interactions. Participants also completed a face memory task, a Stroop task, and self-report measures of alexithymia, depression and anxiety. RESULTS Relative to the low EDI group, high EDI participants exhibited a general deficit in recognition of emotion, which was related to their scores on the alexithymia measure and the bulimia subscale of the EDI. They also exhibited a specific deficit in the recognition of anger, which was related to their scores on the body dissatisfaction subscale of the EDI. CONCLUSIONS In line with clinical eating disorders, non-clinical disordered eating is associated with emotion recognition deficits. However, the nature of these deficits appears to be dependent upon the type of eating psychopathology and the degree of co-morbid alexithymia.

Childhood obesity and socioeconomic status: a novel role for height growth limitation.

OBJECTIVE:To assess prevalence and socioeconomic context of overweight and obesity in a cohort of Scottish children.DESIGN:Cross-sectional study.SETTING:Primary schools in Dundee, Angus, and Fife, Eastern Scotland, UK.PARTICIPANTS:A total of 1240 boys and 1214 girls aged between 4–10 y.MAIN OUTCOME MEASURE:Weight, height and body mass index (weight/height2).RESULTS:Overall overweight or obesity prevalence was 24.6%, while prevalence of obesity alone was 6.1%. Individuals from schools with a high level of low-income families were 65% more likely to be overweight as judged by BMI. However, these children weighed the same as more affluent children of the same age, but were 1.26 cm shorter.CONCLUSION:These data confirm the continued increase in childhood obesity in the UK and reveal a role for height-growth limitation in the absence of overall growth restriction, among children from low-income groups. This observation raises important questions regarding socioeconomic environmental factors in promoting the currently increasing levels of obesity.

Using intervention mapping to develop a work-related guidance tool for those affected by cancer

BackgroundWorking-aged individuals diagnosed and treated for cancer require support and assistance to make decisions regarding work. However, healthcare professionals do not consider the work-related needs of patients and employers do not understand the full impact cancer can have upon the employee and their work. We therefore developed a work-related guidance tool for those diagnosed with cancer that enables them to take the lead in stimulating discussion with a range of different healthcare professionals, employers, employment agencies and support services. The tool facilitates discussions through a set of questions individuals can utilise to find solutions and minimise the impact cancer diagnosis, prognosis and treatment may have on their employment, sick leave and return to work outcomes. The objective of the present article is to describe the systematic development and content of the tool using Intervention Mapping Protocol (IMP).MethodsThe study used the first five steps of the intervention mapping process to guide the development of the tool. A needs assessment identified the ‘gaps’ in information/advice received from healthcare professionals and other stakeholders. The intended outcomes and performance objectives for the tool were then identified followed by theory-based methods and an implementation plan. A draft of the tool was developed and subjected to a two-stage Delphi process with various stakeholders. The final tool was piloted with 38 individuals at various stages of the cancer journey.ResultsThe tool was designed to be a self-led tool that can be used by any person with a cancer diagnosis and working for most types of employers. The pilot study indicated that the tool was relevant and much needed.ConclusionsIntervention Mapping is a valuable protocol for designing complex guidance tools. The process and design of this particular tool can lend itself to other situations both occupational and more health-care based.

“All eyes are on you”: anorexia nervosa patient perspectives of in-patient mealtimes.

The aim of this qualitative study was to investigate in-patient perceptions of mealtimes on eating disorders units. Individual interviews were conducted with 12 women with anorexia nervosa. Using thematic analysis, three themes emerged as important: 1) Mealtime delivery (logistical factors influencing meals); 2) Individual outcomes (cognitions, emotions, behaviours and physical sensations during meals); and 3) Mealtime characteristics (including disengagement, perceived battlegrounds, and a desire for involvement in mealtimes). Future research should focus on areas of treatment delivery identified as important by patients. Recommendations are made regarding mealtime protocols based on patients’ views, with increased recognition of behavioural, cognitive, physical and emotional aspects.

Effects of distraction and focused attention on actual and perceived food intake in females with non-clinical eating psychopathology.

The aim of this study was to determine the effects of distraction and focused attention on both food intake and accuracy of perceived intake in women with non-clinical levels of disordered eating. In a laboratory study, twenty-seven young women consumed three identical pasta meals once a week for three consecutive weeks. Meals were eaten ad libitum during a control and two test conditions, in which attention was either diverted away from (distraction condition) or directed towards food-related stimuli (focused attention condition). They also completed the drive for thinness, bulimia and body dissatisfaction subscales of the Eating Disorders Inventory-2. Intake was significantly higher in the distraction than in the control or focused attention conditions, but was not related to eating psychopathology. A measure of accuracy of perceived intake indicated that drive for thinness was associated with overestimation of food intake in the focused attention condition. This study suggests that distraction could promote food intake in all non-clinical consumers, irrespective of individual differences in eating behaviours. Furthermore, it suggests that those with a high drive for thinness may overestimate intake when required to focus on their food. These findings could have implications for mealtime interventions in the treatment of eating disorders.

The influence of emotional intensity on facial emotion recognition in disordered eating

Significant facial emotion recognition (FER) deficits have been observed in participants exhibiting high levels of eating psychopathology. The current study aimed to determine if the pattern of FER deficits is influenced by intensity of facial emotion and to establish if eating psychopathology is associated with a specific pattern of emotion recognition errors that is independent of other psychopathological or personality factors. Eighty females, 40 high and 40 low scorers on the Eating Disorders Inventory (EDI) were presented with a series of faces, each featuring one of five emotional expressions at one of four intensities, and were asked to identify the emotion portrayed. Results revealed that, in comparison to Low EDI scorers, high scorers correctly recognised significantly fewer expressions, particularly of fear and anger. There was also a trend for this deficit to be more evident for subtle displays of emotion (50% intensity). Deficits in anger recognition were related specifically to scores on the body dissatisfaction subscale of the EDI. Error analyses revealed that, in comparison to Low EDI scorers, high scorers made significantly more and fear-as-anger errors. Also, a tendency to label anger expressions as sadness was related to body dissatisfaction. Current findings confirm FER deficits in subclinical eating psychopathology and extend these findings to subtle expressions of emotion. Furthermore, this is the first study to establish that these deficits are related to a specific pattern of recognition errors. Impaired FER could disrupt normal social functioning and might represent a risk factor for the development of more severe psychopathology.

Can physical activity help to maintain cognitive functioning and psychosocial well-being among breast cancer patients treated with chemotherapy? A randomised controlled trial study protocol

BackgroundEvidence suggests chemotherapy treatment for breast cancer is associated with side effects such as cognitive impairment in domains of memory, attention, concentration and executive function. Cognitive impairments reported by patients have been associated with higher levels of emotional distress. To date, intervention studies to alleviate cognitive impairment associated with chemotherapy have focused on psycho-educational techniques or cognitive training. Studies have not yet considered physical activity as a potential for alleviating cognitive problems. Physical activity interventions are reported to be effective in alleviating emotional distress and fatigue in those with breast cancer. They have also been reported to improve cognitive functioning in the elderly, in those suffering with dementia and in children. We propose that physical activity could also help to alleviate cognitive impairments in women diagnosed with breast cancer. The study has been designed using a recently developed taxonomy of behaviour change techniques to reliably report the content of the intervention to allow future replication.MethodThis study will deliver a home-based moderate intensity walking intervention to women diagnosed with breast cancer mid-way through their chemotherapy treatment and will compare them to patients receiving usual care alone. The primary outcome measure for this intervention is changes in an objective measure of memory assessed using the Digit Span. Secondary outcome measures include: objective measures of executive function; attention; visual spatial skills; self report cognitive function; self-report fatigue; anxiety; depression; mood and self-esteem. As emotional distress has been associated with self-reporting of cognitive problems, this intervention will further test whether emotional distress mediates between the amount of walking undertaken during the intervention period and levels of self-reported cognitive functioning.DiscussionThe development of an effective intervention for preventing difficulties in emotional and cognitive functioning of cancer patients’ post-treatment will help to guide health care professionals to improve patients’ overall quality of life. It will also provide direction for future research, ultimately to improve the day to day functioning of breast cancer survivors.Trial RegistrationCurrent Controlled Trials ISRCTN50709297.

Attentional Bias and Slowed Disengagement from Food and Threat Stimuli in Restrained Eaters Using a Modified Stroop Task

This experiment examined fast (orientation) and slow (disengagement) components of attention to food and interpersonal threat words in high and low restrained eaters using a modified Stroop task. Target words (food, interpersonal ego threat, neutral) were presented prior to a sequence of four matched neutral words. Participants were slow to disengage from food and ego threat words, and this pattern was particularly striking for the high restraint group. Findings show no evidence of an orientation bias but indicate that slowed disengagement from these stimuli can be demonstrated consistently using the Stroop task. However, restraint was not a significant predictor, and slowed disengagement was also found in the neutral condition, suggesting a categorical effect. This study provides important suggestions for modifications of Stroop tasks designed to target both attention bias and disengagement. Implications of slowed disengagement from disorder-relevant stimuli are discussed in relation to the development of disordered eating.