Emily H. Feig

Dieting and restrained eating as prospective predictors of weight gain

Research in normal weight individuals paradoxically suggests that measures of attempted eating restriction might represent robust predictors of weight gain. This review examined the extent to which measures of dieting (e.g., self-reported weight loss dieting in the past year) and dietary restraint (e.g., the Cognitive Restraint scale from the Three-Factor Eating Questionnaire) have prospectively predicted weight change. We located and reviewed 25 prospective studies containing 40 relevant comparisons. Studies were limited to those in which participants were non-obese (with a mean BMI between 18.5 and 30) and averaged at least 12 years old. Neither measure predicted future weight loss. Fifteen of the 20 comparisons (75%) that examined measures of dieting significantly predicted future weight gain whereas only 1 of 20 (5%) that examined restrained eating measures did so. Two plausible explanations for these findings are that: (1) dieters and restrained eaters do not differ in terms of an underlying proneness toward weight gain, but restrained eating represents a more effective means of preventing it; and (2) normal weight individuals who diet do so because they are resisting a powerful predisposition toward weight gain which dieting ultimately fails to prevent. Recent dieting in non-obese individuals may be a valuable proxy of susceptibility to weight gain. This easily assessed characteristic could identify individuals for whom obesity prevention interventions would be particularly appropriate.

Differentiating nonrestorative sleep from nocturnal insomnia symptoms: demographic, clinical, inflammatory, and functional correlates

STUDY OBJECTIVES Recent studies have suggested that nonrestorative sleep (NRS) symptoms may be distinct from nocturnal insomnia symptoms (NIS). However, there is limited information on the demographic, medical, and biologic correlates of NRS independent from NIS in the general population. This report presents the sociodemographic correlates, patterns of comorbidity with other sleep and physical disorders, C-reactive protein (CRP) levels, and general productivity associated with NIS and NRS in a nationally representative sample of US adults. DESIGN National Health and Nutrition Examination Survey (NHANES). SETTING The 2005-2008 surveys of the general population in the United States. PARTICIPANTS There were 10,908 individuals (20 years or older). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Respondents were classified by the presence or absence of NIS and NRS. Compared with those without insomnia symptoms, respondents with NIS were older and had lower family income and educational levels than those with NRS. In addition, there was a significant association between NIS and cardiovascular disease, whereas NRS was associated with other primary sleep disorders (including habitual snoring, sleep apnea, and restless legs syndrome), respiratory diseases (emphysema and chronic bronchitis), thyroid disease, and cancer as well as increased CRP levels. In addition, the study participants with NRS only reported poorer scores on the Functional Outcomes of Sleep Questionnaire (FOSQ) than those without insomnia symptoms or those with NIS only. CONCLUSIONS These findings suggest that there are substantial differences between NIS and NRS in terms of sociodemographic factors, comorbidity with other sleep and physical disorders, increased CRP level, and functional impairment. An inflammatory response might play a unique role in the pathogenesis of NRS.

Suicidal behavior in adolescents and adults with bulimia nervosa

BACKGROUND Recent evidence suggests increased risk for mortality in bulimia nervosa (BN). However, little is yet known about suicidal behavior in BN. AIMS To examine frequency and correlates of suicidal ideation and attempts in adolescents and adults with BN in two population-based samples. METHOD A total of 10,123 adolescents and 2980 adults in two nationally representative surveys of mental disorder were queried regarding eating disorder symptoms and suicidal ideation and attempts. RESULTS Less than 1 percent (0.9%) of adolescents and 1.0% of adults met the criteria for BN. Suicidal ideation was more common among adolescents with BN (53.0%) compared with those with binge eating disorder (BED) (34.4%), other psychopathology (21.3%) or no psychopathology (3.8%). Similar trends emerged for the association between BN and self-reported suicidal plans or attempts. Among adults, suicidality was more common in BN than in the no psychopathology group, but not significantly different from the anorexia nervosa (AN), BED, or other psychopathology subgroups. CONCLUSION There is a high risk of suicidal ideation and behavior among those with BN. These results underscore the importance of addressing suicide risk in adolescents and adults with eating disorder symptoms.

Short-term variability in body weight predicts long-term weight gain

BACKGROUND Body weight in lower animals and humans is highly stable despite a very large flux in energy intake and expenditure over time. Conversely, the existence of higher-than-average variability in weight may indicate a disruption in the mechanisms responsible for homeostatic weight regulation. OBJECTIVE In a sample chosen for weight-gain proneness, we evaluated whether weight variability over a 6-mo period predicted subsequent weight change from 6 to 24 mo. DESIGN A total of 171 nonobese women were recruited to participate in this longitudinal study in which weight was measured 4 times over 24 mo. The initial 3 weights were used to calculate weight variability with the use of a root mean square error approach to assess fluctuations in weight independent of trajectory. Linear regression analysis was used to examine whether weight variability in the initial 6 mo predicted weight change 18 mo later. RESULTS Greater weight variability significantly predicted amount of weight gained. This result was unchanged after control for baseline body mass index (BMI) and BMI change from baseline to 6 mo and for measures of disinhibition, restrained eating, and dieting. CONCLUSIONS Elevated weight variability in young women may signal the degradation of body weight regulatory systems. In an obesogenic environment this may eventuate in accelerated weight gain, particularly in those with a genetic susceptibility toward overweight. Future research is needed to evaluate the reliability of weight variability as a predictor of future weight gain and the sources of its predictive effect. The trial on which this study is based is registered at clinicaltrials.gov as NCT00456131.

Variability in Weight Change Early in Behavioral Weight Loss Treatment: Theoretical and Clinical Implications

Response early in weight loss treatment predicts long‐term weight change. Weight variability, independent of absolute early weight change, may also relate to long‐term outcomes. This study examined whether weight variability early in treatment predicted later weight loss and maintenance.

Menstrual cycle loss and resumption among patients with anorexia nervosa spectrum eating disorders: Is relative or absolute weight more influential?

OBJECTIVE Prior research suggests that both body mass index (BMI) and weight suppression (highest past weight minus current weight; WS) are important in determining adult anorexia nervosa (AN) severity. We examined associations between amenorrhea and WS, DSM-5 BMI severity category, and highest premorbid BMI among patients with AN. METHOD Participants (N = 69) were adult female AN-spectrum patients at two residential treatment facilities. At admission, height, and weight were measured, and participants completed questionnaires assessing menstrual status and weight history. RESULTS Greater WS, adjusted for BMI, was associated with menstrual function at admission. First amenorrhea onset occurred at a normal BMI for 38.5% of participants. Premorbid highest BMI positively correlated with BMI at amenorrhea onset, and higher BMI at amenorrhea onset was associated with higher BMI at menses resumption. DISCUSSION These findings add to the literature indicating that relative and absolute weight status are dual indicators of illness severity in AN, and preliminarily suggest that a large proportion of adults who present for treatment initially may have shown symptoms of starvation at a normal BMI. Results underscore the need to focus on weight loss in early detection efforts and may inform target weight setting in the treatment of AN.

The relation of hedonic hunger and restrained eating to lateralized frontal activation.

Asymmetrical alpha activation in the prefrontal cortex (frontal asymmetry) in electroencephalography (EEG) has been related to eating behavior. Prior studies linked dietary restraint with right frontal asymmetry [1] and disinhibition with left frontal asymmetry [2]. The current study simultaneously assessed restrained eating and hedonic hunger (drive for food reward in the absence of hunger) in relation to frontal asymmetry. Resting-state EEG and measures of restrained eating (Revised Restraint Scale; RRS) and hedonic hunger (Power of Food Scale; PFS) were assessed in 61 non-obese adults. Individually, hedonic hunger predicted left asymmetry. However, PFS and RRS were correlated (r=0.48, p<0.05) and there was a significant interaction between PFS and RRS on frontal asymmetry, p<0.01. Results indicated that those high in hedonic hunger exhibited left asymmetry irrespective of RRS scores; among those low in PFS, only those high in RRS showed right asymmetry. Results were consistent with literature linking avoidant behaviors (restraint) with right-frontal asymmetry and approach behaviors (binge eating) with left-frontal asymmetry. It appears that a strong drive toward palatable foods predominates at a neural level even when restraint is high. Findings suggest that lateralized frontal activity is an indicator of motivation both to consume and to avoid consuming highly palatable foods.

The role of hunger state and dieting history in neural response to food cues: An event-related potential study

A history of dieting to lose weight has been shown to be a robust predictor of future weight gain. A potential factor in propensity towards weight gain is the nature of peoples reactions to the abundance of highly palatable food cues in the environment. Event Related Potentials (ERPs) have revealed differences in how the brain processes food cues between obese and normal weight individuals, as well as between restrained and unrestrained eaters. However, comparisons by weight status are not informative regarding whether differences predate or follow weight gain in obese individuals and restrained eating has not consistently been found to predict future weight gain. The present study compared ERP responses to food cues in non-obese historic dieters (HDs) to non-obese never dieters (NDs). HDs showed a blunted N1 component relative to NDs overall, and delayed N1 and P2 components compared to NDs in the hungry state, suggesting that early, perceptual processing of food cues differs between these groups, especially when food-deprived. HDs also showed a more hunger-dependent sustained ERP (LPP) compared to NDs. Future research should test ERP-based food cue responsivity as a mediator between dieting history and future weight gain to better identify those most at risk for weight gain as well as the nature of their vulnerability.

Measurement of adherence in bariatric surgery: a systematic review

After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.

Psychological Well-Being and Type 2 Diabetes

Positive psychological characteristics such as optimism, positive affect, gratitude, and related constructs may play an important role in health. In patients with type 2 diabetes (T2D), positive psychological constructs have been associated with superior medical outcomes, including better glucose control and lower mortality rates. The beneficial effects of positive psychological states in T2D are most likely mediated through health behaviors such as increased physical activity and adherence to a healthier diet. Furthermore, numerous studies with non-diabetic populations have shown that performing various positive psychological exercises (e.g., writing gratitude letters, performing acts of kindness) have led to greater well-being. Compared to other available treatments, these activities are simple and involve constructs that have been associated with superior adherence and diabetes-related outcomes. However, there has been minimal research on the use of positive psychological interventions in T2D, though small studies of related interventions have been linked to improvements in positive affect and, in some cases, greater health behavior adherence and lower blood sugar. Continued work is needed to ascertain whether positive psychology interventions can truly impact functioning, blood sugar, and overall health in this key population.