Joyce Corsica

Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review

Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. Initial research suggests that mindfulness meditation may be an effective intervention for binge eating; however, no systematic review has examined interventions where mindfulness meditation was the primary intervention and no review has examined its effect on subclinical disordered eating or weight. Using the PRISMA method for systematic reviews, we reviewed 14 studies that investigated mindfulness meditation as the primary intervention and assessed binge eating, emotional eating, and/or weight change. Results suggest that mindfulness meditation effectively decreases binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight is mixed. Additional research is warranted to determine comparative effectiveness and long-term effects of mindfulness training.

Food addiction: true or false?

Purpose of review Food addiction has been implicated as a putative causal factor in chronic overeating, binge eating, and obesity. The concept of food addiction has been controversial historically due to definitional and conceptual difficulties and to a lack of rigorous scientific data. Recent findings Support for the food addiction hypothesis comes from alterations in neurochemistry (dopamine, endogenous opioids), neuroanatomy (limbic system), and self-medication behaviors. Foods identified as having potential addictive properties include sweets, carbohydrates, fats, sweet/fat combinations, and possibly processed and/or high salt foods. Eating topography has been identified as a necessary factor in neural pathway changes that promote addiction-like properties in response to some foods. A recently developed food addiction scale shows promise in identifying food addiction. Summary Recent findings have strengthened the case for food addiction. These findings may serve to validate the perception of food addiction in patients and inform psychoeducational, cognitive-behavioral, and/or pharmacological treatment for chronic food cravings, compulsive overeating, and binge eating that may represent a phenotype of obesity. Screening for food addiction has the potential to identify people with eating difficulties that seriously compromise weight management efforts. Future research should include a focus on human food addiction research; evaluating the impact of treatment on underlying neurochemistry; and prevention or reversal of food addiction in humans.

Examining the Binge Eating Scale in screening for binge eating disorder in bariatric surgery candidates.

BackgroundThis study assessed the utility of the Binge Eating Scale (BES) as a measure of binge eating disorder (BED) in a bariatric surgery-seeking population by (a) determining the optimal BES cut score for predicting BED, (b) calculating concordance statistics, and (c) determining the predictive value of each BES item.MethodsFour hundred seventy-three patients presented for a psychological evaluation prior to Roux-en-Y gastric bypass surgery. The BES and the SCID semi-structured interview for BED were administered.ResultsReceiver operating characteristic curve analyses identified an optimal BES cut score of 17, which correctly classified 78% of patients with BED. A cut score of 27 improved this statistic, but significantly increased the number of false negatives, which is undesirable for a screening assessment. Discriminant function analyses revealed that nearly all BES items significantly predicted BED.ConclusionsThe BES is a valid screener of BED for patients seeking bariatric surgery; however, false positives can be expected. Administering the BES as part of a comprehensive psychological evaluation can help improve the assessment and treatment of patients presenting for bariatric surgery.

What do we know about mobile applications for diabetes self-management? A review of reviews

Diabetes is a chronic illness with significant health consequences, especially for those who are unable to adhere to the complex treatment regimen. Self-management tasks such as regular medication and insulin use, frequent blood sugar checks, strict diet management, and consistent exercise can be quite challenging. Mobile technologies, specifically mobile applications (apps), present a unique opportunity to help patients improve adherence to these behaviors. The availability of commercial diabetes self-management apps is increasing rapidly, making it difficult for patients and providers to stay informed about app options. A number of reviews have described commercial app technology and use for patients with diabetes. The aims of this article are to summarize the results and themes of those reviews, to review outcomes of apps described in the research literature, and to identify areas for further consideration in the use of mobile apps for diabetes self-management.

Carbohydrate craving: A double-blind, placebo-controlled test of the self-medication hypothesis

Carbohydrate craving, the overwhelming desire to consume carbohydrate-rich foods in an attempt to improve mood, remains a scientifically controversial construct. We tested whether carbohydrate preference and mood enhancement could be demonstrated in a double-blind, placebo-controlled self-administration trial. Overweight females who met strict operational criteria for carbohydrate craving participated in two 3-day discrete choice trials over a 2-week period. Participants reported their mood before and at several time points after undergoing a dysphoric mood induction and ingesting, either a carbohydrate beverage or a taste and calorie-matched protein-rich balanced nutrient beverage. Every third testing day, participants were asked to self-administer the beverage they preferred based on its previous mood effect. Results showed that, when rendered mildly dysphoric, carbohydrate cravers chose the carbohydrate beverage significantly more often than the protein-rich beverage and reported that carbohydrate produced greater mood improvement. The carbohydrate beverage was perceived as being more palatable by the carbohydrate cravers, although not by independent taste testers who performed the pre-trial taste matching. This study, performed under rigorous study conditions, supports the existence of a carbohydrate craving syndrome in which carbohydrate self-administration improves mildly dysphoric mood.

Factor structure and predictive utility of the Binge Eating Scale in bariatric surgery candidates

BACKGROUND Screening for binge eating before bariatric surgery is a component of the recommended clinical practice for bariatric surgery candidates. The Binge Eating Scale (BES) is 1 of the most commonly used self-report measures of eating behaviors in preoperative evaluations; however, the factor structure of this measure has not been evaluated in the bariatric population. The aims of the present study were to report the mean, standard deviation, and reliability of the BES for patients seeking bariatric surgery; to evaluate the 2-factor structure of the BES using confirmatory factor analysis; and to investigate the association between the BES and its factors with surgical weight loss. The setting was an academic medical center. METHODS A total of 530 patients completed the BES as a component of their psychological evaluation before undergoing Roux-en-Y gastric bypass surgery. RESULTS Approximately one third of patients reported at least mild to moderate binge eating, with 9% of patients reporting severe binge eating on the BES. The BES demonstrated good internal consistency. The results of the confirmatory factor analysis indicated that a 2-factor structure, consisting of feelings/cognitions related to binge eating and behavioral manifestations of binge eating, was the best fit to the data. Nonsignificant correlations were found between the BES and its 2 factors with short-term postoperative weight loss. CONCLUSION The BES measures 2 aspects of binge eating in bariatric surgery candidates, feelings/cognitions and behavioral manifestations of binge eating. Consideration of these factors in patients presenting for bariatric surgery could allow for a more detailed understanding of binge eating in this population.

Psychosocial correlates of binge eating in Hispanic, African American, and Caucasian women presenting for bariatric surgery

Research suggests that that binge eating, stress, and depression are prevalent among individuals seeking bariatric surgery. However, ethnic differences in the prevalence of binge eating and binge eating disorder (BED) in this population remain unclear, as does the impact of depression and stress on any such relationship. Further, no studies to date have examined the prevalence of binge eating in Hispanic women presenting for bariatric surgery. This study sought to (a) compare the prevalence and severity of binge eating symptomatology and BED diagnosis in Hispanic, African American, and Caucasian women presenting for gastric bypass surgery, (b) examine the impact of depressive symptoms and stress on binge eating symptomatology, and (c) investigate whether ethnicity moderated any relationship between depression, stress, and binge eating. Results indicated that Hispanic women exhibited equal rates of binge eating symptomatology, BED, and depressive symptomatology as African American and Caucasian women. However, Caucasian women exhibited greater binge eating symptomatology than African American women, and African American women endorsed greater levels of stress than Caucasian women. Across all ethnic groups, depressive symptomatology, but not stress, significantly predicted binge eating severity. These findings suggest that Hispanic women presenting for bariatric surgery report binge eating rates equivalent to Caucasian and African American women, and that depressive symptoms are an important predictor of binge eating in female bariatric surgery candidates across ethnic groups.

Confirmatory factor analysis of the Beck Depression Inventory-II in bariatric surgery candidates.

Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples, evidencing a significant gap in the present literature. The purpose of the present study is to evaluate the structural validity of the BDI-II and to examine the reliability and convergent and criterion validity of this instrument within a bariatric surgery-seeking sample. The study population consisted of 505 ethnically diverse bariatric surgery candidates presenting for presurgical psychological evaluations in a midwestern urban academic medical center. Confirmatory factor analytic results indicated that a 3-factor model consisting of affective, cognitive, and somatic factors was the best fitting model of depression within this sample. Internal consistency reliability was satisfactory for each subscale, ranging from .72 to .82. Moderate to large correlations were observed between each BDI-II subscale and a measure of depression previously validated with bariatric surgery candidates indicating adequate convergent validity. On the basis of clinical interview, 14% of the sample was diagnosed with current major depression. Significant mean differences were observed between depressed and nondepressed patients with respect to each BDI-II subscale score, demonstrating criterion-related validity. The BDI-II is a reliable and valid measure of depression for bariatric surgery candidates. Understanding the factor structure of the BDI-II can be useful for planning potential presurgical psychological interventions.

The Personality Assessment Inventory: Clinical Utility, Psychometric Properties, and Normative Data for Bariatric Surgery Candidates

BackgroundThe Personality Assessment Inventory (PAI), an overall measure of personality and psychopathology, features a number of dimensions that may be useful in the psychological assessment of bariatric surgery candidates. However, its clinical utility is limited because psychometric properties of the PAI with bariatric surgery candidates have never been evaluated, and normative data for this population have never been published.MethodsWe examined the psychometric properties and clinical utility of the PAI with a large sample of bariatric surgery candidates (n = 546) presenting for evaluation in an urban medical center. Internal consistency reliability analyses were performed on the PAI full scales and subscales. Exploratory factor analysis using principal components analysis with oblique rotation was performed and the results compared with community, clinical, and medical samples. Normative data and scale elevation frequencies for the bariatric sample are presented.ResultsAlpha coefficients and mean interitem correlations were acceptable and similar to the test standardization samples. Factor analyses supported the consistency of the underlying factor structure with bariatric surgery candidates and also revealed a factor for warmth and social support. Normative data indicate that overall bariatric surgery candidates appear quite similar to the community standardization sample. Sixteen percent of candidates reported significant (T ≥ 70) somatic complaints, consistent with the greater health problems in this sample.ConclusionsOur findings support the clinical utility of the PAI in the psychological assessment of bariatric surgery candidates. The availability of PAI normative data and profile elevation statistics will help to facilitate clinical interpretation and inform treatment recommendations for candidates undergoing bariatric surgery.

Eating Disorders in an Obesogenic Environment

An obesogenic environment is an environment that produces and supports overweight and obesity through several intersecting mechanisms. Obesogenic environments and behavior, particularly in the context of genetic susceptibility to obesity, are believed to account for the increased prevalence of overweight and obesity in the world today. Such an environment includes decreased physical activity, increased energy intake, heavy promotion of energy-dense foods, greater number of overweight people, biological predisposition to weight difficulties, food addiction and changes in neurochemistry, and impact of both social discrimination and media manipulation of the ideal body image. Together these factors pose substantial problems for individuals with disordered eating behaviors, as will be discussed in this article. Although the development of eating disorders is complex and multifactorial, the combination of these factors in the obesogenic environment has the potential to contribute to the disordered eating behavior and cognitions to which some young people are vulnerable.