Kerstin K. Blomquist

Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning.

OBJECTIVE Widespread bias against obese individuals may lead to the internalization of weight bias in obese persons. This study examined correlates of internalized weight bias (IWB) in obese patients with binge eating disorder (BED). METHOD One hundred treatment-seeking obese patients with BED were administered with the eating disorders examination interview and questionnaires assessing IWB, fat phobia, depression, and self-esteem. RESULTS The mean IWB score in this group of patients with BED was significantly greater than the mean IWB score observed previously in a community sample of overweight adults. IWB was positively associated with eating disorder psychopathology, fat phobia, and depression, and negatively associated with self-esteem. IWB made significant independent contributions to the variance in eating disorder psychopathology even after accounting for fat phobia, depression, and self-esteem. DISCUSSION Treatment-seeking obese patients with BED demonstrate high levels of IWB. IWB may contribute to the variance in eating disorder psychopathology in BED patients, beyond the contributions of fat phobia, depression, and self-esteem.

Development and Validation of the Eating Loss of Control Scale

Recurrent objective bulimic episodes (OBE) are a defining diagnostic characteristic of binge eating disorder (BED) and bulimia nervosa (BN). OBEs are characterized by experiencing loss of control (LOC) while eating an unusually large quantity of food. Despite nosological importance and complex heterogeneity across patients, measurement of LOC has been assessed dichotomously (present/absent). This study describes the development and initial validation of the Eating Loss of Control Scale (ELOCS), a self-report questionnaire that examines the complexity of the LOC construct. Participants were 168 obese treatment-seeking individuals with BED who completed the Eating Disorder Examination interview and self-report measures. Participants rated their LOC-related feelings or behaviors on continuous Likert-type scales and reported the number of LOC episodes in the past 28 days. Principal component analysis identified a single-factor, 18-item scale, which demonstrated good internal reliability (α = .90). Frequency of LOC episodes was significantly correlated with frequency of OBEs and subjective bulimic episodes. The ELOCS demonstrated good convergent validity and was significantly correlated with greater eating pathology, greater emotion dysregulation, greater depression, and lower self-control but not with body mass index. The findings suggest that the ELOCS is a valid self-report questionnaire that may provide important clinical information regarding experiences of LOC in obese persons with BED. Future research should examine the ELOCS in other eating disorders and nonclinical samples.

Exploring Weight Gain in Year Before Treatment for Binge Eating Disorder: A Different Context for Interpreting Limited Weight Losses in Treatment Studies

OBJECTIVE To examine weight changes in obese patients with binge-eating disorder (BED) during the year before seeking treatment and to explore correlates of weight changes. METHOD Seventy-eight consecutive, treatment-seeking, obese BED patients were assessed with structured interviews and self-report questionnaires. RESULTS Overall, participants reported a mean weight gain of 15.1 pounds during the 12 months before treatment. This overall weight gain comprised remarkable heterogeneity, ranging from a 30-pound loss to a 53-pound gain. The subgroup of participants who reported gaining weight (76% of sample) reported gaining an average of 22.2 pounds during the 12 months before treatment. Weight change was associated with significantly more frequent binge eating and overeating during breakfasts. DISCUSSION Treatment-seeking obese patients with BED reported having gained substantial amounts of weight during the previous year. These findings provide an important context for interpreting the modest weight losses typically reported by treatment studies of BED.

Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology

OBJECTIVE Research has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED. METHODS Participants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures. RESULTS Social anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint. DISCUSSION Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.

Energy expenditure of genuine laughter

Objective:To measure energy expenditure (EE) and heart rate (HR) during genuine laughter.Design:Experimental trial of viewing film clips in four cycles either intended to evoke laughter (humorous −10 min) or unlikely to elicit laughter (not humorous −5 min) under strictly controlled conditions of a whole-room indirect calorimeter equipped with audio recording system.Participants:Forty five adult friend dyads in either same-sex male (n=7), same-sex female (n=21) and mix-sex male-female (n=17); age 18–34 years; body mass index 24.7±4.9 (range 17.9–41.1).Measurements:Energy expenditure in a whole-room indirect calorimeter, HR using Polar HR monitor. Laugh rate, duration and type from digitized audio data using a computerized system and synchronized with HR and EE results.Results:Laughter EE was 0.79±1.30 kJ/min (0.19±0.31 kcal/min) higher than resting EE (P<0.001, 95% confidence interval=0.75–0.88 kJ/min), ranging from –2.52 to 9.67 kJ/min (−0.60–2.31 kcal/min). Heart rate during laughter segments increased above resting by 2.1±3.8 beats/min, ranging from −7.6 to 26.8 beats/min. Laughter EE was correlated with HR (r s=0.250, P<0.01). Both laughter EE and HR were positively correlated with laughter duration (r s=0.282 and 0.337, both P<0.001) and rate (rs=0.256 and 0.298, both P<0.001).Conclusion:Genuine voiced laughter causes a 10–20% increase in EE and HR above resting values, which means that 10–15 min of laughter per day could increase total EE by 40–170 kJ (10–40 kcal).

Interpersonal problems and developmental trajectories of binge eating disorder.

OBJECTIVE The aim of the present study was to explore associations between specific interpersonal constructs and the developmental progression of behaviors leading to binge eating disorder (BED). METHOD Eighty-four consecutively evaluated, treatment-seeking obese (body mass index ≥30 kg/m(2)) men and women with BED were assessed with structured diagnostic and clinical interviews and completed a battery of established measures to assess the current and developmental eating- and weight-related variables as well as interpersonal functioning. RESULTS Using the interpersonal circumplex structural summary method, amplitude, elevation, the affiliation dimension, and the quadratic coefficient for the dominance dimension were associated with eating- and weight-related developmental variables. The amplitude coefficient and more extreme interpersonal problems on the dominance dimension (quadratic)-that is, problems with being extremely high (domineering) or low in dominance (submissive)-were significantly associated with a younger age at onset of binge eating, BED, and overweight as well as accounted for significant variance in age at binge eating, BED, and overweight onset. Greater interpersonal problems with having an overly affiliative interpersonal style were significantly associated with and accounted for significant variance in a younger age at diet onset. DISCUSSION Findings provide further support for the importance of interpersonal problems among adults with BED and converge with recent work highlighting the importance of specific types of interpersonal problems for understanding heterogeneity and different developmental trajectories of individuals with BED.

Metabolic syndrome in obese men and women with binge eating disorder: developmental trajectories of eating and weight-related behaviors

Metabolic syndrome (MetSyn), characterized by vascular symptoms, is strongly correlated with obesity, weight-related medical diseases, and mortality and has increased commensurately with secular increases in obesity in the United States. Little is known about the distribution of MetSyn in obese patients with binge eating disorder (BED) or its associations with different developmental trajectories of dieting, binge eating, and obesity problems. Furthermore, inconsistencies in the limited data necessitate elucidation. This study examined the frequency and correlates of MetSyn in a consecutive series of 148 treatment-seeking obese men and women with BED assessed with structured clinical interviews. Almost half of the participants met the criteria for MetSyn. Participants with MetSyn did not differ from those without MetSyn on demographic variables or disordered eating psychopathology. However, our findings suggest that MetSyn is associated with a distinct developmental trajectory, specifically a later age at BED onset and shorter BED duration. Although the findings from this study shed some light on MetSyn and its associations with developmental trajectories of eating and weight-related behaviors, notable inconsistencies characterize the limited literature. Prospective studies are needed to examine causal connections in the development of the MetSyn in relation to disordered eating in addition to excess weight.

Predictive significance of changes in dietary restraint in obese patients with binge eating disorder during treatment

OBJECTIVE To examine whether changes in different aspects of dietary restraint in obese patients with binge eating disorder (BED) participating in a treatment study predict outcomes. METHOD Fifty obese patients with BED in a randomized controlled study of orlistat administered with cognitive-behavioral therapy, guided-self-help (CBTgsh) completed dietary restraint measures at baseline, during- and post-treatment, and three-month follow-up. RESULTS Change in the restraint scale of the Eating Disorder Examination-Questionnaire did not predict binge abstinence or 5% weight loss. Increased flexible restraint subscale of the Three Factor Eating Questionnaire (TFEQ) during treatment significantly predicted binge abstinence at post-treatment and three-month follow-up and 5% weight loss at post-treatment. Change in the rigid restraint subscale of the TFEQ predicted binge abstinence at post-treatment. DISCUSSION Our findings clarify further pathologic and adaptive aspects of restraint and suggest the importance of enhancing flexible restraint in order to improve both binge eating and weight loss outcomes.

The body project 4 all: A pilot randomized controlled trial of a mixed-gender dissonance-based body image program.

OBJECTIVE The Body Project is a cognitive dissonance-based body image improvement program with ample research support among female samples. More recently, researchers have highlighted the extent of male body dissatisfaction and disordered eating behaviors; however, boys/men have not been included in the majority of body image improvement programs. This study aims to explore the efficacy of a mixed-gender Body Project compared with the historically female-only body image intervention program. METHOD Participants included male and female college students (N = 185) across two sites. We randomly assigned women to a mixed-gender modification of the two-session, peer-led Body Project (MG), the two-session, peer-led, female-only (FO) Body Project, or a waitlist control (WL), and men to either MG or WL. Participants completed self-report measures assessing negative affect, appearance-ideal internalization, body satisfaction, and eating disorder pathology at baseline, post-test, and at 2- and 6-month follow-up. RESULTS Linear mixed effects modeling to estimate the change from baseline over time for each dependent variable across conditions were used. For women, results were mixed regarding post-intervention improvement compared with WL, and were largely non-significant compared with WL at 6-month follow-up. Alternatively, results indicated that men in MG consistently improved compared with WL through 6-month follow-up on all measures except negative affect and appearance-ideal internalization. DISCUSSION Results differed markedly between female and male samples, and were more promising for men than for women. Various explanations are provided, and further research is warranted prior to drawing firm conclusions regarding mixed-gender programming of the Body Project.

Parental Substance Use History of Overweight Men and Women with Binge Eating Disorder Is Associated with Distinct Developmental Trajectories and Comorbid Mood Disorder

OBJECTIVE To examine the significance of parental histories of substance use disorders (SUDs) in the expression of binge eating disorder (BED) and associated functioning. METHOD Participants were 127 overweight patients with BED assessed using diagnostic interviews. Participants were administered a structured psychiatric history interview about their parents (N = 250) and completed a battery of questionnaires assessing current and historical eating and weight variables and associated psychological functioning (depression and self-esteem). RESULTS Patients with BED with a parental history of SUD were significantly more likely to start binge eating before dieting, had a significantly earlier age at BED onset, and reported less time between binge eating onset and meeting diagnostic criteria for BED than did patients without a parental history of SUD. For psychiatric comorbidity, patients with BED with a parental history of SUD were significantly more likely to meet the criteria for a mood disorder. A parental history of SUD was not significantly associated with variability in current levels of binge eating, eating disorder psychopathology, or psychological functioning. DISCUSSION Our findings suggest that a parental history of SUD is associated with certain distinct trajectories in the development of binge eating (earlier binge onset predating dieting onset) and with elevated rates of comorbidity with mood disorders in patients with BED.