Megan M. Hood

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.

Chronotype Is Independently Associated With Glycemic Control in Type 2 Diabetes

OBJECTIVE To examine whether chronotype and daily caloric distribution are associated with glycemic control in patients with type 2 diabetes independently of sleep disturbances. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes had a structured interview and completed questionnaires to collect information on diabetes history and habitual sleep duration, quality, and timing. Shift workers were excluded. A recently validated construct derived from mid-sleep time on weekends was used as an indicator of chronotype. One-day food recall was used to compute the temporal distribution of caloric intake. Hierarchical linear regression analyses controlling for demographic and sleep variables were computed to determine whether chronotype was associated with HbA1c values and whether this association was mediated by a higher proportion of caloric intake at dinner. RESULTS We analyzed 194 completed questionnaires. Multiple regression analyses adjusting for age, sex, race, BMI, insulin use, depressed mood, diabetes complications, and perceived sleep debt found that chronotype was significantly associated with glycemic control (P = 0.001). This association was partially mediated by a greater percentage of total daily calories consumed at dinner. CONCLUSIONS Later chronotype and larger dinner were associated with poorer glycemic control in patients with type 2 diabetes independently of sleep disturbances. These results suggest that chronotype may be predictive of disease outcomes and lend further support to the role of the circadian system in metabolic regulation.

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.

The Relationship Between Breakfast Skipping, Chronotype, and Glycemic Control in Type 2 Diabetes

Breakfast skipping is associated with obesity and an increased risk of type 2 diabetes. Later chronotypes, individuals who have a preference for later bed and wake times, often skip breakfast. The aim of the study was to explore the relationships among breakfast skipping, chronotype, and glycemic control in type 2 diabetes patients. We collected sleep timing and 24-h dietary recall from 194 non-shift-working type 2 diabetes patients who were being followed in outpatient clinics. Mid-sleep time on free days (MSF) was used as an indicator of chronotype. Hemoglobin A1C (HbA1C) values were obtained from medical records. Hierarchical linear regression analyses controlling for demographic, sleep, and dietary variables were computed to determine whether breakfast skipping was associated with HbA1C. Additional regression analyses were performed to test if this association was mediated by chronotype. There were 22 participants (11.3%) who self-reported missing breakfast. Breakfast skippers had significantly higher HbA1C levels, higher body mass indices (BMI), and later MSF than breakfast eaters. Breakfast skipping was significantly associated with higher HbA1C values (B = 0.108, p = 0.01), even after adjusting for age, sex, race, BMI, number of diabetes complications, insulin use, depressive symptoms, perceived sleep debt, and percentage of daily caloric intake at dinner. The relationship between breakfast skipping and HbA1C was partially mediated by chronotype. In summary, breakfast skipping is associated with a later chronotype. Later chronotype and breakfast skipping both contribute to poorer glycemic control, as indicated by higher HbA1C levels. Future studies are needed to confirm these findings and determine whether behavioral interventions targeting breakfast eating or sleep timing may improve glycemic control in patients with type 2 diabetes.

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.

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.

Night eating in patients with type 2 diabetes. Associations with glycemic control, eating patterns, sleep, and mood

Night eating is a complex behavior associated with disruptions in eating, sleep, and mood regulation. While night eating has been associated with alterations in neuroendocrine functioning, night eating and Night Eating Syndrome (NES) are not well understood in patients with prevalent metabolic conditions, such as diabetes. In this study, 194 adults with Type 2 diabetes completed questionnaires assessing night eating symptoms as well as eating, sleep, and depressive symptoms. Glycemic control data, as measured by hemoglobin A1c (HbA1c), were gathered from patient medical charts. Results indicated that 7% of participants met criteria for NES. Increased symptoms of night eating were associated with poorer glycemic control and disruptions in eating, sleep, and mood, including significantly increased likelihood of having HbA1c levels >7% and endorsing clinical levels of depressive symptoms. Increasing understanding of the relationship between night eating and metabolic and psychosocial functioning in patients with diabetes may provide new avenues for treatment of these patients.