Suzanne E. Mazzeo

Preventing weight gain in first year college students: an online intervention to prevent the "freshman fifteen".

The transition to college has been identified as a critical period for increases in overweight status. Overweight college students are at-risk of becoming obese adults, and, thus prevention efforts targeting college age individuals are key to reducing adult obesity rates. The current study evaluated an Internet intervention with first year college students (N=170) randomly assigned to one of four treatment conditions: 1) no treatment, 2) 6-week online intervention 3) 6-week weight and caloric feedback only (via email), and 4) 6-week combined feedback and online intervention. The combined intervention group had lower BMIs at post-testing than the other three groups. This study demonstrated the effectiveness and feasibility of an online intervention to prevent weight gain among college students.

Association Between Childhood Physical and Emotional Abuse and Disordered Eating Behaviors in Female Undergraduates: An Investigation of the Mediating Role of Alexithymia and Depression

Although disordered eating behaviors are relatively common among college women, many questions about their etiology remain. In the present study, structural equation modeling was used to investigate potential mediating associations among variables previously found to be associated with the continuum of disordered eating behaviors in a large sample of college women. Results indicated that family conflict, family cohesion, and childhood physical and emotional abuse and neglect were not directly associated with disordered eating. Rather, their association with disordered eating was mediated by alexithymia and depression. These results were cross-validated in a second sample of college women. These data highlight the complexity of disordered eating and provide future directions for the prevention and treatment of the continuum of disordered eating behaviors.

Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey‐replication study

OBJECTIVE The comorbidity of posttraumatic stress disorder (PTSD) and eating disorders (EDs) is high among women but has been understudied in men. Little is known about the association between partial or subthreshold PTSD and EDs among women or men. METHOD This study included PTSD and ED data from male (n = 2,382) and female (n = 3,310) National Comorbidity Survey-Replication study participants. RESULTS The vast majority of women and men with anorexia nervosa, bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with BN and BED. Subthreshold PTSD was more prevalent than threshold PTSD among women with BN and women and men with BED. DISCUSSION Interpersonal forms of trauma, PTSD, and subthreshold/partial PTSD, were prevalent among men and women with EDs. Findings highlight the importance of assessing for trauma and PTSD in ED patients.

The structure of perfectionism: A Twin study

Background: Perfectionism may be a premorbid risk factor for eating disorders. Evidence of familial transmission suggests features of perfectionism may be genetically determined. This study examines the structure of perfectionism using classical twin design models. Methods: Independent (IP) and common (CP) pathway models are used to investigate the extent to which genetic and environmental factors can help to identify and differentiate three behavioral domains of Perfectionism as measured by a shortened version of the Multidimensional Perfectionism Scale (MPS) [Frost et al. (1990). Cognit. Ther. Res. 14: 449–468]. Three of the original subscales were included: Personal standards (PS), Doubts about actions (DA), Concern over mistakes (CM). We studied a sample of 1022 paired and unpaired female twins from the Mid-Atlantic Twin Registry. Results: MZ correlations were consistently higher than DZ twin correlations for all three composite subscales. The multivariate independent pathway model provided a better fit to the twin correlations then did the more parsimonious common pathway model suggesting the pattern of familial resemblance for the three subscales is not well characterized by a unidimensional perfectionism factor. CM phenotypic variance was completely accounted for by common heritability influences in both the IP and CP models. Based on the IP model results, there was evidence that PS and CM but not DA shared some common genetic effects, with DA and CM sharing some common environmental factors. Conclusions: These multivariate twin modeling results support conceptualizations of perfectionism as a multidimensional construct. The biometric structural results for the three subscales examined here suggest CM is the core feature of Perfectionism with DA and PS serving as indicators of CM. Although not the best fitting model, the common pathway model estimated this behavioral domain to be isomorphic with the construct of perfectionism. The better fitting independent pathway model provided evidence of non-trivial differences in the pattern of heritability for CM, DA, and PS.

A Twin Study of Dietary Restraint, Disinhibition and Hunger: An Examination of the Eating Inventory (Three Factor Eating Questionnaire)

The Eating Inventory (EI) is commonly used to measure a range of eating behaviors. It includes three subscales: Cognitive Restraint, Hunger, and Disinhibition. In this study, we decomposed the variance of the three subscales, and evaluated the genetic, common environment and specific environmental effects on each in a sample of female-female twin pairs. Multivariate models were also used to examine whether the EI represented three individual factors, or whether there was extensive covariance among subscales. Heritabilities were estimated at 45% (CI of 32-57%) for Disinhibition, 8% (CI of 0-38%) for Hunger, and 0% (CI of 0-30%) for Restraint. Common environmental influences were estimated at 0% (CI of 0-23%) for Disinhibition, 16% (CI of 0-34%) for Hunger, and 31% (4-42%) for Restraint. Specific environmental influences accounted for the rest of the variance of the subscales. However, multivariate modeling indicated that Disinhibition and Hunger covaried significantly, indicating that these two subscales are influenced by the same set of genetic factors. Furthermore, Restraint appeared to be empirically distinct from Hunger or Disinhibition.

Examining the construct validity of the eating disorder inventory

The construct validity of the Eating Disorder Inventory (EDI) was examined in 3 samples. An archival clinic sample (n = 318) of women completed the EDI, a structured interview, and the Millon Clinical Multiaxial Inventory-II (MCMI-II). Confirmatory factor analyses (CFAs) indicated that neither null nor 1-factor models of the EDI fit item-level or item-parcel data. The proposed 8-factor model did not fit at the item level but did fit item-parcel data. Reliability estimates of the 8 scales ranged from .82 to .93, and low-to-moderate interscale correlations among the eating and weight-related scales provided partial support for convergent validity. EDI personality scales showed moderate interscale correlations and were associated with MCMI-II scales. A final CFA of the EDI scales supported a 2-factor model (Eating and Weight, Personality) of the 8 EDI scales. Strong associations between depression and several EDI scale scores were found in a treatment study sample (n = 50). The archival clinic sample scored significantly higher on the 8 EDI scales than the nonpatient college comparison sample (n = 487).

Does the Internet function like magazines? An exploration of image-focused media, eating pathology, and body dissatisfaction

Research has identified a relation between exposure to thin-ideal magazine and television media images and eating disorder pathology. However, few studies have examined the potential influence of Internet media on eating disorder behaviors and attitudes. This study investigated associations among image-focused media exposure, body dissatisfaction, eating pathology and thin-ideal internalization in a sample of 421 female undergraduates. Undergraduate women spent significantly more time viewing online appearance-oriented media, rather than reading image-focused magazines. Appearance-oriented Internet and television use were associated with eating pathology. Moreover, the association between image-focused Internet use and BD was mediated by thin-ideal internalization. These findings are consistent with those of previous research, and highlight the vulnerability individuals high in thin-ideal internalization might have to media exposure. They also suggest that Internet media use is an important topic to attend to in eating disorders prevention and treatment.

Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: Implications for DSM-5

OBJECTIVE We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED). METHOD We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold. RESULTS The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED. DISCUSSION The proposed changes to the DSM-5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED.

The Heritability of Eating Disorders: Methods and Current Findings

Family, twin, and adoption studies of anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and the proposed purging disorder presentation (PD) have consistently demonstrated that genetic factors contribute to the variance in liability to eating disorders. In addition, endophenotypes and component phenotypes of eating disorders have been evaluated and provide further insight regarding genetic factors influencing eating disorders and eating disorder diagnostic criteria. Many of these phenotypes have demonstrated substantial heritability. This chapter reviews biometrical genetic methods and current findings from family and twin studies that investigate the role of genes and environment in the etiology of eating disorders. We review the methodology used to estimate heritability, the results of these studies, and discuss the implications of this research for the basic conceptualization of eating disorders and the future value of twin modeling in the molecular genetic era.

An Evaluation of the Reliability and Construct Validity of Eating Disorder Measures in White and Black Women.

Most measures of eating disorder symptoms and risk factors were developed in predominantly White female samples. Yet eating disorders affect individuals of all racial and ethnic backgrounds. Black women appear more vulnerable to certain forms of eating pathology, such as binge eating, and less susceptible to other eating disorder symptoms and risk factors, such as body dissatisfaction, compared with their White peers. Despite concern that extant measures do not adequately assess eating concerns among Black women, the construct validity of scores on most of these measures has not been adequately examined within this population. This study included 2,208 Black and White women who completed the following: the Binge Eating Scale (BES), the Eating Disorder Diagnostic Scale (EDDS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorder Inventory Body Dissatisfaction and Drive for Thinness subscales, the Bulimia Test-Revised (BULIT-R), the Multidimensional Body-Self Relations Questionnaire-Appearance Evaluation subscale (MBSRQ-AE), and the Objectified Body Consciousness Scale (OBCS). Most measures yielded internally consistent scores in both races. Confirmatory factor analyses indicated that loadings for some measures, including the EAT-26 and EDDS, were not invariant across groups and thus do not assess equivalent constructs in White and Black women. However, others, including the BULIT-R, BES, OBCS, and MBSRQ-AE, exhibited factorial invariance in both races. Results suggest scores are likely not equivalent across races for several popular measures of eating disorder symptoms and risk factors. Thus, it is recommended that researchers and clinicians obtain additional information regarding racial/cultural factors when using these instruments with Black women.