Tomoko Udo

Sex differences in biopsychosocial correlates of binge eating disorder: a study of treatment-seeking obese adults in primary care setting

OBJECTIVE Although community-based studies suggest equivalent levels of physical and psychological impairment by binge eating disorder (BED) in men and women, men with BED are still underrepresented in clinical studies. This study aimed to provide a comprehensive analysis of sex differences in biopsychosocial correlates of treatment-seeking obese patients with BED in primary care. METHOD One hundred-ninety obese adults (26% men) were recruited in primary care settings for a treatment study for obesity and BED. RESULTS Very few significant sex differences were found in the developmental history and in current levels of eating disorder features, as well as psychosocial factors. Women reported significantly earlier age at onset of overweight and dieting and greater frequency of dieting. Men reported more frequent strenuous exercise. Men were more likely than women to meet criteria for metabolic syndrome; men were more likely to show clinically elevated levels of triglycerides, blood pressure, and fasting glucose levels. CONCLUSION Despite few sex differences in behavioral and psychosocial factors, metabolic problems associated with obesity were more common among treatment-seeking obese men with BED than women. The findings highlight the importance of including men in clinical studies of BED and active screening of BED in obese men at primary care settings.

Gender differences in the impact of stressful life events on changes in body mass index.

OBJECTIVE The positive association between stress and weight has been consistently demonstrated, particularly in women. The effect of stress on changes in weight, however, is less clear. METHODS A total of 33,425 participants in Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Condition (NESARC) were included in this study. The study examined the relationship between stressful life events during the 12months prior to the Wave 2 interview and changes in body mass index (BMI) between Wave 1 and Wave 2 interviews. RESULTS Women reported significantly greater increases in BMI than men. Stressful life events, particularly job-related changes, legal problems, and death of family or friends, were associated significantly with increases in BMI among women but not men. CONCLUSIONS In a nationally representative sample, stressful life events were associated with greater weight gain in women. Prevention of weight gain in women should focus on the behavioral and physiological mechanisms underlying female-specific effects of stressful life events on weight gain.

Modeling the effects of positive and negative mood on the ability to resist eating in obese and non-obese individuals

This pilot study adapted a well-established drug self-administration paradigm to examine the effects of mood induction on the ability to resist high-calorie foods and subsequent food consumption differently in 15 obese individuals (40.0% women, BMI: 35.1±3.70) and 15 non-obese individuals (46.7% women, BMI: 23.0±1.96). Participants completed two laboratory sessions (positive vs. negative mood conditions) consisting of 3-hour food deprivation, followed by mood induction, and a 3-hour ad-lib eating period, where they were asked to choose between favorite high-calorie snacks and monetary reinforcement. Obese individuals were less able to resist eating and increased high-calorie food consumption during the positive mood condition than the negative condition. Non-obese individuals were less able to resist eating during the negative mood condition than the positive condition, but their total consumption was not affected by the mood conditions. In obese individuals, food craving was associated with less ability to resist eating and greater calorie consumption during the negative mood condition. This is the first study to experimentally demonstrate that mood state may increase vulnerability to food consumption by reducing the ability to resist eating. The ability to resist eating may be a novel dimension of eating behaviors that has a significant contribution to understanding mood-eating relationships.

Perceived weight discrimination, childhood maltreatment, and weight gain in U.S. adults with overweight/obesity.

Perceived weight discrimination and childhood maltreatment have been independently associated with physical and mental health issues, as well as weight gain. It is not known, however, whether childhood maltreatment modifies the relationship between perceived weight discrimination and weight changes.

Menopause and metabolic syndrome in obese individuals with binge eating disorder.

Menopausal transition has been associated with the emergence of metabolic abnormalities, which may increase risk for chronic medical conditions in women. This study compared metabolic function between premenopausal women (n = 152), postmenopausal women (n = 88), and men (n =9 8) recruited for treatment studies for obesity co-occurring with binge eating disorder (BED), a high-risk population for developing metabolic syndrome (MetS). Postmenopausal women were more likely than premenopausal women to show elevated total cholesterol (OR = 2.75; 95% CI = 1.56-4.80) and poor glycemic control (OR = 2.92; 95% CI = 1.32-6.33) but were more likely to have lower HDL levels (OR = 0.36; 95% CI = 0.19-0.68). These became non-significant after adjusting for age. Both pre- and postmenopausal women were less likely than age-matched men to show elevated levels of triglycerides (OR = 0.27; 95% CI = 0.13-0.53 [postmenopausal], OR = 0.29; 95% CI = 0.16-0.53 [premenopausal]), blood pressure (OR = 0.48; 95% CI = 0.25-0.91 [postmenopausal], OR=0.40; 95% CI = 0.23-0.69 [premenopausal]), and less likely to have MetS (OR = 0.41; 95% CI = 0.21-0.78 [postmenopausal], OR = 0.46; 95% CI = 0.27-0.79 [premenopausal]). Premenopausal women were also less likely to have elevated fasting glucose level (OR = 0.50; 95% CI = 0.26-0.97) than age-matched men. Among obese women with BED, aging may have a more profound impact on metabolic abnormalities than menopause, suggesting the importance of early intervention of obesity and symptoms of BED. The active monitoring of metabolic function in obese men with BED may also be critical.

Heightened vagal activity during high-calorie food presentation in obese compared with non-obese individuals--results of a pilot study.

Eating behaviours are highly cue-dependent. Changes in mood states and exposure to palatable food both increase craving and consumption of food. Vagal activity supports adaptive modulation of physiological arousal and has an important role in cue-induced appetitive behaviours. Using high-frequency heart rate variability (HF HRV), this preliminary study compared vagal activity during positive and negative mood induction, and presentation of preferred high-calorie food items between obese (n = 12; BMI ≥ 30) and non-obese individuals (n = 14; 18.5 < BMI < 30). Participants completed two laboratory sessions (negative vs. positive mood conditions). Following 3-h of food deprivation, all participants completed a mood induction, and then were exposed to their preferred high-calorie food items. HF HRV was assessed throughout. Obese and non-obese individuals were not significantly different in HF HRV during positive or negative mood induction. Obese individuals showed significantly greater levels of HF HRV during presentation of their preferred high-calorie food items than non-obese individuals, particularly in the positive mood condition. This is the first study to demonstrate increased vagal activity in response to food cues in obese individuals compared with non-obese individuals. Our findings warrant further investigation on the potential role of vagally-mediated cue reactivity in overeating and obesity.

Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity

This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables.

Delineating Potential Mechanisms of Implicit Alcohol Cognitions: Drinking Restraint, Negative Affect, and their Relationship with Approach Alcohol Associations

Problem drinkers may use alcohol to avoid negative mood states and may develop implicit cognitive associations between negative emotional states and reinforcing properties of drinking. It is paradoxical that attempts to control drinking, such as among those high in drinking restraint, may inadvertently increase desire to drink and subsequent alcohol consumption, and this may be exaggerated under times of emotional distress when urges to drink are high. We examined whether individuals who are high on drinking restraint would demonstrate stronger alcohol-related thoughts elicited by stimuli that represent the desire to use alcohol, in response to stronger versus weaker negative mood arousal. Seventy hazardous drinkers completed measurements of drinking restraint, alcohol consumption, and consequences of use. After being randomized to view negative or positive pictures sets, participants completed an Implicit Association Task (IAT) to test differences in the strength of the association between desire to approach or avoid alcohol or water cues, and then a measurement of subjective craving following the IAT. Regression analyses showed that trait restriction not temptation was positively related to IAT scores, after controlling for relevant covariates and explained 7% of the total variance. Trait temptation not IAT predicted subjective craving. Negative affect was unrelated to IAT scores, singly or in conjunction with measures of drinking restraint, contrary to predictions. In sum, implicit alcohol cognitions are related to attempts to restrict drinking not temptation to drink and are less strongly influenced by mood state.

A lifetime history of alcohol use disorder increases risk for chronic medical conditions after stable remission.

BACKGROUND The long-term impact of a past alcohol use disorder (AUD) among those who are currently in stable remission has not been well-explored. This study examined whether a past history of AUD was associated with increased risk for chronic medical conditions in a large U.S. nationally representative sample of adults ≥30 years old. METHODS Using 25,840 participants from Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Condition (NESARC), multiple logistic regression analysis was conducted to compare the risk for reporting metabolic, cardiovascular, liver, gastrointestinal, and inflammatory conditions between those in full-remission from AUD for longer than 5 years and those without a history of AUD diagnosis. RESULTS Compared with a model adjusting only for age, a model adjusting for other potential psychosocial confounders revealed fewer significant associations between AUD history and chronic medical conditions, particularly for the middle-aged population and for men. For the elderly, AUD history was associated with more chronic medical conditions in fully adjusted models. AUD history was associated with severe medical conditions such as liver diseases and myocardial infarction in women. In general, longer AUD exposure and shorter remission were also associated with the risk for chronic medical conditions. CONCLUSIONS Our findings suggest associations between past AUD diagnosis and chronic medical conditions, particularly for the elderly individuals. Screening for past alcohol use problems and associated health risks are important for the promotion of aging and prevention of chronic medical conditions even when an individual presents no current symptoms of AUD.

Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults

Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n=28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n=43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV.