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PubMed2000

Comparison of the yale-brown-cornell eating disorders scale in recovered eating disorder patients, restrained dieters, and nondieting controls.

OBJECTIVE: Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) scores were assessed in recovered eating disorder patients, restrained dieters, and unrestrained nondieters. METHOD: YBC-EDS interviews were conducted with 53 recovered eating disorder patients who had no symptoms within at least 6 months, 29 restrained dieters, and 36 unrestrained controls. RESULTS: Unrestrained control subjects had no typical eating-disordered preoccupations or rituals. The majority (62%) of restrained dieters did have current eating-disordered preoccupations but only 5 had current eating-disordered rituals. Most recovered eating disorder subjects had no current eating-disordered preoccupations (66%) and 76% had no current eating-disordered rituals. Unrestrained eating controls had significantly lower Preoccupation, Total, and Motivation to Change scores on the YBC-EDS than the other groups and significantly lower Ritual scores than the recovered eating disorder group. There were no significant differences between the restrained dieters and the recovered eating disorder group. DISCUSSION: Recovered eating disorder patients who no longer meet any of the DSM-IV criteria for an eating disorder are similar in severity of eating concern to normal weight restrained eating dieters. Both of these groups have more eating and weight concerns as compared with the unrestrained eating, nondieting controls. The YBC-EDS effectively distinguishes the healthy eating controls from restrained eating dieters and recovered eating disorder patients.

Adult↗

PubMed2001

Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation.

The aim of this study was to describe the types and extent of eating difficulties, the need for assistance when eating, the nutritional status and pressure ulcers in consecutive patients (n = 162) admitted for stroke rehabilitation over a period of 1 year. Structured observations and assessments of eating, nutritional status (subjective global assessment of nutritional status), pressure ulcers and activities in daily living (Katz ADL-index) were performed by a nurse who also trained the staff to perform these assessments. Difficulties in eating were found in 80%, and 52.5% were unable to eat without assistance. Eating difficulties were: 'eats three-quarters or less of served food' (60%), difficulties in 'manipulating food on the plate' (56%), 'transportation of food to the mouth' (46%), 'sitting position' (29%), 'aberrant eating speed' (slow or forced) (26%), 'manipulating food in the mouth' (leakage, hoarding, chewing difficulties) (24%), 'swallowing difficulties' (18%), 'opening and/or closing the mouth' (16%), and 'alertness' (9%). Thirty-two percent were undernourished (49% of patients needing assisted eating and 13% of those not needing assistance, P < 0.0005). Among patients who were dependent in one or more functions according to the Katz ADL-index, 15% had pressure ulcers. The strongest eating variables for predicting nutritional status were 'alertness', 'swallowing difficulties', 'eats three-quarters or less of served food', and 'aberrant eating speed'. Nutritional status could in turn significantly predict pressure ulcers. Eating difficulties among patients with stroke are complex and the patient's situation before stroke adds to this complexity, especially among those dependent on assisted eating. As difficulties occur both among patients needing and not needing assisted eating, all patients with stroke admitted for rehabilitation need to be systematically assessed for eating difficulties and action needs to be taken to facilitate eating, especially as patients with eating difficulties risk becoming undernourished and in turn developing pressure ulcers.

Activities of Daily Living↗

PubMed2005

Prevalence of obesity, binge eating, and night eating in a cross-sectional field survey of 6-year-old children and their parents in a German urban population.

BACKGROUND: To assess the prevalence of obesity, obesity-related binge eating, non-obesity-related binge eating, and night eating in five- to six-year-old children and to examine the impact of parental eating disturbances. METHODS: When 2020 children attended their obligatory health exam prior to school entry in the city of Aachen, Germany, 1979 parents (97.9%) filled out a questionnaire on their child's eating habits and weight development in a cross-sectional survey. Anthropometric measurements were collected for all children in a standardized form. RESULTS: Episodes of binge eating were found in 2.0% of the children surveyed and night eating in 1.1%. There was a significant relationship between binge eating and obesity but not between night eating and the child's weight. Children's binge eating and night eating were strongly associated with eating disturbances on the part of their mothers (adjusted odds ratios [95% confidence intervals]: 6.1 [2.7-13.5] and 7.8 [2.1-29.4], respectively) and with a non-German native language (adjusted odds ratios [95% confidence intervals]: 2.6 [1.2-5.5] and 11.6 [3.5-38.7], respectively). CONCLUSIONS: In concurrence with studies on adulthood, binge eating is linked to obesity already in early childhood. Children of mothers with eating disorders and children of mothers with a non-German native language are at increased risk of developing eating disorders themselves. Future studies should focus on obesity and eating disorders in early childhood; prevention programs should seek to target young children at risk as early as possible.

Adolescent↗

PubMed2005

Validation of the Portuguese version of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) for the screening of binge eating disorder.

OBJECTIVE: The present paper describes the validation of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) designed for the diagnosis of binge eating disorder (BED) and sub-clinical binge eating. METHODS: 89 overweight women seeking treatment for binge eating and/or obesity were assessed with the Portuguese version of the Questionnaire of Eating and Weight Patterns and were, subsequently, interviewed with the eating disorders module of the Structured Clinical Interview for DSM-IV (SCID-I/P). Rates of binge eating disorder and sub-clinical cases of binge eating obtained with the Questionnaire on Eating and Weight Patterns-Revised were then compared to those obtained with the Structured Clinical Interview for DSM-IV. RESULTS: In the identification of binge eating, irrespective of the presence of all criteria for binge eating disorder the QEWP-R Questionnaire on Eating and Weight Patterns-Revised yielded a sensitivity value of 0.88, a specificity value of 0.63 and a positive predictive value of 0.825. Rates for the identification of the full syndrome of binge eating disorder were: sensitivity value of 0.548, a specificity value of 0.8 and a positive predictive value of 0.793. CONCLUSIONS: The Questionnaire on Eating and Weight Patterns-Revised can be useful in a first-step screening procedure to identify probable cases of binge eating. It can be useful as a screening tool and as a first step of clinical assessment of patients seeking treatment for binge eating and/or obesity.

Adolescent↗

PubMed2007

Loss of control over eating reflects eating disturbances and general psychopathology.

This study examined the clinical significance of the loss of control over eating as a key component of eating disorders. It investigated the association of eating-related psychopathology and general psychopathology with objective bulimic episodes (OBEs; experiencing a loss of control while consuming large amounts of food) and subjective bulimic episodes (SBEs; experiencing a loss of control while consuming small/moderate amounts). A community sample of 81 women with a range of disordered eating was recruited: binge-eating disorder, bulimia nervosa, subclinical eating disturbances, or no eating disorders. They were interviewed using the Eating Disorder Examination and completed measures of eating-related and general psychopathology. Both OBE and SBE frequencies correlated significantly with measures of eating-related and general psychopathology, and no significant differences were found between the magnitudes of the correlations with either binge episode type. SBE frequency significantly and independently predicted global eating disorder psychopathology. The loss of control over eating, without consuming large amounts of food, was as closely associated with specific eating disorder psychopathology and general mental health as were traditionally defined OBEs. SBEs may be an important target of treatment and should be considered for future diagnostic classifications of eating disorders.

Adolescent↗

PubMed2006

Surfing for thinness: a pilot study of pro-eating disorder Web site usage in adolescents with eating disorders.

OBJECTIVE: Pro-eating disorder Web sites are communities of individuals who engage in disordered eating and use the Internet to discuss their activities. Pro-recovery sites, which are less numerous, express a recovery-oriented perspective. This pilot study investigated the awareness and usage of pro-eating disorder Web sites among adolescents with eating disorders and their parents and explored associations with health and quality of life. PATIENTS AND METHODS: This was a cross-sectional study of 698 families of patients (aged 10-22 years) diagnosed with an eating disorder at Stanford between 1997 and 2004. Anonymous surveys were mailed and offered in clinic. Survey content included questions about disease severity, health outcomes, Web site usage, and parental knowledge of eating disorder Web site usage. RESULTS: Surveys were returned by 182 individuals: 76 patients and 106 parents. Parents frequently (52.8%) were aware of pro-eating disorder sites, but an equal number did not know whether their child visited these sites, and only 27.6% had discussed them with their child. Most (62.5%) parents, however, did not know about pro-recovery sites. Forty-one percent of patients visited pro-recovery sites, 35.5% visited pro-eating disorder sites, 25.0% visited both, and 48.7% visited neither. While visiting pro-eating disorder sites, 96.0% reported learning new weight loss or purging techniques. However, 46.4% of pro-recovery site visitors also learned new techniques. Pro-eating disorder site users did not differ from nonusers in health outcomes but reported spending less time on school or schoolwork and had a longer duration of illness. Users of both pro-eating disorder and pro-recovery sites were hospitalized more than users of neither site. CONCLUSIONS: Pro-eating disorder site usage was prevalent among adolescents with eating disorders, yet parents had little knowledge of this. Although use of these sites was not associated with other health outcomes, usage may have a negative impact on quality of life and result in adolescents' learning about and adopting disordered eating behaviors.

Adolescent↗

PubMed1999

Binge eating severity, self-concept, dieting self-efficacy and social support during treatment of binge eating disorder.

OBJECTIVE: In treatment of binge eating, measures of self-concept, eating self-efficacy, and social support were examined at 0, 6, and 18 months to determine if improvements in these variables were associated with reductions in binge eating severity. METHOD: Obese adult females (N = 125) were treated for 6 months, with 12 months of maintenance meetings. The Binge Eating Scale (BES), Tennessee Self-Concept Scale (TSC), Dieter's Inventory of Eating Temptations (DIET), and a social support measure (SocSup) were used. RESULTS: Over the first 6 months, improvements in BES were associated with improvements in the TSC and DIET. Over 18 months, improvements in BES were associated with improvements in the TSC, DIET, and SocSup. DISCUSSION: Therapy for binge eating should result in improvement in self-concept and eating self-efficacy, as well as reductions in binge eating. This study showed that self-concept and eating self-efficacy were associated with improvement in binge eating severity. The association with social support did not appear until long-term follow-up. Improvement in self-concept and eating self-efficacy may be processes leading to clinical improvement in this eating disorder, or they may result from changes in binge eating.

Adult↗

PubMed1998

Reasons for initiation and cessation of eating in obese men and women and the affective consequences of eating in everyday situations.

Reasons for the initiation and termination of eating were investigated in 78 female and 36 male obese subjects following a weight control programme. Self-monitoring diaries were completed during a 24-h period, in which subjects selected the main reason for starting and stopping an eating episode. Additionally, subjects recorded mood before and after eating using visual analogue scales. Hunger was chosen as a reason to start eating in only 20% of cases. Environmental cues such as mealtime were selected as the main reason for the initiation of the majority of eating episodes. In contrast, self-assessments such as "I felt I had eaten enough" was the main reason for terminating eating (39.4%). Gender differences in the reasons for initiating eating revealed a greater tendency for men to initiate eating for environmental reasons than women, whereas the opposite was found for the termination of eating, with women more likely to stop eating for environmental reasons than men. Changes in affect during eating revealed a significant decline in negative emotions such as tension and tiredness, and in the heavier subjects a trend for increased happiness was observed following eating. As hunger was less commonly reported as a reason to start eating than external reasons, treatment strategies for the obese might benefit by targeting individual reasons for meal initiation.

Affective Symptoms↗

PubMed2004

Social anxiety and agoraphobia in the eating disorders: associations with eating attitudes and behaviours.

BACKGROUND: While eating disorders have a high comorbidity with anxiety disorders, little is presently known about how anxiety links to eating attitudes and behaviours and other related characteristics of eating-disordered individuals. The present study aimed to determine whether social anxiety and agoraphobia in eating-disordered individuals are linked to different eating attitudes and behaviours and levels of ego functioning. METHOD: The participants were 70 women who met DSM-IV criteria for an eating disorder. The Eating Disorder Inventory (EDI) was used as a measure of eating attitudes and ego-functioning characteristics, while the Social Phobia and Anxiety Inventory (SPAI) was used as a measure of levels of social anxiety and agoraphobia. RESULTS: High scores on the eating attitude scales of the EDI were associated with higher levels of social anxiety in eating-disordered individuals. High scores on the ego-dysfunction scales of the EDI were associated with higher levels of social anxiety and agoraphobia. CONCLUSIONS: The present findings suggest that eating-related attitudes and behaviours are associated with high levels of social anxiety, while psychological characteristics not specifically related to eating are associated with anxiety more broadly. The results highlight the importance of identifying and addressing comorbid anxiety in eating-disordered individuals, and suggestions are made for the treatment of such cases. Implications for future research are also discussed.

Adult↗

PubMed2003

Socially driven eating and restriction in the eating disorders.

The aims of this study were: to develop a measure to examine the relationship between socially driven eating and specific eating behaviours; to examine whether different social situations increase or decrease eating in different diagnostic groups; and to determine whether dimensional links exist between responses to social triggers and different aspects of eating pathology. A clinical group of 107 eating-disordered women and 143 nonclinical women completed a measure of socially driven eating and restriction (the Social Eating Scale, or SES) and the Eating Disorders Inventory. The SES had good psychometric properties. Patients with binge-eating disorder (BED) ate more in all social situations, while those with anorexia nervosa ate less. In contrast, bulimia nervosa (BN) patients ate more in general social situations but less in situations where the social trigger was related to food, shape, or weight. There were consistent dimensional links between responses to social triggers and different aspects of eating pathology. These findings support the recent literature on social triggers of eating behaviours but stress the relevance of the mixed pathology of women with BN. The role of social triggers for eating might help to explain the effectiveness of interpersonal psychotherapy when applied to the eating disorders.

Journal Article↗

PubMed2026

Genome-wide association meta-analysis of eating behavior traits revealed one susceptibility locus for emotional eating.

In order to identify new and genome-wide significant loci for eating behavior traits (cognitive restraint, uncontrolled eating and emotional eating), we conducted a meta-GWAS with seven studies of European ancestry (n = 11,250). Eating behavior was assessed using the Three-Factor Eating Questionnaire. Genotype effects of single studies were estimated using additive models adjusting for age, sex, BMI, and principal components and single study results were combined by fixed-effect meta-analysis.For cognitive restraint and uncontrolled eating, no genome-wide significant association could be detected. For emotional eating, one genomic region on chromosome 5 comprising two polymorphisms attained genome-wide significance (P = 4.0×10-8 for rs6877636 and P = 3.2×10-8 for rs6897090). The minor alleles were associated with higher emotional eating scores (β=0.093 ± 0.017), with a similar direction of effect in each study. Both SNPs, in near perfect linkage disequilibrium, mapped to RP11-24P24.1, a processed pseudogene of ornithine decarboxylase 1 (ODC1). Enrichment analysis revealed a significant overlap between genome-wide BMI-associated variants and nominal emotional eating variants, supporting the hypothesis that shared genetic factors may influence both eating behavior traits and obesity risk. Finally, we observed a number of interesting associations reaching suggestive significance (P < 10-6) involving BMI candidate genes, including a suggestive association between FTO variants and cognitive restraint (rs9922708, β = 0.069, P = 5.9×10-7).In conclusion, our meta-GWAS identified for the first time a robust chromosomal region associated with emotional eating in seven studies. Given that emotional eating strongly influences body weight but is often stigmatized, recognizing genetic susceptibility to certain eating behaviors may help reduce stigma and alleviate guilt.

Journal Article↗

PubMed2001

Night eating and nocturnal eating-two different or similar syndromes among obese patients?

OBJECTIVE: The main aim of this study was to identify subjects with (1) night eating syndrome (defined as morning anorexia, evening hyperphagia and insomnia) and (2) nocturnal eating syndrome (defined as eating at night after having gone to bed). In the literature the differences and similarities between these two syndromes are not clear. SUBJECTS: One-hundred and ninety-four obese patients from an academic, clinical obesity unit. Mean BMI (+/-s.d.) was 40+/-5 kg/m2, age 44+/-12 y and 76% were women. MEASUREMENTS: Questionnaires with multiple choices and open questions along with the Binge Eating Scale. RESULTS: Fourteen percent of the patients met the criteria for night eating and/or nocturnal eating syndrome. Night eating syndrome was manifest in 6% of the patients and nocturnal eating syndrome in 10%. Both the night eaters and the nocturnal eaters had more trouble getting to sleep than the patients without night/nocturnal eating problems (P<0.001 and P<0.01). The nocturnal eaters also had more trouble staying asleep (P<0.001). Morning anorexia was not typically found in nocturnal eaters. Being on long-term sick leave was more common among the nocturnal eaters (P<0.01). CONCLUSION: Fourteen percent of the patients at our obesity unit met the criteria for night eating and/or nocturnal eating syndrome. There are clear similarities between night eating syndrome and nocturnal eating syndrome, but also differences.

Adult↗

PubMed2004

eat-2 and eat-18 are required for nicotinic neurotransmission in the Caenorhabditis elegans pharynx.

Mutations in eat-2 and eat-18 cause the same defect in C. elegans feeding behavior: the pharynx is unable to pump rapidly in the presence of food. EAT-2 is a nicotinic acetylcholine receptor subunit that functions in the pharyngeal muscle. It is localized to the synapse between pharyngeal muscle and the main pharyngeal excitatory motor neuron MC, and it is required for MC stimulation of pharyngeal muscle. eat-18 encodes a small protein that has no homology to previously characterized proteins. It has a single transmembrane domain and a short extracellular region. Allele-specific genetic interactions between eat-2 and eat-18 suggest that EAT-18 interacts physically with the EAT-2 receptor. While eat-2 appears to be required specifically for MC neurotransmission, eat-18 also appears to be required for the function of other nicotinic receptors in the pharynx. In eat-18 mutants, the gross localization of EAT-2 at the MC synapse is normal, suggesting that it is not required for trafficking. These data indicate that eat-18 could be a novel component of the pharyngeal nicotinic receptor.

Amino Acid Sequence↗

PubMed2000

Seasonality of eating pathology on the eating attitudes test in a nonclinical population.

OBJECTIVE: To determine whether there are seasonal fluctuations in eating pathology in a nonclinical population. METHOD: The Eating Attitudes Test (EAT) was completed by 322 subjects during winter and again during summer. Summer and winter responses were compared to investigate differences in EAT total and subscale scores and for individual EAT items. Numbers of subjects fluctuating across the seasons by more than 2 SDs of the cohort's scores were identified. RESULTS: The cohort showed no significant seasonal change on EAT-40 totals, EAT-26 totals, or within the EAT subscales. There were significant (p <.025) seasonal fluctuations on four of the EAT-40 questions. For individual respondents, there was no greater likelihood of scoring significantly higher in the winter than in the summer. DISCUSSION: Clinically significant seasonal fluctuations in eating pathology on the EAT did not occur in this nonclinical population. It is debatable whether items within the EAT which show significant seasonal fluctuations should be retained or discarded.

Adult↗

PubMed1995

Nocturnal eating in binge eating disorder and matched-weight controls.

OBJECTIVE: To examine the association of nocturnal eating (getting up out of bed to eat) with overweight, binge eating, and negative mood or anxiety. METHOD: Forty overweight women diagnosed with binge eating disorder (BED) and 39 overweight controls monitored their nocturnal eating for an average of eight nights. RESULTS: Seven instances of nocturnal eating were recorded by 6 patients, all of whom were binge eaters. Foods consumed nocturnally tended to be selected from those favored for binge episodes, and reported control over nocturnal eating was low. Patients reported tiredness, but not poor mood or anxiety, at the nocturnal eating episodes. DISCUSSION: In this sample, nocturnal eating was associated more with eating disorder than overweight. This report should provide the basis of future work to determine whether nocturnal eating should be evaluated and treated among eating disordered or overweight groups of patients.

Adult↗

PubMed2004

Comparison of the child and parent forms of the Questionnaire on Eating and Weight Patterns in the assessment of children's eating-disordered behaviors.

OBJECTIVE: The assessment of eating-disordered behaviors in middle childhood is challenging. Frequently, both child and parents are queried about the child's eating behavior. However, no direct comparisons between parent and child reports of child eating disturbance have been published. We compared results from the adolescent and parent versions of the Questionnaire on Eating and Weight Patterns (QEWP-A and QEWP-P, respectively) in a nontreatment sample of overweight and normal weight children. METHOD: The QEWP-A and QEWP-P were administered to 142 overweight (body mass index [BMI] > or = 85th percentile) and 121 normal weight (BMI 15th-84th percentile) children, age 9.7 +/- 1.9 years, recruited from the community. RESULTS: The QEWP-A and QEWP-P showed good agreement for the absence of eating-disordered behavior but were not concordant in terms of the number or type of binge eating, overeating episodes, or compensatory weight control behaviors in the past 6 months. Children categorized by their own reports (QEWP-A) as engaging in no overeating, simple overeating, or binge eating behaviors did not differ significantly in body composition or in eating and general psychopathology. Children categorized according to their parents' reports (QEWP-P) as engaging in binge eating had significantly greater body adiposity, eating-disordered cognitions, body dissatisfaction, and parent-reported problems (all ps <.001) than children engaging in no overeating or simple overeating according to the QEWP-P. DISCUSSION: Child and parent reports of eating behaviors are not concordant regarding the presence of binge eating or compensatory behaviors. Further investigation of the utility of these questionnaires is needed before either can serve as a surrogate for a clinical interview.

Adult↗

PubMed2006

Situational effects on meal intake: A comparison of eating alone and eating with others.

Eating in competition with other tasks has been shown to increase food intake, particularly when tasks are cognitively demanding. To test the hypothesis that social facilitation of eating occurs, in part, as a function of distraction which impairs the ability to self-monitor, eating with others was compared with eating alone or in front of the television. Using a repeated measure within-subjects design, thirty-seven participants (21 males) visited the laboratory 4 times to eat a buffet-style lunch ad libitum. All eating episodes were filmed. Energy intake (EI) was measured when participants ate alone (A), ate alone while watching TV (B), ate with two same sex strangers (C), and ate with two same sex friends (D) in a counterbalanced order. EI was significantly enhanced by presence of familiar others (D: 4565+/-272 kJ, p < 0.001) and watching TV (B: 4350+/-252 kJ, p < 0.05) compared to baseline (A: 3861+/-200 kJ). Length of eating episode correlated significantly (p < 0.05) with EI, however, amount of time spent eating and looking at food differed by condition with a greater percentage of time focussed on food during baseline (p < 0.001). Eating with friends increased EI by 18% and eating in front of the TV increased EI by 14% relative to baseline. Engaging in conversation or watching TV draws attention away from the eaten food and can stimulate food intake. However, since eating with strangers also drew attention away from food but did not result in increased intake, social facilitation effects are not simply due to distraction. Thus food intake can be enhanced when attention to food and self-monitoring are impaired during distraction, however, this effect is moderated when eating with strangers.

Adult↗

PubMed2003

Emotional eating, alexithymia, and binge-eating disorder in obese women.

OBJECTIVE: To investigate the relationships between alexithymia and emotional eating in obese women with or without Binge Eating Disorder (BED). RESEARCH METHODS AND PROCEDURES: One hundred sixty-nine obese women completed self-report questionnaires, including the Beck Depression Inventory, the State Trait Anxiety Inventory, the Stress Perceived Scale, the Dutch Eating Behaviour Questionnaire, and the Toronto Alexithymia Scale. The presence of BED, screened using the Questionnaire of Eating and Weight Patterns, was confirmed by interview. RESULTS: Forty obese women were identified as having BED. BED subjects and non-BED subjects were comparable in age, body mass index, educational level, and socioeconomic class. According to the Dutch Eating Behaviour Questionnaire, BED subjects exhibited higher depression, anxiety, perceived stress, alexithymia scores, and emotional and external eating scores than non-BED subjects. Emotional eating and perceived stress emerged as significant predictors of BED. The relationships between alexithymia and emotional eating in obese subjects differed between the two groups according to the presence of BED. Alexithymia was the predictor of emotional eating in BED subjects, whereas perceived stress and depression were the predictors in non-BED subjects. DISCUSSION: This study pointed out different relationships among mood, alexithymia, and emotional eating in obese subjects with or without BED. Alexithymia was linked to emotional eating in BED. These data suggest the involvement of alexithymia in eating disorders among obese women.

Adolescent↗