Dietary Restraint Research Articles

Persistence: A key factor in understanding the circumstances under which dietary restraint predicts restriction of caloric intake

Dietary restraint refers to the intention to restrict caloric intake, whereas dietary restriction refers to the actual intentional and sustained restriction of caloric intake for weight-control purposes. Findings regarding the relation between dietary restraint and restriction to date are inconsistent. Our study sought to clarify this complex relationship using a novel laboratory task. Participants (N = 103; 56.3% female) completed a Paced Visual Serial Addition Task (PVSAT). Participants were provided a choice between ending each of eight PVSAT rounds at any time and drinking a high-calorie Kool-Aid® mixture or correctly completing 10 consecutive computations to access to a zero-calorie mixture for each round. We measured participants' dietary restraint using the Three-Factor Eating Questionnaire – Restraint Subscale and measured persistence and dietary restriction using the PVSAT. Results indicated a positive association between persistence and restriction. Female participants demonstrated higher eating disorder psychopathology, dietary restraint, and dietary restriction compared to male participants. Restraint was positively associated with restriction the more individuals persisted, indicating that persistence is a potentially important modifier of the relation between dietary restraint and restriction. Our findings highlight the complexity of the relation between dietary restraint and restriction; that is, measures of dietary restraint alone may not reliably predict short-term dietary restriction during laboratory consumption tasks; however, other factors, such as persistence, may play critical roles.

Associations among weight suppression, self-acceptance, negative body image, and eating disorder behaviors among women with eating disorder symptoms

ABSTRACT The present study aimed to clarify existing research that has inconsistently shown that weight suppression (differences between individuals’ highest and current body weights) is associated with worse eating disorder (ED) behaviors and negative body image among women with lifetime EDs, by examining whether an understudied client-supported protective factor for ED pathology – self-acceptance – moderates these associations. Currently symptomatic women with lifetime EDs (N = 108) completed measures assessing self-acceptance and ED symptoms via an online survey. Moderated regressions examined whether self-acceptance moderated associations between weight suppression and both body image (weight/shape preoccupation, overvaluation, dissatisfaction) and ED behavior (dietary restraint, compensatory behaviors, binge eating) outcomes. Results indicated that weight suppression was associated with more severe negative body image and dietary restraint, but not compensatory behaviors or binge eating. In contrast, self-acceptance consistently emerged as a protective factor relative to all negative body image and ED behavior indices. This protective effect did not offset apparent risk factor associations between weight suppression, and negative body image and ED behavior outcomes. These results support further assessment of self-acceptance as an understudied protective factor for women’s ED symptoms and as a mechanism of change in EDs intervention research. Women’s weight suppression should be assessed during ED prevention initiatives.

Recognition and duration of illness in adolescent eating disorders: Parental perceptions of symptom onset.

To understand the earliest parent reported signs suggesting their child may have an eating disorder (ED), and to quantify time from symptom onset to specialist assessment. This is a secondary analysis of data derived from parents of 78 young people presenting to a British community ED service who completed a questionnaire asking when they first noticed their child displaying (a) a change in eating pattern, (b) weight concerns, (c) shape concerns. Parents were also asked to describe the first thing they noticed in terms of possible ED symptoms. Mean age was 14.9 (SD: 1.58), 94% were female with diagnoses of anorexia nervosa (n=50), bulimia nervosa (n=10) and atypical anorexia nervosa (n=18). Weight and shape concerns were most often noticed over a year prior to assessment (mean 12.7 months [SD: 12.8] and 13.3 months [SD: 13.2], respectively), with eating pattern change observed a mean of 9.7 months (SD: 7.6) before referral to specialist care. Seven main themes were developed from parents' descriptions of their child's symptoms: (1) eating pattern change, (2) shape concern, (3) weight concern, (4) observed weight loss, (5) binge eating/compensatory behaviours, (6) other mental health concerns and (7) physical symptoms. The most common parental concerns were eating pattern change, specifically their child becoming more rigid/rule-bound with regard to eating and dietary restraint. Such external changes are likely observed before physical changes such as weight loss, offering potential for early identification by parents, primary care and other professionals, with implications for improved prognosis.

Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12–20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.

Who loses weight in a weight gain prevention program? A comparison of weight losers and weight maintainers at 3 years.

Despite weight loss challenges in young adulthood, 17% of participants in the Study of Novel Approaches to Weight Gain Prevention (SNAP) weight gain prevention study lost ≥ 5% of their body weight at 3 years. These "weight losers" (n = 88) were compared to "weight maintainers" (n = 143), who successfully prevented weight gains by staying within ± 2.5% of their baseline weight at 3 years. Weight losers and maintainers (n = 231; 18-35 years old) were drawn from the SNAP randomized controlled trial (n = 599), which compared two weight gain prevention interventions with a control group. Participants completed anthropometric and psychosocial assessments at baseline, 4 months (end of face-to-face intervention), and 1, 2, and 3 years. Three-year weight losers had significantly greater weight losses than maintainers by 4 months, and weight trajectories continued to diverge. Three-year weight change group was not associated with treatment assignment. At pretreatment, weight losers were heavier, closer to their self-reported highest ever weight, and further away from their self-identified ideal weight. Across treatment, weight losers had greater dietary restraint and autonomous motivation, had lower disinhibition and self-identified ideal weight, and self-weighed more frequently than weight maintainers. Weight gain prevention messaging may be sufficient to initiate weight loss in a subset of young adults who are heavier and closer to their highest weight at baseline. Psychological and behavioral characteristics more consistent with weight loss may explain differences in weight outcomes between losers and maintainers at 3 years. Future studies may consider the effects of weight gain prevention versus weight loss messaging in tailoring weight control interventions for young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A higher dietary restraint is associated with higher BMI: a cross-sectional study in college students.

BackgroundCollege students tend to have eating and lifestyle habits that can lead to weight gain. Paradoxically, weight gain could also lead to calorie restriction, a practice that is common among those who are concerned about their body weight. Thus, the objective of this study was to investigate the association between habits related to overweight and obesity and dietary intake, physical activity, and BMI among college students. MethodologyOne hundred ninety-two participants (18–26 years; 75% female) were included in this cross-sectional study. Participants completed the ‘habits related to overweight and obesity questionnaire’ which evaluates five dimensions: the concern about caloric intake, healthy eating, physical activity, alcohol consumption, and eating for psychological well-being. Additionally, anthropometric parameters, dietary intake, and physical activity were evaluated. Linear regression models were used to examine the associations between outcome and exposure variables. ResultsHigher concern about caloric intake was associated with higher BMI (1.05 kg/m2 [95%CI: 0.58, 1.51]), but lower energy (-312.2 kcal/day [95%CI: -404.6, -219.8]) and fat intake (-1.88% [95%CI: -2.94, -0.83]). Furthermore, healthy eating was related to better diet quality 0.96 [95%CI: 0.47,1.44] and lower energy intake (-231.4 kcal/day [95%CI: -367.7, -95.2]). Meanwhile, higher scores in the physical activity dimension were associated with better diet quality (0.41 [95%CI: 0.16,0.66]). ConclusionsCollege students with the highest dietary restraint had the greatest BMI and the lowest energy and fat intake. Our results highlight the importance of promoting healthy behaviors among college students.

Targeting dietary restraint to reduce binge eating: a randomised controlled trial of a blended internet- and smartphone app-based intervention.

Existing internet-based prevention and treatment programmes for binge eating are composed of multiple distinct modules that are designed to target a broad range of risk or maintaining factors. Such multi-modular programmes (1) may be unnecessarily long for those who do not require a full course of intervention and (2) make it difficult to distinguish those techniques that are effective from those that are redundant. Since dietary restraint is a well-replicated risk and maintaining factor for binge eating, we developed an internet- and app-based intervention composed solely of cognitive-behavioural techniques designed to modify dietary restraint as a mechanism to target binge eating. We tested the efficacy of this combined selective and indicated prevention programme in 403 participants, most of whom were highly symptomatic (90% reported binge eating once per week). Participants were randomly assigned to the internet intervention (n = 201) or an informational control group (n = 202). The primary outcome was objective binge-eating frequency. Secondary outcomes were indices of dietary restraint, shape, weight, and eating concerns, subjective binge eating, disinhibition, and psychological distress. Analyses were intention-to-treat. Intervention participants reported greater reductions in objective binge-eating episodes compared to the control group at post-test (small effect size). Significant effects were also observed on each of the secondary outcomes (small to large effect sizes). Improvements were sustained at 8 week follow-up. Highly focused digital interventions that target one central risk/maintaining factor may be sufficient to induce meaningful change in core eating disorder symptoms.

Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries.

Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention. To determine the prevalence of running-related injuries and describe factors related to a history of injury. Retrospective cross-sectional study. Survey distributed online to middle school runners. Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation. Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age. Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858). Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001). Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.

Disordered eating and eating disorders among women seeking fertility treatment: A systematic review.

The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.

Eight weeks of intermittent fasting versus calorie restriction does not alter eating behaviors, mood, sleep quality, quality of life and cognitive performance in women with overweight

Human trials that compare intermittent fasting (IF) to calorie restriction (CR) with psychological, behavioral and cognition outcomes are limited. We hypothesized that there would be no difference between CR and IF on perceived eating behaviors, mood, sleep quality, quality of life (QOL) and cognition in women with overweight and obesity. In this prespecified secondary analysis of an open-label, single center, parallel assignment, randomized controlled trial, healthy women with overweight or obesity (N = 46, mean [SD] age 50 [9] years, BMI 32.9 [4.4] kg/m2), without a diagnosed eating disorder and who were randomized into 2 weight loss groups (prescribed 70% of calculated energy requirements as IF or CR) were included. Measurements were assessed in both IF and CR groups following a 12-hour overnight fast during baseline and week 8 and additionally following a 24-hour fast in the IF group only at week 8. We observed that IF produced greater weight and body fat loss than CR (P < .001). We did not detect any statistical difference between groups for the change in dietary restraint, disinhibition, hunger, mood, sleep quality, and QOL. An increase in cognitive performance was found in both IF (P = .036) and CR (P = .006) groups in one of the cognitive tasks, but there was no statistical difference between groups. Perceived eating behaviors, mood, sleep quality and cognitive performance were not changed by an acute 24-hour fast within the IF group (all P > .05). IF may be a viable alternative to CR for weight loss, in the short-term, without adversely impacting eating behaviors, mood, sleep quality, QOL or cognition in healthy women with overweight or obesity. However, larger and long term trials are required.

Is time restricted eating superior to continuous dietary restraint for weight management?

Is time restricted eating superior to continuous dietary restraint for weight management?

Clinically significant body dissatisfaction: prevalence and association with depressive symptoms in adolescent boys and girls.

Body dissatisfaction is distressing and a risk factor for adverse consequences including eating disorders. However, data pertaining to the prevalence of body dissatisfaction in adolescence, a key period for its emergence, are lacking. This is a substantial barrier to tailored assessment and early intervention. This study addresses this gap and provides the prevalence of body dissatisfaction and associations with depressive symptoms and body change strategies. Adolescent boys (n = 367; Mage = 12.8, SD = 0.7) and girls (n = 368; Mage = 12.7, SD = 0.7) completed measures of body dissatisfaction and depressive symptoms with established cut-off levels. They also completed measures of dietary restraint and strategies to increase muscle size. Of boys and girls, 37.9% and 20.7%, respectively experienced moderate, and 6.8% and 19.6% experienced clinically significant body dissatisfaction, with higher rates among girls than boys and among adolescents aged 13 and 14 than aged 12. More than one-quarter of boys (26.70%) and one-third of girls (33.15%) reported subthreshold depressive symptoms or possible, probable or major depressive episodes. Girls revealed a higher prevalence of possible-, probable-, or major depressive episode than boys. Relative to those with no or low body dissatisfaction, adolescents with clinically significant body dissatisfaction were 24 times more likely to also report possible-, probable-, or major depressive episodes. Among boys and girls, clinically significant body dissatisfaction was associated with higher levels of dietary restraint and engagement in strategies to increase muscle size. Greater attention to identification and early intervention for body dissatisfaction is needed, especially for girls.

An Intuitive Eating Intervention Improves Dietary Restraint, Body Appreciation, and Intuitive Eating in Female Undergraduates: A Pilot Study

ObjectivesDietary restraint and low body appreciation are common among female undergraduates and are related to disordered eating. Intuitive eating is an approach to eating that promotes listening to internal cues (e.g., hunger and fullness) and may help reduce disordered eating. It was hypothesized that an intuitive eating intervention would decrease levels of dietary restraint and increase levels of body appreciation and intuitive eating. MethodsFourteen female undergraduates were randomized to two groups. The intervention consisted of 5 weekly intuitive eating sessions led by two Registered Dietitians. One group received the intervention after the other. The Three-Factor Eating Questionnaire-18 (TFEQ-18) assessed dietary restraint across three subscales, the Body Appreciation Scale-2 (BAS-2) assessed body appreciation, and the Intuitive Eating Scale-2 (IES-2) assessed intuitive eating and its four subscales. SPSS v 26 software was used for analyses. Paired sample t-tests were run to examine within-participants changes in outcome variables pre- and post-intervention and at a 5-week follow-up. The significance level was set at .05. ResultsThere was a significant decrease in TFEQ-18 subscales pre- to post-intervention, including cognitive restraint (61.5 ± 20.4 to 39.3 ± 18.0, P < .001), uncontrolled eating (55.8 ± 17.9 to 43.9 ± 10.1, P = .01), and emotional eating (68.3 ± 23.0 to 44.4 ± 18.5, P < .001). There was a significant increase in BAS-2 scores (3.1 ± 0.6 to 3.7 ± 0.5, P = .001) and all IES-2 subscales, including unconditional permission to eat (2.7 ± 0.7 to 3.8 ± 0.6, P < .001), eating for physical rather than emotional reasons (2.5 ± 0.6 to 3.3 ± 0.7, P < .001), relying on hunger and satiety cues (2.8 ± 0.7 to 3.7 ± 0.6, P < .001), body food-choice congruence (3.8 ± 0.6 to 4.1 ± 0.7, P = .02), and total IES-2 scores (2.8 ± 0.5 to 3.7 ± 0.5, P < .001), pre- to post-intervention. Post-intervention scores compared to the 5-week follow-up (n = 7) revealed no significant changes indicating that the pre- to post-intervention changes were sustained. ConclusionsThis study provides data suggesting that a 5-week intuitive eating intervention may help decrease dietary restraint and increase body appreciation and intuitive eating in female undergraduates. Intuitive eating may be a promising strategy to prevent disordered eating in undergraduates. Funding SourcesNo external funding.

Maternal Eating Behavior in Low-Income Mothers Influences Attitudes Toward Infant Feeding

ObjectivesEating behavior is established early in life, influences infant development and health, and is likely to originate with the mother. We examined if maternal eating behaviors influenced attitudes towards infant feeding styles and whether these associations differed by infant feeding mode (breastfeeding and formula-feeding). MethodsThis was an observational study in 35 low-income mother-infant dyads. Postpartum women (≥18 years old, 25 ≤ BMI < 40 kg/m2) in the Louisiana Women, Infants, and Children (WIC) program completed the Eating Inventory and Infant Feeding Styles Questionnaire to assess maternal eating behavior (dietary restraint, disinhibition, and perceived hunger) and infant feeding styles (restrictive feeding, responsive feeding, and pressuring/overfeeding), respectively, 8 weeks after delivery. Linear models with fixed effects were computed with maternal age, BMI, and maternal eating behavior as covariates using SPSS (p < 0.05 to indicate significance). ResultsThirty-four % of the mothers were breastfeeding (n = 12) and 66.0% were formula-feeding (n = 23). Infant feeding styles were not predicted by maternal eating behaviors (all p > 0.05). In mothers who breastfed, maternal dietary restraint was positively associated with infant pressuring/overfeeding (β = 0.91, p < 0.05) and was different from those in the formula fed group (Δ = 1.37, p = 0.02). In addition, maternal disinhibition was negatively associated with restrictive infant feeding (β = –0.53, p < 0.05) and was different from those in the formula fed group (Δ = –0.95, p = 0.003). Comparatively, in mothers who formula-fed, restrictive infant feeding was predicted by maternal disinhibition (β = 0.42, p < 0.01; Δ = –0.95, p = 0.003) and maternal perceived hunger (β = 0.43, p < 0.01; Δ = 0.71, p = 0.007). ConclusionsMaternal eating behavior is associated with infant feeding styles only when feeding mode is considered. Interventions educating mothers on how their own eating behaviors have the potential to influence eating behaviors of their children are needed. Funding SourcesUSDA Small Grants Program and the NIH (T32DK064584, and U54 GM104940).

Food Palatability Directs Our Eyes Across Contexts.

It is often believed that attentional bias (AB) for food is a stable trait of certain groups, like restrained eaters. However, empirical evidence from this domain is inconsistent. High-calorie foods are double-faceted, as they are both a source of reward and of weight/health concern. Their meaning might depend on the food-related context (i.e., focus on health or on enjoyment), which in turn could affect AB for food. This study primed 85 females with hedonic, healthy, and neutral contexts successively and examined whether food-related context affected AB for food and if effects were moderated by dietary restraint. Both the mean tendencies of AB for food and variability of AB for food were assessed in a food dot-probe task with a recording of both reaction times and eye movements. Contrary to our hypotheses, AB for food was not significantly affected by either context or the interaction between context and dietary restraint. Instead, liking of the presented food stimuli was related to longer initial fixations and longer dwell time on the food stimuli. In addition, in line with prior research, body mass index (BMI) was correlated with variability of AB for food instead of mean AB for food. In conclusion, this study did not find any support that AB for food is dependent on food-related context, but interestingly, reaction time-based variability of AB for food seems to relate to BMI, and eye movement-based mean AB seems to relate to appetitive motivation.

Recalling a recent meal reduces desire and prospective intake measures for pictures of palatable food

AbstractRecalling what was eaten at a meal today, relative to yesterday, reduces subsequent food intake. We explored one cause of this effect by examining how this memory manipulation affects food specific (desire/how much you would eat) and general (hunger) motivation to eat. Participants rated hunger before random assignment to either recall their last meal (experimental) or lunch yesterday (control). They then judged specific motivation to eat a set of palatable foods (as pictures), followed by hunger ratings and a measure of dietary restraint. Specific motivation to eat was significantly lower in the experimental group, even though hunger ratings increased following exposure to food images in both groups. Dietary restraint was negatively correlated with specific motivation to eat in controls, but not in the experimental group, and these two relationships significantly differed. We suggest an explicit cognitive process akin to dietary restraint inhibits specific motivation to eat following last meal recall.

A two-week daily diary study examining the association between daily self-compassion and symptoms of bulimia nervosa.

Individuals with symptoms of bulimia nervosa (BN) are more likely to binge and purge on days of greater negative affect. Given that self-compassion helps individuals cope more adaptively with distress, the present study examined the contribution of daily fluctuations in self-compassion to eating disorder symptoms in women who endorse symptoms of BN. The directionality of these associations was also examined. For 2 weeks, 124 women who met the DSM-5 criteria for BN completed nightly measures of their daily eating pathology and self-compassion. Self-compassion levels varied almost as much within a person from day-to-day as between-persons (i.e., from one person to the next). Multilevel modeling revealed that within persons, higher daily levels of self-compassion were associated with a reduced probability of both binge eating and inappropriate compensation, and lower levels of dietary restraint and clinical impairment. Secondary analyses revealed that these variables mutually influenced one another within but not across days. Between persons, higher mean levels of self-compassion over the 2 weeks were associated with less dietary restraint and clinical impairment but were unrelated to binge eating and compensatory behaviors. For women who report symptoms consistent with BN, responding to daily distress with greater self-compassion than usual may attenuate the psychosocial and behavioral symptoms of their eating disorder. Similarly, days of reduced eating pathology may facilitate self-compassion. Future research using experimental paradigms and ecological momentary assessments may shed further light on the ways in which self-compassion and eating pathology relate to one another in this population.

The effect of misgendering on body dissatisfaction and dietary restraint in transgender individuals: Testing a Misgendering-Congruence Process.

Despite research findings that transgender individuals have higher rates of body dissatisfaction and disordered eating than their cisgender peers, reasons for greater eating pathology remain unclear. We propose a Misgendering-Congruence Process by which being misgendered (i.e., labeled a gender other than that with which one identifies) could lead transgender individuals to feel greater incongruence between their bodies and internal identities, which in turn leads to body dissatisfaction and efforts to bring one's body in line with one's identified gender by engaging in weight and shape control behaviors such as dietary restraint. One hundred and thirty transgender individuals completed measures of misgendering frequency, transgender congruence, body dissatisfaction, and dietary restraint. Mediation analyses provided preliminary support for the Misgendering-Congruence Process when conducted with the overall sample as well as with transgender subgroups: transgender women (n=41), transgender men (n=42), and nonbinary transgender individuals (n=47). Social recognition of transgender people's gender identities appears to play a unique role in their body satisfaction and restrained eating behaviors.

Contextualising Eating Disorder Concerns for Paediatric Obesity Treatment

Eating disorders are complex mental health conditions that share risk factors with obesity. This review outlines the context for concerns that paediatric obesity treatment presents a risk for eating disorder development. Most children and adolescents undergoing professionally supervised obesity treatment will have improvements or no change to eating disorder risk profiles. However, some may subsequently develop a clinical eating disorder, and this is proposed to relate to weight-focussed dietary interventions that are standard in paediatric obesity treatment. Nevertheless, dietary restraint may not be a strong predictor of eating disorder risk in the context of paediatric obesity treatment. Most international guidelines recommend weight maintenance or weight loss as a treatment goal, and weight loss is related to improvements in cardiometabolic health but not eating disorder risk in the short term. The risk of inducing or exacerbating an eating disorder during paediatric weight management is likely to be low; however, the serious consequences combined with increasing scale of obesity treatment, and lack of empirical evidence, are of concern. There is a need for further research to identify long-term predictors of eating disorder development for children and adolescents who seek treatment for their obesity.

Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach.

Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.