Maladaptive Eating Behavior Research Articles

Effect of Grazing Behavior on Weight Regain Post-Bariatric Surgery: A Systematic Review.

Grazing, a type of maladaptive eating behavior, has been associated with poor weight outcomes in bariatric patients. The purpose of this study was to conduct a systematic review of the association between grazing behavior and weight regain post-bariatric surgery. Literature searches, study selection, design of the method, and quality appraisal were carried out by two independent authors. The search strategy was performed until October 2017 in Medline, Embase, Cochrane, Lilacs, Scopus, Web of Science, Google Scholar, ProQuest Dissertation & Theses, and Open Grey. Of a total of 3764 articles, five papers met the inclusion criteria (four original articles and one thesis), comprising 994 subjects, mostly women. The prevalence of grazing behavior ranged from 16.6 to 46.6%, and the highest prevalence of significant weight regain was 47%. The association between grazing and weight regain was observed in four of the five evaluated studies. Our findings support an association between grazing behavior and weight regain after bariatric surgery, regardless of surgery type and contextual concept of grazing. Further studies are needed to confirm the clarity of the real prevalence and interfering factors related to grazing behavior and weight outcomes.

Maladaptive eating behavior assessment among bariatric surgery candidates: Evaluation of the Eating Disorder Diagnostic Scale

BackgroundEating pathology among bariatric surgery candidates is common and associated with adverse outcomes. However, its assessment is complicated by the inconsistent use of standardized measures. We addressed this by examining the use of the Eating Disorder Diagnostic Scale (EDDS) in a large bariatric sample (N = 343). ObjectivesTo evaluate the EDDS among bariatric surgery candidates via examination of: (1) Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) and fifth edition (DSM-5) rates of binge eating disorder, bulimia nervosa, and maladaptive eating behaviors, and (2) the relationship between response biases and self-reported eating disorder symptoms. SettingParticipants were bariatric surgery candidates at a large public hospital in the Midwest. MethodsAs part of a larger preoperative evaluation, 343 patients seeking bariatric surgery completed the EDDS and measures of problematic response bias. ResultsApproximately 16% of the sample met full threshold criteria for binge eating disorder using DSM-5 criteria. Using the DSM-IV-TR, rates were lower but still substantial at 13%. Rates for bulimia nervosa were 8% (DSM-5) and 6% (DSM-IV-TR). The majority (66.1%) of participants reported at least one binge-eating episode per week. The most commonly used compensatory behavior was fasting (20.4%), followed by excessive exercise (11.7%), laxative use (5.6%), and vomiting (1.8%). An inverse relationship between severity of the eating symptomatology and problematic response bias emerged. ConclusionThe EDDS shows promise as a screening tool that uses diagnostic criteria to provide rates of binge eating and eating psychopathology among surgical candidates. Our findings suggest that subsequent validation studies of this measure are needed, should address potential response bias concerns, and should employ clear definitions of binge eating to promote standardization of eating pathology assessment in the bariatric population.

Maladaptive Eating Behaviors and Metabolic Profile in Patients Submitted to Bariatric Surgery: a Longitudinal Study.

This study aims to investigate relations between maladaptive eating behaviors (MEB) and metabolic profile in patients submitted to bariatric surgery. Longitudinal study including 70 patients before (T0), in the first year after surgery assessment (T1), and the second year after surgery assessment (T2). A face-to-face clinical interview assessed MEB at T0 and T2. Blood samples were collected at T0, T1, and T2 to assess fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), insulin, insulin resistance (IR), and triglycerides (TG). Mixed model analyses with growth curves tested the differences between patients with MEB (M group) and non-MEB patients (NM group) on the course of metabolic parameters, while controlling for total weight loss and type of surgery. No differences between both groups were reached for levels of FPG (F(1, 140)=2.936, p=0.089), HbA1c (F(1, 96)=0.099, p=0.754), insulin (F(1, 121)=0.146, p=0.703), IR (F(1, 60)=0.976, p=0.327), and TG (F(1, 128)=0.725, p=0.396). All parameters improved from T0 to T1 for both groups. A distinct trend on the course of metabolic markers in the M group but not the NM group is observed, presenting an increase in HbA1c levels, insulin, and TG levels. Both groups progressed favorably in the first 12months of surgery. MEB may be associated with a trend for deterioration of metabolic profile after 12months of surgery. The study should be replicated with longer-term assessments and a larger sample size.

"Strong beats skinny every time": Disordered eating and compulsive exercise in women who post fitspiration on Instagram.

Fitspiration is a recent Internet trend designed to motivate people to eat healthily and to exercise. The aim of the study was to investigate disordered eating and exercise in women who post fitspiration on Instagram. Participants were 101 women who post fitspiration images on Instagram and a comparison group of 102 women who post travel images. Both groups completed measures of disordered eating and compulsive exercise. Women who post fitspiration images scored significantly higher on drive for thinness, bulimia, drive for muscularity, and compulsive exercise. Almost a fifth (17.5%) of these women were at risk for diagnosis of a clinical eating disorder, compared to 4.3% of the travel group. Compulsive exercise was related to disordered eating in both groups, but the relationship was significantly stronger for women who post fitspiration images. For some women, posting fitspiration images on Instagram may signify maladaptive eating and exercise behaviors. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:76-79).

Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study

Background(Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance, reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone. MethodsOne hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5year following surgery.

The role of anxiety sensitivity in daily physical activity and eating behavior

Anxiety sensitivity (AS), or the fear of somatic arousal, has been linked to both maladaptive eating behavior as well as exercise avoidance in both self-report and laboratory-based experiments. The current pilot study sought to extend these finding to the naturalistic setting. A sample of 32 adults completed affect and dietary monitoring and wore actigraphs across a three-day monitoring period. Results indicated that high AS was associated with greater calorie consumption overall in women and less consumption in men, and high AS predicted an increase in calories consumed following participants' greatest increase in negative affect in both sexes. For physical activity, results indicated an AS by BMI interaction such that obese individuals with high AS engaged in less moderate-intensity physical activity, whereas the opposite was true for normal weight individuals. These results indicate that AS may represent a double-edged risk factor for obesity contributing to both exercise avoidance and calorie consumption.

Erratum to: Predicting One and Three Month Postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors in Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF)

Erratum to: Predicting One and Three Month Postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors in Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF)

Predicting One and Three Month Postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors in Bariatric Surgery Candidates with the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF)

Presurgical psychological screening of bariatric surgery candidates includes some form of standardized psychological assessment. However, associations between presurgical psychological screening and postoperative outcome have not been extensively studied. Here, we explore associations between presurgical Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) scores and early postoperative Somatic Concerns, Psychological Distress, and Maladaptive Eating Behaviors. The sample consisted of male (n = 238) and female (n = 621) patients who were administered the MMPI-2-RF at their presurgical psychological evaluation and received bariatric surgery. Patients were evaluated at their 1- and 3-month postoperative appointments. Confirmatory factor analysis indicated that three latent constructs-somatic concerns, psychological distress, and maladaptive eating behaviors-were represented by responses to a postoperative assessment and that these constructs could be measured consistently over time. Presurgical scores on MMPI-2-RF scales measuring internalizing dysfunction were associated with more psychological distress at postoperative follow-ups, scores on scales measuring somatization were associated with more postoperative somatic concerns, and scores on scales assessing emotional/internalizing, behavioral/externalizing, cognitive complaints, and thought dysfunction prior to surgery were associated with maladaptive eating behaviors after surgery. In conjunction with a presurgical psychological interview, the MMPI-2-RF provides information that can assist in anticipating postoperative outcomes and inform efforts to prevent them.

Associations Between Fear of Negative Evaluation and Eating Pathology During Intervention and 12-Month Follow-up.

Fear of negative evaluation, a core feature of social anxiety disorder, has been prospectively related to eating pathology over and above other established risk factors, suggesting that it may be an important cognitive risk factor for eating disorders. The present study examined reciprocal longitudinal relations among fear of negative evaluation and eating disorder risk factors using a female undergraduate sample (N=82) enrolled in an eating disorder prevention program. Cross-lagged panel analysis revealed that fear of negative evaluation was a determinant of subsequent body dissatisfaction and eating disorder symptoms. Fear of negative evaluation also predicted subsequent thin-ideal internalization among participants with high BMI, but not among those with low BMI. Fear of negative evaluation did not predict future dietary restraint or negative affect but was itself predicted by prior levels of thin ideal internalization, body dissatisfaction, dietary restraint, and negative affect. Findings suggest that fear of negative evaluation may be a useful target for reducing body image concerns and maladaptive eating behavior.

The Role of Anxiety Sensitivity and Eating Expectancy in Maladaptive Eating Behavior

Research has shown that anxiety sensitivity (AS), or the fear of somatic arousal, predicts distress and maladaptive coping in a range of psychiatric conditions. More recently, the role of AS has been examined in pathological eating. In the current investigation, a two-study design was employed to examine the role of AS and eating expectancies in both self-reported and actual eating behavior. For Study 1, 42 overweight/obese participants completed questionnaires assessing AS, as well as eating behaviors and attitudes. In Study 2, 60 participants representing all weight ranges completed the same questionnaire battery and underwent a negative mood induction task followed by food exposure. Results of this study revealed a 3-way interaction between Anxiety Sensitivity Index-mental concerns subscale, Eating Expectancy Inventory—eating leads to feeling out of control subscale, and BMI suggesting that those elevated on all 3 constructs consumed the most calories. Results are discussed in relation to better understanding the role of AS and eating expectancy and its utility in identifying a subset of overweight/obese individuals at risk for maladaptive eating behavior.

Distinctions between two expectancies in the prediction of maladaptive eating behavior

In this longitudinal study, the authors provide support for the validity of the claim that differences in the nature of the reinforcement that adolescent girls expect from eating contribute to the development of different forms of maladaptive eating. The learned expectancy that eating is pleasurable and rewarding predicted higher levels of social/celebratory over-eating across the first year of middle school but did not predict higher levels of clinical binge eating. In contrast, the expectancy that eating helps one manage negative affect predicted higher levels of binge eating but not of social/celebratory over-eating across the same time period ( n = 394). The results also supported a reciprocal model in which binge eating predicted higher levels of the expectancy that eating will manage negative affect but not that eating is pleasurable and rewarding; conversely, social/celebratory over-eating predicted higher levels of the expectancy that eating is pleasurable and rewarding but not that eating will manage negative affect.

Epistatic interaction between COMT and DAT1 genes on eating behavior: A pilot study

Problems related to food and weight in women may be influenced by the (DA) dopamine system. Catechol-o-methyl transferase (COMT) and the dopamine transporter (DAT) exert control on concentrations of extracellular DA. High and low functioning alleles of the COMT Val158Met and DAT1 3' UTR VNTR polymorphisms have been identified, and their associations with reward and cognition suggest a role in the modulation of eating behavior. A sample of undergraduate college women ( N = 71) was characterized for binge eating and eating psychopathology and genotyped for the COMT and DAT1 markers. Results revealed a significant epistatic interaction between COMT and DAT1 genes on eating psychopathology and binge eating ( p = .02 for both). This suggests that genetic studies of risk for maladaptive eating behavior involving the dopamine system should explicitly consider epistasis.

When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery?

Background Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment. However, it is unknown whether these interventions are best delivered pre- or postoperatively. The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention, before or after surgery. Methods A total of 32 pre- and postoperative patients were referred to a 10-week intervention designed to reduce eating behaviors associated with postoperative weight gain (e.g., loss of control while eating, grazing). The sample was 78.1% female and 84.4% white, with an average age of 49.43 ± 9.13 years and a body mass index of 44.22 ± 6.48 kg/m 2. Of the 32 patients, 21 were referred preoperatively and 11 were referred postoperatively (5.63 ± 2.91 months after surgery). These patients were tracked prospectively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention. Results Compared with the preoperative patients, the postoperative patients were more likely to follow-up with their referral and initiate treatment [χ 2(1) = 10.06, P = .002]. Of the postoperative patients, 100% attended the first intervention session compared with only 43% of preoperative patients. The postoperative patients also attended more intervention sessions [ t(18) = 2.51, P = .02] and were more likely to complete the intervention [χ 2(1) = 7.21, P = .007]. Only 14% of the preoperative referral patients completed the program compared with 91% of the postoperative patients. Conclusion Comprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery.

A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This report describes the development and implementation of a 10-week cognitive-behavioral mindfulness-based group intervention designed to reduce binge eating and address the specific needs of bariatric surgery patients. Posttreatment data showed improvement in binge eating symptoms, depressive symptomatology, and emotion regulation skills and increased motivation to change maladaptive eating behavior.

A study of psycho-pathology and treatment of children with phagophobia.

Phagophobia is a disorder characterized by a conditioned excessive fear of eating and is initiated by an event such as vomiting or choking. During childhood, vomiting often occurs as a result of infection or overeating, and painful experiences bring about maladaptive eating behavior like food refusal. There have been few reports of phagophobia, and patients have sometimes been misdiagnosed with anorexia nervosa (AN). The objective of this study was to elucidate the psycho-pathology and current treatment of patients with phagophobia by analyzing case studies. We describe 6 cases with phagophobia. Patients with strong obsessions were refractory to treatment, indicating that evaluation of premorbid personality is crucial to the prognosis. It is important to classify this disorder according to psycho-pathology into "post-traumatic type" and "gain-from-illness type" to make a treatment plan. A solution focused approach is also effective for patients and their family. Paying close attention to these conditions and to the diagnostic concept referred as "hagophobia" is useful in achieving these aims.

Eating Disorder Prevention Research: A Meta-Analysis

Eating disorder prevention programs have yielded mixed results and are somewhat controversial, primarily because of claims they may produce iatrogenic effects. We used meta-analysis to evaluate the effectiveness of eating disorder prevention programs and investigate moderators of intervention effects. Overall, prevention programs had large effects on improving knowledge and small net effects on reducing maladaptive eating attitudes and behaviors. Studies targeting participants at a relatively higher risk for developing an eating disorder produced greater benefits. Concerns about iatrogenic effects of including psychoeducational material on eating disorders were not supported by the data. These findings challenge conclusions drawn in previous review articles regarding the ineffectiveness of prevention programs and support the ability of eating disorder prevention programs to demonstrate behavioral improvements. Portions of this paper were presented at the 2003 convention for the Association for Advancement of Behavior Therapy.

Weight concern, dieting and eating behaviors. A survey of Israeli high school girls

The main goal of the present study was to explore some of the risk-factor variables for eating disorders among Israeli junior high and high school adolescent girls (12-18 years old) from different residential areas in the northern district of Israel. Additionally, this study examined and identified which group was most prone to develop disordered eating behaviors and attitudes. A representative sample of 1,316 Jewish adolescent females from five Israeli school sub-groups and from five different residential areas was selected proportionally to various school sub-groups and residential areas. The Eating Disorder Inventory-2 (EDI-2) was the assessment tool used, yielding scores on 11 sub-scales. In regard to age, the 16.6-18 year-olds were found to have significantly higher total EDI-2 scores, as compared to the other age groups. Girls aged 16.6 and up were found to have the highest score in six sub-scales out of eleven. As for different types of schools in different residential settings, the secular boarding school sub-group had the significantly highest scores, while the kibbutz sub-group had the lowest scores for the total EDI-2, as well as for most subscales. The majority of scores for the other school sub-groups fell midway between the two extreme groups. The results are discussed in terms of cultural, religious, ethnic, and socioeconomic influences. The results highlight the need to conduct a systematic methodological study comparing various psychological and socioeconomic factors, including maladaptive eating behavior in different types of religious residential schools.

Better clinical management of anorexia nervosa in teens

To the Editor In their recent wjm paper on eating disorders in adolescents, Brown and colleagues discussed key issues in diagnosis and clinical management.1 There were two important issues, however, that they failed to address. Firstly, although the authors state that their data are relevant to adolescents with anorexia nervosa, it is important to remember that some patients present with partial syndromes. These are classified by the American Psychiatric Association as “eating disorders not otherwise specified.”2 Patients with partial syndromes do not have all of the clinical manifestations that characterize the classical subtypes of eating disorders, but their medical complications are the same as those of anorexia nervosa. Patients with partial syndromes may not show the usual overvalued ideas that are common in the classic anorexia nervosa syndrome,3 and they are therefore able to correct their pathologic thoughts about “becoming too fat.” Indeed, in some cases, gentle discussion with patients may assist them in changing their maladaptive eating behavior, with consequent clinical improvement. Secondly, the authors suggest that most adolescents with eating disorders can be treated as outpatients. They recommend that hospitalization be reserved only for those teens whose weight loss has been rapid or intense, or for those adolescents with cardiovascular arrhythmias. Although this is good clinical advice, clinicians should remember that a change in the patient's environment may be therapeutic, particularly if patients are experiencing difficulties in the home setting.4 Perhaps hospital-based day programs for eating disorders would offer the best compromise.

Bulimia nervosa, restrained, and unrestrained eaters: a comparison of non-binge eating behavior.

This study investigated non-binge eating behavior in bulimia nervosa, restrained and unrestrained eaters. Nine females with bulimia nervosa, 12 female restrained eaters, and 13 female unrestrained eaters were administered the Eating Disorder Inventory-2 (EDI-2), the Body Shape Questionnaire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Revised Restraint Scale (RRS). All subjects were videotaped during a midday meal and their eating behavior was subsequently rated using the Eating Behaviour Rating Scale (EBRS). EBRS ratings were higher for bulimic than for unrestrained subjects. Restrained subjects' ratings did not differ from those of either bulimic or unrestrained subjects. EBRS scores were positively correlated with RRS and EDI-2 total scores. Bulimic subjects display aberrant eating behavior, and the extent to which subjects engage in maladaptive eating behavior is related to the degree of eating pathology. These results support the utility of the EBRS as a useful index of eating behaviors in clinical and nonclinical populations.

Depression and maladaptive eating practices in college students.

University students (n = 234) enrolled in sections of a required undergraduate course were administered the Center for Epidemiologic Studies Depression (CES-D) Scale and the Maladaptive Eating Behavior (MEB) Scale to determine if selected maladaptive eating practices correlated with depressive symptoms. Stepwise multiple regression on data from female subjects (n = 138) revealed that four eating practices related to depression, and produced a multiple R = .68, accounting for 46.2% of the variance. Maladaptive eating practices were not predictive of depression among males (n = 96) with "feeling uncomfortable eating in the presence of others" the only significantly correlated variable. This study confirms previous research that has found an association between maladaptive eating practices and depressed mood in nonclinical samples of university students.