The Role of Disordered Eating in Type 2 Diabetes: A Pilot Study.

Rates of type 2 diabetes mellitus continue to rise around the world, largely due to lifestyle factors such as poor diet, overeating, and lack of physical activity. Diet and eating is often the most challenging aspect of management and, when disordered, has been associated with increased risk for diabetes-related complications. Thus, there is a clear need for accessible and evidence-based interventions that address the complex lifestyle behaviors that influence diabetes management. The current study sought to assess the efficacy and acceptability of a pilot lifestyle intervention for women with type 2 diabetes and disordered eating. The intervention followed a cognitive behavioral therapy guided-self-help (CBTgsh) model and included several pillars of lifestyle medicine, including: diet, exercise, stress, and relationships. Ten women completed the 12-week intervention that provided social support, encouraged physical activity, and addressed eating behaviors and cognitions. Results indicate the lifestyle intervention was a feasible treatment for disordered eating behaviors among women with type 2 diabetes and was also associated with improved diabetes-related quality of life. The intervention was also acceptable to participants who reported satisfaction with the program. The current CBTgsh lifestyle intervention is a promising treatment option to reduce disordered eating and improve diabetes management.

Examining predictors of binge eating behaviors among racially and ethnically diverse college men.

Objective: College men may be at risk for binge eating (BE) but are underrepresented in research. This study aimed to examine if body weight/shape concerns, perceived stress, and psychological distress significantly contributed to the likelihood of BE over the past 28 days. Participants: A racially/ethnically diverse sample (N = 873) of college men. Method: An anonymous online survey was administered. Logistic regression analysis was conducted to examine the hypothesized associations for the entire sample, and exploratory analyses were conducted within each racial/ethnic group. Results: The model explained approximately 25% of the variance in BE, with body weight/shape concerns as the only significant predictor in the overall sample and for the White, Black, and Asian subsamples; none of the variables were significant among Latino men. Conclusions: Body weight/shape concerns predict BE among diverse college men. The findings have implications for future research, as well as for prevention and intervention for college men.

Randomized controlled trial of a culturally-adapted program for Latinas with binge eating.

Binge eating disorder (BED) is the most prevalent eating disorder among Latinas. Furthermore, Latinas report more frequent binge eating and higher levels of associated mental health symptoms as compared with non-Latino White women. Research demonstrates that Latinas' eating problems largely go undetected and untreated and that they face numerous barriers to seeking professional help. Cognitive-behavioral therapy (CBT)-based guided self-help (CBTgsh) for binge eating is a more affordable and disseminable intervention than traditional CBT treatment. In this paper, we present the findings from a randomized controlled trial (RCT) of a culturally adapted CBTgsh program in a sample of overweight and obese Latinas with BED, the first RCT of this type with an ethnic minority population. Study participants (N = 40) diagnosed with BED were randomly assigned to the CBTgsh (n = 21) or waitlist (n = 19) condition. Treatment with the CBTgsh program resulted in significant reductions in frequency of binge eating, depression, and psychological distress and 47.6% of the intention-to-treat CBTgsh group were abstinent from binge eating at follow-up. In contrast, no significant changes were found from pre- to 12-week follow-up assessments for the waitlisted group. Results indicate that CBTgsh can be effective in addressing the needs of Latinas who binge eat and can lead to improvements in symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The need for cultural adaptations to health interventions for African American women: A qualitative analysis.

OBJECTIVE: Binge eating disorder (BED) is associated with obesity and psychological distress. Although rates in African American (AA) and White women are similar, AA women report more severity of symptoms and higher frequency of binge eating episodes. However, few AA women seek help due to a lack of acknowledgment of sociocultural influences that shape experiences and behaviors related to BED in currently available interventions. Culturally adapted interventions are an important way to acknowledge these sociocultural factors and produce expected outcomes within a specific group. This qualitative study begins the process of culturally adapting evidence-based treatment for AA women to reduce BED. METHOD: Sixteen AA women with BED participated in focus groups to determine the need for adaptations to an evidence-based intervention. Thematic content analysis was used to analyze data from focus groups. RESULTS: The unique experiences of AA women including lack of awareness of BED, cultural deviation from the "thin ideal," influence of family on eating practices, social meanings of food, role of religion, binge eating as coping, skepticism about weight standards, and the importance of motivation to change are highlighted. CONCLUSION: This research adds to the current discourse on the importance of culturally adapting interventions for more targeted use and helps to expand what is known about AA women with BED and associated obesity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Personality Disorders and Psychological Functioning Among Latina Women with Eating Disorders.

Little is known about personality disorders (PD) and comorbidities among Latinas with eating disorders (ED). The dysregulation and chronicity of PDs can complicate and augment the symptomatology of EDs. This set of analyses provides a preliminary examination of PD and psychopathology in a sample of Latina women with ED. Participants (N = 34) were administered the Structured Clinical Interview for the Diagnostic and Statistical Manual, Eating Disorders Examination, and Millon Clinical Multiaxial Inventory-III to assess personality pathology, and questionnaires (Beck Depression Inventory-II and Brief Symptom Inventory) to assess psychological functioning. Results indicated the most common clinically significant trait in the sample was depressive personality (50% of the sample had a score of 75 or higher on this trait). For Bulimia Nervosa (BN) and Binge Eating Disorder (BED), avoidant (41%) and depressive (65%) personalities, respectively, were the most common clinically significant traits. Anxiety disorders were the most common psychiatric diagnoses, and 52.9% of the sample reported both clinically significant PD traits and other major psychopathology. There were no significant differences between the BED and BN groups on prevalence of PD traits and psychopathology. This pilot study highlights the need for further examination of PD and psychopathology in Latinas with ED. Unlike previous research with White women, we found no differences on PD and psychopathology between BED and BN, and the most prevalent PDs among Latinas were different than White women. Personality and psychological functioning should be assessed in all patients with ED, with ongoing research focused on identifying patterns in understudied groups such as Latinas, a practice that may improve treatment for this underserved population.

Initial treatment seeking from professional health care providers for eating disorders: A review and synthesis of potential barriers to and facilitators of "first contact".

The objective of this study is to provide a comprehensive review of empirical research exploring barriers to and facilitators of initial treatment seeking ("first contact") from professional health care providers by adults and young adults with eating disorders (EDs). A search of databases PsycINFO and MEDLINE using the terms "treatment" and "eating disorder*" yielded 9,468 peer-reviewed articles published from January 1945 to June 2016. Screening identified 31 articles meeting the following criteria: (1) participants were 16 or older and presented with a self-reported or clinically diagnosed ED; (2) studies focused on (a) initial treatment seeking (b) for an ED (c) from professional health care providers; (3) articles were empirical, and (4) peer reviewed. Quantitative studies revealed few consistent correlates of treatment seeking, perhaps because most variables were examined in only one or two investigations. Variables with some degree of predictive utility (i.e., produced significant results in multiple studies) were age (older), ethnicity (nonethnic minority), ED type (anorexia, purging BN), specific ED-related behaviors (i.e., purging), and time spent on a treatment waitlist following referral (less). Although BMI was one of the most investigated variables, it did not predict treatment seeking. Qualitative studies revealed the following perceived barriers: (1) personal feelings of shame/fear, (2) ED-related beliefs/perceptions, (3) lack of access/availability, and (4) aspects of the treatment process. Perceived facilitators included (1) health-related concerns, (2) emotional distress, and (3) social support. Implications for clinical practice and areas for further research are discussed. Results highlight the need for shared definitions and methodologies across studies of treatment seeking.

Associations between meal patterns, binge eating, and weight for Latinas.

Establishing a regular pattern of eating is a core element of treatment for binge eating, yet no research to date has examined meal patterns of Latina women. OBJECTIVE: Compare eating patterns of Latinas who binge eat and those who do not, and examine associations between meal patterns and binge episodes, associated distress and concerns, and body mass index (BMI). METHOD: One-hundred fifty-five Latinas [65 Binge Eating Disorder (BED), 22 Bulimia Nervosa (BN), 68 with no eating disorder] were assessed with the Eating Disorder Examination. RESULTS: There were no significant differences in eating patterns between groups. Breakfast was the least and dinner the most consumed meal. For the BED group: greater frequency of lunch consumption was associated with higher BMI while more frequent evening snacking was associated with lower BMI and with less weight importance; more frequent breakfast consumption, mid-morning snack consumption and total meals were associated with greater distress regarding binge eating. For the BN group, evening snack frequency was associated with less dietary restriction and more weight and shape concern; total snack frequency was associated with more weight concern. Regular meal eaters reported more episodes of binge eating than those who did not eat meals regularly. DISCUSSION: Associations with meal patterns differed by eating disorder diagnosis. Study findings mostly are not consistent with results from prior research on primarily White women. CBT treatments may need to be tailored to address the association between binge eating and regular meal consumption for Latinas. Culturally, appropriate modifications that address traditional eating patterns should be considered. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:32-39).

Mexican American women's perspectives on a culturally adapted cognitive-behavioral therapy guided self-help program for binge eating.

The prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among Latinas is comparable to those of the general population; however, few interventions and treatment trial research have focused on this group. Cognitive-behavioral therapy (CBT) is the treatment of choice for binge eating related disorders. CBT-based guided self-help (CBTgsh)-a low-cost minimal intervention-has also been shown effective in improving binge eating related symptom, but the effectiveness of the CBTgsh among ethnic minority women is not well understood. Cultural adaptation of evidence-based treatments can be an important step for promoting treatment accessibility and engagement among underserved groups. This qualitative study was part of a larger investigation that examined the feasibility and efficacy of a culturally adapted CBTgsh program among Mexican American women with binge eating disorders. Posttreatment focus groups were conducted with 12 Mexican American women with BN or BED who participated in the intervention. Data were analyzed with the grounded theory methodology (Corbin & Strauss, 2008). Three themes emerged from the data: (a) eating behavior and body ideals are socially and culturally constructed, (b) multifaceted support system is crucial to Mexican American women's treatment engagement and success, and (c) the culturally adapted CBTgsh program is feasible and relevant to Mexican American women's experience, but it can be strengthened with increased family and peer involvement. The findings provide suggestions for further adaptation and refinement of the CBTgsh, and implications for future research as well as early intervention for disordered eating in organized care settings.

Culturally adapted cognitive behavioral guided self-help for binge eating: a feasibility study with Mexican Americans.

Objective was to test feasibility and preliminary efficacy of a culturally adapted cognitive-behavioral self-help program to treat binge eating and related problems in Mexican Americans. Participants were 31 women recruited from the Los Angeles area and diagnosed with binge eating disorder, recurrent binge eating, or bulimia nervosa. Participants completed a culturally adapted version of a CBT-based self-help program with 8 guidance sessions over a 3-month period. Treatment efficacy was evaluated in terms of binge eating, psychological functioning, and weight loss. Intent-to-treat analyses revealed 35.5% abstinence from binge eating at posttreatment and 38.7% diagnostic remission. Results indicated significant pretreatment to posttreatment improvement on distress level, BMI, eating disorder psychopathology, and self-esteem. Satisfaction with the program was high. Findings demonstrate that the program is acceptable, feasible, and efficacious in reducing binge eating and associated symptoms for Mexican American women. Study provides "proof of concept" for implementation of culturally adapted forms of evidence-based programs.

Understanding Eating Disorders among Latinas.

This paper provides a brief summary of the literature on eating disorders (EDs) among Latinas in the U.S and presents data that illustrate symptomatology and associated psychopathology in this group. The current empirical evidence suggests similarities between Latinas and white European-American women in regards to risk factors, symptomatology, psychopathology, and prevalence of EDs. Despite these similarities, Latinas are less likely to report dieting, dietary restriction, and are more likely to be obese compared to white women. Although Latinas report distress associated with EDs, only a small proportion ever seek treatment. Several factors appear to contribute to their under-utilization of services including lack of knowledge, stigma, beliefs about seeking treatment, lack of health insurance, and lack of affordable and accessible treatment services. It is unclear whether the identified differences between white and Latina women are the result of cultural factors or are better explained by disparities in SES. Efforts to meet the treatment needs of Latinas in the U.S. should aim to increase awareness and education about EDs in this population and to address cultural beliefs and norms that may act as barriers to treatment utilization. Further, it is important to educate and train healthcare professionals to be aware that EDs may develop in or affect Latina patients, and to develop accessible, culturally-appropriate and cost-effective evidence-based treatments that can be disseminated through partnerships with primary care providers and community organizations.

Predictors of maternal child-feeding practices in an ethnically diverse sample and the relationship to child obesity.

OBJECTIVE: To investigate the relationship between maternal child-feeding practices and child adiposity in an ethnically diverse sample by examining three categories of relationships: 1) mothers' weight status; 2) mothers' investment in eating-related issues; and 3) mothers' concerns about child's weight. It was predicted that these variables would be related to mothers' use of restriction, monitoring, and pressure in child feeding, influencing child adiposity. DESIGN AND METHODS: A total of 563 mothers (306 Hispanic, 76 Asian, 36 Black, and 145 White) with children aged 2-11 years completed the Child Feeding Questionnaire and Eating Attitudes Test. Analyses used structural equation modeling. RESULTS: Ethnic differences in the resulting models emerged. Mothers' weight status negatively predicted maternal control over child's eating; heavier mothers reported less control over child's eating. Greater concern about child's weight was associated with more maternal control of child's eating for all groups. Maternal control over child's eating was predictive of child's body mass index only in the White group. CONCLUSIONS: Although maternal investment in eating-related issues did predict maternal control over child's eating for White mothers, this relationship did not exist for Hispanics. Different maternal factors influence mothers' control over their child's eating in Hispanic and White groups. In ethnic minorities, maternal control over child's eating may not influence child adiposity.

How many therapists? Practical guidance on investigating therapist effects in randomized controlled trials for eating disorders.

OBJECTIVE: An important question in implementation/dissemination research is whether the efficacy of a given treatment varies in part based on the therapist delivering the treatment. This study sought to provide practical guidance to researchers in the field of eating disorders for building measurement of therapist effects into the design of a typical, relatively small randomized controlled trial (RCT). METHOD: Using assumptions based on past trials of eating disorder treatments, Monte Carlo simulations were used to examine 12 different scenarios based on crossing the number of therapists (between two and five) and the estimated therapist effect size (small, medium, and large). Patient sample size and study design were held constant. RESULTS: There was reasonable power (≥70%) to detect the therapist effect with three or four therapists and a large effect size. DISCUSSION: Several practical implications for testing therapist effects in RCT are discussed.

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self-Help Program for Mexican American Women With Binge Eating Disorders.

Data on the compatibility of evidence-based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N = 12) feedback on a cognitive behavior therapy guided self-help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation process and highlighted the importance of balancing the fidelity and cultural relevance of evidence-based treatment when disseminating it across diverse racial/ethnic groups.

Binge eating and purging in a multi-ethnic community sample.

OBJECTIVE: The purpose of the present study is to document the frequency of three eating disorder-related behaviors (binge eating; self-induced vomiting; and use of laxatives, diuretics, and diet pills) among a multi-ethnic community sample. METHOD: A questionnaire was administered to 1225 Hispanic, Asian, black, and white women and men. Participants responded to items (based on DSM-IV diagnostic criteria for eating disorders) about binge eating and purging behavior. RESULTS: Binge eating and purging were more common among women than among men in Hispanic, black, and white subsamples (frequency rates were similar among Asian men and women). Ethnic differences were found in frequency of purging among women (ethnicity was not associated with behavior rates among men). Fewer Asian than Hispanic, black, and white women induced vomiting and used laxatives, diuretics, and diet pills as weight control methods. CONCLUSION: The fact that frequency rates differed as a function of participant sex and ethnicity underscores the importance of considering both of these group variables when examining disordered eating and weight control behaviors.

Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders.

OBJECTIVE: The study examined treatment seeking for eating disorders in Mexican American and European American women. METHOD: One hundred forty-five women with eating disorders (76 Mexican American, 69 European American) were diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Eating Disorder Examination (EDE). RESULTS: Only 28% of the sample reported having sought treatment for their eating problems and only 17% had received treatment. Both groups were equally likely to believe they have significant eating problems and to want help. However, Mexican Americans were less likely to have sought treatment and, having sought help, were less likely to have been diagnosed or treated. European Americans were more likely to have utilized psychotherapists, psychiatrists, and psychotropic medications, whereas Mexican Americans largely had sought help from general practitioners for weight concern. The two groups endorsed similar barriers to treatment seeking. CONCLUSION: Results support clinical impressions that eating disorders largely go undetected and untreated. Nonspecialists may be likely to fail to detect eating disorders.

Body image and size perceptions of Mexican American women.

Purpose was to examine in Mexican American women the influences of age, weight, socioeconomic status and acculturation level on body image, perceptions of attractive and acceptable female shapes, and tolerance for overweight and obesity. Participants were 276 Mexican American women. Age, body mass index, socioeconomic status, and acculturation level were measured. The Figure Rating Scale was used to assess body image, preferences for body size, and perceptions of underweight to obese and acceptable body sizes. Significant effects for acculturation level and current weight were found. Women who were more Anglo oriented showed greater preference for thinner figures. As compared to normal weight women, obese women chose larger figures as ideal, realistic, attractive, and thinnest acceptable. Findings point to the impact of acculturation and obesity on body image and size perceptions. Health professionals working with Mexican Americans should consider each individual's current weight and level of acculturation.

Factors that influence food amount ratings by white, Hispanic, and Asian samples.

OBJECTIVE: Two studies explored in nonclinical samples variables that may influence meal size assessments. RESEARCH METHODS AND PROCEDURES: In Study 1, the contribution of dietary restraint, weight, depressive symptoms, and gender to ratings on the Food Amount Rating Scale was examined in 153 white women and 121 white men; in Study 2, the contribution of dietary restraint, weight, ethnicity, and ethnic group identification to Food Amount Rating Scale ratings was examined in 67 Asian, 81 Hispanic, and 107 white women. RESULTS: Study 1 indicated that food amounts were rated as larger when rated by male rather than female raters (male rater, mean=62.37, SD=1.14; female rater, mean=59.28, SD=0.89), for female rather than male targets (male target, mean=56.16, SD=0.97; female target, mean=64.87, SD=1.02), and by restrained rather than unrestrained eaters (restrained, mean=63.14, SD=1.11; unrestrained, mean=58.69, SD=0.91). Study 2 indicated that food amounts were rated as larger when rated by restrained eaters (restrained, mean=67.53, SD=1.21; unrestrained, mean=64.99, SD=1.09), Hispanic women (Asian, mean=64.59, SD=1.61; Hispanic, mean=68.71, SD=1.30; white, mean=65.41, SD=1.34), and underweight women (underweight, mean=70.38, SD=1.68; normal weight, mean=64.52, SD=0.93; overweight: mean=64.23, SD=1.64). DISCUSSION: Food amount judgments may be influenced by personal characteristics. Future research should examine whether variation in food amount judgments is related to dieting behavior, disordered eating, or obesity.

Dieting and its relationship to smoking, acculturation, and family environment in Asian and Hispanic adolescents.

The objective of this article was to examine dieting and its relationship to smoking behaviors and attitudes, acculturation, and family environment in an ethnically diverse sample of adolescents. Participants were 211 adolescent girls and boys: 57% Asian, 16% Hispanic, 27% White. Regular dieting was determined using the Restraint Scale (Herman, 1978). Dependent variables were measured using the Smoking Beliefs and Attitude Questionnaire (Pederson & Lefcoe, 1985), Family Functioning in Adolescence Questionnaire (Roelofse & Middleton, 1985), and Suinn-Lew Asian Self-Identity Acculturation Scale (Suinn, Rickard-Figurroa, Lew, & Vigil, 1987). Dieting girls, as compared to nondieters, had more favorable attitudes toward smoking, more strongly believed that smoking keeps one from eating, and first experimented with cigarettes at an older age. Chronic dieting was related to reports of poorer family functioning, and Asian dieters were more acculturated than nondieters. For boys, there was no relationship between dieting and smoking, acculturation, or family environment. Smoking prevention programs targeted toward ethnic minority adolescent females need to address the issue of weight concern.

Does ethnicity influence body-size preference? A comparison of body image and body size.

OBJECTIVE: Obesity is most common in the United States among women of ethnic minority groups (black and Hispanic). Researchers have hypothesized that these subcultures are more accepting of overweight figures. The purpose of this study was to examine body image and body size assessments in a large community sample of men and women. RESEARCH METHODS AND PROCEDURES: Participants were 801 women and 428 men: 23% Asian, 45% Hispanic, 17% black, and 15% white. The figure rating scale was used to rate: body dissatisfaction, attractive male and female shapes, acceptable female size, and perceptions of underweight to obese female figures. RESULTS: Controlling for age, education, and body weight, no ethnic differences were found for men. Asian women reported less body dissatisfaction than the other groups. Women were more dissatisfied with their size than men and chose thinner female figures as attractive and acceptable. DISCUSSION: Ethnicity, independent of age, education, and body weight, does not influence preference for female and male shapes or tolerance for obesity.