Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up.

OBJECTIVE: To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice. METHOD: Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month follow-up using generalized linear models with multiple imputation. RESULTS: Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = -.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant). DISCUSSION: Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. PUBLIC SIGNIFICANCE: In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder. Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder psychopathology faster, there was a trend toward relapse in CBT at 6-month follow-up. Therefore, the less costly DBT-program can be considered a relevant treatment in clinical practice.

Mediation of emotional and external eating between dieting and food intake or BMI gain in women.

OBJECTIVE: Dieting to control body weight is often associated with weight gain, particularly so in women; however, the underlying mechanisms are unclear. In a series of studies on women, we examined whether the relationship between dieting and weight gain can be explained by (serial) mediation of emotional eating (EE) and/or subsequent external eating (EX). METHODS: In a pilot study (116 women), we first assessed this (serial) mediation between dieting or dietary restraint and actual food consumption in the laboratory. In Study 1, a four-year follow up on patients with newly diagnosed type 2 diabetes (51 women), we assessed this (serial) mediation between dietary restraint and change in BMI and intake of energy (Kcal; Food Frequency Questionnaire). In Study 2, a three-year follow up study in a representative Dutch sample (287 women), we assessed this (serial) mediation between dieting and change in BMI. RESULTS: There was consistent support for (serial) mediation: In the pilot study, frequency of dieting and dietary restraint were both indirectly associated with grams of crackers eaten through EE and EX. In study 1, dietary restraint had a significant (95% CI) indirect association with subsequent change in measured BMI and a marginally (90% CI) significant indirect association with intake of energy through EE and EX. In study 2, EE marginally (90% CI) acted as a mediator between frequency of dieting and subsequent self-reported change in BMI. In the subsample of overweight women (n = 146) frequency of dieting was indirectly associated with subsequent self-reported change in BMI through EE and EX. CONCLUSION: The possibility that female dieters may gain weight through EE and/or subsequent EX should be taken into account when treating women with overweight or obesity.

Depression, emotional eating and long-term weight changes: a population-based prospective study.

BACKGROUND: Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations. METHODS: Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline (n = 5024), height, weight and WC were measured in a health examination. At follow-up (n = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses. RESULTS: Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI (R2 = 0.048) and WC (R2 = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI (P = 0.007 for the interaction) and WC (P = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI (P < 0.001 for the interaction) and WC (P = 0.065, respectively) increase in younger participants, but not in older participants. CONCLUSIONS: Our findings offer support for the hypothesis that emotional eating is one behavioural mechanism between depression and development of obesity and abdominal obesity. Moreover, adults with a combination of shorter night sleep duration and higher emotional eating may be particularly vulnerable to weight gain. Future research should examine the clinical significance of our observations by tailoring weight management programs according to these characteristics.

Duration of breastfeeding is associated with emotional eating through its effect on alexithymia in boys, but not girls.

Emotional eating (EE), or eating in response to negative emotions, was earlier shown to be associated with difficulty in identifying emotions (alexithymia). To improve our understanding of possible causes of alexithymia and EE, we assessed possible associations with duration of breastfeeding in infancy. The aim of the present study was to examine in a prospective, longitudinal study whether duration of breastfeeding is associated with EE in adolescence, through its effect on alexithymia difficulty identifying emotions, and whether this mediation effect is contingent on gender. Our hypothesis was that longer duration of breastfeeding would be associated with lower EE in adolescence through its effect on lower alexithymia difficulty identifying feelings in boys but not in girls (Moderated mediation). The sample included 129 children and their families (67 boys and 62 girls). Duration of breastfeeding was reported by the mother when the infant was 15 months old. Alexithymia difficulty identifying feelings (Toronto Alexithymia Scale) and EE (Dutch Eating Behavior Questionnaire) were reported by the child at 12 years of age. EE was also reported by the child at 16 years of age. Moderated mediation was significant for EE at 12 years, and borderline significant for EE at 16 years. As hypothesized, for boys but not for girls, longer duration of breastfeeding was related to less difficulties in identifying feelings, resulting in lower degrees of EE in adolescence. It is concluded that breastfeeding in infancy may protect boys against EE through its positive association with better ability to identify feelings.

Parenting quality in infancy and emotional eating in adolescence: Mediation through emotion suppression and alexithymia.

This study assessed the association between parenting quality at age 15 and 28 months and emotional eating (EE) at age 12 and 16 years through serial mediation by suppression of emotions and alexithymia at 12 years. The sample included 129 children and their parents. Lower parental quality in infancy was related to more suppression of emotions, which in turn was related to more difficulty identifying emotions, and in turn to higher EE in adolescence. This serial mediation model was significant for EE at 12 years, and for EE at 16 years. If future studies reveal converging findings, this knowledge points to the need for programs preventing the development of EE in adolescence through increasing the quality of parenting in infancy.

Depression and eating styles are independently associated with dietary intake.

Depression and eating styles are two important, interrelated factors associated with dietary intake. However, it remains unclear whether depression and eating styles are independently associated with dietary intake, and whether associations between depression and dietary intake are mediated by eating styles. Therefore, the aim of the current study was to investigate the associations of, and interplay between depression and eating styles in relation to different aspects of dietary intake. Cross-sectional data from 1442 participants (healthy controls (22.7%), remitted (61.0%) and current patients (16.3%)) from the Netherlands Study of Depression and Anxiety were used. Linear regression analyses were used to determine associations of depressive disorders (DSM-IV based psychiatric interview), self-reported depressive symptoms (Inventory of Depressive Symptomatology), emotional, external and restrained eating (Dutch Eating Behavior Questionnaire) with 4 measures of dietary intake (total energy intake (kcal/d), Mediterranean diet score (MDS), intake of sweets foods (g/d), and snack/fast-food (g/d)) measured with a 238-item food frequency questionnaire. Statistical mediation analyses were used to study whether associations between depression and dietary intake were mediated by eating styles. Current depression diagnosis and severity were associated with lower MDS and higher intake of sweet foods and snack/fast-food. Emotional and external eating were associated with higher intakes of snack/fast-food; external eating was also associated with higher total energy intake. Restrained eating was associated with lower total energy and intake of sweet foods, and higher MDS. Associations between current depression or severity and intake of snack/fast-food were mediated by external eating. In general, depression and eating styles contributed independently to poorer diet quality and higher intake of sweet and snack/fast-food. The association between depression and higher intake of snack/fast-food was mediated by external eating.

Causes of Emotional Eating and Matched Treatment of Obesity.

PURPOSE OF THE REVIEW: Eating in response to negative emotions (EE) may be an explanatory factor of the weight regain of many dieters. This narrative review presents evidence on possible causes of EE and the association of EE with depression and obesity and discusses implications of these findings for the treatment of obesity. RECENT FINDINGS: Possible causes of EE are high dietary restraint, poor interoceptive awareness, alexithymia, emotion dysregulation and a reversed hypothalamic pituitary adrenal (HPA) stress axis. EE may be the outcome of inadequate parenting or depressive feelings in interaction with genetic susceptibility. There is also robust evidence that EE is a mediator between depression and obesity. The association of EE with depression and poor emotion regulation skills suggests that the treatment of obese people with high EE should not focus on calorie-restricted diets but on emotion regulation skills. The DEBQ (Dutch Eating Behavior Questionnaire) enables such a matched treatment of obesity.

Is desire to eat in response to positive emotions an 'obese' eating style: Is Kummerspeck for some people a misnomer?

Is desire to eat in response to positive emotions an 'obese' eating style: a style more prevalent in people with obesity? In other words: Is Kummerspeck (German: sorrow-fat) for some people a misnomer? This question was addressed in three studies on women. Study 1 (n = 188) tested the moderator effect of subjective well-being on the association of BMI with the scale on desire to eat in response to negative emotions (DEBQ-E). Study 2 tested in women (n = 832) whether items on desire to eat in response to positive emotions loaded on the same factor as those in response to negative emotions and body mass. Study 3 assessed in the total sample (n = 203) and an overweight subsample (n = 40) a) whether self-reported desire to eat in response to positive emotions predicted actual food intake and b) whether this also held true over and above self-reported desire to eat in response to negative emotions. Study 1 showed only for women with low positive affect a significant positive association of BMI with DEBQ-E. In Study 2, only items on desire to eat in response to negative emotions loaded on the same factor as BMI. Study 3: In the total sample, the significant effect on food intake of the scale on desire to eat in response to positive emotions disappeared when a scale on desire to eat in response to negative emotions was added to the model. In the overweight-subsample there was only an effect on food intake for desire to eat in response to negative emotions. It is concluded that only desire to eat in response to negative emotions is an 'obese' eating style, suggesting that Kummerspeck is not a misnomer.

The association of eating styles with weight change after an intensive combined lifestyle intervention for children and adolescents with severe obesity.

UNLABELLED: The main purpose of this prospective intervention study was to determine whether eating styles after an intensive, partly inpatient, one year combined lifestyle intervention are associated with weight change in the following year in severely obese children and adolescents. A total of 120 participants (8-19 years) with an average SDS-BMI of 3.41 (SD = 0.38) was included. Measurements were conducted at baseline (T0), at the end of treatment (T12) and at the end of follow up two years after baseline (T24). The primary outcome measurement was the ΔSDS-BMI between T12 and T24. As primary determinant of weight change after treatment, the participants eating styles were evaluated with the Dutch Eating Behavior Questionnaire - child report that measures external, emotional and restraint eating. The association between outcome and determinant was assessed in linear regression analyses. Complete data were available for 76 of the 120 participants. This study shows that for girls a higher score on restraint eating at T12 and a higher score on external eating at T12 were associated with more weight (re)gain in the year after treatment. No statistically significant association with emotional eating at T12 was found. In addition for girls a higher score on external eating at T0 was associated with more weight (re)gain in the year after treatment. Furthermore, the observed changes in eating styles suggest that on average it is possible to influence these with treatment, although the detected changes were different for girls and boys and for the different eating styles. More generally, this study indicates that for girls the levels of restraint and external eating after treatment were associated with the weight change during the following year. TRIAL REGISTRATION: Netherlands Trial Register (NTR1678, registered 20-Feb-2009).

The mediation effect of emotional eating between depression and body mass index in the two European countries Denmark and Spain.

In two European countries with a different prevalence of depression, namely Denmark (high) and Spain (low), we assessed whether the mediation effect of emotional eating between depression and Body Mass Index (BMI) as found in earlier studies can be replicated and whether this mediation effect is contingent on 1) change in appetite and 2) gender. Mediation and moderated mediation was assessed with Hayes' PROCESS macro in SPSS. Emotional eating (DEBQ: Dutch Eating Behavior Questionnaire), depressive symptoms (CES-D: Center for Epidemiologic Studies Depression Scale), change in appetite, weight and height were self-reported. In both countries, emotional eating acted as a mediator between depression and BMI (Denmark: B = 0.03 (SE = 0.01), 95% CI, [0.03, 0.05]; Spain: B = 0.03 (SE = 0.01), 95% CI, [0.02, 0.04]). In Denmark this mediation effect was stronger for participants with increased appetite and for females than for participants with decreases/no change in appetite and for males (more appetite: B = 0.08, (SE = 0.03), [0.03, 0.15]; decreased appetite/no change in appetite: B = 0.03 (SE = 0.01), [0.02, 0.04]); females: B = 0.05 (SE = 0.01), [0.03, 0.07]; males: B = 0.01 (SE = 0.01), [0.004, 0.04]. This supports depression with atypical features as an underlying mechanism in the mediation effect of emotional eating. In Spain there was no support for depression with atypical features as underlying mechanism because the mediation effect was neither moderated by change in appetite nor by gender. Instead, post-hoc analyses suggested 'stress of unemployment' as possible explanatory factor of the mediation effect, with stronger mediation effects for unemployed than for employed people (unemployed: B = 0.05 (SE = 0.01), [0.03, 0.07]; employed B = 0.02 (SE = 0.01), [0.01, 0.04]). The mediating effect of emotional eating between depressive symptoms and body mass index in both countries suggests that obesity interventions should take emotional eating into account.

Emotional eating as a mediator between depression and weight gain.

Depression is often associated with weight gain but underlying mechanisms are unclear. This study assessed whether three psychological eating styles (emotional eating, external eating and restrained eating) act as mediators between depression and weight gain. We used structural equation modelling to test the hypothesized mediation models in a sample of 298 fathers and 294 mothers by assessing self-reported eating styles (Dutch Eating Behavior Questionnaire), depressive feelings (Depressive Mood List) and body mass index (BMI) at baseline and BMI after five years. In the model with emotional eating we also assessed the moderation effect of 5-HTTLPR genotype in a sub-sample of 520 Caucasians. All analyses were performed separately for the two sexes. Although the overall effect of depression on weight gain was statistically non-significant in both sexes, there was a causal chain between depression, emotional eating and weight gain in the mothers. Depressive symptoms were related to higher emotional eating and emotional eating predicted greater increases in BMI independently of depression. Moreover, the indirect effect (via emotional eating) of depression on BMI change was significant (Beta = 0.18, P = 0.026). This mediation effect was found to be independent of 5-HTTLPR genotype. No such mediation effect was found for the fathers. Further, external eating and restrained eating did not act as mediators between depression and weight gain in either sex. The finding that emotional eating acted as mediator between depression and weight gain in the mothers suggests that obesity interventions should take emotional eating into account.

Internal Structure and Measurement Invariance of the Dutch Eating Behavior Questionnaire (DEBQ) in a (Nearly) Representative Dutch Community Sample.

The Dutch Eating Behavior Questionnaire is a widely used instrument for assessment of emotional, external and restrained eating. The aim of the present study is to (i) analyse its internal structure using exploratory structural equation modelling; (ii) to assess its measurement invariance with respect to sex, BMI, age and level of education; and (iii) to evaluate the relations of the factors with these variables. Except that women were slightly over-represented, the sample (n = 2173) closely followed the sociodemographic characteristics of the overall Dutch population. The three theoretical factors that emerged from the analysis were in close correspondence with the three scales for emotional, external and restrained eating. Only two items (item 3 - 'desire to eat when nothing to do…' and item 21 - 'resist delicious food...') presented problematic loadings. The questionnaire showed satisfactory measurement invariance, and expected patterns of mean differences and relations were found. All in all, the results highlight the adequate psychometric properties of the Dutch Eating Behavior Questionnaire. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Season of birth, the dopamine D4 receptor gene and emotional eating in males and females. Evidence of a genetic plasticity factor?

Emotional eating has a female preponderance and an understanding of possible genetic and environmental underpinnings is still in the early stages. The current study focuses on the possible role of the dopamine D4 receptor (DRD4) 'plasticity' gene in emotional eating and the possible moderator effects of sex and season of birth therein. We tested this in two samples (n = 93 and n = 586) of male and female Caucasian adults by genotyping DRD4 and assessing self-reported emotional eating. Participants were defined as high risk carriers if they had at least one long (7-repeat) allele, which confers hypo-function to DRD4. We also ran analyses that grouped 2- and 7-repeat carriers together. In the first sample there only was a moderator effect of sex. In the second sample there also was a 3 way interaction between season of birth, sex and genotype. In line with the idea that the Drd4 gene functions as a plasticity gene that affects the sensitivity to environmental influences, the moderator effect of sex was only found for the participants born in fall. Only in females the hypo-functional variants of DRD4 were associated with significantly higher degrees of emotional eating. Furthermore, the sex × genotype effects were somewhat stronger when the 2-repeat allele was grouped together with the 7-repeat allele. Our data suggest that DRD4 hypo-functional genetic variants are associated with emotional eating, only in females.

Predictors of outcome for cognitive behaviour therapy in binge eating disorder.

The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients.

Dietary restraint and body mass change. A 3-year follow up study in a representative Dutch sample.

OBJECTIVE: To determine in a representative Dutch sample the association of dietary restraint, Concern for Dieting, and Weight Fluctuation with subsequent change in body mass index (BMI; in kg/m(2)) in addition to possible moderator effects of sex, level of education, age category, ethnicity, overweight level and physical activity. DESIGN: In a longitudinal study in a representative Dutch sample consisting of 675 participants (331 females, 344 males), dietary restraint (including Concern for Dieting and Weight Fluctuation) was assessed with the Restraint Scale at baseline, and also self-reported weight and height. Three years later, weight and height were also assessed. RESULTS: Dietary restraint was significantly associated with an increase in BMI after three years (B=.272, p=001). Inspection of the significant moderator effect of sex (B=-.387, p=.012) indicated that dietary restraint was significantly associated with increases in BMI only in females. There was no main effect for Concern for Dieting (p=.091). There was a moderator effect of sex on the association between Concern for Dieting and BMI change (B=-.424; p=.002): initial concern for dieting was positively associated with subsequent body mass gain only in women. Weight Fluctuation was significantly associated with an increase in BMI after three years (B=.162, p=008) and sex did not moderate this association. There were no moderator effects for level of education, age category, ethnicity, overweight level and physical activity. CONCLUSION: Dietary restraint and Concern for Dieting are associated with increases in BMI only in females. Weight Fluctuation is associated with increases in BMI in both males and females.

Hunger, inhibitory control and distress-induced emotional eating.

Self-reported emotional eating has been found to significantly moderate distress-induced food intake, with low emotional eaters eating less after a stress task than after a control task and high emotional eaters eating more. The aim of the present study was to explore possible underlying mechanisms by assessing possible associations with (1) ability to experience the typical post-stress reduction of hunger and (2) inhibitory control. We studied these effects in 54 female students who were preselected on the basis of extremely high or low scores on an emotional eating questionnaire. Using a within subject design we measured the difference of actual food or snack intake after a control or a stress task (Trier Social Stress Test). As expected, the moderator effect of emotional eating on distress-induced food intake was found to be only present in females with a failure to report the typical reduction of hunger immediately after a stress task (an a-typical hunger stress response). Contrary to our expectations, this moderator effect of emotional eating was also found to be only present in females with high ability to stop motor impulses (high inhibitory control). These findings suggest that an a-typical hunger stress response but not poor inhibitory control may underlie the moderator effect of emotional eating on distress-induced food intake. However, inhibitory control may play a role whether or not there is a moderator effect of self-reported emotional eating on distress-induced food intake.

Relationship between eating styles and temperament in an Anorexia Nervosa, Healthy Control, and Morbid Obesity female sample.

OBJECTIVES: Eating styles have been studied in both Obesity (OB) and Eating Disorders (ED), but they have not been examined in these two weight conditions together. The present study explores differences in eating styles in an Anorexia Nervosa (AN) and OB sample, compared to Healthy Controls (HC), and it analyses their relationship with Body Mass Index (BMI) and personality traits. METHOD: The total sample consisted of 291 female participants (66 AN, 79 OB and 146 HC). EVALUATION: Assessment measures included the Dutch Eating Behaviour Questionnaire-DEBQ- and the Temperament and Character Inventory-Revised-TCI-R-. RESULTS: The MANCOVA test showed significant differences among the three groups for all eating styles, with emotional eating being more typical in the OB group and restrained eating more typical in the AN group. Partial correlation analyses showed relationships between emotional and external eating and BMI, as well as relationships with different temperament and character traits. The stepwise discriminant function analysis showed that the DEBQ correctly classified 65.6% of the sample into the three weight categories; when combined with the TCI-R, correct classification increased to 72.6%. CONCLUSIONS: Weight conditions showed different eating behaviour patterns. Temperament and character traits were related to eating behaviours. DEBQ and TCI-R were able to discriminate between groups. Differences in eating styles in the weight groups can have implications for understanding the development and maintenance of OB and ED.

Emotional, external and restrained eating behaviour and BMI trajectories in adolescence.

Individual differences in eating behaviours might partly explain the variations in development of weight gain and subsequent overweight and obesity. In the current study, identified trajectories of BMI in adolescence and their associations with restrained, emotional and external eating were tested. For the assessment of BMI trajectories growth mixture modelling was used; a method used to identify clusters of individuals within a population that follow distinct developmental trajectories. In total 328 Dutch adolescents (13-15years old at baseline) self-reported their height and weight at five annual waves and their eating behaviour at baseline. Development of BMI was best fitted in five distinct trajectories that showed similar moderate increase of BMI over time; parallel but at a different level. High restrained eaters had a higher chance of being in the higher BMI trajectories. Emotional and external eating were unrelated to the BMI trajectories. In conclusion, adolescents in this study followed very parallel patterns of moderate increases in BMI which suggests that factors acting on individual differences in weight status have had their influence mostly at a - perhaps much - younger age. Restraint eating was related to BMI in early adolescence, but not to an increases or decreases in BMI over the course of adolescence.

Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study.

Objectives: Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical. Methods: An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated. Results: A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies. Conclusion: Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.

The predictive validity of the DEBQ-external eating scale for eating in response to food commercials while watching television.

OBJECTIVE: To challenge the conclusion by Jansen et al., Int J Eat Disord 2011; 44:164-168, that the widely used Dutch Eating Behavior Questionnaire (DEBQ) External Eating subscale (DEBQ-EX) lacks validity for external eating, because of limitations of that study. METHOD: In a seminaturalistic setting we measured participants' intake of crisps and M&Ms while they watched food commercials or neutral commercials spliced into a film. To avoid misclassification due to the use of median splits we used extreme scores on the DEBQ-ex (n = 60) in addition to the full range of scores (n = 125). RESULTS: As was expected, high external eaters in the food commercial condition ate more crisps than did high external eaters in the neutral commercial condition, whereas low external eaters did not eat more crisps in one condition than in the other. No such moderator effect was found for emotional eating. No significant moderator effect was found for external eating in the original sample (n = 125) using the median-split procedure. DISCUSSION: The DEBQ scale for external eating has validity and specificity for external eating provided that the participants have sufficiently extreme external eating scores and a natural setting is used.