Executive functioning and treatment outcome among adolescents undergoing cognitive-behavioral therapy for binge-eating disorder.

BACKGROUND: Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real-world contexts. METHODS: We assessed 73 adolescents [82.2% female; Mage = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m2] with BED at baseline, posttreatment, 6-, 12-, and 24-month follow-up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition. RESULTS: More impulsive decision-making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (ß = .07; p = .019) and more frequent LOC eating following treatment (ß = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T-scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (ß = -.03; p = .003). Inhibition, concentration, attention, and parent-reported EF behavior symptoms were not associated with outcome, attendance, or attrition. CONCLUSIONS: More impulsive decision-making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre-treatment EF.

Enhancing the Connection Between Basic and Applied Research in Eating Disorders: Steps Toward More Effective Translation.

Translational research applies laboratory-generated scientific discoveries to real-world practice with the goal of potentiating more rapid solutions to health challenges. In 2023, the authors of this editorial (Hildebrandt and Goldschmidt) aimed to develop a special issue for the International Journal of Eating Disorders (IJED) focusing on translational eating disorder research. The goal for this issue was to begin closing the gap between basic and applied research by soliciting articles that improve our understanding of mechanisms that cause or maintain eating disorders, which could result in more robust research advances and dissemination of information to the public. Further goals for the issue included exposing IJED's readership to a wide range of translational research and inspiring new collaborative efforts. While strong submissions were received, challenges were encountered in soliciting enough articles, potentially reflecting long-standing communication barriers between basic and clinical scientists within the eating disorders field. In this editorial, we highlight work included in the special section, identify potential barriers in translational eating disorder research, and offer a multipronged approach to support more rapid progress across the translational spectrum. By improving how our field approaches translational research, we can promote better outcomes for those with or at risk for eating disorders.

State-level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study.

BACKGROUND: Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait-level working memory (WM), which may limit adaptive responding to intra- and extra-personal cues related to eating. Understanding of how WM performance relates to eating behavior in real-time is currently limited. METHODS: We studied 32 youth (ages 10-17 years) with LOC eating and overweight/obesity (LOC-OW; n = 9), overweight/obesity only (OW; n = 16), and non-overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone-based ecological momentary assessment. Linear mixed effects models estimated group-level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating. RESULTS: LOC-OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between-subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within-subject effects (reflecting variations in moment-to-moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05). CONCLUSIONS: Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory-based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored. PUBLIC SIGNIFICANCE STATEMENT: Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal-weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment-to-moment basis.

The parents aren't alright, either: Commentary on Wilksch (2023).

Eating disorders (EDs) present high costs to the individual and society, and need for services far surpasses their availability. Caregivers are often on the "front lines" of managing their child's illness yet may have very little support to sustain them in this role. It is well-established that caregiver burden related to EDs is high, although most research has focused on caregivers of adult patients. Wilksch describes the need for additional attention to caregivers of children and adolescents with EDs, given the elevated psychological, interpersonal, and financial burden incurred on this segment of the population. In this commentary, we describe three major gaps in service delivery and research that may exacerbate caregiver stress: (1) limited exploration of "nontraditional" delivery modalities that could enhance access to care; (2) lack of research into viability of caregiver peer coaching/support models including respite resources; and (3) scarcity of accessible ED training for healthcare providers (particularly physicians) which increases length to receipt of competent care as families search for well-trained providers and/or languish on waitlists. We propose prioritizing additional research in these areas to help alleviate caregiver burden associated with pediatric EDs, and facilitate delivery of prompt, comprehensive, and competent care to support optimal prognosis.

When eating disorder attitudes and cognitions persist after weight restoration: An exploratory examination of non-cognitive responders to family-based treatment for adolescent anorexia nervosa.

OBJECTIVE: Family-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa (AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the end of FBT but continued to experience elevated psychological symptoms post-treatment. METHODS: Data were drawn from two randomised controlled trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n = 80; 83.7% female, Agemean [SD] = 14.66 [1.73]). RESULTS: By 12 months post-treatment, there were no differences in weight between NCRs and FRs. However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-up period. CONCLUSIONS: A subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12 months after FBT even when weight restoration is achieved.

Implementation and outcomes of home-based treatments for adolescents with anorexia nervosa: Study protocol for a pilot effectiveness-implementation trial.

OBJECTIVE: Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement. METHODS: This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families. HYPOTHESES: We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB. POTENTIAL IMPLICATIONS: The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.

Dynamic associations between anxiety, stress, physical activity, and eating regulation over the course of a behavioral weight loss intervention.

Negative emotional experiences are associated with dysregulated eating behaviors that impede weight management. While weight loss interventions promote physical activity and self-regulation of eating, no studies have examined how physical activity may directly influence eating by attenuating associations between negative emotions and eating. OBJECTIVE: The current study examined how momentary negative emotions (stress and anxiety), moderate-to-vigorous intensity physical activity (MVPA), and their interactions predict eating dysregulation (i.e., intensity of eating temptations, inability to resist eating tempting foods, overeating), as well as how these associations change during a weight loss intervention. METHODS: Women with overweight/obesity (N = 55) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after a three-month internet-based weight loss program. RESULTS: Three-way interactions emerged predicting overeating and eating tempting foods. When women experienced higher than usual levels of momentary anxiety or stress at end-of-treatment, they were less likely to subsequently overeat or eat tempting foods when they had recently engaged in more MVPA (relative to their usual level). No significant associations were found for ratings of temptation intensity. CONCLUSIONS: Findings suggest MVPA may exert direct effects on eating regulation. Specifically, MVPA appears to increasingly buffer the effect of negative emotional states on dysregulated eating behavior over the course of a weight loss intervention. Future work is needed to develop ways of communicating to patients how activity can have both indirect and direct effects on body weight, and examine whether such knowledge improves outcomes.

The moderating role of sleep duration on momentary relations between negative affect and loss-of-control eating in children and adolescents.

OBJECTIVE: Loss-of-control (LOC) eating is associated with eating disorders and obesity, and thus it is imperative to understand its momentary risk factors in order to improve intervention efforts. Negative affect has been proposed as a momentary risk factor for LOC eating, but the evidence for its effects in children and adolescents is mixed. Short sleep duration (which is very common in youth), may be one variable that moderates the relation between negative affect and subsequent LOC eating. As such, we aimed to examine the moderating role of within-person sleep duration on the momentary relations between negative affect and subsequent LOC eating. METHOD: We recruited children (N = 30) with overweight/obesity ages 8-14, who completed a 2-week ecological momentary assessment protocol assessing negative affect and LOC eating several times per day, while also wearing a sleep actigraphy device and completing sleep diaries. RESULTS: Consistent with hypotheses, within-person sleep duration moderated the next-day momentary relation between within-person negative affect and LOC eating, such that shorter sleep duration strengthened the positive relation between negative affect and loss-of-control eating. CONCLUSIONS: Results suggest that, in children and adolescents, fluctuations in sleep duration may influence susceptibility to losing control over eating after experiencing negative affect. Future research should further investigate other metrics of sleep disturbance as they relate to emotion regulation and LOC eating. Such research will set the stage for augmenting paediatric interventions to better target maintenance factors for LOC eating.

Pain, eating behavior, and weight outcomes in adolescent girls.

OBJECTIVE: In adults, pain is prospectively associated with overweight/obesity and concurrently associated with dysregulated eating, with evidence for stronger associations in women than men. This study aimed to evaluate whether similar associations among pain response, BMI, and loss of control (LOC) eating are also evident in adolescent girls. METHOD: Girls (n = 202) completed the cold pressor test (CPT) at age 10, and BMI and LOC eating were assessed annually from ages 10-16 years. Generalized linear models were used to test associations between pain tolerance (total immersion time) and threshold (latency to highest pain rating), and changes in BMI and LOC eating. RESULTS: Lower pain tolerance and threshold at age 10 were associated with increases in LOC eating from age 10 to 16 (tolerance: B < -.01, SE < .01, p = .005; threshold: B = -.03, SE = .01, p = .0118). No significant associations were observed between pain tolerance/threshold and increasing BMI. DISCUSSION: Pain responsivity in childhood is associated with increases in dysregulated eating from childhood to adolescence. These findings provide support for the early development of an interface between pain and eating behaviors.

Momentary affective response to bouts of moderate-to-vigorous physical activity predicts changes in physical activity and sedentary behavior during behavioral weight loss.

BACKGROUND: Affective responses are posited to be key predictors of the uptake and maintenance of health behaviors. However, few studies have examined how individuals' affective response to physical activity, as well as the degree to which their affect response changes, may predict changes in physical activity and sedentary time during behavioral weight loss treatment. PURPOSE: The current study examined how baseline momentary affective response (i.e., stress and anxiety) to moderate-to-vigorous physical activity (MVPA) and the degree of pre--post intervention change in this response predicted change in daily sedentary, light, and MVPA time during a three-month internet-based weight loss program. METHODS: Women with overweight/obesity (final N=37) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after the intervention. RESULTS: Women who had more reinforcing responses to MVPA (i.e., greater reductions in anxiety and stress response following MVPA bouts) at baseline had greater increases in overall MVPA at the end of the intervention. Those who had greater anxiety reductions after MVPA bouts at baseline also evidenced less sedentary time at the end of the intervention. Changes in affective responses across the intervention were not related to changes in physical activity levels. CONCLUSIONS: Findings suggest initial levels of affective reinforcement from MVPA bouts predict future change in MVPA and sedentary time during behavioral weight loss. Future work is needed to examine the utility of more precisely targeting affective responses to physical activity to optimize intervention approaches.

Differences in severity of eating disorder symptoms between adults with depression and adults with anxiety.

OBJECTIVES: Anxiety and depression are both considered maintaining factors for eating disorders (ED) but it is still unclear if one is more strongly associated with ED symptoms than the other. We examined differences in severity of ED symptoms among adults with either, both, or neither depression and anxiety. METHODS: Volunteers (N = 3,780) to the project implicit mental health website ( https://implicit.harvard.edu/ ) self-reported their ED status (current ED: n = 374, past ED: n = 436; no ED: n = 2,970), their current depression/anxiety status, and their ED symptoms (using the Eating Attitudes Test). ANOVAs with post hoc comparisons were used to examine relationships between ED symptoms and comorbid depression/anxiety status among currently ill, recovered, and never ill individuals. RESULTS: Participants without comorbidities had the least and participants with both comorbidities had the most severe ED symptoms (p = .021). Participants with anxiety alone had more severe ED symptoms relative to those with depression alone across groups (current ED: p = .024; past ED: p = .019; no EDs: p = .021). DISCUSSION: These findings demonstrate, in contrast with an earlier study among youth with EDs (Hughes et al., 2013), that comorbid anxiety may be linked with more severe ED symptoms relative to comorbid depression. It is possible that anxiety serves as a maintaining factor for ED symptoms such that dieting and other ED-related behaviors may function to modulate symptoms of anxiety. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Momentary associations between positive affect dimensions and dysregulated eating during puberty in a diverse sample of youth with overweight/obesity.

OBJECTIVE: The link between dysregulated positive affect and binge-eating behavior in youth with obesity is poorly understood. In addition, it is unclear how putative associations differ across developmental periods of rapid biological and emotional change, such as puberty, and in racial and ethnic minority youth, who are more likely to be overweight but are underrepresented in the literature. METHOD: This study used a 2-week ecological momentary assessment protocol to examine independent and interactive effects of positive affect intensity/instability, and pubertal stage on two components of binge-eating behavior, loss of control eating (LOCE), and overeating. RESULTS: Participants were 38 youth with overweight/obesity (ages 8-14 years; 78% African American/Hispanic). Positive affect instability was calculated using probability of acute change (PAC), representing the likelihood of extreme affective changes, and mean squared successive difference (MSSD), representing the average change in affect over successive recordings. There were no main effects of positive affect intensity on LOCE or overeating, but positive affect instability was negatively associated with overeating severity using both MSSD (p = .005) and PAC metrics (p = .001). However, moderation analyses including interactions with pubertal status revealed more extreme changes in positive affect (i.e., higher PAC) were related to greater overeating (p = .001) and LOCE severity (p = .043) in mid-late pubertal youth but not in pre-early pubertal youth. DISCUSSION: Pubertal status may influence the association between disruptions in positive affect and dysregulated eating in youth, and positive affect instability may be important to consider in order to understand the emotional correlates of binge eating in youth with overweight/obesity.

The interactive effects of parental self-efficacy and child eating styles in relation to naturalistically-assessed craving, overeating, and loss of control eating.

OBJECTIVE: Parental factors have been linked to weight-related outcomes in children, though less is known regarding the role of parental self-efficacy (PSE) for promoting healthy dietary behaviors (HDBs). This study examined associations between PSE for promoting HDBs and child reports of craving, overeating, and loss of control eating in daily life. The interactive effects of PSE and child eating style (emotional eating, external eating, and restraint) were also explored. METHOD: Thirty-eight youth (ages 8-14; 55.3% female) with overweight/obesity and their parents completed the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) and Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors Scale, respectively. Youth completed ecological momentary assessment (EMA) to report craving, overeating, and loss of control eating. RESULTS: Generalized estimating equations indicated no consistent main effects of PSE on EMA outcomes, but PSE interacted with DEBQ-C child eating styles to predict each EMA outcome. Among children of parents with lower PSE, (a) higher emotional eating was associated with greater overeating and loss of control eating; (b) higher external eating was associated with greater craving; and (c) higher restraint was associated with greater loss of control eating and craving. Conversely, these associations were attenuated among children of parents with higher PSE. DISCUSSION: Together findings suggest the interplay of child characteristics and PSE regarding children's eating behaviors warrants future investigation in the context of eating and weight disorders. In particular, further research is needed to examine the directionality of effects and mechanisms underlying these associations.

Associations between naturalistically assessed physical activity patterns, affect, and eating in youth with overweight and obesity.

Insufficient physical activity (PA) and excessive stationary behavior (SB) are contributors to pediatric obesity, though antecedents and consequences of these behaviors in this population are relatively unknown. This pilot study examined affect, loss of control eating (LOCE), overeating, and hunger surrounding PA and SB in 17 youth with overweight/obesity. Participants completed a 14-day ecological momentary assessment (EMA) wearing accelerometers. At the momentary level, higher negative affect and lower positive affect predicted SB increases and PA decreases following EMA prompts; higher PA and lower SB also predicted increases in positive affect. Higher LOCE predicted SB increases and PA decreases, while increases in PA and decreases in SB predicted short-term increases in LOCE and overeating. At the individual level, higher SB and lower PA were related to lower positive affect and higher negative affect, LOCE, overeating, and hunger. Findings suggest affect is a relevant antecedent and consequence of PA/SB, and dysregulated eating may acutely impact PA/SB.

Naturalistic, multimethod exploratory study of sleep duration and quality as predictors of dysregulated eating in youth with overweight and obesity.

Although poor sleep has been found to adversely impact eating and weight regulation in youth, past research is limited by retrospective reporting and/or non-naturalistic designs. We investigated the feasibility of combining three momentary, ecologically valid approaches to assessing sleep and eating behavior, and associations between these constructs, among youth (aged 8-14y) with overweight/obesity (n = 40). Participants completed 14 overlapping days of actigraphy assessment and smartphone-based ecological momentary assessment (EMA) of eating behavior, of which 3 days also included computerized, self-guided 24-h dietary recall. Feasibility of completing measures concurrently was evaluated by generating frequencies of compliance. Associations between sleep indices and next-day eating behavior were examined via generalized estimating equations. Of 29 participants who provided EMA and 24-h recall data that aligned with previous night actigraphy data, both EMA and sleep data were available on an average of 8.6 out of 14 possible days, and both 24-h recall and sleep data on an average of 2.7 out of 3 possible days. Each additional hour of sleep was associated with consuming fewer calories from solid fats, alcohol, and added sugars (b = 0.70; p = .04). Combining naturalistic, momentary assessments of sleep and eating behavior appears to be acceptable in youth. Larger experimental studies are needed to further understand associations between sleep parameters and eating behavior.

Psychotropic medication use in treatment-seeking youth with eating disorders.

OBJECTIVE: Psychotropic medication use in youth with eating disorders (EDs) is poorly understood despite high co-occurrence of psychiatric disorders. This study examined characteristics associated with medication use in treatment-seeking youth with EDs. METHOD: Youth up to age 18 reported on medication use when presenting to an academic medical center outpatient ED service in the United States. Data presented were collected between 1998-2015. RESULTS: The sample (N = 604) was predominantly female (90.6%) with a mean age of 15.3 years (SD = 2.3). Approximately one-third (30%, n = 173) were taking psychotropic medications (40%, n = 70, were taking multiple medications). Antidepressant use was most common (26%, n = 152), followed by atypical antipsychotics (8%, n = 43). Adjusting for co-occurring psychiatric disorders, non-Hispanic Whites who had received prior treatment (psychotherapy, hospitalization) were significantly more likely to be using medication. Longer illness duration and prior treatment were associated with greater antidepressant use. For atypical antipsychotics, prior hospitalization was associated with greater use. CONCLUSIONS: Findings confirm moderate psychotropic medication use among young patients with EDs despite a lack of clarity regarding optimally effective pharmacologic interventions in this population. Pharmacological trials examining the efficacy of medications for young patients with EDs are warranted to inform future prescribing practice.

The utility of DSM-5 indicators of loss of control eating for the bariatric surgery population.

OBJECTIVES: This study investigated the utility of DSM-5 indicators of loss of control (LOC) eating in adult bariatric surgery patients who presented with binge-eating episodes. METHODS: Participants (all women) were 40 preoperative and 28 postoperative bariatric surgery patients reporting objective binge eating (OBE), 46 preoperative and 52 postoperative with subjective binge-eating (SBE), 53 bulimia nervosa (BN) controls, and 34 binge-eating disorder (BED) controls. Face-to-face Eating Disorder Examination interviews and questionnaires were administered. ANOVA, T-test, χ 2 , and regressions compared the groups in terms of LOC indicators endorsed and to explain disordered eating psychopathology. RESULTS: The indicator most commonly reported by bariatric patients with OBE was "feeling disgusted" (90% and 75% of pre- and postoperative groups), and the least endorsed was "eating alone" (40 and 28.6%). These indicators were reported by >84.9% of the BN and BED. Bariatric patients (pre- or post-surgery) with OBE only reported a higher number of indicators than patients with SBE only (t(150) = 2.34, p = .021). A higher number of indicators reported were associated with increased eating-related psychopathology (F(1,134) = 31.06, p < .001), but only for the post-surgery patients. CONCLUSIONS: The LOC indicators proposed by DSM-5 need to be refined or revised for the bariatric population. Highlights Bariatric patients endorse fewer LOC indicators than BN or BED during a binge-eating episode. Some of the DSM-5 LOC indicators may not be suited to assess episodes of loss of control eating among bariatric patients. The Higher the number of LOC indicators reported, the higher the eating-related psychopathology.

Introduction to the special issue on advancing assessment of, and interventions for, eating disorders via innovative uses of technology.

The aim of this editorial is to introduce a Special Issue of the International Journal of Eating Disorders on "Advancing Assessment of, and Interventions for, Eating Disorders via Innovative Uses of Technology." The 10 contributions to the Special Issue focus on the following main questions: (a) How can we optimize technology-enhanced interventions for eating disorders? (b) To what extent can technology help professionals to reach underserved populations? (c) How can innovative technology-enhanced tools improve assessment and treatment of eating disorders? The findings cumulatively suggest that technology can play a critical role in the detection and treatment of eating disorders, and may be used to enhance understanding of the etiology, maintenance, and course of these conditions. The contributions to this Special Issue have important implications for the conceptualization, design, and evaluation of technology-enhanced interventions as well as for the optimization of current assessment methods. Hopefully, they will stimulate future research in this quickly evolving field.

Differences in risk factors for binge eating by socioeconomic status in a community-based sample of adolescents: Findings from Project EAT.

OBJECTIVE: Binge eating is prevalent across socioeconomic status (SES) groups, but it is unclear whether risk factors for binge eating vary by SES. This study examined the prevalence of several risk factors for binge eating by SES and SES as a potential moderator of these risk factors. METHOD: Participants included 2,179 individuals involved in Project EAT during early/middle adolescence (EAT-I) and 5 years later during late adolescence/emerging adulthood (EAT-II). Risk ratios were computed using modified Poisson regression of incident EAT-II binge eating on EAT-I risk factors among participants of high and low SES. Interactions between each risk factor and SES were tested. RESULTS: Among higher SES adolescents, overweight/obesity (RR = 3.2; 95% CI: 1.8, 5.7), body dissatisfaction (RR = 2.6; 95% confidence intervals (CI): 1.2, 5.5), dieting (RR = 4.0; 95% CI: 2.0, 8.2), and family weight-teasing (RR = 2.3; 95% CI: 1.3, 4.3) predicted increased risk for binge eating. Among adolescents from low-SES backgrounds, overweight/obesity (RR = 1.5; 95% CI: 0.9, 2.5), dieting (RR = 2.2; 95% CI: 1.2, 3.9), and food insecurity (RR = 1.4; 95% CI: 0.7, 2.7) predicted increased risk for binge eating. Moderator analyses revealed that overweight/obesity, body dissatisfaction, dieting, and family weight-teasing were stronger risk factors in the high-SES group than the low-SES group; interactions with food insecurity could not be examined given the low prevalence of food insecurity in the high-SES group. DISCUSSION: Risk factors for binge eating may vary by SES, suggesting the potential utility of modifying intervention and prevention methods based on SES. In particular, the role of food insecurity must be addressed.

The relationship between body mass index, body dissatisfaction, and eating pathology in sexual minority women.

OBJECTIVE: Eating pathology is more prevalent among women compared to men, but prevalence and correlates associated with eating pathology likely vary among subgroups of women. This study examines prevalence and correlates of restrictive and weight control-related eating pathology in sexual minority women. METHOD: Data were collected from the Pittsburgh Girls Study (PGS). Participants reported on sexual orientation, and race, and body mass index (BMI) was derived from interviewer collected height and weight. Participants completed the Body Image Measure and the Eating Attitudes Test-26. RESULTS: Sexual minority women reported higher BMIs [F (1, 862) = 14.69, p < .001], higher levels of body dissatisfaction [F (1, 960) = 3.12, p < .01], and higher levels of eating pathology [F (1, 950) = 14.21, p < .001] than heterosexual women. Body dissatisfaction mediated the relationship between BMI and eating pathology, and levels of associations were not attenuated by sexual minority status. Race moderated the association between sexual orientation and eating pathology; compared to all other groups, White sexual minority women had the highest level of eating pathology. Discussion Results indicate that White sexual minority women have higher levels of eating pathology than Black sexual minority women and both Black and White heterosexual women. Future studies that draw from larger and more diverse, community-based samples are needed.