Does the design of the NHS Low-Calorie Diet Programme have fidelity to the programme specification? A documentary review of service parameters and behaviour change content in a type 2 diabetes intervention.

BACKGROUND: NHS England commissioned four independent service providers to pilot low-calorie diet programmes to drive weight loss, improve glycaemia and potentially achieve remission of Type 2 Diabetes across 10 localities. Intervention fidelity might contribute to programme success. Previous research has illustrated a drift in fidelity in the design and delivery of other national diabetes programmes. AIMS: (1) To describe and compare the programme designs across the four service providers; (2) To assess the fidelity of programme designs to the NHS England service specification. METHODS: The NHS England service specification documents and each provider's programme design documents were double-coded for key intervention content using the Template for Intervention Description and Replication Framework and the Behaviour Change Technique (BCT) Taxonomy. RESULTS: The four providers demonstrated fidelity to most but not all of the service parameters stipulated in the NHS England service specification. Providers included between 74% and 87% of the 23 BCTs identified in the NHS specification. Twelve of these BCTs were included by all four providers; two BCTs were consistently absent. An additional seven to 24 BCTs were included across providers. CONCLUSIONS: A loss of fidelity for some service parameters and BCTs was identified across the provider's designs; this may have important consequences for programme delivery and thus programme outcomes. Furthermore, there was a large degree of variation between providers in the presence and dosage of additional BCTs. How these findings relate to the fidelity of programme delivery and variation in programme outcomes and experiences across providers will be examined.

Are motivational and self-regulation factors associated with 12 months' weight regain prevention in the NoHoW study? An analysis of European adults.

PURPOSE: Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months. METHODS: The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost > 5% weight in the past year (N = 870, complete data only, 68.7% female, 44.10 ± 11.86 years, 84.47 ± 17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus' path analytical models informed by NoHoW's logic model. RESULTS: The bivariate correlations confirmed key mediators' potential effect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2 = 23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifically, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain prevention via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are significant in participants who regained or maintained their weight. CONCLUSIONS: These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents. TRIAL REGISTRATION: ISRCTN, ISRCTN88405328 , registered 12/22/2016.

Users' Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial.

BACKGROUND: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. OBJECTIVE: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)-a DBCI that targets weight loss maintenance-over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. METHODS: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. RESULTS: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. CONCLUSIONS: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content. TRIAL REGISTRATION: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-029425.

A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study.

BACKGROUND: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. OBJECTIVE: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. METHODS: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. RESULTS: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. CONCLUSIONS: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.

Validity and reliability of a shorter version of the Geriatric Depression Scale in institutionalized older Portuguese adults.

OBJECTIVES: Depressive symptoms are common in older adults in institutional contexts; however, there is a lack of validated measures for these settings. Identifying depressive symptoms can help clinicians to manage them and to prevent or delay their complications. This study aimed to validate the Geriatric Depression Scale (GDS) in an institutionalized sample of older adults. METHOD: 493 institutionalized older people (73% women) aged 60 or over were evaluated through the GDS, the Mini International Neuropsychiatric Interview (MINI) (depression vs. no depression = 11% vs. 89%), the Geriatric Anxiety Inventory (GAI), the Positive Affect (PA) and Negative Affect (NA) Schedule, and the Satisfaction with Life Scale (SWLS). Test-retest reliability was assessed with 57 older adults. RESULTS: An 8-item version presented a Cronbach's alpha value of .87 with a single factor explaining its variance. The correlations (p < .01) attested the concurrent validity (GAI: r = .76; PA: r = -.22; AN: r = .62; SWLS: r = -.32). Test-retest reliability (6.51 months) was adequate (r = .52). ROC analysis (AUC = .82; sensitivity = 80%; specificity = 77%) and Youden index revealed a cutoff of 5/6 for the diagnosis of depression. CONCLUSION: Results support the validity and the screening capacity of a short version of GDS in institutional contexts. Short screening instruments for depressive symptoms may facilitate their identification, allowing for timely clinical interventions in institutional settings.

Consistent sleep onset and maintenance of body weight after weight loss: An analysis of data from the NoHoW trial.

BACKGROUND: Several studies have suggested that reduced sleep duration and quality are associated with an increased risk of obesity and related metabolic disorders, but the role of sleep in long-term weight loss maintenance (WLM) has not been thoroughly explored using prospective data. METHODS AND FINDINGS: The present study is an ancillary study based on data collected on participants from the Navigating to a Healthy Weight (NoHoW) trial, for which the aim was to test the efficacy of an evidence-based digital toolkit, targeting self-regulation, motivation, and emotion regulation, on WLM among 1,627 British, Danish, and Portuguese adults. Before enrolment, participants had achieved a weight loss of ≥5% and had a BMI of ≥25 kg/m2 prior to losing weight. Participants were enrolled between March 2017 and March 2018 and followed during the subsequent 12-month period for change in weight (primary trial outcome), body composition, metabolic markers, diet, physical activity, sleep, and psychological mediators/moderators of WLM (secondary trial outcomes). For the present study, a total of 967 NoHoW participants were included, of which 69.6% were women, the mean age was 45.8 years (SD 11.5), the mean baseline BMI was 29.5 kg/m2 (SD 5.1), and the mean weight loss prior to baseline assessments was 11.4 kg (SD 6.4). Objectively measured sleep was collected using the Fitbit Charge 2 (FC2), from which sleep duration, sleep duration variability, sleep onset, and sleep onset variability were assessed across 14 days close to baseline examinations. The primary outcomes were 12-month changes in body weight (BW) and body fat percentage (BF%). The secondary outcomes were 12-month changes in obesity-related metabolic markers (blood pressure, low- and high-density lipoproteins [LDL and HDL], triglycerides [TGs], and glycated haemoglobin [HbA1c]). Analysis of covariance and multivariate linear regressions were conducted with sleep-related variables as explanatory and subsequent changes in BW, BF%, and metabolic markers as response variables. We found no evidence that sleep duration, sleep duration variability, or sleep onset were associated with 12-month weight regain or change in BF%. A higher between-day variability in sleep onset, assessed using the standard deviation across all nights recorded, was associated with weight regain (0.55 kg per hour [95% CI 0.10 to 0.99]; P = 0.016) and an increase in BF% (0.41% per hour [95% CI 0.04 to 0.78]; P = 0.031). Analyses of the secondary outcomes showed that a higher between-day variability in sleep duration was associated with an increase in HbA1c (0.02% per hour [95% CI 0.00 to 0.05]; P = 0.045). Participants with a sleep onset between 19:00 and 22:00 had the greatest reduction in diastolic blood pressure (DBP) (P = 0.02) but also the most pronounced increase in TGs (P = 0.03). The main limitation of this study is the observational design. Hence, the observed associations do not necessarily reflect causal effects. CONCLUSION: Our results suggest that maintaining a consistent sleep onset is associated with improved WLM and body composition. Sleep onset and variability in sleep duration may be associated with subsequent change in different obesity-related metabolic markers, but due to multiple-testing, the secondary exploratory outcomes should be interpreted cautiously. TRIAL REGISTRATION: The trial was registered with the ISRCTN registry (ISRCTN88405328).

Association between objectively measured sleep duration, adiposity and weight loss history.

BACKGROUND: An association between sleep and obesity has been suggested in several studies, but many previous studies relied on self-reported sleep and on BMI as the only adiposity measure. Moreover, a relationship between weight loss history and attained sleep duration has not been thoroughly explored. DESIGN: The study comprised of 1202 participants of the European NoHoW trial who had achieved a weight loss of ≥5% and had a BMI of ≥25 kg/m2 prior to losing weight. Information was available on objectively measured sleep duration (collected during 14 days), adiposity measures, weight loss history and covariates. Regression models were conducted with sleep duration as the explanatory variable and BMI, fat mass index (FMI), fat-free mass index (FFMI) and waist-hip ratio (WHR) as response variables. Analyses were conducted with 12-month weight loss, frequency of prior weight loss attempts or average duration of weight maintenance after prior weight loss attempts as predictors of measured sleep duration. RESULTS: After adjusting for physical activity, perceived stress, smoking, alcohol consumption, education, sex and age, sleep duration was associated to BMI (P < 0.001), with the highest BMI observed in the group of participants sleeping <6 h a day [34.0 kg/m2 (95% CI: 31.8-36.1)]. Less difference in BMI was detected between the remaining groups, with the lowest BMI observed among participants sleeping 8-<9 h a day [29.4 kg/m2 (95% CI: 28.8-29.9)]. Similar results were found for FMI (P = 0.008) and FFMI (P < 0.001). We found no association between sleep duration and WHR. Likewise, we found no associations between weight loss history and attained sleep duration. CONCLUSION: In an overweight population who had achieved a clinically significant weight loss, short sleep duration was associated with higher BMI, with similar associations for fat and lean mass. We found no evidence of association between weight loss history and attained sleep duration.

Biological and psychological mediators of the relationships between fat mass, fat-free mass and energy intake.

BACKGROUND: While recent studies in humans indicate that fat-free mass (FFM) is closely associated with energy intake (EI) when in energy balance, associations between fat mass (FM) and EI are inconsistent. OBJECTIVES: The present study used a cross-sectional design to examine the indirect and direct effects of FFM, FM and resting metabolic rate (RMR) on EI in individuals at or close to energy balance. METHODS: Data for 242 individuals (114 males; 128 females; BMI = 25.7 ± 4.9 kg/m2) were collated from the non-intervention baseline conditions of five studies employing common measures of body composition (air-displacement plethysmography), RMR (indirect calorimetry) and psychometric measures of eating behaviours (Dutch Eating Behaviour Questionnaire). Daily EI (weighed dietary records) and energy expenditure (flex heart rate) were measured for 6-7 days. Sub-analyses were conducted in 71 individuals who had additional measures of body composition (dual-energy X-ray absorptiometry) and fasting glucose, insulin and leptin. RESULTS: After adjusting for age, sex and study, linear regression and mediation analyses indicated that the effect of FFM on EI was mediated by RMR (P < 0.05). FM also independently predicted EI, with path analysis indicating a positive indirect association (mediated by RMR; P < 0.05), and a stronger direct negative association (P < 0.05). Leptin, insulin and insulin resistance failed to predict EI, but cognitive restraint was a determinant of EI and partially mediated the association between FM and EI (P < 0.05). CONCLUSIONS: While the association between FFM and EI was mediated by RMR, FM influenced EI via two separate and opposing pathways; an indirect 'excitatory' effect (again, mediated by RMR), and a stronger direct 'inhibitory' effect. Psychological factors such as cognitive restraint remain robust predictors of EI when considered alongside physiological determinants of EI, and indeed, have the potential to play a mediating role in the overall expression of EI.

Activity energy expenditure is an independent predictor of energy intake in humans.

BACKGROUND: There is evidence that the energetic demand of metabolically active tissue is associated with day-to-day food intake (EI). However, the extent to which behavioural components of total daily energy expenditure (EE) such as activity energy expenditure (AEE) are also associated with EI is unknown. Therefore, the present study examined the cross-sectional associations between body composition, resting metabolic rate (RMR), AEE and EI. METHODS: Data for 242 individuals (114 males; 128 females; BMI = 25.7 ± 4.9 kg/m2) were collated from the baseline control conditions of five studies employing common measures of body composition (air displacement plethysmography) and RMR (indirect calorimetry). Daily EI (weighed-dietary records) and EE (FLEX heart rate) were measured over 6-7 days, and AEE was calculated as total daily EE minus RMR. RESULTS: Linear regression indicated that RMR (ß = 0.39; P < 0.001), fat mass (ß = -0.26; P < 0.001) and AEE (ß = 0.18; P = 0.002) were independent predictors of mean daily EI, with AEE adding ≈3% of variance to the model after controlling for age, sex and study (F(10, 231) = 18.532, P < 0.001; R2 = 0.445). Path analyses indicated that the effect of FFM on mean daily EI was mediated by RMR (P < 0.05), while direct (ß = 0.19; P < 0.001) and indirect (ß = 0.20; P = 0.001) associations between AEE and mean daily EI were observed. CONCLUSIONS: When physical activity was allowed to vary under free-living conditions, AEE was associated with mean daily EI independently of other biological determinants of EI arising from body composition and RMR. These data suggest that EE per se exerts influence over daily food intake, with both metabolic (RMR) and behavioral (AEE) components of total daily EE potentially influencing EI via their contribution to daily energy requirements.

What makes dietary restraint problematic? Development and validation of the Inflexible Eating Questionnaire.

This study presents the Inflexible Eating Questionnaire (IEQ), which measures the inflexible adherence to subjective eating rules. The scale's structure and psychometric properties were examined in distinct samples from the general population comprising both men and women. IEQ presented an 11-item one-dimensional structure, revealed high internal consistency, construct and temporal stability, and discriminated eating psychopathology cases from non-cases. The IEQ presented significant associations with dietary restraint, eating psychopathology, body image inflexibility, general psychopathology symptoms, and decreased intuitive eating. IEQ was a significant moderator on the association between dietary restraint and eating psychopathology symptoms. Findings suggested that the IEQ is a valid and useful instrument with potential implications for research on psychological inflexibility in disordered eating.

Assessing positive emotional memories with peers: The Early Memories of Warmth and Safeness with Peers Scale for adolescents.

Research on the association between early positive relational experiences and later psychosocial adjustment is growing. The quality of peer relationships may have a particularly important effect on adolescents' wellbeing and mental health. The current study aimed at examining a measure of personal emotional memories of peer relationships characterized by warmth, safeness and affection, which occurred in childhood and adolescence (EMWSSPeers-A). Distinct samples (N = 584) of adolescents aged between 12 and 18 were used to assess the EMWSSPeers-A' factorial structure through a Principal Component Analysis and a Confirmatory Factor Analysis, and to analyse the scale's psychometric properties. Results indicated a one-dimensional structure with 12 items with very good internal consistency, and construct, convergent, divergent and incremental validities. By allowing the examination of the role played by memories of positive peer relationships on adolescents' psychological adjustment, the EMWSSPeers-A may be potentially useful for future model testing and for the assessment of interventions.

Body image as a target of victimization by peers/parents: Development and validation of the Body Image Victimization Experiences Scale.

This study developed and established the psychometric properties of the Body Image Victimization Experiences Scale (BIVES). The BIVES retrospectively assesses the frequency (Part A-frequency) and effect (Part B-impact) of victimization experiences pertaining to body image, perpetrated by peers and parents/caregivers in childhood and adolescence. Distinct samples of Portuguese women were recruited in 2013-2014: two nonclinical samples of the general population (n = 1,177), aged 18-60 years, and a clinical sample of patients with Binge Eating Disorder (BED; n = 73), aged 19-59 years. An exploratory factor analysis was conducted in 632 participants. A confirmatory factor analysis (CFA) and the scale's psychometric properties were tested in 545 participants. The ability of the BIVES to discriminate the clinical from a nonclinical sample was examined. The scale presented two factors indicating the sources of the victimization-peers and parents. CFA results confirmed the scale's structure. The BIVES presented very good internal consistency, construct and discriminant validity, good test-retest reliability, and was associated with related constructs, body image shame, and eating psychopathology. The scale adequately discriminated between the clinical sample and a nonclinical sample. The BIVES is a valid and reliable measure that allows for a comprehensive assessment of body image-related victimization experiences.

Ashamed and Fused with Body Image and Eating: Binge Eating as an Avoidance Strategy.

Binge Eating Disorder (BED) is currently recognized as a severe disorder associated with relevant psychiatric and physical comorbidity, and marked emotional distress. Shame is a specific negative emotion that has been highlighted as central in eating disorders. However, the effect of shame and underlying mechanisms on binge eating symptomatology severity remained unclear. This study examines the role of shame, depressive symptoms, weight and shape concerns and eating concerns, and body image-related cognitive fusion, on binge eating symptomatology severity. Participated in this study 73 patients with the diagnosis of BED, established through a clinical interview-Eating Disorder Examination 17.0D-who completed measures of external shame, body-image related cognitive fusion, depressive symptoms and binge eating symptomatology. Results revealed positive associations between binge eating severity and depressive symptoms, shame, weight and shape concerns, eating concerns and body image-related cognitive fusion. A path analysis showed that, when controlling for the effect of depressive symptoms, external shame has a direct effect on binge eating severity, and an indirect effect mediated by increased eating concern and higher levels of body image-related cognitive fusion. Results confirmed the plausibility of the model, which explained 43% of the severity of binge eating symptoms. The proposed model suggests that, in BED patients, perceiving that others see the self negatively may be associated with an entanglement with body image-related thoughts and concerns about eating, which may, in turn, fuel binge eating symptoms. Findings have important clinical implications supporting the relevance of addressing shame and associated processes in binge eating. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Shame is a significant predictor of symptomatology severity of BED patients. Shame significantly impacts binge eating, even controlling for depressive symptoms. Shame significantly predicts body image-related cognitive fusion and eating concern. Body image-fusion and eating concern mediate the link between shame and binge eating. Binge eating may be seen as an avoidance strategy from negative self-evaluations.

Compassionate Attention and Regulation of Eating Behaviour: A pilot study of a brief low-intensity intervention for binge eating.

A low-intensity 4-week intervention that included components of compassion, mindfulness, and acceptance was delivered to women diagnosed with binge eating disorder. Participants were randomly assigned to 1 of 2 conditions: intervention (n = 11) or waiting list control (n = 9). Participants in the intervention condition were invited to practise mindfulness, soothing rhythm breathing, and compassionate imagery practices with a focus on awareness and acceptance of emotional states and triggers to binge eating and engagement in helpful actions. Results revealed that, in the intervention group, there were significant reductions in eating psychopathology symptoms, binge eating symptoms, self-criticism, and indicators of psychological distress; there were significant increases in compassionate actions and body image-related psychological flexibility. Data suggest that developing compassion and acceptance competencies may improve eating behaviour and psychological well-being in individuals with binge eating disorder.

BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion.

Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow-up assessments. Developing mindfulness and self-compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation-, mindfulness-, and compassion-based components for treating women with binge eating and obesity. OBJECTIVE: To test the acceptability and efficacy up to 6-month postintervention of a psychological program based on psychoeducation, mindfulness, and self-compassion for obese or overweight women with BED. DESIGN: A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3- and 6-month follow-up. RESULTS: BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self-criticism, body-image psychological inflexibility, and body-image cognitive fusion; and in improving obesity-related quality of life and self-compassion when compared to a WL control group. Results were maintained at 3- and 6-month follow-up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. CONCLUSIONS: These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self-compassion when treating BED in obese or overweight women. KEY PRACTITIONER MESSAGE: The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self-compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6-month postintervention.

At the core of eating disorders: Overvaluation, social rank, self-criticism and shame in anorexia, bulimia and binge eating disorder.

This study examined the similarities and differences in eating psychopathology symptoms, overvaluation of body shape, weight and eating, general psychopathology, social comparison, self-criticism and shame, between AN, BN and BED patients. Also, the mediator effect of self-criticism and social comparison on the association between overvaluation and shame, was tested. Participants were 119 patients (34 AN, 34 BN and 51 BED) diagnosed through the Eating Disorder Examination. Results indicated that BED patients are older and present higher BMI. The groups differed regarding eating disorders' symptomatology, but no significant differences were observed in overvaluation, self-criticism, shame and overall psychopathology symptoms. The path model confirmed that overvaluation has a significant indirect association with shame, which is mediated by severe self-criticism and negative social comparisons. The model was fond to be invariant between the clinical groups. These findings contribute for the understanding of the common processes that feed the perpetual cycle of eating psychopathology. Thus, these data have potential implications for transdiagnostic approaches to treatment.

Caught in the struggle with food craving: Development and validation of a new cognitive fusion measure.

Cognitive fusion has been related to the development and maintenance of a series of mental health difficulties. Specifically, growing research on eating psychopathology has been demonstrating the important role of cognitive fusion related to body image in these disorders. Nonetheless, cognitive fusion specifically focused on eating remained to be investigated. The current study aimed at developing and validating the Cognitive Fusion Questionnaire-Food Craving, a measure assessing the extent to which an individual is fused with food-craving undesirable and disturbing thoughts and urges. This study was conducted with distinct samples comprising men and women from the student and general population. A principal component analysis was conducted to assess the scale's structure, which was further examined in a confirmatory factor analysis. The scale's reliability and validities were also analysed. Results indicated that the CFQ-FC presented a one-dimensional structure with 7 items, accounting for 66.14% of the variance. A CFA confirmed the plausibility of the measurement model, which was found to be invariant in both sexes. The CFQ-FC also revealed very good internal consistency, construct reliability, temporal stability, and convergent and divergent validity, being positively associated with similar constructs and with indicators of eating and general psychopathology. CFQ-FC also discriminated individuals with clinically significant symptoms of binge eating from participants with no symptoms. Finally, the CFQ-FC presents incremental validity over a global measure of cognitive fusion in predicting eating psychopathology, namely binge eating. The CFQ-FC is a psychometrically sound measure that allows for a brief and reliable assessment of eating-related cognitive fusion. This is a novel measure that may significantly contribute for the assessment of this specific dimension of cognitive fusion and for the understanding of its role in eating psychopathology.

Normative body dissatisfaction and eating psychopathology in teenage girls: the impact of inflexible eating rules.

PURPOSE: Adolescence has been considered a critical time for the development of body image-related difficulties and disordered eating behaviours, especially in females. Although adherence to eating rules has been linked to disordered eating, literature has not yet explored how the inflexible subscription to those rules impacts on eating psychopathology. Therefore, the aim of the current study was to explore whether inflexible eating impacts on the relationships between weight and body image-related variables, and disordered eating. METHODS: Participated in this study are 497 female adolescents from the community, aged between 14 and 18 years old, who completed self-report measures. RESULTS: Results revealed that the majority of the participants were dissatisfied with their weight and body shape. Moreover, 6.64 % of the participants demonstrated severe eating psychopathology. A path analysis revealed that BMI, body dissatisfaction and social comparisons based on physical appearance impact on disordered eating behaviours, through the mechanism of inflexible adherence to eating rules. This model explained 52 % of eating psychopathology's variance. CONCLUSIONS: Findings highlight the relevance of body image-related difficulties in adolescence and additionally they emphasise the importance of promoting more flexible attitudes towards eating in prevention and intervention programmes with female adolescents.

Being bullied and feeling ashamed: Implications for eating psychopathology and depression in adolescent girls.

The current study examined the associations between peer victimization, body image shame, self-criticism, self-reassurance, depressive symptoms and eating psychopathology in 609 female adolescents. Correlational analyses showed that being the victim of bullying was positively associated with body image shame, self-criticism, with low self-reassurance, depressive symptoms and eating psychopathology. A path analysis indicated that victimization experiences were associated with increased depressive symptoms partially through increased levels of body image shame, and a severe form of self-criticism - hated self. Body image shame and hated-self self-criticism fully mediated the association between victimization experiences eating psychopathology. The tested model accounted for a total of 51% of depressive symptoms variance and for 52% of eating psychopathology variance. These findings may have important intervention and prevention implications, by suggesting that bullying experiences fuel body image shame and consequent self-directed hostility and anger, which, in turn, predict increased depressive symptomatology and eating psychopathology in female adolescents.

Body Image as a Source of Shame: A New Measure for the Assessment of the Multifaceted Nature of Body Image Shame.

UNLABELLED: Theoretical and empirical accounts highlight the link between shame and body image difficulties, and disordered eating behaviours. Specifically, body image shame seems to play a particularly important role in this association. The current study aimed at developing and validating a new measure of body image shame and its phenomenology, the Body Image Shame Scale (BISS). Distinct samples of women from the general and student populations were used to test the BISS factorial structure using principal component analysis (PCA) and confirmatory factor analysis (CFA), and to examine the psychometric properties of the BISS. Principal component analysis results indicated that the scale presents a two-factor structure assessing an externalized and an internalized dimension underlying body image shame, which explains a total of 62.41% of the variance. A confirmatory factor analysis further corroborated the adequacy of this structure, which revealed good global and local adjustment indices. The BISS also presented very good internal consistency, construct and discriminant validities and good test-retest reliability. The scale also showed good concurrent and divergent validities. Furthermore, the scale discriminates between women with higher or lower levels of disordered eating behaviours. Finally, a mediation analysis revealed that the BISS fully mediates the previously established association between external shame and eating psychopathology. The BISS is a psychometrically robust and short measure of body image shame and its external and internal dimensions. KEY PRACTITIONER MESSAGE: The BISS is a brief and reliable self-report instrument of body image-related shame. The BISS assesses the phenomenology of body image shame considering an externalized dimension and an internalized dimension, which may have important clinical implications. The BISS presents very good internal consistency, construct and discriminant validities, test-retest reliability, concurrent and divergent validities, and accurately distinguishes between women with higher and normative levels of disordered eating behaviours. Body image shame, as assessed by the BISS, contributes to a better understanding of eating psychopathology with findings suggesting that the association between external shame and eating psychopathology fully depends on the extent to which one's body image becomes the source of shame, with the consequent activation of defensive attitudes and behaviours.