Prospective associations between early childhood parental feeding practices and eating disorder symptoms and disordered eating behaviors in adolescence.

OBJECTIVE: Nonresponsive parental feeding practices are associated with poorer appetite self-regulation in children. It is unknown whether this relationship extends beyond childhood to be prospectively associated with the onset of eating disorder (ED) symptoms in adolescence. This exploratory study therefore investigated prospective associations between early childhood parental feeding practices and adolescent ED symptoms and disordered eating behaviors. METHODS: Data were from two population-based cohorts with harmonized measures: Generation R (Netherlands; n = 4900) and Gemini (UK; n = 2094). Parents self-reported their pressure to eat, restriction and instrumental feeding (i.e., using food as a reward) at child age 4-5 years. Adolescents self-reported their compensatory behaviors (e.g., fasting, purging), binge-eating symptoms, restrained eating, uncontrolled eating, and emotional eating at 12-14 years. Associations between feeding practices and ED symptoms were examined separately in each cohort using generalized linear models. RESULTS: In Gemini, pressure to eat in early childhood was associated with adolescents engaging in compensatory behaviors. In Generation R, parental restriction was associated with adolescents engaging in compensatory behaviors, restrained eating, uncontrolled eating, and emotional eating. Instrumental feeding was associated with uncontrolled eating and emotional eating in Generation R. DISCUSSION: Nonresponsive parental feeding practices were associated with a greater frequency of specific ED symptoms and disordered eating in adolescence, although effect sizes were small and findings were inconsistent between cohorts. Potentially, the cultural and developmental context in which child-parent feeding interactions occur is important for ED symptoms. Further replication studies are required to better understand parents' role in the development and maintenance of ED-related symptoms. PUBLIC SIGNIFICANCE: Prospective research examining how early childhood parental feeding practices might contribute to adolescent ED symptoms is limited. In two population-based cohorts, nonresponsive feeding practices (restriction, instrumental feeding, pressure to eat) predicted increased frequency of some ED symptoms and disordered eating behaviors in adolescence, although associations were small and further replication is required. Findings support the promotion of responsive feeding practices, which may benefit young children's developing relationship with food.

Compensatory health motivations and behaviors scale: Development, evaluation, psychometric properties and a preliminary validation.

The "Compensatory Health Beliefs" scale assesses the degree to which one believes that unhealthy behaviours can be compensated through healthier ones. However, no validated scale to assess compensatory weight-related behaviors exists. The study's objective was to develop (Study 1) and validate (Study 2) a questionnaire measuring compensatory health motivations and behaviors (CHMB) and to assess their associations with body mass index (BMI) and psychological weight-related measures. An initial 34-item measure was constructed based on a target sample's (Study 1, n = 158) suggestions and refined based on expert feedback. The measure was then tested in a representative Canadian adult sample (N = 1400, 48.7% male). The sample was stratified by sex and age and then randomly split into two (N = 701 for exploratory factor analysis; N = 699 for confirmatory factor analysis (CFA) cross-validation). Fit indices, standardized Cronbach's alphas and the associations between the CHMB model with cognitive restraint, weight concerns, and BMI were assessed in multiple linear regression models controlling for age and sex. The final CHMB model (n = 17 items) consisted of four subscales: (1) motivation, (2) use on special occasions, (3) general use, (4) compensatory health beliefs. Fit indices (Goodness of Fit Index = 0.922) and Cronbach's alphas were good (α = 0.88). In multiple linear regression models, all CHMB subscales were associated with greater cognitive restraint in eating. Compensatory behavior use on special occasions was associated with greater weight concern (B = 0.12, p < .0001), while general compensatory behavior use was associated with lower weight concern (B = -0.07, p < .05). None of the subscales were associated with BMI. The validated CHMB scale allows for the assessment of compensatory health motivations and behaviors in a Canadian population. Research on whether this scale can predict weight changes and general health is needed.

Characterizing alcohol-related disordered eating behaviors in adults with binge eating.

PURPOSE: Alcohol-related disordered eating behaviors (ADEBs; i.e., engagement in dietary restriction or excessive exercise before or after drinking alcohol to avoid weight gain) are associated with negative psychosocial and medical consequences. Previous research has primarily studied ADEBs among community samples. Individuals with clinically significant binge eating may also engage in ADEBs given high rates of alcohol use and inappropriate weight-control behaviors. The current study aimed to characterize the prevalence and psychological correlates (i.e., weight and shape concerns, alcohol consumption, binge eating frequency) of ADEBs among individuals with clinically significant binge eating. METHODS: Participants were 166 treatment-seeking individuals who engaged in once weekly binge eating over the past three months. Participants completed a clinical interview to assess eating disorder symptoms and self-report measures of alcohol consumption patterns and ADEBs engagement. RESULTS: Over one-fourth of participants endorsed at least one ADEBs in the past three months. Participants who endorsed ADEBs reported greater alcohol consumption than participants who drank alcohol but did not endorse ADEBs, after controlling for eating disorder diagnosis. Greater frequency of ADEBs was related to higher weight and shape concerns among individuals who endorsed ADEBs in the past three months. Presence of ADEBs and ADEBs frequency were not related to binge eating frequency. CONCLUSION: Results suggest that clinicians treating individuals with binge eating who drink alcohol should screen for ADEBs and assess how ADEBs may contribute to an individual's eating pathology. Future research should assess the temporal relationship between alcohol use and ADEBs engagement, and study ADEBs in BN-spectrum samples. LEVEL OF EVIDENCE: Level V, descriptive studies.

Latent trajectories of symptom change during cognitive-behavior therapy predict post-treatment worsening of symptoms: a preliminary examination among outpatients with bulimia-spectrum eating disorders.

PURPOSE: Up to 44% of individuals with bulimia nervosa (BN) experience worsening of symptoms after cognitive behavior therapy (CBT). Identifying risk for post-treatment worsening of symptoms using latent trajectories of change in eating disorder (ED) symptoms during treatment could allow for personalization of treatment to improve long-term outcomes METHODS: Participants (N = 56) with BN-spectrum EDs received 16 sessions of CBT and completed digital self-monitoring of eating episodes and ED behaviors. The Eating Disorder Examination was used to measured ED symptoms at post-treatment and 3-month follow-up. Latent growth mixture modeling of digital self-monitoring data identified latent growth classes. Kruskal-Wallis H tests examined effect of trajectory of change in ED symptoms on post-treatment to follow-up symptom change. RESULTS: Multi-class models of change in binge eating, compensatory behaviors, and regular eating improved fit over one-class models. Individuals with high frequency-rapid response in binge eating (H(1) = 10.68, p =0 .001, η2 = 0.24) had greater recurrence of compensatory behaviors compared to individuals with low frequency-static response. Individuals with static change in regular eating exhibited greater recurrence of binge eating than individuals with moderate response (H(1) = 8.99, p = 0.003, η2 = 0.20). CONCLUSION: Trajectories of change in ED symptoms predict post-treatment worsening of symptoms. Personalized treatment approaches should be evaluated among individuals at risk of poor long-term outcomes. LEVEL OF EVIDENCE: IV, evidence obtained from multiple time series. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT03673540, registration date: September 17, 2018.

Winning compensations: Adaptable gaming approach for upper limb rehabilitation sessions based on compensatory movements.

Recent research has been using automatic difficulty adjustment techniques as an effective channel to improve the quality of physical rehabilitation. Notably, these approaches often incorporate adaptation metrics such as emotions and performance. Nonetheless, compensatory movements, which hinder movement correctness and are considered as a core quality evaluation criterion of rehabilitation, have not been considered as an adaptation metric. Weighting how visual feedback interfaces increase patient engagement, we leverage an interactive system with a compensatory movements-based difficulty adjustment framework to enhance the upper-limb physical rehabilitation process. We conducted user tests with professionals (N = 15), which included observation sessions, co-design workshops, semi-structured interviews, and usability testing, to evaluate our prototype. Results showed that our interactive system achieved scores of perceived usability between 74 and 78.17, along with participants praising both the dynamic and manual customization of difficulty parameters. Our findings empower physical therapists and health professionals by reducing their burden on physical rehabilitation monitorization.

Improving prediction of eating-related behavioral outcomes with zero-sensitive regression models.

OBJECTIVE: Outcome variables gauging the frequency of specific disordered eating behaviors (e.g., binge eating, vomiting) are common in the study of eating and health behaviors. The nature of such data presents several analytical challenges, which may be best addressed through the application of underutilized statistical approaches. While zero-sensitive models are well-supported by methodologists, application of these models has yet to gain traction among a widespread audience of researchers who study eating-related behaviors. The current study examined several approaches to predicting count-based behaviors, including zero-sensitive (i.e., zero-inflated and hurdle) regression models. METHOD: Exploration of alternative models to predict eating-related behaviors occurred in two parts. In Part 1, participants (N = 524; 54% female) completed the Eating Disorder Examination-Questionnaire and Daily Stress Inventory. We considered the theoretical basis and practical utility of several alternative approaches for predicting the frequency of binge eating and compensatory behaviors, including ordinary least squares (OLS), logistic, Poisson, negative binomial, and zero-sensitive models. In Part 2, we completed Monte Carlo simulations comparing negative binomial, zero-inflated negative binomial, and negative binomial hurdle models to further explore when these models are most useful. RESULTS: Traditional OLS regression models were generally a poor fit for the data structure. Zero-sensitive models, which are not limited to traditional distribution assumptions, were preferable for predicting count-based outcomes. In the data presented, zero-sensitive models were useful in modeling behaviors that were relatively rare (laxative use and vomiting, 9.7% endorsed) along with those that were somewhat common (binge eating, 33.4% endorsed; driven exercise, 40.7% endorsed). Simulations indicated missing data, sample size, and the number of zeros may impact model fit. DISCUSSION: Zero-sensitive approaches hold promise for answering key questions about the presence and frequency of common eating-related behaviors and improving the specificity of relevant statistical models. The current manuscript provides practical guidance to aid the use of these models when studying eating-related behaviors.

Predicting persistence of eating disorder compensatory weight control behaviors.

OBJECTIVE: The study aimed to identify variables that predicted persistence versus desistence of eating disorder-related compensatory behaviors in a high-risk factor sample of women who reported repeated compensatory behaviors at baseline. Data came from a randomized trial evaluating two brief obesity prevention interventions for college students with weight concerns. METHOD: Two hundred and sixty one young women (Mean age = 19.1, 79% European American) with weight concerns were randomly assigned to one of two brief obesity prevention interventions or educational video control. Participants were assessed at baseline, post-intervention, 6- and 12-month follow-up by interview, survey, and physical measurements on 6 eating disorder features and 13 psychosocial variables hypothesized to predict onset or maintenance of eating pathology. RESULTS: Approximately half (48%) reported engaging in recurrent compensatory behaviors in the year preceding study involvement. Among this subset, 61% reported persistent compensatory behaviors over 12-month follow-up. Neither study condition and adjunctive treatment, nor eating disorder features predicted persistence. Persistent compensatory behavior was significantly associated with greater sociocultural pressure to be thin, impulsivity, and substance use, and lower perceived sexual attractiveness. DISCUSSION: Perceived pressure to be thin is an established risk factor for the initiation of disorder eating behaviors but also may serve as a maintenance factor for unhealthy compensatory behaviors. Impulsivity, either as a trait factor or resulting from substance misuse may contribute to poor judgment and ongoing compensatory behaviors. Additional research on factors that predict persistence of eating disordered behaviors is needed. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:561-568).

Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men.

OBJECTIVE: The transition to college is considered as a risk period for the development of behavioral symptoms of eating disorders (BSEDs) and some evidence suggests that, amongst men, these symptoms occurring on a regular basis remain relatively stable over the college period. Nevertheless, little is known about factors associated with persistent engagement in and initiation of recurrent (or regular) binge eating and inappropriate weight compensatory behaviors in this population. The objective of this report was to address these research gaps. METHOD: Data were examined from 2,555 male first-year college students who completed an assessment of potential vulnerability factors and BSEDs at the beginning of the autumn semester (baseline) and nine months later (end of the spring semester; follow-up). RESULTS: Elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem at baseline were predictive of persistent engagement in regular binge eating and four compensatory behaviors (self-induced vomiting, laxative/diuretic abuse, fasting, exercise) at follow-up, as well as initiation of all these behaviors occurring regularly (i.e., at least weekly for 3 months). Self-objectification (thinking and monitoring the body's outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms. DISCUSSION: Data emphasize that the same psychological factors underlie initiation and persistence of recurrent BSEDs and should shape the focus of future interventions for college men. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:581-590).

Behavioral, emotional, and situational context of purging episodes in anorexia nervosa.

OBJECTIVE: The current study examined behavioral, emotional, and situational factors involved in purging among women with anorexia nervosa (AN). METHOD: Women with AN (n=118) completed a two-week ecological momentary assessment protocol involving daily reports of eating disorder behaviors, mood, and stressful events. Generalized estimating equations examined the likelihood and context of purging following eating episodes involving both overeating and loss of control (binge eating; BE); loss of control only (LOC); overeating only (OE); and neither loss of control nor overeating (non-pathological eating; NE). RESULTS: Relative to NE, purging was more likely to occur following BE, LOC, and OE (Wald chi-square = 18.05; p < .001). BE was more strongly associated with subsequent purging than LOC but not OE; the latter two did not differ from one another. Negative affect predicted purging following NE (Wald chi-square = 7.71; p = .005). DISCUSSION: Binge eating involving large amounts of food was the strongest predictor of purging in AN, which challenges the notion that loss of control is the most salient aspect of experiencing distress in bulimia nervosa and BE disorder. Parallel to findings from the BE literature, negative affect strongly predicted purging following NE. Further research should clarify the function and triggers of purging in AN.

A preliminary examination of a nonpurging compensatory eating disorder.

OBJECTIVE: To evaluate correlates of a compensatory eating disorder (CED) characterized by recurrent nonpurging compensatory behaviors in the absence of objectively large binge episodes among normal weight individuals who endorse undue influence of weight/shape on self-evaluation as possible indicators of clinical significance and distinctiveness. METHOD: Women with CED (n = 20), women with bulimia nervosa (BN) (n = 20), and controls (n = 20) completed an interview and questionnaires assessing eating disorder and general psychopathology and weight history. RESULTS: Compared with controls, women with CED reported significantly greater body image disturbance and disordered eating, higher anxiety proneness, increased perfectionism, and greater weight suppression. Compared with BN, CED was associated with significantly less body image disturbance, disordered eating, weight suppression, and lower likelihood of being overweight in childhood. However, CED and BN did not differ on anxiety proneness or perfectionism. DISCUSSION: CED merits further examination to determine whether it is a clinically significant and distinct eating disorder.