The Double Consciousness Body Image Scale: A body image assessment centering the experiences of Black women.

OBJECTIVE: Body image among Black women is poorly understood; emerging research suggests that Black women experience pressures to adhere to a body type not currently captured in commonly used body image measures. This study assessed the psychometric properties and validity of the Double Consciousness Body Image Scale (DCBIS), a new culturally relevant body image assessment for Black women. METHOD: Black women living in the United States (n = 198; 73.4% identified as African American; the remainder identified as African, Afro-Latina, Caribbean, Caribbean American, Black descent, or multiple racial identities) completed online surveys assessing behaviors used to modify physical features, pressures to adhere to certain physical features, and eating disorder symptomatology. RESULTS: Exploratory factor analysis identified a unitary factor structure focused on pressures to adhere to physical characteristics, as well as behavior manifestation of those pressures. The DCBIS demonstrated good internal consistency (α = .96). The DCBIS demonstrated convergent validity with measures of body image and disordered eating behaviors and attitudes. DISCUSSION: The DCBIS is a culturally relevant assessment of body image centering the experiences of Black women living in the context of U.S. culture. Future research is needed to confirm the factor structure of the DCBIS and evaluate its psychometric properties among a broader representation of Black women, globally.

The nature of night eating syndrome: Using network analysis to understand unique symptomological relationships.

OBJECTIVES: Despite the initial characterization of night eating syndrome (NES) in 1955, the definition and operationalization of its symptoms has varied considerably. To standardize the definition of NES and its symptoms, Allison et al. developed research diagnostic criteria. Even so, conceptualization and intervention of NES remains guided by medical models, which assume that pathology is driven by a distinct, underlying causal mechanism. Conversely, recent work on other eating disorders (EDs) has used network analysis to reconceptualize ED psychopathology and treatment by identifying (a) unique relationships between key symptoms, and (b) the symptoms most central to specific EDs. The present study examined NES symptoms through network analysis to identify the most central symptoms within the NES network. METHOD: Regularized partial correlation networks were estimated using 144 individuals in a community sample diagnosed with NES. Participants completed semi-structured interviews, self-report measures, and food/sleep diaries to measure NES symptoms, nonspecific health domains (e.g., sleep disturbance, overall mood, stress, and circadian rhythm functioning), and transdiagnostic ED symptoms. RESULTS: Depressed mood, poor sleep quality, and a strong urge to eat upon awakening at night were highly central to the psychopathology network for NES and were significantly more central than most other NES symptoms and nonspecific health domains. DISCUSSION: This study provides insight on the unique symptomological relationships of NES and sets the stage for future work that can identify causal linkages among NES symptoms. These symptoms represent key elements of the core psychopathology of NES and should represent primary targets for intervention.

A Systematic Review of Bright Light Therapy for Eating Disorders.

OBJECTIVE: Bright light therapy is a noninvasive biological intervention for disorders with nonnormative circadian features. Eating disorders, particularly those with binge-eating and night-eating features, have documented nonnormative circadian eating and mood patterns, suggesting that bright light therapy may be an efficacious stand-alone or adjunctive intervention. The purpose of this systematic literature review, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, was (1) to evaluate the state of the empirical treatment outcome literature on bright light therapy for eating disorders and (2) to explore the timing of eating behavior, mood, and sleep-related symptom change so as to understand potential mechanisms of bright light therapy action in the context of eating disorder treatment. DATA SOURCES: A comprehensive literature search using PsycInfo and PubMed/MEDLINE was conducted in April 2016 with no date restrictions to identify studies published using bright light therapy as a treatment for eating disorders. Keywords included combinations of terms describing disordered eating (eating disorder, anorexia nervosa, bulimia nervosa, binge eating, binge, eating behavior, eating, and night eating) and the use of bright light therapy (bright light therapy, light therapy, phototherapy). After excluding duplicates, 34 articles were reviewed for inclusion. STUDY SELECTION AND DATA EXTRACTION: 14 published studies of bright light therapy for eating disorders met inclusion criteria (included participants with an eating disorder/disordered-eating behaviors; presented as a case study, case series, open-label clinical trial, or randomized/nonrandomized controlled trial; written in English; and published and available by the time of manuscript review). RESULTS: Results suggest that bright light therapy is potentially effective at improving both disordered-eating behavior and mood acutely, although the timing of symptom response and the duration of treatment effects remain unknown. CONCLUSIONS: Future research should systematically control for placebo response, assess symptom change frequently and across a broad range of systems, and evaluate the longer-term efficacy of bright light therapy for eating disorders.

Albert J. Stunkard: His Research on Obesity and Its Psychological Impact.

Albert J. ("Mickey") Stunkard, MD, was a leader in the field of obesity research, with his work spanning more than five decades. He published several groundbreaking findings on the psychosocial influences of obesity, the genetics of obesity, and the relationship between obesity and factors such as socioeconomic status, stigma, and mood. He also helped establish two eating disorders associated with obesity-binge eating disorder and night eating syndrome. This paper highlights his work and its implications for the field.

Quantitative and Qualitative Analysis of the Quality of Life of Individuals With Eating Disorders.

OBJECTIVE: To examine the quality of a broad range of life domains using both quantitative and qualitative methodologies. METHOD: Forty-eight individuals seeking inpatient treatment for an eating disorder (mean age = 29.8 years, female = 100%, white = 96.4%) from 2007 to 2009 completed the Quality of Life Inventory (QOLI) and the Eating Disorder Examination Questionnaire; a medical chart review confirmed diagnosis and treatment history. Patients diagnosed with anorexia nervosa (n = 24) and bulimia nervosa (n = 24) were compared. Body mass index (kg/m(2)), treatment history, number of comorbid psychiatric conditions, and eating disorder severity were used to predict quality of life. Finally, an inductive content analysis was performed on qualitative QOLI responses to contextualize the quantitative findings. RESULTS: Participants with anorexia nervosa, compared to those with bulimia nervosa, reported significantly less satisfaction with the domain of relatives (F 1,46 = 5.35; P = .025); no other significant group differences were found. The only significant predictor of QOLI global score was number of previous treatments (F 1,41 = 8.67; P = .005; R (2) = 0.175). Content analysis of qualitative data yielded complementary findings to the quantitative data; interesting group differences emerged for satisfaction with health with implications for measuring quality of life domains. CONCLUSIONS: Across several life domains, individuals seeking treatment for anorexia nervosa and bulimia nervosa appear to have similar levels of satisfaction, as evidenced by numeric and descriptive responses. Satisfaction with relatives, however, appears to differ between groups and suggests a specific target for intervention among patients in treatment for anorexia nervosa (eg, a family-based intervention such as the Maudsley approach). The use of quantitative and qualitative assessments, such as the QOLI, provides more clinically meaningful, contextualized information about quality of life than traditional self-report assessments alone.

Comparison of obese adults with poor versus good sleep quality during a functional neuroimaging delay discounting task: A pilot study.

This study aimed to determine if obese adults with poor versus good sleep quality demonstrate reduced self-regulatory capacity and different patterns of neural activation when making impulsive monetary choices. Six obese, good quality sleepers (M age=44.7 years, M BMI=38.1 kg/m(2)) were compared to 13 obese, poor quality sleepers (M age=42.6, M BMI=39.2 kg/m(2)) on sleep and eating behavior and brain activation in prefrontal and insular regions while engaging in a delay discounting task during functional magnetic resonance imaging (fMRI). Poor quality sleepers demonstrated significantly lower brain activation in the right inferior frontal gyrus, right middle frontal gyrus, and bilateral insula when making immediate and smaller (impulsive) monetary choices compared to the baseline condition. Behaviorally, poor compared to good quality sleepers reported higher scores in the night eating questionnaire. Obese adults with poor sleep quality demonstrate decreased brain activation in multiple regions that regulate cognitive control and interceptive awareness, possibly reducing self-regulatory capacity when making immediately gratifying decisions.

Bright light therapy for the treatment of night eating syndrome: A pilot study.

The effect of bright light therapy (BLT) on the symptoms of night eating syndrome was evaluated. Fifteen adults completed two weeks of daily 10,000 lux BLT administered in the morning. Significant reductions were found pre-to-post treatment in night eating symptomatology, mood disturbance, and sleep disturbance. This pilot trial provides preliminary support for the efficacy of BLT for the treatment of night eating syndrome.

Perceptions of factors associated with weight management in obese adults with schizophrenia.

OBJECTIVE: Individuals with serious mental illnesses are at increased risk of obesity, although the behavioral factors contributing to excess weight are not well understood. We report on the eating behavior, physical activity, and body image of obese adults with and without schizophrenia spectrum disorders. METHODS: Twenty-two obese adults diagnosed with schizophrenia or schizoaffective disorder were compared to demographically matched obese adults without psychiatric diagnoses on their responses to a comprehensive assessment of several psychosocial and behavioral domains relevant to obesity and weight management. RESULTS: The schizophrenia group, compared to controls, reported more difficulty with several eating behaviors that were self-identified as contributing to increased weight. They also reported more enjoyment of physical activity and greater satisfaction with body weight and shape compared to controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Clinically relevant group differences were identified that should be considered when designing ecologically valid weight management assessments and interventions for individuals diagnosed with serious mental illnesses. Health care providers are encouraged to assess an individual's weight management strengths and barriers through available assessment tools and home visits, as well as offer specific environmental and behavioral changes to manage hunger and modify eating patterns.

Night eating behavior and metabolic heath in mothers and fathers enrolled in the QUALITY cohort study.

BACKGROUND: Desynchrony between eating and sleeping patterns and poor sleep quality have been associated with obesity and metabolic abnormalities. This study examined the metabolic health correlates of night eating syndrome in adults enrolled in the QUALITY cohort study. METHODS: Night eating symptoms were assessed in 310 women (mean age = 40.3 ± 5.1 years, mean BMI = 28.8 ± 6.2 kg/m(2)) and 305 men (mean age = 42.5 ± 5.9 years, mean BMI = 30.3 ± 5.0 kg/m(2)). Anthropometric measures, fasting blood samples and blood pressure were used to diagnose metabolic syndrome (MetS) and type 2 diabetes (T2D) diagnosis was self-report. Correlational and case/control comparisons assessed night eating symptoms in persons with and without MetS and T2D. RESULTS: Night eating questionnaire (NEQ) scores were positively correlated with BMI. When controlling for BMI, NEQ scores were significantly negatively correlated with blood pressure in women and positively correlated with waist circumference and triglycerides in men. MetS diagnosis was associated with morning anorexia in both women and men and urges to eat at night in women only. T2D was associated with a depressed mood in women and with insomnia in men. CONCLUSION: Symptoms of night eating syndrome are associated with higher BMI and poor metabolic health. Future research is needed to determine if night eating syndrome per se is a unique causal pathway in the development of obesity and metabolic disease.

Validation of screening questions and symptom coherence of night eating in the Swedish Twin Registry.

BACKGROUND: Screening criteria have been used to estimate the prevalence of night eating syndrome (NES), but no validation studies have been conducted. METHOD: We examined the validity of two screening questions for NES using a structured interview with adults enrolled in the Swedish Twin Study of Adults: Genes and Environment (STAGE) study. We also examined the coherence of the proposed diagnostic criteria for NES. A total of 416 participants (men=179; women=237) completed the interview and reported complete data for study inclusion. RESULTS: The following values were calculated for the screening items after confirmation by interview for men and women, respectively: positive predictive value=.66 and .67, negative predictive value=.52 and .45, sensitivity=.62 and .63, and specificity=.56 and .50. As increasingly stringent diagnostic criteria were applied to the sample, prevalence of NES dropped. Nocturnal ingestions were more likely to co-occur with other NES symptoms than evening hyperphagia, which occurred frequently, but often in isolation; women were more likely to report a co-occurrence of symptoms than men, who were not likely to report distress related to NES symptoms. CONCLUSION: In sum, almost two-thirds of participants were correctly identified as having NES (without considering distress or impairment) if they answered positively on the screening questions, and about half of the participants were correctly identified as not having NES when answering negatively on the screening questions. Although self-report questions are somewhat informative, a structured interview remains the gold standard for diagnosing NES.

Using the Neuroscience of Obesity, Eating Behavior, and Sleep to Inform the Neural Mechanisms of Night Eating Syndrome.

The development and maintenance of night eating syndrome (NES) is likely influenced by physiological, psychological, and social factors. Within the physiological domain, neural mechanisms (e.g., neurotransmitters and specific brain region functioning) remain understudied in contrast to other eating disorders and obesity. The serotonin system has been hypothesized to contribute to NES based on one single photon emission computed tomography (SPECT) study and supportive pharmacologic treatment outcome findings, but additional neural models are plausible. Functional magnetic resonance imaging (fMRI) is a brain imaging tool that is increasingly being used to study obesity, eating behavior, and sleep. Converging data from these literatures using food motivation and decision making fMRI paradigms suggest that the prefrontal and limbic brain systems might also play a role in the development and/or maintenance of NES. We use these data to support a new neural model of NES for future testing and validation.

Evening hyperphagia and food motivation: a preliminary study of neural mechanisms.

Evening hyperphagia (EH; consumption of ≥25% of total daily calories after the evening meal) is a circadian delay in the pattern of daily food intake and is a core criterion of night eating syndrome (Allison et al., 2010). This preliminary study examined the brain response to food cues using functional magnetic resonance imaging (fMRI) in seven obese adults with EH compared to seven obese adults without EH. When contrasting food to non-food and blurry baseline images pre-meal, groups differed in brain activation in the inferior frontal gyrus, precentral gyrus, cingulate gyrus, superior temporal gyrus and cerebellum. At post meal, groups differed in brain activation in the fusiform gyrus, inferior frontal gyrus, inferior parietal lobule and the cerebellum. Significant interactions between time (pre-meal, post-meal) and group (EH, control) when contrasting food to non-food images were also noted in the inferior frontal gyrus and the superior temporal gyrus. Further research is necessary to replicate these findings and determine if they have a mechanistic role in the development of circadian delayed eating behavior in obese adults with EH.

Daily physical activity patterns of children with delayed eating behaviors.

Night eating syndrome (NES) is a delayed pattern of energy intake. It is unknown if symptoms associated with this syndrome are accompanied by a delayed pattern of physical activity. This study examines the relationship between physical activity patterns and delayed eating behaviors in children. Children from the QUALITY cohort (n = 269, 45% female, aged 8-11 y) completed the Night Eating Questionnaire (NEQ), which measures NES symptoms on a continuous scale and identifies single NES symptoms. Daily accelerometer data were transformed into mean counts per wear-time minute for each hour of the day. Children with high NEQ scores had higher levels of daily (p < 0.001) and evening physical activity (p = 0.05) and reached 75% of their total daily physical activity 20 minutes later than children with low NEQ scores (p < 0.05). Excessive evening snacking and a strong urge to eat in the evening or at night were the symptoms most related to these physical activity patterns. Children with delayed eating behaviors had higher levels of physical activity in the late morning and evening and a delayed physical activity pattern compared to children with no or fewer symptoms. Future research is needed to determine if physical activity plays a role in the onset or maintenance of night eating.

Childhood obesity: survey of physician assessment and treatment practices.

BACKGROUND: This study examined physician experience with the 2007 Expert Committee Recommendations (ECR) on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity. METHODS: Pediatricians and family physicians (n = 194) practicing in the Midwest completed a survey designed to assess knowledge of, adherence to, and self-efficacy in implementing the 2007 Expert Committee recommendations. RESULTS: The majority of physicians (71%) were aware of the ECR and adhered to approximately 60% of the recommendations. Adherence was significantly higher for physicians who were aware of the ECR. Differences in awareness of and adherence to the ECR were noted among physician groups by specialty and location. Self-efficacy for assessing and treating pediatric obesity was significantly positively correlated with adherence to the ECR (Pearson r = 0.46). When asked for strategies that would facilitate improved pediatric weight management, physicians most often reported desiring to learn effective methods to increase patient motivation. CONCLUSIONS: Efforts to improve adherence to the Expert Committee recommendations should focus on improving physician awareness of and training in the use of the recommendations and on improved training and development of self-efficacy in pediatric weight assessment and patient counseling skills.

Lifetime medical and psychiatric comorbidity of night eating behavior in the Swedish Twin Study of Adults: Genes and Environment (STAGE).

The medical and psychosocial comorbidity of two core features of night eating syndrome (NES), evening hyperphagia (EH) and nocturnal awakening and ingestion of food (NI), was evaluated in adults enrolled in the Swedish Twin Study of Adults: Genes and Environment (STAGE) study. As part of the STAGE study, more than 20,000 participants completed assessments of their physical and mental health, which included two night eating screening questions designed to assess EH and NI. STAGE participants who completed a night eating validation interview to confirm the presence or absence of night eating and who had comorbidity data available (n=463) were compared on the lifetime prevalence of several psychiatric and medical conditions. In contrast to previous studies, night eating (EH and/or NI) was not significantly associated with lifetime history of any mental or physical health variable.

Prevalence and familial patterns of night eating in the Québec adipose and lifestyle investigation in youth (QUALITY) study.

The prevalence and familial patterns of night eating syndrome (NES) in families enrolled in the Québec Adipose and Lifestyle InvesTigation in Youth (QUALITY) study was examined. Families (n = 395; one child, mother, and father for whom at least one parent was obese or had abdominal obesity) completed the Night Eating Questionnaire (NEQ) as part of a longitudinal study on the development of metabolic disease in children at risk for obesity. Responses on the NEQ were used to establish a diagnosis of NES and to determine the correlation and heritability of NES symptoms in families. Using comprehensive research diagnostic criteria, full threshold NES was rare: 0% of children, 0.5% of mothers, and 0.3% of fathers met criteria. When controlling for age, sex, and BMI, NEQ scores of spouses were not significantly correlated, but mothers' NEQ scores were significantly correlated with the scores of both sons (r = 0.19, P < 0.001) and daughters (r = 0.15, P = 0.05). The heritability of NEQ scores was 0.24 when controlling for age, sex, and BMI. These findings replicate previous research suggesting a low prevalence of night eating behavior in children and the aggregation of NES in families.

Self-report and startle-based measures of emotional reactions to body image cues as predictors of Drive for Thinness and Body Dissatisfaction in female college students.

The purpose was to compare self-report and psychophysiological assessment techniques in the measurement of emotional response to body image cues. Female college students (n=53; % Caucasian=53.6; M body mass index=26.1 kg/m²) completed the Eating Disorder Inventory (EDI-3) and viewed photos of themselves both unaltered and morphed to simulate weight gain. Response to the photos was assessed by self-report and the affect modulated startle paradigm. EDI-3 Drive for Thinness (DT) and Body Dissatisfaction (BD) scale scores were correlated with startled amplitude for the largest simulated weight gain photo. Startle eye blink amplitude predicted more variance in DT and BD subscales than self-reported response to the image. The affect modulated startle paradigm may provide unique information in the assessment of eating disorder symptomatology that cannot be captured via self-report techniques, and has potential to inform evaluation of treatment outcomes of eating and body image disorders.

Changes in brain activation to food pictures after adjustable gastric banding.

BACKGROUND: Adjustable gastric banding is an effective weight-loss treatment, but little is known about the neural mechanisms underlying weight loss. The purpose of the present study was to determine whether gastric banding affects brain function in regions previously implicated in food motivation, reward, and cognitive control. The setting for the study was the University of Missouri-Kansas City, Department of Psychology; Hoglund Brain Imaging Center, University of Kansas Medical Center; and private practice in the United States. METHODS: Ten obese participants were recruited before adjustable gastric banding surgery (mean body mass index before surgery 40.6 ± 1.96 kg/m2). Their mean body mass index at 12 weeks after surgery was 36.1 ± 2.32 kg/m2, with a mean percentage of excess weight loss of 25.21% ± 8.41%. Functional magnetic resonance imaging scans were conducted before and 12 weeks after adjustable gastric banding surgery. At each assessment point, the participants completed questionnaires assessing food motivation and were scanned while hungry (before eating) and immediately after a standardized meal (after eating). During the functional magnetic resonance imaging scans, the participants viewed food pictures, nonfood pictures (animals), and blurred baseline control pictures. The functional magnetic resonance imaging data were analyzed using BrainVoyager QX. RESULTS: After surgery, the participants reported significantly less food motivation and more cognitive restraint. The participants also showed decreased brain activation to food versus nonfood pictures in regions implicated in food motivation and reward, including the parahippocampus, medial prefrontal cortex, insula, and inferior frontal gyrus. In contrast, they demonstrated increased activation to food versus nonfood pictures in anterior prefrontal cortex, a region implicated in cognitive control and inhibition. CONCLUSION: This is the first study to examine the functional brain changes after gastric banding surgery and 1 of the first studies to longitudinally examine neural changes associated with weight loss. These results have provided preliminary evidence that adjustable gastric banding alters brain function in regions known to regulate reward and cognitive control.

Night eating patterns of individuals with eating disorders: implications for conceptualizing the night eating syndrome.

The prevalence, correlates, and symptom coherence of night eating syndrome (NES) in individuals seeking inpatient treatment for eating disorders were assessed. Inpatients (n=68; M age=29.8 years; % female=94.1; % diagnosed with anorexia nervosa [AN]=47.1; % diagnosed with bulimia nervosa [BN]=47.1) were interviewed with the Night Eating Syndrome History and Inventory. Additionally, medical charts were reviewed and participants completed measures of eating behavior and quality of life. NES was diagnosed in 25% of patients; significantly more patients diagnosed with BN meet criteria for NES compared to those diagnosed with AN. In general, patients with NES did not differ from patients without NES on eating behaviors, attitudes, or quality of life; symptoms of NES frequently co-occurred. This study supports previous research finding that night eating behavior is common in individuals diagnosed with eating disorders.

Startle as an objective measure of distress related to teasing and body image.

OBJECTIVE: The startle reflex was used to assess negative emotion in response to body image cues in persons with and without body-related teasing histories. METHOD: Fifty-three female college students viewed photos of themselves both unaltered and morphed to look heavier and thinner. Participants with a teasing history were compared to participants without a teasing history on self-report measures and the affect modulated startle paradigm when viewing the photos. RESULTS: All participants, regardless of teasing history, self-reported that the photo morphed to look heaviest was more unpleasant than the neutral photo. When assessed by the affect modulated startle paradigm, a significant teasing history by photo interaction was found between the neutral and morphed to look heaviest photos and the neutral and morphed to look smallest photo. Those with a teasing history had greater startle response to the morphed images in comparison to the neutral images than did those without a teasing history. DISCUSSION: College-aged women with weight-related teasing histories may have negative emotional reactions to personally relevant body image cues, as measured by the startle reflex, even when they subjectively report no distress. Objective measures, such as the startle reflex should be considered when assessing emotional reactions to body image cues.