Psychometric properties of the Eating in the Absence of Hunger Questionnaire in treatment-seeking adults with overweight and obesity.

Understanding eating behaviors that contribute to overweight and obesity (OW/OB) is an important public health objective. One eating behavior known to contribute to overeating is eating in the absence of hunger (EAH). The Eating in the Absence of Hunger Questionnaire for Children was developed to assess external events and internal experiences that lead children to overeat. Despite the measure's adaptation for use with adults (i.e., EAH-A), its psychometric properties within this population have not been explored. This study assessed the psychometric properties of the EAH-A in sample of 311 treatment-seeking adults with OW/OB (mean BMI = 34.5 [5.1]; mean age = 46.3 [12.1]; 81.7% female; 20.6% Latinx, 59.2% white). The EAH-A contains 14 items and assesses three domains: negative affect eating (EAH-NAE), external eating, and fatigue/boredom eating, through two parallel sets of items assessing initiating EAH and continuing EAH. Exploratory Factor Analysis was performed with promax rotation and maximum likelihood factor extraction. Results supported a unitary factor of EAH, with scale responses driven by EAH-NAE items. Results may be explained in part by scale structure and domain imbalance favoring EAH-NAE items, or the true internal structure of EAH may consist of a singular latent construct. Follow-up analyses indicated redundancy of the scale's parallel sections. If researchers are primarily interested in EAH-NAE, only the three "start eating" or "keep eating" items may be needed. This study highlights the importance of validating the psychometric properties of a measure within intended populations to ensure interpretations are valid.

Adults with overweight or obesity use less efficient memory strategies compared to adults with healthy weight on a verbal list learning task modified with food words.

Several studies suggest poorer episodic memory among adults with overweight (OW) relative to those with healthy weight (HW); however, few have used food stimuli. To understand the salience of food-related items when assessing memory, we adapted an episodic memory task, by replacing some non-food words with snack foods. Participants were 96 weight-loss seeking adults with OW compared to 48 adults with HW from the community matched on age, gender, ethnicity, and education. Overall memory ability was similar, although a trend showed the adults with HW performed better than adults with OW on immediate recall (d = 0.32, p = 0.07). However, there were clear differences in the use of learning strategies. Adults with HW utilized sematic clustering more effectively than adults with OW during all test phases (ds = 0.44-0.62; ps ≤ 0.01). Adults with HW also utilized serial clustering more effectively (d = 0.51; p < 0.01). Adults with HW showed better semantic clustering for both food and non-food words during immediate and short delay recall (ds = 0.42-0.78; ps ≤ 0.01) but semantic clustering was only better for the non-food category at long delay (d = 0.55; p < 0.01). These results show that adults with OW utilized less efficient learning strategies throughout the task and food-related content may impact learning. Clinically, these findings may suggest that weight-loss treatments should consider incorporating the teaching of learning and memory strategies to help increase utilization of new skills.

The complicated relationship among parent and child disinhibited eating behaviors.

Disinhibited eating behaviors (e.g., loss of control eating (LOC) and eating in the absence of hunger (EAH)) contribute to overeating and obesity. This study aimed to evaluate whether these traits are related in parent-child dyads and how the reporter of child eating behavior (parent or child) impacts this relationship. Two-hundred and ninety treatment-seeking children, ages 8-13, with overweight or obesity (BMI percentile for age and sex 85-99.9%) and their parents were included. LOC and EAH were assessed by child report for self, parent report for self, and parent report for child. Parent and child disinhibited eating behaviors were related only when parents reported on both their own and their child's eating behaviors (p-values < 0.04). Child report of LOC and EAH for self was not associated with parent report of LOC and EAH for self (p-values > 0.05). There was a significant interaction between parent's EAH and BMI as it related to parent report of child EAH (B = 0.02; SE = 0.005; p = 0.004) such that parents with lower BMI reported their own EAH to be lower than parents with higher BMI, but parent report of child EAH was similar regardless of the parent's BMI. Disinhibited eating behaviors were related only when a single parent reported on both their own and their child's behavior, suggesting a potential reporting bias. Given that the relation between parent and child disinhibited eating behaviors varies based on who is reporting the child's behavior, it may be important to consider both parent and child report when designing research studies or in clinical settings while also recognizing potential reporting biases.

Psychometric properties of the Perceived Benefits of Thinness Scale in college-aged women.

Thin ideal internalization is a risk factor for disordered eating behaviors, poor body image, and eating disorders (EDs). This paper evaluated the psychometric properties of a novel measure, the Perceived Benefits of Thinness Scale (PBTS), which assesses how individuals feel being thinner would affect various aspects of their lives. Three separate studies with unique samples of college-aged women over 18 years were conducted to assess reliability and validity. In Study 1, exploratory and confirmatory factor analyses suggested all PBTS items loaded onto one factor that was distinct from a measure of weight and shape concerns. A large correlation between changes in PTBS scores and changes in ED psychopathology scores over 8 months (r = .57, p < .01) suggested sensitivity to change. Greater severity in ED pathology was also associated with higher scores on the PBTS. In Study 2, the PBTS showed good test-retest reliability (r = .84, p < .001) and, in Study 3, expected correlations with existing measures of thin ideal internalization (rs = .38-.60, ps < .001). Overall, the PBTS displayed good factor structure, reliability, concurrent validity, and sensitivity to change. By emphasizing social, emotional, and quality of life benefits, the PBTS may serve clinicians, researchers, and patients in understanding thin ideal internalization and associated ED risk.

Longer-term follow-up of college students screening positive for anorexia nervosa: psychopathology, help seeking, and barriers to treatment.

The purpose of this study was to conduct a longer-term (i.e., 9-month) follow-up of students identified with possible anorexia nervosa (AN) as part of the Healthy Body Image Program, an online platform for screening and delivering tailored feedback and interventions, offered at 36 US universities. Participants were 61 individuals who screened positive for AN and who completed the follow-up. Regarding results, some indices of ED pathology and psychiatric comorbidity decreased over time, while others did not. Participants most commonly endorsed feeling ashamed, nervous, validated, and sad in response to receiving the referral. One-third (33%) reported already being in treatment at the time they received the referral, 26% initiated treatment since that time, and 41% did not initiate treatment. The most common reasons for seeking treatment were emotional distress, concern with eating, and health concerns. The strongest treatment barriers were believing one should be able to help themselves, believing the problem was not serious enough to warrant treatment, and not having time. Findings highlight the high level of pathology in students identified with possible AN, even nine months after they were first identified and provided resources, and the relatively low rates of treatment utilization given the seriousness of these illnesses.

Design of the PACIFIC study: A randomized controlled trial evaluating a novel treatment for adults with overweight and obesity.

The majority of adults in the United States have overweight or obesity which is associated with significant health and psychological consequences. Behavioral Weight Loss (BWL) is the current gold-standard weight-loss program for adults but recidivism rates continue to be disturbingly high. Given the health consequences of excess weight and the lack of long-term effectiveness of BWL, it is important to identify novel weight-loss programs. We developed the ROC (Regulation of Cues) program to reduce overeating through improvement in sensitivity to appetitive cues and decreased responsivity to external food cues. This study is a 4-arm randomized control trial designed to evaluate the efficacy of ROC, ROC combined with BWL, BWL alone and an active comparator over 24 months. Study recruitment completed in November 2017. Two hundred and seventy-one participants were randomized (mean age = 46.97 years; 82% female, mean BMI = 34.59; 20% Hispanic) and assessments were conducted at baseline, mid-treatment (6 months) and post-treatment (12 months). At this time, participants are completing 6- (18 months) and 12-month (24 months) follow-ups. Targeting novel mechanisms is critically important to improve weight-loss programs. Through this trial, we hope to identify treatments for adults with overweight and obesity to facilitate long-term weight loss and improved health.

Screening and offering online programs for eating disorders: Reach, pathology, and differences across eating disorder status groups at 28 U.S. universities.

OBJECTIVE: The Internet-based Healthy Body Image (HBI) Program, which uses online screening to identify individuals at low risk of, high risk of, or with an eating disorder (ED) and then directs users to tailored, evidence-based online or in-person interventions to address individuals' risk or clinical status, was deployed at 28 U.S. universities as part of a randomized controlled trial. The purpose of this study is to report on: (a) reach of HBI, (b) screen results, and (c) differences across ED status groups. METHOD: All students on participating campuses ages 18 years or older were eligible, although recruitment primarily targeted undergraduate females. RESULTS: The screen was completed 4,894 times, with an average of 1.9% of the undergraduate female student body on each campus taking the screen. ED risk in participating students was high-nearly 60% of students screened were identified as being at high risk for ED onset or having an ED. Key differences emerged across ED status groups on demographics, recruitment method, ED pathology, psychiatric comorbidity, and ED risk factors, highlighting increasing pathology and impairment in the high-risk group. DISCUSSION: Findings suggest efforts are needed to increase reach of programs like HBI. Results also highlight the increasing pathology and impairment in the high-risk group and the importance of programs such as HBI, which provide access to timely screening and intervention to prevent onset of clinical EDs.

Understanding and promoting treatment-seeking for eating disorders and body image concerns on college campuses through online screening, prevention and intervention.

While there have been important recent advances in the development of effective universal prevention and intervention programs, it is not yet clear how to engage large numbers of students in these programs. In this paper, we report findings from a two-phase pilot study. In the first phase, we used a population-level, online survey to assess eating disorder symptom level and habits/attitudes related to service utilization (N=2180). Using validated screening tools, we found that roughly one in three students has significant symptoms of eating disorders or elevated weight concerns, the vast majority of whom (86.5%) have not received treatment. In the second phase, we referred students to online prevention and selective/indicated intervention programs based on symptom classification (N=1916). We find that program enrollment is highest for students in the indicated intervention (18.1%) and lowest for students in the universal prevention (4.1%). We find that traditionally-emphasized barriers such as stigma, misinformation, and financial limitations do not appear to be the most important factors preventing treatment-seeking. Rather students report not seeking help for reasons such as lack of time, lack of perceived need, and a desire to deal with the issue "on my own." Findings offer insight into the treatment-seeking habits and attitudes of college students, including those barriers that may be overcome by offering online programs and those that persist despite increased access to and convenience of relevant resources.

Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses.

PURPOSE: Given shared risk and maintaining factors between eating disorders and obesity, it may be important to include both eating disorder intervention and healthy weight management within a universal eating disorder care delivery program. This study evaluated differential eating disorder screening responses by initial weight status among university students, to assess eating disorder risk and pathology among individuals with overweight/obesity versus normal weight or underweight. METHODS: 1529 individuals were screened and analyzed. Screening was conducted via pilot implementation of the Internet-based Healthy Body Image program on two university campuses. RESULTS: Fifteen percent of the sample had overweight/obesity. Over half (58%) of individuals with overweight/obesity screened as high risk for an eating disorder or warranting clinical referral, and 58% of individuals with overweight/obesity endorsed a ≥10-pound weight change over the past year. Compared to individuals with normal weight or underweight, individuals with overweight/obesity were more likely to identify as Black, endorse objective binge eating and fasting, endorse that eating disorder-related concerns impaired their relationships/social life and made them feel badly, and endorse higher weight/shape concerns. CONCLUSIONS: Results suggest rates of eating disorder pathology and clinical impairment are highest among students with overweight/obesity, and targeted intervention across weight categories and diverse races/ethnicities is warranted within universal eating disorder intervention efforts. Integrating eating disorder intervention and healthy weight management into universal prevention programs could reduce the incidence and prevalence of eating disorders, unhealthy weight control practices, and obesity among university students.

Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students.

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.