The transdiagnostic role of food craving: An application of substance use models.

Food craving is a transdiagnostic process underlying clinically significant disordered eating behaviors and eating disorder diagnoses. However, the lack of literature examining the role of food craving as it relates to the full spectrum of disordered eating behaviors, including restrictive eating and compensatory behaviors, may be due to the traditional definition of food craving as the desire to consume particular foods. Applying motivational models of substance use craving to food craving may help to explain inconsistencies within existing literature. Three motivational models of craving from the substance use literature may be particularly applicable to (1) provide a clear definition of food craving as a motivational process, (2) understand the role of that motivational process as it underlies the full spectrum of disordered eating behavioral patterns, (3) provide insight for the most appropriate ways in which to accurately assess food craving, and (4) establish ways in which food craving may represent a useful motivational process to target in eating disorder treatments. This narrative review describes three models of substance use craving and provides suggestions for utilizing motivational models to understand the transdiagnostic role of food craving as it relates to the full spectrum of disordered eating behaviors in both research and clinical work.

Body image in older women: a mediator of BMI and wellness behaviors.

Negative body image is prevalent among mid- and late-life women. In younger women, negative body image is associated with reduced quality of life (QOL) when controlling for body mass index (BMI), and mediates the relationship between obesity and emotional wellbeing. Yet, much remains unknown about body image in older populations. In our sample of women aged 50-86 (N = 181), negative body image mediated the relationship between BMI and sleep, all four domains of QOL, negative affect, nutritious food consumption, and psychosocial impairment, but not enjoyment of physical activity. Findings suggest negative body image impacts the wellbeing of older women.

Support for a two-dimensional model of food craving using self-report questionnaire and cue-reactivity methodologies.

OBJECTIVE: Evidence supports the transdiagnostic importance of food cravings across the spectrum of disordered eating behaviors. The ambivalence model of craving (AMC), originally applied to substance use craving, highlights the need to consider not just the motivational state of "approach," but also that of "avoidance." The aims of this project were to (a) extend the existing literature by providing additional psychometric support for the food approach and avoidance questionnaire (FAAQ), (b) extend research supporting the validity of applying the AMC to disordered eating by incorporating a cue-reactivity paradigm, and (c) examine the unique contributions of the FAAQ and in-the-moment cue-elicited craving to the prediction of disordered eating. METHOD: Participants (N = 223; 52.0% female, age M = 20.51 years) were recruited from a large southeastern university. Participants completed a food cue-reactivity paradigm and measures of food craving and disordered eating in a lab setting. RESULTS: The factor structure and construct validity of the FAAQ was supported and both general states of food craving (i.e., FAAQ) and cue-elicited food craving were incrementally associated with the spectrum of disordered eating behaviors. As anticipated, both FAAQ and in-the-moment cue-elicited approach were primarily associated with overeating behaviors, whereas FAAQ and cue-elicited avoidance were primarily associated with restrictive eating behaviors. DISCUSSION: Findings highlight the importance of including an avoidance dimension of food craving and have important implications for disordered eating prevention and intervention work.

The role of craving in emotional and uncontrolled eating.

This study presents a novel application of the cognitive processing model of alcohol craving (CPMA) from the addictions field to the role of food craving in the well-established restrained eating-overeating relationship associated with binge eating disorder (BED). A community sample (N = 1058, ages 18-66) completed an online survey assessing four core domains: restrained eating, trait food craving, uncontrolled eating, and emotional eating. In accordance with the CPMA, food craving emerged as a significant indirect effect of the association between restrained eating and both uncontrolled and emotional eating. Gender did not significantly moderate any direct or indirect associations, suggesting that gender may not change the pattern of association between restrained eating and different facets of overeating. Results suggest that treatments targeting binge eating behaviors may benefit from 1) explicitly addressing the activation of food craving rather than concentrating on reducing restrained eating and 2) recognizing that food craving may be an important gender-neutral target with the potential to reduce binge and overeating behaviors. Future research should extend these preliminary findings by examining the application of the CPMA to eating behaviors while jointly investigating antecedents and contextual factors.

The Longitudinal Associations of Body Dissatisfaction with Health and Wellness Behaviors in Midlife and Older Women.

Emerging research suggests that body dissatisfaction (BD) is prevalent among midlife and older women (i.e., upwards of 70%). Cross-sectionally, BD is associated with myriad poor health and wellness outcomes (e.g., depression, disordered eating, bad nutrition) in midlife/older women. However, relatively few studies have examined the longitudinal relations between BD and health outcomes in this population. This preliminary study investigated the longitudinal associations of BD with wellbeing and health-related quality of life (QOL) among midlife/older adult women over one year. Participants (n = 86, women aged 40-72 years, M = 51.49, SD = 7.34, 86% white) completed self-report measures of BD, psychosocial impairment, health behaviors, and QOL at baseline (T1) and 12-month follow-up (T2). A series of multiple linear regression models included T1 BD as the predictor variable of health outcomes at T2, covarying for T1 BMI and age in all models. BD was associated with greater negative emotions and psychosocial impairment, less physical activity enjoyment, and poorer physical, psychological, and social QOL one year later. Findings suggest that BD is associated with negative consequences for women across the lifespan (ƒ2 ranges = 0.06-0.60). Future research investigating BD as a unique, modifiable risk factor for health outcomes among diverse samples of midlife/older women is warranted. Targeting BD in interventions may improve health indices beyond eating disorders for this population.

Invariance of the Eating Disorder Inventory-Drive for Thinness subscale across university and community samples.

The Eating Disorder Inventory-Drive for Thinness (EDI-DT) subscale is commonly used in research and as an eating disorder screening measure, but extant evidence is scant regarding its psychometric properties. University and community samples often are treated as interchangeable in terms of research conclusions. Given established demographic differences between these two populations, the present study tested measurement invariance of the EDI-DT across these two sample types. Two large samples of university students (n = 537; 50% female, 67% White; n = 584; 52% female, 67% White) and community participants (n = 535; 57% female, 81% White; n = 533; 63% female, 82% White) completed the EDI-DT online. Multiple group confirmatory factor analyses tested configural, metric, scalar, and strict invariance by sample type. The EDI-DT subscale was not invariant across university and community samples. Post-hoc-regularized multiple nonlinear factor analyses suggested potential item bias associated with sample type, age, and body mass index on six of the seven items. Item bias, however, appeared to be associated with minimal clinical impact. Collectively, results suggest that the EDI-DT may be functionally invariant and appropriate for use with broad populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study.

BACKGROUND: Existing research has primarily focused on weight as the outcome of interest for bariatric surgery; however, patients frequently report other lifestyle and interpersonal surgery motivations and goals. Understanding the spectrum of bariatric surgery goals and motivations has important implications for enhancing patient-centered care and surgery outcomes. OBJECTIVES: The current study characterized the nature of bariatric patient motivations and goals for surgery, described the extent to which motivations matched goals, and examined whether men and women differed in the specific motivations/goals described. SETTING: Teaching hospital, United States METHODS: Data were obtained via retrospective chart review of bariatric patient responses to the clinic's standard open-ended questions about motivations and goals for bariatric surgery. A mixed method approach was used, including content analysis, to identify themes and χ2/t test analyses to test gender differences. RESULTS: Surgery motivations and outcome goals were reflected by 8 overarching and overlapping themes. The most common motivations were related to general health and quality of life. The most common goals were to improve health/longevity and mobility. Over a quarter of patients showed no overlap between motivations and goals. Few gender differences were observed. CONCLUSION: Findings underscore the importance of goals beyond weight loss, as well as the utility of helping patients shape their goals in accordance with goal-setting theories.

Eating Disorder Symptomatology Among Adolescents Presenting for Bariatric Surgery Candidacy: Examining Differences by Sex and Racial Minority Status.

BACKGROUND: Research on adolescent bariatric surgery candidates is limited by insufficient inclusion of ethnic minorities and males, and lack of consideration of the full spectrum of disordered eating behaviors (i.e., restriction, compensatory behaviors [e.g., purging], overeating/binge eating behaviors). OBJECTIVES: The current study investigated differences in the full range of disordered eating behaviors across sex and ethnicity among adolescents seeking bariatric surgery. SETTING: Teaching hospital, United States. METHODS: Data were collected using retrospective chart review of 79 adolescent bariatric surgery candidates (59% female, 46.8% Hispanic, MBMI = 50.2, SDBMI = 10.0, Mage = 17.3, SDage = 2.02) who had completed the self-reported Eating Disorder Diagnostic Scale for DSM-5 at intake. RESULTS: Approximately 33% of study participants met self-reported criteria for an eating disorder, with 35% endorsing binge eating behaviors and 50% endorsing compensatory behaviors. Few differences in behavior frequencies were observed across sex or racial/ethnic status. CONCLUSIONS: Findings underscore the importance of assessing the full spectrum of disordered eating behaviors among adolescent bariatric surgery candidates.

Body image in adult women: Associations with health behaviors, quality of life, and functional impairment.

This study examined body image in adult women along with probable correlates including health behaviors, negative affect, quality of life, and functional impairment. Adult women (N = 738, age = 25-86 years) completed an online survey assessing these domains. Women across all ages reported similar body image concerns. Negative body image significantly correlated with poorer wellness behaviors, negative affect, quality of life, and functional impairment. The inverse held for positive body image. The majority of correlations remained even when controlling for negative affect. Further research is warranted to investigate nature of the correlational relationships identified in this study.

The role of drive for thinness in the association between weight status misperception and disordered eating.

Weight status misperception is related to disordered eating outcomes, but little research has explored the differential impacts of misperception directionality, nor factors that explain these relationships. Self-Discrepancy Theory applied to body image gives a framework to how weight status over-perception may prompt a drive for thinness, which in turn may be important in the development of disordered eating cognitions and behaviors. AIMS: To that end, the current study tested whether drive for thinness may account for the association between direction of weight status misperception and disordered eating behaviors. METHODS: Young adults (N = 522) completed measures identifying weight status perception (accurate, under-, and over-perception), drive for thinness, and disordered eating attitudes and behaviors (appearance satisfaction, restrained, uncontrolled, and emotional eating). Indirect effect models with drive for thinness entered as the intervening variable were estimated for each outcome. RESULTS: Drive for thinness accounted for the associations between weight status misperception and all outcomes. In general, compared to either accurate or under-perception, over-perception of weight status was associated with more disordered eating attitudes and behaviors via higher drive for thinness. CONCLUSIONS: Consistent with Self-Discrepancy Theory, drive for thinness emerged as a possible mechanism of the association between weight status misperception and disordered eating outcomes. Findings suggest potential utility in targeting drive for thinness, as opposed to accuracy of weight status perception, for prevention of disordered eating attitudes and behaviors, including those that may contribute to weight gain.

Self-objectification and eating disorder pathology in an ethnically diverse sample of adult women: cross-sectional and short-term longitudinal associations.

BACKGROUND: Extensive support exists for objectification theory's original aim of explaining patterns of women's mental health risk through a sociocultural lens. One pathway in objectification theory proposes a mediational role of body shame in the relationship between self-objectification and eating disorder (ED) pathology. Robust past cross-sectional research supports this proposed pathway, but largely in non-Hispanic Caucasian, college-aged samples; this pathway has yet to be empirically demonstrated longitudinally. Given previously documented concerns regarding direct measurement of body shame, we tested two measures of body shame as mediators in both cross-sectional and longitudinal models in a diverse sample of adult women. METHOD: Utilizing snowball sampling via email, we recruited age and racially/ethnically diverse women predominantly within the United States. Participants completed online surveys assessing self-objectification (operationalized as body surveillance), body shame, and ED pathology at baseline, 3-months and 6-months. RESULTS: Racial/ethnic minority (n = 139) and non-Hispanic Caucasian (n = 181) adult women completed the measures. Cross-sectional moderated mediation models indicated that racial/ethnic status did not moderate relationships, and that body shame significantly mediated the relation between body surveillance and ED pathology at each time point. The longitudinal model, analyzed using cross-lagged panel analyses, was nonsignificant, as body surveillance failed to predict future body shame when controlling for past body shame. CONCLUSIONS: Racial/ethnic status did not moderate relations at any time point. Cross-sectional findings replicated past research; the longitudinal model did not support a core mediation pathway linking self-objectification to ED pathology through body shame. Because self-objectification putatively develops earlier in life, future research also should examine these relations in younger diverse samples over a longer time period.

Body mass index as a moderator of the association between weight status misperception and disordered eating behaviors.

Weight status under-perception is protective against disordered eating behaviors and weight gain; however, it is unclear whether under-perception may confer protection across all weight classes. This work explored body mass index as a moderator of the association between weight status perception accuracy and disordered eating behaviors among adults with overweight or obesity. A total of 572 adults (58.7% female; age M = 39.50, SD = 11.57) with overweight or obesity (body mass index M = 31.50, SD = 6.24) completed a series of online questionnaires assessing uncontrolled, emotional, and restrained eating, eating disorder symptoms, weight status perception, and demographics. Controlling for race/ethnicity, age, and sex, linear and negative binomial regressions were used to test hypotheses. Compared to accurate weight status perception, under-perception was associated with less uncontrolled (p = .003) and restrained eating (p = .002). Under-perception was particularly protective against emotional eating (p = .022) and eating disorder symptoms (p = .017) for individuals of overweight or Class I obesity. In general, weight status under-perception was associated with fewer disordered eating behaviors. The protective effects of under-perception of weight status may be maximized for individuals of overweight or Class I obesity statuses.