The relationship between non-purging compensatory behaviors, clinical severity, and treatment outcomes in adults with binge-spectrum eating disorders.

Non-purging compensatory behaviors (NPCB; e.g. driven exercise, fasting, other extreme behaviors) are a subcategory of compensatory behaviors typically characterized as infrequent and less severe. Limited prior research has studied NPCB despite their increasing prevalence among adults with binge-spectrum eating disorders (B-ED). More research is needed to understand the types of NPCB present among B-ED and the association between NPCB, clinical severity, and treatment outcomes. Secondary analyses were conducted among 155 adults with B-ED in cognitive-behavioral (CBT)-based clinical trials. At baseline and post-treatment, clinical interviews of eating pathology assessed binge eating frequency, purging compensatory behavior frequency, and global eating pathology. The following NPCB were also assessed: driven exercise, 24-h fasting, 8+ waking hours of compensatory fasting, chewing and spitting, and other extreme weight control behaviors. Participants engaging in NPCB reported higher global eating pathology than those not engaging in NPCB. Frequency of chewing and spitting and 24-h fasting significantly decreased over treatment. Engagement in NPCB at baseline did not predict CBT outcomes. The current study highlights the prevalence and clinical severity of NPCB in B-ED but offers promising results regarding the potential for CBT to improve these behaviors. More research is needed on other extreme weight control behaviors reported qualitatively in our sample and on the maintenance of improvements in non-purging behaviors after CBT.

Latent classes of alcohol and cannabis use among adults with binge-spectrum eating disorders: Associations with eating disorder symptom severity and personality features.

OBJECTIVE: Alcohol and cannabis use are prevalent among individuals with binge-spectrum eating disorders (B-ED) and vary in terms of frequency and associated problems. The current study aimed to identify latent classes of alcohol and cannabis use patterns among B-ED and examine associations between latent classes and demographic characteristics, eating disorder symptoms, and personality features. METHODS: Participants (N = 236) were treatment-seeking adults with B-ED who completed a clinical interview of eating pathology and self-report measures of alcohol and cannabis use in the past 3 months, alcohol and cannabis-related problems, and personality features (i.e., impulsivity, affect lability). RESULTS: Latent class analysis identified three heterogeneous classes, labelled as (a) Low Alcohol, (b) Moderate Drinking and Problems with Occasional Cannabis Use, and (c) No Alcohol and Cannabis Use. Latent classes significantly differed in terms of substance use engagement and problems, demographic characteristics, dietary restraint, impulsive personality features, and affect lability. CONCLUSIONS: Study findings support heterogeneity in alcohol and cannabis use among B-ED and suggest patient characteristics and clinical severity associated with specific substance use presentations. Future research should replicate results using larger, diverse samples engaging in a broader range of alcohol and cannabis use symptoms.

The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity.

OBJECTIVE: To determine whether acceptance-based behavioral treatment (ABT) would result in greater weight loss than standard behavioral treatment (SBT), and whether treatment effects were moderated by interventionist expertise or participants' susceptibility to eating cues. Recent research suggests that poor long-term weight-control outcomes are due to lapses in adherence to weight-control behaviors and that adherence might be improved by enhancing SBT with acceptance-based behavioral strategies. DESIGN AND METHODS: Overweight participants (n = 128) were randomly assigned to 40 weeks of SBT or ABT. RESULTS: Both groups produced significant weight loss, and when administered by experts, weight loss was significantly higher in ABT than SBT at post-treatment (13.17% vs. 7.54%) and 6-month follow-up (10.98% vs. 4.83%). Moreover, 64% of those receiving ABT from experts (vs. 46% for SBT) maintained at least a 10% weight loss by follow-up. Moderation analyses revealed a powerful advantage, at follow-up, of ABT over SBT in those potentially more susceptible to eating cues. For participants with greater baseline depression symptomology, weight loss at follow-up was 11.18% in ABT versus 4.63% in SBT; other comparisons were 10.51% versus 6.00% (emotional eating), 8.29% versus 6.35% (disinhibition), and 9.70% versus 4.46% (responsivity to food cues). Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action. CONCLUSIONS: Results offer strong support for the incorporation of acceptance-based skills into behavioral weight loss treatments, particularly among those with greater levels of depression, responsivity to the food environment, disinhibition, and emotional eating, and especially when interventions are provided by weight-control experts.