Sexual self-concept, functioning, and practices of women with binge eating episodes.

PURPOSE: Positive sexuality has received little empirical attention in relation to eating disorders. Two tendencies related to sexuality have been identified among women with anorexia nervosa (avoidance) and bulimia nervosa (disinhibition), but it is unclear if they also apply to women with binge eating episodes without compensatory behaviors. This study aimed at (1) exploring the sexual self-concept, functioning, and practices of women with binge eating episodes with or without comorbid restrictive and/or compensatory behaviors, considering past experiences of violence, and (2) verifying the presence of distinct profiles of sexual dispositions among this population. METHODS: In total, 253 women reporting recurrent episodes of loss of control related to food intake in the past 5 years, completed a web-based questionnaire. Descriptive and correlational analyses were conducted to outline participants' sexual self-concept, functioning, and practices and to examine the relationship between these factors. A two-step cluster analysis was also performed to determine whether participants presented distinct profiles of sexual dispositions. RESULTS: Participants were generally characterized by a negative sexual self-concept and poor sexual functioning. While a first subgroup of participants displayed a pattern of sexual difficulties and avoidance, a second subgroup had a positive sexual self-concept, better sexual functioning and a wider range of sexual practices. Subgroups did not differ relative to binge eating. CONCLUSIONS: Sexuality offers a platform for positive embodiment, which can lead to the improvement of body image and mind-body connection and may thus constitute an essential clinical target to improve treatment related to binge eating episodes. LEVEL OF EVIDENCE: Level II: The experimental study is a non-randomized controlled trial.

Extreme weight control behaviors among adolescent athletes: Links with weight-related maltreatment from parents and coaches and sport ethic norms.

The use of extreme weight-control behaviors is prevalent among adolescent athletes and may result from individual and sport-specific factors. Weight-related maltreatment from coaches and parents, and conformity to sport ethic norms have recently been linked to the use of extreme weight-control behaviors. This study aims to investigate the role of sport ethic norms and weight-related maltreatment from coaches and parents in the use of extreme weight-control behaviors among adolescent athletes. A sample of 999 French-Canadian athletes aged 14-17 years competing in a variety of sports completed an online survey assessing extreme weight-control behaviors, weight-related maltreatment from coaches and parents, and conformity to sport ethic norms. A total of 16.9% of the adolescent athletes reported having adopted extreme weight-control behaviors during their athletic careers. Extreme weight-control behaviors were significantly more prevalent among girls (19.75% vs 9.7% in boys) and weight-class-sport athletes (44%). In addition, 7.4% of the sample experienced at least one type of weight-related maltreatment by coaches or parents. Sex, weight-related neglect by coaches and parents, and weight-related psychological violence by coaches explained 24.4% of extreme weight-control behaviors variance. Indeed, participants who engaged in extreme weight-control behaviors experienced significantly more violence than the other participants did. In contrast, no differences were observed between people who engaged in extreme weight-control behaviors and those who did not due to conformity to sport ethic norms.

Feminist identification, social dominance orientation, and weight bias in men.

Weight bias has deleterious consequences on individuals considered overweight and has similarities with forms of prejudice linked to social dominance orientation (SDO). Feminism can counter oppression that women are subject to notably through weight bias and SDO, but no studies have focused directly on these variables among men, as feminist identity is linked to less endorsement of certain beliefs in SDO and weight bias. The purpose of the present study is to explore the associations between feminist identification and beliefs, SDO, and weight bias among men from Quebec. Participants were divided into four feminist identification groups. Results indicate that feminist identification in men is linked to lower levels of SDO and less dislike toward people considered overweight. Also, feminism seems to predict prejudice toward others, but not toward oneself whereas SDO-D seems to be a good predictor of the belief that weight is controllable.

Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec.

PURPOSE: To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting. DESIGN: Quasi-experimental design evaluating eating behaviors and psychological factors. SETTING: The HAES intervention is offered in Health and Social Services Centers in Québec (Canada). PARTICIPANTS: For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m2) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m2) from a comparison group. INTERVENTION: The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating. MEASURES: Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up. ANALYSIS: Group, time, and interaction effects analyzed with mixed models. RESULTS: Significant group by time interactions were found for flexible restraint ( P = .0400), disinhibition ( P < .0001), susceptibility to hunger ( P < .0001), intuitive eating ( P < .0001), obsessive-compulsive eating ( P < .0001), body-esteem ( P < .0001), depression ( P = .0057), and self-esteem ( P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term. CONCLUSION: The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.

Psychological Meanings of Eating Disorders and Their Association With Symptoms, Motivation Toward Treatment, and Clinical Evolution Among Outpatients.

Unlike patients suffering from egodystonic disorders, people with eating disorders sometimes attribute positive meanings to their symptoms, and this attribution process contributes to the maintenance of the disorder. This study aims at exploring psychological meanings of eating disorders and their associations with symptoms, motivation toward treatment, and clinical evolution. Eighty-one adults with an eating disorder (anorexia nervosa, n = 46 and bulimia nervosa, n = 35) treated in a day-hospital program were asked, each week over an 8-week period, to identify the psychological meanings they ascribed to their eating disorder. Avoidance was the most frequently identified meaning, followed by mental strength, security, death, confidence, identity, care, and communication. Avoidance was more frequently mentioned by participants with bulimia than in cases of anorexia. Security and mental strength were associated with less motivation toward treatment. Death was associated with more depressive and anxious symptoms. An exploratory factor analysis showed that these meanings formed three main dimensions: Avoidance, Intrapsychic, and Relational. Findings suggest that psychological meanings associated with eating disorders can be assessed and used as a clinical tool to increase treatment acceptability and effectiveness.

Eating Pathology Among Patients With Anorexia Nervosa and Bulimia Nervosa: The Role of Narcissism and Self-Esteem.

We sought to deepen our understanding of the relationship between pathological narcissism and eating disorders (ED) by examining specific facets that composed grandiose and vulnerable narcissism while taking into account self-esteem, a well-known and consistent risk factor for ED. Twenty-seven women diagnosed with anorexia nervosa (AN) and 23 women diagnosed with bulimia nervosa (BN) completed standardized measures of pathological narcissism, self-esteem, and dysfunctional eating attitudes and behaviors. Different patterns of associations between the facets of pathological narcissism and eating pathology arose between AN and BN diagnoses. Closer examination of the facets of pathological narcissism revealed that hiding the self, a vulnerable narcissistic facet, contributed significantly to dysfunctional eating attitudes and behaviors over and above self-esteem for women with AN. Hiding the self should continue to be explored in regard to treatment of ED.

Emotion suppression and food intake in the context of a couple discussion: A dyadic analysis.

Using dyadic analysis, this study examined whether emotion suppression is a valid mediator in the relationship between mood change following a stressful couple discussion and subsequent food intake among cohabiting couples. In a laboratory setting, 80 heterosexual couples were presented with a bogus taste test immediately after discussing aspects that they would like each other to change. Mood change, emotion suppression and appetite perceptions were self-reported using visual analogue scales, and BMI was calculated based on objective measures. The moderated-mediation Actor-Partner Interdependence Model revealed a significant indirect conditional effect, showing that mood worsening was significantly associated with higher emotion suppression and that emotion suppression was significantly associated with more food intake among spouses with a high BMI. For spouses with a low BMI, the reverse effect was found, i.e., mood worsening was significantly associated with less food intake through the indirect effect of emotion suppression. Furthermore, an indirect partner effect was observed regardless of BMI, i.e., mood worsening was related to more food intake, which was mediated by the partner's emotion suppression. These results highlight the key role of emotion suppression in the relationship between mood change and food intake in the context of a stressful couple discussion.

[Identification of promising practices in the treatment of anorexia nervosa]. / Identification des pratiques prometteuses dans le traitement de l'anorexie mentale.

Anorexia nervosa concerned, firstly, because this disorder is associated with many medical complications and secondly, because it is linked with a poor prognosis. Given these facts, it is imperative that effective treatments be available for anorexia nervosa. This article aims to present a systematic review of the literature on the best therapeutic modalities in the field of anorexia nervosa. Among these, we find outpatient treatment, importance of multidisciplinary team and various therapeutic approachs, like familial therapy.

Induced dyadic stress and food intake: Examination of the moderating roles of body mass index and restraint.

Restrained eaters and overweight and obese people are prone to increase their food intake during stressful situations. This study examines the impact of a stressful couple discussion on food intake in both spouses, while simultaneously taking into account the effect of BMI and restraint on this association. For 15min, 80 heterosexual couples discussed an aspect that they wanted their partner to change followed by an individual bogus taste test for the purpose of measuring his or her stress-induced food intake. Prior to and after the discussion, subjective mood state was assessed, as well as appetite perceptions, and the mood change before and after the discussion was calculated. Multiple regression analyses with a three-way interaction between mood change, BMI, and restraint were used to predict food intake for both men and women, while controlling for appetite perceptions. Only restrained women with a high BMI ate more when their mood worsened. For men, only appetite perceptions significantly predicted food intake. These results suggest that an induced negative mood in the form of a stressful couple discussion impacts food intake differently for men and women, and that particular attention should be given to the concomitant effect of both restraint and BMI when studying stress-induced eating among women.

Examining women's perceptions of their mother's and romantic partner's interpersonal styles for a better understanding of their eating regulation and intuitive eating.

Intuitive eating is a positive approach to weight and eating management characterized by a strong reliance on internal physiological hunger and satiety cues rather than emotional and external cues (e.g., Tylka, 2006). Using a Self-Determination Theory framework (Deci & Ryan, 1985), the main purpose of this research was to examine the role played by both the mother and the romantic partner in predicting women's intuitive eating. Participants were 272 women (mean age: 29.9 years) currently involved in a heterosexual romantic relationship. Mothers and romantic partners were both found to have a role to play in predicting women's intuitive eating via their influence on women's motivation for regulating eating behaviors. Specifically, both the mother's and partner's controlling styles were found to predict women's controlled eating regulation, which was negatively related to their intuitive eating. In addition, autonomy support from the partner (but not from the mother) was found to positively predict intuitive eating, and this relationship was mediated by women's more autonomous regulation toward eating. These results were uncovered while controlling for women's body mass index, which is likely to affect women's eating attitudes and behaviors. Overall, these results attest to the importance of considering women's social environment (i.e., mother and romantic partner) for a better understanding of their eating regulation and ability to eat intuitively.

Trajectories of eating and clinical symptoms over the course of a day hospital program for eating disorders.

Although it is well-established that day hospital programs for eating disorders significantly reduce clinical symptoms, the pre-test/post-test designs that were previously used do not provide information regarding the trajectory of symptoms during treatment. This study observed, on a weekly basis, the evolution of symptoms of 61 women suffering from eating disorders engaged in a day hospital program, and compared the trajectories of specific subgroups of patients. Results show that (a) the first half of the program was crucial for symptom changes; (b) although completers and non-completers presented similar initial improvement, their trajectories rapidly differentiated; and (c) poorer respondents initially reported more symptoms, showed a slower improvement, and never reached the non-clinical zone, whereas better-respondents reached the non-clinical cut-off point more rapidly.

Associations between eating patterns, dietary intakes and eating behaviors in premenopausal overweight women.

The regulation of energy intake is complex and many biological, psychosocial and environmental influences have been identified. To our knowledge, no study has yet investigated how eating patterns could mediate associations between eating behaviors and self-reported energy intake in premenopausal overweight women. Therefore, objectives of this study were to examine associations between eating behaviors and eating patterns in premenopausal overweight women and to test if eating patterns could mediate the associations between eating behaviors and self-reported energy intake. Women completed a 3-day food record and the Three-Factor Eating Questionnaire was used to assess eating behaviors (dietary restraint, disinhibition, hunger). In the total sample of women, flexible restraint was negatively (r=-0.18; p=0.03) and binge eating severity was positively (r=0.24; p=0.004) associated with self-reported energy intake. Moreover, flexible restraint was positively associated with the proportion of energy intake at breakfast (r=0.24; p=0.004), whereas disinhibition and binge eating severity were positively associated with the proportion of energy intake from snacks consumed after 5:00 pm (r=0.22, p=0.007 and r=0.22, p=0.01, respectively). In addition, mediational analyses showed that proportion of energy intake from snacks consumed after 5:00 pm explained 24.1% of the association between binge eating severity and self-reported energy intake. In conclusion, these results suggest that eating patterns are important factors to consider in order to explain the associations between eating behaviors and self-reported energy intake.

Subtyping weight-preoccupied overweight/obese women along restraint and negative affect.

Previous clustering analysis performed among samples of bulimic or binge eating women have consistently yielded two subtypes (Dietary and Dietary-Depressive). The present study verifies whether this clustering solution could be replicated among weight-preoccupied overweight/obese women and compares the different clusters on personality-, eating- and weight-related variables. Cluster analysis was performed along dietary restraint and negative affect among a sample of 156 overweight/obese weight-preoccupied women. Results failed to replicate the original two-cluster solution, rather evidencing a three-cluster solution (Dietary, Depressive, Low-Dietary/Low-Depressive). Also, dietary restraint did not appear to be a core feature for all weight-preoccupied overweight/obese women as it is for eating-disordered women since only one group presented dietary restraint. The presence of a pure Depressive group and a pure Dietary group showed that dietary restraint and negative affect may act independently among our sample. In term of clinical severity, the Dietary group, even in the absence of high negative affect, occupied an intermediate position between the Low-Dietary/Low-Depressive and the Depressive group, the most impaired one, in accordance with previous studies. It thus suggests that other factors beside negative affect can contribute to eating and psychological impairment among overweight/obese women.

Psychological Impact of a "Health-at-Every-Size" Intervention on Weight-Preoccupied Overweight/Obese Women.

The aim of the present study was to assess the impact of a "Health-at-every-size" (HAES) intervention on psychological variables and body weight the weight-preoccupied overweight/obese women. Those women were randomized into three groups (1) HAES, (2) social support (SS), (3) waiting-list (WL), and were tested at baseline, post-treatment and six-month and one-year follow-ups. All participants presented significant psychological improvement no matter if they received the HAES intervention or not. However, even if during the intervention, the three groups showed improvements, during the follow up, the HAES group continued to improve while the other groups did not, even sometimes experiencing some deterioration. Furthermore, in the HAES group only, participant's weight maintenance 12 months after the intervention was related to their psychological improvement (quality of life, body dissatisfaction, and binge eating) during the intervention. Thus, even if, in the short-term, our study did not show distinctive effects of the HAES intervention compared to SS and WL on all variables, in the long-term, HAES group seemed to present a different trajectory as psychological variables and body weight are maintained or continue to improve, which was not the case in other groups. These differential long-term effects still need to be documented and further empirically demonstrated.

Can we apply the dual-pathway model of overeating to a population of weight-preoccupied overweight women?

OBJECTIVE: The aim of the study is to verify the applicability of the dual-pathway model among weight-preoccupied overweight women and to document the restraint pathway, the negative affect pathway, and the possibility of a direct pathway from body dissatisfaction to overeating. METHOD: Structural equations were performed to test the model on baseline data of 153 weight-preoccupied overweight women recruited to participate in a randomized trial. RESULTS: Findings suggest that the model obtains satisfactory fit. Although the restraint pathway is partially supported, the negative affect pathway is confirmed. A third pathway linking directly body dissatisfaction to overeating is also evidenced. DISCUSSION: The dual-pathway model of overeating seems to be representative of the reality of weight-preoccupied overweight women, which could be pointed as a population in need of clinical attention, particularly considering the dramatically increasing rates of obesity.

Personality traits in overweight and obese women: associations with BMI and eating behaviors.

This study aimed at assessing the extent to which personality traits are related to BMI and eating behaviors in overweight and obese women (N=154; mean body mass index (BMI) of 30.5+/-3.0 kg/m(2)). The NEO Five-Factor Inventory was used to capture the five dimensions of personality (neuroticism, extraversion, openness to experience, agreeableness and conscientiousness). Anthropometric measurements (weight, height and BMI) were performed and eating behaviors (cognitive dietary restraint, disinhibition and susceptibility to hunger) were measured by the Three-Factor Eating Questionnaire. Regressional analyses showed that only conscientiousness was positively related to BMI. A higher level of neuroticism was identified as a significant predictor of higher scores for cognitive dietary restraint, disinhibition and susceptibility to hunger. Conscientiousness was also found to be a positive determinant of cognitive dietary restraint and a higher level of agreeableness predicted a lower score of susceptibility to hunger. Results also underline the presence of other psychological factors, i.e. dysphoria and body esteem, involved in the associations between personality traits and some eating behaviours. These findings suggest that particular dimensions of personality may contribute, either directly or through their association with other psychological factors, to a better understanding of weight and eating behaviors in overweight and obese women.