Evaluating whether a peer-led dissonance-based eating disorder prevention program prevents onset of each eating disorder type.

BACKGROUND: This study tested whether the dissonance-based Body Project eating disorder prevention program reduced onset of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) over long-term follow-up. METHODS: Data were combined from three prevention trials that targeted young women at high-risk for eating disorders (N = 1092; M age = 19.3). Participants were randomized to Body Project groups led by peer educators or expressive writing/educational controls and completed masked diagnostic interviews over 2- to 4-year follow-ups. Logistic regressions tested whether onset of each eating disorder over follow-up differed between Body Project and control participants. RESULTS: Peer-led Body Project groups produced a 46% reduction in onset of subthreshold/threshold BN and a 62% reduction in onset of PD relative to controls over follow-up. Rates of onset of subthreshold/threshold AN and BED did not significantly differ between peer-led Body Project participants and control participants. CONCLUSIONS: Results support the dissemination of the peer-led Body Project for reducing future onset of BN and PD. This study and recent research suggest that thin-ideal internalization, the risk factor for eating disorders targeted in the Body Project, may be more relevant for predicting onset of BN and PD compared to AN and BED. Findings support the development of a version of the Body Project aimed to reduce risk factors that have predicted future onset of all four types of eating disorders (e.g. overvaluation of weight/shape, fear of weight gain), which may more effectively prevent all eating disorder types.

Targeting dietary restraint to reduce binge eating: a randomised controlled trial of a blended internet- and smartphone app-based intervention.

BACKGROUND: Existing internet-based prevention and treatment programmes for binge eating are composed of multiple distinct modules that are designed to target a broad range of risk or maintaining factors. Such multi-modular programmes (1) may be unnecessarily long for those who do not require a full course of intervention and (2) make it difficult to distinguish those techniques that are effective from those that are redundant. Since dietary restraint is a well-replicated risk and maintaining factor for binge eating, we developed an internet- and app-based intervention composed solely of cognitive-behavioural techniques designed to modify dietary restraint as a mechanism to target binge eating. We tested the efficacy of this combined selective and indicated prevention programme in 403 participants, most of whom were highly symptomatic (90% reported binge eating once per week). METHOD: Participants were randomly assigned to the internet intervention (n = 201) or an informational control group (n = 202). The primary outcome was objective binge-eating frequency. Secondary outcomes were indices of dietary restraint, shape, weight, and eating concerns, subjective binge eating, disinhibition, and psychological distress. Analyses were intention-to-treat. RESULTS: Intervention participants reported greater reductions in objective binge-eating episodes compared to the control group at post-test (small effect size). Significant effects were also observed on each of the secondary outcomes (small to large effect sizes). Improvements were sustained at 8 week follow-up. CONCLUSIONS: Highly focused digital interventions that target one central risk/maintaining factor may be sufficient to induce meaningful change in core eating disorder symptoms.

Updates in the treatment of Eating Disorders in 2022: a year in review in Eating Disorders: The Journal of Treatment & Prevention.

A broad array of important and diverse studies surrounding the treatment of eating disorders were published in Eating Disorders: The Journal of Treatment & Prevention in 2022. Novel interventions such as neurosurgical and neuromodulatory treatments were discussed, as evidence continues to mount around their potential utility in treating eating disorders, in particular namely anorexia nervosa. Important pragmatic and theoretical developments around feeding and refeeding approaches emerged, and are also discussed. In this review, we carefully review evidence alluding to the potential efficacy of exercise in partially ameliorating binge eating disorder symptomatology, while examining broader evidence underscoring the importance of therapeutically ameliorating compulsive exercise in anorexia nervosa and bulimia nervosa. In addition, we overview evidence relating to the risk and sequelae associated with premature discharge from intensive eating disorder treatment, as well as the efficacy of CBT versus group therapy-based maintenance treatments. Finally, important developments around the use of open versus blind weighing in treatment are assessed. Overall, the articles published in Eating Disorders: The Journal of Treatment & Prevention in 2022 evidence the promise of treatment advances in the field and requires further work to address the development of efficacious treatments to achieve greater outcomes for those with eating disorders.

Protective and therapeutic benefits of environmental enrichment on binge-like sucrose intake in C57BL/6J mice.

Binge eating disorder (BED) is characterized, in part, by recurrent episodes of eating large quantities of food in a short period of time. Repetitive binge episodes are a common pattern of consumption during the early stages of substance abuse, and it has been proposed that binge patterns of consumption might favor the transition to BED and "food addiction". Therefore, it is of paramount importance to provide new behavioral strategies that protect vulnerable binge-prone individuals from transitioning to BED and food addiction. Recently, we showed protective and therapeutic benefits of environmental enrichment (EE) on binge-like intake of ethanol in C57BL/6J mice, in agreement with previous evidence showing EE modulation of drug intake, drug relapse and drug reward. In the present study, adolescent mice reared under EE conditions were evaluated for binge-like consumption of sucrose during adulthood in a long-term drinking in the dark (DID) procedure that effectively models binge consumption in humans. Additionally, we tested binge-like intake in adults reared under standard conditions (SE) with long-term exposure to sucrose DID and the effects on sucrose DID of switching from SE to EE conditions. We report here, for the first time, that early EE exposure protects mice from binge-like excessive sucrose intake during adulthood. Ongoing binge-like high sucrose intake in SE-reared mice was also significantly reduced when switched to EE conditions. The present observations suggest that EE exposure might be a promising tool for preventing repetitive binge-like sucrose consumption from transitioning to BED and food addiction.

Childhood risk factors for lifetime bulimic or compulsive eating by age 30 years in a British national birth cohort.

OBJECTIVE: To examine whether previously identified childhood risk factors for bulimia or compulsive eating (BCE) predict self-reported lifetime BCE by age 30 years in a prospective birth cohort. METHOD: Using data from the 1970 British Cohort Study at birth, 5, and 10 years, associations between 22 putative childhood risk factors and self-reported lifetime BCE at 30 years were examined, adjusting for sex and socioeconomic status. RESULTS: Only female sex (odds ratio (OR): 9.2; 95% confidence interval (CI): 1.9-43.7; p = 0.005), low self-esteem (OR:2.9; 95%CI: 1.1-7.5; p = 0.03) and high maternal education (OR:5.4; 95%CI: 2.0-14.8; p = 0.001) were significantly associated with higher risk of BCE, whereas high SES at 10 years was significantly protective (OR:0.2; 95%CI: 0.1-0.8; p = 0.022) of BCE in fully adjusted multivariable logistic regression analysis. DISCUSSION: Our findings do not support a strong role for childhood weight status and eating behaviours in the development of bulimia and compulsive eating pathology, rather suggesting a focus on self esteem may have greater relative importance. Findings in relation to maternal education and SES need further exploration.

The relative stigmatization of eating disorders and obesity in males and females.

OBJECTIVE: Anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and obesity are stigmatized conditions known to affect both men and women. However, little research has examined differences in stigmatization of individuals with these diagnoses or the impact of gender on stigmatization. Such perceptions may play an important role in understanding and reducing the stigma associated with weight and dysfunctional eating behaviors. This study investigated stigmatizing attitudes toward eating disorders and obesity in men and women. METHOD: Participants were university undergraduates (N = 318; 73.6% female; mean age = 21.58 years, SD=3.97) who were randomly assigned to read one vignette describing a male or female target diagnosed with AN, BN, BED, or obesity. Participants then completed measures of stigma and perceived psychopathology. Measures were analyzed using a 4 (target diagnosis) x 2 (target gender) MANOVA and subsequent ANOVAs. RESULTS: Measures of stigma and perceived psychopathology revealed significant main effects for diagnosis (p < .001), but not for target gender. There were no interactions between target diagnosis and gender. Although all diagnostic conditions were stigmatized, more biased attitudes and perceptions of impairment were associated with targets with AN and BN compared to targets with BED and obesity. Additionally, individuals with AN, BN, and BED were perceived as having significantly more psychological problems and impairment than individuals with obesity. CONCLUSION: Although individuals with eating disorders and obesity both face stigmatizing attitudes, bias against individuals with AN, BN, and BED may exceed stigma toward obesity in the absence of binge eating. Future research is necessary to address stigmatizing beliefs to reduce and prevent discrimination against both men and women with eating disorders and obesity.

[Not without my family! The importance of the entourage in primary care medicine with youth]. / Pas sans ma famille! L'importance de l'entourage en médecine de premier recours avec des jeunes.

At the doctor's office primary care, symptomatology of young is often vague or nonspecific. Faced with such symptoms, via the analysis of a clinical case, significant in many clinical situations, we show the importance of considering the significant members of the entourage and invite them to the surgery. A therapeutic alliance better weaves between the youth and his doctor if the environment is taken into account and will lead to better therapeutic response.

Binge eating in bariatric surgery candidates: The role of insecure attachment and emotion regulation.

Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates.

Acute responses to opioidergic blockade as a biomarker of hedonic eating among obese women enrolled in a mindfulness-based weight loss intervention trial.

There are currently no commonly used or easily accessible 'biomarkers' of hedonic eating. Physiologic responses to acute opioidergic blockade, indexed by cortisol changes and nausea, may represent indirect functional measures of opioid-mediated hedonic eating drive and predict weight loss following a mindfulness-based intervention for stress eating. In the current study, we tested whether cortisol and nausea responses induced by oral ingestion of an opioidergic antagonist (naltrexone) correlated with weight and self-report measures of hedonic eating and predicted changes in these measures following a mindfulness-based weight loss intervention. Obese women (N = 88; age = 46.7 ± 13.2 years; BMI = 35.8 ± 3.8) elected to complete an optional sub-study prior to a 5.5-month weight loss intervention with or without mindfulness training. On two separate days, participants ingested naltrexone and placebo pills, collected saliva samples, and reported nausea levels. Supporting previous findings, naltrexone-induced cortisol increases were associated with greater hedonic eating (greater food addiction symptoms and reward-driven eating) and less mindful eating. Among participants with larger cortisol increases (+1 SD above mean), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b = -0.95, SE(b) = 0.40, 95% CI [-1.74, -0.15], p = .021. Naltrexone-induced nausea was marginally associated with reward-based eating. Among participants who endorsed naltrexone-induced nausea (n = 38), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b = -1.00, 95% CI [-1.85, -0.77], p = .024, and trended toward reduced reward-based eating, binge eating, and weight, post-intervention. Single assessments of naltrexone-induced cortisol increases and nausea responses may be useful time- and cost-effective biological markers to identify obese individuals with greater opioid-mediated hedonic eating drive who may benefit from weight loss interventions with adjuvant mindfulness training that targets hedonic eating.

Opioid system in the medial prefrontal cortex mediates binge-like eating.

Binge eating disorder is an addiction-like disorder characterized by excessive food consumption within discrete periods of time. This study was aimed at understanding the role of the opioid system within the medial prefrontal cortex (mPFC) in the consummatory and motivational aspects of binge-like eating. For this purpose, we trained male rats to obtain either a sugary, highly palatable diet (Palatable rats) or a chow diet (Chow rats) for 1 hour/day. We then evaluated the effects of the opioid receptor antagonist, naltrexone, given either systemically or site-specifically into the nucleus accumbens (NAcc) or the mPFC on a fixed ratio 1 (FR1) and a progressive ratio schedule of reinforcement for food. Finally, we assessed the expression of the genes proopiomelanocortin (POMC), pro-dynorphin (PDyn) and pro-enkephalin (PEnk), coding for the opioids peptides in the NAcc and the mPFC in both groups. Palatable rats rapidly escalated their intake by four times. Naltrexone, when administered systemically and into the NAcc, reduced FR1 responding for food and motivation to eat under a progressive ratio in both Chow and Palatable rats; conversely, when administered into the mPFC, the effects were highly selective for binge eating rats. Furthermore, we found a twofold increase in POMC and a ∼50% reduction in PDyn gene expression in the mPFC of Palatable rats, when compared to control rats; however, no changes were observed in the NAcc. Our data suggest that neuroadaptations of the opioid system in the mPFC occur following intermittent access to highly palatable food, which may be responsible for the development of binge-like eating.

PROBIOTIC SUPPLEMENTATION ATTENUATES BINGE EATING AND FOOD ADDICTION 1 YEAR AFTER ROUX-EN-Y GASTRIC BYPASS: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL.

AIM: The use of probiotics as adjuvants in the treatment of eating disorders, known as psychobiotics, has already been investigated as a means of modulating the microbiota-gut-brain axis. This study aimed to assess the effect of probiotic supplementation on binge eating and food addiction in subjects after Roux-en-Y gastric bypass surgery. METHODS: This is a randomized, double-blind, placebo-controlled trial involving 101 patients who received probiotic (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) or placebo supplements for 90 days after bariatric surgery, starting on the seventh postoperative day. They were evaluated preoperatively (T0) and postoperatively at 90 days (T1) and 1 year (T2) after surgery. The Yale Food Addiction Scale (YFAS) and Binge Eating Scale (BES) were applied to assess food addiction and binge eating, respectively. RESULTS: Before surgery, one-third of the patients presented with a food addiction and binge eating diagnosis. The number of symptoms of YFAS and the BES score decreased significantly in both groups at T1 compared to T0. However, a significant effect of treatment with probiotics was observed 1 year after surgery (T2). Both the number of symptoms of food addiction and the binge eating score were lower in the probiotic group than in the placebo group (p=0.037 and p=0.030, respectively). CONCLUSION: The use of probiotic supplementation for 90 days in the immediate postoperative period may decrease food addiction symptoms and binge eating score up to 1 year after surgery compared to controls.

Cognitive deficits in obese persons with and without binge eating disorder. Investigation using a mental flexibility task.

OBJECTIVE: Studies suggest that cognitive deficits and attentional biases play a role in the development and maintenance of obesity and eating disorders. In this study, we simultaneously examine attentional biases, as well as inhibitory control and mental flexibility, which are keys to controlling unwanted behaviors and thoughts in obese patients with and without binge eating disorder. METHODS: 16 obese patients with binge eating disorder and 16 patients without binge eating disorder were compared with 16 normal-weight controls on a "food/body-mental flexibility task", which allows the investigation of inhibitory control, mental flexibility and attention for stimuli related to the body and food. RESULTS: All obese patients made significantly more errors (i.e., pressing a key when a distracter displayed) and more omissions (i.e., not pressing a key when a target displayed) than controls in both food and body sections of the task. Obese participants with binge eating disorder made significantly more errors and omissions than those without binge eating disorder. No difference between groups was found concerning mental flexibility and cognitive biases for food- and body-related targets. DISCUSSION: These results suggest that obese patients have a general inhibition problem and difficulty focusing attention, which do not depend on the types of stimuli processed. The results also suggest that these cognitive deficits are more severe in obese patients with binge eating disorder, which indicates that there is a continuum of increasing inhibition and cognitive problems with increasingly disordered eating. These cognitive deficits may contribute to problematic eating behaviors.

The Empirical Status of Cue Exposure and Response Prevention Treatment for Binge Eating: A Systematic Review.

Approximately 50% of individuals fail to obtain treatment benefits when undergoing cognitive-behavioral therapy (CBT) for binge-eating behaviors, making it necessary to evaluate additional approaches. Cue exposure and response prevention (CERP) is one such approach, although its effectiveness across studies has been inconsistent. This may be due to inconsistent implementation of theoretically based CERP strategies. This possibility has not yet been systematically investigated. To address this gap, this review investigated which CERP strategies have been incorporated into treatment protocols for binge eating, and if the use of certain strategies improves treatment effectiveness. Relevant studies were identified through reference lists, grey literature, and searches of electronic databases using multiple search terms related to CERP and binge eating, which resulted in 18 eligible studies. Most studies were underpowered, many were of low methodological quality, and none of the included studies utilized all of the strategies that have been recommended to optimize CERP. Despite these weaknesses, CERP appeared to reduce the frequency of binge eating in the short and long term. This review underscores the need for higher quality research that utilizes larger samples and uniform outcome measures that are more strongly grounded in theory. Such research would help improve treatment outcomes for binge eating.

Interpersonal psychotherapy for the prevention of binge-eating disorder and adult obesity in an African American adolescent military dependent boy.

OBJECTIVE: Military adolescent boys report similar levels of disordered-eating as their female counterparts. Yet, interventions for the prevention of full-threshold eating disorders in adolescent boys are lacking. Interpersonal psychotherapy (IPT), an evidenced-based therapy adapted for the prevention of BED and adult obesity, has been studied in adolescent girls, but it is unclear whether IPT might resonate with adolescent boys. METHOD: The current case study elucidates the use of a 12-week IPT group intervention for the prevention of BED and adult obesity in adulthood for an African American adolescent military dependent boy with reported loss-of-control (LOC)-eating, obesity, and elevated mood symptoms. RESULTS: LOC-eating and body mass index metrics decreased immediately post-intervention and further decreased by one-year follow-up. Social functioning scores improved and anxiety and depression scores decreased from baseline to one-year follow-up. In contrast to previous observations among girls, these improvements were evidenced without the teen's explicit acknowledgement of the link between mood and eating behaviors. DISCUSSION: Although the mechanism of change may manifest differently than for girls, adapted IPT may be an effective intervention strategy for adolescent boys with LOC-eating and obesity who endorse elevated mood symptoms.

A developmental framework of binge-eating disorder based on pediatric loss of control eating.

Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, suggesting that a developmental perspective of binge eating may be warranted. Thus, loss of control eating may be a marker of prodromal binge-eating disorder among certain susceptible youth. The present article offers a broad developmental framework of binge-eating disorder and proposes areas of future research to determine which youths with loss of control eating are at risk for persistent and exacerbated behavior that may develop into binge-eating disorder and adult obesity. To this end, this article provides an overview of loss of control eating in childhood and adolescence, including its characterization, etiology, and clinical significance, with a particular focus on associations with metabolic risk, weight gain, and obesity. A conceptual model is proposed to further elucidate the mechanisms that may play a role in determining which youths with loss of control are at greatest risk for binge-eating disorder and obesity. Ways in which treatments for adult binge-eating disorder may inform approaches to reduce loss of control eating and prevent excess weight gain in youth are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Dulaglutide reduces binge episodes in type 2 diabetic patients with binge eating disorder: A pilot study.

AIMS: Binge eating disorder (BED) is the most common eating disorder in the United States and Europe and is associated with obesity and type 2 diabetes (T2D). Presence and severity of BED have been associated with worse metabolic control and greater BMI in T2D patients. Glucagon Like Peptide-1 (GLP1) receptors are present in central nervous system areas involved in appetite regulation and treatment with GLP-1 receptor agonists modulates appetite and reward-related brain areas in humans. We evaluated the effects of treatment with dulaglutide on eating behavior in T2D outpatients with BED. METHODS: This was a pilot open label, prospective controlled study. Inclusion criteria were: Age ≤65, HbA1c between 7.5 and 9% on metformin therapy alone, normal renal function and diagnosis of BED. Patients were randomly assigned to receive either Dulaglutide 1,5 mg/sett or Gliclazide 60 mg for 12 weeks. We evaluated baseline binge eating scale score (BES), weight, BMI, percentage fat mass, HbA1c and their changes after treatment. A multivariate linear regression model was used to verify the association between Δ BES from baseline with Δ Hba1c and variation of anthropometric parameters after treatment. RESULTS: After 12 weeks patients treated with dulaglutide had grater reduction of binge eating behaviour (p < 0.0001), body weight (p < 0,0001), BMI (p < 0.0001), percentage fat mass (p < 0.0001) and HbA1c (p = 0.009) than patients treated with gliclazide. Reduction in BES was associated with reduction in body weight (p < 0.0001) and HbA1c (p = 0.033). CONCLUSION: Dulaglutide treatment reduces binge eating behaviour in T2D patients with BED.

Five-year longitudinal predictive factors for disordered eating in a population-based sample of overweight adolescents: implications for prevention and treatment.

OBJECTIVE: The objective of this study is to identify predictors of prevalence and incidence of disordered eating (binge eating and extreme weight control behaviors) among overweight adolescents. METHOD: Five-year longitudinal associations were examined in 412 overweight adolescents who participated in Project EAT-I and II. RESULTS: Among both overweight males and females, risk factors for disordered eating included exposure to weight loss magazine articles, higher weight importance, and unhealthy weight control behaviors, while family connectedness, body satisfaction, and regular meals were protective factors, although there were some differences in predictors of prevalence (total cases) versus incidence (new cases) of disordered eating. Among males, poor eating patterns, including fast food and sweetened beverage intake, increased risk for disordered eating, and the use of healthy weight control behaviors was protective. DISCUSSION: Attention should be directed toward decreasing disordered eating among overweight adolescents. Findings suggest the importance of promoting positive family relationships, psychological health, and regular meals, and steering adolescents away from overemphasizing weight and using unhealthy weight control behaviors.

"Overeating is not about the food": women describe their experience of a yoga treatment program for binge eating.

As part of a larger mixed-methods study, data from 20 personal journals were analyzed to examine the experience of a 12-week yoga treatment program for binge eating among a sample of 25 women who were obese. Qualitative analysis revealed a positive shift experienced by the women during the program, summarized by a general structural description: disconnection versus connection. Women's comments suggested that the program appeared to encourage a healthy reconnection to food, as well as the development of physical self-empowerment, through cultivating present-moment awareness. Specifically, women perceived an overall reduction in the quantity of food they consumed, decreased eating speed, and an improvement in food choices throughout the program. The women also reported feeling more connected to and positive about their physical well-being. These evolving outcomes were summarized through two major themes: the way their physicality changed, and the way their food consumption changed over time. Findings provide insights relevant to therapeutic processes that might occur within eating disorder interventions that draw on meditation-based approaches.

Eating Disorder Prevention.

Thirteen percent of girls and women experience an eating disorder, yet most do not receive treatment. Thus, broad implementation of eating disorder prevention programs that reduce eating disorder symptoms and future eating disorder onset is a critical priority. This article (1) reviews risk factors that have been shown to predict future onset of eating disorders, because this should guide the content of prevention programs and high-risk subgroups to target with selective prevention programs; (2) reviews the evidence base for eating disorder prevention programs that have reduced eating disorder symptoms or future onset of eating disorders; and (3) discusses directions for future research.