Maladaptive Food Attitudes and Behaviors in Individuals with Celiac Disease and Their Association with Quality of Life.

BACKGROUND: The only treatment for celiac disease (CeD) is strict lifelong adherence to a gluten-free diet (GFD). In some individuals the demands of a GFD may contribute to maladaptive eating attitudes and behaviors that impair quality of life (QOL). The Celiac Disease Food Attitudes and Behaviors (CD-FAB) is an easily administered and scored 11-item tool querying potentially maladaptive food attitudes and behaviors resulting from beliefs around gluten exposures and food safety. OBJECTIVES: To assess the usefulness of the CD-FAB in establishing the presence of maladaptive food attitudes and behaviors among adults with CeD and to explore the relationship between these attitudes and behaviors and other factors including QOL, anxiety, depression, CeD symptoms and personality traits. METHODS: The study is a cross-sectional pilot of 50 adults (mean age 29.6 years) with biopsy-proven CeD who followed a GFD for at least one year and had no self-reported eating disorder diagnosis. High scores on the CD-FAB tool suggest higher disordered eating attitudes and beliefs. RESULTS: Compared to lower scores (mean 20.2), higher (worse) CD-FAB scores (mean 54.5) were positively associated with recency of diagnosis, number of CeD-related gastrointestinal symptoms, and the personality trait of neuroticism. Higher CD-FAB scores were statistically and clinically significantly associated with diminished QOL (p < 0.001). The relationship with anxiety and depression was less clear but trended in the expected direction. CONCLUSION: The CD-FAB may be a useful tool for dietitians who wish to monitor maladaptive food attitudes and behaviors among their CeD patients, especially in the first-year post-diagnosis.

Restrictive eating across a spectrum from healthy to unhealthy: behavioral and neural mechanisms.

BACKGROUND: Restriction of food intake is a central feature of anorexia nervosa (AN) and other eating disorders, yet also occurs in the absence of psychopathology. The neural mechanisms of restrictive eating in health and disease are unclear. METHODS: This study examined behavioral and neural mechanisms associated with restrictive eating among individuals with and without eating disorders. Dietary restriction was examined in four groups of women (n = 110): healthy controls, dieting healthy controls, patients with subthreshold (non-low weight) AN, and patients with AN. A Food Choice Task was administered during fMRI scanning to examine neural activation associated with food choices, and a laboratory meal was conducted. RESULTS: Behavioral findings distinguished between healthy and ill participants. Healthy individuals, both dieting and non-dieting, chose significantly more high-fat foods than patients with AN or subthreshold AN. Among healthy individuals, choice was primarily influenced by tastiness, whereas, among both patient groups, healthiness played a larger role. Dorsal striatal activation associated with choice was most pronounced among individuals with AN and was significantly associated with selecting fewer high-fat choices in the task and lower caloric intake in the meal the following day. CONCLUSIONS: A continuous spectrum of behavior was suggested by the increasing amount of weight loss across groups. Yet, data from this Food Choice Task with fMRI suggest there is a behavioral distinction between illness and health, and that the neural mechanisms underlying food choice in AN are distinct. These behavioral and neural mechanisms of restrictive eating may be useful targets for treatment development.

Eating behavior in atypical anorexia nervosa.

OBJECTIVE: Atypical anorexia nervosa (AN) has been increasingly identified in the community and in clinical settings. Initial studies indicate that psychological symptoms are similar or more severe among patients with atypical AN, as compared with AN. This study examined whether eating behavior differed among patients with AN (n = 98), patients with atypical AN (n = 18), and healthy controls (HC, n = 75). METHOD: Adults and adolescents chose what to eat from a standardized, laboratory-based multi-item meal. Total intake, macronutrient composition, diet variety, and energy density were compared between groups. RESULTS: Both AN and atypical AN severely restricted caloric intake as compared with HC (431 ± 396 kcal and 340 ± 338 kcal vs. 879 ± 350 kcal, F2,188  = 35.4, p < .001). Individuals with AN and atypical AN did not differ in the mean intake of total calories or percentage of calories from fat (15.2 ± 25.2% vs. 11.5 ± 16.9%). DISCUSSION: This study demonstrates that individuals with atypical AN are at least as restrictive in their food intake as individuals with AN, and the restriction of dietary fat is particularly notable. Examination of eating behavior in a larger sample would be useful to replicate these findings. The current study highlights the need to understand maladaptive eating behavior in atypical AN in order to develop appropriate treatment recommendations. PUBLIC SIGNIFICANCE: Atypical anorexia nervosa is emerging as a prevalent eating disorder in community and clinical populations. The findings that patients with atypical anorexia nervosa limit calorie and fat intake in a pattern similar to that of patients with anorexia nervosa highlights the need for research to identify appropriate treatment strategies for normalization of eating patterns.

Associations between mealtime anxiety and food intake in anorexia nervosa.

OBJECTIVE: A salient disturbance in anorexia nervosa (AN) is the persistent restriction of food intake. Eating behavior in AN is thought to be influenced by anxiety. The current study probed associations between mealtime anxiety and food intake among individuals with AN and healthy comparison individuals (HC). METHOD: Data were combined across three studies (total of 92 AN and 78 HC) for secondary data analysis. Participants completed a multiitem laboratory buffet meal and visual analogue scale assessments of pre-meal and post-meal anxiety. Linear regression models assessed the association between mealtime anxiety and calorie and fat intake at the meal, and whether associations differed by diagnostic group. RESULTS: Among individuals with AN, pre-meal anxiety was significantly associated with reduced calorie intake and reduced consumption of calories from fat at the meal; these associations were not observed among HC. There was no evidence for an association between calorie/fat intake at the meal and post-meal anxiety in either group. DISCUSSION: Treatments that target mealtime anxiety may improve eating and nourishment among individuals with AN. Interventions like exposure therapy that provide skills in overcoming mealtime anxiety might be enhanced by informing patients that post-meal anxiety is not related to intake.

The association between leptin and weight maintenance outcome in anorexia nervosa.

OBJECTIVE: Relapse after weight restoration in anorexia nervosa (AN) is a critical problem. Higher body fat percentage after weight gain has been shown to predict better weight maintenance outcome. Leptin, a fat-derived hormone, has been associated with progress during weight gain, but its association with weight maintenance is unknown. This study aims to determine whether leptin levels after weight restoration in AN are associated with weight maintenance. METHOD: Participants were 41 women with AN hospitalized for inpatient treatment. Participants were evaluated 2-4 weeks after weight restoration to body mass index (BMI) ≥ 19.5 kg/m2 for plasma leptin and body composition. Weight maintenance outcome was defined by whether a participant maintained a BMI of at least 18.5 kg/m2 at the end of 1 year following hospital discharge. RESULTS: Twenty (48.8%) out of 41 patients maintained their weight at 1 year. Percent body fat and leptin were significantly higher in the group who maintained weight (body fat, p = .004, Hedges' g = 0.944; log-leptin, p = .010, Hedges' g = 0.821), but there were no differences in predischarge BMI, duration of illness, and duration of amenorrhea. Using regression modeling, only higher log-leptin (pWald = .021) and percent body fat (pWald = .010), as well as fat-adjusted leptin (pWald = .029), independently predicted weight maintenance at 1 year. DISCUSSIONS: Our findings suggest that for acutely-weight restored women with AN, higher predischarge leptin measurements are associated with better outcome in the year following treatment. Prospective studies examining leptin as well as other parameters of metabolic health could offer insights into biomarkers that may improve clinical outcomes.

Habits are stronger with longer duration of illness and greater severity in anorexia nervosa.

OBJECTIVE: The aim of this study was to examine the relationship between habit strength and clinical features of anorexia nervosa (AN). Habit strength, separate from intention, relates to the persistence of behavior, and is measured by the Self-Report Habit Index (SRHI). We hypothesized that habit strength would be greater among individuals with AN than healthy controls (HC) and that habit strength would be associated with duration and severity of illness. METHOD: Participants were 116 women with AN (n = 69) and HC (n = 47) who completed the SRHI, the Eating Disorder Examination-Questionnaire (EDE-Q), and a multi-item laboratory meal. The SRHI assessed four domains and these subscales were averaged for the total score. RESULTS: Individuals with AN demonstrated significantly greater habit strength than HC in the total score (t114 = 7.00, p < .01), and within each domain (restrictive eating, compensatory behavior, delay of eating, and rituals). Total SRHI score was significantly associated with EDE-Q scores for both AN and HC groups (rAN = .59, pAN = <.001; rHC = .32, pHC = .030). Among patients, there was a significant association between SRHI and duration of illness (r = .38, p = .001). There was no significant association between SRHI and caloric intake (rAN = -.20, pAN = .10; rHC = -.25, pHC = .09). DISCUSSION: Habit strength was related to chronicity and severity of AN, suggesting that habit formation may play an important role in illness. These data suggest avenues for mechanism research and treatment development.

Relationship between three factor eating questionnaire-restraint subscale and food intake.

OBJECTIVE: Dietary restraint refers to an individual's intention to restrict food intake, measured via self-report questionnaires, whereas dietary restriction refers to actual reduction in caloric intake. The aim of this research was to investigate the association between dietary restraint scales and actual caloric restriction. METHOD: Data were collected from six previously published or two ongoing eating behavior studies in which participants (n = 183) completed the Three Factor Eating Questionnaire (TFEQ) and Eating Disorders Examination Questionnaire (EDE-Q) and participated in a laboratory-based research lunch meal. Participants were individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC). The primary analysis was the association between TFEQ Restraint subscale and caloric intake in the meal. RESULTS: There was a significant negative correlation between total caloric intake and TFEQ Restraint scores (r = -.60, p < .001) and EDE-Q Restraint scores (r = -.54, p < .001). For TFEQ Restraint score, this relationship was significant within each diagnostic group (HC: r = -.32, p = .007; AN: r = -.38, p < .001; BN: r = -.43, p = .02). DISCUSSION: These results suggest that the TFEQ Restraint scale is a useful measure of dietary restriction, especially among individuals with eating disorders.

Fat preference and fat intake in individuals with and without anorexia nervosa.

Fat restriction is a characteristic eating behavior among individuals with anorexia nervosa (AN), and laboratory meal studies demonstrate restricted fat intake among low-weight patients. The Geiselman Food Preference Questionnaire-I© (FPQ) is a validated self-report measure that yields a fat preference score (FPS). Prior research reported that patients with AN had a significantly lower FPS than did healthy control (HC) participants. The goal of the current study was to compare self-reported fat preference (FPS) to fat intake (multi-item meal (MIM) study) in low-weight ANs and HCs. Specific aims were 1) to determine if the FPS differed between ANs and HCs; 2) to determine if fat and energy intakes differed between ANs and HCs; and 3) to determine if the FPS was associated with fat and energy intakes in ANs and HCs. Forty-four female AN inpatients and 48 female HCs completed the FPQ and participated in a MIM study. Compared to HCs, ANs consumed less energy (469.1 ±â€¯397.7 vs. 856.4 ±â€¯346.8 kcal, p < 0.001), less fat (16.4 ±â€¯20.4 vs. 36.7 ±â€¯18.9 g, p < 0.001), and a smaller percentage of calories from fat (22.9 ±â€¯13.8 vs. 36.6 ±â€¯8.0%, p < 0.001) at the MIM. Compared to HCs, ANs also had a lower FPS (79.7 ±â€¯27.4 vs. 102.3 ±â€¯18.9, p < 0.001). The FPS was significantly and positively correlated with caloric intake (r = 0.481, p < 0.01), total fat (r = 0.453, p < 0.01), and the percentage of calories from fat (r = 0.37, p < 0.05) in ANs as well as in HCs (kcal: r = 0.583, p < 0.001; fat: r = 0.621, p < 0.001; % fat kcal: r = 0.601, p < 0.001). The FPS is related to objective measures of energy and fat intake in patients with AN as well as in healthy individuals.

Rigor and reproducibility via laboratory studies of eating behavior: A focused update and conceptual review.

OBJECTIVE: The eating behavior of individuals with eating disorders has been examined in laboratory settings over the last 30 years. In this focused review, we build on prior research and highlight several feeding laboratory paradigms that have successfully demonstrated quantifiable and observable behavioral disturbances, and thereby add rigor and reproducibility to the examination of disturbances of eating behavior. This review describes the measures commonly obtained via these laboratory techniques. Supporting Information Appendices with detailed information about implementation are provided to allow for the reproducible execution of these techniques across labs. METHODS/RESULTS: Literature documenting the existence of objective abnormalities in eating behavior among individuals with eating disorders or in comparison to healthy controls (n > 40) is briefly summarized. These protocols, conducted across at least 17 independent labs, are sensitive and reproducible, can be used to assess subjective and physiological parameters associated with eating, and elucidate the impact of treatment. Laboratory studies from patients with eating disorders compared with healthy controls reproducibly demonstrate both that patients with Anorexia Nervosa ingest fewer calories and that individuals with Bulimia Nervosa and Binge-Eating Disorder ingest more calories when asked to binge-eat. DISCUSSION: Feeding laboratory studies have the potential for quantifying the characteristic behavioral psychopathology of patients with eating disorders, and may provide a useful tool to explore the potential utility of new treatments for individuals with Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder.

The effect of acute weight restoration on dietary fat preference in hospitalized patients with anorexia nervosa.

OBJECTIVE: Individuals with anorexia nervosa (AN) restrict fat intake. The Geiselman Food Preference Questionnaire-I© (FPQ) is a validated self-report instrument that yields a fat preference score (>100 = high fat preference, <100 = low fat preference). The goal of the study was to assess the utility of the FPQ in patients with AN. SPECIFIC AIMS: (1) to examine change in fat preference scores before and after weight restoration in hospitalized patients; and (2) to compare patients' scores before and after weight restoration to scores from healthy participants (HPs). METHOD: The FPQ was completed by 88 patients and 115 HPs. RESULTS: Compared with HPs, patients had significantly lower fat preference scores before (74.03 ± 32.03 vs. 102.93 ± 16.89, P < 0.001) and after (81.51 ± 26.89 vs. 102.92 ± 16.89, P < 0.001) weight restoration. Fat preference scores increased with weight gain (74.03 + 32.03 vs. 81.51 + 26.89, P < 0.01) but did not normalize in AN. DISCUSSION: Acutely weight restored patients continue to endorse decreased preference for high fat foods. The FPQ may be a useful metric by which to assess improvements in diet during treatment. Further study is warranted to validate the FPQ against observed food intake in AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:148-151).

Impulsivity and test meal intake among women with bulimia nervosa.

Many patients with bulimia nervosa (BN) also meet criteria for a lifetime alcohol use disorder (AUD). In order to understand possible mechanisms contributing to the co-occurrence and perpetuation of these disorders, this study investigated the importance of impulsivity and test meal intake among patients with BN by comparing women with BN only (n = 18), BN and current/past AUDs (n = 13), and healthy controls (n = 12). All participants completed assessments of eating disorder symptoms, frequency of alcohol use, binge eating, and purging via questionnaires and semi-structured interviews over two sessions. Measures of impulsivity consisted of computerized and self-report measures, and laboratory test meals. Significant differences between individuals with BN with/without comorbid AUDs were not found for test meal intake, impulsivity measures, or self-reported psychological symptoms. As hypothesized, compared to healthy controls, individuals with BN had significantly higher scores on two subscales and the total score of the Barratt Impulsiveness Scale, a trait measure of impulsivity, and consumed significantly more calories in the binge instruction meal. Total Barratt Impulsiveness Scale scores were also significantly related to kcal consumed during the laboratory test meal when individuals were instructed to binge eat (BN groups). Data from this study add to the existing literature implicating impulsivity in the psychopathology of disorders of binge eating, including BN, and also support the use of laboratory meals as a symptom-specific measure of this trait in eating disorder populations.

Assessment of the motivation to use artificial sweetener among individuals with an eating disorder.

Eating disorders are associated with a range of abnormalities in eating behavior. Some individuals consume large amounts of non-caloric artificial sweeteners, suggesting abnormalities in appetitive responding. The current study aimed to quantify hedonic and motivating effects of artificial sweetener in individuals with and without an eating disorder. Two laboratory studies were conducted. Hedonic preference was estimated using the number of artificial sweetener packets (0-10) added to unsweetened cherry flavored Kool-Aid (study 1). Motivation to obtain sweetener was assessed by a progressive ratio (PR) work task (study 2). Ninety-three participants (25 anorexia nervosa restricting type (AN-R), 23 AN binge/purge type (AN-B/P), 20 bulimia nervosa (BN), and 25 normal controls (NC)) completed the study. No significant difference in hedonic preference was found among participant groups. Work completed at the PR task ranged from 0 to 9500 key-board presses. The AN-B/P group had a significantly higher breakpoint and performed significantly more work for sweetener compared to the BN and NC groups. Among AN-B/P and AN-R participants, the preferred number of Equal packets was significantly correlated with the breakpoint and total work. The increased amount of work for sweetener among individuals with AN-B/P supports an enhanced reward value of sweet taste in this population, and suggests that the characteristic food avoidance in AN cannot be accounted for by decreased reward value of all taste-related stimuli. This study also supports the novel application of a PR ratio task to quantify the motivating effect of sweet taste among individuals with an eating disorder.

Assessment of fat taste in individuals with and without anorexia nervosa.

OBJECTIVE: Avoidance of dietary fat is a highly characteristic eating behavior of individuals with anorexia nervosa (AN). To date, no study has determined whether these individuals are better able to perceive the fat content of foods than individuals without AN. The goal of this study was to compare blinded taste ratings of fat-free, low fat, and regular cream cheese in patients with AN and in normal controls (NC). METHOD: AN (n = 25) and control (NC; n = 25) participants were presented with a series of nine cream cheese samples of three differing fat contents and asked to taste and rate each sample from very low to very high fat. RESULTS: Repeated measures ANOVA found no significant main effect of fat content and no interaction between fat content and diagnosis; however, a significant three-way interaction between fat content, diagnosis, and trial was observed. Post hoc analysis revealed a significant fat content by trial interaction within the AN group, suggesting a significant trial effect for the fat-free samples only with improving ability to detect fat-free samples over repeated trials. DISCUSSION: The current study suggests that individuals with AN do not have a markedly greater ability to taste fat than NC, and that; therefore, fat avoidance is likely primarily based on cognitive factors.

Can the reinforcing value of food be measured in bulimia nervosa?

Binge eating is a core clinical feature of bulimia nervosa (BN). Enhanced reinforcing value of food may play a role in this behavioral disturbance, but a systematic behavioral assessment of objective measures of the rewarding value of binge eating is lacking. The purpose of this study was to quantify the reinforcing value of food in BN patients as compared with normal controls. A progressive ratio (PR) computerized work task was completed under binge and non-binge instruction. The task consisted of 12 trials. The first trial required 50 keyboard taps to earn one portion of yogurt shake, and subsequent trials required progressive work increments of 200 taps for each additional portion. Completion of all 12 trials required 13,800 taps to earn 2100ml of shake. The breakpoint, defined as the largest ratio completed before a participant stopped working, was the measure of reinforcing efficacy. Ten patients and 10 controls completed the experiment. Under binge instruction, patients completed more trials and taps, and had a higher breakpoint than controls. The non-binge instruction yielded opposite findings; compared to controls, patients completed fewer trials and taps, and had a lower breakpoint. These results support the feasibility and potential utility of a PR task to quantify the reinforcing value of food in patients with BN.

Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series.

OBJECTIVE: Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating-related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and obsessive compulsive disorder, namely exposure therapy and response prevention. METHOD: We developed a brief treatment intervention for AN (AN-EXRP) and evaluated its effects in an open series of nine individuals with AN towards the end of acute weight restoration. We focused on eating behavior as the primary outcome, as it is related both to anxiety and to longer term course. RESULTS: Change in anxiety with AN-EXRP was associated with greater caloric intake. DISCUSSION: These findings support the anxiety-centered model of AN and suggest the potential utility of further developing this treatment approach.

Dietary energy density and diet variety as risk factors for relapse in anorexia nervosa: a replication.

OBJECTIVE: To replicate our previous findings of an association between energy density and diet variety in recently weight-restored patients with anorexia nervosa (AN) and clinical outcome in the year following treatment. METHOD: Nineteen hospitalized, weight-restored women with AN completed a food record, from which a diet energy density score (DEDS) and a diet variety score (DVS) were calculated. After hospital discharge, patients were contacted regularly; at the end of one year, clinical outcome was determined using modified Morgan-Russell criteria. As in our previous study, outcome was dichotomized into "full, good, or fair" and "poor" groups. RESULTS: Data from 16 subjects were available. The DEDS was significantly lower (p < .05) in the poor outcome group (0.7 ± 1) compared with the "full, good, or fair" outcome group (0.9 ± 1). Although the DVS was also lower in the poor outcome group (13.9 ± 2) compared with the "full, good or fair" outcome group (15.7 ± 1.8), this difference was not statistically significant. DISCUSSION: In recently weight-restored patients with AN, a lower DEDS, but not DVS, is associated with poor clinical outcome after inpatient treatment. This finding may be important in the assessment of risk for relapse in patients with AN.

Eating behavior in anorexia nervosa: before and after treatment.

OBJECTIVE: The purpose of this study was to assess eating behavior in patients with anorexia nervosa before and after weight normalization and healthy controls using a standardized, multiple-item lunch meal paradigm. METHOD: Eighteen patients were studied shortly after inpatient admission and again after gaining to a BMI ≥ 19.5 kg m(-2) . Fifteen healthy controls were studied twice, ∼2-3 months apart. RESULTS: When underweight, patients with AN consumed fewer total calories (364 ± 208 kcal) and a lower percentage of calories from fat (18% ± 10%) compared to controls (775 ± 228 kcal, p = 0.001; 38% ± 7%, p = 0.001). After weight normalization, despite a modest increase in total calories (364 ± 208 kcal vs. 516 ± 273 kcal, p = 0.04) and in percent of calories from fat (18% ± 10% vs. 23% ± 9%, p = 0.04), patients continued to consume fewer total calories and a reduced percent of calories from fat compared to controls (758 ± 346 kcal, p = 0.03; 38% ± 18%, p = 0.004). DISCUSSION: Patients with AN, even after acute treatment, consume fewer total calories and fewer calories from fat, compared to healthy controls. The reduced overall intake and persistent avoidance of fat may contribute to relapse, and therefore are potential therapeutic targets.

Accuracy of self-reported energy intake in weight-restored patients with anorexia nervosa compared with obese and normal weight individuals.

OBJECTIVE: To compare self-reported and measured energy intake in weight-restored patients with anorexia nervosa (AN), weight-stable obese individuals (OB), and normal weight controls (NC). METHOD: Forty participants (18 AN, 10 OB, and 12 NC) in a laboratory meal study simultaneously completed a prospective food record. RESULTS: AN patients significantly (p = .018) over-reported energy intake (16%, 50 kcal) and Bland-Altman (B-A) analysis indicated bias toward over-reporting at increasing levels of intake. OB participants significantly (p = .016) under-reported intake (19%, 160 kcal) and B-A analysis indicated bias toward under-reporting at increasing levels of intake. In NC participants, NS (p = .752) difference between reported and measured intake was found and B-A analysis indicated good agreement between methods at all intake levels. DISCUSSION: Self-reported intake should be cautiously interpreted in AN and OB. Future studies are warranted to determine if over-reporting is related to poor outcome and relapse in AN, or under-reporting interferes with weight loss efforts in OB.

Striatal dopamine in bulimia nervosa: a PET imaging study.

OBJECTIVE: Bulimia nervosa (BN) has been characterized as similar to an addiction, though the empirical support for this characterization is limited. This study utilized PET imaging to determine whether abnormalities in brain dopamine (DA) similar to those described in substance use disorders occur in BN. METHOD: PET imaging with [(11) C]raclopride, pre/post methylphenidate administration, to assess dopamine type 2 (D(2)) receptor binding (BP(ND)) and striatal DA release (ΔBP(ND)). RESULTS: There was a trend toward lower D(2) receptor BP(ND) in two striatal subregions in the patient group when compared with the control group. DA release in the putamen in the patient group was significantly reduced and, overall, there was a trend toward a difference in striatal DA release. Striatal DA release was significantly associated with the frequency of binge eating. DISCUSSION: These data suggest that BN is characterized by abnormalities in brain DA that resemble, in some ways, those described in addictive disorders.

Behavioral assessment of the reinforcing effect of exercise in women with anorexia nervosa: further paradigm development and data.

OBJECTIVE: To use a Progressive Ratio (PR) computerized "work" paradigm to measure course and correlates of exercise motivation in in-patients with Anorexia Nervosa (AN). METHOD: Sixteen inpatients with AN participated in a PR task assessing the relative reinforcing effect of two different increments of cash versus the opportunity to exercise for upto 30 min, twice; at low weight, and, for n = 10 participants, after weight restoration. RESULTS: There was a trend toward a higher work for exercise with 2 versus 5 increments of cash as the alternative reinforcer. Exercise breakpoint did not differ between low and normal-weight states. Exercise breakpoint at each time point was correlated with prehospitalization exercise "commitment" (Commitment to Exercise Scale, r = .613, p = .012 at T1; r = .634, p = .049 at T2). DISCUSSION: Patients with AN will work at a PR task for access to even a small amount of exercise. Exercise motivation during hospitalization is correlated with prehospital exercise commitment and does not appear to change consistently with weight restoration.