Autonomic indices and loss-of-control eating in adolescents: an ecological momentary assessment study.

BACKGROUND: Loss-of-control (LOC) eating commonly develops during adolescence, and it predicts full-syndrome eating disorders and excess weight gain. Although negative emotions and emotion dysregulation are hypothesized to precede and predict LOC eating, they are rarely examined outside the self-report domain. Autonomic indices, including heart rate (HR) and heart rate variability (HRV), may provide information about stress and capacity for emotion regulation in response to stress. METHODS: We studied whether autonomic indices predict LOC eating in real-time in adolescents with LOC eating and body mass index (BMI) ⩾70th percentile. Twenty-four adolescents aged 12-18 (67% female; BMI percentile mean ± standard deviation = 92.6 ± 9.4) who reported at least twice-monthly LOC episodes wore biosensors to monitor HR, HRV, and physical activity for 1 week. They reported their degree of LOC after all eating episodes on a visual analog scale (0-100) using a smartphone. RESULTS: Adjusting for physical activity and time of day, higher HR and lower HRV predicted higher self-reported LOC after eating. Parsing between- and within-subjects effects, there was a significant, positive, within-subjects association between pre-meal HR and post-meal LOC rating. However, there was no significant within-subjects effect for HRV, nor were there between-subjects effects for either electrophysiologic variable. CONCLUSIONS: Findings suggest that autonomic indices may either be a marker of risk for subsequent LOC eating or contribute to LOC eating. Linking physiological markers with behavior in the natural environment can improve knowledge of illness mechanisms and provide new avenues for intervention.

Food Insecurity and Eating Pathology in Adolescents.

Adolescence is a critical period for the emergence of eating disorders, and food insecurity may be related to eating pathology and weight, as evidenced in adults. However, little is known about food insecurity and eating pathology during this developmental period, and associations between food insecurity and body mass index (BMI) are mixed. Therefore, we examined associations between food insecurity and BMI percentile, self-reported eating-related pathology and binge eating, and subgroup differences by race/ethnicity. In a subset, we examined the relationship between food insecurity and real-world hunger, food craving, and loss-of-control eating using ecological momentary assessment (EMA). Fifty-eight adolescents at two sites (clinical sample, n = 38, BMI percentile ≥ 70th; community sample, n = 20, all BMI strata) completed self-report questionnaires. Adolescents were 15.2 ± 2.1 years old, 62% female, 50% Black, 34.5% Hispanic, with BMI percentile = 80.5 ± 25.8 (range 4-99). In the full sample, food insecurity was associated with greater BMI (p < 0.01), higher shape/weight overvaluation (p = 0.04), and greater number of binge eating episodes among those reporting at least one binge episode (p < 0.01), with significant relationships for BMI percentile, shape/weight overvaluation, body dissatisfaction, and binge episode frequency among Hispanic adolescents only (each p < 0.01). As in adults, food insecurity may be a risk factor for eating pathology, particularly for Hispanic teens.