A randomized controlled trial of a reading-based weight bias intervention.

OBJECTIVE: Weight bias, or negative attitudes about larger bodies, is a prevalent issue associated with problems in psychological and physical health, as well as discriminatory behaviors and weight stigma. Literature is mixed regarding the efficacy of weight bias reduction efforts. This study sought to combine three elements that yielded promising results from previous studies (i.e., reductions in beliefs about controllability of weight, reductions in stereotypical beliefs, and promotion of empathy) in a reading-based intervention to reduce weight bias. METHODS: Participants (N = 319) were randomized to read a third-person fictional narrative passage about a peer with obesity (intervention) or information on overweight and obesity (control). RESULTS: Linear mixed models controlling for body mass index and gender indicated the intervention was effective in producing reductions in overall weight bias and beliefs about controllability of weight from baseline to 1-month follow-up, but significant differences were not found in the domains of bias related to character disparagement or physical unattractiveness. DISCUSSION: This combination-approach reading intervention is a promising strategy to reduce weight bias; however, future work is needed to more effectively target negative weight-related attitudes pertaining to character and attractiveness. PUBLIC SIGNIFICANCE STATEMENT: A reading-based intervention targeting controllability of weight, stereotypes, and empathy can produce reductions in overall weight bias compared with a control condition. Reductions in beliefs about controllability of weight were shown from the reading-based intervention. These findings may inform the development of programs to reduce negative attitudes about weight, which could help enhance quality of life and reduce risk for several mental health issues.

Hormonal contraceptive use and women's well-being: links with body image, eating behavior, and sleep.

The goal of the current study was to examine associations between hormonal contraceptive use and indicators of well-being including body image, eating behavior, sleep and energy level. Drawing on a health protection framework, we expected that individuals who use hormonal contraceptives would be more attuned to health and report more positive health attitudes and behaviors on these dimensions. Undergraduate college women (N = 270; M = 19.39 years, SD = 2.43, range 18-39 years) from diverse racial/ethnic and sexual orientation groups completed a survey online. Measures included hormonal contraception use, body image, weight control behavior, breakfast consumption, sleep behavior, and daytime energy level. Nearly 1/3 (30.9%) of the sample reported current hormonal contraceptive use, with most users reporting use of birth control pills (74.7%). Women who used hormonal contraceptives reported significantly higher appearance orientation and body surveillance, lower average energy, more frequent night awakenings, and more naps. Longer duration of hormonal contraceptive use was significantly related to higher body surveillance, and engaging in more unhealthy weight control behavior. Hormonal contraceptive use is not related to indicators of greater well-being. Rather, hormonal contraceptive use is related to greater attention to appearance, lower daytime energy, and some indicators of poorer sleep quality. Clinicians who prescribe hormonal contraceptives should attend to body image, sleep and energy concerns among users.

The effects of sleep on body image: examining the roles of depression, perceived stress, and anxiety.

Objective: Although health and wellness behaviors are associated with positive body image, research is limited regarding the relationship between sleep and positive body image. We propose that negative affective states may link sleep and body image. Specifically, we examined whether better sleep may relate to positive body image through reductions in negative affective experiences. Participants: Participants were 269 undergraduate women. Methods: Cross-sectional surveys were administered. Results: We found correlations in the expected directions between sleep, positive body image variables (i.e., body appreciation, appearance evaluation, and appearance orientation), and negative affective states (i.e., depression, anxiety, and stress). There were group differences in negative affective states and body image based on adequate sleep. Data supported indirect effects of sleep through depression on appearance evaluation, and through depression and stress on body appreciation, respectively. Conclusions: Our findings indicate sleep warrants further research attention as a wellness behavior related to more positive body image.

Understanding eating disorder symptoms in same-gender couples: social environmental factors.

BACKGROUND: Sexual minority individuals are at disproportionately greater risk for eating disorders, yet little is known about the ways in which factors in the social environment relate to eating disorder symptoms in this population. Utilizing an ecological systems theory framework, we investigated the relative relationships of macro level (i.e., internalization of sociocultural attitudes about appearance) and micro level (i.e., quality of romantic relationship) social environment influences. METHODS: Men (n = 144) and women (n = 144) in committed same-gender relationships were recruited as a dyad and completed study questionnaires, including multiple measures of eating disorder symptoms. Multilevel models controlling for key variables (e.g., body mass index) were used to examine gender differences, main effects, and interactions. RESULTS: Men reported greater internalization of sociocultural attitudes and uncontrolled eating. Greater internalization of sociocultural attitudes was related to greater eating pathology across all measures. For men, greater relationship quality was related to less uncontrolled eating. CONCLUSIONS: Individuals in same-gender relationships experience macro (e.g., sociocultural) level vulnerability factors in relation to disordered eating; however, internalization of sociocultural attitudes may be greater for men. Support at the microsystem level in the form of a high quality committed romantic relationship appears to be helpful protection against uncontrolled eating for men.

Sexual minority individuals are at disproportionately greater risk for eating disorders, yet little is known about the ways in which factors in the social environment relate to eating disorder symptoms in this population. This research investigates sociocultural attitudes and romantic relationship quality as factors in the social environment in relation to eating disorder symptoms for men and women in same-gender relationships. We found differences in the occurrence of eating disorder symptoms, such that sexual minority men had more uncontrolled eating compared to sexual minority women. Across all participants, internalization of sociocultural attitudes was linked to greater disordered eating symptoms. We also investigated a potential buffering role of a romantic partner on eating disorder symptoms, and found that high quality, committed, romantic relationships were beneficially associated with less uncontrolled eating for sexual minority men.

The importance of sleep and parity in understanding changes in weight and breastfeeding behavior among postpartum women.

BACKGROUND: Breastfeeding duration has been linked with the health of both women and their children, but research that considers women's weight change postpartum and practical factors that may impact their quality of life (i.e., sleep quantity, number of children) is limited. METHOD: A survey was administered to 568 women (M age = 31.32 years; SD = 4.21) who had given birth within the past year. The survey included assessments of pre- and post-pregnancy weight and height, breastfeeding practices, current sleep quantity, presence of breastfeeding-specific support, and other demographics including their total number of children. RESULTS: Greater pre-pregnancy to postpartum weight increase was related to shorter duration of breastfeeding. Mothers who exclusively breastfed for the first six months had less postpartum weight increase (i.e., the discrepancy between their pre-pregnancy and post-pregnancy weight was smaller) than those who did not. Fewer children and greater hours of sleep were significantly associated with longer duration of breastfeeding. Sleep partially accounted for the relationship between body mass index change and breastfeeding duration. Breastfeeding-specific support did not impact the effect of low sleep on shorter breastfeeding duration. CONCLUSIONS: Duration of breastfeeding may suffer due to fatigue. Sleep plays a key role in understanding the ways in which weight change impact breastfeeding behavior. Greater holistic support for mothers in the postpartum period is needed to foster an environment that encourages breastfeeding.

Breastfeeding, body image, and weight control behavior among postpartum women.

The goal of this study was to examine breastfeeding behavior and attitudes as predictors of women's body image and weight control behavior. This study extends past research by focusing on positive body image variables including body appreciation and perceived body functionality. Women (N = 597) from the United States who had recently birthed biological babies ages 0-12 months participated in an online study. Current breastfeeding rates were high (86 %), and average breastfeeding duration was approximately 3 months. Women who were currently breastfeeding indicated more positive body images and less likelihood of engaging in maladaptive weight control behaviors than women who were no longer breastfeeding or had never breastfed their baby. Women's positive attitudes toward breastfeeding were associated with awareness and appreciation of body functionality and fewer maladaptive weight control behaviors. These findings extend research on the health benefits of positive body image and suggest that breastfeeding may occur within a constellation of beliefs and behaviors indicative of positive body image.

Coping with childhood maltreatment: Avoidance and eating disorder symptoms.

Childhood maltreatment is associated with eating disorder symptoms; however, the nature of this association is unclear. We found those who experienced childhood maltreatment had higher avoidant coping and eating disorder symptoms. We also found an additive effect for maltreatment, such that with more types of maltreatment experienced, avoidant coping and eating disorder symptoms were greater. We also found evidence of an indirect effect such that childhood maltreatment was related to eating disorder symptoms through avoidant coping. Future research is needed to better understand factors that may promote development of adaptive coping patterns and prevention of eating disorder symptoms.

Feeling let down: An investigation of breastfeeding expectations, appreciation of body functionality, self-compassion, and depression symptoms.

BACKGROUND: Public health efforts to promote breastfeeding have resulted in many women expecting to exclusively breastfeed their infants. Women who plan to exclusively breastfeed but are not able to do so may experience psychological distress, including poor body image and symptoms of depression. AIM: We sought to investigate discrepancies between desired and actual breastfeeding behaviors, appreciation of the functionality of one's body, and self-compassion, in relation to symptoms of depression. METHODS: A convenience sample of women (N = 536) who had recently given birth and expected to feed their infants exclusively with breastmilk provided information on an online survey. RESULTS: There was an indirect effect of feeding discrepancies on depressive symptoms via lower appreciation of body functionality; women who expected to exclusively feed their infant breastmilk but were not able to do so had lower appreciation of body functionality. The effect of appreciation of body functionality was moderated by self-compassion such that those with the lowest self-compassion had the lowest appreciation of body functionality and the highest depressive symptoms; there was no difference in depressive symptoms for those with the highest levels of self-compassion. CONCLUSIONS: Implications of this work include the potential for interventions to bolster body image and self-compassion, which may reduce the likelihood of depressive symptoms in this population. Recommendations are provided regarding balancing the importance of increasing breastfeeding rates while also normalizing the challenges of breastfeeding and promoting body positivity and self-compassion.

Participant and interventionist perceptions of challenges during behavioral weight loss treatment.

No prior studies have examined how interventionists' perceptions of participants' weight control challenges or the agreement between participants and interventionists on these perceptions relate to outcomes during group-based behavioral weight loss treatment. This study characterized participants' and interventionists' perceptions of, and agreement about, weight control challenges and assessed how these factors relate to weight loss. Three months into treatment, participants and interventionists independently selected three weight control challenges believed to be most relevant for each participant. Weight was measured at baseline, 3 months, and 12 months. Interventionists and participants had "no" (κ < 0) or "slight" (0 < κ< .20) agreement on most challenges. Although endorsement of certain challenges by participants and/or interventionists was related to 3- and 12-month weight losses, agreement between participants and interventionists was unrelated to weight loss at either time point. Additional research is needed to better understand the role of perceived challenges and participant/interventionist agreement about challenges on treatment outcomes.

Examination of Nutrition Literacy and Quality of Self-monitoring in Behavioral Weight Loss.

Background: Few have examined nutrition literacy (i.e., capacity to process and make informed nutritional decisions) in behavioral weight loss. Nutrition literacy (NL) may impact necessary skills for weight loss, contributing to outcome disparities. Purpose: The study sets out to identify correlates of NL; evaluate whether NL predicted weight loss, food record completion and quality, and session attendance; and investigate whether the relations of race and education to weight loss were mediated by NL and self-monitoring. Methods: This is a secondary analysis of 6-month behavioral weight loss program in which overweight/obese adults (N = 320) completed a baseline measure of NL (i.e., Newest Vital Sign). Participants self-monitored caloric intake via food records. Results: NL was lower for black participants (p < .001) and participants with less education (p = .002). Better NL predicted better 6-month weight loss (b = -.63, p = .04) and food record quality (r = .37, p < .001), but not food record completion or attendance (ps > 0.05). Black participants had lower NL, which was associated with poorer food record quality, which adversely affected weight loss. There was no indirect effect of education on weight loss through NL and food record quality. Conclusions: Overall, results suggest that lower NL is problematic for weight loss. For black participants, NL may indirectly impact weight loss through quality of self-monitoring. This might be one explanation for poorer behavioral weight loss outcomes among black participants. Additional research should investigate whether addressing these skills through enhanced treatment improves outcomes. Clinical trial information: NCT02363010.

Do participants with children age 18 and under have suboptimal weight loss?

OBJECTIVES: Parenthood is a time marked by behaviors that may promote risk for weight gain, including decreased physical activity and increased unhealthy eating. Little is known about parents in the context of behavioral weight loss, such as whether they differ in weight losses, and related barriers, or behaviors. METHOD: We compared parents of children aged 18 and younger (n = 105) to other participants who did not have children, or whose children were in adulthood (n = 215) in a behavioral weight loss program to evaluate six-month weight losses, and weight loss barriers and behaviors. RESULTS: Parents of minor children lost less weight than other participants, and parental status interacted with gender such that men without minor children lost the most weight. Although parents of minor children identified greater stress, depression, time-related barriers to physical activity, and had less adherence to calorie goals, they did not differ from other participants in session attendance, emotional overeating, disinhibited eating, or physical activity. DISCUSSION: Parents of minor children appear to have greater weight loss barriers, greater difficulty adhering to calorie goals, and less weight loss. Additional research is needed to identify ways to better serve parents in behavioral weight loss programs.

Daily self-weighing and weight gain prevention: a longitudinal study of college-aged women.

Daily self-weighing has been suggested as an important factor for weight loss maintenance among samples with obesity. This study is a secondary analysis that examined daily self-weighing in association with weight and body composition outcomes over 2 years among young women with vulnerability for weight gain. Women (N = 294) of varying weight status completed self-weighing frequency questionnaires and weight was measured in the clinic at baseline, 6 months, 1, and 2 years; DXA scans were completed at baseline, 6 months and 2 years. Multilevel models examined the relationship between daily self-weighing (at any point in the study) and trajectories of BMI and body fat percentage. Daily self-weighing was associated with significant declines in BMI and body fat percent over time. Future research is needed to examine causal relations between daily self-weighing and weight gain prevention. Nonetheless, these data extend the possibility that daily self-weighing may be important for prevention of unwanted weight gain.

Does cognitive avoidance mediate the relation of anxiety and binge eating?

PURPOSE: Theory suggests that binge eating symptoms may develop in an attempt to avoid distressing states that arise in the context of negative affect. In light of its theoretical significance, including the "escape from awareness" model of binge eating, surprisingly few empirical evaluations have examined the empirical evidence for this variable in relation to anxiety and binge eating symptoms. In addition, although it is understood that anxiety is more prevalent among women than men, empirical investigations of gender differences in cognitive avoidance in binge eating are thus far absent from the published literature. METHODS: Participants (N = 436) were recruited from diverse geographic regions across the United States to take part in an online study. Cognitive avoidance, anxiety, and binge eating measures were collected. RESULTS: Cognitive avoidance partially mediated the relation between anxiety and binge eating in the full sample; however, results differed across genders. Specifically, cognitive avoidance was a mediator for women, but not for men. CONCLUSIONS: Findings support the "escape from awareness" model of binge eating among women, and suggest that targeting cognitive avoidance in binge eating treatment may be a promising clinical avenue. Future research may benefit from exploring the broader construct of experiential avoidance to determine if the gender differences in cognitive avoidance observed in this study are indicative of a larger pattern of avoidance behavior, and if factors other than cognitive avoidance may have greater relevance for men.

Energy intake highs and lows: how much does consistency matter in weight control?

Behavioural weight control programmes recommend adherence to daily energy intake goals, yet also allow for flexibility in intake across days. Evidence is lacking as to whether intake consistency is important for weight control. The current study explored the relation between day-to-day intake consistency and weight loss in the context of behavioural weight loss treatment and examined the relationship between variability in intake and several factors known to be associated with weight control success. Participants (N = 283) enrolled in a 12-month behavioural weight loss programme completed 24-h recalls of dietary intake and psychological measures. At the end of treatment, low intake variability and greater weight loss were associated, but variability was not predictive of weight loss independent of mean intake in continuous analyses. Interestingly, participants who met the programme goal of ≥10% weight loss had less intake variability compared to those who lost <10%, although groups did not differ significantly on mean intake. Results suggest that daily intake consistency may facilitate successful weight loss for some. Additionally, autonomous motivation for weight management and cognitive dietary restraint were inversely related to end-of-treatment intake variability. Additional research is needed to examine whether recommendations to limit intake variability during behavioural weight loss treatment improve long-term weight control.

Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities.

BACKGROUND: Little is known about the clinical profile and treatment priorities of women with binge eating disorder (BED), a diagnosis new to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. We identified comorbidities and patients' treatment priorities, because these may inform implementation of clinical services. METHODS: Data were collected from women veteran primary care patients. Analyses compared those who screened positive for BED (BED+), and those without any binge eating symptoms (BED-). RESULTS: Frequencies of comorbid medical and psychological disorders were high in the BED+ group. The BED+ group's self-identified most common treatment priorities were mood concerns (72.2%), weight loss (66.7%), and body image/food issues (50%). Among those with obesity, a greater proportion of the BED+ group indicated body image/food issues was their top treatment priority (12.9% vs. 2.8%; p < .01), suggesting that these patients may be more apt to seek treatment beyond weight management for their problematic eating patterns. CONCLUSIONS: Women primary care patients with BED demonstrate high medical and psychological complexity; their subjective treatment priorities often match objective needs. These findings may inform the development of targeted BED screening practices for women with obesity in primary care settings, and the eventual adoption of patient-centered BED treatment resources.

The role of negative reinforcement eating expectancies in the relation between experiential avoidance and disinhibition.

OBJECTIVES: Eating-related disinhibition (i.e., a tendency to overeat in response to various stimuli) is associated with weight gain and poorer long-term weight loss success. Theoretically, experiential avoidance (i.e., the desire or attempts to avoid uncomfortable internal experiences), may predispose individuals to developing negative reinforcement eating expectancies (i.e., the belief that eating will help to mitigate distress), which in turn promote disinhibition. Such relationships are consistent with an acquired preparedness model, which posits that dispositions influence learning and subsequent behavior. Drawing from this framework, the current study represents the first investigation of relations between negative reinforcement eating expectancies, experiential avoidance (both general and food-specific) and disinhibited eating. In particular, the mediating role of negative reinforcement eating expectancies in the relation between experiential avoidance and disinhibited eating was examined. METHOD: Participants (N=107) were overweight and obese individuals presenting for behavioral weight loss treatment who completed measures of general and food-related experiential avoidance, negative reinforcement eating expectancies, and disinhibition. RESULTS: Experiential avoidance and negative reinforcement eating expectancies significantly related to disinhibition. Furthermore, the relation between experiential avoidance and disinhibition was mediated by negative reinforcement eating expectancies. DISCUSSION: The current study supports an acquired preparedness model for disinhibition, such that the relation between experiential avoidance and disinhibition is accounted for by expectations that eating will alleviate distress. Findings highlight the potential role of eating expectancies in models accounting for obesity risk, and identify negative reinforcement eating expectancies as a potential treatment target for reducing disinhibition.

Understanding the complexity of biopsychosocial factors in the public health epidemic of overweight and obesity.

Obesity is a complex and multifaceted public health problem. This commentary reflects on a new theoretical model of obesity (i.e. Homeostatic Theory of Obesity proposed by Marks), and calls for additional research to examine biopsychosocial factors that may be of importance in developing interventions that promote long-term maintenance of weight loss and in developing obesity prevention programs. Furthermore, we discuss the role of socioeconomic factors in obesity and call for interdisciplinary efforts to address obesity risk factors in the interest of public health.

The relation of anxiety, depression, and stress to binge eating behavior.

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.

Health care utilisation in patients with non-cardiac chest pain: a longitudinal analysis of chest pain, anxiety and interoceptive fear.

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.

The Role of Anxiety in Binge Eating Behavior: A Critical Examination of Theory and Empirical Literature.

The purpose of this manuscript is to expand the understanding of binge eating by reviewing the role of aspects of negative affect. Specifically, this paper will present evidence for further investigation of the bearing that anxiety may have in binge eating development and maintenance. A comprehensive review of the literature regarding the relation of binge eating and anxiety was performed. Valuable contributions have been made to the binge eating literature regarding some aspects of negative affect (i.e., depression); however, outside of bulimia nervosa studies, much of the theoretical and empirical binge eating research to date has not directly addressed the role of anxiety. Research supports expansion of investigations of negative emotionality and binge eating to include specific study of anxiety. Greater inclusivity and specificity in the unique contributions of various negative emotions may further the development of temporal models and intervention efforts.