Are attention deficit hyperactivity disorder symptoms stable irrespective of recovery from eating disorders? A 1-year follow-up of adult females.

OBJECTIVE: To explore the influence of recovery from eating disorders (ED) at 1-year follow-up on self-reported attention deficit hyperactivity disorder (ADHD) symptoms in an unselected group of patients in a specialized ED clinic. METHODS: Four hundred and eight adult females with an ED were assessed with the World Health Organization adult ADHD Self-Report Scale-Screener, and for comorbid psychiatric symptoms at baseline and 1-year follow-up. Recovery was registered at follow-up. RESULTS: ADHD symptoms decreased between baseline and follow-up in recovered patients treated for bulimic ED. In not recovered patients, ADHD symptoms were stable. Decreased depressive symptoms were associated to decreased ADHD symptoms at 1-year follow-up. CONCLUSIONS: Bulimic ED and ADHD are linked together. This link, although not known in every detail, has clinical implications with possible value for bulimic ED patients. Clinical studies exploring implementation of ADHD treatment strategies for Bulimia Nervosa are recommended.

Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life.

OBJECTIVE: Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN. METHOD: In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers. RESULTS: Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants. DISCUSSION: These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients.

[Treatment of eating disorders with concurrent ADHD symptoms: knowledge, knowledge gaps and clinical implications]. / Behandling av ätstörningar vid samtidiga ADHD-symtom - Observerat samband kan ge nya möjligheter till medicinering, främst av bulimia nervosa ­ men ännu finns kunskapsluckor.

Emerging evidence supports a prevalence overlap between ADHD and bulimia nervosa/binge eating disorder. A high degree of ADHD symptoms may have a negative impact on recovery in eating disorders with loss of control over the eating, bingeing and purging. Screening/diagnostic evaluation of ADHD in all persons with loss of control over the eating/bingeing/purging eating disorders is required. For patients diagnosed with ADHD, treatment with stimulants can be tested and evaluated for both eating disorders and ADHD symptoms. While there is evidence that lisdexamfetamine reduces symptoms of binge eating disorder, rigorous studies evaluating ADHD treatment, including medication, for bulimia nervosa are still missing.

Plasma neurofilament light chain concentration is increased in anorexia nervosa.

Anorexia nervosa (AN) is a severe psychiatric disorder with high mortality and, to a large extent, unknown pathophysiology. Structural brain differences, such as global or focal reductions in grey or white matter volumes, as well as enlargement of the sulci and the ventricles, have repeatedly been observed in individuals with AN. However, many of the documented aberrances normalize with weight recovery, even though some studies show enduring changes. To further explore whether AN is associated with neuronal damage, we analysed the levels of neurofilament light chain (NfL), a marker reflecting ongoing neuronal injury, in plasma samples from females with AN, females recovered from AN (AN-REC) and normal-weight age-matched female controls (CTRLS). We detected significantly increased plasma levels of NfL in AN vs CTRLS (medianAN = 15.6 pg/ml, IQRAN = 12.1-21.3, medianCTRL = 9.3 pg/ml, IQRCTRL = 6.4-12.9, and p < 0.0001), AN vs AN-REC (medianAN-REC = 11.1 pg/ml, IQRAN-REC = 8.6-15.5, and p < 0.0001), and AN-REC vs CTRLS (p = 0.004). The plasma levels of NfL are negatively associated with BMI overall samples (ß (±se) = -0.62 ± 0.087 and p = 6.9‧10-12). This indicates that AN is associated with neuronal damage that partially normalizes with weight recovery. Further studies are needed to determine which brain areas are affected, and potential long-term sequelae.

Symptoms of disordered eating among adult international adoptees: A population-based cohort study.

OBJECTIVE: There is a paucity of data on disordered eating among adoptees. The aim of the present study was to explore the prevalence of symptoms of disordered eating and body image concerns among international adoptees in a large representative community survey on health-related behaviours. METHOD: Combining survey data from the Stockholm Public Health Cohort and Swedish population data, adult international adoptees were compared with total participant data to assess differences in disordered eating and body dissatisfaction. RESULTS: International adoptee women displayed significantly higher levels of self-induced vomiting, loss-of-control eating, food preoccupation, underweight, and wish for thinness compared with nonadoptee women, albeit with small or very small effect sizes. No significant differences were found in terms of mean body mass index, cognitive restraint, or emotional eating. CONCLUSION: International adoptee women were disproportionally affected on several measures of disordered eating, although the magnitude of these differences were generally small in absolute terms.

A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder.

OBJECTIVE: Avoidant/restrictive food intake disorder (ARFID) was introduced as a new diagnosis in the DSM-5. This systematic scoping review explores how ARFID as a diagnostic entity is conceptualized in the research literature and evaluates the diagnostic validity according to the Feighner criteria. METHOD: A systematic scoping review of papers on ARFID in PubMed/MEDLINE and Web of Science was undertaken, following PRISMA and Joanna Briggs Institute guidelines. RESULTS: Fifty-one original research publications, 23 reviews and commentaries, and 20 case reports were identified. The use of ARFID as a conceptual category varies significantly within this literature. At this time, the ARFID diagnosis does not fulfil the Feighner criteria for evaluating the validity of diagnostic constructs, the most urgent problem being the demarcation toward other disorders. A three-dimensional model-lack of interest in food, selectivity based on sensory sensitivity, and fear of aversive consequences-is gaining support in the research literature. DISCUSSION: The introduction of the ARFID diagnosis has undoubtedly increased the recognition of a previously largely neglected group of patients. However, this article points to an inability of the current DSM-5 diagnostic criteria to ensure optimal diagnostic validity, which risks making them less useful in clinical practice and in epidemiological research. To increase the conceptual validity of the ARFID construct, several possible alterations to the current diagnostic criteria are suggested, including a stronger emphasis of the three identified subdomains and further clarifying the boundaries of ARFID.

OBJETIVO: El trastorno evitativo/restrictivo de la ingesta de alimentos (TERIA) (ARFID, en sus siglas en inglés), fue introducido como una nueva categoría diagnóstica en el DSM-5. Esta revisión sistemática del alcance explora cómo es conceptualizado el ARFID en la literatura científica y evalúa la validez diagnóstica de acuerdo a los criterios de Feighner. MÉTODO: Se realizó una revisión sistemática del alcance de ARFID en los artículos publicados en PubMed/MEDLINE y en Web of Science siguiendo los lineamientos PRISMA y del Instituto Joanna Briggs. RESULTADOS: se identificaron 51 publicaciones de investigación originales, 23 revisiones y comentarios, y 20 reportes de caso. El uso de ARFID como categoría conceptual varía significativamente dentro de esta literatura. En la actualidad, el diagnóstico de ARFID no reúne los criterios de Feighner para evaluar la validez del constructo diagnóstico, siendo el problema más urgente la delimitación con otros trastornos. Un modelo tridimensional -falta de interés en la comida, selectividad basada en la sensibilidad sensorial y miedo a las consecuencias aversivas - está ganando apoyo en la literatura científica. DISCUSIÓN: La introducción del diagnóstico de ARFID indudablemente ha incrementado el reconocimiento de un grupo grande de pacientes previamente ignorado. Sin embargo, esta revisión señala la incapacidad de los criterios actuales del DSM-5 para asegurar una validez diagnóstica óptima, lo cual pone en riesgo su utilidad tanto en la práctica clínica como en la investigación epidemiológica. Se sugieren varias modificaciones posibles a los criterios diagnósticos actuales, con el fin de aumentar la validez conceptual del constructo ARFID, incluyendo un mayor énfasis en los tres subdominios identificados así como una mayor clarificación de los límites de ARFID.

[ARFID: food restriction without fear of weight gain]. / ARFID: restriktivt ätande utan rädsla för viktuppgång - En patientgrupp som behandlats styvmoderligt i vården.

Avoidant/restrictive food avoidance disorder, or ARFID, is characterized by restrictive eating or avoidance of food in the absence of the cognitive restraint and weight phobia typically seen in anorexia nervosa. It is often based on a general disinterest in eating, selective eating due to sensory preferences, and/or fear of adverse consequences such as choking, although the diagnostic criteria allow for a number of other clinical presentations. Patients with ARFID tend to be younger, more often male, and have a longer duration of illness compared to patients with other eating disorders. Delimitation from other disorders affecting food intake can sometimes be problematic. Established specialized treatment models for restrictive eating disorders such as anorexia nervosa appears to be potentially effective in ARFID as well, but prospective treatment studies are much needed.

Are treatment results for eating disorders affected by ADHD symptoms? A one-year follow-up of adult females.

OBJECTIVE: To explore the influence of self-reported Attention Deficit Hyperactivity Disorder (ADHD) symptoms on recovery rate at 1-year follow-up in an unselected group of patients in a specialized eating disorder (ED) clinic. METHODS: Four hundred forty-three adult females with an ED were assessed with the ADHD Self-Report Scale for Adults (ASRS-screener), and for demographic variables and ED symptoms. Recovery was registered at 1-year follow-up. RESULTS: A high degree of ADHD symptoms at baseline was predictive for nonrecovery of ED at 1-year follow-up in patients with loss of control over eating, bingeing, or purging. The presence of inattentive ADHD symptoms was stronger associated with nonrecovery than hyperactive/impulsive symptoms. CONCLUSIONS: A high degree of ADHD symptoms may have a negative impact on recovery in ED. Screening/diagnostic evaluation of ADHD in all loss of control over eating/bingeing/purging ED patients and studies of the effect of implementing ADHD-treatment strategies in this patient group are recommended.

A register-based case-control study of health care utilization and costs in binge-eating disorder.

OBJECTIVE: Capturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED. METHODS: A case-control design and nationwide registers were used. All individuals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case). RESULTS: Cases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher. CONCLUSION: Individuals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden associated with BED.

Self-admission to inpatient treatment in psychiatry: lessons on implementation.

BACKGROUND: Interest has increased in programs offering self-admission to inpatient treatment for patients with severe psychiatric illness, whereby patients who are well-known to a service are afforded the opportunity to admit themselves at will for a brief period of time. The aim of the present study was to examine patient experiences of practical considerations during the start-up phase of a self-admission program in an eating disorder service. METHODS: Sixteen adult participants in a self-admission program at a specialist eating disorders service were interviewed at 6 months about their experiences during the implementation phase. A qualitative content analysis approach was applied in order to identify recurring themes. RESULTS: Six subcategories regarding implementation and logistics of self-admission were identified: "Start-up problems", "Problems associated with reserving a bed", "Lack of staff continuity", "Not enough emphasis on long-term goals", "Too demanding in terms of freedom and responsibility", and "Suggestions for alternative models". CONCLUSIONS: Practical recommendations can be offered for the implementation of future self-admission programs, such as thoroughly informing all participants about the rationale behind self-admission with particular emphasis on patient accountability, establishing a waiting list procedure for occasions when all designated beds are occupied, and assigning an individual contact staff member responsible for each self-admitted patient. TRIAL REGISTRATION: The study protocol is retrospectively registered at ClinicalTrials.gov as ID: NCT02937259 .

Self-admission to inpatient treatment for patients with anorexia nervosa: The patient's perspective.

The aim of the present study was to explore patients' experiences of participating in a self-admission program at a specialist eating disorders clinic. Sixteen adult program participants with a diagnosis of anorexia nervosa were interviewed at 6 months about their experiences in the self-admission program. A qualitative content analysis approach was applied to identify recurring themes. Four themes were identified: Agency and Flexibility, Functions, Barriers, and Applicability. Participants used self-admission to boost healthy behaviors, to prevent deterioration, to forestall the need for longer periods of hospitalizations, and to get a break from overwhelming demands. Quick access to brief admissions provides a safety net that can increase feelings of security in everyday life, even for patients who do not actually make use of the opportunity to self-admit. It also provided relief to participants' relatives. Furthermore, participants experienced that self-admission may foster agency and motivation. However, the model also requires a certain level of maturity and an encouraging environment to overcome barriers that could otherwise hinder optimal use, such as ambivalence in asking for help. Informants experienced that self-admission could allow them to gain greater insight into their disease process, take greater responsibility for their recovery, and transform their health care from crisis-driven to proactive. By offering a shift in perspective on help-seeking and participation, self-admission may potentially strengthen participants' internal responsibility for their treatment and promote partnership in treatment.

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients.

BACKGROUND: Very little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic. METHODS: In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables. RESULTS: Almost one third (31.3 %) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35-37 %) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1-4 and Binge Eating Disorder patients reported slightly below average (26-31 %), and Anorexia Nervosa restricting subtype patients even lower (18 %). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses. CONCLUSIONS: There is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group.

Binge-eating disorder in the Swedish national registers: Somatic comorbidity.

OBJECTIVE: To evaluate associations between binge-eating disorder (BED) and somatic illnesses and determine whether medical comorbidities are more common in individuals who present with BED and comorbid obesity. METHOD: Cases (n = 850) were individuals with a BED diagnosis in the Swedish eating disorders quality registers. Ten community controls were matched to each case on sex, and year, month, and county of birth. Associations of BED status with neurologic, immune, respiratory, gastrointestinal, skin, musculoskeletal, genitourinary, circulatory, and endocrine system diseases were evaluated using conditional logistic regression models. We further examined these associations by adjusting for lifetime psychiatric comorbidity. Amongst individuals with BED, we explored whether comorbid obesity was associated with risk of somatic disorders. RESULTS: BED was associated with most classes of diseases evaluated; strongest associations were with diabetes [odds ratio (95% confidence interval) = 5.7 (3.8; 8.7)] and circulatory systems [1.9 (1.3; 2.7)], likely indexing components of metabolic syndrome. Amongst individuals with BED, those with comorbid obesity were more likely to have a lifetime history of respiratory [1.5 (1.1; 2.1)] and gastrointestinal [2.6 (1.7; 4.1)] diseases than those without comorbid obesity. Increased risk of some somatic disease classes in individuals with BED was not simply due to obesity or other lifetime psychiatric comorbidity. DISCUSSION: The association of BED with many somatic illnesses highlights the morbidity experienced by individuals with BED. Clinicians treating patients with BED should be vigilant for medical comorbidities. Nonpsychiatric providers may be the first clinical contact for those with BED underscoring the importance of screening in primary care. © 2016 The Authors International Journal of Eating Disorders Published by Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:58-65).

A Register-Based Case-Control Study of Prescription Medication Utilization in Binge-Eating Disorder.

OBJECTIVE: Individuals with binge-eating disorder (BED) experience psychiatric and somatic comorbidities and obesity, but the nature and magnitude of prescription medication utilization is unclear. We investigated utilization using Swedish registry data and a case-control design. METHODS: Cases were identified from Riksät and Stepwise longitudinal registers and were individuals diagnosed with BED per DSM-IV-TR criteria between July 1, 2006, and December 31, 2009, at eating disorder clinics (n = 238, 96% female, mean age = 22.8 years). For each case, 10 controls were matched on sex and year, month, and county of birth (n = 2,380). An index date was derived for each control, which was the date of diagnosis of BED in the corresponding case. The association between BED and prescription medication utilization was investigated before and within 12 months after diagnosis. RESULTS: Before diagnosis, cases were significantly more likely than matched controls to have been prescribed nervous system (odds ratio = 6.4; 95% confidence limit = 4.7, 8.6), tumors and immune disorders (3.5; 1.3, 9.3), cardiovascular (2.2; 1.4, 3.5), digestion and metabolism (2.1; 1.5, 2.9), infectious diseases (1.9; 1.4, 2.6), skin (1.8; 1.3, 2.5), and respiratory system (1.3; 1.0, 1.8) medications. Cases also had higher odds of prescription use than controls across most categories within 12 months after diagnosis. Several associations were significant after accounting for lifetime psychiatric comorbidity and obesity. CONCLUSIONS: Individuals with BED had increased utilization of psychiatric and nonpsychiatric medications compared with matched controls. Findings confirm that the illness burden of BED extends to high medication utilization and underscore the importance of thorough medication reviews when treating individuals with BED.

Treatment-seeking patients with binge-eating disorder in the Swedish national registers: clinical course and psychiatric comorbidity.

BACKGROUND: We linked extensive longitudinal data from the Swedish national eating disorders quality registers and patient registers to explore clinical characteristics at diagnosis, diagnostic flux, psychiatric comorbidity, and suicide attempts in 850 individuals diagnosed with binge-eating disorder (BED). METHOD: Cases were all individuals who met criteria for BED in the quality registers (N = 850). We identified 10 controls for each identified case from the Multi-Generation Register matched on sex, and year, month, and county of birth. We evaluated characteristics of individuals with BED at evaluation and explored diagnostic flux across eating disorders presentations between evaluation and one-year follow-up. We applied conditional logistic regression models to assess the association of BED with each comorbid psychiatric disorder and with suicide attempts and explored whether risk for depression and suicide were differentially elevated in individuals with BED with or without comorbid obesity. RESULTS: BED shows considerable diagnostic flux with other eating disorders over time, carries high psychiatric comorbidity burden with other eating disorders (OR 85.8; 95 % CI: 61.6, 119.4), major depressive disorder (OR 7.6; 95 % CI: 6.2, 9.3), bipolar disorder (OR 7.5; 95 % CI: 4.8, 11.9), anxiety disorders (OR 5.2; 95 % CI: 4.2, 6.4), and post-traumatic stress disorder (OR 4.3; 95 % CI: 3.2, 5.7) and is associated with elevated risk for suicide attempts (OR 1.8; 95 % CI: 1.2, 2.7). Depression and suicide attempt risk were elevated in individuals with BED with and without comorbid obesity. CONCLUSIONS: Considerable flux occurs across BED and other eating disorder diagnoses. The high psychiatric comorbidity and suicide risk underscore the severity and clinical complexity of BED.

Psychiatric comorbidity in women and men with eating disorders results from a large clinical database.

Psychiatric comorbidity is common in patients with eating disorders (ED), but prevalence estimates are heterogeneous, probably due to methodological differences between studies (population, diagnostic method, sampling procedure etc.) and a few studies include men. The aim of this study is to investigate psychiatric DSM-IV Axis I comorbidity in a large sample of adult patients, both males and females, with the whole spectrum of DSM-IV ED diagnoses. Initial presentation assessment data on 11,588 adult men and women presenting to specialist ED clinics in Sweden between 2008 and 2012 were extracted from a large clinical database. Diagnostics were based on semi-structured interviews (SCID-I) and the Structured Eating Disorder Interview (SEDI). Seventy-one percent of the patients with ED had at least one other Axis I disorder. The most common type of diagnosis was anxiety disorders (53%), where generalized anxiety disorder was the most common diagnosis. The highest levels of comorbidity were found for women with Binge Eating Disorder (BED) and men with Bulimia Nervosa (BN). Findings are consistent with previous research showing a high prevalence of psychiatric comorbidity in both men and women with ED. The small gender differences observed seem negligible compared to the general similarity in comorbidity.

Patient-controlled hospital admission in psychiatry: A systematic review.

BACKGROUND: Patient-controlled admission is a concept that invites patients with long-term mental illness to decide for themselves when inpatient treatment is necessary without a clinician serving as gatekeeper. AIM: To review the current knowledge of patient-controlled hospital admission in adult psychiatry. METHOD: A systematic literature search was conducted in PubMed/MEDLINE, EMBASE and the Cochrane Library with the aim of identifying all relevant scientific papers from 1990 onwards. RESULTS: Six articles reporting on four different study sites were identified. Detailed account of the models is given and quantitative and qualitative outcome data is reviewed. Rationales behind the concept include increased patient autonomy, promotion of coping skills, early help-seeking, avoidance of power struggles, establishment of an asylum function, reduced time spent in inpatient care and prevention of coercive measures. Quantitative data points toward a dramatic reduction of total time spent in inpatient care and of involuntary admissions in patients with previously high inpatient care consumption, whereas qualitative data indicates that the concept increases patient autonomy, responsibility and confidence in daily life. CONCLUSION: Patient-controlled admission is a promising novel approach to inpatient care in psychiatry. However, available studies are small and quality of evidence is generally low.

The change in eating behaviors in a Web-based weight loss program: a longitudinal analysis of study completers.

BACKGROUND: Eating behaviors are essential components in weight loss programs, but limited research has explored eating behaviors in Web-based weight loss programs. OBJECTIVES: The aim was to evaluate an interactive Web-based weight loss program on eating behaviors using the 18-item Three-Factor Eating Questionnaire Revised (TFEQ-R18) which measures uncontrolled eating, emotional eating, and cognitive restrained eating. Our Web-based weight loss program is comprised of information about healthy lifestyle choices, weekly chats with experts, social networking features, databases for recipe searches, and features allowing members to self-report and track their weight, physical activity, and dietary intake on the website. METHODS: On registering for the weight loss program, 23,333 members agreed to take part in the research study. The participants were then asked to complete the TFEQ-R18 questionnaire at baseline and after 3 and 6 months of participation. All data collection was conducted online, with no face-to-face contact. To study changes in TFEQ-R18 eating behaviors we restricted our study to those members who completed all 3 TFEQ-R18 questionnaires. These participants were defined as "completers" and the remaining as "noncompleters." The relationships between sex, change in eating behaviors, and total weight loss were studied using repeated measures ANOVA and Pearson correlation coefficient. RESULTS: In total, 22,800 individuals participated (females: 19,065/22,800, 83.62%; mean age 39.6, SD 11.4 years; BMI 29.0 kg/m(2); males: 3735/22,800, 16.38%; mean age 43.2, SD 11.7 years; BMI 30.8 kg/m(2)). Noncompleters (n=22,180) were younger and reported a lower score of uncontrolled eating and a higher score of cognitive restrained eating. Over time, completers (n=620) decreased their uncontrolled eating score (from 56.3 to 32.0; P<.001) and increased their cognitive restrained eating (from 50.6 to 62.9; P<.001). Males decreased their emotional eating (from 57.2 to 35.9; P<.001), but no significant change was found among females. The baseline cognitive restrained eating score was significantly and positively associated with weight loss for completers in both men (P=.02) and women (P=.002). CONCLUSIONS: To our knowledge, this is the largest TFEQ sample that has been documented. This Web-based weight loss intervention suggests that eating behaviors (cognitive restrained eating, uncontrolled eating, and emotional eating) measured by TFEQ-R18 were significantly changed during 6 months of participation. Our findings indicate differences in eating behaviors with respect to sex, but should be interpreted with caution because attrition was high.