Engagement in binge eating and fasting associated with poorer sleep quality in an online sample of adults.

OBJECTIVES: Both disordered eating and disturbed sleep represent significant threats to mental health. Accumulating evidence suggests that disordered eating behaviors and sleep problems co-occur. A majority of current research, however, has focused on these behaviors as components of eating disorder diagnoses, rather than investigating the independent associations of transdiagnostic disordered eating behaviors and sleep. The present study sought to examine fasting, binge eating, self-induced vomiting, laxative or diuretic misuse, and driven exercise as predictors of sleep quality complaints. METHOD: An online sample of 648 U.S. adults completed the Eating Disorder Examination - Questionnaire, the Pittsburgh Sleep Quality Index, and the Patient Health Care Questionnaire-2 as part of a larger parent study. RESULTS: Results of a hierarchical linear regression revealed that, collectively, disordered eating behaviors predicted worse sleep quality [R2 = 0.30, F(7, 640) = 31.21, p < .001], and that both binge eating and fasting, but not other compensatory behaviors, accounted for unique variance in sleep quality after controlling for BMI and depression. CONCLUSIONS: Overall, findings suggest that transdiagnostic disordered eating behaviors are associated with sleep quality complaints. Improved understanding of the specific relationships between individual eating behaviors and sleep characteristics can help refine the identification of individuals at high risk for sleep disturbance and address the potential reciprocal influence of sleep quality on disordered eating behaviors.

Physician homicide: Reports in the National Violent Death Reporting System (2003-2018).

OBJECTIVE: To explore the occurrence, demographics, and circumstances of homicides of physicians. METHOD: Authors interrogated the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention's surveillance system tracking violent deaths between 2003 and 2018 which integrates data from law enforcement and coroner/medical examiner reports. Authors identified cases of homicide decedents whose profession was physician, surgeon, or psychiatrist. Data collected included decedents' demographics as well as circumstances of death. RESULTS: Data were provided by 7-41 states as participating states increased over time. Fifty-six homicides were reported, most were male (73.2%) and white (76.8%). Most (67.9%) identified assailants reportedly knew decedents: 23.2% were perpetrated by partners/ex-partners; 10.7% by patients/patients' family members. Deaths were mainly due to gunshot wounds (44.6%), stabbing (16.1%), and blunt force trauma (16.1%). More (58.9%) homicides occurred at victims' homes than work (16.1%). CONCLUSIONS: Physician homicides are relatively rare and occur at lower rates than in the general population. Physicians were more frequently killed by partners or ex-partners than by patients. Most homicides occurred away from the workplace. Broader efforts are needed to promote interventions throughout America's violent society to reduce domestic/partner violence and gun violence.

Sleep is the best medicine: assessing sleep, disordered eating, and weight-related functioning.

Sleep quality is linked to disordered eating, obesity, depression, and weight-related functioning. Most research, however, has focused on clinical populations. The current study investigated relationships between sleep quality, disordered eating, and patterns of functioning in a community sample to better understand relationships among modifiable health behaviors. Participants (N = 648) recruited from Amazon Mechanical Turk completed assessments of eating, depression, weight-related functioning, and sleep. Self-reported height and weight were used to calculate body mass index (M = 27.3, SD = 6.9). Participants were on average 37.6 years (SD = 12.3), primarily female (65.4%), and White, not Hispanic (72.7%). Over half of participants endorsed poor sleep quality, and average sleep scores were above the clinical cutoff for poor sleep quality. Sleep scores were significantly positively correlated with disordered eating, depression, and weight-related functioning, even after adjusting for age, body mass index, and sex. Multivariate regression models predicting weight-related functioning and depression showed that both sleep quality and disordered eating independently predicted depression. Sleep quality did not independently predict weight-related functioning; however, disordered eating did. To the best of our knowledge, this is the first study to assess sleep behaviors, disordered eating, and weight-related functioning in a community sample of weight diverse participants. Results indicate that most participants endorsed poor sleep quality, which was associated with disordered eating patterns, including binge eating and poorer weight-related functioning, even after controlling for body mass index, highlighting that this relationship exists across the weight spectrum. These results speak to the importance of health behavior assessment and intervention within nonclinical samples.Level of evidence Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Homicides of psychologists, physicians, nurses, pharmacists, social workers, and other health professionals: National Violent Death Reporting System data 2003-2020.

OBJECTIVE: Homicide is the extreme endpoint along the continuum of interpersonal violence. Violence in healthcare settings and directed toward healthcare workers has been a growing concern. Analysis of health professionals' homicides is needed to inform prevention interventions. METHODS: Decedent numbers, age, and sex in the National Violent Death Reporting System are reported for 10 types of health professionals: advance practice registered nurses, dentists, nurses, pharmacists, physicians, physician assistants, psychiatrists, psychologists, social workers, and veterinarians. RESULTS: Between 2003 and 2020, 944 homicides of these professionals were reported to the NVDRS. Nearly 80% of victims were women; 53% of homicides involved guns. Nurses, social workers, physicians, and pharmacists comprised the most victims. In 2020, nurses, social workers, pharmacists, and psychologists had the highest homicide rates relative to their workforce size. Few of these homicides were related to professionals' work. The number of homicides within these professions correlated highly with the size of professions' workforces. CONCLUSIONS: Health professionals' homicides constitute a small proportion of US homicides generally at lower rates than seen in the general population. Age is likely one of the protective factors. Future, more comprehensive data will provide greater insights into emerging trends to inform strategies to mitigate homicide risk in health professionals. Prevention needs to go beyond healthcare settings and address societal roots of violence.

Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

Ethnic and racial comparisons of weight-loss treatment utilization history and outcomes in patients with obesity and binge-eating disorder.

BACKGROUND: This study examined ethnic/racial differences in reported utilization of weight-loss methods/treatments and weight loss among adults with binge-eating disorder (BED) with co-existing obesity. METHODS: Participants were 400 adults (non-Hispanic Black: n = 99, Hispanic: n = 38, non-Hispanic White: n = 263) seeking treatment for BED in Connecticut from 2007 to 2012. Participants were asked about prior weight-loss methods/treatments and resulting weight losses. RESULTS: Overall, self-help diets were utilized most; mental-health services were utilized least. While non-significant differences for most methods/treatments were observed by ethnicity/race, significant differences emerged for self-help diets and supervised programs with non-Hispanic Whites, in general, utilizing these diets more frequently and losing more weight on these types of diets. CONCLUSIONS: Among treatment-seeking patients with BED and obesity, non-Hispanic White patients reported histories of greater weight-loss treatment utilization and weight loss than non-White patients for supervised and self-help diets. Findings highlight the need for greater understanding of treatment utilization and outcomes among minority patients with obesity and BED.

Digital self-harm is associated with disordered eating behaviors in adults.

PURPOSE: Eating-disorder psychopathology is associated with self-harm behaviors. With much time spent and many social interactions taking place online, self-cyberbullying has emerged as a new form of self-harm that is digital. The current study examined digital self-harm in adults and its associations with eating-disorder psychopathology and behaviors. METHODS: Participants were adults (N = 1794) who completed an online cross-sectional survey. Participants reported whether they had ever posted mean things about themselves online, whether they had ever anonymously bullied themselves online and completed measures of eating-disorder psychopathology and disordered eating behaviors. RESULTS: Digital self-harm was reported by adults across demographic characteristics and across the lifespan, although there were some significant differences in demographic characteristics associated with reported digital self-harm. Participants who engaged in digital self-harm were younger than those denying digital self-harm. Eating-disorder psychopathology and disordered eating behaviors were significantly higher among individuals reporting digital self-harm compared with age-matched controls. CONCLUSIONS: This was the first study to examine digital self-harm among adults and the first study to examine associations of digital self-harm with eating-disorder psychopathology and disordered eating behaviors. Importantly, digital self-harm is reported by adults and therefore is not limited to youth. Our findings that digital self-harm is associated with disordered eating suggests that digital self-harm is a clinically significant topic that needs further research to inform clinical practice and clinical research. LEVEL OF EVIDENCE: Level III, Evidence obtained from well-designed cohort or case-controlled analytic studies.

Examining impairment and distress from food addiction across demographic and weight groups.

Rates of food addiction (FA) vary across weight and demographic groups. Factors influencing discrepant prevalence rates are largely unknown. Rates of clinically significant distress or impairment also vary across demographic groups, yet prior studies have overlooked the diagnostic significance of distress/impairment in heterogenous groups. We tested if weight and demographic groups differed in their likelihood of endorsing distress/impairment from FA. Participants (N = 1832) recruited from Amazon Mechanical Turk completed the modified Yale Food Addiction Scale 2.0 (mYFAS). The mYFAS includes 11 dichotomous symptom indicators and one dichotomous distress/impairment indicator. Differences in distress/impairment were tested across weight, sex, racial/ethnic, and educational groups using logistic regression. FA severity was controlled for using FA symptom count. There were no differences among racial/ethnic and educational groups (p > 0.05). Compared to men, women were more likely to report distress/impairment (aOR = 1.96, 95% CI = 1.28-3.03). People with obesity were more likely to report distress/impairment compared to people with overweight (aOR = 2.20, 95% CI = 1.39-3.49) or normal weight (aOR = 1.99, 95% CI = 1.26-3.13). Individual characteristics (i.e., sex, weight) may influence reporting of distress/impairment from FA. Further inquiry may be appropriate for men and people with normal weight or overweight presenting with FA symptoms who otherwise deny distress/impairment.

Getting a head start: identifying pretreatment correlates associated with early weight loss for individuals participating in weight loss treatment.

Early weight loss is associated with greater weight loss following treatment cessation and years later. The present study aimed to identify pretreatment correlates associated with early weight loss in adults participating in weight-loss treatment in primary care. Participants (N = 89) were in the overweight/obesity range seeking weight-loss treatment in primary-care settings and randomized to one of three treatments: Motivational Interviewing and Internet Condition (MIC), Nutrition Psychoeducation and Internet Condition (NPC), or Usual Care (UC). At baseline, participants were assessed with the Eating Disorder Examination (EDE) interview and completed self-report measures of emotional overeating, exercise, exercise self-efficacy, and depression. Percent weight loss at week six was used as the Early Weight Loss variable. MIC/NPC groups had significantly greater Early Weight Loss than UC. Among MIC/NPC participants only, greater Early Weight Loss was associated with significantly lower pretreatment disordered eating and depressive symptoms. Participants in MIC/NPC who achieved clinically meaningful weight loss (>2.5%) by week six compared with those who did not (<2.5%) reported lower pretreatment disordered eating. Demographic factors and binge-eating disorder diagnosis were unrelated to Early Weight Loss. Our findings suggest that greater early weight loss may be associated with less pretreatment disordered eating and depressive symptoms. CLINICAL TRIALS: NCT01558297.

Examining the construct validity of food addiction severity specifiers.

PURPOSE: Food addiction (FA) is related to greater body mass index (BMI), eating-disorder psychopathology, food craving, and psychosocial impairment. Less is known regarding the utility of the FA severity specifiers, as measured by the number of symptoms endorsed on the Yale Food Addiction Scale (YFAS 2.0). METHODS: Participants (N = 1854) were recruited from Amazon Mechanical Turk to complete an online survey on eating behaviors. Participants completed self-report measures assessing FA, eating-disorder psychopathology (Eating Disorder Examination Questionnaire), and food craving (Food Craving Inventory). Based on the YFAS 2.0 specifiers, participants were classified into four FA groups: No FA (n = 1643), mild (n = 40), moderate (n = 55), and severe (n = 116). RESULTS: There were significant differences found in age, sex, BMI, and frequency of objective binge-eating episodes (OBEs) among the FA groups. Using ANCOVA, adjusted for multiple comparisons and covariates (e.g., BMI, sex, OBEs), the No FA group reported significantly lower levels of shape concern (η2 = 0.05; p < 0.001), weight concern (η2 = 0.04; p < 0.001), eating concern (η2 = 0.15; p < 0.001), and global eating-disorder psychopathology (η2 = 0.06; p < 0.001) than mild, moderate, or severe FA groups. The No FA group reported significantly lower levels of dietary restraint (η2 = 0.01; p < 0.01) than mild and severe FA groups. The severe FA group reported higher food craving scores (η2 = 0.02; p < 0.001) compared to the No FA group. CONCLUSION: Our findings parallel the severity specifiers literature for eating and substance use disorders by also indicating the limited utility of severity specifiers based on symptom count. Future research should investigate alternative targets for discriminating among levels of FA. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Characterizing fear of weight gain and sensitivity to weight gain in individuals seeking weight loss treatment.

PURPOSE: Weight concern, including fear of weight gain and sensitivity to weight gain, is indicative of disordered eating in individuals with underweight or healthy weight. It is unknown, however, whether or how these constructs present in individuals with excess weight, particularly among those with binge-eating disorder (BED). This study sought to characterize fear of weight gain and sensitivity to weight gain and examine their relationship with disordered eating and depression symptoms, in individuals seeking weight loss treatment, both with and without BED. METHODS: Adults seeking weight loss treatment in an urban primary care clinic (N = 131) completed the Eating Disorder Examination interview and Beck Depression Inventory. Height and weight were collected. RESULTS: Clinical levels of fear of weight gain and sensitivity to weight gain were present in this sample. Individuals with BED reported experiencing fear of weight gain (48.6%), significantly more than those without BED (20.9%); both groups reported similar and clinically elevated sensitivity to weight gain. Both constructs were related to greater levels of disordered eating and depression symptoms, at times based on BED status. Fear of weight gain was associated with overvaluation of weight and shape for those without BED only. Objective and subjective bulimic episodes were unrelated to fear of weight gain or sensitivity to weight gain, regardless of BED status. CONCLUSION: Fear of weight gain and sensitivity to weight gain were common in this sample and may be maladaptive, as evidenced by associations with elevated eating psychopathology. Future studies should examine these variables within larger samples and should employ longitudinal designs. LEVEL OF EVIDENCE: Level III: case-control analytic study.

12 Months later: Motivational interviewing plus nutrition psychoeducation for weight loss in primary care.

PURPOSE: Motivational interviewing (MI) weight-loss interventions have garnered much attention, particularly in primary care. Few studies, however, have examined long-term outcomes of MI for weight loss in primary care. This study sought to examine the longer-term outcomes of a combination approach comprising MI and nutrition psychoeducation (MINP) with a publically available web-support component (i.e., livestrong.com). METHODS: Thirty-one adults with overweight/obesity were enrolled in a 3-month MINP treatment delivered in primary care by medical assistants. Weight, blood pressure, and depression (beck depression inventory) were assessed at baseline and 1-year following treatment cessation (i.e., 15 months total). RESULTS: Participants' average BMI was significantly lower 12-months following treatment. Approximately one-third of participants (34.8%) maintained 5% or more weight loss. Participants also experienced significant decreases in diastolic blood pressure, resting heart rate, and depression symptoms, but not systolic blood pressure or waist circumference. CONCLUSION: The scalable (2.5 h total) MINP intervention delivered in primary care by medical assistants resulted in significant weight (medium effect size) and psychological improvements 12 months later. These findings complement previous RCT findings that MI or nutrition psychoeducation interventions, delivered separately, resulted in small weight loss effects after 12 months, with 5% and 17% of participants, respectively, maintaining 5% weight loss. It remains unclear, however, if implementing MI in primary care for weight loss is cost effective beyond providing nutrition psychoeducation alone. CLINICAL TRIAL REGISTRATION: The clinical trial registration number is NCT02578199. LEVEL OF EVIDENCE: IV, uncontrolled trial.

Characterizing emotional overeating among patients with and without binge-eating disorder in primary care.

OBJECTIVE: Emotional overeating and loss-of-control eating are associated with poorer weight-related and psychiatric outcomes, yet our understanding of the relationship between these variables is limited, particularly among individuals in primary care. This study examined the frequency of emotional overeating and relationship with loss-of-control eating among patients with and without binge-eating disorder (BED) seeking weight loss treatment in primary care. METHOD: Participants were 131 adults (n = 105 female) with overweight/obesity seeking weight loss treatment in primary care. Participants completed the Eating Disorder Examination (semi-structured interview) and Yale Emotional Overeating Scale, which measures emotional overeating episodes. Height and weight were measured. Mean age and BMI were 47.60 years and 35.31 kg/m2, respectively. BED criteria were met by n = 35 (26.7%) participants. RESULTS: Participants with BED endorsed more frequent emotional overeating episodes compared to those without BED. While total emotional overeating scores were not associated with loss-of-control eating, discrete types of emotional overeating episodes (e.g., loneliness) were associated with loss-of-control eating. Emotional overeating was most often reported in response to loneliness, boredom, or anxiety, which varied by BED status. CONCLUSIONS: Most participants endorsed recent episodes of emotional overeating; those with BED endorsed more frequent episodes. Future research examining the impact of emotional overeating on weight loss treatment outcomes is warranted.

Loss-of-control eating after bariatric/sleeve gastrectomy surgery: Similar to binge-eating disorder despite differences in quantities.

OBJECTIVE: To characterize loss-of-control eating following sleeve gastrectomy surgery by comparing relevant patient groups. METHOD: Participants were 431 adults seeking treatment for eating/weight concerns categorized into one of four groups: 1) overweight/obesity (OW/OB), 2) binge-eating disorder (BED), 3) "Bariatric Binge-Eating Disorder" (Bar-BED) defined as meeting all criteria for DSM-5 binge-eating disorder, except for the requirement of an unusually large amount of food, following sleeve gastrectomy surgery, and 4) "Bariatric Loss-of-Control Eating" (Bar-LOC Only), defined as experiencing at least once weekly loss-of-control eating episodes during the past month without the other associated clinical features and distress that characterize Bar-BED, following sleeve gastrectomy surgery. RESULTS: The Bar-BED and BED groups reported comparable levels of overall eating-disorder and depressive symptoms, and these levels were significantly higher than those levels reported by the OW/OB and Bar-LOC Only groups. Adjusting for age, body mass index, and race did not change the overall pattern of findings. CONCLUSION: "Bariatric Binge-Eating Disorder" shares clinical features of DSM-5 binge-eating disorder, regardless of the quantity of food consumed. Careful assessment of loss-of-control eating, associated behavioral features, and distress is warranted following surgery. More broadly, our findings highlight the importance of assessing loss-of-control eating across patient groups with obesity.

Early weight loss predicts weight loss treatment response regardless of binge-eating disorder status and pretreatment weight change.

OBJECTIVE: Individuals seeking weight loss treatment have diverse pretreatment weight trajectories, and once enrolled, individuals' response to weight loss treatments also varies greatly and may be influenced by the presence of binge-eating disorder (BED). Reported average weight losses may obscure these considerable differences. This study examined whether BED status and different weight-related change variables are associated with successful weight loss treatment outcomes in a controlled treatment study. METHOD: Participants (N = 89) with overweight/obesity, with and without BED, participated in a 3-month weight loss trial in primary care with 3- and 12-month follow-ups. We tested the prognostic significance of four weight-related change variables (the last supper, early weight loss, pretreatment weight trajectory, weight suppression) on outcomes (weight loss-overall, weight loss-"subsequent," weight loss during second half of treatment). RESULTS: Early weight loss was positively associated with weight loss-overall at post-treatment, and at 3-month and 12-month follow-up. Early weight loss was positively associated with weight loss-subsequent at post-treatment only. No other weight-related variables were significantly associated with weight loss. Models including BED status and treatment condition were not significant. DISCUSSION: Participants with early weight loss were more likely to continue losing weight, regardless of BED status or treatment condition. The results highlight the importance of early dedication to weight loss treatment to increase the likelihood of positive outcomes.

Examining motivational interviewing plus nutrition psychoeducation for weight loss in primary care.

OBJECTIVE: Our previous randomized controlled trial found that nutrition psychoeducation (NP), an attention-control condition, produced statistically significantly more weight loss than usual care (UC), whereas motivational interviewing (MI) did not. NP, MI, and UC resulted in medium-large, medium, and negligible effects on weight loss, respectively. To examine whether weight loss could be further improved by combining MI and NP, the current study evaluated the scalable combination (MINP) with accessible web-based materials. METHODS: 31 adults with overweight/obesity, with and without binge-eating disorder (BED), were enrolled in the 3-month MINP treatment in primary care. Participants were assessed at baseline, post, and 3-month follow-up. Mixed-model analyses examined MINP effects over time and the prognostic significance of BED. RESULTS: Mixed-model analyses revealed that percentage weight loss was statistically significant at post and 3-month follow-up; d'=0.59 and 0.53, respectively. BED status did not predict or moderate weight loss. Twenty-one percent (6 of 28) and 26% (7 of 27) of participants attained 5% weight loss by post-treatment and 3-month follow-up, respectively. Participants with BED had statistically significantly greater improvements in disordered eating and depression (in addition to binge-eating reductions) compared to those without BED. CONCLUSION: MINP resulted in weight and psychological improvements at post-treatment and through 3-months after treatment completion. There did not appear to be additional benefits to combining basic nutrition information with MI when compared to the previous randomized controlled trial testing nutrition psychoeducation alone. CLINICAL TRIAL REGISTRATION: NCT02578199.

Back to Basics? No Weight Loss from Motivational Interviewing Compared to Nutrition Psychoeducation at One-Year Follow-Up.

OBJECTIVE: Weight loss interventions have begun to receive increasing attention in primary care. Motivational interviewing (MI) is compatible with primary care because it requires relatively limited time and resources. Few studies, however, have examined the long-term impact of MI for weight loss in primary care, and none have used attention-control comparisons. This study was the first randomized controlled trial with a 12-month follow-up of two Web-supported interventions: motivational interviewing and internet condition (MIC) and nutrition psychoeducation and internet condition (NPC). METHODS: Fifty-nine patients with overweight or obesity, with and without binge-eating disorder (BED), were randomized to treatments and assessed at 12-month follow-up after completing 3-month treatments in primary care (15 months total). RESULTS: Mixed models examining weight loss at 12 months revealed a group and time interaction effect trend (P = 0.054; d' = 0.57). Secondary end point analysis showed a decrease (-1.7%) versus an increase (1.3%) in weight at 12 months among NPC and MIC patients, respectively (P = 0.056; d' = 0.57). Overall, 5 of 44 (11.4%) participants lost or maintained 5% weight losses; differences between treatments were not significant. BED status did not impact weight loss. CONCLUSIONS: Two brief and scalable weight loss interventions resulted in small effect sizes for weight loss 12 months following treatment conclusion. Because MIC required significantly more resources for adequate implementation, NPC may be more cost-effective.

Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder.

Motivational interviewing (MI) treatment for weight loss is being studied in primary care. The effect of such interventions on metabolic syndrome or binge eating disorder (BED), both highly related to excess weight, has not been examined in primary care. This study conducted secondary analyses from a randomized controlled trial to test the impact of MI for weight loss in primary care on metabolic syndrome. 74 adult participants with overweight/obesity recruited through primary care were randomized to 12weeks of either MI, an attentional control, or usual care. Participants completed measurements for metabolic syndrome at pre- and post-treatment. There were no statistically significant differences in metabolic syndrome rates at pre-, X2(2)=0.16, p=0.921, or post-, X2(2)=0.852, p=0.653 treatment. The rates in metabolic syndrome, however, decreased for MI (10.2%) and attentional control (13.8%) participants, but not for usual care. At baseline, metabolic syndrome rates did not differ significantly between participants with BED or without BED across treatments. At post-treatment, participants with BED were significantly more likely to meet criteria for metabolic syndrome than participants without BED, X2(1)=5.145, p=0.023, phi=0.273. Across treatments, metabolic syndrome remitted for almost a quarter of participants without BED (23.1%) but for 0% of those with BED. These preliminary results are based on a small sample and should be interpreted with caution, but they are the first to suggest that relatively low intensity MI weight loss interventions in primary care may decrease metabolic syndrome rates but not for individuals with BED.

Loss-of-control eating following sleeve gastrectomy surgery.

BACKGROUND: Postoperative loss-of-control (LOC) eating is related to poorer weight loss outcomes after bariatric surgery, but little is known about LOC eating after sleeve gastrectomy surgery. OBJECTIVES: To examine LOC eating severity and weight loss after sleeve gastrectomy SETTING: University School of Medicine, United States METHODS: Participants were 71 individuals (84.5% female; n = 60) who underwent sleeve gastrectomy surgery within the previous 4 to 9 months and reported LOC eating at least once weekly during the previous 28 days. LOC eating was assessed using the Eating Disorder Examination (EDE) Bariatric Surgery Version. Current mean age and body mass index were 47.3 (SD = 10.1) years and 37.9 (SD = 8.2) kg/m2. Two groups, bariatric binge-eating disorder (Bar-BED) and loss-of-control eating only (LOC-only), were created based on modified binge-eating disorder (BED) criteria, which excluded the "unusually large quantity of food" criterion due to limited gastric capacity postsurgery. Bar-BED criteria mirrored BED criteria and consisted of the following: at least 12 LOC eating episodes over the prior 3 months (once weekly), 3 of 5 associated symptoms, marked distress over LOC eating, and lack of regular compensatory behaviors. RESULTS: Based on these revised criteria, 49.3% (n = 35) were classified as the Bar-BED group and 50.7% (n = 36) as the LOC-only group. Compared with the LOC-only group, the Bar-BED group had significantly greater EDE global and subscale scores and lower percent weight loss by 6 months postsurgery. CONCLUSION: Findings suggest LOC eating that parallels BED postsurgery is associated with poorer outcomes after sleeve gastrectomy including poorer weight loss and greater severity of eating-disorder psychopathology.

Preferred descriptions for loss of control while eating and weight among patients with binge eating disorder.

Patients with binge eating disorder (BED) typically also have excess weight, making them vulnerable to stigmatizing attitudes about mental illness and obesity. Further, one of the diagnostic features of BED is experiencing a loss of control during binge eating episodes. It is possible that patients feel negatively judged when clinicians assess for loss of control as it may activate stereotypes of patients with obesity lacking willpower. We developed a questionnaire to assess preferences for common loss of control descriptions and gathered data on preferences for weight-related terms among 46 patients with BED. Analyses revealed the majority of common descriptors for loss of control eating were viewed neutrally, with loss of control being the most preferred term. Descriptions suggesting patients were addicted to food or did not consider stopping eating once they started binge eating were viewed negatively. The following weight descriptions were viewed negatively: heaviness, large size, obesity, excess fat, and fatness. Terms such as BMI, and unhealthy body weight or BMI were viewed more favorably and weight was the most preferred term. These findings provide empirical support for healthcare providers' use of terms to use and terms to avoid when talking to patients with BED about eating and weight.