A naturalistic examination of feeling fat: Characteristics, predictors, and the relationship with eating disorder behaviors.

OBJECTIVE: Although literature implicates feeling fat in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa, binge-ED), research in this area is small, nascent, and relies on retrospective self-report. The current study sought to understand the temporal pattern of feeling fat and its role as a precipitant and consequence of ED behaviors. METHODS: Totally 106 treatment-seeking adults with binge-spectrum EDs completed 7-14-day ecological momentary assessments. They rated feeling fat, negative affect states, and reported on ED behaviors six times per day. Multilevel models evaluated whether feeling fat mediates prospective links between negative affect states and ED behaviors, assessed if negative affect states mediate the prospective association of feeling fat on ED behaviors, and examined the bidirectional prospective association between feeling fat and ED behaviors. RESULTS: Feeling fat was highest in the early morning (6-8:59 a.m.). Individuals with binge-ED-spectrum EDs demonstrated greater variability in feeling fat than those with bulimia nervosa-spectrum EDs who had stable and high levels of feeling fat. Guilt, sadness, anxiety, and the overall NA at Time 2 mediated the prospective associations between at Time 1 feeling fat and Time 3 dietary restraint, actual dietary restriction, and compensatory exercise. There was a bidirectional prospective association between feeling fat and binge eating. DISCUSSION: Feeling fat serves as a proximal predictor and mediator of the prospective association between guilt and binge eating. Feeling fat and binge eating mutually reinforce each other. PUBLIC SIGNIFICANCE: Little is understood regarding the experience of feeling fat in natural environments among individuals with binge-spectrum eating disorders. We found that the risk for having the experience of feeling fat is high in the morning and evening. Feeling fat triggers guilt, anxiety, and sadness which in turn, increases engagement in dietary restraint/restriction and compensatory exercise. Feeling fat also triggers binge eating, and binge eating leads to feelings of fatness.

A preliminary study of latent trajectories of change in dietary restraint during CBT-E for bulimia-spectrum eating disorders and their associations with treatment response.

OBJECTIVE: Dietary restraint is a primary target of CBT-E. However, little research has examined how specific types of dietary restraint change during CBT-E for bulimia-spectrum eating disorders (BN-EDs) or the association between changes in dietary restraint and treatment response. This study examined latent trajectories of change in eating enough, eating a range of macronutrients, and following dietary rules during CBT-E for BN-EDs and the relationships between these trajectories and pre- to post-treatment change in BN symptoms and remission. METHOD: Participants were 56 adults with BN-EDs who received 16 sessions of CBT-E and completed the Eating Disorder Examination and ecological momentary assessments (EMA) of eating behaviors and BN symptoms. Latent growth mixture modeling identified trajectories of change in dietary restraint, which were compared on pre- to post-treatment BN symptom change and remission. RESULTS: Three trajectories of change were identified for eating enough, eating a range of macronutrients, and food rules. Trajectories of change in eating enough were differentially associated with pre- to post-treatment change in BN symptoms, and trajectories of change in eating a range of macronutrients and food rules were differentially associated with remission. CONCLUSIONS: CBT-E yields heterogeneous trajectories of change in dietary restraint, which are associated with treatment response.

Cannabis use and binge eating: Examining the relationship between cannabis use and clinical severity among adults with binge eating.

Cannabis use is prevalent among individuals with binge eating (BE; i.e., the inability to control eating behavior). Yet, only two studies to date (both over 20 years old) have tested if cannabis use relates to clinical severity among BE samples. Characterizing the relationship between cannabis use, eating disorder (ED) severity, and other psychiatric symptoms in BE samples is necessary for informing screening and clinical recommendations. The present study characterized cannabis use among adults with BE and tested between-group and within-group relationships between cannabis use and eating disorder symptoms, alcohol consumption and symptoms, and depression symptoms. Participants (N = 165) were treatment-seeking adults with at least once weekly BE in the past 3 months who completed clinical interviews and self-report measures before treatment. Over 23% of participants reported cannabis use in the past 3 months, with most persons using cannabis reported using "once or twice" or "monthly." Most persons using cannabis reported cannabis-related symptoms. Persons using cannabis reported significantly greater alcohol consumption and were more likely to report alcohol-related symptoms compared to persons not using cannabis. No associations were observed between cannabis use, eating disorder symptoms, and depressions symptoms. These findings indicate that a notable subset of patients with BE use cannabis and experience cannabis-related problems, and that cannabis and alcohol use may be related for these individuals. Considering legal and sociocultural shifts in cannabis availability and prevalence, results from the present study support screening for cannabis and alcohol use patterns in patients with BE. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Working out measurement overlap in the assessment of maladaptive exercise.

OBJECTIVE: Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. METHOD: We used a Jaccard Index to quantify content overlap among 15 commonly-used self-report instruments measuring maladaptive exercise, with 31 features identified across 224 items. RESULTS: The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. CONCLUSIONS: Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. PUBLIC SIGNIFICANCE: Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self-report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research.

Attachment-Based Family Therapy to Improve Family Functioning in Adolescent Binge-Spectrum Eating Disorders: An Initial Evaluation Via Case Series Design.

Binge-spectrum eating disorders (EDs; bulimia nervosa, binge eating disorder) often develop during adolescence and are associated with serious psychological and physical consequences. Current treatments for adolescents are highly behavioral in nature and while efficacious, many patients do not reach remission indicating that current treatments fail to target a key maintenance factor for EDs. One potential maintenance factor is poor family functioning (FF). In particular, high family conflict (e.g., arguing, critical comments) and low family cohesion (e.g., warmth, support) are known to maintain ED behaviors. Poor FF can (1) cause or exacerbate an adolescent's use of ED behaviors to cope with life stress and/or (2) inhibit parents from being a resource to adolescents during ED treatment. Attachment-Based Family Therapy (ABFT) is specifically designed to improve FF, and thus may be a promising adjunct to behavioral ED intervention strategies. ABFT, however, has not been tested in adolescents with binge-spectrum EDs. Thus, the current study is the first to evaluate a 16-week adapted ABFT treatment for adolescents with EDs (N = 8, Mage = 16.00, 71.43% female, 71.43% White) fusing together behavioral treatment for EDs with ABFT for highest possible impact. Eight families were treated in an open pilot trial to examine treatment feasibility, acceptability, and preliminary efficacy on FF and eating pathology. Overall, findings were promising. ABFT + B treatment was feasible and acceptable and showed preliminary evidence that it could improve FF and ED behaviors. Future research will test this intervention in a larger sample and further examine the role of FF in maintaining ED symptoms.

Subtypes of exercise are differentially associated with baseline eating disorder pathology and treatment outcome among individuals with bulimia nervosa.

OBJECTIVE: Individuals with bulimia nervosa (BN) engage in both maladaptive (i.e., compulsive and/or compensatory) and adaptive exercise (e.g., for enjoyment). No research has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting intervention efficacy. METHOD: We examined associations of baseline exercise engagement with baseline and posttreatment BN pathology among 106 treatment-seeking adults (Mage = 37.4, SDage = 12.95, 87.74% female, 68.87% White) enrolled across four clinical trials of outpatient enhanced cognitive behavioral therapy for BN (range: 12-16 sessions). Analysis of covariances examined associations between baseline exercise type and baseline/posttreatment global eating pathology, dietary restraint, loss-of-control (LOC) eating, and purging frequency. RESULTS: Those engaging in only adaptive exercise reported lower global eating pathology compared to those engaging in compulsive-only exercise (Est = -1.493, p = .014, Mdiff = -.97) while those engaging in baseline compulsive exercise reported less LOC eating compared to those not engaging in exercise (Est = -22.42, p = .012, Mdiff = -12.50). Baseline engagement in compulsive-only exercise was associated with lower posttreatment global eating pathology compared to baseline engagement in no exercise (Est = -.856, p = .023, Mdiff = -.64) and both compulsive and compensatory exercise (Est = .895, p = .026, Mdiff = -1.08). DISCUSSION: Those engaging in compulsive, compensatory, adaptive, and no exercise exhibit different patterns and severity of BN pathology. Future research is needed to position treatments to intervene on maladaptive, while still promoting adaptive, exercise. PUBLIC SIGNIFICANCE STATEMENT: No research to date has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting targeted intervention efforts. We found that those engaging in compulsive, compensatory, and adaptive exercise exhibit different patterns of BN pathology and that adaptive exercise engagement was related to lower cognitive eating disorder symptoms at baseline.

The Assessment of Post-COVID Fatigue and Its Relationship to the Severity and Duration of Acute COVID Illness.

Emerging data suggests that COVID-19 is associated with fatigue well beyond the acute illness period. The present analysis aimed to: (1) characterize the prevalence and incidence of high fatigue at baseline and follow-up; (2) examine the impact of COVID-19 diagnosis on fatigue level following acute illness; and (3) examine the impact of acute COVID-19 symptom severity and duration on fatigue at follow-up. Subjects (n = 1417; 81.0% female; 83.3% White; X¯age = 43.6 years) completed the PROMIS-Fatigue during the initial wave of the pandemic at baseline (April-June 2020) and 9-month follow-up (January-March 2021). A generalized linear model (binomial distribution) was used to examine whether COVID-19 positivity, severity, and duration were associated with higher fatigue level at follow-up. Prevalence of high fatigue at baseline was 21.88% and 22.16% at follow-up, with 8.12% new cases at follow-up. Testing positive for COVID-19 was significantly associated with higher fatigue at follow-up. COVID-19 symptom duration and severity were significantly associated with increased fatigue at follow-up. COVID-19 symptom duration and severity during acute illness may precipitate longer-term fatigue, which could have implications for treatment planning and future research. Future studies should further evaluate the relationship between symptom severity, duration, and fatigue.

Behavioral weight loss outcomes in individuals with binge-eating disorder: A meta-analysis.

OBJECTIVE: Binge-eating disorder (BED) is highly comorbid with obesity. Weight loss may benefit individuals with BED; however, these individuals are often excluded from behavioral weight loss interventions (BWLIs), and findings from BWLIs including participants with and without BED are mixed. To the authors' knowledge, this study represents the first meta-analysis of weight loss outcomes of individuals with and without BED in BWLIs, while adjusting for weight-influencing variables. Treatment dropout rates were also examined. METHODS: Electronic search engines and grey literature search methods were used to identify manuscripts published through December 2022 related to BWLIs and BED. Thirty manuscripts (BED n = 1519; 25 non-BED n = 6345) were included. RESULTS: A meta-regression found that individuals with BED lost less weight compared with individuals without BED (~1.4 kg; ~2.9 kg among studies without meal replacements), but they still lost ~8.1 kg at post-treatment. A random-effects model showed that BED diagnosis increased odds of treatment dropout by 50%. CONCLUSIONS: BWLIs produced robust weight loss in those with BED, but those with BED lost less weight and had higher risk of dropout compared with those without. Future research should aim to close the gap in weight loss outcomes and retention between those with and without BED.

Affective profiles of exercise episodes are associated with maladaptive and adaptive motivations for exercise.

OBJECTIVE: Maladaptive exercise (i.e., driven and/or compensatory exercise) is common in binge-spectrum eating disorders (EDs; e.g., bulimia nervosa, binge ED) and associated with adverse treatment outcomes. Alternatively, individuals with EDs are often also engaging in adaptive exercise (e.g., for enjoyment or health improvement), and increasing adaptive exercise may decrease ED symptoms. The current study aimed to understand which exercise episodes are likely to be maladaptive/adaptive so that interventions can appropriately decrease/increase maladaptive and adaptive exercise. METHOD: We used latent profile analysis (LPA) to identify pre-exercise affective profiles of 661 exercise episodes among 84 individuals with binge-spectrum EDs and examined associations between LPA-identified profiles and subsequent exercise motivations using ecological momentary assessment. RESULTS: A two-profile solution best fit our data: Profile 1 (n = 174), 'positive affectivity,' and Profile 2 (n = 487), 'negative affectivity.' Episodes in the 'negative affectivity' profile were more likely to be endorsed as both driven and intended to influence body shape/weight. Episodes in the 'positive affectivity' profile were more likely to be endorsed as exercising for enjoyment. CONCLUSIONS: Results support two phenotypes of exercise episodes, and differential associations of these phenotypes with adaptive and maladaptive motivations for exercise.

Using Wearable Passive Sensing to Predict Binge Eating in Response to Negative Affect Among Individuals With Transdiagnostic Binge Eating: Protocol for an Observational Study.

BACKGROUND: Binge eating (BE), characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. Negative affect is a well-established antecedent for BE. The affect regulation model of BE posits that elevated negative affect increases momentary risk for BE, as engaging in BE alleviates negative affect and reinforces the behavior. The eating disorder field's capacity to identify moments of elevated negative affect, and thus BE risk, has exclusively relied on ecological momentary assessment (EMA). EMA involves the completion of surveys in real time on one's smartphone to report behavioral, cognitive, and emotional symptoms throughout the day. Although EMA provides ecologically valid information, EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal including heart rate, heart rate variability, and electrodermal activity may augment EMA surveys to improve accurate real-time prediction of BE. These sensors can objectively and continuously measure biomarkers of nervous system arousal that coincide with affect, thus allowing them to measure affective trajectories on a continuous timescale, detect changes in negative affect before the individual is consciously aware of them, and reduce user burden to improve data completeness. However, it is unknown whether sensor features can distinguish between positive and negative affect states, given that physiological arousal may occur during both negative and positive affect states. OBJECTIVE: The aims of this study are (1) to test the hypothesis that sensor features will distinguish positive and negative affect states in individuals with BE with >60% accuracy and (2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect to predict the occurrence of BE will predict BE with greater accuracy than an algorithm using EMA-reported negative affect alone. METHODS: This study will recruit 30 individuals with BE who will wear Fitbit Sense 2 wristbands to passively measure heart rate and electrodermal activity and report affect and BE on EMA surveys for 4 weeks. Machine learning algorithms will be developed using sensor data to distinguish instances of high positive and high negative affect (aim 1) and to predict engagement in BE (aim 2). RESULTS: This project will be funded from November 2022 to October 2024. Recruitment efforts will be conducted from January 2023 through March 2024. Data collection is anticipated to be completed in May 2024. CONCLUSIONS: This study is anticipated to provide new insight into the relationship between negative affect and BE by integrating wearable sensor data to measure affective arousal. The findings from this study may set the stage for future development of more effective digital ecological momentary interventions for BE. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47098.

Does virtual reality enhance the effects of inhibitory control training for loss-of-control eating? A pilot factorial experiment.

Inhibitory control, one's ability to inhibit automatic responses to desirable stimuli, may be inadequately targeted in interventions for loss-of-control eating (LOC). Promising evidence has identified inhibitory control trainings (ICTs) as an avenue to target inhibitory control directly; however, effects of ICTs on real-world behavior are limited. Compared to typical computerized trainings, virtual reality (VR) presents several potential advantages that may address key shortcomings of traditional ICTs, i.e. poor approximation to everyday life. The present study utilized a 2 × 2 factorial design of treatment type (ICT vs sham) by treatment modality (VR vs standard computer), which allows for increased statistical power by collapsing across conditions. Our primary aim was to examine the feasibility and acceptability of six weeks of daily training among groups. A secondary aim was to preliminarily assess main and interactive effects of treatment type and modality on target engagement and efficacy (i.e., training compliance, change in LOC episodes, inhibitory control, and implicit liking of foods). Participants (N = 35) with ≥1×/weekly LOC were assigned to one of four conditions and completed ICTs daily for six weeks. The trainings were feasible and acceptable, evinced by high retention and compliance across time and condition. Although completing daily trainings across treatment types and modalities was associated with large decreases in LOC, there were no meaningful effects of either treatment type or modality, nor a significant interaction effect, on LOC or mechanistic variables. Future research should aim to increase the efficacy of ICT (both standard and VR-based) and test in fully-powered clinical trials.

Change in adaptive and maladaptive exercise and objective physical activity throughout CBT for individuals with eating disorders.

Maladaptive exercise (i.e., exercise that compensates for binge eating or is used to avoid negative consequences of not exercising-like weight gain) is a common eating disorder (ED) behavior, yet, some individuals with EDs only engage in adaptive exercise. CBT for EDs targets reducing maladaptive exercise but does not address adaptive exercise. Thus, research is limited on how adaptive and maladaptive exercise are impacted during CBT for EDs. The current study examined how assessor-rated adaptive and maladaptive exercise and objectively measured physical activity changed over a 12-week CBT treatment among adults with transdiagnostic binge eating and restrictive eating that did and did not engage in maladaptive exercise at the start of treatment (n = 13 non-maladaptive exercise group, n = 17 maladaptive exercise group). The overall amount of adaptive and maladaptive exercise was measured via the Eating Disorder Examination Interview and objectively measured physical activity (e.g., step count, minutes of moderate-to-vigorous physical activity [MVPA]) was measured via a wrist-worn fitness tracker. Throughout treatment, the overall amount of adaptive exercise did not significantly change for both groups, but the overall amount of maladaptive exercise significantly decreased in the maladaptive exercise group. Step count did not significantly change for both groups, but minutes of MVPA significantly increased over treatment for the non-maladaptive exercise group. Increases in step count and minutes of MVPA were not associated with ED symptom changes in either group. These results enhance an understanding of exercise changes during transdiagnostic CBT-based ED treatment for individuals with varying baseline exercise profiles.Level of evidence: Level 1, randomized controlled trial.

Fear of weight gain during cognitive behavioral therapy for binge-spectrum eating disorders.

PURPOSE: Fear of weight gain may play a central role in maintaining eating disorders (EDs), but research on the role of fear of weight gain during cognitive behavioral therapy (CBT-E) for binge-spectrum EDs is sparse. We examined changes in fear of weight gain during CBT-E for binge-spectrum EDs. We investigated whether fear of weight gain predicted loss of control (LOC) eating or weight change. METHODS: Participants (N = 63) were adults of any gender recruited as part of a larger trial. Participants received 12 sessions of CBT-E, completed diagnostic assessments at pre-, mid-, and post-treatment, and completed brief surveys before sessions. RESULTS: Fear of weight gain decreased across treatment, moderated by diagnosis. Those with bulimia nervosa spectrum EDs (BN-spectrum), compared to binge eating disorder, reported higher fear of weight gain at baseline and experienced a larger decrease in fear across treatment. Those reporting higher fear of weight gain at a given session experienced more frequent LOC episodes the following week. Fear of weight gain was not associated with session-by-session changes in BMI. CONCLUSION: CBT-E results in decreases in fear of weight gain, but levels remain high at post-treatment, especially for those with BN-spectrum EDs. Future interventions should consider targeting fear of weight gain as a maintaining factor for LOC episodes TRIAL REGISTRATION: NCT04076553. LEVEL OF EVIDENCE: Level II controlled trial without randomization.

Divergent trajectories of positive affect following maladaptive and non-maladaptive exercise among individuals with binge-spectrum eating disorders.

OBJECTIVE: Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology. Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with binge episodes and poor body image. However, no research has considered the presence of non-maladaptive exercise or evaluated this theory in binge-spectrum EDs. METHODS: This study evaluated affective trajectories pre- and post-exercise and examined exercise type (maladaptive or non-maladaptive) as a moderator. We recruited adults with binge-spectrum EDs (N = 107; n = 84 endorsed exercise) to complete a 7- to 14-day ecological momentary assessment protocol assessing NA (anxiety, guilt, and sadness), PA (excitement and cheerfulness), and exercise. RESULTS: There was a significant quadratic trajectory of PA pre-exercise, suggesting that the upward trajectory of PA leveled out as it moved closer to an exercise episode. Exercise type significantly moderated the cubic trajectory of PA post-exercise, such that the upward trajectory of PA accelerated in the hours following non-maladaptive exercise episodes while the downward trajectory of PA accelerated in the hours following maladaptive exercise episodes. No trajectories of NA demonstrated significant effects. CONCLUSIONS: Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA. Future research should evaluate when, and for whom, exercise serves to regulate affect and examine other momentary risk factors of exercise in EDs. PUBLIC SIGNIFICANCE: Individuals with EDs often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating). Maladaptive exercise has been theorized to help individuals with EDs regulate emotions. This study evaluated affective trajectories pre- and post-exercise and examined whether exercise type (maladaptive or non-maladaptive) changed these trajectories. Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA.

Differentiating types of dietary restraint and their momentary relations with loss-of-control eating.

OBJECTIVE: Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary restraint results in successful dietary restriction, or which types of restraint/restriction confer highest risk for LOC eating. Furthermore, little research has evaluated momentary, temporal associations between dietary restraint and LOC eating. Thus, the present study aimed to (1) characterize dietary restraint and restriction, among individuals with LOC eating, and (2) examine temporal relationships between restraint/restriction and LOC eating within- and between-subjects. METHOD: The current study recruited adults with binge spectrum EDs (n = 96, 80.4% female) to complete a 7-14-day ecological momentary assessment protocol assessing ED symptoms. Multilevel models and linear regression evaluated within- and between-subjects associations between momentary restraint/restriction and LOC eating, respectively. RESULTS: Attempted avoidance of enjoyable foods, limiting the amount eaten, and any restraint predicted greater likelihood of LOC eating at the next survey. Attempts to delay eating predicted reduced likelihood of LOC eating at the next survey, though this effect was no longer statistically significant after correcting for multiple comparisons. Diagnostic presentation moderated the association between attempted avoidance of enjoyable foods and LOC eating such that this association was significantly stronger for those on the BN-spectrum. DISCUSSION: Dietary restraint seems to be more predictive of LOC eating than dietary restriction both within- and between-subjects. Future treatments should target dietary restraint to reduce LOC eating. PUBLIC SIGNIFICANCE: Some research suggests that dietary restriction (i.e., reduced calorie intake) and restraint (i.e., attempted restriction) may not be linked to LOC eating in all contexts. We found that dietary restraint is more predictive of LOC eating than dietary restriction both within and between individuals. Future treatments should target dietary restraint to reduce LOC eating.

Latent profiles of dietary restraint among individuals with binge-spectrum eating disorders: Associations with eating disorder symptom severity.

OBJECTIVE: The relationship of dietary restraint in increasing risk for binge eating among individuals with binge-spectrum eating disorders (B-EDs) is well established. However, previous research has not yet identified whether these individuals exhibit heterogeneous profiles of dietary restraint and whether these profiles are associated with differences in eating pathology. METHODS: Individuals with B-EDs (N = 290) completed the Eating Disorder Examination. Latent profile analysis was conducted on dietary restraint frequency data, including restriction of overall amount of food consumed, avoidance of eating, desire for an empty stomach, food avoidance, and dietary rules. Identified latent profiles were compared on binge eating frequency, compensatory behaviors frequency, and ED pathology using the three-step procedure. RESULTS: A four-class model of dietary restraint best fit the data. Classes significantly differed in frequency of compensatory behaviors (F[3, 286] = 31.01, p < .001), EDE Eating Concern (F[3, 286] = 14.36, p < .001), EDE Shape Concern (F[3, 286] = 7.06, p < .001), EDE Weight Concern (F[3, 286] = 6.83, p < .001), and ED Pathology (F[3, 286] = 12.86, p < .001), but did not differ in frequency of objective (F[3, 286] = 2.45, p = .06) or subjective binge episodes (F[3, 286] = 1.87, p = .14). DISCUSSION: Individuals with B-EDs exhibit distinct profiles of dietary restraint, which are associated with frequency of compensatory behaviors and severity of ED pathology. PUBLIC SIGNIFICANCE STATEMENT: Individuals with binge-spectrum eating disorders have different patterns of restrictive eating symptoms. These profiles of restrictive eating behaviors are associated with differences in severity of compensatory behaviors and cognitive eating disorder symptoms, like shape and weight dissatisfaction. Understanding the relationships between profiles of restrictive eating behaviors and other eating disorder symptoms may allow for personalization of treatment and improvements in treatment efficacy.

Feasibility, Acceptability, and Preliminary Target Engagement of a Healthy Physical Activity Promotion Intervention for Bulimia Nervosa: Development and Evaluation via Case Series Design.

Bulimia nervosa (BN) is characterized by a pattern of binge eating and compensatory behaviors as well as an overemphasis on body weight and shape in self-evaluation. Although cognitive behavioral therapy (CBT) is efficacious, recent reviews suggest that only 30% of patients reach abstinence at posttreatment. One potential reason for these poor outcomes is that CBT fails to adequately reduce elevated negative affect (NA) and shape and weight concern, which have been shown to be correlated with poorer treatment outcomes in BN. Therefore, novel treatment components that focus on improving NA and shape and weight concern are needed in order to enhance outcomes. Promoting physical activity (PA) is a promising avenue through which to reduce NA and improve body image in healthy individuals, other clinical populations (e.g., individuals with depression or anxiety), and individuals with eating disorders. While prescribing PA for individuals with BN has been controversial (due to concerns that exercise maybe be used to compensate for binge episodes or become driven or compulsive), this approach may have many benefits, including promoting healthy lifetime exercise habits that reduce likelihood of relapse through the improvement of emotion regulation skills and weight regulation. Given the promise of PA for targeting key maintenance factors of BN, we developed a 12-session healthy PA promotion intervention for BN and tested initial feasibility, acceptability, and preliminary target engagement in an iterative case series design (n = 3). The treatment provided cognitive-behavioral skills designed to identify, practice, and achieve behavioral goals while asking patients to engage in up to 150 minutes of moderate-to-vigorous PA per week, which was preplanned during each session with the client's therapist. Results suggested that the healthy PA promotion intervention was both feasible and acceptable to deliver. In addition, the intervention resulted in a clinically significant decrease in BN symptom frequency in each participant. Further, participants showed clinically significant decreases in NA and shape and weight concern. The current study demonstrates that healthy PA interventions can have beneficial effects on BN symptoms, NA, and shape and weight concern. However, due to the small sample size, conclusions must be treated with caution. Future research should investigate additional approaches for promoting healthy PA and include a larger sample in order to further test initial efficacy of this treatment approach.

Perceived influence of wearable fitness trackers on eating disorder symptoms in a clinical transdiagnostic binge eating and restrictive eating sample.

Wearable fitness trackers are an increasingly popular tool for measuring physical activity (PA) due their accuracy and momentary data collection abilities. Despite the benefits of using wearable fitness trackers, there is limited research in the eating disorder (ED) field using wearable fitness trackers to measure PA in the context of EDs. Wearable fitness trackers are often underused in ED research because there is limited knowledge about whether wearable fitness trackers negatively or positively impact PA engagement and ED symptoms in individuals with EDs. The current study aimed to assess the perceived impact wearable fitness trackers have on PA engagement and ED symptoms over a 12-week CBT treatment for 30 individuals with binge eating and restrictive eating that presented to treatment engaging or not engaging in maladaptive exercise. Participants in the maladaptive exercise group (n = 17) and non-maladaptive exercise group (n = 13) wore a fitness tracker for 12 weeks and completed questionnaires assessing participants' perceptions of the fitness trackers' influence on ED symptoms and PA engagement throughout treatment. Results demonstrated a small percentage of individuals perceived the fitness tracker influenced ED behaviors or PA engagement, and there were mixed results on whether participants positively or negatively perceived the fitness tracker influenced them to engage in ED behaviors or PA engagement. Although preliminary, these results demonstrate the need to continue using objective measurements of PA via wearable fitness trackers to further our understanding of the positive and negative effects of fitness trackers on clinical ED samples.Level of Evidence: Level 1, randomized controlled trial.

An examination of daily sleep characteristics and subsequent eating disorder behavior among individuals with binge-spectrum eating disorders.

INTRODUCTION: Specific characteristics of sleep (e.g., duration, quality, and fatigue) are positively associated with (ED) behaviors, specifically binge eating (BE) potentially through decreased self-regulation and increased appetite. However, prior work has been largely cross-sectional and has not examined temporal relationships between sleep characteristics and next-day ED behaviors. Thus, the present study examined daily relationships between sleep and ED behaviors among individuals with binge-spectrum EDs. METHOD: Participants (N = 96) completed 7 daily ecological momentary assessment (EMA) surveys over 7-14 days; morning surveys assessed sleep characteristics and 6 randomly timed surveys each day captured ED behaviors. Analyses examined within-subject and between-subject effects of sleep quality, duration, and fatigue on BE, compensatory purging behaviors, and maladaptive exercise. RESULTS: Within-subject sleep quality was significantly negatively associated with engagement in maladaptive exercise later that day. Additionally, between-subject sleep duration was significantly negatively associated with engagement in compensatory purging behaviors. DISCUSSION: Within- and between-subjects associations between sleep quality and duration and compensatory behavior engagement indicate that sleep plays an important role in ED behaviors. Future research should incorporate sensor-based measurement of sleep and examine how specific facets of sleep impact BE and treatment response. LEVEL OF EVIDENCE: Level II: Evidence obtained from controlled trial without randomization.

Sensor technology in eating disorders research: A systematic review.

OBJECTIVE: Sensor technologies offer exciting potential to objectively measure psychopathological correlates of eating pathology and eating disorder (ED) research utilizing sensors has rapidly proliferated in the past several years. The aims of the present review are: (1) characterize the types of sensors that have been utilized in ED research, (2) identify the psychopathological factors relevant to EDs that have been assessed using sensors, (3) describe the data supporting the validity and reliability of these sensors, (4) discuss limitations associated with these sensors, and (5) identify gaps that persist within the ED literature with regard to use of sensor technologies. METHOD: A systematic search was conducted of PubMed, PsycINFO, Web of Science, ProQuest, and "gray" literature sources. Eligible publications were empirical studies that utilized sensors to measure at least one psychological variable among clinical ED populations. RESULTS: Sensors have been utilized with ED samples to measure eating behaviors, physical activity, sleep, autonomic nervous system activity, eyeblink startle response, visual attention, and visual-haptic object integration. The reliability and validity of these sensors varies widely and there are a number of significant gaps that remain in the literature with regard to the types of sensors utilized, context in which sensors have been used, and populations studied. DISCUSSION: The existing literature utilizing sensors within ED research largely support the feasibility and acceptability of these tools. Sensors should continue to be utilized within the field, with a specific focus on examining the reliability and validity of these tools within ED samples and increasing the diversity of samples studied. PUBLIC SIGNIFICANCE STATEMENT: Sensor technologies, such as those included in modern smartwatches, offer new opportunities to measure factors that may maintain or contribute to symptoms of eating disorders. This article describes the types of sensors that have been used in eating disorders research, challenges that may arise in using these sensors, and discusses new applications of these sensors that may be pursued in future research.