Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis.

BACKGROUND: Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. OBJECTIVE: This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. METHODS: A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. RESULTS: Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. CONCLUSIONS: There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. TRIAL REGISTRATION: PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060.

A systematic review and meta-analysis of loss-of-control eating in relation to cardiometabolic health components and inflammatory markers.

INTRODUCTION: Loss-of-control (LOC) eating, or the subjective experience of being unable to stop eating, is a hallmark feature of binge-eating episodes, which are also characterized by consuming an unusually large amount of food. However, regardless of the size of eating episode, LOC-eating may be a risk factor for adverse health outcomes. This systematic review and meta-analysis comprehensively examine the relationship of LOC-eating with cardiometabolic health components and inflammatory markers. METHODS: Search procedures were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines in six electronic databases. Studies of adult or youth samples published in English from the year 2000 onward were included. Given heterogeneity in age groups and adjustment for body mass index across studies, these factors were included as meta-regression moderators. RESULTS: Fifty-eight studies were identified through the literature search. Among individuals with (versus without) LOC-eating, relative risk ratios provided evidence of a greater relative risk for metabolic syndrome, hypertension, and dyslipidemia; standardized mean differences also provided evidence of higher waist circumference and impaired levels of fasting plasma glucose, high-density lipoprotein (HDL)-cholesterol, and triglycerides, but not blood pressure. Age group did not impact cardiometabolic health components. Body mass index differences moderated the effect on waist circumference. A narrative review of inflammatory markers revealed mixed findings linking inflammatory markers to LOC-eating. DISCUSSION: Overall, evidence for the relationship between LOC-eating and impaired cardiometabolic health underscores LOC-eating as an important early intervention target for prevention of serious adverse health outcomes.

Food Cue Reactivity Meets the Reinforcer Pathology Model: Behavioral Economic Measures of Cue-Induced Changes in Food Reinforcer Efficacy.

Food cue reactivity, or behavioral sensitivity to conditioned food cues, is an eating pattern observed in those with obesity and binge-eating disorder. The reinforcer pathology model, which characterizes overconsumption of a reinforcer such as food may be relevant to food cue reactivity, especially in those with obesity and binge-eating disorder. The reinforcer pathology model posits that steep delay discounting (DD) and demand elasticity are processes involved in the overconsumption of food. Two of our recent studies examine the extent to which reactivity to conditioned food cues may be involved in food reinforcer pathologies. First, food cues were conditioned with Oreo cookies with binge-eating prone (BEP) and binge-eating resistant (BER) rats. Delay discounting was compared before and after conditioning. Food cues induced steeper DD for rats, though BEP rats showed some evidence for greater sensitivity to this effect than BER rats, albeit this difference was not significant. Second, healthy-weight humans and humans with overweight/obese BMI underwent conditioning of visual cues paired with M&M candies. After acquisition, cues induced greater demand intensity and inelasticity for food compared to baseline. Participants with overweight/obese BMI, compared to controls, also showed some evidence for greater sensitivity to this change ininelasticity compared to healthy-weight participants, but this difference was also not significant. Food cues, then, may induce changes in DD and economic demand, supporting the relevance of reinforcer pathologies.

Neural Responses to Auditory Food Stimuli Following Cognitive Behavioral Therapy for Binge-Eating Disorder.

OBJECTIVE: Adults with binge-eating disorder (BED), compared with those without BED, demonstrate higher blood-oxygen-level-dependent (BOLD) response to food cues in reward-related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge-eating cues following CBT versus wait-list control (WLC). METHOD: Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (fMRI) to measure BOLD response while listening to personalized scripts of binge-eating and neutral-relaxing cues. Data were analyzed using general linear models with mixed effects. RESULTS: Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge-eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge-eating stimuli during the fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward-based eating drive, disinhibition, and hunger as assessed by questionnaires (ps < 0.05). DISCUSSION: CBT was effective in reducing binge eating, but, contrary to our hypothesis, CBT did not improve BOLD response to auditory binge-eating stimuli in reward regions of the brain. Further studies are needed to assess mechanisms underlying improvements with CBT for BED. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03604172.

Sleep quality in eating disorders: A systematic review and meta-analysis.

Eating disorders (ED) are psychological disorders characterized by dangerous eating behaviours, including protracted fasting and binge eating. Mental disorders comorbidities (e.g., anxiety and depression), as well as sleep difficulties, are common and might interfere with treatment response. This work investigated sleep quality, circadian preferences, and sleep disorders in ED patients compared to healthy controls (HC) and the impact of ED treatment on patients' sleep. A literature search on Pubmed, Web of Science, Medline, and PsychInfo included 27 studies. Random effect analyses were performed (sample eating disorders = 711; sample healthy controls = 653) and subgroup analyses were calculated based on the ED subgroups: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder. Whole sample analyses showed poorer physiological and subjective sleep quality in patients. Subgroup analyses showed that poorer physiological sleep was present only in anorexia nervosa. Two studies reporting circadian preferences and sleep disorders showed higher evening preference in patients and no differences in apnea prevalence between patients and healthy controls, respectively. Some studies suggested that specialized eating disorder treatments (e.g., Cognitive Behavioural Therapy for ED) can improve sleep quality in patients. Although these findings highlight poorer sleep in patients with ED compared to healthy controls, the mechanisms underlying sleep alterations in eating disorders remain to be identified.

Integrating behavioral interventions into a holistic approach to metabolic dysfunction-associated steatotic liver disease.

INTRODUCTION: The therapeutic landscape of Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is rapidly evolving with the FDA approval of resmetirom, the first authorized molecule to treat metabolic dysfunction-associated steatohepatitis. Clinical trials are investigating other promising molecules. However, this focus on pharmacotherapy may overshadow lifestyle interventions, which remain the cornerstone of MASLD management. A significant percentage of patients with MASLD struggle with an underlying eating disorder, often a precursor to obesity. The obesity pandemic, exacerbated by the increasing prevalence of binge eating, underscores the need for a psychological approach to address their common roots. AREAS COVERED: We reviewed the current evidence on behavioral interventions for MASLD. Interventions such as self-monitoring, goal setting, and frequent counseling, have proven effective in achieving at least 5% weight loss. Cognitive behavioral therapy is the first-line treatment for eating disorders and has shown efficacy in treating binge eating and obesity. Further research is needed to establish the optimal behavioral therapy for MASLD, focusing on enhancing compliance and achieving sustained weight loss through diet and physical exercise. EXPERT OPINION: The treatment of MASLD should not rely solely on pharmacotherapy targeting a single-organ manifestation. Instead, we must consider behavioral interventions, emphasizing the pivotal role of a holistic approach to this multifaceted disorder. [Figure: see text].

Gender stereotypes in eating disorder recognition.

PURPOSE: Eating disorder (ED) awareness is low. We assessed if ED symptom recognition, perceived need for treatment, perceived distress, perceived acceptability, and perceived prevalence differed depending on the gender of the individual with the ED. METHODS: 276 community participants were randomly assigned to one of three gender conditions (female, male, and non-binary), read three vignettes describing three different individuals with ED symptoms [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)], and then answered a series of questions related to participants ED symptom recognition, perceived need for treatment, perceived distress associated with having ED symptoms, perceived acceptability (e.g., the extent to which it may not be too bad to have an ED), and perceived prevalence. Mixed ANOVAs and chi-square analyses were conducted to examine differences between groups. RESULTS: There were no significant main effects of gender condition across the outcome variables. There were main effects of ED type for problem recognition, perceived need for treatment, perceived level of distress, and perceived prevalence, with participants being more likely to recognize a problem in the AN and BN vignettes than the BED vignettes, refer for treatment and rate a higher perceived level of distress in then AN vignette than the BN and BED vignettes, and perceive a higher prevalence rate in the BN vignette than the AN vignette. There was a significant gender by condition interaction for perceived prevalence, with participants rating a higher prevalence of AN in women and non-binary individuals than men and a higher prevalence of BN in women than non-binary individuals and men. CONCLUSION: These results highlight the importance of education on EDs and awareness that EDs can occur in any individual, regardless of their gender identification. LEVEL OF EVIDENCE: Level I, experimental study with randomization.

Loneliness as a moderator of the association of affective symptoms and binge eating among college women.

Affective symptoms (e.g., depression, anxiety, shame) are a potent risk factor for binge eating. However, less is known on the role of loneliness as a moderator of affective symptoms and binge eating. This objective of the current study was to investigate main effects and interactions of affective symptoms and loneliness in relation to binge eating in college women. A sample of 556 undergraduate women completed self-report questionnaires of affective symptoms, loneliness, and binge eating. Results revealed significant interactions between each affective symptom variable and loneliness in relation to binge eating, such that loneliness strengthened the positive association of affective symptoms and greater binge eating. The findings of this study demonstrate an important role of loneliness to binge eating among college women, especially those with underlying affective vulnerabilities. More theoretical and treatment-oriented work on the role of loneliness in binge eating is needed to understand mechanisms and interventions/preventions.

Behaviourally assessed negative urgency is uniquely associated with binge-eating frequency.

OBJECTIVE: Binge eating appears to be associated with impulsivity, especially in response to negative affect (i.e., negative urgency). However, negative urgency is typically assessed via self-report, which captures only some aspects of urgency and may be subject to bias. Few studies have examined impulsivity following experimental manipulations of affect in binge-eating samples. METHOD: In the present study, individuals who engage in regular binge eating completed a behavioural impulsivity (go/no-go) task with high- and low-calorie food stimuli, once following negative affect induction and once following neutral affect induction. RESULTS: Greater behavioural impulsivity to high-calorie food cues while in a negative (and not a neutral) affective state was associated with more frequent binge-eating behaviour. Further, this behavioural measure of negative urgency uniquely accounted for variance in binge-eating frequency when controlling for self-reported negative urgency, suggesting that behavioural measures may be a useful complement to self-report measures. DISCUSSION: These findings provide novel and compelling evidence for the relationship between negative urgency and binge eating, highlighting negative urgency as a potentially important target for intervention.

Relationship of Genetic Polymorphisms and Microbial Composition with Binge Eating Disorder: A Systematic Review.

Humans are the result of an evolutionary process, and because of this, many biological processes are interconnected with each other. The intestine-brain axis consists of an intricately connected neuronal-neuroendocrine circuit that regulates the sensation of hunger and satiety. Genetic variations and the consumption of unnatural diets (ultra-processed foods, high contents of sugars, etc.) can override this circuit and cause addiction to certain foods and/or the inability to feel satiety in certain situations. The patients who come to consultations (mainly psychology or nutrition) in an attempt to resolve this problem sometimes fail, which leads to them looking for new strategies based on biological predisposition. This investigation aims to evaluate the genetic studies regarding the microbiota carried out in the last 12 years in humans to try to determine which genes and microbes that have been recently studied are related to patients diagnosed with binge eating disorder or compulsive eating (presenting obesity or not). The protocol followed the PRISMA statement, and the following databases were searched from 2012 until the present day: PubMed, PsycINFO, SCOPUS, and Web of Science. Twenty-four international articles were analyzed, including cross-sectional or exploratory studies; five of them referred to the microbial composition, and in nineteen, the existence of genetic polymorphisms present in binge eating disorder or in compulsive eating could be observed: DRD2, OPRM1, COMT, MC4R, BNDF, FTO, SLC6A3, GHRL, CARTPT, MCHR2, and LRP11. Even though there is still much to investigate on the subject, it must be highlighted that, in the last 4 years, a two-fold increase has been observed in potential markers and in studies related to the matter, also highlighting the importance of different analyses in relation to psychosocial factors and their interaction with the genetic and microbial factors, for which research on the matter must be continued.

An Efficient Combination Therapy with Lisdexamfetamine Dimesylate and Topiramate in Improving Binge Eating Scale & Metabolic Profile in Binge Eating Disorder: A Randomized Control Trial.

Objective: Comprehensive evaluation of lisedexamfetamine dimesylate (LDX) alone and in combination with topiramate (TPM) was done for treatment of binge eating disorder (BED) in adults aged 18-55 years. Methods: In the present randomized clinical trial study, 93 patients were selected by convenience sampling method and were allocated to two groups of 48 and 45 using the permuted block randomization method. This study was conducted from January to September 2022 in Shiraz, Iran. Patients received LDX (n = 48) or LDX plus TPM. Average dose of LDX was 37.5 mg/day and 38 mg/day in the first and second group respectively. The second group (n = 45) also received TPM with average dose of 77.7 mg/day. Results: Twelve weeks treatment caused significant higher mean reduction in level of triglyceride (73.68 vs. 58.97 respectively, p = 0.024), low density lipo-protein (LDL) (9.66 vs. 5.16 respectively, p < 0.001) and body mass index (5.48 vs. 3.41 respectively, p < 0.001) with TPM plus LDX and also greater significant improvement (p < 0.001) in binge eating scale compared to use of LDX alone. Combination therapy with TPM and LDX had better tolerability and lower adverse events such as insomnia (p < 0.001), paresthesia (p = 0.001), confusion (p = 0.035) and ataxia (p = 0.009) compared to monotherapy in BED. Conclusion: The combinative treatment was more effective than single drug in terms of higher tolerability, safety and causing lesser adverse events for BED patients. However, more studies with larger samples are needed.

Associations of Adult ADHD symptoms with binge eating spectrum conditions, psychiatric and somatic comorbidity, and healthcare utilization in a metropolitan Brazilian city.

OBJECTIVES: To investigate the associations among symptoms of attention deficit hyperactivity disorder (ADHD) with binge eating spectrum conditions - BESC - [binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE)], and psychiatric and somatic comorbidity and healthcare utilization in a representative sample of a Brazilian city. METHODS: A household survey with 2,297 adults and residents in Rio de Janeiro was conducted. The Adult Self-Rating Scale Screener was used to assess ADHD symptoms. BESC was assessed using the Questionnaire of Eating and Weight Patterns 5 and confirmed by telephone interview. Standardized questionnaires were used to assess psychiatric comorbidity. Close-ended questions investigated somatic comorbidity and healthcare utilization. RESULTS: ADHD symptoms were highly associated with BESC [BED, OR=13.2, 95%CI= 4.3-40.6; BN, OR=27.5, 95%CI= 5.9-128.7; RBE, OR=5.8, 95%CI= 2.9-11.4). However, with further adjustment for psychiatric comorbidity (depression, anxiety, alcohol use and impulsivity), the ORs were no longer significant. Healthcare resource utilization was significantly higher in participants with ADHD and BESC but lost significance after controlling for the psychiatric comorbidity. CONCLUSION: ADHD was associated with an increased prevalence of BESC, and healthcare utilization. Nonetheless, there was an essential interplay among psychiatric comorbidity in the associations of ADHD and BESC.

Testing "Feeling Fat" as a Mediator of the Longitudinal Relationship Between Negative Emotions and Eating Disorder Behaviors.

OBJECTIVE: Negative affect is central to eating disorder maintenance models; identifying mechanisms underlying this link may inform specific treatment targets. The current study evaluated which emotions (i.e., distress, fear, and moral emotions) were most strongly linked to feeling fat and tested feeling fat as a longitudinal mediator of the relationship between these emotions and restricting or binge eating (https://osf.io/3d5cq/). METHOD: Community adults (N = 714, M[SD] age = 41.5[13.7], 84.6% female, 85.9% white) provided data at baseline, 3-month, and 6-month follow-up. Relative weights analysis examined which emotion categories exhibited the strongest longitudinal relationships with feeling fat. Cross-lagged panel models tested feeling fat as a mediator of the relationship between emotions and eating disorder behaviors. RESULTS: Distress and moral emotions were the strongest emotional predictors of feeling fat. Feeling fat predicted binge eating (p's < 0.001), but not restricting (p's ≥ 0.832), in random effects cross-lagged panel models. Feeling fat partially mediated the longitudinal relationship between distress and binge eating (p = 0.044); however, this effect became nonsignificant after adjusting for BMI (p = 0.354). Feeling fat did not mediate relationships between moral emotions and binge eating or between either distress or moral emotions and restricting (p's ≥ 0.638). DISCUSSION: Feeling fat was associated with binge eating, not restricting, highlighting the importance of specificity in maintenance models. Because the mediating effect of feeling fat was accounted for by body size, factors associated with body size, such as internalized weight stigma, may be more relevant mediators of the relationship between negative emotions and eating disorder behaviors. Future research on feeling fat should adjust for body size.

Efficacy of Pharmacotherapies for Bulimia Nervosa: A Systematic Review and Meta-Analysis.

Objective: The main purpose was to evaluate the efficacy and tolerability of different medications used to treat bulimia nervosa (BN). Methods: Randomized controlled trials (RCTs) were identified from published sources through searches in PubMed, Cochrane Library, Web of Science, and Embase from inception to November 2022. Primary outcomes were changes in the frequency of binge eating episodes and vomiting episodes from baseline to endpoint. Secondary outcomes were differences in the improvement of scores in depressive symptoms, tolerability (dropout due to adverse events) and weight change. Results: The literature search ultimately included 11 drugs, 33 studies and 6 types of drugs, 8 trials with TCAs (imipra-mine, desipramine), 14 with SSRIs (fluoxetine, citalopram and fluvoxamine), 6 with MAOIs (phenelzine, moclobemide and brofaromine), 3 with antiepileptic drugs (topiramate), 1 with mood stabilizers (lithium), and 1 with amphetamine-type appetite suppressant (fenfluramine). The reduction in binge eating episodes was more likely due to these drugs than the placebo, and the SMD was -0.4 (95% CI -0.61 ∼ -0.19); the changes in the frequency of vomiting episodes (SMD = -0.16, 95% CI -0.3 ∼ -0.03); weight (WMD = -3.05, 95% CI -5.97 ∼ -0.13); and depressive symptoms (SMD =-0.32, 95% CI -0.51 ∼ -0.13). However, no significant difference was found in dropout due to adverse events (RR = 1.66, 95% CI 1.14 ∼ 2.41). Conclusions: This meta-analysis indicates that most pharmacotherapies decreased the frequency of binge-eating and vomiting episodes, body weight, and depressive symptoms in BN patients, but the efficacy was not significant. In each drug the efficacy is different, treating different aspects, different symptoms to improve the clinical performance of bulimia nervosa.Appeared originally in BMC Pharmacol Toxicol 2023; 24:72.

Overvaluation of weight and shape in obesity: a comparative study between people with and without binge eating disorder.

Introduction: The overvaluation of weight and shape is a diagnostic criterion in eating disorders, except in binge eating disorder (BED), where it has received less attention. This aspect is also not usually analyzed in people with overweight or obesity without an eating disorder. This research aims to identify the indicators of symptomatology, as well as those of self-construction and cognitive structure, that are associated with overvaluation in obesity, either alone or in conjunction with BED. Method: A sample of 102 overweight or obese participants was accessed. The sample was divided into four groups: one without overvaluation or BED (n = 33); a second with overvaluation and without BED (n = 21); a third with BED, but without overvaluation (n = 15), and a fourth with BED and overvaluation (n = 33). The groups completed instruments regarding eating symptomatology, anxiety, depression, and stress. In addition, they were administered the Repertory Grid Technique, a semi-structured interview to evaluate the cognitive structure involved in the construal of the self and others. Results: The factors of overvaluation and the presence of BED independently explained eating symptomatology, and the latter also showed a tendency to influence anxiety, depression, and stress. In terms of cognitive structure, weight polarization was explained by overvaluation, while BED was associated with a high presence of cognitive conflicts. In self-construction, BED was the factor that explained the differences, particularly in Self-Ideal discrepancy. Discussion: The results highlight the importance of overvaluation in obesity, even in the absence of BED. Its evaluation and treatment are recommended. Furthermore, in the case of BED, it is also advisable to evaluate the overvaluation of weight and shape since it can be a severity specifier.

Habitual behavioural control moderates the relation between daily perceived stress and purging.

OBJECTIVE: Evidence suggests that interpersonal stress plays a role in maintaining binge eating and purging (e.g., self-induced vomiting, misuse of laxatives). Stress is especially likely to promote engagement in maladaptive behaviour if the behaviour is habitual; therefore, individuals whose binge eating and/or purging are habitual may be particularly likely to engage in these behaviours in the context of interpersonal stress. We aimed to investigate this hypothesis in a sample of women with binge eating and/or purging using ecological momentary assessment (EMA). METHOD: Women (N = 81) with binge-eating and/or purging symptoms completed a self-report measure assessing habit strength of binge eating and purging followed by a 14-day EMA protocol assessing daily perceived interpersonal stress and binge-eating and purging episodes. RESULTS: Habit strength of purging moderated the within-person effect of interpersonal stress on purging frequency, such that higher daily stress was associated with greater same-day purging frequency when purging was more habitual. Contrary to expectations, the interactive effect of habit strength of binge eating and daily interpersonal stress on same-day binge-eating frequency was non-significant. CONCLUSIONS: Findings suggest that individuals with habitual purging may be vulnerable to engaging in purging when they are experiencing high levels of interpersonal stress.

Exploring the relationship between binge eating and differentiation of self: the mediating role of emotional distress and work stress.

Binge Eating Disorder (BED) is a prevalent eating disorder outlined in the DSM-5. Emotional distress (including stress, anxiety, and depression) stands out as a critical risk factor for developing eating disorders, and specifically BED. Recent studies have identified differentiation of self- a family pattern involving the ability to balance emotions and cognitions, as well as intimacy and autonomy-as a factor that exacerbates emotional distress. This relationship highlights the importance of addressing both emotional distress and family dynamics in understanding BED. While associations have been found between work-related factors and family dynamics with emotional distress, there has been limited investigation into the specific risk factors that are uniquely linked to BED. It was hypothesized that differentiation of self would relate to BED symptoms through the mediation of emotional distress and work stress. A systematic sampling method was applied to select a total of 275 participants for this study, with 60% women and 40% men (aged 20-45, M = 32.71, SD = 7.50). The findings suggest that low differentiation of self may increase vulnerability to BED symptoms by increasing susceptibility to emotional distress, including stress in the workplace. In addition, the analyses indicated that women reported higher levels of BED symptoms, while men reported higher levels of differentiation of self. The study sheds light on the contribution of unregulated family and emotional patterns to BED, providing valuable insights for organizations seeking to promote healthier work environments.

Bulimia Nervosa and Binge-Eating Disorder Across the Lifespan.

This article aims to review the current evidence-based psychotherapy and psychopharmacological treatments for adults and youths with bulimia nervosa (BN) and binge-eating disorder (BED). Treatments for adults and for children and adolescents are discussed separately, including developmental considerations in the management of these disorders among youths. Although several evidence-based psychotherapy and psychopharmacological treatment options have been established for adults with BN or BED, there is much less empirical support for the management of these eating disorders among children and adolescents. This review concludes by discussing promising modalities and innovations, highlighting the potential utility of integrating technology into treatment approaches. Despite decades of treatment development and testing, a sizable proportion of individuals with BN or BED do not respond to the current evidence-based treatments, highlighting the need for continued research in these domains. Future research should focus on testing psychotherapy treatments among diverse samples in large, randomized controlled trials, as well as on treatments that can be easily scaled and implemented in community settings.

Racial, Ethnic, and Sex Differences in Eating Disorder Onset Among U.S. Military Service Members.

Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. The present study examined independent associations and interactions between sex, race, ethnicity, and probable BED and BN onset. The sample included 91,413 and 96,245 service members from the Millennium Cohort Study for BED and BN analyses, respectively. Up to four datapoints (from 2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, Multiracial, Black, and Asian/Pacific Islander (API) while BED was less likely among Black and API versus non-Hispanic/Latinx White (NHW) service members. Interactions revealed greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed amongst racially and ethnically diverse groups in preventing and detecting EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.

Sleep and aberrant eating behaviors in metabolic/bariatric presurgical candidates.

BACKGROUND: Metabolic/bariatric surgery (MBS) is the most effective treatment for obesity, yet many factors influence successful individual weight loss. Among those are a variety of health behaviors that are assessed in the process of presurgical psychological evaluations, including eating pathology and sleep disturbance (both of which are relatively common among surgical candidates). OBJECTIVES: This study aims to examine the relationship between sleep, binge eating, and night eating behaviors among individuals seeking MBS. SETTING: Medical center and private psychological practice in Mississippi. METHODS: Patients (N = 311) seeking presurgical psychological evaluations for bariatric surgery completed self-report measures. Of these, 83.0% were females and 70.7% of those with ethnicity data identified as White. Average body mass index (BMI) in the sample was 46.5 (standard deviation [SD] = 8.02). Correlations between variables were calculated and examination of the indirect effect of sleep disturbance on night eating as mediated by binge eating was conducted. RESULTS: Sleep disturbance, binge eating, and night eating were significantly associated (b = .22-.45). Mediation analysis yielded a significant indirect effect, indicating that binge eating propensity explains the relationship between impaired sleep and night eating symptoms (b = .09, standard error [SE] = .03, confidence interval [CI]: .04-.18). CONCLUSIONS: The observed relationship between sleep disturbance, night eating, and binge eating among bariatric candidates provides implications for future research and treatment approaches. Specifically, additional attention to sleep disturbance in the presurgical assessment process and consideration of sleep hygiene as a potential target for intervention may facilitate improvements in overall health, adjustment, and sustained weight loss.