Background
Food insecurity occurs when access to food is limited by financial hardship. Yet, paradoxically, food insecurity is associated with overeating, with emerging evidence that it may be ...related to disordered eating. A recent report found that food insecurity was associated with binge‐eating disorder (BED), but it is not yet known whether food insecurity is also associated with bulimia nervosa (BN).
Methods
Participants were 873 respondents recruited online who completed a battery of established measures and were categorized into three study groups: healthy‐weight (HW), BED, and BN. Hierarchical logistic regressions evaluated the extent to which low and very low food security were associated with BN compared with HW and BED study groups.
Results
Low and very low food security were both associated with increased likelihood of BN group membership compared with HW but not BED.
Conclusions
Our findings suggest that food insecurity is associated with BN and also suggest that food insecurity's association with BN is similar to that for BED. These findings highlight the need for greater clinical and research attention to associations between food insecurity and eating disorders that include binge eating to inform eating‐disorder prevention and treatment.
Certain treatments have demonstrated acute efficacy for binge-eating disorder (BED) but there is a dearth of controlled research examining pharmacotherapies as maintenance treatments for responders ...to initial interventions. This gap in the literature is particularly critical for pharmacotherapy for BED which is associated with relapse following discontinuation. The current study tested the efficacy of naltrexone/bupropion maintenance treatment amongst responders to acute treatments for BED.
Prospective randomized double-blind placebo-controlled single-site trial, conducted August 2017-December 2021, tested naltrexone/bupropion as maintenance treatment for responders to acute treatments with naltrexone/bupropion and/or behavioral weight-loss therapy for BED with comorbid obesity. Sixty-six patients (84.8% women, mean age 46.9, mean BMI 34.9 kg/m
) who responded to acute treatments were re-randomized to placebo (
= 34) or naltrexone/bupropion (
= 32) for 16 weeks; 86.3% completed posttreatment assessments. Mixed models and generalized estimating equations comparing maintenance treatments (naltrexone/bupropion
placebo) included main and interactive effects of acute treatments.
Intention-to-treat binge-eating remission rates following maintenance treatments were 50.0% (
= 17/34) for placebo and 68.8% (
= 22/32) for naltrexone/bupropion. Placebo following response to acute treatment with naltrexone/bupropion was associated with significantly decreased probability of binge-eating remission, increased binge-eating frequency, and no weight loss. Naltrexone/bupropion following response to acute treatment with naltrexone/bupropion was associated with good maintenance of binge-eating remission, low binge-eating frequency, and significant additional weight loss.
Adult patients with BED with co-occurring obesity who have good responses to acute treatment with naltrexone/bupropion should be offered maintenance treatment with naltrexone/bupropion.
Many children experience weight-based bullying (WB), when individuals are treated poorly or demeaned because of weight. WB has negative mental and physical health consequences. The current study ...examined how children's experiences of different forms of WB (verbal, social, physical, cyber) were associated with impaired functioning in school, social life, and family life.
Data were collected in Spring 2021. Participants (N = 224) were parents of a school-aged child and lived in the United States. Sixty percent of parents were mothers and 72% of parents self-identified as White. They completed surveys regarding weight, eating, and bullying.
Social and cyber WB were associated with clinically significant impairment for both children and parents. Children who experienced social and physical WB were more likely to skip school, whereas physical and cyber WB were associated with skipping a particular class. All forms of bullying were associated with skipping gym class. Social and cyber WB were associated with isolating. Cyber WB was associated with all disordered eating behaviors. In addition, physical WB was associated with binge eating, social WB was associated with purging, and verbal WB was associated with secretive eating.
Victims of WB experience impairment in school, social life, and family life, absenteeism, and disordered eating. It is essential to develop approaches to address WB in its various forms to identify strategies for reducing and preventing WB across various levels of influence, including peer groups, schools, and families.
Adolescence is a critical developmental period when youth are vulnerable to messages that promote unrealistic body shapes and a culture of weight-based stigma. Adolescents' vulnerability is reflected ...in high prevalence of body dissatisfaction among adolescents of all genders,
which can lead to negative mental health consequences including disordered eating and depression.
Importantly, body concerns are compounded among adolescents with higher weights who are more likely to experience weight-based victimization and internalize weight-based stigma compared with adolescents with lower weights.
Health care providers have an opportunity to advocate for well-being of adolescent patients by providing nonstigmatizing messages regarding body image, eating, and weight. While body image prevention programs emphasize the need to promote positive body image and awareness of weight-based victimization, clinical guidelines instead focus on preventing or treating conditions (ie, obesity or eating disorders). Yet, adolescents' well-being would benefit from weight-inclusive, positive body image messages. Providers can model the importance of prioritizing positive body image messages by spending time discussing body image through a positive rather than problem-focused lens. We propose an advocacy framework for health care providers to support adolescents' body image and to reduce the impact of weight bias across 4 settings: the clinic, social media, adolescents' homes, and school.
Objective
This study addressed gaps in the existing literature about correlates of parental perception of child weight using a community sample. This study evaluated how weight‐status and its ...perception related to parents’ personal and parenting attitudes/behaviors.
Design and Methods
Participants were parents (N = 1,007; 65.3% mothers, 34.4% fathers) of children 5 to 15 years old. Parents completed online measures of personal eating attitudes/behaviors, attitudes/behaviors about their children's eating and weight, and parental practices related to weight‐related attitudes.
Results
Parents frequently underestimated children's overweight/obesity, even more frequently than their own overweight/obesity (P < 0.001). Parents’ personal eating attitudes/behaviors were related to their own weight‐status (P < 0.001) and perceived child weight‐status (P < 0.001) but not actual child weight‐status. Parents’ child‐focused eating attitudes/behaviors were related to actual (P < 0.001) and perceived child weight‐status (P < 0.001), but not parent weight‐status.
Conclusions
In general, parents’ personal attitudes/behaviors did not extend into their perceptions of their children's weight or their response to it. Results suggest a dual need to improve parent accuracy perceiving children's overweight/obesity and to guide parent responses to perceived overweight/obesity. Given the high prevalence of childhood obesity, and the serious consequences during childhood and into adulthood, further research is needed to enhance understanding of parents’ specific needs to engage in prevention and treatment programs.
ABSTRACT Objective The objective of this study was to test the feasibility and acceptability of a treatment for weight bullying. Method Participants who had experienced weight‐related bullying and ...were currently experiencing traumatic stress were recruited and enrolled in a feasibility trial of trauma‐focused cognitive behavioral therapy combined with cognitive‐behavioral therapy for eating disorders (TF‐CBT‐WB). Thirty adolescents (aged 11–17) were determined eligible and 28 began treatment (12 weeks). Results This study demonstrated the treatment feasibility and acceptability of TF‐CBT‐WB for adolescents with traumatic stress following weight‐bullying experiences. Overall retention and treatment satisfaction were good. Within‐subjects improvements were observed for intrusion symptoms of traumatic stress, global eating‐disorder severity, overvaluation of weight/shape, dissatisfaction with weight/shape, dietary restraint, and depression. Clinically‐meaningful improvements were attained for several patient outcomes. Clinically‐meaningful decreases in functional impairment were attained by more than half of the participants. Conclusions Overall, this clinical trial testing TF‐CBT‐WB for adolescents experiencing traumatic stress following weight‐bulling experiences demonstrated therapy feasibility, acceptability, and initial evidence that clinically‐meaningful improvements in patient outcomes were feasible. However, some patient outcomes thought to be more central to how the youth viewed the world failed to show improvements, suggesting that additional content related to these constructs might yield greater benefit. Trial Registration This pilot study was registered on clinicaltrials.gov : NCT04587752, Cognitive‐Behavioral Therapy for Weight‐related Bullying.
Binge-eating disorder, the most prevalent eating disorder, is a serious public health problem associated with obesity, psychiatric and medical comorbidities, and functional impairments. Binge-eating ...disorder remains underrecognized and infrequently treated, and few evidence-based treatments exist. The authors tested the effectiveness of naltrexone-bupropion and behavioral weight loss therapy (BWL), alone and combined, for binge-eating disorder comorbid with obesity.
In a randomized double-blind placebo-controlled trial conducted from February 2017 to February 2021, using a 2×2 balanced factorial design, 136 patients with binge-eating disorder (81.6% women; mean age, 46.5 years; mean BMI, 37.1) were randomized to one of four 16-week treatments: placebo (N=34), naltrexone-bupropion (N=32), BWL+placebo (N=35), or BWL+naltrexone-bupropion (N=35). Overall, 81.7% of participants completed independent posttreatment assessments.
Intention-to-treat binge-eating remission rates were 17.7% in the placebo group, 31.3% in the naltrexone-bupropion group, 37.1% in the BWL+placebo group, and 57.1% in the BWL+naltrexone-bupropion group. Logistic regression of binge-eating remission revealed that BWL was significantly superior to no BWL, and that naltrexone-bupropion was significantly superior to placebo, but there was no significant interaction between BWL and medication. Mixed models of complementary measures of binge-eating frequency also indicated that BWL was significantly superior to no BWL. The rates of participants attaining 5% weight loss were 11.8% in the placebo group, 18.8% in the naltrexone-bupropion group, 31.4% in the BWL+placebo group, and 38.2% in the BWL+naltrexone-bupropion group. Logistic regression of 5% weight loss and mixed models of percent weight loss both revealed that BWL was significantly superior to no BWL. Mixed models revealed significantly greater improvements for BWL than no BWL on secondary measures (eating disorder psychopathology, depression, eating behaviors, and cholesterol and HbA
levels).
BWL and naltrexone-bupropion were associated with significant improvements in binge-eating disorder, with a consistent pattern of BWL being superior to no BWL.
Objective
Certain treatments have demonstrated acute efficacy for binge‐eating disorder (BED) but many patients who receive “evidence‐based” interventions do not derive sufficient benefit. Given the ...dearth of controlled research examining treatments for patients who fail to respond to initial interventions, this study tested the efficacy of cognitive‐behavioral therapy (CBT) for patients with BED who do not respond to initial acute treatments.
Methods
Prospective randomized double‐blind placebo‐controlled single‐site trial, conducted August 2017–December 2021, tested 16‐weeks of therapist‐led CBT for non‐responders to initial treatment (naltrexone/bupropion and/or behavioral therapy) for BED with obesity. Thirty‐one patients (mean age 46.3 years, 77.4% women, 80.6% White, mean BMI 38.99 kg/m2) who were non‐responders to initial acute treatments were randomized to CBT (N = 18) or no‐CBT (N = 13), in addition to continuing double‐blinded pharmacotherapy. Independent assessments were performed at baseline, throughout treatment, and posttreatment; 83.9% completed posttreatment assessments.
Results
Intention‐to‐treat remission rates were significantly higher for CBT (61.1%; N = 11/18) than no‐CBT (7.7%; N = 1/13). Mixed models of binge‐eating frequency (assessed using complementary methods) converged revealing a significant interaction between CBT and time and a significant main effect of CBT. Binge‐eating frequency decreased significantly with CBT but did not change significantly with no‐CBT. Since only four patients received behavioral treatment during the acute treatments, we performed “sensitivity‐type” analyses restricted to the 27 patients who received pharmacotherapy during the acute treatment and found the same pattern of findings for CBT versus no‐CBT.
Conclusions
Adult patients with BED who fail to respond to initial pharmacological treatments should be offered CBT.
Public Significance
Even with leading evidence‐based treatments for binge‐eating disorder, many patients do not derive sufficient benefit. Almost no controlled research has examined treatments for patients who fail to respond to initial interventions. This study found that that cognitive‐behavioral therapy was effective for patients with binge‐eating disorder who did not respond to initial interventions, with 61% achieving abstinence.
We examined distinctiveness of different aspects of body-image disturbance in persons categorized with eating/weight disorders. We compared dissatisfaction with weight/shape, overvaluation of ...weight/shape, preoccupation with weight/shape, and fear of weight gain – in three study groups of persons categorized with overweight/obesity O/O, bulimia nervosa BN, and binge-eating disorder BED and examined how each body-image construct relates to clinical measures within and between the study groups.
1017 community volunteers completed measures of body-image, eating-disorder psychopathology, and depression. Participants were categorized into three study groups: O/O (N = 511), BN-purging type (N = 167), and BED (N = 339).
Groups differed significantly on the four body-image constructs (medium-to-large effect sizes) with a consistent severity gradient with BN greater than BED greater than O/O. Both within and between groups, the four body-image constructs varied in strengths of association among themselves and with clinical measures. Analyses revealed considerable variability in variance accounted for in the clinical measures; distinctive significant patterns observed across the groups included: dissatisfaction with BMI, preoccupation and fear with eating concerns and restraint, and overvaluation with depression.
Clinical manifestations of body-image disturbances are complex and show important differences across study groups defined as overweight/obesity, BN, and BED. Improved understanding of distinctions between different body-image constructs and their differential salience across different eating/weight disorders is needed to improve case conceptualization and treatment formulation.
•Our findings highlight the complex nature of body-image concerns in persons with eating/weight disorders.•Body-image disturbances were highest in bulimia nervosa, followed by binge-eating disorder, and then by overweight/obesity.•Body-image disturbances varied in their strengths of association among themselves and with clinical measures across groups
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