Article

Effect of dichotomous thinking on the association of depression with BMI and weight change among obese females

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Abstract

This study tested whether a dichotomous thinking style moderates the association of depression with body mass, and investigated the effect of dichotomous thinking and depression on weight loss during a cognitive behavioural therapy (CBT) intervention. Overweight and obese females (n=76) participated in CBT for weight management for 12 weeks. Before treatment, dichotomous thinking moderated the association of depression with BMI, such that depression was positively associated with BMI among those with low dichotomous thinking, but was not associated among those with high dichotomous thinking. Weight loss was negatively associated with pre-treatment depression and frequency of treatment attendance, but not with dichotomous thinking. Females who regard their weight as unacceptably high and who think dichotomously may experience high levels of depression irrespective of their actual weight, while depression may be proportionate to the degree of obesity among those who do not think dichotomously. Depression, but not dichotomous thinking, is likely to interfere with the ability to adhere to short-term weight loss strategies.

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... Dichotomous thinking can manifest itself in many different ways, from extreme appraisals of food ("good" or "bad") to extreme appraisals of the diet ("on" or "off") and the weight status ("acceptable" or "unacceptable") (Dove et al., 2009). It has been shown that consumers tend to employ simplistic thinking styles, as they categorize foods as good/bad or healthy/unhealthy (Dean et al., 2011;Rozin et al., 1996) and make unfounded inferences about the food attributes based on these crude categorizations (Rozin et al., 1996). ...
... Despite the potential relevance of dichotomous thinking in the food and eating domain, the relationship between dichotomous thinking and behavioral parameters such as dietary restraint and weight regain has been explored in very few studies so far and mainly within the areas of obesity and/or eating disorders research (Alberts et al., 2012;Byrne et al., 2003Byrne et al., , 2004Dove et al., 2009;Lethbridge et al., 2011;Lingswiler et al., 1989;Ramacciotti et al., 2008;Seamoore et al., 2006). The relationship between cognitive and behavioral outcomes is expected to be more pronounced in people with eating disorders, who are more likely to hold dysfunctional cognitions related to food and eating (Epstein and Meier, 1989;Teasdale et al., 2001). ...
... It is likely that the effect of dichotomous thinking on weight regain diminishes for longer time intervals (e.g. 4 years follow-up). Dove et al. (2009) found that dichotomous thinking was not related to short-term weight loss in a sample of 76 obese and overweight women who participated in a weight management program for 12 weeks. The authors suggest that dichotomous thinking may have a different effect among people. ...
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This study explores the role of dichotomous thinking on eating behavior and its association with restraint eating and weight regain in a wide range of people. In a web-based survey with 241 adults, dichotomous thinking and behavioral outcomes related to eating (restraint eating, weight regain, body mass index, dieting) were assessed. Results showed that eating-specific dichotomous thinking (dichotomous beliefs about food and eating) mediates the association between restraint eating and weight regain. We conclude that holding dichotomous beliefs about food and eating may be linked to a rigid dietary restraint, which in turn impedes people's ability to maintain a healthy weight. © The Author(s) 2015.
... Obez bireylerin çoğunluğu şiddetli derecede tıkınırcasına yeme problemi gibi yeme bozukluğu davranışı göstermektedir (2). Obezite ve depresyon gibi duygu durum bozuklukları arasındaki ilişkiyi düzenleyen bir potansiyel faktör ise "siyah ya da beyaz'' kognitif düşünme tarzı olarak tanımlanan dikotomik düşünmedir (3)(4)(5). ...
... Dikotomik düşünme, depresyon, yeme bozuklukları, tıkınırcasına yeme alışkanlığı olan ve diyet yapan bireylerde yaygın olarak görülmektedir. Yemek yeme ve vücut ağırlığı ile ilgili dikotomik düşünme biçimine sahip bireyler besinleri "iyi" ya da "kötü", kendilerini "diyet yapan" ya da "diyet yapmayan", vücut ağırlıklarını "kabul edilebilir" ya da "kesinlikle kabul edilemez" olarak tanımlamaktadır (3)(4)(5). Vücut ağırlığı ve yemek yeme ile ilgili endişeli bireylerde sıklıkla diyet kurallarının devamında "ya hep ya da hiç" düşünme biçimleri görülmektedir (4). Dikotomik düşünme katı diyet kurallarının gelişimine ve/veya tıkınırcasına yeme davranışı gelişimini arttırması sebepleriyle yeme bozukluğu gelişimine neden olabilmektedir (5). ...
Article
Amaç: Yeme bozuklukları; yeme davranışları ile ilişkili düşünceler, tutumlar ve duygularla oluşan fizyolojik bozukluklardır. Katı bir kognitif düşünme tarzı olan dikotomik düşünme aşırı yeme ve vücut ağırlığının artması ile ilişkilendirilmektedir. Buna dayanarak bu araştırmada, obez veya fazla kilolu olan yetişkin kadınlarda Yeme Bozukluklarında Dikotomi Düşünme Ölçeği’nin (DTEDS) beslenme durumu ile ilişkisinin değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Gözlemsel araştırma türündeki bu çalışma Ankara ilinde Ocak 2018 – Temmuz 2019 tarihleri arasında yürütülmüştür ve Beden Kütle İndeksi’ne (BKİ) göre fazla kilolu veya obez olarak sınıflandırılan 110 kadını (36.8±12.03 yıl) kapsamaktadır. Tanımlayıcı ve antropometrik bulgular ile birlikte bireylere yeme bozuklukları ile ilişkili Yeme Tutum Testi (EAT-26), Yale Besin Bağımlılığı Ölçeği (YALE) ve DTEDS içeren soru kağıdı uygulanmıştır. Ayrıca 30 bireye tekrar test yöntemi uygulanarak DTEDS’nin Türkçe geçerlilik ve güvenilirlik çalışması yapılmıştır. Bulgular: DTEDS’nin Türkçe uyarlama çalışmasına göre geçerlilik (coefficient=0.075; t=0.940, p=0.355) ve güvenilirliği (cronbach alfa=0.808) uygun düzeyde bulunmuştur. Ortalama BKİ 30.3±4.8 kg/m2 olup fazla kilolu olan 61 kadın, obez olan 49 kadın bulunmaktadır. BKİ ile YALE puanı negatif yönlü düşük korelasyon göstermektedir (p=0.008). DTEDS açısından riskli sayılan fazla kilolu kadınların %55.8’inde, şişman kadınların ise %44.2’sinde dikotomik düşünme bozukluğu ve buna bağlı yeme bozukluğu riski olduğu görülmüştür. Dondurma, çikolata, yağda kızarmış hamur ve tatlı, poğaça, pirinç pilavı, kraker, tuzlu simit, kurabiye, kek-pasta, şekerleme, pizza, gazoz, biftek, pastırma, muz gibi besinlerin yeme bozukluğuyla ilişkili olabileceği görülmüştür (p<0.05). Yapılan egzersiz türüyle DTEDS (p=0.027), EAT-26 (p=0.036) ve YALE (p=0.007) arasında, düzenli egzersiz yapma durumu ile EAT-26 (p=0.046) arasında da anlamlı bir ilişki mevcuttur. Sonuç: Sonuç olarak, Türkçe uyarlama çalışmasına göre geçerli ve güvenilir olduğu tespit edilen DTEDS’nin yeme bozukluğu ile ilgili araştırmalarda ve obezite ile ilişkili yeme tutum davranışlarının incelenmesinde kullanılabileceği belirlenmiştir. Fazla kilolu/obez kadınlarda BKİ değerlerinin dikotomik düşünme ile ilişkili olabileceği ve yeme bozukluğunun enerji/şeker/yağ içeriği yüksek besinleri tüketme eğilimine katkıda bulunabileceği gösterilmiştir.
... Type of study Besides obesity, Annesi and colleagues (2008,2010,2014) found a direct relationship between depression and waist circumference (Annesi and Unruh 2008; Annesi and Gorjala 2010; Annesi and Porter 2014). Dove and colleagues (Dove et al. 2009) found that both obesity and body acceptance influenced depression, while depression influenced the adherence to short-term strategies (Dove et al. 2009). Moreover, Sliwa et al. (2016) found greater depressive symptoms and purchases of take-out foods in the same population (Sliwa et al. 2016). ...
... Type of study Besides obesity, Annesi and colleagues (2008,2010,2014) found a direct relationship between depression and waist circumference (Annesi and Unruh 2008; Annesi and Gorjala 2010; Annesi and Porter 2014). Dove and colleagues (Dove et al. 2009) found that both obesity and body acceptance influenced depression, while depression influenced the adherence to short-term strategies (Dove et al. 2009). Moreover, Sliwa et al. (2016) found greater depressive symptoms and purchases of take-out foods in the same population (Sliwa et al. 2016). ...
Article
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This study aimed to systematically review the relationship of obesity-depression in the female sex. We carried out a systematic search (PubMed, MEDLINE, Embase) to quantify the articles (controlled trials and randomized controlled trials) regarding obesity and depression on a female population or a mixed sample. Successively, we established whether the sex specificities were studied by the authors and if they reported on collecting data regarding factors that may contribute to the evolution of obesity and depression and that could be responsible for the greater susceptibility of females to those conditions. After applying the inclusion and exclusion criteria, we found a total of 20 articles with a female sample and 54 articles with a mixed sample. More than half of all articles (51.35%, n = 38) evaluated the relationship between depression and obesity, but only 20 (27.03%) evaluated this relationship among females; still, 80% of those (n = 16) presented supporting results. However, few articles considered confounding factors related to female hormones (12.16%, n = 9) and none of the articles focused on factors responsible for the binomial obesity-depression in the female sex. The resulting articles also supported that depression (and related impairments) influencing obesity (and related impairments) is a two-way road. This systematic review supports the concurrency of obesity-depression in females but also shows how sex specificities are ultimately under-investigated. Female sex specificity is not being actively considered when studying the binomial obesity-depression, even within a female sample. Future studies should focus on trying to understand how the female sex and normal hormonal variations influence these conditions.
... However, even if this inventory has a narrower content coverage, results also revealed a positive correlation with dysfunctional traits. For instance, dichotomous thinking correlated positively with depression (Antoniou, Bongers, & Jansen, 2017) and dysfunctional eating attitudes (Dove, Byrne, & Bruce, 2009). In both pathologies, this cognitive bias is experienced intensely, and it hinders the individual from creating strategies to face difficult situations. ...
... The replicability of the instruments in other cultures was satisfactory, indicating a construct presented in several regions. Future studies should aim to understand how dichotomous thinking influences Western culture since, so far, the focus of research has been countries such as Japan and Australia (e.g., Dove et al., 2009;Jonason et al., 2018;Oshio et al., 2016). ...
Article
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Dichotomous thinking is a propensity for individuals to understand events as opposites, in a binary way. There are currently two inventories that accurately measure this construct, the Dichotomous Thinking Inventory, and the Dichotomous Thinking in Eating Disorders Scale. The present study aimed to carry out a review process to compile all the empirical studies that have made use of either of these instruments. To achieve this goal, we carried out a scoping review. We conducted a search using the keywords “Dichotomous Thinking Inventory,” “Dichotomous Thinking in Eating Disorders Scale,” and “Thinking Style” in the databases PubMed, Science Direct, and PsycInfo. No limits were imposed on the review. We found 19 articles that met the pre-established criteria; the concentration of research occurred in the last 10 years. It was possible to clarify that the dichotomous way of understanding events occurs, in general, in the presence of maladaptive traits of personality.
... Dichotomous thinking can be defined as the tendency to think in terms of binary oppositions such as "good or bad," "black or white," "healthy or unhealthy" (Oshio, 2009). This type of thinking can be applied under different conditions, such as when assessing one's diet as either "on" or "off", when judging one's weight status as either "acceptable" or "unacceptable" or when evaluating foods as either "good" or "bad" (Dove, Byrne & Bruce, 2009;Heatherton & Baumeister, 1991;Lingswiler, Crowther & Stephens, 1989). Even though this thinking style might be useful for quick comprehension and decision making, binary thinking about one's diet and weight status reflects a type of cognitive inflexibility that has been associated with binge eating, restraint eating and a rigid response to dietary transgressions, which in turn impedes people's ability to maintain a healthy weight (Fairburn, Cooper & Shafran, 2003;Lingswiler et al., 1989;Tiggemann, 2000;Palascha, van Kleef & van Trijp, 2015). ...
... It has been suggested that an 'all-or-nothing' approach to eating and weight control behaviours might make individuals sensitive to frequent lapses in dietary restraint, leading to binge eating or overeating and a failure to lose weight Polivy & Herman, 1985). Extreme forms of dichotomous thinking have mostly been explored within the area of obesity and/or eating disorders research (Alberts et al., 2012;Byrne, Cooper & Fairburn, 2003Dove et al., 2009;Lethbridge, Watson, Egan, Street & Nathan, 2011;Lingswiler et al., 1989). However, as witnessed by the tendency to judge foods as either good or bad, there is evidence that the general population applies this thinking style as well (Oakes, 2005a(Oakes, , 2005bTiggemann, 2000). ...
... Mood disorders lead to more negative thoughts which results in poor HRV scores [34,35]. Moreover, these are reflected through sleep patterns and hence Insomnia and hypersomnia pose to be two major attributes to the mood disorder, substantiated by the work of [36] and Negative thoughts, as evident in the work of [37] are also found within this group. It can be stated that the COVID-19 pandemic during the time of the study could have played a significant role in the mental states of the test-takers. ...
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Background: Subclinical traces of depression are difficult to diagnose; although, it influences other mental faculties. Lyfas is a smartphone-based ubiquitous and non-invasive biomedical application that captures Heart Rate Variability (HRV) and its associated Cardiovascular biomarkers (CVb), which might help detect such traces as mind and body are intertwined through autonomic modulation. Aim: Using Lyfas, an attempt has been made to (i) screen Subclinical depression states in adults by assessing the CVb scores, and (ii) analyze the psychophysiological effects of Subclinical depression on other mental faculties for establishing a correlation. Methods: The paper presents a retrospective observational study of 86 adults, comprised of 52 males and 36 females who took the Lyfas test. Lyfas findings are validated by an established questionnaire-based instrument under the supervision of a senior psychiatrist. Results: The study found that 77% of the subjects (84% females and 72% males) showed traces of Subclinical depression, further validated by a senior psychiatrist through a series of consultations. ‘Insomnia’ (males 36% and females 71%) and ‘Negative thoughts’ (males 36% and females 46%) were the two correlated high-rank effects of the Subclinical depression in the sample. Conclusion: The paper proposes that Lyfas can detect the traces of Subclinical depression in adults by capturing and interpreting CVb scores that surrogate for the Cardiac Autonomic Modulation (CAM) and provide the snapshot of the mind-body state of homeostasis
... The DTEDS-11 has been used with diverse samples (Byrne et al., 2008(Byrne et al., , 2004Dove et al., 2009;Egan et al., 2007). The subscales have good psychometric properties: DTESD-11-General (α = .86), ...
Article
Objectives: This study aimed to investigate whether self-regulation and dichotomous thinking might help to explain why some individuals maintain a normal body weight despite living in an obesogenic environment. Design: Cross sectional correlational design. Methods: Young Australians (142 female, 56 male; aged 20-35 years) completed a survey which included the Behavioural Weight Self-Regulation Questionnaire (BEWS-Q), the Dichotomous Thinking in Eating Disorders Scale (Byrne et al., 2008), and the SCOFF eating disorders screening tool (Morgan, 1999). Results: Results regarding self-regulation were opposite to those hypothesised; BEWS-Q scores were positively correlated with maximum lifetime Body Mass Index (BMI), dichotomous thinking, and disordered eating. Marked gender differences emerged throughout, with significant relationships between variables for the females in the sample, but not for the males. Weight pattern across time (e.g., lifelong weight maintainer, or weight cycler) was significantly associated with more variables than was BMI category. Conclusions: A uniform approach to weight management is unlikely to be effective, given the differences between males and females in this study. Also, excessive focus on weight behaviours and eating may be counterproductive to weight management. Weight across time may be more important than current BMI when considering weight management. KEY POINTS What is already known about this topic: (1) Overweight and obesity are global problems, and most Australians are overweight or obese. Although most Australians live in obesogenic environments it is not known why some people maintain normal bodyweight. (2) Self-regulation is the ability to alter one’s behaviour by making purposeful self-corrective adjustments towards a goal or to maintain an achieved goal. This ability may help explain why some people maintain normal bodyweight. (3) Patterns of dichotomous thinking may disrupt weight self-regulation, impeding the ability to make self-corrective adjustments in working towards weight goals. What this topic adds: (1) There were marked gender differences throughout the results, with significant relationships across all variables for females, but not for males. (2) Counter to prediction, weight self-regulation was positively associated with maximum lifetime BMI, dichotomous thinking, and disordered eating. Compared to current BMI, changes in weight pattern across time were associated with more predictors. (3) A uniform approach to weight management is unlikely to be effective.
... Individuals with BPD may only understand their experiences in extremes (all good or all bad) and thus resort to risky/impulsive behaviors to compensate , avoid, or regulate their feelings. Prior work in other populations has found a significant association between highly polarized reports of experience and disordered eating behavior (e.g., Dove, Byrne, & Bruce, 2009) as well as heightened suicide risk (e.g., Litinsky & Haslam, 1998). However, to our knowledge, there is no prior research linking polarized reports of either affective or relational experience to impulsive behavior in BPD. ...
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A core feature of borderline personality disorder (BPD) is the tendency to evaluate one's experience with extreme polarity (i.e., feeling all good or all bad; Beck, Freeman, & Davis, 2004; Kernberg, 1975; Linehan, 1993). In this investigation, we examined the polarity of within-person reports of experience in individuals with BPD and healthy adults over the course of a 21-day, experience-sampling diary. We applied multilevel modeling techniques (Rafaeli, Rogers, & Ravelle, 2007) to capture the within-person covariance of momentary reports of negative and positive features of experience, either affective or relational. Our data indicated significantly greater polarity in reports of affective and relational experiences in BPD that increased during heightened interpersonal stress. We also examined the association of affective and relational polarity to reports of impulsive behaviors (e.g., self-injury, substance use, etc.) and found evidence that increased polarity in reports of affective (in low-stress contexts) and relational experiences (in high-stress contexts) predicted increased rate of reports of impulsive behaviors. Together, these data present strong evidence for the role of polarized experiences in BPD, and have implications for the treatment of individuals with this disorder.
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This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
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Objective This prospective study examined whether stable personality traits, as measured by the Karolinska Scales of Personality (KSP), predicted initial weight loss or long-term maintenance in obesity patients.Method The KSP was administered to 102 obese patients prior to entering an 8-week weight loss program. Patients were weighed again at the end of treatment and at 3- and 12-month follow-up.ResultsThe KSP did not predict initial weight loss after the 8-week program. Several of the KSP scales (Muscle Tension, Monotony Avoidance, Suspicion, and Guilt) had weak associations with 12-month relapse status. Weight gain at the 3-month follow-up was the strongest predictor of 12-month relapse status (O.R. = 0.46; 95% C.I. = 0.32, 0.66).DiscussionPersonality traits, as measured by the KSP, do not appear to be important predictors of initial weight loss or 12-month relapse status. Personality assessment may not substantially contribute to predicting treatment outcome in obesity research. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 25: 301–309, 1999.
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Multivariate analyses were used to compare key eating behavior, cognitive, affective, and body variables to determine the similarities and differences between eating-disordered, symptomatic, and asymptomatic female undergraduates. On the eating behavior (i.e., bulimic symptoms, concern for dieting, weight fluctuation), and some of the cognitive (i.e., impression management, approval by others, dichotomous thinking, self-control, rigid weight regulation, weight and approval) and body (i.e., concern with body shape, satisfaction with face) variables, the eating-disorder group reported the most severe symptoms, followed linearly by the symptomatic and asymptomatic groups. On the affective (i.e., sad, anxious, guilty, shameful, stressed, happy, confident, overall self-esteem) and the remaining cognitive (i.e., vulnerability, catastrophizing) and body (i.e., importance of being physically fit and being attractive, satisfaction with body) variables, the symptomatic and eating-disorder groups did not differ from one another but had higher levels of distress than did the asymptomatic women. These findings suggest that (1) counselors need to be aware that a large percentage of female undergraduates are nondiagnosable yet experience eating-disorder symptoms, and (2) these symptomatic women are experiencing high levels of distress, particularly in the areas of affect and body image.
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This study aimed to investigate the relationship between dieting and global cognitive style in a non-clinical sample. Questionnaires were administered to 218 Australian undergraduate students. Dieting was operationalized in two ways: self-reported current dieting behaviour; and scores on dietary restraint. It was found that current, but not past, dieters had more dysfunctional cognitive attitudes, confirming the necessity of distinguishing between current and past dieting behaviour. The Concern for Dieting subscale of dietary restraint was also related to a dysfunctional cognitive style, even after level of depressed mood was statistically controlled. In particular, the dysfunctional attitude of Dichotomous Thinking was implicated. Taken together, the findings imply that dieters do not have an enduring maladaptive cognitive style, but rather that current dieting concerns and behaviour are associated with poorer cognitive functioning.
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This study examined attrition and weight loss in 235 female obese binge eaters, episodic overeaters, and nonbingers treated by a 26-week program of behavior modification and very low calorie diet. No significant differences were observed among conditions in the number of Ss who completed treatment. Episodic overeaters, however, were more likely than Ss in the other 2 conditions to drop out during the last 7 weeks of treatment, when Ss resumed consumption of a conventional diet. End-of-treatment weight losses for the 3 conditions, which did not differ significantly, averaged 21.5, 19.4, and 21.7 kg, respectively. No significant differences were observed among conditions in weight regain (which averaged 8.8 kg) in the year following treatment, although small sample sizes prevented an adequate evaluation.
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This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
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A four-course meal was presented to six obese and 18 normal weight women in which the second course was eaten ad libitum and the other three courses were fixed in amount. Eating behaviour was observed directly and intake was monitored via an electronic scale built into the table under the plate. Intake deceleration was observed in the normal weight women who scored low on the Herman-Polivy (1980) restraint questionnaire and on the cognitive restraint factor (F1) of Stunkard and Messick's (1985) questionnaire, whereas the normal weight and obese restrained women displayed linear cumulative food intake. In all groups, if deceleration occurred in the second course it was usually identical in the third and fourth courses, and constant eating rate persisted from the second course to the later courses. Food-specific eating rates were positively correlated to relative palatability, and removed deviation from linearity in cumulative intake over the four courses.
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We first establish the association between binge eating and dieting and present sequence data indicating that dieting usually precedes binging, chronologically. We propose that dieting causes binging by promoting the adoption of a cognitively regulated eating style, which is necessary if the physiological defense of body weight is to be overcome. The defense of body weight entails various metabolic adjustments that assist energy conservation, but the behavioral reaction of binge eating is best understood in cognitive, not physiological, terms. By supplanting physiological regulatory controls with cognitive controls, dieting makes the dieter vulnerable to disinhibition and consequent overeating. Implications for therapy are discussed, as are the societal consequences of regarding dieting as a "solution" to the problem of binging.
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The relationships between body weight change during a six-year follow-up period and a number of psychosocial variables were studied in a representative population sample of middle-aged women. Those women who had gained weight ⩾ 5.0 kg were compared with the rest of the sample taking into account age, social class and initial level of obesity. Never-married women were over- represented among the women with weight gain ⩾ 5.0 kg. Husband's social class (based on occupation) was inversely related with weight gain. Educational level, own social class and annual income were not significantly different between the two groups. There was a positive relation between mental illness (disability degree), depth of depression and weight gain. Use of psychotropic drugs, frequency of anxiety attacks and phobia grade were not related to weight gain, however. The personality trait order was positively related to weight gain, while there were no significant relationships between the other personality variables studied and weight gain. The study thus indicates that psychosocial factors might be of causal importance for the development of obesity in adult women. Further studies on the role of these factors for regulation of energy intake and expenditure seem to be justified.
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This investigation attempted to determine psychological correlates of weight fluctuation in a sample of 497 normal weight and obese adults who were enrolled in a prospective, natural history study. Subjects were stratified by gender, obesity, and age and classified as weight maintainers, gainers, or losers based on their changes in weight over a 1-year period. Subjects were further classified as either weight fluctuators or nonfluctuators based on historical self-report. Nonfluctuators reported significantly higher general well-being, greater eating self-efficacy, and lower stress than weight fluctuators, regardless of body weight. Weight maintainers had more favorable eating self-efficacy related to negative affect than weight gainers. Results suggest that weight fluctuation is strongly associated with negative psychological attributes in both normal weight and obese individuals. Future research should focus on the assessment and treatment of weight fluctuation and on weight maintenance, irrespective of weight status.
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A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.
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This research investigated the internal consistency and test-retest reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q), a 41-item measure adapted from the Eating Disorder Examination (EDE). The EDE is a structured clinical interview assessing the key behavioral features and associated psychopathology of eating disorders. Results indicated excellent internal consistency and 2-week test-retest reliability for the four subscales of the EDE-Q: Restraint, Weight Concern, Shape Concern, and Eating Concern. There was somewhat less stability in the items measuring the occurrence and frequency of the key behavioral features of eating disorders. Overall, results support the psychometric adequacy of the EDE-Q.
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This prospective study examined whether stable personality traits, as measured by the Karolinska Scales of Personality (KSP), predicted initial weight loss or long-term maintenance in obesity patients. The KSP was administered to 102 obese patients prior to entering an 8-week weight loss program. Patients were weighed again at the end of treatment and at 3- and 12-month follow-up. The KSP did not predict initial weight loss after the 8-week program. Several of the KSP scales (Muscle Tension, Monotony Avoidance, Suspicion, and Guilt) had weak associations with 12-month relapse status. Weight gain at the 3-month follow-up was the strongest predictor of 12-month relapse status (O.R. = 0.46; 95% C.I. = 0.32, 0.66). Personality traits, as measured by the KSP, do not appear to be important predictors of initial weight loss or 12-month relapse status. Personality assessment may not substantially contribute to predicting treatment outcome in obesity research.
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This study identified predictors of weight gain versus continued maintenance among individuals already successful at long-term weight loss. Weight, behavior, and psychological information was collected on entry into the study and 1 year later. Thirty-five percent gained weight over the year of follow-up, and 59% maintained their weight losses. Risk factors for weight regain included more recent weight losses (less than 2 years vs. 2 years or more), larger weight losses (greater than 30% of maximum weight vs. less than 30%), and higher levels of depression, dietary disinhibition, and binge eating levels at entry into the registry. Over the year of follow-up, gainers reported greater decreases in energy expenditure and greater increases in percentage of calories from fat. Gainers also reported greater decreases in restraint and increases in hunger, dietary disinhibition, and binge eating. This study suggests that several years of successful weight maintenance increase the probability of future weight maintenance and that weight regain is due at least in part to failure to maintain behavior changes.
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Previous research has documented prejudicial attitudes and discrimination against overweight people. Yet the extent to which overweight people themselves perceive that they have been mistreated because of their weight has not been carefully studied. The purpose of this study was to examine the prevalence of perceived mistreatment due to weight and sources of perceived mistreatment. A non-clinical sample of healthy adults (187 men and 800 women) enrolled in a weight gain prevention program comprised the study population. A self-administered questionnaire was used to measure perceived mistreatment due to weight. Overall, 22% of women and 17% of men reported weight-related mistreatment. The most commonly reported sources of mistreatment among women were strangers (12.5%) and a spouse or loved one (11.9%). Men were most likely to report mistreatment by a spouse or loved one (10.2%) and friends (7.5%). Somewhat surprisingly, sex differences in perceived weight-related mistreatment were significant only for stranger as the source. Perceived weight-related mistreatment was positively associated with body mass index (BMI) (r = 0.39, p<0.0001). Reported mistreatment was nearly ten times as pervalent among individuals in the highest quartile of the BMI distribution (42.5%) than among those in the lowest BMI quartile (5.7%), but was significantly greater than zero in all but the very lean. Perceived mistreatment due to weight is a common experience and is not restricted to the morbidly obese. Results are discussed in light of the sociocultural value for thinness.
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This study sought to test the relationships between relative body weight and clinical depression, suicide ideation, and suicide attempts in an adult US general population sample. Respondents were 40,086 African American and White participants interviewed in a national survey. Outcome measures were past-year major depression, suicide ideation, and suicide attempts diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The primary predictor was relative body weight, treated both continuously (i.e., body mass index [BMI]) and categorically in logistic regression analyses. Covariates included age, income and education, disease status, and drug and alcohol use. Relative body weight was associated with major depression, suicide attempts, and suicide ideation, although relationships were different for men and women. Among women, increased BMI was associated with both major depression and suicide ideation. Among men, lower BMI was associated with major depression, suicide attempts, and suicide ideation. There were no racial differences. Differences in BMI, or weight status, were associated with the probability of past-year major depression, suicide attempts, and suicide ideation. Longitudinal studies are needed to differentiate the causal pathways and mechanisms linking physical and psychiatric conditions.
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The purpose of this study was to examine the associations between work stress and nutritional status in relation to dietary restraint in a community sample of adults. The design included a cross-sectional and a longitudinal study element. Ninety staff members (58 women and 32 men) of a large department store were assessed on four occasions over a 6-month period with measures of diet, weight, and perceived stress. Work stress was indexed in terms of the hours of work over the past 7 days, which provided an objective indicator of demand. Participants worked an average of 47 hours on the high-work-stress session compared with 32 hours on the low-work-stress session. The highest work-stress session was compared with the lowest work-stress session in the longitudinal analyses, and the moderating effects of gender and restrained eating were examined. High-workload periods were associated with higher energy and saturated fat and sugar intake. There was a significant moderating effect of restrained eating, with a hyperphagic response to work stress in restrained eaters, compared with no effect in unrestrained eaters. The results indicate that the associations between restraint and stress-induced eating that have been observed in the laboratory extend to the real-life setting. They raise the possibility that restrained eaters are particularly vulnerable to adverse effects of stress on health, through influences on food intake.
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Individuals with binge eating disorder (BED) have high rates of comorbid psychopathology, yet little is known about the relation of comorbidity to eating disorder features or response to treatment. These issues were examined among 162 BED patients participating in a psychotherapy trial. Axis I psychopathology was not significantly related to baseline eating disorder severity, as measured by the Structured Clinical Interview for DSM-III-R (SCID-I and SCID-II) and the Eating Disorder Examination. However, presence of Axis II psychopathology was significantly related to more severe binge eating and eating disorder psychopathology at baseline. Although overall presence of Axis II psychopathology did not predict treatment outcome, presence of Cluster B personality disorders predicted significantly higher levels of binge eating at 1 year following treatment. Results suggest the need to consider Cluster B disorders when designing treatments for BED.
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While behavioural approaches to the management of obesity are often successful in achieving clinically significant weight loss, the weight lost is generally regained. The great majority of patients return to their pre-treatment weight within 3 years. There have been attempts to improve the long-term effectiveness of behavioural treatment but the results have been disappointing. In this paper we suggest that, among other factors, this is because of the neglect of the contribution of cognitive factors to weight regain, and because there is often ambiguity over the goals of treatment. We present a cognitive behavioural analysis of the processes involved in weight regain, and we describe a new cognitive behavioural treatment derived from it. This treatment is designed to minimise the problem of weight regain by addressing psychological obstacles to the acquisition of, and long-term adherence to, effective weight-control behaviour.
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The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and the Reynolds Adolescent Depression Scale (RADS; Reynolds, 1987) were administered to 56 female and 44 male psychiatric inpatients whose ages ranged from 12 to 17 years old. The Cronbach coefficient alpha(s) for the BDI-II and RADS were, respectively, .92 and .91 and indicated comparably high levels of internal consistency. The correlation between the BDI-II and RADS total scores was .84,p <.001. Binormal receiver-operating-characteristic analyses indicated that both instruments were comparably effective in differentiating inpatients who were and were not diagnosed with a major depressive disorder; the areas under the ROC curves for the BDI-II and RADS were, respectively, .78 and .76. The results (a) indicate that the BDI-II and the RADS have similar psychometric characteristics and (b) support the convergent validity of the BDI-II for assessing self-reported depression in adolescent inpatients.
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Depression has been linked to poor health outcome in a number of studies; however, the mechanism underlying this relationship has received little attention. This paper explores the possibility that adherence mediates the relationship between depression and outcome. Principal findings regarding the relationship between depression, adherence, and outcome are reviewed. The data suggest that depression is related, at least moderately, to poorer adherence to a variety of treatment components. The relationship between adherence and outcome is more difficult to establish. In addition, current data, albeit limited, do not support the hypothesis that adherence mediates the relationship between depression and outcome. An alternative model in which adherence precedes and influences both mood state and health outcome is discussed. Finally, possible explanations for these relationships are explored and suggestions for future research provided.
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This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
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The prevalence of depression (10%) and overweight (65%) indicates that there is a probability that they will co-occur, but are they functionally related? This report used the moderator/mediator distinction to approach this question. Moderators, such as severity of depression, severity of obesity, gender, socioeconomic status (SES), gene-by-environment interactions and childhood experiences, specify for whom and under what conditions effects of agents occur. Mediators, such as eating and physical activity, teasing, disordered eating and stress, identify why and how they exert these effects. Major depression among adolescents predicted a greater body mass index (BMI = kg/m(2)) in adult life than for persons who had not been depressed. Among women, obesity is related to major depression, and this relationship increases among those of high SES, while among men, there is an inverse relationship between depression and obesity, and there is no relationship with SES. A genetic susceptibility to both depression and obesity may be expressed by environmental influences. Adverse childhood experiences promote the development of both depression and obesity, and, presumably, their co-occurrence. As most knowledge about the relationship between these two factors results from research devoted to other topics, a systematic exploration of this relationship would help to elucidate causal mechanisms and opportunities for prevention and treatment.
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To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization. Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss. A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m(2)) were recruited from a large Midwestern US managed care organization. Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline. Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men. Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.
Article
In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.
Article
We examined the psychometric properties of the Beck Depression Inventory-Second Edition (BDI-II) [Beck et al., 1996, San Antonio: The Psychological Corporation]. Four hundred fourteen undergraduate students at two public universities participated. A confirmatory factor analysis supported the BDI-II two-factor structure measuring cognitive-affective and somatic depressive symptoms. In addition, the internal consistency was high and the concurrent validity of the BDI-II was supported by positive correlations with self-report measures of depression and anxiety. These findings replicate prior research supporting the validity and reliability of the BDI-II in a college sample.
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It is a consistent finding that, among obese patients, the weight lost as a result of the most widely available treatments for obesity is almost always regained. This relapse appears to be attributable to the individual's inability to persist with the behavioural strategies needed to maintain the new lower weight. Little research has investigated the psychological mechanisms that might account for this phenomenon. This study aimed to identify psychological factors that predict weight regain. Fifty-four women with obesity who had lost weight by attending community slimming clubs were interviewed immediately after losing 10% of their initial body weight, and then followed-up every 2 months for a period of 1 year by means of telephone interviews. The results identified two prospective predictors of weight regain: one cognitive factor (dichotomous thinking) and one historical variable (maximum lifetime weight). The finding that a specific cognitive style is a significant predictor of relapse has implications for the treatment of obesity.
Article
To investigate the effects of chronic stress on weight changes and related behavioral changes in parents with a child who had just been diagnosed with cancer compared to parents with healthy children. Longitudinal case-control study with assessments occurring over a three-month period following the child's diagnosis of cancer. In total, 49 parents of healthy children and 49 parents of cancer patients aged 19-58. Body weight, diet, physical activity, self-reported mood and stress. Parents of cancer patients were more likely to gain weight, and experienced significantly greater weight gain over the 3 months than parents of healthy children. The magnitude of weight gain was related to the degree of psychological distress that the parents experienced. Parents of cancer patients reported lower levels of physical activity and lower caloric intake than parents of healthy children, with the most marked differences between groups occurring in the area of physical activity. Findings suggest that a major stressor, such as a child's diagnosis of cancer, is associated with weight gain. Further research is needed to determine how long these weight gains persist and whether other types of stress also produce weight gains. Such studies should focus not only on the effect of stress on eating behavior but also on physical activity.
Article
Comorbid depression has been found to increase morbidity in a variety of disorders. This study aimed to investigate whether the presence of depressive symptoms in overweight and obese people is related to increased specific eating psychopathology and decreased self-esteem. Overweight/obese people seeking dietary treatment were grouped according to their scores on the Beck Depression Inventory (BDI), resulting in a mildly to moderately depressed group (BDI > or = 10; n = 66; the symptomatic group) and a non-depressed group (BDI < 10; n = 83). Eating psychopathology was measured by the Eating Disorder Examination-Questionnaire (EDE-Q); self-esteem was measured by the Rosenberg Self-Esteem Scale. Symptomatic people had more shape, weight and eating concerns (P-values < 0.001); scored higher on restraint (P < 0.01); had lower self-esteem (P < 0.001); and had a higher BMI (P < 0.05) than non-depressed people. Furthermore, the percentage of bingers was higher in the symptomatic group (P < 0.01). Symptomatic participants suffered more than non-depressed participants, and not only from their depression. For dieticians treating overweight and obese people, the BDI is a useful instrument for identifying the subgroup with depressive symptoms--the group that is at risk for (eating) psychopathology.
Article
Survey research is demonstrating that binge eating and compulsive eating may be a significant problem in the obese population. There is higher incidence of binge eating among women, associated with subjective distress and poor prognosis for weight control. Despite attendant health risks, researched clinical responses have not been developed. A before and after uncontrolled pilot study aimed to evaluate the effectiveness of group therapy for women who binge eat and compulsively eat. Participants attended a weekly integrative therapy group for 6 months. Measurements before and after the group intervention were taken using the Binge Eating Scale and Clinical Outcomes in Routine Evaluation inventories. Before and after interviews were thematically analysed for changes in eating behaviour. Following the group intervention, all participants demonstrated changes in eating behaviour measured by the Binge Eating Scale, the overall effect from baseline to 1 year demonstrates statistical significance. Qualitative data revealed four categories that underpinned reduction in binge eating: changes in dichotomous thinking, awareness of eating behaviour, detachment from food and dietary changes. An integrative model of group therapy warrants further research and refinement for this population, a group protocol for nurses working in the field of obesity and eating disorders could be developed.
Article
The Dichotomous Thinking in Eating Disorders Scale (DTEDS) is a short, self-report measure that can be used to assess the presence of a rigid, "black-and-white" cognitive thinking style. It was originally developed for use in a study of psychological predictors of weight regain in obesity. The DTEDS consists of two subscales. Items on the Eating subscale assess dichotomous thinking with regards to eating, dieting or weight, and items on the General subscale assess dichotomous thinking more generally. This study aimed to examine the factor structure and psychometric properties of the DTEDS in a sample of treatment-seeking eating disordered (N=87) and overweight/obese (N=111) women. Confirmatory factor analysis demonstrated that a two-factor model provided a better fit to the data than a one-factor model. The psychometric properties of the final scale were excellent, with evidence being provided for the reliability and validity of the two subscales. Overall, the results indicated that the DTEDS is a reliable instrument that can be used to assess eating-specific as well as more general aspects of dichotomous thinking.
Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation The reliability and validity of the dichotomous thinking in eating disorders scale
  • A T Beck
  • R A Steer
  • G K Brown
  • S M Byrne
  • K L Allen
  • E R Dove
  • F J Watt
  • P R Nathan
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. Byrne, S. M., Allen, K. L., Dove, E. R., Watt, F. J., & Nathan, P. R. (2008). The reliability and validity of the dichotomous thinking in eating disorders scale. Eating Behaviors, 9, 154–162.
Psychological correlates of weight fluctuation
  • Foreyt
Dieting and cognitive style
  • Tiggemann