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Although dietary restraint has been shown to be a robust predictor of binge eating among women, many women report elevated levels of dietary restraint but do not concurrently exhibit symptoms of binge eating. Moderating variables could therefore interact with dietary restraint to affect its relation to binge eating. One potential factor that may attenuate this relationship is eating-related self-efficacy, defined as the tendency to feel confident in the ability to control eating behaviour under a diverse set of circumstances (e.g., under negative affect, social conflicts). This cross-sectional study examined whether eating-related self-efficacy moderated the relationship between flexible (i.e., a graded approach to dieting, defined by behaviour such as taking smaller servings to regulate body weight, yet still enjoying a variety of foods) and rigid restraint (i.e., an all-or-none approach to eating, characterised by inflexible diet rules) and binge eating. Data were analysed from 237 women. Greater levels of rigid restraint, flexible restraint, and a poorer self-efficacy were shown to predict unique variance in binge eating severity. A significant interaction effect was observed between flexible (but not rigid) restraint and self-efficacy scores on binge eating. Contrary to expectations, however, the flexible restraint-binge eating relationship was largest for those with moderate to strong self-efficacy, and was non-significant for those with poor self-efficacy. Overall, findings suggest that different mechanisms may be operating to maintain binge eating in those with varying levels of eating-related self-efficacy.
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... Los atracones, específicamente, se relacionan con los intentos por restringir la dieta, la que generalmente tiene normas rígidas, que al romperse generan descontrol y un abandono total de las estrictas pautas de alimentación 9 . Esta asociación entre restricción-atracón parece estar moderada por la capacidad de autoeficacia relacionada con la alimentación 10 . ...
... Los problemas interpersonales en TA se relacionan con un gran afecto negativo, a la vez este se vincula a una alta frecuencia de atracones y de psicopatología, por lo que el impacto de los problemas interpersonales en la sintomatología de TA parece estar mediada, en parte, por el afecto negativo 10 . ...
... De esta forma es que varios autores han remarcado la importancia de clarificar un modelo explicativo que pueda cubrir la interacción entre factores que influyen en el TA, para de este modo además entregar un diagnóstico acorde y un tratamiento efectivo que pueda abarcar a largo plazo la dismi-nución de los factores de riesgo internos, entre ellos los pensamientos y emociones negativos, la impulsividad y la desregulación emocional vinculada a la alimentación 10,41 . ...
Introducción: el Trastorno por Atracón (TA) es habitual en obesidad y en quienes buscan tratamiento para bajar de peso, aunque también puede presentarse en personas con peso normal. En el desarrollo y mantenimiento de este cuadro psicopatológico interfieren distintos factores psicológicos y sociales que es relevante tener en cuenta para su abordaje. Objetivo: este artículo tiene por objetivo proponer una perspectiva integral de esta problemática, que considera estos distintos elementos psicosociales implicados, considerando también las consecuencias que acarrea este problema. Metodología: se realiza una revisión narrativa de antecedentes teóricos y empíricos a fin de generar un modelo comprehensivo de TA. Resultados: para contextualizar, se comienza describiendo el TA y ofreciendo cifras de prevalencia, para posteriormente presentar factores de riesgo, la relación de la enfermedad con la salud mental y algunas de sus consecuencias. A partir de todo esto se presenta el modelo que sintetiza toda esta información. Discusión: en el desarrollo de TA influyen factores internos y externos que es necesario tener presentes al momento de realizar diagnóstico e intervención para este trastorno. Conclusión: es relevante que los distintos profesionales de la salud implicados en el abordaje de la obesidad y la nutrición en general, como médicos, nutricionistas y psicólogos, mantengan una mirada atenta al posible diagnóstico de TA, adoptando una comprensión compleja del fenómeno, a fin de favorecer la efectividad de su intervención.
... Individuals who practice this form of restraint tend to think dichotomously about food and dieting, set themselves multiple demanding diet "rules," and engage in various regimented dieting behaviors (e.g., calorie counting, fasting, skipping meals; Westenhoefer et al., 1999). This form of restraint has been consistently shown in experimental (Knight & Boland, 1989), prospective (Agras & Telch, 1998), and cross-sectional (Linardon, 2018;Tylka, Calogero, & Daníelsdóttir, 2015) studies to be strongly associated with more severe and frequent binge eating. Flexible restraint, however, reflects a more graded approach to dieting, defined by behaviors such as allowing oneself to eat a wide variety of food types while still paying attention to weight/shape, and opting for "healthier" foods if "unhealthier" foods were consumed earlier. ...
... The flexible control subscale has demonstrated good internal consistency (α > .80) construct validity (e.g., via its association with lower self-reported energy intake and weight loss), and incremental validity in community samples (Linardon, 2018), in individuals who are obese (Westenhoefer et al., 1999), and in individuals with BED (Blomquist & Grilo, 2011). ...
Previous research has shown that certain eating patterns (rigid restraint, flexible restraint, intuitive eating) are differentially related to binge eating. However, despite the distinctiveness of these eating patterns, evidence suggests that they are not mutually exclusive. Using a machine learning-based decision tree classification analysis, we examined the interactions between different eating patterns in distinguishing recurrent (defined as ≥4 episodes the past month) from nonrecurrent binge eating.
Data were analyzed from 1,341 participants. Participants were classified as either with (n = 512) or without (n = 829) recurrent binge eating.
Approximately 70% of participants could be accurately classified as with or without recurrent binge eating. Intuitive eating emerged as the most important classifier of recurrent binge eating, with 75% of those with above-average intuitive eating scores being classified without recurrent binge eating. Those with concurrently low intuitive eating and high dichotomous thinking scores were the group most likely to be classified with recurrent binge eating (84% incidence). Low intuitive eating scores were associated with low binge eating classification rates only if both dichotomous thinking and rigid restraint scores were low (33% incidence). Low flexible restraint scores amplified the relationship between high rigid restraint and recurrent binge eating (81% incidence), and both a higher and lower BMI further interacted with these variables to increase recurrent binge eating rates.
Findings suggest that the presence versus absence of recurrent binge eating may be distinguished by the interaction among multiple eating patterns. Confirmatory studies are needed to test the interactive hypotheses generated by these exploratory analyses.
... Some studies demonstrated the relation between eating self-efficacy and eating disorders [26,27] or disordered eating habits in non-clinical samples (e.g. [28,29]), evidencing its potential role not only in obesity but also in eating disorders research, prevention and treatment. ...
... In particular, the two latent ESEBS scales were negatively correlated with two measures of disordered eating and emotional eating. The association between eating self-efficacy and behavioural and psychological characteristics related to eating disorders [1, is well documented in previous studies. Moreover, it has been reported an association between the use of dysfunctional strategies for regulating emotions and food intake increase [5,6]. ...
PurposeEating self-efficacy (ESE) is the belief in one’s ability to self-regulate eating. Social and emotional situations may be differently challenging depending on the individual eating habits, body mass index and affects. Several ESE scales have been developed but most of them focus on weight management, dieting or healthy eating. The aim of the study was to validate a new brief scale assessing ESE in situations in which people face social or emotional pressures for excessive food intake.Methods
Study 1: A sample of 412 volunteer females (age M = 25.44 ± 5.03) completed a first 25-item version of the scale. Exploratory factor analysis (EFA) was conducted for selecting a subgroup of items composing the ESE brief scale (ESEBS). Study 2 assessed its psychometric properties through a Confirmatory Factor Analysis (CFA), analyzing the responses of 410 volunteer adults (273 females, 137 males).ResultsEFA of Study 1 evidenced a bifactorial structure. Four items for each factor were selected, explaining 63% of the variance. Study 2 confirmed the good fit of the bifactorial model (CFI = 0.9589; χ2 (19) = 62.852, p < 0.001; RMSEA = 0.075; SRMR = 0.040) and provided support for the measurement invariance of the scale across gender. The internal consistency was as follows: Social (α = 0.786), Emotional (α = 0.820). The concurrent validity of the subscales was demonstrated by significant latent negative correlations with measures of eating disorders and emotional eating.Conclusions
The 8-items ESEBS appears as a valid and reliable instrument to assess eating self-efficacy related to social and emotional situations. Future studies should evaluate its potential use in non-clinical and clinical research and interventions.Level of evidenceLevel V, descriptive cross-sectional study.
... ResEat was also predisposed to adequate intake of fruit and vegetables. Nevertheless, promoting restrained eating to improve one's dietary habits in the long-term is controversial due to the results showing correlation between ResEat intensity, poorer psychological parameters, higher risk of binge eating episodes, or even higher BMI [9,10,15,35,54]. Those aspects were not included in the study, except for BMI. ...
... Links between restrained, emotional, and external eating [8,15] were confirmed by positive correlations in our study, yet their strength was mostly weak. Only EmoEat and ExtEat were found to moderately correlate (r = 0.49). ...
Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.
... There has been considerable debate regarding the utility of an FA "diagnosis" without considering the contribution of dietary restraint in increasing FA symptoms . While FA is not recognized by the DSM, the term diagnosis is used loosely throughout this manuscript. ...
... Newly proposed models suggest that clinicians go beyond a "no dieting" approach for all ED presentations and should incorporate addiction neuroscience [46,47]. Some authors recommend that researchers and clinicians distinguish between flexible and rigid restraint . In some cases, restraint is related to a lower body weight, better weight regulation, and a better diet quality while in others, restraint predicts poor diet, overeating, and obesity . ...
Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.
... Of the small number of low intensity or brief family interventions to have been developed in EDs, none involve adult patients (see ), something that may be particularly important given the need to support selfefficacy in this population [42,43]. ...
Plain English Summary Eating disorders are serious problems that can have negative consequences for both the person affected and their family members. Research shows that family involvement can support treatment, but little is known about whether adults with eating disorders want their families involved or how much. This study asked if adding a brief family intervention to normal treatment would be safe, viable and effective. The uptake of, and impact from, a one-off family consultation was measured in 24 adult patients and 22 carers who identified the problems they were facing as a result of the eating disorder, how often these were happening, how worried they felt about them, and how much the issues were interfering in their life before and after the family session. Both the patients and carers reported change in these areas. Issues regarding the eating disorder and communication were the most common concerns of adult patients and carers. Feedback about the sessions was positive and one session was enough to address the immediate concerns for many families. Single session family consultation may be a promising option for services working with the families of adults affected by eating disorders to consider in the future.
... Rigid behaviors like fasting prospectively predict (Agras and Telch, 1998), and in cross-sectional research are linked, with binge eating among women with bulimia and binge eating disorder (Masheb et al., 2011). In weight loss cohorts, there are links between rigid restraint and binge eating, shape/weight overvaluation, body dissatisfaction, disinhibited eating, dichotomous thinking, depressive and anxiety symptoms, and poorer wellbeing (Linardon, 2018;Linardon and Mitchell, 2017;Smith et al., 1999;Timko and Perone, 2005;Tylka et al., 2015;Westenhoefer et al., 1999). In contrast, flexible restraint is linked with lowered disordered eating, body image concerns, body weight, and psychological distress (Shearin et al., 1994;Smith et al., 1999;Westenhoefer et al., 1999Westenhoefer et al., , 2013 and increases in flexible control are associated with binge eating abstinence, greater weight loss in the course of therapy (Blomquist and Grilo 2011), and in one study, predicted long-term weight maintenance among women with obesity (Teixeira et al., 2010). ...
The popularity of physique sports is increasing, yet there are currently few comprehensive nutritional guidelines for these athletes. Physique sport now encompasses more than just a short phase before competition and offseason guidelines have recently been published. Therefore, the goal of this review is to provide an extensive guide for male and female physique athletes in the contest preparation and recovery period. As optimal protein intake is largely related to one’s skeletal muscle mass, current evidence supports a range of 1.8-2.7 g/kg. Furthermore, as a benefit from having adequate carbohydrate to fuel performance and activity, low-end fat intake during contest preparation of 10-25% of calories allows for what calories remain in the “energy budget” to come from carbohydrate to mitigate the negative impact of energy restriction and weight loss on training performance. For nutrient timing, we recommend consuming four or five protein boluses per day with one consumed near training and one prior to sleep. During competition periods, slower rates of weight loss (≤0.5% of body mass per week) are preferable for attenuating the loss of fat-free mass with the use of intermittent energy restriction strategies, such as diet breaks and refeeds, being possibly beneficial. Additionally, physiological and psychological factors are covered, and potential best-practice guidelines are provided for disordered eating and body image concerns since physique athletes present with higher incidences of these issues, which may be potentially exacerbated by certain traditional physique practices. We also review common peaking practices, and the critical transition to the post-competition period.
... Overeating might be associated with one of the following eating styles: Restrained, emotional, or external. In restrained eating, when someone is following a strict dietary regimen, eating something forbidden may induce "all-or-nothing" reaction leading to overconsumption . Negative, positive, or neutral emotional states (e.g., sadness, anxiety, joy, boredom) might also increase food intake (emotional eating). ...
Rapidly increasing prevalence of overweight and obesity indicates a need to search for their main causes. Addictive-like eating and associated eating patterns might result in overconsumption, leading to weight gain. The aim of the study was to identify main determinants of food intake variety (FIV) within eating addiction (EA), other lifestyle components, and sociodemographic characteristics. The data for the study were collected from a sample of 898 Polish adults through a cross-sectional survey in 2019. The questionnaire used in a study included Food Intake Variety Questionnaire (FIVeQ), Eating Preoccupation Scale (EPS) and questions regarding lifestyle and socio-demographic factors. High eating addiction was found in more than half of people with obesity (54.2%). In the study sample physical activity at leisure time explained FIV in the greatest manner, then subsequently EPS factor: Eating to provide pleasure and mood improvement. In the group of people with obesity, the score of this EPS factor was the best predictor of FIV, in a way that its higher score was conducive to a greater variety of food intake. Socio-demographic characteristics differentiated FIV only within group with normal body weight (age) and with overweight (education). As conclusion, food intake variety (FIV) was associated with physical activity at leisure time, and then with EPS factor “Eating to provide pleasure and mood improvement”, whereas socio-demographic characteristics were predictors of FIV only within groups identified by Body Mass Index (BMI). Nevertheless, our observations regarding Eating to provide pleasure and mood improvement factor and its associations with food intake variety indicate a need for further research in this area. Future studies should also use other tools to explicitly explain this correlation.
... Eating behavior has a crucial role in energy balance and weight control. Changes eating behavior may have an effect on losing and gaining weight (16) . ...
It is known that social isolation process has an impact on individuals’ eating behaviors. Continuing nutritional behavior resulting from emotional eating, uncontrolled eating and cognitive restriction may turn into eating disorders in the future. The purpose of this study is to evaluate the possible effects of Corona Virus Disease-2019 (COVID-19) pandemic and social isolation process on individuals’ nutritional behaviors and body weight changes.
Retrospective cohort study.
Nutritional behaviors of the participants before the COVID-19 pandemic and in the social isolation process were evaluated with the Three Factor Nutrition Questionnaire (TFEQ-R18). The changes in individuals’ body weight during this period was also evaluated.
A total of 1036 volunteer individuals (827 women, 209 men) aged 18 and over participated in the study.
During the COVID-19 pandemic and social isolation process, there was an increase in emotional eating and uncontrolled eating behaviors of individuals, but no significant change in cognitive restriction behavior occurred (p = <0.00; p = <0.00 and p = 0.53, respectively). It was reported that the body weight of 35% of the individuals who participated in the study increased during this period.
Social isolation process practiced as a result of COVID-19 pandemic may lead to changes in some nutritional behaviors. Some precautions should be taken to prevent this situation that occurs in nutritional behaviors from causing negative health problems in the future.
... Dieting, disordered eating, or eating disorders appearing in the past can also alter the sensation of hunger and satiety [7,57]. For example, higher intake of unfavorable foods as a result of unconditional permission to eat what is desired (UPE) might be only a temporary effect observed among individuals previously engaging in rigid dietary control and restrictions, known as a risk factor for excessive consumption or eating for reasons unrelated to physical hunger [58,59]. Our results may be due to the influence of previous individuals' experiences, yet such factors were not included in our study. ...
Intuitive (IE) and mindful (ME) eating share internally focused eating, yet previous studies have shown that these concepts are not strongly correlated, which suggests that they might be differently related to food intake. The study aimed to adapt the original Intuitive (IES-2) and Mindful (MES) Eating Scales to the Polish language, to test their psychometric parameters and, further, to examine associations of IE and ME with an intake of selected food groups, i.e., healthy foods (fresh and processed vegetables, fresh fruit) and unhealthy foods (sweets, salty snacks). A cross-sectional study was conducted in 2020 in a group of 1000 Polish adults (500 women and 500 men) aged 18–65 (mean age = 41.3 ± 13.6 years). The factor structure was assessed with exploratory (EFA) and confirmatory (CFA) factor analysis as well as structural equation modeling (SEM). Measurement invariance across gender was assessed with multiple-group analysis. Internal consistency and discriminant validity of the two scales was tested. Spearman’s correlation coefficient was used to examine the correlation between IES-2 and MES subscales with food intake. A 4-factor, 16-item structure was confirmed for IES-2, while EFA and CFA revealed a 3-factor, 17-item structure of MES. Both scales demonstrated adequate internal consistency and discriminant validity. Full metric and partial scalar invariance were found for IES-2, while MES proved partial invariances. “Awareness” (MES) and “Body–Food Choice Congruence” (IES-2) positively correlated with intake of healthy foods and negatively with the intake of unhealthy ones. “Eating For Physical Rather Than Emotional Reasons” (IES-2) and “Act with awareness” (MES) favored lower intake of unhealthy foods, whereas “Unconditional Permission to Eat” and “Reliance on Hunger and Satiety Cues” (IES-2) showed an inverse relationship. A greater score in “Acceptance” (MES) was conducive to lower intake of all foods except sweets. The results confirmed that adapted versions of the IES-2 and MES are valid and reliable measures to assess IE and ME among Polish adults. Different IE and ME domains may similarly explain intake of healthy and unhealthy foods, yet within a single eating style, individual domains might have the opposite effect. Future studies should confirm our findings with the inclusion of mediating factors, such as other eating styles, childhood experiences, dieting, etc.
... Ironically, however, rigid restriction can lead to more disinhibited eating (Westenhoefer et al., 1999). This is in part due to the physiological and emotional pressures of hunger (Greenway, 2015;MacLean et al., 2015; for a discussion, see; Linardon, 2018), as well as a common all-or-nothing mindset of dieting whereby any violation of restriction becomes a binge (e.g., the abstinence violation effect; Carels et al., 2004;Herman & Mack, 1975;Mooney et al., 1992;(Polivy, Herman, & Rajbir, 2010); for reviews, see Polivy & Herman, 2020;Keel & Heatherton, 2010). Although feelings of eating self-efficacy can lead to improvements in the quality of one's nutrition (e.g. ...
Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, β = 0.135, p < .001, and more disinhibited eating, β = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.
... Moreover, cross-sectional research examining the impact of a specific rigid control behavior, namely meal-skipping, has linked this behavior with an increased frequency of binge eating in women with BED  and with depressive symptoms, anxiety symptoms, and quality of life impairment in women with AN and BN . Finally, numerous other cross-sectional studies using the Rigid Control subscale of the Cognitive Restraint Scale-which assesses the broad range of inflexible dietary behaviors -have reported consistent and robust links between rigid control and numerous adverse health outcomes in both male and female participants, including disordered eating behaviors and attitudes (e.g., binge eating, disinhibited eating, dichotomous thinking), body image concerns (e.g., shape/weight overvaluation, body dissatisfaction), psychological distress (e.g., depressive and anxiety symptoms), and poorer wellbeing [11,83,. Taken together, the available evidence suggests that a rigid approach to dieting may be potentially detrimental. ...
Physique athletes strive for low body fat with high lean mass and have higher body image and eating disorder rates than the general population, and even other weightlifting populations. Whether athletes with a background or tendency to develop these issues are drawn to the sport, or whether it drives these higher incidences, is unknown. However, the biological drive of cyclical energy restriction may contribute to binge-eating behavior. Additionally, requisite monitoring, manipulation, comparison, and judgement of one’s physique may contribute to body image concerns. Contest preparation necessitates manipulating body composition through energy restriction and increased expenditure, requiring dietary restraint and nutrition, exercise, and physique assessment. Thus, competitors are at mental health risk due to (1) pre-existing or predispositions to develop body image or eating disorders; (2) biological effects of energy restriction on eating psychology; and (3) dietary restraint attitudes and resultant physique, exercise, and nutrition monitoring behavior. In our narrative review we cover each factor, concluding with tentative best-practice recommendations, including dietary flexibility, slower weight loss, structured monitoring, gradual returns to offseason energy intakes, internal eating cues, appropriate offseason body compositions, and support from nutrition and mental health professionals. A mental health focus is a needed paradigm shift in bodybuilding nutrition practice and research.
This study aims to investigate relationships among body mass index (BMI), socioeconomic variables, dietary self-efficacy and consumer dietary stress in healthy food buying and explore whether different levels of personal values influence these relationships.
The study is based on an online representative cross-sectional study with 380 food consumers. Structural equation modeling served to estimate direct, mediating and moderating effects between the studied constructs and variables.
Examples of moderating and moderated mediating effects include a negative impact of BMI on dietary stress for consumers with low levels of enjoyment value but no significant effect for consumers with high levels of enjoyment. BMI also had a greater negative impact on dietary self-efficacy when the level of respect/achievement was high (vs low), and respect/achievement positively moderated the mediating effect of BMI on dietary stress through dietary self-efficacy.
This study focuses on analyzing healthy food buying in a particular cultural setting and may suffer from a lack of generalizability to other cultures. The results suggest that research should take into account personal values when investigating stress.
Food managers and health authorities can improve their ability to reduce dietary stress when addressing consumers by understanding the role of personal values in healthy food choice and the impact on mental well-being.
This study offers a novel, more fine-grained conceptual model of how consumers develop dietary stress when buying healthy food.
Binge eating is increasingly prevalent among adolescents and young adults and can have a lasting harmful impact on mental and physical health. Mechanistic insights suggest that aberrant reward-learning and biased cognitive processing may be involved in the aetiology of binge eating. We therefore investigated whether recently developed approaches to catalyse brief interventions by putatively updating maladaptive memory could also boost the effects of cognitive bias modification training on binge eating behaviour. A non-treatment-seeking sample of 90 binge eating young adults were evenly randomised to undergo either selective food response inhibition training, or sham training following binge memory reactivation. A third group received training without binge memory reactivation. Laboratory measures of reactivity and biased responses to food cues were assessed pre-post intervention and bingeing behaviour and disordered eating assessed up to 9 months post-intervention. The protocol was pre-registered at https://osf.io/82c4r/. We found limited evidence of premorbid biased processing in lab-assessed measures of cognitive biases to self-selected images of typical binge foods. Accordingly, there was little evidence of CBM reducing these biases and this was not boosted by prior ‘reactivation’ of binge food reward memories. No group differences were observed on long-term bingeing behaviour, caloric consumption or disordered eating symptomatology. These findings align with recent studies showing limited impact of selective inhibition training on binge eating and do not permit conclusions regarding the utility of retrieval-dependent memory ‘update’ mechanisms as a treatment catalyst for response inhibition training.
The current study evaluated components of existing theoretical models for loss of control (LOC) eating in young men. The link between body image concerns, including concerns with fat and muscularity, and LOC eating frequency was evaluated in 1109 ethnically/racially diverse men (18–30y). Dietary restraint, compulsive exercise, and emotion dysregulation were evaluated as putative mediators. Body mass index (BMI) and race/ethnicity were examined as moderators. Participants completed online surveys. Path analyses in Mplus tested indirect paths using the bias-corrected bootstrap method. Higher body fat concerns were directly linked to LOC eating frequency and indirectly linked through greater dietary restraint, compulsive exercise, and emotional dysregulation (ps<.01). The link among fat concerns, restraint, and LOC eating frequency was moderated by body mass, such that this association was particularly strong for men with a low-to-average BMI relative to those with a high BMI (p < .001). Higher muscularity concerns were not directly linked to LOC eating frequency but were indirectly linked through greater emotion dysregulation (p < .001). Body image concerns are associated with LOC eating in young men. The pathways to LOC eating may differ depending on the nature of men’s body image concerns (muscularity vs. thinness). Prospective data are needed to verify these findings.
In this chapter we discuss nutritional interventions for food addiction (FA). As of yet, there is no clear established diet or food plan for FA treatment. Many approaches will likely prove useful, with further study. One potential approach is an abstinence-based one, essentially promoting strict restriction from certain types of foods that are highly addictive (especially those including high sugar, fat, and salt or highly refined ingredients). An alternate approach would be to not abstain from any food in particular, but rather to pay more attention to the quantity of foods consumed. Still others have recommended taking a more individualized approach, paying attention to particular trigger foods for each person. Increasing consumption of more nutritional and filling foods can also be emphasized. Other considerations to keep in mind include underlying comorbidities including eating disorders (EDs) and other psychiatric illnesses including addiction to other substances. In this chapter we explore the evidence to support the various approaches, including effects on cravings and maintenance of recovery.
Independently, food insecurity (FI) and binge-spectrum eating disorders (B-ED) are widespread problems; moreover, FI is associated with elevated binge-eating symptoms. However, extant research has not explored how FI may contribute to the development of B-ED symptoms, nor potential impacts of FI on eating disorder treatment.
This study aimed to qualitatively examine (1) mechanisms by which FI impacts B-ED development and maintenance, (2) effects of past and/or present FI on ED treatment, and (3) participant recommendations for addressing FI in future B-ED treatment. Fourteen individuals who completed B-ED treatment and endorsed FI completed a 30-min interview about their experiences.
Participants reported that FI contributed to binge eating by maintaining dietary restraint-binge-eating cycle and by leading them to use food as a coping mechanism or for emotional comfort, both in past and present situations. Present FI interfered with treatment, particularly with adhering to treatment recommendations and food purchasing choices, however, participants did not report any impact of past FI on B-ED treatment. Participants reported that rarely was FI addressed as part of treatment; most participants suggested that future treatments work to (1) assess and problem solve present FI to minimize interference and (2) assess and understand the influence of past FI on current symptoms to validate the function of behavior.
These findings provide qualitative support that FI may reinforce B-ED symptoms and present FI may interfere with treatment. This study emphasizes the need for assessment and consideration of FI as a factor when treating individuals with B-EDs.
Background: Eating disorders (EDs) are prevalent in adolescents and young adults, leading to various psychiatric and physical complications that affect the quality of life and even mortality. Objectives: The present study aimed to investigate the mediating role of self-efficacy and self-esteem in the relationship of perfectionism and negative reactivity with EDs. Methods: This descriptive study was performed on 302 students selected from the University of Tehran during 2018 - 2019. The data collection tools were the ED Examination-Questionnaire Short form, Self-esteem Scale, Weight Efficacy Lifestyle Questionnaire‑Short Form, ED Inventory-Perfectionism Scale, and Perth Emotional Reactivity Scale. Pearson’s correlation coefficient and structural equation modeling were used to analyze the data. Results: The results showed that EDs had significant positive correlations with perfectionism (r = 0.4, P = 0.01) and general negative reactivity (r = 0.53, P = 0.01). On the other hand, these disorders had a significant negative correlation with self-esteem (r = -0.48, P = 0.01) and self-efficacy (r = 0.53, P=0.01). Self-esteem had a negative significant relationship with perfectionism (r = -0.12, P = 0.05) and negative reactivity (r = -0.68, P = 0.01). Moreover, self-efficacy had a negative significant relationship with perfectionism (r = -0.28, P = 0.01) and negative reactivity (r = -0.5, P = 0.01). The findings of path analysis showed that self-esteem and self-efficacy played mediating roles in the relationship of negative reactivity and perfectionism with EDs. Negative reactivity directly affected eating pathology (t = 1.27, ß = 0.13) but is not significant. Conclusions: Our findings showed that self-esteem and self-efficacy are protective factors against the negative effects of perfectionism and negative reactivity. Therefore, self-esteem and self-efficacy can be considered as parts of prevention and treatment programs for EDs.
Binge eating behavior has been defined as an increased intake of palatable food during a short time period. The experimental models with rodents that had studied this eating behavior had implicitly or explicitly assumed that the induction protocol produced a permanent change in palatable eating, although there is no description of the persistence of the behavioral pattern despite this pice of information may be needed to evaluate any therapeutic strategy. Therefore, present objectives were: a) determine whether binge eating behavior persist after its induction with a 2h access to sucrose solution concurrent to free access to rat chow food for 24 h and, b) determine whether the deprivation level of chow food modulates maintenance of binge eating behavior. To this aim, rats had a 2h daily access to 10% sucrose with concurrent access to ad lib food and water. It was observed that after 25 days subjects develop binge eating behavior. It was also observed that along 8 weeks at least, binge eating behavior was stable and neither ad lib access or food deprivation modulated binge eating behavior, that remained similar to the last induction day. Stability of binge eating behavior reproduced observations with human patients and may aloud the study of long term neural changes induced after binge induction.
The Inflexible Eating Questionnaire (IEQ) is a recently developed measure that assesses an individual's inflexible adherence to rigid eating rules, along with the tendency to respectively feel empowered or distressed when such rules are or are not followed. At present, evidence supporting the unidimensional structure and psychometric properties of the IEQ is limited to one specific sample of Portuguese adults. Establishing whether the IEQ is a valid and reliable measure in a different sample and by an independent research team is needed. We sought to examine the factor structure and psychometric properties of the IEQ in large sample (n = 1000) of Australian female adults. A unidimensional structure was replicated and evidence of internal consistency (α = .89) was found. IEQ scores were significantly and moderately correlated with various eating restraint measures and intuitive eating, providing evidence of convergent validity. IEQ scores also predicted incremental variance in global eating disorder symptomatology and psychosocial impairment after controlling for intuitive eating, flexible control, and rigid dietary control. Present findings offer further support for the validity and reliability of the IEQ in a non-clinical sample of women. A brief measure that assesses the inflexible adherence to eating rules may be valuable for validating current models of eating disorder psychopathology. Furthermore, incorporating the IEQ into the assessment of future randomized trials of eating disorder prevention or treatment programs may be beneficial for elucidating these interventions mechanisms of change.
Binge eating disorder (BED) is characterized by recurrent overeating episodes, accompanied by loss of control (LOC), in the absence of compensatory behaviors. The literature supports that men overeat as often or more often than do women, but they are less likely to endorse LOC and other BED symptoms. Thus, rates of BED are lower among men. However, differences in prevalence rates may reflect gender bias in current conceptualizations of eating disorders and BED diagnostic criteria, not necessarily truly lower rates of disordered eating among men. The purpose of this study was to gather detailed information about how men experience overeating and related body image concerns, to identify common themes. The grounded theory approach was utilized to examine narratives from 11 overweight/obese male college students about their experiences with overeating, with results suggesting that overeating is consistent with male gender role, but LOC is not. Other overeating themes included mindless eating, emotional antecedents, negative consequences, unintentional dietary restriction, and social encouragement to overeat. Participants also reported dissatisfaction with their bodies, a desire for their bodies to be both muscular and thin, concerns related to their physical functioning and health, and a distinction between body image and self-worth. Collectively, these themes suggest further study to more fully explore the features and consequences of how disordered eating and body image concerns may manifest among men.
This study aimed to replicate and extend from Tylka, Calogero, and Daníelsdóttir (2015) findings by examining the relationship between rigid control, flexible control, and intuitive eating on various indices of disordered eating (i.e., binge eating, disinhibition) and body image concerns (i.e., shape and weight over-evaluation, body checking, and weight-related exercise motivations). This study also examined whether the relationship between intuitive eating and outcomes was mediated by dichotomous thinking and body appreciation. Analysing data from a sample of 372 men and women recruited through the community, this study found that, in contrast to rigid dietary control, intuitive eating uniquely and consistently predicted lower levels of disordered eating and body image concerns. This intuitive eating-disordered eating relationship was mediated by low levels of dichotomous thinking and the intuitive eating-body image relationship was mediated by high levels of body appreciation. Flexible control predicted higher levels of body image concerns and lower levels of disordered eating only when rigid control was accounted for. Findings suggest that until the adaptive properties of flexible control are further elucidated, it may be beneficial to promote intuitive eating within public health approaches to eating disorder prevention. In addition to this, particular emphasis should also be made toward promoting body acceptance and eradicating a dichotomous thinking style around food and eating.
Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. However, inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria.
Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11.
Experimentally induced changes in attitudes, norms, and self-efficacy all led to medium-sized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38, norms-d+ = .36, self-efficacy-d+ = .47). These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, and features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance.
The present review lends novel, experimental support for key predictions from health behavior theories, and demonstrates that interventions that modify attitudes, norms, and self-efficacy are effective in promoting health behavior change. (PsycINFO Database Record
Although sociocultural pressures are thought to contribute to bulimia nervosa, little research has examined the mechanisms by which these factors might actually produce eating pathology. The present study tested an integrative model of bulimia that centers around dietary restraint and affect regulation pathways. It also incorporates perceived sociocultural pressure, body-mass, ideal-body internalization, and body dissatisfaction. Using data from 257 female undergraduates, structural equation modeling revealed that the model accounted for 71% of the variance in bulimic symptomatology. The relation between perceived sociocultural pressure and bulimic symptoms was mediated by ideal-body internalization, body dissatisfaction, dietary restraint, and negative affect. The results support the dual pathway model of bulimia and suggest variables that might be targeted in prevention efforts.
Examine the association between components of restrained eating, cognitive performance and weight loss maintenance.
106 women, all members of a commercial slimming organisation for at least 6months (mean±SD: 15.7±12.4months), were studied who, having lost 10.1±9.7kg of their initial weight, were hoping to sustain their weight loss during the 6month study. Dietary restraint subcomponents flexible and rigid restraint, as well as preoccupying cognitions with food, body-shape and diet were assessed using questionnaires. Attentional bias to food and shape-related stimuli was measured using a modified Stroop test. Working memory performance was assessed using the N-back test. These factors, and participant weight, were measured twice at 6month intervals.
Rigid restraint was associated with attentional bias to food and shape-related stimuli (r=0.43, p<0.001 resp. r=0.49, p<0.001) whereas flexible restraint correlated with impaired working memory (r=-0.25, p<0.05). In a multiple regression analyses, flexible restraint was associated with more weight lost and better weight loss maintenance, while rigid restraint was associated with less weight loss.
Rigid restraint correlates with a range of preoccupying cognitions and attentional bias to food and shape-related stimuli. Flexible restraint, despite the impaired working memory performance, predicts better long-term weight loss. Explicitly encouraging flexible restraint may be important in preventing and treating obesity.
Following from Bandura's (1977a) self-efficacy theory, an Eating Self-Efficacy Scale (ESES) was developed and its psychometric properties established. Factor analysis of the 25-item scale yielded two reliable factors—one concerned with eating when experiencing negative affect (NA) and the other with eating during socially acceptable circumstances (SAC). The ESES demonstrated good internal consistency, test-retest reliability, and convergent validity. A clinical study using this measure found that increases in ESES scores were significantly related to weight losses among weight loss program participants. A laboratory study using a mood induction procedure found that NA subscale scores predicted food consumption irrespective of whether negative affect was induced. This finding may indicate that people have difficulty accurately discriminating the specific circumstances under which their eating difficulties occur and/or that eating difficulties tend to be global in nature. The significant correlation of the two ESES subscales (r =.39, p .001) supports these possibilities. The clinical and research utility of the ESES and the implications of the findings are discussed.
The purpose of this study was to examine the potential improvements in eating self-efficacy, eating behavior and other psychological factors in obese subjects participating in a weight management program. The participants in this study consisted of 96 persons (76 women and 20 men) who were attending the first session of a commercially run 20-week treatment program for weight reduction. Self-efficacy in relation to eating was assessed by the Weight Efficacy Lifestyle Questionnaire. The participants also completed the Three Factor Eating Questionnaire (TFEQ), Rosenberg Self-esteem Scale, Social Physique Anxiety Scale, State Trait Anxiety Inventory and Body Parts Satisfaction Scale prior to weight management program and again 20 weeks after the program. High self-efficacy score was significantly associated with high weight loss among all participants. Also, high negative emotions and physical discomfort scores were significantly associated with high weight loss among all participants. Results indicated that there was a significant decrease in the TFEQ hunger and disinhibition scores during the study. As a conclusion, our findings suggest that the role of self-efficacy has an important role in obesity treatment regarding to weight control behavior.
Nisbett's (1972) model of obesity implies that individual differences in relative deprivation (relative to set-point weight) within obese and normal weight groups should produce corresponding within-group differences in eating behavior. Normal weight subjects were separated into hypothetically deprived (high restraint) and non-deprived (low restraint) groups. The expectation that high restraint subjects' intake would vary directly with preload size while low restraint subjects would eat in inverse proportion to preload size, was confirmed. It was concluded that relative deprivation rather than obesity per se may be the cirtical determinant of individual differences in eating behavior. Consideration was given to the concept of "restraint" as an important behavioral mechanism affecting the expression of physiologically-based hungar.
The purpose of this study was to conduct an assessment of binge eating severity among obese persons. Two questionnaires were developed. A 16-item Binge Eating Scale was constructed describing both behavioral manifestations (e.g., eating large amounts of food) and feeling/cognitions surrounding a binge episode (e.g., guilt, fear of being unable to stop eating). An 11-item Cognitive Factors Scale was developed measure two cognitive phenomena thought to be related to binge eating: the tendency to set unrealistic standards for a diet (e.g., eliminating "favorite foods") and low efficacy expectations for sustaining a diet. The results showed that the Binge Eating Scale successfully discriminated among persons judged by trained interviewers to have either no, moderate or severe binge eating problems. Significant correlation between the scales were obtained such that severe bingers tended to set up diets which were unrealistically strict while reporting low efficacy expectations to sustain a diet. The discussion highlighted the differences among obese persons on binge eating severity and emphasized the role of cognitions in the relapse of self control of eating.
This study was designed to test the hypothesis that different types of dieting strategies are associated with different behavioral outcomes by investigating the relationship of dieting behaviors with overeating, body mass and mood. A sample of 223 adult male and female participants from a large community were studied. Only a small proportion of the sample (18%) was seeking weight loss treatment, though almost half (49.3%) of the subjects were significantly overweight (body mass index, BMI>30). Subjects were administered questionnaires measuring dietary restraint, overeating, depression and anxiety. Measurements of height and weight were also obtained in order to calculate BMI. Canonical correlation was performed to evaluate the relationship of dietary restraint variables with overeating variables, body mass, depression and anxiety. The strongest canonical correlation (r=0.65) was the relationship between flexible dieting and the absence of overeating, lower body mass and lower levels of depression and anxiety. The second strongest canonical correlation (r=0.59) associated calorie counting and conscious dieting with overeating while alone and increased body mass. The third canonical correlation (r=0.57) found a relationship between low dietary restraint and binge eating. The results support the hypothesis that overeating and other adverse behaviors and moods are associated with the presence or absence of certain types of dieting behavior.
Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior.
Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales.
Rigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program.
Rigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control.
In treatment of binge eating, measures of self-concept, eating self-efficacy, and social support were examined at 0, 6, and 18 months to determine if improvements in these variables were associated with reductions in binge eating severity.
Obese adult females (N = 125) were treated for 6 months, with 12 months of maintenance meetings. The Binge Eating Scale (BES), Tennessee Self-Concept Scale (TSC), Dieter's Inventory of Eating Temptations (DIET), and a social support measure (SocSup) were used.
Over the first 6 months, improvements in BES were associated with improvements in the TSC and DIET. Over 18 months, improvements in BES were associated with improvements in the TSC, DIET, and SocSup.
Therapy for binge eating should result in improvement in self-concept and eating self-efficacy, as well as reductions in binge eating. This study showed that self-concept and eating self-efficacy were associated with improvement in binge eating severity. The association with social support did not appear until long-term follow-up. Improvement in self-concept and eating self-efficacy may be processes leading to clinical improvement in this eating disorder, or they may result from changes in binge eating.
This study represented the first attempt to directly evaluate Fairburn et al's (1986) cognitive-behavioral model of bulimia nervosa--the model on which the most widely used treatment for bulimia nervosa is based.
The major predictions of the model were tested using structural equation modeling. Data were collected from the responses of 526 subjects to a number of self-report measures.
The factors of self-esteem, overconcern with weight and shape, and dietary restraint accounted for a large proportion of the variance in binge eating and purging. The key pathway in the model was the link between overconcern with weight and shape and the adoption of purgative behaviors, which then fed into a vicious cycle of binge eating and purging. Contrary to Fairburn's hypothesis, high levels of dietary restraint did not predict increased binge eating.
The results suggest that the components of Fairburn's model may operate to maintain the bulimic cycle in a slightly different way to that originally proposed.
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.
Most research on eating self-efficacy has focused on its relationship with eating behaviors and weight-loss in clinical populations. The purpose of this study was to investigate the relationship between eating self-efficacy and the behavioral and psychological characteristics associated with eating disorders in a non-clinical sample of adults. A total of 219 men and women aged 18 and older completed questionnaires measuring eating disorder symptoms and eating self-efficacy. The results indicated that low confidence in the ability to control eating while experiencing negative emotions was associated with greater weight preoccupation and bulimic thought and behaviors. In addition, low confidence in ability to control eating when an abundance of food is available was inversely related to feelings of ineffectiveness or general negative self-evaluation. Ultimately, the findings suggest that low eating self-efficacy may also be associated with eating problems within populations not seeking treatment for either eating disorders or weight-loss. The implications of the findings are discussed.
In this trial, adolescent girls with body dissatisfaction (N = 481, M age = 17 years) were randomized to an eating disorder prevention program involving dissonance-inducing activities that reduce thin-ideal internalization, a prevention program promoting healthy weight management, an expressive writing control condition, or an assessment-only control condition. Dissonance participants showed significantly greater reductions in eating disorder risk factors and bulimic symptoms than healthy weight, expressive writing, and assessment-only participants, and healthy weight participants showed significantly greater reductions in risk factors and symptoms than expressive writing and assessment-only participants from pretest to posttest. Although these effects faded over 6-month and 12-month follow-ups, dissonance and healthy weight participants showed significantly lower binge eating and obesity onset and reduced service utilization through 12-month follow-up, suggesting that both interventions have public health potential.
Self-efficacy: toward a unifying theory of behavioral change
L S Aiken
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Using multivariate statistics
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