Eating behavior in anorexia nervosa: Before and after treatment

Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 03/2012; 45(2):290-3. DOI: 10.1002/eat.20924
Source: PubMed


The purpose of this study was to assess eating behavior in patients with anorexia nervosa before and after weight normalization and healthy controls using a standardized, multiple-item lunch meal paradigm.
Eighteen patients were studied shortly after inpatient admission and again after gaining to a BMI ≥ 19.5 kg m(-2) . Fifteen healthy controls were studied twice, ∼2-3 months apart.
When underweight, patients with AN consumed fewer total calories (364 ± 208 kcal) and a lower percentage of calories from fat (18% ± 10%) compared to controls (775 ± 228 kcal, p = 0.001; 38% ± 7%, p = 0.001). After weight normalization, despite a modest increase in total calories (364 ± 208 kcal vs. 516 ± 273 kcal, p = 0.04) and in percent of calories from fat (18% ± 10% vs. 23% ± 9%, p = 0.04), patients continued to consume fewer total calories and a reduced percent of calories from fat compared to controls (758 ± 346 kcal, p = 0.03; 38% ± 18%, p = 0.004).
Patients with AN, even after acute treatment, consume fewer total calories and fewer calories from fat, compared to healthy controls. The reduced overall intake and persistent avoidance of fat may contribute to relapse, and therefore are potential therapeutic targets.

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    • "AN is characterized primarily by disturbances in eating behavior, particularly restriction of energy intake relative to one's energy needs (American Psychiatric Association, 2013), yet relatively little is known about specific eating patterns in AN. With regard to typical eating behaviors in AN, evidence suggests that individuals with the disorder tend to consume fewer kilocalories and less fat than healthy controls when under observation in controlled laboratory conditions (Fernstrom et al., 1994; Gwirtsman et al., 1989; Hadigan et al., 2000; Mayer et al., 2012; Sysko et al., 2005). However, results from one study that collected data via daily dietary recall based on ecological momentary assessment, or EMA (which addresses concerns about the artificial nature of the laboratory setting by collecting data in " real time " in the natural environment; Shiffman et al., 2008), suggest that the mean daily caloric intake of individuals with AN may be closer to nutritional recommendations than one might expect based on laboratory data (Burd et al., 2009). "
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    ABSTRACT: Background Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. Methods Women with AN (n=118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. Results The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. Conclusions Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder.
    Full-text · Article · Jun 2014 · Journal of Psychiatric Research
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    • "circuits to the same degree as healthy controls (Marsh et al., 2009). Clinically, patients with anorexia nervosa display a remarkable ability to control their food intake behavior (Mayer et al., 2012) and demonstrate enhanced ability to delay monetary (e.g. nonfood ) rewards (Steinglass et al., 2012). "
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    ABSTRACT: The ability to exert self-control in the face of appetitive, alluring cues is a critical component of healthy development. The development of behavioral measures that use disease-relevant stimuli can greatly improve our understanding of cue-specific impairments in self-control. To produce such a tool relevant to the study of eating and weight disorders, we modified the traditional go/no-go task to include food and non-food targets. To confirm that performance on this new task was consistent with other go/no-go tasks, it was given to 147 healthy, normal weight volunteers between the ages of 5 and 30. High-resolution photos of food or toys were used as the target and nontarget stimuli. Consistent with expectations, overall improvements in accuracy were seen from childhood to adulthood. Participants responded more quickly and made more commission errors to food cues compared to nonfood cues (F(1,140)=21.76, P<0.001), although no behavioral differences were seen between low- and high-calorie food cues for this non-obese, healthy developmental sample. This novel food-specific go/no-go task may be used to track the development of self-control in the context of food cues and to evaluate deviations or deficits in the development of this ability in individuals at risk for eating problem behaviors and disorders.
    Full-text · Article · May 2014 · Psychiatry Research
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    ABSTRACT: A disturbance in eating behavior is the defining characteristic of the clinical eating disorders, Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Surprisingly little research has been devoted to assessing objectively the nature of the eating disturbances in these disorders, to elucidating what factors contribute to the development and persistence of these disturbances, or to describing how they change with treatment. This review, which is based on a Mars lecture delivered at the 2010 meeting of the Society for the Study of Ingestive Behavior, reviews objective information about the nature of the disturbances of eating behavior in eating disorders. These data suggest that more detailed knowledge of eating behavior is an essential component of a full understanding of eating disorders and may provide a foundation for studies of pathophysiology and for the development of new treatment methods.
    Preview · Article · May 2011 · Physiology & Behavior
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