Momentary Affect Surrounding Loss of Control and Overeating in Obese Adults With and Without Binge Eating Disorder

Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA.
Obesity (Impact Factor: 3.73). 09/2011; 20(6):1206-11. DOI: 10.1038/oby.2011.286
Source: PubMed
ABSTRACT
Research suggests that loss of control (LOC) while eating (the sense that one cannot control what or how much one is eating) is a more salient feature of binge eating than the amount of food consumed. This study examined the unique contributions of LOC and episode size to negative affect surrounding eating episodes in binge eating disorder (BED) and obesity. Twenty-two obese adults with (n = 9) and without (n = 13) BED completed daily records of eating patterns and mood using ecological momentary assessment (EMA). Linear mixed modeling revealed that across groups, greater premeal self-reported LOC was associated with higher premeal negative affect independent of episode size. For individuals with BED, greater premeal self-reported LOC was associated with higher postmeal negative affect, regardless of the amount of food eaten, whereas for obese controls, the combination of LOC and consumption of large amounts of food was associated with lower postmeal negative affect. Results indicate that LOC, but not the quantity of food consumed, is associated with momentary distress related to aberrant eating in BED. Findings also highlight the need for further research investigating the emotional context surrounding aberrant eating in obese individuals without BED.

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Behavior and Psychology
Recurrent binge eating is the hallmark feature of binge eating
disorder (BED) and bulimia nervosa, two disorders character-
ized by considerable impairment and distress (1). Binge eating
is strongly associated with obesity and weight gain (2), mark-
ing it as a behavior that is particularly relevant to study in obese
samples. In accordance with the Diagnostic and Statistical
Manual of Mental Disorders 1–4th Edition, binge eating epi-
sodes must consist of an unambiguously large amount of food
accompanied by a sense of loss of control (LOC) over eating
(i.e., objective binge eating (3)). us, individuals reporting
subjective binge eating (i.e., consumption of an amount of food
that is not unambiguously large, but is viewed as excessive by
the respondent, accompanied by LOC (4)) would not meet the
binge eating criterion for either of these disorders. However,
research suggests that LOC is the most salient aspect of binge
eating (5), and that this feature is more strongly associated
with psychiatric symptomatology than the quantity of food
consumed (6). To date, however, no research has systematically
explored whether momentary precursors and consequences of
aberrant eating episodes dier depending on the presence or
absence of LOC and/or the consumption of unambiguously
large amounts of food. As LOC eating is prevalent among
obese individuals without eating disorders (7) and is related to
psychiatric impairment independent of episode size as noted
above (6), it is important to characterize the precipitants and
consequences of this behavior in obesity even in the absence
of BED.
e importance of quantity (i.e., consumption of an unam-
biguously large amount of food vs. an amount of food that is not
unambiguously large) vs. subjective experience (i.e., presence
or absence of LOC) of aberrant eating episodes has long been a
source of contention in the eating disorders literature (8). Early
studies show that binge eating episodes in bulimia nervosa
oen consist of relatively small amounts of food (i.e., fewer
than 500–600 kilocalories; (9,10)), but that these episodes are
nevertheless associated with as much momentary distress as
eating episodes meeting the operational criteria for binge eat-
ing. Other research suggests that within both clinical and com-
munity samples, LOC, rather than episode size, accounts for the
severity of eating disorder symptoms, psychiatric comorbidity,
Momentary Affect Surrounding Loss of Control
and Overeating in Obese Adults With and
Without Binge Eating Disorder
Andrea B. Goldschmidt
1
, Scott G. Engel
2,3
, Stephen A. Wonderlich
2,3
, Ross D. Crosby
3,4
,
Carol B. Peterson
5
, Daniel Le Grange
1
, Marian Tanofsky-Kraff
6
, Li Cao
4
and James E. Mitchell
2,3
Research suggests that loss of control (LOC) while eating (the sense that one cannot control what or how much one is
eating) is a more salient feature of binge eating than the amount of food consumed. This study examined the unique
contributions of LOC and episode size to negative affect surrounding eating episodes in binge eating disorder (BED)
and obesity. Twenty-two obese adults with (n = 9) and without (n = 13) BED completed daily records of eating patterns
and mood using ecological momentary assessment (EMA). Linear mixed modeling revealed that across groups,
greater premeal self-reported LOC was associated with higher premeal negative affect independent of episode size.
For individuals with BED, greater premeal self-reported LOC was associated with higher postmeal negative affect,
regardless of the amount of food eaten, whereas for obese controls, the combination of LOC and consumption of
large amounts of food was associated with lower postmeal negative affect. Results indicate that LOC, but not the
quantity of food consumed, is associated with momentary distress related to aberrant eating in BED. Findings also
highlight the need for further research investigating the emotional context surrounding aberrant eating in obese
individuals without BED.
Obesity (2012) 20, 1206–1211. doi:10.1038/oby.2011.286
1
Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA;
2
Department of Clinical Research, Neuropsychiatric
Research Institute, Fargo, North Dakota, USA;
3
Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo,
North Dakota, USA;
4
Department of Biostatistics, Neuropsychiatric Research Institute, Fargo, North Dakota, USA;
5
Department of Psychiatry, University of Minnesota
Medical School, Minneapolis, Minnesota, USA;
6
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda,
Maryland, USA. Correspondence: Andrea B. Goldschmidt (goldschmidta@uchicago.edu)
Received 13 May 2011; accepted 17 August 2011; advance online publication 22 September 2011. doi:10.1038/oby.2011.286
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Behavior and Psychology
interpersonal dysfunction, and treatment-seeking behavior
(11–14); however, it is currently unknown whether similar
associations exist with regard to immediate distress surround-
ing eating episodes. Taken together, these ndings suggest that
the current diagnostic scheme for BED and bulimia nervosa
may fail to capture a signicantly impaired subset of the popu-
lation who consequently may not receive adequate clinical
attention for their eating disturbances. e current literature
could be further strengthened by examining the unique con-
tributions of self-reported LOC and episode size to the experi-
ence of momentary distress in the context of aberrant eating.
Binge eating episodes frequently occur against a backdrop of
negative aect. According to aect regulation theories, binge
eating may provide an escape from aversive emotions and sub-
sequent self-awareness (15), or enable a trade-owhereby
distressing emotional antecedents to binge eating (e.g., anxi-
ety) are replaced by less distressing emotions consequent to
binge eating (e.g., regret (16)). Aect regulation theories have
been supported by both self-report and experimental data in
individuals with BED (e.g., refs 5,17,18). However, these stud-
ies are oen constrained by retrospective recall biases or by
the use of an articial setting. Over the past decade, ecological
momentary assessment (EMA) methodology has been used to
study the relation between mood and binge eating prospec-
tively in the natural environment. EMA studies consistently
demonstrate that binge eating in BED is preceded by the expe-
rience of negative emotions (19–23). Yet, the literature is less
consistent regarding aective consequences of binge eating,
with one study showing a slight (but nonsignicant) decrease
in negative emotions immediately following a binge episode
(19), and others showing an increase in postbinge negative
aect (22,23). It is currently unclear whether antecedents and
consequences vary according to objective size of an eating
episode and/or the subjective experience of reported aberrant
eating episodes. EMA methodology is well-suited to address
this research question because of its ability to assess mood and
eating behavior in “real time.
One unanticipated nding in the EMA literature has been
the degree to which binge eating occurs among obese individ-
uals without a full diagnosis of BED. Indeed, in one early study
~2/3 of obese control participants self-reported binge eating
during the EMA assessment timeframe (20), and another
study reported no dierences between BED and control
groups in the frequency of self-identied binge eating episodes
(21). Moreover, in contrast to laboratory-based studies which
have found that individuals with BED consume more food
during binge meals than obese controls (24,25), Greeno and
colleagues (20) found no dierences between obese individu-
als with and without BED in terms of the kilocalorie content
of self-reported binge meals using EMA. ese unexpected
ndings may be related to reliance on respondents subjective
perception, rather than standardized investigator-based crite-
ria, to identify binge eating episodes. Indeed, recent work by
our group (26) demonstrated that when EMA data were aug-
mented by the use of 24-h dietary recall to quantify eating epi-
sodes, individuals with BED reported signicantly more binge
eating episodes during a 1-week period than obese controls.
Nevertheless, these studies suggest that aberrant eating is prev-
alent among obese individuals, even in the absence of BED.
The aim of the current study was to examine, within a
sample of obese adults with and without BED, precursors to
and consequences of aberrant eating episodes characterized
by the presence of LOC, consumption of an unambiguously
large amount of food, or the combination of both. Based on
the previous literature (19–23), we hypothesized that LOC
would be a strong predictor of pre- and postepisode negative
affect whereas the amount of food consumed would not. We
further hypothesized that the interaction between LOC and
the amount of food consumed would not improve the pre-
diction of postepisode negative affect beyond the independ-
ent effects of LOC, as consistent with prior data (11–14). To
our knowledge, no other study has investigated whether the
immediate emotional context surrounding aberrant eating
varies according to the subjective experience and/or quan-
tity of eating episodes.
METHODS AND PROCEDURES
Participants
Data were collected as part of a larger study of binge eating behavior
among obese adults with BED, obese adults without BED, and nonobese
adults without BED (26). Obese adults (BMI (kg/m
2
) >30) with and
without BED were recruited through community and university yers,
and referrals from an eating disorders treatment facility. Individuals
were excluded due to pregnancy or breastfeeding, a current diagnosis
of a psychotic disorder, previous gastrointestinal surgery, any medical
illness requiring dietary modication, the use of medications associated
with weight or eating change, concurrent treatment for BED, suicidal
ideation, purging, and inability to read English. Inclusion and exclu-
sion criteria were assessed during the phone screen (see “Procedures
section). A total of 75 participants were screened for the study, 40 of
whom were enrolled, provided 1-day trial data (see “Proceduressec-
tion), and completed the EMA protocol (this number includes the non-
obese participants without BED whose data were excluded from the
current study). Two participants were excluded from data analyses for
what appeared to be invalid EMA data. is le a total sample of 38
participants in the overall study, of whom 22 were included in the cur-
rent study. Participants received $100 for study participation and were
oered another $50 for attending all scheduled appointments. is
study was approved by the University of North Dakota Institutional
Review Board.
Procedures
Interested participants completed a phone screen to ascertain BED
status. e phone screen consisted of assessing eating behaviors over
the past month using the eating disorder module from the Structured
Clinical Interview for Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition Axis I Disorders/Patient Edition (SCID-I/P;
(27)) supplemented by probes from the Eating Disorder Examination
(4). Phone screens were administered by master’s-level assessors who
were trained in the SCID-I/P and the Eating Disorder Examination.
Aer study eligibility was determined, participants attended an infor-
mational session at the research facility during which they provided
written informed consent. Participants then received thorough instruc-
tions on how to use the handheld computer (Handspring Visor) for the
EMA assessment protocol. Participants were instructed to complete
EMA recordings of mood and eating behavior each time they initiated
an eating episode; each time they completed an eating episode; before
bedtime; and in response to six semi-random prompts by investigators,
which occurred every 2–3 h between 8:00  and 10:00  (28). Each
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Behavior and Psychology
participant completed a 1-day trial period to ensure that they understood
EMA procedures; trial data were not included in the analyses.
All 22 participants came to the research facility almost every day
during the 7-day data collection period. In-person assessments for
weekends were typically completed on Mondays. During these assess-
ments, data from the handheld computer were uploaded and moni-
tored for compliance, and research coordinators provided feedback
to participants about the quality of the data. Missed EMA assess-
ments were discussed and the research coordinator and participant
attempted to problem-solve any issues that limited compliance with
the protocol. e eating recordings were then used to interview the
participants about their dietary intake.
Measures
EMA. For the 7-day EMA protocol, each participant was asked to
rate mood, stress, hunger, and level of control over eating immediately
before and aer any eating episode. Negative mood was assessed using
the Positive and Negative Aect Scale (29). e Negative Aect Scale
comprised the sum of ve items (afraid, scared, upset, distressed, and
jittery), all of which were rated on a 5-point scale, with a score of “1”
indicating “Not at alland a score of “5” indicating “Extremely” for each
mood state. LOC assessment was based on the construct as described in
the Eating Disorder Examination. at is, during the EMA orientation
period discussed above, participants were instructed that LOC refers to
the feeling that one cannot control what or how much one is eating, or
the experience of feeling driven or compelled to start or continue eat-
ing. Ratings for premeal LOC (“Please rate how much control you cur-
rently feel over your eating”) were made on a 1- to 5-point Likert-type
scale. A rating of 1 on the scale corresponded to “Complete control
and a ve signied “Complete LOC”; postmeal, participants responded
to a “yes/no” question as to whether they had experienced LOC while
eating. For the current study, we opted to utilize LOC ratings prior to
the eating episode to limit retrospective recall bias and to allow for
examination of the full range of experience of LOC (i.e., use of a con-
tinuous vs. categorical variable). LOC ratings prior to eating episodes
were signicantly associated with those reported aer eating episodes (t
(463) = 8.20; P < 0.001), indicating that if individuals reported feelings
of LOC before initiating an eating episode, they were likely to report
having experienced LOC upon completing the episode as well.
Eating behavior. Upon presenting to the research institute each day,
participants were queried about the details of each eating episode
recorded on their handheld computer, as well as if they had forgot-
ten to record any eating episodes. Next, the Nutritional Data System
for Research (30) was used to generate nutritional intake data for each
reported eating episode. e Nutritional Data System for Research is
an interviewer-based assessment that provides nutrient intake data
for foods eaten over a 24-h time interval. It has been described as the
gold standard method of assessing food intake in the natural environ-
ment (31), and it has been used successfully for research in overweight
and obese samples (32). Following each Nutritional Data System for
Research interview, the nutritional data of interest were merged with
the time-stamped EMA data in order to create a temporal prole of eat-
ing episodes and LOC ratings for the previous day.
Statistical analysis. Data were analyzed using SPSS 18.0. All analy-
ses included participants with and without BED. A linear mixed model
approach was used to examine the relation between the dependent
variable of momentary mood, and the independent variables of LOC,
episode size (i.e., kilocalorie content of eating episodes), and group.
Mixed-eects analyses were based on a general linear model with a
random intercept and random eect for study day. Serial correlation
between observations was modeled using a heterogeneous rst-order
autoregressive structure. Two mixed model regressions were run: the
rst model examined premeal negative mood state, while the second
model examined postmeal negative mood state. e second model con-
trolled for premeal negative mood state. For each model, we tested all
two- and three-way interactions among the independent variables. e
intraclass correlation coecient for the premeal negative aect model
was 0.38 and for the postmeal negative aect model was 0.14.
RESULTS
Descriptive characteristics
Participants were 22 obese (M BMI = 38.90 ± 8.67) adults
(86.4% female; n = 19), 9 of whom met criteria for BED and 13
of whom served as non-BED controls. Participants were 35.7
years old, on average (s.d. = 11.9), and described themselves as
white (90.9%; n = 20), black (4.5%; n = 1), or American Indian/
Alaska Native (4.5%; n = 1). Due to the small sample size and
the relative homogeneity of the sample, demographic compari-
sons were not conducted.
A total of 2,009 separate EMA recordings were provided by
the 22 participants over 166 separate participant days, which
included 566 premeal recordings, 477 postmeal recordings,
838 responses to semi-random prompts (out of a possible
total of 924 responses (six signals per day over the 7-day study
period for each of 22 participants); 90.7%), and 128 before-
bedtime recordings (out of a possible total of 154 recordings
(one recording per day over the 7-day study period for each
of 22 participants); 83.1%). e average number of recordings
per day was 12.1 and the average number of eating episodes
per day was 3.4. e average premeal LOC rating across all
observations, including those obtained prior to meals, before
bedtime, and in response to semi-random prompts, was 3.75 ±
1.16 (n = 1467; range = 1–5). e average kilocalories con-
sumed per eating episode was 586.9 ± 625.4 (n = 251) for par-
ticipants with BED and 569.0 ± 556.3 (n = 315) for participants
without BED. For participants with BED, 11.9% of all eating
episodes were classied as binge eating (i.e., consumption of
at least 1,000 kilocalories accompanied by a LOC rating of 3 or
greater on the 1- to 5-point Likert-type scale, indicating at least
moderate LOC; 26) compared to 7.7% for participants without
BED.
Premeal negative affect
For premeal negative aect, there was a signicant main eect
for LOC (t (1,427) = 4.61; P < 0.001; see Ta ble 1), indicating
that for all participants, greater LOC was associated with higher
premeal negative aect regardless of the amount of food eaten.
e pseudo R
2
for the full model was 0.06, which is between a
small (R
2
= 0.02) and a medium (R
2
= 0.14) eect size (33).
Postmeal negative affect
For postmeal negative aect (adjusted for premeal negative
aect), there were no main eects for LOC, kilocalories, or
group status (Ps > 0.10; see Ta ble 1). However, the two-way
interaction between kilocalories and group was signicant
(t (1,59) = −2.86; P = 0.006). Figure 1 illustrates that for the BED
group, postmeal negative aect was unrelated to the amount of
food consumed; however, for individuals without BED, greater
kilocalorie consumption was associated with lower postmeal
negative aect. e three way-interaction between LOC, kilo-
calories, and group was also signicant (t (1,59) = −2.28; P =
0.03), such that for the BED group, greater LOC was associated
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Behavior and Psychology
with greater postmeal negative aect, and lower LOC was
associated with lower postmeal negative aect, regardless
of the amount of food consumed. For individuals without
BED, the combination of greater LOC and greater kilocalorie
consumption was associated with lower postmeal negative
aect. For participants without BED who reported low LOC,
postmeal negative aect was unrelated to the amount of food
consumed (see Figure 2). e pseudo R
2
for the full model was
0.04, which is between a small (R
2
= 0.02) and a medium (R
2
=
0.14) eect size (33).
DISCUSSION
e purpose of the current study was to examine the impor-
tance of LOC and the amount of food consumed in relation
to pre- and postmeal negative aect among obese adults with
and without BED. Consistent with our hypotheses, we found
that LOC, but not the amount of food consumed, was associ-
ated with higher premeal negative aect regardless of diagnos-
tic status. Moreover, for individuals with BED, greater feelings
of LOC were associated with higher postmeal negative aect,
regardless of the amount of food eaten. For obese controls,
the combination of LOC and consumption of large amounts
of food was associated with lower postmeal negative aect.
Overall, results suggest that for individuals with BED, LOC is
a salient feature in determining the immediate emotional con-
text surrounding eating episodes.
Our nding that LOC, but not the quantity of food consumed,
nor their interaction, was associated with premeal negative
aect seems to suggest that low mood may be a trigger for LOC
eating but not necessarily for overeating. is nding is con-
sistent with aect regulation theories of binge eating (15) and
suggests that obese individuals predisposed to aberrant eating
may be more likely to disinhibit or abandon control over eat-
ing in the face of distressing feelings. Alternatively, LOC may
be experienced as a way of numbing outor dissociating when
confronted with dicult emotional stimuli (5). In turn, indi-
viduals may minimize awareness of the amount of food being
consumed, which could explain the unimportance of episode
size with regards to momentary negative aect. However, for
Table 1 Linear mixed-model results for predicting pre- and
postmeal negative affect based on binge eating disorder
status, kilocalorie intake, and premeal loss of control
Independent
variable Estimate s.e. d.f.
Test
statistic
Premeal negative affect
Intercept 9.15 0.64 160.03 t = 14.20***
Study day 0.12 0.06 Wald
z = 2.03*
Group 1.57 1.25 148.31 t = 1.26
Kilocalories 0.00 0.00 445.72 t = 0.82
LOC 0.68 0.15 427.34 t = 4.61***
Group X
kilocalories
0.00 0.00 445.20 t = −0.38
Group X LOC 0.40 0.29 427.45 t = 1.36
Kilocalories X LOC 0.00 0.00 445.02 t = 0.51
Group X
kilocalories X LOC
0.00 0.00 444.89 t = −0.77
Postmeal negative affect
Intercept 2.51 0.49 22.61 t = 5.12***
Study day 0.000 0.01 Wald
z = 0.70
Group −0.49 0.75 15.67 t = −0.65
Kilocalories 0.00 0.00 69.28 t = −1.46
LOC 0.17 0.10 37.56 t = 1.68
Premeal negative
affect
0.67 0.03 57.73 t = 20.57***
Group X
kilocalories
0.00 0.00 58.96 t = −2.86**
Group X LOC −0.15 0.20 40.28 t = −0.73
Kilocalories X LOC 0.00 0.00 66.69 t = −0.59
Group X
kilocalories X LOC
0.00 0.00 59.18 t = −2.28*
Group, binge eating disorder or nonbinge eating disorder; LOC, loss of control.
*
P < 0.05,
**
P < 0.01,
***
P < 0.001.
5.4
5.6
5.8
6
6.2
6.4
6.6
6.8
140 401 1,285
Kilocalorie consumption
Negative affect
BED
Non-BED
Figure 1 The two-way interaction between binge eating disorder status
and kilocalorie consumption with respect to postmeal negative affect.
BED, binge eating disorder. Higher scores on the y-axis indicate greater
negative affect. Figure estimates are model-based.
BED
4
5
6
7
8
0 500 1,000 1,500
Kilocalorie consumption
Negative affect
High loss of control
Medium loss of control
Low loss of control
Non-BED
4
5
6
7
8
0 500 1,000 1,500
Kilocalorie consumption
Negative affect
High loss of control
Medium loss of control
Low loss of control
Figure 2 The three-way interaction among binge eating disorder status,
loss of control, and kilocalorie consumption with respect to postmeal
negative affect. BED, binge eating disorder. Higher scores on the y-axis
indicate greater negative affect. Figure estimates are model-based.
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individuals with BED, this purported coping method does not
appear to be eective regardless of the amount of food con-
sumed, as indicated by our nding that increased feelings of
LOC were related to greater postmeal negative aect irrespec-
tive of kilocalorie consumption. ese results are consistent
with previous EMA studies of binge eating (22,23) and may
support the trade-o theory of binge eating (16), which pur-
ports that specic aversive emotions experienced prior to
binge eating (e.g., loneliness) are replaced by less aversive emo-
tions subsequent to binge eating (e.g., guilt). However, further
research regarding changes in specic mood states surround-
ing aberrant eating is needed.
More generally, these results appear to indicate that the cur-
rent Diagnostic and Statistical Manual of Mental Disorders, 4th
Edition criteria for binge eating (i.e., consumption of unam-
biguously large amounts of food accompanied by LOC) may
not accurately reect the experience of individuals with BED.
Indeed, LOC, when accompanied by relatively small amounts of
food, was as strongly related to postmeal distress as LOC accom-
panied by larger amounts of food. us, the overeating criterion
for binge eating may not be necessary, and its elimination could
potentially result in improved identication and treatment for
individuals struggling with aberrant eating. In particular, inter-
ventions focused on tolerating negative aect may be helpful in
reducing problematic eating among obese adults.
A dierent relationship between eating behavior and post-
meal mood state was identied among obese controls, whereby
the combination of greater feelings of LOC and increased kilo-
calorie consumption was related to lower postmeal negative
aect. It is possible that because obese controls do not engage
in recurrent binge eating (at least at a threshold warranting a
BED diagnosis), the eects of binge eating are still positively
reinforcing. Conversely, individuals with a persistent pattern
of binge eating (i.e., those with BED) may experience greater
negative consequences secondary to binge eating (e.g., inter-
ruptions in interpersonal relationships, occupational impair-
ments (34)) during the course of their illness.
We detected a signicant two-way interaction between
group and kilocalorie intake with respect to postmeal negative
aect, such that among the obese controls, greater intake was
related to decreased postmeal negative aect, whereas within
the BED sample, intake was unrelated to postmeal negative
aect. is nding may reect disturbances in sensitivity to
food as a reward among obese individuals (35). Several studies
have found that obese individuals dier from those of nono-
verweight status in terms of their behavioral and neurological
responsivity to food cues (e.g., (36)), and preliminary data sug-
gest that dierences are even more pronounced in obese indi-
viduals with BED (37). ere are competing theories about the
nature of reward sensitivity in obesity, with some investigators
hypothesizing that hypersensitivity to food as a reward leads to
obesity, as the inherent reinforcing properties of food lead to
over-consumption (38). By contrast, others suggest hyposensi-
tivity to food as a reward as an alternative pathway to obesity,
whereby individuals overeat to compensate for a reward decit
(39). It is unclear whether obese individuals with and without
BED dier in terms of the nature of their neurological response
to food cues. Future research should elucidate the dierences
we found between individuals with and without BED in rela-
tion to associations between quantity of eating episodes and
subsequent mood state.
Strengths of the current study include the use of Nutritional
Data System for Research data to quantify eating episodes,
which not only enhances the validity of our ndings, but also
minimized reliance on participantssubjective perception of
eating episodes (i.e., whether or not to label an episode as a
binge). In addition, the use of EMA data speaks to the eco-
logical validity of our ndings. Finally, to our knowledge, EMA
methodology has not yet been utilized to study the importance
of LOC and episode size with respect to momentary negative
aect, making this a novel contribution to the binge eating and
obesity literature.
e current study also has several limitations. Our sample
size was quite small and, because of this limitation, we were
unable to compare dierent types of categorical eating epi-
sodes (i.e., objective binge eating vs. subjective binge eating vs.
overeating without LOC) in terms of aective precursors and
consequences. Nevertheless, examining the amount of food
eaten and LOC ratings continuously allowed us to include a
large number of data points across participants and sampling
time-points. Moreover, although EMA data limit retrospec-
tive recall bias, data collected were still based on self-report,
which is prone to other types of biases (e.g., social desirability
bias). Because an abbreviated form of the Positive and Negative
Aect Scale was utilized in the EMA protocol, we were not
able to examine specic facets of negative aect (e.g., guilt) in
relation to eating episodes; as noted previously, future studies
should investigate changes in specic mood states surrounding
aberrant eating. Daily monitoring of mood and eating behav-
ior, and presenting for repeated in-person assessments over
the study period, could have altered participants behavior,
thus compromising the reliability of our data; however, previ-
ous research has demonstrated that EMA assessment produces
minimal reactive eects in terms of eating disorder behaviors
(40). Finally, LOC ratings were collected prior to and subse-
quent to, but not during eating episodes. It is possible that in
some instances, LOC may have developed during the course of
the meal. However, due to the practicality and possible reactive
eects of obtaining such measurements, it was not feasible to
assess LOC during eating episodes.
In summary, the current study suggests that overeating and
LOC have dierential contributions to the emotional context
surrounding eating episodes in obesity. Results have impor-
tant implications for both the classication and theoretical
understanding of binge eating, namely, suggesting that for
individuals with BED, LOC, regardless of the amount of food
consumed, is related to increased feelings of distress. Findings
also underscore the importance of further investigating binge
eating and emotional eating in obese individuals without
BED, as these types of pathological eating episodes appear to
be prevalent and related to distressing emotions even in the
absence of full-syndrome BED. Further research is needed to
Page 5
OBESITY | VOLUME 20 NUMBER 6 | jUNE 2012 1211
articles
Behavior and Psychology
better understand the long-term emotional consequences of
LOC and overeating in obesity with and without BED.
ACKNOWLEDGMENTS
This study was funded by the National Eating Disorders Association, The
Midwest Regional Postdoctoral Program in Eating Disorders Research (grant
T32-MH082761), and the Minnesota Obesity Center (P30-DK050456).
DISCLOSURE
The authors declared no conflict of interest.
© 2011 The Obesity Society
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  • Source
    • "Indeed, negative emotions have found to be associated with (Svaldi et al., 2014a) and preceded by (Agras and Telch, 1998; Goldschmidt et al., 2012) failures in the behavioral control over eating. It has been suggested that loss of control may be the most salient aspect of binge eating (Agras & Telch, 1998; Wolfe et al., 2009; Goldschmidt et al., 2012). A negative mood may lower an individual's threshold for losing control over eating with binge eating as a result. "
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    • "Body dissatisfaction, elevated depressive symptoms, low self-esteem, and ruminative tendencies during early adolescence more consistently predict the onset and persistence of LOC eating in late adolescence and young adulthood (Stice et al. 2002; Nolen-Hoeksema et al. 2007; Goldschmidt et al. 2014a–c). While adolescent dieting and extreme weight control behaviors also predict LOC eating patterns (Haines & Neumark-Sztainer, 2006; Keel & Forney, 2013), negative affect may be more salient when both constructs are considered together (Goldschmidt et al. 2012a, b). Overall, these data (see Supplementary Table S3) suggest that the NVS alone is insufficient to characterize LOC eating, and identify adolescence as a potential sensitive period for the increasing influence of NVS disturbances on LOC eating. "
    [Show abstract] [Hide abstract] ABSTRACT: Pediatric loss-of-control (LOC) eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to LOC eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions. We review evidence within constructs of the Negative Valence Systems (NVS) domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating-disorder risk. Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures. We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of LOC and binge-type eating disorders is required.
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  • Source
    • "Binge eating not only involves eating a large amount of food in a short period of time, but is also accompanied by a sense of a loss of control over eating (American Psychiatric Association , 2013). Binge eating episodes are often associated with negative affect and are triggered by emotional stressors (Goldschmidt et al., 2012; Haedt-Matt and Keel, 2011; Hilbert and Tuschen-Caffier, 2007). Stress reactivity, attention, and mood are modulated, in part, by brain norepinephrine (NE) (Hamon and Blier, 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: Binge eating is a prominent feature of bulimia nervosa and binge eating disorder. Stress or perceived stress is an often-cited reason for binge eating. One notion is that the neural pathways that overlap with stress reactivity and feeding behavior are altered by recurrent binge eating. Using young adult female rats in a dietary-induced binge eating model (30min access to binge food with or without 24-h calorie restriction, twice a week, for 6weeks) we measured the neural activation by c-Fos immunoreactivity to the binge food (vegetable shortening mixed with 10% sucrose) in bingeing and non-bingeing animals under acute stress (immobilization; 1h) or no stress conditions. There was an increase in the number of immunopositive cells in the dorsal medial prefrontal cortex (mPFC) in stressed animals previously exposed to the binge eating feeding schedules. Because attention deficit hyperactive disorder (ADHD) medications target the mPFC and have some efficacy at reducing binge eating in clinical populations, we examined whether chronic (2week; via IP osmotic mini-pumps) treatment with a selective alpha-2A adrenergic agonist (0.5mg/kg/day), guanfacine, would reduce binge-like eating. In the binge group with only scheduled access to binge food (30min; twice a week; 8weeks), guanfacine increased total calories consumed during the 30-min access period from the 2-week pre-treatment baseline and increased binge food consumption compared with saline-treated animals. These experiments suggest that mPFC is differentially activated in response to an immobilization stress in animals under different dietary conditions and chronic guanfacine, at the dose tested, was ineffective at reducing binge-like eating.
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