Carlos M Grilo's research while affiliated with Yale-New Haven Hospital and other places
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Publications (552)
Objective:
Binge-eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or "resigned" to LOC. This study examined differences in psychopathology among treatment-seeking patients with binge-eating disorder categorized with fear of LOC, resig...
Objective:
This study examined baseline predictors of rapid response and its prognostic significance in a clinical trial of behaviorally based weight loss treatment (BBWLT) for binge eating disorder in patients with obesity.
Methods:
One hundred ninety-one participants receiving BBWLT were assessed at baseline, throughout treatment, and at postt...
Objective:
A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for identification of the most strongly connected symptoms, which could inform...
Background: Assessment of eating disorder psychopathology during presurgical psychological evaluations could be facilitated with psychometrically valid measures. One of the most commonly used measures, the Eating Disorder Examination–Questionnaire (EDE-Q), is both lengthy and has been found to have psychometric limitations. Research has identified...
Objective:
Binge-eating disorder, the most prevalent eating disorder, is a serious public health problem associated with obesity, psychiatric and medical comorbidities, and functional impairments. Binge-eating disorder remains underrecognized and infrequently treated, and few evidence-based treatments exist. The authors tested the effectiveness of...
Background
Emerging research suggests that food intake timing, eating behavior and food preference are associated with aspects of the circadian system function but the role that the circadian system may play in binge eating (BE) behavior in humans remains unclear.
Objective
To systematically evaluate the evidence for circadian system involvement i...
Background:
Loss-of-control (LOC)-eating postoperatively predicts suboptimal longer-term outcomes following bariatric surgery. This study examined longer-term effects through 24-month follow-ups after completing treatments in a randomized controlled trial testing guided-self-help treatments (cognitive-behavioral therapy [gshCBT] and behavioral wei...
Objective
While Latinx Americans in the general population are more likely to have obesity than non-Hispanic Whites, limited research has examined ethnic differences in obesity and its correlates among military veterans. To address this gap, we examined the prevalence, physical health and functional correlates of obesity in a population-based sampl...
Purpose
Nonhomeostatic drives (e.g., reward and negative emotion) for eating are associated with weight gain over time. Higher average and lower intraindividual variability in physical activity (PA) levels are positively associated with health and weight outcomes, but have not been evaluated in relation to nonhomeostatic eating. The aim of this pap...
Purpose
Eating-disorder psychopathology is associated with self-harm behaviors. With much time spent and many social interactions taking place online, self-cyberbullying has emerged as a new form of self-harm that is digital. The current study examined digital self-harm in adults and its associations with eating-disorder psychopathology and behavio...
Purpose of review:
Public policy efforts for prevention of and intervention upon eating disorders is severely limited in the United States due to the paucity of population-based data. This review article summarizes findings regarding eating disorders based on the National Epidemiological Studies on Alcohol and Related Conditions, Third Wave. The s...
Background
Current therapies for obesity treatment are effective at producing short-term weight loss, but weight loss maintenance remains a significant challenge. Here we investigate the impact of pre-intervention dietary fat intake on the efficacy of a dietary supplement to support weight loss maintenance. Preclinical work demonstrates that a vaga...
Objective:
Effective treatments exist for binge-eating disorder (BED), although roughly 50% of patients fail to attain binge-eating abstinence. Evidence on how to refine treatments is lacking. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for the identification of the most strongly connected symptoms, whic...
Purpose
To examine how parents’ and adolescents’ weight histories were associated with parents’ approach to eating/weight-related parenting and children’s eating-disorder behaviors.
Methods
Participants were 502 parents (69.3% mothers, 30.7% fathers) of children 12–16 years old who completed an online survey. Parents reported their own and their c...
PurposePost-operative loss-of-control (LOC)-eating is a negative prognostic indicator for long-term outcomes following bariatric surgery. Emerging research suggests that night eating might also be associated with poorer post-operative outcomes. This study examined the co-occurrence and clinical features of night eating in patients with LOC-eating f...
Background
Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD...
Background
This study examined ethnic/racial differences in reported utilization of weight-loss methods/treatments and weight loss among adults with binge-eating disorder (BED) with co-existing obesity.
Methods
Participants were 400 adults (non-Hispanic Black: n = 99, Hispanic: n = 38, non-Hispanic White: n = 263) seeking treatment for BED in Conn...
Purpose
To compare prevalence of self-reported diabetes between U.S. state-born, Puerto Rico-born, Mexico-born, Cuba-born, and South/Central America-born Hispanic groups, and examine whether risk for diabetes differs by country of origin and experiences with discrimination when accounting for BMI.
Methods
Data from 6223 Hispanic respondents from t...
Background:
The Attitudes Toward Persons with Obesity (ATOP) scale is widely used to assess stigmatization toward persons with obesity. The measure has previously been suggested to assess three facets-self-esteem, personality, and social difficulties-however, psychometric support for this has been inconsistent and warrants further study if the mea...
Background
While effective treatments exist for binge-eating disorder (BED), prediction of treatment outcomes has proven difficult, and few reliable predictors have been identified. Machine learning is a promising method for improving the accuracy of difficult-to-predict outcomes. We compared the accuracy of traditional and machine-learning approac...
Background
Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes.
Methods
In total, 108 patients with BED ( N FEMALE = 84) in a random...
Objective:
Preoccupation (excessive and constant thoughts) about shape/weight and food/eating is thought to be prominent in individuals with eating disorders but has received much less research than overt behavioral features. This study examined the significance and distinctiveness of different foci of preoccupation in individuals categorized with...
Objective
Cognitive-behavioral therapy (CBT)—therapist-led (CBTth) and guided-self-help (CBTgsh)—has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods.
Method
Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treat...
Objective
This secondary analysis examined physical activity (PA) changes and their prognostic significance among Latinx patients with obesity, with and without binge eating disorder (BED), who participated in a randomized, placebo-controlled trial testing the addition of orlistat to behavioral weight-loss (BWL) treatment in a “real-world” clinical...
Background
The current study examined a range of body image concerns and associated distress and impairment in patients who have undergone bariatric surgery and are seeking subsequent body contouring surgery following bariatric surgery.
Objectives
Individuals seeking body contouring were hypothesized to endorse a broad pattern of body image concer...
Objective
Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depres...
Stigma and recurrent discriminatory experiences can lead to distress and internalization of biases. Self-compassion is a widely recognized resilience factor that may decrease the impact of discrimination on psychological well-being. Research highlights the potential utility of self-compassion in counteracting the harmful effects of discrimination,...
Objective
This study compared sociodemographic and clinical profiles of adult patients with lifetime DSM-5-defined anorexia nervosa (AN) categorized by age-of-onset using data from U.S. national sample of adults.
Method
Study included 216 participants from Third National Epidemiological Survey Alcohol and Related Conditions (NESARC-III) who met cr...
Objective
A substantial proportion of patients with binge-eating disorder (BED) do not derive sufficient benefits from available evidence-based psychological interventions. We examined depression scores as predictors and moderators of response to cognitive-behavioral therapy (CBT) and behavioral weight-loss (BWL) for BED. We explored associations b...
Importance
Rates of suicide are increasing. Although borderline personality disorder (BPD) and other psychiatric disorders are associated with suicide, there is a dearth of epidemiological research on associations between BPD and suicide attempts (SAs). Delineating the SA risk associated with BPD and its specific criteria in a nationally representa...
Background
Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes.
Methods
In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout,...
Objective
Loss‐of‐control (LOC) eating postoperatively is a consistent predictor of suboptimal longer‐term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self‐help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing L...
Objective
People with eating disorders (EDs) have elevated rates of suicide attempts. A need exists to identify factors that help predict which people with EDs might be at greater risk for suicidal behavior. Adverse childhood experiences (ACEs) are associated with both EDs and with suicide attempts. Thus, the current study examined whether having h...
Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratif...
Purpose
Eating disorders are prevalent public health problems associated with broad psychosocial impairments and with elevated rates of psychiatric and medical comorbidities. Critical reviews of the treatment literature for eating disorders indicate that although certain specialized psychological treatments and specific medications show efficacy to...
Objective
To examine the distinctiveness and significance of two body image constructs, dissatisfaction with weight and shape and overvaluation of weight and shape, with respect to eating disorder psychopathology, weight, and depression in White and Latinx/Hispanic men and women.
Methods
Participants were White (n = 1,941) and Latinx/Hispanic (n =...
Importance
Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions.
Objective
To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Lon...
Purpose
Binge-eating disorder (BED), the most prevalent eating disorder, is associated strongly with obesity and functional impairments. Few evidence-based treatments for BED exist; a pharmacotherapy effective in reducing both binge eating and weight needs to be identified. This placebo-controlled double-blind pilot RCT evaluated the acute effects...
Purpose
Emerging work indicates divergence in the neurobiologies of binge-eating disorder (BED) and obesity despite their frequent co-occurrence. This review highlights specific distinguishing aspects of BED, including elevated impulsivity and compulsivity possibly involving the mesocorticolimbic dopamine system, and discusses implications for diff...
Objective:
This study aimed to examine longer-term effects of behavioral weight loss (BWL) and Stepped Care for binge-eating disorder and obesity through 12-month follow-up after completing treatments.
Methods:
A total of 191 patients with binge-eating disorder/obesity were randomized to 6 months of BWL (n = 39) or Stepped Care (n = 152). Within...
Objective:
This study aimed to assess the effects of exposures to food cues and stress on hunger and food intake and examine whether cue responses differ by weight status.
Methods:
In a laboratory-based experimental study, participants (n = 138) were exposed to stress, neutral, and food cues delivered using an individualized script-driven imager...
Objective:
Binge-eating disorder (BED) is the most prevalent eating disorder; however, few evidence-based treatments are available. The aim of this study was to evaluate the efficacy and safety of dasotraline, a novel dopamine and norepinephrine reuptake inhibitor, in adults with BED.
Methods:
Patients with a DSM-5 diagnosis of BED (intent-to-tr...
Purpose:
Motivational interviewing (MI) weight-loss interventions have garnered much attention, particularly in primary care. Few studies, however, have examined long-term outcomes of MI for weight loss in primary care. This study sought to examine the longer-term outcomes of a combination approach comprising MI and nutrition psychoeducation (MINP...
There is significant variability in the type and severity of symptoms reported by individuals diagnosed with binge-eating disorder (BED). Using latent class analysis (LCA), the current study aimed to investigate potential sources of heterogeneity among individuals with BED. Participants were 775 treatment-seeking adults with DSM-IV-defined BED. Doc...
Background
Clinical assessment of eating behaviors with patients who undergo bariatric surgery is challenging due to the complexity of symptom presentation post-operatively. The Eating Disorder Examination (EDE) is a widely-used semi-structured clinical interview of eating-disorder psychopathology, yet no studies have examined the interrater reliab...
Objective
Bariatric surgery affects the quantity of food individuals can eat, yet some individuals still experience loss of control (LOC) while eating. This cross‐sectional study examined a new classification system for binge/LOC eating following bariatric surgery.
Methods
A total of 168 individuals who underwent bariatric surgery 6 months earlier...
Background.:
The nature and significance of impulse-control difficulties in binge-eating disorder (BED) are uncertain. Most emerging research has focused on food-specific rather than general impulsivity. The current study examines the clinical presentation of patients with BED categorized with and without clinical levels of general impulsivity.
M...
Objective
Patients who seek or undergo bariatric surgery are likely to experience pervasive societal biases regarding weight and eating behaviors in the health care system. This cross‐sectional study examined patient preferences for desired weight‐ and eating‐related terms for health care providers among individuals with loss‐of‐control eating afte...
Background
Eating-disorder severity indicators should theoretically index symptom intensity, impairment, and level of needed treatment. Two severity indicators for binge-eating disorder (BED) have been proposed (categories of binge-eating frequency and shape/weight overvaluation) but have mixed empirical support including modest clinical utility. T...
Objective
Physical activity (PA) is an integral component of the medical management of patients following bariatric surgery as it is thought to be associated with biopsychosocial outcomes, including mood and physical function. This study examined self-reported PA (SR-PA) and psychosocial correlates among patients with loss-of-control (LOC) eating f...
Purpose
Exercise can enhance health and well-being. Exercise can also, when it is highly driven and compulsive, reflect eating disorder psychopathology. The present study examined associations of compulsive exercise and youth athletics with child disordered eating behaviors (overeating, binge eating, and secretive eating) and with parenting practic...
Objective.:
The aim of this fixed-dose study was to evaluate the efficacy and safety of dasotraline in the treatment of patients with binge-eating disorder (BED).
Methods.:
Patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for BED were randomized to 12 weeks of double-blind treatment with fixed doses...
Objective
Adverse childhood experiences (ACEs) and restricted food access have been associated with risk for eating disorders (EDs). This study examined the relationship between childhood food neglect, an ACE specifically involving restricted food access, and DSM-5-defined EDs in a nationally representative sample of U.S. adults, with a particular...
Objective
The Eating Disorder Examination – Questionnaire (EDE‐Q) is a widely used self‐report measure of eating‐disordered behaviors and attitudes. Recent studies utilizing confirmatory factor analyses (CFA) have proposed alternative and shorter forms. The aim of this study was to compare the full‐length version of the EDE‐Q and several proposed s...
Background
Dasotraline is a long-acting dopamine/norepinephrine reuptake inhibitor with a PK profile characterized by slow absorption and a t½ of 47-77 hours, permitting once-daily dosing. In a previous flexible dose study, dasotraline demonstrated significant efficacy in the treatment of binge-eating disorder (BED). The aim of this confirmatory fi...
Objective: Internalized weight bias (IWB), or negative weight related self-evaluation, is associated with eating-disorder psychopathology and common among patients seeking bariatric surgery, but little is known about the clinical presentation of IWB post-operatively. This study examined IWB and clinical correlates among adult patients with loss-of-...
Approximately 70% of adults in the United States have obesity or are overweight and at risk of developing obesity over time. Obesity is associated with an increased risk of morbidity and mortality; the economic impact of the health care costs associated with obesity is anticipated to have a profound, detrimental effect on the country's economy with...
Objective:
To test the validity and clinical utility of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) severity specifiers for binge-eating disorder (BED) in predicting treatment outcomes.
Method:
Participants (N = 521) were patients in randomized controlled trials (RCTs) at 1 medical center testing treatments for BED...
This randomized controlled trial (RCT) tested effectiveness of adaptive SMART stepped-care treatment to "standard" behavioral weight loss (BWL [standard]) for patients with binge-eating disorder (BED) and obesity. One hundred ninety-one patients were randomly assigned to 6 months of BWL (standard; n = 39) or stepped care (n = 152). Within stepped c...
Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, sugges...
An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosolo...
Early weight loss is associated with greater weight loss following treatment cessation and years later. The present study aimed to identify pretreatment correlates associated with early weight loss in adults participating in weight-loss treatment in primary care. Participants (N = 89) were in the overweight/obesity range seeking weight-loss treatme...
Objectives:
This study compared the patterns of moderate and vigorous physical activity (PA) and health conditions in a nationally representative sample of adults categorized with healthy weight (HW) without eating disorder history, obesity without eating disorder history (OB), or current binge-eating disorder (BED) with obesity (BED+OB).
Method:...
This study examined self-weighing behaviors and correlates in patients with BED. Hypotheses: (1) women would weigh more frequently than men, (2) > weekly weighers would have higher restraint scores than < weekly weighers, (3) the self-weighing-restraint relationship would be stronger in women, (4) self-weighing frequency would be inversely related...
Background
Sleep is associated with post-bariatric surgical outcomes; however, little is known about sleep in bariatric patients with loss-of-control (LOC) eating, a consistent predictor of poorer weight outcomes. This study examined sleep quality and clinical correlates in sleeve gastrectomy patients with LOC eating.
Methods
Participants (N = 145...
Objective:
This study examined associations of different aspects of weight bias, which can include negative attitudes toward and beliefs about obesity, with eating/weight-related psychopathology.
Methods:
Participants (N = 544) were White (n = 376) and Latino (n = 168) men living in the United States who completed an online battery of establishe...
Purpose:
Pediatric obesity and eating disorders have adverse consequences on children's health and psychosocial functioning. Parents are involved in children's daily lives and their health, but the extent to which children's eating behaviors or weight impact parents' daily functioning is unknown.
Methods:
The present study examined parent and ch...
Objective:
The increased occurrence of disordered eating behaviors among sexual minorities is well established; however, few studies have examined disparities in eating disorder diagnoses among this population. This study sought to examine lifetime prevalence estimates of DSM-5 defined EDs, including anorexia nervosa (AN), bulimia nervosa (BN), an...
Objective:
This study examined whether sex predicted and/or moderated treatment outcomes among men and women who participated in binge-eating disorder (BED) randomized controlled trials (RCTs).
Method:
Data were aggregated from RCTs performed at one medical center. RCTs tested cognitive-behavioral therapy, behavioral weight loss, multimodal trea...
Objective:
This study examined the distinctiveness of specific constructs of body-image disturbance in patients with anorexia nervosa (AN) and bulimia nervosa (BN). We compared weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain in patients with AN and BN and examined how each specific body...
Objective:
While physical activity (PA) is known to have positive effects on psychological and physical health, little is understood about the association between non-compensatory PA (i.e., not compulsive or intended to control weight or shape) and psychopathology among individuals with eating-disorder features. The present study explored associat...
Objective:
This study aimed to examine the prevalence of overvaluation of shape or weight in a nationally representative sample of U.S. adults with binge-eating disorder (BED) and to compare functioning correlates using a group of adults with bulimia nervosa (BN).
Methods:
Participants included 207 respondents from the National Epidemiologic Sur...
Background
Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients.
Objective
This study presents a psychometric examination of the ELOCS...
Objective
Food addiction and binge eating share overlapping and non-overlapping features; the presence of both may represent a more severe obesity subgroup among treatment-seeking samples. Loss-of-control (LOC) eating, a key marker of binge eating, is one of the few consistent predictors of suboptimal weight outcomes post-bariatric surgery. This st...
Objective:
We examined distinctiveness of different aspects of body-image disturbance in persons categorized with eating/weight disorders. We compared dissatisfaction with weight/shape, overvaluation of weight/shape, preoccupation with weight/shape, and fear of weight gain - in three study groups of persons categorized with overweight/obesity [O/O...
Objective:
To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) eating disorders (EDs) and to examine sex and ethnic/racial differences.
Patients and methods:
The 2012-2013 National Epidemiologic Survey o...
Background:
Rates of suicide are increasing in the US. Although psychiatric disorders are associated with suicide risk, there is a dearth of epidemiological research on the relationship between suicide attempts (SAs) and eating disorders (EDs). The study therefore aimed to examine prevalence and correlates of SAs in DSM-5 EDs-anorexia nervosa (AN)...
Objective:
Little is known regarding overvaluation of weight or shape, a key cognitive feature of eating disorders, among individuals with disordered eating following bariatric surgery. This study examined the significance of overvaluation of weight or shape among post-bariatric surgery patients with loss-of-control (LOC) eating.
Methods:
Partic...
Objective:
The current study examined whether variations in patient weight and eating-disorder behavior frequency influenced the recognition of bulimia nervosa (BN) and the perception that it is a serious mental health concern.
Method:
Participants (N = 320) were randomly assigned to one of six conditions in which they read a vignette describing...
Objective
Some individuals eat furtively and conceal evidence of eating, and this seems to occur beyond binge‐eating episodes. This type of secretive eating is common among youth and emerging evidences suggests that it is a relevant marker of eating disorder psychopathology among adults with significant eating and weight concerns.
Method
We assess...
Objective:
To examine whether race predicted or moderated response to treatments for binge-eating disorder (BED).
Method:
Participants were 592 adults (n = 113 Black; n = 479 White) with DSM-IV-defined BED who participated in randomized controlled trials (RCTs) at 1 medical center. Data were aggregated from RCTs for BED testing cognitive-behavio...
Parents are key to children’s health because they can influence children’s eating behavior and body image and can make health-related decisions for children. Despite their influence, research on parents’ opinions about parenting practices related to weight and eating is limited. Experimental vignettes examined parents’ perceptions of parent-child i...
Objective
This study aimed to examine racial differences in postoperative eating‐disorder psychopathology, psychosocial functioning, and weight loss among adults with loss‐of‐control (LOC) eating following sleeve gastrectomy.
Methods
Participants were 123 patients (n = 74 non‐Hispanic White and n = 49 non‐Hispanic Black) who underwent sleeve gastr...
Background
Food insecurity occurs when access to food is limited by financial hardship. Yet, paradoxically, food insecurity is associated with overeating, with emerging evidence that it may be related to disordered eating. A recent report found that food insecurity was associated with binge‐eating disorder (BED), but it is not yet known whether foo...
Objective
To examine physical activity and correlates among three subgroups of adults: healthy weight without binge eating (HW), overweight/obesity without binge eating (OW/OB), and core features of binge‐eating disorder (BED).
Method
Participants (N = 2,384) completed an online survey with established measures of physical activity, eating psychop...
Objective
Secretive eating is characterized by eating furtively and concealing the act and evidence of eating. Among youth, secretive eating is common and associated with eating‐disorder psychopathology. Yet, secretive eating among adults, including adults with eating disorders, is relatively unexplored.
Method
We assessed secretive eating among t...
Background
Food insecurity stems from limited financial resources. Yet, paradoxically, food insecurity is associated with overeating and excess weight. One subcategory of overeating is binge eating, which includes eating an unusually large amount of food while feeling a concurrent sense of loss of control. Associations between binge‐eating disorder...
