Artificial sweetener use among individuals with eating disorders

Klein, David; Boudreau, Gillian; Devlin, Michael J.; Walsh, B. Timothy

doi:10.1002/eat.20260

Cited by 45 publications

(31 citation statements)

References 20 publications

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“…We reported (Klein, Schebendach, Devlin, Smith, & Walsh, 2006) and others later substantiated (Brown & Keel, 2013; Klein, Boudreau, Devlin, & Walsh, 2006; Marino et al, 2009) use of large amounts of low-calorie sweetened products, such as diet beverages, chewing gum, and packets of artificial sweetener, among at least a proportion of patients with AN. While this behavior is consistent with the desire to avoid calories, it also implies that patients desire sweet tastes, raising the question of whether artificial sweetener use represents a marker of appetitive drive in people with AN.…”

Section: Introductionsupporting

confidence: 55%

“…Clinical impressions and self-report measures indicate that patients with eating disorders use more artificially sweetened products than do their healthy counterparts (Brown & Keel, 2013; Klein et al, 2006; Klein, Schebendach, Brown, Smith, & Walsh, 2009; Klein, Schebendach, Gershkovich, Smith, & Walsh, 2010; Marino et al, 2009). To our knowledge, this is the first study to assess motivation to use artificial sweetener among people with eating disorders.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of the motivation to use artificial sweetener among individuals with an eating disorder

et al. 2017

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Eating disorders are associated with a range of abnormalities in eating behavior. Some individuals consume large amounts of non-caloric artificial sweeteners, suggesting abnormalities in appetitive responding. The current study aimed to quantify hedonic and motivating effects of artificial sweetener in individuals with and without an eating disorder. Two laboratory studies were conducted. Hedonic preference was estimated using the number of artificial sweetener packets (0 to 10) added to unsweetened cherry flavored Kool-Aid (study 1). Motivation to obtain sweetener was assessed by a progressive ratio (PR) work task (study 2). Ninety-three participants (25 anorexia nervosa restricting type (AN-R), 23 AN binge/purge type (AN-B/P), 20 bulimia nervosa (BN), and 25 normal controls (NC)) completed the study. No significant difference in hedonic preference was found among participant groups. Work completed at the PR task ranged from 0 to 9500 key-board presses. The AN-B/P group had a significantly higher breakpoint and performed significantly more work for sweetener compared to the BN and NC groups. Among AN-B/P and AN-R participants, the preferred number of Equal packets was significantly correlated with the breakpoint and total work. The increased amount of work for sweetener among individuals with AN-B/P supports an enhanced reward value of sweet taste in this population, and suggests that the characteristic food avoidance in AN cannot be accounted for by decreased reward value of all taste-related stimuli. This study also supports the novel application of a PR ratio task to quantify the motivating effect of sweet taste among individuals with an eating disorder.

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Section: Introductionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Assessment of the motivation to use artificial sweetener among individuals with an eating disorder

et al. 2017

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“…The heavy consumption of artificially sweetened soft drinks could be a prediction of an eating disorder. Bulimic patients have been found to binge on excessive amounts of noncaloric sweeteners [11] , and women with other types of eating disorder, binge eating disorders, have been shown to have a higher intake of artificial sweeteners, compared with women without eating disorders [12] . Binge eating disorder is the most common of the eating disorders, with a lifetime prevalence of 3.5% among women and 2.0% among men [13] .…”

Section: Discussionmentioning

confidence: 99%

Predictors of Dropping Out in a Weight Loss Intervention Trial

2010

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Background/Aim: Dropouts in intervention trials can affect the statistical power of the study. The aim was to assess predictors of dropping out in a weight loss trial. Methods: Each subject (n = 114) was instructed to follow a diet, energy-restricted by 30% from estimated energy expenditure (approximately 600 kcal/day), for 8 consecutive weeks. A detailed meal plan as well as recipe booklets and instructions were provided by a nutritionist. Results: Antidepressants were used by 19.2% of the dropouts, compared with 1.8% of the completers (p < 0.001). Additionally, those dropping out consumed 35% more soft drinks in total and 44% more diet (artificially sweetened) soft drinks at baseline (habitual intake) than those completing the trial (p = 0.012). Dropouts (18.6%) were on average 1.9 years younger than those completing the study, but the difference was of borderline significance (p = 0.085). Conclusions: The use of antidepressants and heavy habitual soft drink consumption might be considered as exclusion criteria when preparing weight loss intervention trials including dietary restrictions.

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“…It was our hypothesis, based on evidence that at least a proportion of AN patients consume large quantities of non-caloric, artificially sweetened beverages ((22), e.g., liters of “diet” beverages per day), and engage in chewing and spitting behavior (23), arguably “naturalistic” forms of sham feeding, that this sip-and-spit model of MSF providing sweet taste stimulation in the absence of calories would elicit larger intakes in patients with AN than controls.…”

Section: Introductionmentioning

confidence: 99%

Modified sham feeding of sweet solutions in women with anorexia nervosa

Klein

Schebendach

Gershkovich

et al. 2010

Physiology & Behavior

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Anorexia Nervosa (AN) is a disorder of self-starvation characterized by decreased meal size and food intake. While it is possible that reduced food intake in AN reflects an excess of inhibitory factors, e.g., cognitive inhibition related to fear of weight gain or abnormal postingestive negative feedback, it is also possible that decreased intake reflects diminished orosensory stimulation of food intake. This has been difficult to test directly because the amount of food ingested during a test meal by patients with AN reflects an integration of orosensory excitatory, and cognitive, learned, and postingestive inhibitory controls of eating. To begin to dissociate these controls, we adapted the modified sham feeding technique (MSF) to measure the intake of a series of sweetened solutions in the absence of postingestive stimulation. Subjects with AN (n=24) and normal controls (NC, n=10) were randomly presented with cherry Kool Aid® solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 15 1-minute trials and to spit the fluid out into another opaque container. Subjects with AN sipped less unsweetened solution than NC (p<0.05). Because this difference appeared to account completely for the smaller intakes of sweetened solutions by AN, responsiveness of intake to sweet taste per se was not different in AN and NC. Since MSF eliminated postingestive and presumably cognitive inhibitory controls, and the orosensory response to sweet taste was not different in AN than NC, we conclude that decreased intake by AN subjects under these conditions reflects the increased inhibition characteristic of this disorder that is presumably learned, with a possible contribution of decreased potency of orosensory stimulation by the sipped solutions.

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Artificial sweetener use among individuals with eating disorders

Abstract: These data suggest an increased drive for sweet orosensory stimulation in women with AN and BN.

Cited by 45 publications

References 20 publications

Assessment of the motivation to use artificial sweetener among individuals with an eating disorder

Assessment of the motivation to use artificial sweetener among individuals with an eating disorder

Predictors of Dropping Out in a Weight Loss Intervention Trial

Modified sham feeding of sweet solutions in women with anorexia nervosa

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