Weight Dysregulation, Positive Energy Balance, and Binge Eating in Eating Disorders

Lowe, Michael R.; Haller, Leora L.; Singh, Simar; Chen, Joanna Y.

doi:10.1007/978-3-030-43562-2_5

Cited by 5 publications

(13 citation statements)

References 53 publications

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“…The experts' general recognition that obesity and binge eating disorder are commonly—but not always—linked ( theme 1, subtheme i ) aligns with current incidence and prevalence estimates ( 13 – 16 ), however, the nature of the relationship is less clear amongst interviewed experts. The experts' emphasis on the role of body/weight/shape stigmatization (theme 1, subtheme ii) seems to align with psychological contributions to intense concerns about body weight/shape/size overvaluation and heightened incentive for change ( 17 ). Evidence suggests comorbid obesity and binge eating disorder is associated with more severe and prevalent levels of mental health disorders and negative affect than those observed in individuals with obesity or binge eating disorder alone ( 43 – 46 ).…”

Section: Discussionmentioning

confidence: 99%

“…Negative health implications associated with obesity (e.g., cardiometabolic syndrome) highlight another important question of the extent to which binge eating disorder should be considered a purely mental health disorder vs. a physiological/biological one. Weight regulation models of eating disorders are under development that propose weight and weight history are causal variables that have clinically significant impacts on eating disorder psychopathology and perpetuation ( 17 ). However, these models remain to be tested.…”

Section: Introductionmentioning

confidence: 99%

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Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives

Bray

Sadowski²,

Bray³

et al. 2023

Front. Psychiatry

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IntroductionResearch on binge eating disorder continues to evolve and advance our understanding of recurrent binge eating.MethodsThis mixed-methods, cross-sectional survey aimed to collect information from experts in the field about clinical aspects of adult binge eating disorder pathology. Fourteen experts in binge eating disorder research and clinical care were identified based on receipt of relevant federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Anonymously recorded semi-structured interviews were analyzed by ≥2 investigators using reflexive thematic analysis and quantification.ResultsIdentified themes included: (1) obesity (100%); (2) intentional/voluntary or unintentional/involuntary food/eating restriction (100%); (3) negative affect, emotional dysregulation, and negative urgency (100%); (4) diagnostic heterogeneity and validity (71%); (5) paradigm shifts in understanding binge eating disorder (29%); and (6) research gaps/future directives (29%).DiscussionOverall, experts call for a better understanding of the relationship between binge eating disorder and obesity, including a need for clarification around the extent to which the two health issues are separate vs. related/overlapping. Experts also commonly endorse food/eating restriction and emotion dysregulation as important components of binge eating disorder pathology, which aligns with two common models of binge eating disorder conceptualization (e.g., dietary restraint theory and emotion/affect regulation theory). A few experts spontaneously identified several paradigm shifts in our understanding of who can have an eating disorder (beyond the anorexi-centric “thin, White, affluent, cis-gendered neurotypical female” stereotype), and the various factors that can drive binge eating. Experts also identified several areas where classification issues may warrant future research. Overall, these results highlight the continual advancement of the field to better understand adult binge eating disorder as an autonomous eating disorder diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives

Bray

Sadowski²,

Bray³

et al. 2023

Front. Psychiatry

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“…Research comparing ED symptoms across atypAN and specific AN subtypes (AN-R, AN-BP) in large samples is needed to understand how to differentiate between AN and atypAN as diagnostic entities, and whether they should even be differentiated based on BMI (Birgegård et al, 2023;Moskowitz & Weiselberg, 2017). Comparing atypAN and AN, with and without controlling for BMI as a covariate, may illuminate how BMI may interface with ED psychopathology (Lowe et al, 2020). In other words, these analyses may illuminate whether low BMI is indicative of more severe AN, and whether BMI should be the sole criterion differentiating between atypAN and AN diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Is there a basis for a weight cut‐off point? A large‐scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre

Wong,

Lowe

2024

Euro Eating Disorders Rev

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ObjectiveThere is debate surrounding how to differentiate between anorexia nervosa (AN) and atypical AN (atypAN) as diagnostic entities, and whether a distinction based on BMI is warranted. Better understanding eating disorder (ED) and emotional symptoms across atypAN and AN subtypes [AN‐restricting (AN‐R), AN‐binge/purge (AN‐BP)], with and without controlling for BMI, can elucidate how atypAN differs from AN subtypes and whether there is a basis for a BMI cut‐off.Methods1810 female patients at an ED treatment centre completed intake surveys. ANCOVAs assessed differences across AN‐R (n = 853), AN‐BP (n = 726), and atypAN (n = 231) groups on ED, depressive, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness, with and without controlling for BMI.ResultsRelative to AN‐R, atypAN and AN‐BP groups endorsed significantly higher ED and depressive symptoms, anxiety sensitivity, experiential avoidance, and significantly lower mindfulness (all p < 0.001), but atypAN and AN‐BP groups did not differ from one another. When controlling for BMI, all previously significant differences between atypAN and AN‐R did not remain significant.ConclusionIndividuals with atypAN who have a higher BMI experience more pronounced ED and emotional symptoms, suggesting that relying solely on BMI as a marker of illness severity may be problematic.

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“…One, WS does not consider the height, sex, or age at which highest past weight was reached; why this is so problematic has been enumerated previously (Lowe et al, 2022). Consequently, researchers have suggested that a "developmental" measure of WS (DWS) might be superior to the traditional measure that has been used in most WS studies (Lowe et al, 2018(Lowe et al, , 2020Schaumberg et al, 2016;Singh et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Physiological, body composition, and body mass measures show that a developmental measure of weight suppression is more valid than the traditional measure

Lowe,

Singh,

Rosenbaum

et al. 2024

Intl J Eating Disorders

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ObjectiveThe traditional measure of weight suppression (TWS; the difference between an individual's highest past weight at adult height and current weight), has been associated with many psychological, behavioral and biological variables in those with eating disorders. A new measure of weight suppression, called developmental weight suppression (DWS), corrects two major problems in the original measure. Initial research indicates that DWS represents a superior operationalization of the construct weight suppression was originally designed to measure (Lowe [1993, Psychol Bull, 114: 100]). This study is the first to examine the relation between both WS measures and weight history, body composition and a variety of metabolic hormones.MethodsData were collected in 91 women with bulimia nervosa (BN) or BN‐spectrum disorders.ResultsBoth weight suppression indices were related to multiple hormones. However, multiple regression analyses showed that the independent effects of DWS differed from the independent effects of TWS in that only DWS was negatively related to: (1) current z‐BMI, (2) body fat percentage, and (3) insulin, leptin, T3 free, and TSH. This differential pattern also occurred when results were corrected for multiple comparisons.DiscussionFindings provide stronger biological support for the construct validity of DWS than TWS and suggest that: (1) from the perspective of individuals with BN, high DWS embodies success at food restriction and weight loss, (2) elevated DWS may trap individuals with BN in a powerful biobehavioral bind, and (3) DWS is the preferred measure of weight suppression in future research on eating disorders.Public SignificanceMost individuals with bulimia nervosa lose substantial weight in the process of developing their disorder. Such weight suppression is related to many characteristics of those with the eating disorder bulimia nervosa. This study shows why a new measure of weight suppression, based on an individual's growth during development, is more biologically valid than the traditional measure of weight suppression.

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Weight Dysregulation, Positive Energy Balance, and Binge Eating in Eating Disorders

Cited by 5 publications

References 53 publications

Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives

Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives

Is there a basis for a weight cut‐off point? A large‐scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre

Physiological, body composition, and body mass measures show that a developmental measure of weight suppression is more valid than the traditional measure

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