To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT). Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session. Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges. Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making.
Abstract Objectives Elevated glucose variability may be one mechanism that increases risk for significant psychological and physiological health conditions among individuals with binge‐spectrum eating disorders (B‐EDs), given the impact of eating disorder (ED) behaviors on blood glucose levels. This study aimed to characterize glucose variability among individuals with B‐EDs compared with age‐matched, sex‐matched, and body mass index‐matched controls, and investigate the association between frequency of ED behaviors and glucose variability. Methods Participants were 52 individuals with B‐EDs and 22 controls who wore continuous glucose monitors to measure blood glucose levels and completed ecological momentary assessment surveys to measure ED behaviors for 1 week. Independent samples t ‐tests compared individuals with B‐EDs and controls and multiple linear regression models examined the association between ED behaviors and glucose variability. Results Individuals with B‐EDs demonstrated numerically higher glucose variability than controls ( t = 1.42, p = .08, d = 0.43), although this difference was not statistically significant. When controlling for covariates, frequency of ED behaviors was significantly, positively associated with glucose variability ( t = 3.17, p = .003) with medium effect size ( f 2 = 0.25). Post hoc analyses indicated that binge eating frequency was significantly associated with glucose variability, while episodes of 5+ hours without eating were not. Discussion Glucose variability among individuals with B‐EDs appears to be positively associated with engagement in ED behaviors, particularly binge eating. Glucose variability may be an important mechanism by which adverse health outcomes occur at elevated rates in B‐EDs and warrants future study. Public Significance This study suggests that some individuals with binge ED and bulimia nervosa may experience elevated glucose variability, a physiological symptom that is linked to a number of adverse health consequences. The degree of elevation in glucose variability is positive associated with frequency of eating disorder behaviors, especially binge eating.
Abstract Objective The comorbidity of binge eating and heavy drinking (BE + HD) is concerning due to high prevalence and associated consequences. Affective pathways may maintain BE + HD, yet more micro‐level research is needed. This study used ecological momentary assessment (EMA) to examine between‐person and day‐level relationships between positive and negative affect and binge eating or heavy drinking episodes in BE + HD. Methods Participants ( N = 53) were adults with binge‐spectrum eating disorders who completed between 7 and 14 days of EMA prior to a treatment for binge eating. Results Anxiety was highest on days with both binge eating and heavy drinking, while excitement and confidence were highest on days with only heavy drinking episodes for BE + HD. Global negative affect was relatively stable surrounding binge eating episodes. Guilt significantly increased prior to binge eating, and sadness significantly decreased following binge eating. Global positive affect significantly decreased prior to and stopped decreasing following heavy drinking episodes. Discussion Results support binge eating being negatively reinforced by specific aspects of negative affect, while heavy drinking may be positively reinforced by global positive affect for individuals with BE + HD. Clinicians should incorporate interventions that focus on specific negative affect dimensions and that promote alternative rewarding activities besides heavy drinking.
Abstract Objective Individuals with bulimia nervosa (BN) engage in both maladaptive (i.e., compulsive and/or compensatory) and adaptive exercise (e.g., for enjoyment). No research has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting intervention efficacy. Method We examined associations of baseline exercise engagement with baseline and posttreatment BN pathology among 106 treatment‐seeking adults ( M age = 37.4, SD age = 12.95, 87.74% female, 68.87% White) enrolled across four clinical trials of outpatient enhanced cognitive behavioral therapy for BN (range: 12–16 sessions). Analysis of covariances examined associations between baseline exercise type and baseline/posttreatment global eating pathology, dietary restraint, loss‐of‐control (LOC) eating, and purging frequency. Results Those engaging in only adaptive exercise reported lower global eating pathology compared to those engaging in compulsive‐only exercise (Est = −1.493, p = .014, M diff = −.97) while those engaging in baseline compulsive exercise reported less LOC eating compared to those not engaging in exercise (Est = −22.42, p = .012, M diff = −12.50). Baseline engagement in compulsive‐only exercise was associated with lower posttreatment global eating pathology compared to baseline engagement in no exercise (Est = −.856, p = .023, M diff = −.64) and both compulsive and compensatory exercise (Est = .895, p = .026, M diff = −1.08). Discussion Those engaging in compulsive, compensatory, adaptive, and no exercise exhibit different patterns and severity of BN pathology. Future research is needed to position treatments to intervene on maladaptive, while still promoting adaptive, exercise. Public significance statement No research to date has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting targeted intervention efforts. We found that those engaging in compulsive, compensatory, and adaptive exercise exhibit different patterns of BN pathology and that adaptive exercise engagement was related to lower cognitive eating disorder symptoms at baseline.
