Loss of control is central to psychological disturbance associated with binge eating disorder

Objective: Binge eating disorder (BED) is positively associated with obesity and psychological distress, yet the behavioral features of BED that drive these associations are largely unexplored. The primary aim of this study was to investigate which core behavioral features of binge eating are most strongly related to psychological disturbance. Methods and Procedures: A cross‐sectional study involved 180 bariatric surgery candidates, 93 members of a non‐surgical weight loss support group, and 158 general community respondents (81 men/350 women, mean age 45.8 ± 13.3, mean BMI 34.8 ± 10.8, BMI range 17.7–66.7). Validated questionnaires assessed BED and binge eating, symptoms of depression, appearance dissatisfaction (AD), quality of life (QoL) and eating‐related behaviors. Features of binge eating were confirmed by interview. BMI was determined by clinical assessment and self‐report. Results: The loss of control (LOC) over eating, that is, being unable to stop eating or control what or how much was consumed was most closely related to psychological markers of distress common in BED. In particular, those who experienced severe emotional disturbance due to feelings of LOC reported higher symptoms of depression (P < 0.001), AD (P = 0.009), and poorer mental health–related QoL (P = 0.027). Discussion: Persons who report subjective binge episodes or do not meet BED frequency criteria for objective binge episodes may still be at elevated risk of psychological disturbance and benefit from clinical intervention. Feelings of LOC could drive binge eaters to seek bariatric surgery in an attempt to gain control over body weight and psychologically disturbing eating behavior.     

Energy Intake Patterns in Obese Women with Binge Eating Disorder

Objective: For binge eating disorder (BED) to be accepted as a distinct diagnostic category in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, it must be demonstrated that the criteria identify a diagnostic entity that is distinct from bulimia nervosa and obesity. This study examined the difference in total energy intake per day, patterns of energy intake throughout the day, and nutrient content of foods consumed in obese individuals who met the criteria for BED (on binge and non‐binge days) and those who did not. Research Methods and Procedures: Twenty women, 12 who met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria for BED and 8 matched obese controls, participated in the study. All participants underwent six random 24‐hour dietary recall telephone interviews conducted by experienced interviewers using the Nutrition Data Software System. Results: The BED group ingested significantly more kilocalories on days when they had binge eating episodes than the obese control group on average. The BED group ate significantly more in the evening on binge days than their control group counterparts. There is some indication in the data that those with BED may be restricting caloric intake. Finally, data indicated that the BED group ate significantly more protein, carbohydrate, and fat on binge days than on non‐binge days. However, the proportion of kilocalories from each nutrient shifted on BED binge days compared with non‐binge days to favor consumption of fat over carbohydrates. Discussion: More research needs to be done to determine if these findings are reproducible. Then, the neurobiological underpinnings of these differences in nutrient intake patterns and nutrient selection can be studied to help to determine the biological basis of the disorder.     

On the Relation of Attempting to Lose Weight,Restraint, and Binge Eating in Outpatients with Binge Eating Disorder

Objective: To examine the relationship among attempts to lose weight, restraint, and eating behavior in outpatients with binge eating disorder (BED). Research Methods and Procedures: Participants were 93 consecutive outpatients evaluated for a clinical trial who met Diagnostic and Statistical Manual, Fourth edition criteria for BED. The Eating Disorder Examination Interview was administered to assess attempts at weight loss, restraint, different forms of overeating, and the attitudinal psychopathology of eating disorders (i.e., concerns regarding eating, shape, and weight). In addition, the Three‐Factor Eating Questionnaire was used to assess cognitive restraint, hunger, and disinhibition. Psychometrically established measures were given to assess body dissatisfaction, depression, and self‐esteem. Results: The majority of participants (75.3%; N = 70) reported attempting to lose weight, but only 37.6% (N = 35) reported dietary restraint on at least half the days of the month. Dietary restraint and cognitive restraint were not associated with any form of binge eating or overeating. Dietary restraint and cognitive restraint were positively correlated with weight concern, shape concern, and body dissatisfaction, and negatively correlated with body mass index. To further examine the interplay between attempting to lose weight and restraint, three study groups were created: unrestrained nonattempters (21.5%, N = 20), unrestrained attempters (40.9%; N = 38), and restrained attempters (34.4%; N = 32). The three groups did not differ significantly on binge eating or other eating behaviors; however, significant differences were observed for weight concern, shape concern, and body dissatisfaction. Discussion: Attempts to lose weight and restraint are not synonymous for patients with BED. Although 75.3% of BED patients reported that they were attempting to lose weight, only 37.6% reported dietary restraint on at least half the days of the previous month. While restraint was negatively associated with body mass index, it was not related to binge eating or overeating. Our findings raise questions about prevailing models that posit restraint as a predominant factor in the maintenance of binge eating in BED.     

Grazing and loss of control related to eating: two high-risk factors following bariatric surgery

Background: Gastric restrictive surgery induces a marked change in eating behavior. However, the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention. Objective: This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates, and impact on weight loss. Methods and Procedures: A 12‐month observational study assessed presurgical and postsurgical binge eating disorder (BED), uncontrolled eating, night eating syndrome (NES), grazing, nutrient intake and eating‐related behaviors, and markers of psychological distress. A total of 129 subjects (26 male and 103 female, mean age 45.2 ± 11.5 and BMI 44.3 ± 6.8) participated in this study. Results: Presurgical BED, uncontrolled eating, and NES occurred in 14%, 31%, and 17.1% of subjects, which reduced after surgery to 3.1%, 22.5%, and 7.8%, respectively (P = 0.05 for all). Grazing was prevalent before (26.3%) and after surgery (38.0%). Preoperative BED most frequently became grazers (P = 0.029). The average percentage weight loss (%WL) was 20.8 ± 8.5%; range ?0.67 to 50.0% and percentage of excess weight loss (%EWL) 50.0 ± 20.7%; range ?1.44 to 106.9% (P < 0.001). Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer %WL (P = 0.008 and P < 0.001, respectively) and elevated psychological distress. Discussion: Consistent with recent studies, uncontrolled eating and grazing were identified as two high‐risk eating patterns after surgery. Clearer characterization of favorable and unfavorable postsurgical eating behaviors, reliable methods to assess their presence, and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well‐being in at‐risk groups.     

Treatment outcome in people with subthreshold compared with full-syndrome binge eating disorder

Objective: There is a controversial discussion in the literature as to whether individuals with subthreshold binge eating disorder (subBED) differ clinically significantly from individuals with full‐syndrome binge eating disorder (BED). This study was designed to compare eating‐related and general psychopathology at baseline and in response to a multimodal treatment program in obese people with subBED compared with BED. Research Methods and Procedures: A total of 96 obese participants (BMI ≥ 30 kg/m²) were assessed for eating‐related and general psychopathology at baseline. Thirty‐nine participants meeting criteria for BED and 19 participants meeting criteria for subBED attended a 15‐session outpatient group therapy including cognitive behavioral therapy extended by interpersonal therapy, nutritional counseling, and a supervised walking exercise. Participants with eating disorders were reassessed at the end of treatment and at 3‐month follow‐up. The obese control group without an eating disorder (n = 38) was assessed once. This was not a randomized controlled trial. Results: Intent‐to‐treat analyses revealed no differences between subBED and full‐syndrome BED participants with regard to eating‐related and general psychopathology at baseline and with regard to treatment outcome. All participants experienced substantial improvements, and the results remained stable during follow‐up (except for dietary restraint). At follow‐up, participants with subBED and BED remained different from non‐eating disorder controls in eating‐related but not general psychopathology. Discussion: The findings indicate that our multimodal treatment program is equally effective in obese subBED and BED participants, suggesting that a differentiation currently seems not to be of clinical significance.     

Adiposity and eating behaviors in patients under second generation antipsychotics

Background: Second generation antipsychotics (SGA) induce substantial weight gain but the mechanisms responsible for this phenomenon remain speculative. Objective: To explore eating behaviors among SGA‐treated patients and compare them with nonschizophrenic healthy sedentary individuals (controls). Methods and Procedures: Appetite sensations were recorded before and after a standardized breakfast using visual analog scales. Three hours after breakfast, a buffet‐type meal was offered to participants to document spontaneous food intake and food preferences. Satiety quotients (SQs) were calculated to determine the satiation of both meals and the Three‐Factor Eating Questionnaire (TFEQ) was used to document eating behaviors. Body composition and abdominal fat distribution were assessed. Results: Compared with controls (n = 20), SGA‐treated patients (n = 18) showed greater adiposity indices (P ≤ 0.04). Patients' degree of hunger was also higher following the standardized breakfast (P = 0.03). Moreover, patients had significantly higher cognitive dietary restraint, disinhibition, and susceptibility to hunger scores than the reference group (P ≤ 0.05). Disinhibition in the reference group was positively associated with hunger triggered by external cues (r = 0.48, P = 0.03) whereas internal cues seem to mainly regulate emotional susceptibility to disinhibition in patients (r = 0.56, P = 0.02). Higher strategic restraint behavior in patients was associated with decreased satiation right after the buffet‐type meal (r = ?0.56, P = 0.02). Discussion: These exploratory findings suggest that patients under SGA seem to develop disordered eating behaviors in response to altered appetite sensations and increased susceptibility to hunger, a factor which may influence the extent of body weight gain triggered by these drugs.     

Effect of orlistat on eating behavior among participants in a 3-year weight maintenance trial

Objective: To examine the effect of orlistat on dietary restraint, disinhibition, hunger, and binge eating and to understand the relation between changes in eating behavior and weight maintenance. Methods and Procedures: Subjects were 306 women and men (age: 19–45 years; BMI: 37.5 ± 4.1 kg/m²) included in the Scandinavian Multicenter study of Obese subjects with the Metabolic Syndrome, a 3‐year clinical trial of orlistat or placebo following an 8‐week very low energy diet (VLED). Outcomes were changes in weight and in the Three Factor Eating Questionnaire (TFEQ) and Binge Eating Scale (BES) between screening and 17 and 33 months after randomization. As reported previously, weight gain following VLED was lower in subjects treated with orlistat than with placebo. Results: Compared to screening results, dietary restraint was increased and disinhibition, hunger, and binge eating were decreased in both groups. These changes were similar in both groups with the exception of the hunger score at month 33 that was reduced more in the placebo than in the orlistat group (difference between groups ?1.1 (95% CI (?2.0, ?0.2)) P = 0.014). In multivariate analyses, scores for restraint, disinhibition and binge eating were associated with weight loss after adjustment for BMI, gender, age, and treatment (all P ≤ 0.002, model R ² = 0.12–0.17). Discussion: Orlistat did not affect eating behavior differently in any substantial way than the placebo did in this long‐term weight maintenance trial. The results indicate that increased restraint and decreased disinhibition and binge eating are important for sustained weight maintenance in obese subjects with the metabolic syndrome.     

A model of emotional stress‐induced binge eating in female mice with no history of food restriction

Overeating is a major contributing factor to obesity and related health complications. For women, in particular, negative emotions such as stress strongly influence eating behavior and bingeing episodes. Modeling this type of binge eating in rodents presents challenges: firstly, stress‐induced anorexia is commonly observed in rodents therefore a mild stressor is required in order to observe an orexigenic effect. Second, many studies report using calorie restriction to observe the required behavior; yet this does not necessarily reflect the human condition. Thus, the aim of this study was to develop a model of emotional stress‐induced bingeing independent of caloric restriction. Female and male C57BL/6J mice were divided into ad libitum (n = 20 per sex) and food‐restricted (n = 20 per sex) groups which were both further split into a control group and a group exposed to frustration stress (n = 10 per group). All mice were provided intermittent access to a highly palatable food in 2 cycles. At the end of each cycle the stress group was subjected to a 15‐minute frustration episode where highly palatable food was within the home cage but inaccessible. Both groups were then given free access for 15 minutes. Frustrated female mice from the ad libitum displayed binge‐like behavior compared with controls (P = .0001). Notably, this behavior was absent in males. Ovariectomy had no impact on binge‐like behavior. Collectively, these data validate a novel model of emotional stress‐induced binge eating specific to female mice which does not require caloric restriction and is not driven by ovarian hormones.     

Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle‐aged and Older Adults

Water consumption acutely reduces meal energy intake (EI) among middle‐aged and older adults. Our objectives were to determine if premeal water consumption facilitates weight loss among overweight/obese middle‐aged and older adults, and to determine if the ability of premeal water consumption to reduce meal EI is sustained after a 12‐week period of increased water consumption. Adults (n = 48; 55–75 years, BMI 25–40 kg/m²) were assigned to one of two groups: (i) hypocaloric diet + 500 ml water prior to each daily meal (water group), or (ii) hypocaloric diet alone (nonwater group). At baseline and week 12, each participant underwent two ad libitum test meals: (i) no preload (NP), and (ii) 500 ml water preload (WP). Meal EI was assessed at each test meal and body weight was assessed weekly for 12 weeks. Weight loss was ～2 kg greater in the water group than in the nonwater group, and the water group (β = ?0.87, P < 0.001) showed a 44% greater decline in weight over the 12 weeks than the nonwater group (β = ?0.60, P < 0.001). Test meal EI was lower in the WP than NP condition at baseline, but not at week 12 (baseline: WP 498 ± 25 kcal, NP 541 ± 27 kcal, P = 0.009; 12‐week: WP 480 ± 25 kcal, NP 506 ± 25 kcal, P = 0.069). Thus, when combined with a hypocaloric diet, consuming 500 ml water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle‐aged and older adults. This may be due in part to an acute reduction in meal EI following water ingestion.     

Pre-meal water consumption reduces meal energy intake in older but not younger subjects

Objective: To determine whether the consumption of water 30 minutes before an ad libitum meal reduces meal energy intake in young and older adults. Research Methods and Procedures: Healthy, non‐obese young (n = 29; age, 21 to 35 years) and older (n = 21; age, 60 to 80 years) individuals were provided with an ad libitum lunch meal on two occasions. Thirty minutes before the lunch meals, subjects were given either a water preload (WP: 375 mL, women; 500 mL, men) or no preload (NP). Energy intake at the two lunch meals was measured. Visual analog scales were used to assess changes in hunger, fullness, and thirst during the meal studies. Results: There was no significant difference in meal energy intake between conditions in the young subjects (892 + 51 vs. 913 ± 54 kcal for NP and WP, respectively; p = 0.65). However, meal energy intake after the WP was significantly reduced relative to the NP condition in the older subjects (682 + 53 vs. 624 ± 56 kcal for NP and WP, respectively; p = 0.02). This effect was caused primarily by the reduction in meal energy intake after water consumption in older men. Hunger ratings were lower and fullness ratings were higher in older compared with younger adults (p < 0.01). Fullness ratings were higher in the WP condition compared with the NP condition for all subjects (p = 0.01). No age differences in thirst were detected during the test meals. Discussion: Under acute test meal conditions, pre‐meal water consumption reduces meal energy intake in older but not younger adults. Because older adults are at increased risk for overweight and obesity, intervention studies are needed to determine whether pre‐meal water consumption is an effective long‐term weight management strategy for the aging population.     

Maladaptive Eating Patterns,Quality of Life,and Weight Outcomes Following Gastric Bypass: Results of an Internet Survey

Bariatric surgery is the most effective treatment for severe obesity. However, evidence suggests that maladaptive eating behaviors such as binge eating, grazing, and a loss of control when eating may impact postsurgical weight outcomes. The current study sought to characterize the weight outcomes, eating patterns, and perceived health‐related quality of life of individuals 3–10 years following gastric bypass (GBP) surgery and to assess the relationships between eating behaviors, weight outcomes, and quality of life. Eligible participants (N = 497) completed an Internet survey of their eating behaviors, health‐related quality of life, and weight history. Participants self‐reported a mean maximum postsurgical loss of 81% of their excess weight and maintained a mean weight loss of 70% 3–10 years following surgery (mean 4.2 years). Eighty‐seven percent reported weight regain ranging from 1 to 124 lb (mean 22.6 lb). Frequency of binge eating, a loss of control when eating, and grazing were all significantly correlated with greater weight regain (binge eating r = 0.24, P = 0.006; loss of control r = 0.36, P < 0.01; grazing r = 0.39, P < 0.001) and lesser excess weight loss (EWL) (binge eating r = ?0.21, P = 0.013; loss of control r = ?0.41, P < 0.001; grazing r = ?0.27, P < 0.001). Poorer health‐related quality of life was associated with binge eating disorder (BED) (t[463] = 9.7, P < 0.001) and grazing two or more times per week (t[361] = 9.0, P < 0.001). These findings suggest that eating disturbances and a loss of control when eating are significant following GBP and are risk factors for diminished weight outcomes.     

A Model of Binge‐Like Eating Behavior in Mice That Does Not Require Food Deprivation or Stress

Binge eating disorder (BED) is characterized by excessive food intake during a short period of time and is often associated with obesity. Mouse models of binge‐like eating behavior are lacking making it difficult to employ genetic models in the identification of mechanisms regulating excessive eating. We report a rapid and simple model to induce binge‐like eating behavior in mice that does not require food deprivation or exogenous stressors. Weekly 24 h access to a nutritionally complete high energy diet (HED), along with continuous access to standard chow, resulted in a significant increase in HED intake following its presentation compared to mice that had continuous access to both diets. Mice exhibiting binge‐like eating consumed one‐third of their normal total daily caloric intake within 2.5 h of HED presentation. Moreover, total 24‐h caloric intakes were increased by 50% in mice exhibiting binge‐like eating. Following repeated cycles, binge‐like eating of the HED was maintained over several weeks with no evidence of habituation or significant alterations in body weight and adiposity. Pharmacological evaluation of binge‐like eating behavior was performed using clinically employed compounds. Interestingly, binge‐like eating was dose‐dependently decreased by fluoxetine, but not baclofen or topiramate. These data support clinical validation of this mouse model of binge‐like eating behavior, as fluoxetine has been shown to reduce binge frequency in human subjects with BED. The availability of transgenic and knockout mice will allow for the determination of genes that are involved in the initiation and maintenance of binge‐like eating behavior.     

Self-Efficacy in Overweight Individuals with Binge Eating Disorder

MILLER, PETER M., JULIA A. WATKINS, ROGER G. SARGENT, AND EDWARD J. RICKERT. Self-efficacy in overweight individuals with binge eating disorder. Obes Res. Objective: To evaluate the relationship between self-efficacy judgments in obese individuals with binge eating disorder, “borderline” binge eating disorder, and no binge eating problems. Research Methods and Procedures: Before participation in a residential weight management program, 79 male and female subjects were administered the Weight Efficacy Lifestyle Questionnaire (WEL) and the Binge Eating Scale (BES). Based on DSM-IV diagnostic questions, subjects were categorized as BED, Borderline BED, or non-BED. Results: Krusal-Wallace Rank-Order analysis of variance revealed significant negative associations between binge eating and total WEL scores as well as the subscales of Negative Emotions, Social Pressure, Physical Discomfort, and Positive Activities. Differences were significant between the BED and the Borderline BED groups with the exception of the Social Pressure scale and the Total WEL scores. BED diagnosis as well as severity of binge eating were strongly associated with low self-efficacy ratings. Discussion: These results indicate that obese individuals with binge eating disorder demonstrate lower self-efficacy than those without this condition and that self-efficacy is related to the severity of binge eating.     

Food Form and Portion Size Affect Postprandial Appetite Sensations and Hormonal Responses in Healthy,Nonobese, Older Adults

Data are limited concerning the dietary factors that influence appetite control in older adults. This study examined the effects of food form and portion size on appetite in 43 older adults (age: 72 ± 1 years; BMI: 25.6 ± 0.3 kg/m²). Subjects were assigned to groups based on portion size of the test meal (12.5% (n = 18) vs. 25% (n = 25) of estimated energy need). Subjects randomly consumed, on two separate days, the respective solid or beverage test meal. Appetite sensations and hormonal responses were measured over 4 h. Main effects of food form (P < 0.05) and/or portion size (P < 0.05) were observed for each appetite sensation. Postprandial hunger and desire to eat were greater following beverage vs. solid meal (between 12.5% vs. 25%), whereas fullness was lower after beverage vs. solid meal (P < 0.05). Main effects of food form and/or portion size were observed for glucose, insulin, and ghrelin. Postprandial glucose and insulin concentrations were lower after beverage vs. solid meal (between 12.5% vs. 25%; all comparisons, P < 0.05) whereas beverage meal led to greater 4‐h ghrelin vs. solid meal (P = 0.09). No main effects were observed for glucagon‐like peptide‐1 (GLP‐1) or cholecystokinin (CCK). When adjusting for age, food form remained significant for postprandial hunger and fullness; portion size remained significant for postprandial glucose. Greater hunger and reduced satiety with accompanying glucose, insulin, and ghrelin following the beverage vs. solid meals, and to some extent, in smaller vs. larger portions suggest that appetite control is influenced by food form and portion size in older adults. These findings may enhance the development of appropriate dietary strategies that help to regulate energy balance.     

Dopamine for “Wanting” and Opioids for “Liking”: A Comparison of Obese Adults With and Without Binge Eating

Obesity research suffers from an overinclusion paradigm whereby all participants with a BMI beyond a certain cutoff value (e.g., 30) are typically combined in a single group and compared to those of normal weight. There has been little attempt to identify meaningful subgroups defined by their salient biobehavioral differences. In order to address this limitation, we examined genetic and psychological indicators of hedonic eating in obese adults with (n = 66) and without (n = 70) binge eating disorder (BED). Our analyses focused on dopamine (DA) and opioid genetic markers because of their conjoint association with the functioning of brain reward mechanisms. We targeted three functional polymorphisms related to the D2 receptor (DRD2) gene, as well as the functional A118G polymorphism of the mu‐opioid receptor (OPRM1) gene. We found that significantly more obese controls had the “loss‐of‐function” A1 allele of Taq1A compared to their BED counterparts, whereas the “gain‐of‐function” G allele of A118G occurred with greater frequency in the BED group. A significant gene–gene combination χ² analysis also indicated that of those participants with the gain‐gain genotype (G⁺ and A1), 80% were in the BED group whereas only 35% with the loss‐loss genotype (G^? and A1⁺) were in this group. Finally, BED subjects had significantly higher scores on a self‐report measure of hedonic eating. Our findings suggest that BED is a biologically based subtype of obesity and that the proneness to binge eating may be influenced by a hyper‐reactivity to the hedonic properties of food—a predisposition that is easily exploited in our current environment with its highly visible and easily accessible surfeit of sweet and fatty foods.     

Teasing History,Onset of Obesity,Current Eating Disorder Psychopathology,Body Dissatisfaction,and Psychological Functioning in Binge Eating Disorder

Objective: The primary goal of this study was to examine associations among teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in women with Binge Eating Disorder (BED). Research Methods and Procedures: Subjects were 115 female adults who met DSM‐IV criteria for BED. Measurements assessing teasing history (general appearance [GAT] and weight and size [WST] teasing), current eating disorder psychopathology (binge frequency, eating restraint, and concerns regarding eating, shape, and weight), body dissatisfaction, and psychological functioning (depression and self‐esteem) were obtained. Results: History of GAT, but not WST, was associated with current weight concerns and body dissatisfaction, whereas both GAT and WST were significantly associated with current psychological functioning. Patients with earlier onset of obesity reported more WST than patients with later onset of obesity, but the groups did not differ significantly in GAT, current eating disorder psychopathology, body dissatisfaction, or psychological functioning. Obese women reported more WST than non‐obese women, but no differences in GAT or the other outcome variables were observed. Higher frequency of GAT was associated with greater binge frequency in obese women, and with greater eating restraint in non‐obese women. Discussion: Although physical appearance teasing history is not associated with variability in most eating disorder psychopathology, it is associated with related functioning, most notably body dissatisfaction, depression, and self‐esteem. Our findings also suggest that the age of onset of obesity and current body mass index status in isolation are not associated with eating psychopathology or associated psychological functioning in adult patients with BED.     

Low-dose pramlintide reduced food intake and meal duration in healthy, normal-weight subjects

Objective: We previously reported that a single preprandial injection (120 μg) of pramlintide, an analog of the β‐cell hormone amylin, reduced ad libitum food intake in obese subjects. To further characterize the meal‐related effects of amylin signaling in humans, we studied a lower pramlintide dose (30 μg) in normal‐weight subjects. Research Methods and Procedures: In a randomized, double‐blind, placebo‐controlled, cross‐over study, 15 healthy men (age, 24 ± 7 years; BMI, 22.2 ± 1.8 kg/m²) underwent a standardized buffet meal test on two occasions. After an overnight fast, subjects received a single subcutaneous injection of pramlintide (30 μg) or placebo, followed immediately by a standardized pre‐load meal. After 1 hour, subjects were offered an ad libitum buffet meal, and total caloric intake and meal duration were measured. Results: Compared with placebo, pramlintide reduced total caloric intake (1411 ± 94 vs. 1190 ± 117 kcal; Δ, ?221 ± 101 kcal; ?14 ± 9%; p = 0.05) and meal duration (36 ± 2 vs. 31 ± 3 minutes; Δ, ?5.1 ± 1.4 minutes; p < 0.005). Visual analog scale profiles of hunger trended lower and fullness higher during the first hour after pramlintide administration. In response to the buffet, hunger and fullness changed to a similar degree after pramlintide and placebo, despite subjects on pramlintide consuming 14% fewer kilocalories. Visual analog scale nausea ratings remained near baseline, without differences between treatments. Plasma peptide YY, cholecystokinin, and ghrelin concentrations did not differ with treatment, whereas glucagon‐like peptide‐1 concentrations after meals were lower in response to pramlintide than to placebo. Discussion: These observations add support to the concept that amylin agonism may have a role in human appetite control.     

Binge eating disorder and night eating syndrome in adults with type 2 diabetes

Objective: To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study. Research Methods and Procedures: The Eating Disorders Examination–Questionnaire (EDE‐Q) and the Night Eating Questionnaire (NEQ) were used to screen patients. Phone interviews were conducted using the EDE for those who reported at least eight episodes of objective binge eating in the past month and using the Night Eating Syndrome History and Interview for those who scored ≥25 on the NEQ. Recruitment at four sites (Birmingham, n = 200; Houston, n = 259; Minneapolis, n = 182; and Philadelphia, n = 204) yielded 845 participants (58% women; mean age = 60.1 ± 6.7 years; mean BMI = 36.2 ± 6.3 kg/m²). Results: Screening scores were met by 47 (5.6%) applicants on the EDE‐Q and 71 (8.4%) on the NEQ. Of the 85% (40/47) who completed the EDE interview, 12 were diagnosed with BED, representing 1.4% of the total sample. Of the 72% (51/71) who completed the Night Eating Syndrome History and Interview, 32 were diagnosed with NES, equal to 3.8% of the total sample. Three participants had both BED and NES. Participants with eating disorders were younger, heavier, and reported more eating pathology than those without eating disorders. Discussion: Among obese adults with type 2 diabetes, NES was reported more frequently than BED, which, in turn, was less common than expected.     

Night Eating Syndrome Is Associated with Depression,Low Self‐Esteem,Reduced Daytime Hunger,and Less Weight Loss in Obese Outpatients

Objective: The objective of this study was to assess the relationship between the night eating syndrome (NES), measures of depression and self‐esteem, test meal intake, and weight loss in obese participants. Research Methods and Procedures: The study included 76 overweight (body mass index = 36.7 ± 6.5 SD) outpatients (53 women and 23 men; aged 43.5 ± 9.5 years) entering a weight loss program. They completed a Night Eating Questionnaire, the Zung Depression Inventory, and the Rosenberg Self‐Esteem Scale. Based on criteria by Stunkard et al. (Stunkard A, Berkowitz R, Wadden T, Tanrikut C, Reiss E, Young L. Binge eating disorder and the night eating syndrome. Int J Obes Relat Metab Disord. 1996;20:1–6), participants had NES if they reported: (1) skipping breakfast ≥4 d/wk, interpreted as morning anorexia; (2) consuming more than 50% of total daily calories after 7 pm ; and (3) difficulty falling asleep or staying asleep ≥4 d/wk. Eleven (14%) participants met the criteria for NES. After an 8‐hour fast, all participants ingested a nutritionally complete liquid meal through a straw from a large opaque cooler until extremely full. They also completed ratings of hunger and fullness before and after this meal. Results: Night eaters had higher depression (p = 0.04), lower self‐esteem (p = 0.003), and less hunger (p = 0.005), and a trend for more fullness (p = 0.06) before the daytime test meal than the others. However, there were no significant differences in test‐meal intake between groups. Nevertheless, test‐meal intake was greater later in the day only for the night eaters (p = 0.01). Over a 1‐month period, the night eaters lost less weight (4.4 ± 3.2 kg) than the others (7.3 ± 3.2 kg; p = 0.04), after controlling for body mass index. Discussion: NES is a syndrome with distinct psychopathology and increased food intake later in the day, both of which may contribute to poorer weight loss outcome. NES criteria need to be better quantified and NES deserves consideration as a diagnostic eating disorder.     

The Effects of Consuming Frequent,Higher Protein Meals on Appetite and Satiety During Weight Loss in Overweight/Obese Men

The purpose of this study was to determine the effects of dietary protein and eating frequency on perceived appetite and satiety during weight loss. A total of 27 overweight/obese men (age 47 ± 3 years; BMI 31.5 ± 0.7 kg/m²) were randomized to groups that consumed an energy‐restriction diet (i.e., 750 kcal/day below daily energy need) as either higher protein (HP, 25% of energy as protein, n = 14) or normal protein (NP, 14% of energy as protein, n = 13) for 12 weeks. Beginning on week 7, the participants consumed their respective diets as either 3 eating occasions/day (3‐EO; every 5 h) or 6 eating occasions/day (6‐EO; every 2 h), in randomized order, for 3 consecutive days. Indexes of appetite and satiety were assessed every waking hour on the third day of each pattern. Daily hunger, desire to eat, and preoccupation with thoughts of food were not different between groups. The HP group experienced greater fullness throughout the day vs. NP (511 ± 56 vs. 243 ± 54 mm · 15 h; P < 0.005). When compared to NP, the HP group experienced lower late‐night desire to eat (13 ± 4 vs. 27 ± 4 mm, P < 0.01) and preoccupation with thoughts of food (8 ± 4 vs. 21 ± 4 mm; P < 0.01). Within groups, the 3 vs. 6‐EO patterns did not influence daily hunger, fullness, desire to eat, or preoccupation with thoughts of food. The 3‐EO pattern led to greater evening and late‐night fullness vs. 6‐EO but only within the HP group (P < 0.005). Collectively, these data support the consumption of HP intake, but not greater eating frequency, for improved appetite control and satiety in overweight/obese men during energy restriction‐induced weight loss.