Eunice Y Chen
Temple University, Psychology, Faculty Member
Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral... more
Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with heightened threat sensitivity and reduced reward sensitivity, interacting with an environment reinforcing overcontrol and punishing imperfection. Case Series 1 utilized standard DBT, resulting in retention of 5/6 patients and a body mass index (BMI) effect size increase of d = -0.5 from pre- to post-treatment. Case series 2, using standard DBT augmented with skills addressing overcontrol, resulted in retention of 8/9 patients with an effect size increase in BMI at post-treatment that was maintained at 6- and 12-months follow-up (d = -1.12, d = -0.87, and d = -1.12). Findings suggest that skills training targeting rigidity and increasing openness an...
Research Interests: Psychology, Research Design, Eating Disorders, Medicine, Anorexia Nervosa, and 15 moreEmotions, Humans, Rt, Behavior Therapy, Female, Male, Body Mass Index, Middle Aged, Adult, Dialectical Behavior Therapy, Bf, Pilot Projects, Ambulatory Care, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Education, Advertising, Obesity, Childhood Obesity, Adolescent, and 15 moreMedicine, Child Behavior, Humans, Child, Female, Candy, Male, Gender Difference, Child Psychology, Nutrition Education, Infection prevention and control, Choice Behavior, Child preschool, Prevention and Control, and Medical and Health Sciences
Meta-analyses of neuroimaging studies have not found a clear relationship between the orbitofrontal cortex and obesity, despite animal and human studies suggesting the contrary. Our primary meta-analysis examined what regions are... more
Meta-analyses of neuroimaging studies have not found a clear relationship between the orbitofrontal cortex and obesity, despite animal and human studies suggesting the contrary. Our primary meta-analysis examined what regions are associated with reduced gray matter volume, given increased body mass index. We identified 23 voxel-based morphometry studies examining the association between gray matter volume and body mass index. In a sample of 6,788 participants, we found that greater body mass index is associated with decreased gray matter volume in the right Brodmanns’ area 10 and 11, forming part of the right orbitofrontal cortex (FWE, p=0.05). Use of Brodmanns’ areas 10 and 11 as seeds in a Neurosynth network coactivation and text decoding analysis revealed that these regions are associated with studies of emotional regulation and processing, clinical symptoms and disorder, ‘mentalizing’ and social cognition, and the Default mode network. Our finding uniquely contributes to the lit...
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Taste perception influences food choice, and may contribute to both weight status and disordered eating. Relatively little work has attempted to disentangle contributions of weight status and Binge Eating Disorder (BED) to human taste... more
Taste perception influences food choice, and may contribute to both weight status and disordered eating. Relatively little work has attempted to disentangle contributions of weight status and Binge Eating Disorder (BED) to human taste perception. We predicted weight status and BED would interact, showing difference in taste perception from non-eating disorder matched groups. The four study groups included: normal weight BED (NW BED), normal weight healthy controls (NW HC), overweight BED (OW BED), and overweight healthy controls (OW HC) (N = 60). Groups were matched for age (±5 years), ethnicity, and weight status. Participants were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, the Eating Disorder Examination Version 16.0, and the NIH Toolbox Gustatory Assessment with additional taste solutions and taste stimulus delivered with edible taste strips. Interactions were found between weight status and diagnosis on measures of regional taste intensity for ...
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Body image concerns in binge eating disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to... more
Body image concerns in binge eating disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to assess the multifactorial construct of body image using subscales of the Eating Disorder Examination 16.0 (EDE-16.0) and a Body Comparison Task. Independent of weight status and when controlling for age and race, women with BED are distinguished from those without BED by significantly greater overvaluation of shape and weight on the EDE-16.0 and significantly reduced weight satisfaction after a Body Comparison Task. Both BED diagnosis and weight status were independently associated with Weight Concern and Shape Concern subscales on the EDE-16.0. Taken together, these data provide further support for the consideration of body image concerns in the diagnostic criteria for BED.
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Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion... more
Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ(2) = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (rpb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.
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Reward and punishment sensitivities have been identified as potential contributors to binge eating and compensatory behaviors, though few studies have examined gender differences in these behaviors. A college-aged sample (N = 1,022)... more
Reward and punishment sensitivities have been identified as potential contributors to binge eating and compensatory behaviors, though few studies have examined gender differences in these behaviors. A college-aged sample (N = 1,022) completed both the Eating Disorders Diagnostic Scale (EDDS) and Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). Rates of binge eating were similar in males and females. Among those reporting compensatory behaviors, women reported engaging in compensatory behaviors more frequently than men. Sensitivity to reward and sensitivity to punishment were both positively associated with binge eating frequency in both genders. In contrast, women with high reward sensitivity reported engaging in compensatory behaviors more frequently. Rates of binge eating and compensatory weight control behaviors were similar between college-aged males and females, though females who engaged in compensatory behaviors did so more frequently than males. Sensiti...
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To examine neural mechanisms of action in behavioral weight loss treatment (BWL) and explore neural and genetic predictors of BWL. Neural activation to milkshake receipt and genetics were compared in 17 women with obesity who received 12... more
To examine neural mechanisms of action in behavioral weight loss treatment (BWL) and explore neural and genetic predictors of BWL. Neural activation to milkshake receipt and genetics were compared in 17 women with obesity who received 12 weeks of BWL and 17 women who received no intervention. Participants were scanned twice using functional magnetic resonance imaging at baseline and 12 weeks. Weight was assessed at baseline, 12, 36, and 60 weeks. BWL participants lost more weight than controls at 12 weeks (-4.82% versus -0.70%). After 12 weeks, BWL had greater reduction in right caudate activation response to milk shake receipt than did controls. Among BWL participants, baseline to 12-week reduction in frontostriatal activation to milk shake predicted greater weight loss at 12, 36, and 60 weeks. Possessing the A/A or T/A genotype of the fat mass and obesity-associated (FTO) variant rs9939609 predicted greater weight loss at 12 and 36 weeks. These preliminary data reveal that reducti...
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We examined the preliminary acceptability and efficacy of family-based therapy (FBT) for weight restoration in young adults (FBTY) with Anorexia Nervosa (AN). Twenty-two primarily female participants ranging from age 18 to 26, with AN or... more
We examined the preliminary acceptability and efficacy of family-based therapy (FBT) for weight restoration in young adults (FBTY) with Anorexia Nervosa (AN). Twenty-two primarily female participants ranging from age 18 to 26, with AN or atypical AN (ICD-10) and their support adults were enrolled in a 6-month open trial of FBTY. Participants were assessed at baseline, after treatment, and at six and 12 month follow-up visits. The primary outcome was BMI and secondary outcomes included eating disorder psychopathology, current eating disorder obsessions, and compulsions, number of other Axis I disorders and global assessment of functioning. Although FBTY was rated as suitable by participants and their support adults, during FBTY, 9/22 participants dropped out and 3/22 dropped out at follow-up assessments. Despite being offered 18-20 sessions over six months, a mean of 12 FBTY sessions (SD = 6) were attended. After FBTY, 15 of the intent-to-treat sample of 22 were no longer underweight (BMIs ≥ 19 kg/m(2) ) and 12 months after treatment, 13/22 were no longer underweight. The magnitude of the BMI increase during FBTY (Hedges g = 1.20, 95th percentile CI = 0.55-1.85) was comparable to findings for adolescent FBT for AN. Secondary outcomes also improved. FBTY for young adults with AN and atypical AN, which involves support adults participants have chosen, results in weight restoration that is sustained up to a year after treatment. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:701-707).
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Almost 40% of individuals with eating disorders have a comorbid addiction. The current study examined weight/shape concerns as a potential moderator of the relation between the hypothesized latent factor... more
Almost 40% of individuals with eating disorders have a comorbid addiction. The current study examined weight/shape concerns as a potential moderator of the relation between the hypothesized latent factor "addiction vulnerability" (i.e., impairments in reward sensitivity, affect regulation and impulsivity) and binge eating. Undergraduate women (n=272) with either high or low weight/shape concerns completed self-report measures examining reward sensitivity, emotion regulation, impulsivity and disordered (binge) eating. Results showed that (1) reward sensitivity, affect regulation and impulsivity all loaded onto a latent "addiction vulnerability" factor for both women with high and with low weight/shape concerns, (2) women with higher weight/shape concerns reported more impairment in these areas, and (3) weight/shape concerns moderated the relation between addiction vulnerability and binge eating. These findings suggest that underlying processes identified in addiction are present in individuals who binge eat, though weight/shape concerns may be a unique characteristic of disordered eating.
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The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients... more
The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients describe other maladaptive eating patterns prior to surgery, such as eating in response to emotions. The goals of this study were to describe presurgical emotional eating patterns in morbidly obese individuals, determine whether these individuals were binge eaters, and assess the effect of this eating behavior on weight loss after surgery. Prior to surgery, 144 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R) and the Emotional Eating Scale to assess eating patterns prior to surgery. Their eating behavior, levels of depression, and weight were assessed after surgery. High emotional eaters tended to have higher levels of depression, binge eating, and eating in response to external cues than low emotional eaters prior to surgery. However, there appeared to be a distinct group of individuals who were high emotional eaters but who did not engage in binge eating. At a mean of 8 months after surgery, High Emotional Eaters and Low Emotional Eaters were indistinguishable on these subscales and there were no differences in weight lost. RYGBP has an equally positive impact on eating behavior and weight loss for both High Emotional Eaters and Low Emotional Eaters. Further replication is needed with longer follow-up times and larger samples.
Research Interests: Bariatric Surgery, Depression, Treatment Outcome, Bulimia Nervosa, Emotions, and 16 moreHumans, Weight Loss, Female, Male, Eating Behavior, Follow-up studies, Feeding Behavior, Obesity Surgery, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Retrospective Studies, Morbid Obesity, Gastric Bypass, and Binge eating
Bariatric surgery frequently leads to rapid weight loss post-surgery that may impact... more
Bariatric surgery frequently leads to rapid weight loss post-surgery that may impact participants' ability to gauge a realistic ideal body shape. In the present study, 57 obese participants' perception of their current and ideal body shape pre and post gastric bypass surgery were assessed. Results indicate prior to surgery, participants reported a 4 point difference between current and desired body shape. One year post surgery, as their own body shape decreased, so did the size of their ideal body shape (4.1-3.3). These findings suggest a consequence of rapid weight loss may suggest to participants that unrealistic body shapes are attainable. Implications for patient counseling are discussed.
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Binge eating is seen across the spectrum of eating disorder diagnoses as well as among individuals who do not meet diagnostic criteria. Analyses of the specific types of foods that are frequently binged upon reveal that sugar-rich items... more
Binge eating is seen across the spectrum of eating disorder diagnoses as well as among individuals who do not meet diagnostic criteria. Analyses of the specific types of foods that are frequently binged upon reveal that sugar-rich items feature prominently in binge-type meals, making the effects of binge consumption of sugar an important focus of study. One avenue to do this involves the use of animal models. Foundational and recent studies of animal models of sugar bingeing, both outlined here, lend insight into the various neurotransmitters and neuropeptides that may participate in or be altered by this behavior. Further, several preclinical studies incorporating sugar bingeing paradigms have explored the utility of pharmacological agents that target such neural systems for reducing sugar bingeing in an effort to enhance clinical treatment. Indeed, the translational implications of findings generated using animal models of sugar bingeing are considered here, along with potential a...
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Background / Purpose: Few neuroimaging studies have investigated the effects of cognitive behavior treatment (CBT) on neural activity in obese patients. Main conclusion: Participants with greater weight loss showed greater activation in... more
Background / Purpose: Few neuroimaging studies have investigated the effects of cognitive behavior treatment (CBT) on neural activity in obese patients. Main conclusion: Participants with greater weight loss showed greater activation in the left orbitofrontal cortex (OFC) after treatment.
This study tests the validity of the "dietary-depressive" subtype (typified by greater negative affect) and a "dietary" subtype (typified by dietary restraint only) using a diverse longitudinal community sample. Girls... more
This study tests the validity of the "dietary-depressive" subtype (typified by greater negative affect) and a "dietary" subtype (typified by dietary restraint only) using a diverse longitudinal community sample. Girls at ages 10, 12, and 14 completed the Child Eating Attitudes Test, the Child Symptom Inventory-4, and Body Image Measure. Body Mass Index was assessed at each age. Unlike previous studies, cluster analysis revealed an at-risk "dietary-depressive" (R+) subtype (18.7%,100/534) and a not at-risk (R-) subtype, distinguished by few depressive symptoms and little dietary restraint (81.3%,434/534), but no "dietary" subtype. When compared with the R- subtype, the R+ subtype had significantly greater eating disordered behavior and attitudes. The R+ subtype at age 10 was a risk factor for binge-eating but not obesity at ages 12 and 14. Dietary restraint and depressive symptoms combined predict binge-eating longitudinally in a diverse commun...
Research Interests: Depression, Obesity, Eating Disorders, Risk, Body Image, and 19 moreAdolescent, Bulimia Nervosa, Emotions, Affect, Humans, Child, Negative Affect, Female, Cluster Analysis, Depressive Disorder, Body Mass Index, Risk factors, Feeding Behavior, Longitudinal Studies, Educational Status, Risk Factors, Predictive value of tests, Socioeconomic Factors, and Psychiatric Status Rating Scales
Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral... more
Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with heightened threat sensitivity and reduced reward sensitivity, interacting with an environment reinforcing overcontrol and punishing imperfection. Case Series 1 utilized standard DBT, resulting in retention of 5/6 patients and a body mass index (BMI) effect size increase of d = -0.5 from pre- to post-treatment. Case series 2, using standard DBT augmented with skills addressing overcontrol, resulted in retention of 8/9 patients with an effect size increase in BMI at post-treatment that was maintained at 6- and 12-months follow-up (d = -1.12, d = -0.87, and d = -1.12). Findings suggest that skills training targeting rigidity and increasing openness an...
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The purpose of this study was to determine if early response predicted remission at the end of a controlled trial. Eighty adolescents with bulimia nervosa participated in an RCT comparing family-based treatment and individual supportive... more
The purpose of this study was to determine if early response predicted remission at the end of a controlled trial. Eighty adolescents with bulimia nervosa participated in an RCT comparing family-based treatment and individual supportive psychotherapy. Response to treatment was assessed via self-report of bingeing and purging. Remission was defined as abstinence from bingeing and purging for the last 28 days and measured by investigator-based interview, that is, the Eating Disorder Examination. Receiver-operating characteristic analyses showed that, regardless of treatment, symptom reduction at session six predicted remission at posttreatment (AUC = 0.814 (p < .001)) and 6-month follow-up (AUC = 0.811 (p < .001)). Results suggest that adolescents with BN who do not show early reductions in bulimic symptoms are unlikely to remit at posttreatment or follow-up.
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This treatment development study provides summary data for standard Dialectical Behavior Therapy (DBT) with minimal adaptation for 8 women with binge-eating disorder (BED) (5) or bulimia nervosa (BN) (3) and Borderline Personality... more
This treatment development study provides summary data for standard Dialectical Behavior Therapy (DBT) with minimal adaptation for 8 women with binge-eating disorder (BED) (5) or bulimia nervosa (BN) (3) and Borderline Personality Disorder (BPD). DBT involved 6 months of weekly skills group, individual DBT, therapist consultation team meeting, and 24-hour telephone coaching. Assessments were conducted at pre-, post-treatment, and 6-months follow-up and utilized standardized clinical interviews including the Eating Disorders Examination (EDE), Personality Disorders Exam, and the Structured Clinical Interview for DSM-IV. From pre- to post-treatment, effect sizes for objective binge eating, total EDE scores and global adjustment were large and for number of non-eating disorder axis I disorders and for suicidal behavior and self-injury were medium. From pre- to 6-months follow-up, effect sizes were large for all these outcomes. This provides promising pilot data for larger studies utilizing DBT for BED or BN and BPD.
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This study prospectively examined the role of compensatory eating disorder behavior on gastric bypass (GB) surgery weight-loss outcome. The compensatory behaviors of 199 GB patients were evaluated presurgically using the Questionnaire of... more
This study prospectively examined the role of compensatory eating disorder behavior on gastric bypass (GB) surgery weight-loss outcome. The compensatory behaviors of 199 GB patients were evaluated presurgically using the Questionnaire of Eating and Weight Patterns. Hierarchical linear regression was used to assess the presence of compensatory behavior on 6-month postsurgery body mass index (BMI), and 1-year postsurgery BMI, controlling for age, sex, race, age becoming overweight, number of weeks postsurgery, and presurgery BMI. The presence of presurgery compensatory behavior emerged as a small but significant predictor of lower BMI 6-months postsurgery although not at 1-year postsurgery. Other common predictors for lower BMI at 6-months and 1-year postsurgery were lower presurgery BMI and greater number of weeks postsurgery. Female sex also predicted lower BMI 1-year postsurgery. These results must be taken with caution as they contradict clinical guidelines. Future research is needed to replicate these findings.
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Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking.... more
Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking. This review describes the post-operative psychosocial predictors of weight loss in bariatric surgery. Results suggest empirical support for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictors of weight loss. With the exception of depression, psychological comorbidities were not consistently associated with weight loss outcomes. Results highlight the need for post-operative assessment of disordered eating and depressive disorder, further research on the predictive value of post-operative psychosocial factors, and development of targeted interventions.
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There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education,... more
There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of physical and/or sexual abuse, and lifetime major depression were associated with current suicide ideation. Some of the correlates of suicide ideation in severely obese bariatric surgery-seeking samples are similar to those found in the general community and this knowledge may serve to improve the psychological assessment and care for this group.
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The aim of this study was to determine if presurgery (T1), post-surgery (T2), or the change in body mass index (BMI) between these time points are useful predictors for predicting longer-term (T3) outcome in gastric bypass surgery. The... more
The aim of this study was to determine if presurgery (T1), post-surgery (T2), or the change in body mass index (BMI) between these time points are useful predictors for predicting longer-term (T3) outcome in gastric bypass surgery. The sample consisted of 72 gastric bypass surgery patients with an average age of 40.5. The mean presurgery BMI was 54.7 (SD = 8.6). T2 assessments (BMI, depressed mood, binge eating status) occurred on average 21 weeks (SD = 19) after surgery and T3 assessments occurred on average 63 weeks (SD = 34) after surgery. Three separate hierarchical linear regressions were performed to assess the predictive value of (1) BMI at T1, (2) BMI at T2, and (3) change in BMI from T1 to T2 on the dependent variable, BMI at T3, when age, sex, ethnicity, education status, age of overweight, binge eating status, depressed mood, and number of weeks after surgery were controlled for. When these demographic and psychological variables were controlled for, lower BMI at T1 and lower BMI at T2 predicted lower BMI at T3. However, change in BMI from T1 to T2, did not significantly predict BMI at T3 (p < .001). Higher presurgery BMI and post-surgery BMI predict poorer 1-year follow-up BMI in gastric bypass surgery, and these measures can be used as easy "rules of thumb" for predicting longer term outcome.
Research Interests: Bariatric Surgery, Obesity, Treatment Outcome, Humans, Outcome, and 17 moreWeight Loss, Female, Male, Body Mass Index, Obesity Surgery, Clinical Sciences, Middle Aged, Body mass index (BMI), Adult, Public health systems and services research, Time Factors, Retrospective Studies, Linear Regression, Gastric Bypass, Binge eating, Predictive value of tests, and Cohort Studies
Bariatric surgery is becoming a common procedure to control the obesity problem in the United States. However, despite the prevalence of the surgery, little is known regarding the motivation of patients who seek out these procedures. This... more
Bariatric surgery is becoming a common procedure to control the obesity problem in the United States. However, despite the prevalence of the surgery, little is known regarding the motivation of patients who seek out these procedures. This present study aims to qualitatively and quantitatively examine in a moderate-sized sample of bariatric seeking patients their reported reasons for wanting surgery. 109 severely obese patients (mean BMI 49.9) seeking either the duodenal switch or gastric bypass surgery between 1999 and 2002 were surveyed as to their motivations for seeking weight loss surgery. Their responses were coded into psychological, medical and quality of life categories for analysis. Depression and Quality of Life data was also obtained. Descriptive analysis of the data indicated the vast majority (73.4%) of respondents endorsed current medical ailments as their primary reason for seeking weight loss surgery. Patients who responded with a secondary reason for desiring surgery reported primarily psychological and quality of life reasons. Scores on depression and quality of life measures did not impact their endorsed reasons for seeking surgery. Patients in the present sample appear motivated for surgery primarily to control current medical problems. However, a significant portion of patients do endorse psychological and quality of life factors as important in their decision to seek weight loss surgery.
Research Interests: Bariatric Surgery, Quality of life, Life Style, Body Image, Motivation, and 15 moreHumans, Weight Loss, United States, Female, Male, Depressive Disorder, Body Mass Index, Obesity Surgery, Clinical Sciences, Self Concept, Adult, Public health systems and services research, Genetic analysis for qualitative and quantitative traits of crop plants, Morbid Obesity, and Gastric Bypass
The impact of pre-surgical binge eating on postoperative outcomes is poorly understood. Previous studies have found marked preoperative differences between binge eaters (BE) and non-binge eaters (NBE) in hunger and disinhibition using the... more
The impact of pre-surgical binge eating on postoperative outcomes is poorly understood. Previous studies have found marked preoperative differences between binge eaters (BE) and non-binge eaters (NBE) in hunger and disinhibition using the Three-Factor Eating Questionnaire (TFEQ). Short-term prospective data are mixed regarding whether these differences persist after surgery and if preoperative binge eating impacts postoperative weight outcomes. The purpose of the present study was to compare self-reported eating behavior and weight outcomes between BE and NBE after the first postoperative year. Prior to surgery, 72 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R), to assess binge eating status which was defined as one objective binge episode per week over the past 6 months. Subjects also completed the TFEQ prior to surgery and again > or = 12 months after surgery. For BE, higher scores were found for both hunger and disinhibition prior to surgery. At a mean of 18 months after surgery, BE and NBE were indistinguishable on these subscales and there were no differences in weight lost. RYGBP surgery has an equally positive impact on eating behavior and weight loss for both BE and NBE. Within a multidisciplinary clinic, preoperative BE status does not appear to be a negative prognostic indicator for RYGBP surgery in the domains of weight loss and disinhibition. Further replication is needed with longer follow-up times and larger samples.
Research Interests: Bariatric Surgery, Treatment Outcome, Hunger, Humans, Weight Loss, and 16 moreFemale, Male, Eating Behavior, Follow-up studies, Feeding Behavior, Obesity Surgery, Recurrence, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Time Factors, Morbid Obesity, Gastric Bypass, Binge eating, and Bulimia
The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients... more
The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients describe other maladaptive eating patterns prior to surgery, such as eating in response to emotions. The goals of this study were to describe presurgical emotional eating patterns in morbidly obese individuals, determine whether these individuals were binge eaters, and assess the effect of this eating behavior on weight loss after surgery. Prior to surgery, 144 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R) and the Emotional Eating Scale to assess eating patterns prior to surgery. Their eating behavior, levels of depression, and weight were assessed after surgery. High emotional eaters tended to have higher levels of depression, binge eating, and eating in response to external cues than low emotional eaters prior to surgery. However, there appeared to be a distinct group of individuals who were high emotional eaters but who did not engage in binge eating. At a mean of 8 months after surgery, High Emotional Eaters and Low Emotional Eaters were indistinguishable on these subscales and there were no differences in weight lost. RYGBP has an equally positive impact on eating behavior and weight loss for both High Emotional Eaters and Low Emotional Eaters. Further replication is needed with longer follow-up times and larger samples.
Research Interests: Bariatric Surgery, Depression, Treatment Outcome, Bulimia Nervosa, Emotions, and 16 moreHumans, Weight Loss, Female, Male, Eating Behavior, Follow-up studies, Feeding Behavior, Obesity Surgery, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Retrospective Studies, Morbid Obesity, Gastric Bypass, and Binge eating
Greater depressed mood in Class III obese surgery-seeking clients may be due to weight-related stigma, weight-related physical disability (e.g. mobility) or the presence of binge-eating (BE). 60 Class III obese surgery-seeking adults were... more
Greater depressed mood in Class III obese surgery-seeking clients may be due to weight-related stigma, weight-related physical disability (e.g. mobility) or the presence of binge-eating (BE). 60 Class III obese surgery-seeking adults were administered the Beck Depression Inventory (BDI), weight-related physical disability (IWQOL-PF) and another weight-related stigma (IWQOL-PD), and assessed for BE (SCID-1 or Questionnaire of Eating and Weight Patterns) before surgery. In a hierarchical regression analysis, BMI, gender, and age of obesity onset did not account for a significant portion of the variance in BDI scores in the first step. The second step of the model was statistically significant (F(3,53)=8.469, P<0.000), accounting for 33.6% of the variance in BDI scores. IWQOL-PD scores were the only significant predictor of BDI scores (b=0.518, P=0.001), and this independently contributed to 32.6% of the variance in BDI scores. This suggests that depressed mood seen in Class III obese surgery-seeking individuals may be most related to weight-related stigma rather than BE status, or weight-related physical disability.
Research Interests: Depression, Prejudice, Quality of life, Humans, Female, and 17 moreMale, Regression Analysis, Statistical Significance, Depressive Disorder, Risk factors, Beck Depression Inventory, Physical disability, Obesity Surgery, Health Status, Clinical Sciences, Middle Aged, Psychological Tests, Adult, Public health systems and services research, Risk Factors, Binge eating, and Bulimia
The Beck Depression Inventory (BDI) is an assessment frequently used in pre-surgical evaluation for patients seeking bariatric surgery. Items on the BDI reflect both cognitive and somatic symptoms associated with depression. However, many... more
The Beck Depression Inventory (BDI) is an assessment frequently used in pre-surgical evaluation for patients seeking bariatric surgery. Items on the BDI reflect both cognitive and somatic symptoms associated with depression. However, many patients seeking bariatric surgery have medical symptomatology and health concerns independent of the syndrome of depression, and thus scores on the BDI may inflate their actual level of depression. With depression viewed by some clinicians as contraindicated for bariatric surgery, clarification of the BDI items is necessary. Pre-surgical BDIs of 259 bariatric patients were reviewed. An exploratory factor analysis was conducted to examine the factor structure of the BDI in this population. Independent sample t-tests compared the means of the cognitive and somatic items. A clear two-factor solution emerged on the BDI, indicating items mapped on to either a cognitive or a somatic domain. The patients in the present sample also were more likely to endorse somatic and health-related symptoms on the BDI. The factor structure of the BDI in this population is similar to that in other non weight-loss surgery populations. However, this population is more likely to endorse somatic complaints that may not be indicative of depression, rather an acknowledgement of actual medical complaints. Thus, assessors should be mindful of specific symptom endorsement, rather than a total depression score when utilizing the BDI to help determine surgery suitability.
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Depressed mood in severely obese, bariatric surgery-seeking candidates is influenced by obesity stigma, yet the strategies for coping with this stigma are less well understood. This study hypothesized that coping strategies are... more
Depressed mood in severely obese, bariatric surgery-seeking candidates is influenced by obesity stigma, yet the strategies for coping with this stigma are less well understood. This study hypothesized that coping strategies are significantly associated with depressed mood above and beyond demographic factors and frequency of weight-related stigma, with specific coping strategies differing between racial groups. Severely obese, bariatric surgery-seeking adults (N = 234; 91 African Americans) completed the Beck Depression Inventory (BDI) and Stigmatizing Situations Inventory (SSI). Two hierarchical linear regressions were conducted separately for African Americans and whites. For both racial groups, age, sex, BMI, years overweight, annual income, and education level did not account for a significant portion of the variance in BDI scores. The frequency of stigmatizing situations and coping strategies significantly explained 16.4% and 33.2%, respectively, of the variance for whites, and 25.9% and 25%, respectively, for African Americans (P < 0.001). Greater depressed mood in whites was associated with older age, lower education, fewer positive self-statements, and less self-love and more crying; while in African Americans greater depressed mood was associated only with ignoring the situation (P < 0.05). The study found that regardless of race, depressed mood in severely obese, bariatric surgery-seeking clients is related to the frequency of stigmatizing experiences and associated coping strategies. This suggests that efforts to reduce the deleterious effects of weight-related stigma need to focus both on reducing the frequency of stigmatization and on teaching effective coping strategies. These efforts also need to take into account the client's racial background.
Research Interests:
Research Interests: Obesity, Stigma, Sex, Prejudice, Adolescent, and 19 moreMultidisciplinary, Interpersonal Relationship, Interpersonal Relationships, Humans, Female, College Students, Male, Sexual Behavior, Gender Difference, Research Method, Physical disability, Weight, Questionnaires, Adult, Weight Management, Eating Disorder, Binge Eating Disorder, Sexual Partners, and Sex Characteristics
We examined the rates of sexually transmitted diseases (STDs) in women with borderline personality disorder (BPD) (using PDE and SCID-II) and substance abuse or dependence (SCID-I) (BPD-SUD) (N=82) compared with those with BPD-only... more
We examined the rates of sexually transmitted diseases (STDs) in women with borderline personality disorder (BPD) (using PDE and SCID-II) and substance abuse or dependence (SCID-I) (BPD-SUD) (N=82) compared with those with BPD-only (N=102), exploring mediators of this relationship. Participants were interviewed about STD history (gonorrhea, genital herpes, syphilis, trichomonas, human papillomavirus, and HIV), condom use, number of sexual partners, poverty, and prostitution. BPD-SUD appeared to be particularly at high risk for STDs, reporting significantly more STDs than BPD (F[1,172]=11.74, p=0.001, d=.27), particularly for gonorrhea, trichomonas, and human papillomavirus. The relationship between BPD-SUD and STDs is mediated by poverty, prostitution in the last year, recent unprotected sex with two or more partners, and >20 lifetime partners (z=-2.16 which is p=0.03), with prostitution alone making a significant contribution to this relationship (z=-2.49, p=0.01).
Research Interests: Psychology, Cognitive Science, Addiction, Poverty, Borderline Personality Disorder, and 20 moreRisk Taking, Comparative Study, Comorbidity, Humans, Substance Abuse, Prostitution, Female, Sexual Behavior, Drug Addiction, Clinical Sciences, Prevalence, Risk Factor, Adult, Condoms, Sexual Partners, Sexually Transmitted Diseases, Sexually Transmitted Disease, Unsafe Sex, Substance-Related Disorders, and Substance Use Disorder
Page 1. ORIGINAL PAPER A Case Series of Family-Based Therapy for Weight Restoration in Young Adults with Anorexia Nervosa Eunice Y. Chen Daniel le Grange Angela Celio Doyle Shannon Zaitsoff Peter Doyle James P. Roehrig Blaine... more
Page 1. ORIGINAL PAPER A Case Series of Family-Based Therapy for Weight Restoration in Young Adults with Anorexia Nervosa Eunice Y. Chen Daniel le Grange Angela Celio Doyle Shannon Zaitsoff Peter Doyle James P. Roehrig Blaine Washington ...
Research Interests:
Previous research using self-report measures has shown an association between nonsuicidal self-injurious behavior (NSSI) and impulsive tendencies. However, self-injurers have not been shown to be different from comparison groups on... more
Previous research using self-report measures has shown an association between nonsuicidal self-injurious behavior (NSSI) and impulsive tendencies. However, self-injurers have not been shown to be different from comparison groups on laboratory tasks putatively assessing impulsive behavior. One explanation for these contradictory findings is that self-report and laboratory measures of impulsive behavior tap into distinct but related constructs. Moreover, performance on laboratory measures of impulsive behavior can be influenced by myriad contextual and affective factors not present during past self-reported NSSI events. Accordingly, a relationship between behavioral tasks of impulsivity and self-injurious behavior could emerge if both are assessed relatively close in time under controlled laboratory conditions. To test this possibility, both self-ratings and laboratory task measures of self-injurious and impulsive behavior were employed in the current study. This multi-modal assessmen...
Research Interests:
To examine the relationship between Intermittent Explosive Disorder (IED; a psychiatric diagnosis characterized by episodes of affective aggression) and adverse physical health outcomes. A large epidemiological sample drawn from the... more
To examine the relationship between Intermittent Explosive Disorder (IED; a psychiatric diagnosis characterized by episodes of affective aggression) and adverse physical health outcomes. A large epidemiological sample drawn from the Collaborative Psychiatric Epidemiological Surveys (N = 10,366), was used to compare participants with a lifetime diagnosis of IED (n = 929) to those without any history of IED (n = 9,437) on demographic variables (age, education, gender, race) common risk factors (smoking status, body mass index, substance use disorders, past accident or injury requiring treatment, major depression) and the presence of 12 adverse health outcomes. History of heart attacks, coronary heart disease, hypertension, stroke, lung disease, diabetes, cancer, arthritis, back/neck pain, ulcer, headaches, and other chronic pain. Logistic regression analysis controlling for demographic and other risk factors indicated that IED was associated with 9 of the 12 adverse physical health outcomes (coronary heart disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headaches, and other chronic pain). Only cancer, heart attacks, and lung disease were not significantly related to IED. IED may be a risk factor for several significant adverse physical health outcomes.
Research Interests: Health Psychology, Education, Chronic Pain, Adolescent, Comorbidity, and 27 moreHumans, Impulse Control Disorders, Substance Use, Aggression, Physical Health, Female, Male, Neck Pain, Young Adult, Body Mass Index, Risk factors, Logistic Regression Analysis, Health Status, Aged, Middle Aged, Major Depression, Psychological Tests, Adult, Body Mass, Coronary heart disease, Risk Factors, Logistic Models, Substance Use Disorder, Health Outcome, Case Control Studies, Socioeconomic Factors, and Psychiatric Status Rating Scales
Bariatric surgery frequently leads to rapid weight loss post-surgery that may impact... more
Bariatric surgery frequently leads to rapid weight loss post-surgery that may impact participants' ability to gauge a realistic ideal body shape. In the present study, 57 obese participants' perception of their current and ideal body shape pre and post gastric bypass surgery were assessed. Results indicate prior to surgery, participants reported a 4 point difference between current and desired body shape. One year post surgery, as their own body shape decreased, so did the size of their ideal body shape (4.1-3.3). These findings suggest a consequence of rapid weight loss may suggest to participants that unrealistic body shapes are attainable. Implications for patient counseling are discussed.
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Research Interests: Psychology, Eating Disorders, Emotion Regulation, Body Image, Human Eating Behaviours, and 20 moreAdolescent, Anorexia Nervosa, Bulimia Nervosa, Emotions, Affect, Humans, Negative Affect, Female, College Students, Male, Risk factors, Awareness, Adult, Eating Disorder, Risk Factors, Binge eating, Weight Gain, Eating Behaviors, Food Restriction, and Personality Inventory
Research Interests:
Approximately 10% of severely obese bariatric-surgery-seeking individuals report a lifetime history of suicide attempts, a higher rate than in the general community. Being overweight is associated with weight-related stigma, making an... more
Approximately 10% of severely obese bariatric-surgery-seeking individuals report a lifetime history of suicide attempts, a higher rate than in the general community. Being overweight is associated with weight-related stigma, making an individual more vulnerable to social isolation, a potential risk factor for suicidal ideation and/or behavior. In this cross-sectional study of surgery-seeking adults with severe obesity, we examined whether weight-related stigma increases (1) the likelihood of suicidal ideation and/or behavior or (2) the degree of loneliness; and whether hypotheses (1) and (2) are supported (3) if loneliness mediates the effect of weight-related stigma on suicidal ideation and/or behavior. Online questionnaires were administered to 301 women and 95 men seeking bariatric surgery. Approximately 30.3% reported having at least a passing thought of suicide, and 5.55% a suicide attempt during their lifetime. The suicide attempt rate appears lower than other bariatric surgery samples, but possibly higher than community and other surgery sample rates. For severely obese surgery-seeking women, weight-related stigma was associated with suicidal ideation and/or behavior, though this was not mediated by loneliness. Future studies are needed to model and compare suicidal ideation and/or behavior in bariatric-surgery-seeking individuals and control groups.
Research Interests: Psychology, Bariatric Surgery, Crisis, Humans, Female, and 18 moreMale, Loneliness, The Water Crisis, Social Isolation, Risk factors, Middle Aged, Questionnaires, Suicidal Ideation, Adult, Communication and media Studies, Sex Factors, Risk Factors, Cross sectional Study, Suicide Attempt, Cross Sectional Studies, Logistic Models, Attempted Suicide, and Control Group
... Additionally, she would like to express her heartfelt appreciation to her loving husband, Bob Forman, and dear sons, Aaron Telch and James Forman, for their generosity of spirit and unending ... Binge-Eating Disorder and Bulimia... more
... Additionally, she would like to express her heartfelt appreciation to her loving husband, Bob Forman, and dear sons, Aaron Telch and James Forman, for their generosity of spirit and unending ... Binge-Eating Disorder and Bulimia Nervosa: Why Dialectical Behavior Therapy? ...
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Research Interests:
Research Interests:
Cluster analyses of eating disorder patients have yielded a... more
Cluster analyses of eating disorder patients have yielded a "dietary-depressive" subtype, typified by greater negative affect, and a "dietary" subtype, typified by dietary restraint. This study aimed to replicate these findings in an adolescent sample with bulimia nervosa (BN) from a randomized controlled trial and to examine the validity and reliability of this methodology. In the sample of BN adolescents (N=80), cluster analysis revealed a "dietary-depressive" subtype (37.5%) and a "dietary" subtype (62.5%) using the Beck Depression Inventory, Rosenberg Self-Esteem Scale and Eating Disorder Examination Restraint subscale. The "dietary-depressive" subtype compared to the "dietary" subtype was significantly more likely to: (1) report co-occurring disorders, (2) greater eating and weight concerns, and (3) less vomiting abstinence at post-treatment (all p's<.05). The cluster analysis based on "dietary" and "dietary-depressive" subtypes appeared to have concurrent validity, yielding more distinct groups than subtyping by vomiting frequency. In order to assess the reliability of the subtyping scheme, a larger sample of adolescents with mixed eating and weight disorders in an outpatient eating disorder clinic (N=149) was subtyped, yielding similar subtypes. These results support the validity and reliability of the subtyping strategy in two adolescent samples.