Scott G. Engel

Objective: Limited research has examined the function or consequences of dietary restriction among individuals for whom it may serve differential purposes, such as those with food insecurity. Indeed, food insecurity may uniquely relate to differential functions for engaging in dietary restriction, which may relate to subsequent changes in mood; this study sought to assess these associations.Method: A subsample of 77 young adults from the Minnesota‐based EAT (Eating and Activity over Time) cohort with food insecurity (M_age = 25.2 ± 1.8 years; Women = 72.7%; Black = 18.2%; Latinx = 19.5%; Asian = 18.2%; White = 27.3%) reported on state‐level functions for dietary restriction (financial only, weight‐control only, or both) versus no restriction, and state‐level mood, via ecological momentary assessment (EMA). Demographics‐adjusted linear mixed models were conducted to examine the function of dietary restriction since the last EMA signal and current mood.Results: Across a 14‐day EMA period, 29.9% of observations involved dietary restriction due to financial functions only, 6.2% involved dietary restriction due to both financial and weight‐control functions, and 3.0% involved restriction for weight‐control functions only. Compared to instances of no dietary restriction, overall negative mood was higher after engaging in dietary restriction for both functions (B = 0.43; p = 0.002), but not for financial (B = 0.12; p = 0.14) or weight‐control (B = 0.30; p = 0.06) functions only.Discussion: These findings suggest dual‐purpose dietary restriction (i.e., for both financial and weight‐control) is common in young adults with food insecurity and may influence mood; thus, it may be an important intervention target.

Background: Loss of control eating is more likely to occur in the evening and is uniquely associated with distress. No studies have examined the effect of treatment on within-day timing of loss of control eating severity. We examined whether time of day differentially predicted loss of control eating severity at baseline (i.e. pretreatment), end-of-treatment, and 6-month follow-up for individuals with binge-eating disorder (BED), hypothesizing that loss of control eating severity would increase throughout the day pretreatment and that this pattern would be less pronounced following treatment. We explored differential treatment effects of cognitive-behavioral guided self-help (CBTgsh) and Integrative Cognitive-Affective Therapy (ICAT).Methods: Individuals with BED (N = 112) were randomized to receive CBTgsh or ICAT and completed a 1-week ecological momentary assessment protocol at baseline, end-of-treatment, and 6-month follow-up to assess loss of control eating severity. We used multilevel models to assess within-day slope trajectories of loss of control eating severity across assessment periods and treatment type.Results: Within-day increases in loss of control eating severity were reduced at end-of-treatment and 6-month follow-up relative to baseline. Evening acceleration of loss of control eating severity was greater at 6-month follow-up relative to end-of-treatment. Within-day increases in loss of control severity did not differ between treatments at end-of-treatment; however, evening loss of control severity intensified for individuals who received CBTgsh relative to those who received ICAT at 6-month follow-up.Conclusions: Findings suggest that treatment reduces evening-shifted loss of control eating severity, and that this effect may be more durable following ICAT relative to CBTgsh.

ObjectiveEmerging research indicates that skills acquisition may be important to behavior change in cognitive behavior therapy (CBT) for eating disorders. This study investigated whether skills use assessed in real time during the initial 4 weeks of CBT-based day treatment was associated with momentary eating disorder behavior change and rapid response to treatment.MethodsParticipants with DSM-5 bulimia nervosa or purging disorder (N = 58) completed ecological momentary assessments (EMA) several times daily for the first 28 days of treatment. EMA assessed skills use, the occurrence of binge eating and/or purging, and state negative affect. Rapid response was defined as abstinence from binge eating and/or purging in the first 4 weeks of treatment.ResultsGreater real-time skills use overall, and use of "planning ahead," "distraction," "social support," and "mechanical eating" skills in particular, were associated with a lower likelihood of engaging in binge eating or purging during the same period. After controlling for baseline group differences in overall difficulties with emotion regulation, rapid and non-rapid responders did not differ in overall skills use, or skills use at times of higher negative affect, during the EMA period.DiscussionMomentary use of skills appears to play an important role in preventing binge eating and purging, and certain skills appear to be particularly helpful. These findings contribute to the literature elucidating the processes by which CBT treatments for eating disorders work by providing empirical evidence that skills use helps to prevent binge eating and purging behaviors.Public SignificanceIndividuals with eating disorders learn new skills during treatment to help them improve their symptoms. This study shows that for people with eating disorders, using skills helps prevent eating disorder behaviors in the moment. Certain skills may be particularly helpful, including planning ahead, distracting activities, support from others, and focusing on eating meals and snacks regardless of how one is feeling. These findings help us better understand how treatments work.