Paper Session 5: Diet, Nutrition, and Disordered Eating

Binge eating disorder (BED) is a debilitating health concern that has consistently been associated with mortality and morbidity. Also, >50% of people with BED remain symptomatic after existing BED treatments. Despite these adverse health impacts and poor treatment outcomes, little is known about mechanisms that are theorized to promote disordered eating behaviors in the natural environment (e.g., home, work/school), particularly transdiagnostic self-regulatory processes such as affect and emotion dysregulation. Also, it is unclear whether these processes differentially promote different types of loss of control (LOC) eating—an important disordered eating behavior that presents across eating disorders and is a marker of greater BED severity. To address these research gaps, this study examined whether: (1) emotion dysregulation mediated associations between negative and positive affect, and LOC eating at the within-person level; (2) these associations varied across distinct LOC eating types.
Adults with BED (N=107; Mage=39.87, SD=13.35) completed 6 surveys per day for a 7-day EMA period. Multilevel structural equation models examined whether momentary emotion dysregulation mediated momentary associations between negative and positive affect, and different LOC eating outcomes (general LOC while eating; difficulties resisting eating; difficulties stopping eating after starting; feeling driven to eat; not paying attention to one’s eating; feeling disconnected while eating [e.g., numb, on auto-pilot]).
Greater momentary emotion dysregulation mediated momentary associations between greater negative affect and several LOC eating types, with variations based on LOC eating type. For example, when participants experienced a worsening of negative affect and, in turn, emotion dysregulation over a day, they had a greater general sense of LOC while eating, more difficulties resisting eating, felt driven to eat, and felt more disconnected while eating later that day (but no difficulties stopping eating after starting or paying attention to one’s eating). Also, all indirect effects with positive affect as a predictor were not significant.
Collectively, these findings provide insight into the temporality of dynamic associations among affect and emotion dysregulation as factors that promote different LOC eating types in daily life. It may be helpful to leverage these two self-regulatory processes for testing as targets in new mHealth interventions to improve BED outcomes.

Co-Author - Carol Peterson, PhD,
University of Minnesota

Co-Author - Glen Forester, PhD,
Sanford Health

Co-Author - Joseph Wonderlich, PhD,
Sanford Health

Co-Author - Stephen Wonderlich, PhD,
Sanford Health

Co-Author - Ross Crosby, PhD,
Sanford Health

Eating disorders (EDs) are associated with substantial morbidity and mortality, yet a significant proportion of people with EDs are not properly screened or referred to treatment. We examined caller characteristics and trends in the utilization of a national EDs helpline in an initial effort to understand the utility of a community service that could be leveraged to improve ED care pathways. Data were collected by The National Alliance for Eating Disorders (“The Alliance”), a nonprofit organization that staffs its helpline with trained clinicians. A total of 13,360 people contacted the helpline between January 2019-December 2024. Call volume increased 688.6% between 2019 (n = 763) and 2024 (n = 6,017). Most callers were USA-based (87.7%), across all 50 states. The majority were people with EDs calling for themselves (43.3%), followed by family members calling on another’s behalf (37.7%), and outpatient (9.7%), treatment center (1.3%), hospital (0.8%), school (0.6%), and insurance (0.1%) personnel calling on behalf of a client. Callers sought care for clients ages 2-93 years old (M = 26.49, SD = 15.31) that were predominantly female (n = 10,563, 79.1%; male n = 1,805, 13.5%; transgender and nonbinary n = 263, 1.9%) with a self-reported diagnosis of anorexia nervosa (n = 4,819, 36.1%). Most were seeking outpatient (45.8%) and inpatient (12.0%) or residential (10.1%) treatment. Regarding insurance, 39.5% had private plans, typically Blue Cross Blue Shield (23.8%). Approximately 30% were under- or uninsured (17.3% had Medicaid, 8.2% had Medicare, 1.5% had TriCare, 3.9% were uninsured). The remainder had other forms of coverage or did not disclose. Callers were directed to the helpline in multiple ways, most often though social media and web searches (37.8%), The Alliance itself (18.4%), and treatment providers (20%). An average of 24.37 (SD = 15.64) minutes were dedicated per call. Findings suggest that this community-based EDs helpline is highly and increasingly utilized, with various pathways through which individuals with EDs, and their families and healthcare providers, reach out for support. A large percentage of callers were under- or uninsured, which is notable given well-documented cost- and insurance-related barriers to ED treatment. Healthcare systems, community-based services, and families can work in tandem to facilitate connection to appropriate care resources for people with EDs.

Presenter - Matthew Murray, PhD,
University of Chicago Medicine

Co-Author - Elizabeth Dougherty, PhD,
University of Chicago Medicine

Co-Author - Kelly Romano, PhD,
University of Minnesota Medical School

Co-Author - Brianne Richson, MA, PhD,
Sanford Center for Biobehavioral Research

Co-Author - Wesley R. Barnhart,
Bowling Green State University

Co-Author - Allie Weiser, PsyD,
National Alliance for Eating Disorders

Co-Author - Johanna Kandel, BA,
National Alliance for Eating Disorders

Co-Author - Jennifer Wildes, PhD, PhD,
University of Chicago Medicine

Purpose: To determine if individuals who rank health promotion as a primary driver of food choice will have lower weight status and better diet quality than those who rank weight, neither, or both as primary drivers of food choice.

Methods: College students received course credit to complete validated measures in this cross-sectional study. Body mass index (BMI) was calculated from researcher measured height and weight. Percent body fat (%BF) was obtained from bioelectrical impedance (Tanita, Arlington Heights, IL). Skin carotenoid concentrations (SCC) served as a biomarker of diet quality as these values are associated with dietary intake of carotenoid rich food (i.e., fruit and vegetables) and were assessed with reflection spectroscopy (Veggie Meter ®, Longevity Link Corp, Salt Lake City, UT). A web-based survey included 1) Start the Conversation (STC), a brief validated diet quality screener; and 2) a food choice determinant ranking list. Participants ranked how important 10 factors (e.g., cost, convenience) were when making food choices. Participants were grouped depending on whether they ranked “health promotion” (FC_HP), “weight control” (FC_W), neither health or weight control (FC_N), or both (FC_HPW) as one of the top three determinants of food choice. Group differences were examined with ANOVA after controlling for age, race, ethnicity, and sex at birth.

Results: After removing cases with missing data (n=210), a final analytic sample consisted of 764 mostly young adults (Mage=21, SD=2.6; 55% female) from several racial/ethnic groups (38% white, 15% Black, 29% Hispanic, 39% Asian). Between subject results showed group differences on BMI (p=.01), STC (p<.001), and SCC (p=.005); but not on %BF (p= .066). Pairwise comparisons showed the FC_HP group had 1) lower BMI, %BF, and STC and higher SCC than FC_W, and 2) lower STC and higher SCC than those in FC_N.

Conclusions: Those who prioritize health when making food choices had more desirable body composition and diet quality than those who prioritize weight control. In addition, those who prioritize health when making food choices had more desirable diet quality than those who did not prioritize either health or weight when making food choices. Future research should examine whether food choice determinants are modifiable and whether prioritization of health when making food choices leads to improvements in body composition and diet quality over time.

Co-Author - Craig Johnston, PhD,
University of Houston

Co-Author - Randi Betts, PhD,
University of Houston

Co-Author - Cynthia Yoon, PhD, RD,
University of Houston

Background: Cardiovascular disease (CVD) is a leading cause of death among Latino adults, underscoring the importance of early prevention. Research shows that dietary improvements during adolescence can reduce the risk of CVD later in life. Anti-immigration policies may shape diet by deterring participation in the Supplemental Nutrition Assistance Program (SNAP) and reducing food pantry usage for Latino families. However, the impact of these policies on the dietary behaviors of Latino adolescents remains unexplored. In light of the 472 immigration actions enacted in the first Trump Administration, we examined fruit and vegetable consumption among adolescents both before and during this period. We also stratified the analysis to explore variations by ethnicity and state immigration policies.
Methods: We conducted a secondary analysis using the Youth Risk Behavior Survey (YRBS) collected in 2015 to 2019. Participants were included if aged 12 to 18 and identified as non-Latino White (NL White) or Latino. The main exposure was time, categorized as 2015 (pre-Trump), 2017 (early-Trump), and 2019 (later-Trump). The main outcome was a “Fruit & Vegetable Scale (FVS)”, scored from 6 (low intake) to 42 (high intake) using responses for weekly consumption of fruit, fruit juice, salad, carrots, potatoes, and other vegetables. Multivariable linear models were generated using Stata 18, and adjusted for individual race/ethnicity, age, and sex, and state residence, SNAP participation, and immigration criminalization policies.
Results: The final sample (n=300,909) was 67.5% NL White and 32.5% Latino. In the adjusted model, NL White and Latino adolescents in 2019 had a 0.71 (p<0.05) decrease in FVS-score compared to NL White and Latino adolescents in 2015. Stratifying by ethnicity, Latino adolescents in 2019 had a 1.21 (p<0.05) decrease in FVS-score compared to Latino adolescents in 2015. Stratifying by immigration, Latino adolescents in states with high immigration criminalization in 2019 had a 1.04 (p<0.05) decrease in FVS-score compared to Latino adolescents in states with high immigration criminalization in 2015.
Conclusion: We found the weekly consumption of fruits and vegetables significantly decreased from 2015 to 2019 in adolescents. This reduction was strongest for Latino adolescents, but living in a state with high immigration criminalization did not appear to worsen FVS-scores among this group. Future research should explore these impacts for Latino adolescents.

Presenter - Elizabeth Silva, MPH,
Brown University

Co-Author - Monika Doshi, PhD, MPH,
Brown University

Co-Author - David Zelaya, PhD,
Brown University

Co-Author - Alison Tovar, PhD, MPH,
Brown University