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Background: Cardiac myopathy manifesting as arrhythmias is common in the neurological disease, myotonic dystrophy type 1 (DM1). The purpose of the present study was to evaluate heart rate variability (HRV) in patients with DM1.Methods: In a multicenter study, history, ECG, and genetic testing were performed in DM1 patients.Results: In 289 patients in whom the diagnosis of DM1 was confirmed by a prolonged cytosine-thymine-guanine (CTG) repeat length the most common ambulatory ECG abnormality was frequent ventricular ectopy (16.3%). The 24-hour time domain parameters of SDNN (SD of the NN interval) and SDANN (SD of the mean NN, 5-minute interval) declined as age and CTG repeat length increased (SDNN: -8.5 ms per decade, 95% confidence intervals [CI]-12.9, -4.2, -8.7 ms per 500 CTG repeats, CI -15.7, -1.8, r=0.24, P<0.001; SDANN: -8.1 ms per decade, CI -12.4, -3.8, -8.8 ms per 500 CTG repeats, CI -15.7, -1.9, r=0.23, P<0.001). Short-term frequency domain parameters declined with age only (total power: -658 ms2 per decade, CI: -984, -331, r=0.23, P<0.001; low frequency (LF) power -287 ms2 per decade, CI: -397, -178, r=0.30, P<0.001; high frequency (HF) power: -267 ms2 per decade, CI: -386, -144, r=0.25, P<0.001). The LF/HF ratio increased as the patient aged (0.5 per decade, CI: 0.1, 0.9, r=0.13, P=0.03).Conclusions: In DM1 patients a decline in HRV is observed as the patient ages and CTG repeat length increases. [ABSTRACT FROM AUTHOR]

Introduction: Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of momentary self-regulation in achieving behavior change has been infrequently examined. Using a novel momentary self-regulation scale, this study examined how targeting self-regulation through a digital therapeutic impacts adherence to the therapeutic and two different health risk behavioral outcomes., Methods: This prospective interventional study included momentary data for 28 days from 50 participants with obesity and binge eating disorder and 50 participants who smoked regularly. An evidence-based digital therapeutic, called Laddr™, provided self-regulation behavior change tools. Participants reported on their momentary self-regulation via ecological momentary assessments and health risk behaviors were measured as steps taken from a physical activity tracker and breathalyzed carbon monoxide. Medical regimen adherence was assessed as daily Laddr usage. Bayesian dynamic mediation models were used to examine moment-to-moment mediation effects between momentary self-regulation subscales, medical regimen adherence, and behavioral outcomes., Results: In the binge eating disorder sample, the perseverance [ β 1  = 0.17, 95% CI = (0.06, 0.45)] and emotion regulation [ β 1  = 0.12, 95% CI = (0.03, 0.27)] targets of momentary self-regulation positively predicted Laddr adherence on the following day, and higher Laddr adherence was subsequently a positive predictor of steps taken the same day for both perseverance [ β 2  = 0.335, 95% CI = (0.030, 0.717)] and emotion regulation [ β 2  = 0.389, 95% CI = (0.080, 0.738)]. In the smoking sample, the perseverance target of momentary self-regulation positively predicted Laddr adherence on the following day [ β  = 0.91, 95% CI = (0.60, 1.24)]. However, higher Laddr adherence was not a predictor of CO values on the same day [ β 2  = -0.09, 95% CI = (-0.24, 0.09)]., Conclusions: This study provides evidence that a digital therapeutic targeting self-regulation can modify the relationships between momentary self-regulation, medical regimen adherence, and behavioral health outcomes. Together, this work demonstrated the ability to digitally assess the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and pro-health behavioral outcomes., Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT03774433)., Competing Interests: In addition to her academic affiliation with Dartmouth College, LM is affiliated with Square2 Systems, Inc., the small business that developed the mobile Laddr intervention and has worked extensively with relevant institutions (including Dartmouth College and the NIH) to manage any potential conflict of interest. All research data collection, data management, and statistical analyses are conducted by individuals with no affiliation with Square2 Systems. In addition to her academic affiliation with Stanford University, JP has served as an expert witness against the tobacco companies in lawsuits for which she has received fees for the work and has provided consultation to pharmaceutical and technology companies that make medications and other treatments for quitting smoking. CS was employed by Apple Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2025 Plaitano, McNeish, Bartels, Bell, Dallery, Grabinski, Kiernan, Lavoie, Lemley, Lowe, MacKinnon, Metcalf, Onken, Prochaska, Sand, Scherer, Stoeckel, Xie and Marsch.)

Objective: In the CBT model of anorexia nervosa, emaciation is assumed to occur because individuals over-value their weight and shape. However, current BMI (for adolescents, BMI z-score) may be relevant to psychopathology beyond its relation with weight concern. We explored the relations between BMI/z-BMI and attempts to change one's eating and/or weight (restraint and eating concern) before and after controlling for weight concern among individuals with AN or atypical AN (AAN)., Method: Participants were 1666 female residential patients with AN or AAN. For those below age 21, we examined the relations between z-BMI and EDE-Q Restraint and Eating Concern when Weight Concern was and was not controlled. For adults, we conducted the same analyses using BMI., Results: BMI and z-BMI were positively related to weight concern, restraint, and eating concern. When controlling for weight concern, the positive relationships between z-BMI and both restraint and eating concern became significant negative relationships. This pattern also emerged among adults, though the negative relationship between BMI and restraint did not reach significance., Conclusions: In AN-spectrum disorders, (1) BMI/z-BMI was related to weight/eating concerns despite substantial weight loss and (2) when weight concern was controlled, these relationships between BMI/z-BMI and restraint/eating concerns were largely reversed., (© 2024 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Among those with bulimia nervosa, weight suppression has been associated with illness severity and treatment prognosis. Although significant weight loss is known to reduce metabolic rate, the relation between weight suppression and resting energy expenditure (REE) in bulimia nervosa has not been examined. This study tested the hypothesis of an inverse relation between weight suppression and REE in a sample of women with bulimia nervosa (N = 84)., Methods: In primary analyses, linear regressions were conducted between weight suppression and REE, corrected for fat-free mass. In follow-up, exploratory analyses, stepwise linear regressions were conducted to explore the main and interaction effects of weight history and weight suppression on REE., Results: Neither traditional (TWS) nor developmental weight suppression (DWS) correlated with REE. Results from exploratory analyses, however, revealed a medium-to-large inverse relation between several weight history variables and REE (highest past weight, sr 2  = 0.05; lowest postmorbid weight, sr 2  = 0.07; current weight, sr 2  = 0.05). Additionally, DWS interacted with current (sr 2  = 0.08) and highest premorbid (sr 2  = 0.05) z-BMI to influence REE with a medium-to-large effect. For individuals low in current and premorbid z-BMIs, higher DWS associated with lower REE levels. However, for individuals at higher premorbid z-BMIs, higher DWS unexpectedly associated with greater REE levels., Discussion: In this sample of women with bulimia nervosa, reduced REE associated with higher weights across all timepoints. If the interaction effect between DWS and z-BMI history persists in future studies, this may indicate unique challenges faced by individuals low in z-BMI and high in DWS related to weight gain and normalization of eating., (© 2024 Wiley Periodicals LLC.)

Objective: The traditional measure of weight suppression (TWS; the difference between an individual's highest past weight at adult height and current weight), has been associated with many psychological, behavioral and biological variables in those with eating disorders. A new measure of weight suppression, called developmental weight suppression (DWS), corrects two major problems in the original measure. Initial research indicates that DWS represents a superior operationalization of the construct weight suppression was originally designed to measure (Lowe [1993, Psychol Bull, 114: 100]). This study is the first to examine the relation between both WS measures and weight history, body composition and a variety of metabolic hormones., Methods: Data were collected in 91 women with bulimia nervosa (BN) or BN-spectrum disorders., Results: Both weight suppression indices were related to multiple hormones. However, multiple regression analyses showed that the independent effects of DWS differed from the independent effects of TWS in that only DWS was negatively related to: (1) current z-BMI, (2) body fat percentage, and (3) insulin, leptin, T3 free, and TSH. This differential pattern also occurred when results were corrected for multiple comparisons., Discussion: Findings provide stronger biological support for the construct validity of DWS than TWS and suggest that: (1) from the perspective of individuals with BN, high DWS embodies success at food restriction and weight loss, (2) elevated DWS may trap individuals with BN in a powerful biobehavioral bind, and (3) DWS is the preferred measure of weight suppression in future research on eating disorders., Public Significance: Most individuals with bulimia nervosa lose substantial weight in the process of developing their disorder. Such weight suppression is related to many characteristics of those with the eating disorder bulimia nervosa. This study shows why a new measure of weight suppression, based on an individual's growth during development, is more biologically valid than the traditional measure of weight suppression., (© 2024 Wiley Periodicals LLC.)

Objective: There is debate surrounding how to differentiate between anorexia nervosa (AN) and atypical AN (atypAN) as diagnostic entities, and whether a distinction based on BMI is warranted. Better understanding eating disorder (ED) and emotional symptoms across atypAN and AN subtypes [AN-restricting (AN-R), AN-binge/purge (AN-BP)], with and without controlling for BMI, can elucidate how atypAN differs from AN subtypes and whether there is a basis for a BMI cut-off., Methods: 1810 female patients at an ED treatment centre completed intake surveys. ANCOVAs assessed differences across AN-R (n = 853), AN-BP (n = 726), and atypAN (n = 231) groups on ED, depressive, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness, with and without controlling for BMI., Results: Relative to AN-R, atypAN and AN-BP groups endorsed significantly higher ED and depressive symptoms, anxiety sensitivity, experiential avoidance, and significantly lower mindfulness (all p < 0.001), but atypAN and AN-BP groups did not differ from one another. When controlling for BMI, all previously significant differences between atypAN and AN-R did not remain significant., Conclusion: Individuals with atypAN who have a higher BMI experience more pronounced ED and emotional symptoms, suggesting that relying solely on BMI as a marker of illness severity may be problematic., (© 2024 Eating Disorders Association and John Wiley & Sons Ltd.)

Loss-of-control (LOC) eating involves a subjective feeling that one cannot stop eating or control one's eating. Individuals with LOC eating may exhibit strong appetitive drives and weak inhibitory control, and these two opposing motivations have been related to EEG measurements of frontal asymmetry or lateralized frontal activation. The present study investigated whether frontal asymmetry is related to hedonic hunger, LOC eating severity and frequency, and eating in the absence of hunger (EAH) in the laboratory. Fifty-nine individuals participated in an ostensible taste study after resting-state electroencephalogram (EEG) recordings. After the EEGs, they were provided a meal to eat until fullness, followed by an array of snacks and instructions to eat as much as they would like. The results indicated that several measures of right-frontal asymmetry were related to greater EAH and greater self-reported LOC eating severity. Although right-frontal asymmetry has been theorized to reflect avoidance motivation, recent evidence suggests it may indicate effortful control during approach-avoidance conflicts. Because individuals with LOC eating presumably experience heightened conflict between drives to eat beyond energy needs and to minimize such eating, those experiencing greater LOC may exert greater effort to manage these conflicting motivations. An integration of these neurobiological correlates of LOC eating may help provide a more comprehensive understanding of LOC eating and inform treatments., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Published by Elsevier Ltd.)

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state., (© 2023 The Obesity Society.)

Hedonic hunger, reward-driven eating outside of biological need, is a newer construct in eating behavior research. During behavioral weight loss (BWL), greater improvements in hedonic hunger are associated with higher weight loss, but it remains unclear if hedonic hunger predicts weight loss independent of more well-established, similar constructs (uncontrolled eating and food craving). Research also is needed to understand how hedonic hunger interacts with contextual factors (e.g., obesogenic food environment) during weight loss. Adults (N = 283) in a 12-month randomized controlled trial of BWL were weighed at 0, 12, and 24 months, and completed questionnaires assessing hedonic hunger, food craving, uncontrolled eating, and the home food environment. All variables improved at 12 and 24 months. Decreases in hedonic hunger at 12 months were associated with higher concurrent weight loss, but not when accounting for improvements in craving and uncontrolled eating. At 24 months, reduction in craving was a stronger predictor of weight loss than hedonic hunger, but improvement in hedonic hunger was a stronger predictor of weight loss than change in uncontrolled eating. Changes to the obesogenic home food environment failed to predict weight loss, regardless of levels of hedonic hunger. This study adds novel information on the individual and contextual factors associated with short- and long-term weight control, which can help refine conceptual models and treatment strategies., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The sense of 'loss of control' (LOC), or a feeling of being unable to stop eating or control what or how much one is eating, is the most salient aspect of binge eating. However, the neural alterations that may contribute to this experience and eating behavior remain poorly understood., Methods: We used functional near-infrared spectroscopy (fNIRS) to measure activation in the prefrontal cortices of 23 women with bulimia nervosa (BN) and 23 healthy controls (HC) during two tasks: a novel go/no-go task requiring inhibition of eating responses, and a standard go/no-go task requiring inhibition of button-pressing responses., Results: Women with BN made more commission errors on both tasks. BN subgroups with the most severe LOC eating ( n = 12) and those who felt most strongly that they binge ate during the task ( n = 12) showed abnormally reduced bilateral ventromedial prefrontal cortex (vmPFC) and right ventrolateral prefrontal cortex (vlPFC) activation associated with eating-response inhibition. In the entire BN sample, lower eating-task activation in right vlPFC was related to more frequent and severe LOC eating, but no group differences in activation were detected on either task when this full sample was compared with HC. BN severity was unrelated to standard-task activation., Conclusions: Results provide initial evidence that diminished PFC activation may directly contribute to more severe eating-specific control deficits in BN. Our findings support vmPFC and vlPFC dysfunction as promising treatment targets, and indicate that eating-specific tasks and fNIRS may be useful tools for identifying neural mechanisms underlying dysregulated eating.

Purpose: Difficulty reappraising drives to consume palatable foods may promote poorer inhibition and binge eating (BE) in adults with obesity, but neural underpinnings of food-related reappraisal are underexamined., Methods: To examine neural correlates of food-related reappraisal, adults with obesity with and without BE wore a portable neuroimaging tool, functional near-infrared spectroscopy (fNIRS). fNIRS measured activity in the prefrontal cortex while participants watched videos of food and attempt to "resist" the food stimuli (i.e., "consider the negative consequences of eating the food")., Results: Participants (N = 32, 62.5% female; BMI 38.6 [Formula: see text] 7.1; 43.5 [Formula: see text] 13.4 y) had a BMI > 30 kg/m 2 . Eighteen adults (67.0% female; BMI 38.2 [Formula: see text] 7.6) reported BE (≥ 12 BE-episodes in preceding 3 months). The control group comprised 14 adults who denied BE (64.0% female; BMI 39.2 [Formula: see text] 6.6). Among the entire sample, mixed models showed significant, small hyperactivation during crave and resist compared to watch (relax) condition bilaterally in the medial superior frontal gyrus, dorsolateral areas, and middle frontal gyrus (optodes 5, 7, 9, 10, 11, and 12) in the total sample. No statistically significant differences in neural activation were observed between the BE and control group. Moreover, there were no significant group by condition interactions on neural activation., Conclusion: Among adults with obesity, BE status was not linked to differential activation in inhibitory prefrontal cortex areas during a food-related reappraisal task. Future research is needed with larger samples, adults without obesity, and inhibition paradigms with both behavioral and cognitive components., Level of Evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies., Trial Registration: # NCT03113669, date April 13, 2017., (© 2023. The Author(s).)

Objective: Weight suppression (WS) is associated with many eating disorder (ED)-related symptoms. However, traditional calculations of WS do not consider the age or height at which one's highest past weight was reached. Lowe et al. (2022) found that developmental WS (DWS) was associated with a wider variety of ED-related symptoms compared with traditional WS (TWS). This study replicated and extended these findings in a larger sample of individuals with bulimia nervosa (BN) at a residential ED treatment center., Methods: Participants were 1051 female patients with BN. We examined the relations between each WS measure and ED symptoms, emotional symptoms, and weight history variables., Results: TWS and DWS showed a similar number of relations with ED-related symptoms. DWS was positively related to behavioral symptoms (e.g., vomiting), and negatively related to cognitive symptoms (e.g., weight/eating concern). TWS was positively related to highest premorbid, highest postmorbid, and lowest postmorbid weights. DWS was also positively related to highest premorbid z-scored body mass index (zBMI), but negatively related to lowest and highest postmorbid zBMI., Conclusions: DWS, relative to TWS, may better capture the psychobiological impact of the weight discrepancy that a measure of WS is meant to reflect., Public Significance: Weight suppression, the difference between an individual's past highest weight and current weight, is significantly related to many ED-related symptoms. This study found that a new weight suppression measure, based on expected weight-for-height during physical development, relates to ED characteristics in a different manner from the traditional measure of weight suppression, showing positive associations with behavioral symptoms and negative associations with cognitive symptoms., (© 2022 Wiley Periodicals LLC.)

Weight suppression (WS) has been consistently related to eating pathology. The weight loss that produces weight suppression has always been assumed to be intentional, but no study has tested whether unintentional weight loss would also be associated with eating pathology. The current study examined whether the association between WS and eating pathology may be moderated by intentionality of weight loss in a community-based sample of 520 adults. Participants were categorized into low WS (<5% weight loss from highest past weight), intentional, high WS (>5% intentional weight loss), and unintentional, high WS (>5% unintentional weight loss) groups. The intentional WS group reported greater restraint than the unintentional WS and low WS groups, and the low WS group reported greater restraint and more frequent loss-of-control (LOC) eating than those with unintentional WS. Further, WS was positively related to loss-of-control eating frequency only in the intentional WS group, and negatively associated with LOC eating frequency in the low WS group. Additionally, BMI was positively associated with LOC and binge eating frequency and restraint only in the low WS group. Given the relatively high prevalence of substantial but unintended weight loss found in this study, researchers studying weight suppression should consider asking about intentionality of weight loss and analyzing their data with and without unintentional weight suppressors included in the sample., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

African American men are at a greater risk for contracting HIV infection, and geography may play an important role in the spread of the virus. This study aimed to quantitatively assess the readiness of rural African American men to participate in a barbershop-based HIV prevention program. A paper-and-pencil survey was administered to rural African American male barbershop attendees to assess their readiness for barbershop-based HIV prevention programs. The results suggested that participants were amenable to this form of programming in the barbershop setting. There was no significance detected by demographic variables in readiness for barbershop-based HIV prevention programs. The results of the study give health education specialists and other public health practitioners insight into ways to effectively research, communicate to, and develop culturally appropriate programming for this priority population in a setting in which they are more likely to frequent., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Self-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary contexts to a substantial degree. Because most health behaviors (e.g., eating, drinking, smoking) occur in the context of everyday activities, digital technologies may help us better understand and influence these behaviors in real time. Using a momentary self-regulation measure, the current study (which was part of a larger multi-year research project on the science of behavior change) used ecological momentary assessment (EMA) to assess if self-regulation can be engaged and manipulated on a momentary basis in naturalistic, non-laboratory settings., Methods: This one-arm, open-label exploratory study prospectively collected momentary data for 14 days from 104 participants who smoked regularly and 81 participants who were overweight and had binge-eating disorder. Four times per day, participants were queried about momentary self-regulation, emotional state, and social and environmental context; recent smoking and exposure to smoking cues (smoking sample only); and recent eating, binge eating, and exposure to binge-eating cues (binge-eating sample only). This study used a novel, momentary self-regulation measure comprised of four subscales: momentary perseverance, momentary sensation seeking, momentary self-judgment, and momentary mindfulness. Participants were also instructed to engage with Laddr, a mobile application that provides evidence-based health behavior change tools via an integrated platform. The association between momentary context and momentary self-regulation was explored via mixed-effects models. Exploratory assessments of whether recent Laddr use (defined as use within 12 h of momentary responses) modified the association between momentary context and momentary self-regulation were performed via mixed-effects models., Results: Participants (mean age 35.2; 78% female) in the smoking and binge-eating samples contributed a total of 3,233 and 3,481 momentary questionnaires, respectively. Momentary self-regulation subscales were associated with several momentary contexts, in the combined as well as smoking and binge-eating samples. For example, in the combined sample momentary perseverance was associated with location, positively associated with positive affect, and negatively associated with negative affect, stress, and tiredness. In the smoking sample, momentary perseverance was positively associated with momentary difficulty in accessing cigarettes, caffeine intake, and momentary restraint in smoking, and negatively associated with temptation and urge to smoke. In the binge-eating sample, momentary perseverance was positively associated with difficulty in accessing food and restraint in eating, and negatively associated with urge to binge eat. While recent Laddr use was not associated directly with momentary self-regulation subscales, it did modify several of the contextual associations, including challenging contexts., Conclusions: Overall, this study provides preliminary evidence that momentary self-regulation may vary in response to differing momentary contexts in samples from two exemplar populations with risk behaviors. In addition, the Laddr application may modify some of these relationships. These findings demonstrate the possibility of measuring momentary self-regulation in a trans-diagnostic way and assessing the effects of momentary, mobile interventions in context. Health behavior change interventions may consider measuring and targeting momentary self-regulation in addition to trait-level self-regulation to better understand and improve health risk behaviors. This work will be used to inform a later stage of research focused on assessing the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and health outcomes., Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03352713., Competing Interests: JP has provided consultation to pharmaceutical and technology companies that make medications and other treatments for quitting smoking and has served as an expert witness in lawsuits against tobacco companies. In addition to her academic affiliation, LM is affiliated with Square2 Systems, Inc., the small business that developed the mobile Laddr intervention and has worked extensively with relevant institutions (including Dartmouth College and NIH) to manage any potential conflict of interest. All research data collection, data management, and statistical analyses are conducted by individuals with no affiliation with Square2 Systems. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Scherer, Metcalf, Whicker, Bartels, Grabinski, Kim, Sweeney, Lemley, Lavoie, Xie, Bissett, Dallery, Kiernan, Lowe, Onken, Prochaska, Stoeckel, Poldrack, MacKinnon and Marsch.)

This paper is a commentary on Polivy, Herman and Mills' (2020) article, entitled "What is restrained eating and how do we identify it?". Polivy et al.'s paper makes a useful contribution by providing guidelines to researchers for choosing the most appropriate measure of restraint for their research questions. However, the authors assume that restrained eating can be appropriately conceptualized as a trait, an assumption I question. They also assume that restrained eating has a causal influence on the outcomes (e.g., counterregulatory eating, negative affect eating, binge eating) with which it has been associated, which I also question. Finally, they ignored a second prominent model for conceptualizing dieting behavior, the Three-Factor Model of Dieting. The Three-Factor Model decomposes the construct of restrained eating into two types of dieting (current weight loss dieting and weight suppression) that do appear to be causally related to eating control and one type (restrained eating to avoid excessive consumption) that modulates likelihood of overeating but does not cause it. I conclude by noting that scientific progress is best served by promoting, not avoiding, discussion and debate about a multiplicity of perspectives on topics of interest, especially when incompatible hypotheses and data exist on such topics., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Research regarding the definition and consequences of dieting has generated controversy for years. This controversy has spilled over into the public domain, especially as eating disorders and obesity have become more prevalent. One of the earliest and longest-lasting controversies involves the restrained eating framework, which was originally developed by Herman and Polivy and also strongly influenced the development of the cognitive-behavioral model of bulimia nervosa. An alternative framework for understanding the role of dieting in nonclinical and clinical groups, called the Three-Factor Model of Dieting, took a sharply different approach to defining, and understanding the impact of, dieting. This paper provides a brief historical review of the development of these divergent perspectives and updates the Three Factor Model's critical distinction between restraining eating to prevent over-consumption and dieting to lose weight. We suggest that three historical trends impacted the development of Restraint Theory in ways that unfairly impugned dieting for weight control: the emergence of the new eating disorders of bulimia nervosa and binge eating disorder, a population-based increase in loss of control eating and a population-based increase in obesity. This update is aimed in part at encouraging new research to reconcile ongoing, unresolved issues between Herman and Polivy's restrained eating model and the Three-Factor model of Dieting model. Such research might also contribute to the public's understanding of the pros and cons of dieting and to new approaches to treating eating disorders and obesity., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: This study tested the hypothesis that greater weight variability (WV; measured as root mean square error [RMSE]) during the first year of life predicts weight gain at year two and greater WV during the second year of life predicts greater weight gain at year three., Methods: This was a prospective study using mother and offspring data from the Avon Longitudinal Study of Parents and Children. Infant z-BMI (BMI z score) and WV scores were calculated separately during years one and two. Maternal demographic, weight, and nursing-related measures were also used in analyses., Results: Sample sizes in year-one and year-two analyses were 814 (448 male; 366 female) and 783 (432 male; 351 female), respectively. RMSE in year one significantly predicted z-BMI change in year two (β [SE]: 0.32 [0.12]; p = 0.01; adjusted R 2 = 0.07), controlling for z-BMI change in year one and z-BMI at birth. Similar significant prediction was found using year-two RMSE for year-three z-BMI (β [SE]: 0.33 [0.14]; p = 0.02; adjusted R 2 = 0.10). Maternal characteristics were not related to RMSE in year one or year two., Conclusions: Previous findings that WV predicts subsequent increases in body mass in adults were, for the first time, extended to infants., (© 2021 The Obesity Society.)

Objective: Weight suppression (WS) has demonstrated associations with numerous indices of eating behavior, psychopathology and eating disorder prognosis. However, because WS has traditionally been measured as a simple subtraction of current weight from highest past weight at adult height, this calculation is problematic for most individuals with disordered eating, who usually reach their highest past weight during adolescence. Here we propose a new method for computing WS to address this shortcoming, termed "developmental weight suppression" (DWS), and provide a web-based tool for ease of calculation., Method: DWS is calculated as the difference between one's highest premorbid z-BMI (i.e., BMI z-score), and current z-BMI. z-BMIs were calculated using Cole's lambda-mu-sigma (LMS) approach, in accordance with LMS parameters publicly available from the Center for Disease Control (2010). A web-based user interface is available at https://niuxin.shinyapps.io/devws/, making its computation easier and its adoption by researchers simpler., Discussion: By using z-BMIs in place of weights, DWS is more sensitive to the developmentally-relevant factors of age, height, and sex. Preliminary findings suggest that DWS is more strongly related to measures of eating pathology and biological reactions to weight loss than traditionally-computed WS, although more research is needed to test this hypothesis., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Patterns of response to eating disorder (ED) treatment are heterogeneous. Advance knowledge of a patient's expected course may inform precision medicine for ED treatment. This study explored the feasibility of applying machine learning to generate personalized predictions of symptom trajectories among patients receiving treatment for EDs, and compared model performance to a simpler logistic regression prediction model., Method: Participants were adolescent girls and adult women (N = 333) presenting for residential ED treatment. Self-report progress assessments were completed at admission, discharge, and weekly throughout treatment. Latent growth mixture modeling previously identified three latent treatment response trajectories (Rapid Response, Gradual Response, and Low-Symptom Static Response) and assigned a trajectory type to each patient. Machine learning models (support vector, k-nearest neighbors) and logistic regression were applied to these data to predict a patient's response trajectory using data from the first 2 weeks of treatment., Results: The best-performing machine learning model (evaluated via area under the receiver operating characteristics curve [AUC]) was the radial-kernel support vector machine (AUC RADIAL = 0.94). However, the more computationally-intensive machine learning models did not improve predictive power beyond that achieved by logistic regression (AUC LOGIT = 0.93). Logistic regression significantly improved upon chance prediction (M AUC[NULL] = 0.50, SD = .01; p <.001)., Discussion: Prediction of ED treatment response trajectories is feasible and achieves excellent performance, however, machine learning added little benefit. We discuss the need to explore how advance knowledge of expected trajectories may be used to plan treatment and deliver individualized interventions to maximize treatment effects., (© 2021 Wiley Periodicals LLC.)

Objective: The oscillations between binge eating, purging, and dieting in bulimia nervosa (BN) may produce substantial within-subject weight variability. Although weight variability has been predictive of eating- and weight-related variables in community samples, it has not been empirically examined in eating disorders. The current study examined cross-sectional and prospective associations between weight variability and BN pathology., Method: Four weights were collected over an average of 42.02 days, and weight variability was calculated as the root mean square error around each individual's weight trajectory regression line. Linear regressions were performed to examine the association between weight variability and eating disorder psychopathology, cross-sectionally at baseline and prospectively at 6-month follow-up, adjusting for baseline BMI., Results: Weight variability was cross-sectionally associated with eating pathology, but these relationships became non-significant after adjusting for BMI. However, at 6-month follow-up, greater baseline weight variability predicted increases in body dissatisfaction, shape and weight concerns, and global eating pathology, even after adjusting for baseline BMI., Discussion: These findings demonstrate, for the first time, that within-subject weight variability predicts greater eating disorder pathology over time in BN. The results add to evidence that weight history variables contribute to BN psychopathology above and beyond well-documented psychological dysfunction in BN., (© 2021 Wiley Periodicals LLC.)

Background: The Renfrew Unified Treatment for Eating Disorders and Comorbidity (UT) is a transdiagnostic, emotion-focused treatment adapted for use in residential group treatment. This study examined the effect of UT implementation across five years of treatment delivery. Methods: Data were collected by questionnaire at admission, discharge (DC), and 6-month follow-up (6MFU). Patient outcomes were measured by the Eating Disorder Examination-Questionnaire, Center for Epidemiologic Studies-Depression Scale, Brief Experiential Avoidance Questionnaire (BEAQ), Anxiety Sensitivity Index, and Southampton Mindfulness Scale. Data were analyzed for N = 345 patients treated with treatment-as-usual (TAU), and N = 2,763 treated with the UT in subsequent years. Results: Results from multilevel models demonstrated a significant interaction between implementation status (TAU vs. UT) and time, both linear and quadratic, for the depression, experiential avoidance, anxiety sensitivity, and mindfulness variables. Patients treated with the UT showed more improvement in these variables on average, as well as more rebound between DC and 6MFU. Results from multilevel models examining eating disorder outcome showed no significant difference between the TAU and UT for the full sample, but a significant three-way interaction indicated that the UT produced more improvement in the EDE-Q relative to the TAU particularly for patients who entered treatment with high levels of experiential avoidance (BEAQ score). Conclusion: This long-term study of a transdiagnostic, evidence-based treatment in residential care for eating disorders and comorbidity suggests implementation was associated with beneficial effects on depression and emotion function outcomes, as well as eating disorder severity for patients with high levels of baseline emotion regulation problems. These effects did not appear to diminish in the 5 years following initial implementation., Competing Interests: The authors include Research Consultants to The Renfrew Center (HT-B, ML, SS); Advisory Board Members for The Renfrew Center (JB), and employees of The Renfrew Center (TG, GB, MS). The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Thompson-Brenner, Singh, Gardner, Brooks, Smith, Lowe and Boswell.)

Humans show a high degree of stability in their body weights over time, a phenomenon explained by powerful, redundant homeostatic mechanisms. Nonetheless, human populations are also highly susceptible to develop epidemic levels of overweight in an obesogenic environment. Relatively little is known about the process responsible for the transition from remarkable weight stability to relentless weight gain. We have been studying individual differences in within-subject variability in body weights to learn more about this transition. This research has revealed that those who show greater WV over time are more susceptible to future weight gain; greater WV in those losing weight also predicts poorer weight loss maintenance. All the above findings continue to hold when baseline BMI and weight change over the WV assessment period are controlled. The relation of these newer findings to several trends in existing research was considered; these include the relation of weight cycling and morbidity, WV and eating/affective dysregulation, WV and medical diseases and WV and variability in daily energy intake. It appears that elevated WV per se is a risk factor for unfavorable clinical outcomes but little is known about the mechanisms accounting for these associations., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Eating disorder (ED) treatment outcomes are highly variable from beginning to end of treatment; however, little is known about differential trajectories during the course of treatment. This study sought to characterize heterogeneous patterns of ED treatment response during residential care., Method: Participants were adolescent girls and adult women (N = 360) receiving residential ED treatment for anorexia nervosa, bulimia nervosa, binge-eating disorder, other specified feeding or eating disorder, unspecified feeding or eating disorder, or avoidant/restrictive food intake disorder. Self-report symptom assessments were completed at admission, discharge, and approximately weekly throughout the residential stay to assess curvilinear patterns of change. Latent growth mixture modeling was applied to identify subgroups of patients with similar treatment response trajectories., Results: Three latent groups emerged, including gradual response (58.3%; steady improvements from admission to discharge), rapid response (23.9%; steep early improvements that were maintained through discharge), and low-symptom static response (17.8%; nearly nonclinical self-reported symptoms at admission that remained static through discharge). Groups differed on important clinical characteristics, such as body mass index, endorsement of compensatory behaviors, severity of global ED psychopathology at admission, and degree of symptom improvement by end of treatment., Discussion: Patients follow heterogeneous response patterns in residential ED treatment, and these patterns are associated with differential treatment outcome. Future work should explore whether these trajectories are associated with differential outcomes at follow-up and whether tailoring clinical intervention to a patient's trajectory type can improve treatment response., (© 2020 Wiley Periodicals LLC.)

Objective: To provide a review of cognitive outcomes across a full neuropsychological profile in patients who underwent laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE)., Methods: We examined cognitive outcomes following LiTT for mTLE by reviewing a consecutive series of 26 patients who underwent dominant or nondominant hemisphere procedures. Each patient's pre- and postsurgical performance was examined for clinically significant change (>1SD improvement or decline on standardized scores), with a neuropsychologic battery that included measures of language, memory, executive functioning, and processing speed., Results: Presurgical performance was largely consistent with previous research, where patients suffering from dominant hemisphere epilepsies demonstrated deficits in verbal learning and memory, whereas patients with nondominant hemisphere scored lower on visually mediated tests. Case-by-case review comparing presurgical to postsurgical scores revealed clinically significant improvement in both dominant and nondominant patients in learning and memory and other aspects of cognition such as processing speed and executive functioning. Of the few patients who did experience clinically significant decline following LiTT, a greater proportion had undergone dominant hemisphere procedures., Conclusions: Compared with the outcome literature of dominant open anterior temporal lobectomies (ATLs), where postsurgical decline has been documented in up to 40%-60% of cases, our LiTT case series exhibited a much lower incidence of postoperative language or verbal memory decline. Moreover, promising rates of postoperative improvements were also observed across multiple cognitive domains. Future studies exploring cognitive outcomes following LiTT should include comprehensive neuropsychological findings, rather than only select domains, as clinically significant change can occur in areas other than those typically associated with mesiotemporal structures., (© 2019 American Academy of Neurology.)

Background: Obesity treatments often do not produce long-term results. It is therefore critical to better understand biological and behavioral correlates or predictors of future weight change., Objective: We tested the hypothesis that greater weight variability, independent of total body weight change, during early weight loss would predict degree of long-term success., Subjects/methods: We included 24,009 American users of the Withings smart scale with over a year's worth of self-monitored weight data. Multilevel modeling was used to calculate weight variability as the root mean square error around participants' weight trajectory regression line, using weekly average weights from the first 12 weeks of weight loss. Linear regressions were then used to examine whether weight variability predicted weight change from week 12 to week 48, 72, and 96., Results: Greater weight variability predicted less weight loss/more weight regain at week 48 (b ± SE: 1.18 ± 0.17, p < 0.001), week 72 (b ± SE: 1.45 ± 0.21, p < 0.001), and week 96 (b ± SE: 1.45 ± 0.23, p < 0.001), controlling for baseline BMI and overall weight change during the first 12 weeks. An interaction effect was found between weight variability and baseline BMI such that the relationship between weight variability and later weight change was stronger in individuals with lower baseline BMI., Conclusions: This study found that in a large population sample, weight variability early on during weight loss significantly predicted longer term weight loss outcomes. The results provide further support that weight variability be considered an important predictor of future weight change. Research is needed to understand the mechanisms underlying this effect.

Objective: We aimed to identify risk factors for seizures after intracerebral hemorrhage, and to validate the prognostic value of the previously reported CAVE score (0-4 points: cortical involvement, age <65, volume >10 mL, and early seizures within 7 days of hemorrhage)., Patients and Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) was a prospective study of spontaneous intracerebral hemorrhage. We included patients who did not have a prior history of seizure and survived to discharge. Univariate analysis and multiple logistic regression modeling were used to identify risk factors for seizure., Results: From 2010-2015, 3000 cases were recruited, and 2507 patients were included in this study. Seizures after hospital discharge developed in 77 patients 3.1 %). Patients with lobar (cortical) hemorrhage (OR 3.0, 95 % CI 1.8-5.0), larger hematoma volume (OR 1.5 per cm 3 , 95 % CI 1.2-2.0), and surgical evacuation of hematoma (OR 2.6, 95 % CI 1.4-4.8) had a higher risk of late seizure, and older patients had a lower risk (OR 0.88 per 5-year interval increase, 95 % CI 0.81-0.95). The CAVE score was highly associated with seizure development (OR 2.5 per unit score increase, 95 % CI 2.0-3.2, p < 0.0001). The CAVS score, substituting surgical evacuation for early seizure, increased the OR per unit score to 2.8 (95 % CI 2.2-3.5)., Conclusions: Lobar hemorrhage, larger hematoma volume, younger age, and surgical evacuation are strongly associated with the development of seizures. We validated the CAVE score in a multi-ethnic population, and found the CAVS score to have similar predictive value while representing the current practice of AED use., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Despite calls for routine use of progress and outcome monitoring in private and intensive treatment centres for eating disorders (EDs), existing measures have limited relevance to these supervised treatment settings. This study sought to develop and validate the progress monitoring tool for eating disorders, a multidimensional measure for progress monitoring in the context of intensive ED treatment., Method: Thirty-seven items were generated by a team of content experts, clinicians, and administrative staff from the target treatment setting. Adolescent and adult females (N = 531) seeking residential ED treatment completed the items at admission as part of the clinic's routine assessment battery; 83% were retained for repeat assessment at discharge. Exploratory factor analysis was conducted for preliminary measure development., Results: Results yielded a five-factor, 26-item structure explaining 50% of total variance. Final construct domains included weight and shape concern, ED behaviours and urges, emotion avoidance, adaptive coping, and relational connection. The measure demonstrated adequate internal consistency, sensitivity to change during treatment, and convergence with validated assessment measures., Conclusions: Preliminary data support the progress monitoring tool for eating disorders as a novel and valid multidimensional measure of treatment-relevant constructs. This measure may have utility in measuring treatment progress for patients receiving intensive treatment for EDs., (© 2020 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective : Data are lacking from empirically supported therapies implemented in residential programs for eating disorders (EDs). Common elements treatments may be well-suited to address the complex implementation and treatment challenges that characterize these settings. This study assessed the preliminary effect of implementing a common elements therapy on clinician treatment delivery and patient ( N  = 616) symptom outcomes in two residential ED programs. Method : The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders was adapted to address ED and co-occurring psychopathology and implemented across sites. Therapists' treatment fidelity was rated independently to assess implementation success. Additionally, longitudinal (pre-post) design compared treatment outcomes among patients treated before and after implementation. Patient outcomes included ED and depressive symptoms, experiential avoidance, anxiety sensitivity, and mindfulness. Results : Following training and implementation, clinicians demonstrated adequate to good fidelity. Relative to pre-implementation, post-implementation patients showed significantly greater improvements in experiential avoidance, anxiety sensitivity, and mindfulness at discharge ( p s ≤ .04) Relative to patients who were treated during the pre-implementation phase, patients in the post-implementation phase experienced more favorable outcomes on ED symptom severity, depression, mindfulness, and anxiety sensitivity at 6-month-follow-up ( p s ≤ .001). A similar result was observed for experiential avoidance, yet this interaction effect was no longer statistically significant ( p = .10) when the time x length of stay effect/covariate was added to the model. Conclusions : Preliminary pilot data support the feasibility of implementing transdiagnostic common elements therapy in residential ED treatment, and suggest that implementation may benefit transdiagnostic outcomes for patients. Clinical or methodological significance of this article: Limited data are available to guide evidence-based residential treatment for eating disorders. This study represents a unique effort to adapt, implement, and test an evidence-based therapy protocol across a large private network of intensive eating disorder treatment programs.

Objective: Weight suppression (WS) and body mass index (BMI) have predicted weight change in individuals with eating disorders, but the interaction between these variables is understudied. Furthermore, WS is usually measured as absolute WS-the numeric difference between current weight and highest past weight-overlooking the potentially important influence of how much a person weighed at their highest historical weight., Method: The current study investigated the independent and interacting effects of BMI and two measures of WS at admission on residential treatment weight change. WS measures included absolute WS and the relative WS index, the percentage of total body weight lost from highest past weight. Participants were women with anorexia nervosa (n = 357) or bulimia nervosa (n = 293) who provided complete data, 87% of the eligible treatment sample., Results: In both diagnostic subsamples, BMI, absolute WS, and the relative WS index all significantly predicted weight change. The interaction between BMI and WS predicted weight change, but only when the relative WS index was used., Discussion: Results highlight the potential importance of considering an individual's weight and weight history when predicting their treatment weight change and support the importance of utilizing both methods of calculating WS in future research., (© 2019 Wiley Periodicals, Inc.)

Objective: To assess the associations between dietary cognitive restraint, disinhibited eating, and how taste and health perceptions relate to food preference; and further, whether cognitive restraint and disinhibited eating are associated with food preference decision reaction time., Methods: Five hundred and seventeen adults participated in the study. Dietary cognitive restraint and disinhibited eating were assessed using the shortened Three-Factor Eating Questionnaire (TFEQ-R18). Participants also completed a dietary decision-making task to examine their food-related decisions. Participants were presented with 50 food items and asked to rate them for health and for taste. Participants were then presented with a reference food item and comparison items one at a time and asked to indicate which of the two foods they would prefer to eat., Results: Participants with higher levels of cognitive restraint were more sensitive to health perceptions whereas those with higher levels of disinhibited eating were more sensitive to taste perceptions when indicating food preference. Reaction time analysis corroborated these results. Being classified as high for cognitive restraint was associated with faster reaction times if the preferred food was rated as healthier than the referent food. Conversely, being classified as high for disinhibited eating was associated with faster reaction times if the preferred food was rated as tastier than the referent food., Conclusion: The dietary decision-making task appears to capture distinct aspects of dietary restraint and disinhibition and may be useful in future studies to measure and/or alter levels of dietary restraint and disinhibition., (Copyright © 2019 Masterson, Brand, Lowe, Metcalf, Eisenberg, Emond, Gilbert-Diamond and Marsch.)

Many adults enter behavioral weight loss (BWL) programs at a weight below their highest lifetime weight. The discrepancy between highest lifetime weight and current weight is known as weight suppression (WS). Research has yet to characterize WS during BWL or investigate its relation to weight loss outcomes or treatment acceptability. Adults (N = 272) in a 12-month BWL program were assessed. WS was calculated by subtracting measured baseline weight from self-reported highest lifetime weight. Participants with higher WS lost significantly less weight than those with lower WS during treatment, although they still had clinically meaningful weight losses (e.g., participants with WS above the median: 7.8 kg; participants with WS below the median: 12.0 kg). WS was unrelated to weight losses at 24-month follow-up. Controlling for weight loss, treatment acceptability was unrelated to WS. BWL appears appropriate for those with high WS, but future research should aim to improve outcomes in this group.

Body image disturbance is widely viewed as contributing to the development and maintenance of disordered eating. Yet this perspective is not inconsistent with the possibility that elevated premorbid BMIs also increase the risk of developing eating disorders. Research examining whether actual body size may play a role in eating disorder development reveals a curious pattern of findings. Few prospective risk factor studies conducted with community-based samples found a relationship between premorbid BMI and subsequent eating disorder pathology whereas retrospective research conducted with clinical samples indicates a consistent pattern of elevated premorbid BMIs relative to population norms or control groups. This study documents these disparate findings, considers potential explanations for them and proposes further study of premorbid BMI as a factor contributing to the psychopathology of eating disorders, particularly among those who come to the attention of treatment providers., (© 2019 Wiley Periodicals, Inc.)

Body concerns (e.g., body dissatisfaction and weight preoccupation) are well-supported prospective risk factors for the development of eating disorders in women. Body concerns are psychological variables but they are partly based on actual body mass. This study tested whether (a) body concerns predict increases in eating disorder characteristics measured both continuously (via subscale scores on the Minnesota Eating Behavior Survey (MEBS) and categorically (via transition to a probable or definite eating disorder), (b) body concerns predict changes in BMI, and (c) BMI predicts changes in eating disorder symptoms or development of an eating disorder. Beginning with 762 girls at age 11, the MEBS' Body Dissatisfaction (BD) and Weight Preoccupation (WP) scales were used to predict change in the MEBS' Bulimic Behavior scale (the sum of the Binge Eating and Compensatory Behaviors scales), in BD and WP themselves and in BMI over 18 years of follow up. Baseline BMI was also used to predict BMI and MEBS change. Contrary to expectations, BD and WP predicted significantly reduced growth in all MEBS scales and also predicted significantly reduced growth in BMI. BD, WP and BMI did not predict development of an ED. This pattern was strengthened when predictors were measured at age 17 instead of 11. We consider the possibility that the divergence between the current findings and past findings on eating disorder risk factors may stem from the unusually long developmental period studied, ranging from age 11 (or 17) through age 29. Additional longitudinal research that spans a similar developmental period could shed light on the plausibility of this explanation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Identifying predictors of increases in weight (or in fat mass) is important for understanding the genesis of obesity and for the design of prevention programs. We examined the predictive utility of 6 variables that have been predictive of weight gain in past research: depression, disinhibition, family history of overweight, body dissatisfaction, self-reported dieting and weight suppression (the difference between highest past and current weight). Percentage fat gain was evaluated with DEXA. We tested these variables as predictors of fat gain two years later in 294 female first-year students who were selected to have characteristics associated with future weight gain. Participants were categorized as weight stable or weight gainers at the two-year follow-up and logistic regression was used to evaluate the independent predictive ability of the 6 variables. Baseline body fat was entered as a covariate and predicted fat gain, as expected. The only significant predictor of the 6 tested was weight suppression, with those gaining weight showing greater weight suppression at baseline. Previous research has supported weight suppression as a robust predictor of future weight gain mostly among individuals with eating disorders. The current study indicates that weight suppression is a predictor of long-term fat gain among nonclinical female first-year students who were overwhelmingly in a healthy weight range., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose of Review: Weight suppression, the discrepancy between an individual's highest past weight at adult height and his or her current weight, is related to many characteristics of individuals with eating disorders. This paper reviews research findings from the past 5 years, draws several implications regarding the mechanism underlying these effects, and proposes new approaches to measuring weight suppression., Recent Findings: Studies were reviewed under the categories of anorexia nervosa, bulimia nervosa, and mixed or miscellaneous samples, with more studies falling into the last category than in the first two. Recent findings have continued to show that weight suppression is related to a wide variety of biological and behavioral features in both diagnosed and sub-clinical samples. Weight suppression promotes weight gain which is anathema to individuals with eating disorders, putting them in a biobehavioral bind that appears to prolong their disorder. Priorities for future research are to understand the mechanisms underlying the effects of weight suppression, evaluate new ways of defining weight suppression, and study its implications for modifying treatment.

Objectives: A rich body of literature has established the role of body image distortion and dissatisfaction in the development and maintenance of eating disorders. However, many of the currently used techniques require explicit comparison of the person's body to an external stimulus. As the body schema is a largely unconscious construct, explicit comparison tasks may reflect a proxy, rather than the body schema itself., Methods: Here we use an implicit mental motor imagery (MMI) task to interrogate the body schema in healthy control participants (N=40) and participants at a residential eating disorder treatment center (N=42). By comparing the time it takes to imagine making a movement along a part of the body to the time it takes to actually make the same movement, we were able to assess participants' mental image of their body (i.e., body schema)., Results: We found that participants with eating disorders, but not healthy controls, exhibited distortions of the body schema such that they believed their abdomen, buttocks, and thighs to be larger than they really are. Additionally, the MMI task used here provided information above and beyond traditional self-report measures (i.e., Body Shape Questionnaire). Together the MMI task and traditional measures provide the most information., Conclusions: Findings using the novel MMI task are in line with the literature; participants with eating disorders consider themselves to be larger than they truly are. Taken together, results of this study suggest that MMI tasks provide complementary information to traditional self-report measures. (JINS, 2018, 24, 715-723).

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain., Competing Interests: The authors declare that there are no conflicts of interest.

Peripheral infiltration is defined as the inadvertent delivery of nonvesicant fluid or medication into surrounding tissue that has the potential to harm the patient. Vesicant fluid that has leaked into the tissue space is called extravasation. At present, there is no agreement in the literature on the best practice for managing these injuries in pediatric patients. The purpose of this study was to identify occurrences of peripheral infiltration injuries and examine treatment modalities used to treat pediatric patients who suffered such an injury.