No description available.

No description available.

This study examines the relationship that people have with the modern day food environment. This study used a qualitative approach using interviews, videotapes, and questionnaires with seventeen participants. This varied approach was used to understand the decision-making process at dinnertime when deciding whether to cook at home or eat out at a restaurant. This was examined primarily through semi-structured interviews as well as the observation and videotaping of individuals preparing meals at dinnertime. The research resulted in three different categories of importance: why people choose to eat out, how people utilize restaurants, and the current roles restaurants have in modern American society. The results show the importance of restaurants in modern society beyond the nourishment that a meal can provide. Many of the themes that arose in this research have been seen in other research in this field, but a few new areas came up. For example, using a restaurant as a resource for new recipes to prepare at home was an area that emerged that had not been mentioned in the previous research. This shows that the relationship that American’s have with the food environment outside the home is continuously transforming. Understanding all of the reasons people eat outside the home is important, as there is a general decrease in cooking practices inside the home. Gaining knowledge in how people make food choices on a daily basis is a good first step in being able to address public health issues that relate to food. This study explores the current food environment in order to have a deeper understanding of why people make the choice to eat outside the home, the ways people utilize restaurants, and the roles of restaurants in society.

Clinicians and researchers have traditionally viewed eating disorders (EDs) as disorders of adolescence and early adulthood; however, mounting evidence suggests these debilitating disorders also occur in older women (those 30 years of age and older). Unfortunately, the vast majority of research conducted on EDs has ignored older age groups, making it difficult to determine whether older women represent a distinct group among those with EDs. In order to address this limitation I conducted two separate, but related, studies designed to explore the experiences of older Canadian women with EDs and whether this group differs from younger women with EDs in meaningful ways. Study 1 explored how a treatment seeking sample of women ages 30 years and older diagnosed with an ED (N=14) experience their ED and the precipitating factors of ED episodes among this age group using qualitative framework analysis. Study 2 examined the differences in ED severity, symptomatology, comorbidities, and quality of life between women under the age of 30 (younger women; n=338) and those 30 years and older (older women; n=98) in a treatment-seeking sample using quantitative methods. Across both studies the core ED experiences and symptoms of older women were not significantly different from those of younger women. However, differences emerged that suggest older women with EDs are somewhat less severe in terms of their ED symptomatology and comorbid mental disorders, yet older women with EDs may face some unique challenges and consequences that set them apart from their younger counterparts. These results are discussed in the context of previous research understanding the relationship between aging, mental health, and emotional regulation. In sum, the current thesis suggests treatment for older women with EDs should incorporate interventions designed to address the core symptoms of EDs, improve healthy emotion regulation skills, reduce shame, address the consequences for the patients’ families and partners, and treat the multitude of physical health complications seen in this group. Moreover, greater awareness should be brought to the occurrence of EDs in older age groups in order to reduce shame, stigma, and improve early detection of and treatment for EDs among this population.Clinicians and researchers have traditionally viewed eating disorders (EDs) as disorders of adolescence and early adulthood; however, mounting evidence suggests these debilitating disorders also occur in older women (those 30 years of age and older). Unfortunately, the vast majority of research conducted on EDs has ignored older age groups, making it difficult to determine whether older women represent a distinct group among those with EDs. In order to address this limitation I conducted two separate, but related, studies designed to explore the experiences of older Canadian women with EDs and whether this group differs from younger women with EDs in meaningful ways. Study 1 explored how a treatment seeking sample of women ages 30 years and older diagnosed with an ED (N=14) experience their ED and the precipitating factors of ED episodes among this age group using qualitative framework analysis. Study 2 examined the differences in ED severity, symptomatology, comorbidities, and quality of life between women under the age of 30 (younger women; n=338) and those 30 years and older (older women; n=98) in a treatment-seeking sample using quantitative methods. Across both studies the core ED experiences and symptoms of older women were not significantly different from those of younger women. However, differences emerged that suggest older women with EDs are somewhat less severe in terms of their ED symptomatology and comorbid mental disorders, yet older women with EDs may face some unique challenges and consequences that set them apart from their younger counterparts. These results are discussed in the context of previous research understanding the relationship between aging, mental health, and emotional regulation. In sum, the current thesis suggests treatment for older women with EDs should incorporate interventions designed to address the core symptoms of EDs, improve healthy emotion regulation skills, reduce shame, address the consequences for the patients’ families and partners, and treat the multitude of physical health complications seen in this group. Moreover, greater awareness should be brought to the occurrence of EDs in older age groups in order to reduce shame, stigma, and improve early detection of and treatment for EDs among this population. / May 2016

Concerns about weight, shape and eating and attempts at dietary restraint are prevalent among young girls, but may increase the risk of the development of eating disorders, especially if low self-esteem or symptoms of depression are also present. The literature suggests that there may be links between mothers and daughters attitudes towards weight, shape and dietary restraint. The aim of the study was to investigate whether concerns about weight, shape and eating and attempts at dietary restraint differed between overweight and average-weight girls; and whether overweight girls had lower self-esteem, and/or more symptoms of depression than average-weight girls. Possible links between mothers' and daughters' attitudes towards weight and shape and dietary restraint were also investigated. Results showed that overweight girls had more concerns about weight, shape and eating and attempted dietary restraint more than average weight girls. Overweight girls had more negative perception of their athletic competence, physical appearance and global self-worth, and more symptoms of depression than average-weight girls. Mothers of overweight girls, who themselves had higher BMIs than the mothers of average-weight girls, had more concerns and negative beliefs about weight, shape and eating and attempted more dietary restraint, than the mothers of average-weight girls. Although there was some association between mothers' and daughters' concerns in the average-weight group these associations were not present in the overweight group. The conclusions were that overweight girls may be particularly vulnerable to the development of eating disorders, but that the links between mothers' and daughters' concerns are not straightforward.

L’acte de manger est toujours présent dans notre mode d’être-au-monde, traduisant un mode d’existence et un mode de relation avec le corps propre, avec les autres et avec le monde. L’hyperphagie nous renvoie à une expérience vécue par un sujet qui ne peut pas ne pas manger, qui place souvent l’acte de manger au centre de sa vie et qui exprime un mode psychopathologique à travers la prise alimentaire. Dès lors que l’hyperphagie est devenue un trouble alimentaire reconnu, classifié et de plus en plus étudié, elle s’est présentée comme un « nouvel » élément, souvent associé à la problématique de l’obésité. Cette thèse a pour but de proposer une approche phénoménologique de l’expérience hyperphagique dans l’obésité. Notre parcours de recherche est divisé en quatre parties. Dans la première partie, nous présentons l’historique du corps et du discours psychiatrique autour des troubles alimentaires et de l’obésité, tout en identifiant la manière dont cette histoire et ces discours peuvent marquer l’expérience hyperphagique dans l’obésité. La deuxième partie est consacrée à la phénoménologie de Merleau-Ponty en tant que point de vue fécond pour la compréhension des troubles alimentaires et de l’obésité. Nous faisons un parcours qui démarre avec sa phénoménologie du corps, passe par sa notion de schéma corporel comme voie d’organisation de ce mode d’être corps et finit par son concept de chair. En s’approchant d’unephénoménologie clinique, nous discutons, dans la troisième partie, les contributions de Ludwig Binswanger et d’Arthur Tatossian pour le dévoilement de l’expérience hyperphagique dans l’obésité et nous présentons l’état de l’art actuel des publications phénoménologiques contemporaines sur les troubles alimentaires et sur l’obésité. En utilisant la méthode phénoménologique critique de recherche, nous présentons, dans la quatrième partie, les résultats des entretiens cliniques réalisés dans le contextes français (à Paris) et brésilien (à Fortaleza). Vingt sujets ont été interviewés dans les services de santé publique de chaque pays afin d’avoir un référentiel clinique plus direct, de pouvoir comprendre leur expérience hyperphagique et leur mode d’être obèse puis de comparer les nuances et les sens des spécificités de chaque contexte. Cette approche phénoménologique se constitue dansl’intersection entre la théorie, présentée dans les trois premières parties, et la pratique, mise en évidence à partir du contact clinique avec les patients. Parmi les résultats, nous retenons d’abord l’objectification du corps qui marque les modes de le vivre, produit de la souffrance et traverse la composition des troubles alimentaires et de l’obésité. Nous avons observé une désappropriation du corps souvent vécue dans l’expérience hyperphagique dans l’obésité. D’un côté, l’expérience hyperphagique dénote l’incapacité de ressentir les sentiments corporels et de pouvoir contrôler les actes alimentaires dans un bouleversement du mode d’éprouver le corps, tout en signalant l’« hyper » centralité de l’acte de manger. De l’autre côté, l’obésité signale l’expérience d’un sujet qui est souvent réduit à sa condition corporelle et porte une souffrance liée aux limitations physiques, à la visibilité de ce corps hors norme, aux jugements et à la pression des autres pour ne plus avoir ce corps. Ces deux expériences, recherchées ensemble, n’ont pas de frontières rigides et révèlent un sujet souvent perdu dans son mode d’être et d’avoir un corps. Nous concluons que le travail clinique passe par la réappropriation de ce corps par le sujet et par la récupération de sa condition de sujet qui peut ressentir, choisir, souffrir et aussi (ne pas) manger / The act of eating is present in our ways of being in the world and also translates our relationships with existence, with our own bodies, with other people’s bodies and with the world. The concept of Hyperphagia brings to our notice the experience of an individual that is incapable of not eating, and who very often elevates the act of eating to central position in life, which presents a psychopathology by means food ingestion. Once hyperphagia became officially recognized as an eating disorder along with due classification and increasing interest as an object of investigation, a “fresh” element was presented and turned out to be rather frequently associated with the obesity problem. The objective of this thesis is to propose a phenomenological approach of hyperphagic experience in obesity. Our research procedure is divided into four parts. In the first part, we introduce the history of the body and of the psychiatric discourse upon eating disorders and obesity while identifying the means by which such history and discourses might influence the hyperphagic experience in obesity. The second part is dedicated to Merleau-Ponty’s phenomenology as a fruitful point of view for understanding eating disorders and obesity. The route we have followed starts with his phenomenology of the body, and then goes through his concept of body scheme as a means of organization of this bodily way of being, and finally reaches his concept of flesh. In close proximity to clinical phenomenology, we have discussed, in the third part, the contributions of Ludwig Binswanger and Arthur Tatossian towards unveiling the hyperphagic experience in obesity and presented the current state of the art in contemporary phenomenological publications on the theme of eating disorders and obesity. Employing the critical phenomenological method of research, we present, in the fourth part, the results of clinical interviews realized in the French (in Paris) and Brazilian (in Fortaleza) context. Twenty individuals were interviewed at centers of public health care in each country in order to have a more direct clinical reference, and also in order to understand the hyperphagic experience and the obese way of being and then compare nuances and specificity meanings in each context. This phenomenological approach is constituted by the intersection of theory, presented in the first three parts, and practice, highlighted by the clinical contact with patients. Among results, we initially highlight the objectification of the body that defines this body’s ways of living, produces suffering and permeates the composition of eating disorders and obesity. We have observed an expropriation of the body that is frequently experienced in the hyperphagic experience in obesity. On the one hand, the hyperphagic experience denotes an incapacity to feel bodily feelings and to control eating habits in a strong alteration in the ways of experiencing the body, hinting at a hyper centrality in the act of eating. On the other hand, obesity reflects the experience of an individual that is quite often reduced to his bodily condition and bears much suffering connected to physical limitations, to the visibility of such overweight body, and to other people’s judgementalism and pressure into no longer having that obese body. These two experiences, when researched together, do not present clearly defined borderlines and reveal an individual who is very often lost in his own way of being and having a body. We reach a conclusion in which clinical work implies the individual’s repossession of his own body as well as of his ability to feel, choose, suffer and also eat, or not. / O ato de comer está sempre presente no nosso modo de ser-no-mundo, traduzindoum modo de existência e de relação com o corpo próprio, com os outros e com o mundo. Ahiperfagia nos remete a uma experiência vivida por um sujeito que não pode não comer, queposiciona frequentemente o ato de comer no centro de sua vida e que expressa um modopsicopatológico através da ingestão de alimentos. Uma vez que a hiperfagia tornou-se umtranstorno alimentar reconhecido, classificado e cada vez mais estudado, foi apresentado umelemento "novo" muitas vezes associado ao problema da obesidade. Esta tese tem comoobjetivo propor uma abordagem fenomenológica da experiência hiperfágica na obesidade.Nosso percurso de pesquisa é dividido em quatro partes. Na primeira parte, apresentamos ahistória do corpo e do discurso psiquiátrico em torno dos transtornos alimentares e daobesidade, identificando como essa história e esses discursos podem marcar a experiênciahiperfágica na obesidade. A segunda parte é consagrada à fenomenologia de Merleau-Pontycomo um ponto de vista fecundo para a compreensão dos transtornos alimentares e daobesidade. Fazemos um percurso que começa com sua fenomenologia do corpo, passa por seuconceito de esquema corporal como via de organização desse modo de ser corporal e terminacom seu conceito de carne. Aproximando-se de uma fenomenologia clínica, discutimos, naterceira parte, as contribuições de Ludwig Binswanger e de Arthur Tatossian para odesvelamento da experiência hiperfágica na obesidade e apresentamos o estado da arte atualdas publicações fenomenológicas contemporâneas sobre os transtornos alimentares e sobre aobesidade. Utilizando o método fenomenológico crítico de pesquisa, apresentamos, na quartaparte, os resultados das entrevistas clínicas realizadas nos contextos francês (em Paris) ebrasileiro (em Fortaleza). Vinte sujeitos foram entrevistados em serviços de saúde pública decada país, a fim de ter uma referência clínica mais direta, compreender a experiênciahiperfágica e o modo de ser obeso e, então, comparar as nuances e os sentidos dasespecificidades de cada contexto. Esta abordagem fenomenológica é constituída na interseçãoentre a teoria, apresentada nas três primeiras partes, e a prática, destacada pelo contato clínicocom os pacientes. Entre os resultados, destacamos inicialmente a objetificação do corpo quemarca os modos de viver esse corpo, produz sofrimento e atravessa a composição dostranstornos alimentares e da obesidade. Observamos uma desapropriação do corpofreqüentemente vivida na experiência hiperfágica na obesidade. Por um lado, a experiênciahiperfágica denota a incapacidade de sentir os sentimentos corporais e poder controlar os atosalimentares em uma forte alteração do modo de experienciar o corpo, sinalizando para uma“hiper” centralidade do ato de comer. Por outro lado, a obesidade sinaliza a experiência de umsujeito que é muitas vezes reduzido a sua condição corporal e carrega um sofrimento ligado àslimitações físicas, à visibilidade desse corpo fora da norma, aos julgamentos e à pressão dosoutros para não ter mais esse corpo. Essas duas experiências, pesquisadas juntas, não têmfronteiras rígidas e revelam um sujeito muitas vezes perdido em seu modo de ser e ter umcorpo. Concluímos que o trabalho clínico envolve a reapropriação deste corpo pelo sujeito e arecuperação de sua condição como sujeito que pode sentir, escolher, sofrer e também (não)comer.

No description available.

Approximately one-third of U.S. adults are at increased risk for life-threatening diseases such as atherosclerosis and type 2 diabetes mellitus. Such individuals are considered healthy without any diagnosed cardiometabolic conditions but may have a constellation of cardiometabolic complications that include obesity, glucose intolerance, hyperinsulinemia, dyslipidemia, hypertension, insulin resistance, and hypertriglyceridemia. When most of these preclinical conditions comorbidly occur, the condition has been referred to as metabolic syndrome (MetS). MetS is considered to reflect one or more early pathophysiological processes in cardiometabolic disease; however, the extent to which these complications and their underlying pathophysiology interact with behavioral factors such as stress, diet, and physical activity have not been clearly established. For example, diet consisting of high total caloric intake and high fat composition is posited to contribute to obesity and other cardiometabolic risk factors, but research is inconsistent regarding the effect of psychological distress (i.e., anxiety, stress, depression, anger) on dietary intake and whether dietary intake mediates a relationship between distress and preclinical cardiometabolic disease risk. One factor that has been suggested to play a role in the distress – dietary intake relationship is eating style. Research on eating styles has identified four main types that may be related to distress and dietary intake: restrained, disinhibited, emotional, and external eating. Restrained eaters consciously restrict food intake to control body weight and body shape. Disinhibited eating refers to overeating that occurs following failure of restraint. Emotional eaters consume foods to reduce and alleviate negative emotions, such as anxiety. External eating occurs in response to immediate food-related external stimuli, regardless of internal physiological cues of hunger. Current evidence suggests each of these eating styles moderates the relationship between distress and dietary intake. There is also some research to suggest a relationship between eating styles and weight gain, body mass index (BMI), and development of obesity. However, no study has examined the interrelationships among psychological distress, eating style, and central obesity, and whether these relationships differ according to gender. Moreover, the extent to which distress and eating style may be associated with cardiometabolic risk beyond obesity is unknown. Thus, the main aim of the present study was to test a model of mediation and moderation to evaluate how psychological distress, eating styles, dietary intake, and gender are associated with measures of cardiometabolic risk in healthy individuals (Figure 1). Four hundred sixty-four participants contributed data from two different studies: Obesity, Metabolic Syndrome, and Meal-Related Glycemia (SUGAR) and Markers Assessing Risk for Cardiovascular Health (MARCH). All participants were aged 18-55 years, had no major systemic disease, were not using medications having a cardiovascular, carbohydrate, endocrine, or psychiatric effect, and had no history of substance or alcohol abuse or dependence. The study employed a structural equation modeling (SEM) approach to assess the following aims: 1) to develop composite, latent factors to reflect psychological distress, eating style, and dietary intake using confirmatory factor analysis (CFA) and to develop a hybrid model of cardiometabolic risk; and 2) to simultaneously test the interrelationships among factors in a comprehensive model so that the strength of direct and indirect effects can be evaluated while statistically controlling for the other factors and covariates in the model. Latent factor models of psychological distress and eating style fit the data and were statistically acceptable, and a hybrid model of cardiometabolic risk fit the data and its CFA components were acceptable. A latent factor model of dietary intake would have likely fit the data and been statistically acceptable given the high intercorrelations among dietary variables, but no such factor was created because dietary variables failed to confirm the hypothesized associations with other model components (e.g., waist girth, eating styles); thus, these measures were excluded from further SEM analyses. Final model results showed that psychological distress was positively related to restrained, emotional, and external eating styles, but only restrained eating was directly associated with greater waist girth. Distress was not directly related to cardiometabolic risk, but an indirect effect was found in which higher levels of distress led to greater waist girth via higher levels of restrained eating. Waist girth, in turn, served as a significant mediator between restrained eating and worse insulin sensitivity, higher blood pressure, diminished glucose tolerance, and greater dyslipidemia. These effects were significant when controlling for age, gender, education, and physical activity, and when analyzed in a comprehensive SEM model simultaneously including distress, eating style, and cardiometabolic risk variables. Of note, results suggest the possibility for a reversed effect such that waist girth leads to restrained eating. Findings also suggest that emotional eating may lead to distress. In contrast, the relationship between distress and the other two eating styles, restrained and external eating, appeared unidirectional such that distress leads to restrained and external eating but not the reverse. Future studies using longitudinal data are needed to better understand these relationships in regards to causality. Data from the MARCH subsample was excluded from the above final modeling analyses because eating style data were only available for the SUGAR subsample. Thus, the role of gender in how distress, eating styles, and cardiometabolic risk are interrelated could not be examined due to the small number of women in the SUGAR study (n = 38). It remains unknown whether the significant effect of distress on each of the eating styles found in the current study was driven primarily by men, women, or both equally. Similarly, the sample size would not permit the evaluation of whether gender moderated the effect of restrained eating on central obesity. Given that women in the current study reported more restrained, emotional, and external eating than men, future studies with larger samples should follow-up by assessing for potential moderating effects of gender. The present findings suggest that decreasing restrained eating style may lead to less central fat deposition and hence reduced cardiometabolic risk. Such “non-diet” interventions show potential for improved cardiometabolic health, but more research is needed. Particularly needed are studies examining prevention and intervention outcomes based on type of restrained eating – flexible versus rigid – to better understand how these different subtypes operate and how they can be altered effectively to improve health.

Although recent data suggest the existence of anti-fat attitudes, fear of fatness, and maladaptive eating attitudes among Indian women, few researchers have examined the cross-cultural validity of their instruments before assessing Indian samples. The present study assessed the measurement equivalence of three related measures, the Anti-Fat Attitudes Scale, the Goldfarb Fear of Fat Scale, and the Eating Attitudes Test-26, and tested the invariance of latent means among Indian (n = 226) and Euro-American (n = 211) female college students. Multi-group confirmatory factor analyses using maximum likelihood estimation with robust standard errors demonstrated reasonable measurement equivalence of the instruments across Indian and Euro-American groups. Confidence interval comparisons of latent means suggested that the Indians and Euro-Americans did not differ significantly in levels of fear of fatness or eating attitudes, but there were some group differences in anti-fat attitudes. Structural equation modeling suggested that fear of fatness and anti-fat attitudes predict about 66% of the variance in Indian eating attitudes; however, these results must be interpreted cautiously due to a poorly fitting measurement model. Results of multiple regression analyses suggested that the eating attitudes of the Indian respondents were not significantly predicted by theirsocioeconomic status or degree of Westernization. In conclusion, these data suggest that there are some similarities, but also some important differences, in the eating-related attitudes and behaviors of Euro-American and Indian women.

Eating disorders are known for their chronic and relapse-ridden course. The cyclical nature of these disorders poses not only grave physical and mental health risks for the sufferer; it also presents serious challenges for the treating professionals and places a high demand and cost on the health care system. In spite of extensive research, no reliable predictors of long-term EDs have been identified in either adult or adolescent populations, nor have treatments emerged that are specifically targeted towards treating those with a long-term ED. It is fundamental to understand who is at risk and what factors are involved in long-term EDs, as the clinical and treatment implications gleaned from this evidence could be quite impactful. The current project will include three studies that will explore long-term EDs in a large transdiagnostic sample of adolescents with an ED. It will also attempt to overcome methodological limitations associated with past studies of this type, and apply an operational definition of this course of illness that may provide a more reliable and valid method with which to identify these cases. As such, the use of the term refractory ED, defined as a return to same-type treatment, will be applied to best identify this group. The three studies proposed in this research project will provide long overdue information on predictors, profiles and growth trajectories of those adolescents who suffer from a refractory course of an ED. This research project attempts to answer the question of: who will be affected, and how will the individual be affected by a refractory ED. With the ability to identify these cases and how the course of illness is being affected, treatment approaches can better aim to provide the appropriate treatment to those individuals most at risk of suffering from a refractory course of illness.