A randomised controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): a new approach to compulsive exercise in anorexia nervosa

Objective: To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualised cognitive behavioural therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. Method: Seventy-eight adults were randomised to CBT-AN, delivered with or without 8 embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6-months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. Results: There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of- treatment participant satisfaction were satisfactory across both conditions. Discussion: CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs towards exercise and general improvements in BMI and eating disorder psychopathology in people with AN

The short inventory of grazing (SIG): development and validation of a new brief measure of a common eating behaviour with a compulsive dimension

Abstract Background Grazing, the repetitious and unplanned eating of small amounts of food with or without a sense of loss of control (LOC), is an eating pattern of recent interest which is highly prevalent in eating disorders and obesity. The current study aimed to (1) assess psychometric properties of a short inventory of grazing (SIG), consisting of a “grazing in general” item and a “compulsive/LOC grazing” item and (2) examine associations between compulsive and non-compulsive grazing and body mass index (BMI), eating disorder psychopathology, distress and health-related quality of life. Methods Participants recruited from a university and the community (n = 227; 75.3% female; age = 25.00 (9.88; 17.58–57.17) years; BMI = 23.24 (4.91, 14.20–46.06) kg/m2) completed an online test battery including the SIG. Parametric and non-parametric statistics were computed to assess internal consistency, test-retest reliability and construct validity, to test associations between the SIG and the other study variables, and to examine between-group differences. Results The SIG demonstrated appropriate psychometric properties. Results indicated that both grazing in general and low-frequency LOC grazing are common; however, LOC grazing of moderate-severe frequency and/or associated with marked distress is unusual. Frequency of LOC grazing, but not grazing in general, was significantly associated with higher BMI, psychological distress, compensatory behaviours and lower mental health-related quality of life. The presence of compulsive grazing was also associated with eating disorder caseness and binge-type eating disorder diagnostic groups. Conclusions Results support the positioning of “compulsive” LOC grazing on a continuum of problematic eating. The SIG is a parsimonious measure of this eating pattern of emergent interest

Grazing Prevalence and Associations with Eating and General Psychopathology, Body Mass Index, and Quality of Life in a Middle-Income Country

Research from high-income countries has shown that grazing is a common but problematic eating pattern, particularly when associated with a sense of loss of control. However, it is unclear whether these patterns hold globally. Thus, the goal of this study was to extend previous research by examining the prevalence and clinical correlates of compulsive grazing (CG) and non-compulsive grazing (NCG) in a middle-income country. Participants (N = 2297) comprised adult residents from Rio de Janeiro, Brazil. Recruitment of this population-based household survey occurred from September 2019 to February 2020. The short inventory of grazing was used to operationalise grazing subtypes. Chi-square analyses, logistic regression, and univariate tests were conducted using the complex samples procedure. The point prevalence of regular CG was 10.2% (n = 239) and was consistent with high-income countries, while NCG was 29.8% (n = 679) and was less frequent than reported in high-income countries. Additionally, similar to high-income countries, CG was associated with a higher body mass index and higher odds of eating disorders, eating disorder symptomatology, depression, anxiety, and a lower physical and mental health-related quality of life, than no grazing and NCG. Overall, this study demonstrated that grazing patterns in high-income countries extend to middle-income countries

Grazing in adults with obesity and eating disorders: A systematic review of associated clinical features and meta-analysis of prevalence

Grazing, the unstructured, repetitive eating of small amounts of food, is a pattern of eating which has been associated with negative outcomes following bariatric surgery. Less is known about grazing in eating disorders and in non-surgical obese samples. This review aims to critically examine the existing research on the prevalence of grazing, associated treatment outcomes, and clinical correlates in adults with eating disorders and/or obesity, in clinical and community settings. A systematic electronic database search yielded 38 studies which met inclusion criteria for the review. A meta-analysis was conducted using prevalence data from 32 studies (31 datasets). Mean pooled prevalence in obesity (n = 26 studies) was 33.20% (95% CI [27.54, 39.11]) at pre-weight loss treatment, 28.16% (95% CI [17.86, 39.73]) at follow-up, and 23.32% (95% CI [3.07, 52.04]) in the community. Nine studies provided prevalence estimates in eating disorders: 58.25% (95% CI [52.75, 63.66]) in bulimia nervosa; 67.77% (95% CI [44.96, 87.13]) in binge eating disorder; and 34.31% (95% CI [26.56, 42.49]) in anorexia nervosa. The results suggest that grazing is widely prevalent within obesity and eating disorders. There is mixed evidence to suggest that grazing (especially a "compulsive" subtype including a sense of loss of control) is associated with poorer weight loss treatment outcomes in obesity, lower mood, increased eating disorder symptomatology, and decreased mental health-related quality of life. Differences in the operationalisation of grazing may account for inconsistent findings in regards to specific correlates and risks associated with this behaviour; therefore, there is an urgent need to refine and adopt a consistent definition of grazing