Elsevier

Appetite

Volume 43, Issue 3, December 2004, Pages 303-307
Appetite

Impulsivity and test meal intake in obese binge eating women

https://doi.org/10.1016/j.appet.2004.04.006Get rights and content

Abstract

Greater impulsivity has been observed in those with chemical (cocaine, marijuana, alcohol) and behavioral addictions (gambling, sex, shopping), as well as in individuals with personality and conduct disorders. Greater impulsivity has also been described in those with Bulimia Nervosa and attributed to aberrations in serotonin, as has eating in response to negative affect.However, less is known about the impact of impulsivity on eating behavior in obese humans in general, and in those who meet sub-clinical and full clinical criteria for Binge Eating Disorder (BED) in particular. Using a laboratory test meal paradigm, we demonstrated: (1) greater Motor Impulsivity (Barratt Impulsivity Scale (BIS) (p=0.05) in those with BED (n=11) as compared to those without BED (n=11), (2) a positive correlation between BED criteria and BIS scores (p<0.01), (3) a positive correlation between test meal duration and Zung Depression Score, and (4) a positive correlation between Motor Impulsivity and mood rated before consuming the test meal. These associations suggest potential aberrations in serotonin transmission in BED, and a possible target for pharmacotherapy of BED especially in those who are resistant to Cognitive Behavioral Therapy.

Introduction

Current literature define impulsivity as (1) the inclination to choose small, immediately available rewards over larger, delayed rewards, and/or (2) the inclination to respond rapidly without forethought and/or attention to consequences (Evenden, 1999, Swann et al., 2002). Greater impulsivity has been reported in those with chemical (cocaine, alcohol, nicotine) (Allen et al., 1998, Richards et al., 1999, Mitchell, 1999) and behavioral addictions (gambling, sex, shopping) as well as in those with personality and conduct disorders (Hollander & Evers, 2002), where it correlates with severity of dependence or disordered state. Some investigators, using treatment program patients, report greater impulsivity in individuals with eating disorders compared to normal controls (Fahy and Eisler, 1993, Newton et al., 1993, Wolfe et al., 1994, Keel and Mitchell, 1997). Bushnell et al. (1996) reports that rates of impulsivity in those with substance use disorder or Bulimia Nervosa (BN), who are not in treatment programs, are no greater than in the general population. Furthermore, he cautions that eating disorder patients in treatment programs, who often have multiple co-morbid conditions, may show greater impulsivity and therefore not be representative of individuals with eating disorders in general.

The lack of consistent association of impulsivity with treatment response lends support to Bushnell's suggestion for caution. Wolfe et al. (1994) report that in BN patients, impulsivity did not correlate with frequency of binge eating episodes, while Fahy and Eisler, 1993, Keel and Mitchell, 1997 found association between poor treatment response and high impulsivity in patients with BN. Steiger et al. (2001) demonstrated that impulsivity in women with BN is related to decreased serotonin functioning, and Fischer, Smith, and Anderson (2003) suggest that impulsivity in those with BN, correlates with eating in response to negative affect, which is also related to aberrant serotonin functioning. The lack of association between impulsivity and severity of binge eating in BN may be related to variations in serotonin aberrations among individuals with BN. Another possibility as Fischer et al. (2003) suggest, is that a different component of impulsivity, i.e. ‘urgency’ impulsivity (the tendency to act rashly when experiencing negative affect) rather than the more commonly assessed ‘lack of planning’ impulsivity, correlates positively with bulimia symptoms. Fischer et al. results would seem to agree with those of Steiger, Lehoux, and Gauwin (1999) who reported that the ‘urge to binge’ correlates with ‘dietary cognitive control’ in BN individuals with low impulsivity but not in those with high impulsivity. Prior work of Herman and Polivy, 1980, Heatherton and Baumeister, 1991 demonstrated a correlation between ‘dietary cognitive restraint’ and incidence of binge eating, and high dietary cognitive restraint is common in those who are obese (Herman & Polivy, 1980).

Very little has been noted about impulsivity and Binge Eating Disorder (BED) in obese individuals, and available instruments to measure impulsivity (Eysenck and Eysenck, 1977, Barratt Impulsivity Scale, Patton, Stanford, & Barratt , 1995) do not specifically include items related to eating behavior. Barratt (1993) describes the impulsive person as someone who acts without thinking, acts on the spur of the moment, is restless when required to sit still, likes to take chances, is happy-go-lucky, has difficulty in concentrating, and is a doer and not a thinker.The clinical definition (DSM-IV) for BED includes a number of criteria which could be considered descriptive of impulsive behavior, namely: (1) intake of an abnormally large amount of food in a short period of time, (2) the frequency of binge episodes, and (3) being embarrassed and disgusted about overeating which leads to eating in isolation, (4) lack of control over eating during a binge episode, (5) eating more rapidly, (6) eating when not physically hungry, (7) eating until one feels uncomfortably full. Consequently, we aimed to investigate the relationship between impulsivity, laboratory test meal intake (which is increased in those with BED, Geliebter, Hassid, and Hashim (2001), and correlates with their larger gastric capacity, Geliebter, Yahav, Gluck, & Hashim, 2004), self-reported binge eating symptoms, and negative affect in obese women enrolled in a weight loss research study. We hypothesized that women meeting criteria for BED would show greater impulsivity as measured by the three subscales of the Barratt Impulsivity Scale (BIS, Patton et al., 1995). The three subscales of the BIS include: Nonplanning Impulsivity, characterized as ‘present orientation or a lack of futuring’; Motor Impulsivity, defined as acting without thinking; and Cognitive Impulsivity, the making of quick decisions. Additionally, we hypothesized that measures of food consumption from a laboratory test meal study (intake, duration) as well as selected BED criteria would correlate positively with BIS scores, and that impulsivity and performance in the test meal would be positively correlated with negative affect.

Section snippets

Participants

Obese individuals were recruited through local advertisements for participation in an outpatient weight loss program at the New York Obesity Research Center of St Luke's/Roosevelt Hospital. During the initial phone interview, participants were screened for serious illness such as heart disease, cancer, and diabetes. Women could not be pregnant or lactating. A physical examination including medical history, ECG, and blood tests, was performed to ensure otherwise good health. The study protocol

Results

Demographic characteristics (Section 2) of the groups are displayed in Table 1. A significant difference was observed between the groups in the BES score (p=0.015) with BED>Binge Eaters∼Controls, and in the Zung score (p=0.037) with BED>Binge Eaters=Controls. No significant difference was observed in Restraint score between the groups or in age, weight, BMI, or rating of mood before the test meal.

Table 2 shows the test meal measures and BIS Impulsivity scores in the three groups. There was no

Discussion

We observed a significant difference in the BIS-Motor subscale, with greater Motor Impulsivity in BED than in controls, as well as a significant correlation between BED status and duration of the test meal, a positive correlation between Zung Depression score and duration of the test meal, and a positive correlation between mood rating before the meal and Motor impulsivity. Since the Motor subscale of the BIS measures the tendency to ‘act without thinking’ or rather, to react; these

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