Impulsivity and test meal intake in obese binge eating women
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
References (25)
- et al.
Impulsivity and history of drug dependence
Drug and Alcohol Dependence
(1998) - et al.
Gastric capacity, test meal intake, and appetitive hormones in binge eating disorder
Physiology and Behavior
(2004) - et al.
The assessment of binge eating severity among obese persons
Addictive Behaviors
(1982) - et al.
Two models of impulsivity: relationship of personality traits and psychopathology
Biological Psychiatry
(2002) Impulsivity: integrating cognitive, behavioral, biological and environmental data
- et al.
Impulsivity in disordered eating, affective disorders and substance use disorders
British Journal of Psychiatry
(1996) Varieties of impulsivity
Psychopharmacology
(1999)- Eysenck, S. B., & Eysenck, H. J. (1977). The place of impulsiveness in a dimensional system of personality description....
- et al.
Impulsivity and eating disorders
British Journal of Psychiatry
(1993) - et al.
Clarifying the role of impulsivity in bulimia nervosa
The International Journal of Eating Disorders
(2003)
Test meal intake in obese binge eaters in relation to mood and gender
The International Journal of Eating Disorders
Binge size increases with body mass index in women with Binge eating disorder
Obesity Research
Cited by (144)
Characterizing motor impulsivity of individuals classified as overweight to obese
2023, Sports Medicine and Health ScienceThe role of rash impulsivity and sensitivity to reward in soft drink consumption
2022, AppetiteCitation Excerpt :Impulsive tendencies have been linked to the development and maintenance of excessive consumption behaviour both in the general population and in clinical samples. For example, researchers have found that both obese men (Rydén et al., 2003) and women (Nasser, Gluck, & Geliebter, 2004) are more impulsive than normal-weight controls. Impulsivity has also been positively correlated with binge eating (Giel, Teufel, Junne, Zipfel, & Schag, 2017) and excessive food consumption (Guerrieri, Nederkoorn, & Jansen, 2007; Murphy, Stojek, & MacKillop, 2014).