Temporalización de la investigación

Although research has established a link between binge eating behaviors and obesity or weight-related health disorders, little attention has been devoted to the

relationship between eating behaviors and problem-solving styles and planned behavior.

Binge eating disorders are traditionally investigated from a clinical standpoint in which the behavior has resulted in bulimia nervosa (Fingeret, Warren, Cepeda-Benito, &

Gleaves, 1996), or by assessing dietary management, treatment programs, psychosocial interactions, physical risks, medication, and clinician skill in the treatment process (Treasure, Tchanturia, & Schmidt, 2005). The purpose of this chapter is to discuss the roles of decision making and planned behaviors on eating behaviors. These assessments underscore the need to expand research in this area to promote alternative means to resolve binge eating behaviors and associated health-related disorders.

Organization of Chapter

This review defines current literature regarding binge eating behavior, the TPB, and the adaption-innovation theory. The chapter begins with a broad overview of how binge eating has been researched and includes research surrounding how social

influences affect eating behavioral decision-making strategies and body mass. Next, the TPB is discussed with a focus on current research surrounding eating behaviors. The adaption-innovation theory is then examined to address previous research on the relationship between cognitive decision making style and behavior. This chapter builds on the literature to demonstrate the need to conduct research to understand how eating

behavior in the adult population may be associated with internal and external decision-making processes.

Strategy for Literature Review

Information in this review was obtained from a multitude of scholarly journals and primary author books. The majority of the literature was obtained from EBSCOhost databases which include Mental Measurements Yearbook, PsycARTICLES, SocINDEX, Health Source: Nursing/ Academic Edition, Academic Search Premier, and CINAHL Plus. The review focuses on articles published in the last ten years but does include several later references from the original authors of the TPB and the adaption-innovation theory. Search terms include, but are not limited to the following: binge eating,

overeating, TPB, cognitive style, adaption and innovation, body mass index, problem solving, obesity, food addictions, food behavior, social eating, dietary restraint, diets, food intake, health attitudes, hunger, health behavior, eating disorders, body image, and decision making.

Content

The scope of this literature review includes binge eating and general eating behaviors as they are associated with psychological decision making processes, and behaviors regarding food selection processes for binge eating and obesity issues, psychological and social implications, the TPB, health behaviors, binge behaviors, and adaption-innovation theory of problem solving style. Some clinical eating disorders and general obesity related disorders are out of the scope of this research including general knowledge regarding overeating behaviors, caloric intake, exercise behaviors, and

biological and genetic related eating disorders or obesity in addition to others are excluded from review. Additionally, cognitive behavioral treatments and

psychopharmacological treatments are out of scope of this research.

Quantitative and Qualitative Methodologies

Literature related to the use of differing methodologies to investigate the

outcomes of interest has been reviewed. Qualitative research is quite prevalent in the area of addressing eating behaviors as many researchers use ethnographical techniques or one on one interview techniques. For example, clinician based interviews have been used to assess psychopathology in eating disorders (First, Spitzer, Gibbon, & Williams, 1997).

Additionally, binge eating behaviors have been qualitatively documented during diagnostic interviews (Mitchell & Peterson, 2008). Medical practitioners have also incorporated qualitative analyses into identifying any potential barriers for obesity focused assessments (Fairburn & Brownell, 2002). For the purpose of this literature review the quantitative methodology was focused on although multiple qualitative studies have been cited. This is based on the selected predictor and criterion variables which are quantitative in nature.

Binge Eating

Eating disorders have been popularized with the increase in television and media exposure surrounding young females with body image disorders and anorexia and bulimia are now household terms (Serdar, 2005). For most individuals the more

prominent eating disorder is that of overeating or deviating from a normal eating pattern which can lead to obesity. Fairburn (2008) defines regular eating as consisting of a

pattern of consuming breakfast, a small midday snack, lunch, a small afternoon snack, dinner, and a small evening snack. Binge eating, in contrast, is defined as an episode of uncontrolled eating that is usually triggered by an event, a mood, or by breaking a dietary rule. Binge eating often results in feelings of uncomfortable fullness after eating, shame, and guilt. Those who binge may feel uncomfortable fullness after consumptions. Binge eating disorder was introduced in 1992 and has been used to describe excessive eating without purging the food to lose weight, often resulting in obesity (Academy for Eating Disorders, 2008). Yet binge eating has not been officially recognized as an eating disorder in the American Psychiatric Association’s (2000) Diagnostic and Statistical Manual (DSM- IV-TR), as it is considered to be in the category of Eating Disorder Not Otherwise Specified (EDNOS). Although binge eating is more common among women than men, it is a challenge that affects Hispanics Americans, African Americans, and European Americans fairly equally (Regan & Cachelin, 2006).

Eating Behaviors and Food Choices

A binge eating episode is defined as having a sense of lack of control over a period of eating which includes a consumption of food that is traditionally larger than what would be considered to be normal by others in the same situation (Fairburn, 1995).

Binge eating can also represent the deviation from an eating plan or program associated with health requirements such as avoiding simple carbohydrates when diabetic or avoiding salt with hypertension diseases (Sohn, 2008). Foods that are most often

consumed in a binge eating episode noted in those with clinical disorders include but are not limited to ice cream, popcorn and salty foods, cheese, cereal, candy, and donuts; the

range of caloric intake can vary from 1,200 to 11,500 over a period of 15 minutes to 8 hours (Mitchell, Pyle, & Eckert, 1981). Although these boundaries have been specified, less research is available for those suffering with overweight-related binge eating who eat a variety of foods in a rapid manner after they have skipped meals or avoided specific foods for a period of time due to dieting.

Binge eating has also been associated with behaviors such as breaking a dietary rule. These behaviors could include eating something considered to be fattening or salty, eating alone, having premenstrual tension, drinking alcohol, or having a lack of a dietary routine (Abraham & Beumont, 1982; see Figure 1). Body image dissatisfaction is also associated with having higher incidences of dieting, unhealthy eating behaviors, and binge eating (Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006). Women with binge eating disorder rate body image dissatisfaction as higher influences on their behaviors than do men; however, men also rate body image dissatisfaction as

contributing factors to binge eating disorder behind depression and self-esteem (Grilo &

Masheb, 2005; Grilo et al., 2005). Age of onset of binge eating or individual age does not seem to be a predictor of binge eating disorder or adult obesity (Masheb & Grilo, 2008).

Yet, there are biological and social reasons associated with eating behaviors that may develop in early childhood that contribute to lifelong decisions about eating.

Figure 1. Note. From “Cognitive behavior therapy and eating disorders (p. 140) by C. G.

Fairburn, 2008, New York, NY: The Guilford Press. Copyright 2008 by Fairburn.

Reprinted with permission.

Food Selection and Binge Eating

Food selection and availability also play a role in understanding eating behaviors.

Humans are no longer dependent on eating readily and obsessively when food is made available to us in an effort to survive thanks to mass agriculture, so it is important to be aware of consumption behaviors. One particular less formal type of dining, often called a buffet, offers a different view of the implications eating behaviors and decision-making processes. Dietary diversity traditionally is looked on as a benefit to diet maintenance and overall nutritional health (Toray & Cooley, 1997). However, there are also negative implications to diet diversity. For example, if people are presented with a wide variety of high-caloric foods low in nutritional value they will eat more than they normally would if they were only presented with one option (Kennedy, 2004). The same concept applies from a positive-incentive perspective because the desirability to eat one food decreases

Binge Analysis

•

Breaking a dietary rule

•

Being disinhibited (e.g. alcohol)

•

Under eating for a period of time

•

Adverse event or mood

BINGE EATING

upon consumption. However, when presented with a wide variety of food options, such as a cafeteria, the positive-incentive desire to indulge in the rest of the foods is not as strong as with the first item, but it still exists and contributes to overeating (Nayga, 2000).

The pleasure of each food and the positive incentive of the value of taste for each new food will decrease (Pinel, 2006). Although the human stomach can hold one liter of food comfortably, in many situations, such as being presented with a variety of food options, it can be pushed to hold two liters even though there are chemical and stretch receptors that are signaled when overeating occurs (Toray & Cooley, 1997).

Biological factors also contribute to binge eating. The brain codes food choices in the orbitofrontal cortex and assigns a value with the level of reward a person experiences when consuming a specific food (Zald, 2008). This area of the brain responds to tastes, the visual appearance of food, aromas, and texture and makes decisions regarding food selection. Recent research demonstrated that binge eating occurred in patients after self-reported satiety; these patients had various levels of abnormal functioning in their orbitofrontal cortex (Woolley et al., 2007). These findings suggest this area of the brain places greater value on the immediate reward of certain food selections over long-term rewards such as long-term health and weight management (Zald, 2008).

Social psychologists have noted non-biological instances that contribute to binge eating behaviors. For example, the positive incentive theory suggests that individuals eat out of habits, social stimuli, the physical appearance and smell of food, and other reasons unrelated to biologically-induced hunger (Pinel, 2006). Food selections in binge eating

behaviors seem consistent with this theory. Eating patterns are often based on consumption habits and are not always based upon eating behavioral goals.

Many individuals are not aware of the external factors that mold their eating habits. For example, in a study conducted by the University of Toronto, 120 female college students were observed eating either alone or with friends (Liebman, 1995). The students who ate alone consumed 375 calories, whereas the students who ate with friends consumed over 700 calories, suggesting that social factors influence how much someone eats and the social influence usually results in increased consumption. In an additional study, a group of college students was given unlimited access to mini pizzas and they were allowed to consume as many of the pizzas as they wanted in the group setting while they watched television together (Herman et al., 2005). The results showed that members of the group ate similar amounts of pizza during the timeframe, again suggesting that the group environment dictated the eating behavior.

Social influences can also positively influence eating behaviors. Neumark-Sztainer, Wall, Story, and Fulkerson (2004) used logistical regression in a population of 4746 ethnically diverse adolescent females and noted that 18.1% of those females who ate 1-2 meals per week with their family reported eating disorders whereas only 8.8% of females who ate 3-4 meals with their family reported similar behaviors. Additionally, in a study by Vartanian, Herman, and Wansink (2008) two groups participated in a study which measured their awareness of the influences that dictated their food selection process. Variables such as eating partners, hunger, taste, satiety, free will and behavior of co-eater were taken into consideration to assess the determinants of food consumption for

each individual. The results suggested that although the individuals were able to

determine what factors contributed to their partner’s eating behavior they were unable to recognize these behaviors in their own eating behaviors. This suggests that subconscious social cues may also play a role in eating behaviors.

Psychological and Sociological Implications

Fairburn (2008) noted that many individuals who participate in a binge do not necessarily eat an extreme amount of food nor do they always experience guilt. Rather, they may feel an overwhelming awareness of their body image as a result which could result in excessive temporary dieting which increases the risk for repeat binge episodes or they could be disinhibited, such as being under the influence of alcohol, which

contributes to the episode. A person is considered to have binge eating disorder if quality of life is affected but, this can also be caused by emotional issues that initiate a binge eating period.

For example, Chua, Touyz, and Hill (2004) demonstrated that the induction of a negative mood after viewing a sad film did promote overeating in 40 obese female participants by assessing hunger motivation, dietary restraint, and food intake. In comparison with individuals with normal body mass indexes, overweight binge eaters had great concern with body image but had a tendency to over eat when they were in a negative mood (Eldredge & Agras, 1994). Negative affect has further been demonstrated to contribute to binge eating and abnormal eating behaviors (Lyubomirsky, Casper, &

Sousa, 2001).

In addition to the external social environment, social groups have proven to be significant influences on whether or not a person binges eats. Using two sorority groups Crandall (1988) found that the members of the sorority binged in equal frequencies and amounts compared to the mean of the other members of the group. Although this study noted the influence of social norms on eating behaviors, it did not address any cognitive decision-making styles for the individuals. Decision-making processes and social influences that do contribute to binge eating include a person’s role in the immediate family, cultural influences, early life experiences with in the family, community, and social class (Wethington, 2008).

Although social situations can influence eating behaviors, many individuals feel that binge eating behavior is a result of poor self-esteem or depression (Mond & Hay, 2008). Obese individuals self-report that binge eating behaviors are often a result of an inability to manage the social pressures in society to be thin (Sorbara & Geliebter, 2001).

These stereotypes and social pressures can be damaging and can encourage additional episodes of binge eating that contribute not only to the negative psychological health of the individual but also impacts negative physical health.

Much research has been dedicated to understanding how binge eating is related to overall health, obesity, and body mass index (BMI). The cycle of binge eating results in challenges maintaining a healthy BMI, risks to being obese, challenges losing weight, and weight regain (Elfhag & Rössner, 2004) although binge eating has been reported approximately equally in women at all levels of the body mass index scale (Shisslak et al., 2006). Weight maintenance, which means a person does not regain weight that was

successfully lost prior, is influenced by many variables such as social factors, personal motivation, realistic goal measurement, eating restraint, and binge eating. Binge eating specifically has been found to be related to weight regain over a five year period in patients who have had multiple forms of obesity related surgery (Pekkarinen, Koskela, Huikuri, & Mustajoki, 1994).

All of these health implications can be related to motivation and problem solving styles. However, limited research has been conducted in these areas including the theory that assesses planned behavior and relationships with motivation. Rather, the majority of research focuses on the implications of cognitive behavioral therapy and

psychopharmacological solutions (Fairburn, 2008; Grilo, Masheb, & Wilson, 2006; Kaye, Bastiani, & Moss, 1995). Guided self-help programs using cognitive behavioral therapies have demonstrated success for treating BED but have not proven successful as a first step for individuals with BED who are considered obese (Grilo & Masheb, 2005).

Cognitive behavioral therapies such as self-help programs and motivational interviewing are considered to be the treatments of choice for BED according to a study by Dunn, Neighbors, and Larimer (2006). In this study 90 undergraduate college students received either motivational enhancement therapy or a self-help manual to promote their readiness to change eating behaviors. Using repeated measures ANOVA there was an increase in both groups for being able to abstain from binge eating episodes temporarily. However, this does not contribute to understanding the intentions of the individuals who abstained or did not abstain nor do these studies contribute to

understanding how people make decisions about eating behaviors. With all of the focus

on therapeutic interventions and lack of research in surrounding prevention, it is important to understand underlying theories of overall health behaviors.

Theory of Planned Behavior

Factors that have been noted to prevent eating disordered behaviors include general knowledge about nutrition, an understanding of eating pathology, dieting

behaviors, thin-ideal internalization, and body dissatisfaction (Fingeret, Warren, Cepada-Benito, & Gleaves, 2006). However, understanding how a person’s internal cognitive decision making process with regard to how it applies to poor eating behaviors has had limited discussion. The TPB is one theory that can be used to investigate a person’s intention and perceived behavioral control when applied to health behaviors.

The TPB is an extension of a model called the theory of reasoned action which was developed by Fishbein and Ajzen (1975). The original theory of reasoned action suggested that individuals systematically assessed a variety of inputs before making a decision whether or not to act on or avoid acting on a certain behavior. These inputs include individual beliefs, social influence, attitude towards a behavior, importance of attitude and subjective norms, and the person’s overall intention for the attitude. This theory was extended by Ajzen with the addition of the concept of perceived behavioral control (Ajzen, 1988). The addition of perceived behavioral control as a component can measure the effect a person’s experience with acting on a specific behavior has upon the current ability to perform the behavior (see Figure 2).

Figure 2. Note. From “Constructing a theory of planned behavior questionnaire” by I.

Ajzen, 2009, TPB Model, Retrieved February 15, 2009 from: www.people.umass.edu.

Copyright 2006 by I. Ajzen. Reprinted with permission.

Armitage et al. (1999) noted that the TPB has been studied in relationship to a variety of social psychology issues including eating behaviors and binge drinking.

Psychologically this theory is similar to understanding how a person measures locus of control; however, it also measures a person’s feeling of control over a behavior rather than just the internal control of events. Even with compelling evidence regarding the dangers of unhealthy eating behaviors many individuals still demonstrate ambivalence regarding changing their eating behavior and as this is often a result of personal decisions and social influences (Snow, 2000).

The TPB was created to understand the interactions of beliefs, attitudes, and social influences on a person’s final behavior with regard to personal intentions (Ajzen, 2008). The model has three tiers. The first tier is that a person will have behavioral

beliefs surrounding whether or not a specific behavior will result in an outcome which impacts personal attitudes towards a behavior (Armitage et al., 1999). The second tier addresses normative beliefs (which are perceived behavioral expectations of individuals the person feels is important) and subjective norms (which are the perceived social pressure to perform the specific behavior) as they apply to an initial behavioral belief

beliefs surrounding whether or not a specific behavior will result in an outcome which impacts personal attitudes towards a behavior (Armitage et al., 1999). The second tier addresses normative beliefs (which are perceived behavioral expectations of individuals the person feels is important) and subjective norms (which are the perceived social pressure to perform the specific behavior) as they apply to an initial behavioral belief

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