This may sound counterintuitive at first, but I’m thankful for two aspects of my eating disorder, which I believe helped me make the choice to aim towards recovery: the development of binge eating after chronic food restriction and the physical inability to purge through self-induced vomiting. Like many individuals diagnosed with anorexia nervosa that go on to develop binge eating, I tended to choose high-fat foods and sweets as my “go-to” food items. I had always enjoyed such foods and was a notorious junk food aficionado as a young girl (way before any eating disorder symptoms developed). Once the bingeing behavior started, I couldn’t stop.
Sitting with the discomfort after a binge made me seriously consider whether this was something I could maintain for any lengthy period of time, and that’s when I started getting help. In a sense, I believe my affection for sweet foods, and propensity to binge on them, was a “life saver” of sorts. I also think these behaviors got me used to eating foods that I had deemed “forbidden” while I was restricting. With this forced confrontation, I was determined to start developing a healthy relationship with these foods again.
Given my history, the recent article by Witt and Lowe (2013), examining the power of hedonic hunger (the drive to eat to obtain pleasure in the absence of an energy deficit) among anorexia and bulimia nervosa patients to lead to binge eating, caught my eye. I was particularly interested in how this article may inform recovery outcomes, and hypothesized that those who found food to be more “pleasurable” would be more likely to develop binge eating behaviors and may eventually be more likely to develop a healthy relationship with food again.
The authors examined how individual differences in subjective ratings of attraction and motivation to consume highly palatable foods may relate to the development of binge eating behaviors among individuals with AN and BN. They assessed these differences using the Power of Food (PFS)11 scale, a questionnaire used specifically assesses motivation TO eat, but NOT how much food is actually consumed, providing a measure of food motivation independent from food consumption patterns.
Assessing the role of hedonics in food-related motivation can be tricky. Pure hunger from low energy balance can also enhance motivation to eat and influence subjective ratings of the rewards anticipated from food consumption. This influence can be hard to disentangle from motivation to eat because food is pleasurable. The PFS scale has been shown to be predictive of the consumption of palatable foods, but not food in general. In studies of overeating in obese populations, it has been shown to predict “loss of control” over food intake, but not BMI in these populations.
Taken as a whole, the PFS seems to assess hedonic drive to overeat palatable foods; it doesn’t seem to reflect patterns of food intake that are related to metabolic influences or general hunger states. However, this scale has only been used in obesity studies in the past, and has yet to be used to examine how hedonic motivation to consume food may impact symptoms of AN and BN and how it may affect recovery from these disorders.
The authors administered the scale to 119 AN and 144 BN patients admitted to a residential treatment facility. Then, they monitored fluctuations in hedonic hunger and weight change during treatment, controlling for the impact of variables such as pre-treatment BMI.
WHAT DID THE AUTHORS FIND?
- Higher PFS scores were associated with an INCREASED LIKELIHOOD of subjective and objective binge eating among both AN and BN patients.
- Higher PFS scores were associated with HIGHER BMI in the AN sample.
- Higher PFS scores PRIOR to treatment were associated with weight gain in the AN but not BN sample.
- The BN group had the highest PFS scores, followed by anorexia nervosa binge/purge subtype, and anorexia nervosa restricting subtype, suggesting that the hedonic drive to eat may contribute to different eating disorder symptoms.
So, it seems like having a higher level of hedonic hunger is good for recovery outcomes in anorexia nervosa? My personal experience validates by this assertion. I feel like having an affinity for palatable foods before my eating disorder made me more capable of regaining the ability to enjoy food again. However, I must remember to not let my personal experience bias my interpretation of the results. In fact, the authors never assert that this study was meant to examine treatment outcomes, but rather to assess whether the PFS could be informative in an eating disorder sample.
It is important to emphasize that this study only examined individuals in a treatment setting and used BMI change as the primary indicator of compliance with treatment. It is not known whether those individuals that gained more weight actually felt like they were more recovered. Personally, I would love to see a follow-up on these patients to see if those in the AN population with higher PFS scores were more likely to maintain a recovered state. It is likely that some crossed over to a diagnosis of BN, but the question is how many? I’m really interested in seeing if this scale could be a useful indicator of recovery prognosis.
Witt, A.A., & Lowe, M.R. (2013). Hedonic hunger and binge eating among women with eating disorders. The International Journal of Eating Disorders PMID: 24014479