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THE GUILFORD PRESS
EATING DISORDERS AND OBESITY
Weight Bias: Nature, Consequences, and Remedies
Edited by Kelly D. Brownell, Rebecca M. Puhl, Marlene B. Schwartz, and Leslie Rudd
Eating Disorders and Obesity
A Comprehensive Handbook
THIRD EDITION
EDITED BY Kelly D. Brownell
B. Timothy Walsh
The Guilford Press
New York London
Copyright © 2017 The Guilford Press
A Division of Guilford Publications, Inc.
370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com
Paperback edition 2018
All rights reserved
No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2
The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources.
Library of Congress Cataloging-in-Publication Data
Names: Brownell, Kelly D., editor. | Walsh, B. Timothy, 1946– editor.
Title: Eating disorders and obesity : a comprehensive handbook / edited by Kelly D. Brownell, B. Timothy Walsh.
Description: Third edition. | New York : The Guilford Press, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2016028018 | ISBN 9781462529063 (hardcover) | ISBN 9781462536092 (paperback)
Subjects: LCSH: Eating disorders—Handbooks, manuals, etc. | Obesity— Handbooks, manuals, etc.
Classification: LCC RC552.E18 E2825 2017 | DDC 616.85/26—dc23 LC record available at https://lccn.loc.gov/2016028018
About the Editors
Kelly D. Brownell, PhD, is Dean of the Sanford School of Public Policy at Duke University, where he is also Robert L. Flowers Professor of Public Policy and Professor of Psychology and Neuroscience. Prior to joining the faculty at Duke, Dr. Brownell was the James Rowland Angell Professor of Psychology, Professor of Epidemiology and Public Health, and Director of the Rudd Center for Food Policy and Obesity at Yale University. His work focuses on obesity and food policy. Dr. Brownell has been named to the National Academy of Medicine (Institute of Medicine); has received numerous awards, including the Lifetime Achievement Award from the American Psychological Association; and in 2006 was named by Time magazine as one of the World’s 100 Most Influential People.
B. Timothy Walsh, MD, is Ruane Professor of Pediatric Psychopharmacology at the College of Physicians and Surgeons of Columbia University and Director of the Division of Clinical Therapeutics at the New York State Psychiatric Institute. The clinical research group he founded and has led at Columbia has conducted studies of the etiology and treatment of eating disorders, with a particular focus on underlying pathophysiological mechanisms. Dr. Walsh has served as president of the Academy for Eating Disorders and of the Eating Disorders Research Society, and chaired the Eating Disorders Work Group for DSM-IV and DSM-5. He has received awards from the American Psychiatric Association, the Academy for Eating Disorders, the National Eating Disorders Association, and the Association for Behavioral and Cognitive Therapies.
Contributors
Karina L. Allen, PhD, Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom; School of Psychology, University of Western Australia, Crawley, Western Australia, Australia
David B. Allison, PhD, Nutrition Obesity Research Center and Office of Energetics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Kelly C. Allison, PhD, Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Tatiana Andreyeva, PhD, UConn Rudd Center for Food Policy and Obesity, Hartford, Connecticut; Department of Agriculture and Resource Economics, University of Connecticut, Storrs, Connecticut
Louis J. Aronne, MD, Comprehensive Weight Control Center, Weill Cornell Medical College, Cornell University, New York, New York
Nerys Astbury, PhD, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
Arne Astrup, MD, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
Evelyn Attia, MD, Department of Psychiatry, Weill Cornell Medical College, Cornell University, and New York State Psychiatric Institute, New York, New York
S. Bryn Austin, ScD, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
Linda M. Bartoshuk, PhD, Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida
Bryan C. Batch, MD, Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
Anne E. Becker, MD, PhD, Department of Global Health and Social Medicine, Harvard Medical School, and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
Gary G. Bennett, PhD, Department of Psychology and Neuroscience and Duke Global Health Institute and Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
Laura A. Berner, PhD, Eating Disorder Center for Treatment and Research, Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla, California
Leann L. Birch, PhD, Department of Foods and Nutrition, University of Georgia, Athens, Georgia
Heidi M. Blanck, PhD, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jennie Brand-Miller, PhD, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
Gerome Breen, PhD, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Foundation Trust, King’s College London, London, United Kingdom
Kelly D. Brownell, PhD, Sanford School of Public Policy, Duke University, Durham, North Carolina
Rachel Bryant-Waugh, MSc, DPhil, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Cynthia M. Bulik, PhD, Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Meghan L. Butryn, PhD, Department of Psychology, Drexel University, Philadelphia, Pennsylvania
John Cawley, PhD, Department of Policy Analysis and Management and Department of Economics, Cornell University, Ithaca, New York
Frank J. Chaloupka, PhD, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
Jamie F. Chriqui, PhD, MHS, Division of Health Policy and Administration, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
Ilseung Cho, MD, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
Philip Chuang, MD, Department of Medicine, New York University School of Medicine, New York, New York
Scott Crow, MD, Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
Christopher R. Daigle, MD, FRCSC, The Bariatric Center, Cleveland Clinic Akron General, Akron, Ohio
Michael J. Devlin, MD, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York
William H. Dietz, MD, PhD, Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, DC
Dawn M. Eichen, PhD, Center for Healthy Eating and Activity Research Center, UC San Diego School of Medicine, University of California, San Diego, La Jolla, California
Ivan Eisler, PhD, Institute of Psychiatry, King’s College London, London, United Kingdom
Elissa S. Epel, PhD, Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California
Leonard H. Epstein, PhD, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, New York
Christopher G. Fairburn, DM, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, and Warneford Hospital, Oxford, United Kingdom
Myles S. Faith, PhD, Department of Counseling, School and Educational Psychology, Graduate School of Education, University at Buffalo, State University of New York, Buffalo, New York
Thomas A. Farley, MD, MPH, Department of Public Health, City of Philadelphia, Philadelphia, Pennsylvania
Lucy F. Faulconbridge, PhD, Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jennifer Orlet Fisher, PhD, Center for Obesity Research and Education, Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania
Paul C. Fletcher, MD, Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Jennifer I. Flynn, PhD, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Gary D. Foster, PhD, Weight Watchers International, New York, New York; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
Alexis C. Frazier-Wood, PhD, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas
Roberta R. Friedman, ScM, RFriedman Consulting, Hamden, Connecticut
Dympna Gallagher, EdD, New York Obesity Research Center, Columbia University, New York, New York
Ashley N. Gearhardt, PhD, Department of Psychology, University of Michigan, Ann Arbor, Michigan
Timothy Gill, PhD, Boden Institute and the Prevention Research Collaboration, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Neville H. Golden, MD, Division of Adolescent Medicine, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, California
Richard A. Gordon, PhD, Psychology Program, Bard College, Annandale-on-Hudson, New York
Steven L. Gortmaker, PhD, Department of Social and Behavioral Sciences, Harvard T. F. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
Carlos M. Grilo, PhD, Program for Obesity, Weight, and Eating Research, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
Angela S. Guarda MD, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
John Gunstad, PhD, Department of Psychological Sciences, Kent State University, Kent, Ohio
Kevin D. Hall, PhD, Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Jennifer L. Harris, PhD, UConn Rudd Center for Food Policy and Obesity, Hartford, Connecticut; Department of Applied Health Sciences, University of Connecticut, Storrs, Connecticut
Corinna Hawkes, PhD, Centre for Food Policy, City University of London, London, United Kingdom
Misty A. W. Hawkins, PhD, Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
Phillipa J. Hay, DPhil, MD, Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
Stephen T. Higgins, PhD, Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, Vermont
Andrew J. Hill, PhD, Institute of Health Sciences, Leeds University School of Medicine, Leeds, United Kingdom
Hans W. Hoek, MD, PhD, Parnassia Psychiatric Institute, The Hague, Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands; Department of
Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Adela Hruby, PhD, MPH, Nutritional Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
Frank B. Hu, MD, PhD, MPH, Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
James I. Hudson, MD, ScD, Department of Psychiatry, Harvard Medical School, and Biological Psychiatry Laboratory, McLean Hospital, Boston, Massachusetts
John M. Jakicic, PhD, Physical Activity and Weight Management Center, Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pittsburgh, Pennsylvania
Michelle A. Joyner, MS, Department of Psychology, University of Michigan, Ann Arbor, Michigan
Walter H. Kaye, MD, Eating Disorder Center for Treatment and Research, Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla, California
Pamela K. Keel, PhD, Department of Psychology, Florida State University, Tallahassee, Florida
Neha Khandpur, ScD, Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
Samantha M. R. Kling, PhD, Department of Nutritional Sciences, Pennsylvania State University, Philadelphia, Pennsylvania
Judith Korner, MD, PhD, Division of Endocrinology and Metabolism, Department of Medicine, Columbia University Medical Center, New York, New York
Shiriki K. Kumanyika, PhD, MPH, African American Collaborative Obesity Research Network, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
Rekha B. Kumar, MD, Comprehensive Weight Control Center, Weill Cornell Medical College, Cornell University, New York, New York
Robert F. Kushner, MD, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
Jason M. Lavender, PhD, Neuropsychiatric Research Institute, Fargo, North Dakota
Hannah G. Lawman, PhD, Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
Daniel Le Grange, PhD, Departments of Psychiatry and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
Rudolph L. Leibel, MD, Naomi Berrie Diabetes Center and Department of Pediatrics, Division of Molecular Genetics, Columbia University Medical Center, New York, New York
Tim Lobstein, PhD, World Obesity Federation, London, United Kingdom; Public Health Advocacy Institute, Curtin University, Bentley, Western Australia, Australia
Ruth J. F. Loos, PhD, Charles Bronfman Institute for Personalized Medicine and Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York
Katie A. Loth, PhD, MPH, RD, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
Michael R. Lowe, PhD, Department of Psychology, Drexel University, Philadelphia, Pennsylvania
Angela Makris, PhD, RD, private practice, Huntingdon Valley, Pennsylvania
Marsha D. Marcus, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Ashley E. Mason, PhD, Osher Center for Integrative Medicine, University of California, San Francisco School of Medicine, San Francisco, California
Laurel E. S. Mayer, MD, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, New York
Philip S. Mehler, MD, FACP, FAED, Eating Recovery Center, ACUTE at Denver Health, University of Colorado School of Medicine, Denver, Colorado
Marion Nestle, PhD, MPH, Department of Nutrition, Food Studies, and Public Health, New York University, New York, New York
Dianne Neumark-Sztainer, PhD, MPH, RD, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
Meghan L. O’Connell, MPH, UConn Rudd Center for Food Policy and Obesity, Hartford, Connecticut
Cynthia L. Ogden, PhD, MRP, Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
Emily Oken, MD, MPH, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
Russell R. Pate, PhD, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Lilia S. Pedraza, MSc, Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; National Institute of Public Health of Mexico, Morelos, Mexico
Katharine A. Phillips, MD, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, and Body Dysmorphic Disorder Program, Rhode Island Hospital, Providence, Rhode Island
Kathleen M. Pike, PhD, Department of Psychiatry, Columbia University Medical Center, and New York State Psychiatric Institute, New York, New York
Jennifer L. Pomeranz, JD, MPH, College of Global Public Health, New York University, New York, New York
Harrison G. Pope, Jr., MD, MPH, Department of Psychiatry, Harvard Medical School, and Biological Psychiatry Laboratory, McLean Hospital, Boston, Massachusetts
Lizzy Pope, PhD, RD, Department of Nutrition and Food Sciences, University of Vermont, Burlington, Vermont
Rebecca M. Puhl, PhD, UConn Rudd Center for Food Policy and Obesity, Hartford, Connecticut; Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
Claudia Ivonne Ramirez-Silva, PhD, National Institute of Public Health of Mexico, Morelos, Mexico
Eric Ravussin, PhD, Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
Graham W. Redgrave, MD, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Tirissa J. Reid, MD, Division of Endocrinology and Metabolism, Department of Medicine, Columbia University Medical Center, New York, New York
Juan A. Rivera, PhD, National Institute of Public Health of Mexico, Morelos, Mexico
Christina A. Roberto, PhD, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Thomas N. Robinson, MD, MPH, Departments of Pediatrics and Medicine, Stanford Solutions Science Lab, Division of General Pediatrics, and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
Renee J. Rogers, PhD, Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pittsburgh, Pennsylvania
Barbara J. Rolls, PhD, Department of Nutritional Sciences, Pennsylvania State University, State College, Pennsylvania
Michael Rosenbaum, MD, Department of Pediatrics, Division of Molecular Genetics, Columbia University Medical Center, New York, New York
James F. Sallis, PhD, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
David B. Sarwer, PhD, Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
Lauren Schaefer, MA, Department of Psychology, University of South Florida, Tampa, Florida
Philip R. Schauer, MD, Bariatric and Metabolic Institute, Cleveland Clinic, and Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
Ulrike Schmidt, MD, PhD, FRCPsych, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
Erica M. Schulte, MS, Department of Psychology, University of Michigan, Ann Arbor, Michigan
Gary J. Schwartz, PhD, Departments of Medicine and Neuroscience, Albert Einstein College of Medicine, New York, New York
Marlene B. Schwartz, PhD, UConn Rudd Center for Food Policy and Obesity, Hartford, Connecticut; Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
Gerard P. Smith, MD, Department of Psychiatry, Weill Cornell Medical College, New York, New York
Kendrin R. Sonneville, ScD, RD, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
Joanna E. Steinglass, MD, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, New York
June Stevens, PhD, Departments of Nutrition and Epidemiology, Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Eric Stice, PhD, Oregon Research Institute, Eugene, Oregon
Robyn Sysko, PhD, Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
Marian Tanofsky-Kraff, PhD, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Deborah F. Tate, PhD, Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Elsie M. Taveras, MD, MPH, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
Jennifer J. Thomas, PhD, Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
J. Kevin Thompson, PhD, Department of Psychology, University of South Florida, Tampa, Florida
Stephen W. Touyz, PhD, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
Janet Treasure, OBE, PhD, FRCP, FRCPsych, Department of Psychological Medicine, King’s College London, London, United Kingdom
Adam G. Tsai, MD, MSCE, Kaiser Permanente of Colorado and Division of General Internal Medicine, University of Colorado School of Medicine, Denver, Colorado
Dorothy J. Van Buren, PhD, Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
Eric M. VanEpps, PhD, VA Center for Health Equity Research and Promotion and Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Thomas A. Wadden, PhD, Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Tracey D. Wade, PhD, School of Psychology, Flinders University, Adelaide, South Australia, Australia
Elizaveta Walker, MPH, Division of Bariatric Surgery, Oregon Health and Science University, Portland, Oregon
B. Timothy Walsh, MD, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, New York
Y. Claire Wang, MD, ScD, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
Brian Wansink, PhD, Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York
Theodore E. Weltzin, MD, FAED, CEDS, FAPA, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Delia Smith West, PhD, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Kitty Westin, MA, LP, The Emily Program Foundation, St. Paul, Minnesota
Denise E. Wilfley, PhD, Department of Psychiatry, Washington University in St Louis School of Medicine, St. Louis, Missouri
G. Terence Wilson, PhD, Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
Rena R. Wing, PhD, Weight Control and Diabetes Research Center, The Miriam Hospital, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
Alexis C. Wojtanowski, BS, Weight Watchers International, New York, New York
Bruce M. Wolfe, MD, FACS, Division of Bariatric Surgery, Oregon Health and Science University, Portland, Oregon
Stephen A. Wonderlich, PhD, Neuropsychiatric Research Institute, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
Margo G. Wootan, DSc , Center for Science in the Public Interest, Washington, DC
Sonja Yokum, PhD, Oregon Research Institute, Eugene, Oregon
Yiying Zhang, PhD, Department of Pediatrics, Division of Molecular Genetics, Columbia University Medical Center, New York, New York
Hisham Ziauddeen, PhD, Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Preface
The previous two editions of this book were published in 1995 and 2002, both with Christopher G. Fairburn and one of us (Kelly D. Brownell) as coeditors. We are grateful for the pioneering role Chris has played in the creation of this book, and in the field overall. He continues to be a pioneer, an inspiring figure, and a wonderful colleague. B. Timothy Walsh has taken on Chris’s role in this edition.
The preface of each of the prior editions noted the exciting possibilities and the glaring gaps that existed when considering the eating disorders and obesity fields as possible companions. We argued that an improved exchange of information between the two fields could expand the knowlege of both, and might yield new theories to be explored, a better understanding of mechanisms governing eating behavior and weight control, more effective treatments, and the ability to intervene in one area without causing harm in the other. It is informative to look now, some two decades after the first edition was published, at how things have changed, and to what degree these hopes have been realized.
The scientific underpinnings of our understanding of eating disorders and of obesity have advanced in impressive ways, leading to much better knowledge of causes, risk factors, pathophysiology, treatment, prevention, and, especially for obesity, policy. There have been stunning discoveries in genetics (and epigenetics), diagnostic advances have occurred, social causes and consequences are better understood, medical complications are better defined, and treatment options have expanded. These are exciting intellectual advances, but, most importantly, they offer more hope for those who suffer from eating disorders and obesity.
In both of the earlier editions of the book, strong calls were made to better connect the eating disorders and obesity fields. How much progress has there been?
Our sense is that although connections have improved in some ways, the fields remain largely distinct from one another. At most meetings on obesity, eating disorders are rarely mentioned, and obesity is rarely a major topic at meetings on eating disorders. However, there are signs of modest progress. The prior intense concern that recommendations to diet were a major causal factor in the development of eating disorders has largely subsided. It is increasingly recognized that a minority of obese individuals meet criteria for binge-eating disorder, which was officially recognized in DSM-5 in 2013, and that such individuals may benefit from specifically tailored treatments. Perhaps most promising is the growing focus on brain mechanisms in both the obesity and the eating
disorders fields. There is increasing recognition that changes in behavior are an essential component of effective treatment interventions for both problems, and an improved understanding of how the brain regulates eating behavior is a critical common foundation in both areas.
This New Edition
This third edition follows the same model as the prior two. We asked leading authorities to write about the area they know best. To provide concise, easily “digestable” and accessible content, we limited the length of the chapters and eliminated the typical intext references. Rather, we asked that each chapter have a Suggested Reading section, with very brief annotations. These principles have allowed us to assemble a volume of manageable size but containing more than 100 chapters, thereby providing what we hope is comprehensive coverage. The chapters have been organized into three broad sections, Foundations, Eating Disorders, and Obesity, each of which has several subsections.
Behind the theories, statistics, randomized trials, and policy proposals that comprise most of the content of the chapters is the desire and goal to provide assistance for people in need. Eating disorders and obesity bring a cascade of medical, social, and psychological consequences that can have a profound effect on affected individuals, their families, and friends. Our hope is that this book aids the important work of clinicians and researchers to help alleviate and prevent this suffering.
Acknowledgments
We are deeply grateful to the chapter authors for their willingness to contribute to this volume and for helping to describe, clarify, and synthesize complex ideas and vast areas of knowledge into brief chapters. We would also like to thank Jim Nageotte, Senior Editor, and Seymour Weingarten, Editor-in-Chief, and many of their colleagues at The Guilford Press for making this and previous editions possible.
We are especially grateful for the outstanding assistance of Ryan Smith, who was responsible for keeping us and the contributors on task and on time, and keeping track of the myriad details entailed in a volume with over 100 chapters and authors. His help has been invaluable.
We hope this book will help generate innovation and creativity in our fields, and provoke new thinking.
II.
PART III. OBESITY
Treatment of Obesity
Part I FOUNDATIONS
REGULATION OF BODY WEIGHT
1 Central Neural Pathways and Integration in the Control of Food Intake and Energy Balance
GARY J. SCHWARTZ
The transmission of gut neural signals related to the controls of food intake, such as gastric volume and gastrointestinal nutrient exposure, is primarily mediated by the afferent vagus nerves supplying the gut. Complete surgical transection of these gut afferent vagal nerves chronically increases meal size in rodent models, yet does not promote increases in body weight, because decreased meal number compensates for the additional caloric intake in each larger meal. Gut vagal afferents project first to central nervous system caudal brainstem sites important in the control of meal size, including the nucleus of the solitary tract (NTS) and area postrema (AP), then via distinct pathways to the brainstem lateral parabrachial nucleus (lPBN) and forebrain limbic and hypothalamic regions, including the amygdala, bed nucleus of the stria terminalis, and the lateral and paraventricular nuclei of the hypothalamus (PVN).
The Melanocortin Pathway
The PVN is a neuroanatomical crossroads between ascending control feeding signals arising from the brainstem, and feeding excitatory and inhibitory neuropeptide signals from hypothalamic arcuate nucleus (ARC) projection neurons, located within the base of the brain abutting the third intracerebral ventricle. ARC neurons include neurochemically distinct populations of feeding-stimulatory (orexigenic) agouti-related peptide (AgRP)/ neuropeptide Y (NPY), and feeding-inhibitory (anorexigenic) pro-opiomelanocortinergic (POMC) neurons. AgRP acts as a melanocortin receptor 3/4 (MC3/4R) antagonist in PVN neurons to promote food intake and body weight gain, while the POMC product alpha-melanocyte-stimulating hormone (alpha-MSH) acts as an agonist at PVN MC3/4R to reduce feeding and adiposity.
Results from molecular genetic studies support the relevance of brain melanocortin receptor signaling in obesity and food intake. Mutations in the MC4R gene, occurring
in the obese population at approximately 6%, are the most common known cause of monogenic human obesity, characterized by early onset hyperphagia and increased meal size. Mice lacking MC4R demonstrate a similar profile of hyperphagia early in development that promotes obesity in adulthood, and mice unable to synthesize the endogenous MC4R agonist alpha-MSH are hyperphagic and obese. Furthermore, hypothalamic PVN and brainstem administration of MC4R agonists reduce food intake by limiting meal size, resulting in decreased body weight. In contrast, parenchymal administration of MC4R antagonists in these sites increases food intake, body weight, and adiposity.
Distinct brainstem projecting populations of MC3/4R neurons in the PVN produce glutamate and oxytocin, two neurochemicals with important feeding modulatory actions at caudal brainstem neurons that receive feeding control signals. Stimulation of glutamatergic projections from the PVN to neurons in the lPBN inhibits feeding, while oxytocinergic nerve projections from the PVN innervate NTS neurons that are activated by feeding inhibitory doses of the gut satiety peptide cholecystokinin (CCK), a negative feedback control of food intake. Brainstem application of oxytocin receptor (OR) antagonists blocks the ability of CCK to inhibit food intake, and brainstem administration of OR antagonists alone markedly increases meal size. In addition to the feeding modulatory PVN hypothalamic glutamatergic and oxytocinergic projections to the brainstem, alpha-MSH fibers arising from the ARC project directly to the NTS, where pharmacological activation of MCR3/4R reduces feeding and body weight. Together, these findings identify reciprocal functional connections between brainstem (NTS and lPBN) and hypothalamus (PVN, ARC) that can drive a recurrent loop to limit feeding by forebrain modulation of gut-derived control signals acting in the brainstem.
The relevance of AgRP for the control of body weight and feeding is highlighted by the consequences of selective stimulation or inhibition of AgRP neurons; neurochemically specific photo- or chemostimulation of AgRP neurons inhibits PVN oxytocin neurons and rapidly increases meal size, while photostimulation of ARC POMC neurons reduces feeding and body weight. Ablation of AgRP/NPY neurons in adult mice results in profound anorexia and starvation, accompanied by hyperactivation of lPBN neurons. Stimulation of inhibitory lPBN gamma-aminobutyric acid (GABA) A receptors prevents the anorexia produced by AgRP neuronal ablation, suggesting a descending hypothalamic modulatory pathway to limit the activation of the lPBN, a brainstem relay that processes negative feedback controls of ingestion.
Brainstem integration of peripheral meal-related controls and central feeding modulatory neurochemical signals is supported by the neuroanatomical convergence of gut feeding controls and central melanocortin action: alpha-MSH projections to the brainstem terminate on gut-sensitive, CCK-responsive NTS neurons, and brainstem application of MC4R antagonists block the satiety actions of peripheral feeding inhibitory doses of CCK. Taken together with the previously discussed consequences of hypothalamic melanocortin pathway activation, these data demonstrate that central melanocortins have neuroanatomically distributed, redundant effects that are important for the control of feeding behavior and energy balance.
Leptin
The adiposity signal leptin has been importantly implicated in both forebrain and brainstem control of food intake and body weight through both melanocortin-dependent and
independent mechanisms. In very rare cases of human genetic leptin deficiency accompanied by severe obesity, pharmacological administration of leptin eliminates hyperphagia and normalizes body weight and adiposity. A central action of leptin in these effects is suggested by the dense distribution of leptin receptors in hypothalamic ARC POMC and AgRP neurons, as well as in brainstem NTS/AP neurons. Each of these populations is localized near circumventricular organs, characterized by a relatively porous blood–brain barrier that permits enhanced brain access to peripherally circulating factors. Leptin reaches hypothalamic ARC neurons via a highly selective transport system mediated by tanycytes, specialized glial cells lining the third ventricle. Hypothalamic leptin uptake is disrupted in both diet-induced obesity and genetic obesity in db/db mice lacking the leptin receptor. Given the morphological similarities shared among circumventricular organs, it is likely that leptin access to the brainstem relies on transport processes similar to those in the hypothalamic ARC.
Leptin injections into the ARC produce long-lasting suppression of meal size and total chow intake, and rats prone to develop diet-induced obesity have defective projections arising from ARC neurons, accompanied by reduced leptin signaling that persists into adulthood. The ability of ARC leptin signaling to reduce feeding is significantly blunted by brainstem injection of MC4R antagonists, suggesting a leptin-activated ARC–PVN–NTS melanocortin circuit. Genetically obese ( fa(k)/fa(k)) rats lack functional leptin receptors and are consequently obese and hyperphagic; their hyperphagia is characterized by increased meal size and reduced feeding inhibitory actions of CCK. Selective restoration of leptin receptors confined to the ARC restores the ability of peripherally administered CCK to both activate brainstem NTS/AP neurons and to limit food intake by a reduction in meal size. Thus, neuroanatomical connectivity between leptin sensitive hypothalamic sites and the caudal brainstem is an important determinant of the brainstem processing of satiety signals.
The metabolic context provided by central signals of adiposity such as leptin also determines the magnitude of the neural response to gut negative feedback signals and their ability to reduce meal size. Gut-sensitive neurons in the NTS are dose-dependently activated by increasing gastric volume stimuli, and central leptin administration increases the neurophysiological potency of such stimuli. Thus, NTS neurons integrate central adiposity signals with peripheral controls of feeding. Such integration occurs not only at the level of the individual neuron but also at a population level, as central leptin also increases the number of NTS cells activated by gastric loads. From a behavioral standpoint, ventricular, lPBN, and NTS leptin administration reduces food intake and body weight in rats, and increases the degree of feeding suppression produced by gastric loads and duodenal nutrient infusions. Conversely, molecular genetic knockdown of brainstem leptin receptors increases food intake by increasing the size of spontaneous meals, increases body weight and adiposity, and blunts the feeding inhibitory effects of CCK. Taken together, these demonstrate the ability of leptin acting at both the brainstem and hypothalamus to modulate the brainstem control of food intake, meal size, body weight, and adiposity. However, the metabolic milieu determined by either dietary or genetic obesity does not strictly limit the inhibitory potency of all feeding and body weight regulatory stimuli. For example, the ability of oxytocin to (1) reduce food intake and body weight and (2) activate brainstem NTS and AP is preserved in hyperleptinemic, leptin-resistant rats with diet-induced obesity and in Koletsky fa/fa rats lacking leptin receptors. In this way, leptin- and obesity-independent determinants of feeding and body weight may also engage brainstem sites that process direct control signals.