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Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 25 November 2025 | Viewed by 6909

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Dr. Cristina Segura Garcia

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Department of Medical and Surgical Sciences, Università degli Studi Magna Graecia di Catanzaro, 88100 Catanzaro, Italy
Interests: eating disorders; pathological eating behaviors; obesity; mental health; psychopharmacology
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Special Issue Information

Dear Colleagues,

This Special Issue explores the intricate relationship between eating behaviors and eating disorders, emphasizing the prevention, clinical characterization, and treatment.

Eating behaviors include a wide spectrum, from healthy dietary habits to disordered patterns, and play a key role in the onset of eating disorders (i.e., anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder) and obesity.

Pathological eating behaviors such as binge eating, grazing, food dependence, nocturnal eating, and a preference for sweets can be critical indicators of eating disorders and may also reflect underlying endocrine/metabolic disturbances that warrant clinical attention. Additionally, maladaptive eating patterns, combined with body dissatisfaction, distorted body image, and psychological distress, are core symptoms that define the clinical presentation of major eating disorders.

Preventive strategies focus on promoting healthy eating behaviors, increasing awareness, and implementing early interventions to reduce the incidence of these conditions. Treatment approaches are multifaceted, including cognitive-behavioral therapy, mindfulness, nutritional counseling, and pharmacotherapy with the goal of restoring healthy eating patterns and improving overall well-being. Additionally, a multidisciplinary approach, involving healthcare professionals from various fields, can enhance treatment outcomes. By addressing both the behavioral and psychological aspects of eating behaviors, we can work towards more effective prevention and intervention strategies, ultimately improving patient care and quality of life.

Dr. Cristina Segura Garcia
Guest Editor

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Keywords

eating disorders
pathological eating behaviors
binge eating
grazing
binge eating disorders
food addiction
food dependence
night eating
nocturnal eating
sweet eating
clinical characterization
obesity
mental health
prevention
treatment

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Published Papers (8 papers)

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Research

15 pages, 247 KiB

Open AccessArticle

Eating Behaviors of Autistic Women with an Eating Disorder

by Sabrina Schröder, Annemarie van Elburg, Annelies Spek and Unna Danner

Nutrients 2025, 17(10), 1622; https://doi.org/10.3390/nu17101622 - 9 May 2025

Viewed by 380

Abstract

Background: Autistic women with eating disorders (EDs) often present with more complex EDs and may not fully benefit from current treatments, yet the reasons for this remain unclear. This study aims to examine the eating behaviors of autistic women with EDs and how these differ from those of (1) non-autistic women with EDs, (2) autistic women without EDs, and (3) non-autistic female controls. It investigates autism-related eating behaviors, traditionally disordered eating behaviors, and avoidant–restrictive food intake disorder (ARFID)-related behaviors to better understand their complex ED presentations. Methods: A cross-sectional study was conducted with 30 autistic women with EDs, 30 non-autistic women with EDs, 29 autistic women without EDs, and 60 non-autistic female controls. Participants completed questionnaires assessing eating behaviors, quality of life, and comorbid psychological symptoms. Results: Autistic women with EDs exhibited higher levels of both autism-related and disordered eating behaviors than all other groups, including food selectivity, mealtime rigidity, and sensory-related eating difficulties. They also reported notable weight and shape concerns. Additionally, they showed higher levels of comorbidity and reported lower mental health-related quality of life compared to all other groups. Conclusions: These findings suggest that the overlap of autism-related and disordered eating behaviors contributes to the complexity and severity of EDs in autistic women, potentially limiting the effectiveness of current treatment approaches. Developing autism-informed interventions that address sensory sensitivities, rigidity, and cognitive differences may improve treatment outcomes. Future research should explore how these factors interact in maintaining ED pathology and identify strategies to distinguish adaptive from maladaptive eating behaviors. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

17 pages, 1144 KiB

Open AccessArticle

Discounting of Hyper-Palatable Foods Is Associated with Eating Motives and Binge Eating Behavior

by Joseph S. Bellitti, Alexa M. L’Insalata and Tera L. Fazzino

Nutrients 2025, 17(8), 1356; https://doi.org/10.3390/nu17081356 - 16 Apr 2025

Viewed by 373

Abstract

Background: High delay discounting (DD), or the tendency to prefer immediate rewards over larger delayed rewards, has been associated with health risk behaviors. This study examined the DD of hyper-palatable foods (HPFs) and money, and their associations with eating motives and binge eating behavior. Methods: An adult sample (N = 296) completed a DD task with single- and cross-commodity conditions with rewards of money and/or HPF (e.g., HPF now vs. HPF later; HPF now vs. money later). Regression models tested the association between DD, and eating motives and binge eating. Results: DD in the HPF now vs. money later condition was positively associated with the reward enhancement motive (

β

= 0.291; p = 0.008) and binge eating behavior (

β

= 0.041; p = 0.017). There were no other significant associations. Conclusions: Decisional impulsivity specific to HPFs (and not decisional impulsivity in general) may be associated with reward-motivated eating and binge eating behavior. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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13 pages, 230 KiB

Open AccessArticle

Food Concepts Among Black and Hispanic Preschool-Age Children: A Preliminary Qualitative Descriptive Study Using Ethnographic Techniques and an Internet Conferencing Platform

by Celeste M. Schultz, Mary Dawn Koenig and Cynthia A. Danford

Nutrients 2025, 17(8), 1313; https://doi.org/10.3390/nu17081313 - 10 Apr 2025

Viewed by 401

Abstract

Background/Objectives: Little is known about preschool-age children’s food concepts among diverse populations. Grounded in the Theory of Mind and Naïve Biology, the primary aim of this study was to describe Black and Hispanic preschool-age children’s food concepts. A secondary aim was to determine the feasibility of collecting data from preschool-age children via a video conferencing platform. Methods: Preliminary qualitative descriptive study. A purposive sample of nine 4- to 6-year-old children (

\bar{x}

age = 4.9; Black, n = 7; Hispanic, n = 2), mostly female (n = 7) participated. Children generated two free lists: foods they think of, and foods they eat, reported mouthfeel of 16 foods, and performed a constrained card sort with rationale. Results: All children were able to use the video conference platform. Foods that Black and Hispanic children frequently listed as thought of (

\bar{x}

= 6.75) included chicken, rice, carrots, and apples; those frequently listed as foods they eat (

\bar{x}

= 8.33) included pancakes and grapes. Black and Hispanic children used various lexicon such as warm, soft, crunchy, and “ouchy” to describe mouthfeel. All preschool-age children sorted foods into piles (range 4–20 piles). Younger children used discrete labels to categorize foods and created many piles while older children used broader labels and created fewer piles. Conclusions: This is the first study to add to the literature about Black and Hispanic preschool-age children’s food concepts before receiving formal education about nutrition. Additionally, we highlight the novel and successful use of ethnographic techniques via internet video conferencing. Subtle differences in their experiential knowledge about food reflect culturally salient qualities that are critical to consider when developing interventions to promote healthy eating behavior. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

15 pages, 612 KiB

Open AccessArticle

Clinical Assessment of Altered Eating Behaviors in People with Obesity Using the EBA-O Questionnaire

by Vittorio Oteri, Laura Contrafatto, Gaetano Maria Santoro, Ignazio Barca, Andrea Tumminia, Federica Vinciguerra, Lucia Frittitta, Francesco Frasca, Laura Sciacca and Roberto Baratta

Nutrients 2025, 17(7), 1209; https://doi.org/10.3390/nu17071209 - 30 Mar 2025

Viewed by 708

Abstract

Background/Objectives: Over the past decade, numerous studies have explored the bidirectional relationship between obesity and mental health, mainly eating disorders (EDs). This study aimed to assess the prevalence and characteristics of altered eating behaviors (AEBs) in a cohort of people with obesity (PwO) using the validated Eating Behaviors Assessment for Obesity (EBA-O). Methods: We conducted a cross-sectional study from May 2023 to April 2024, recruiting consecutive PwO seeking weight loss. Participants completed the 18-item EBA-O questionnaire, which focuses on five primary eating behaviors: night eating, food addiction, sweet eating, hyperphagia, and binge eating. Unlike other validated tools, the EBA-O is specifically designed to capture these behaviors in PwO and is easy for patients to self-administer. We also collected sociodemographic and clinical data. Results: A total of 127 participants were included (76 women, median age 52 years, median BMI 42.9 kg/m²). We found a significant prevalence of AEBs: 33.1% for sweet eating, 23.6% for hyperphagia, 15.7% for food addiction, 14.2% for binge eating, and 7.1% for night eating. The EBA-O scores correlated positively with BMI (r = 0.201, p = 0.024) and increased across BMI categories (p = 0.001). Males had higher scores for night eating and hyperphagia (p = 0.01), and active smokers had higher hyperphagia scores (p = 0.043) than ex-smokers and non-smokers. The night eating scores were inversely correlated with sleep hours (r = −0.197, p = 0.026), and food addiction was positively correlated with age (r = 0.261, p = 0.003); conversely, hyperphagia (r = −0.198, p = 0.025) and binge eating (r = −0.229, p = 0.010) were inversely correlated with age. PwO without diabetes had higher scores for food addiction (p = 0.01) and binge eating (p = 0.004) compared to those with diabetes. Conclusions: These results highlight the potential to characterize PwO based on their AEBs, offering new opportunities to tailor treatment strategies for PwO by targeting specific eating behaviors. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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17 pages, 4715 KiB

Open AccessArticle

Broader Validation of New Zealand Eating Behavior Questionnaire as Clinical Assessment Tool to Identify Actionable Eating Behavior Traits

by Ole Schmiedel, Melissa Ivey and Rinki Murphy

Nutrients 2025, 17(6), 1049; https://doi.org/10.3390/nu17061049 - 17 Mar 2025

Viewed by 495

Abstract

Background/Objectives: The New Zealand Eating Behavior Questionnaire (NZ-EBQ) is a validated questionnaire that comprises three distinct scales that measure satiation at mealtimes, satiety in the post-eating period, and emotional eating behavior. This study evaluated the model validity of the NZ-EBQ across two additional samples of demographically diverse participants using confirmatory factor analysis. Methods: We compared the classification of the eating behavior (EB) type with that of the initial cohort used to develop the three-factor model. Two cohorts of 81 and 214 participants provided complete data sets for analysis. Cohort 1 was characterized by the use of more weight management medications, and participants in Cohort 2 were significantly heavier. Confirmatory factor analysis was performed using combined data from both cohorts to maximize the sample size. Results: Except for one item, all items demonstrated a factor loading consistent with the established three-factor model. After removing one item from the emotional eating scale, the model fit statistics did not change significantly. Participants were assigned to one of the three EB types based on their highest median score, and most could be classified into one of the three EB types, with only a few who could not be classified (Cohort 1:12.3%; Cohort 2:13.0%). The test-retest reliability performed in a subset of participants was comparable to that of the initial validation cohort. A significant positive correlation was found between BMI and the individual EB scores. Conclusions: The NZ-EBQ may serve as a screening tool for identifying actionable EB traits that help select targeted interventions based on EB, supporting precision medicine-based approaches. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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12 pages, 624 KiB

Open AccessArticle

Nutritional Counseling Based on Mindful Eating for the Eating Behavior of People Living with Overweight and Obesity: A Randomized Clinical Trial

by Maria Fernanda Souza Moreira, Brenda Eduarda Fabris de Azevedo, Mileni Vanti Beretta and Fernanda Michielin Busnello

Nutrients 2024, 16(24), 4388; https://doi.org/10.3390/nu16244388 - 20 Dec 2024

Cited by 1 | Viewed by 1602

Abstract

Objectives: This study aimed to evaluate the effect of a counseling approach based on Mindful Eating on the eating behavior of individuals living with overweight and obesity. Methods: A 16-week randomized clinical trial was conducted to compare an online group intervention (IG) with individual online nutritional counseling (TAU). Volunteers (n = 61), aged 18 or older with BMI ≥ 25 kg/m², were randomly assigned to the two groups and invited to participate in eight biweekly sessions. Eating behavior was assessed using the Three-Factor Eating Questionnaire (TFEQ-21), and anthropometric measures were collected through self-report. Comparison between the groups was performed using generalized linear models and Poisson models with robust variance estimators. A sensitivity analysis was conducted to evaluate the group-by-time interaction. The study was approved by the UFCSPA Ethics Committee. Results: At baseline, the eating behavior domain with the highest mean score was emotional eating (EE) in both groups. At the end of the study, all domains decreased, while an increase in cognitive restraint (CR) was observed in the TAU group, showing a difference between the groups (−23.1; 95%CI −37.7 to −8.5; p = 0.004). A group-by-time interaction difference was noted only in the CR domain, explained by the change in the TAU group for the CR comparison before and after treatment and by the difference between the IG and TAU groups at the end of the treatment period. Conclusions: A Mindful Eating approach may aid in managing dysfunctional cognitive restraint, a key component for sustainable excess weight treatment. The protocol can be found on ClinicalTrials.gov (NCT05845411). Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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14 pages, 2880 KiB

Open AccessArticle

The Greater the Number of Altered Eating Behaviors in Obesity, the More Severe the Psychopathology

by Elvira Anna Carbone, Marianna Rania, Ettore D’Onofrio, Daria Quirino, Renato de Filippis, Lavinia Rotella, Matteo Aloi, Vanessa Teresa Fiorentino, Rinki Murphy and Cristina Segura-Garcia

Nutrients 2024, 16(24), 4378; https://doi.org/10.3390/nu16244378 - 19 Dec 2024

Cited by 1 | Viewed by 1024

Abstract

Background: Altered eating behaviors (AEBs) are not only associated with eating disorders but also play a role in obesity. This study assessed AEBs in individuals with obesity and their association with general and eating psychopathology, using the “Eating Behaviors Assessment for Obesity” (EBA-O). The hypothesis posited that a higher frequency of pathological eating behaviors would correlate with more severe psychopathology. Methods: Participants seeking weight loss treatment answered the EBA-O and other measures of eating and general psychopathology. The analysis employed MANOVA to estimate psychopathological variance based on AEBs and a cluster analysis to identify patient clusters by AEB type and number. Results: Out of the 244 participants, approximately two-thirds reported clinically relevant AEBs, with almost half exhibiting more than two AEBs. Predominant AEBs included sweet eating, binge eating, and hyperphagia. A significant impact of the numbers of AEBs on both eating and general psychopathology severity (p < 0.001; η² = 0.167) was evident. Three clusters emerged, with Cluster 3 showing the highest AEB frequency and greater psychopathological impairment. Conclusions: The present findings confirm the correlation between the frequency of AEBs and the severity of general and eating psychopathology in individuals with obesity. AEBs deserve clinical attention, and their screening might aid their clinical characterization and foster more tailored treatments. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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13 pages, 1639 KiB

Open AccessArticle

The Mediating Effect of Eating Behaviors on Interoception, Self-Regulation and Weight Status Among College Students

by Shanté Jeune, Paulo Graziano, Adriana Campa and Catherine Coccia

Nutrients 2024, 16(23), 3986; https://doi.org/10.3390/nu16233986 - 21 Nov 2024

Viewed by 1272

Abstract

Background/Objectives: Obesity among college students has been consistently high in the recent decades. Regulatory processes such as interoception and self-regulation have been studied to identify specific health behaviors that lead to weight gain. Reduced interoception and self-regulation may lead to increased body mass index (BMI), however, various eating styles may indirectly affect this relationship. It is proposed that poor interoception and self-regulation can increase the incidence of maladaptive eating styles, such as emotional or external eating, which may indirectly contribute to weight gain. Conversely, eating styles like cognitive restraint and intuitive eating may indicate an opposing indirect effect, exhibiting eating behaviors likely to maintain optimal weight status. To date, it is unknown which eating styles mediate the relationship between interoception and self-regulation on BMI. Additionally, study variables were examined throughout time to identify any potential influences throughout a typical semester. Methods: There were 104 female participants who completed the study measures. Participants were primarily identified as Hispanic (75.1%), mean age = 23.39 (SD = 6.312), and mean BMI = 25.45 (SD = 5.48) at baseline. Preliminary statistics and longitudinal mediation analyses were conducted to examine the relationships among eating styles, interoception, self-regulation, and BMI. Results: Intuitive eating was the only eating style that was found to be a significant mediator among both interoception and self-regulation, and BMI. It is theorized that these regulation skills occur more commonly among college females who intuitively eat, thus accurately explaining the associations with BMI. Conclusions: The study has provided foundational evidence on the indirect effect of eating behaviors on one’s relationship with interoception and self-regulation on BMI and can be useful in future interventions regarding college students and their associated risk for obesity. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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