Andrea Goldschmidt Hi, my name is Andrea  Goldschmidt and I’m a Clinical Psychologist   and Associate Professor of Psychiatry at the  University of Pittsburgh School of Medicine.   And today, I’m going to be talking to you  about mechanisms of loss of control eating.   So, loss of control eating is a key  construct involved in binge eating,   which involves feeling unable to control  what or how much one is eating. It may or   may not be accompanied by the experience  of ingesting large amounts of food. When   both loss of control eating and overeating are  present, this is referred to as binge eating. So, I study loss of control eating in children  and adolescents. Children and adolescents often   report loss of control eating behaviours. It’s  one of the most commonly reported disordered   eating behaviours in children and adolescents,  and the reason we studied the loss of control   construct is because children and adolescents  often engage in loss of control eating episodes   that involve smaller amounts of food, and  this is for many reasons. Children often   don’t have complete autonomy around what food  is available in their homes and are not able to   ingest large amounts of food at any time, as  adults might be. But they often report feeling out   of control with their eating, even when they’re  ingesting relatively small amounts of food. So, much of my research has focused on  understanding behavioural and cognitive mechanisms   that are involved in the onset and maintenance of  loss of control eating in youth. In early studies,   we tried to understand how dietary restraint  and negative affect might precipitate binge   eating episodes in youth. And this was based  on literature showing that dietary restraint,   so having behaviours and attitudes designed to  limit one’s food intake in support of weight   maintenance or weight loss, are – as well as  negative affects, so the experience of having   higher levels of negative emotions,  sort of, at a broad trait level,   were prospective predictors of loss of control  and binge eating in both adults and youth. Much of my research is focused on how these  two factors might be momentary precipitants   of loss of control eating in youth. So, in the  moment when an adolescent is trying to restrict   their eating and/or feeling negative emotions,  are they more at risk for engaging in loss of   control eating episodes? And unlike in the adult  literature, the findings have really been mixed.   So, many children who have loss of control eating  episodes seem to have developed dietary restraint   as a consequence of loss of control eating,  rather than a cause. And the literature shows that   negative affect in the moment is not a consistent  predictor of loss of control eating in youth. This has led me to try and understand how  self-regulation as a general construct may   be involved in the experience of loss of control  eating in the moment. And self-regulation is a   more general factor that can include things  like dietary restraint and negative affect.   You can imagine if a child has difficulties  regulating their behaviour and their cognitions,   they might experience particular  difficulty exper – regulating their   eating behaviours when they’re  experiencing negative affect. So,   we have looked at one specific aspect of  self-regulation, executive functioning,   and this is the cognitive efforts that govern  goal-directed behaviours as a specific type   of trait level self-regulation factor that  might predict loss of control eating in youth. And our research started by focusing on executive  functioning as a trait level correlate of loss of   control eating, and it’s now evolved into trying  to understand how disruptions in executive   functioning in the moment might be related to  the experience of loss of control eating on a   day-to-day basis. So, we started this research  by looking more broadly at executive functioning   at a trait level and we found that children  with loss of control eating did experience   some deficits in executive functioning  relative to their peers with higher body   weight who did not have loss of control eating,  as well as those with a normal weight status,   specifically in the domains of working memory and  planning. And we’ve now tried to translate these   findings into using smartphone-based assessments  to understand how executive functioning,   particularly planning and working memory, might  relate to loss of control eating in the moment.  So, we have kids come into our lab and we send  them home with a smartphone, and for typically   two weeks of time, we’re prompting them with  questions about their eating, their mood and their   executive functioning in their day-to-day lives  at various timepoints throughout the day. And   we’ve integrated a working memory assessment into  this ecological momentary assessment protocol. So,   kids will have to do things like remember  information and manipulate it in real-time,   and then we can look at how their performance  on that task predicts later loss of control   eating in their natural environment. We’re also  currently testing an inhibitory control task in   relation to maladaptive eating in youth,  as well, and we’re looking at how sleep   might impact inhibitory control in the moment to  predict subsequent eating behaviour in real-time. So, teens may experience difficulties accessing  treatment for binge eating and loss of control   eating. First of all, this is a highly  under-recognised problem, so it might not   even be apparent to the teen themselves, or their  healthcare providers, that they have disordered   eating problems that they might need treatment  for. There’s a lot of shame and stigma in teens,   especially around disordered eating behaviours,  like binge eating and loss of control eating,   that might prevent them from accessing care that  is available. And most teens do not live in areas   where there are a plethora of providers trained  to deliver evidence-based treatments for binge   eating and loss of control eating. So, even if  they are ready and willing to undergo treatment,   they may not be able to pro – find a Therapist  in their area. Which means that digital tools can   be really helpful for delivering interventions  to teens that might not otherwise have access.   And we know that cognitive behavioural therapy  is a very efficacious intervention for teens   with binge eating. However, to date, it  has not been available in digital format. Another project that we’re working on, which  integrates understanding of self-regulation   and executive functioning, is to develop a  digital intervention for adolescents to use   in real-time in their natural environment  that integrates aspects of self-regulation   training in pras – practice into a standard  cognitive behavioural therapy intervention   delivered in digital format. So, we can  have adolescents using the intervention   on their phones or computers in real-time,  and at the same time, they’ll be practising   self-regulation skills to improve their adherence  to the cognitive behavioural interventions that   we know can be efficacious for reducing binge  eating and loss of control eating in teens. So, although teens are a subset of youth who are  growing in independence, in autonomy, parents can   still be really important, integral, in helping  support their teens in terms of developing   healthier coping skills and eating habits to  support regulation of their eating and weight   over time. And so, we often integrate family  members into interventions for teens, as well,   acting as key support people to their teens,  helping the implement intervention components,   such as homework assignments, helping support  a healthy environment that will facilitate   reduction in binge and loss of control eating  episodes, and generally supporting the treatment   goals of their teens. And we’ll be testing out  this intervention over the next year or two. We hope to have findings to report, especially  for adolescents who might have difficulties   accessing cognitive behavioural therapy in  their geographic region. Accessing a digital   tool can really help improve access  and delivery in real-time can help a   lot with supporting intervention skills in the  moments and contexts they’re needed most. So,   we hope to have some findings to report  to you over the next couple of years. Thank you so much for listening and  it’s been nice chatting with you today.