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. Author manuscript; available in PMC: 2023 Jan 1.
Published in final edited form as: Int J Eat Disord. 2021 Oct 13;55(1):120–124. doi: 10.1002/eat.23628

Eating expectancies and hedonic hunger among individuals with bulimia-spectrum eating disorders who plan binge-eating episodes

Megan N Parker 1,2, Megan L Michael 3, Rowan A Hunt 4, Alessandra Ortiz 3, Stephanie M Manasse 5, Adrienne S Juarascio 3,5
PMCID: PMC8766881  NIHMSID: NIHMS1746597  PMID: 34643949

Abstract

Objective:

Binge planning (BP; i.e., preparatory thoughts and actions to facilitate future binge-eating episodes) is hypothesized to distract individuals from negative affect and increase the salience of food. Thus, individuals who engage in BP may report greater positive eating expectancies (i.e., beliefs about the outcomes of eating) and hedonic hunger (i.e., desire to eat for pleasure), as BP may increase the likelihood of obtaining these expected outcomes; but empirical tests of this possibility are needed.

Method:

Prior to starting treatment, adults (N=86) with bulimia-spectrum eating disorders were assessed for engagement in BP and self-reported on eating expectancies and hedonic hunger.

Results:

Twenty-nine participants (33.7%) reported planning at least one binge-eating episode in the previous 28 days. Compared to individuals who did not report BP, individuals who reported BP had greater expectancies that eating would alleviate negative affect (t = −2.54, p = .013) and boredom (U = 503.50, p = .006). Groups did not differ on levels of hedonic hunger (t = −1.68, p = .096).

Discussion:

These findings suggest that BP status is linked to expectancies that eating will reduce negative affect. However, more data are needed to determine the temporal relationships among eating expectancies, hedonic hunger and BP.

Keywords: binge planning, binge eating, eating expectancies, hedonic hunger, bulimia nervosa

Introduction

Bulimia-spectrum eating disorders (EDs), disorders characterized by recurrent binge-eating episodes and compensatory behavior use (e.g., self-induced vomiting, laxative misuse) are associated with high levels of mortality and morbidity (Chesney, Goodwin, & Fazel, 2014; Crow et al., 2009), decreased quality of life (DeJong et al., 2013), and suicide risk (Corcos et al., 2002). Recent conceptualizations of bulimia-spectrum EDs have proposed that ED behaviors may become compulsive (Pearson, Wonderlich, & Smith, 2015). One behavioral component of compulsive binge eating is engagement in binge planning (BP; i.e., preparatory thoughts and actions to facilitate future binge-eating episodes). Engagement in BP can involve thinking about what time, locations, or foods one might eat during a future binge-eating episode. In a preliminary study, BP was reported by a significant subset of individuals with EDs characterized by binge eating, and individuals who engaged in BP showed increased purging frequency and ED pathology (Manasse, Murray, Parker, Forman, & Juarascio, 2020). Identifying processes associated with engagement in BP could elucidate factors that promote this clinically relevant behavior.

Expectancy theories broadly suggest that individuals learn to expect specific outcomes of their behaviors and that these expectancies, rather than actual outcomes, influence continued engagement in specific behaviors. Studies applying such theories to EDs indicate that eating expectancies (i.e., beliefs about the outcomes of eating), particularly the expectancy that eating relieves negative affect, is associated with binge eating status (Fischer, Peterson, & McCarthy, 2013) and frequency (Fischer & Smith, 2008). Additionally, individuals with bulimia nervosa demonstrate heightened hedonic hunger (i.e., a drive to eat to obtain pleasure and despite a lack of physiological hunger) compared to individuals with anorexia nervosa or without EDs (Witt & Lowe, 2014). Hedonic hunger is associated with more frequent binge eating (Manasse et al., 2015; Witt & Lowe, 2014), and predictive of binge eating in college-aged women (Lowe et al., 2016), further establishing its relevance for bulimia-spectrum EDs. Although eating expectancies and increased hedonic hunger are associated with binge eating, their relevance for BP is undetermined.

It has been hypothesized that BP functions to distract individuals from momentary negative affect, reduce anticipation of the negative consequences of binge eating (e.g., guilt, shape and weight concerns), and increase sensitivity to reward (Pearson, Chester, Powell, Wonderlich, & Smith, 2016). Indeed, BP has been reported to distract from unpleasant experiences (Manasse et al., 2020) and reduce negative affect (Pearson et al., 2016). A small neuroimaging study examining neural activation while planning a future binge-eating episode found that BP is associated with increased activation in reward-related brain regions (Pearson et al., 2016). Thus, BP may be associated with greater hedonic hunger by increasing anticipation of obtaining pleasure from eating. Moreover, BP may be linked to eating expectancies and hedonic hunger by increasing the probability of obtaining a positive outcome or desired pleasure from binge eating.

The current study aimed to assess positive eating expectancies and hedonic hunger among individuals with bulimia-spectrum EDs who have and have not recently engaged in BP. We hypothesized that compared to individuals who do not report BP, those who report recent BP would have greater positive eating expectancies and greater hedonic hunger.

Methods

Participants and Procedures

We conducted a secondary analysis of data collected during two randomized clinical trials for bulimia-spectrum EDs (clinical trial numbers: NCT02716831, NCT03673540). Given data suggesting that the size of binge-eating episodes does not correspond with clinical impairment (Brownstone et al., 2013), adults who reported an average of 12 subjectively-large or objectively-large binge-eating episodes in the prior 3 months, and met all other behavioral criteria for bulimia nervosa (i.e., an average of at least once weekly compensatory behavior) were studied. Exclusion criteria included pregnancy, current enrollment in other weight loss or ED treatment programs, comorbid diagnoses that would impact ability to comply with study procedures (e.g., intellectual disability, psychotic disorder, substance dependence), and history of bariatric surgery. Data were collected prior to the start of treatment. Participants completed a diagnostic interview to determine DSM-5 ED diagnosis and assess recent BP behavior. Participants completed self-report questionnaires relating to eating expectancies and hedonic hunger. Both studies were approved by the Institutional Review Board at Drexel University. Individuals with bulimia-spectrum EDs were studied because they are more likely to report engagement in BP than individuals with binge-eating spectrum EDs (Manasse et al., 2020). Binge planning data from one of the included protocols (NCT02716831) accounting for 29.1% of the present sample (n=25) were previously reported (Manasse et al., 2020). This study’s analyses do not overlap with previous analysis of these data.

Measures

Demographics

Participants self-reported their age, gender, and race. Height and weight were measured by a research assistant during the appointment and used to calculate body mass index (BMI; kg/m2).

Eating Disorder Diagnosis

The Eating Disorder Examination Interview 17.0 (Cooper & Fairburn, 1987), a widely used semi-structured interview, was administered to determine DSM-5 ED diagnosis.

Binge Planning

Recent engagement in BP was assessed during the Eating Disorder Examination Interview immediately following the binge module. One item was added by the study team to assess if individuals took steps to plan for a future binge-eating episode, “Over the past four weeks, when you have lost control over your eating, do you take steps to plan for, or to facilitate binge eating episodes to occur (e.g., grocery shopping specifically for food to eat during a binge, setting aside time for the binge to occur)”. When BP was endorsed, interviewers obtained examples of planning behaviors, including how far in advance the planning occurred. Reported planning behaviors included shopping for foods that one can binge eat later in the week, arranging one’s obligations to ensure time and privacy for binge eating, planning a route home from work that allows for the purchase of food to binge eat, planning a binge-eating episode (e.g., foods to eat, date/time to eat) to celebrate the completion of a work project. Planning was not deemed present if, for example, an individual stopped at a restaurant/grocery store on their way home without having planned to do so earlier in the day/week. A specific time requirement for BP was not enforced. When planning behaviors occurred less than an hour in advance, or there was uncertainty, the behaviors were discussed during a monthly consensus meeting. Individuals were determined to be in the BP group if they endorsed at least one occasion of BP in the prior 28 days.

Eating Expectancies

The Eating Expectancies Inventory (Hohlstein, Smith, & Atlas, 1998) assessed the degree to which individuals expect eating to: 1) alleviate boredom, 2) reduce negative affect, 3) be pleasurable and rewarding, 4) enhance cognitive competence, and 5) lead to feeling out of control. Thus, there are four subscales assessing positive outcome, and one assessing negative outcome (e.g., feeling out of control) expectancies. Given the current study’s interest in positive eating expectancies, the feeling out of control subscale was not analyzed. Higher scores represent greater expectancies of positive outcomes. The measure has demonstrated good internal consistency and construct validity (Hohlstein et al., 1998). In the present study, internal consistency for each subscale ranged from acceptable to excellent. Cronbach’s alphas for each subscale are as follows: negative affect=.918; boredom=.748; pleasurable/rewarding=.879; cognitive competency=.909.

Hedonic Hunger

The Power of Food Scale (Lowe et al., 2009) was used to measure hedonic hunger, one’s drive to eat to obtain pleasure, rather than to satisfy a physiological energy deficit. Higher scores represent greater hedonic hunger. This measure has demonstrated adequate internal consistency and test-retest reliability (Lowe et al., 2009; Witt & Lowe, 2014). Internal consistency in the current sample was good (Cronbach’s alpha=.895).

Statistical Analyses

Natural log transformations were applied to variables that were not normally distributed (skewness and/or kurtosis <−1 or >1). T-tests were used to compare eating expectancies and hedonic hunger between individuals who did and did not report BP. When log transformations did not improve normality, Mann-Whitney U non-parametric tests were conducted. Cohen’s d was computed to determine whether the size of the effect for t-tests were small (d=0.2–0.49), medium (d=0.5–0.79), or large (d ≥ 0.8) (Cohen, 1988). To determine the size of effect of Mann-Whiteny U test, r was computed by dividing Z by the square root of the total sample size. Effect sizes for r were categorized as small (0.0–0.3), medium (0.3–0.5), or large (>0.5)(Cohen, 1988).

Results

Participant (N=86) characteristics are presented in Table 1. Twenty-nine participants (33.7%) endorsed recent engagement in BP. Groups did not differ on any demographic characteristics.

Table 1.

Participant demographics and eating disorder pathology

No BP (n=57) Recent BP (n=29) Group differences
n % n % X 2 p
Gender (female)a 38 66.67 15 51.72 2.65 .27
Race 2.49 .87
White 35 61.4 17 58.6
Black/African American 5 8.8 1 3.4
Asian 4 7.0 2 6.9
Multiple 1 1.8 0 0.0
Other 3 5.3 3 10.3
Unknown 5 8.8 4 13.8
Latino/a 4 7.0 2 6.9
ED Diagnosis 0.40 .82
BN 48 84.21 23 79.31
OSFED BN 2 3.51 1 3.44
OSFED other 7 12.28 5 17.24
M SD M SD t p
Age 36.93 14.71 36.9 14.98 0.07 .948
BMI (kg/m2) 30.13 7.45 28.17 5.73 1.25 .215
Open in a new tab

BP = binge planning; ED = eating disorder; BN = bulimia nervosa; OSFED = other specified feeding and eating disorder; BMI = Body Mass Index.

a

One participant from each group chose not to disclose their gender.

b

Other races includes Native American/Alaskan Native, Caribbean or unspecified other. OSFED BN refers to individuals who reported compensatory behaviors use and a combination of objectively- and subjectively large binge-eating episodes. OSFED other refers to individuals who reported compensatory behaviors use and subjectively large, but no objectively large, binge-eating episodes.

Group differences

Group differences in eating expectancies, and hedonic hunger are reported in Table 2. Compared to participants who did not report BP in the prior 28 days, individuals who recently engaged in BP reported greater expectancies that eating would reduce boredom (U=503.50, p=.006, r=.22) and negative affect (t(83)=−2.54, p=.013, d=.59). Groups did not statistically differ on pleasurable (t(83)=−0.16, p=.874, d=.04) and cognitive competency (t(84)=−1.41, p=.161, d=.32) eating expectancies, or hedonic hunger (t(84)=−1.68, p=.096, d=.39).

Table 2.

Group Differences in Eating Disorder Pathology, Eating Expectancies and Hedonic Hunger

No BP (n = 57) Recent BP (n = 29) Group differences
M SD M SD Mann-Whitney U p r
Eating alleviates boredom 19.68 4.96 22.04 5.41 503.50 .006 .30
M SD M SD t p Cohens d
Eating reduces negative affect 82.73 20.34 94.1 18.04 −2.54 .013 .59
Eating is pleasurable 30.42 8.82 30.72 7.26 −0.16 .874 .04
Eating enhances cognitive competenciesa 7.18 3.75 8.55 3.84 −1.41 .161 .32
Hedonic hunger 3.75 0.72 4.03 0.71 −1.68 .096 .39
Open in a new tab

BP = binge planning. Eating expectancies were measured by the Eating Expectancies Inventory. Hedonic hunger was measured by the Power of Food Scale. No binge planning group was set as the reference category for t-tests.

a

Unadjusted means and standard deviations are presented, but log transformed variable was used in analyses.

Discussion

This study examined if recent engagement in BP was associated with positive eating expectancies and hedonic hunger among individuals with bulimia-spectrum EDs. Individuals who recently engaged in BP reported greater boredom and negative affect reduction eating expectancies. Hedonic hunger did not differ among those who had and had not recently engaged in BP. These results provide support for BP as a clinically relevant behavior linked to specific eating expectancies.

Compared to individuals who did not report BP, individuals who recently engaged in BP reported greater negative affect and boredom reduction eating expectancies, but not increased pleasure or cognitive competency eating expectancies. These findings are consistent with previous studies suggesting that negative affect eating expectancies are most closely associated to binge eating (Brosof, Munn-Chernoff, Bulik, & Baker, 2019; Hayaki, 2009). These results also lend support to the hypothesis that individuals may engage in BP to modulate affective states (Manasse et al., 2020; Pearson et al., 2015). It is possible that expectancies about the outcomes from engaging in BP may be a pertinent pathway for the maintenance of BP. Therefore, future studies should investigate how engagement in BP may contribute to, or result from, learned associations between binge eating and affect.

Hedonic hunger was not significantly greater among those who recently engaged in BP. Yet, Pearson et al. (2016) observed increased reward while planning a binge-eating episode. It may be that BP is linked to momentary desires to obtain pleasure from eating, but not one’s trait level of hedonic hunger. To test this possibility, studies should explore the associations among BP and both trait and state levels of hedonic hunger.

These findings should be considered in light of the study’s limitations. Cross-sectional data were examined, which prohibits investigation of temporal relationships. Although a large subset of the current sample recently engaged in BP, the overall sample size was small. Therefore, longitudinal studies among larger, independent samples should aim to replicate and extend our findings. We utilized a single item measurement of BP, which may not be sensitive enough to identify individuals who plan binge-eating episodes. To date, no research has defined the critical features of BP, such as how far in advance planning must occur, what planning behaviors are relevant, whether presence or frequency of BP is most clinically significant. Thus, development of a comprehensive and validated measure of BP behavior is needed to better understand this phenomenon. Lastly, the Eating Expectancy Inventory does not assess attitudes or cognitions about binge eating specifically. Rather, it assess expectancies of eating generally. As such, our findings may reflect a tendency for individuals who engage in BP to think about eating more broadly. Future studies should consider adapting measure of expectancies with specific behaviors of interest (e.g., binge eating, self-induced vomiting, binge planning).

This study offers insight into characteristics of individuals who engage in BP. Providers should assess for engagement in BP in patients with bulimia-spectrum EDs. Further, to facilitate reductions in binge eating among patients engaging in BPs, therapists might teach healthy emotion regulation strategies for coping with distress. Studies identifying factors that promote the development of and engagement in BP could improve our ability to develop targeted interventions for individuals who are compulsively engaging in ED behaviors.

Acknowledgments

FUNDING SOURCE: This work was supported by the National Institutes of Health, USA, K23 MH105680 (PI: Juarascio), R34 MH116021 (PI: Juarascio), K23 DK124514 (PI: Manasse)

Footnotes

CONFLICTS OF INTEREST: The authors have no conflict of interest to disclose.

DECLARATION: The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of USU, or the U.S. Department of Defense.

TRIAL REGISTRATION NUMBERS: NCT02716831, NCT03673540

DATA AVAILABILITY STATEMENT:

The data that support the findings of this study are available from the corresponding author upon request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon request.

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