Abstract: Purpose To evaluate interoceptive accuracy (Iac) before and after a single yoga class in a population of patients with anorexia nervosa (AN) and in a population of healthy controls (HC). Methods Fifteen patients with AN and twenty HC were included in the study. All individuals participated in a single yoga class. Before (T0) and after (T1) the yoga class, they underwent the heartbeat detection task for the evaluation of Iac. At T0, all participants also underwent a psychological assessment, including evaluation of depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders psychopathology. Results Patients with AN had lower Iac than HC at T0. A significant improvement of Iac at T1 was found in the HC group but not in the group of patients with AN. Conclusion We infer that our findings might be linked to the fact that patients with AN, differently from HC, did not properly attend to their bodies, despite the yoga class. This hypothesis is consistent with previous studies showing that patients with AN have decreased Iac during self-focused behavior because of body-related avoidance. Moreover, we surmise that HC might be keener to improve their perception of internal body signals even after a single yoga class because their emotional awareness system is not impaired. Patients with AN, on the contrary, may have an intrinsic impairment of their emotional awareness, making it harder for them to modulate their Iac. Level of evidence Level III, evidence obtained from well-designed cohort or case–control analytical studies. PubDate: 2020-07-01
Abstract: Purpose This study examined the association between anti-fat attitudes (fear of fat, dislike of fat, willpower) and dietary restraint within the mother–daughter relationship. Methods Mother–adolescent daughter dyads (Npairs = 100) were recruited from a Midwestern community to participate in a study together. They completed self-report measures of anti-fat attitudes and eating behavior. Data were analyzed with an Actor–Partner Interdependence Model (APIM). Results Significant actor effects for mothers include fear of fat (b = 0.270, B = 0.319, p < 0.05) and willpower (b = 0.228, B = 0.280, p < 0.05) predicting her own dietary restraint. For daughters, fear of fat (b = 0.554, B = 0.612, p < 0.05) and dislike (b = 0.202, B = 0.214, p < 0.05) predict her own dietary restraint. Regarding partner effects, mothers’ fear of fat was related to daughters’ dietary restraint (b = 0.126, B = 0.138, p < 0.05), and daughters’ dislike was related to mothers’ restraint (b = 0.257, B = 0.294, p < 0.05). Regarding dyad-level interaction effects, mother and daughter fear of fat interacted to predict daughter dietary restraint (b = 0.184, B = 0.201, p < 0.05), such that when both mother and daughter fear of fat is high, daughters appear to engage in more dietary restraint. Conclusions Given the role of mothers’ fear of fat in daughter eating behavior, parent-focused or parent-involved interventions may improve family culture around weight and eating, contributing to better adolescent outcomes. Level of evidence V, cross-sectional descriptive study. PubDate: 2020-06-28
Abstract: Objectives Anxiety and depression are both considered maintaining factors for eating disorders (ED) but it is still unclear if one is more strongly associated with ED symptoms than the other. We examined differences in severity of ED symptoms among adults with either, both, or neither depression and anxiety. Methods Volunteers (N = 3,780) to the project implicit mental health website (https://implicit.harvard.edu/) self-reported their ED status (current ED: n = 374, past ED: n = 436; no ED: n = 2,970), their current depression/anxiety status, and their ED symptoms (using the Eating Attitudes Test). ANOVAs with post hoc comparisons were used to examine relationships between ED symptoms and comorbid depression/anxiety status among currently ill, recovered, and never ill individuals. Results Participants without comorbidities had the least and participants with both comorbidities had the most severe ED symptoms (p = .021). Participants with anxiety alone had more severe ED symptoms relative to those with depression alone across groups (current ED: p = .024; past ED: p = .019; no EDs: p = .021). Discussion These findings demonstrate, in contrast with an earlier study among youth with EDs (Hughes et al., 2013), that comorbid anxiety may be linked with more severe ED symptoms relative to comorbid depression. It is possible that anxiety serves as a maintaining factor for ED symptoms such that dieting and other ED-related behaviors may function to modulate symptoms of anxiety. Level of evidence Level III, case-control analytic study. PubDate: 2020-06-26
Abstract: Purpose Monogenic forms of obesity are caused by single-gene variants which affect the energy homeostasis by increasing food intake and decreasing energy expenditure. Most of these variants result from disruption of the leptin–melanocortin signaling, which can cause severe early-onset obesity and hyperphagia. These mutation have been identified in genes encoding essential proteins to this pathway, including leptin (LEP), melanocortin 2 receptor accessory proteins 2 (MRAP2) and proopiomelanocortin (POMC). We aimed to investigate the prevalence of LEP, MRAP2 and POMC rare variants in severely obese adults, who developed obesity during childhood. To the best of our knowledge, this is the first study screening rare variants of these genes in patients from Brazil. Methods A total of 122 Brazilian severely obese patients (BMI ≥ 35 kg/m2) were screened for the coding regions of LEP, MRAP2 and POMC by Sanger sequencing. All patients are candidates to the bariatric surgery. Clinical characteristics were described in patients with novel and/or potentially pathogenic variants. Results Sixteen different variants were identified in these genes, of which two were novel. Among them, one previous variant with potentially deleterious effect in MRAP2 (p.Arg125Cys) was found. In addition, two heterozygous mutations in POMC (p.Phe87Leu and p.Arg90Leu) were predicted to impair protein function. We also observed a POMC homozygous 9 bp insertion (p.Gly99_Ala100insSerSerGly) in three patients. No pathogenic variant was observed in LEP. Conclusion Our study described for the first time the prevalence of rare potentially pathogenic MRAP2 and POMC variants in a cohort of Brazilian severely obese adults. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-06-23
Abstract: Purpose Orthorexia is a proposed disorder that involves a pathological obsession with healthy eating. The condition has received much attention in popular media in recent years, but more empirical research is needed. Currently, orthorexia is an emerging construct with multiple proposed versions of diagnostic criteria, and there is confusion regarding the exact symptoms and pathology. This qualitative study aimed to explore the experiences of orthorexia from the perspective of recovered persons, as defined by Dunn and Bratman’s 2016 criteria (Eat Behav 21:11–17, 2016). Methods Eight participants from around the world were interviewed via Skype. These interviews were analysed using a descriptive and interpretive thematic analysis (Elliott and Timulak. A handbook of research methods for clinical and health psychology. Oxford University Press, London, pp 147–159, 2005). Informed consent was obtained from all participants. Results Data analysis revealed four domains: (1) strong external influences; (2) psychological effects; (3) interpersonal functioning effects; and (4) classic eating disorder (ED) behaviours and processes. Some symptoms mirrored those seen in EDs and in obsessive compulsive disorder. Conclusions Orthorexia negatively impacted participants' physical, psychological, and social health. Additional research exploring valid and reliable screening instruments, body image, and psychological functioning would help to further understand this proposed disorder. Level of evidence Level V, qualitative interview study. PubDate: 2020-06-23
Abstract: Objective To compare the global health status, frequency of somatic and psychological problems, and alcohol use in adulthood among women hospitalized in adolescence for severe anorexia nervosa (AN), with a matched control sample from the general population. Method Women (n = 86) who had been hospitalized for AN 9.31 ± 1.82 years previously were compared with 258 controls matched for gender, age, and socio-professional category. Data were retrieved from a French survey on health and social insurance coverage, and was mainly collected by self-report, except for the assessment of current eating disorders for those previously hospitalized for AN (assessed with the MINI). Results The women who had been hospitalized for AN reported significantly poorer current health status compared to controls (OR 2.9, 95% CI 1.5–5.79). According to the MINI, 13 women previously hospitalized with severe AN still presented an eating disorder (ED). Women with past AN reported more frequent acute throat infections (OR 4.9, 95% CI 1.81–13.51), gastralgia (OR 3.6, 95% CI 1.9–6.83), gastro-oesophageal reflux (OR 5.279, 95%CI 2.11–13.22), excess blood cholesterol or triglyceride levels (OR 2.55, 95% CI 1.03–6.33), anxiety (OR 8.7, 95% CI 3.48–21.8) and depression (OR 5.02 (2.8–9.01). These differences remained significant and of the same order of magnitude in sensitivity analyses among subjects with previous AN but without current ED, except for perceived health status and excess cholesterol and triglyceride levels. Discussion Women who had been hospitalized for severe AN reported more symptoms 10 years after treatment, implies psychological and somatic follow-up in the long term. Level of evidence Level III, case–control analytic study. PubDate: 2020-06-23
Abstract: Purpose The Levels of Emotional Awareness Scale (LEAS), a measure of the ability to identify and describe one’s own and others’ emotions, may complement work with women with disordered eating symptoms. The study purpose was to (a) examine differences in hand (LEAS) versus computerized (e-LEAS) scoring methods and (b) examine the e-LEAS’ psychometric properties, including convergent and discriminant validity, among women endorsing eating disorder symptoms. Methods Forty women (ages 18–21) scoring high on a self-report measure of disordered eating symptoms completed the LEAS and measures of convergent validity including a self-report measure of alexithymia (the perceived ability to identify and describe one’s own emotions) and a measure of facial affect recognition as well as discriminant validity, including affect and facial memory. Inter-rater reliability was assessed via a two-way mixed effects model and correlations between the LEAS and the study constructs were examined. Results Computerized scoring (e-LEAS) offered benefits over hand scoring and correlations between LEAS and e-LEAS were statistically significant. Better total emotional awareness scores on the e-LEAS were significantly associated with more perceived difficulty identifying and describing emotions. Better total emotional awareness scores were also significantly associated with better facial memory and greater depression scores. The e-LEAS showed weak associations with facial affect recognition. Conclusion The e-LEAS offers practical advantages over the LEAS in the assessment of emotional awareness among women endorsing eating disorder symptoms. Results suggest that the e-LEAS measures the ability to describe emotional experiences in oneself and others, but not facial affect recognition. Level of evidence Level V: Evidence obtained from a cross-sectional descriptive study. PubDate: 2020-06-20
Abstract: Background Few studies have investigated the weight of patients with schizophrenia in China. Objective The aim of this study was to analyse the prevalence, clinical characteristics and influencing factors of obesity and underweight in patients with chronic schizophrenia in China. Methods A total of 325 patients with schizophrenia and 172 sex- and age-matched healthy controls from the community were recruited. Socio-demographic data and laboratory measurements were collected for all subjects. Using the Positive and Negative Syndrome Scale (PANSS), we evaluated the psychiatric symptoms of patients with schizophrenia. According to the body mass index (BMI) criteria in China, BMI ≥ 28 kg/m2 indicates obesity, and BMI < 18.5 kg/m2 indicates underweight. Results Of the patients with schizophrenia, 16.3% were obese, and 6.8% were underweight; 11.0% of the healthy controls were obese, and 3.5% were underweight. There was no difference between the two groups in the prevalence of obesity and underweight. After controlling for relevant variables, the obesity rate remained non significant, but the underweight rate appeared to be different. The multinomial regression analysis revealed that among the patients with schizophrenia, female sex, triglyceride level and LDL level were independent risk factors for obesity and that HDL level was an independent protective factor against obesity. In contrast, male sex and HDL level were independent risk factors for underweight. Conclusion We found that the patients with schizophrenia had an increased rate of underweight and some factors related to weight. Level of evidence Level V, descriptive study PubDate: 2020-06-17
Abstract: Purpose It is known that childhood maltreatment and problematic eating behaviors are higher in bariatric surgery patients compared to over- and normal-weight persons. The aim of the study is to investigate the relationship between childhood maltreatment and problematic eating behaviors such as restraint, eating concern, weight concern, shape concern, and emotional eating in bariatric surgery patients. Materials and methods 112 consecutive obese individuals seeking bariatric surgery at a University Hospital were administered asset of scales, including Childhood Trauma Questionnaire (CTQ), Dutch Eating Behavior Questionnaire-Emotional Eating subscale (DEBQ-E), and Eating Disorder Examination-Questionnaire (EDE-Q) and sociodemographic form, cross-sectionally. After descriptive statistics, a regression analysis was conducted to understand the relationships of CTQ scores with EDE-Q total, and subscale scores and DEBQ-E. Results In the Pearson correlation analysis, a statistically significant positive correlation was found between CTQ total score with EDE-Q total score and all subscales scores. In linear regression analyses, it was found that emotional abuse (β = 0.39, p = 0.02) and physical abuse (β = 0.36, p = 0.01) predicted increased DEBQ-E scores. In addition, sexual abuse was found to significantly predict weight concern (β = 0.26, p = 0.04) and shape concern (β = 0.31, p = 0.01). Conclusion Our findings showed that the dynamics of problematic eating behaviors may differ depending on the type of childhood trauma. Psychiatric evaluation of bariatric surgery patients is important in understanding the relationship between childhood maltreatment and problematic eating behaviors. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-06-13
Abstract: Objective There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample. Method The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)Duration = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients’ medical charts. Results In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not. Conclusions Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation. Level of evidence Level IV, uncontrolled intervention. PubDate: 2020-06-07
Abstract: Purpose Body shame has been strongly associated with eating pathology. However, less is known about the predisposing factors linked to these feelings and how they interact with other variables in eating disorder development. Thus, the aim of the present study was to provide a preliminary understanding of the relationship between body shame and some of the major risk factors for eating disorder onset, identifying the possible mechanisms of action. Specifically, we tested a structural equation model in which perceived parental bonding, self-esteem, perfectionism, and body mass index are associated with eating disorder risk via body shame. Methods 1156 high school students aged 13–20 were screened by means of self-report measures of parental behavior, self-esteem, perfectionism, body shame and eating disorder risk. The height and weight of each individual were measured. Results In predicting eating disorder risk, parental protectiveness (β = 0.09), body mass index (β = 0.18), self-esteem (β = − 0.14) and body shame (β = 0.58) had a direct effect on this variable and overall our model accounted for 58% of its variance. The experience of shame related to one’s body appeared to have a considerably significant influence on eating disturbances vulnerability and it also serves as a mediator between other risk factors and eating disturbance risk. A series of multi-group analyses indicated no significant difference between males and females. Conclusion The emotion of shame may enhance our understanding of eating disorders, as well as being a salient factor for the development of preventive programs and treatment approaches. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2020-06-01
Abstract: Purpose Drunkorexia represents an emerging phenomenon that is still understudied especially among adolescents. The present study aimed to investigate the relation between drunkorexia and psychological characteristics relevant and commonly associated with existing forms of eating disorders. Methods The sample was composed of 849 adolescents (513 boys, 334 girls, 2 unknown; range 14–22) who completed a survey composed of Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale and Psychological scales of the Eating Disorders Inventory-3. Results Our findings highlighted that drunkorexia was associated with low self-esteem, personal alienation, interoceptive deficits, emotional dysregulation, and asceticism. Hierarchical multiple regression analysis indicated that difficulties with emotion regulation and ascetic tendencies were significant predictors of drunkorexia among adolescents. Conclusions Our findings suggest the importance for programs preventing drunkorexia to be focused on training adolescents in using more adaptive strategies to manage emotions and accepting both emotional and physical signals without feeling guilty or threatened. Level of evidence Level V, descriptive study. PubDate: 2020-06-01
Abstract: Purpose This study presents the results of methodological research that derives evaluation items and tests the validity and reliability of the scale to measure quality of life of the overweight women. Methods The scale items were developed by the current researchers directly from the consultation data following a group interviewing process aiming to capture the women’s experiences, who are currently receiving primary health care. Pretest interviews were used to ensure that the questions were understood correctly. Six experts determined items for content validity of the scale and the evaluations of experts were scored using a content validity index. The scale is a Likert-type scale, ranging from 1 to 5. The items were tested on a sample of 506 healthy women. The body mass indices of participants were 30 and above. Psychometric analyses included explanatory factor analysis (EFA) and item response theory. Parallel analysis was used to extract factors in EFA. Internal consistency and Spearman Brown split-half test correlation were used for testing reliability. Results The scale was refined as four final dimensions, comprising 40 items as a whole. The result of Bartlett’s Test of Sphericity was found sufficient (χ2 = 14164.92; p < 0.001) and the KMO value was 0.959. This statistically significant value (p < 0.001) indicates that the sampling was sufficient and data had normal distribution. Cronbach’s alpha was 0.967. The Spearman Brown coefficient was found to be 0.884. Conclusion It was found that the scale is a valid and reliable assessment tool that can be used to measure the quality of life of overweight women. Level of evidence Methodological study, Level V. PubDate: 2020-06-01
Abstract: Purpose The purpose of the study was to assess the psychometric properties of the Portuguese version of the Clinical Impairment Assessment (CIA) in eating disorders (ED) patients. Method The CIA is a 16-item brief self-reported instrument developed to assess psychosocial impairment secondary to EDs. The CIA was administered to a clinical sample of 237 women with EDs and a college sample of 196 women. The clinical sample completed the Eating Disorders Examination Questionnaire, the Beck Depression Inventory and the Outcome-45 Questionnaire. Reliability, confirmatory factor analysis, validity, and clinically significant change were calculated. Results Confirmatory factor analysis validated the original 3-factor structure showing an adequate model fit. CIA showed good psychometric properties with high internal consistency, good convergent validity with the EDE-Q, the OQ-45, and the BDI. For divergent validity, participants CIA scores in the clinical sample were significantly higher than in the non-clinical sample. ROC curve analysis provided a cutoff of 15. For known-groups validity participants’ scoring above CIA cutoff reported significantly higher CIA scores. In addition, non-underweight participants and participants reporting the presence of dysfunctional ED behaviors had significantly higher CIA scores. Finally, for clinically significant change, a reliable change index of 5 points was obtained to consider a reliable change in the CIA global score. Conclusions Our findings support the validity and clinical utility of the CIA as a good self-report measure to be used in both clinical and research settings. Level of evidence Level V. Cross-sectional descriptive study. PubDate: 2020-06-01
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