Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity最新文献

Background: Anorexia nervosa (AN) is a severe psychiatric disorder associated with extreme malnutrition and multi-organ complications, including cutaneous manifestations.

Case presentation: We report an 11-year-old girl with restrictive-type AN who presented with a critically low BMI (7.7-9.0 kg/m²), who presented with striking cutaneous findings. These included widespread striae distensae with a translucent, "cellophane-like" appearance, desquamative lesions reminiscent of the "flaky paint" dermatosis seen in kwashiorkor, and sacral pressure ulcers. Laboratory findings revealed severe protein-energy deficiency, anemia, electrolyte imbalance, and endocrine alterations. A structured refeeding program with close monitoring led to substantial clinical improvement. Over 8 weeks, her weight increased by 6 kg, and the skin gradually regained thickness, elasticity, and integrity.

Discussion: This case highlights the interplay of nutritional deficiency, catabolism, cortisol elevation, and mechanical stress in producing rare dermatoses in anorexia nervosa. The co-occurrence of glassy striae and flaky desquamation suggests a marasmic-kwashiorkor phenotype of malnutrition. The reversibility of these lesions further underscores the remarkable regenerative capacity of the skin under restored nutritional conditions.

Purpose: ADHD and Autism are overrepresented in adults with bulimic-spectrum eating disorders (EDs) and are associated with unique underlying mechanisms and poorer treatment outcomes. This qualitative study explores how Neurodivergent and potentially Neurodivergent individuals with bulimic-spectrum EDs make sense of their (potential) Neurodivergence, its impact on their ED, and their treatment needs.

Methods: Sixteen adults with bulimic-spectrum EDs who either self-reported a diagnosis of ADHD and/or Autism or scored highly on screeners (ASRS-Screener > 3; AQ-10 > 5) were interviewed. Data was analysed using reflexive thematic analysis, with cross-group comparisons between ADHD-only and ADHD + Autism presentations. Reflexivity was strengthened through critical friend discussions, and member reflections.

Results: We developed four themes and 12 sub-themes: 1. Difficulty making sense of potential Neurodivergence: participants expressed mixed feelings about identifying as Neurodivergent. While some found the label helpful, others felt uncertain about whether they were Neurodivergent or had concerns around stigma. Participants struggled to distinguish features of Neurodivergence from those of their ED. 2. Bingeing as ADHD self-regulation: bingeing was used to manage emotional overwhelm or under-stimulation linked to ADHD, and often became compulsive over time. 3. Restriction shaped by Autistic traits: restriction was associated with interoceptive and exteroceptive sensory differences, preference for sameness, and social disconnect, particularly among those with co-occurring Autism. 4. Balancing personalised and structured care: participants wanted flexible, personalised care that also provided structure to support recovery.

Conclusions: ADHD and Autistic traits may influence bulimic-spectrum EDs in distinct ways. Helping Neurodivergent individuals and clinicians understand these connections can guide personalised treatment priorities and adaptations, improving treatment engagement and outcomes for Neurodivergent individuals.

Level of evidence: Level IV, qualitative exploratory study.

Objective: Despite several studies assessing the impact of resveratrol on obesity indices, previous meta-analyses show conflicting results. Therefore, we conducted this critical umbrella review of interventional meta-analyses on the effect of resveratrol supplementation on body mass index (BMI), body weight (BW), waist circumference (WC), and body fat.

Methods: Searches were conducted across multiple databases to identify all relevant meta-analyses up to September 30th, 2025. Reported pooled effect sizes (ESs) and 95% confidence intervals (CIs) were extracted from each included study and synthesized using a random-effects model. Methodological quality was assessed using the AMSTAR 2 tool.

Results: Ultimately, 18 meta-analyses were included, with results showing a small but statistically significant reduction in BW (ES: - 0.18 kg, 95% CI - 0.32 to - 0.03, p = 0.02), BMI (ES: - 0.14 kg/m², 95% CI - 0.2 to - 0.08, p < 0.001), WC (ES - 0.43 cm, 95% CI - 0.64 to - 0.22, p < 0.001), and body fat (ES: - 0.3 kg, 95% CI - 0.48 to - 0.12, p = 0.001) in the resveratrol group compared to the control group, with subgroup analysis revealing statistical significance only in subgroups with doses > 400 mg/day and study duration ˃ 12 weeks.

Conclusion: Our review confirms that resveratrol supplementation reduces BW, BMI, WC, and body fat, particularly on doses > 400 mg/day and interventions lasting ˃12 weeks, with small effect sizes. Based on our findings, resveratrol supplementation could be considered as a complementary therapy in the management of obesity.

Purpose: Physicians can play a critical role in the early identification and treatment of eating disorders (EDs), yet many report low confidence in diagnosing and managing these illnesses. ED education during medical training has the potential to improve physician's competence in recognizing, diagnosing, and treating EDs. This study assessed the content of ED education in preclinical medical training to identify opportunities to strengthen curricula.

Methods: Slide content from 15 ED lecture presentations used between 2019 and 2024 in preclinical medical education at either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) institutions in the United States was analyzed. Through a directed qualitative content analysis, the depth and breadth of textual content were examined and the use of visual aids in slide content was assessed.

Results: Slides often acknowledged the multifactorial nature of EDs. They primarily focused on anorexia nervosa and bulimia nervosa, but not other EDs. Images reinforced stereotypes about who develops EDs, and there was limited mention of weight stigma as a barrier to diagnosis and treatment. Furthermore, ED treatment options, including therapeutic modalities, pharmacotherapies, and levels of care, were introduced but not described in detail.

Conclusion: Physicians are well-positioned to identify and treat EDs. However, findings suggest that significant gaps exist in the coverage of EDs in preclinical medical education. Current preclinical education may inadvertently reinforce misconceptions that hinder the ability of physicians to detect diverse presentations of EDs early. Recommendations are offered to guide future lecture development and strengthen ED-related educational content.

Level of evidence: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Purpose: Widely used eating disorder (ED) measures, such as the Eating Disorder Examination-Questionnaire (EDE-Q) or the Eating Attitudes Test-26 (EAT-26), were originally developed and standardized in young White women, leading to poor performance, unclear factor structures, and inconsistent measurement invariance across diverse groups. As ED prevalence rises among middle-aged women, the need for age-appropriate and psychometrically sound assessment tools has become increasingly important. This study evaluated the factor structure, measurement invariance, and internal consistency of the EDE-Q and EAT-26 when administered online across two developmentally relevant age groups: emerging adults and middle-aged women.

Method: A sample of 829 women from across the U.S. (emerging adults: 419; middle-aged: 410) completed the EDE-Q and EAT-26 through an online survey platform. We tested the original factor structures and two alternative models for each measure through confirmatory factor analysis. Measurement invariance analyses were conducted on good-fitting models.

Results: The original EDE-Q model failed to converge, while the original EAT-26 model demonstrated poor fit. The alternative factor models-Grilo et al.'s (2013) EDE-Q model, and Bazo Perez et al.'s (2023) EAT-26 model-demonstrated best fit and measurement invariance across both age groups. The EDE-Q subscales exhibited good internal consistency, while the EAT-26 showed acceptable to good internal consistency.

Conclusion: These findings emphasize the need for developmentally sensitive tools to improve diagnostic accuracy, early detection, and treatment of EDs across the lifespan. Because the factor structure and measurement invariance results reflect online administration, they should be interpreted within this context and motivate continued evaluation of these instruments across administration formats. Addressing a critical gap in ED research and clinical practice, this work underscores the need to refine ED assessment methods, to ensure equitable, accurate, and developmentally appropriate identification of ED risk in women beyond early adulthood.

Level of evidence: V, descriptive (cross-sectional) study.

Purpose: The Children's Eating Behavior Questionnaire (CEBQ) is a reliable and widely used tool to assess eating behavior traits in children. However, currently no Danish version of the CEBQ exists. This study aimed to translate the CEBQ into Danish and investigate its psychometric properties and factor structure in children with overweight and obesity. Secondly, differences in eating behavior traits between children with overweight and obesity were explored.

Methods: Children (7-14 years) were recruited from a 10-week multicomponent lifestyle camp. Parents completed the CEBQ with their child before camp, and anthropometry was measured. CEBQ is scored from 1 to 5, with higher scores indicating a higher tendency toward a specific behavior. A confirmatory factor analysis (CFA) was performed to test the original eight-factor structure. Internal reliability was assessed using McDonald's Omega.

Results: In total, 190 children (12.3 ± 1.36 years) participated. The CFA confirmed the eight-factor model, with all items loading significantly on their respective factors. Internal reliability was acceptable for the full CEBQ scale (ω = 0.85) and most subscales (ω ≥ 0.70) but only moderate for Satiety Responsiveness (ω = 0.59) and Emotional Undereating (ω = 0.65). No statistically significant difference was found between children with overweight and obesity according to the Bonferroni-adjusted alpha.

Conclusions: The Danish CEBQ is a valid tool to assess eating behavior traits in Danish children with overweight and obesity; although, generalizability may be limited due to a relatively small sample size. Future studies should further validate the Danish CEBQ by assessing test-retest reliability, construct validity, and factor structure in a generalizable sample across weight categories.

Level of evidence: Level V, Cross-sectional, Psychometric study.

Purpose: This study examined what is associated with self-objectification, body uneasiness, body investment, and depersonalization in adults who altered their bodies. We tested adults involved in body modification (BM) or plastic surgery (PS), and we compared them to controls to clarify these associations.

Methods: We conducted an observational cross-sectional study of 235 adults (72.8% female) and grouped them into three categories: BM (n = 63), PS (n = 48), and controls (n = 124). Participants completed the Objectified Body Consciousness Scale, the Body Investment Scale, and the Body Uneasiness Test. We used analysis of covariance to compare groups while controlling for age and gender. We tested mediation by Body Investment Scale subscales and moderation by the number of BM and PS interventions in the relationship between self-objectification and depersonalization.

Results: PS showed the highest self-objectification and body uneasiness, BM was intermediate, and controls were lowest. Body investment, particularly the body image subscale, mediated the association between self-objectification and depersonalization. The number of BM interventions strengthened the association between body investment and depersonalization, and PS tended to moderate the direct link between self-objectification and depersonalization.

Conclusion: These findings suggest that body investment partly explains the connection between self-objectification and depersonalization, and that BM and PS relate differently to depersonalization in nonclinical adults. Given the cross-sectional design, we can only draw associative (not causal) conclusions.

Level of evidence: III, observational cross-sectional study.

Purpose: This study examined the incidence of hypermagnesemia in patients with eating disorders, its associations with renal function, body mass index, and magnesium oxide use, and the correlation between different methods of estimating renal function and serum magnesium levels.

Methods: This retrospective cohort study was conducted in female patients with eating disorders treated at Nagoya University Hospital between January 2018 and December 2022. Patients diagnosed as eating disorders, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, were included. Serum magnesium levels, estimated glomerular filtration rate, body mass index, and magnesium oxide prescriptions were collected. Linear mixed-effects models were used to analyze factors affecting serum magnesium levels. Renal function screening methods were compared in underweight patients.

Results: Among 194 patients, 42 (21.6%) developed hypermagnesemia (≥ 2.5 mg/dL; maximum 5.3 mg/dL). Younger age, lower body mass index, and reduced estimated glomerular filtration rate were linked to higher magnesium levels, whereas magnesium oxide use showed no clear association. Further analysis showed that the alternative estimated glomerular filtration rate method, adjusted for body size, negatively correlated with elevated serum magnesium levels in underweight patients.

Conclusion: The incidence of hypermagnesemia in patients with eating disorders receiving magnesium oxide was comparable to previous studies. Risk factors include low body mass index, impaired renal function, and younger age. Although monitoring is warranted, severe complications were not observed, suggesting magnesium oxide need not be avoided. The use of body size-adjusted estimated glomerular filtration rate may improve the screening for hypermagnesemia in underweight patients.

Level of evidence: Level III, well-designed cohort or case-control analytic studies.

Purpose: Carotid-femoral pulse wave velocity (cfPWV), an index of arterial stiffness, is one of the earliest indicators of cardiovascular risk. Studies of adolescents with anorexia nervosa have demonstrated increased arterial stiffness compared to healthy controls. Little information is available on the effect of weight restoration on arterial stiffness in adolescents with anorexia nervosa.

Methods: This pilot longitudinal study examined changes in arterial stiffness during weight restoration in adolescent females admitted to an inpatient eating disorder unit. Female adolescents aged 15-19 years with a diagnosis of anorexia nervosa and a body mass index (BMI) < 85% of median BMI for age and sex, were recruited from consecutive eating disorder admissions at Westmead Hospital, Australia. Weekly measurements of cfPWV were performed for up to 4 consecutive weeks.

Results: 12 participants were included, with an average follow-up of 3.2 ± 1.1 weeks. Using mixed-effects models, we observed a significant increase in BMI (95% CI 0.60, 0.80; p < 0.01) along with a modest but statistically significant decrease in cfPWV. The rate of change in cfPWV observed was - 0.2 m/s per week (95% CI - 0.37, - 0.03; p = 0.03). Mean arterial pressure (MAP) was significantly associated with cfPWV (p < 0.01). There was a borderline association between cfPWV and BMI (p = 0.05).

Conclusions: Our findings suggest a possible reduction in arterial stiffness with weight restoration, although results must be interpreted with caution due to the small sample. Nevertheless, serial measurements of cfPWV in this population are feasible, supporting the need for larger longitudinal studies in this population.

Level of evidence: Level III.