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

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.

Purpose: Obesity is associated with increased perceived fatigue and reduced physical activity. This study tested whether a placebo ergogenic treatment could reduce perceived exertion and enhance motor performance in individuals with obesity.

Methods: Forty-four participants were randomized to a Placebo group, which received sham transcutaneous electrical stimulation paired with positive suggestions, or to a Control group. Endurance (repetitions), perceived exertion (RPE load), and the late Readiness Potential were recorded during a finger-flexion task performed to exhaustion at 60% 1-RM in two sessions separated by 30 min of rest. Outcomes (Repetitions, RPE load, and RP amplitude) were expressed as percentage change (Δ%) from baseline to test, and group differences were analysed through one-way ANOVAs.

Results: Compared with Controls, the Placebo group exhibited smaller declines in repetitions and RPE load and a smaller increase in RP amplitude. Outcomes are in line with a reduced perceived fatigue.

Conclusions: These findings suggest that positive expectations can alleviate perceived fatigue and reduce the cortical cost of motor preparation in obesity.

Level of evidence: Randomized Experimental Trial.

Purpose: Anorexia nervosa (AN) is a severe eating disorder characterized by perceptual distortions and restrictive eating behaviours. This pilot study examines portion size estimation in adolescent AN patients using a mixed-reality (MR) approach. The objective is to evaluate the potential of this method for the assessment and treatment of AN, with a particular focus on its ecological validity and its applicability for investigating portion size estimation.

Methods: A total of 30 female participants were recruited: 15 adolescent AN patients and 15 healthy adults as pretest. Participants engaged in a simulated meal assembly task within an MR environment, adjusting portion sizes of virtual food components to match a "typical" meal size (100%). Decision-making patterns and self-reported eating disorder symptoms were recorded. Statistical analyses included descriptive statistics, group comparisons and correlation analysis to examine associations between clinical variables and portion sizes, decision-making time and other decision parameters.

Results: AN patients consistently selected significantly smaller portion sizes than healthy adults, particularly for high-calorie foods. No significant differences were observed in decision-making time or uncertainty indicators.

Conclusion: The findings support the hypothesis that AN patients exhibit altered food perception in the sense that they tend to overestimate the size of visually presented food portions. The MR approach proved effective in simulating meal selection, Future studies should include larger and more diverse samples and incorporate real food intake to further validate these results.

Purpose: Generating real-world evidence on individuals living with severe overweight or obesity in Italy, focusing on their characterization and management from general practitioners (GPs) perspective.

Methods: This was a non-interventional longitudinal observational cohort study using data from the Italian IQVIA Longitudinal Patient Database (LPD), conducted in collaboration with a working group from the 'Società Italiana di Obesità'. The study included individuals with body mass index (BMI) ≥ 27 kg/m² during 'January 2018-June 2022'. Data on clinical conditions, GP interventions (including drug prescriptions, and referrals for laboratory tests, instrumental examinations, and specialist visits), and hospitalizations were collected during the year preceding (baseline) and following BMI recording. Data were analyzed according to time (follow-up versus baseline) and BMI thresholds.

Results: The final cohort consisted of 134,776 individuals: 44.9% with severe overweight, 36.7% with class I, 12.9% with class II, and 5.6% with class III obesity. Overall mean age was 59.9 years and men accounted for 52.9%. Mean age and male proportions decreased across increasing BMI categories. Most frequently recorded conditions during follow-up were hypertension (51.4%), cardiovascular disease (27.5%), and type-2 diabetes (25.1%). Proportions of subjects presenting with clinical conditions and of individuals requiring clinical interventions were higher during follow-up compared to baseline. The likelihood of presenting with most of clinical conditions and interventions increased with BMI.

Conclusion: Patients living with overweight or obesity experience a significant worsening of their health status which increases healthcare resources utilization. Public health interventions could benefit from supporting GPs with training and resources to enhance obesity management and improve patient outcomes.

Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.