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

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.

Background: In recent years, the intricate interplay between physical health and mental well-being has garnered significant attention, specifically highlighting the potential influence of adipose tissue distribution, notably visceral adipose tissue (VAT) in the abdomen, on psychological states. VAT is implicated in systemic inflammation and metabolic disruptions, which are hypothesized to contribute to the onset and progression of mental health disorders, particularly major depressive disorder (MDD).

Methods: To investigate the relationship between VAT and MDD, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) covering 2011 to 2014. We employed multivariate logistic regression analysis to ensure the robustness of our findings. Interaction and stratified analyses were conducted to elucidate the complex relationships between these variables, and restricted cubic spline (RCS) plots were utilized to visualize these interactions. Furthermore, Mendelian randomization (MR) analysis was performed to ascertain the directionality of the causal relationship.

Results: The weighted, multivariable-adjusted logistic regression analysis demonstrated a positive correlation between VAT and the risk of MDD, with an odds ratio (OR) of 1.635 (95% CI 1.004-2.664). Further analysis, after accounting for potential confounding factors, revealed a more pronounced association in women, with an OR of 1.903 (95% CI 1.051-3.445). Interaction analysis indicated a potential gender-specific association between VAT and MDD, suggesting that the relationship may differ by sex (P for interaction = 0.003). Mendelian randomization (MR) analysis supported a bidirectional causal relationship between VAT and MDD. Sensitivity analyses confirmed the robustness and reliability of the results.

Conclusion: This study suggests that monitoring and managing VAT could enhance our understanding of the pathogenesis of MDD and provide new insights for developing more effective treatment strategies.

Purpose: Given the high prevalence of autistic traits among individuals with eating disorders (EDs), this study investigates the relationship between social camouflaging and eating disorder symptoms. It specifically examines how camouflaging behaviors may influence the manifestation and severity of disordered eating.

Methods: A total of 70 patients with EDs and 50 healthy controls (HCs) were assessed using the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Eating Disorder Inventory-2 (EDI-2). Independent samples t tests were used to compare CAT-Q scores between groups. ANOVA followed by Bonferroni post-hoc tests examined differences across EED subtypes. Pearson correlation analyses assessed associations between CAT-Q and EDI-2 scores. Finally, a linear regression model was used to evaluate whether camouflaging (CAT-Q total score) significantly predicted eating disorder symptom severity (EDI-2 total score).

Results: ED patients scored significantly higher than HCs across all CAT-Q domains and on the total score (all p < .001). No significant differences in camouflaging scores were observed among the different ED subtypes. CAT-Q domain and total scores were significantly positively correlated with all EDI-2 domains, with few exceptions. Linear regression analysis indicated that CAT-Q total score was a significant predictor of EDI-2 total score (β = .728, p < .001).

Conclusions: Our findings reinforce the notion that social camouflaging, often used as a coping strategy, is associated with the presence and severity of eating disorder symptoms. Overall, the study underscores the complex interplay between autistic traits and disordered eating, highlighting the importance of further research into this connection.

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

Energy balance and thermodynamic laws regulate body weight. Therefore, obesity must occur over a sufficiently long period of time in which energy intake exceeds energy expenditure. It is clear that a strict application of the law of energy balance cannot fully explain what is observed in real life. One possible hypothesis is that some individuals may have an energy-sparing metabolism, predisposing them to obesity. Furthermore, energy balance can be regulated to maintain body weight within a fixed individual range, a set point, which is influenced by genetic or epigenetic factors. An energy balance regulator, the ponderostat, may be able to increase or decrease both energy expenditure and energy intake, depending on food availability (e.g., periods of famine or low-calorie diet, periods of overeating), to maintain body weight within the set point. The ponderostat is regulated by a complex neuroendocrine system that includes central structures located in the frontal cortex, hypothalamus, and diencephalic region, with peripheral afferents and efferents. Therefore, in many cases, obesity could be considered the consequence of a dysregulated ponderostat. This narrative review proposes a unifying perspective that considers obesity as a biological condition with an abnormal set point and dysregulated energy balance due to abnormalities in ponderostat function. Current and future antiobesity pharmacological treatments may be considered curative for ponderostat dysregulation.

Purpose: This study aimed to validate a core beliefs model of disordered eating in a sample of adults with a current eating disorder diagnosis. This model outlines important processes and pathways from maladaptive eating disorder core beliefs to dietary restraint, objective binge eating and compensatory behaviours.

Methods: Participants were adults (N = 232) living in English-speaking countries who self-reported having a current eating disorder diagnosis given by a healthcare professional. Preliminary analyses included examining correlations between included variables and internal consistency. Path analysis was conducted in R to test the core beliefs model.

Results: The original model demonstrated poor to acceptable fit to the observed data. Minor modifications were utilised to remove non-significant paths to improve fit, including the removal of 'perfectionism' as a mediating variable in the model. The final modified model indicated acceptable model fit. This model demonstrates specific pathways that maladaptive core beliefs contribute to the development of dietary restraint, objective binge eating and compensatory behaviours, through either increased pre-occupation with eating, weight and shape, or through increased negative affect, emotional dysregulation and meta-cognitive beliefs about binge eating.

Conclusions: The present study provides partial validation of a core beliefs model of disordered eating and extends the current understanding of how maladaptive core beliefs may impact the development of key disordered eating symptomatology.

Level of evidence: IV.

Purpose: Currently, there is a growing awareness among individuals about health and nutrition. Therefore, it is important to comprehend the factors that influence eating habits and attitudes. This study aims to investigate the potential mediation effect of eating attitudes in the relationship between social media use and well-being, as well as to explore whether the moderating effect of the level of orthorexia nervosa influences this relationship.

Methods: The sample consisted of 599 adults (M_age = 29.82, SD = 9.39; 68% female) from Turkey and Northern Cyprus. Participants were recruited via convenience sampling through university networks, reflecting a culturally diverse context rooted in Mediterranean and Middle Eastern dietary norms. The study used the Social Media Usage Purposes, Eating Attitudes Test Short Form, Orthorexia nervosa Questionnaire-11, and the WHO-Five Well-being Index. A cross-sectional design was employed, and data were analysed using Hayes' Process Macro (Model 58) to test for moderated mediation.

Results: The study found that eating attitudes played a partial mediating role in the relationship between social media use and well-being among adults. Social media use positively predicted eating attitudes (β = .83, p < .001) and well-being (β = 1.05, p < .05), and eating attitudes significantly predicted well-being (β = .94, p < .001). Also, orthorexia nervosa moderated the mediating effect of eating attitudes in the relationship between social media use and well-being. Interestingly, the moderating effect was stronger among individuals with low levels of orthorexia nervosa, contrary to initial expectations.

Conclusions: The current study suggests that eating attitudes are a key behavioral mechanism linking social media use and well-being, and this pathway is influenced by individuals' orthorexia nervosa tendencies. These findings could aid in the development of interventions for eating disorders at both clinical and social levels and guide individuals towards healthier lifestyles. Importantly, while orthorexia nervosa moderated the indirect relationship between social media use and well-being, the study did not find a direct association between orthorexia nervosa and social media use.

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

Objective: The study sought to explore mental health trajectories of children and young people (CYP) who retrospectively reported eating problems prior to the pandemic, over a 2-year period (2021-23). Given the rapid increase in eating disorder presentations during the pandemic, these CYP may be particularly susceptible to pandemic-related challenges, including social and functional restrictions.

Methods: Data on 2023 CYP from the Children and Young People with Long COVID (CLoCk) study recruited Jan-March 2021 who completed questionnaires at 3-, 6-, 12-, and 24-months post SARS-CoV-2 PCR-testing were analysed. Associations between baseline eating problems (N = 241) and emotional and behavioural symptoms (measured by the Strengths and Difficulties Questionnaire (SDQ) total difficulties and impact scores) at each time-point were examined by regression models. Multi-level models were used to determine whether SDQ total and impact trajectories of those with/without prior self-reported eating problems differed.

Results: Compared to CYP who did not report pre-existing eating problems, those that did had more mental health difficulties at all time points: reflected in significantly higher SDQ total difficulties and impact scores. However, mental health scores of CYP reporting pre-pandemic eating problems were stable over time. Whereas, CYP without eating problems had a slight increase in mental health difficulties over time. Differences between groups diminished but remained significant when controlling for potential confounding variables including prior mental health difficulties.

Discussion: Young people with eating problems had more emotional and behavioural symptoms during 2021-23, compared with those that did not have eating problems. However, mental health did not worsen over time amongst CYP with pre-existing eating problems, providing evidence of some relative resilience to the effects of the pandemic in this population.

Public significance: Eating disorders are a major public health concern and presentations have remained high since the Covid-19 pandemic. Understanding how eating difficulties relate to mental health symptomology over time has implications for service planning.

Level of evidence: Level III: Evidence obtained from well-designed cohort study.

Purpose: Binge Eating Disorder (BED) is a prevalent condition with limited evidence-based treatments. Naltrexone and Bupropion Combination (NB) targets neurobiological pathways implicated in BED. The Objective of this paper is to evaluate the efficacy of NB for BED in adults through a systematic review and meta-analysis.

Methods: Following PRISMA guidelines, we searched major databases and trial registries (up to Feb 2025) for randomized controlled trials (RCTs) comparing NB to placebo or usual care in adults with BED. The primary outcome was binge eating frequency; secondary outcomes included weight loss and BMI. Risk of bias (ROB2) and certainty of evidence (GRADE) were assessed. A fixed-effects meta-analysis was performed.

Results: Four RCTs (n = 444 participants) met inclusion criteria. Meta-analysis of three studies indicated NB did not significantly reduce binge eating frequency compared to controls (Mean Difference [MD] - 1.49, 95% CI - 3.63 to 0.64, p = 0.17). However, NB significantly reduced weight (MD -3.57 kg, 95% CI - 4.86 to - 2.27, p < 0.001) and BMI (MD - 1.24 kg/m², 95% CI - 1.79 to - 0.70, p < 0.001). The certainty of evidence was assessed as moderate for binge frequency and low for weight and BMI outcomes.

Conclusion: NB aids weight reduction in adults with BED, but current evidence is insufficient to confirm its efficacy for reducing binge eating frequency. Further high-quality RCTs are warranted.

Level of evidence: Level I, systematic reviews and meta-analyses.

Background: Severe anorexia nervosa can result in life-threatening systemic complications. However, arterial rupture in the context of anorexia nervosa has not been reported.

Case report: A 31-year-old woman who had developed anorexia nervosa in her early teens and had extreme malnutrition with a body mass index of 8.5 kg/m² was admitted to our hospital with impaired consciousness due to hypoglycemia. During the management of hypoglycemia and refeeding syndrome, the patient developed hematochezia and shock. Contrast-enhanced computed tomography revealed rupture of the right external iliac and bilateral femoral arteries. Nonocclusive mesenteric ischemia was also detected. Surgical interventions for the ruptured arteries and the intestinal lesion were not indicated due to her poor condition with coagulopathy, as well as the presumed vascular fragility suggested by the presence of multiple arterial ruptures. The patient died later that day.

Conclusions: This case highlights a previously unreported and fatal vascular complication of anorexia nervosa. Extreme malnutrition may cause vascular fragility, increasing the risk of arterial rupture due to structural collapse of the vessel wall. Clinicians should be aware of this rare but life-threatening complication when treating patients with severe anorexia nervosa.

Level of evidence: Level V, case report.