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

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.

Purpose: Obesity is a major health challenge, requiring the development of more effective interventions. Setting realistic goals and developing detailed plans that anticipate potential challenges can be helpful strategies for bridging the intention-behavior gap. Immersive technologies, such as virtual reality (VR), are considered to further support closing this gap by reducing the distance to one's future self.

Methods: This study investigates a novel VR-supported reflection exercise as an additional treatment module within a conservative obesity treatment regime. It examines its feasibility, acceptance and short- and medium-term effects on participants' therapy motivation, body dissatisfaction, self-esteem, depressive symptoms, and eating behavior. 23 participants (BMI: M = 43.44 kg/m², SD = 4.42) were presented with a real-time animated body avatar that had the average body shape for their individual height, initial weight, and realistic target weight (- 10%), and standard appearance matched in terms of hair and skin color. The avatar could be viewed from first-person and mirror perspectives. The exercise included reflective questions about their experience, well-being, daily life, and eating and movement behavior.

Results: Participation and dropout rates of the VR-supported reflection exercise, user experience ratings, assessments on general discomfort and qualitative feedback demonstrated good feasibility and acceptance of the VR exercise. There were no measurable effects of a single session on clinical outcomes, including motivation to change, eating disorder psychopathology, self-esteem and depressive symptoms.

Conclusions: The VR-based reflection exercise was feasible and well-accepted. The sample was highly burdened with multimorbidity, severe obesity (grade III), and psychological stress. A clinical trial with sufficient dosage would be required to infer about clinical effects.

Level of evidence: Level 4.

Purpose: Bariatric surgery has proven effective in enhancing metabolic health and achieving sustainable weight loss for individuals with obesity. However, some patients experience adverse psychological outcomes and reduced quality-of-life post-surgery, potentially linked to changes in the gut-brain axis. This review aims to synthesize current evidence on the interplay between bariatric surgery-induced gut-brain axis modifications and patients' psychological status.

Methods: A systematic literature search was conducted across PubMed, Web of Science, and Embase, prioritizing clinical studies, mechanistic investigations, and meta-analyses. Inclusion criteria encompassed English-language articles examining psychological parameters, gut-derived hormones, and gut microbiota in adults after Roux-en-Y gastric bypass or sleeve gastrectomy.

Results: Bariatric surgery fundamentally reprograms gut-brain communication through anatomical, endocrine, and neural plasticity mechanisms, a process associated with dual-edged metabolic benefits and neuropsychiatric risks. Mechanistic analyses suggest that postoperative dysregulation of GLP-1/PYY secretion, altered vagal afferent signaling, and sustained microbiota dysbiosis (reduced Bifidobacterium, elevated Proteobacteria) may represent potential correlates of these outcomes.

Conclusions: Studies have demonstrated significant associations between mood, quality of life, psychological status, and gut-derived hormones or microbiota. A comprehensive understanding of how bariatric surgery impacts gut-brain signaling pathways is critical for optimizing long-term therapeutic outcomes and enhancing patient quality of life.

Level of evidence: This manuscript is a Narrative Review. According to the grading criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM), this manuscript is categorized as Level III-IV evidence.

Purpose: Seasonal body image refers to within-person variations in body image satisfaction that correspond with climatic seasonality (winter, spring, summer, and autumn). Previous cross-sectional research involving male participants from northern (UK, USA, and Canada) and southern hemisphere (Australia) nations reports a peak in body image dissatisfaction during the summertime, with a decrease in the wintertime. Big Data extracted from social media platforms provides a novel means of further exploring the seasonal body image hypothesis in a larger and more diverse sample across several years.

Methods: This study utilised panel data drawn from X/Twitter, a social media platform, to investigate the posts (N = 12,017,766) of users/authors (N = 1534) between 2020 and 2023. The panel consisted of authors from countries in both the northern and southern hemispheres. A template-driven search algorithm identified expressions of body image dissatisfaction (BID) in users' posts.

Results: The rate of BID (relative to the overall number of posts) was calculated for each calendar month. A statistically significant summer spike was observed in the Northern hemisphere, while the data were non-significant but directionally supportive of a similar summer spike in the Southern hemisphere.

Conclusions: This study partially supports the seasonal body image hypothesis, adding nuance to the current understanding of seasonality. This research has implications for the timing of public health initiatives aimed at preventing body image issues and eating disorders.

Level of evidence iv: Evidence obtained from multiple time series without intervention.

Background: Weight regain (WR) and insufficient weight loss (WL) occur in 20-25% of patients after bariatric surgery due to various factors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown promise in promoting WL; however, evidence regarding their effectiveness in managing WL and preventing WR post-bariatric surgery remains limited.

Objective: This study aims to evaluate the role of GLP-1RAs in treating and preventing WR following bariatric surgery.

Methods: A systematic search was conducted across PubMed, Scopus, and Web of Science for studies assessing the impact of GLP-1RAs on WR after bariatric surgery.

Results: Our search identified 27 original studies, with 10 included in the meta-analysis involving 769 participants (392 treated with GLP-1RAs). The mean age was 44.05 years, with 30.47% male. The time interval from surgery to the initiation of GLP-1RAs treatment ranged from 1.5 to 86.7 months, with treatment durations between 4 and 12 months. The analysis showed significantly greater WL in the GLP-1RAs group compared to placebo (SMD = 0.82, 95% CI 0.23 to 1.42). Subgroup analysis for treatment durations ≤ 6 months indicated a higher WL in the GLP-1RAs group (SMD = 0.79, 95% CI 0.25 to 1.34). Adverse events were primarily gastrointestinal, with nausea significantly more frequently in the GLP-1RAs group (OR = 2.01, 95% CI 1.24 to 3.27).

Conclusion: GLP-1RAs effectively promote WL among participants experiencing WR after bariatric surgery. Initiating GLP-1RAs therapy shortly after surgery may help prevent WR. Further research is warranted to explore long-term outcomes and optimize treatment protocols for this patient population.

Purpose: Eating disorders, encompassing a spectrum of conditions, significantly affect individuals throughout their lifespan, especially children and adolescents. Because of their rising incidence, misdiagnosis remains a challenge in paediatrics.

Methods: This study presents an educational case series documenting organic disorders that were initially misdiagnosed as feeding and eating disorders.

Results: Through comprehensive assessments, including medical history, physical examinations, and specialized evaluations, we stress the importance of ruling out medical conditions that can mimic an eating disorder at presentation. Timely recognition and referral to specialized care are essential for improved outcomes.

Conclusion: We highlight the crucial role of continuous reassessment, particularly in cases of evolving symptoms or inadequate response to treatments. A multidisciplinary approach in diagnosing and managing paediatric feeding and eating disorders is of fundamental importance to ensure prompt identification and adequate referral.

Level of evidence iv:

Objective: This study examines the prevalence of family dysfunction and food addiction among tertiary students in Ghana and investigates the moderating role of psychological resilience in this relationship.

Background: Food addiction is an emerging behavioural health concern among tertiary students, particularly in environments characterised by family dysfunction.

Methods: A cross-sectional survey was conducted among a random sample of 553 tertiary students at the University of Education, Winneba. Pearson Product-Moment correlation and the Hayes Process Macro were employed to examine relationships among the study variables and test for moderation effects.

Results: The study found that 26.9% of students experienced high family dysfunction, 39.0% had food addiction, 31.3% were overeaters, and 40.0% had low psychological resilience. Correlation analysis showed weak to moderate positive associations between resilience, family dysfunction, and food addiction. Psychological resilience also buffered the relationship between family dysfunction and food addiction.

Conclusion: The study underscores the interplay between family dysfunction, psychological resilience, and food addiction among tertiary students.

Implication: Universities should implement mental health support services, resilience training programmes, and nutritional education to address food addiction risks among students.

Level of evidence: This study contributes cross-sectional data from Ghana showing that psychological resilience may mitigate the negative effects of family dysfunction on food addiction, providing culturally grounded insight into protective factors in tertiary education settings.

Purpose: Mukbang, defined as an audio-visual broadcast in which broadcasters commonly eat large portions of tasty food, is a sociocultural trend that can be associated with eating disorders. This study was conducted to evaluate the effect of watching mukbang on eating attitudes through uncontrolled eating, cognitive restriction, and emotional eating.

Methods: Questionnaire was included the mukbang addiction scale to assess problematic mukbang viewing, the eating attitude test (EAT-26) to assess eating attitudes, and the three-factor eating scale to assess eating behaviours. The direct and indirect effects of mukbang addiction on eating attitudes were evaluated by meditation analysis. Statistical analyses of the data were conducted using IBM SPSS version 24 and PROCESS v4.0 by Andrew Hayes.

Results: This study was carried out with a total of 329 university students. Mukbang addiction scale, uncontrolled eating, and emotional eating factor scores were found to be significantly higher in those with disordered eating attitudes than those with normal eating attitudes (p < 0.05). Mukbang addiction score had a significant direct effect on the eating attitudes score (β = 0.772, p < 0.001), but "uncontrolled eating" and "emotional eating" factors did not have a significant mediator role in this effect. An increase of a one-unit in the mukbang addiction score causes an increase of 0.82 units in the eating attitudes score (p < 0.001). There was no significant relationship between the "cognitive restriction" factor and the scales used (p > 0.05); therefore, it is not included in the mediator variable analysis.

Conclusions: These findings suggest an association between problematic mukbang viewing and eating attitudes; however, it remains unclear whether this relationship is causal or a consequence of underlying conditions. The absence of significant mediation of uncontrolled and emotional eating in this effect suggests that further studies are needed to understand the possible mechanisms. This study is based on a cross-sectional design and is classified as level of evidence 4.

Background: Scientific evidence has demonstrated that psychosocial factors can influence hedonic hunger (HH). Moreover, HH can be a predictor of metabolic and bariatric surgery (MBS) outcomes. The Mediterranean Diet (MD) has been used as a model approach for managing excess weight. In this study, we assessed the association between anxiety and depression levels, HH, and adherence to MD in candidates to MBS and post-MBS subjects.

Methods: This was a cross-sectional observational study that included individuals who were candidates and who were submitted to MBS. Data analysis included anthropometric measurements, assessment of anxiety and depression levels, HH, and adherence to MD.

Results: Of the 64 included individuals, 68.8% were female, with a mean age of 48.39 years. A significant positive correlation was observed between HH and anxiety and depression levels. No statistically significant relationship was found between adherence to MD and HH, nor with anxiety and depression levels.

Conclusion: Psychological status largely contributes to weight control. Therefore, patients should be carefully assessed before and after surgery to ensure treatment and adequate follow-up. Future studies are needed to better determine the complex relationship between psychological factors, HH, food intake, and weight.

Level v: Cross-sectional observational study.