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

Background: Anorexia nervosa is a complex psychiatric pathology with limited therapeutic tools to reduce morbidity and mortality. Equine-assisted therapy could provide additional therapeutic benefits.

Objectives: We aimed to explore the effects of equine-assisted therapy on the experience of adolescents with anorexia nervosa.

Methods: Using a qualitative approach based on Interpretative Phenomenological Analysis, we conducted semi-structured interviews with nine participants who had taken part in equine-assisted therapy sessions.

Results: Three superordinate themes were found. Participants initially described an experience of insecurity when meeting the horses which were perceived as a source of fear within a displaced spatiotemporal framework. Equine therapy led to the development of emotional regulation through interactions that allowed for investment without fear of perceived social judgment, a reassuring experience through relational adjustment with the horse, and an experience of support from the humans present. Finally, equine therapy was a transformative learning experience, enabling participants to embody their physicality and care for someone other than themselves.

Conclusion: Equine-assisted therapy was found to provide bodily, emotional, and relational therapeutic benefits in anorexia nervosa. The setting, place, and function of the equine therapist, the participants' previous experience with horses, and the interaction with other care areas seem to be essential to ensure therapeutic benefit. Level of Evidence Level III.

Purpose: The objective of this study is to assess the validity of the German version of the Children's Eating Attitudes Test (ChEAT), an internationally used tool for the detection of eating disorder (ED) symptoms, in a clinical sample.

Methods: The ChEAT self-report questionnaire, comprising 26 items, was employed to examine eating behaviors of a clinical sample of 342 adolescents (aged 12-18 years) undergoing inpatient treatment at a child and adolescent psychiatric clinic in Germany. The ChEAT was validated through an exploratory factor analysis (EFA), followed by a confirmatory factor analysis (CFA) and an examination of internal consistency. Subsequent analyses were conducted to identify differences associated with participant characteristics, including age, gender, body mass index (BMI), and diagnosis. Furthermore, additional eating behaviors, depression, and anxiety symptoms were documented via supplementary questionnaires and correlated to the ChEAT to evaluate the convergent and discriminant validity.

Results: The factorial validity of the ChEAT was confirmed through EFA and CFA, resulting in a five-factor structure with the following dimensions: 'Body and Weight Concern,' 'Dieting,' 'Social Pressure,' 'Purging and Binge Eating,' and 'Food Preoccupation'. The 24-item model showed high internal consistency and demonstrated an acceptable fit to the data. Convergent and discriminant validity of the ChEAT was supported by significant correlations with other self-report questionnaires. Higher ChEAT average scores were observed in females and those with a history of eating or depressive disorders, whereas age or BMI showed no correlation.

Conclusion: The data demonstrate that the German version of the ChEAT appears to be a reliable and valid instrument for identifying ED symptoms in clinical samples. However, further studies are necessary to evaluate the factor structure and validity.

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

Objective: Eating disorders (EDs), including binge eating disorders (BEDs), bulimia nervosa (BN) and anorexia nervosa (AN), can inflict adverse effects on well-being, daily functioning, and workplace performance, presenting significant occupational, social, and economic challenges. This systematic review seeks to explore the relationship between ED symptomatologies and their impacts on work performance.

Methods: This systematic review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analyses. Formal methods of critical appraisal for both qualitative and quantitative studies were utilized. Six studies were included.

Results: Participants across all studies (n = 20,367) exhibited heightened levels of presenteeism, absenteeism, work productivity impairment, and higher annual burden costs compared to their non-ED counterparts.

Conclusion: Impaired decision-making, cognitive inflexibility, and poor executive functioning significantly impact work participation and performance, underscoring the need for workplace policies that reduce stigma and stress, and calls for further research into how environmental factors and interventions affect ED recovery.

Level of evidence: Level I, systematic review.

Purpose: This study examined how eating disorder symptoms, assessed by the Eating Pathology Symptoms Inventory (EPSI), vary across chronological age in a large national (USA) sample of transgender and gender-diverse (TGD) adults.

Method: Participants were 2098 TGD adults-including transgender men (n = 599), transgender women (n = 293), and gender-diverse individuals (n = 1,206, including nonbinary and those who identified with "another gender identity")-enrolled in The PRIDE Study. A multivariate general linear model tested the effects of chronological age, gender group (with gender-diverse as the reference), and their interaction on the eight EPSI scales.

Results: Multivariate analyses showed significant main effects of age (V = .045, p < .001) and gender group (V = .098, p < .001), but no significant age-by-group interaction. Older age was associated with greater Cognitive Restraint (β = .22, p < .001), Negative Attitudes toward Obesity (β = .22, p < .001), and Excessive Exercise (β = .12, p = .001). Compared to gender-diverse individuals, transgender men exhibited higher Muscle Building, Cognitive Restraint, and Excessive Exercise scores, whereas transgender women reported higher Binge Eating, Purging, Cognitive Restraint, and Negative Attitudes toward Obesity, but lower Muscle Building. A single significant interaction indicated that transgender women showed stronger age-related differences in Purging.

Conclusions: These findings contribute to growing evidence that disordered eating symptoms may not simply resolve with age among TGD individuals and necessitate lifespan-sensitive approaches to eating disorder care. These patterns likely capture a mix of aging processes and cohort-specific exposures to weight-normative and cis-normative ideals. Level of evidence Level V: based on descriptive studies.

Background: Adolescence is a key period for problematic internet use (PIU) and disordered eating (DE), with prior studies linking them, but the role of diet quality unclear.

Objective: This study aimed to investigate the relationships between PIU, diet quality, and DE in adolescents using mediator and network analyses, with a specific focus on the mediating role of diet quality.

Methods: A cross-sectional study was conducted with 647 high-school students in Erzurum, Turkey. Data were collected through validated instruments, including the Young Internet Addiction Test, Social Media Addiction Scale, KIDMED Mediterranean Diet Quality Index, and Eating Attitudes Test (EAT-26). Statistical analyses included mediation modeling and network analysis (NA).

Results: The prevalence of DE risk was 18.2%, while 27% of participants met the criteria for social media addiction. Additionally, 3.6% were classified as at potential risk for internet addiction. In addition to PIU and social media addiction, higher maternal education levels were also significantly associated with greater DE risk (p < 0.05). Mediation analysis showed that problematic internet use was linked to lower adherence to the Mediterranean diet (β = -0.12, p = 0.002), which was associated with higher DE risk (β = 0.15, p < 0.001). The indirect effect was significant (β = -0.02, p = 0.016), supporting partial mediation. NA identified internet addiction as the central node, linking DE risk, social media disorder, and diet quality.

Conclusion: Internet addiction is linked to increased DE risk, mediated by diet quality, highlighting the need to address it in adolescent interventions. Longitudinal studies are needed.

Level evidence v: Evidence obtained from a cross-sectional descriptive study.

Purpose: Anorexia Nervosa can have a major impact on bone health through low bone mass and bone loss. Considering the lack of consensual guidelines for the prevention and treatment of bone loss in this condition, a systematic review was performed to provide practical treatment guidance for clinicians.

Methods: We systematically searched Medline, Cochrane, Psychinfo, and the Web of Science for anorexia nervosa AND (osteopenia OR osteoporosis OR bone density OR bone loss) AND (prevention OR treatment OR medication OR therapeutic) in clinical studies from March 1st, 2017, to October 31st, 2024, and included the last systematic review on the subject. We excluded reviews, editorials, unfinished trials, expert opinions, book chapters, and case reports. This research followed the PRISMA guidelines.

Results: A total of 27 publications were included in this review. The main outcome measured was spinal bone mineral density (BMD). Among 1932 participants (all female), 1439 had AN and the remainder were healthy controls. Monotherapies mostly included various hormonal replacement therapies and bisphosphonates. Combination trials were performed on small numbers or with a modest time range or effect size. Results were statistically significant in 15 studies. Estrogen replacement therapy, bisphosphonates, teriparatide and denosumab showed the most significant effects.

Conclusions: These results and our clinical experience in the field allowed us to formulate a treatment algorithm for managing bone loss in patients with anorexia nervosa according to their BMD and pubertal status.

Level of evidence: Level I, systematic review.

Objectives: Given the significant prevalence of mental health disorders in Iran, this research seeks to examine various epidemiological aspects related to eating disorders (ED). The study specifically focuses on key metrics, including prevalence, incidence, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs), within the Iranian population.

Methods: This research utilized data from the GBD 2019. Indicators related to disease burden, including prevalence, incidence, DALYs, YLDs, and YLLs, were extracted from the database. Population estimates and 95% uncertainty intervals (UIs) were calculated. All results are reported per 100,000 populations.

Results: The age-standardized prevalence rate (ASPR) was documented at 254 per 100,000, with a uncertainty interval ranging from 189 to 328. The age-standardized disability-adjusted life years (DALYs) were calculated at 53.94 per 100,000, within an interval of 33.53 to 80.20. Likewise, the age-standardized years lived with disability (YLDs) were reported at 53.92 per 100,000, with a range extending from 33.51 to 53.92. In 2019, the Age-Standardized Prevalence Rate (ASPR) for anorexia nervosa (AN) was recorded at 68.47 per 100,000 individuals, while for bulimia nervosa (BN), it was 186.42 per 100,000. The ASPR for eating disorders (ED) overall stood at 190.4 per 100,000 for males and 320.33 per 100,000 for females in the same year.

Conclusion: An analysis of the impact of eating disorders (ED) in Iran from 1990 to 2019 highlights a significant increase in their associated burden. This upward trend emphasizes the urgent necessity for the development and implementation of comprehensive health policies aimed at expanding access to mental health care services. Enhancing such access is vital, as it could substantially contribute to alleviating the burden of eating disorders by fostering more effective prevention and treatment strategies.

Level of evidence: Level IV.

Background: Fluoxetine remains the only pharmacological treatment approved for Bulimia Nervosa, and no other drugs have been approved for eating disorders (EDs). The rationale for exploring psilocybin as a treatment for EDs is compelling, both from biological and psychological perspectives. Moreover, its safety profile in healthy individuals appears favorable. This systematic review aims to examine original research articles and registered clinical trials to assess the current psilocybin's therapeutic potential in EDs.

Methods: Systematic review following the indications of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Excerpta Medica Database (EMBASE), and the Cochrane Library from inception until 29 July 2024, with key terms: "psilocybin" and "eating disorders". Quality was assessed through the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group released by the National Heart, Lung, and Blood Institute (NHLBI). We performed an additional search on the registry of clinical trials available at the website https://clinicaltrials.gov .

Results: Two studies met the inclusion criteria for our analysis. The first was an open-label feasibility study involving 10 individuals with Anorexia Nervosa (AN), without a control group. The second was a single case report describing the use of psilocybin in a person with AN. In addition, six registered clinical trials of psilocybin in individuals with EDs were identified.

Conclusions: The initial evidence shows that psilocybin might be safe and well-tolerated in AN. The promising results and the need for tests in enlarged samples encourage further research on psilocybin in EDs.

Level of evidence viii: Evidence from nonrandomized controlled clinical trials, nonrandomized clinical trials, cohort studies, case series, case reports, and individual qualitative studies.

Purpose: Patients with eating disorders show an elevated suicide risk compared to the general population. Adverse childhood experiences, depressive symptoms, and mental pain, often accompanied by hopelessness and demoralization, may increase this risk. This study aims to explore suicidal ideation and self-injurious behaviors in a heterogeneous sample of ED patients, and their association with childhood trauma and negative mental states.

Methods: 101 female patients were recruited from the inpatient and day hospital ED units at Policlinico Umberto I, Rome. Assessments included comorbid psychiatric diagnosis, suicide risk, mental pain, childhood trauma, depressive symptoms, hopelessness, and demoralization.

Results: Suicidal ideation in the past month was significantly associated with trait and state-level mental pain, self-reported sexual abuse, depression, hopelessness, and loss of meaning. In the multivariate model, only childhood sexual abuse and loss of meaning remained significantly associated. Self-injurious behaviors in the past 3 months were associated with trait-level psychache, self-reported sexual and physical abuse, and depression severity, however significantly associated with self-injurious behaviors in the multivariate model.

Conclusions: Findings highlight the importance of assessing childhood trauma, especially sexual abuse, a low sense of meaning in life, depressive symptoms, and psychache in patients with EDs to improve suicide prevention strategies with specific interventions. Level of evidence III-Evidence obtained from well-designed cohort or case-control analytic studies.

Purpose: The present study reports on the psychometric properties of the Dutch translation of the clinical impairment assessment (CIA) questionnaire in female patients with eating disorders. The aim of this study was to determine the factor structure of the CIA as there are conflicting studies supporting a three-factor, bifactor, and single-factor model with a general factor and three specific factors.

Methods: The CIA was translated and administered to 321 female patients with various eating disorders receiving treatment in a specialized eating disorder center. Its factor structure, internal consistency, convergent validity, and sensitivity to change were investigated.

Results: Confirmatory factor analyses showed the best fit was a bifactor model with one strong general factor and three less strong specific factors for personal, social, and cognitive impairment. Furthermore, good internal consistency (Cronbach's α = 0.91), good convergent validity between CIA global score and eating disorder examination questionnaire global score (r = 0.58; p < 0.001) and good sensitivity to change (t (115) = 13.76, p < 0.001) were found.

Conclusions: The Dutch CIA is a reliable and valid instrument to measure impairment secondary to eating disorder symptoms, but interpretations made from subscales scores should be used with caution.

Level of evidence: Level III, validation study.