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

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.

Background: Preadolescence is a critical developmental stage marked by the start of significant physical and cognitive changes posing youths at risk for psychopathology. This study explores the association of Instagram usage with body dissatisfaction, drive for thinness and psychopathological symptoms among preadolescents.

Methods: We recruited 232 female preadolescents aged 9-10 years and their mothers using a snowball sampling technique. Participants were divided into two groups based on their Instagram addiction levels: no addiction (Group 1) and addiction (Group 2). Measures included the Eating Disorders Inventory-Referral Form (EDI-3-RF), Instagram Addiction Scale (IAS-15), and Child Behavior Checklist (CBCL).

Results: Results showed that Group 2 had significantly higher scores in body dissatisfaction, drive for thinness, emotional reactivity, and withdrawal compared to Group 1.

Conclusions: Limitations include the small, homogenous sample, reliance on self-report measures, and cross-sectional design, which limits causal inference. Future research should include more diverse samples, longitudinal designs, and a broader assessment of social media use to better understand these complex relationships. Addressing these limitations will enhance our understanding and contribute to developing effective interventions to support the mental health of preadolescents in the digital age.

Level iii: Evidence obtained from well-designed cohort or case-control analytic studies.

Purpose: Feelings of shame can play a role in the development and maintenance of mental disorders. However, the role and measurement of shame in relation to eating disorders remain poorly understood. The current work presents the adaptation of a measure of external and internal shame in relation to eating disorders (EISS-ED) based on an integrative perspective that leverages the strengths of the biopsychosocial model and shame-pride cycle framework. Specifically, the EISS-ED accounts for how individuals believe they are perceived by others (external shame) and how they perceive themselves (internal shame) in relation to eating.

Methods: The study used confirmatory factor analyses to examine the factor structure and psychometric properties of the EISS-ED (N = 478), Spearman's correlations and Receiver Operator Characteristic curves were used for validity testing.

Results: The results supported the two-factor structure (including 12 items) of the EISS-ED and its factorial invariance by clinical history and gender. Concurrent validity analyses showed positive correlations between external and internal shame and eating disorder symptoms, negative affect, and detachment. Both external and internal shame measures provided fair classification accuracy of participants based on self-reported history of clinical assessment or treatment for eating disorders.

Conclusions: These findings improve the understanding of the role of shame in eating disorders and offer evidence on a valid assessment that can aid in identifying, measuring, and addressing this important construct, supporting targeted interventions.

Level of evidence: Level V, descriptive study.

Purpose: Obesity and overweight in children and adolescents are a growing concern. Treatments should be multidisciplinary, address the whole family and contain aspects of motivation. Motivation is a well-known impact factor in medical treatment but its role in the treatment of pediatric obesity is not clear. This systematic review aims to analyze the role of motivation by summarizing theoretical frameworks and synthesizing effects of weight reduction programs that assessed motivation as either outcome or predictor.

Methods: This systematic review was conducted according to PRISMA guidelines. Four databases (PubMed, Web of Science, PsycINFO, Cochrane) were searched, findings were screened by two authors and assessed according to pre-determined criteria. Risk of bias was assessed with the Quality Assessment Tool for Quantitative Studies by the Effective Public Health Practice Project.

Results: 1899 studies were found, whereof 32 were included. The most commonly used theoretical frameworks were the Transtheoretical Model and Self-Determination Theory. In 18 of the included studies, motivation was assessed as outcome. In most of them, motivation increased towards the end of the weight reduction program. 15 studies used motivation to predict different outcome variables, however, with no conclusive evidence on the predictive power of motivation on different outcomes.

Conclusion: Motivation can be enhanced over the course of a weight reduction program, mainly in pediatric patients. The predictive power of motivation on different outcomes is still not clear due to the heterogeneity of included studies. More research is needed to implement the current findings in future pediatric weight reduction programs.

Level of evidence: Level 1, systematic review.

Purpose: This paper examines transgressive eroticism-specifically the phenomenon of "Overlove"-as an experiential field that both constructs and dissolves embodied selfhood. It asks how hyper-intense erotic practices function not merely as psychopathological symptoms but as existential strategies that disrupt normative consciousness and enable novel forms of self-other relations.

Methods: Through phenomenological and conceptual analysis, the study draws on Georges Bataille's writings, clinical literature on psychopathology, and interpretive readings of literary and case-study material to map the experiential structures and effects of transgressive eroticism on bodily consciousness.

Results: Transgressive eroticism acts as an "anti-moral" force that dismantles subject-object binaries, revealing an elemental layer of being; it dissolves self-boundaries via dissipation and ecstatic union with others. These practices operate as existential praxis rather than mere pathological symptoms. The phenomenology of transgressive eroticism uncovers utopian potentials for new collective intimacies.

Conclusions: By reframing overlove as a dialectical engagement with the boundaries of selfhood, this study challenges entrenched psychiatric binaries and advocates for a clinical ethos attentive to both its hazards and its generative potential. Future research should investigate how the understanding of transgressive erotic practices can enrich therapeutic strategies, ethical frameworks, and theoretical models of identity, agency, and relationality.

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