This case report presents the comprehensive, multidisciplinary treatment of a 17-year-old male adolescent diagnosed with avoidant/restrictive food intake disorder (ARFID) in Turkiye. The patient developed severe food avoidance, vomiting, and significant weight loss after experiencing traumatic medical interventions, including nasogastric tube placement. His clinical course was further complicated by medical comorbidities such as achalasia, superior mesenteric artery syndrome, and gallstones, which contributed to persistent gastrointestinal discomfort and reinforced his restrictive eating behaviors. Treatment combined with outpatient Cognitive Behavioral Therapy for ARFID (CBT-AR), psychopharmacological support, family-based interventions, and ongoing medical management. CBT-AR was flexibly adapted to address the patient's fear of negative eating consequences, sensory sensitivities, and low appetite, while considering family dynamics and culturally relevant eating practices. Over a 12-month period, the patient's weight increased from 42.6 kg to 55 kg, his dietary variety expanded with the addition of 38 new foods, and his ARFID symptoms showed significant clinical improvement. This is the first documented case of CBT-AR applied in Turkiye, highlighting the feasibility and effectiveness of a combined medical-psychological approach for complex ARFID presentations. The case underscores the necessity of individualized, culturally sensitive treatment strategies and multidisciplinary collaboration in addressing ARFID, particularly in medically compromised patients.
Background: Social eating is a key aspect of recovery for many individuals with an Eating Disorder (ED). To develop effective interventions to support recovery of social eating we need to understand the challenges that people with ED face when eating in public spaces. This study was conducted in the context of the development of a virtual reality graded-exposure café intervention for people with ED. The current analysis explores stakeholder perspectives on the challenges that people with ED face in café environments.
Methods: People with lived experience of ED (n = 15), parents/carers (n = 4) and clinicians (n = 6) took part in semi-structured focus groups and 1:1 interviews. Transcripts were analysed thematically.
Results: We identified six major themes: (1) Facing the unexpected and unknown; (2) Cafés elicit difficult emotions; (3) Challenges are highly individual; (4) Challenges relating to the physical café environment; (5) Challenges of social interactions in cafés; (6) Challenges of the process of choosing and consuming food and drink.
Conclusions: This study highlights the challenges cafés present for people with ED, many of which also apply to other social eating scenarios. These findings will enable more targeted support and development of novel interventions to help people with ED return to social eating.
Background: Emotion dysregulation, alexithymia and attentional biases toward food or emotional stimuli have been reported in patients with obesity and food addiction (FA), but the relative contribution of obesity or FA to these characteristics remains unclear. Our objectives were to compare patients with obesity and FA, patients with obesity without FA and patients without obesity regarding cognitive emotion regulation strategies, alexithymia, emotion regulation difficulties, and attentional biases.
Methods: We included 37 bariatric seeking patients (18 FA, 19 without FA) and 37 controls in a cross-sectional, unmatched nested case-control design. We assessed food addiction (YFAS 2.0), emotional regulation strategies (CERQ), emotion regulation difficulties (DERS), alexithymia (TAS-20), and attentional biases (Stroop and Emotional Stroop tasks).
Results: Among patients with obesity, those with FA differed from non-FA only in terms of cognitive emotion regulation strategies: less refocus on planning (p = .04), more catastrophizing (p = .02), and more positive refocusing (p < .001). Patients with obesity (with or without FA) presented higher scores regarding emotion regulation strategies (p < .05), alexithymia (p < .001) and emotion regulation difficulties (p < .001). Neither obesity nor FA were associated with attentional bias toward food or negative emotional stimuli and cognitive inhibition.
Conclusions: Among patients with obesity, having a FA was related to cognitive avoidance toward negative events, but not to change in the saliency of emotional or food stimuli. Alexithymia was more related to obesity than to FA.
Background: Eating disorders have one of the highest mortality rates of any mental illness. However, individuals experiencing an eating disorder are not the only people affected by their condition; informal caregivers (any individual who has a relationship to an individual with an eating disorder but may or may not be a designated caregiver by title) are also impacted by other's eating disorders. Using the tripartite model of uncertainty, this study examines the ways that informal caregivers use online forums to express their uncertainty.
Methods: A random sample of the r/EatingDisorders subreddit was extracted and posts written by informal caregivers were identified, resulting in 163 posts for analysis. A deductive qualitative analysis was conducted using the tripartite model of uncertainty to identify sources of uncertainty for informal caregivers.
Results: Results concluded that individuals express medical, personal, and social uncertainty online independently, but also experience compounding uncertainty, where the experience of one uncertainty creates tension with and may exacerbate another uncertainty.
Conclusions: Future research should continue to explore the implications of compounding uncertainties to assist in the future creation of educational resources for individuals who may be informal caregivers of people with eating disorders.
Background: Food addiction (FA) is a condition in which ultra-processed foods (UPFs) activate the brain's reward pathways, leading to binge eating, loss of control, and continued consumption despite negative consequences. It can appear early in childhood and is linked to behavioral, sociodemographic, and metabolic factors. This study assessed the contribution of FA, its structure, and connectivity in relation to sociodemographic, nutritional status, and metabolic variables in network analysis.
Methods: A cross-sectional study was conducted with 93 children (7-11 years old) living in Vitória de Santo Antão, Brazil. FA was assessed using the Yale Food Addiction Scale for Children, which was translated and validated for the Brazilian child population. Sociodemographic (age, sex, race, socioeconomic class), anthropometric (body weight, height, waist circumference, BMI, BMI-for-age, body fat percentage, lean mass, and fat mass), and metabolic (blood pressure, total cholesterol, triglycerides, HDL, LDL, and fasting glucose) factors were analyzed. For network analysis, the degree centrality (DC), closeness centrality (CC), betweenness centrality (BC), and eigenvector centrality (EC) were evaluated.
Results: FA exhibited moderate centrality in sociodemographic and metabolic networks, acting as a connector between key variables such as age and socioeconomic class (BC = 0.071-0.500; EC = 0.301-0.500; CC = 0.636-0.667). These metrics indicate that FA, while not dominant, maintains access to influential nodes and participates in relevant information pathways. In contrast, within the anthropometric network, FA showed a peripheral role, with fewer direct links (DC = 0.222-0.285) and limited intermediation (BC = 0.111).
Conclusion: Variation in centrality across domains underscores the selective integration of FA, suggesting that its impact is context dependent.
Background: The Weight Stigma Exposure Inventory (WeSEI) is a newly developed instrument designed to assess weight stigma exposure across both interpersonal and non-interpersonal contexts. While prior studies have supported its use in individual regions, its cross-cultural applicability has not been comprehensively evaluated.
Objective: The present study examined the psychometric properties and cross-cultural measurement equivalence of the WeSEI across six culturally diverse jurisdictional regions in Asia (i.e., Taiwan, China, Hong Kong, Indonesia, Türkiye, and Malaysia).
Methods: A total of 7,787 participants completed the 35-item WeSEI via various online platforms. The WeSEI assesses weight stigma exposure across seven domains: social media, traditional media, television/movies, parents/siblings, friends/peers, significant others, and strangers. Rasch analysis was conducted to evaluate item fit, rating scale functioning, person separation reliability, and unidimensionality for each domain. Differential item functioning (DIF) was assessed across sex, weight status, and jurisdictional region.
Results: The WeSEI demonstrated strong internal consistency, acceptable item fit, and unidimensionality across all domains, with only two items showing misfit (i.e., Friends/Peers_2 and Significant Other_2). Person separation indices exceeded 2.0 for each domain, confirming the scale's ability to distinguish individuals with varying levels of stigma exposure. Minimal DIF was observed by sex and weight status, supporting measurement equivalence across these groups. However, 19 out of 35 items showed significant jurisdictional region-level DIF, particularly those related to slim-normative attractiveness and family-based stigma. Malaysian participants consistently endorsed these items more than Chinese participants, suggesting cultural variation in the exposure of weight stigma.
Conclusion: The WeSEI is a psychometrically sound and culturally responsive tool for assessing weight stigma exposure across diverse populations in Asia. Cultural adaptation is recommended for cross-national comparisons.
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