Long-term interdisciplinary therapy decreases symptoms of binge eating disorder and prevalence of metabolic syndrome in adults with obesity

Relationship between adherence to dietary treatment and binge-eating disorder in obese patients

Introduction

Introduction: the binge eating disorder (BED) is the eating disorder that most affects the obese population, and BED is an aspect that possibly interferes with the rate of adherence to nutritional treatment, which is also low in individuals with chronic non-communicable disease. Objective: to examine the relationship between adherence to dietary treatment and BED presence in obese individuals. Methods: this cohort study was conducted with a sample of 73 obese individuals at a nutrition and metabolic disease outpatient unit. Anthropometric data were collected, and a three-day food record was used for dietary assessment. BED was identified using the Binge Eating Scale, and patients were divided into two groups (BED and non-BED controls). Patients were reassessed at three-month follow-up. Data were analyzed using Student's t-tests and generalized estimating equations with Bonferroni correction. Adherence to dietary treatment was assessed by calculating differences between recommended and actual energy intakes. Results: BED was identified in 28.7 % of obese individuals. There was no significant difference in adherence to dietary treatment between BED and control patients. Both groups showed similar eating habits and physical activity levels throughout the study period. Conclusion: obesity is one of the factors contributing to the lack of adherence to nutritional guidelines. The importance of cognitive methods in dietary treatment programs should be further investigated.

Models of care for eating disorders: findings from a rapid review

BACKGROUND

Delayed diagnosis, gaps in services and subsequent delays in specialist care and treatment lead to poorer health outcomes for individuals with eating disorders (EDs) and drive significant government healthcare expenditure. Given the significant disease burden associated with EDs, it is imperative that current implementation research is summarised to identify gaps in care and enable refinement for optimal patient outcomes. This review aimed to provide an updated synthesis on models of care for EDs in developed healthcare systems.

METHODS

This paper was conducted as part of a series of Rapid Reviews (RRs) to be published in a special series in the Journal of Eating Disorders. To provide a current and rigorous review, peer-reviewed articles published in the English language between 2009 and 2021 across three databases (ScienceDirect, PubMed and Ovid/Medline) were searched, with priority given to higher level evidence (e.g., meta-analyses, large population studies, Randomised Control Trials (RCTs)). The current review synthesises data from included studies investigating models of care for people with EDs.

RESULTS

Sixty-three studies (4.5% of the original RR) were identified, which included several diagnostic populations, the most common being Anorexia Nervosa (AN) (30.51%). Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. Few studies investigated the interaction of different ED services (e.g., inpatient, community services, primary care), however stepped care models emerged as a promising approach to integrate ED services in a targeted and cost-effective way. Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services.

CONCLUSION

Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter 'hospitalisations' emerging as promising avenues. Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. This paper is part of a larger Rapid Review series carried out to guide Australia's National Eating Disorders Research and Translation Strategy 2021-2031. Rapid reviews aim to thoroughly summarise an area of research over a short time period, typically to help with policymaking in this area. This Rapid Review summarises the evidence relating to how we care for people with eating disorders in Western healthcare systems. Topics covered include inpatient/hospital care, residential care, day programs, outpatient/community care, and referral pathways. Findings suggested specialist eating disorder services may enhance detection, referral, and patient care. Stepped care models presented as a cost-effective approach which may help with linkage between different eating disorder services. There was a trend towards shorter hospital stays and approaches which allow for greater connection with the community, such as day programs. Evidence was also found of treatment delays, due to system issues (long waiting lists, lack of accurate assessment and diagnosis) and patient-related barriers (stigma, recognition). Upskilling and involving primary care clinicians in diagnosis and referral as part of a stepped care model may help to address some of these concerns. Further efforts to improve mental health literacy and de-stigmatise help-seeking for eating disorders are needed.

Factors associated with the improvement of body image dissatisfaction of female patients with overweight and obesity during cognitive behavioral therapy

BACKGROUND

Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss.

OBJECTIVE

The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss.

METHODS

One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m², age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires.

RESULTS

Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID.

CONCLUSION

Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID.

CLINICAL TRIAL REGISTRATION

[https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052], identifier [UMIN000006803] and [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850], identifier [UMIN000049041].

The linkage "Body Mass Index-Insomnia Levels-Eating Disorder Flexibility" in Italian nurses during the Covid-19 outbreak: a psychoendocrinological employment disease

AIM

To evaluate differences between insomnia condition and flexibility attitude to eating in Italian nurses directly involved in the care of patients affected by Covid-19 according to sex, Body Mass Index, shift working condition and incidence of new Covid-19 cases in the region of participants. Moreover, any correlations between the insomnia condition and the flexible attitude to eat have been investigated.

METHODS

An online questionnaire was administered in October 2020, including the socio-demographic section, the insomnia condition assessment, and the behavioral flexibility evaluation to develop an eating disorder.

RESULTS

341 Italian nurses answered the questionnaire. Regarding the insomnia condition levels, nurses belonging to regions with a higher incidence rate of the Covid-19 pandemic recorded higher levels of insomnia than others (p=.004). Females and nurses belonging to areas with lower Covid-19 incidence rate recorded a significantly higher total eating flexibility attitude (p=.003; p<.001), also, in the Food and Exercise flexibility (p=.007; p<.001). As regards the flexible attitude for weight and shape, significant differences were recorded among nurses according to their BMI values (p<.001) and to their incidence rate of the belonging region (p<.001). The insomnia condition levels significantly correlated with the eat flexibility attitude both in its total score (p=.010), in the general score (p=.010), and the weight and shape score (p<.001). All correlations between the insomnia conditions and the flexibility to eat were significantly inverse except for the food and exercise dimension. All the eat flexibility sub-dimensions significantly correlated among them (p<.001).

CONCLUSION

There was a direct correlation among socio-demographic factors, BMI values, insomnia, and behavioral flexibility scores in Italian nurses. So, it could be assumed that the nursing profession is at risk of developing a metabolic syndrome condition. Therefore, it could be considered a psychoendocrinological employment disease during the Covid-19 outbreak.

Cognitive Behavioral Approach to Treat Obesity: A Randomized Clinical Trial

Our aim was to analyze and compare the effects of three different long-term treatments on anthropometric profiles, eating behaviors, anxiety and depression levels, and quality of life of groups of adults with obesity. Methods: The 43 participants in the study were randomly assigned to one of three groups: the education and health group (EH, n = 12), which received lectures on health topics; the physical exercise group (PE, n = 13), which underwent physical training; and the interdisciplinary therapy plus cognitive behavioral therapy (IT + CBT) (n = 18) group, which received physical training, nutritional advice, and physical and psychological therapy. Results: Total quality of life increased significantly in the EH group (△ = 2.00); in the PE group, body weight significantly decreased (△ = -1.42) and the physical domain of quality of life improved (△ = 1.05). However, the most significant changes were seen in the IT + CBT group, in which the anthropometric profile improved; there were an increase in quality of life in all domains (physical, psychological, social, and environmental), an improvement in eating behaviors [Dutch Eating Behavior Questionnaire (DEBQ), total △ = -8.39], and a reduction in depression [Beck Depression Inventory (BDI), △ = -10.13). Conclusion: The IT + CBT program was more effective than the PE and EH programs. Clinical Trial Registration Number: NCT02573688.

Influence of magnitude of weight loss on Adipo/lep ratio in adolescents with obesity undergoing multicomponent therapy

BACKGROUND AND AIMS

The expansion of adipose tissue increases leptin secretion associated with a reduction of adiponectin concentration, which negatively affects health of adolescents with obesity. This study aims to investigate the effects of non-intensive interdisciplinary therapy on cardiometabolic parameters including leptin, adiponectin and adiponectin/leptin ratio as a dependent manner on its magnitude of weight loss reduction.

METHODS AND RESULTS

Thirty-eight adolescents (14-19 y.o) were enrolled in an interdisciplinary therapy for 20 weeks. Body composition, biochemical parameters, leptin and adiponectin were measured at baseline and after therapy. The adolescents were divided into two groups according to the magnitude of total weight loss, less than 5% (<5%-n = 18) or greater than or equal to 5% (≥5%-n = 20). Leptin decreased in whole group after therapy, while adiponectin, and adiponectin/leptin ratio increased. Additionally, body composition was improved. Only the group who lost ≥5% of body weight could reduce the inflammatory state.

CONCLUSION

The interdisciplinary therapy contributes to improve cardiometabolic parameters that could be involved on inflammation in adolescents with obesity, this improvement occurred mainly when the weight loss is ≥5% of body weight. It could be a target for control the inflammatory process related to obesity in adolescents.

Effects of functional training and 2 interdisciplinary interventions on maximal oxygen uptake and weight loss of women with obesity: a randomized clinical trial

Our aim was to analyze and compare functional training, interdisciplinary therapy, and interdisciplinary education on cardiorespiratory fitness (CF) and anthropometric characteristics of women with obesity. Forty-four women (age = 39.7 ± 5.9 years, body mass index (BMI) = 35.5 ± 2.8 kg/m²) completed 30 weeks of intervention randomly assigned to 3 groups: functional training (FT) (n = 14), interdisciplinary therapy (IT) (n = 19), and interdisciplinary education (IE) (n = 11). The FT group participated in the training program (3/week), the IT group received the same training intervention plus nutrition (1/week) and psychology advice (1/week) and physical therapy (1/week). The IE group participated in interdisciplinary lectures on topics related to health promotion (1/month). CF (ergospirometry), anthropometry, and body composition (electrical bioimpedance) were measured pre-intervention (Pre) and post-intervention (Post). CF increased (p ≤ 0.05) significantly (Pre vs. Post) in the FT (7.5%) and IT (10.8%) groups, but not in the IE group (1.8%). Body mass (BM), BMI, relative fat mass, and waist circumference significantly (p ≤ 0.05) decreased (Pre vs. Post) in IT (-4.4%, -4.4%, -2.3%, and -5.1%, respectively). The IE group showed a significant decrease in BM (-3.7%), BMI (-3.7%), and waist circumference (-3.5%), whereas the FT group promoted significant decrease in waist circumference (-3.4%). In conclusion, functional training increased CF but only interdisciplinary interventions improved the anthropometric profile of women with obesity. Novelty Interdisciplinary therapy provided more comprehensive adaptations in women with obesity, including morphological variables and CF. Functional training increased CF but reduced only abdominal obesity. Interdisciplinary education provided benefits on morphological variables, but it does not increase CF.

Nutraceutical prospective: The synergetic mechanism of action of inositols and resveratrol on metabolic syndrome

It has been known that inositols function as insulin second messengers and mediate different insulin-dependent processes and are a valid natural, non-pharmaceutical alternative to contrast insulin-resistance as well as associated metabolic syndrome in women with Polycystic ovarian disease (PCOS). Several studies also have shown positive effects of resveratrol in reducing glucose and lipid concentrations in patients. Recently, clinical evidence has proven that an D-chiro-inositol/resveratrol combination has a potential role to play in maintaining metabolic and endocrine health, however no large clinical trials have demonstrated the medical effectiveness of the combination, and the combined mode of action remains poorly discussed. Herein, we address the hypothesis of a synergistic mechanism adopted by D-chiro-inositol and resveratrol in reducing insulin resistance and hyperlipidemia and thus showing a greater therapeutic potential compared to treatment with inositol’s alone.