1
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Yan WS, Liu MM, Liu SJ. A Behavioral and Event-Related Potentials Study of Food-Related Inhibitory Control in Probable Binge Eating Disorder. Psychol Res Behav Manag 2023; 16:4737-4748. [PMID: 38024662 PMCID: PMC10676687 DOI: 10.2147/prbm.s441949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Background Similar to addictive disorders, deficits on cognitive control might be involved in the onset and development of Binge Eating Disorder (BED). However, it remains unclear whether general or food-related inhibitory control impairments would be basically linked to overeating and binge eating behaviors. This study thus aimed to investigate behavioral performance and electrophysiological correlates of food-related inhibitory control among individuals with binge eating behavior. Methods Sixty individuals with probable BED (pBED) and 60 well-matched healthy controls (HCs) were assessed using the typical Stop-Signal Task, a revised Go/No Go Task, and a food-related Go/No Go Task. Besides, another separate sample, including 35 individuals with pBED and 35 HCs, completed the food-related Go/No Go Task when EEG signals were recorded with the event-related potentials (ERPs). Results The data revealed that the pBED group performed worse with a longer SSRT on the Stop-Signal Task compared with HCs (Cohen's d = 0.58, p = 0.002). Moreover, on the food-related Go/No Go Task, the pBED group had a lower success rate of inhibition in no-go trials (Cohen's d = 0.47, p = 0.012). The ERPs data showed that in comparison with HCs, the pBED group exhibited increased P300 latency (FC1, FC2, F3, F4, FZ) in the no-go trials of the food-related Go/No Go Task (Cohen's d 0.56-0.73, all p < 0.05). Conclusion These findings suggested that individuals with binge eating could be impaired in both non-specific and food-related inhibitory control aspects, and the impairments in food-related inhibitory control might be linked to P300 abnormalities, implying a behavioral-neurobiological dysfunction mechanism implicated in BED.
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Affiliation(s)
- Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, People’s Republic of China
- Guizhou Research Institute for Health Development, Guizhou Medical University, Guiyang, People’s Republic of China
| | - Meng-Meng Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, People’s Republic of China
| | - Su-Jiao Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, People’s Republic of China
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2
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Schag K, Schlatter JE, Martus P, Zipfel S, Giel KE. Reduction of impulsivity after an impulsivity-focused group intervention in patients with binge eating disorder in a long-term follow-up of the randomized controlled IMPULS trial. Psychol Med 2023; 53:4821-4822. [PMID: 35435156 DOI: 10.1017/s0033291722000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Johanna E Schlatter
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Medical University Hospital Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), Tübingen, Germany
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3
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Hilbert A. Psychological and Medical Treatments for Binge-Eating Disorder: A Research Update. Physiol Behav 2023:114267. [PMID: 37302642 DOI: 10.1016/j.physbeh.2023.114267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
Binge-eating disorder (BED), characterized by recurrent binge eating in the absence of regular weight-compensatory behaviors, is the most common eating disorder, associated with pronounced mental and physical sequelae. An increasing body of research documents the efficacy of diverse approaches to the treatment of this disorder, summarized in meta-analyses. This research update narratively reviewed randomized-controlled trials (RCTs) on the psychological and medical treatment of BED published between January 2018 to November 2022, identified through a systematic literature search. A total of 16 new RCTs and 3 studies on previous RCTs providing efficacy- and safety-related data were included. Regarding psychotherapy, confirmatory evidence supported the use of integrative-cognitive therapy and, with lower effects, brief emotion regulation skills training for binge eating and associated psychopathology. Behavioral weight loss treatment was revealed to be efficacious for binge eating, weight loss, and psychopathology, but its combination with naltrexone-bupropion did not augment efficacy. New treatment approaches were explored, including e-mental-health and brain-directed treatments, mostly targeting emotion and self-regulation. Additionally, different therapeutic approaches were evaluated in complex stepped-care models. In light of these advances, future research is necessary to further optimize effects of evidence-based treatments for BED, through improvement of existing or development of new treatments, based on mechanistic and/or interventional research, and/or tailoring treatments to personal characteristics in a precision medicine approach.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
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4
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Max SM, Schag K, Giel KE, Plewnia C. Behavioural biases in the interaction with food objects in virtual reality and its clinical implication for binge eating disorder. Eat Weight Disord 2023; 28:46. [PMID: 37225914 DOI: 10.1007/s40519-023-01571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023] Open
Abstract
Cognitive processes play a central role in the development, maintenance and remission in mental disorders, like in Binge Eating Disorder (BED). Insights into cognitive mechanisms reflected by embodied interaction with food and its connections to clinically relevant psychopathology offer new possibilities for translational diagnostics and interventions. We longitudinally investigated the manual interaction with food in a virtual reality (VR) in 31 patients with BED. Patients were assessed at baseline before participating in a randomized-controlled trial (RCT) investigating a computer-based inhibitory control training programme enhanced by transcranial direct current stimulation (tDCS) and at a 6-week follow-up. At both assessments, an experimental VR paradigm was conducted and patients were characterized concerning eating disorder psychopathology, eating behaviour, general impulsivity and food craving. In the experimental task, one of two simultaneously presented objects (food vs. office tools) had to be collected. Food was recognized faster than office tools and subsequent approach behaviour was initiated faster, whereas thereafter, food was collected slower than office tools. Exploratory, we could not find a modulatory effect of applied tDCS on the interaction with food. No relationship between behavioural biases and sample characterizations could be detected. Two different stages in the manual interaction with food were found: a faster first stage that comprises recognition and movement initiation and a slower second stage that comprises controlled handling and may reflect aversive motivational processes. As the behavioural patterns do not change with an ameliorated BED-psychopathology at the second assessment, the task seems insensitive in detecting translational interconnections between behavioural biases and BED-characteristics.Level of evidence: Level I, experimental study.
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Affiliation(s)
- Sebastian M Max
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital Tübingen, Neurophysiology & Interventional Neuropsychiatry, Calwerstraße 14, 72076, Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital Tübingen, Neurophysiology & Interventional Neuropsychiatry, Calwerstraße 14, 72076, Tübingen, Germany.
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5
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Virtual Rejection and Overinclusion in Eating Disorders: An Experimental Investigation of the Impact on Emotions, Stress Perception, and Food Attitudes. Nutrients 2023; 15:nu15041021. [PMID: 36839379 PMCID: PMC9965581 DOI: 10.3390/nu15041021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: the investigation of how interpersonal functioning affects eating psychopathology has been receiving increasing attention in the last decade. This study evaluates the impact of virtual social inclusion or ostracism on emotions, perceived stress, eating psychopathology, and the drive to binge or restrict in patients across the eating disorder spectrum. (2) Methods: a group of 122 adolescent and adult females with different eating disorder diagnoses were compared to 50 healthy peers with regards to their performance on, and responses to the Cyberball task, a virtual ball-tossing game. Each participant was randomly assigned to playing a social inclusion or a social exclusion block of the Cyberball task and completed self-report assessments of emotions, perceived stress and urge to restrict/binge before and after the task. (3) Results: patients with anorexia nervosa showed a more negative impact on psychological well-being evaluated with the need threat scale after the excluding block, while patients with bulimia nervosa reported more negative effects after the overincluding condition. Patients with binge eating disorder showed a reduction in specific negative emotions after the overincluding block, unlike all other participants. (4) Conclusions: findings show significant correlations between restraint thoughts in patients with bulimia nervosa and binge thoughts in patients with binge eating disorder after being exposed to the inclusion condition. Different reactions in cognitive and emotional states of patients with eating disorders after different interpersonal scenarios confirm the impact of inclusive or exclusive relationships on eating psychopathology, with specific and different responses across the eating disorder spectrum, that have been discussed, linked to their eating behavioral cognition.
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6
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Schuller J, Koch M. Investigating a role of orexin and ‘cocaine- and amphetamine-regulated transcript’ in the nucleus accumbens shell in binge eating of male rats and the relationship with impulsivity. Physiol Behav 2022; 257:114000. [DOI: 10.1016/j.physbeh.2022.114000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
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7
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Todisco P, Meneguzzo P, Garolla A, Diomidous E, Antoniades A, Vogazianos P, Tozzi F. Understanding dropout and non-participation in follow-up evaluation for the benefit of patients and research: evidence from a longitudinal observational study on patients with eating disorders. Eat Disord 2022; 31:337-352. [PMID: 36271711 DOI: 10.1080/10640266.2022.2135738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Treatment outcomes in eating disorders (EDs) are still an open field for clinicians and researchers. Besides difficulties in egosyntonic-linked treatment engagements, dropout is one of the most crucial elements that cause a reduction in the treatment efficacy. Thus, the aim of this study is to evaluate factors that could contribute to high dropout rates and non-participation in follow-up evaluation in patients with ED. This study used a large sample of patients from a specialized ED ward and day hospital (DH). A sample of 428 individuals was recruited for this study. Psychological and demographic data were collected at the time of hospitalization and discharge from the facilities. These data were used to explore a possible link between dropout and follow-up non-participation. Specially, the random forest was used to rank demographic and psychological features in importance and evaluate the top results with regression analyses for statistical significance. A dropout rate of 12.14% during inpatient and DH treatment was found. Anger-hostility and general psychopathology were found to be predictors of dropout during treatment, while the duration of the hospitalization predicted non-participation at the six-month follow-up. Specific psychological features should be considered before and during treatments for patients with EDs to reduce dropout rates. The duration of the hospitalization should also be evaluated as a relevant healthcare element that could affect engagement and, accordingly, outcome.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano (VI), Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano (VI), Italy
| | - Eva Diomidous
- Research & Development, Stremble Ventures, Limassol, Cyprus
| | | | - Paris Vogazianos
- Behavioral Sciences Department, European University Cyprus , Nicosia, Cyprus
| | - Federica Tozzi
- Research & Development, Stremble Ventures, Limassol, Cyprus
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8
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Camacho-Barcia L, Munguía L, Gaspar-Pérez A, Jimenez-Murcia S, Fernández-Aranda F. Impact of Food Addiction in Therapy Response in Obesity and Eating Disorders. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00421-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Meneguzzo P, Mancini C, Ormitti A, Garolla A, Bonello E, Donini LM, Todisco P. Impulsivity and eating disorders: The relationship between serum 25-hydroxyvitamin D and different impulsivity facets in a transdiagnostic sample. World J Biol Psychiatry 2022; 23:401-409. [PMID: 34842504 DOI: 10.1080/15622975.2021.2011404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Eating disorders (EDs) are severe psychiatric conditions characterised by malnutrition, dysfunctional behaviours, and hypovitaminosis D. In various psychiatric conditions, including EDs, preliminary evidence has correlated impulsivity to a low level of 25-hydroxyvitamin D [25(OH)D]. This study aims to reinforce this evidence by examining different facets, both behavioural and psychological, of the impulsivity construct in patients with ED. METHODS A sample of 119 women was evaluated with a validated questionnaire and computerised neuropsychological tasks: the UPPS-P impulsive behaviour scale, a go/no-go task, and the Balloon Analogue Risk Task (BART). A clinical evaluation for EDs and blood sample collection were also performed to assess specific psychopathology and determine the serum level of 25(OH)D. RESULTS Significant correlations were found between serum levels of 25(OH)D and BART scores (p = 0.012) and lack of perseverance (p = 0.034). Moreover, regression analyses showed that higher BART scores may be explained by hypovitaminosis D and higher levels of lack of perseverance in patients with EDs. CONCLUSIONS The specific aspect of impulsivity linked to goal strategy and behaviours may be explained in patients with EDs by hypovitaminosis D. A possible connection to the brain inflammatory system is also discussed, along with possible directions for future research.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neurosciences, University of Padova, Padova, Italy
| | - Cecilia Mancini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - Aurora Ormitti
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Lorenzo M Donini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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10
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Meneguzzo P, Tenconi E, Collantoni E, Longobardi G, Zappalà A, Vindigni V, Favaro A, Pavan C. The Cyberball task in people after obesity surgery: preliminary evaluation of cognitive effects of social inclusion and exclusion with a laboratory task. Eat Weight Disord 2022; 27:1523-1533. [PMID: 34510394 PMCID: PMC8435164 DOI: 10.1007/s40519-021-01297-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Social cognition and temperamental and interpretative styles could play a role in the outcome of bariatric surgery. This study aims to assess preliminary evidence about how obesity surgery patients evaluate social inclusion and exclusion through a ball-tossing game called Cyberball, looking at the influence of early maladaptive schemas. METHODS Thirty-four patients with a history of obesity surgery interventions and 44 controls were recruited for this study. A psychological evaluation was performed before and after the Cyberball task with self-report questionnaires. RESULTS In the ostracism condition, significant differences were seen across all the patients' fundamental psychological needs with less perceived ostracization (p = 0.001) even if they recognized less interaction via fewer ball tosses than controls. Moreover, the ostracism paradigm resulted in patients experiencing a higher urge to binge (p = 0.010) and a higher urge to restrain (p = 0.012) than controls. Looking at differences due to the Cyberball paradigm applied, clear differences emerged only between controls subgroups at the specific self-report scales applied, corroborating the reduced perception of the exclusion. As evidenced by the schema domains, the study found a connection between the impaired limits-schema domain and the drive to binge. CONCLUSION The results show that obesity surgery patients reported different effects of the Cyberball task than controls. Different possible interpretations are discussed, and future directions for studies are exposed, both for the evaluation of social interactions effects and in the assessment of the role of specific cognitive schemas. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | | | - Adele Zappalà
- Department of Medicine, University of Padova, Padova, Italy
| | - Vincenzo Vindigni
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Chiara Pavan
- Department of Medicine, University of Padova, Padova, Italy
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11
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Chew HSJ, Lau ST, Lau Y. Weight-loss interventions for improving emotional eating among adults with high body mass index: A systematic review with meta-analysis and meta-regression. EUROPEAN EATING DISORDERS REVIEW 2022; 30:304-327. [PMID: 35460323 PMCID: PMC9320927 DOI: 10.1002/erv.2906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/15/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate the effectiveness of weight‐loss interventions on emotional eating among adults with high body mass index (BMI). Methods A systematic review, meta‐analysis and meta‐regression were performed on randomized controlled trials published from inception until 19 March 2021. Results Thirty‐one studies were included, representing 1203 participants with mean ages ranging from 21.8 to 57.3 years old and BMI 27.2–43.5 kg/m2. We found small‐to‐medium interventional effects on emotional eating (n = 18; Hedges' g = 0.22; p = 0.01, I2 = 61.7%), uncontrolled eating (n = 16; Hedges' g = 0.46; p < 0.001, I2 = 71.6%) and cognitive restraint (n = 18; Hedges' g = 0.42; p < 0.001, I2 = 75.8%). Small‐to‐medium interventional effects were only found for emotional eating (n = 8; Hedges' g = 0.45; p = 0.02, I2 = 74.3%) 3‐month post‐intervention, and on BMI (n = 4; Hedges' g = 0.43; p < 0.05, I2 = 33.4%) and weight (n = 6; Hedges' g = 0.36; p < 0.01, I2 < 10.4%) 12‐month post‐intervention. Age, male proportion, baseline BMI, attrition rate and intervention length were not significant moderators of the heterogeneity between studies. Conclusion Interventions improved emotional eating and weight loss along a year‐long trajectory. Weight‐loss interventions such as Cognitive Behaviour Therapy (CBT), diet and exercise, and mindfulness are effective in improving emotional eating, uncontrolled eating/external eating and cognitive restraint/restrained eating. Purely mindfulness‐based interventions showed a higher interventional effect size over a combination of CBT and mindfulness, CBT and diet and/or exercise. Small‐to‐medium interventional effect size on body mass index and weight was only observed 12‐month post‐intervention.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Giel KE, Bulik CM, Fernandez-Aranda F, Hay P, Keski-Rahkonen A, Schag K, Schmidt U, Zipfel S. Binge eating disorder. Nat Rev Dis Primers 2022; 8:16. [PMID: 35301358 PMCID: PMC9793802 DOI: 10.1038/s41572-022-00344-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.
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Affiliation(s)
- Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany.
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, Australia
| | | | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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13
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Munguía L, Gaspar-Pérez A, Jiménez-Murcia S, Granero R, Sánchez I, Vintró-Alcaraz C, Diéguez C, Gearhardt AN, Fernández-Aranda F. Food Addiction in Eating Disorders: A Cluster Analysis Approach and Treatment Outcome. Nutrients 2022; 14:nu14051084. [PMID: 35268059 PMCID: PMC8912776 DOI: 10.3390/nu14051084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background: A first approach of a phenotypic characterization of food addiction (FA) found three clusters (dysfunctional, moderate and functional). Based on this previous classification, the aim of the present study is to explore treatment responses in the sample diagnosed with Eating Disorder(ED) of different FA profiles. Methods: The sample was composed of 157 ED patients with FA positive, 90 with bulimia nervosa (BN), 36 with binge eating disorder (BED), and 31 with other specified feeding or eating disorders (OSFED). Different clinical variables and outcome indicators were evaluated. Results: The clinical profile of the clusters present similar characteristics with the prior study, having the dysfunctional cluster the highest ED symptom levels, the worse psychopathology global state, and dysfunctional personality traits, while the functional one the lowest ED severity level, best psychological state, and more functional personality traits. The dysfunctional cluster was the one with lowest rates of full remission, the moderate one the higher rates of dropouts, and the functional one the highest of full remission. Conclusions: The results concerning treatment outcome were concordant with the severity of the FA clusters, being that the dysfunctional and moderate ones had worst treatment responses than the functional one.
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Affiliation(s)
- Lucero Munguía
- Department of Psychiatry, Universitary Hospital of Bellvitge, 08907 Barcelona, Spain; (L.M.); (A.G.-P.); (S.J.-M.); (I.S.); (C.V.-A.)
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
| | - Anahí Gaspar-Pérez
- Department of Psychiatry, Universitary Hospital of Bellvitge, 08907 Barcelona, Spain; (L.M.); (A.G.-P.); (S.J.-M.); (I.S.); (C.V.-A.)
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Universitary Hospital of Bellvitge, 08907 Barcelona, Spain; (L.M.); (A.G.-P.); (S.J.-M.); (I.S.); (C.V.-A.)
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
- Clinical Sciences Department, School of Medicine, Barcelona University, 08907 Barcelona, Spain
- CIBER Physiopatology, Obesity and Nutrition (CIBERobn), Health Institute Carlos III, 28029 Madrid, Spain;
| | - Roser Granero
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
- CIBER Physiopatology, Obesity and Nutrition (CIBERobn), Health Institute Carlos III, 28029 Madrid, Spain;
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08907 Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Universitary Hospital of Bellvitge, 08907 Barcelona, Spain; (L.M.); (A.G.-P.); (S.J.-M.); (I.S.); (C.V.-A.)
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
- CIBER Physiopatology, Obesity and Nutrition (CIBERobn), Health Institute Carlos III, 28029 Madrid, Spain;
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, Universitary Hospital of Bellvitge, 08907 Barcelona, Spain; (L.M.); (A.G.-P.); (S.J.-M.); (I.S.); (C.V.-A.)
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
- CIBER Physiopatology, Obesity and Nutrition (CIBERobn), Health Institute Carlos III, 28029 Madrid, Spain;
| | - Carlos Diéguez
- CIBER Physiopatology, Obesity and Nutrition (CIBERobn), Health Institute Carlos III, 28029 Madrid, Spain;
- Department of Physiology, CIMUS, Instituto de Investigación Sanitaria, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | | | - Fernando Fernández-Aranda
- Department of Psychiatry, Universitary Hospital of Bellvitge, 08907 Barcelona, Spain; (L.M.); (A.G.-P.); (S.J.-M.); (I.S.); (C.V.-A.)
- Psychoneurobiology of Eating Disorders and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain;
- Clinical Sciences Department, School of Medicine, Barcelona University, 08907 Barcelona, Spain
- CIBER Physiopatology, Obesity and Nutrition (CIBERobn), Health Institute Carlos III, 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-93-2607227; Fax: +34-93-2607193
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Liquori S, Faidutti G, Garzitto M, Saetti L, Bendotti M, Balestrieri M. Efficacy of a Group Psychoeducation Treatment in Binge Eating Disorder: An Open-Label Study. Front Psychiatry 2022; 13:822282. [PMID: 35558418 PMCID: PMC9086709 DOI: 10.3389/fpsyt.2022.822282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS To evaluate the effectiveness of a multidisciplinary group psychoeducation treatment (GPT) in patients with Binge Eating Disorder (BED). METHODS We designed an open-label efficacy study that included a population of 45 patients diagnosed with BED. A measure of eating attitudes and associated psychological constructs was obtained through the use of the self-report instruments Eating Disorder Inventory (EDI-3), Binge Eating Scale (BES) and Body Uneasiness Test (BUT). The Symptom Checklist-90 (SCL-90) was also administered to assess general psychopathology. All participants participated in 12 weekly group psychoeducational treatment meetings, 8 of which were conducted by mental health professionals, and a second module of 4 meetings, oriented on health and nutrition education topics, conducted by a dietician. RESULTS At the end of treatment, patients showed significant improvements in body mass index (BMI) and binge eating. Paired t-tests showed significant differences at p-value < 0.05 in all eating disorder risk scales and for most of the general psychological scales related to eating disorders. In addition, patients experienced an improvement in their perception of overall body image, a decrease in concerns about physical appearance and less body image avoidance. Finally, results showed that psychoeducation treatment was associated with significant improvements in interpersonal sensitivity. CONCLUSIONS The results of this study may indicate that significant short-term improvements can be achieved through a psychoeducation group for BED patients. Although limited by the lack of a control condition, this study adds to a growing body of evidence with promising results, setting the stage for further case-control studies of BED treatment.
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Affiliation(s)
- Silvia Liquori
- Unit of Psychiatry, Department of Medicine (DAME), Centre for Eating Disorders, University of Udine and Friuli Centrale Health-University Trust (ASUFC), Udine, Italy
| | - Giovanni Faidutti
- Unit of Psychiatry, Department of Medicine (DAME), Centre for Eating Disorders, University of Udine and Friuli Centrale Health-University Trust (ASUFC), Udine, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), Centre for Eating Disorders, University of Udine and Friuli Centrale Health-University Trust (ASUFC), Udine, Italy
| | - Luana Saetti
- Unit of Psychiatry, Department of Medicine (DAME), Centre for Eating Disorders, University of Udine and Friuli Centrale Health-University Trust (ASUFC), Udine, Italy
| | - Monica Bendotti
- Unit of Psychiatry, Department of Medicine (DAME), Centre for Eating Disorders, University of Udine and Friuli Centrale Health-University Trust (ASUFC), Udine, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), Centre for Eating Disorders, University of Udine and Friuli Centrale Health-University Trust (ASUFC), Udine, Italy
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Yan WS, Zheng DH, Liu MM. Trait Impulsivity and Choice Impulsivity in Young Adult Students With Probable Binge Eating Disorder. Front Psychiatry 2022; 13:838700. [PMID: 35479492 PMCID: PMC9037330 DOI: 10.3389/fpsyt.2022.838700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/22/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Binge eating disorder (BED) as a public health problem has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Akin to addictive disorders, impulsivity-related neuropsychological constructs might be potentially involved in the onset and development of BED. However, it remains unclear which facets of impulsivity are connected to overeating and binge eating behaviors among non-clinical populations. The present study aimed to detect the relationship between impulsivity and binge eating both on the personality-trait and behavioral-choice levels in undiagnosed young adults. METHODS Fifty-eight individuals with probable BED and 59 healthy controls, matched on age, gender, and educational level, were assessed by using a series of self-report measurements, including the Barratt Impulsiveness Scale (BIS-11), UPPS-P Impulsive Behaviors Scale (UPPS-P), Delay Discounting Test (DDT), and Probability Discounting Test (PDT). RESULTS Multivariate analysis of variance models revealed that compared with healthy controls, the probable BED group showed elevated scores on the BIS-11 Attentional and Motor impulsiveness, and on the UPPS-P Negative Urgency, Positive Urgency, and Lack of Perseverance. However, the probable BED subjects had similar discounting rates on the DDT and PDT with healthy controls. Regression models found that Negative Urgency was the only positive predictor of binge eating behavior. CONCLUSIONS These findings suggested that typical facets of trait impulsivity, which have been recognized in addictive disorders, were associated with binge eating in young adults, whereas choice impulsivity was not aberrantly seen in the same probable BED sample. This study might promote a better understanding of the pathogenesis of BED.
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Affiliation(s)
- Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
| | - Dan-Hui Zheng
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
| | - Meng-Meng Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
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16
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A Multi-Faceted Evaluation of Impulsivity Traits and Early Maladaptive Schemas in Patients with Anorexia Nervosa. J Clin Med 2021; 10:jcm10245895. [PMID: 34945191 PMCID: PMC8703582 DOI: 10.3390/jcm10245895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: patients with Anorexia Nervosa (AN) are classified either as restrictive (ANr) or binge/purge (ANbp) according to the absence or presence of impulsive eating and compensatory behaviors. The aim of the present study was to assess the levels of impulsivity in both AN subtypes and to explore whether individual differences in impulsivity may be explained by differences in the presence of early maladaptive schemas. (2) Methods: the sample group included 122 patients with ANr, 112 patients with ANbp, and 131 healthy women (HW). All of these participants completed the UPPS-P scale for an assessment of impulsive behaviors and the Young Schema Questionnaire (YSQ-S3) for an assessment of early maladaptive schemas. (3) Results: the patients with ANbp displayed higher levels of impulsivity compared with the patients with ANr and HW. Patients with AN, especially the restrictive subtype, also reported higher levels of early maladaptive schemas than HW, and regression analyses revealed that specific maladaptive schemas partially explain the variability in impulsivity in both patients and HW. (4) Conclusions: it appears that maladaptive beliefs developed during childhood or adolescence may predict the development of impulsivity, a personality trait usually associated with maladaptive behaviors, and appears to be prevalent among ANbp patients. The clinical effects of this, as well as directions for future study, are also discussed in this paper.
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İnce B, Max SM, Plewnia C, Leehr EJ, Zipfel S, Giel KE, Schag K. A Pilot Event-Related Potentials Study on Mechanisms Underlying a tDCS-Enhanced Food-Specific Response Inhibition Task for Patients With Binge Eating Disorder. Front Psychol 2021; 12:721672. [PMID: 34712172 PMCID: PMC8546297 DOI: 10.3389/fpsyg.2021.721672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Behavioural studies demonstrate alterations in cognitive functioning, particularly impaired response inhibition and increased attentional bias towards food in binge eating disorder (BED). This pilot study aimed to investigate the neurophysiological processing of a food-specific inhibition training combined with anodal transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex (DLPFC) in 16 patients with BED (mean age = 38.6, mean BMI = 33.7 kg/m2). Patients performed a food-specific antisaccade task at baseline (T0) and in a cross-over design with verum vs. sham stimulation at T1 and T2. We investigated (i) event-related potentials (ERPs; N2, ERN and P3 amplitudes) while executing the task at baseline, (ii) whether baseline ERPs would predict task performance at T1 and T2 and (iii) associations between ERPs, eating disorder pathology and impulsivity at baseline. The mean amplitude of N2 was less pronounced in erroneous saccades (ES) than correct saccades (CS), whereas ERN and P3 mean amplitudes were more pronounced in ES. Moreover, the P3 mean amplitude of ES predicted the percentage of ES at both follow up-measurements irrespective of the applied stimulation (sham vs. verum). N2 in trials with correct saccades were negatively correlated with nonplanning trait impulsivity, while P3 in erroneous antisaccade trials was negatively correlated with food-related impulsivity. Overall, the findings of reduced ERN, enhanced P3 and N2 amplitude might be interpreted as difficulties in response inhibition towards food in individuals with BED. In particular, P3 predicts task outcome at follow-up and might represent a potential marker for inhibitory control processes.
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Affiliation(s)
- Başak İnce
- Department of Psychology, Haliç University, Istanbul, Turkey
| | - Sebastian M Max
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine & Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University Hospital Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine & Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University Hospital Tübingen, Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine & Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University Hospital Tübingen, Tübingen, Germany
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Direct Oral Anticoagulants in Patients with Obesity and Atrial Fibrillation: Position Paper of Italian National Association of Hospital Cardiologists (ANMCO). J Clin Med 2021; 10:jcm10184185. [PMID: 34575306 PMCID: PMC8468506 DOI: 10.3390/jcm10184185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
The use of the direct oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban (DOACs) offers some major advantages over warfarin and other vitamin K antagonists (VKAs). One advantage is the possibility to use a fixed dose in normal-weight patients, overweight patients and patients with obesity. However, the "one size fits all" strategy raised a concern regarding the possibility to undertreat patients with a high body mass index. No randomized controlled trials (RCTs) have ever compared VKAs and DOACs in this population. We analyzed data from the literature on DOAC pharmacokinetics and pharmacodynamics, results from the four pivotal phase III trials on non-valvular atrial fibrillation, retrospective observational studies and metanalyses. While we are aware of the limitation imposed by the absence of specific RCTs, we propose the position of the Italian Association of Hospital Cardiologists (ANMCO) on the use of DOACs in patients with obesity based on the existing evidence.
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Veit R, Schag K, Schopf E, Borutta M, Kreutzer J, Ehlis AC, Zipfel S, Giel KE, Preissl H, Kullmann S. Diminished prefrontal cortex activation in patients with binge eating disorder associates with trait impulsivity and improves after impulsivity-focused treatment based on a randomized controlled IMPULS trial. NEUROIMAGE-CLINICAL 2021; 30:102679. [PMID: 34215149 PMCID: PMC8102655 DOI: 10.1016/j.nicl.2021.102679] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/18/2023]
Abstract
Persons with binge eating disorder show increased impulsivity. We investigated cognitive control to food cues using fNIRS. Compared to healthy controls, binge eaters show weaker activation of the prefrontal cortex. After behavioral therapy, binge eaters increase prefrontal cortex activation.
Background Behavioral and cognitive control are vital for healthy eating behavior. Patients with binge eating disorder (BED) suffer under recurrent binge eating episodes accompanied by subjective loss of control that results, among other factors, from increased impulsivity. Methods In the current study, we investigated the frontal network using functional near-infrared spectroscopy (fNIRS) during a food specific go/nogo task to assess response inhibition in 24 patients with BED (BMI range 22.6–59.7 kg/m2) compared to 12 healthy controls (HC) (BMI range 20.9–27 kg/m2). Patients with BED were invited to undergo fNIRS measurements before an impulsivity-focused cognitive behavioral group treatment, directly after this treatment and 3 months afterwards. As this was a planned subgroup analysis of the randomized controlled IMPULS trial, patients with BED were randomized either to the treatment group (n = 14) or to a control group (n = 10). The treatment group received 8 weekly sessions of the IMPULS treatment. Results We found a significant response inhibition effect (nogo minus go), in terms of an increased oxygenated hemoglobin response in the bilateral prefrontal cortex in both groups. The greatest response was observed when participants were instructed to go for healthy and withhold their response to unhealthy high caloric food cues. The healthy nogo condition failed to show a significant prefrontal inhibitory response, which was probably related to the task design, as the condition was considered more demanding. BED patients, especially those with higher trait impulsivity, showed a weaker activation of the prefrontal cortex during response inhibition, predominantly in the right hemisphere. Interestingly, three months after the treatment, patients of the treatment group increased their right prefrontal cortex activity during response inhibition. Likewise, increased prefrontal cortex activation correlated with decreased trait impulsivity after treatment. Conclusions Our results suggest that patients with BED have limited resources to activate the prefrontal cortex when asked to inhibit a reaction onto food-specific stimuli. However, this effect could be partly driven by differences in BMI between the HC and BED group. Cognitive-behavioral therapy targeting impulsive eating behavior may improve prefrontal cortex recruitment during response inhibition.
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Affiliation(s)
- Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Center of Excellence for Eating Disorders Tübingen (COMET), Tübingen, Germany
| | - Eric Schopf
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Maike Borutta
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Jann Kreutzer
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Center of Excellence for Eating Disorders Tübingen (COMET), Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Center of Excellence for Eating Disorders Tübingen (COMET), Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Germany; Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Germany.
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