Effects of cognitive-behavioural therapy on health-related quality of life in obese subjects with and without binge eating disorder

A Pilot Study of a Videoconferencing-Based Binge Eating Disorder Program in Overweight or Obese Females

Background: There has been increasing interest in using videoconferencing in health care, but limited research was conducted in Binge Eating Disorder (BED) patients. This 3-month pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of a videoconferencing (VC)-based treatment program in overweight and obese females with BED. Methods: Eighteen participants, aged 20-73, were diagnosed and randomized into either a face-to-face (F2F) group or a VC-based group. In the F2F group, participants received 12 one-on-one weekly counseling sessions from a Licensed Mental Health Counselor and Registered Dietitian Nutritionist. In the VC group, participants received the same counseling through an online telemedicine software. Measured outcomes include retention, adherence to treatment, and attitudinal and behavioral changes of participants. Results: In the end of study, of the 9 participants randomized into each group, 8 (88.9%) F2F participants and 4 (44.4%) VC participants completed the study. On average, F2F finishers attended 94.8% of sessions and completed 66.2% of dietary diaries. VC finishers attended 95.8% of sessions and completed 55.4% of diaries. No changes in weight and binge eating episode were observed in either group. F2F finishers had significant improvement on uncontrolled eating (p = 0.01), emotional eating (p = 0.004), food addiction diagnosis (p = 0.04), loss of control (p = 0.04), and clinical significance (p = 0.04). VC finishers observed significant improvements in eating disorder examination shape concern (p = 0.03) and global score (p = 0.03). Conclusion: VC-based treatment program is feasible and could be effective for BED patients. Long-term large-scale randomized clinical trials are warranted to further assess the efficacy.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder

PURPOSE

To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

METHODS

A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro.

RESULTS

Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively.

CONCLUSIONS

AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.

Improving health-related quality of life through an evidence-based obesity reduction program: the Healthy Weights Initiative

When evaluating any health intervention, it is critical to include the impact of the intervention on health-related quality of life (HRQL). Among those who are obese, HRQL is often lower than the general population and even more when considering obesity-related comorbidities and bodily pain. The objectives of this paper were to determine the impact of a multidisciplinary, community-based obesity reduction program on HRQL and to determine the independent risk factors for lack of improvement from baseline to follow-up. HRQL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline and follow-up (24 weeks). To date, 84.5% of those who completed the program had improvements in their overall SF-36 score. Significant increases in the mean scores on eight dimensions of health were also observed. Lack of improvement was independently affected by smoking status (odds ratio 3.75; 95% confidence interval 1.44–9.78; P=0.007) and not having a buddy to attend the program (odds ratio 3.70; 95% confidence interval 1.28–10.68; P=0.015). Obesity reduction programs that target increasing exercise, improving diet, and cognitive behavioral therapy can positively impact HRQL in obese adults. Social support has a strong role to play in improving outcomes.

Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review

BACKGROUND

People with eating disorders (ED) often report poor health-related quality of life (HRQoL), which is explicitly correlated to illness' severity and its effects on cognitive performance. We aimed to analyze health-related quality of life (HRQoL) in subgroups of eating disorder (ED) patients by using the brief version of WHOQoL questionnaire (WHOQoL-BREF) before treatment administration. Moreover, in order to compare our findings with other published data, we carried out a comprehensive review of the literature on HRQoL in ED patients.

METHODS

Our review was carried out by means of an accurate data mining of PsychInfo and Medline databases and other available sources. In our cross-sectional study, eighty female ED patients (26 with bulimia nervosa, 33 with anorexia nervosa, 7 with binge eating disorder and 14 with ED not otherwise specified) completed the WHOQoL-BREF. HRQoL scores were compared among ED subgroups and clinical information (presence of previous contacts, length of illness, psychiatric comorbidity) was considered in the analysis.

RESULTS

Our review shows that with few exceptions ED patients have a poorer HRQoL than the healthy population of control and sometimes the mental component of HRQoL is the most involved dimension. Moreover, there are no differences in the HRQoL among ED groups, even if AN patients in some studies have a lower HRQoL scores. Furthermore, BED patients have a poorer HRQoL than obese patients who do not have binge episodes. Finally, all treatments were positively correlated with an improvement on general and specific QoL dimensions. In our sample, ED subgroups differed only for Psychological Health HRQoL scores (F = 4.072, df = 3; p = 0.01). No differences were found between inpatients and outpatients, treatment naïve and previously treated patients and patients with or without psychiatric comorbidity. Moreover, HRQoL scores were not correlated to length of illness within each ED subgroup.

CONCLUSIONS

The analysis of the literature adds some relevant information on HRQoL in ED and may address the future research toward the exploration of specific questions. One of these may be the prominent role of Psychological Health domain in HRQoL, since our study confirms that this component is able to differentiate eating disorders.

Does Binge Eating Disorder Impact Weight-Related Quality of Life?

OBJECTIVES

To determine whether binge eating disorder (BED) impacts weight-related quality of life in obese individuals seeking weight loss treatment and to investigate the role of psychological symptoms, BMI, and demographic variables in the relationship between BED and weight-related quality of life.

RESEARCH METHODS AND PROCEDURES

Three hundred seventeen women (BMI = 37.6) and 213 men (BMI = 41.3) completed questionnaires on admission into an intensive residential lifestyle modification program. Weight-related quality of life was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). The presence of BED was determined using the Questionnaire on Eating and Weight Patterns-Revised. Psychological symptoms were assessed using the Beck Depression Inventory and the global severity index of the Symptom Checklist 90-R.

RESULTS

BED prevalence in this sample was 17.9%. Participants with BED, in comparison with those without BED, were more likely to be women (75.8% vs. 56.3%, p < 0.001), younger (45.0 vs. 49.7 years, p = 0.003), white (98.9% vs. 91.7%), heavier (BMI = 42.0 vs. 38.5, p = 0.002), psychologically distressed, and more impaired on total IWQOL-Lite (51.5 vs. 65.3, p < 0.001) and all IWQOL-Lite subscales. However, after controlling for demographic variables, BMI, and psychological symptoms, BED was not independently associated with weight-related quality of life.

DISCUSSION

The association between BED and impairment in quality of life that has been previously reported in the literature may largely be accounted for by differences between those with and without BED on demographic variables, BMI, and psychological symptoms. BED does not seem to independently impact weight-related quality of life.

An overview of treatments for obesity in a population with mental illness

Obesity is associated with early mortality and has overtaken smoking as the health problem with the greatest impact on quality of life, mortality, and morbidity. Despite public health initiatives and numerous commercial enterprises focusing on weight loss, obesity rates continue to rise. In part, this is because obesity is a multifaceted, complex illness, impacted by numerous social, psychological, and behavioural factors that are unrecognized in most current initiatives. One significant factor associated with obesity is mental illness. While having a psychiatric illness does not make weight gain inevitable, it does often require that additional tools be added to lifestyle recommendations around diet and exercise. The following article reviews the common approaches to obesity management and addresses how these strategies can be implemented in psychiatric care. It is important that health professionals involved in the care of people with a mental illness become familiar with the interventions available to control and treat the obesity epidemic, as this will improve treatment compliance and ultimately lead to improved physical and psychological outcomes.

Acceptance and efficacy of a guided internet self-help treatment program for obese patients with binge eating disorder

INTRODUCTION

A significant percentage of obese patients suffer from binge eating disorder (BED), with negative consequences on psychological health, quality of life, weight loss treatment and maintenance. Cognitive behavioral therapy (CBT), delivered in traditional or self-help format, is effective in reducing BED symptoms. To improve dissemination, a self-help treatment program composed of eleven CBT based modules was implemented on the Internet and evaluated in a population of adult obese patients with BED.

METHOD

Forty-two obese BED patients wait-listed for a multi-disciplinary obesity treatment took part in the study. Twenty-two patients completing the six-month online guided self-help treatment program were compared to a control group of twenty patients without intervention. Both groups were evaluated before and after six months of Internet self-help treatment or waiting list. A follow-up evaluation was carried out six months later.

RESULTS

Participants in the online self-help treatment program showed higher binge eating abstinence rates, lower EDE-Q shape and weight concerns, and improved TFEQ disinhibition of eating and hunger scores compared to the control group. They also scored better on psychological health and quality of life measures after intervention, and gains were maintained at follow-up. No effect was found regarding BMI. The number of modules completed was correlated with a better quality of life improvement at post evaluation. Participants rated the program as useful and easy to use.

CONCLUSION

The Internet seems to be a valuable tool for disseminating CBT for BED obese patients. Acceptance of new technology was good in this population. Further research is needed with a larger sample to corroborate these results.

Clinical and psychological correlates of health-related quality of life in obese patients

Background

Health-related quality of life (HRQL) is poor in obese subjects and is a relevant outcome in intervention studies. We aimed to determine factors associated with poor HRQL in obese patients seeking weight loss in medical units, outside specific research projects.

Methods

HRQL, together with a number of demographic and clinical parameters, was studied with generic (SF-36, PGWB) and disease-specific (ORWELL-97) questionnaires in an unselected sample of 1,886 (1,494 women; 392 men) obese (BMI > 30 kg/m²) patients aged 20-65 years attending 25 medical units scattered throughout Italy. The clinics provide weight loss treatment using different programs. General psychopathology (SCL-90 questionnaire), the presence of binge eating (Binge Eating scale), previous weight cycling and somatic comorbidity (Charlson's index) were also determined. Scores on SF-36 and PGWB were compared with Italian population norms, and their association with putative determinants of HRQL after adjustment for confounders was assessed through logistic regression analysis.

Results

HRQL scores were significantly lower in women than in men. A greater impairment of quality of life was observed in relation to increasing BMI class, concurrent psychopathology, associated somatic diseases, binge eating, and weight cycling. In multivariate analysis, psychopathology (presence of previously-diagnosed mental disorders and/or elevated scores on SCL-90) was associated with lower HRQL scores on both psychosocial and somatic domains; somatic diseases and higher BMI, after adjustment for confounders, were associated with impairment of physical domains, while binge eating and weight cycling appeared to affect psychosocial domains only.

Conclusions

Psychopathological disturbances are the most relevant factors associated with poor HRQL in obese patients, affecting not only psychosocial, but also physical domains, largely independent of the severity of obesity. Psychological/psychiatric interventions are essential for a comprehensive treatment of obesity, and to improve treatment outcome and to reduce the burden of disease.

Qualidade de vida e transtornos alimentares: uma revisão sistemática

O objetivo foi fazer uma revisão sistemática dos estudos que avaliam qualidade de vida em pessoas com transtornos alimentares. Foram realizadas buscas bibliográficas em seis bases de dados e buscas manuais em duas revistas, abrangendo o período de janeiro de 1975 até junho de 2008. As estratégias de busca forneceram um total de 29.537 referências. Quarenta e um estudos preencheram os critérios de inclusão desta revisão e 36 foram analisados no presente trabalho. De modo geral, os estudos revelam prejuízos na qualidade de vida de pacientes com transtornos alimentares quando comparados a grupos normais ou outras patologias psiquiátricas. O aspecto mental da qualidade de vida mostra-se mais prejudicado. A avaliação da qualidade de vida em sujeitos com transtorno da compulsão alimentar periódica revela prejuízos nos aspectos físico e mental da qualidade de vida. Há pouca evidência e discussão para indivíduos com bulimia nervosa isoladamente. Em sujeitos com anorexia nervosa, a avaliação requer cautela, já que o aparente menor impacto físico pode ser reflexo da psicopatologia específica deste transtorno e não do funcionamento saudável.

Obesity and its relationship to addictions: is overeating a form of addictive behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

The validity and clinical utility of binge eating disorder

OBJECTIVE

This review attempted to examine the validity and clinical utility of the DSM-IV binge eating disorder (BED) diagnosis across a wide range of validating strategies.

METHOD

Various electronic databases (Pub Med, Psych Info) were searched for terms relevant to the diagnosis of BED (e.g., binge eating disorder, binge eating) in order to identify papers. Additionally, published papers were reviewed in order to locate additional manuscripts and papers that were presented at meetings.

RESULTS

The validity and utility of BED varied substantially according to the validator chosen. There is reasonable evidence that BED can be differentiated from other existing eating disorders and is associated with significant impairment and clinical levels of eating disorder psychopathology. The relationship of BED to obesity is complex, and in spite of some positive findings, further research examining the predictive power of BED, beyond the simple presence of obesity and associated psychopathology, in relationship to clinically relevant outcomes is needed.

DISCUSSION

Binge eating disorder is being considered for inclusion in the DSM-V and various options regarding this decision are reviewed based upon the empirical findings in the paper.

Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment

Treatment for binge-eating disorder (BED) is directed towards either the physical or psychopathological impairments, and often does not cover all the alterations characterizing the disease. In 30 BED patients, we monitored the effects of three types of 6-month treatment, randomly assigned to one of the three treatment groups, each consisting of 10 patients. Group 1 received a 1700-kcal diet (21% proteins, 27% lipids, 52% carbohydrate), cognitive-behavioural therapy (CBT), sertraline (50-150 mg/day) and topiramate (25-150 mg/day); group 2 received the same diet, CBT, sertraline; and group 3 received nutritional counselling and CBT. Binge frequency and weight were assessed every month. The Eating Disorder Inventory-2, the Symptoms Check List-90-Revised (SCL-90-R) and the Personality Diagnostic Questionnaire-4-Revised (PDQ-4-R) were administered before and after treatment. Binge frequency and excessive weight decreased significantly only in group 1 patients, in whom improvement was noted in total Eating Disorder Inventory-2 scores and the subitems 'bulimia', 'drive for thinness', 'maturity fear', 'ascetism', in total SCL-90-R scores and in the subitem 'somatization', in PDQ-4-R subitems 'schizotypic personality' and 'dependent personality'. Group 2 patients improved on the SCL-90-R subitems 'depression' and 'interpersonal relationship' and in the PDQ-4-R 'schizoid personality'. Combination therapy seems to be the only fully effective treatment in BED patients.

Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet

BACKGROUND AND AIMS

Lifestyle changes are considered first line treatment in type 2 diabetes, but very few data are available in the "real world" of diabetes units. We aimed to measure the effectiveness of moderate and high intensity interventions on weight loss, metabolic control and insulin use. We report a prospective cohort study, carried out in 822 consecutive subjects with type 2 diabetes, first seen in a 4-year period in a diabetes unit of an academy hospital.

METHODS AND RESULTS

Subjects were treated with either a sole prescriptive diet (Diet), or received an additional short-course Elementary Nutritional Education (4 group sessions-ENE) or an intensive Cognitive Behavioural Therapy (12-15 group sessions-CBT). The results were adjusted for the propensity score to be assigned different treatments, derived from logistic regression on the basis of age, gender, BMI, HbA1c, diabetes duration and insulin use at baseline. Main outcome measures were weight loss and weight loss maintenance, metabolic control, and secondary failure to insulin use. Both structured programmes produced a larger weight loss, and the adjusted probability of achieving the 7% weight loss target was increased. Similarly, both programmes favoured metabolic control, irrespective of insulin use. After adjustment for propensity score, both ENE (hazard ratio, 0.48; 95% CI, 0.27-0.84) and CBT (hazard ratio, 0.36; 95% CI, 0.16-0.83) were associated with a reduced risk of de novo insulin treatment.

CONCLUSION

Structured behavioural programmes aimed at lifestyle changes are feasible and effective in the "real world" setting of a diabetes unit for the treatment of type 2 diabetes.

Health-related quality of life and eating disorders: a review and update

OBJECTIVE

The aim of this article is to provide a narrative review of empirical studies related to health-related quality of life (HRQOL) and eating disorders and to report recent changes in the measurement of HRQOL in eating disorders.

METHOD

Twenty-five articles of central importance to the topic were identified in a systematic search of six databases. All articles were selected based on a consensus relevancy rating process. Key themes were extracted from the articles and validated by all authors.

RESULTS

We identify six themes in the extant empirical literature.

DISCUSSION

We discuss these six themes and review them in light of the fact that they are identified in studies using only generic measures of HRQOL. Four recently developed disease-specific HRQOL measures specific to patients with eating disorder are discussed.

The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment: a meta-analysis

Background

This meta-analysis examined differences in health-related quality of life (HRQoL) between seekers of surgical and non-surgical treatment, and non-treatment seekers, over and above differences that are explained by weight, age, and gender.

Methods

Our literature search focused on the ‘Impact of Weight on Quality of Life-Lite’ (IWQOL-Lite) and the ‘Short Form-36’ (SF-36) questionnaires. Included were studies published between 1980 and April 2006 providing pre-treatment descriptive statistics of adult overweight, obese or morbidly obese persons. Excluded were elderly and ill patient groups.

Results

54 articles, with a total number of nearly 100,000 participants, met the inclusion criteria. Persons seeking surgical treatment demonstrated the most severely reduced HRQoL. IWQOL-Lite scores showed larger differences between populations than SF-36 scores. After adjustment for weight, the population differences on the IWQOL disappeared. In contrast, the differences on the SF-36 between the surgical treatment seeking population and the other populations were maintained after adjustment for weight.

Conclusion

The IWQOL-Lite questionnaire predominantly reflects weight-related HRQoL, whereas the SF-36 mostly reflects generic HRQoL that is determined by both weight and other factors. Our metaanalysis provides reference values that are useful when explaining or evaluating obesity-specific (IWQOL-Lite) or generic (SF-36) HRQoL, weight, and demographic characteristics of obese persons seeking or not seeking surgical or non-surgical treatment.

Group versus individual cognitive-behavioral treatment for obesity: results after 36 months

OBJECTIVE

This study is aimed at the comparison between an individual and a group cognitive-behavioral program for the treatment of obesity.

DESIGN

Parallel series, prospective, 3-year study. A group program of 10 weekly sessions focused on lifestyle modification was compared with a similar, individual 10-session program. Fifty-seven patients were assigned to individual treatment, and 84 patients to the group program.

SUBJECTS

One hundred- forty-one obese female outpatients without binge eating disorder, aged 42.0+/-11.6 years (m+/-SD), with Body Mass Index (BMI) 37.3+/-5.2 kg/m(2).

MEASUREMENTS

BMI and waist circumference were measured at 0, 6, 12 and 36 months. Analysis was performed on an intention-to-treat basis.

RESULTS

Mean weight loss was superior with the group program at 6 months (2.0+/-3.9 vs 0.8+/-2.5 kg/m(2); p<0.05), while no difference between the two treatments was observed at 12 and 36 months. Mean waist circumference was significantly different at 6 months (group 97.4+/-2.5 vs individual 102.9+/-2.4, p<0.05), still remaining superior in the patients following individual treatment (100.2+/-5.0 vs 103.7+/-5.9) at 12 months, while no difference between the two treatments was observed at 36 months. The proportion of patients losing more than 5% of initial body weight with the group program (16.6, 15.5, and 38.1% at 6, 12, and 36 months, respectively) was not significantly different from that observed with individual treatment (5.3, 14.0, and 35.0%, respectively).

CONCLUSION

A group cognitive-behavioral program for the treatment of obesity is not inferior to a similar program applied in individual setting, and it may enhance weight loss (especially fat mass, according to the waist measurement) in the short term.

Quality of life in Mexican-American children following a weight management program

OBJECTIVE

The objective was to evaluate quality of life (QOL) in at-risk-for-overweight and overweight Mexican-American children after participating in 6 months of intensive weight management or self-help.

RESEARCH METHODS AND PROCEDURES

Eighty sixth- and seventh-grade at-risk-for-overweight (BMI >or=85th to <95th percentile) and overweight (BMI >or=95th percentile) Mexican-American children were randomly assigned to either intensive instructor-led intervention (ILI) or self-help (SH). The ILI condition included daily participation for 12 weeks in a school-based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self-report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated.

RESULTS

Children in the ILI condition not only achieved significantly greater weight loss (zBMI, -0.13 +/- 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change.

DISCUSSION

These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican-American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.

[Binge eating disorder in a population of morbid obese candidates to bariatric surgery at the Oswaldo Cruz University Hospital in Recife, PE]

OBJECTIVES

To analyze the frequency of binge eating disorder (BED) and of the main psychiatric disorders associated with morbid obesity in individuals on the waiting list for bariatric surgery.

METHOD

Cross sectional study. Interviews with patients from the Surgery for Obesity Program of Oswaldo Cruz University Hospital were conducted evaluating socio-demographic profile, quality of life (SF-36 scale), BED (Binge Eating Scale BES) and psychiatric disorders (M.I.N.I./DSM-IV).

RESULTS

67 out of 400 patients enrolled in the program were interviewed (16.8%). The BMI varied from 36.1 to 81.8 kg/m(2) (average 48.5 +/- 8.8). All have associated diseases, the most frequent being systemic arterial hypertension, sleeping disorders and osteopathies. The most frequent psychiatric disorders were: 47.8% generalized anxiety disorder, 29.9% major depressive disorder, single episode, 34.3% recurrent major depressive disorder. In this group 56.7% showed BED (25.4% moderate and 31.3% severe) and the worse scores in all the domains of quality of life (SF-36 scale).

CONCLUSIONS

High prevalence of BED. The compulsive eaters showed a higher number of obesity treatments, higher prevalence of actual major depression, and the worse scores in all the domains of the SF-36 scale. Considering the ample range of psychopathology associated with BED and the greater probability of jeopardizing the surgery results it is very important to improve the detection of these disorders in order to provide adequate treatment.

Mid-term effectiveness of behavioral and psychodynamic inpatient treatments of severe obesity based on a randomized study

BACKGROUND

The objective of this study was to compare the effectiveness of psychodynamic and behavioral inpatient treatments of severely obese patients regarding weight and distress.

METHODS

In a longitudinal study obese patients (body mass index, BMI >or=35) were randomly assigned to behavioral or to psychodynamic inpatient treatment. Mostly female (n = 267; 85%) obese patients with psychiatric and somatic comorbidity (age 20-64 years, BMI 35-74) were examined with standardized self-report scales on distress (SCL-90R), interpersonal problems (Inventory of Interpersonal Problems), eating behavior (Fragebogen zum Essverhalten) and body image (Fragebogen zum Korperbild).

RESULTS

During 49 days (mean) of inpatient treatment, patients lost an average of 5.6 kg (4.4%) in the behavioral (n = 130) and 5.7 kg (4.4%) in the psychodynamic setting (n = 137). In both settings, eating behavior, well-being and body image also improved significantly. One year after discharge, return rate was 73%. Forty percent had further reduced their weight (by more than 5% compared to intake), 36% had regained weight, but were still below intake level, and another 24% had increased weight above intake.

CONCLUSION

Behavioral and psychodynamic treatments were equally effective reducing weight and distress over 1 year.

Training to estimate blood glucose and to form associations with initial hunger

BACKGROUND

The will to eat is a decision associated with conditioned responses and with unconditioned body sensations that reflect changes in metabolic biomarkers. Here, we investigate whether this decision can be delayed until blood glucose is allowed to fall to low levels, when presumably feeding behavior is mostly unconditioned. Following such an eating pattern might avoid some of the metabolic risk factors that are associated with high glycemia.

RESULTS

In this 7-week study, patients were trained to estimate their blood glucose at meal times by associating feelings of hunger with glycemic levels determined by standard blood glucose monitors and to eat only when glycemia was < 85 mg/dL. At the end of the 7-week training period, estimated and measured glycemic values were found to be linearly correlated in the trained group (r = 0.82; p = 0.0001) but not in the control (untrained) group (r = 0.10; p = 0.40). Fewer subjects in the trained group were hungry than those in the control group (p = 0.001). The 18 hungry subjects of the trained group had significantly lower glucose levels (80.1 +/- 6.3 mg/dL) than the 42 hungry control subjects (89.2 +/- 10.2 mg/dL; p = 0.01). Moreover, the trained hungry subjects estimated their glycemia (78.1 +/- 6.7 mg/dL; estimation error: 3.2 +/- 2.4% of the measured glycemia) more accurately than the control hungry subjects (75.9 +/- 9.8 mg/dL; estimation error: 16.7 +/- 11.0%; p = 0.0001). Also the estimation error of the entire trained group (4.7 +/- 3.6%) was significantly lower than that of the control group (17.1 +/- 11.5%; p = 0.0001). A value of glycemia at initial feelings of hunger was provisionally identified as 87 mg/dL. Below this level, estimation showed lower error in both trained (p = 0.04) and control subjects (p = 0.001).

CONCLUSION

Subjects could be trained to accurately estimate their blood glucose and to recognize their sensations of initial hunger at low glucose concentrations. These results suggest that it is possible to make a behavioral distinction between unconditioned and conditioned hunger, and to achieve a cognitive will to eat by training.

The new questionnaire health-related quality of life for eating disorders showed good validity and reliability

BACKGROUND AND OBJECTIVES

To describe the development and investigate the psychometric properties of a new instrument to measure health-related quality of life (HRQoL) for individuals with an eating disorder (ED).

METHODS

Seven focus groups were convened and an extensive literature review was carried out to generate the items. The first draft of the questionnaire was pilot tested. Three hundred twenty-four ED patients took part in the final field study. The 12-Item Short Form Health Survey, the Eating Attitudes Test-26, and two items from the Eating Disorders Inventory-2 also were applied to examine the concurrent validity. Factor analysis, item scale correlation correcting for overlap, test-retest, Cronbach's alpha coefficient, known-groups validation, and the sensitivity of the questionnaire in different populations also were examined.

RESULTS

The final Health-Related Quality of Life in Eating Disorders (HeRQoLED) questionnaire consisted of 50 items. Principal axis factor analysis identified eight subscales. Concurrent validity showed correlations >.40 with the criteria measures. Excellent reliability and stability were obtained. The HeRQoLED was sensitive in discriminating both between known-different groups and from the general population.

CONCLUSION

The results provide evidence of the good psychometric properties of the new HeRQoLED questionnaire, except for one domain, which had to be eliminated.

Topiramate treatment in bulimia nervosa patients: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

The aim of the current study was to test the influence of topiramate on behavior, body weight, and health-related quality of life (HRQOL) in bulimic patients.

METHOD

Thirty patients with bulimia nervosa were treated with topiramate in a 10-week randomized, double-blind, placebo-controlled study. The subjects were randomly assigned to receive topiramate (topiramate group [TG]; n = 30) or a placebo (control group [CG]; n = 30). Primary outcome measures were changes in the frequency of binging/purging, in body weight, and on the SF-36 Health Survey (SF-36) scales.

RESULTS

In comparison to the CG group (according to the intent-to-treat principle), significant changes in the frequency of binging/purging (a > 50% reduction: TG, n = 11 [36.7%]; CG, n = 1 [3.3%]; p < .001), body weight (difference in weight loss between the two groups: 3.8 kg, 95% confidence interval [CI] = -5.4 to -2.1; p < .001), and SF-36 (all ps < .001) could be seen. All patients tolerated topiramate well.

CONCLUSION

Topiramate appears to safe and effective in influencing the frequency of binging/purging, body weight, and HRQOL in bulimic patients.

Eating behavior affects quality of life in type 2 diabetes mellitus

We evaluated the prevalence of disordered eating behavior in 168 unselected outpatients with type 2 diabetes mellitus (T2DM) and the effects on the health related quality of life (HRQL). Subjects in generally good glycemic control, treated by diet or oral hypoglycemic agents (58% M; 63.8+/-SD 10.1 years; BMI, 29.7+/-5.9 kg/m2) completed self-administered questionnaires for HRQL (SF-36) and eating behavior [(Three-Factor Eating Questionnaire (TFEQ); Binge Eating Scale (BES)]. Data on HRQL were computed as effectsizes in comparison to population norm. The prevalence of altered TFEQ scales was not different between genders, and varied between 22.1% (disinhibition) and 41.4% (restriction), but only 6.7% had a positive BES score. Age (OR, 0.58 for decade; 95% CI, 0.39-0.87), duration of diabetes (OR, 1.33 for 5 years; 1.01-1.74) and BMI (OR, 1.11; 1.04-1.18) were predictive for the presence of disinhibition. BMI also predicted hunger (OR, 1.16; 1.08-1.25). SF36 domains were not different in relation to positive BES. Disinhibition at TFEQ was significantly associated with poor social functioning (p=0.018) and role-emotional (p=0.022), whereas hunger was associated with poor physical functioning (p=0.010), role-physical (p=0.0014), social functioning (p=0.015) and role-emotional (p=0.0001). Metabolic control, duration of diabetes, and the presence of complications were not associated with HRQL. A disordered eating behavior may be present in T2DM patients, and is associated with poor HRQL. This condition must be considered for an olistic approach to weight control.

A review of psychosocial pre-treatment predictors of weight control

Prompted by the large heterogeneity of individual results in obesity treatment, many studies have attempted to predict weight outcomes from information collected from participants before they start the programme. Identifying significant predictors of weight loss outcomes is central to improving treatments for obesity, as it could help professionals focus efforts on those most likely to benefit, suggest supplementary or alternative treatments for those less likely to succeed, and help in matching individuals to different treatments. To date, however, research efforts have resulted in weak predictive models with limited practical usefulness. The two primary goals of this article are to review the best individual-level psychosocial pre-treatment predictors of short- and long-term (1 year or more) weight loss and to identify research needs and propose directions for further work in this area. Results from original studies published since 1995 show that few previous weight loss attempts and an autonomous, self-motivated cognitive style are the best prospective predictors of successful weight management. In the more obese samples, higher initial body mass index (BMI) may also be correlated with larger absolute weight losses. Several variables, including binge eating, eating disinhibition and restraint, and depression/mood clearly do not predict treatment outcomes, when assessed before treatment. Importantly, for a considerable number of psychosocial constructs (e.g. eating self-efficacy, body image, self-esteem, outcome expectancies, weight-specific quality of life and several variables related to exercise), evidence is suggestive but inconsistent or too scant for an informed conclusion to be drawn. Results are discussed in the context of past and present conceptual and methodological limitations, and several future research directions are described.

Quality of life in patients with binge eating disorder

OBJECTIVE

To examine Health-Related Quality of Life (HRQL) in patients with binge eating disorder (BED).

DESIGN

Cross-sectional comparison of HRQL in a BED sample to published normative and clinical samples. Further cross-sectional comparisons within the BED sample comparing obese and non-obese subjects, and depressed and non-depressed subjects.

SUBJECTS

Ninety-four patients (73 women and 21 men), who met DSM-IV criteria and attended a medical school based program for BED, participated. Mean body mass index (BMI) was 35.2 (SD = 8.1), and mean age was 44.9 (SD = 8.3); 78.7% of participants were Caucasian.

MEASUREMENTS

Subjects completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), a self-report measure of HRQL.

RESULTS

BED patients reported worse functioning in all HRQL domains than US norms, and in some domains of HRQL than obese treatment seekers. Among BED patients, obese BED subjects had significantly worse Physical Component summary scores than non-obese BED subjects, whereas depressed BED subjects had significantly worse Mental Component summary scores than non-depressed BED subjects.

CONCLUSION

Obesity status and depression appear to be related to HRQL among BED patients with obesity being related to physical HRQL and depression being related to mental HRQL.

Medical morbidity in binge eating disorder

OBJECTIVE

To explore the extent to which binge eating disorder (BED) is associated with medical morbidity.

METHOD

We reviewed all existing studies on the effects of BED on physical health.

RESULTS

BED may be associated with medical morbidity independent of the effects of comorbid psychopathology or comorbid obesity.

DISCUSSION

Additional research specifically designed to explore the effects of BED on physical health in both clinical and community samples is required before definitive conclusions can be drawn.

Psychological and dietary treatments of binge eating disorder: conceptual implications

OBJECTIVE

The authors review the available literature on psychological and dietary treatment approaches for binge eating disorder (BED).

METHODS

Studies were grouped according to psychological versus dietary approaches to BED. Studies were reviewed in terms of general implications, but particular emphasis was placed on drop-out rates, abstinence from binge eating, and weight loss.

RESULTS

Drop-out rates from psychological or dietary approaches to treatment averaged 20% and the presence of binge eating did not confer a greater risk of drop-out among obese individuals. Both psychological and dietary approaches to treatment produced abstinence rates from binge eating of approximately 50% at the 12-month follow-up. Both psychological and dietary approaches show modest efficacy of short-term weight loss, but these effects are generally not sustained in long-term follow-up assessments.

DISCUSSION

Psychological and dietary approaches to BED treatment show reasonable efficacy in binge eating reduction, but limited efficacy in weight loss. These findings are discussed in terms of the validity of the BED construct and the need for more psychopathology studies of BED.