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Edwards-Hampton SA, Ard J. The latest evidence and clinical guidelines for use of meal replacements in very-low-calorie diets or low-calorie diets for the treatment of obesity. Diabetes Obes Metab 2024; 26 Suppl 4:28-38. [PMID: 39109480 DOI: 10.1111/dom.15819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024]
Abstract
Obesity is a complex chronic disease with increasing prevalence across the globe. Medical nutrition therapy (MNT) is an important component of obesity treatment, and low-calorie diets (LCDs) and very-low-calorie diets (VLCDs) are part of the MNT toolbox. This narrative review focuses on the latest evidence and clinical guidelines regarding the use and impact of meal replacements (MRs) as part of LCDs/VLCDs for the treatment of obesity and some associated complications. MRs can be used in conjunction with food as partial diet replacement (PDR) or can be used exclusively to serve as the sole source of dietary energy (total diet replacement [TDR]). Use of MR may be associated with better control of cravings and hunger typically observed during reduced calorie intake through effects of ketosis or stimuli narrowing, although the exact mechanisms for these effects remain unclear. Several clinical guidelines have endorsed the use of MRs as a part of MNT for obesity, primarily based on evidence that shows an average weight reduction of ~10 kg or more with TDR over at least 12 months in large, randomized controlled trials. When compared to usual care controls, these effects are 6-8 kg greater, and when compared to food-based diets, the effects are nearly twice the effect of a food-based diet. MR-based diets have been found to be safe and associated with improvements in quality of life. These diets are also effective for improving key cardiometabolic health outcomes, including dysglycaemia, blood pressure, lipids, and metabolic associated fatty liver. The effectiveness, safety, and associated health improvement makes MRs use a valuable strategy for several higher risk clinical scenarios where weight reduction is indicated.
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Affiliation(s)
- Shenelle A Edwards-Hampton
- Department of General Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, USA
| | - Jamy Ard
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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2
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Jebeile H, Baur LA, Kwok C, Alexander S, Brown J, Collins CE, Cowell CT, Day K, Garnett SP, Gow ML, Grunseit AM, Henderson M, House ET, Inkster MK, Lang S, Paxton SJ, Truby H, Varady KA, Lister NB. Symptoms of Depression, Eating Disorders, and Binge Eating in Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial. JAMA Pediatr 2024:2822792. [PMID: 39186289 PMCID: PMC11348093 DOI: 10.1001/jamapediatrics.2024.2851] [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] [Received: 05/08/2024] [Accepted: 06/12/2024] [Indexed: 08/27/2024]
Abstract
Importance Depression and eating disorders are heightened for adolescents with obesity. Clinical reviews alongside self-report questionnaires are important to ensure appropriate intervention. Objective To evaluate changes in self-report symptoms of depression, eating disorders, and binge eating in adolescents with obesity during the Fast Track to Health trial. Design, Setting, and Participants This was a randomized clinical trial conducted from 2018 to 2023. It was a multisite trial conducted at children's hospitals in Sydney, New South Wales, and Melbourne, Victoria, Australia, and included adolescents (13-17 years) with obesity (defined as adult equivalent body mass index ≥30; calculated as weight in kilograms divided by height in meters squared) and 1 or more related complications. Interventions Duration was 52 weeks including a very low energy diet for 4 weeks followed by intermittent energy restriction (IER) or continuous energy restriction (CER). Main Outcomes and Measures Self-report symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised 10-Item Version for Adolescents [CESDR-10]; scores 0-30), eating disorders (Eating Disorder Examination Questionnaire [EDE-Q]; scores 0-6), and binge eating (Binge Eating Scale [BES]; scores 0-46) were assessed. Adolescents were screened for depression and eating disorders (weeks 0, 4, 16, and 52) and monitored for the onset of new symptoms of disordered eating during dietetic consults. Results Of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) enrolled, median baseline EDE-Q score was 2.28 (IQR, 1.43-3.14), median baseline CESDR-10 score was 9.00 (IQR, 4.00-14.50), and median baseline BES score was 11.00 (IQR, 5.00-17.00). There were no differences between groups for change in CESDR-10 (mean difference at week 52, 0.75; 95% CI, -1.86 to 3.37), EDE-Q (mean difference at week 52, 0.02; 95% CI, -0.41 to 0.45), or BES (mean difference at week 52, -2.91; 95% CI, -5.87 to 0.05). The within-group reductions at week 4 were maintained at week 52, for CESDR-10 and EDE-Q, indicating reduced symptoms of depression and eating disorders. Within-group reductions on the BES were maintained in the IER group only. Seventeen adolescents (12.1%) required support or referral for depression and/or disordered eating, including 7 (5%; 5 IER, 2 CER) adolescents who experienced the onset or reemergence of symptoms during the intervention. Conclusions and Relevance Results suggest that many treatment-seeking adolescents with obesity self-reported symptoms of depression and eating disorders. Although symptoms reduced for most, some required additional support. Obesity treatment is an opportune time to screen and monitor for depression and disordered eating. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12617001630303.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- The Children’s Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
| | - Louise A. Baur
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- The Children’s Hospital at Westmead, Weight Management Services, Westmead, New South Wales, Australia
| | - Cathy Kwok
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- The Children’s Hospital at Westmead, Weight Management Services, Westmead, New South Wales, Australia
| | - Shirley Alexander
- The Children’s Hospital at Westmead, Weight Management Services, Westmead, New South Wales, Australia
| | - Justin Brown
- Monash Children’s Hospital, Department of Paediatric Endocrinology and Diabetes, Clayton, Victoria, Australia
- Monash University, Department of Paediatrics, Clayton, Victoria, Australia
| | - Clare E. Collins
- University of Newcastle, School of Health Sciences, College of Health, Medicine and Wellbeing, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical research Institute, New Lambton Heights, New South Wales, Australia
| | - Christopher T. Cowell
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kaitlin Day
- Monash University, Nutrition, Dietetics & Food, Melbourne, Victoria, Australia
- School of Agriculture, Food and Ecosystem Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah P. Garnett
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- Kids Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L. Gow
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
| | - Alicia M. Grunseit
- The Children’s Hospital at Westmead, Nutrition and Dietetics, Westmead, New South Wales, Australia
| | - Maddison Henderson
- The Children’s Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
| | - Eve T. House
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- The Children’s Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
| | - Mary-Kate Inkster
- Monash Children’s Hospital, Department of Paediatric Endocrinology and Diabetes, Clayton, Victoria, Australia
- Monash University, Nutrition, Dietetics & Food, Melbourne, Victoria, Australia
| | - Sarah Lang
- Monash University, Nutrition, Dietetics & Food, Melbourne, Victoria, Australia
| | - Susan J. Paxton
- La Trobe University, School of Psychology and Public Health, Melbourne, Victoria, Australia
| | - Helen Truby
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Krista A. Varady
- University of Illinois, Department of Kinesiology and Nutrition, Chicago
| | - Natalie B. Lister
- The University of Sydney, Sydney Medical School, Westmead, New South Wales, Australia
- The Children’s Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
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Tsompanaki E, Aveyard P, Park RJ, Koutoukidis DA. The impact of low-energy total diet replacement with behavioural support for remission of type 2 diabetes on disordered eating (ARIADNE): Protocol for a non-inferiority randomised controlled trial. Contemp Clin Trials 2024; 142:107542. [PMID: 38685400 DOI: 10.1016/j.cct.2024.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The National Health Service (NHS) in England is currently piloting a weight loss programme for remission of newly diagnosed type 2 diabetes (T2D), where participants replace all food with low-energy nutritionally complete formula products for 12 weeks (total diet replacement, TDR) and receive behavioural support. In a clinical trial, this programme led to remission in nearly half the participants. However, this weight loss programme might also worsen disordered eating and prompt eating disorders in susceptible people. We aim to investigate if the TDR programme is non-inferior to standard care in terms of disordered eating in susceptible individuals. METHODS Fifty six people with newly diagnosed T2D, BMI ≥ 27 kg/m2, and medium to high scores of disordered eating based on the Eating Disorders Examination questionnaire (EDE-Q) will be randomised 1:1 to TDR receiving remote weekly/bi-weekly dietetic support or standard care. Participants will be re-assessed remotely at 1, 3, 4, 6, and 12 months. The primary outcome will be the between-group difference in the score of the EDE-Q. If the sample size can be expanded to 150, we will reduce the non-inferiority boundary. Weight, glycated haemoglobin (HbA1c), impairment from disordered eating, and distress will be secondary outcomes. Using the recorded consultations, we will evaluate the process in observed changes in eating behaviour and disordered eating. CONCLUSIONS If TDR for T2D remission is deemed non-inferior to standard care, more people may enrol and benefit from T2D remission. If TDR exacerbates disordered eating, screening may reduce unintended harm. TRIAL REGISTRATION NCT05744232 (ClinicalTrials.gov, prospectively registered).
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Affiliation(s)
- E Tsompanaki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R J Park
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - D A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sebastian SA, Shah Y, Arsene C. Intermittent fasting and cardiovascular disease: A scoping review of the evidence. Dis Mon 2024:101778. [PMID: 38910053 DOI: 10.1016/j.disamonth.2024.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Intermittent fasting (IF), characterized by alternating periods of fasting and unrestricted eating, typically within an 8-hour window or less each day, has gained significant attention as a possible dietary approach. While it is recognized for its metabolic advantages, like weight loss and enhanced glucose and insulin sensitivity, its effect on cardiovascular health remains a topic of mixed opinions. Recent findings suggest a potential downside, with reports indicating a concerning association: a 91 % higher risk of cardiovascular disease (CVD) mortality compared to eating spread across a 12- to 16-hour period. Despite this alarming statistic, the evidence cannot establish a causal link. The impact of IF on CVD is still insufficiently understood, with benefits sometimes exaggerated and risks downplayed in popular discourse. This scoping review aims to consolidate the current evidence, addressing unresolved questions about the benefits and risks of IF, particularly its association with CVD risks and mortality. The goal is to provide a balanced perspective on the potential health implications of IF, emphasizing the need for further research to clarify its long-term effects on cardiovascular health.
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Affiliation(s)
| | - Yash Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, Michigan, USA
| | - Camelia Arsene
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, Michigan, USA
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5
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Lister NB, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit A, Cooper K, Kyle TK, Heeren FA, Hunter KE, McMaster CM, Johnson BJ, Seidler AL, Jebeile H. Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design. Nutr Res Rev 2024; 37:32-42. [PMID: 36788665 PMCID: PMC7615933 DOI: 10.1017/s0954422423000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Kids Research, Sydney Children's Hospital Network, Westmead, New South Wales2145, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Denise E Wilfley
- School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales2145, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, 2nd Floor, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Grunseit
- The Children's Hospital at Westmead, Nutrition and Dietetics, Weight Management Services, Westmead, New South Wales, NSW 2145, Australia
| | | | | | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia5042, Australia
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
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Abstract
Overweight and obesity are an important public health problem that affects a significant part of the world population and increases the risk of many metabolic diseases. Weight loss is the primary goal in obesity treatment, and many different dietary interventions are tried for this purpose. Intermittent fasting is a diet that has become popular in recent years with the weight loss it provides and includes periods of fasting and feeding. In addition to providing weight loss, intermittent fasting also has positive effects on important risk factors such as glucoregulatory parameters, blood lipids, and oxidative stress. Intermittent fasting appears to be an effective and safe way to achieve weight loss in obesity. It could also have therapeutic effects on obesity-related diseases. The aim of this review was to bring together up-to-date information on the effects of intermittent fasting on obesity and various obesity-related diseases, mechanisms of action, possible benefits and harms, and potential uses.
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Affiliation(s)
- Caner Özyildirim
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Türkiye -
| | - Asli Uçar
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Türkiye
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7
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Forney KJ, Rogers ML, Grillot CL, Pucci G, Joiner TE, Keel PK. Testing replicability of the relationship between weight suppression and binge eating in three non-clinical samples varying in lifetime weight history. Eat Behav 2023; 50:101784. [PMID: 37515999 DOI: 10.1016/j.eatbeh.2023.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Increased weight suppression, the difference between an individual's highest and current weight at present height, predicts binge eating among eating disorder samples. Less is known about this relationship in non-clinical samples of individuals with a history of higher weight. METHODS Lifetime highest BMI was tested as a moderator of the relationship between weight suppression and binge eating in three independent samples (N = 1740). RESULTS At the bivariate level, weight suppression was not associated with binge eating in any sample (p's ≥ 0.20). Lifetime highest BMI moderated the relationship between weight suppression and binge eating in Sample 1 (p = .04), such that greater weight suppression was associated with lower binge eating among those with a history of higher weight (i.e., BMI = 40 kg/m2). In Samples 2 and 3, the lifetime highest BMI by weight suppression interaction term was not significant and dropped from the model (p's = 0.10-0.12). Accounting for age, gender, and lifetime highest BMI, greater weight suppression was associated with lower binge eating scores (p's < 0.04). A meta-analysis combining results revealed a small but significant interaction effect (r = 0.07, p = .02). CONCLUSIONS Findings highlight the importance of investigating the generalizability of eating disorder risk and maintenance theories across the weight spectrum. Weight loss may not increase risk for binge eating among those with a history of higher weight. Future work should replicate and extend this finding using longitudinal designs. More research is needed to elucidate which weight loss motivations and/or behaviors are most closely linked to binge eating.
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Affiliation(s)
- K Jean Forney
- Department of Psychology, Ohio University, Athens, OH, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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8
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Via E, Contreras-Rodríguez O. Binge-Eating Precursors in Children and Adolescents: Neurodevelopment, and the Potential Contribution of Ultra-Processed Foods. Nutrients 2023; 15:2994. [PMID: 37447320 DOI: 10.3390/nu15132994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Binge-eating disorder (BED) is a highly prevalent disorder. Subthreshold BED conditions (sBED) are even more frequent in youth, but their significance regarding BED etiology and long-term prognosis is unclear. A better understanding of brain findings associated with BED and sBED, in the context of critical periods for neurodevelopment, is relevant to answer such questions. The present narrative review starts from the knowledge of the development of emotional self-regulation in youth, and the brain circuits supporting emotion-regulation and eating behaviour. Next, neuroimaging studies with sBED and BED samples will be reviewed, and their brain-circuitry overlap will be examined. Deficits in inhibition control systems are observed to precede, and hyperactivity of reward regions to characterize, sBED, with overlapping findings in BED. The imbalance between reward/inhibition systems, and the implication of interoception/homeostatic processing brain systems should be further examined. Recent knowledge of the potential impact that the high consumption of ultra-processed foods in paediatric samples may have on these sBED/BED-associated brain systems is then discussed. There is a need to identify, early on, those sBED individuals at risk of developing BED at neurodevelopmental stages when there is a great possibility of prevention. However, more neuroimaging studies with sBED/BED pediatric samples are needed.
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Affiliation(s)
- Esther Via
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain
| | - Oren Contreras-Rodríguez
- Medical Imaging, Girona Biomedical Research Institute (IdIBGi), Parc Hospitalari Martí i Julià-Edifici M2, Salt, 17190 Girona, Spain
- Health Institute Carlos III (ISCIII) and CIBERSAM, 28029 Madrid, Spain
- Department of Psychiatry and Legal Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Jebeile H, Libesman S, Melville H, Low‐wah T, Dammery G, Seidler AL, Jones RA, McMaster CM, Paxton SJ, Hill AJ, Ahern AL, Garnett SP, Braet C, Wilfley DE, Baur LA, Lister NB. Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis. Obes Rev 2023; 24:e13561. [PMID: 36919475 PMCID: PMC10909435 DOI: 10.1111/obr.13561] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Sol Libesman
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Hannah Melville
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Timothy Low‐wah
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Genevieve Dammery
- InsideOut Institute for Eating DisordersThe University of SydneySydneyNew South WalesAustralia
| | - Anna L. Seidler
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Caitlin M. McMaster
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeCB2 0QQUK
| | - Sarah P. Garnett
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Kids ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityHenri Dunantlaan 2Ghent9000Belgium
| | - Denise E. Wilfley
- School of Medicine, Washington University in St. LouisMissouriSt. LouisUSA
| | - Louise A. Baur
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Natalie B. Lister
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
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10
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McMaster CM, Paxton SJ, Maguire S, Hill AJ, Braet C, Seidler AL, Nicholls D, Garnett SP, Ahern AL, Wilfley DE, Lister NB, Jebeile H. The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment. Int J Eat Disord 2023; 56:914-924. [PMID: 36694273 PMCID: PMC10946556 DOI: 10.1002/eat.23898] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.
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Affiliation(s)
- Caitlin M. McMaster
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating DisordersCharles Perkins Centre, The University of SydneySydneyNew South WalesAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityGhentBelgium
| | - Anna L. Seidler
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah P. Garnett
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
- Kids ResearchSydney Children's Hospital NetworkWestmeadNew South WalesAustralia
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | | | - Natalie B. Lister
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
| | - Hiba Jebeile
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
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11
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Manasse SM, Lampe EW, Abber SR, Fitzpatrick B, Srivastava P, Juarascio AS. Differentiating types of dietary restraint and their momentary relations with loss-of-control eating. Int J Eat Disord 2023; 56:969-977. [PMID: 36688566 PMCID: PMC10159894 DOI: 10.1002/eat.23896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary restraint results in successful dietary restriction, or which types of restraint/restriction confer highest risk for LOC eating. Furthermore, little research has evaluated momentary, temporal associations between dietary restraint and LOC eating. Thus, the present study aimed to (1) characterize dietary restraint and restriction, among individuals with LOC eating, and (2) examine temporal relationships between restraint/restriction and LOC eating within- and between-subjects. METHOD The current study recruited adults with binge spectrum EDs (n = 96, 80.4% female) to complete a 7-14-day ecological momentary assessment protocol assessing ED symptoms. Multilevel models and linear regression evaluated within- and between-subjects associations between momentary restraint/restriction and LOC eating, respectively. RESULTS Attempted avoidance of enjoyable foods, limiting the amount eaten, and any restraint predicted greater likelihood of LOC eating at the next survey. Attempts to delay eating predicted reduced likelihood of LOC eating at the next survey, though this effect was no longer statistically significant after correcting for multiple comparisons. Diagnostic presentation moderated the association between attempted avoidance of enjoyable foods and LOC eating such that this association was significantly stronger for those on the BN-spectrum. DISCUSSION Dietary restraint seems to be more predictive of LOC eating than dietary restriction both within- and between-subjects. Future treatments should target dietary restraint to reduce LOC eating. PUBLIC SIGNIFICANCE Some research suggests that dietary restriction (i.e., reduced calorie intake) and restraint (i.e., attempted restriction) may not be linked to LOC eating in all contexts. We found that dietary restraint is more predictive of LOC eating than dietary restriction both within and between individuals. Future treatments should target dietary restraint to reduce LOC eating.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth W Lampe
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Brighid Fitzpatrick
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Paakhi Srivastava
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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12
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Harris RA, Fernando HA, Seimon RV, da Luz FQ, Gibson AA, Touyz SW, Sainsbury A. Effects of total diet replacement programs on mental well-being: A systematic review with meta-analyses. Obes Rev 2022; 23:e13465. [PMID: 35997170 PMCID: PMC9786773 DOI: 10.1111/obr.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/30/2022]
Abstract
This systematic review with meta-analyses assessed the effects of total diet replacement (TDR) programs on mental well-being in clinical trial participants with a body mass index greater than or equal to 25 kg/m2 . TDR programs involve replacing all dietary requirements with nutritionally replete formula foods and are generally administered to induce rapid weight loss. To date, it is largely unclear what effects TDR programs may have on mental well-being, particularly in the long-term. To address this, we screened 25,976 references across six databases and extracted 35 publications. These 35 publications provided sufficient data to evaluate the effects of TDR programs on depression, anxiety, stress, positive affect, negative affect, vitality, role-emotional, social functioning, mental health, mental composite summary score, self-esteem, and general psychological health in 24 meta-analyses. Due to the lack of research comparing TDR programs to comparator groups, 22 of our 24 meta-analyses explored change in these mental well-being sub-domains over time in TDR programs without comparators. Specifically, we assessed the change from pre-diet (before the TDR program) to either post-diet (up to and including two months after the TDR program); and/or follow-up (more than two months after the TDR program). For depression and anxiety, we were also able to assess the change from pre-diet to mid-diet (which fell within two weeks of the diet half-way point). The remaining two meta-analyses assessed the difference in depression scores between a TDR group and a food-based comparator group from pre-diet to post-diet and from pre-diet to follow-up. Across all meta-analyses, our results found no marked adverse effects of TDR programs on any mental well-being sub-domain. In fact, clear improvements were observed for depression, anxiety, stress, vitality, role-emotional, and social functioning at post-diet. Interestingly, the improvements for depression, vitality and role-emotional were maintained at follow-up. All improvements were observed in meta-analyses without comparators. While the two comparator-based meta-analyses showed no difference between TDR programs and food-based diets in depression symptoms, there was low statistical power. For all meta-analyses containing three or more independent samples, we constructed prediction intervals to determine the range within which the mean of the true effects may fall for future populations. While these prediction intervals varied between sub-domains, we found that mean depression scores are only likely to increase (i.e., depression will worsen) in less than 3% of future TDR interventions which meet our inclusion/exclusion criteria. Taken together, we concluded that for adults with a body mass index greater than or equal to 25 kg/m2 , TDR programs are unlikely to lead to marked adverse effects on mental well-being. These findings do not support the exclusion of participants from trials or interventions involving TDR programs based on concerns that these programs may adversely affect mental well-being. In fact, by excluding these participants, they may be prevented from improving their metabolic health and mental well-being.
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Affiliation(s)
- Rebecca A Harris
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Hamish A Fernando
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Darlington, New South Wales, Australia
| | - Radhika V Seimon
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia
| | - Felipe Q da Luz
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, Brazil
| | - Alice A Gibson
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Stephen W Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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13
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Ralph AF, Brennan L, Byrne S, Caldwell B, Farmer J, Hart LM, Heruc GA, Maguire S, Piya MK, Quin J, Trobe SK, Wallis A, Williams-Tchen AJ, Hay P. Management of eating disorders for people with higher weight: clinical practice guideline. J Eat Disord 2022; 10:121. [PMID: 35978344 PMCID: PMC9386978 DOI: 10.1186/s40337-022-00622-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. AIM The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. METHODS The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. RECOMMENDATIONS Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. CONCLUSIONS This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.
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Affiliation(s)
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Australia
| | - Sue Byrne
- Department of Psychology, University of Western Australia, Perth, Australia
| | | | - Jo Farmer
- Lived Experience Advocate, Melbourne, Australia
| | - Laura M. Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gabriella A. Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, Sydney, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Macarthur Clinical School, Sydney, Australia
- Camden and Campbelltown Hospitals, Sydney, Australia
| | - Julia Quin
- Lived Experience Advocate, Melbourne, Australia
| | - Sarah K. Trobe
- National Eating Disorders Collaboration, Sydney, Australia
| | - Andrew Wallis
- Sydney Children’s Hospitals Network, The Children’s Hospital Westmead, Sydney, Australia
| | | | - Phillipa Hay
- Eating Disorders and Body Image (EDBI), Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Local Health District, Sydney, Australia
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14
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Real-World Data of a Group-Based Formula Low Energy Diet Programme in Achieving Type 2 Diabetes Remission and Weight Loss in an Ethnically Diverse Population in the UK: A Service Evaluation. Nutrients 2022; 14:nu14153146. [PMID: 35956322 PMCID: PMC9370492 DOI: 10.3390/nu14153146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Formula low energy diets (LED) are effective at inducing weight loss and type 2 diabetes (T2DM) remission. However, the effect of LED programmes in ethnic minority groups in the UK is unknown. (2) Methods: A service-evaluation was undertaken of a group-based LED, total diet replacement (TDR) programme in London, UK. The programme included: a 12-week TDR phase, 9-week food reintroduction and a 31-week weight maintenance phase and was delivered by a diabetes multi-disciplinary team. (3) Results: Between November 2018 and March 2020, 216 individuals were referred, 37 commenced the programme, with 29 completing (78%). The majority were of Black British (20%) ethnicity with a mean (SD) age of 50.4 (10.5) years, a body mass index of 34.4 (4.4) kg/m2 and a T2DM duration of 4.2 (3.6) years. At 12 months, 65.7% achieved T2DM remission, with a mean bodyweight loss of 11.6 (8.9) kg. Completers lost 15.8 (5.3) kg, with 31.4% of participants achieving ≥15 kg weight loss. Quality of life measures showed significant improvements. (4) Conclusions: This service evaluation shows for the first time in the UK that a group-based formula LED programme can be effective in achieving T2DM remission and weight loss in an ethnical diverse population.
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15
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Brown A, Brosnahan N, Khazaei D, Wingrove J, Flint SW, Batterham RL. UK dietitians' attitudes and experiences of formula very low- and low-energy diets in clinical practice. Clin Obes 2022; 12:e12509. [PMID: 35068081 PMCID: PMC9286801 DOI: 10.1111/cob.12509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/07/2021] [Accepted: 01/06/2022] [Indexed: 01/13/2023]
Abstract
Despite evidence that formula very low-energy diets (VLED) and low-energy diets (LED) are both effective and safe as treatments for obesity and type 2 diabetes, these diets remain underutilized in the United Kingdom. The aim of this study was to explore UK dietitians' attitudes and experiences of using formula VLED and LED. A cross-sectional survey was disseminated between September 2019 and April 2020 through websites, social media platforms and dietetic networks using snowball sampling. In total, 241 dietitians responded to the online survey with 152 participants included in the final analysis (female [94.1%], mean age 40.8 years [SD 9.5]; median 12 years [interquartile range 8, 22] within dietetic practice). One hundred and nine (71.7%) participants reported currently using VLED/LED in clinical practice and 43 (28.3%) did not. Those with lower motivation and confidence in implementing VLED/LED in clinical practice were less likely to use them. Cost and adherence were the two highest reported barriers to use. Dietitians perceived VLED/LED were effective, but concerns remained about long-term effectiveness, particularly for some patient groups. Dietitians also reported that further education, funding and service infrastructure, including access to clinic space and administrative support, were required to help embed VLED/LED into routine clinical practice. With clinical services now regularly offering VLED/LED programmes in the United Kingdom, dietitians are ideally placed to provide long-term support. However, understanding, reporting and addressing the potential barriers (funding/infrastructure and education) appear to be key requirements in increasing the delivery of VLED/LED programmes nationally.
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Affiliation(s)
- Adrian Brown
- Centre for Obesity ResearchUniversity College LondonLondonUK
- Bariatric Centre for Weight Management and Metabolic SurgeryUniversity College London Hospital NHS TrustLondonUK
- National Institute of Health ResearchUCLH Biomedical Research CentreLondonUK
| | - Naomi Brosnahan
- School of Medicine, Dentistry & NursingUniversity of GlasgowScotlandUK
- Counterweight LtdLondonUK
| | - Dorsa Khazaei
- Centre for Obesity ResearchUniversity College LondonLondonUK
| | - Jed Wingrove
- Centre for Obesity ResearchUniversity College LondonLondonUK
- Bariatric Centre for Weight Management and Metabolic SurgeryUniversity College London Hospital NHS TrustLondonUK
- National Institute of Health ResearchUCLH Biomedical Research CentreLondonUK
| | - Stuart W. Flint
- School of PsychologyUniversity of LeedsLeedsUK
- Scaled Insights, NexusUniversity of LeedsLeedsUK
| | - Rachel L. Batterham
- Centre for Obesity ResearchUniversity College LondonLondonUK
- Bariatric Centre for Weight Management and Metabolic SurgeryUniversity College London Hospital NHS TrustLondonUK
- National Institute of Health ResearchUCLH Biomedical Research CentreLondonUK
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16
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Queiroz JDN, Macedo RCO, Dos Santos GC, Munhoz SV, Machado CLF, de Menezes RL, Menzem EN, Moritz CEJ, Pinto RS, Tinsley GM, de Oliveira AR. Cardiometabolic effects of early v. delayed time-restricted eating plus energetic restriction in adults with overweight and obesity: an exploratory randomised clinical trial. Br J Nutr 2022; 129:1-13. [PMID: 35614845 DOI: 10.1017/s0007114522001581] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This exploratory study investigated the effects of early v. delayed time-restricted eating (TRE) plus caloric restriction (CR) on body weight, body composition and cardiometabolic parameters in adults with overweight and obesity. Adults (20-40 years) were randomised to one of three groups for 8 weeks: early time-restricted eating (eTRE; 08.00-16.00) plus CR, delayed time-restricted eating (dTRE; 12.00-20.00) plus CR or only CR (CR; 08.00-20.00). All groups were prescribed a 25 % energy deficit relative to daily energy requirements. Thirteen participants completed the study in the eTRE and CR groups and eleven in the dTRE group (n 37). After the interventions, there was no significant difference between the three groups for any of the outcomes. Compared with baseline, significant decreases were observed in the body weight (eTRE group: -4·2 kg; 95 % CI, -5·6, -2·7; dTRE group: -4·8 kg; 95 % CI, -5·9, -3·7; CR: -4·0 kg; 95 % CI, -5·9, -2·1), fat mass (eTRE group: -2·9 kg; 95 % CI, -3·9, -1·9; dTRE group: -3·6 kg; 95 % CI, -4·6, -2·5; CR: -3·1 kg; 95 % CI, -4·3, -1·8) and fasting glucose levels (eTRE group: -4 mg/dl; 95 % CI, -8, -1; dTRE group: -2 mg/dl; 95 % CI, -8, 3; CR: -3 mg/dl; 95 % CI, -8, 2). In a free-living setting, TRE with a energetic deficit, regardless of the time of day, promotes similar benefits in weight loss, body composition and cardiometabolic parameters. However, given the exploratory nature of our study, further investigation is needed to confirm these findings.
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Affiliation(s)
- Jéssica do Nascimento Queiroz
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Cauduro Oliveira Macedo
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Nutrition, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Gabriela Cristina Dos Santos
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Samuel Vargas Munhoz
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Leonardo Figueiredo Machado
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Leal de Menezes
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Elisa Nascimento Menzem
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cesar Eduardo Jacintho Moritz
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ronei Silveira Pinto
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Grant M Tinsley
- Department of Kinesiology & Sport Management at Texas Tech University, Lubbock, TX, USA
| | - Alvaro Reischak de Oliveira
- Exercise Research Laboratory, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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17
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Iceta S, Panahi S, García-García I, Michaud A. The Impact of Restrictive and Non-restrictive Dietary Weight Loss Interventions on Neurobehavioral Factors Related to Body Weight Control: the Gaps and Challenges. Curr Obes Rep 2021; 10:385-395. [PMID: 34318394 DOI: 10.1007/s13679-021-00452-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Restrictive diets, such as low-calorie diets, are difficult to maintain in the long term. For this reason, their popularity has decreased compared to non-restrictive approaches, which instead promote healthy eating strategies. Since both strategies may entail different neurobiological mechanisms, this review will examine the current evidence on the effects of restrictive and non-restrictive interventions on neurobehavioral factors. RECENT FINDINGS Restrictive diets appear to improve eating behaviors, and the evidence reviewed argues against the notion that they may worsen the severity of binge eating. Moreover, they may lead to short-term changes in brain structure and improvements in cerebrovascular markers which, in turn, could impact eating behaviors. Non-restrictive interventions may have a positive effect on weight management and eating behaviors. However, evidence of their neural effects is scarce. Small sample sizes, short follow-ups, and the absence of control groups are limitations of the studies targeting both interventions. Rigorous long-term randomized studies are needed to examine the neurobehavioral effects of restrictive and non-restrictive approaches.
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Affiliation(s)
- Sylvain Iceta
- Quebec Heart and Lung Institute Research Center, Québec, QC, G1V 4G5, Canada
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Québec, QC, G1V OA6, Canada
- School of Nutrition, Université Laval, Québec, QC, G1V OA6, Canada
| | - Shirin Panahi
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Québec, QC, G1V OA6, Canada
- Faculty of Educational Sciences, Department of Physical Education, Université Laval, Québec, QC, G1V OA6, Canada
- Faculty of Medicine, Department of Kinesiology, Université Laval, Québec, QC, G1V OA6, Canada
| | - Isabel García-García
- Department of Clinical Psychology and Psychobiology, University of Barcelona, 08035, Barcelona, Spain
| | - Andréanne Michaud
- Quebec Heart and Lung Institute Research Center, Québec, QC, G1V 4G5, Canada.
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Québec, QC, G1V OA6, Canada.
- School of Nutrition, Université Laval, Québec, QC, G1V OA6, Canada.
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18
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Brown A, McArdle P, Taplin J, Unwin D, Unwin J, Deakin T, Wheatley S, Murdoch C, Malhotra A, Mellor D. Dietary strategies for remission of type 2 diabetes: A narrative review. J Hum Nutr Diet 2021; 35:165-178. [PMID: 34323335 DOI: 10.1111/jhn.12938] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
Type 2 diabetes (T2DM) is a growing health issue globally, which until recently has been considered to be one that is both chronic and progressive. Treatments, although having lifestyle and dietary change as core components, have been focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies which have set out to achieve remission; remission of T2DM has emerged as treatment goal. A group of specialist dietitians, medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM, and undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss, and although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, but may rather constitute a 'state of mitigation' of T2DM. This technical point may not be considered important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches which can help to achieve it. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Adrian Brown
- Centre for Obesity Research, University College London, London, UK.,National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Paul McArdle
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | - Campbell Murdoch
- Private GP, Farmborough, Bath, UK.,Diabetes Digital Media, Coventry, UK
| | - Aseem Malhotra
- Visiting Professor of Evidence Based Medicine, Bahiana School of Medicine and Public Heath, Salvador, Brazil
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, UK
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19
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Bristow C, Meurer C, Simmonds J, Snell T. Anti-obesity public health messages and risk factors for disordered eating: a systematic review. Health Promot Int 2021; 35:1551-1569. [PMID: 32150266 DOI: 10.1093/heapro/daaa018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In response to the increasing prevalence of overweight and obesity, public health efforts to curb these conditions have been delivered in abundance. There is concern however that the messages used to target these conditions may be increasing risk factors for disordered eating. Therefore, we sought to systematically review the literature on the effects of anti-obesity public health messages on risk factors for disordered eating. Seven electronic databases were searched for articles meeting the inclusion criteria, resulting in the inclusion of 12 studies of various methodologies that measured one or more risk factors for disordered eating following exposure to public health messages. Few studies specifically and accurately measured disordered eating behaviours. Most studies found that messages were stigmatizing towards persons who are overweight/obese, and exacerbate thin ideals and drive for thinness. Interestingly, the same was not found for measures of body dissatisfaction. Messages promoting smaller meals were also thought to be potential triggers for disordered eating. Whilst the studies included in this review offered both quantitative and qualitative insights into how public health messages may have adverse effects on eating behaviours, there was a consistent lack of valid reporting measures and clear classification of outcomes overall. Hence, future research is recommended using valid reporting tools such as validated questionnaires, as well as prolonged exposure to the intervention condition to determine longer-term impact.
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Affiliation(s)
- Claire Bristow
- Faculty of Education, Monash University, Wellington Road Clayton, Melbourne, VIC 3800, Australia
| | - Capella Meurer
- Faculty of Education, Monash University, Wellington Road Clayton, Melbourne, VIC 3800, Australia
| | - Janette Simmonds
- Faculty of Education, Monash University, Wellington Road Clayton, Melbourne, VIC 3800, Australia
| | - Tristan Snell
- Faculty of Education, Monash University, Wellington Road Clayton, Melbourne, VIC 3800, Australia
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20
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Bristow C, Allen KA, Simmonds J, Snell T, McLean L. Anti-obesity public health advertisements increase risk factors for the development of eating disorders. Health Promot Int 2021; 37:6323697. [PMID: 34279033 DOI: 10.1093/heapro/daab107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although overweight and obesity are increasing in prevalence, eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disorder are simultaneously on the rise. It is important to address the burden of disease of overweight and obesity on the population, yet there is concern that some of these efforts may be encouraging unhealthy weight control behaviours (UWCB). Using an online survey, 137 participants were exposed to four anti-obesity public health advertisements presented in random order. Weight satisfaction, shape satisfaction, desire to control weight, desire to control shape and desire to engage in UWCB were measured on a 100-point visual analogue scale. A significant effect of the experimental condition was found after exposure to Image 1 with a decrease in weight satisfaction, and increased desire to control body weight, body shape and engage in UWCB. Mean scores for UWCB also increased, on average, across all four image conditions. Public health advertisements targeting obesity risk encouraging unhealthy weight control and subsequent disordered eating behaviours. Those responsible for the implementation of such advertisements must consider very carefully the potential to cause unintended harm.
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Affiliation(s)
- Claire Bristow
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Kelly-Ann Allen
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Janette Simmonds
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Tristan Snell
- School of Psychology, Faculty of Health, Deakin University, Melbourne Victoria, Australia
| | - Louise McLean
- Faculty of Education, Monash University, Melbourne Victoria, Australia
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21
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Björkman S, Wallengren O, Laurenius A, Eliasson B, Larsson I. Nocturnal eating but not binge eating disorder is related to less 12 months' weight loss in men and women with severe obesity: A retrospective cohort study. Clin Obes 2020; 10:e12408. [PMID: 32851796 PMCID: PMC7685102 DOI: 10.1111/cob.12408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
There is a paucity of studies on the frequency of binge-eating disorder (BED) and nocturnal eating (NE) and their potential role as barriers in non-surgical weight loss treatment in subjects with severe obesity (body mass index [BMI] ≥35 kg m2 ). The aim was to identify BED and NE, and their effect on weight loss treatment. In total, 1132 (727 women, 405 men), BMI ~41 kg/m2 were patients in a 12-month weight loss programme at a specialist clinic. The questionnaire for eating and weight patterns-revised was completed by the patients before start of treatment. BED was diagnosed in 5.1% of men and 12.4% of women. NE prevalence was 13.5% and 12.7%, respectively. Mean (±SEM) 12-month weight loss was less in patients with NE compared to those without (-11.0 ± 1.5 vs -14.6 ± 0.7 kg, P = .008) but did not differ in patients with and without BED, (-12.3 ± 1.9 vs -14.2 ± 0.6 kg, P = .24). Factors associated with dropout were BED (odds ratio, OR 1.57, 95% confidence interval (CI) 1.14-2.17; P = .006) and previous weight loss attempts (OR 1.35, 95% CI 1.0-1.7; P = .02). BED did not seem to hinder weight loss whereas NE resulted in less weight loss in patients with severe obesity who completed a 12-month treatment programme. Previous weight loss attempts affect both dropout and ability to lose weight.
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Affiliation(s)
- Sofia Björkman
- Department of Gastroenterology and Hepatology, Unit of Clinical Nutrition and the Regional Obesity CenterSahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska Academy at the University of GothenburgSahlgrenska University HospitalGothenburgSweden
| | - Ola Wallengren
- Department of Gastroenterology and Hepatology, Unit of Clinical NutritionSahlgrenska University HospitalGothenburgSweden
| | - Anna Laurenius
- Department of Gastroenterology and Hepatology, Unit of Clinical NutritionSahlgrenska University HospitalGothenburgSweden
- Department of Surgery, Institute of Clinical SciencesSahlgrenska Academy at the University of GothenburgGothenburgSweden
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy at the University of GothenburgSahlgrenska University HospitalGothenburgSweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Unit of Clinical Nutrition and the Regional Obesity CenterSahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska Academy at the University of GothenburgSahlgrenska University HospitalGothenburgSweden
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22
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PROFAST: A Randomized Trial Assessing the Effects of Intermittent Fasting and Lacticaseibacillus rhamnosus Probiotic among People with Prediabetes. Nutrients 2020; 12:nu12113530. [PMID: 33212907 PMCID: PMC7698325 DOI: 10.3390/nu12113530] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023] Open
Abstract
Both intermittent fasting and specific probiotics have shown promise in improving glucose tolerance with a potential for synergistic effects through alterations to gut microbiota. In this randomized, double-blinded, two-arm feasibility study, we investigated whether intermittent fasting, supplemented with Lacticaseibacillus rhamnosus HN001 probiotic, reduces HbA1c in individuals with prediabetes. All participants with HbA1c 40-50 mmol/mol commenced intermittent fasting (2 days per week of calorie restriction to 600-650 kcal/day) and were randomized 1:1 to either daily probiotic (Lacticaseibacillus rhamnosus HN001) or placebo for 12 weeks. The primary outcome was a change in HbA1c. Secondary outcomes included changes in anthropometry, body composition, glucoregulatory markers, lipids, hunger hormones, liver enzymes, inflammatory markers, gut hormones, calorie and macronutrient intake, quality of life, hunger, mood and eating behavior. Of 33 participants who commenced the trial, 26 participants (mean age 52 years, body mass index (BMI) 34.7 kg/m2) completed the intervention (n = 11 placebo, n = 15 probiotic). HbA1c decreased from 43 ± 2.7 mmol/mol to 41 ± 2.3 mmol/mol, p < 0.001, with average of 5% weight loss. No significant between-group differences were seen in primary or secondary outcomes except for social functioning (p = 0.050) and mental health (p = 0.007) scores as improvements were seen in the probiotic group, but not in the placebo group. This study shows additional psychological benefits of probiotic supplementation during intermittent fasting to achieve weight loss and glycemic improvement in prediabetes.
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23
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Memon AN, Gowda AS, Rallabhandi B, Bidika E, Fayyaz H, Salib M, Cancarevic I. Have Our Attempts to Curb Obesity Done More Harm Than Good? Cureus 2020; 12:e10275. [PMID: 33042711 PMCID: PMC7538029 DOI: 10.7759/cureus.10275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/06/2020] [Indexed: 01/26/2023] Open
Abstract
Dieting is a common method for weight loss, maintenance, and prevention of weight gain, but the harmful outcomes of dieting are understudied. Dieting is typically advised for obese patients for the sake of their health, though this does not account for the many complicated factors surrounding obesity. We conducted a search through the PubMed database on obesity, dieting, and eating disorders and did not limit the study by population or year. We found studies showing that although dieting may cause short-term weight loss, it is associated with weight gain in the long-term. We also found studies assessing the negative psychological and physical outcomes of dieting. Though there are many studies that emphasize the negative psychological impact of dieting, few studies have explored how dieting may contribute to the development of eating disorders in the obese. Studies on the physical impact of dieting were less conclusive but warrant further study. While it is difficult to draw any substantial conclusions from the data, our results showed that dieting may carry more risks than benefits as a means to lose weight.
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Affiliation(s)
- Areeba N Memon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Asavari S Gowda
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bhavana Rallabhandi
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Erjola Bidika
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hafsa Fayyaz
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Marina Salib
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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24
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Carmen M, Safer DL, Saslow LR, Kalayjian T, Mason AE, Westman EC, Sethi S. Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series. J Eat Disord 2020; 8:2. [PMID: 32010444 PMCID: PMC6988301 DOI: 10.1186/s40337-020-0278-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many patients with obesity and comorbid binge eating symptoms present with the desire to lose weight. Although some studies suggest that dietary restriction can exacerbate binge eating, others show dietary restriction is associated with significant reductions in binge eating. The effect of a particular type of dieting on binge eating, the ketogenic diet (a high fat, moderate protein, very low carbohydrate diet), is not known. CASE PRESENTATIONS We report on the feasibility of a low-carbohydrate ketogenic diet initiated by three patients (age 54, 34, and 63) with obesity (average BMI 43.5 kg/m2) with comorbid binge eating and food addiction symptoms. All patients tolerated following the ketogenic diet (macronutrient proportion 10% carbohydrate, 30% protein, and 60% fat; at least 5040 kJ) for the prescribed period (e.g., 6-7 months) and none reported any major adverse effects. Patients reported significant reductions in binge eating episodes and food addiction symptoms including cravings and lack of control as measured by the Binge-Eating Scale, Yale Food Addiction Scale, or Yale-Brown Obsessive-Compulsive Scale modified for Binge Eating, depending on the case. Additionally, the patients lost a range of 10-24% of their body weight. Participants reported maintenance of treatment gains (with respect to weight, binge eating, and food addiction symptoms) to date of up to 9-17 months after initiation and continued adherence to diet. CONCLUSIONS Although the absence of control cases precludes conclusions regarding the specific role of ketogenic diets versus other forms of dietary restriction, this is the first report to demonstrate the feasibility of prescribing a ketogenic diet for patients with obesity who report binge eating and food addiction symptoms. Further research should seek to reproduce the observed effects in controlled trials as well as to explore potential etiologies.
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Affiliation(s)
| | - Debra Lynn Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 - 5723 USA
| | | | - Tro Kalayjian
- Yale University School of Medicine, New Haven, CT USA
| | - Ashley E. Mason
- The University of California San Francisco, San Francisco, CA USA
| | | | - Shebani Sethi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 - 5723 USA
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25
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Touyz LM, Wakefield CE, Grech AM, Quinn VF, Costa DSJ, Zhang FF, Cohn RJ, Sajeev M, Cohen J. Parent-targeted home-based interventions for increasing fruit and vegetable intake in children: a systematic review and meta-analysis. Nutr Rev 2019; 76:154-173. [PMID: 29319789 DOI: 10.1093/nutrit/nux066] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context Parent interventions delivered in the home represent a valuable approach to improving children's diets. Objective This review aims to examine the effectiveness of parent-targeted in-home interventions in increasing fruit and vegetable intake in children. Data Sources Five electronic databases were searched: MEDLINE, Embase, PubMed, CINAHL, and PsycINFO. Study Selection Randomized and nonrandomized trials conducted in children aged 2 to 12 years and published in English from 2000 to 2016 were eligible. Data Extraction Eighteen publications were reviewed, and 12 randomized trials were analyzed. Studies were pooled on the basis of outcome measure and type of intervention, resulting in 3 separate meta-analyses. Results Nutrition education interventions resulted in a small but significant increase in fruit intake (Hedges' g = 0.112; P = 0.028). Taste exposure interventions led to a significant increase in vegetable intake, with a moderate effect (Hedges' g = 0.438; P < 0.001). Interventions involving daily or weekly sessions reported positive outcomes more frequently than those using monthly sessions. Conclusions Future interventions should incorporate regular taste exposure to maximize increases in vegetable intake in children. This is particularly important because fewer children meet national recommendations for vegetable intake than for fruit intake.
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Affiliation(s)
- Lauren M Touyz
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Allison M Grech
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Veronica F Quinn
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Richard J Cohn
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Mona Sajeev
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jennifer Cohen
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
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26
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Pattinson AL, Nassar N, da Luz FQ, Hay P, Touyz S, Sainsbury A. The Real Happy Study: Protocol for a Prospective Assessment of the Real-World Effectiveness of the HAPIFED Program-a Healthy APproach to we Ight management and Food in Eating Disorders. Behav Sci (Basel) 2019; 9:bs9070072. [PMID: 31266238 PMCID: PMC6680425 DOI: 10.3390/bs9070072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023] Open
Abstract
The prevalence of obesity with comorbid binge eating behaviour is growing at a faster rate than that seen for either obesity or eating disorders as separate conditions. Approximately 6% of the population are affected and they potentially face a lifetime of poor physical and mental health outcomes and an inability to sustain long-term weight loss. Current treatment options are inadequate in that they typically address either obesity or eating disorders exclusively, not the combination of both conditions. By treating one condition without treating the other, relapse is common, and patients are often left disappointed with their lack of weight loss. An integrated approach to treating these individuals is needed to prevent a worsening of the comorbidities associated with excess body weight and eating disorders. A new therapy has recently been developed, named HAPIFED, which addresses both overweight/obesity and comorbid binge eating behaviour with the combination of behavioural weight loss therapy and cognitive behaviour therapy-enhanced (CBT-E). The aim of this paper is to document the protocol for the Real Happy Study, which will evaluate the effectiveness of the HAPIFED program in treating overweight or obesity with comorbid binge-eating behaviour in a real-world setting.
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Affiliation(s)
- Andrea L Pattinson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
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27
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Abstract
Binge eating disorder (BED) is the most common eating disorder and is accompanied by multiple medical comorbidities, many of which are associated with obesity-related diseases. However, the BED itself is likely to confer additional risk factors. BED presents with medical symptoms in virtually every body system and can have devastating consequences on both quality and length of life. This review covers the major comorbidities of BED and highlights areas of ongoing research in this disorder.
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Affiliation(s)
| | - Julie Friedman
- Binge Eating Treatment and Recovery, Eating Recovery Center, Northwestern University Medical School, Department of Psychiatry, Eating Recovery Center Insight, 333 North Michigan Avenue, 19th Floor, Chicago, IL 60601, USA
| | - Philip S Mehler
- Eating Recovery Center, ACUTE @ Denver Health, Glassman Professor of Medicine, University of Colorado School of Medicine, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA
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28
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da Luz FQ, Sainsbury A, Mannan H, Touyz S, Mitchison D, Girosi F, Hay P. An investigation of relationships between disordered eating behaviors, weight/shape overvaluation and mood in the general population. Appetite 2018; 129:19-24. [DOI: 10.1016/j.appet.2018.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022]
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29
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Rationale and Protocol for a Randomized Controlled Trial Comparing Fast versus Slow Weight Loss in Postmenopausal Women with Obesity-The TEMPO Diet Trial. Healthcare (Basel) 2018; 6:healthcare6030085. [PMID: 30036996 PMCID: PMC6165329 DOI: 10.3390/healthcare6030085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022] Open
Abstract
Very low energy diets (VLEDs), commonly achieved by replacing all food with meal replacement products and which result in fast weight loss, are the most effective dietary obesity treatment available. VLEDs are also cheaper to administer than conventional, food-based diets, which result in slow weight loss. Despite being effective and affordable, these diets are underutilized by healthcare professionals, possibly due to concerns about potential adverse effects on body composition and eating disorder behaviors. This paper describes the rationale and detailed protocol for the TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity), in a randomized controlled trial comparing the long-term (3-year) effects of fast versus slow weight loss. One hundred and one post-menopausal women aged 45–65 years with a body mass index of 30–40 kg/m2 were randomized to either: (1) 16 weeks of fast weight loss, achieved by a total meal replacement diet, followed by slow weight loss (as for the SLOW intervention) for the remaining time up until 52 weeks (“FAST” intervention), or (2) 52 weeks of slow weight loss, achieved by a conventional, food-based diet (“SLOW” intervention). Parameters of body composition, cardiometabolic health, eating disorder behaviors and psychology, and adaptive responses to energy restriction were measured throughout the 3-year trial.
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30
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da Luz FQ, Hay P, Touyz S, Sainsbury A. Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches. Nutrients 2018; 10:E829. [PMID: 29954056 PMCID: PMC6073367 DOI: 10.3390/nu10070829] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 12/29/2022] Open
Abstract
Obesity and eating disorders are each associated with severe physical and mental health consequences, and individuals with obesity as well as comorbid eating disorders are at higher risk of these than individuals with either condition alone. Moreover, obesity can contribute to eating disorder behaviors and vice-versa. Here, we comment on the health complications and treatment options for individuals with obesity and comorbid eating disorder behaviors. It appears that in order to improve the healthcare provided to these individuals, there is a need for greater exchange of experiences and specialized knowledge between healthcare professionals working in the obesity field with those working in the field of eating disorders, and vice-versa. Additionally, nutritional and/or behavioral interventions simultaneously addressing weight management and reduction of eating disorder behaviors in individuals with obesity and comorbid eating disorders may be required. Future research investigating the effects of integrated medical, psychological and nutritional treatment programs addressing weight management and eating disorder psychopathology in individuals with obesity and comorbid eating disorder behaviors—such as binge eating—is necessary.
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Affiliation(s)
- Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia.
- CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020, Brazil.
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Stephen Touyz
- Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia.
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31
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Ashtary-Larky D, Ghanavati M, Lamuchi-Deli N, Payami SA, Alavi-Rad S, Boustaninejad M, Afrisham R, Abbasnezhad A, Alipour M. Rapid Weight Loss vs. Slow Weight Loss: Which is More Effective on Body Composition and Metabolic Risk Factors? Int J Endocrinol Metab 2017; 15:e13249. [PMID: 29201070 PMCID: PMC5702468 DOI: 10.5812/ijem.13249] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Achieving weight loss (WL) in a short time regardless of its consequences has always been the focus of many obese and overweight people. In this study, anthropometric and metabolic effects of two diets for rapid and slow WL and their consequences were examined. METHODS Forty-two obese and overweight individuals were randomly divided to 2 groups; rapid WL (weight loss of at least 5% in 5 weeks) and slow WL (weight loss of at least 5% in 15 weeks). To compare the effects of the rate of WL in 2 groups, the same amount of was achieved with different durations. Anthropometric indices, lipid, and glycemic profiles, and systolic and diastolic blood pressures were evaluated before and after the intervention. RESULTS Both protocols of rapid WL and slow WL caused reduction in waist circumference, hip circumference, total body water, body fat mass, lean body mass, and resting metabolic rate (RMR). Further reduction in waist circumference, hip circumference, fat mass, and percentage of body fat was observed in slow WL and decreased total body water, lean body mass, fat free mass, and RMR was observed in rapid WL. Improvement in lipid and glycemic profiles was observed in both groups. Reduction of low-density lipoprotein and fasting blood sugar, improvement of insulin resistance, and sensitivity were more significant in rapid WL in comparison to slow WL. CONCLUSIONS Weight Loss regardless of its severity could improve anthropometric indicators, although body composition is more favorable following a slow WL. Both diets improved lipid and glycemic profiles. In this context, rapid WL was more effective. (IRCT2016010424699N2).
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Affiliation(s)
- Damoon Ashtary-Larky
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Matin Ghanavati
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Lamuchi-Deli
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh Arefeh Payami
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Alavi-Rad
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Boustaninejad
- Department of Physical Education and Sports Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Reza Afrisham
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Abbasnezhad
- Nutritional Health Research Center, Department of Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Alipour
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding author: Meysam Alipour, Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, P.O.BOX: 159613- 5715794, Ahvaz, Iran. Tel: +98-6133720299, E-mail:
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Hilbert A, Petroff D, Herpertz S, Kersting A, Pietrowsky R, Tuschen-Caffier B, Vocks S, Schmidt R. Meta-analysis of the effectiveness of psychological and medical treatments for binge-eating disorder (MetaBED): study protocol. BMJ Open 2017; 7:e013655. [PMID: 28360240 PMCID: PMC5372140 DOI: 10.1136/bmjopen-2016-013655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Binge-eating disorder (BED) was included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An increasing number of treatment studies have been published, but an up-to-date comprehensive meta-analysis on diverse treatment approaches for BED is lacking. In an updated and extension of a previous meta-analysis, the goals of this study are to assess the short-term and long-term effectiveness of psychological and medical treatments for BED. METHODS AND ANALYSIS We will search bibliographic databases and study registries, including manual searches for studies published before January 2016. The search strategy will include terms relating to binge eating and diverse forms of psychological and medical interventions. Language will be restricted to English. The studies included will be treatment studies, that is, randomised-controlled trials, and non-randomised and non-controlled studies, for individuals with BED (DSM-IV or DSM-5), and studies that provided a pre-treatment and at least one post-treatment or follow-up assessment of binge eating. The primary outcomes will be the number of binge-eating episodes, abstinence from binge eating and diagnosis of BED at post-treatment and/or follow-up(s), and changes from pre-treatment to post-treatment and/or follow-up(s). Likewise, as secondary outcomes, eating disorder and general psychopathology, quality of life, and body weight will be analysed and adverse events and treatment drop-out will be examined. Study search, selection and data extraction, including risk of bias assessment, will be independently performed by 2 reviewers and consensus will be sought. Moderator analyses will be conducted, and equity aspects will be considered. Sensitivity analyses will be conducted to determine the robustness of the results. ETHICS AND DISSEMINATION Ethical approval is not required for this meta-analysis. Published in a peer-reviewed journal and disseminated electronically and in print, this meta-analysis will form the basis of the renewal of the German evidence-based S3 Guidelines of Diagnosis and Treatment of Eating Disorders, specifically BED. TRIAL REGISTRATION NUMBER CRD42016043604.
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Affiliation(s)
- Anja Hilbert
- Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine, LWL-University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Reinhard Pietrowsky
- Department of Clinical Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Osnabrück, Osnabrück, Germany
| | - Ricarda Schmidt
- Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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Palavras MA, Hay P, Filho CADS, Claudino A. The Efficacy of Psychological Therapies in Reducing Weight and Binge Eating in People with Bulimia Nervosa and Binge Eating Disorder Who Are Overweight or Obese-A Critical Synthesis and Meta-Analyses. Nutrients 2017; 9:nu9030299. [PMID: 28304341 PMCID: PMC5372962 DOI: 10.3390/nu9030299] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
Recurrent binge eating episodes, the core feature of Bulimia Nervosa (BN) and Binge Eating Disorder (BED), are frequently comorbid with obesity. Psychological interventions, notably Cognitive Behavioural Therapy (CBT), are effective for binge eating reduction in BED or BN but less so for weight loss. Behavioural Weight Loss Therapy (BWLT) shows effectiveness for binge eating reduction and weight loss but the latter appears poorly sustained over time. Our aim was to review evidence for efficacy of psychological therapies for BN/BED associated with overweight or obesity in reducing binge frequency and weight. A systematic search for randomized controlled trials with adult samples who had BN or BED was conducted considering articles in English, French, Spanish and Portuguese with no restrictions for the timeline publication ending in March 2016. A quality appraisal of the trials and meta-analyses comparing BWLT to CBT were done. This review identified 2248 articles for screening and 19 published articles were selected. No trials of BN were identified. This review found CBT was favoured compared to BWLT with regard to short-term binge eating reduction. However, insufficient evidence was found for superiority for BWLT efficacy compared to CBT considering binge eating remission, reduction of binge eating frequency and weight loss. More research is needed to test the efficacy of psychological treatments for BED or BN with co-morbid overweight or obesity, including trials evaluating binge eating remission and weight loss in the long-term.
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Affiliation(s)
- Marly Amorim Palavras
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo 04038-000, Brazil.
- School of Medicine, Western Sydney University, Sydney 2751, Australia.
| | - Phillipa Hay
- CAPES Foundation, Ministry of Education of Brazil, Brasilia 70047-900, Brazil.
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney 2751, Australia.
| | - Celso Alves Dos Santos Filho
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo 04038-000, Brazil.
| | - Angélica Claudino
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo 04038-000, Brazil.
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Potential Benefits and Harms of Intermittent Energy Restriction and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects-A Narrative Review of Human and Animal Evidence. Behav Sci (Basel) 2017; 7:bs7010004. [PMID: 28106818 PMCID: PMC5371748 DOI: 10.3390/bs7010004] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
Abstract
Intermittent energy restriction (IER) has become popular as a means of weight control amongst people who are overweight and obese, and is also undertaken by normal weight people hoping spells of marked energy restriction will optimise their health. This review summarises randomised comparisons of intermittent and isoenergetic continuous energy restriction for weight loss to manage overweight and obesity. It also summarises the potential beneficial or adverse effects of IER on body composition, adipose stores and metabolic effects from human studies, including studies amongst normal weight subjects and relevant animal experimentation. Six small short term (<6 month) studies amongst overweight or obese individuals indicate that intermittent energy restriction is equal to continuous restriction for weight loss, with one study reporting greater reductions in body fat, and two studies reporting greater reductions in HOMA insulin resistance in response to IER, with no obvious evidence of harm. Studies amongst normal weight subjects and different animal models highlight the potential beneficial and adverse effects of intermittent compared to continuous energy restriction on ectopic and visceral fat stores, adipocyte size, insulin resistance, and metabolic flexibility. The longer term benefits or harms of IER amongst people who are overweight or obese, and particularly amongst normal weight subjects, is not known and is a priority for further investigation.
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da Luz FQ, Swinbourne J, Sainsbury A, Touyz S, Palavras M, Claudino A, Hay P. HAPIFED: a Healthy APproach to weIght management and Food in Eating Disorders: a case series and manual development. J Eat Disord 2017; 5:29. [PMID: 28824810 PMCID: PMC5558732 DOI: 10.1186/s40337-017-0162-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/14/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a high prevalence of overweight or obesity in people with eating disorders. However, therapies for eating disorders, namely binge eating disorder and bulimia nervosa, do not address weight management. Conversely, weight loss treatments for people with overweight or obesity do not address psychological aspects related to eating disorders. Thus we developed a new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa, entitled HAPIFED (a Healthy APproach to weIght management and Food in Eating Disorders). This paper describes HAPIFED and reports a case series examining its feasibility and acceptability. METHODS Eleven participants with overweight or obesity and binge eating disorder or bulimia nervosa were treated with HAPIFED in two separate groups (with once or twice weekly meetings). Weight, body mass index (BMI) and eating disorder symptoms, as well as depression, anxiety and stress, were assessed at baseline and at the end of the 20-session HAPIFED intervention. RESULTS Eight of the 11 participants completed the intervention, with diverse results. Six of the 8 participants who completed HAPIFED reduced their weight between baseline and the end of the intervention. Median scores on the Eating Disorder Examination Questionnaire for binge eating, restraint, and concerns about eating or weight and shape, were reduced in the group overall between baseline and the end of the intervention. One participant, who at baseline was inducing vomiting and misusing laxatives in an attempt to lose weight, reduced these behaviors by the end of the intervention. Three participants at baseline were undertaking episodes of compulsive exercise, and they reduced or stopped this behavior, but one participant commenced episodes of compulsive exercise by the end of the intervention. All participants who completed the intervention rated the suitability and success of HAPIFED as 7 or more out of 10 (0 = not at all suitable/successful; 10 = extremely suitable/successful). CONCLUSION This case series supports the feasibility and acceptability of HAPIFED as a potential new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa. Clinical trials are necessary to examine the efficacy and effectiveness of HAPIFED. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (Universal Trial Number): U1111-1149-7766. Date of registration: 4th November 2013.
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Affiliation(s)
- Felipe Q da Luz
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia.,CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020 Brazil
| | - Jessica Swinbourne
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia
| | - Amanda Sainsbury
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Stephen Touyz
- The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Marly Palavras
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Angelica Claudino
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Schaumberg K, Anderson DA, Anderson LM, Reilly EE, Gorrell S. Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology. Clin Obes 2016; 6:89-100. [PMID: 26841705 DOI: 10.1111/cob.12134] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/26/2015] [Accepted: 11/22/2015] [Indexed: 02/05/2023]
Abstract
Dietary restraint has historically been implicated as a risk factor for the development of eating pathology. Despite existing findings, recent research suggests that many individuals are capable of practicing dietary restraint without negative effects. In order to successfully incorporate the positive aspects of dietary restraint into interventions for healthy weight management, a nuanced examination of the relationship between dietary restraint and resulting eating patterns is necessary. Accordingly, the current review seeks to clarify the existing literature with regard to dietary restraint. First, this review examines the construct of dietary restraint and differentiates dietary restraint from related constructs, such as weight loss dieting. Second, it identifies situations in which dietary restraint has been linked with positive outcomes, such as healthy weight management and prevention of eating pathology. Altogether, it appears that dietary restraint can prove a beneficial strategy for those attempting to control their weight, as it does not relate to increased levels of eating pathology when practiced as part of a well-validated weight management programme.
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Affiliation(s)
- K Schaumberg
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - D A Anderson
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - L M Anderson
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - E E Reilly
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - S Gorrell
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
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Comparing cognitive behavioural therapy for eating disorders integrated with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a randomised controlled trial. Trials 2015; 16:578. [PMID: 26683478 PMCID: PMC4683762 DOI: 10.1186/s13063-015-1079-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/24/2015] [Indexed: 01/13/2023] Open
Abstract
Background Around 40 % of individuals with eating disorders of recurrent binge eating, namely bulimia nervosa and binge eating disorder, are obese. In contrast to binge eating disorder, currently there is no evidence base for weight management or weight loss psychological therapies in the treatment of bulimia nervosa despite their efficacy in binge eating disorder. Thus, a manualised therapy called HAPIFED (Healthy APproach to weIght management and Food in Eating Disorders) has been developed. HAPIFED integrates the leading evidence-based psychological therapies, cognitive behavioural therapy-enhanced (CBT-E) and behavioural weight loss treatment (BWLT) for binge eating disorder and obesity respectively. The aim of the present study is to detail the protocol for a randomised controlled trial (RCT) of HAPIFED versus CBT-E for people with bulimia nervosa and binge eating disorder who are overweight/obese. Method/Design A single-blind superiority RCT is proposed. One hundred Brazilian participants aged ≥ 18 years, with a diagnosis of bulimia nervosa or binge eating disorder, BMI > 27 to < 40 kg/m2, will be recruited from both community and clinics and individually randomised to a therapy arm. Five groups of ten participants will receive the experimental intervention (HAPIFED) and the other five groups of ten the control intervention (CBT-E). Both therapies are manualised, and in this RCT will comprise 1 individual session and 29 office-based group sessions over 6 months. Assessment points will be at baseline, end of therapy, and 6 and 12 months after end of therapy. The primary outcome of this intervention will be reduced weight. Secondary outcomes will be improved metabolic indicators of weight management, reduction in eating disorder symptoms including improved control over eating, improved adaptive function, physical and mental health-related quality of life, and reduced levels of depression and anxiety. Discussion This study will be the first to investigate a psychological therapy that aims to assist weight management in people with co-morbid overweight or obesity bulimia nervosa as well as with binge eating disorder. It will have the potential to improve health outcomes for the rapidly increasing number of adults with co-morbid obesity and binge eating disorder or bulimia nervosa. Trial registration US National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1079-1) contains supplementary material, which is available to authorized users.
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