Australian Healthcare Professionals' Knowledge of and Attitudes toward Binge Eating Disorder

Effect of a patient education program focused on weight stigma on quality of life and self-efficacy in patients living with obesity: study protocol for a randomized controlled trial

BACKGROUND

After a literature review and interviews with patients living with obesity, key psychosocial determinants such as coping strategies, weight bias internalization, body dissatisfaction and self-efficacy were identified as critical to address obesity-related stigma. The intervention was tailored using evidence-based techniques and input from health professionals to ensure relevance and avoid redundancy. This randomized controlled trial (RCT) aims to evaluate the effect of an intervention specifically designed to address weight stigma among individuals living with obesity.

METHODS

The study compares two parallel arms following different interventions: Patient Education as Usual (PEU) program and the newly developed Patient Education STEREOBES (PES) program, which integrates additional components to counteract weight stigma. The PES program, crafted using the Intervention Mapping process, addresses key psychosocial determinants such as self-efficacy, body image, and coping strategies. It incorporates workshops focused on psychoeducation, physical activity, and emotional regulation through innovative techniques like mindfulness, assertiveness training, and Acceptance and Commitment Therapy (ACT). The program emphasizes group activities and patient interaction to foster resilience against stigmatizing experiences and promote healthier lifestyle choices. This comprehensive intervention is designed to improve psychological, behavioral, and physical outcomes, particularly by reducing the internalization of weight bias and enhancing coping mechanisms.

DISCUSSION

Patients in the PES arm should demonstrate significant improvements in quality of life and self-efficacy compared to the PEU arm. Psychosocial factors should mediate the effect of the intervention on the outcomes involving quality of life and behaviors. This study will provide valuable insights into the role of weight stigma in obesity treatment and the effectiveness of targeted interventions.

TRIAL REGISTRATION

This research protocol has been approved by the Individual Protection Committee Northwest IV (National n°2023-A00327-38) and registered on Clinicaltrial.gov (NCT05906238) on June 7, 2023.

Knowledge and attitudes towards eating disorders: A survey of psychiatrists and psychiatry trainees in New South Wales

OBJECTIVE

To evaluate New South Wales (NSW) psychiatrists' and psychiatry trainees' knowledge and attitudes towards eating disorders (EDs).

METHOD

A total of 1781 psychiatrists and trainees in NSW were invited to complete an anonymous questionnaire assessing ED confidence, knowledge and attitudes.

RESULTS

A total of 51 doctors responded to the survey, with 38 completing all items. Significant knowledge gaps were revealed. Respondents expressed a desire for more ED training.

CONCLUSION

Enhanced ED training in psychiatry education and incorporating the lived experience voice to improve attitudes appear necessary.

Screening, assessment and diagnosis in the eating disorders: findings from a rapid review

BACKGROUND

Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems.

METHODS

This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review.

RESULTS

Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males.

CONCLUSIONS

A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.

Valuing the voice of lived experience of eating disorders in the research process: Benefits and considerations

Although the inclusion of individuals with lived experience is encouraged within the research process, there remains inconsistent direct involvement in many mental health fields. Within the eating disorders field specifically, there is a very strong and increasing presence of lived experience advocacy. However, due to a number of potential challenges, research undertaken in consultation or in collaboration with individuals with lived experience of an eating disorder is scarce. This paper describes the significant benefits of the inclusion of individuals with lived experience in research. The specific challenges and barriers faced in eating disorders research are also outlined. It is concluded that in addition to existing guidelines on working with lived experience collaborators in mental health research, more specific procedures are required when working with those with eating disorders.

The recruitment and acceptability of a project ECHO® eating disorders clinic: a pilot study of telementoring for primary medical and behavioral health care practitioners

Early identification and intervention are critical to prevent physical and mental health complications, chronicity, and premature death associated with eating disorders. However, primary medical and behavioral health care clinicians often do not feel confident or competent to diagnose and manage patients with eating disorders. This pilot study describes an innovative telementoring project (Project ECHO® Eating Disorders) that builds a geographically defined collaborative learning community to bridge the knowledge gap between eating disorder specialists located in eating disorder service sites and community-based practitioners, often living in remote areas. We describe the program and recruitment strategies and review baseline participant evaluation findings. Continuing Medical Education (CME) evaluation findings are presented as a measure of practitioner acceptability and satisfaction. Content analysis of CME participant evaluation comments provides an understanding of the impact of the program on participant knowledge and intended practice changes. We end with implications for training, practice, and research.

Relationship between anxiety, depressive symptoms and compulsive overeating disorder in patients with cardiovascular diseases

Objectives:

to identify the presence of compulsive overeating disorder in patients with cardiovascular diseases and to verify its relation with sociodemographic, clinical variables and the presence of anxiety and depressive symptoms.

Method:

cross-sectional, correlational study with a sample of 111 patients with cardiovascular diseases. The presence of anxiety and depressive symptoms was assessed by the Hospital Anxiety and Depression Scale instrument and compulsive overeating disorder was assessed through a likert instrument called the Periodic Eating Disorder Scale (Binge Eating Scale).

Results:

there was a predominance of patients without compulsive overeating disorder (n=91, 82%), followed by moderated compulsive overeating (n=15, 13.5%) and severe (n=5, 4.5%) associating to high levels of body mass index (p=0.010) and the presence of anxiety (p=0.017).

Conclusion:

Compulsive overeating disorder was present in 18% of the patients, being associated with body mass index and anxiety, suggesting that health professionals should pay attention to the comprehensive evaluation of patients with cardiovascular diseases. Important results emerged from this study, emphasizing the need to implement programs to improve the patients’ mental and physical health in both primary and specialized care services.

Public and Healthcare Professionals' Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review

Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs) or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria.