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Calugi S, Dalle Grave A, Conti M, Dametti L, Chimini M, Dalle Grave R. Reply to Meule, A. Comment on "Calugi et al. The Role of Weight Suppression in Intensive Enhanced Cognitive Behavioral Therapy for Adolescents with Anorexia Nervosa: A Longitudinal Study. Int. J. Environ. Res. Public Health 2023, 20, 3221". Int J Environ Res Public Health 2023; 20:6691. [PMID: 37681831 PMCID: PMC10487535 DOI: 10.3390/ijerph20176691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Abstract
We read the comments by Meule on our article with great interest, and we thank the author for his thoughtful suggestions [...].
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Verona, Italy; (A.D.G.); (M.C.); (L.D.); (M.C.); (R.D.G.)
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Dalle Grave R, Sartirana M, Dalle Grave A, Calugi S. Effectiveness of enhanced cognitive behaviour therapy for patients aged 14 to 25: A promising treatment for anorexia nervosa in transition-age youth. Eur Eat Disord Rev 2023. [PMID: 37568266 DOI: 10.1002/erv.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE The study aimed to evaluate the effectiveness of enhanced cognitive behaviour therapy (CBT-E) on patients with anorexia nervosa (AN) aged 14 to 25 treated in a real-world setting. METHOD One hundred and fifteen patients with AN (n = 61, age <18 years) were recruited from consecutive referrals to a clinical eating disorder service offering outpatient CBT-E. Body Mass Index (BMI), BMI centiles, Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment scores were recorded at admission, at the end of treatment, and at 20-week follow-up. RESULTS The seventy-two patients (62.6%) who finished the programme showed considerable weight gain and reduced scores for clinical impairment and eating-disorder and general psychopathology. Changes remained stable at 20 weeks. A comparison between adolescent and adult patients indicates similar improvements in eating-disorder psychopathology. CONCLUSIONS The benchmark data yielded by this study suggest that CBT-E is a well-accepted and promising treatment that could be adopted to ensure continuity of care across the transitional age.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | | | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
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Jebeile H, Lister NB, Libesman S, Hunter KE, McMaster CM, Johnson BJ, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Askie L, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit AM, Cooper K, Kyle TK, Heeren FA, Quigley F, Barnes RD, Bean MK, Beaulieu K, Bonham M, Boutelle KN, Branco BHM, Calugi S, Cardel MI, Carpenter K, Cheng HL, Dalle Grave R, Danielsen YS, Demarzo M, Dordevic A, Eichen DM, Goldschmidt AB, Hilbert A, Houben K, Lofrano do Prado M, Martin CK, McTiernan A, Mensinger JL, Pacanowski C, do Prado WL, Ramalho SM, Raynor HA, Rieger E, Robinson E, Salvo V, Sherwood NE, Simpson SA, Skjakodegard HF, Smith E, Partridge S, Tanofsky-Kraff M, Taylor RW, Van Eyck A, Varady KA, Vidmar AP, Whitelock V, Yanovski J, Seidler AL. Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management. PLoS One 2023; 18:e0282401. [PMID: 37428754 PMCID: PMC10332604 DOI: 10.1371/journal.pone.0282401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/07/2023] [Indexed: 07/12/2023] Open
Abstract
The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Denise E Wilfley
- Washington University in St. Louis, St Louis, Missouri, United States of America
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- The University of Western Australia, School of Human Sciences, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan, Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, United Kingdom
- NIHR ACR Northwest London, London, United Kingdom
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia M Grunseit
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kelly Cooper
- Weight Issues Network, New South Wales, Australia
| | - Theodore K Kyle
- ConscienHealth, Pittsburgh, Pennsylvania, United States of America
| | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Fiona Quigley
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Co. Antrim, Northern Ireland
| | - Rachel D Barnes
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Kristine Beaulieu
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | - Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | | | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
- WW International, Inc., New York, NY, United States of America
| | - Kelly Carpenter
- Optum Center for Wellbeing Research, Seattle, Washington, United States of America
| | - Hoi Lun Cheng
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | | | - Marcelo Demarzo
- Mente Aberta, The Brazilian Center for Mindfulness and Health Promotion, Univesidade Federal de São Paulo, UNIFESP, Brazil
| | | | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Philadelphia, United States of America
| | - Anja Hilbert
- Research Unit Behavioral Medicine, Integrated Research and Treatment Center Adiposity Diseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katrijn Houben
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Mara Lofrano do Prado
- Department of Psychology, California State University, San Bernardino, California, United States of America
- Department of Kinesiology, California State University, San Bernardino, California, United States of America
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Carly Pacanowski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, United States of America
| | - Wagner Luiz do Prado
- Department of Kinesiology, California State University, San Bernardino, California, United States of America
| | - Sofia M Ramalho
- Psychology Research Centre, School of Psychology, University of Minho, Campus Gualtar, Braga, Portugal
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Vera Salvo
- Mente Aberta, The Brazilian Center for Mindfulness and Health Promotion, Univesidade Federal de São Paulo, UNIFESP, Brazil
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon A Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Evelyn Smith
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Stephanie Partridge
- Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marian Tanofsky-Kraff
- Departments of Medical and Clinical Psychology and Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Krista A Varady
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, Illinois, United States of America
| | - Alaina P Vidmar
- Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Los Angeles, California, United States of America
| | | | - Jack Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Anna L Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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Calugi S, Segattini B, Cattaneo G, Chimini M, Dalle Grave A, Dametti L, Molgora M, Dalle Grave R. Weight Bias Internalization and Eating Disorder Psychopathology in Treatment-Seeking Patients with Obesity. Nutrients 2023; 15:2932. [PMID: 37447258 DOI: 10.3390/nu15132932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to investigate the relationship between weight bias internalization and eating disorder psychopathology in treatment-seeking patients with severe obesity using a network approach. Two thousand one hundred and thirteen patients with obesity were consecutively admitted to a specialist clinical unit for obesity and were recruited from January 2016 to February 2023. Body mass index was measured, and each patient completed the Weight Bias Internalization Scale (WBSI) and the Eating Disorder Examination Interview (EDE). Network analysis showed that the most central and highly interconnected nodes in the network were related to the EDE items exposure avoidance, dissatisfaction with shape, and wanting an empty stomach. Bridge nodes were found, but the bootstrap difference test on expected bridge influence indicated non-significant centrality differences. Nevertheless, the eating disorder psychopathology and weight bias internalization network structure in patients seeking treatment for obesity indicate the prominent roles of body dissatisfaction and control of eating and weight in these psychological constructs. This finding, if replicated, could pave the way for a new understanding of the psychological mechanisms operating in patients with obesity.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Barbara Segattini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Gianmatteo Cattaneo
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Mirko Chimini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Manuela Molgora
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
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Calugi S, Dalle Grave A, Conti M, Dametti L, Chimini M, Dalle Grave R. The Role of Weight Suppression in Intensive Enhanced Cognitive Behavioral Therapy for Adolescents with Anorexia Nervosa: A Longitudinal Study. Int J Environ Res Public Health 2023; 20:3221. [PMID: 36833916 PMCID: PMC9967636 DOI: 10.3390/ijerph20043221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The study aimed to establish the role of weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E). One hundred and twenty-eight adolescent patients with anorexia nervosa (128 females and 2 males), aged between 14 and 19 years, were recruited from consecutive referrals to a community-based eating disorder clinic offering intensive CBT-E. Weight, height, Eating Disorder Examination Questionnaire, and Brief Symptom Inventory scores were recorded at admission, end-of-treatment, and at a 20-week follow-up. In addition, the developmental weight suppression (DWS, difference between one's highest premorbid and current z-BMI, i.e., BMI z-scores) was calculated. The mean baseline z-BMI was -4.01 (SD = 2.27), and the mean DWS was 4.2 (SD = 2.3). One hundred and seven patients (83.4%) completed the treatment and showed both considerable weight gain and reduced scores for eating-disorder and general psychopathology. Among completers, 72.9% completed the 20-week follow-up and maintained the improvement reached at the end-of-treatment. DWS was negatively correlated with end-of-treatment and follow-up z-BMI. This indicates that weight suppression is a predictor of the BMI outcome of intensive CBT-E and confirms that this treatment is promising for adolescents with anorexia nervosa.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
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Dalle Grave R, Calugi S, Ruocco C, Chimini M, Segala A, Ragni M, Carruba M, Valerio A, Nisoli E. Efficacy and tolerability of a specific blend of amino acids in patients with anorexia nervosa treated in a hospital setting: study protocol for a randomized controlled trial. Trials 2023; 24:104. [PMID: 36759873 PMCID: PMC9912576 DOI: 10.1186/s13063-023-07120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Specific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet done on patients with anorexia nervosa (AN) who regain weight with specialized intensive treatment. The present study aims to evaluate the efficacy of supplementation with EAA on the change in lean body mass (LBM) and other physical and psychological outcomes in patients with AN who are undergoing specialist treatment for eating disorders. METHODS This is a 13-week randomized, double-blind, placebo-controlled study. Patients will be randomized to either a mixture of a complex blend of EAA and intermediates of the tricarboxylic acid (TCA) cycle (citrate, malate, succinate) supplementation (or placebo) upon admission at the intensive residential and day-hospital treatment for eating disorders. Ninety-two participants with AN aged 16-50 years will be recruited from a specialized intensive treatment of eating disorders. Double-blind assessment will be conducted at baseline (T0) and the end of the 13 weeks of treatment (T1). The study's primary aim is to evaluate the efficacy of supplementation with EAA and TCA intermediates on the change in lean body mass (LBM) with weight restoration in patients with AN who are undergoing specialist treatment for eating disorders. The secondary aims of the study are to assess the effect of dietary supplementation on physical fitness, weight restoration, modification of AN and general psychopathology, and psychosocial impairment. DISCUSSION The study's results will inform researchers and clinicians on whether supplementing a mixture of EAA and TCA cycle intermediates will improve the increase of LBM and other important physical and psychological outcomes in patients with AN who regain weight with specialized intensive treatment. TRIAL REGISTRATION NCT, NCT05290285. Registered on 22 March 2022.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, Garda, 37016, Verona, Italy.
| | - Simona Calugi
- grid.416990.30000 0004 1787 1136Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, Garda, 37016 Verona, Italy
| | - Chiara Ruocco
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
| | - Mirko Chimini
- grid.416990.30000 0004 1787 1136Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, Garda, 37016 Verona, Italy
| | - Agnese Segala
- grid.7637.50000000417571846Department of Molecular and Translational Medicine, Brescia University, Viale Europa 11, 25123 Brescia, Italy
| | - Maurizio Ragni
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
| | - Michele Carruba
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
| | - Alessandra Valerio
- grid.7637.50000000417571846Department of Molecular and Translational Medicine, Brescia University, Viale Europa 11, 25123 Brescia, Italy
| | - Enzo Nisoli
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
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Calugi S, Dametti L, Dalle Grave A, Milanese C, Dalle Grave R. The clinical perfectionism questionnaire: psychometric properties of the Italian version in patients with eating disorders. Eat Weight Disord 2022; 27:3439-3448. [PMID: 36161590 DOI: 10.1007/s40519-022-01480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Problematic perfectionism has been traditionally conceptualized as a multidimensional construct, and specific instruments have been developed to capture its various dimensions. However, the Clinical Perfectionism Questionnaire (CPQ) was recently designed to measure a unidimensional construct called "clinical perfectionism", but the questionnaire has not yet been validated in Italian. AIM This study aimed to propose the Italian version of the CPQ and examine its psychometric properties. METHODS The CPQ was translated into Italian using translation and back-translation procedures. Then, it was administered to 188 Italian-speaking patients with eating disorders and 126 non-eating disorder group (excluded if the Italian version of the Eating Attitudes Test-26 was ≥ 20). The clinical group also completed the Italian versions of the Frost Multidimensional Perfectionism Scale (FMPS), the Eating Disorder Examination Questionnaire (EDE-Q), and the Brief Symptom Inventory (BSI). RESULTS Confirmatory factor analysis revealed a good fit for the bifactor structure of the 10-item version. Internal consistency was high for the general clinical perfectionism factor, and test-retest reliability was good. Convergent validity was acceptable for the general clinical perfectionism and 'overvaluation of striving' group factors. The CPQ showed significantly higher scores in patients with eating disorders than in the non-eating disorder group. CONCLUSIONS Overall, the study demonstrated the good psychometric properties of the Italian version of the CPQ, and validated its use in Italian-speaking patients with eating disorders. Although further research is required, the CPQ has promising evidence as a reliable and valid measure of clinical perfectionism in its Italian version. LEVEL OF EVIDENCE Level V, Descriptive study.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Verona, Garda, Italy.
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Verona, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Verona, Garda, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Verona, Garda, Italy
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Calugi S, Dametti L, Dalle Grave A, Dalle Grave R. Changes in specific and nonspecific psychopathology network structure after intensive cognitive behavior therapy in patients with anorexia nervosa. Int J Eat Disord 2022; 55:1090-1099. [PMID: 35689570 DOI: 10.1002/eat.23755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to compare eating disorder-specific and nonspecific clinical features in patients with anorexia nervosa before and after intensive enhanced cognitive behavior therapy (CBT-E) via network analysis. METHODS All consecutive patients admitted to intensive CBT-E were eligible, and the sample comprised patients aged ≥16 years who completed a 20-week intensive CBT-E program. Body mass index (BMI), Eating Disorder Examination Questionnaire and Brief Symptoms Inventory responses were gathered at baseline and end of treatment, and used to generate statistical networks of the connections between symptoms (nodes) and the strength and centrality thereof. RESULTS A total of 214 patients were included. Most nodes had relatively similar centrality compared to other nodes in the networks. "Eating concern" and "phobic anxiety" showed the greatest bridge centrality at both time points. No differences were found between baseline and the end of treatment in either global network or individual connection strengths. CONCLUSION These findings suggest that some clinical expressions not specific to eating-disorder psychopathology remain strongly connected in the generalized network of patients with anorexia nervosa after CBT-E. Future research should examine whether additional procedures specifically designed to target these symptoms should be integrated into this and other treatments.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Dalle Grave R, Dalle Grave A, Bani E, Oliosi A, Conti M, Dametti L, Calugi S. The impact of the COVID-19 pandemic on intensive cognitive behavioral therapy outcomes in patients with anorexia nervosa-A cohort study. Int J Eat Disord 2022; 56:216-224. [PMID: 35751430 PMCID: PMC9349485 DOI: 10.1002/eat.23765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study aimed to assess the impact of the COVID-19 pandemic on the efficacy of an intensive treatment based on enhanced cognitive behavioral therapy (CBT-E) in patients with anorexia nervosa. METHODS This cohort study analyzed 57 patients with anorexia nervosa who experienced the COVID-19 pandemic during intensive CBT-E, comparing their outcomes (body mass index [BMI], eating-disorder and general psychopathology, and clinical impairment) with those of patients with anorexia nervosa matched by gender, age, and BMI given the same treatment before the COVID-19 outbreak as controls. Patients were assessed at baseline, at the end of treatment and after 20 weeks of follow-up. RESULTS More than 75% of patients during the pandemic versus 85% of controls completed the treatment, a difference that was not significant. BMI, eating disorder and general psychopathology and clinical impairment scores improved significantly from baseline to 20-week follow-up in both groups. However, the improvement was more marked in controls than in those treated during the COVID-19 pandemic. CONCLUSION Patients with anorexia nervosa given intensive CBT-E during the COVID-19 pandemic had significantly improved psychopathology, albeit to a lesser extent than patients given the same treatment before the COVID-19 pandemic. PUBLIC SIGNIFICANCE STATEMENT In this study, the outcome of 57 patients with anorexia treated with intensive enhanced cognitive behavior therapy during the COVID-19 pandemic was compared with a matched group treated before the pandemic hit. The rate of remission from anorexia nervosa was similar between the two groups. However, patients exposed to the COVID-19 pandemic showed lesser improvement than those not exposed.
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Affiliation(s)
| | - Anna Dalle Grave
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Elena Bani
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Alessandra Oliosi
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Maddalena Conti
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Laura Dametti
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Simona Calugi
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
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Calugi S, Morandini N, Milanese C, Dametti L, Sartirana M, Fasoli D, Dalle Grave R. Validity and reliability of the Dietary Rules Inventory (DRI). Eat Weight Disord 2022; 27:285-294. [PMID: 33782917 DOI: 10.1007/s40519-021-01177-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/23/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Dietary rules are common in patients with eating disorders, and according to transdiagnostic cognitive behavioural theory for eating disorders, represent a key behaviour maintaining eating-disorder psychopathology. The aim of this study was to describe the design and validation of the Dietary Rules Inventory (DRI), a new self-report questionnaire that assesses dietary rules in patients with eating disorders. METHODS A transdiagnostic sample of 320 patients with eating disorders, as well as 95 patients with obesity and 122 healthy controls were recruited. Patients with eating disorders also completed the Dutch Eating Behaviour Questionnaire (DEBQ), the Eating Disorder Examination Questionnaire, the Brief Symptoms Inventory and the Clinical Impairment Assessment. Dietary rules were rated on a continuous Likert-type scale (0-4), rating how often (from never to always) they had been applied over the previous 28 days. RESULTS DRI scores were significantly higher in patients with eating disorders than in patients with obesity and healthy controls. Principal factor analysis identified that 55.8% of the variance was accounted for by four factors, namely 'what to eat', 'social eating', 'when and how much to eat' and 'caloric level'. Both global score and subscales demonstrated high internal and test-retest reliability. The DRI global score was significantly correlated with the DEBQ 'restrained eating' subscale, as well as eating-disorder and general psychopathology and clinical impairment scores, demonstrating good convergent validity. CONCLUSIONS These findings suggest that the DRI is a valid self-report questionnaire that may provide important clinical information regarding the dietary rules underlying dietary restraint in patients with eating disorders. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy.
| | - Nicole Morandini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Massimiliano Sartirana
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Deborah Fasoli
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
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11
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Dalle Grave R, Dametti L, Conti M, Bersan C, Dalle Grave A, Calugi S. Day-hospital enhanced cognitive behavior therapy for adults with eating disorders: Immediate and follow-up effects. Int J Eat Disord 2022; 55:125-130. [PMID: 34687248 DOI: 10.1002/eat.23632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess outcomes in adult patients with eating disorders administered enhanced cognitive behavioral therapy (CBT-E) in a day-hospital setting. METHOD Forty-three consecutive patients with eating disorders (86% females; mean age 28.8 [SD = 11.8]) were admitted to a 13-week day-hospital CBT-E program. Twenty-five (58.1%) patients were underweight (i.e., body mass index [BMI] <18.5 kg/m2 ; BMI 15.4 [SD = 2.2]) and 18 not (mean BMI 23.1 [SD = 6.3]) at baseline. All patients responded poorly to prior outpatient treatment. Body mass index and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at baseline, end of treatment, and 20-week follow-up. RESULTS In 37 patients (86.0%) who completed the treatment, there were substantial improvements in eating-disorder features, general psychopathology, clinical impairment, and body weight (only in underweight patients), which were well maintained at follow-up. DISCUSSION Day-hospital CBT-E is a promising treatment for adults with eating disorders.
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Affiliation(s)
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Chiara Bersan
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Frostad S, Calugi S, Engen CBN, Dalle Grave R. Enhanced cognitive behaviour therapy (CBT-E) for severe and extreme anorexia nervosa in an outpatient eating disorder unit at a public hospital: a quality-assessment study. J Eat Disord 2021; 9:143. [PMID: 34727976 PMCID: PMC8561966 DOI: 10.1186/s40337-021-00499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this quality-assessment study was to determine the outcome of patients with severe and extreme anorexia nervosa (AN) in a real-world outpatient setting. METHODS Twenty-one adults with AN and a body mass index (BMI) of < 16 were recruited from consecutive referrals to an outpatient clinic at a public hospital in Western Norway. All enrolled patients were provided with enhanced cognitive behaviour therapy (CBT-E) to treat their AN, commencing between January 2013 and December 2016. Their BMI was recorded at baseline, at the end of CBT-E and 1 year after the end of treatment. RESULTS Ten patients completed the CBT-E treatment and achieved a large weight gain with the change remaining stable at follow-up. Eleven patients did not complete the treatment but had a significant increase in BMI at the premature end of treatment. One year after end of therapy 14/21 (66.7%) of the patients had BMI above 18.5 kg/m2. No severe complications were observed during therapy. CONCLUSIONS Although 52.4% of the patients did not complete outpatient CBT-E, the findings of this quality-assessment study support previous findings indicating that CBT-E may represent a valid alternative to inpatient treatment in patients with severe and extreme AN.
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Affiliation(s)
- Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | | | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
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13
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Calugi S, Dametti L, Chimini M, Dalle Grave A, Dalle Grave R. Change in eating-disorder psychopathology network structure in patients with anorexia nervosa treated with intensive cognitive behavior therapy. Int J Eat Disord 2021; 54:1800-1809. [PMID: 34331465 DOI: 10.1002/eat.23590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study was designed to compare the change in eating-disorder feature networks in patients with anorexia nervosa after treatment with intensive enhanced cognitive behavior therapy (CBT-E). METHODS Patients seeking treatment for anorexia nervosa were consecutively recruited from January 2016 to September 2020. All patients aged ≥16 years who completed a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment) were included in the study. Body mass index (BMI) was measured, and the Eating Disorder Examination Questionnaire completed for each patient, both at baseline and the end of treatment. RESULTS The sample comprised 214 patients with anorexia nervosa. Treated patients showed significant improvements in BMI and eating-disorder psychopathology. Network analysis revealed a significant reduction in the network global and connection strengths at the end of treatment. The most central and highly interconnected nodes in the network at baseline were related to the drive for thinness, but at the end of treatment to body image concerns. Some edge connections were significantly stronger at baseline than at the end of treatment, while others were significantly stronger at the end of treatment than at baseline. DISCUSSION CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa. The differences in central nodes and edge connections between baseline and end of treatment, not detected by classical inferential analysis, may be informative for understanding the centrality of symptoms in the psychopathology network, and how a specific treatment may act to reduce symptoms and change their connections over time.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Mirko Chimini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Basile B, Novello C, Calugi S, Dalle Grave R, Mancini F. Childhood Memories in Eating Disorders: An Explorative Study Using Diagnostic Imagery. Front Psychol 2021; 12:685194. [PMID: 34367006 PMCID: PMC8339314 DOI: 10.3389/fpsyg.2021.685194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/21/2021] [Indexed: 01/01/2023] Open
Abstract
Together with socio-cultural components, the family environment and early parent-child interactions play a role in the development of eating disorders. The aim of this study was to explore the nature of early parent-daughter relationships in a sample of 49 female inpatients with an eating disorder. To acquire a detailed image description of the childhood experiences of the patient, we used diagnostic imagery, a schema therapy-derived experiential technique. This procedure allows exploring specific contents within the childhood memory (i.e., emotions and unmet core needs), bypassing rational control, commonly active during direct verbal questioning. Additionally, patients completed self-report measures to assess for eating disorder severity, general psychopathology, and individual and parental schemas pervasiveness. Finally, we explored possible differences in the diagnostic imagery content and self-report measures in two subgroups of patients with anorexia nervosa and bulimia nervosa. The results showed that the most frequently reported unmet needs within the childhood memories of patients were those of safety/protection, care/nurturance, and emotional expression, referred specifically to the maternal figure. Overall, mothers were described as more abandoning, but at the same time particularly enmeshed in the relationship with their daughters. Conversely, patients perceived their fathers as more emotionally inhibited and neglecting. Imagery-based techniques might represent a powerful tool to explore the nature of early life experiences in eating disorders, allowing a more detailed case conceptualization and addressing intervention on early-life vulnerability aspects in disorder treatment.
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Affiliation(s)
- Barbara Basile
- Association of Cognitive Psychology (APC), School of Cognitive Psychotherapy (SPC), Rome, Italy
| | | | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy
| | | | - Francesco Mancini
- Association of Cognitive Psychology (APC), School of Cognitive Psychotherapy (SPC), Rome, Italy.,Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
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Calugi S, Andreoli B, Dametti L, Dalle Grave A, Morandini N, Dalle Grave R. The Impact of COVID-19 Lockdown on Patients with Obesity after Intensive Cognitive Behavioral Therapy-A Case-Control Study. Nutrients 2021; 13:nu13062021. [PMID: 34208391 PMCID: PMC8231218 DOI: 10.3390/nu13062021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023] Open
Abstract
Background: The COVID-19 lockdown may have negatively impacted the treatment of obesity. This study aimed to assess the effect of COVID-19 lockdown in patients with obesity treated with intensive residential cognitive behavioral therapy (CBT-OB). Methods: This retrospective case-control study analyzed 129 patients with severe obesity who experienced COVID-19 lockdown in the 6 months after discharge from intensive residential CBT-OB, comparing their outcomes on weight loss, binge-eating episodes, and general health status with those in a sample of patients matched by gender, age, and body mass index given the same treatment before the COVID-19 outbreak as control. Patients were assessed at baseline and by phone interview 6-month follow-up. Results: Both groups had lost more than 9% of their baseline bodyweight and reported a significant decrease in binge-eating episodes and similar general health status at 6-month follow-up. However, control patients achieved a significantly greater weight loss than those who experienced lockdown, although half of lockdown patients reported persisting with CBT-OB procedures after their discharge. Conclusion: Patients with obesity treated with CBT-OB and exposed to COVID-19 lockdown, despite achieving lower weight loss than non-exposed patients, had a healthy weight loss at 6-month follow-up and comparable reduction in binge-eating behaviors.
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Fugazzaro S, Denti M, Accogli MA, Costi S, Pagliacci D, Calugi S, Cavalli E, Taricco M, Bardelli R. Self-Management in Stroke Survivors: Development and Implementation of the Look after Yourself (LAY) Intervention. Int J Environ Res Public Health 2021; 18:ijerph18115925. [PMID: 34072998 PMCID: PMC8198104 DOI: 10.3390/ijerph18115925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
Objective: Self-management is recommended in stroke rehabilitation. This report aims to describe timing, contents, and setting of delivery of a patient-centered, self-management program for stroke survivors in their early hospital rehabilitation phase: the Look After Yourself (LAY) intervention. Methods: After extensive literature search, the LAY intervention was developed by integrating the Chronic Disease Self-Management Program, based on the self-efficacy construct of social cognitive theory, with evidence-based key elements and input from stroke survivors. Results: the LAY intervention aims to implement self-management skills in stroke survivors, enabling them to be active in goal setting and problem solving using action plans and to facilitate the critical transition from hospital to community. It includes both group sessions to facilitate sharing of experiences, social comparison, vicarious learning, and increase motivation and one-to-one sessions focused on setting feasible action plans and on teaching personalized strategies to prevent falls. Standardization is ensured by manuals for facilitators and patients. Conclusion: The LAY intervention is the first Italian program to support early self-management in stroke rehabilitation; it has been experimented and its efficacy proven in improving self-efficacy, mental health, and activities of daily living, and detailed results have been published. The LAY intervention is described according to the TIDieR checklist.
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Affiliation(s)
- Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento n°80, 42123 Reggio Emilia, Italy; (S.F.); (M.A.A.)
| | - Monica Denti
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento n°80, 42123 Reggio Emilia, Italy; (S.F.); (M.A.A.)
- Correspondence:
| | - Monia Allisen Accogli
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento n°80, 42123 Reggio Emilia, Italy; (S.F.); (M.A.A.)
| | - Stefania Costi
- Scientific Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Umberto I n°50, 42123 Reggio Emilia, Italy;
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Via del Pozzo n°74, 41100 Modena, Italy
| | - Donatella Pagliacci
- Department of Community Health Care, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Via A. Cocchi n°7/9, 56124 Pisa, Italy;
| | - Simona Calugi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Ugo Foscolo, n°7, 40123 Bologna, Italy;
| | - Enrica Cavalli
- Physical Medicine and Rehabilitation Unit, Azienda Ospedaliero-Universitaria Policlinico S.Orsola-Malpighi, Via Albertoni n°15, 40138 Bologna, Italy; (E.C.); (M.T.)
| | - Mariangela Taricco
- Physical Medicine and Rehabilitation Unit, Azienda Ospedaliero-Universitaria Policlinico S.Orsola-Malpighi, Via Albertoni n°15, 40138 Bologna, Italy; (E.C.); (M.T.)
| | - Roberta Bardelli
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli n°1, 40136 Bologna, Italy;
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Calugi S, Sartirana M, Frostad S, Dalle Grave R. Enhanced cognitive behavior therapy for severe and extreme anorexia nervosa: An outpatient case series. Int J Eat Disord 2021; 54:305-312. [PMID: 33247462 DOI: 10.1002/eat.23428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting. METHOD Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers. RESULTS Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups. DISCUSSION CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Monteleone AM, Troisi J, Serena G, Fasano A, Dalle Grave R, Cascino G, Marciello F, Calugi S, Scala G, Corrivetti G, Monteleone P. The Gut Microbiome and Metabolomics Profiles of Restricting and Binge-Purging Type Anorexia Nervosa. Nutrients 2021; 13:nu13020507. [PMID: 33557302 PMCID: PMC7915851 DOI: 10.3390/nu13020507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
Alterations in the gut microbiome and fecal metabolites have been detected in anorexia nervosa (AN), but differences in those profiles between restricting AN (ANR) and binge-purging AN (ANBP) type have not been explored. We made a secondary analysis of our previous data concerning microbiome and metabolomics profiles of 17 ANR women, six ANBP women and 20 healthy controls (HC). Twelve fecal metabolites differentiating ANR patients, ANBP patients and HC were identified. Both patient groups showed decreased intra-individual bacterial richness with respect to healthy controls (HC). Compared to ANR subjects, ANBP patients had a significant increase in relative abundances of Bifidobacterium, Bifidobacteriaceae, Bifidobacteriales, and Eubacteriacae and a significant decrease in relative abundances of Odoribacter, Haemophilus, Pasteurellaceae, and Pasteurellales. The heatmaps of the relationships of selected fecal metabolites with microbial families showed different structures among the three groups, with the heatmap of ANBP patients being drastically different from that of HC, while that of ANR patients resulted more similar to HC. These findings, although preliminary because of the relatively small sample size, confirm the occurrence of different gut dysbiosis in ANR and ANBP and demonstrate different connections between gut microorganisms and fecal metabolites in the two AN types.
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Affiliation(s)
| | - Jacopo Troisi
- Theoreo srl, Via Degli Ulivi 3, 84090 Montecorvino Pugliano, Italy; (J.T.); (G.S.)
- European Biomedical Research Institute of Salerno (EBRIS), Via S. De Renzi, 3, 84125 Salerno, Italy; (A.F.); (G.C.)
| | - Gloria Serena
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital—Harvard Medical School, Boston, MA 02114, USA;
| | - Alessio Fasano
- European Biomedical Research Institute of Salerno (EBRIS), Via S. De Renzi, 3, 84125 Salerno, Italy; (A.F.); (G.C.)
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital—Harvard Medical School, Boston, MA 02114, USA;
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, 37016 Verona, Italy; (R.D.G.); (S.C.)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, 84081 Baronissi, Italy; (G.C.); (F.M.)
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, 84081 Baronissi, Italy; (G.C.); (F.M.)
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, 37016 Verona, Italy; (R.D.G.); (S.C.)
| | - Giovanni Scala
- Theoreo srl, Via Degli Ulivi 3, 84090 Montecorvino Pugliano, Italy; (J.T.); (G.S.)
| | - Giulio Corrivetti
- European Biomedical Research Institute of Salerno (EBRIS), Via S. De Renzi, 3, 84125 Salerno, Italy; (A.F.); (G.C.)
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, 84081 Baronissi, Italy; (G.C.); (F.M.)
- Correspondence: ; Tel.: +39-089672833
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Dalle Grave R, Sartirana M, Sermattei S, Calugi S. Treatment of Eating Disorders in Adults Versus Adolescents: Similarities and Differences. Clin Ther 2020; 43:70-84. [PMID: 33223229 DOI: 10.1016/j.clinthera.2020.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022]
Abstract
FINDINGS Although several individual psychotherapies for adults with eating disorders are empirically supported, with family-based treatment (FBT) being the leading recommended empiric treatment in adolescents, patients with eating disorders are still difficult to treat, and outcomes are often poor. In some countries, the clinical services for adolescents and adults are separate, and it is common for patients to receive treatments that differ in terms of both theory and content when they are switched from adolescent to adult services. Changes in the nature of treatment also often occur when patients move from less intensive types of care to more intensive treatment, and vice versa. These transitions may create a discontinuity in the care pathway and disorient patients and their significant others about the strategies and procedures used for addressing eating problems. However, the observation that younger and older patients essentially share the same eating-disorder psychopathology has led to evidence-based enhanced cognitive-behavioral therapy (CBT-E) being adapted for use in adolescents. Originally an evidence-based treatment for adults with eating disorders, CBT-E has yielded promising results in trials in cohorts of adolescent outpatients and inpatients, and is recommended as an alternative to FBT in adolescent patients. IMPLICATIONS With a unified treatment such as CBT-E, several issues that plague conventional eating-disorder services could be partially overcome, as patients can move seamlessly from adolescence to adulthood and through different levels of care, with no change in the nature of the treatment itself. Future randomized, controlled trials should compare FBT to CBT-E to better clarify the specific therapeutic needs of subgroups of adolescents and adult patients with eating disorders.
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Affiliation(s)
| | | | - Selvaggia Sermattei
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy.
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20
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Dalle Grave R, Conti M, Calugi S. Effectiveness of intensive cognitive behavioral therapy in adolescents and adults with anorexia nervosa. Int J Eat Disord 2020; 53:1428-1438. [PMID: 32691431 DOI: 10.1002/eat.23337] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive behavioral therapy (CBT-E) in adolescent and adult patients with anorexia nervosa. METHODS A total of 150 consecutive patients (74 adolescents and 81 adults) were admitted to a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment). All patients had responded poorly to previous outpatient treatments and were assessed at admission, end of treatment (EOT), and 20- and 60-week follow-ups. RESULTS About 70% of eligible patients began the program, and more than 85% completed it. Body mass index (BMI) in adults and BMI-for-age percentile in adolescents improved significantly from baseline to EOT, remained stable until 20-week follow-up, and slightly decreased from 20-week follow-up to 60-week follow-up, while remaining in the lower normal range. Eating disorder psychopathology, general psychopathology, and clinical impairment scores decreased significantly at EOT and showed only a slight increase from EOT to follow-ups. No difference was found between adolescent and adult patients in treatment acceptance, dropout, or any outcome measure. DISCUSSION These findings indicate that intensive CBT-E seems to be an effective treatment for severely ill adolescent and adult patients with anorexia nervosa.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Veneto, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Veneto, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Veneto, Italy
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Monteleone AM, Troisi J, Fasano A, Dalle Grave R, Marciello F, Serena G, Calugi S, Scala G, Corrivetti G, Cascino G, Monteleone P, Maj M. Multi-omics data integration in anorexia nervosa patients before and after weight regain: A microbiome-metabolomics investigation. Clin Nutr 2020; 40:1137-1146. [PMID: 32782162 DOI: 10.1016/j.clnu.2020.07.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We have recently reported specific fecal metabolomic changes in acute and short-term weight restored patients with anorexia nervosa (AN). In this study we explored the association between those metabolomic changes and patients' gut microbiome composition. METHODS The gut microbiome of AN women was sequenced in both the underweight phase (n = 21) and after short-term weight restoration (n = 16) and compared to that of 20 healthy women. According to a multi-omics approach, microbiome data were correlated with 49 relevant fecal metabolites previously characterized in our participants by an untargeted metabolomic procedure. RESULTS Compared to healthy women, AN patients showed a decreased intra-individual bacterial richness, an increased Bacteroidetes-to-Firmicutes abundance ratio and significant changes in the relative abundances of several bacteria at phylum, class, order, family and genus levels. These changes were observed in both the underweight and weight-restored condition. Moreover, the relationships among the 49 previously selected fecal metabolites and bacteria genera showed structures of different complexity among the 3 groups. In particular, a quarter of those relationships showed a divergent direction in the acutely ill patients with respect to the weight-restored ones or normal controls. Finally, in acutely ill patients 70% of those correlations showed a negative sign suggesting a prevalent metabolites consummation by gut microbiome. CONCLUSIONS These data confirm a profound perturbation in the gut microbiome composition of AN patients. Moreover, for the first time, they provide the evidence that in AN gut bacteria are connected with several fecal metabolites in a different way from normal controls and with divergent directions in the acute phase with respect to the weight-restored phase.
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Affiliation(s)
| | - Jacopo Troisi
- Theoreo srl, Via degli Ulivi 3, 84090, Montecorvino Pugliano, SA, Italy; European Biomedical Research Institute of Salerno (EBRIS), Via S. De Renzi, 3, 84125, Salerno, SA, Italy
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Gloria Serena
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Giovanni Scala
- Theoreo srl, Via degli Ulivi 3, 84090, Montecorvino Pugliano, SA, Italy
| | - Giulio Corrivetti
- European Biomedical Research Institute of Salerno (EBRIS), Via S. De Renzi, 3, 84125, Salerno, SA, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, SA, Italy.
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Calugi S, Sartirana M, Misconel A, Boglioli C, Dalle Grave R. Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach. Int J Eat Disord 2020; 53:420-431. [PMID: 32314382 DOI: 10.1002/eat.23270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess and compare eating disorder feature networks in adult and adolescent patients with anorexia nervosa. METHODS Patients seeking treatment for anorexia nervosa in inpatient and outpatient settings were consecutively recruited from January 2008 to September 2019. Body mass index was measured, and each patient completed the Eating Disorder Examination Questionnaire. RESULTS The sample comprised 547 adolescent and 724 adult patients with anorexia nervosa. Network analysis showed that in both adults and adolescents, the most central and highly interconnected nodes in the network were related to shape overvaluation and desiring weight loss. The network comparison test identified similar global strength and network invariance, confirming the similarity of the two network structures. DISCUSSION The network structures in adult and adolescent patients with anorexia nervosa are similar, and lend weight to the cognitive behavioral theory that overvaluation of shape and weight is the core feature of anorexia nervosa psychopathology.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Arianna Misconel
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Camilla Boglioli
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Dalle Grave R, Misconel A, Fasoli D, Calugi S. Overvaluation of Shape and Weight and Associated Features in Patients Without Eating Disorders Seeking Treatment for Obesity. Obesity (Silver Spring) 2020; 28:733-739. [PMID: 32108444 DOI: 10.1002/oby.22750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/01/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to evaluate the presence of the overvaluation of shape and weight and its associated features in patients with obesity but no eating disorder who were seeking treatment from a specialist unit. METHODS Overall, 1,134 patients with obesity but no Diagnostic and Statistical Manual of Mental Disorders eating disorder diagnosis were included. The Eating Disorder Examination interview was administered by expert clinicians to assess the eating disorder psychopathology and overvaluation of shape and weight. Patients also completed the Symptom Check List-90-Revised and the 36-Item Short Form Health Survey to assess general psychopathology and quality of life, respectively. RESULTS Roughly 20% of the patients with obesity presented with clinical overvaluation of shape and weight, which was associated with the female gender, higher expected weight loss, more severe eating-related psychopathology, higher general psychopathology, and lower mental quality of life. Linear and logistic regression analyses indicated that the clinical variables independently correlated with overvaluation of shape and weight in these patients were female gender, Eating Disorder Examination Eating Concern subscale score, and 36-Item Short Form Health Survey mental component summary score. CONCLUSIONS These findings are sufficient to justify routine assessment of overvaluation of shape and weight in patients seeking treatment for obesity.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Arianna Misconel
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Deborah Fasoli
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
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Dalle Grave R, Sartirana M, Calugi S. Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures. Biopsychosoc Med 2020; 14:5. [PMID: 32175002 PMCID: PMC7063798 DOI: 10.1186/s13030-020-00177-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 11/29/2022] Open
Abstract
Personalized cognitive-behavioural therapy for obesity (CBT-OB) is a new treatment that combines the traditional procedures of standard behavioural therapy for obesity (i.e., self-monitoring, goal setting, stimulus control, contingency management, behavioural substitution, skills for increasing social support, problem solving and relapse prevention) with a battery of specific cognitive strategies and procedures. These enable the treatment to be individualized, and to help patients to address the cognitive processes that previous research has found to be associated with treatment discontinuation, the amount of weight lost and long-term weight-loss maintenance. The treatment programme can be delivered at three levels of care, outpatient, day hospital and residential, and includes six modules, which are introduced according to the individual patient’s needs as part of a flexible, personalized approach. The primary goals of CBT-OB are to help patients to (i) achieve, accept and maintain healthy weight loss; (ii) adopt a lifestyle conducive to weight control; and (iii) develop a stable “weight-control mindset”. A randomized controlled trial has found that 88 patients suffering from morbid obesity treated with CBT-OB followed a period of residential treatment achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between 6 and 12 months. The treatment efficacy is also supported by data from a study assessing the effects of group CBT-OB delivered in a real-world clinical setting. In that study, 77 patients with morbid obesity who completed the treatment achieved 9.9% weight loss after 18 months. These promising results, if confirmed by future clinical studies, suggest that CBT-OB has the potential to be more effective than traditional weight-loss lifestyle-modification programmes.
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Affiliation(s)
- Riccardo Dalle Grave
- 1Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89 37016 Garda (VR), Verona, Italy
| | | | - Simona Calugi
- 1Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89 37016 Garda (VR), Verona, Italy
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25
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Dalle Grave R, Soave F, Ruocco A, Dametti L, Calugi S. Quality of Life and Physical Performance in Patients with Obesity: A Network Analysis. Nutrients 2020; 12:E602. [PMID: 32110862 PMCID: PMC7146222 DOI: 10.3390/nu12030602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the interconnections between specific quality-of-life domains in patients with obesity and high or low physical performance using a network approach. METHODS 716 consecutive female and male patients (aged 18-65 years) with obesity seeking weight-loss treatment were included. The 36-item Short Form Health Survey (SF-36) and the six-minute walking test (6MWT) were used to assess quality of life and physical performance, respectively. The sample was split into two groups according to the distance walked in the 6MWT. Network structures of the SF-36 domains in the two groups were assessed and compared, and the relative importance of individual items in the network structures was determined using centrality analyses. RESULTS 35.3% (n = 253) of participants covered more distance than expected, and 64.7% (n = 463) did not. Although low-performing patients showed lower quality of life domain scores, the network structures were similar in the two groups, with the SF-36 Vitality representing the central domain in both networks. Mental Health was a node with strong connections in patients who walked less distance. CONCLUSIONS These findings indicate that psychosocial variables represent the most influential and interconnected features as regards quality of life in both groups.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, 37138 Garda (VR), Italy; (F.S.); (A.R.); (L.D.); (S.C.)
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Abstract
OBJECTIVE Enhanced understanding of psychosocial factors associated with obesity may improve knowledge of their interplay mechanisms. The aim of this study was to assess the relationship between psychosocial variables in individuals with obesity using a network analysis. METHODS Patients seeking treatment for obesity were consecutively recruited from a rehabilitative residential treatment program for severe obesity between January 2016 and March 2019. Each patient completed the following questionnaires: Eating Disorder Examination Questionnaire, Symptom Checklist-90, Obesity Related Well-Being, and Weight Bias Internalization Scale. In addition, current body mass index (BMI) was measured, and maximum acceptable and dream BMI were assessed. RESULTS The sample comprised 996 patients with obesity (age 52.3 [SD = 16.0] years; BMI 41.8 [SD = 7.8] kg/m2 ; 65.7% women; 52.2% married or living with a partner). Network analysis showed that interpersonal sensitivity and shape-weight concern, but also internalized weight stigma, were the most central and highly interconnected nodes in the network. In contrast, objective binge-eating episodes and dietary restraint were the most peripheral and least connected nodes. Eating disorder features and psychological distress formed two clearly separate clusters. No difference in network structure was found between men and women. CONCLUSIONS The pattern of network node connections supports the importance of assessing psychological distress, interpersonal sensitivity, shape-weight concern, and internalized weight stigma in patients seeking treatment for obesity.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Italy
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27
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Calugi S, Marchesini G, El Ghoch M, Gavasso I, Dalle Grave R. The association between weight maintenance and session-by-session diet adherence, weight loss and weight-loss satisfaction. Eat Weight Disord 2020; 25:127-133. [PMID: 29931447 DOI: 10.1007/s40519-018-0528-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/12/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the association between weight-loss maintenance and weight-loss satisfaction, adherence to diet and weight loss, all measured session-by-session during the weight-loss phase of cognitive behavioral therapy. METHODS The present exploratory study examined a subgroup of fifty-eight patients who participated in a randomized controlled trial and who lost at least the 10% of their baseline weight. Patients were grouped into weight-loss 'Maintainers' (i.e., those who maintained a weight loss of ≥ 10% of baseline body weight at 6 months after the weight-loss phase) and 'Regainers' (i.e., those who did not maintain > 10% weight loss at 6 months after the weight-loss phase). Body weight, adherence to diet and weight-loss satisfaction were measured session-by-session during the weight-loss phase. RESULTS Thirteen patients (22.4%) were classified as 'Regainers', and 45 (77.6%) as 'Maintainers'. Compared to 'Maintainers', 'Regainers' had a lower adherence to diet after the initial 11 weeks, and a progressively declining weight loss and weight-loss satisfaction from week 15 or 19 of the weight-loss phase. 11-week dietary adherence and 15-week weight loss were significantly associated with weight maintenance. Similar results were obtained using the amount of weight change as dependent variable. CONCLUSIONS Adherence to diet, weight loss and weight-loss satisfaction, measured during the late weight-loss phase, are associated with weight-loss maintenance. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort or case-control analytical studies.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy.
| | - Giulio Marchesini
- Unit of Metabolic Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University, Bologna, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
| | - Ilaria Gavasso
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
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Dalle Grave R, Sartirana M, Calugi S. Enhanced cognitive behavioral therapy for adolescents with anorexia nervosa: Outcomes and predictors of change in a real-world setting. Int J Eat Disord 2019; 52:1042-1046. [PMID: 31199022 DOI: 10.1002/eat.23122] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The study aimed to establish the outcomes and predictors of change in a cohort of adolescents with anorexia nervosa treated via enhanced cognitive behavioral therapy (CBT-E) in a real-world clinical setting. METHOD Forty-nine adolescent patients with anorexia nervosa were recruited from consecutive referrals to a clinical eating disorder service offering outpatient CBT-E. Body Mass Index centiles and Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment scores were recorded at admission, at the end of treatment, and at 20-week follow-up. RESULTS Thirty-five patients (71.4%) who finished the program showed both considerable weight gain and reduced scores for clinical impairment and eating disorder and general psychopathology. Changes remained stable at 20 weeks. No baseline predictors of drop-out or treatment outcomes were detected. CONCLUSIONS Based on these results, CBT-E seems suitable for adolescent patients with anorexia nervosa seeking treatment in a real-world clinical setting.
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Affiliation(s)
| | | | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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29
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Miniati M, Calugi S, Savino M, Mauri M. The Anorexia-Bulimia Spectrum: an Integrated Approach to Eating and Feeding Disorders. IJEDO 2019:48-56. [DOI: 10.32044/ijedo.2019.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Rossi AP, Rubele S, Calugi S, Caliari C, Pedelini F, Soave F, Chignola E, Vittoria Bazzani P, Mazzali G, Dalle Grave R, Zamboni M. Weight Cycling as a Risk Factor for Low Muscle Mass and Strength in a Population of Males and Females with Obesity. Obesity (Silver Spring) 2019; 27:1068-1075. [PMID: 31231958 DOI: 10.1002/oby.22493] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/28/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to determine whether multiple weight cycles in adulthood are an independent predictor of lower muscle mass and reduced strength, with potential implication for sarcopenia in adults with obesity. METHODS A total of 60 males and 147 females with obesity were included, with a mean BMI of 37.9 ± 6.0 kg/m2 and a mean age of 52.6 ± 12.4 years. Muscle strength was evaluated with handgrip and appendicular skeletal muscle mass was measured with dual-energy x-ray absorptiometry. RESULTS Participants were categorized into the following three groups: non-weight cyclers, mild weight cyclers, and severe weight cyclers. From a binary logistic regression that considered muscle mass categories as a dependent variable and weight cycling categories, age, and sex as independent variables, severe weight cyclers showed a 3.8-times increased risk of low muscle mass (95% CI: 1.42-10.01). Considering handgrip strength categories as a dependent variable and weight cycling categories, age, sex, and BMI as independent variables, severe weight cycling was associated with an increased risk of low muscle mass (about 6.3 times, 95% CI: 1.96-20.59). Severe weight cyclers showed a 5.2-times greater risk of developing sarcopenia. CONCLUSIONS In adults with obesity, weight cycling is associated with lower muscle mass and strength and a greater likelihood of developing sarcopenic obesity.
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Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Sofia Rubele
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Cesare Caliari
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Francesco Pedelini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Fabio Soave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Elisa Chignola
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | | | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
- Healthy Aging Center Verona, Verona, Italy
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Abstract
The aim of this study was to validate the latest version of the Eating Problem Checklist (EPCL), a tool designed to assess eating-disorder behaviours and psychopathology in patients with eating disorders, session-by-session. The EPCL was completed at baseline by participants with eating disorders (n = 161) and a healthy control group (n = 379) and then administered session-by-session in a subgroup of 75 participants with eating disorders. The EPCL demonstrated good internal consistency, test-retest reliability, and concurrent and criterion validity, and principal axis analysis of the session-by-session data identified two factors ('eating concerns' and 'body image concerns') that accounted for 51.3% of the variance. Furthermore, session-by-session analysis indicated that the EPCL is able to identify specific weekly improvements and/or deterioration in eating-disorder psychopathology. These findings suggest that the EPCL is a valid and reliable self-report questionnaire that provides relevant clinical information regarding weekly changes in eating-disorder behaviours and psychopathology in patients with eating disorders.
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Affiliation(s)
- Riccardo Dalle Grave
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Garda (Verona) , Italy
| | - Massimiliano Sartirana
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Garda (Verona) , Italy
| | - Chiara Milanese
- b Department of Neurosciences, Biomedicine and Movement Sciences , University of Verona , Verona , Italy
| | - Marwan El Ghoch
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Garda (Verona) , Italy
| | - Chiara Brocco
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Garda (Verona) , Italy
| | - Chiara Pellicone
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Garda (Verona) , Italy
| | - Simona Calugi
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Garda (Verona) , Italy
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Calugi S, Dalle Grave R. Body image concern and treatment outcomes in adolescents with anorexia nervosa. Int J Eat Disord 2019; 52:582-585. [PMID: 30702170 DOI: 10.1002/eat.23031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To ascertain the role of baseline measures of body-image concern (BIC) in changes in body mass index (BMI) centile and psychopathological outcomes associated with intensive enhanced cognitive behavioral therapy (CBT-E) in adolescents with anorexia nervosa (AN). METHOD The BMI centile of 62 adolescent patients with AN was recorded at four time-points over 12 months, and Eating Disorder Examination interview (EDE) and Brief Symptom Inventory (BSI) scores, were recorded at admission and discharge from CBT-E. Changes in three BIC components, namely "Preoccupation with shape/weight", "Fear of weight gain" and "Feeling fat", were assessed at admission and discharge. RESULTS CBT-E was associated with a significant improvement in outcome variables and BIC components. Among completers, 96.4% reached an end-of treatment BMI centile corresponding to a BMI ≥ 18.5 at 18 years, which fell slightly to 78.7% and 80.4% at 6- and 12-month follow-ups, respectively. Baseline "Preoccupation with shape/weight" and "Feeling fat" predicted improvement in BMI centile over time, and all three baseline BIC components independently predicted end-of-treatment EDE Eating Concern subscale score. Baseline "Feeling fat" also predicted end-of-treatment EDE Dietary Restraint subscale and BSI scores. DISCUSSION These findings highlight the importance of assessing and addressing body image when managing adolescent patients with AN.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
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Calugi S, Chignola E, Dalle Grave R. A Longitudinal Study of Eating Rituals in Patients With Anorexia Nervosa. Front Psychol 2019; 10:15. [PMID: 30713513 PMCID: PMC6345676 DOI: 10.3389/fpsyg.2019.00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/04/2019] [Indexed: 01/31/2023] Open
Abstract
Background: Eating rituals are any problematic behaviors involving food. They are usually observed in patients with anorexia nervosa, but research into these behaviors and their role in treatment outcomes is lacking. Objective: We set out to assess the presence of eating rituals in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioral therapy (ICBT-E), in addition to their change over time and role as potential predictors of treatment outcome. Materials and Methods: Ninety adult female inpatients with anorexia nervosa were recruited. The Participants' body mass index (BMI), and scores for Starvation Symptoms Inventory (SSI), Eating Disorder Examination (EDE), and Brief Symptom Inventory (BSI) were recorded, and a purpose-designed 9-item checklist of eating rituals was completed by trained dieticians during assisted eating - an integral part of the ICBT-E. The Structured Clinical Interview for DSM-IV was used at admission to identify the presence of coexisting axis I psychiatric disorders. All other tests were administered at baseline (admission), the end of treatment and 6-month follow-up. BMI, EDE, and BSI were also re-administered after 4 weeks of treatment in order to examine how refeeding affects these variables. Results: We found a correlation at baseline between eating rituals and both general and eating-disorder psychopathology scores. Eating rituals were also associated with the presence of at least one comorbid anxiety disorder. ICBT-E treatment was associated with a significant reduction in eating rituals, as well as a significant increase in BMI and improved eating-disorder and general psychopathology. However, our most relevant finding was that neither baseline eating ritual scores nor their change during treatment was associated with either BMI or general or eating-disorder psychopathology scores taken at either the end of therapy or at 6-month follow-up. Conclusion: Neither the presence of nor change in eating rituals influence treatment outcomes in patients with anorexia nervosa.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Elisa Chignola
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Dalle Grave R, Eckhardt S, Calugi S, Le Grange D. A conceptual comparison of family-based treatment and enhanced cognitive behavior therapy in the treatment of adolescents with eating disorders. J Eat Disord 2019; 7:42. [PMID: 31893120 PMCID: PMC6937631 DOI: 10.1186/s40337-019-0275-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this paper is to give a conceptual comparison of family-based treatment (FBT), a specific form of family therapy, and enhanced cognitive behavior therapy (CBT-E) in the management of adolescents with eating disorders. MAIN TEXT FBT and CBT-E differ in the conceptualization of eating disorders, the nature of involvement of parents and the child/adolescent, the number of treatment team members involved, and evidence of efficacy. FBT is the leading recommended empirically- supported intervention for adolescents with eating disorders. Data from randomized controlled trials indicate that FBT works well with less than half of the parents and adolescents who accept the treatment, but cannot be used with those who do not have available parents, or for those with parents who are not accepting of a FBT model, or are unable to participate in a course of this treatment. CBT-E has shown promising results in cohort studies of patients between ages 11 and 19 years, and has recently been recommended for youth with eating disorders when FBT is unacceptable, contraindicated, or ineffective. CONCLUSION There is a need to compare these two treatments in a randomized controlled trial to assess their acceptability, effectiveness, relative cost and cost-effectiveness, and to explore moderators of treatment response.
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Affiliation(s)
- Riccardo Dalle Grave
- 1Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo 89 1-37016 Garda (VR), Verona, Italy
| | - Sarah Eckhardt
- Center for the Treatment of Eating Disorders, Children's Minnesota, Minneapolis, MN USA
| | - Simona Calugi
- 1Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo 89 1-37016 Garda (VR), Verona, Italy
| | - Daniel Le Grange
- 3Department of Psychiatry, University of California, San Francisco, CA USA.,4Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL USA
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Itani L, Calugi S, Kreidieh D, El Kassas G, El Masri D, Tannir H, Dalle Grave R, Harfoush A, El Ghoch M. Validation of an Arabic Version of the Obesity-Related Wellbeing (ORWELL 97) Questionnaire in Adults with Obesity. Curr Diabetes Rev 2019; 15:127-132. [PMID: 29332589 DOI: 10.2174/1573399814666180111111934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/22/2017] [Accepted: 01/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND No specific questionnaire that evaluates Health-Related Quality Of Life (HRQOL) in individuals with obesity is available in the Arabic language. The aim of this study was therefore to propose and examine the validity and reliability of an Arabic language version of the ORWELL 97, a validated obesity-related HRQOL questionnaire. METHODS The ORWELL 97 questionnaire was translated from English to Arabic language and administered to 318 Arabic-speaking participants (106 from clinical and 212 from community samples), and underwent internal consistency, test-retest reliability, construct and discriminative validity analysis. RESULTS Internal consistency and the test-retest reliability were excellent for ORWELL 97 global scores in the clinical sample. Participants with obesity displayed significantly higher ORWELL 97 scores than participants from the community sample, confirming the good discriminant validity of the questionnaire. Confirmatory factor analysis in the clinical sample revealed a good fit for a modified two-factor structure. CONCLUSION Overall, the Arabic version of the ORWELL 97 can be considered validated in Arabic adult patients with obesity, paving the way to further assessment of its responsiveness in measuring changes in health-related quality of life associated with obesity treatment.
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Affiliation(s)
- Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| | - Dima Kreidieh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Germine El Kassas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Dana El Masri
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Hana Tannir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| | - Aya Harfoush
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
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Dalle Grave R, Sartirana M, El Ghoch M, Calugi S. DSM-5 severity specifiers for anorexia nervosa and treatment outcomes in adult females. Eat Behav 2018; 31:18-23. [PMID: 30059831 DOI: 10.1016/j.eatbeh.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate treatment outcomes across the BMI (body mass index)-based DSM-5 severity specifiers in a sample of adult females with anorexia nervosa (AN) treated with enhanced cognitive behavioural therapy (CBT-E). METHOD One hundred and twenty-eight participants with AN (64 outpatients and 64 inpatients) were sub-categorised using DSM-5 severity specifiers and compared by baseline clinical characteristics and treatment outcomes at the end of treatment and at 6- and 12-month follow-ups. RESULTS No significant differences were found across the four severity groups for 'weight recovery' (i.e., BMI ≥ 18.5 kg/m2) or 'good outcome' (i.e., BMI ≥ 18.5 kg/m2 and minimal accompanying eating disorder psychopathology). DISCUSSION Our data suggest that the DSM-5 severity specifiers for anorexia nervosa may have limited clinical utility in predicting treatment outcomes of CBT-E.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy
| | - Massimiliano Sartirana
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy.
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Abstract
OBJECTIVE The aim of this study was to evaluate the change in starvation symptoms over time and their role as potential predictors of change in eating disorder and general psychopathology in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioral therapy (ICBT-E). METHOD Ninety adult female patients with anorexia nervosa (63 restricting type and 27 binge-eating/purging type) were recruited. Body mass index (BMI), Eating Disorder Examination (EDE) interview, Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI) and Starvation Symptoms Inventory (SSI) scores were recorded at admission, at the end of treatment, and at 6-month follow-up. All tests, except for the EDE, were also administered after 4 weeks of treatment to assess the role of refeeding on these variables. RESULTS At baseline, starvation symptoms were correlated with measures of eating disorder and general psychopathology. The treatment was associated with a significant increase in BMI, improvement in eating disorder and general psychopathology, and a significant reduction in starvation symptoms. The change in SSI scores from baseline to 4 weeks predicted the improvement in EDE eating concern subscale and global BSI scores. Among patients who had restored their body weight by the end of treatment, dietary restraint and eating concern EDE-Q subscales, global EDE-Q and SSI scores showed greater improvement in the first 4 weeks than in the remaining 16 weeks of treatment. DISCUSSION The findings underline the close relationship between improvements in both starvation symptoms and eating disorder and general psychopathology and indicate the important role of refeeding in ameliorating both.
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Affiliation(s)
- Simona Calugi
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Verona , Italy
| | - Elisa Chignola
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Verona , Italy
| | - Marwan El Ghoch
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Verona , Italy
| | - Riccardo Dalle Grave
- a Department of Eating and Weight Disorders , Villa Garda Hospital , Verona , Italy
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Abstract
Over the last decade, a new condition, which occurs in the presence of both sarcopenia and obesity, has been termed “sarcopenic obesity”. The term describes the coexistence of obesity, defined as the increase in body fat mass deposition, and sarcopenia, defined as the reduction in lean mass and muscle strength. However, many uncertainties still surround the condition of sarcopenic obesity in terms of its definition, the adverse short- and long-term health effects (i.e., medical disease, psychosocial functioning, quality of life and mortality) and its clinical management. The aim of this short communication is to emphasize some crucial aspects that future research should take into account in order to avoid bias and misinterpretations and to underline that the study of sarcopenic obesity should be considered a scientific and clinical priority, as reported by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO).
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Calugi S, Sartirana M, Milanese C, El Ghoch M, Riolfi F, Dalle Grave R. The clinical impairment assessment questionnaire: validation in Italian patients with eating disorders. Eat Weight Disord 2018; 23:685-694. [PMID: 29368290 DOI: 10.1007/s40519-018-0477-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 12/30/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The Clinical Impairment Assessment (CIA) is a measure of functional impairment secondary to eating disorder symptoms. AIM The aim of this study was to examine the psychometric proprieties of the Italian-language version of the CIA. METHODS The tool was translated into Italian and administered to 259 Italian-speaking in- and outpatients with eating disorders and 102 healthy controls. The clinical group also completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Brief Symptom Inventory (BSI). RESULTS Confirmatory factor analysis revealed a good fit for the original three-factor structure. Internal consistency was high for both the global CIA and all subscale scores, and test-retest reliability was acceptable. The high correlation between CIA and EDE-Q and BSI confirmed the convergent validity of the instrument. T test indicated higher raw scores on CIA in patients with eating disorders than healthy controls, and a cut-off score of 16 on the CIA discriminated between eating disorder and general psychopathology scores. Finally, global CIA and subscale scores were significantly higher in patients who reported objective bulimic episodes, purging behaviours, and excessive exercising than in those who did not; in underweight than in not-underweight patients, and in inpatients than outpatients, confirming the good known-groups validity of the tool. CONCLUSIONS Overall, the study showed the good psychometric properties of the Italian version of the CIA, and validated its use in Italian-speaking eating disorder patients. LEVEL OF EVIDENCE Level V, Descriptive study.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy.
| | - Massimiliano Sartirana
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Federica Riolfi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
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Abstract
Background Interpersonal psychotherapy (IPT) is a time-limited and affect-, life-event-, and present-focused psychotherapy originally conceptualized for unipolar depression, and then adapted to the treatment of other disorders, including eating disorders (EDs). The purpose of this paper is to conduct a systematic review of studies on IPT for EDs. Methods The authors performed literature searches, study selection, method, and quality evaluation independently. Data were summarized using a narrative approach. Results Of the 534 papers retrieved, 37 studies met the inclusion criteria, and 15 were considered for the systematic review (randomized controlled trials and long-term follow-up studies derived from the randomized controlled trials). Their analysis revealed six main findings: 1) no significant differences between IPT and cognitive-behavioral therapy (CBT) were found when administered as monotherapy to patients with anorexia nervosa; 2) when administered as monotherapy to patients with bulimia nervosa (BN), IPT had lower outcomes than CBT and its enhanced version; 3) patients with BN who remitted with IPT showed a prolonged time spent in clinical remission, when followed up on the long term; 4) IPT and CBT, with different timings and methods, have both shown efficacy in the mid-term/long-term period in patients with BN; 5) CBT and its enhanced version produced rapid changes in the acute phase. IPT led to improvements occurring later, with slower changes that tended to maintain efficacy in the long term; 6) abstinence from binge eating with group IPT for binge eating disorder is stable and maintained (or further improved) in the long term. Conclusion IPT is a reasonable, cost-effective alternative to CBT for the overall ED spectrum.
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Affiliation(s)
- Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Antonio Callari
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Alessandra Maglio
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy
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El Ghoch M, Rossi AP, Calugi S, Rubele S, Soave F, Zamboni M, Chignola E, Mazzali G, Bazzani PV, Dalle Grave R. Physical performance measures in screening for reduced lean body mass in adult females with obesity. Nutr Metab Cardiovasc Dis 2018; 28:917-921. [PMID: 30017438 DOI: 10.1016/j.numecd.2018.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Little is known about the reduction of lean body mass (LBM) in obesity, or how to identify it in standard clinical settings. We therefore aimed to assess the prevalence of low LBM in adult females with obesity, and to identify the reliability of simple tools for its screening in this population. METHODS AND RESULTS Dual-energy X-ray absorptiometry (DXA) body composition assessment was used to categorise 147 female participants with obesity as with or without low LBM, according to the new definition that takes into account both appendicular lean mass (ALM) and body mass index (BMI)-ALM/BMI <0.512. Participants were also administered the six-minute walking test, handgrip-strength test and 4-metre gait-speed test. Of the sample of 147 participants, 93 (63.3%) met the criteria for reduced LBM. Stepwise multivariate logistic regression analysis showed that the six-minute walking test was the only independent test associated with low LBM (OR = 0.992, 95%CI 0.987-0.998). Receiver operating characteristic (ROC) curve analysis found that the discriminating cut-off points of the tests considered were 470 m, 3.30 s (gait speed = 1.2 m/sec) and 23.5 kg respectively; the 4-metre gait-speed test seems to provide the best balance of sensitivity and specificity, and the greatest discriminatory power at 90% sensitivity. CONCLUSIONS Treatment-seeking adult females with obesity display a great prevalence of reduced LBM. The six-minute walking test was the only independent test associated with low LBM, but the 4-metre gait-speed test seems to be the most accurate functional test for screening for this condition in that population.
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Affiliation(s)
- M El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy.
| | - A P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - S Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - S Rubele
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - F Soave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - M Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - E Chignola
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - G Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Italy
| | - P V Bazzani
- Department of Radiology, Villa Garda Hospital, Via Montebaldo 89, Garda, 37016, Italy
| | - R Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
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Miniati M, Benvenuti A, Bologna E, Maglio A, Cotugno B, Massimetti G, Calugi S, Mauri M, Dell'Osso L. Mood spectrum comorbidity in patients with anorexia and bulimia nervosa. Eat Weight Disord 2018; 23:305-311. [PMID: 27766498 DOI: 10.1007/s40519-016-0333-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/07/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). METHOD 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not satisfying DSM-IV criteria for Axis I mood disorders were evaluated with the Lifetime Mood Spectrum Self-Report (MOODS-SR) and the Mini-International Neuropsychiatric Interview (MINI). The MOODS-SR explored the subthreshold comorbidity for mood spectrum symptoms in patients not reaching the threshold for a mood disorder Axis I diagnosis. MOODS-SR included 161 items. Separate factor analyses of MOODS-SR identified 6 'depressive factors' and 9 'manic-hypomanic factors'. RESULTS The mean total score of MOODS-SR was significantly higher in BN than in AN-R patients (97.5 ± 25.4 vs 61.1 ± 38.5, respectively; p = 0.0001). 63.6 % of the sample (n = 35) endorsed the threshold of ≥61 items, with a statistically significant difference between AN-R and BN (39.3 % vs 88.9 %; χ 2 = 14.6; df = 1; p = 0.0001). Patients with BN scored significantly higher than AN-R patients on several MOODS-SR factors: (a) MOODS-SR depressive component: 'depressive mood' (11.2 ± 7.4 vs 16.0 ± 5.8; p < 0.05), 'psychomotor retardation' (5.4 ± 5.6 vs 8.9 ± 3.8; p = 0.003), 'psychotic features' (2.0 ± 1.8 vs 4.1 ± 1.6; p = 0.001), 'neurovegetative symptoms' (5.0 ± 2.6 vs 7.7 ± 1.7; p = 0.001); (b) MOODS-SR manic/hypomanic component: 'psychomotor activation' (4.3 ± 3.6 vs 7.4 ± 3.1; p = 0.002), 'mixed instability' (1.0 ± 1.5 vs 2.0 ± 1.6; p < 0.05), 'mixed irritability' (2.5 ± 1.8 vs 3.7 ± 1.6; p < 0.05), 'inflated self-esteem' (1.1 ± 1.4 vs 2.1 ± 1.6; p < 0.05), and 'wastefulness/recklessness' (1.0 ± 1.4 vs 2.0 ± 1.2; p = 0.009). CONCLUSIONS MOODS-SR identifies subthreshold mood signs/symptoms among patients with AN-R, and BN and with no Axis I comorbidity for mood disorders, and provides a better definition of clinical phenotypes.
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Affiliation(s)
- Mario Miniati
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
| | - Antonella Benvenuti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Elena Bologna
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Alessandra Maglio
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Biagio Cotugno
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Simona Calugi
- Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
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Calugi S, El Ghoch M, Conti M, Dalle Grave R. Preoccupation with shape or weight, fear of weight gain, feeling fat and treatment outcomes in patients with anorexia nervosa: A longitudinal study. Behav Res Ther 2018; 105:63-68. [PMID: 29689516 DOI: 10.1016/j.brat.2018.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study aimed to evaluate the trajectories of change over time in body-image concern components in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioural therapy. Moreover, it aimed to study the role of body-image concern components in changes in eating and general psychopathology as well as work and social functioning. METHOD Sixty-six adult patients with anorexia nervosa were recruited. Body mass index (BMI); Eating Disorder Examination 'Dietary Restraint' and 'Eating Concern' subscales; Brief Symptom Inventory (BSI); and Work and Social Adjustment Scale (WSAS) scores were recorded at admission, end of treatment, and at 6- and 12-month follow-ups. The trajectories of change of three components of body image concern, namely 'preoccupation with shape or weight', 'fear of weight gain' and 'feeling fat', were assessed. RESULTS The treatment was associated with a significant improvement in outcome variables and body-image concern components. Baseline 'preoccupation with shape or weight' predicted improvement in Eating Concern, BSI and WSAS scores, while the change in 'fear of weight gain' was associated with improvement in dietary restraint. Baseline and end-of-therapy scores for all three measured body-image concern components predicted achievement of BMI ≥18.5 kg/m2 at 6- and 12-month follow-ups. DISCUSSION These findings highlight the importance of assessing and addressing body-image concern in the management of patients with anorexia nervosa.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy.
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
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Idolazzi L, El Ghoch M, Dalle Grave R, Bazzani PV, Calugi S, Fassio S, Caimmi C, Viapiana O, Bertoldo F, Braga V, Rossini M, Gatti D. Bone metabolism in patients with anorexia nervosa and amenorrhoea. Eat Weight Disord 2018; 23:255-261. [PMID: 27787773 DOI: 10.1007/s40519-016-0337-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/17/2016] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Aim of this study is focusing on bone metabolism in AN patients with amenorrhoea and related estrogen deficiency effects. METHODS AN patients were compared both with healthy females and with postmenopausal women (reference model for estrogen deficiency). The study sample included 81 females with AN. Laboratory tests [25-OH vitamin D, bone turnover markers, intact parathyroid hormone, sclerostin (SOST) and dickkopf-related protein (DKK1)] and dual energy X-ray absorptiometry (DXA) were taken into account. RESULTS AN patients had higher levels of C-terminal telopeptide of type I collagen (CTX) than both control groups. AN adolescents had CTX higher than AN young adults. In postmenopausal women, intact N-propeptide of type I collagen was higher if compared with each other group. In AN groups, Dickkopf-related protein 1 was significantly lower than the two control groups. No differences were found in sclerostin except in adolescents. In AN adolescents, DXA values at femoral sites were higher than in AN young adults and a positive correlation was found with body weight (p < 0.01) and with fat mass evaluated using DXA (p < 0.01). CONCLUSIONS AN women with amenorrhoea have an increased bone resorption like postmenopausal women but bone formation is depressed. The consequent remodeling uncoupling is considerably more severe than that occurring after menopause.
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Affiliation(s)
- L Idolazzi
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy.
| | - M El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, 37016, Verona, Italy
| | - R Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, 37016, Verona, Italy
| | - P V Bazzani
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, 37016, Verona, Italy
| | - S Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, Garda, 37016, Verona, Italy
| | - S Fassio
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
| | - C Caimmi
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
| | - O Viapiana
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
| | - F Bertoldo
- Internal Medicine, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
| | - V Braga
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
| | - M Rossini
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
| | - D Gatti
- Unit of Rheumatology, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy
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Sasdelli AS, Petroni ML, Delli Paoli A, Collini G, Calugi S, Dalle Grave R, Marchesini G. Expected benefits and motivation to weight loss in relation to treatment outcomes in group-based cognitive-behavior therapy of obesity. Eat Weight Disord 2018; 23:205-214. [PMID: 29368291 DOI: 10.1007/s40519-017-0475-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. METHODS We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived treatment needs, readiness and self-confidence to be successful and a battery of psychopathology questionnaires in 793 subjects with obesity (68% women; mean age 48.7; 46% obesity class III) enrolled into a group-based cognitive-behavioral treatment program. Their relevance on attrition and successful weight loss outcome were tested by logistic regression analysis. RESULTS The expected benefits of weight loss scored very high in all physical, psychological and social areas, with differences between genders. Attrition rate was 24, 41 and 65% at 6-, 12-, and 24-month follow-up. Average weight loss was 5.8 ± 7.1 kg (- 4.8%) at 6 months, with 17% of cases (32% of continuers) maintaining weight loss > 10% at 24 months. After adjustment for confounders, attrition was reduced by concern for present health, motivation/consciousness of the importance of physical activity and need for support; treatment discontinuation was favored by concern for body image, by expectations for drug treatment or bariatric surgery, and by high-challenging weight loss targets. Male gender, higher BMI and concern for present health predicted weight loss > 10%, whereas concern for body appearance was associated with lower probability of attaining the desired weight loss targets. CONCLUSION A more precise definition of needs and expectations might help tailor treatment to individual patients, but attrition rates and target reach remain difficult to predict. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Anna Simona Sasdelli
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Maria Letizia Petroni
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy.,Obesity Unit, "Solatrix" Private Hospital, Via Bellini 11, 38068, Rovereto, Italy
| | - Anna Delli Paoli
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Giulia Collini
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Garda, Verona, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy.
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Calugi S, Franchini C, Pivari S, Conti M, El Ghoch M, Dalle Grave R. Anorexia nervosa and childhood sexual abuse: Treatment outcomes of intensive enhanced cognitive behavioural therapy. Psychiatry Res 2018; 262:477-481. [PMID: 28927864 DOI: 10.1016/j.psychres.2017.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/25/2017] [Accepted: 09/11/2017] [Indexed: 09/30/2022]
Abstract
Sexual abuse has been widely studied as a risk factor in anorexia nervosa, but data on its influence on treatment outcomes are scarce. Hence, we compared short- and long-term outcomes of inpatient enhanced cognitive-behavioural therapy (CBT-E) in patients with anorexia nervosa who had and had not suffered sexual abuse. Eighty-one patients were recruited, and body mass index (BMI), Eating Disorder Examination, Brief Symptom Inventory, and Work and Social Adjustment Scale scores were recorded before and after treatment, and at 6- and 12-month follow-ups. Twenty patients (24.7%) reported experiencing childhood sexual abuse before anorexia nervosa onset, while 61 (75.3%) reported none. Both groups displayed similar characteristics before treatment, and similarly large increases in BMI, eating-disorder, general psychopathology, and work and social functioning from baseline to 12-month follow-up. Based on these findings, childhood sexual abuse does not appear to compromise outcomes in patients with anorexia nervosa treated via intensive CBT-E.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy.
| | - Cecilia Franchini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Silvia Pivari
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
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Dalle Grave R, Calugi S, El Ghoch M. Are Personality Characteristics as Measured by the Temperament and Character Inventory (TCI) Associated with Obesity Treatment Outcomes? A Systematic Review. Curr Obes Rep 2018; 7:27-36. [PMID: 29427047 DOI: 10.1007/s13679-018-0294-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Some personality traits seem to be associated with obesity, but there is little information available regarding their association with obesity treatment outcomes. The aim of this systematic review was therefore to assess the associations between personality traits-evaluated by means of the Temperament and Character Inventory (TCI)-and outcomes of obesity treatment, including attrition, weight loss, and weight loss maintenance. The PubMed database was searched, and studies were screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and data were collated using a narrative approach. RECENT FINDINGS Of the 886 articles retrieved, 9 studies assessing personality traits by means of the TCI in participants with obesity met the inclusion criteria and were reviewed. This approach revealed three main findings: (i) only one study found that attrition rate-during a 6-month behavioral weight loss program-is predicted by low reward dependence scores at baseline; (ii) two studies found that lower novelty-seeking and higher self-directedness scores at baseline positively predict short-term weight-loss magnitude; and (iii) four studies found that higher persistence and lower novelty-seeking scores at baseline predicted weight maintenance at 12 and 24 months. Novelty-seeking and self-directedness traits appear to be predictors of short-term weight loss (≤ 6 months), and persistence and novelty-seeking traits may be related to long-term weight loss maintenance (≥ 12 months), although great uncertainty still exists regarding predictors of attrition.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, VR, Italy
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Saleh F, Itani L, Calugi S, Dalle Grave R, El Ghoch M. Adipose-derived Mesenchymal Stem Cells in the Treatment of Obesity: A Systematic Review of Longitudinal Studies on Preclinical Evidence. Curr Stem Cell Res Ther 2018; 13:466-475. [PMID: 29766824 DOI: 10.2174/1574888x13666180515160008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Obesity is an increasing global health problem, but its treatment is not yet optimal, especially in the long term. For this reason, preclinical studies have been conducted relating to a new therapeutic strategy for obesity based on adipose-derived mesenchymal stem cells (AD-MSCs). The aim of our systematic review is to summarize these findings deriving from the animal model in order to establish whether there is sufficient evidence to justify going forward to clinical studies. METHODS Literature searches, study selection, methods and quality appraisal were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were collated using a narrative approach. RESULTS Of the 578 articles retrieved, seven studies met the inclusion criteria, and their analysis revealed several main findings. There was a strong evidence of the positive effect of AD-MSCs in obesity treatment in terms of body weight, glucose metabolism homeostasis, lipid profiles, non-alcoholic fatty liver disease and systemic inflammation. Moreover, there was recent evidence from a few studies for a significant effect of AD-MSCs transplantation on the improvement of obesity-related hormonal status, (i.e., leptin) and body composition patterns, though these investigations may need further replication. CONCLUSION The effects of AD-MSCs transplantation on obesity, in terms of weight loss and obesityrelated diseases, are promising in animal models. In the future, further well-designed studies should be performed to understand the mechanism of action and to overcome some methodological limitations such as the small sample sizes and risk of bias evidenced in our systematic review, before moving forward to assess AD-MSCs as a potential strategy for human obesity management.
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Affiliation(s)
- Fatima Saleh
- Faculty of Health Sciences, Department of Medical Laboratory Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Leila Itani
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, via Montebaldo, 89, 37016 Garda, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, via Montebaldo, 89, 37016 Garda, Italy
| | - Marwan El Ghoch
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
- Department of Eating and Weight Disorders, Villa Garda Hospital, via Montebaldo, 89, 37016 Garda, Italy
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Kreidieh D, Itani L, El Kassas G, El Masri D, Calugi S, Dalle Grave R, El Ghoch M. Long-term Lifestyle-modification Programs for Overweight and Obesity Management in the Arab States: Systematic Review and Meta-analysis. Curr Diabetes Rev 2018; 14:550-558. [PMID: 28625131 DOI: 10.2174/1573399813666170619085756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/29/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity is a growing health problem worldwide. It is associated with serious medical and psychosocial comorbidities that increase the risk of mortality. However, strong evidence confirms lifestyle-modification programs as the cornerstone treatment for excess weight and obesity. The aim of this systematic review was to assess the effectiveness of the lifestyle-modification programs for weight management delivered in Arabic-speaking countries. METHODS The PubMed database was searched, and studies conducted in humans were identified and screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. RESULTS Of the 1057 articles retrieved, six studies, conducted in four Arab countries, comprising a total of 444 adolescent and adult participants of both genders with overweight and obesity, met the inclusion criteria and were reviewed. Most studies that assessed weight loss at 6-month follow-up showed no significant reduction in body weight. Meta-analysis confirmed that the lifestyle-modification programs delivered were no more effective than other treatments. Only one article reported significant weight-loss maintenance after 12 months of follow-up. However this was a prospective non-controlled study in which the weight loss maintained (=4%) did not conform to the standard for clinical significance (>10%). CONCLUSION Lifestyle-modification programs for weight management delivered in Arabic-speaking countries seem lacking in effectiveness due to methodological weaknesses in program adaptation, a lack of expert clinical supervision before and during implementation, and the presence of barriers to lifestyle modification, especially for women. Future studies should bear these features in mind.
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Affiliation(s)
- Dima Kreidieh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Germine El Kassas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Dana El Masri
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
| | - Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut, Lebanon
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda (VR), Italy
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El Ghoch M, Calugi S, Dalle Grave R. Weight cycling in adults with severe obesity: A longitudinal study. Nutr Diet 2017; 75:256-262. [PMID: 29114979 DOI: 10.1111/1747-0080.12387] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/12/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
AIM Although weight cycling is a common phenomenon in treatment-seeking patients with obesity, its consequences on health outcomes have not yet been completely clarified. We therefore aimed to investigate the effect of one cycle of intentional weight loss and regain on energy expenditure, body composition, cardiovascular risk factors and psychosocial variables in patients with severe obesity. METHODS Clinical and psychosocial variables were measured in 38 adult patients with severe obesity (body mass index (BMI): 43.5 ± 7.2 kg/m2 ) consecutively readmitted to rehabilitative residential treatment (T1) for severe obesity after a cycle of weight loss (16.7 ±7.7 kg) and regain (15.1 ±11.3 kg), and compared with those recorded at a prior admission (T0). RESULTS No significant differences were found between T0 and T1 values for weight, BMI, waist circumference, total body fat percentage, fat-free mass percentage, respiratory quotient, measured or predicted resting energy expenditure, metabolic adaptation, cardiovascular risk factors or psychosocial variables. However, younger patients (r = -0.38, P = 0.023) and those with higher historical weight (r = 0.43, P = 0.010) tended to regain more weight. CONCLUSIONS The absence of negative physical and psychological effects of weight cycling indicates that the risk of weight regain should not be a barrier to encouraging weight loss efforts in patients with severe obesity.
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
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