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1.
Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample.
Kesby, A, Maguire, S, Vartanian, LR, Grisham, JR
Journal of behavior therapy and experimental psychiatry. 2019;:101492
Abstract
BACKGROUND AND OBJECTIVES Intolerance of uncertainty (IU) is a transdiagnostic process contributing to the maintenance of anxiety disorders, and is a potential target for treatment. Recent literature has investigated IU as a cognitive process underpinning pathological fear and anxiety in Anorexia Nervosa (AN). The current study was designed to examine trait and state IU, and their relationship to restrictive eating disorder symptoms, anxiety, worry, cognitive rigidity and eating behaviour. METHODS A sample of undergraduate women (N = 85) completed measures of eating disorder symptoms, IU, cognitive rigidity and worry. Participants were randomised to complete an eating task under one of two conditions: the "certain" condition received a high-calorie meal and nutritional information, while the "uncertain" condition received the meal alone. During the meal, state IU and state anxiety were examined at three time-points (baseline, pre-eating, post-eating). RESULTS Trait IU was correlated with cognitive rigidity, worry, global eating disorder symptoms, and, in particular, dietary restraint. No differences emerged between conditions with respect to eating-related anxiety, or amount of food eaten. Controlling for condition and eating disorder symptoms, state IU predicted pre-eating anxiety. Beyond the contribution of condition, BMI and eating disorder symptoms, state IU predicted consumption, specifically greater dietary restriction. LIMITATIONS The study employed a non-clinical sample. CONCLUSIONS IU may be implicated in a rigid cognitive style, the anxiety response to energy-dense food, and restrictive eating behaviour. Should these findings be replicated in a clinical sample, then IU might emerge as an adjunctive treatment target for AN.
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2.
Problematic Eating Behaviors and Eating Disorders Associated with Bariatric Surgery.
Brode, CS, Mitchell, JE
The Psychiatric clinics of North America. 2019;(2):287-297
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Abstract
Bariatric surgery candidates often report problematic and/or eating disordered behaviors. For most patients, these eating behaviors improve after surgery. A subset, however, experience a recurrence or new onset of problematic eating behaviors as early as 2 months to 18 months after surgery, which can result in compromised weight loss/excessive weight regain. Those most at risk are individuals with comorbid psychopathology (ie, loss-of-control eating or depression) after surgery. For some, such problems are present before surgery. Therefore, it is critical to monitor patients closely after surgery so that appropriate psychiatric treatments can be provided if indicated.
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Eating disorders risk among medical students: a global systematic review and meta-analysis.
Jahrami, H, Sater, M, Abdulla, A, Faris, MA, AlAnsari, A
Eating and weight disorders : EWD. 2019;(3):397-410
Abstract
PURPOSE Medical students appear to be a high-risk group to develop psychological problems including eating disorders (ED). The prevalence estimates of ED risk vary greatly between studies. This systematic review and meta-analysis was done to estimate the prevalence of ED risk among medical students. METHODS An electronic search of EMBASE, MEDLINE, ProQuest and Google Scholar was conducted. Studies that reported the prevalence of ED risk among medical students and were published in English peer-reviewed journals between 1982 and 2017 were included. Information about study characteristics and the prevalence of ED risk were extracted by four investigators. Each article was reviewed independently by at least two investigators. Estimates were pooled using random-effects meta-analysis using the DerSimonian-Laird method. The main outcome of interest was the prevalence of ED risk in medical students. RESULTS The prevalence of ED risk among medical students was extracted from nineteen cross-sectional studies across nine countries (total participants n = 5722). The overall pooled prevalence rate of ED risk was 10.4% (497/5722 students, 95% CI 7.8-13.0%), with statistically significant evidence between-study heterogeneity (Q = 295, τ2 = 0.003, I2 = 94.0%, P < 0.001). Prevalence estimates between studies ranged from 2.2 to 29.1%. CONCLUSION In this systematic review and meta-analysis, the summary prevalence of ED risk among medical students was 10.4%. Further research is needed to identify and prevent ED in this population. Studies are also needed to investigate concurrent pathologies associated with ED risk. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Problematic Internet Use as a Predictor of Eating Disorders in Students: A Systematic Review and Meta-Analysis Study.
Hinojo-Lucena, FJ, Aznar-Díaz, I, Cáceres-Reche, MP, Trujillo-Torres, JM, Romero-Rodríguez, JM
Nutrients. 2019;(9)
Abstract
Problematic Internet use (PIU) has begun to be linked to the development of certain eating disorders. This uncontrolled use of the Internet is mainly found in the student population. The purposes of this paper were to determine PIU-related eating disorders in students from a systematic review of the literature and to analyze the incidence of PIU in eating disorders through a meta-analysis of the literature. We used two electronic databases (Web of Science and Scopus) from inception to June 2019. The systematic literature review was based on fixed inclusion and exclusion criteria. A total of 12 studies were identified (systematic review) and 10 studies for meta-analysis, which included 16,520 students. Different eating disorders were associated with PIU: anorexia nervosa, bulimia nervosa, binge-eating disorder, food preoccupation, loss of control eating, and dieting. Furthermore, meta-analysis confirmed that PIU is a predictor of eating disorders in students. The groups of students with PIU presented a higher rate in the presence of eating disorders, these differences being significant. Finally, this study showed empirical evidence on the link between PIU and eating disorders. The need for prevention in childhood and adolescence is highlighted.
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Psychosocial Concerns Following Bariatric Surgery: Current Status.
Kalarchian, MA, Marcus, MD
Current obesity reports. 2019;(1):1-9
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the current status of research on psychosocial concerns following bariatric surgery. RECENT FINDINGS Bariatric surgery has a positive overall impact on weight and obesity-related comorbidities, as well as a positive short-term impact on mental health and psychosocial functioning. Nonetheless, research has documented a number of different psychosocial concerns that may emerge following surgery including maladaptive eating, substance use disorders, suicide, lack of social support, and excess skin. Moreover, special populations of patients may have distinctive psychosocial concerns based on sociodemographic factors such as age or severity of obesity. Available studies suggest that psychosocial interventions have a positive impact on post-surgery outcomes, particularly maladaptive eating. However, research is limited, and long-term data are lacking. Monitoring patients after bariatric surgery for negative psychosocial outcomes is warranted. Research is needed to develop and evaluate personalized approaches to optimize long-term weight loss and psychosocial adjustment.
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The Female Athlete Body project study: 18-month outcomes in eating disorder symptoms and risk factors.
Stewart, TM, Pollard, T, Hildebrandt, T, Wesley, NY, Kilpela, LS, Becker, CB
The International journal of eating disorders. 2019;(11):1291-1300
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Abstract
OBJECTIVE To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors. METHOD This study was a community participatory three-site, two-arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18-month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin-ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]). RESULTS Linear mixed effects models with team as a cluster level variable and study condition as a between-subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin-ideal internalization and increased BMI at 18-months. No other significant differences were found. DISCUSSION This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18-month follow-up. This trial is one of only three trials with female athletes that have shown long-term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18-month follow-up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes. TRIAL REGISTRATION Clinical trials NCT01735994.
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A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3-month follow-up.
Castillo, I, Solano, S, Sepúlveda, AR
European eating disorders review : the journal of the Eating Disorders Association. 2019;(5):541-556
Abstract
Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (η2 = 0.04) and in disordered eating attitudes/behaviours (η2 = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs.
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Neural responses to food stimuli among individuals with eating and weight disorders: a systematic review of event-related potentials.
Chami, R, Cardi, V, Lautarescu, A, Mallorquí-Bagué, N, McLoughlin, G
International review of psychiatry (Abingdon, England). 2019;(4):318-331
Abstract
A systematic review was conducted to investigate event-related potentials (ERPs) in response to food and non-food stimuli among individuals with eating and weight disorders. Limiting the search to studies that have analysed ERPs relating to motivated attention and inhibitory control, 19 research papers were extracted from a systematic search in PubMed, Ovid, and Web of Science (2000-2018). An enhanced attentional bias towards food over non-food images (as indexed by P3(00) and LPP amplitudes) was evident for all populations. Individuals with binge eating disorder showed an enhanced attentional response to food cues compared to healthy controls. Inhibitory control-related ERP components (N2(00) and P3a) increased during food-specific no-go trials, but did not differentiate overweight from 'healthy' weight groups. The N2 amplitude to food pictures were positively correlated with caloric intake and food craving among individuals with obesity and binge eating disorder, respectively, while P3(00) was sensitive to hunger levels among overweight and obese females. The heterogeneity of stimuli/paradigms adopted, component timescales extracted, ERPs analysed, and data presented has challenged this review's ability to produce a robust synthesis of results. Some recommendations for future research are discussed.
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Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis.
Trindade, AP, Appolinario, JC, Mattos, P, Treasure, J, Nazar, BP
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;(2):179-187
Abstract
OBJECTIVE To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED. METHODS The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO). RESULTS Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively). CONCLUSION Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.
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Adverse Birth Outcomes Associated with Types of Eating Disorders: A Review.
Charbonneau, KD, Seabrook, JA
Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada. 2019;(3):131-136
Abstract
At least 5% of women have an eating disorder (ED) during pregnancy. These EDs affect prepregnancy body mass index (BMI) and weight gain during pregnancy, factors associated with birth complications and adverse neonatal outcomes. This review contributes to the literature by examining several adverse birth outcomes associated with EDs and differentiates between past and present EDs. Of the 18 articles reviewed, EDs were associated with preterm birth in 5/14 (36%) and small-for-gestational-age in 5/8 (63%) studies. Anorexia Nervosa increases the odds of a low birth weight baby, particularly when women enter pregnancy with a low BMI. Binge Eating Disorder is positively associated with having a large-for-gestational-age infant, and Bulimia Nervosa is associated with miscarriage when symptomatic during pregnancy. Having a current ED increases the risk for adverse birth outcomes more than a past ED. Since the aetiology of adverse birth outcomes is multi-factorial, drawing conclusions about causal relationships between EDs and birth outcomes is problematic given the small number of studies reporting these outcomes. Resources should target preconception interventions that put EDs into remission and help women achieve a healthier BMI prior to pregnancy, as these have been consistently shown to improve birth outcomes.