Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity

To allocate obese patients to the correct therapeutic setting, the Italian Obesity Society (SIO) has suggested a new algorithm based on the Edmonton obesity staging system (EOSS). The aim of our study was to apply in two retrospective cohorts of obese patients both the EOSS and the activities of daily life (ADL) scale to identify also their rehabilitation needs. 288 out-patients and 298 in-patients were recruited. All patients were evaluated with a multidisciplinary approach and the mental, mechanical, and metabolic comorbidities were scored. The 2 groups differed for gender (28.8% men in out-patients, p = 0.001), age (> 60 years in in-patients, p = 0.03), BMI (40.8 ± 6.3 kg/m2 in in-patients, p < 0.001), and ADL (44.0 ± 16.0 in in-patients, p < 0.001). EOSS distribution was significant different: stages 0 and 1 were more present in out-patients and stages 3 and 4 in in-patients. In both groups, BMI increased significantly in EOSS category [95% CI + 1.4 (+ 0.5; + 2.2) for out-patients and + 1.7 (+ 0.7; + 2.6) for in-patients] and ADL were positively correlated with EOSS [95% CI + 5.0 (+ 2.5; + 7.4) for out-patients and + 9.9 (+ 7.7; + 12.2) for in-patients]. Mean ADL difference between the two groups, adjusted for age (over/under 60 years), BMI category, and EOSS was 24.8 (p < 0.0001). SIO algorithm seems an effective tool for staging obesity in relation to the clinical impairment. To better define the correct rehabilitative allocation of obese patients, we suggest to integrate the SIO algorithm with the ADL score. Level III, retrospective case-control analytic study.

For malnourished patients with end stage renal disease (ESRD) on hemodialysis (HD), refeeding is complex; true weight (dry weight) gain must be accounted for as it accrues to safely dialyze. This case describes the challenge of following true weight to appropriately adjust treatment for a patient with ESRD on HD requiring inpatient refeeding. A 17-year-old female presented to an adolescent clinic after referral from her nephrologist for malnutrition and disordered eating. Her weight was 38.3 kg and height was 155.2 cm (76.2% of mean estimated body mass index, MEBMI). Her history was remarkable for a diagnosis of ESRD. The patient was admitted to the inpatient disordered eating program. The patient continued HD three times a week and was followed by nephrology. The team noted that the patient’s dry weight for dialysis had not yet been adjusted, leading to increasingly aggressive dialysis. The nephrology team addressed the need for reassessments of dry weight by utilizing the “crit line” method. Frequent assessment allowed the nephrology team to account for intensive renourishment of the patient. After a 64 day hospital stay, the patient achieved 88.1% of MEBMI, calculated using her most up to date dry weight. Among patients with malnutrition and ESRD requiring HD, it is imperative to determine a patient’s dry weight at the beginning of refeeding so the treatment plan can be adjusted according to the dynamic, true weight of the patient. This case illustrates the importance of interdisciplinary teamwork when managing a patient with malnutrition and ESRD on HD.

The Power of Food Scale (PFS) is designed to measure the personal susceptibility to highly processed and palatable foods. The purpose of this study was to validate the Italian version of PFS (PFS-It) in the adult population. Data were obtained from 536 Italian adults aged between 18 and 86 years. The PFS-It and the Binge Eating Scale (BES) were administered to all participants. The factorial structure of the PFS-It was investigated using a CFA that returned excellent fit indices. The Cronbach’s alpha coefficients for the PFS-It total score and for its subscales (Food Available, Food Present, and Food Tasted), as well as for the BES total score, revealed good to moderate reliability. Finally, PFS-It was positively and significantly correlated with BES. To our knowledge, this is the first study to propose the norms and psychometric characteristics of the Power of Food Scale in an Italian population. The results show that PFS-it is a valid and reliable instrument for the measurement of Hedonic Hunger in an adult Italian population. Level V, cross-sectional descriptive study.

Mothers serve as a primary socializing figure among adolescent girls at a time when they are at high risk of body image concerns and disordered eating behavior, and this influence may vary by weight status. Body talk may be one mechanisms of influence in this relationship. The current study utilized an observational measure of body talk to investigate the relationship between adolescent girls’ body talk with mothers, eating disorder symptoms, and body dissatisfaction. Participants included 100 mother–daughter dyads who completed self-report measures of body dissatisfaction and eating behavior and engaged in a 10-min discussion about the daughter’s body image. Results indicated that the relationship between both positive and negative body talk and body dissatisfaction varied by weight status. For healthy/underweight adolescents, negative body talk is related to higher body dissatisfaction (b = 0.04, SE 0.01, p < 0.01) and positive talk is related to lower body dissatisfaction (b = − 0.06, SE 0.02, p < 0.001). No relationship was found for individuals of overweight/obese status. Body talk was unrelated to eating disorder symptoms for all adolescents. Given the current findings, mothers should continue to limit their engagement in body talk (particularly negative talk) within the home. V, cross-sectional descriptive study.

Vitamin A deficiency (VAD) after bariatric surgery is recognised as a significant post-operative complication that can lead to visual impairment. We report two cases of night blindness and visual impairment caused by VAD after malabsorptive bariatric surgery. Both patients were treated with intramuscular vitamin A replacement and made near complete recovery in their vision. Ocular complications due to VAD should be diagnosed and treated promptly in patients after bariatric surgery because these complications are reversible.

Food craving has been shown to induce states of psychological challenge, indexed by increases in adrenaline but not cortisol production. The study aimed to test the relationship between challenge and (1) desire thinking (the active processing of the pleasant consequences of achieving a desired target and planning how to do so) and (2) craving. Participants (N = 61) self-reported their levels of craving and desire thinking. They were then presented with situations in which their craving would be fulfilled or not via a false feedback practice task (a wordsearch task). During this period psycho-physiological measures of challenge and threat were taken. Higher levels of craving were linked to challenge only when the craved object was likely to be obtained. Whilst anticipating reward fulfillment, higher levels of craving were linked to higher levels of desire thinking. In turn, higher levels of desire thinking were related to lower levels of challenge. In contrast, during the processes of reward fulfillment, desire thinking was linked to increased challenge (i.e., a positive indirect effect). Craving is linked to increased levels of psychological challenge when the object of the craving can be obtained, but it is unrelated to craving when it is not. The research also highlights the importance of desire thinking as an important, but complex, mediator in the relationship between craving and motivational states: desire thinking inhibited challenge when anticipating craving fulfillment, but encouraging it during the process of fulfillment itself. I: Evidence obtained from at least one properly designed randomized controlled trial.

Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries. Level of evidence Level V, descriptive cross-sectional survey.

The aim of this study was to expand the evidence on the feasibility and impact of food-specific inhibitory control training in a community sample of people with disinhibited eating. Recruitment and data collection were conducted during the COVID-19 outbreak, in Italy. Ninety-four adult individuals with disinhibited eating were randomised to one of two conditions: App-based food-specific inhibitory control training or waiting list. Participants were assessed at baseline, end of intervention (2 weeks following baseline) and follow-up (one week later). The assessment measures included questionnaires about eating behaviour and mood. Seventy-three percent of the sample reported a diagnosis of binge eating disorder, and 20.4% a diagnosis of bulimia nervosa. Retention rates were 77% and 86% for the food-specific inhibitory control training and the waiting list conditions, respectively. Almost half of the participants allocated to the training condition completed the “recommended” dose of training (i.e., 10 or more sessions). Those in the training condition reported lower levels of wanting for high-energy dense foods (p < 0.05), a trend for lower levels of perceived hunger (p = 0.07), and lower levels of depression (p < 0.05). Binge eating symptoms, disinhibition, wanting for high-energy dense foods, stress and anxiety were significantly lower at end of intervention, compared to baseline (p < .05). Findings corroborated the feasibility of food-specific inhibitory control training, and its impact on high-energy dense foods liking. The study expands the evidence base for food-specific inhibitory control training by highlighting its impact on perceived hunger and depression. The mechanisms underlying these effects remain to be clarified. Level I, Evidence obtained from at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.