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

Feeling fat, a subjective feeling of being overweight that does not always correspond to actual body weight, is commonly reported in patients with an eating disorder. Research suggests that feeling fat relates to deficits in interoceptive awareness, the perception and integration of signals related to body states. Relatedly, recent work has linked feeling fat to affective constructs, such as depressive symptoms and guilt. The current study explores the unique relationships between feeling fat, self-reported, and objective IA, guilt, alexithymia, and depressive symptoms. Female undergraduates (N = 128) completed the 11th item of the Eating Disorder Examination Questionnaire, the Toronto Alexithymia Scale, the Guilt subscale of the Positive and Negative Affect Schedule, and the Beck Depression Inventory-II. Participants also completed two IA measures: a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness. All collected measures explained 56% of the variability in feeling fat. Depressive symptoms, self-reported IA, and BMI accounted for significant variability in feeling fat. Relative weights analyses revealed that depressive symptoms accounted for the most variability in feeling fat (19%). This finding remained significant after controlling for BMI, which also accounted for significant variability in feeling fat (25%). Our results replicate previous findings that depressive symptoms relate significantly to feeling fat and extend this work by incorporating the role of interoceptive awareness, guilt, and alexithymia. Endorsement of feeling fat during an intake assessment may alert clinicians to assess for depressive symptoms, and focusing on depressive symptoms in treatment may improve feeling fat. Level I Evidence obtained from an experimental study.

BACKGROUND: To estimate the prevalence of overweight and obesity among adolescents in Sardinia and to examine the association with several biological and geographic factors. METHODOLOGY: A cross-sectional study was performed in 3,946 unselected adolescents (2,011 boys, 1,935 girls; aged 11–15 years) attending the public secondary schools in 33 Sardinian municipalities: 28 semi-rural, 5 urban, sub-grouped according to their geographic location (mountain, hillside and plain). Oversized children were measured and their BMI defined as being above normal values according to parameters provided by the International Obesity Task Force (IOFT) by Cole et al. (BMI for age >= 95th percentile). Relative risk for overweight and obesity was calculated using Poisson regression analysis: risks associated to each covariate were reciprocally adjusted. The 95% confidence interval (CI) of the estimated risk was calculated using Wald’s formula (RR, RR = logn ß±1.96seß). MAIN FINDINGS: The overall prevalence rate found for overweight and obesity was 14.9% (95% C.I.: 13.7–16.1%) and 3.7% (95% C.I. 3.1–4.3%), respectively. Overweight rate showed no association with gender, whereas belonging to the female sex constituted a significant protection against obesity. Increasing age in the range 12-14 years was protective against both overweight and obesity in the whole sample. A similar finding however was not observed for obesity in girls or overweight in boys, when considered separately. Boys, but not girls, living in urban areas displayed a modest though significant 20% increase in overweight and a 40% decrease in obesity risk. Living in a mountainous area conveyed a 30% decrease in risk of overweight and a 50% decrease in risk of obesity, when compared to living on the plains and hillside combined. However, the small sample size of study subjects living in mountainous areas generated extremely wide 95% confidence intervals, thereby preventing the drawing of any significant conclusions. CONCLUSION: In comparison with other surveys performed by the IOFT, Sardinian adolescents show a low prevalence rate for oversize, emphasizing a marked discrepancy with the general north-south rising trend of oversize observed throughout Europe. Geographic location, aesthetic or other age related factors seem to exert a different genderspecific influence on overweight and obesity. SIGNIFICANCE: The present report is cross sectional and the consequences of overweight and obesity on individuals over time are not traceable. However, the outcome of the study suggests the need to implement suitable policies and public health programs leading to increased awareness.

This study explored intellectual profile of children attending a clinic for obesity and to what extent their characteristics predicted full scale IQ. Totally, 60 patients aged 8–16 years were recruited consecutively from the National Childhood Obesity Centre at Karolinska University Hospital in Sweden. These patients were tested using the Wechsler Intelligence Scale for Children (WISC). Of these 60 patients, 51 (85%) parents gave informed consent for their children’s results to be included in this study (mean age 12.94, standard deviation, SD 2.42). The children’s mean full scale IQ was 85.39. Parental education was strongly associated with child IQ. After adjustment for parental education, female gender and a higher level of obesity were associated with lower IQ. Obese children are at increased risk of having below average IQ and strategies to tackle associated problems should be developed in paediatric obesity clinics.

Leptin is an adipocyte-derived signal factor (167 amino acid protein) encoded by the ob gene in chromosome 7q31 that regulates eating behaviour via central neuroendocrine mechanisms. It has been shown that serum leptin levels correlate with weight and percentage body fat in normal and obese individuals, but the exact correlation between leptin and body weight in anorexic and bulimic patients has not yet been clarified. We investigated leptin levels in the serum of 58 female subjects aged 15-36 years: 10 with bulimia nervosa (BN); 12 with anorexia nervosa (AN); 12 overweight controls (not BN); 12 weight-reduced controls (not AN); and 12 normal weight controls. The aim of the study was to evaluate the possible correlations between leptin levels and the body mass index (BMI) in all five groups. Our results showed that the serum leptin levels of the bulimic patients were similar to those of the healthy controls, with a positive correlation between leptin and BMI. Although bulimic patients have very bad nutritional behaviour, their leptin levels do not appear altered. Serum leptin was significantly (p<0.001) reduced in the anorexic patients because of the dramatic decrease in adipose mass caused by the nutritional defect, as: is further supported by the significantly (p<0.001) low level of transferrinemia. Our data suggest that, although significantly reduced, serum leptin levels in fasting anorexic patients are non-linearly related to body weight (BMI).

Emotional eaters eat to relieve their emotions. However, food also contains esthetic information. People generally perceive ugly food as unhealthy and unpalatable. Does the esthetic information of food influence an emotional eater’s desire for food in a negative emotional state? In particular, do they have the same lower eating intentions for low esthetic food as non-emotional eaters? Based on these questions, the present study examined whether the esthetic value of food influences emotional eaters’ desires for food. The experiment used a 2 (eating type: emotional eating vs. non-emotional eating) × 2 (food style: high esthetic vs. low esthetic) mixed experimental design. We measured the emotional and non-emotional eaters’ eating intentions for different esthetic foods when experiencing negative emotions. The results showed that emotional eaters have higher intention to eat high esthetic foods. However, they did not have a high eating intention for all foods, and their eating intention did not differ from that of non-emotional eaters when faced with low esthetic food. In conclusion, food esthetic value can affect individual eating intentions. Even for emotional eaters who are in a negative mood, they also did not have a higher eating intention for low esthetic food compared with no-emotional eater. Level II: controlled trial without randomization.

Food addiction (FA) refers to a condition characterized by addiction in relation to some high-fat and high-sugar carbohydrate that leads to clinically significant impairment or distress on several areas of functioning. The Yale Food Addiction Scale 2.0 (YFAS 2.0) has been recently updated to measure FA according to the DSM-5 criteria for substance-related and addictive disorders. This study aimed at validating the Italian version of YFAS 2.0. A sample of 574 Italian university students was involved in this research. Confirmatory Factor Analysis (CFA) and Kuder–Richardson’s alpha for dichotomous data were run to evaluate scale structure and reliability. Correlations between YFAS 2.0 and eating psychopathology, binge eating, sleep, and mood symptoms were evaluated. Analogously to the original version, a single factor structure emerged at the CFA. The alpha coefficient was 0.87. Moreover, sound, from moderate to high, correlations were found with other measures. The Italian version of the YFAS 2.0 has demonstrated in a sample of university students to be a useful tool to investigate food addictions. Level of evidence Level V, descriptive study.

Chúng tôi đã đánh giá tính hữu ích của bài kiểm tra Stroop đã được sửa đổi như một thước đo mối quan tâm về hình ảnh cơ thể ở phụ nữ có nguy cơ mắc rối loạn ăn uống. Dữ liệu đã được thu thập từ 31 người tham gia trong một chương trình phòng ngừa rối loạn ăn uống. Bài Stroop đã được sửa đổi có mối liên hệ đáng kể với các tập hào hứng ăn uống thái quá và một thước đo rõ ràng về mối quan tâm hình dạng. Hiệu ứng Stroop truyền thống đã được tìm thấy trong khi hiệu ứng Stroop đã được sửa đổi là không đáng kể. Kết quả đặt ra câu hỏi về tính hữu ích của bài kiểm tra Stroop đã sửa đổi trong việc xác định những phụ nữ có nguy cơ. Các vấn đề phương pháp và lâm sàng được thảo luận.

The aim of the study was to examine the effects of meal supervision, provided by health professionals, volunteers or family members, on anthropometric, nutritional, psychological, and behavioural outcomes in patients with eating disorders (EDs). The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The last search was conducted in three databases (PubMed, Scopus, and the Cochrane library). Inclusion criteria considered paediatric and adult patients suffering from EDs, regardless of ethnicity, and treated in different therapeutic settings. The quality of the studies was evaluated using the Newcastle Ottawa Scale (NOS) adapted for cross-sectional studies and Version 2 of the Cochrane risk-of-bias assessment tool for randomised trials. 3282 articles were retrieved, out of which only 6 met the eligibility criteria. A marked heterogeneity in definitions and approaches to supervised mealtime was observed. This variability emerged in the methodologies used in the supervised meal, and in the reference values for the outcome measures that were used, such as the analysis of different parameters. Based on these observations, mealtime assistance provided to patients with EDs shows an overall positive effect on eating behaviour and dysfunctional attitudes. Future research should be prompted to provide a thorough definition of a structured procedure for meal assistance to be potentially and systematically included in the nutritional rehabilitation protocols for patients with EDs. Level IV systematic reviews of uncontrolled trials.

Night eating syndrome (NES) is characterized by evening hyperphagia and/or nocturnal ingestion. The main objective of this study was to assess the percentage of students complying with symptoms and behaviors consistent with the diagnostic criteria for NES, and explore its association with body mass index (BMI), dietary habits, physical activity, smoking status, and sleep patterns, among a sample of college students. A cross-sectional survey was conducted among a sample of 413 undergraduate students, mean age of 20.6 ± 1.68 SD, at Central Michigan University. Students completed an online survey including demographic information and the Night Eating Diagnostic Questionnaire (NEDQ) and Pittsburgh Sleep Quality Index Questionnaire (PSQI). Participants were grouped based on self-reporting of the presence and frequency of night eating-related symptoms and behaviors related to the diagnostic criteria for NES as follows: normal, mild night eater, moderate night eater, and full-syndrome night eater. Pearson’s Chi-squared, Student’s t test, and Wilcoxon rank-sum test were used to test the association between students with and without any night eating behavior in relation to BMI, lifestyle variables, and sleep duration/quality. Results showed that the proportion of students complying with symptoms and behaviors consistent with full-syndrome of NES was 1.2%. There were no significant differences between students complying with symptoms and behaviors consistent with any level of NES and those without any night eating behavior regarding BMI, eating habits, physical activity, and smoking status. NES was significantly related to sleep duration (P = 0.023). Students complying with symptoms consistent with any level of NES reported shorter sleep time and had higher total PSQI score (6.73 ± 4.06) than students without the syndrome (5.61 ± 2.61) (P = 0.007). Although the percentage of students complying with full-syndrome NES was relatively low in our student sample, those students had shorter sleep time and poorer sleep quality than the other groups. However, it is unclear whether evening hyperphagia is a response to a lack of sleep or vice versa, and further research is needed. Level III, case-control analytic study.