Eating and weight disorders: EWD

We examined the relation of different behavioral dimensions of depression with weight-related variables (BMI percentile, sedentary behavior, eating attitudes, and weight control behaviors) in children aged 11 to 13 years. Depression was assessed using the Children's Depression Inventory (CDI). Sedentary behavior was measured in 45 sixth grade students (23 boys and 22 girls) using a validated 24-hour recall instrument, the Self-Administered Physical Activity Checklist. BMI was calculated directly from measured height and weight (kg/m2). The Children's Eating Attitudes Test (ChEAT) was used to measure eating attitudes and weight control behaviors. There were not significant gender differences in reported minutes (142 vs. 91 minutes for boys vs. girls; p=0.25) of sedentary behavior (i.e., television watching and video game playing). The major finding of this study was that certain aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) were correlated with higher levels of sedentary behavior in children aged 11 to 13. A factor analysis of the study variables indicated that most dimensions of depression, sedentary behavior, and body size represent distinct but correlated behavioral dimensions. This study provides support for a link between specific aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) and sedentary behavior in children.

A cross sectional study was performed to evaluate the presence, in a sample of subjects in the age of pubertal transition, of those psychological characteristics and abnormal eating behaviours, which are generally considered the predictors of eating disorders (EDs) in adolescence. The primary aim of our study was to evaluate the presence of EDs-related psychological traits and of abnormal eating behaviours, in a wide sample of natural 11-13-year-old population, and to determine if, in this period of transition, there are the same differences between males and females, which are related to the ED psychological characteristics that are often observed and assessed in samples of adolescents or young adults; our secondary aim was to evaluate, in the female sample, if and how the episode of menarche, and the related pubertal body transformation, play a role in the development of ED symptomatology. We screened 2925 school children by means of an ad-hoc socio-demographic schedule, the EDI 2 and the EDI-Symptom Checklist questionnaires. We compared each EDI 2 scales score (Mann-Whitney U) and the abnormal eating behaviours (chi(2) analyses) between pre- and post-menarche female subjects, for each age subgroup. Fourteen percent of the entire sample scored higher than the cut-off value at the EDI 2 drive for thinness scale and have to be considered at risk for an ED onset. The EDI 2 scores and the adoption of abnormal eating behaviour increase, in the female population, depending on whether they have had menarche. In the male sample the mean values at EDI 2 scales decrease with increasing age. The abnormal eating behaviours and the psychological ED attitude are widespread even among a "cross-pubertal" population. Our data confirm the differences between male and female subjects at the EDs attitude, suggesting a strong relation in the female children between the pubertal body transformation and the risk of ED onset.

A number of studies have shown that dieting and body dissatisfaction are highly frequent among adolescents. We here describe the relationship between dieting and body dissatisfaction in 4,952 children selected from the 11, 13 and 15 year age cohorts of the Norwegian national sample in the multinational WHO survey "Health Behavior in School Children". Body dissatisfaction was defined as the subjective experience of being a bit or much too fat and, using this definition, about 20% of the boys reported body dissatisfaction and 7% that they were on a diet. About 37% of the girls reported body dissatisfaction and 15% that they were on a diet. Within the age cohorts, respectively 22%, 30% and 32% reported body dissatisfaction, whereas about 40% overall indicated no body dissatisfaction. Being on a diet was reported by 8% of the 11-year olds, and subsequently increased to 10% (13 years) and 14% (15 years). Multiple regression analysis showed that body dissatisfaction explained 33% of the variance in dieting behaviour, and that the overall effect of gender and age was small. Dieting and body dissatisfaction should therefore be recognised as being equally important among boys, and be counteracted within the framework of a health promotion strategy aimed at the general adolescent population.

With data from the Christina-Barz-Study, we report mortality rates and predictors of death in purging disorder (PurD) as well as additional information concerning the fatal cases. The study was conducted with 225 consecutively admitted inpatients during the years 1999-2005. About 9 years later, fatal cases were identified by local registration office records. The standardised mortality ratio (SMR) was calculated through mortality tables of the Federal Office of Statistics, Germany. To identify predictors of death, survival analyses were performed. Spouses, relatives or doctors of the deceased were consulted by interview or questionnaire for further information of pathogenesis and circumstances of death. Six of the 225 sample individuals could not be located for the follow-up. Eleven of 219 former inpatients had died during the follow-up interval. The crude mortality rate was 5.0 %. The SMR was 3.90 [95 % confidence interval (2.05; 7.21)]. Age at admission and presence of one or more co-morbid somatic illnesses at admission were factors associated with a shorter time period until death. Our data indicate that there is a higher number of deaths within the study population than expected. Paying particular attention to age and the severity of co-morbid somatic symptoms could improve the outcome of patients with PurD.

The aim of the present study is to assess the psychometric properties of the Eating Disorder Examination (EDE) 12.0D in obese adult patients without Binge Eating Disorder (BED). A consecutive series of 115 obese patients without BED (23 M; 92 F), seeking treatment for obesity at the Outpatient Clinic of the Section of Metabolic Diseases and Diabetology of the University of Florence was studied using the EDE 12.0D. Patients had a mean (+/- SD) age of 40.8 +/- 15.1 years, and a Body Mass Index (BMI) of 36.3 +/- 5.9 Kg/m2. Internal consistency of EDE and its scales was evaluated through Cronbach's alpha; factor structure of EDE 12.0D was studied with factor analysis. EDE total and Shape Concern (SC) scores were found to be higher in females than in males. EDE total, SC and Eating Concern (EC) scores were inversely correlated to age, but not BMI. Factor analysis suggested the grouping of items in two subscales. The first scale includes all the items from EC, Weight Concern (WC) and SC except reaction to prescribed weighing; the second scale consists of all the items from Restraint. Data obtained show that items from EC, WC and SC all converge into the same factor analysis derived scale in obese patients without BED. EDE 12.0D provides relevant information about psychopathological features of obese patients, but a grouping of items into subscales different from those originally described could be indicated.

A clinical pathology characterized by disturbances in eating behaviour has been often associated to socio-cultural factors that influence the psychopathology of these disorders. The alarming increase in the number of teenagers with eating disorders underscores the need to promote research on the underlying causes, and to identify high-risk subpopulations in need of effective targeted treatment. The objective of this study was to assess the prevalence of eating disorders among an adolescent population of both sexes on the island of Gran Canaria. The sample was composed of adolescent boys and girls aged 12 to 17 years old (N=1364) who resided in different municipalities of Gran Canaria. The EAT-40 questionnaire was administered (cut-off point at 30), and body mass index measurements were assessed. The mean BMI for the 1364 subjects was 21.8 Kg/m²; 15% were underweight, and of these at least 1% obtained BMI values below 15 Kg/m². Thus, 13.4% of adolescents were potentially at risk of eating disorders according to the EAT-40 questionnaire. Moreover, the BMI was not significantly correlated to the EAT-40 and was not considered a sufficient parameter to establish the incidence of eating disorders.

To describe and evaluate long-term efficacy (18 months from the end of treatment) of a new cognitive short-term weight reducing treatment program for obese patients. One hundred and five obese [Body Mass Index (BMI) > or = 30] patients participated in the study. Of these, 62 took part in the treatment program and 43 served as controls. From an obesity unit's waiting list, the patients were randomly assigned to either a treatment group or remained in the waiting list to serve as a control group. The treatment group participated in a 10-week (30 hours) cognitive group treatment program. All participants were weighed at the outset of the study, directly after treatment and at a 6-, 12- and 18-month post-treatment follow-up without any booster treatment after the 10-week program. Fifty-seven (92%) patients completed treatment. For the 34 (60%) patients who participated in the study 18 months after treatment was terminated, the mean weight loss at treatment's end was 8.5 kg (SD=16.1). Eighteen months later their mean weight loss was 10.4 kg (SD=10.8). The control patients (n=31.72%) that participated in the study during the same period increased in weight by 2.3 kg (SD=7.0). The weight difference between the treatment and control group at the 18-month follow-up was highly significant (p<0.001). The cognitive group treatment program was highly acceptable among the participants and was completed by nearly all the patients. The 10-week treatment program resulted in satisfactory weight loss. The weight difference between the treatment group and controls was nearly the same at 18 months after end of treatment as at six months. The study, therefore, does not provide support for the contention that a lengthy therapy for obesity is necessary if treatment results are lasting.

Purpose: Recent studies have shown that body image perception is an important factor in weight management and can be influenced by several social or cultural factors in Western or non-Western societies; however, body image perception and its nutritional and demographic determinants in Iran have not been extensively studied. In the current study, we aimed to evaluate body image perception and its socio-demographic and nutritional determinants among female university students in Tabriz City of Iran. Methods: In the current cross-sectional survey, 184 female students aged 18-35 years from Tabriz, Iran, were enrolled. Anthropometric variables including weight, height, waist and hip circumference were measured and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Body image perception and distortion were assessed by Figure Rating Scale (FRS) developed by Stunkard consisting of nine silhouettes. Nutrition intake was assessed by a 3-day 24-h dietary recall method and analyzed by Nutritionist IV software. Results: Most of the participants in the underweight (41.66 %), normal weight (67.71 %) and overweight (57.14 %) categories of BMI selected the thinnest figure as their desirable or ideal body image perception. The total prevalences of body image dissatisfaction and distortion were 51.63 % and 64.13 %, respectively. Subjects who had undistorted body image perception consumed more time for physical activity and had more night sleeping hours compared with others (P < 0.05). Subjects who perceived themselves as being of normal weight had significantly lower intake of total fat and saturated fatty acids and higher intakes of monounsaturated fatty acids (MUFAs) compared with other groups (P < 0.05). Conclusions: According to our findings, female participants had a higher tendency to consider thinness as the preferred body image style. Persons with undistorted body image perception had healthy nutritional status compared with others. Due to high prevalence of body image dissatisfaction, the need for appropriate interventional programs to prevent the associated co-morbidities is emphasized.

On Friday, October 24, 1873, at a meeting of the Clinical Society of London, Sir William Gull achieved a coup de maitre by delivering two seminal reports. The first was called, "Anorexia Nervosa, (Apepsia Hysterica, Anorexia Hysterica)". The second was entitled, "On a Cretinoid State supervening in Adult Life in Women." The manuscript on anorexia was regarded by Gull's peers to be significant, but of lesser importance. The essay on hypothyroidism was generally regarded to be Gull's chef d'oeuvre. One hundred and twenty-four years later, the situation has reversed itself: the anorexia paper is heralded, while the other manuscript is all but forgotten. Gull's life, death and contributions will be reviewed.

Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion = 0.58) related to comparison groups (average proportion = 0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion = 0.44) and a borderline personality disorder (average proportion = 0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion = 0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects.

The present review summarizes recent findings on the metabolic and gastroenteric role of the VGF gene and a peptide derived by post-translational cleavage of the VGF pro-hormone, i.e. TLQP-21. The vgf gene is widely expressed through the central nervous system as well as in the peripheral nervous system, in myenteric plexus ganglia and also in the glandular portion of the stomach. A few VGF derived peptide have been shown to possess biological activity, among them TLQP-21 attracted particular interest following its identification within rat nervous system. In particular, recent studies from our and other groups implicated TLQP-21 in both the modulation of energy homeostasis, body weight regulation and neuroendocrine functions as well as in the central control of gut functions. Overall, findings available point to a role for TLQP-21 in negatively affecting the body energy balance.

To determine the kind of treatment patients with anorexia nervosa (AN) seek for their eating disorder following hospitalization. Twenty-four women previously treated in the Toronto General Hospital were interviewed to determine the nature and amount of treatment received following discharge. Mean age: 31 years (SD=9.18). Mean body mass index (BMI) at assessment: 19.97 (SD=4.00). All had seen at least one or more professionals, mainly family doctors and psychiatrists, within the first 6 months. Mean hours of treatment: 85. Eighty-eight per cent had taken psychotropic medication (most commonly antidepressants). Symptomatic and asymptomatic patients did not differ in amount of treatment received. Regardless of their symptom state, AN patients continue to use the health system heavily following weight restoration. Their aftercare is thus essential for ongoing maintenance treatment and to prevent relapse, and training primary-care physicians to provide it may be one way to contain health care costs.

The main purpose of the present study was to assess the factor structure, the convergent and divergent validity, and the reliability of the Eating Attitude Test (EAT-26) in a sample of female Iranian students. After a rigorous translation and back-translation of the EAT-26, 561 female students from the Tonekabon branch of the Islamic Azad University completed the EAT-26, the Binge Eating Scale (BES), the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Six weeks later, 74 of these students participated in a test-retest procedure. The exploratory factor analysis resulted in a five-factor solution that accounted for 50 % of the total variance. The factors included "drive for thinness", "restrained eating", "perceived social pressure to eat", "oral control", and "bulimia". These factors demonstrated satisfactory concurrent validity, acceptable to high internal consistency (0.76-0.92), and low test-retest reliability (0.26-0.64). The factors effectively identified the students who were currently on a diet, and those who had never participated in a weight reduction program. The results provide mixed support for the reliability and validity of the EAT-26 for a non-clinical Iranian population. However, its discriminant validity makes it a useful measure for screening purposes and identifying women at risk for developing disordered eating or eating disorders. Future research should replicate this study in both non-clinical and clinical settings in Iran.

Eating disorders (EDs) affect an increasing proportion of young women in western countries. Psychometric questionnaires represent valuable tools to investigate various and critical areas directly involved in the pathogenesis of EDS and to support diagnosis and therapeutic decisions. 162 young women (16-35 years old) seeking diet therapy were recruited. We classified subjects in normal eating behaviour (NEB) (n = 87), binge eating disorder (BED) (n = 12) and bulimic EDNOS (Eating Disorders not Otherwise Specified) (n = 63). The SCOFF, Eating Attitudes Test (EAT 26) and Three Factor Eating Questionnaire (TFEQ) were administered. Body mass index (BMI) was utilised to assess the nutritional status. An analysis of the reliability and validity (sensitivity and specificity) of the SCOFF, EAT 26 and TFEQ was performed. Body mass index (BMI) of NEB, BED and bulimic EDNOS was 27.7, 35 and 31.1, respectively. BED showed the highest values at the dishinibition, hunger and food preoccupation scales but conversely, they were the least restrained group. The SCOFF was significantly associated with the dishinibition (r = 0.31), hunger (0.31), dieting (r = 0.34) and food preoccupation scales (r = 0.34). The reliability analysis showed that the SCOFF, EAT 26 and TFEQ had a Cronbach alpha of 0.47, 0.85 and 0.75, respectively. The ROC curves identified cut off points of 3, 10 and 25 as the best compromise between specificity and sensitivity for the SCOFF, EAT 26 and TFEQ, respectively. The SCOFF is a valuable tool for the screening of abnormal eating behaviours but the diagnosis should be always confirmed and supported by the administration of other questionnaires and structured interviews. We have also confirmed the high reliability of the EAT 26 and TFEQ even though the utilisation of these questionnaires has generated some issues about their application in populations characterised by loss of control and overeating episodes.

The purpose of this study was to assess the validity of the Eating Attitude Test (EAT) in identifying the presence and severity of eating pathology in male and female Omani urban adolescents and to establish cut-off scores that matched those of anorexia identified by gold standard interviews without fear of fatness criteria. Both females (n=126) and males (n=136) were screened using the Arabic version of the EAT-26 and interviewed using a semi-structured, Composite International Diagnostic Interview (CIDI) in order to investigate the relationship between false positives and false negatives at various EAT-26 cut-off points. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the EAT-26 for every possible threshold score. The EAT-26 identified 29% of the subjects as probable anorexic cases as against 9.5% identified during the structured interview based on the anorexia gold standard (32% males and 68% females). The sensitivity and specificity of the EAT-26 were respectively 24% and 69.6%. When using the ROC curve, a cut-off score of 10 gave the best compromise between sensitivity (64%) and specificity (38%). Although the EAT-26 is the most widely used screening instrument in cross-cultural studies, it does not appear to be reliable in identifying probable cases of anorexia among Omani adolescents. The use of a gold standard interview without fat phobia criteria indicated that the rate of anorexia nervosa may be more prevalent among males than previously estimated. This intriguingly high preponderance of males is discussed in terms of prevailing demographic trends in Oman.

The Italian from of the short, 26-item Eating Attitudes Test (EAT-26) has been administered to 1277 Roman high-school students, mostly females, as a screening device. Ninety-five students with a total score > 20 and 40 students with a low score, were randomly selected, interviewed and diagnosed. The EAT-26 proved to be more sensitive to the presence of an eating disorder than to a specific clinical entity. Item analysis performed on the EAT-26 variables showed satisfactory reliability coefficients. Factor analysis using an oblique rotation was similar to that obtained by Garner et al. (1). Factor analysis with an orthogonal rotation (Cattell's screen test) identified five factors. Results suggested that the EAT-26 isolates cases at risk of clinical spectrum eating disorders.

Recent estimates in US have shown that more than a third of 65 years old subjects are obese. The objective of this study was to test the accuracy of six prediction equations to estimate resting energy expenditure (REE) in elderly obese subjects (age >60 years). Twenty-nine obese Caucasian male (n=8) and female (n=21) subjects (age range: 60-77 years) attended the Outpatient Clinic of the Neuroscience Department of Naples "Federico II" University Medical School (Italy), Section of Aging and Nutrition from January 2005 to January 2006. Weight, height, BMI and body composition (bioimpedance) were measured. REE was measured using a ventilated-hood indirect calorimetry and compared to six prediction equations (Harris-Benedict, Fredrix, Mifflin, Owen, WHO, Livingston). Mean age and body mass index (BMI) were 65.9+/-4.8 years and 36.8+/-5.3 kg/m2, respectively. The measured REE was 1658+/-289 kcal/day. The Harris-Benedict', Owen' and Livingston's equations performed less well than the other equations and they showed a tendency towards underestimation. The equation with the best REE prediction was the Fredrix's one (DeltaREE=-19.4kcal/day) with 66% of REE predictions lying within 10% of measured REE. These data support the utilization of the Fredrix's equation to calculate REE in obese elderly subjects.

In anorexia nervosa estrogen deficient amenorrhea is associated with reduced bone mineral density and increased fracture risk. We report a case of a 53 years old female patient affected with AN since the age of 17 years when also amenorrhea started. During the subsequent 31 years she refused to modify her body weight, she always remained with a BMI below 17, and amenorrhea persisted throughout all the period. In November 2005, when she was 48 years old (BMI 15.6 kg/m²), she came to the Eating Disorder Unit of Niguarda Hospital to treat surgical complication of lower limb wound persisting after two operation; she also presented a marked reduction of bone density. After 6 months of intensive day hospital treatment she got a normal body weight and resumption of menses; in the following four years she has still been well and with normal menses, and bone density showed an improvement.

The symptomatology of Eating Disorders (ED) varies considerably and it is of interest to determine whether one can attribute this to different personality structures and hence establish the most effective treatment. The present study investigates the psychopathological characteristics of clinical ED subjects divided by diagnostic subtypes, age at onset and duration of disorder on admission. Three hundred and twenty-seven women were administered the EAT 40 and MMPI. One-way ANOVA and Bonferroni post-hoc multiple comparisons were performed on subsamples: no significant differences emerged with regard to age at onset and duration of ED, whereas the diagnostic subtypes obtained significantly different MMPI validity scale scores. These results can be referred to a common core of ED represented by cognitive organization and personal meaning.

This study is aimed at the comparison between an individual and a group cognitive-behavioral program for the treatment of obesity. Parallel series, prospective, 3-year study. A group program of 10 weekly sessions focused on lifestyle modification was compared with a similar, individual 10-session program. Fifty-seven patients were assigned to individual treatment, and 84 patients to the group program. One hundred- forty-one obese female outpatients without binge eating disorder, aged 42.0+/-11.6 years (m+/-SD), with Body Mass Index (BMI) 37.3+/-5.2 kg/m(2). BMI and waist circumference were measured at 0, 6, 12 and 36 months. Analysis was performed on an intention-to-treat basis. Mean weight loss was superior with the group program at 6 months (2.0+/-3.9 vs 0.8+/-2.5 kg/m(2); p<0.05), while no difference between the two treatments was observed at 12 and 36 months. Mean waist circumference was significantly different at 6 months (group 97.4+/-2.5 vs individual 102.9+/-2.4, p<0.05), still remaining superior in the patients following individual treatment (100.2+/-5.0 vs 103.7+/-5.9) at 12 months, while no difference between the two treatments was observed at 36 months. The proportion of patients losing more than 5% of initial body weight with the group program (16.6, 15.5, and 38.1% at 6, 12, and 36 months, respectively) was not significantly different from that observed with individual treatment (5.3, 14.0, and 35.0%, respectively). A group cognitive-behavioral program for the treatment of obesity is not inferior to a similar program applied in individual setting, and it may enhance weight loss (especially fat mass, according to the waist measurement) in the short term.

The current study describes detailed eating behaviors, dieting behaviors, and attitudes about shape and weight in 4023 women ages 25 to 45. The survey was delivered on-line and participants were identified using a national quota-sampling procedure. Disordered eating behaviors, extreme weight loss measures, and negative cognitions about shape and weight were widely endorsed by women in this age group and were not limited to White participants. Thirty-one percent of women without a history of anorexia nervosa or binge eating reported having purged to control weight, and 74.5% of women reported that their concerns about shape and weight interfered with their happiness. Unhealthy approaches to weight control and negative attitudes about shape and weight are pervasive even among women without eating disorders. The development of effective approaches to address the impact of these unhealthy behaviors and attitudes on the general well-being and functioning of women is required.