Massimo Cuzzolaro

Purpose Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with “correct” eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus de...

The study of the relationship between sexual orientation and eating behavior began in the last decades of the twentieth century. Research in gender and gender non-conforming people coincides with the gender revolution of the current century. The chapter opens with a reminder of the non-binary view of sex/gender and a look back at ICD and DSM histor...

Prader-Willi syndrome (PWS) is the most common form of compulsive hyperphagia and obesity on a genetic basis. Together with Angelman syndrome, PWS was the first genomic imprinting disorder described in humans.

In the 1930s, Otto Ullrich and Henry Turner independently described a syndrome that two decades after was associated with a chromosomal anomaly, a complete or partial absence of the second X chromosome.

Parkinson’s disease (PD) is a progressive systemic neurodegenerative disease. At present, there is no cure capable of resolving PD or significantly halting its progression.

DSM-5 and ICD-11 offer eight categories for the diagnosis of feeding and eating disorders. New expressions appear continuously to describe other food and eating-related phenomena that can harm physical and psychological well-being.

Aim In some cases, detrimental consequences on health are generated by self-imposed dietary rules intended to promote health. The pursuit of an “extreme dietary purity” due to an exaggerated focus on food may lead to a disordered eating behavior called “orthorexia nervosa” (ON). ON raises a growing interest, but at present there is no universally s...

The rates of obesity and eating disorders (ED) continue to rise and, in the last two decades, a growing number of researchers and scientific institutions have supposed that an integrated approach to the prevention of obesity and ED could be more efficient than the only-focus-programs. An integrated prevention program is designed to provide a coordi...

Body image is a broad and multifaceted construct that describes subjective perceptions of and attitudes toward the body, mostly its appearance. Body image concerns characterize a variety of psychiatric disorders and in non-affected individuals alike. Some factors make the assessment of body image difficult: body image varies over time, and it also...

Body mass index (BMI) is still the most widely used indicator of obesity, and it is widely accepted as a strong predictor of excess weight-related mortality. However, in several clinical settings, in patients with many different diseases, an inverse association between BMI and mortality has been reported: hemodialysis, cardiovascular diseases, hype...

The expression body dysmorphic disorder (BDD) was first used as an official psychiatric diagnosis in 1987, in the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (American Psychiatric Association, DSM-III-R). The term replaced the original word dysmorphophobia coined by Enrico Morselli in 1891. The core feature of BDD i...

Disorders of body experience may be associated with evident lesions and diseases affecting the nervous system or be part of some psychiatric syndromes without established neurobiological alterations. They challenge the descriptive classifications of mental disorders. Current medical and psychological literature identify a large number of different...

The Italian alienist Enrico Agostino Morselli (1852–1929) wrote many scientific articles and books on clinical and forensic psychiatry, experimental psychology, sociology, and anthropology. However, in the history of psychiatry, he is primarily known for having coined, in 1891, the word dysmorphophobia to describe a morbid condition in which a pers...

Gender incongruence, gender dysphoria, and many eating and weight disorders share a troubling body uneasiness. Gender nonconformities were considered to be diseases, in particular, mental disorders, till the last decades of the twentieth century. In this chapter the new DSM-5 diagnostic category gender dysphoria is discussed together with some rece...

The rationale and the procedures of Rehabilitation Medicine can be optimally applied to the natural history of obesity, which is characterised by the presence of comorbidities, chronicity and disability with an important impact on quality of life. Level of Evidence (LoE): I; Strength of the Recommendation (SoR): A

Obesity is still defined on the basis of body mass index (BMI) and BMI in itself is generally accepted as a strong predictor of overall early mortality. However, an inverse association between BMI and mortality has been reported in patients with many disease states and in several clinical settings: hemodialysis, cardiovascular diseases, hypertensio...

Aim: Aim of this study was to validate the Comprehensive Appropriateness Scale for the Care of Obesity in Rehabilitation (CASCO-R) and to determine the cut-off score for indicating the most appropriate health care setting for patients with obesity. Methods: The CASCO-R scale was developed according to the available scientific literature and expe...

Obesity is a chronic disease as well as a risk factor for cardiovascular, metabolic and osteoarticular diseases, affecting the psychosocial health and the quality of life. Recent evidence suggests that the adequate treatment of obesity should provide a multidimensional multidisciplinary approach including nutritional therapy, psycho-educational cla...

Obesity is the result of a complex interplay among several factors leading to medical, functional and psychosocial consequences that markedly reduce life expectancy and impair quality of life. Is obesity itself a disease? Is obesity a brain disease? Who should treat obesity? This paper is a narrative review aimed to describe and to argue the preval...

Personality traits can affect eating behaviors, the development of obesity as well as obesity treatment failure. We investigated the personality characteristics and their relation with disordered eating in 586 obese women consecutively seeking treatment at eight Italian medical centers (age, 47.7±9.8 years) and 185 age-matched, normal weight women...

The aim of the present study was to evaluate the concurrent validity, specificity and sensitivity of the Disordered Eating Questionnaire (DEQ). The DEQ is a brief questionnaire (24 items), that can be used for epidemiological screenings. It addresses face valid questions to evaluate frequency and intensity of disordered eating attitudes and behavio...

To validate a new obesity-specific disability assessment test: the Obesity-related Disability test (Test SIO Disabilità Obesità Correlata, TSD-OC). Adult obese individuals were assessed with the TSD-OC, 36-Item Short-Form Health Survey (SF-36), 6-min walking test (6MWT) and grip strength. The TSD-OC is composed of 36 items divided into seven sectio...

Obesity is an increasing health problem and surgery seems to be the only treatment effective in achieving weight loss without relapse. Among bariatric techniques, many differences exist in terms of weight loss and resolution of comorbidities. Up to now, there are no prospective studies comparing long-term effects of malabsorptive vs restrictive tec...

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eat...

Obesity incidence and prevalence rates are extremely high and growing, in both sexes and in all age groups. The consequences on physical and psychological status, on disability, on the quality of life call for complex and coordinated action strategies, both in terms of primary prevention and in terms of treatment and secondary prevention. The defin...

Debate continues regarding the nosological status of binge eating disorder (BED) and the specific diagnostic criteria, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by body image disturbances in addition to abnormal eating behaviour. The aims of this article are: a) to concisely review the main points of t...

Body image dissatisfaction is common in treatment-seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs. A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 +/- standa...

To investigate the psychometric properties of the Body Uneasiness Test (BUT) in a large sample of subjects with obesity seeking treatment. BUT is a 71-item self-report questionnaire in two parts: BUT-A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own bod...

The present work has examined the perceived stress degree, coping strategies, personality traits (investigated by the Eysenck Personality Questionnaire Revised-Abbreviated) and the way these variables seem to influence each other in a population of elderly. The aim is to confirm a possible relation between perceived stress, coping strategies and pe...

The objective of this paper is to provide descriptive information on anthropometric status, pathological conditions, cognitive impairment and lifestyle in apparently healthy elderly Italian people. In order to recruit the volunteers for the ZENITH study, 359 Italian participants (167 men and 192 women), aged between 70 and 85 years, free living in...

The aim of the present work is to investigate the comorbidity among the symptoms of cognitive impairment and of depression in a population of elderly (switching off serious somatic or psychopathological illness). The study is developed in two areas in Rome. The sample is composed from 348 subject preselected (158 M; 190 F; average 70-85 years old)....

To investigate the causes of attrition reported by obese patients treated by medical centres. Observational study. Obese patients enrolled in a long-term study involving 18 Italian medical centres. A total of 940 obese patients (727 female; mean age, 49 years; mean BMI, 38.6 kg/m2). Causes of attrition reported by dropouts during a structured telep...

To investigate the psychometric properties of the Body Uneasiness Test (BUT), a 71-item self-report questionnaire that consists of two parts: BUT*A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own body (depersonalization); and BUT*B which looks at specif...

The BioEnterics Intragastric Balloon (BIB) System in association with restricted diet has been used for the short-term treatment of morbid obesity. Aim of this study was to evaluate the real, short term, efficacy of the BIB for weight reduction in morbidly obese patients by using a prospective, double-blind, randomised, sham-controlled, crossover s...

To assess the quality of positive and negative affect (mood) in an ageing European sample. Mood quality has important implications for both physical and mental wellbeing. Poor quality moods are associated with deficits in the diverse areas of cognitive function, health, and social relationships. The ageing process presents a number of potential cha...

To explore the psychometric properties of the Italian version of the Bulimic Investigatory Test, Edinburgh (BITE). A general population sample of 995 subjects (621 females), a clinical sample of 388 eating disordered females and a clinical sample of 710 patients with obesity (575 females). Internal consistency was satisfactory. The factor analysis...

To ascertain whether women with eating disorders have a higher frequency of separation anxiety symptoms in childhood, and a higher prevalence of insecure styles of adult attachment, compared with healthy women. The Separation Anxiety Symptom Inventory (SASI) and the Attachment Style Questionnaire (ASQ) were administered to 78 women with eating diso...

To investigate weight loss expectations (expected 1-year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss. 1891 obese patients seeking treatment in 25 Italian med...

To determine parameters of weight history useful for the assessment of weight cycling and their association with psychological distress and binge eating. Cross-sectional. A total of 1889 treatment-seeking obese subjects, enrolled by 25 Italian centers (78% female subject), aged 20-65 y (median 45); 1691 reported previous efforts to lose weight (med...

Obesity is a major risk factor for several metabolic diseases, frequently clustering to form the metabolic syndrome, carrying a high risk of cardiovascular mortality. We aimed to assess the prevalence of the metabolic syndrome in treatment-seeking obese subjects and the potential protective effect of physical activity. A cross-sectional analysis of...

Abnormal patterns of family functioning have often been reported in anorexia nervosa. Moreover, members of families with an adult with eating disorders have different family functioning perspectives. This study investigated whether differences in family members' perspectives, similar to the ones found in families of adults with eating disorders, ca...

Obesity is a major risk factor for several chronic diseases, but the burden associated with it also extends to psychosocial areas and to perceived health status. In 1999 an observational study on health-related quality of life in obesity was planned. The study was entirely web-based. Case Report Forms and the individual items of 7 self-administered...

Obesity is a major risk factor for several chronic diseases, but the burden associated with it also extends to psychosocial areas and to perceived health status. In 1999 an observational study on health-related quality of life in obesity was planned. The study was entirely web-based. Case Report Forms and the individual items of 7 self-administered...

This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did th...

To assess the impact of anorexia nervosa and that of nutritional rehabilitation on bone resorption. Cross-sectional, observational study. Rome, Italy Twenty-eight female patients affected by anorexia nervosa (AN, BMI<or=17.0 kg/m(2)), 18 females rehabilitated from anorexia nervosa and weight-stable for at least 6 months (RE, BMI >or=18.5 kg/m(2)) a...

To determine whether the general equations to predict basal metabolic rate (BMR) can be reliably applied to female anorectics. INDIVIDUALS AND METHODS: Two hundred and thirty-seven female patients with anorexia nervosa (AN) were divided into an adolescent group [n=43, 13-17 yrs, 39.3+/-5.0 kg, body mass index (BMI) (weight/height) 15.5+/-1.8 kg/m2]...

A 6-week double-blind placebo-controlled trial was carried out to examine the efficacy and tolerability of moclobemide, a monoamine oxidase type A selective and reversible inhibitor, in the treatment of bulimia nervosa. Patients were admitted to the study even if they were unable to adhere to a tyramine-free diet. Fifty-two normal-weight women (age...

Leptin is thought to represent a peripheral signal involved in the regulation of energy balance. Its action has been studied in animals and obese subjects. Little is known about leptin's role during negative energy balance. The objective was to evaluate the relation between energy turnover, body composition, and plasma leptin concentrations in anor...

Background. The laparoscopic adjustable silicone gastric banding (LASGB) is the most diffuse bariatric procedure in Europe. The aim of the present paper was to analyze the patient's selection/follow-up carried out by a multidisciplinar staff and the 'learning curve' period. Methods. Between January 1996-February 1999, 460 patients were evaluated by...

To assess the body composition changes in anorexia nervosa and after medium term recovery. A descriptive study. Rome, Italy. Twenty women affected by anorexia nervosa (AN) with a BMI [weight (kg)/height (m2)] below 17 kg/m2 and weight-stable for at least three months, were compared with 10 well nourished control women (CO) and nine rehabilitated su...

Two age- and education-matched groups of 45 women, respectively, with the diagnoses of Bulimia and of Temporo-mandibular Joint Disorder, were administered the Serial Color-Word Test, to assess differences in the pattern of adaptation to conflict (the latter being represented by the Stroop task). Three types of norms (clinical, nonclinical and based...

The point prevalence of eating disorders was investigated in schoolgirls from lower socio-economic classes and a method of case detection was tested. A two-stage procedure (self-report measures and interviews) was followed. All girls meeting at least one of the following three criteria were recruited as possible cases: EAT > or = 30, BMI < 17.5, BM...

1.0 Costi sanitari dell'obesità 2.0 Il concetto di disabilità 3.0 Obesità e disabilità 4.0 Riabilitazione metabolico-nutrizionale 5.0 Approccio multidisciplinare integrato 6.0 Il progetto terapeutico-riabilitativo 7.0 Appropriatezza e qualità delle prestazioni riabilitative 8.0 La proposta SIO-Lazio per il trattamento riabilitativo dell'obesità 8.1...

Objective: a) To study eating attitudes, body image uneasiness and unhealthy behaviours in an adolescent population, b) To evaluate a brief health promotion intervention. Method: The investigation was conducted on an adolescent population (second year of high school) in three steps: a) 1st screening (whole sample); b) brief health promotion interve...