1,721,002 research outputs found
Factors associated with attrition in weight loss programs
No full textAbstract
Attrition in weight loss programs is a complex process, possibly influenced by several pretreatment patients’ characteristics and treatment variables, but available data reveal sometime contradictory results. Only a few pretreatment patients’ characteristics and treatment variables have been confirmed by more than one study as relevant risk factors, but recently new data of clinical utility emerged from “real world” large observational studies. Practical difficulties, unsatisfactory results, some psychological variables (e.g. lack of motivation, unrealistic weight loss expectations, overall level of stress, self-confidence in the ability to lose additional weight without professional help, and sense of abandonment from therapists), duration and type of treatment seem to play a crucial role in the patients’ decision of interrupting the weight loss treatment
Night eating syndrome and weight loss outcome in obese patients
No full textObjective: The clinical significance of diagnosing the night eating syndrome (NES) in obese individuals has not been clearly demonstrated. We aimed to test the effect of NES on weight loss outcome in obesity. Method: In an observational case-control
study, we measured weight loss outcome in obese individuals with NES (32 cases) and 68 non-NES matched participants
entering a weight-loss program. The diagnosis of NES was generated by a two-stage assessment, including the Night Eating
Questionnaire (screening test) and the Night Eating Syndrome History and Inventory. The program included a 21-day inpatient
treatment based on a low-calorie diet, exercise, and psycho-educational groups, followed by a 6-month outpatient follow-up. Body weight, metabolic parameters, and questionnaires of psychopathology were assessed at baseline, at the end of the inpatient period and at the end of follow-up. Results: NES participants were only characterized by significantly higher
scores of the Beck Depression Inventory and the Night Eating Questionnaire. The time course of weight loss did not differ
between groups throughout the study period. Only eight NES participants were still classified as NES at study end. Discussion: The presence of NES does not affect weight loss outcome of an obesity treatment based on lifestyle modification
Objective and subjective binge eating in underweight eating disorders: Associated features and treatment outcome
No full textObjective: To define the utility of the DSM-IV-TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED-NOS).
Method: We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no- RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later.
Results: Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self-induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self-directness than the no-RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups.
Discussion: Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility
Massive weight loss without surgery in a super obese patient
No full textLarge weight losses are rarely achieved through non-surgical procedures, but are also possible without professional help. A massive weight loss may be complicated by the development of an eating disorder psychopathology, followed by weight regain.
We report the case of a male patient with super obesity (BMI, 86.2 kg/m2), who achieved a massive weight loss (170 kg in two years) largely without professional help and without surgery. The final body weight (~100 kg, BMI 32.6) has now been maintained for nearly 2 years. After weight loss, the patient had massive skin redundancy in several areas including the breasts, arms, abdomen, back and thighs and a true body weight probably in the normal range. All laboratory tests were normal, with the exception of low free testosterone. Sonographic examination showed gall bladder microlithiasis. No eating disorders and other axis I and axis II psychiatric disorders were present.
The case illustrates how much weight loss and weight loss maintenance can be exceptionally achieved without surgery and without developing an eating disorder of clinical severity or other psychiatric disorders
Behavior therapy for nonalcoholic fatty liver disease: The need for a multidisciplinary approach
No full textNonalcoholic fatty liver disease (NAFLD) is systematically associated with insulin resistance and the metabolic syndrome, where behavior therapy remains the primary treatment, simultaneously addressing all the clinical and biochemical defects. However, very few studies have tested the effectiveness of intensive behavior therapy in NAFLD, aimed at lifestyle modifications to produce stable weight loss by reduced calorie intake and increased physical activity. Searching the literature for studies testing weight loss and lifestyle modifications for the treatment of NAFLD, only 14 reports were traced where the entry assessment satisfied well-defined criteria. The final effectiveness was based on hard histological outcomes in five cases. All but one were pilot, uncontrolled studies, or limited case series, and in general the details of treatment were scanty. In only three cases treatment was carried out along the guidelines of behavior treatment to reduce excess nutrition and increase exercise; in these cases a remarkable effect on weight loss and an improvement in liver histology were reported. The principles of behavior therapy are presented in detail, to help physicians change their prescriptive attitude into a more empowerment-based approach. A brief section is also reported on the practical aspects and public policies to be implemented at societal level to obtain the maximum effects in lifestyle changes. There is a need for multidisciplinary teams including dietitians, psychologists and physical activity supervisors caring for NAFLD patients. Alternatively, general practitioners and physicians working in GI units should limit their intervention to engage NAFLD patients before referral to specialized teams set up for the treatment of diabetes and obesity
Underweight eating disorder without over-evaluation of shape and weight: Atypical anorexia nervosa?
No full textIntroduction Underweight patients with eating disorder not otherwise specified without the over-evaluation of shape and weight (EDNOS-W) represent a diagnostic challenge. We aimed to evaluate their clinical characteristics and treatment outcome, compared with anorexia nervosa (AN) cases. Method 88 consecutive patients (81 females; age range, 13-50 years, 71 AN and 17 EDNOS-W) were studied. The differential diagnosis of AN and EDNOS-W was based on the Eating Disorder Examination. Results Compared with AN, EDNOS-W cases had a milder eating disorder psychopathology, but no differences in anthropometric and clinical data. The response to inpatient cognitive behavioral treatment was good and similar between groups, and no differences in the dropout rate or time-to-dropout were observed. The normalization of body weight in EDNOS-W cases was not associated with the appearance of the over-evaluation of shape and weight. Conclusion The data give preliminary support to the proposal to include EDNOS-W in the diagnosis of AN
Outcome research in obesity. Lesson from the QUOVADIS study
No full textOutcome research in obesity is aimed at the identification of clinically meaningful goals. Over the years, the focus has moved from surrogate health markers to cardiovascular risk and survival. The 7-10% weight loss recommended by guidelines is a target easily attained with any treatment, but does not guarantee physical and psychological benefits unless it is accompanied by weight loss maintenance, a target very difficult to achieve with either behavior treatment or pharmacological intervention. A reduced cardiovascular risk profile is associated with weight loss, irrespective of the treatment program. In contrast, no controlled studies have so far documented an increased survival, but evidence has been provided by epidemiological surveys. Also bariatric surgery, promoting a larger weight loss and good weight loss maintenance, has failed to demonstrate an improved survival. Health-related quality of life is an additional significant outcome, approved by international agencies. Concern regarding a possible detrimental effect of dieting on mood and depression is not substantiated by the results of controlled studies. The high prevalence of obesity and its consequences pose a serious and unresolved challenge to the medical community and the definition of outcome measures is a key issue for the assessment of result
Self-Induced vomiting in eating disorders: associated features and treatment outcome
No full textSelf-induced vomiting is adopted by people with a variety of eating disorders (ED) to control body shape and weight. We tested the prevalence, the associated features and the role on treatment outcome of self-induced vomiting in 152 ED patients consecutively admitted to an in-patient cognitive-behavioral treatment (CBT), based on the transdiagnostic CBT for ED. The Eating Disorder Examination, together with the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Temperament and Character Inventory were recorded at entry and at end of treatment. Self-induced vomiting was reported in 35.5% of cases, and 21.1% had multiple purging with vomiting. Individuals with vomiting and those with multiple purging had significantly higher BMI and a higher frequency of bulimic episodes, but multiple purging was also characterized by higher levels of depression, longer ED duration, more severe ED psychopathology and lower self-directness. Individuals with vomiting had higher eating concern and novelty seeking compared with those without purging behaviors. However, the three groups had similar dropout rates and outcomes in response to in-patient CBT
Compulsive exercise to control shape or weight in eating disorders: Prevalence, associated features and treatment outcome
No full textObjective: The study was aimed at assessing the prevalence of intense exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome.
Method: Exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive-behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory (TCI).
Results: 45.5% of patients were classified as intense exercisers, the prevalence being highest (80%) in restricting type anorexia nervosa (RAN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging type bulimia nervosa (39.3%). Exercising to control shape and weight was independently predicted by the EDE Restraint score (OR, 1.32; 95% confidence interval, 1.06-1.64; P=0.014), after adjustment for ED; the total amount of exercise was associated with EDE Restraint, as well as with TCI Reward Dependence. At follow-up, an improved EDE Global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last four weeks. Voluntary treatment discontinuation was not predicted by baseline exercise.
Discussion: Intense exercising to control shape and weight is a behavioral feature of RAN, associated with Restraint and temperament dimensions, with influence on treatment outcome
Night eating syndrome in obesity
No full textNight eating syndrome is an eating disorder characterized by a delay in the circadian timing of food intake, which is remarkably reduced during the first part of the day and greatly increased after dinner, frequently with awakenings characterized by nocturnal food ingestion and morning anorexia. In the absence of standard diagnostic criteria, its prevalence is difficult to estimate. According to the most agreed criteria, the disorder affects approximately 1.5% of the general population, it is more common among obese persons and the prevalence increases with increasing adiposity. Longitudinal studies with adequate follow-up are needed to determine whether night eating contributes to weight gain and the development of obesity. The research should also aim to assess the interaction of genetic and environmental processes in the pathogenesis and in the maintenance of the disorder. There is no satisfactory treatment of night eating. Limited information is available on drug treatment (sertraline, topiramate). Lifestyle modifications aimed at weight loss are standard treatment whenever night eating is associated with obesity and have demonstrated a favorable effect, but more research is needed also in this area to optimize the protocols
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