Cognitive Behavioural Therapy for an Adolescent with Anorexia Nervosa

Introduction: The treatment of anorexia nervosa remains a matter of much debate. Though cognitive behavioural therapy would seem to offer good results, there is still no resounding evidence pointing to a single treatment of choice. The case presented in this paper examines the treatment with CBT of a patient presenting anorexia nervosa. Evaluation/diagnosis: An adolescent girl, 17 years of age, voluntarily attends psychological therapy to address eating behaviour problems. After administering the EAT-26, EDI-2, and BSQ standardised screening tests, as well as a clinical interview for assessment, a psychopathological profile is obtained, providing a diagnosis of anorexia nervosa, restricting subtype. Therapeutic goals: The therapeutic goals set were to reach a healthy weight for the patient’s age and height (specified as a minimum BMI of 18.5) and change the structure of thoughts, feelings, and behaviour that was justifying and maintaining the disorder. Treatment: Treatment lasted for 33 sessions and used cognitive behavioural techniques, such as cognitive restructuring, response cost, and positive reinforcement, in addition to family intervention techniques. Nutrition therapy was also carried out in parallel to the treatment sessions. Results: Following eight months of weekly sessions, the patient reached the target weight and changed attitudes towards food and body image, replacing them with healthy thoughts and behaviours. Follow-up made one and two years after the end of the treatment saw that these results were maintained. Discussion and conclusions: In this case, CBT proved effective in achieving the patient’s physical and psychological recovery. Therefore, this case contributes to the evidence of the efficacy of this therapeutic approach in certain cases of ED.

Chocolate craving: does it affect eating attitude and body mass index?

Purpose Some kinds of foods, by producing an effect like addiction, may trigger overeating. This paper aims to investigate whether excessive chocolate consumption and hunger cause food addiction. Design/methodology/approach Food cravings questionnaire-trait-reduced (FCQ-T-r), food cravings questionnaire-state (FCQ-S) and eating attitude test-26 (EAT-26) scales were used. The relation between chocolate addiction, anthropometric measurements, demographic characteristics, eating behavior of the people were analyzed. The study was conducted on 864 individuals between 17 and 64 years old (men = 327, women = 537). Findings As the body mass index (BMI) of the individuals increased, chocolate craving, chocolate hunger, thought of eating chocolate, lack of control of chocolate increased. Also, significant correlations were determined with BMI, respectively, (r = 0.39; r = 0.32; r = 0.33; r = 0.29; p < 0.001). The lack of control overeating chocolate, craving for chocolate was found to be higher in female participants than in male participants. It was seen that craving for chocolate decreases (r = −0.17; p < 0.001) with increasing age; this was more apparent in male participants compared to female participants. Besides, significant correlation was found (r = 0.76, p < 0.05) between the EAT-26, the craving to eat chocolate in this study. It was seen that individual, who were excessively eager to consume chocolate, exhibited abnormal eating behavior (29.50 ± 12.09). This showed that there is a positive relation (r = 0.08, p < 0.001) between food addiction, eating attitude disorder. Originality/value Food craving increases the consumption of food, especially chocolate, sugar, with high carbohydrate content and energy. This can lead to overeating and being overweight.

Are People with Poor Differentiation of Self at Risk of Developing Eating Disorders? A Study of Jewish and Arab Participants

Purpose: In light of findings that Israeli Arabs report higher prevalence of eating disorders (EDs) than Israeli Jews and that higher rates of the risk of EDs have been reported by females than males, the first aim of this study was to further investigate the cultural and gender differences in differentiation of self (DoS) and risk of developing EDs among Israeli young adults. The second aim was to examine whether DoS is associated with the risk of EDs. Methods: Of the 859 participants (670 females, mean age 26.8), 440 were Jewish and 419 were Arab. Participants took the Eating Attitudes Test (EAT-26) and completed the Differentiation of Self-Revised (DSI-R) questionnaire.Results: Results revealed that Jewish participants had significantly lower diet, bulimia, and total EAT-26 scores than their Arab counterparts, while Jewish female participants had higher dieting and lower emotional cutoff scores than Jewish male participants. In addition, Jews who reported higher levels of risk of EDs showed higher levels of BMI, emotional reactivity, emotional cutoff, and fusion with others. Arabs who reported higher levels of risk of EDs reported higher levels of BMI and emotional cutoff and lower levels of I-position. Conclusion: People with high risk of EDs may have difficulty maintaining intimate family relationships. In distressing situations, they tend to disconnect rather than share with or gain support from significant others. In each culture, the risk of EDs increases for differently: among the Arab participants, when feelings and needs remain unexpressed; among the Jewish participants, even when they have symbiotic family relationships.Level of evidence: Level V, cross-sectional descriptive study

Prevalence of Eating Disorders Among Nutritional Sciences Students and Dietitians in Saudi Arabia

Background: Eating disorders (EDs) involve persistent disturbed eating and related behaviors that result in altered consumption or absorption of food with potential physical or psychological function impairment. EDs have four major types: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. The investigation aimed to study the prevalence of EDs by assessing nutritional status for nutrition students and dietitians from multiple provinces in Saudi Arabia.Methods: A cross-sectional study comprising 175 male and female nutrition students or dietitians. EDs were diagnosed using EAT-26 and DSM5. Dietary intake was estimated by repeated 24-hr recall records. Diet was analyzed using food processor nutrition and fitness software. Intakes were compared with the recommended dietary allowances. Results: According to EAT-26 diagnostic criteria, the prevalence of EDs was 15.4%. The mean age was 24.96 ± 4 years. ED subjects had normal BMIs. The diet analysis showed that these subjects had a lower intake of energy, macronutrients, and some micronutrients, and other micronutrients were high as compared to the RDA. Conclusion: EDs were more prevalent among dietitians than students. The EDs comprised a high number of OSFED and UNFED cases. Subjects with an ED had an unbalanced diet with poor nutrition.

The Relationship between Body Appreciation Levels, Eating Attitudes and Physical Profiles of Turkish Elite Artistic Gymnasts

Body dissatisfaction and disordered eating behavior in athletes may occur when sports and social pressures require an ideal body standard, if the athlete perceives that his or her body does not conform to this ideal. For this reason, the aim of this study is to investigate the relationship between artistic gymnasts’ (AG) physical profiles, body appreciation levels and eating attitudes. A total of 32 elite AG (Turkish National Team), 13 women and 19 men, participated in this study. Height and body analyzes of the participants were measured. Body appreciation levels were determined by the Body Appreciation Scale (BAS), and eating attitudes were determined by the Eating Attitudes Test (EAT-26). With the Training Information Form, information about training frequencies and durations was provided. Comparative analyzes of the BAS and EAT-26 results of elite female and male gymnasts were performed. The physical profiles, eating attitudes and body appreciation levels of female AG were evaluated and the relationship between them was determined. While no significant correlation was found between the BAS, EAT-26 and physical profiles of the elite male AG, a negative significant correlation was found between the BAS and body mass index (BMI) of female elite AG (p < 0.05). It was concluded that while BMI rates of elite female AG increased, their body appreciation levels decreased. The BAS results of elite AG’ were found to be significantly higher than those of elite female AGs (p < 0.05).

Psychometric Properties of The 26-Item Eating Attitudes Test (EAT-26): An Application of Rasch Analysis

Background: The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a sample of adults (n=469; age=36.17±17.83 years; female =72.5%; white=66.3%; obese BMI category=58%).Methods: Rasch analysis of the EAT-26 assessed model-data fit, an item-person map to evaluate relative distribution items and persons, item difficulty, and person’s eating disorder (ED) risk level, differential item functioning (DIF), and rating scale functioning. Results: A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< -1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed.Conclusion: Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk. Because the EAT-26 is a frequently used screening tool for nonclinical populations, future work should focus on developing screening tools that are more effective at assessing ED risk in people with overweight and obesity.

The Mediating Effect of Self-Control on Depression and Tendencies of Eating Disorders in Adolescents

Self-control is very important for the adaptation among adolescents. It is associated with depression and tendencies of eating disorders. This study aimed to investigate the relationship between the two and the mediating role of self-control for adolescents. In total, 1,231 adolescents (11–18 years) participated in this study. Self-control, depression, and tendencies of eating disorders were evaluated using the Dual-Mode of Self-Control Scale (DMSC-S), 11-item Kutcher Adolescent Depression Scale (KADS-11), and Eating Attitudes Test (EAT-26). The correlations among these factors were analyzed using mediating effect models. Girls had higher scores on the both subscales (impulse system and control system) of DMSC-S (P &lt; 0.001). Those between 15–18 years had higher scores on impulse system than those between 11–14 years (P &lt; 0.001). A significant mediating effect (12.8%) of the impulse system was observed between depression and tendencies of eating disorders in adolescents.

Mindful eating for overweight and obese women in Brazil: An exploratory mixed-methods pilot study

Background: Worldwide, approximately 95% of obese people who follow diets for weight loss fail to maintain their weight loss in the long term. To fill this gap, mindfulness-based interventions, with a focus on mindful eating, are promising therapies to address this challenging public health issue. Aim: To verify the effects of the Mindfulness-Based Eating Awareness Training (MB-EAT) protocol by exploring quantitative and qualitative data collected from Brazilian women. Methods: A single-group, mixed-methods trial was conducted at a public university with adult women ( n = 34). Four MB-EAT groups were offered weekly for 2.5-h sessions over 12 weeks. Pre- and post-intervention assessments included body mass index (BMI) and self-report measures of anxiety, depression, mindfulness, self-compassion, and eating behaviour. Qualitative information was collected using focus groups in the last session of each group, including both participants and MB-EAT instructors. The qualitative data were examined using thematic analyses and empirical categories. Results: Twenty participants (58.8%) completed both pre- and post-intervention assessments, with adequate attendance (≥4 sessions). There was a significant average decrease in weight of 1.9 ± 0.6 kg from pre- to post-intervention. All participants who had scored at the risk level for eating disorders on the EAT-26 decreased their score below this risk level. Qualitative analysis identified that participants were able to engage a more compassionate perspective on themselves, as well as greater self-awareness and self-acceptance. Conclusion: The MB-EAT showed preliminary efficacy in promoting weight loss and improvements in mindfulness and eating behaviour. This intervention promoted effects beyond those expected, extending to other life contexts.

Examination of Self-Esteem, Body Image, Eating Attitudes and Cardiorespiratory Performance in Adolescents

Self-esteem, body image and eating attitudes are important characteristics regarding adolescent mental health. In our present work, we aimed to investigate these psychological items in adolescent boys and girls examining gender differences and correlations with the BMI-for-age and cardiorespiratory performance. 374 students (209 girls with an average age of 16.4 ± 1.08 years, and 165 boys with an average age of 16.5 ± 1.03 years) underwent investigation using the Rosenberg self-esteem scale, EAT-26 and BAT questionnaires. The BMI-for-age was calculated with BMI growth charts and the cardiorespiratory performance was measured with the 20 m shuttle run test. Our results showed that adolescent girls scored lower self-esteem and higher values for BAT and each scale of eating behaviors, such as uncontrolled eating, cognitive restraints and emotional eating compared to boys despite the fact, that obesity and overweight were more common among boys. No significant correlation was found between BMI and psychological test results in either boys or girls, however, subjective body shape and gender predicted self-esteem and BAT scores and the cognitive restraints in the eating attitudes. Uncontrolled and emotional eating were primarily influenced by gender, in which BMI played only a weaker role. Cardiorespiratory performance was positively associated with self-esteem and body image among boys, and it had a negative correlation regarding BMI in both genders.

Insatisfacción corporal y trastornos de conducta alimentaria en gimnastas: revisión sistemática (Body dissatisfaction and eating disorders in gymnasts: a systematic review)

Introducción: En los deportes gimnásticos ciertas medidas morfológicas como el peso, un índice de masa corporal (IMC) y un porcentaje de grasa bajo adquieren importancia para el éxito deportivo. La preocupación excesiva por estos factores o alteración de la Imagen Corporal (IC), puede llevar a estos gimnastas a padecer Trastornos de Conducta Alimentaria (TCA). Objetivo: El propósito de este estudio fue analizar los TCA y la IC en practicantes de deportes gimnásticos mediante una revisión sistemática. Material y método: Siguiendo la lista de verificación “PRISMA” se realizó la búsqueda en cinco bases de datos electrónicas (WOS, PubMed, SPORTDiscus, Scopus y Google Scholar), de estudios transversales en inglés, español y portugués publicados desde enero del 2000 hasta diciembre del 2020. La selección fue realizada por tres investigadores en dos etapas (cribado y aplicación de criterios de elegibilidad). Se registraron edad, sexo, tamaño muestral, calidad metodológica, variables, instrumento y resultados en 16 artículos que cumplieron los criterios de inclusión. Resultados: El 56,25% de los estudios resaltan la insatisfacción corporal, así como el riesgo de padecer TCA en gimnastas de mayor nivel competitivo, resultando como factores causantes fundamentalmente la insatisfacción corporal y la presión del entorno sobre todo en el periodo de la adolescencia. El instrumento más utilizado fue Eating Attitude Test 26 (EAT-26) (75%). Conclusiones: Los resultados obtenidos indican que existe gran riesgo en gimnastas de padecer TCA, destacando la aparición en categorías superiores, siendo una de las principales causas, la distorsión e insatisfacción con la IC. Abstract. Introduction: In gymnastic sports, certain morphological measures such as weight, body mass index (BMI) and low-fat percentage are important for sporting success. Excessive preoccupation with these factors, or altered Body Image (BI), can lead to eating disorders (ED) in gymnasts. Objective: The purpose of this study was to analyse ED and CI in gymnastics athletes through a systematic review. Material and methods: Following the "PRISMA" checklist, five electronic databases (WOS, PubMed, Sports Discuss, Scopus and Google Scholar) were searched for cross-sectional studies in English, Spanish and Portuguese published from January 2000 to December 2020 Selection was performed by three investigators in two stages (screening and application of eligibility criteria). Age, sex, sample size, methodological quality, variables, instrument and results were recorded in 16 articles that met the inclusion criteria. Results: 56.25% of the studies highlight body dissatisfaction, as well as the risk of suffering from ED in gymnasts at a higher competitive level, with body dissatisfaction and environmental pressure being the main causal factors, especially in the adolescent period. The most commonly used instrument was the Eating Attitude Test 26 (EAT-26) (75%). Conclusion: The results obtained indicate that gymnasts are at high risk of suffering from BAD, with a high incidence in the higher categories, one of the main causes being distortion and dissatisfaction with the CI.