Ana Rita Vaz

Eating Disorder Examination Questionnaire: Psychometric Properties and Norms for the Portuguese Population

OBJECTIVE The first aim of the current study was to establish general population norms for the Portuguese version of the Eating Disorder Examination Questionnaire (EDE-Q) in a large community sample of female adolescents and young women, as well, for a diverse Eating Disorder (ED) clinical sample, and for women with obesity without an ED. A second aim of the study was to assess the discriminant validity of the EDE-Q and providing cut-off scores for the total scale and subscales. METHOD A sample of female adolescents and young women (N = 4091) from the general population, 416 women who met diagnostic criteria for an ED and 138 women seeking obesity treatment completed the EDE-Q. RESULTS Norms for the EDE-Q global subscale were provided. Within the community sample, norms were provided for both high school and college samples. Receiver operating characteristic analysis showed that the EDE-Q total score accurately discriminate between participants with and without an ED. Current norm contributes to the clinical utility of the EDE-Q, providing both a cut-off score and reliable change index. Results showed that the EDE-Q is a reliable instrument, but the theorized four subscales structure was not supported by an explorative factor analysis. CONCLUSION Results will help both researchers and clinicians interpreting the EDE-Q scores and to establish comparison with data produced in different countries.

The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain.

BACKGROUND Maladaptive eating behaviors after bariatric surgery are thought to compromise weight outcomes, but little is known about their frequency over time. OBJECTIVE This study investigates the presence of subjective binge eating (SBE), objective binge eating (OBE) and picking and nibbling (P&N) before surgery and at different time periods postoperative, and their association with weight outcomes. METHODS This cross-sectional study assessed a group of patients before surgery (n=61), and three post-operative groups: 1) 90 patients (27 with laparoscopic adjustable gastric band (LAGB) and 63 with Laparoscopic Roux-en-Y Gastric Bypass (LRYGB)) assessed during their 6month follow-up medical appointment; 2) 96 patients (34 LAGB and 62 LRYGB) assessed during their one year follow-up medical appointment; and 3) 127 patients (62 LAGB and 55 LRYGB) assessed during their second year follow-up medical appointment. Assessment included the Eating Disorders Examination and a set of self-report measures. RESULTS In the first ten months after surgery fewer participants reported maladaptive eating behaviors. No OBEs were reported at 6months. SBE episodes were present in all groups. P&N was the most frequently reported eating behavior. Eating behavior (P&N) was significantly associated with weight regain, and non-behavioral variables were associated with weight loss. CONCLUSIONS This study is cross-sectional study which greatly limits the interpretation of outcomes and no causal association can be made. However, a subgroup of postoperative patients report eating behaviors that are associated with greater weight regain. The early detection of these eating behaviors might be important in the prevention of problematic outcomes after bariatric surgery.

The Development of Eating Disorders After Bariatric Surgery

Surgical treatment for morbid obesity can be very effective in terms of weight loss and reduction of psychopathology. But the (re)emergence of eating problems after surgery is still poorly understood and may be underreported. We describe three cases in which eating disorder symptoms developed after bariatric surgery. The accelerated weight loss and heightened dieting restraint, as well as the systematic reminders to control the amount of food eaten which are crucial for treatment success, might trigger the development of eating disorders after surgery. Implications for pre-surgery assessment and preparation are discussed.

Promoting health behaviour in Portuguese children via Short Message Service: The efficacy of a text-messaging programme

A Short Message Service programme was adapted to monitor three health behaviours and provide supportive feedback. The study aimed to evaluate the effectiveness of the programme to increase fruit/vegetable consumption and physical activity and to decrease screen time. A total of 139 Portuguese children, aged 8–10 years, grouped by classroom, were randomly assigned to an intervention (8 weeks of monitoring/feedback) or a control condition. Participants had their key behaviours assessed at baseline, post-intervention and follow-up. A three-level hierarchical linear model was developed. Results showed that the monitoring and feedback programme significantly increased fruit and vegetable consumption over time.

The Prevalence of Binge Eating Disorder in a Sample of College Students in the North of Portugal

Binge eating disorder (BED) has important associated comorbidities and has been recently considered as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition. This study investigates the prevalence of BED in a sample of college students using a two-stage design. Between October 2008 and July 2009, 805 students attending a public college campus completed the Questionnaire on Eating and Weight Patterns - Revised to screen for possible cases. Eighty-five students meeting key criteria for BED were invited for a second stage interview using the Eating Disorder Examination. At stage 1, 9.6% of the subjects reported binge eating episodes. At stage 2, a prevalence rate of 0.5% for BED was found, and 1% if the criterion for large amount of food was excluded.

Early Response as a Predictor of Success in Guided Self-help Treatment for Bulimic Disorders

The aims of this study were to investigate the number of sessions and time required for a clinical meaningful symptomatic change with a guided self-help treatment and to assess the predictive value of early response and other potential predictors of end-of-treatment clinical status. Participants were 42 patients with a diagnosis of bulimia nervosa or ED not otherwise specified. Survival analyses (Kaplan-Meier) were performed to estimate the median time required to attain a 51% reduction in bulimic symptoms. Logistic regression was used to assess predictors of symptom remission. Results showed that the median time to achieve a 51% reduction in binge and purge frequencies was 3.68 and 3.77, respectively. This change occurred at session 3 for 50% of the participants. Early response was the most significant predictor of binge eating remission. No pretreatment predictors of time to achieve early response were found. These results have implications for allocating treatment resources in a stepped-care intervention model.

Guided self-help CBT treatment for bulimic disorders: effectiveness and clinically significant change.

Abstract The aim of this study was to test the effectiveness of a cognitive-behavioral guided self-help treatment program for bulimia nervosa and similar disorders. Participants were assessed at the beginning and end of treatment, and at 6 months follow-up, using the Eating Disorder Examination Questionnaire (EDE-Q), the Outcome-Questionnaire–45 (OQ-45), and the Beck Depression Inventory (BDI). Forty-two participants from an eating disorders treatment service participated in this study. This study followed a one-group repeated measures naturalistic design with no control group. Results showed a significant reduction in EDE scores, OQ-45 and BDI. Clinically significant change occurred for the majority of participants. Cognitive-behavioral self-help treatment may be of value as an initial treatment for bulimia nervosa and similar disorders such as binge eating disorder.

Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating

OBJECTIVE This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge-eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. METHOD This cross-sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face-to-face assessment: Eating Disorders Examination for binge-eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5-point Likert scale. Self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. RESULTS OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self-report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. DISCUSSION There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology.

The Impact of Exposure to Cartoons Promoting Healthy Eating on Children's Food Preferences and Choices

Objective: This study explored whether a cartoon show with healthy eating messages positively affected childrens food choices and food preferences. Design: Experimental between‐subjects design. Setting: Four elementary schools in Portugal were investigated. Participants: Children (aged 4–8 years; n = 142) were randomly assigned to 1 of 2 groups: a comparison group (n = 73) was exposed to cartoons with no reference to food and an intervention group (n = 69) was exposed to cartoons with healthy eating messages. After viewing, each child was given the opportunity to eat ad libitum for 10 minutes from a small selection of snack foods. Main Outcome Measure: Number of healthy and unhealthy food items chosen. Food preferences were measured using an adapted version of the Leeds Food Preference Checklist. Analysis: Generalized linear models were used to test for differences between groups. Results were considered significant at P ≤ .05. Results: Children in the experimental group chose significantly more healthy food items than did those in the comparison group (B = –.600; SE = .19; P < .05). Conclusions and Implications: Future studies may address the effect of prolonged exposure to healthy eating cartoons. Cartoons can be used to promote healthy food choices and can be a part of health promotion campaigns.

877 – Structural neuroimaging studies in bulimia nervosa: a review

Introduction The understanding of neurobiology of eating disorders has received a remarkable contribution from neuroimaging research. Objective To review the literature on structural neuroimaging in bulimia nervosa. Aim To discuss recent contributions of structural neuroimaging to the understanding of bulimia nervosa. Methods MEDLINE and PubMed databases were searched for peer-reviewed studies, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms structural neuroimaging and bulimia nervosa. A selection of relevant articles to the aim of this review was carried out. Results Relatively few articles on structural neuroimaging were found in bulimia nervosa, and the studies showed conflicting results. Some studies reported evidence of brain volume loss in patients with bulimia nervosa, possibly related to associated chronic dietary restriction. Other studies have found increased grey matter volumes in frontal and ventral striatal areas. Finally, further studies did not find any structural abnormality at all in patients with bulimia nervosa, compared to healthy control subjects. Conclusions The scarce literature available on structural neuroimaging in bulimia nervosa provides conflicting results. Further studies are, therefore, warranted.