Isabelle Carrard

Randomised controlled trial of a guided self-help treatment on the Internet for binge eating disorder.

Binge eating disorder (BED) is a common and under-treated condition with major health implications. Cognitive behavioural therapy (CBT) self-help manuals have proved to be efficient in BED treatment. Increasing evidence also support the use of new technology to improve treatment access and dissemination. This is the first randomised controlled study to evaluate the efficacy of an Internet guided self-help treatment programme, based on CBT, for adults with threshold and subthreshold BED. Seventy-four women were randomised into two groups. The first group received the six-month online programme with a six-month follow-up. The second group was placed in a six-month waiting list before participating in the six-month intervention. Guidance consisted of a regular e-mail contact with a coach during the whole intervention. Binge eating behaviour, drive for thinness, body dissatisfaction and interoceptive awareness significantly improved after the Internet self-help treatment intervention. The number of objective binge episodes, overall eating disorder symptoms score and perceived hunger also decreased. Improvements were maintained at six-month follow-up. Dropouts exhibited more shape concern and a higher drive for thinness. Overall, a transfer of CBT-based self-help techniques to the Internet was well accepted by patients, and showed positive results for eating disorders psychopathology.

Internet-based cognitive-behavioral therapy for bulimia nervosa: a controlled study.

The object of this study was to examine the effectiveness of an Internet-based therapy (IBT) for bulimia nervosa (BN) as compared to a waiting list (WL). Sixty-two female BN patients, diagnosed according to DSM-IV criteria, were assigned to either the IBT or a WL. The control participants (WL) were matched to the IBT group in terms of age, duration of the disorder, number of previous treatments, and severity of the disorder. Assessment measures included the EDI, SCL-90-R, BITE, the TCI-R, and other clinical and psychopathological indices, which were administrated before and after the treatment. Considering the IBT, while the mean scores were lower at the end of the treatment for some EDI scales (bulimic, interpersonal distrust, maturity fears, and total score) and the BITE symptomatology subscale, the mean BMI was higher at posttherapy. Predictors of good IBT outcome were higher scores on the EDI perfectionism scale and EAT and a higher minimum BMI. Drop-out (after IBT 35.5% of cases) was related to higher SCL-anxiety scores, a lower hyperactivity, a lower minimum BMI, and lower TCI-reward dependence scores. At the end of the treatment, bingeing and vomiting abstinence rates differed significantly between the two groups. Results suggest that an online self-help approach appears to be a valid treatment option for BN when compared to a WL control group, especially for people who present a lower severity of their eating disorder (ED) symptomatology and some specific personality traits.

Psychological factors and weight loss in bariatric surgery.

Purpose of review Morbid obesity is associated with a high prevalence of psychopathological conditions that might have an impact on postsurgery outcomes. This review summarizes recent data about psychological disorders in obese patients before and after bariatric surgery as well as the assessment and impact of these factors on postsurgery outcomes. Recent findings Psychological health and quality of life were found to improve after bariatric surgery. Weight loss could not be clearly related to any specific psychological condition prior to surgery, but the presence of more than one psychiatric condition might play a role. A multi-intervention treatment, including approaches for lifestyle changes after bariatric surgery showed positive long-term results in term of weight loss and weight loss maintenance. Recent studies focused on eating behavior changes following bariatric surgery providing important information on the topic of eating disorders after bariatric surgery. Summary Psychological assessment before bariatric surgery and systematic follow-up are necessary to guarantee optimal weight loss and weight loss maintenance. The field of psychological factors in bariatric surgery is still in need of controlled randomized prospective trials to better understand relation between psychological presurgery conditions and surgical outcomes. Self-monitoring and cognitive behavioral programs could prevent weight regain.

Evaluation of a guided internet self-treatment programme for bulimia nervosa in several European countries

OBJECTIVE The purposes of this study were to evaluate the use of an online guided self-treatment programme for bulimia nervosa (BN) and to determine predictors of outcome. Data were collected in four European countries where the programme was simultaneously used. METHOD One hundred and twenty-seven BN or subthreshold BN female patients (mean age of 24.7 years) participated in a 4-month intervention using a CBT based online-guided self-help programme. Contact during the treatment period included weekly e-mails with a coach. ASSESSMENT Measures included the Eating Disorders Inventory-2 (EDI-2) and the Symptom Check List-Revised (SCL-90R). RESULTS Severity of eating disorders symptoms and general psychopathology improved significantly. Twenty-three per cent of patients were symptom free at the end of treatment. The dropout rate was 25.2%. A better score of general psychological health was a predictor of a better outcome. CONCLUSIONS This study encourages further developments and research on innovative therapy approaches, particularly for those disorders such as BN, with difficult therapy and unclear prognosis.

Relations between pure dietary and dietary-negative affect subtypes and impulsivity and reinforcement sensitivity in binge eating individuals.

To investigate potential predictors of the severity of binge eating disorder (BED), two subtypes of patients with the disorder, a pure dietary subtype and a dietary-negative affect subtype, were identified. This study investigated the relationships between the two subtypes and impulsivity and reinforcement sensitivity. Ninety-two women meeting threshold and subthreshold criteria for BED diagnosis filled out questionnaires to determine eating disorder severity, impulsivity and reinforcement sensitivity before and after participating in an online guided self-help program for BED. Cluster analyses revealed a pure dietary subtype (N=66, 71.7%) and a dietary-negative affect subtype (N=26, 28.3%). Compared to the pure dietary subtype, the dietary-negative affect subtype reported a higher frequency of objective binge episodes, more severe eating disorders, higher urgency scores (defined as a tendency to act rashly in the context of negative affect), a greater sensitivity to punishment, and a higher dropout rate during treatment. These findings suggest that BED patients in the dietary-negative affect subtype exhibit heightened anxiety and are highly impulsive, especially in contexts of negative affect. For these individuals, psychological interventions for BED should focus on inhibiting automatic responses to negative emotions.

Dance therapy improves self-body image among obese patients.

OBJECTIVE Obesity and disturbed eating behaviors are both associated with low self-esteem and distorted body images. The aim of this study was to assess the influence of a dance therapy program on the evolution of mental representations linked to body image among obese patients. Changes in body image were evaluated in terms of four parameters: physical, psychological, cognitive, and social. METHODS In total, 18 obese patients were enrolled in a longitudinal dance therapy workshop (DTW) program lasting 36 weeks. Patients danced for 2h per week and were evaluated three times: at baseline, after 18 weeks, and at the end of the study (36 weeks). Evaluation was performed using questionnaires addressing health-related quality of life, sensorial-motor perception, and mental representations linked to body schema and self-body image. RESULTS Obese patients enrolled in the DTW displayed a significant improvement in health-related quality of life (p<0.03), body consciousness (p<0.001), and mental representations linked to self body image (p<0.001). CONCLUSION DTW allowed obese patients to reset both their somatic and psychic consciousness of their body image. PRACTICE IMPLICATIONS Patients are usually reluctant to practice physical activity. Dance therapy improves not only body image, but also psycho-social aspects of their personality.

Comparison of Obese and Nonobese Individuals with Binge Eating Disorder: Delicate Boundary Between Binge Eating Disorder and Non-Purging Bulimia Nervosa

OBJECTIVE To compare obese and nonobese individuals with binge eating disorder (BED) on demographic data, illness history, eating disorders and psychological health. METHODS This study used baseline data from a randomized controlled study on the efficacy of an online cognitive behavioural self-help treatment. Seventy-four women aged between 18 and 60 years were recruited in the community. They had to meet full or subthreshold diagnostic criteria for BED according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS Forty per cent of the sample had a body mass index higher than 30 kg/m(2) . Mean age and severity of eating disorders were similar between obese and nonobese individuals. A statistically significant difference emerged regarding dietary restraint, with nonobese BED individuals exhibiting higher scores than obese BED individuals. CONCLUSIONS Dietary restraint might be one of the factors explaining body mass index differences among BED individuals. This raises the question of the boundary between non-purging bulimia nervosa and BED in nonobese people.

Cognitive distortions in obese patients with or without eating disorders.

In the normal weight population, cognitive distortions are more often found in people with eating disorders such as anorexia and bulimia than in a control population. With these cognitive distortions, weight and body image become central elements in self-esteem. This exploratory study investigated cognitive distortions in obese patients suffering from binge eating disorder or not. The hypothesis was that the patients suffering from binge eating disorder would have more cognitive distortions. Twenty-nine obese women (11 without and 18 with binge eating disorder) and 13 non-obese female controls were selected. To evaluate the cognitive distortions, subjects completed the Mizes Anorectic Cognitions-Revised (MAC-R) questionnaire. Contrary to our hypothesis, we found no difference in evidence between the two obese groups with or without eating disorders. Possible perspectives for treatment are discussed.

Development and Evaluation of e-CA, an Electronic Mobile-Based Food Record

Measures that capture diet as validly and reliably as possible are cornerstones of nutritional research, and mobile-based devices offer new opportunities to improve and simplify data collection. The balance between precision and acceptability of these data collection tools remains debated, and rigorous validations are warranted. Our objective was to develop and evaluate an electronic mobile-based food record for a research setting. We developed e-CA, which includes almost 900 foods and beverages classified in 14 categories and 60 subcategories. e-CA was evaluated using three different methods: (1) usability and acceptability through a logbook and qualitative interviews; (2) dietary intake accuracy through comparison with 2 unannounced 24-h phone recalls on overlapping days; and (3) reliability and process comparison with a paper-based food record in a laboratory setting with a randomized design. e-CA proved to be intuitive and practical and was perceived as modern, trendy, and fun. Comparisons of e-CA with 24-h telephone recalls or paper-based food records in a laboratory setting with two small convenient samples showed good agreement but highlighted the well-known difficulty of estimating portion sizes and a necessary learning time to use the app. e-CA is a functional tool that has the potential to facilitate food intake measurement for research by increasing the pleasure of using the food record tool and reducing the perceived burden for the participants. It also decreases the workload, costs and the risk of transcription errors for researchers.

Effects of a Weight Loss Program on Metabolic Syndrome, Eating Disorders and Psychological Outcomes: Mediation by Endocannabinoids?

Objective: To evaluate the effects of weight loss on endocannabinoids, cardiometabolic and psychological parameters, eating disorders (ED) as well as quality of life (QoL) and to elucidate the role of endocannabinoids in metabolic syndrome (MS). Methods: In total, 114 patients with obesity were prospectively included in a 12-month weight loss program. Plasma endocannabinoids were measured by mass spectrometry; ED, psychological and QoL-related parameters were evaluated by self-reported questionnaires; physical activity was measured by accelerometer. Nutritional assessment was done by a 3-day food diary. Results: Among completers (n = 87), body weight decreased in 35 patients (-9.1 ± 8.6 kg), remained stable in 39 patients, and increased in 13 patients (+5.8 ± 3.4 kg). 75% of patients with MS at baseline were free of MS at follow-up, and their baseline plasma N-palmitoylethanolamide (PEA) values were significantly lower when compared to patients with persisting MS. At baseline, there was a positive relationship between PEA and waist circumference (p = 0.005, R2 = 0.08), fasting glucose (p < 0.0001, R2 = 0.12), total cholesterol (p = 0.001, R2 = 0.11), triglycerides (p = 0.001, R2 = 0.11), LDL-cholesterol (p = 0.03, R2 = 0.05) as well as depression score (p = 0.002, R2 = 0.29). Conclusion: Plasma PEA might play a role in metabolic improvement after weight loss. Even in subjects without weight loss, a multidisciplinary intervention improves psychological outcomes, ED, and QoL.