Paulo P. P. Machado

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.

Cognitive narrative psychotherapy: research foundations.

There has been an increased interest in the study of language processes in psychotherapy. More recently, research and theoretical formulations of the therapeutic process suggested that we must move from the microscopic study of verbal modes to a macroscopic approach in which these modes are organized into narratives. Narratives are conceived, in this perspective, as the basic instruments for meaning making. In this article the research on narrative processes in psychotherapy is reviewed and discussed in terms of its implications for the theory and practice of cognitive narrative psychotherapy. Additionally some of the main data coming from research projects on cognitive narrative psychotherapy are presented.

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.

What is “grazing”? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition

BACKGROUND Grazing, characterized by a repetitive eating pattern, has received increased attention among bariatric surgery patients. However, different definitions and terminology have been used, preventing the accurate measurement of this phenomenon and comparison of data across studies. OBJECTIVE To review existing definitions and associated clinical features of grazing among different samples and to propose a standardized definition that will allow for consistency in future work. SETTING University and Clinical Research Institute. METHODS Of the 39 studies found, 9 provided an original definition and 12 provided data of its association with weight outcomes. Six were studies of nonbariatric surgery populations. Based on this literature review, the most common criteria used in previous studies to define grazing were included in a survey that was sent to 24 individuals who have published work in the field. These experts were asked to provide their opinion on what should constitute grazing. RESULTS Grazing is a frequent behavior in the bariatric surgery population as well as in eating disordered and community samples. Its association with psychopathology is not clear, but its negative impact on weight outcomes after bariatric surgery generally has been supported. Survey data provided a consensus regarding the definition of grazing as an eating behavior characterized by the repetitive eating (more than twice) of small/modest amounts of food in an unplanned manner, with what we characterize as compulsive and noncompulsive subtypes. CONCLUSIONS Given the clinical relevance of grazing among bariatric surgery patients, a unique definition is crucial to better study its associated features and impact on different populations.

Narrative Therapy vs. Cognitive-Behavioral Therapy for moderate depression: Empirical evidence from a controlled clinical trial

Abstract Background: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse. Objective: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT). Method: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures. Results: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. Conclusions: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.

Use of Text Messaging Services to Promote Health Behaviors in Children

OBJECTIVE To examine adherence to, satisfaction with, and preliminary efficacy of mobile phone short message service (SMS) to promote health behaviors in school-aged children. METHODS A total of 49 children (aged 8-10 years) were randomized by school classes into a monitoring vs no-monitoring group. All children participated in 2 educational group sessions that focused on health behaviors: the advantages of increasing fruit and vegetable consumption and physical activity, and decreasing screen time. The monitoring group also reported daily behavior using SMS and received supportive feedback for 8 weeks. RESULTS Children submitted 61% of the required SMS, which indicated good adherence to the intervention. A number of children (95%) reported being satisfied with the program. Analyses of covariance indicated increase in fruit and vegetable consumption (χ² [2] = 7.27; P < .05) and a decrease in screen time (χ² [2] = 6.79; P < .05). CONCLUSIONS AND IMPLICATIONS The current SMS intervention was a useful tool to monitor and promote health behaviors in children.

Disordered Eating among Preadolescent Boys and Girls: The Relationship with Child and Maternal Variables

Objective: (i) To analyze the eating behaviors and body satisfaction of boys and girls and to examine their mothers’ perceptions of these two domains; and (ii) to evaluate eating problem predictors using child body mass index (BMI), self-esteem, and body satisfaction as well as maternal BMI, eating problems, and satisfaction with their child’s body. The participants included 111 children (54.1% girls aged between 9 and 12 years old) and their mothers. Assessment measures included the Child Eating Attitude Test, the Self-Perception Profile for Children, the Eating Disorders Questionnaire, and the Child Eating Behavior Questionnaire. Child and maternal measures also included BMI and Collins Figure Drawings. Results: (i) No association between child and maternal BMI for either sex was found; (ii) no difference was found between boys and girls with regard to eating behavior; (iii) most children revealed a preference for an ideal body image over their actual body image; (iv) most mothers preferred thinner bodies for their children; (v) greater BMI was related to higher body dissatisfaction; and (vi) child BMI and dissatisfaction with body image predicted eating disturbances in boys, whereas self-esteem, maternal BMI, and eating behavior predicted them in girls. Discussion: Maternal eating problems and BMI were related to female eating problems only.

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.

Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study

BACKGROUND The literature is rather mixed regarding the stability and the role of pre- and postoperative problematic eating behaviors (PEBs) on weight outcomes after bariatric surgery. OBJECTIVES To investigate the stability of loss of control (LOC) eating and picking and/or nibbling from pre- to postoperative assessments, and to investigate whether pre- and postoperative PEBs are predictors of different weight loss trajectories. SETTING Central Hospital, University, Portugal. METHODS This longitudinal study assessed LOC eating and picking and/or nibbling before and approximately 2 years after laparoscopic adjustable gastric banding or Roux-en-Y gastric bypass through face-to-face interviews and 2 self-report measures. Weight across follow-up time was retrieved from hospital charts. Of the 130 patients invited to participate in the study, 100 were assessed preoperatively, and of these, 61 were also assessed postoperatively. RESULTS Frequency of PEBs is similar pre- and postoperatively (37.7% and 45.9%, respectively) (McNemar χ2P = .832). Yet, about 40% ceased preoperative PEBs. Those with LOC preoperatively were more likely to develop picking and/or nibbling postoperatively (McNemar χ2P<.05). About 39.5% developed PEBs de novo after surgery. The presence of PEBs postoperatively was a significant predictor of different weight loss trajectories after both laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass. Worse weight loss outcomes were found particularly at 17-20 months postsurgery. Preoperative PEBs were not a significant predictor. CONCLUSIONS Our data do not support the stability of all PEBs across time, highlighting that the absence of preoperative PEBs does not preclude an unfavorable weight loss outcome after surgery. Postoperative but not preoperative PEBs are predictors of poorer weight loss trajectories after surgery.

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.