Sandra Becker

High Levels of Physical Activity in Anorexia Nervosa: A Systematic Review

High level physical activity is a frequent symptom in patients with anorexia nervosa (AN), influencing the development, maintenance, complications, treatment success, relapse rate and severity of the disease. Accelerometry is assumed to be an objective method to assess physical activity (PA) in AN. We aimed to review objectively measured levels of PA in AN and to give an overview for clinical practice and future research. Data were searched in PubMed and PsychINFO until April 2015 following the preferred reporting items for systematic reviews and meta-analyses statement. Twenty studies fulfilled the inclusion criteria. A notable heterogeneity of measurements, outcomes, participants and settings was found. Overall, HLPA is not adressed enough by current evidence. A common valid terminology of HLPA is not available, and accurate criteria of different levels of PA must be defined to create comparability of future studies. Further objective PA assessments are needed to improve treatment outcome and relapse rate.

Impulsivity-focused group intervention to reduce binge eating episodes in patients with binge eating disorder: study protocol of the randomised controlled IMPULS trial

Introduction The core symptom of binge eating disorder (BED) is recurrent binge eating that is accompanied by a sense of loss of control. BED is frequently associated with obesity, one of the main public health challenges today. Experimental studies deliver evidence that general trait impulsivity and disorder-specific food-related impulsivity constitute risk factors for BED. Cognitive-behavioural treatment (CBT) is deemed to be the most effective intervention concerning BED. We developed a group intervention based on CBT and especially focusing on impulsivity. We hypothesise that such an impulsivity-focused group intervention is able to increase control over impulsive eating behaviour, that is, reduce binge eating episodes, further eating pathology and impulsivity. Body weight might also be influenced in the long term. Methods and analysis The present randomised controlled trial investigates the feasibility, acceptance and efficacy of this impulsivity-focused group intervention in patients with BED. We compare 39 patients with BED in the experimental group to 39 patients with BED in the control group at three appointments: before and after the group intervention and in a 3-month follow-up. Patients with BED in the experimental group receive 8 weekly sessions of the impulsivity-focused group intervention with 5-6 patients per group. Patients with BED in the control group receive no group intervention. The primary outcome is the binge eating frequency over the past 4 weeks. Secondary outcomes comprise further eating pathology, general impulsivity and food-related impulsivity assessed by eye tracking methodology, and body weight. Additionally, we assess binge eating and other impulsive behaviour weekly in process analyses during the time period of the group intervention. Ethics and dissemination This study has been approved by the ethics committee of the medical faculty of Eberhard Karls University Tübingen and the University Hospital Tübingen. Data are monitored by the Centre of Clinical Studies, University Hospital Tübingen. Trial registration number German Clinical Trials Register, DRKS00007689, 14/01/2015, version from 11/06/2015, pre-results.

Weight reduction and maintenance in a specialized outpatient health care center

SUMMARY OBJECTIVE To prospectively evaluate the amount of weight loss and subsequent maintenance and to identify correlates of successful weight reduction in overweight and obese outpatients treated in a specialized health care center. TREATMENT A treatment program involving diet, exercise and behavior modification was provided in an outpatient setting. Twenty-four treatment courses with a total of 177 participants (age: 45.5 ± 12.2 year; BMI: 36.7 ± 5.6 kg/m(2)) were run. MEASUREMENTS Weight and baseline characteristics were recorded at start of program; weight was re-assessed at the end of treatment and 1 year after the end of treatment. RESULTS Patients achieved a significant weight loss of 5.6 ± 7.9 kg (5.1 ± 6.4% of initial body weight) in the course of 1 year. An average of 80.8% or 4.8 kg of initial weight loss was maintained a year after treatment, representing a significant weight regain. A higher initial BMI, intake of venlafaxin, a higher percentage of course attendance, course completion and hypertension were associated with greater weight loss. The interaction of the specific treatment course and the percentage of attendance explained 25% of the variance of percental total weight loss. CONCLUSION Significant weight losses can be achieved by overweight and obese patients after a treatment program in specialized health care addressing diet, exercise and behavioral aspects. Weight loss maintenance remains difficult for patients. The specific treatment group itself and attendance of course sessions are critical for weight loss and should be considered in the design and evaluation of group-based treatment programs.

Motivational Interviewing – Hintergründe, Methode, Möglichkeiten

Der Leser soll nach der Durcharbeitung des Artikels kennen: ▶ die Herkunft von Motivational Interviewing (MI) und seinen Bezug zum transtheoretischen Modell ▶ die Unterschiede zwischen MI und anderen motivationalen Ansätzen ▶ Indikationen und Anwendungsbereiche vonMI ▶ theoretische Hintergründe des MI ▶ Basisprinzipien im MI Der Leser soll nach der Durcharbeitung des Artikels übertragen und beginnend praktisch anwenden können: ▶ Einschätzen der Veränderungsbereitschaft eines Patienten ▶ Einsetzen der Basisprinzipien im ärztlichen Gespräch ▶ Übertragen der therapeutischen Grundhaltung und Einsatz des Basisverhaltens ▶ Einsatz von Techniken zum Hervorrufen von Change-Talk ▶ Anpassung der therapeutischen Strategie an die Veränderungsbereitschaft des Patienten

Rückfallprophylaxe bei Anorexia nervosa

Anorexia nervosa is characterised by high relapse rates and thus there is a need for strategies that reduce reoccurrence of illness. One way of achieving this is to integrate relapse prevention into treatment, but clearly this requires identification of risk and maintenance factors. The Maudsley Model of Anorexia Nervosa Treatment in Adults (MANTRA) by Schmidt & Treasure has 5 major treatment stages. These include an initial stage of motivation and dialogue about change, an individual relapse formulation, improvement of cognitive and socio-emotional skills, work on the patients identity and eventually a final stage of ending and parting. These treatment stages are derived from a maintenance model of AN by Schmidt & Treasure and on evidence from recovered patients and part of their objective is to prevent relapse.

Psychotherapie und Verhaltensmodifikation bei Adipositas

ZusammenfassungAdipositas ist eine schwerwiegende chronische Erkrankung mit ausgeprägten Folgeerkrankungen sowie erhöhter Mortalität. Das Therapiekonzept sollte multimodal und interdisziplinär ausgerichtet sein und ist unter anderem vom Ausmaß des Übergewichts, körperlicher und psychischer Komorbidität, bisherigen Therapieversuchen sowie von Motivations- und Persönlichkeitsfaktoren abhängig. Psychotherapeutische Interventionen und Strategien zur Verhaltensmodifikation werden vorwiegend bei einem Body-Mass-Index zwischen 30 und 40 kg/m2 eingesetzt.