Screen time, problematic screen use, and eating disorder symptoms among early adolescents: findings from the Adolescent Brain Cognitive Development (ABCD) Study.

PURPOSE: Emerging research evidence suggests positive relationships between higher screen time and eating disorders. However, few studies have examined the prospective associations between screen use and eating disorder symptoms in early adolescents and how problematic screen use may contribute to symptom development. METHODS: We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,246, 2016-2020, ages 9-14). Logistic regression analyses were used to estimate the longitudinal associations between baseline self-reported screen time and eating disorder symptoms in year two. Logistic regression analyses were also used to estimate cross-sectional associations between problematic screen use in year two (either problematic social media or mobile phone use) and eating disorder symptoms in year two. Eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) included fear of weight gain, self-worth tied to weight, engaging in compensatory behaviors, binge eating, and distress with binge eating. RESULTS: Each additional hour of total screen time and social media use was associated with higher odds of fear of weight gain, self-worth tied to weight, compensatory behaviors to prevent weight gain, binge eating, and distress with binge eating two years later (odds ratio [OR] 1.05-1.55). Both problematic social media and mobile phone use were associated with higher odds of all eating disorder symptoms (OR 1.26-1.82). CONCLUSIONS: Findings suggest greater total screen time, social media use, and problematic screen use are associated with more eating disorder symptoms in early adolescence. Clinicians should consider assessing for problem screen use and, when high, screen for disordered eating. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Maternal sex-hormone exposure and the risk of eating disorders in daughters.

Potential effects of prenatal sex hormones on later eating disorders in offspring have been investigated with two indirect methods (finger length ratio, opposite- versus same-sex twins). We utilized a direct, prospective method, examining the association between prenatal sex-hormones in maternal sera and the risk of bulimia nervosa (BN) and anorexia nervosa (AN) among daughters. Females with BN (55), AN (150), sister controls without eating disorders (one per case), and population controls (one per case) were derived from Finnish registers. Maternal gestational testosterone and estradiol levels were assayed from archived specimens stored in a national serum biobank. When females with BN were compared to their sister controls, those with higher gestational testosterone levels were at an increased risk of BN. No significant associations with BN were found when the comparison was made to population controls, and when estradiol levels and testosterone/estrogen ratio were assessed. We neither found associations between gestational sex-hormone levels and the risk of AN. Among females with familial liability for BN, higher gestational testosterone exposure may have a role in later development of BN, whereas lower testosterone exposure may have a protective effect. We found no evidence for the involvement of gestational sex-hormones in the etiology of AN.

Prevalence of disturbance of body image perception and engagement in risky behaviors for eating disorders motivated by the Korean wave.

BACKGROUND: the global expansion of the Korean wave (hallyu) has led to the idealization of Korean beauty standards among fans. Celebrities share extreme diets and exercise routines through social media that help them lose weight and adhere to this standard, which has been shown in some studies conducted in Asia to significantly influence negative body image perception and risk for eating disorders. AIM: to describe the prevalence of disturbance of body image perception and engagement in risky behaviors for eating disorders among Spanish-speaking fans residing in Western countries, motivated by the Korean wave. METHOD: this cross-sectional and descriptive study employed a quantitative method for data collection. The data were collected through an anonymous online survey created by the author on the Google Forms platform; the survey included demographic questions, information about exposure to hallyu, body perception, body image perception disturbance and engagement in risky behaviors motivated by the Korean wave. A total of 121 participants were recruited to answer through social network X Prevalence was then calculated for each category. RESULTS: a total of 67.8% of the participants reported comparing their bodies to those of Korean celebrities, and 53.7% experienced a disturbance in their body image perception after exposure to hallyu. Risk behaviors related to exercise were more prevalent among participants than were those related to eating. The majority of participants engaging in these behaviors were females aged 18 years or younger. CONCLUSION: disturbance of the body image perception and engagement in risky behaviors for EDs motivated by the Korean wave are prevalent among its fans, especially female adolescents. More research is needed to understand the extent of this influence on body image perception and the risk of ED, which have a negative impact on physical and mental health.

Caregivers' depressive symptoms and eating disorder severity in adults with anorexia and bulimia nervosa.

BACKGROUND: Negative affectivity of caregivers has been linked to difficulties in the caregiver-patient relationship and it is assumed to contribute to the maintenance of eating disorder (ED) symptoms. AIMS: The present study investigated the relationship of patients' ED symptom severity to patients' and caregivers' depressive symptoms, and caregivers' involvement in a mixed sample of adult inpatients with anorexia (AN) and bulimia nervosa (BN), as well as their caregivers. METHOD: The Eating Disorder Examination and Beck Depression Inventory (BDI) were administered to 55 adult ED patients (26 AN and 29 BN), and the BDI as well as the Involvement Evaluation Questionnaire were filled in by one caregiver of each patient. RESULTS: Our results showed caregivers' depressive symptoms to be significantly related to patients' ED symptom severity, however depressive symptoms and ED symptoms of patients were not related. No connection of involvement of caregivers and ED severity of patients was found. AN and BN patients did not significantly differ on ED severity or depressive symptoms. Caregivers of AN and BN patients did not differ significantly on depressive symptoms and involvement. CONCLUSIONS: Our results support the importance of mental health support for caregivers of adults with AN and BN.

Affect and disordered eating behaviours in women's daily lives: The comparative explanatory roles of distinct momentary emotion dysregulation dimensions.

OBJECTIVE: The present study aimed to examine: (a) whether distinct momentary emotion dysregulation dimensions differentially mediated momentary associations between affect and disordered eating behaviours (DEBs) in the natural environment; (b) whether these associations differed based on affect, emotion dysregulation, and DEB type. METHOD: 150 women with eating disorder pathology (Mage = 20.95, SD = 4.14) completed 4 surveys targeting affect, emotion dysregulation, and DEBs each day for a 10-day ecological momentary assessment period. Multilevel structural equation models examined whether four momentary emotion dysregulation dimensions (difficulties with emotional and behavioural modulation, lack of emotional acceptance, awareness, and clarity) mediated momentary associations between negative and positive affect (PA), and loss of control eating, overeating, and dietary restriction. RESULTS: Momentary difficulties with emotional and behavioural modulation mediated momentary associations between negative affect (NA) and women's loss of control eating and overeating. These findings did not extend to PA, the other emotion dysregulation dimensions, or dietary restriction. CONCLUSIONS: Collectively, these results support emotional and behavioural modulation deficits in the natural environment as potential transdiagnostic maintenance mechanisms of overeating and loss of control eating. These findings also support the potential benefits of targeting NA and this type of emotion dysregulation in existing and novel real-time eating disorders interventions.

Lisdexamfetamine maintenance treatment for binge-eating disorder following successful treatments: randomized double-blind placebo-controlled trial.

BACKGROUND: Controlled research examining maintenance treatments for responders to acute interventions for binge-eating disorder (BED) is limited. This study tested efficacy of lisdexamfetamine (LDX) maintenance treatment amongst acute responders. METHODS: This prospective randomized double-blind placebo-controlled single-site trial, conducted March 2019 to September 2023, tested LDX as maintenance treatment for responders to acute treatments with LDX-alone or with cognitive-behavioral therapy (CBT + LDX) for BED with obesity. Sixty-one (83.6% women, mean age 44.3, mean BMI 36.1 kg/m2) acute responders were randomized to LDX (N = 32) or placebo (N = 29) for 12 weeks; 95.1% completed posttreatment assessments. Mixed-models and generalized-estimating equations comparing maintenance LDX v. placebo included main/interactive effects of acute (LDX or CBT + LDX) treatments to examine their predictive/moderating effects. RESULTS: Relapse rates (to diagnosis-level binge-eating frequency) following maintenance treatments were 10.0% (N = 3/30) for LDX and 17.9% (N = 5/28) for placebo; intention-to-treat binge-eating remission rates were 59.4% (N = 19/32) and 65.5% (N = 19/29), respectively. Maintenance LDX and placebo did not differ significantly in binge-eating but differed in weight-loss and eating-disorder psychopathology. Maintenance LDX was associated with significant weight-loss (-2.3%) whereas placebo had significant weight-gain (+2.2%); LDX and placebo differed significantly in weight-change throughout treatment and at posttreatment. Eating-disorder psychopathology remained unchanged with LDX but increased significantly with placebo. Acute treatments did not significantly predict/moderate maintenance-treatment outcomes. CONCLUSIONS: Adults with BED/obesity who respond to acute lisdexamfetamine treatment (regardless of additionally receiving CBT) had good maintenance during subsequent 12-weeks. Maintenance lisdexamfetamine, relative to placebo, did not provide further benefit for binge-eating but was associated with significantly better eating-disorder psychopathology outcomes and greater weight-loss.

Personalized assessment of eating disorder cognitions during treatment: A new measure of cognitive pathology change.

OBJECTIVE: Modifying cognitive distortions, or thinking errors, is crucial in eating disorders (ED) treatment. To address the lack of a personalized measure for ED cognitions, the Thought Inventory was developed. The study aimed to establish its feasibility and validity, identify thinking error contents and types, examine changes in belief of irrational thoughts, and investigate associations with change in ED symptoms. Hypotheses, procedure, and planned analyses were pre-registered to ensure transparency. METHODS: Participants (N = 55) completed the Thought Inventory, the Eating Disorder Examination Questionnaire, the Eating Pathology Symptom Inventory, the Frost Multidimensional Perfectionism Scale, the Beck Depression Inventory, and the Penn State Worry Questionnaire at pre-and post-ten weeks of treatment. Using the Thought Inventory, participants collaborated with study therapists to identify ED-related thinking errors and rate the degree of belief in these thoughts on a scale of 0 to 100 %. RESULTS: Cognitions primarily contained self-judgments, food rules, and concern over shape, while catastrophizing/fortune telling, emotional reasoning, and should/must statements were the most common types of thinking errors. Belief in cognitions significantly decreased over treatment and change in thought belief was positively associated with change in ED symptoms. CONCLUSION: The Thought Inventory shows promise as a personalized measure. Future research should explore whether ED cognitions, assessed in this manner, are a mechanism of change in ED treatment.

Difficulties in Emotion Regulation in Avoidant/Restrictive Food Intake Disorder.

OBJECTIVE: Despite substantial research indicating difficulties with emotion regulation across eating disorder presentations, emotion regulation has yet to be studied in adults with avoidant/restrictive food intake disorder (ARFID). We hypothesized that (1) those with ARFID would report greater overall emotion regulation difficulties than nonclinical participants, and (2) those with ARFID would not differ from those with other eating disorders on the level of emotion regulation difficulty. METHODS: One hundred and thirty-seven adults (age 18-30) from an outpatient clinic with ARFID (n = 27), with other primarily restrictive eating disorders (e.g., anorexia nervosa; n = 34), and with binge/purge eating disorders (e.g., bulimia nervosa; n = 51), as well as nonclinical participants (n = 25) recruited via Amazon Mechanical Turk (MTurk) completed the Difficulties in Emotion Regulation Scale (DERS). We compared DERS scores across groups. RESULTS: In line with expectations, patients with ARFID scored significantly higher than nonclinical participants on the DERS Total (p = 0.01) with a large effect size (d = 0.87). Also as hypothesized, those with ARFID did not differ from those with other primarily restrictive (p = 0.99) or binge/purge disorders (p = 0.29) on DERS Total. DISCUSSION: Adults with ARFID appear to exhibit emotion regulation difficulties which are greater than nonclinical participants, and commensurate with other eating disorders. These findings highlight the possibility of emotion regulation difficulties as a maintenance mechanism for ARFID.

Parental Binge Eating and Child Binge Eating and Weight-Control Behaviors: Cross-Sectional and Longitudinal Findings From the EAT 2010-2018 Study.

OBJECTIVE: In cross-sectional and retrospective research, parental binge eating is associated with their children's eating psychopathology. The current study extended the evidence by cross-sectionally and longitudinally examining the relation between parental binge eating and binge eating and weight-control behaviors in the next generation of their adolescent children and young adult children in a population-based sample. METHODS: Adolescents (Time 1: M = 14.5, SD = 2.0 years) (n = 2367), followed into adulthood (Time 2: M = 22.1, SD = 2.0 years), and their parents (n = 3664) were enrolled in EAT 2010-2018 and Project F-EAT 2010. The current study examined parental binge eating, and child binge eating and weight-control behaviors. Adjusted models covaried for child gender, age, and race/ethnicity. RESULTS: Approximately 7% of adolescents at Time 1 had at least one parent who reported binge eating with no differences by child's age, gender, or race/ethnicity. Having at least one parent experiencing binge eating at Time 1 (vs. not) was associated cross-sectionally with adolescent children's use of extreme weight-control behaviors (9.6% vs. 4.8%; Risk Difference [RD] = 4.9%) and associated longitudinally with binge eating during young adulthood (21.1% vs. 11.6%; RD = 9.5%). Other associations did not reach statistical significance. CONCLUSIONS: Children of parents with binge eating appear to have elevated risk of extreme weight-control behaviors during adolescence and binge eating in young adulthood. Clinicians should assess whether eating psychopathology extends to other family members, and offer additional support to parents with binge eating. Further research is needed to identify risk factors in the children of parents with binge eating and to assess strategies for prevention.

Exploring the relationship between low energy availability, depression and eating disorders in female athletes: a cross-sectional study.

Objective: This cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee consensus statement on Relative Energy Deficiency in Sport (REDs) identified depression as both an outcome of LEA and a secondary risk factor for REDs. However, the direct link between LEA and depression has yet to be fully established. Methods: We assessed 57 female athletes participating in weight-sensitive sports at different levels of competition training at least four times a week. Assessment was conducted using laboratory analyses, clinical interviews and the Patient Health Questionnaire-9 questionnaire. Participants were recruited through various channels, including German sports clubs, Olympic training centres, social media platforms and the distribution of flyers at competitions. Indicators of LEA were defined if at least two of the following three physiological indicators were present: menstrual disturbances, suppressed resting metabolic rate and suppressed thyroid hormones. Logistic and linear regression analysis were used to examine the relationship between LEA, depression and DE/ED. Results: The lifetime prevalence of depressive disorders was 29.6%. 19% of the participants were diagnosed with an ED, and an additional 22.6% exhibited DE.LEA was not significantly associated with either lifetime prevalence of depressive disorders or current depressive symptoms. However, a significant association was found between depression and DE/ED in terms of both lifetime prevalence and current depressive symptoms. DE/ED increased the probability of lifetime prevalence of depressive disorders by 34% (19%-49%) compared with normal eating behaviour. Conclusion: We found no evidence that LEA is an independent factor for depression in female athletes. Its association with LEA and REDs appears to occur primarily in the presence of DE/ED.

The structure of motivation: Assessing readiness to change dimensions and their predictive value with the network validation of the Italian version of the Anorexia Nervosa Stages of Change Questionnarie.

OBJECTIVE: Motivation to change is an important predictor for treatment outcomes in individuals with anorexia nervosa (AN), however, the existence and clinical relevance of distinct motivational dimensions are understudied. This study aimed to structurally validate the AN Stage of Change Questionnaire (ANSOCQ) in the Italian adult AN population to identify separate motivational dimensions and their association with clinical variables and outcomes. METHOD: Inpatients and outpatients with AN (N = 300) completed the ANSOCQ and measures assessing eating and depressive psychopathology. Unique Variable Analysis and Exploratory Graph Analysis were employed to identify dimensions in the network structure of ANSOCQ. Cross-sectional associations with clinical variables were assessed in the whole sample. Predictive value on weight and psychopathology was assessed in inpatients. RESULTS: Two dimensions were identified, one comprising items relative to weight gain, and the second items regarding attitudes towards eating, body, and emotional problems. Feelings associated with eating resulted as most central in the network. Higher scores in the first dimension and ANSOCQ total predicted weight gain during hospitalisation. No significant predictors emerged for changes in eating psychopathology. DISCUSSION: These findings confirm the robust psychometric properties of ANSOCQ and provide support for the use of its subdimensions in clinical practice.

Disordered eating behaviours during the menopausal transition: a systematic review.

Disordered eating refers to a range of eating behaviours and attitudes towards weight and food that can negatively influence physical and psychosocial well-being. The menopausal transition could be a vulnerable period for disordered eating due to major hormonal fluctuations, menopausal symptoms, common body composition shifts, and an increased risk of psychological challenges. This systematic review aimed to summarize evidence on the associations between the menopausal transition and disordered eating. Records published before October 2023 were identified through MEDLINE, PsycINFO, Scopus, Embase, and CINAHL. Studies investigating associations between menopausal status, menopausal symptoms, or reproductive hormone levels, and disordered eating during the menopausal transition were sought. A total of 1301 non-duplicate records were screened, with 10 studies deemed eligible for inclusion. Most included studies used a cross-sectional design (n = 9). Findings include potentially higher levels of binge eating during the perimenopausal stage, whereas restrictive eating behaviours appeared more common during postmenopause compared to premenopause. Both studies investigating menopausal symptoms found strong positive associations with disordered eating. Nonetheless, findings are equivocal with contrasting results and limited methodological quality across studies. Further research is needed to verify these findings and better assist health professionals in supporting healthy eating behaviours in menopausal women during this complex transition. (PROSPERO ID: CRD42021290736).

Adaptation of mental health first aid guidelines for eating disorders for Iran.

BACKGROUND: This study aimed to adapt mental health first aid guidelines to support individuals with or at risk of developing eating disorders in Iran. This adaptation seeks to enhance the support available for the Iranian population dealing with these disorders. METHODS: We employed the Delphi expert consensus method, utilizing two panels: health professionals (n = 37 in the first round; n = 29 in the second) and individuals with lived experience (n = 20 in the first round; n = 18 in the second). The health professionals panel was selected from the graduates of various eating disorders associated scientific fields who had a history of providing services to or conducting research on people with eating disorders, and the lived experience panel had a history of eating disorders themselves or in their family. The panel of individuals with lived experience included those who had personal or familial histories of eating disorders. Efforts were made to ensure cultural, gender, and age diversity in the selection of panel members. Panellists rated the importance of each item for inclusion in the guidelines for Iran based on the English-language Mental Health First Aid guidelines for eating disorders. Items deemed essential by at least 80% of both panels were included in the final guideline. Additionally, panel members were invited to suggest any missing items. RESULTS: A total of 57 participants took part in the first round of the survey, and 47 participated in the second round. In the first round, 204 items across 11 categories were assessed, with 174 items endorsed by the panels. Thirteen items were re-scored in the second round, and 17 items were rejected. Participants suggested 11 new items in the first round. In the second round, 18 out of 24 items were endorsed, while six were rejected. Ultimately, 192 items were incorporated into the Iranian guidelines. CONCLUSIONS: The adaptation process considered Iran's social and cultural characteristics, including the stigma associated with mental health disorders, religious beliefs and rituals such as fasting, linguistic differences between English and Farsi, distrust of strangers, the influence of friends and family, differences in food access, and low mental health literacy. We recommend piloting the adapted guidelines in high schools, universities, and non-governmental organizations to evaluate their feasibility and effectiveness in real-world settings. Furthermore, it is essential to establish mechanisms for feedback, update content based on the latest evidence, and collaborate with the media to promote educational programs and public participation.

Reduction of peripersonal comfort space correlate with eating disorder symptoms in young adolescents: a network analysis approach.

Background: Peripersonal Space (PS) is represented as the immediate area surrounding an individual. The extent of PS changes in relation to several factors, including emotional states, type of relationship or psychopathology. Attachment anxiety has an impact on the social adaptability of peripersonal space and anxiety and fear are associated with an expansion of peripersonal space, possibly serving as a mechanism of self-protection. Peripersonal space appears to be intricately linked to various psychiatric conditions like anxiety disorders and converging evidence suggests that social maladjustment may predict or exacerbate eating disorder symptoms expression. Methods: Fifty-eight healthy adolescents (38F, 20M) performed a comfort distance estimation task to assess peripersonal space. The Adolescent/Adult Sensory Profile (AASP) was used to assess sensory profiles and the SAFA protocol to investigate psychopathological aspects. Data was analysed using Network Analysis, estimating a Gaussian Graphical Models with a Bayesian approach. Results: We found that the task related to comfort estimation distance demonstrated a correlation with the visual scale of the Adolescent/Adult Sensory Profile (AASP). Additionally, a correlation was observed with the Eating Disorder scale of the SAFA protocol. The touch scale also was negatively correlated with Eating disorder symptoms but not with the comfort estimation task. Conclusion: Our results demonstrate a relation between peripersonal space and eating disorder symptoms in healthy adolescents in line with previous findings in adults with eating disorders diagnosis. These findings suggest that socio-emotional difficulties may be possible precursors or reinforce for the development of an eating disorder symptoms.

Is There a Relationship Between Body Mass Index and Eating Disorder Symptoms in Professional Male Fashion Models?

This study is the first to examine the utility of body mass index (BMI) as an indicator of eating disorder (ED) pathology and fitness for employment for professional male fashion models. We assessed the relationship between experimenter-measured BMI, muscle mass, body fat percentage, and ED severity (EDE-Q score) in male models and nonmodels. Except for higher eating concern, the two groups displayed similar EDE-Q scores after controlling for age. Models relative to nonmodels endorsed significantly greater frequency of compulsive exercise and self-induced vomiting as a means of controlling shape or weight. BMI was a poor indicator of body fat percentage in models. Lower BMI in models, and higher BMI in nonmodels, was associated with higher EDE-Q scores. Interestingly, all the male models with clinically significant EDE-Q scores (≥4.0) had >18.5 experimenter-measured BMI. Higher muscle mass in models, and lower muscle mass in nonmodels, was associated with higher EDE-Q scores. Inversely, lower percentage body fat in models, and higher percentage body fat in nonmodels, was associated with higher EDE-Q scores. BMI, muscle mass, and percentage body fat were associated with ED tendencies in male models and nonmodels. Findings also suggest males with clinical ED symptoms would be overlooked if only low BMI (<18.5) was considered. These results may guide the development of more effective mandates to safeguard models' wellbeing, and men generally.

A comprehensive review on the co-occurrence of scurvy and anorexia nervosa.

Scurvy, a rare disease resulting from vitamin C deficiency, can occur in individuals with restrictive eating disorders like anorexia nervosa (AN), leading to severe health complications. This review explores the complex relationship between scurvy and AN, highlighting the overlapping symptoms and challenges in diagnosis and treatment. Vitamin C is essential for collagen synthesis, immune function, and neurotransmitter production, and its deficiency manifests as fatigue, gingival bleeding, joint pain, and perifollicular hemorrhages. AN exacerbates these symptoms through extreme food restriction, causing severe nutritional deficiencies. Analyzing nine case reports, this review reveals that patients with co-occurring AN and scurvy often present with gastrointestinal, psychiatric, and dermatological symptoms. Treatment with vitamin C supplementation typically results in rapid symptom improvement. However, the malnutrition inherent in AN complicates the clinical picture, making timely diagnosis and intervention crucial. This review underscores the importance of a comprehensive, multidisciplinary approach to managing these conditions, emphasizing the need for early recognition and treatment to prevent severe complications. Future research should include a more diverse patient population to enhance understanding of the interplay between AN and scurvy, aiming to improve patient outcomes through tailored treatment strategies.

Non-Pharmacological Interventions for Feeding Disorders in Pediatrics: A Scoping Review.

Feeding disorders represent a common problem that affects children's health and family routines and since information about non-pharmacological interventions is limited, a scoping review was conducted to identify and describe non-pharmacological interventions for pediatric feeding disorders. This review identified 74 studies. Behavioral strategies were the most common type of intervention. Most studies combined two or more different types of interventions, used an interdisciplinary approach was frequently observed and the profession with the highest frequency of occurrence is occupational therapy. Future research could focus on investigating a greater number of studies with higher levels of evidence and analyzing intervention effectiveness.

Obesity as an aggravating factor of systemic lupus erythematosus disease: What we already know and what we must explore? - A rapid scoping review.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs and systems. Symptoms of SLE can vary widely from person to person and over time, including fatigue, joint pain, skin rashes, fever, and inflammation of multiple organs. The association between SLE and excess body weight has been the subject of study, with evidence suggesting that overweight and obesity can worsen the disease´s clinical presentation. Obesity is linked to a state of low-grade chronic inflammation, which can exacerbate the inflammation present in SLE. Additionally, obesity may negatively impact treatment response, disease progression, and patient prognosis. Patients with SLE and obesity may face additional challenges in managing the disease, such as increased symptom severity, higher risk of cardiovascular and renal complications, and a reduced response to conventional treatments. Obesity can also influence the quality of life of patients with SLE, making a holistic approach that considers the individual's nutritional status essential. Therefore, understanding the relationship between obesity and SLE is crucial for optimizing treatment, improving clinical outcomes, and enhancing patients' quality of life. Further research is needed to elucidate the underlying pathophysiological mechanisms, develop more precise and personalized management strategies, and identify biomarkers that can predict disease prognosis and treatment response.

Navigating the ethical complexities of severe and enduring (longstanding) eating disorders: tools for critically reflective practice and collaborative decision-making.

Decisions about the treatment of eating disorders do not occur in a socio-political vacuum. They are shaped by power relations that produce categories of risk and determine who is worthy of care. This impacts who gets access to care and recognition of rights in mental health services. Globally, there are calls for more human rights-based approaches in mental health services to reduce coercion, improve collaborative decision making and enhance community care. Treating individuals with longstanding, Severe and Enduring Eating Disorders (SEED) or Severe and Enduring Anorexia Nervosa (SE-AN) can be particularly problematic when it involves highly controversial issues such as treatment withdrawal and end-of-life decisions and, where legally permissible, medically assisted dying. In this article, we argue that the socio-political context in which clinical decision making occurs must be accounted for in these ethical considerations. This encompasses considerations of how power and resources are distributed, who controls these decisions, who benefits and who is harmed by these decisions, who is excluded from services, and who is marginalised in decision making processes. The article also presents tools for critically reflective practice and collaborative decision-making that can support clinicians in considering power factors in their practice and assisting individuals with longstanding eating disorders, SEED and SE-AN to attain their rights in mental health services.

A Spongy Appetite: A Case of Pica.

Pica is an eating disorder defined as the compulsive and repeated ingestion of substances that have no nutritional value for at least one month. This condition may be hard to diagnose without complications, as a high degree of suspicion is needed. The subject in this case was a teenager who presented with asthenia and unspecific abdominal pain. The etiological workup showed no abnormalities other than mild anemia and iron and folate deficiencies. After a thorough anamnesis, the patient's mother mentioned sporadic ingestion of synthetic mattress foam since childhood, which had become more frequent in the previous year. With this key information, it was possible to establish a diagnosis before serious complications occurred and thus help the patient get the necessary assistance by referring them to pediatrics, nutrition, and child and adolescent psychiatry consultations. This case report highlights the importance of a detailed anamnesis, particularly when dealing with unspecific symptoms, exploring the possibility of disorders that are rarely thought of, such as pica. It also recaps how important it is to address sensitive topics like eating disorders and create an open environment with no judgment, as these attitudes are crucial to ensuring the correct diagnosis and providing the best care for patients.