Use of glucagon-like peptide-1 receptor agonists in eating disorder populations.

Glucagon-like peptide-1 receptor agonists (GLP-1As) are being used as approved or off-label treatments for weight loss. As such, there has been increasing concern about the potential for GLP-1As to impact eating disorder (ED) symptomatology. This article seeks to (1) review the current state of knowledge regarding GLP-1As and ED symptomatology; (2) provide recommendations for future research; and (3) guide ED clinicians in how to discuss GLP-1As in clinical practice. Although evidence is limited, it is possible that GLP-1As could exacerbate, or contribute to the development of, ED pathology and negatively impact ED treatment. Preliminary research on the use of GLP-1As to treat binge eating has been conducted; however, studies have design limitations and additional research is needed. Therefore, at the current time there is not sufficient evidence to support the use of GLP-1s to treat ED symptoms. In summary, more research is required before negative or positive conclusions can be drawn about the impact of GLP-1As on EDs psychopathology. Herein, we provide specific recommendations for future research and a guide to help clinicians navigate discussions with their clients about GLP-1As. A client handout is also provided. PUBLIC SIGNIFICANCE: Despite glucagon-like peptide-1 receptor agonists (GLP-1As; e.g., semaglutide) increasingly being the topic of clinical and public discourse, little is known about their potential impact on ED symptoms. It is possible that GLP-1As could maintain, worsen, or improve ED symptoms. This article reviews the limited literature on GLP-1As and ED symptoms, recommends future research, and provides clinicians with a guide for discussing GLP-1As with ED clients.

The potential role of stimulants in treating eating disorders.

BACKGROUND: Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential. METHOD: To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine. RESULTS: We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on "loss of control" eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials. DISCUSSION: Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.

Do anxiety sensitivity and impulsivity interact in predicting exercise involvement in emerging adult drinkers and cannabis users?

Anxiety sensitivity (AS; i.e. fear of arousal-related sensations) and impulsivity (i.e. tendency to act quickly without regard for longer-term consequences) represent risks for low physical activity participation. Theoretically, higher impulsivity may exacerbate the negative exercise behaviours of high AS individuals given the tendency of impulsive individuals to favour immediate (e.g. watching TV) over delayed rewards (e.g. the benefits of exercise). Our goal was to investigate the main and interactive effects of AS and impulsivity on physical activity levels at varying exercise intensities. Participants were 178 emerging adults (Mean age = 21.9; 68.8% women). Higher AS was associated with less engagement in vigorous intensity exercise. Moderator analyses revealed an AS x impulsivity interaction: high AS predicted significantly less engagement in moderate intensity exercise at low impulsivity levels and marginally more engagement in moderate intensity exercise at high impulsivity levels. Finally, higher impulsivity was associated with more time spent walking. Cognitive behavioural therapy for high AS, or teaching individuals with high AS to focus on immediate, external rewards of exercise, may help them engage in more physical activity. Given the wide-ranging physical and mental health benefits of exercise involvement, developing effective strategies to increase such involvement in high AS individuals is vital.

Understanding the effects of reductionist biological views of eating disorder etiology on patient attitudes and behavior.

While eating disorders were historically considered to be a result of psychological or environmental causes, current evidence suggests that eating disorders are the product of complex gene-environment interactions wherein heritable vulnerabilities are activated by multiple exposures to environmental stimuli over the lifespan. Despite the fact that this integrated biopsychosocial etiological view of eating disorders is accepted among many professionals in the eating disorder field, evidence suggests that the general public and some clinicians are susceptible to dualist, or reductionist, views of psychopathology. Currently, little is known about (a) the prevalence of reductionist biological views of eating disorder etiology in those with eating disorders (this view attributes the cause of eating disorders to predominantly biological factors but does not acknowledge psychosocial factors as important contributors), (b) the effects of reductionist biological views on clinical outcomes, and (c) the most effective methods for modifying these views. In this article, we present the results of a preliminary investigation on the relationship between perceived causes of eating disorders and the attitudes and behaviors of those with eating disorders. We then go on to propose specific avenues for further research on uncovering the effects of reductionist biological views of eating disorder etiology.

The costs and benefits of intensive day treatment programs and outpatient treatments for eating disorders: An idea worth researching.

Outpatient care (e.g., individual, group, or self-help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self-efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost-effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.

Social influences on binge drinking in emerging adults: Which social network members matter most?

BACKGROUND: Binge drinking peaks in emerging adulthood and is associated with a myriad of negative consequences. Research indicates that social network members have a significant influence on binge drinking. In particular, theory suggests that drinking habits of romantic partners and peers have a stronger influence on emerging-adult binge drinking than do drinking habits of siblings and parents. We investigated the relative influences of siblings, parents, romantic partners, and peers on emerging adults' binge drinking using a multisource design and a robust measure of binge drinking. We hypothesized peer and romantic partner binge drinking would more strongly predict emerging-adult (egos) binge drinking than would parent and sibling binge drinking. Methods: We recruited 321 participants (egos) aged 17-25 years, alongside 882 members of their social network (alters). Egos and alters completed self-report measures of binge drinking (frequency, quantity, and self-perception). Results: Structural equation modeling revealed that the direct positive effect from romantic partner binge drinking to ego binge drinking was significant. In contrast, the direct effects from peer, parent, and sibling binge drinking to ego binge drinking were nonsignificant. Conclusion: In emerging adulthood, romantic partners appear to have the strongest association with ego binge drinking.

Reducing the Density and Number of Tobacco Retailers: Policy Solutions and Legal Issues.

INTRODUCTION: Because higher density of tobacco retailers is associated with greater tobacco use, U.S. communities seek ways to reduce the density and number of tobacco retailers. This approach can reduce the concentration of tobacco retailers in poorer communities, limit youth exposure to tobacco advertising, and prevent misleading associations between tobacco and health messaging. METHODS: Communities can reduce the density and number of tobacco retailers by imposing minimum distance requirements between existing retailers, capping the number of retailers in a given geographic area, establishing a maximum number of retailers proportional to population size, and prohibiting sales at certain types of establishments, such as pharmacies, or within a certain distance of locations serving youth. Local governments use direct regulation, licensing, or zoning laws to enact these changes. We analyze each approach under U.S. constitutional law to assist communities in selecting and implementing one or more of these methods. There are few published legal opinions that address these strategies in the context of tobacco control. But potential constitutional challenges include violations of the Takings Clause of the Fifth Amendment, which protects property owners from onerous government regulations, and under the Fourteenth Amendment's Equal Protection and Due Process Clauses, which protect business owners from arbitrary or unreasonable regulations that do not further a legitimate government interest. CONCLUSION: Because there is an evidentiary basis linking the density of tobacco retailers to smoking rates in a community, courts are likely to reject constitutional challenges to carefully crafted laws that reduce the number of tobacco retailers. IMPLICATIONS: Our review of the relevant constitutional issues confirms that local governments have the authority to utilize laws and policies to reduce the density and number of tobacco retailers in their communities, given existing public health data. The analysis guides policy makers in crafting laws that comply with constitutional requirements by outlining the most important procedures and evidentiary justifications to use in development, implementation, and enforcement. This perspective also highlights the importance of reviewing state constitutions, statutes, and municipal codes and getting local input from attorneys and community stakeholders to assess the likely success of some methods over others.

Development of Brief Alcohol and Cannabis Motives Measures: Psychometric Evaluation Using Expert Feedback and Longitudinal Methods.

Objective: Alcohol and cannabis use motives are often studied as contributors to risky substance use patterns. While various measures for capturing such motives exist, most contain 20+ items, which render their inclusion in certain research designs (e.g., daily diary) or with certain populations (e.g., polysubstance users) unfeasible. We sought to generate and validate six-item measures of cannabis and alcohol motives from existing measures, the Marijuana Motives Measure (MMM) and the Modified Drinking Motives Questionnaire-Revised (MDMQ-R). Methods: In Study 1, items were generated, feedback from 33 content- domain experts was obtained, and item revisions were made. In Study 2, the finalized brief cannabis and alcohol motives measures, along with the MMM, MDMQ-R, and substance-related measures, were administered to 176 emerging adult cannabis and alcohol users (71.6% female) at two timepoints, two months apart. Participants were recruited through a participant pool. Results: Study 1 experts indicated satisfactory ratings of face and content validity. Expert feedback was used to revise three items. Study 2 results suggest test-retest reliabilities for the single-item forms (r = .34 to .60) were similar to those obtained with full motives measures (r = .39 to .67). Validity was acceptable-to-excellent in that brief and full-length measures were significantly intercorrelated (r = .40 to .83). The brief and full-length measures had similar concurrent and predictive relationships for cannabis and alcohol quantity x frequency (coping- with-anxiety for cannabis and enhancement for alcohol) and problems (coping-with-depression), respectively. Conclusions: The brief measures represent psychometrically-sound measures of cannabis and alcohol use motives with substantially less participant burden than the MMM and MDMQ-R.

Integrated treatment for comorbid eating disorders and substance use disorders: a scoping review protocol.

OBJECTIVE: This review will identify and summarize the literature on the integrated treatment of comorbid eating disorders and substance use disorders, focusing on clinical practice guidelines and treatment studies. INTRODUCTION: Eating disorders and substance use disorders are the deadliest psychiatric conditions, frequently co-occur, and are linked to greater symptom severity and poorer treatment outcomes. Despite repeated calls for their integrated treatment, such an approach has rarely been empirically evaluated. To advance the development of integrated treatments for comorbid eating disorders and substance use disorders, a critical first step is to describe existing treatment guidelines and summarize research evidence for this approach. INCLUSION CRITERIA: This review will consider all peer-reviewed and gray literature describing the integrated treatment of comorbid eating disorders and substance use disorders, focusing on i) clinical practice guidelines; and ii) treatment studies. We will not place limitations on populations, types of eating disorders, types of substance use disorders, or other contextual factors. METHODS: Databases to be searched will include MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and clinical practice guidelines databases identified by CADTH Grey Matters. No date or language limits will be applied to the search. At the screening stage, we will only consider literature in English or French. Two independent reviewers will screen studies at the title/abstract and full-text levels, and extract relevant studies. Disagreements will be resolved through discussion. Findings will be presented in tabular format and a narrative summary. REVIEW REGISTRATION: Open Science Framework https://osf.io/za35j/.

Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa.

BACKGROUND: There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and qualitative interview results from that feasibility trial. These outcomes explore several purported mechanisms that may explain how stimulants affect symptoms of BN: appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology/impairment and reward-based decision-making. METHODS: Twenty-three participants with BN received LDX for eight weeks. Questionnaires assessing appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology and impairment were administered at baseline and post-treatment. Participants also completed a two-step reinforcement learning task to assess their decision-making. Semi-structured interviews took place at baseline, week 5, and follow-up. RESULTS: Reductions in hunger, food-related impulsivity, obsessive and compulsive features, eating disorder psychopathology and impairment were found. However, reward learning, as far as it is assessed by the task, did not seem to contribute to the effect of LDX on BN symptoms. Qualitative analysis suggested four themes: (1) reprieve from the eating disorder, (2) improvement in function and quality of life, (3) renewed hope for recovery, and (4) ability to normalize eating. CONCLUSIONS: This report suggests several potential mechanisms by which LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the open-label design, we are unable to attribute findings to the medication. Instead, our results should be interpreted as hypothesis generating to inform future studies such as adequately powered randomized controlled trials. Trial registration NCT03397446.

Recent research suggests that stimulant medications could be a potential treatment for bulimia nervosa (BN). Participants in this study took lisdexamfetamine dimesylate (LDX) for 8 weeks while their eating disorder symptoms and medical status were carefully monitored. As part of this study, twenty-three participants with BN completed several interviews, questionnaires and computer tasks at the start and end of treatment which were delivered to help researchers learn more about the how LDX impacts people with BN. Scores on questionnaires measuring different aspects of the eating disorder improved over time. Participants' performance on the computer task which measures a type of decision making did not change during treatment. Interviews exploring participants' experience taking LDX found four common themes: reprieve from the eating disorder, improvement in function and quality of life, renewed hope for recovery, and ability to normalize eating. This report suggests several potential ways LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the size and type of study, we cannot conclude that changes observed were a direct result of the medication. Instead, our results should be used to form new questions that can be explored by larger studies with controlled designs.

Different drugs come with different motives: Examining motives for substance use among people who engage in polysubstance use undergoing methadone maintenance therapy (MMT).

BACKGROUND: Substance use motives (i.e., reasons for using a substance) are thought to be the most proximal variable leading to substance use. These motives have been described by various typologies, the most well known being the four-factor drinking motives model which separates motives into enhancement, social, coping, and conformity (Cooper, 1994). Although extensively studied in adult community samples, motives for use have less commonly been investigated among populations at a later stage of addiction, where polysubstance use is more common. Moreover, because the motives literature has largely focused on drinking motives, it is not clear whether existing findings can also be applied to other substances (Cooper et al., 2016). METHODS: Using Zero-inflated beta Bayesian linear mixed modeling, we investigated the stability of seven distinct substance use motives (enhancement, social, expansion, coping with anxiety, coping with depression, coping with withdrawal, and conformity) across six different drug categories (tobacco, alcohol, cannabis, opioids, stimulants, and tranquilisers) to determine the extent to which drug class can influence motive endorsement. One-hundred-and-thirty-eight methadone maintenance therapy (MMT) clients (F = 34.1%; M = 65.9%; age = 40.18 years) completed a novel short-form polysubstance motives questionnaire. RESULTS: External motives (i.e., conformity and social motives) were the most stable across drug categories, while all internal motives (i.e., enhancement, expansion, and all three coping motives) demonstrated varying levels of inter-drug variability. CONCLUSIONS: These findings have important implications for prevention and intervention strategies among people who engage in polysubstance use, highlighting the importance of both universal and substance-specific programming.

Do romantic partners influence each other's heavy episodic drinking? Support for the partner influence hypothesis in a three-year longitudinal study.

BACKGROUND: Approximately one in five adults engage in heavy episodic drinking (HED), a behavior with serious health and social consequences. Environmental, intrapersonal, and interpersonal factors contribute to and perpetuate HED. Prior research supports the partner influence hypothesis where partners influence each other's HED. OBJECTIVES: We examined the partner influence hypothesis longitudinally over three years in heterosexual couples in serious romantic relationships, while exploring possible sex differences in the magnitude of partner influence. METHODS: One-hundred-and-seventy-nine heterosexual couples in serious relationships (38.5% married at baseline) completed a measure of HED at baseline and again three years later. RESULTS: Using actor-partner interdependence modelling, results showed actor effects for both men and women, with HED remaining stable for each partner from baseline to follow-up. Significant partner effects were found for both men and women, who both positively influenced their partners' HED over the three-year follow-up. CONCLUSIONS: The partner influence hypothesis was supported. Results indicated partner influences on HED occur over the longer term and apply to partners in varying stages of serious romantic relationships (e.g., cohabiting, engaged, married). Women were found to influence their partners' HED just as much as men influence their partners' HED. Findings suggest HED should be assessed and treated as a couples' issue rather than simply as an individual risky behavior.