Supporting healthcare professionals to reduce weight stigma.

BACKGROUND: Reducing weight stigma in healthcare is critical to supporting and improving the health of people living with overweight or obesity and decreasing the risk of adverse patient outcomes. We were invited as stigma researchers to participate in an online workshop alongside community members, healthcare professionals and policymakers to codesign guidance for reducing weight stigma in healthcare. This workshop prompted us to reflect on why and how weight stigma should be addressed in healthcare, and to provide recommendations for healthcare professionals and policymakers to reduce weight stigma in healthcare. OBJECTIVE: This paper presents our reflections and recommendations for addressing weight stigma in healthcare following the codesign workshop. DISCUSSION: Recommendations include targeting individual healthcare professionals and involving clear, practical guidelines and training that leverage the notions of 'do no harm', improving practice and recognising biases. Importantly, such strategies must be couched in broader structural approaches to weight stigma reduction.

Machiavellianism and Intimate Partner Violence Perpetration: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis estimated the size of the relationship between Machiavellianism and intimate partner violence (IPV) perpetration. Further, we explored whether the strength of this relationship varied depending on IPV type (i.e., physical, psychological, sexual, and cyber), and perpetrator gender. Systematic searches of Medline Complete, PsycInfo, Scopus, and Web of Science databases were conducted on July 4, 2023. Studies were included if they were a peer-reviewed published paper or unpublished dissertation, in English, included a measure of Machiavellianism and IPV perpetration, and reported the relationship between these variables. Study quality was assessed using the AXIS tool. Nineteen studies (N = 9,464) were included in a random-effects meta-analysis revealing a significant, weak, positive correlation between Machiavellianism and IPV perpetration (r = .16, 95% CI [0.11, 0.21], p < .001). Machiavellianism had a significant, weak, positive relationship with cyber (r = .25, 95% CI [0.17, 0.32], p < .001), psychological (r = .20, 95% CI [0.15, 0.24], p < .001), and sexual IPV (r = .10, 95% CI [0.02, 0.19], p = .020). No significant relationship was found for physical IPV. There was no significant difference in the strength of the relationship between women and men. These findings are limited by the measures being self-report, heterogeneity across studies, and the cross-sectional nature of the included studies which limits the understanding of causal pathways. Nonetheless, this meta-analysis shows a link between Machiavellianism and IPV perpetration, and future research should examine how this knowledge may be used to reduce IPV perpetration.

Influences of past moral behavior on future behavior: A review of sequential moral behavior studies using meta-analytic techniques.

Experimental research on sequential moral behavior (SMB) has found that engaging in an initial moral (or immoral) behavior can sometimes lead to moral balancing (i.e., switching between positive and negative behavior) and sometimes to moral consistency (i.e., maintaining a consistent pattern of positive or negative behavior). In two meta-analyses, we present the first comprehensive syntheses of SMB studies and test moderators to identify the conditions under which moral balancing and moral consistency are most likely to occur. Meta-Analysis 1 (k = 217 effect sizes, N = 31,242) revealed that engaging in an initial positive behavior only reliably resulted in moral licensing (i.e., balancing) in studies that measured engagement in negative target behaviors (Hedges' g = 0.25, 95% CI [0.16, 0.44]) and only resulted in positive consistency in foot-in-the-door studies using prosocial requests (Hedges' g = -0.44, 95% CI [-0.59, -0.29]). Meta-Analysis 2 (k = 132 effect sizes, N = 14,443) revealed that engaging in an initial negative behavior only reliably resulted in moral compensation (i.e., balancing) in studies that measured engagement in positive target behaviors (Hedges' g = 0.27, 95% CI [0.18, 0.37]). We found no evidence for reliable negative consistency effects in any conditions. These results cannot be readily explained by current theories of SMB effects, and so further research is needed to better understand the mechanisms that drive moral balancing and consistency under the conditions observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and Validation of the Cheers Attitudes towards Non-drinkers Scale (CANS).

Non-drinkers report experiencing stigma, which can act as a barrier to non-drinking. Two studies were undertaken to develop and test a new scale to measure attitudes towards non-drinkers. In Study 1, 29 items were presented to 426 Australian drinkers. In Study 2, the refined 12-item Cheers Attitudes to Non-drinkers Scale (CANS) was presented to 389 drinkers. Alcohol consumption, Harm and the Regan Attitudes towards Non-drinkers Scale (RANDS) were presented for scale validation. Exploratory factor analysis revealed three factors representing the Threats to Fun, Connection and Self that drinkers perceive non-drinkers to pose. Confirmatory factor analysis showed that the scale meets the required fit indices and had good reliability (α = 0.842). Evidence of validity was shown through significant correlations with Alcohol Consumption, Harm and the RANDS. These studies show the CANS to be a reliable and valid measure that could be utilised to understand and modify the stigma experienced by non-drinkers.

A systematic review of ecological momentary assessment studies on weight stigma and a call for a large-scale collaboration.

BACKGROUND: Weight stigma is associated with poor mental health correlates in cross-sectional research. Researchers are increasingly using Ecological Momentary Assessment (EMA) methods, collecting comprehensive within-person data to understand the temporal nature of weight stigma and its biopsychosocial correlates. AIM: To systematically review EMA studies on the effect of weight stigma on biopsychosocial correlates and integrate the findings. METHOD: PsycINFO, CINAHL, Embase, Medline Complete, and Web of Science were searched and studies were doubled screened (H.B. and X.P.G.). RESULTS: Twelve studies (N = 615) met our inclusion criteria. For both between- and within-subject effects, experienced and internalized weight stigmas were associated with negative correlates/outcomes (e.g., higher disordered eating and lower positive mood). However, studies differed in the correlate measures assessed, EMA methods used, and participant instructions provided. Given these inconsistencies, comparison across studies was difficult, and findings could not be reliably integrated. CONCLUSIONS: Consistent with previous research, studies from this review suggest weight stigma leads to adverse outcomes. EMA has the potential to overcome many of the limitations present in cross-sectional research on weight stigma and provide more ecologically valid and reliable results. We argue for a collaborative data-sharing consortium with standardized EMA methodologies, so researchers worldwide can contribute to and make use of a large, collective dataset on weight stigma and health correlates (see osf.io/s5ru6/).

Disentangling Gender-Based Attitudes from Sexuality-Based Attitude: The Person-Based Approach to Measuring Implicit Attitudes Toward Gay Men and Lesbian Women.

In this paper, we present the person-based approach to measuring implicit attitudes toward gay men and lesbian women-this approach uses face stimuli rather than traditionally used symbols, and creates salient social categories through contextual variation techniques. Across 5 experiments using the Go/No Go Association Task (n = 364), we present evidence that the person-based approach can disentangle implicit gender-based attitudes from implicit sexuality-based attitudes, that these attitudes vary as a function of participant gender and sexuality, and that they are different to attitudes elicited by typically used stimuli. We demonstrate that implicit person-based gender attitudes toward straight and gay people are similar and are consistent with the literature (i.e. attitudes toward [lesbian] women are more positive than attitudes toward [gay] men). However, we reveal a reversed pattern of findings for person-based implicit sexuality attitudes (i.e. attitudes toward gay men are more positive than attitudes toward lesbian women). These findings suggest that the person-based approach uniquely captures nuanced implicit attitudes toward gay men and lesbians, raising important questions regarding previous findings.

The correlation between different operationalisations of parental restrictive feeding practices and children's eating behaviours: Systematic review and meta-analyses.

Strategies used by parents to restrict children's access to highly palatable but unhealthy foods have been described collectively as restrictive feeding practices. Ironically, evidence shows these practices may foster maladaptive eating behaviours and increase children's risk of obesity. This systematic review and series of meta-analyses aim to estimate the relationships between different operationalisations of parental restrictive feeding practices and children's eating behaviours measured by either the Children's Eating Behaviour Questionnaire (Wardle et al., 2001) or eating in the absence of hunger paradigm. PsycINFO, Medline Complete, CINAHL, Scopus and Web of Science databases were searched on April 22nd 2021 for terms relating to restrictive feeding practices, children and eating behaviours. Eligible studies (n = 24) reported a correlation between restrictive feeding and children's (2-12-years) eating behaviours. Meta-analyses were conducted on different operationalisations of restrictive feeding practices and different eating behaviours where there were three or more effects to analyse. Studies that were not meta-analysed were synthesised qualitatively. All studies were quality assessed using a standard checklist. Restrictive feeding (Child Feeding Questionnaire; Birch et al., 2001), was significantly correlated with higher food responsiveness, food fussiness, emotional overeating, and lower slowness in eating. Overt restriction (Feeding Practices and Structure Questionnaire, E. Jansen et al., 2014) was significantly correlated with higher food responsiveness. The qualitative synthesis suggests overt restriction is related to maladaptive eating behaviours, but that other operationalisations of restrictive feeding, especially covert restriction, are not. Future research should examine whether covert restriction provides an alternative, non-harmful approach to restriction, by which parents can control children's diet quality without negatively impacting their eating behaviours.

Weight stigma in Australia: a public health call to action.

People living with obesity experience weight stigma in most social settings. This has a negative impact on their health and quality of life. A primary contributor to weight stigma is the misconception that obesity is caused by factors solely within an individual's control. However, this disregards the complex and multifaceted nature of obesity. Weight stigma is perpetuated by the media, healthcare practitioners and researchers, and even in public health campaigns and policies designed to help people living with obesity. This perspective article is a public health call to action to address weight stigma in Australia. We provide key recommendations for public health researchers, practitioners, and policy makers.

Internalised Weight Stigma Mediates Relationships Between Perceived Weight Stigma and Psychosocial Correlates in Individuals Seeking Bariatric Surgery: a Cross-sectional Study.

PURPOSE: Research suggests that internalised weight stigma may explain the relationship between perceived weight stigma and adverse psychological correlates (e.g. depression, disordered eating, body image disturbances). However, few studies have assessed this mechanism in individuals seeking bariatric surgery, even though depression and disordered eating are more common in this group than the general population. MATERIALS AND METHODS: We used data from a cross-sectional study with individuals seeking bariatric surgery (n = 217; 73.6% female) from Melbourne, Australia. Participants (Mage = 44.1 years, SD = 11.9; MBMI = 43.1, SD = 7.9) completed a battery of self-report measures on weight stigma and biopsychosocial variables, prior to their procedures. Bias-corrected bootstrapped mediations were used to test the mediating role of internalised weight stigma. Significance thresholds were statistically corrected to reduce the risk of Type I error due to the large number of mediation tests conducted. RESULTS: Controlling for BMI, internalised weight stigma mediated the relationship between perceived weight stigma and psychological quality of life, symptoms of depression and anxiety, stress, adverse coping behaviours, self-esteem, exercise avoidance, some disordered eating measures and body image subscales, but not physical quality of life or pain. CONCLUSION: Although the findings are cross-sectional, they are mostly consistent with previous research in other cohorts and provide partial support for theoretical models of weight stigma. Interventions addressing internalised weight stigma may be a useful tool for clinicians to reduce the negative correlates associated with weight stigma.

A Systematic and Meta-Analytic Review of Identity Centrality among LGBTQ Groups: An Assessment of Psychosocial Correlates.

The degree to which an identity is an important aspect of one's self-concept (i.e., identity centrality) relates to both health and prejudice experiences of minority groups. Individuals with greater levels of identity centrality view their world through the lens of that identity. This allows them to engage in more positive identity-relevant experiences. However, it could also heighten their perceptions of in-group threat. Among LGBTQ groups, the relationship between identity centrality and psychosocial outcomes is yet to be established. In this paper, we investigated the relationship between LGBTQ identity centrality and psychosocial outcomes via a comprehensive systematic (k = 89, N = 35,950) and meta-analytic (k = 57, N = 26,704) literature review. Results indicated that greater levels of LGBTQ centrality relates to more positive identity-relevant affirmations (.155 ≤ r's ≤ .419), but also greater prejudice/discrimination perceptions and experiences (-.271 ≤ r's ≤ -.128). We found no evidence of a relationship between LGBTQ centrality and health outcomes (-.052 ≤ r's ≤ .040). Importantly, we found that these relationships are more beneficial for some LGBTQ groups (gay men), than for others (bisexual/transgender individuals). Findings from this review provide important and necessary insights on the role of LGBTQ identity centrality and identify crucial gaps in the literature that should be addressed.

Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review.

OBJECTIVE: To systematically review studies that have assessed the mediating role of internalised weight stigma on the relationship between experienced/perceived weight stigma and any biopsychosocial outcomes. METHODS: PsycINFO, PsycExtra, Web of Science, CINAHL, Medline and Embase were systematically searched. Identified studies were double screened (HB and XPG). RESULTS: Seventeen studies (across 16 articles) met our inclusion criteria (N = 21,172), and almost all studies measured only psychological outcomes (n = 15). Eight studies found consistent evidence for internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and disordered eating outcomes. Preliminary evidence was found for the mediating role of internalised weight stigma on the relationship between experienced/perceived weight stigma and body shame, body dissatisfaction, exercise behaviour, healthcare experiences and behaviours, bodily pain and parental weight talk. However, the findings were inconsistent for depression and anxiety, although only two studies reported these. CONCLUSION: This review provides preliminary evidence for internalised weight stigma as an intervening variable in the relationship between experienced/perceived weight stigma and adverse health outcomes. Results suggest that there are potential benefits of interventions addressing internalised weight stigma to improve health outcomes. However, these findings must be considered in the context of the psychometric limitations of the Weight Bias Internalisation Scale, which was used in all but one study.

Emotion Recognition and Traumatic Brain Injury: a Systematic Review and Meta-Analysis.

Traumatic brain injury (TBI) can lead to impairments in emotion recognition that can present considerable challenges to social communication and the maintenance of interpersonal relationships. This review aimed to estimate the magnitude of emotion recognition impairments in TBI patients overall, and at the emotion category level, and to determine if the magnitude of observed impairments were moderated by modality (e.g., face, voice, multi-modal) of emotional expression, and severity of injury. Searches of PubMed, Scopus, PsycINFO, and Medline databases identified 17 studies which satisfied strict inclusion and exclusion criteria for the systematic review (comparing TBI patients to matched controls). Of these studies, 15 were included in the meta-analysis (NTBI = 474; NControl = 461). Moderate/large average deficits emerged for TBI patients relative to controls (Hedges' g = 0.79, 95% CI: 0.61 - 0.96, p < .001; Q = 22.53, p = .068, τ2 = 0.04, I2 = 37.84; indicating low heterogeneity). TBI patients were impaired across all emotion categories, with moderate/large effect sizes observed for fear and anger, moderate effect sizes for disgust, neutral and sadness, while effect sizes for happiness and surprise were small. The magnitude of impairment for individuals with TBI severity classified as moderate/severe TBI was moderate, whereas severe TBI was large. Moderate/large effect sizes were observed across the different modalities of presentation. This meta-analysis provides evidence for marked global impairments in emotion recognition, with the magnitude of impairment greatest for negative emotions (i.e., anger and fear). This meta-analysis provided no evidence to suggest that the magnitude of impairment is influenced by injury severity or modality of stimulus presentation. Recommendations for future research are discussed.

Evaluation of the psychometric properties of self-reported weight stigma measures: A systematic literature review.

OBJECTIVE: Conceptualisation and measurement of weight stigma varies across available studies assessing those affected. This paper aims to systematically review the psychometric properties of available self-reported measures of weight stigma. METHOD: Studies exploring the development and/or validation of weight stigma measures were identified through systematically searching Medline, CINAHL, PsycINFO, Embase, Web of Science, and Scopus databases. The Consensus-based Standards of Health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties of measures. RESULTS: Thirty-six articles, reporting 18 different weight stigma measures, were included. For most included measures, measure development and content validity have not been assessed/reported. Structural validity, internal consistency, and hypothesis testing were the most commonly assessed/reported psychometric properties. High-quality ratings were given only for these properties. Most measures were rated as "indeterminate" and received an overall quality rating of "Very Low" as results were based on limited evidence. CONCLUSIONS: Psychometric properties for published weight stigma measures have rarely been assessed/reported. The observed poor methodological quality for measure development, and limited content validity evidence, negatively impact the quality of evidence for the measures. There is a need for studies assessing the psychometric properties of existing weight stigma measures using COSMIN guidelines, and for a well-designed weight stigma measure informed by both theory and research.

Pre-operative Restraint and Post-operative Hunger, Disinhibition and Emotional Eating Predict Weight Loss at 2 Years Post-laparoscopic Adjustable Gastric Banding.

INTRODUCTION: A principal mechanism of action in bariatric surgery is reduction in calorie consumption due to decreased hunger and increased satiety. Patients' ability to perceive post-operative changes to their hunger is therefore central to optimal results. This study examined factors that may impact how patients perceive post-operative hunger and how perception of hunger impacts eating and subsequent weight loss after laparoscopic adjustable gastric banding (LAGB). METHODS: Patients undertaking LAGB (n = 147) provided pre-surgery and 2-year weight loss data and pre-surgery and 12-month psychological data (perception of hunger, disinhibition related to eating, emotional eating). RESULTS: Path analysis demonstrated that patients with lower levels of pre-surgery cognitive restraint over eating experienced significantly greater reduction in perception of hunger at 12 months post-surgery. Perceived reduction in hunger was significantly associated with lower levels of both emotional eating and disinhibited eating. Finally, reduced emotional eating at 12 months significantly predicted 9% of the variance in percentage of total weight loss (%TWL) at 2 years after surgery. CONCLUSION: These initial findings suggest that preparation for bariatric surgery may be enhanced by psychoeducation regarding cognitive restraint over eating and its effect on hunger perception. In addition, psychological treatment that focuses on identifying and responding to changes in hunger may contribute to improved outcomes for those who have difficulty adjusting to post-operative eating behaviours.

Do body checking and avoidance behaviours explain variance in disordered eating beyond attitudinal measures of body image?

Body checking and body avoidance, considered to be behavioural manifestations of core attitudinal disturbances of body image, are theorized to be important contributors to the development and maintenance of eating disorder symptoms. Currently, however, it is unclear whether body checking and body avoidance accounts for variance in disordered eating behaviours beyond core attitudinal components of body image (i.e., over-evaluation, preoccupation, dissatisfaction). This was the objective of the present study. Cross-sectional data were analysed from 320 females recruited through undergraduate psychology programs and throughout the community. Bivariate correlations demonstrated that body checking and avoidance were significantly and positively correlated with each attitudinal component and with each measure of disordered eating (overeating, objective binge eating, and disinhibition). However, body checking and avoidance did not contribute variance (all R2changes ≤ 0.01) to each disordered eating behaviour beyond the variance accounted for by attitudinal components. Future research should aim to identify what specific and unique function these body image behaviours serve. Overall, eating disorder prevention and early intervention programs may benefit from ensuring that all facets of body image concerns are targeted and addressed.

Psychosocial Predictors of Change in Depressive Symptoms Following Gastric Banding Surgery.

OBJECTIVE: The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. METHODS: Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. RESULTS: Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. CONCLUSIONS: Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.

The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis.

OBJECTIVE: This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders. METHOD: Randomized controlled trials of CBT were searched. Seventy-nine trials were included. RESULTS: Therapist-led CBT was more efficacious than inactive (wait-lists) and active (any psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than behavior therapy or nonspecific supportive therapies. CONCLUSIONS: CBT is efficacious for eating disorders. Although CBT was equally efficacious to certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically, offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are hampered by the fact that many trials were of poor quality. Higher quality RCTs are essential. (PsycINFO Database Record

Appetitive traits associated with higher and lower body mass index: evaluating the validity of the adult eating behaviour questionnaire in an Australian sample.

BACKGROUND: The aims of this study were to evaluate the factor structure of the newly developed Adult Eating Behaviour Questionnaire (AEBQ) (Hunot et al., Appetite 105:356-63, 2016) in an Australian sample, and examine associations between the four food approach and four food avoidance appetitive traits with body mass index (BMI). METHODS: Participants (N = 998) recruited between May and October 2016 via a university research participation scheme and online social network sites completed an online version of the AEBQ and self-reported demographic and anthropometric data. Of the sample, 84.8% were females, 29.6% had completed a university degree and the overall mean age was 24.32 years (SD = 8.32). Confirmatory factor analysis (CFA) was used to test three alternative factor structures (derived from issues raised in the original development study): the original 8 factor model, a 7 factor model with Food Responsiveness and Hunger scales combined, and a 7 factor model with the Hunger scale removed. RESULTS: The CFA revealed that the original 8 factor model was a better fit to the data than the 7 factor model in which Food Responsiveness and Hunger scales were combined. However, while reliability estimates for 7 of the 8 scales were good (Cronbach's α between 0.70-0.86), the reliability of the Hunger scale was modest (0.67) and dropping this factor resulted in a good fitting model. All food avoidance scales (except Food Fussiness) were negatively associated with body mass index (BMI) whereas Emotional Overeating was the only food approach scale positively associated with BMI. CONCLUSIONS: The study supports the use of the AEBQ as a reliable and valid measure of food approach and avoidance appetitive traits in adults. Longitudinal studies that examine continuity and stability of appetitive traits across the lifespan will be facilitated by the addition of this measurement tool to the literature.

Psychotherapy for bulimia nervosa on symptoms of depression: A meta-analysis of randomized controlled trials.

OBJECTIVE: Depressive symptoms are an important risk factor and consequence of binge eating and purging behavior in bulimia nervosa (BN). Although psychotherapy is effective in reducing symptoms of BN in the short- and long-term, it is unclear whether psychotherapy for BN is also effective in reducing depressive symptoms. This meta-analysis examined the efficacy of psychotherapy for BN on depressive symptoms in the short- and long-term. METHOD: Randomized controlled trials (RCTs) on BN that assessed depressive symptoms as an outcome were identified. Twenty-six RCTs were included. RESULTS: Psychotherapy was more efficacious at reducing symptoms of depression at post-treatment (g = 0.47) than wait-lists. This effect was strongest when studies delivered therapist-led, rather than guided self-help, treatment. No significant differences were observed between psychotherapy and antidepressants. There was no significant post-treatment difference between CBT and other active psychological comparisons at reducing symptoms of depression. However, when only therapist-led CBT was analyzed, therapist-led CBT was significantly more efficacious (g = 0.25) than active comparisons at reducing depressive symptoms. The magnitude of the improvement in depressive symptoms was predicted by the magnitude of the improvement in BN symptoms. DISCUSSION: These findings suggest that psychotherapy is effective for reducing depressive symptoms in BN in the short-term. Whether these effects are sustained in the long-term is yet to be determined, as too few studies conducted follow-up assessments. Moreover, findings demonstrate that, in addition to being the front-running treatment for BN symptoms, CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co-occur in BN.

Predictors, Moderators, and Mediators of Treatment Outcome Following Manualised Cognitive-Behavioural Therapy for Eating Disorders: A Systematic Review.

This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty-five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive-behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.