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1.
Int J Eat Disord ; 57(2): 410-422, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38124655

RESUMO

OBJECTIVE: This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE). METHOD: Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion. RESULTS: The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up. DISCUSSION: Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE. PUBLIC SIGNIFICANCE: This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.


Assuntos
Emoções , Empatia , Humanos , Feminino , Projetos Piloto , Estudos de Viabilidade , Hiperfagia/terapia
3.
Proc Nutr Soc ; 81(3): 255-263, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35260206

RESUMO

Emotional overeating is a process that is particularly relevant to people within the binge spectrum of eating disorders. Approximately a third of people with overweight share this phenotype. In addition, this behaviour may occur in neurodevelopmental disorders (attention-deficit hyperactivity disorder (ADHD)) and other psychiatric disorders. The biopsychosocial underpinnings of emotional eating include a genetic vulnerability to a higher weight and various cognitive and emotional traits. The environment also plays a key role. For example, the commodification of food and beauty and exposure to weight stigma, unpleasant eating experiences and general adversity can set the scene. The majority of people with binge-eating disorder do not seek treatment (perhaps related to internalised stigma and shame). Hence opportunities for early intervention and secondary prevention are lost. Most guidelines for binge-eating disorder (based on the limited available research) recommend forms of cognitive psychotherapies and antidepressants. However, novel treatments that target underlying mechanisms are in development. These include interventions to improve emotional regulation and inhibitory control using neuromodulation and/or brain training. New technologies have been applied to talking therapies, including apps which can offer 'just-in-time interventions' or virtual reality or avatar work which can deliver more personalised interventions using complex scenarios. Drugs used for the treatment of ADHD, psychiatric and metabolic disorders may have the potential to be repurposed for binge-eating disorder. Thus, this is an area of rapid change with novel solutions being applied to this problem.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Obesidade , Humanos , Obesidade/terapia , Obesidade/psicologia , Sobrepeso , Hiperfagia/terapia , Emoções/fisiologia , Comportamento Alimentar/psicologia , Ingestão de Alimentos/psicologia
4.
Eat Behav ; 44: 101599, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35144169

RESUMO

BACKGROUND: Much research has focused on precursors to dietary lapses in weight loss programs, but less is known about how individual responses to lapses may influence future non-adherence and program success. The current study examined affective responses to overeating lapses and their influence on subsequent overeating and overall weight loss. METHODS: Women (n = 60) with overweight or obesity (BMI (mean ± SD): 34.3 ± 3.9 kg/m2; age: 48.1 ± 10.1 years) participated in a 3-month group behavioral weight loss intervention (BWLI). At baseline and 3 months, participants completed anthropometric assessments and a 10-day ecological momentary assessment protocol sent 5 times per day reporting on overeating and affect (stress, shame, anxiety, and feeling good about oneself). Across time points, multilevel models were used to examine affective responses to overeating and to predict likelihood of subsequent overeating. Linear regression models were used to examine the effect of affective responses to overeating (at baseline and collapsed across time points) on weight loss. RESULTS: Following self-reported overeating episodes, compared to non-overeating episodes, feeling good about oneself decreased. These decreases lessened with time from overeating. Overeating predicted subsequent overeating episodes, with decreases in feeling good about oneself following overeating marginally predicting increased likelihood (p = 0.065). Neither overeating frequency at baseline nor change in overeating frequency predicted weight loss; however, greater decreases in anxiety following overeating were associated with less weight loss. CONCLUSIONS: Self-reported overeating during a BWLI was associated with negative affective responses and may have increased the likelihood of subsequent overeating, but did not affect overall weight loss in this sample.


Assuntos
Programas de Redução de Peso , Adulto , Feminino , Humanos , Hiperfagia/terapia , Pessoa de Meia-Idade , Obesidade/psicologia , Obesidade/terapia , Sobrepeso/psicologia , Redução de Peso
5.
Psychol Rep ; 125(2): 1011-1040, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33583250

RESUMO

BACKGROUND: Overweight and obesity are important public health priorities. Mindful eating can contribute in preventing automatic eating behavior and emotional dysregulation, both being primary causes of overeating and negative body image. This research outlines an eight-week mindful eating intervention (i.e., project EATT) focusing on people with overweight or obesity in assisting positive behavioral, psychological and physiological change. METHODS: Fifty-seven people residing in Athens were recruited to participate in this research, where participants were allocated to either an experimental or a waitlist condition. Changes in body weight, and eating attitude, mindfulness, self-compassion, anxiety questionnaires were administered at baseline and post-intervention, and at a 14-month follow-up. RESULTS: Results indicated that mindfulness and self-compassion increased significantly, while anxiety symptoms decreased. Significance was also observed in reduction of overeating symptoms and oral control. While a negative relationship was observed between anxiety and mindfulness, and anxiety and self-compassion, self-compassion was negatively associated with overeating episodes. CONCLUSIONS: The intervention improved participants' relationship with food and enabled changes towards successful weight regulation.


Assuntos
Atenção Plena , Sobrepeso , Comportamento Alimentar/psicologia , Humanos , Hiperfagia/terapia , Atenção Plena/métodos , Obesidade/psicologia , Obesidade/terapia , Sobrepeso/psicologia , Sobrepeso/terapia
6.
Eur J Med Genet ; 65(1): 104379, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34748997

RESUMO

Prader-Willi Syndrome (PWS) is a multi-system genetically determined neurodevelopmental disorder and the commonest cause of syndromal obesity. The development of hyperphagia in early childhood is part of the phenotype arising as a result of an impaired neural response to food intake and the inability to regulate food intake in line with energy needs. Severe obesity develops if access to food is not controlled. In this review we evaluate the evidence for increased morbidity and mortality in PWS in order to establish the extent to which it is directly related to the obesity; a consequence of the eating behaviour itself independent of obesity; or associated with other characteristics of the syndrome. Medline, Cochrane, PsychINFO, CINAHL, Web of Science and Scopus databases were used to systematically identify published material on PWS and hyperphagia and syndrome-related morbidity and mortality. One hundred and ten key papers were selected. Data on 500 people with PWS indicated that the average age of death was 21 years and obesity was, as expected, a significant factor. However, the behaviour of hyperphagia itself, independent of obesity, was also important, associated with choking, gastric rupture, and/or respiratory illness. Other syndrome-related factors increased the risk for, and seriousness of, co-morbid illness or accidents. We conclude that improving life-expectancy largely depends on managing the immediate non-obesity and obesity-related consequences of the hyperphagia, through improved support. The development of new treatments that significantly reduce the drive to eat are likely to decrease morbidity and mortality improving quality of life and life expectancy.


Assuntos
Hiperfagia/epidemiologia , Síndrome de Prader-Willi/epidemiologia , Humanos , Hiperfagia/terapia , Morbidade , Síndrome de Prader-Willi/terapia
7.
Addiction ; 117(5): 1242-1255, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34514666

RESUMO

BACKGROUND AND AIMS: Non-invasive brain stimulation has shown potential in clinical applications aiming at reducing craving and consumption levels in individuals with drug addiction or overeating behaviour. However, it is unclear whether these intervention effects are maintained over time. This study aimed to measure the immediate, short- and long-term effects of excitatory transcranial direct current stimulation (tDCS) and high-frequency repetitive transcranial magnetic stimulation (rTMS) targeting at dorsolateral prefrontal cortex (dlPFC) in people with drug addiction or overeating. METHODS: A systematic review and random effects meta-analysis. We included 20 articles (total of 22 studies using randomized controlled trials: 3 alcohol dependence, 3 drug dependence, 12 smoking, 4 overeating; total: 720 participants) from January 2000 to June 2020, which reported at least one follow-up assessment of craving, consumption or abstinence levels after the intervention. We compared effects of active versus sham stimulation immediately after the intervention and at the last follow-up assessment, as compared with baseline. RESULTS: Excitatory neuromodulation of dlPFC activity reduced craving and consumption immediately after the intervention (craving: g = 0.734, CI = 0.447-1.021, P < 0.001; consumption: g = 0.527, CI = 0.309-0.745; P < 0.001), as well as during short-, mid- and long-term abstinence (craving: g = 0.677, CI = 0.440-0.914, P < 0.001; consumption: g = 0.445, CI = 0.245-0.645, P < 0.001; abstinence levels: g = 0.698, CI = 0.433-0.963, P < 0.001; average time of follow-up: 84 ± 83 days after last stimulation). Additional analysis demonstrated that the intervention effects were sustained in all populations studied (food, nicotine, alcohol or drug abuse) and with both stimulation techniques used (rTMS, tDCS). Interventions targeting at the left (vs right) hemisphere may be more effective. CONCLUSIONS: Excitatory neuromodulation targeting the dorsolateral prefrontal cortex appears to lead to a sustained reduction of craving and consumption in individuals with addiction or overeating behaviour.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Estimulação Transcraniana por Corrente Contínua , Fissura/fisiologia , Seguimentos , Humanos , Hiperfagia/terapia , Obesidade , Córtex Pré-Frontal/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos
8.
J Appl Res Intellect Disabil ; 35(2): 460-470, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34904341

RESUMO

BACKGROUND: Despite work on the self-identities of people with intellectual disabilities, research has yet to describe the self-perceptions of people with Prader-Willi syndrome (PWS). The perspectives of those with PWS are also important for rapidly evolving clinical trials aimed at treating symptoms of PWS. METHOD: Twenty-one young people with PWS were administered a semi-structured interview that assessed how they perceive their syndrome and clinical trials. Transcribed interviews were reliably coded using content-driven, applied thematic analyses. RESULTS: Five themes emerged: struggles with chronic hunger and food-seeking that impede goals and relationships; struggles with anxiety and outbursts, schedule changes and school; distancing from PWS; needs for clinical trials that cure PWS, reduce hunger or anxiety, and lead to improved outcomes; and needs for advocacy and awareness of PWS. CONCLUSIONS: Findings shed new light on the self-perceptions of those with PWS and have important implications for current interventions and future clinical trials.


Assuntos
Deficiência Intelectual , Síndrome de Prader-Willi , Adolescente , Ansiedade , Transtornos de Ansiedade , Humanos , Hiperfagia/terapia
9.
Med Sci Sports Exerc ; 53(8): 1638-1647, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34261994

RESUMO

PURPOSE: This efficacy trial tests the hypothesis that exercise training favorably affects hedonic eating (i.e., overeating, stress-induced overeating, disinhibited eating, eating when tempted), in a sample of women who are overweight or obese. METHODS: Participants were inactive at baseline, self-identified as "stress eaters," and were randomized to 12 wk of moderate-intensity exercise training (EX; combination of supervised and objectively confirmed unsupervised sessions) or to a no-exercise control condition (CON). EX participants were given an exercise goal of 200 min·wk-1. No dietary instructions or weight control strategies were provided. Assessments occurred at baseline and 12 wk. Overeating episodes, stress-induced overeating, and dietary temptations were measured over 14 d at each assessment using ecological momentary assessment. Disinhibition and dietary restraint were assessed via a questionnaire. RESULTS: Forty-nine participants (age, 40.4 ± 10.8 yr; body mass index, 32.4 ± 4.1 kg·m-2) enrolled, and 39 completed this study. Adherence to the exercise intervention was high (99.4% of all prescribed exercise). At week 12, the proportion of eating episodes that were characterized as overeating episodes was lower in EX versus CON (21.98% in EX vs 26.62% in control; P = 0.001). Disinhibition decreased in EX but not in CON (P = 0.02) and was driven by internal factors. There was a trend such that CON was more likely to give into dietary temptations (P = 0.08). Stress-induced overeating was low and did not differ between conditions (P = 0.61). CONCLUSIONS: Exercise training reduced the likelihood of overeating and eating in response to internal cues in women who self-identified as stress eaters. This may be one pathway by which exercise affects body weight.


Assuntos
Terapia por Exercício , Hiperfagia/terapia , Adulto , Índice de Massa Corporal , Avaliação Momentânea Ecológica , Comportamento Alimentar , Feminino , Humanos , Inibição Psicológica , Pessoa de Meia-Idade , Obesidade , Sobrepeso , Estresse Psicológico
10.
Obesity (Silver Spring) ; 29(4): 706-712, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33759384

RESUMO

OBJECTIVE: Existing screening tools are inadequate in differentiating binge eating from normative overeating in treatment-seeking individuals with overweight or obesity, as these individuals tend to overendorse loss-of-control (LOC; the hallmark characteristic of binge eating) on self-report measures. In order for treatment centers to efficiently and accurately identify individuals who would benefit from specialized treatment, it is critical to develop effective brief screening tools. This study examined the sensitivity and specificity of a self-report screener designed to be used by an outpatient treatment center on a large scale. METHODS: Participants were treatment-seeking individuals (N = 364) with overweight or obesity who were administered the screener and who completed a subsequent interview assessing for LOC and binge eating. RESULTS: Discriminant analyses revealed that the screener achieved 77.6% sensitivity and 77.0% specificity in predicting clinician-assessed LOC and 75.2% sensitivity and 74.1% specificity in predicting "full-threshold" binge eating (i.e., ≥12 objectively large binge-eating episodes within the past 3 months). Post hoc analyses indicated that male participants were more likely to be misclassified with the screener. CONCLUSIONS: The self-report screener demonstrated satisfactory predictive ability, which is notable given the challenges of discriminating between LOC and normative overeating. However, room for improvement remains. In particular, the inclusion of additional screener items that more fully capture the binge-eating experience in males is warranted.


Assuntos
Transtorno da Compulsão Alimentar/diagnóstico , Hiperfagia/terapia , Obesidade/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Adulto Jovem
11.
Endocrinology ; 161(8)2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32516384

RESUMO

Obesity is a chronic recurring disease whose prevalence has almost tripled over the past 40 years. In individuals with obesity, there is significant increased risk of morbidity and mortality, along with decreased quality of life. Increased obesity prevalence results, at least partly, from the increased global food supply that provides ubiquitous access to tasty, energy-dense foods. These hedonic foods and the nonfood cues that through association become reward predictive cues activate brain appetitive control circuits that drive hyperphagia and weight gain by enhancing food-seeking, motivation, and reward. Behavioral therapy (diet and lifestyle modifications) is the recommended initial treatment for obesity, yet it often fails to achieve meaningful weight loss. Furthermore, those who lose weight regain it over time through biological regulation. The need to effectively treat the pathophysiology of obesity thus centers on biologically based approaches such as bariatric surgery and more recently developed drug therapies. This review highlights neurobiological aspects relevant to obesity causation and treatment by emphasizing the common aspects of the feeding-inhibitory effects of multiple signals. We focus on glucagon like peptide-1 receptor (GLP-1R) signaling as a promising obesity treatment target by discussing the activation of intestinal- and brain-derived GLP-1 and GLP-1R expressing central nervous system circuits resulting from normal eating, bariatric surgery, and GLP-1R agonist drug therapy. Given the increased availability of energy-dense foods and frequent encounters with cues that drive hyperphagia, this review also describes how bariatric surgery and GLP-1R agonist therapies influence food reward and the motivational drive to overeat.


Assuntos
Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Hiperfagia/tratamento farmacológico , Obesidade/tratamento farmacológico , Animais , Cirurgia Bariátrica , Terapia Comportamental , Ingestão de Alimentos/fisiologia , Peptídeo 1 Semelhante ao Glucagon/fisiologia , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Hiperfagia/complicações , Hiperfagia/metabolismo , Hiperfagia/terapia , Obesidade/etiologia , Obesidade/metabolismo , Obesidade/terapia , Receptores de Glucagon/metabolismo , Redução de Peso/fisiologia
12.
Obes Rev ; 21(5): e12996, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31944559

RESUMO

This systematic review and meta-analysis aimed to quantify the effects of laboratory-based interventions targeting specific mechanisms of food craving, to identify moderators of effects, and to qualitatively summarize findings. The study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixty-nine studies were included in the quantitative synthesis, and separate meta-analyses were conducted for the outcomes self-reported craving and objective food intake. Results show small to medium positive effects across specific craving interventions on both outcomes. Effect sizes were partly moderated by intervention type. The most effective intervention regarding food intake was in sensu cue exposure. For subjective craving, the most robust evidence was found for beneficial effects of cognitive regulation strategies (ie, reappraisal, suppression, and distraction). Results further indicate that training inhibitory control through behavioral inhibition might be more effective than approach-avoidance training when considering its effect on subjective craving and food intake. People with external eating habits, overeating, or loss-of-control eating might benefit from these types of specific craving interventions. Future research should focus on long-term effects, transferability, and effectiveness in clinical samples.


Assuntos
Fissura , Ingestão de Alimentos , Alimentos , Adolescente , Adulto , Terapia Comportamental , Criança , Terapia Cognitivo-Comportamental , Fissura/fisiologia , Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Humanos , Hiperfagia/terapia
13.
J Altern Complement Med ; 26(2): 98-106, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31765223

RESUMO

Background: Growing obesity rates are a problem worldwide. Several studies of emotional freedom techniques (EFT), a brief psychophysiologic technique, have indicated that it may be a promising addition to traditional weight loss interventions. Objective: The current study evaluated food cravings, dietary restraint, subjective power of food, weight changes, and self-reported symptoms (e.g., somatic, anxious, and depressive) 2 years after an 8-week online self-directed EFT intervention with additional online support. Design: Participants were initially randomly allocated to a treatment or waitlist group. The treatment group was instructed to self-pace through an online EFT treatment program made up of seven modules throughout the 8-week intervention period, and the waitlist was also completed at the end of this period. Results: Analyses of the online EFT intervention program indicated significantly reduced scores for food cravings (-28.2%), power of food (-26.7%), depression (-12.3%), anxiety (-23.3%), and somatic symptoms (-10.6%) from pre to postintervention and from pre (baseline) until the 2-year follow-up and significantly improved scores for restraint (+13.4%). Further improvements were experienced for carbohydrates and fast food cravings between 6 months and 2 years. Body Mass Index and weight significantly decreased from pre- to 12 months follow-up although there were no differences at the 2-year point. Conclusions: As an online intervention program, EFT was very effective in reducing food cravings, perceived power of food, psychologic symptomatology, and improving dietary restraint and maintaining those improvements over a 2-year period. The addition of EFT to traditional weight loss interventions is timely and supported by this research.


Assuntos
Terapias Complementares/métodos , Hiperfagia/terapia , Internet , Psicofísica/métodos , Adulto , Fissura , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Redução de Peso
14.
Nutrients ; 11(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31487791

RESUMO

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.


Assuntos
Dependência de Alimentos/diagnóstico , Dependência de Alimentos/terapia , Hiperfagia/diagnóstico , Hiperfagia/terapia , Humanos
15.
Int J Behav Med ; 26(4): 443-448, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31236874

RESUMO

BACKGROUND: Poor functional exercise capacity is common among those with obesity; however, objective measures of exercise capacity are rarely examined in behavioral treatments targeting obese individuals. We examined whether a 4-week acceptance and commitment therapy (ACT) intervention for disinhibited eating or a behavioral weight loss (BWL) intervention improved exercise capacity and explored demographic and disinhibited eating variables related to exercise capacity. METHODS: Veterans (n = 61), randomized to receive ACT or BWL, completed an assessment of exercise capacity via the 6-min walk test (6MWT) at baseline and 6-month follow-up. Measures of disinhibited eating patterns and body mass index (BMI), at baseline and post-treatment, were also collected. Change in 6MWT distance and treatment group differences were examined using mixed ANOVAs. Characteristics related to baseline 6MWT and predictors of improvement in 6MWT at 6 months were examined with hierarchical multiple regression. RESULTS: There were overall significant improvements on the 6MWT from baseline to 6-month follow-up (F(1,59) = 11.14, p = .001, ηp2 = .159) but no differences between the ACT and BWL groups. Baseline BMI (ß = - .33, p = .005) was the only variable related to baseline 6MWT. Improvements on the 6MWT were related to younger age (ß = - .41, p = 0.001), female gender (ß = .36, p = .001), and treatment-related increases in dietary restraint behaviors (ß = .42, p = .001). CONCLUSIONS: Functional exercise capacity improved among participants completing behavioral interventions for weight and disinhibited eating. Improvements in dietary behavior regulatory skills may have generalized to improved regulation in other behavioral domains associated with exercise capacity.


Assuntos
Terapia Comportamental/métodos , Tolerância ao Exercício , Hiperfagia/fisiopatologia , Obesidade/fisiopatologia , Adulto , Índice de Massa Corporal , Peso Corporal , Comportamento Alimentar , Feminino , Humanos , Hiperfagia/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/terapia , Resultado do Tratamento , Veteranos , Teste de Caminhada , Caminhada , Redução de Peso
16.
Int J Behav Med ; 26(5): 461-473, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30993601

RESUMO

BACKGROUND: Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity. METHOD: We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression. RESULTS: Women in MMT showed significant reductions in perceived stress (ß = - 0.16) and depressive symptoms (ß = - 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (ß = 0.26) and had lower glucose post-oral glucose tolerance test (ß = - 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group. CONCLUSION: A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683.


Assuntos
Glicemia/metabolismo , Atenção Plena/métodos , Complicações na Gravidez/terapia , Aumento de Peso/fisiologia , Adulto , Depressão/terapia , Dieta Saudável/psicologia , Feminino , Humanos , Hiperfagia/terapia , Obesidade/terapia , Sobrepeso/terapia , Projetos Piloto , Pobreza , Gravidez , Adulto Jovem
17.
Eat Weight Disord ; 24(2): 373-377, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30443799

RESUMO

PURPOSE: The current study investigated the impact of a modified Dialectical Behavior Therapy skills (DBT) training group for patients at a hospital outpatient weight management clinic. Emotional eating is a problematic strategy for managing unpleasant feelings that can have a deleterious impact on weight management. DBT addresses emotional dysregulation via incorporation of skills aimed at coping with unpleasant affect. METHODS: This study examines outcomes for 18 patients who participated in a 12-week DBT skills building group. A pre-post design with 3-month follow-up investigated the impact of the group on emotional eating, psychological distress, emotion regulation, and mindfulness. RESULTS: Four repeated measures ANOVAs were run to assess for changes related to life difficulties and functioning, emotional overeating, emotion regulation, and mindfulness. Fisher's LSD tests assessed for linear and quadratic trends. Improvements in mindfulness, emotion regulation, and emotional overeating were found; these were maintained at follow-up. CONCLUSIONS: This study demonstrated the utility of a group-based intervention aimed at improving emotion regulation and mindfulness skills among weight management patients. Further study is needed to determine whether improvements in the constructs studied in this research would translate to improved weight management outcomes and in determining the pathway for improvements. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.


Assuntos
Terapia do Comportamento Dialético , Emoções , Hiperfagia/terapia , Atenção Plena , Estresse Psicológico/terapia , Adulto , Idoso , Feminino , Humanos , Hiperfagia/psicologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estresse Psicológico/psicologia , Resultado do Tratamento
18.
J Med Econ ; 21(12): 1230-1237, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30256699

RESUMO

OBJECTIVES: Prader-Willi syndrome (PWS) is a rare genetic disorder associated with varying degrees of hyperphagia, obesity, intellectual disability, and anxiety across the affected individuals' lifetimes. This study quantified caregiver priorities for potential treatment endpoints to identify unmet needs in PWS. METHODS: The authors partnered with the International Consortium to Advance Clinical Trials for PWS (PWS-CTC) and a diverse stakeholder advisory board to develop a best-worst scaling instrument. Seven relevant endpoints were assessed using a balanced incomplete block design. Caregivers were asked to determine the most and least important of a sub-set of four endpoints in each task. Caregivers were recruited nationally though patient registries, email lists, and social media. Best-worst score was calculated to determine caregiver priorities; ranging from 0 (least important) to 10 (most important). A novel kernel-smoothing approach was used to analyze caregiver endpoint priority variations with relation to age of the PWS individual. RESULTS: In total, 457 caregivers participated in the study. Respondents were mostly parents (97%), females (83%), and Caucasian (87%) who cared for a PWS individual ranging from 4-54 years. Caregivers value treatments addressing hyperphagia (score = 7.08, SE = 0.17) and anxiety (score = 6.35, SE = 0.16) as most important. Key variations in priorities were observed across age, including treatments targeting anxiety, temper outbursts, and intellectual functions. CONCLUSIONS: This study demonstrates that caregivers prioritize hyperphagia and, using a novel method, demonstrates that this is independent of the age of the person with PWS. This is even the case for parents of young children who have yet to experience hyperphagia, indicating that these results are not subject to a hypothetical bias.


Assuntos
Cuidadores/psicologia , Determinação de Ponto Final/métodos , Preferência do Paciente/psicologia , Síndrome de Prader-Willi/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ansiedade/terapia , Criança , Pré-Escolar , Feminino , Humanos , Hiperfagia/terapia , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Doenças Raras , Adulto Jovem
19.
Am J Psychother ; 71(1): 2-8, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29733675

RESUMO

This article examines psychological sequelae underlying dysregulated eating in the overweight and obese patient and proposes a psychotherapy approach informed by classical and modern attachment theory, developmental trauma, and neuroscience to address these structural deficits.


Assuntos
Hiperfagia/psicologia , Hiperfagia/terapia , Obesidade/psicologia , Obesidade/terapia , Apego ao Objeto , Psicoterapia , Humanos
20.
Sci Rep ; 8(1): 5702, 2018 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-29632306

RESUMO

Mindfulness-based interventions are thought to reduce compulsive behavior such as overeating by promoting behavioral flexibility. Here the main aim was to provide support for mindfulness-mediated improvements in reversal learning, a direct measure of behavioral flexibility. We investigated whether an 8-week mindful eating intervention improved outcome-based reversal learning relative to an educational cooking (i.e., active control) intervention in a non-clinical population. Sixty-five healthy participants with a wide BMI range (19-35 kg/m2), who were motivated to change their eating habits, performed a deterministic reversal learning task that enabled the investigation of reward- and punishment-based reversal learning at baseline and following the intervention. No group differences in reversal learning were observed. However, time invested in the mindful eating, but not the educational cooking intervention correlated positively with changes in reversal learning, in a manner independent of outcome valence. These findings suggest that greater amount of mindfulness practice can lead to increased behavioral flexibility, which, in turn, might help overcome compulsive eating in clinical populations.


Assuntos
Comportamento Alimentar/psicologia , Hiperfagia/terapia , Atenção Plena/métodos , Educação de Pacientes como Assunto/métodos , Reversão de Aprendizagem , Adulto , Comportamento Compulsivo/psicologia , Comportamento Compulsivo/terapia , Culinária , Feminino , Voluntários Saudáveis , Humanos , Hiperfagia/psicologia , Masculino , Pessoa de Meia-Idade , Punição , Recompensa , Adulto Jovem
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