The expression of cytokines and chemokines in the blood of patients with severe weight loss from anorexia nervosa: an exploratory study.

Anorexia nervosa (AN) is a serious, potentially life-threatening disorder characterized by severe weight loss, dysregulated eating, and often excessive exercise. While psychiatric illnesses such as depression are associated with increased levels of pro-inflammatory mediators, evidence for such disturbances in patients with AN has been less clear. In an exploratory study of possible disturbances in immune responses in AN, we assayed a panel of cytokines and chemokines in the blood of patients undergoing inpatient treatment, testing the hypothesis that metabolic disturbances in this disease would lead to a pattern of immune disturbances distinct from that of other psychiatric diseases. For this purpose, we evaluated patients by the Beck Depression Inventory-II (BDI-II) and the Eating Disorders Examination-Questionnaire and assessed cytokines and chemokines by enzyme-linked immunosorbent assays. Patients reported a moderate level of depression (mean BDI-II = 22.6) but exhibited few immunologic abnormalities of the kind associated with major depressive disorder [e.g., increased interleukin (IL)-6]; RANTES showed the most frequent elevations and was increased in 4 of the patients studied. Together, these findings suggest that features of AN such as loss of adipose tissue and excessive exercise may attenuate cytokine production and thus modulate the experience of illness that impacts on core features of disease.

Associations between imprinted gene differentially methylated regions, appetitive traits and body mass index in children.

BACKGROUND: Knowledge regarding genetic influences on eating behaviours is expanding; yet less is known regarding contributions of epigenetic variation to appetitive traits and body mass index (BMI) in children. OBJECTIVE: The purpose of this study was to explore relationships between methylation at differentially methylated regions (DMRs) of imprinted genes (insulin-like growth factor 2/H19 and Delta-like, Drosophila, homolog 1/maternally expressed gene 3) using DNA extracted from umbilical cord blood leucocytes, two genetically influenced appetitive traits (food responsiveness and satiety responsiveness) and BMI. METHODS: Data were obtained from participants (N = 317; mean age = 3.6 years; SD = 1.8 years) from the Newborn Epigenetic STudy. Conditional process models were implemented to investigate the associations between DMRs of imprinted genes and BMI, and test whether this association was mediated by appetitive traits and birthweight and moderated by sex. RESULTS: Appetitive traits and birthweight did not mediate the relationship between methylation at DMRs. Increased insulin-like growth factor 2 DMR methylation was associated with higher satiety responsiveness. Higher satiety responsiveness was associated with lower BMI. Associations between methylation at DMRs, appetitive traits and BMI differed by sex. CONCLUSIONS: This is one of the first studies to demonstrate associations between epigenetic variation established prior to birth with appetitive traits and BMI in children, providing support for the need to uncover genetic and epigenetic mechanisms for appetitive traits predisposing some individuals to obesity.

A group parent-training program: a novel approach for eating disorder management.

OBJECTIVE: To describe the rationale, development, and preliminary acceptability of a Group Parent Training Program (GPT) as an alternative approach for the treatment of adolescent eating disorders. METHOD: Sixteen families participated in a 16-session group treatment. After four months, parents were administered a treatment satisfaction questionnaire. RESULTS: Parent response to the intervention was positive. All parents indicated GPT was essential for the management of their child, improved general parenting skills, improved their own self-care, and decreased the burden they experienced as a result of managing their child's illness. DISCUSSION: Given the magnitude of task demands placed on a family for the management of adolescent eating disorders, there is the need for the development of effective intervention strategies that ease the stress of illness management for parents. Preliminary satisfaction data from GPT are promising and argue for a more systematic test of this intervention.

Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study.

OBJECTIVE: The purpose of this study was to investigate long-term outcome and prognosis in a bulimic and subthreshold bulimic sample. METHOD: In a follow-up study, 44 patients diagnosed with bulimia nervosa and subthreshold bulimia nervosa were contacted after an average follow-up period of 9 years. RESULTS: Results revealed that 72.7% (n = 32) of the participants were recovered at the time of follow-up. An investigation of prognostic variables showed that good outcome was associated with a shorter duration of illness, which was defined as the time between onset of symptoms and first treatment intervention. If participants were initially treated within the first few years of the illness, the probability of recovery was above 80%. However, if they were initially treated 15 years or more after the onset of the illness, the probability of recovery fell below 20%. DISCUSSION: This finding suggests that early identification of bulimia nervosa may be a very important factor in preventing a chronic eating disorder.

Body image assessment for obesity (BIA-O): development of a new procedure.

OBJECTIVE: A new measure of body image, named the body image assessment for obesity (BIA-O) was developed and tested for reliability and validity in a sample of 1,209 adult men and women. Separate BIA-O procedures were developed for men and women. Current, ideal and reasonable body image estimates of Caucasian and African-American men and women were compared. METHOD: Figural stimuli of males and females were developed for body sizes ranging from very thin to very obese in 18 increments. Participants selected figures that represented estimates of current, ideal and reasonable (a body size that could be maintained over time) body size. Some participants (n=641) also completed two measures of body dissatisfaction in a test of the validity of the BIA-O as a measure of body dissatisfaction. A sample of 77 participants was administered the BIA-O on two occasions to test the test-retest reliability of the BIA-O. RESULTS: The reliability of the BIA-O was supported by test-retest reliability coefficients which ranged from 0.65 to 0.93. Concurrent validity of the discrepancy between current and ideal and current and reasonable body size estimates was supported by positive correlations with two measures of body dissatisfaction. The BIA-O body size estimates of Caucasians and African-Americans, controlled for age and BMI, were compared. As BMI increased, Caucasian men and women were found to select larger current body size estimates in comparison to African-Americans. DISCUSSION: The reliability and validity of the BIA-O were supported. Greater body size dissatisfaction in obese Caucasians, relative to African-Americans of the same size, may be a function of biased estimates of current body size.

Psychosocial variables associated with binge eating in obese males and females.

OBJECTIVE: This study tested a psychosocial model of binge eating symptoms in obese men and women. Predictor variables included depression, dietary restraint, self-esteem, weight cycling, history of teasing, body dissatisfaction, and neuroticism. METHOD: Participants (N = 808) completed a packet of self-report questionnaires. RESULTS: Weight cycling, teasing about weight and shape, body dissatisfaction, negative affect, and dietary restraint comprised the best fitting models (original and cross-validation) for binge eating in women and men. These variables explained 61-72% of the variance in symptoms of binge eating in the samples of men and 70% of the variance in the samples of women. Although the male and female models were mostly similar, notable differences between them were found. DISCUSSION: The variables that comprise these etiological models should be considered in the development of prevention programs for obese binge eaters. Longitudinal studies, however, are needed to examine these etiological paths and to test for causal relationships.