Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O).

INTRODUCTION: Obesity is a major health problem with an increasing risk of mortality, associated with comorbidities and high rates of dropout. Research demonstrated that pathological eating behaviors could help to phenotype obese patients thus tailoring clinical interventions. Therefore, our aim was to develop (study 1), validate (study 2), and test in a clinical setting (study 3) the Eating Behaviors Assessment for Obesity (EBA-O). METHOD: Study 1 included the exploratory factor analysis (EFA) and McDonald's ω in a general population sample (N = 471). Study 2 foresaw the confirmatory factor analysis (CFA) and convergent validity in 169 participants with obesity. Study 3 tested the capability of the EBA-O to characterize eating behaviors in a clinical sample of 74 patients with obesity. RESULTS: Study 1. EFA identified five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia), explaining 68.3% of the variance. The final EBA-O consisted of 18 items. McDonald's ω ranged between 0.80 (hyperphagia) and 0.92 (binge eating), indicating very good reliability. STUDY 2: A second-order five-factor model, through CFA, showed adequate fit: relative chi-square (χ2/df) = 1.95, CFI = 0.93, TLI = 0.92, RMSEA = 0.075, and SRMR = 0.06, thus suggesting the appropriateness of the EBA-O model. Significant correlations with psychopathological questionnaires demonstrated the convergent validity. Study 3. Significant associations between EBA-O factors and emotional-related eating behaviors emerged. CONCLUSION: The EBA-O demonstrated to be a reliable and easy-to-use clinical tool to identify pathological eating behaviors in obesity, particularly useful for non-experts in eating disorders. LEVEL OF EVIDENCE: Level V, descriptive research.

An open-label trial on the efficacy and tolerability of naltrexone/bupropion SR for treating altered eating behaviours and weight loss in binge eating disorder.

PURPOSE: Binge eating disorder (BED) has a considerable clinical relevance by virtue of its high numerous psychiatric and medical comorbidities; among the latter, the most frequent is obesity. Available treatments for BED have shown frequent relapse of binges or weight regain in the long term. The new combination of naltrexone and bupropion sustained release (NB) has proved to be effective for weight loss among obese patients. As NB acts on hypothalamic and reward circuits, that seem involved in the pathogenesis and maintenance of BED symptoms, this study aims to evaluate the efficacy of NB in improving pathological eating behavior and losing weight in BED patients. METHODS: In this preliminary study, 23 obese-BED patients and a control group of 20 obese non-BED patients (respectively, Groups 1 and 2) who had previously undergone at least 5 unsuccessful weight-loss programs were treated with NB in addition to modified life style. Evaluation at t0 and after 16 weeks of treatment (t1) included anthropometric measurement, eating behavior assessment and psychopathological questionnaires (EDE-Q, BES, YFAS, BDI and STAI). RESULTS: A significant and similar weight loss (ΔBMI% ≈ 8%) was evident for both groups. Pathological eating behavior (i.e., binge, grazing, emotional eating, craving for carbohydrates, and post-dinner eating), BES score and YFAS severity significantly improved, especially among BED. NB was well tolerated and drop-out rate was low. CONCLUSION: Treatment with NB, in addition to a reduced-calorie diet and increased physical activity, seems an effective and well-tolerated option for improving pathological eating behavior and losing weight in obese-BED patients. LEVEL OF EVIDENCE: Level III case-control study.

Personality traits predict residual pain after total hip and knee arthroplasty.

AIM OF THE STUDY: We assessed the role of personality traits, anxiety, and depression in residual pain among patients who underwent total hip (THA) and knee (TKA) arthroplasty. METHOD: Eighty-three patients (40 THA and 43 TKA) were interviewed pre-operatively (t0); five days (t1) after surgery; and one (t2), three (t3), six (t4), and 12 months (t5) after surgery. Personality (TCI-R), pain (VAS), anxiety and depression (HADS), quality of life (SF-12), functionality (HHS/KSS), and disability (WOMAC) were evaluated. RESULTS: Pain reduction and functional improvement were reported at t5 (both p < 0.001) in both THA and TKA patients. THA patients showed earlier and greater functional improvement after surgery (both p < 0.001) in comparison with TKA. Residual pain (VAS > 30 mm) was noted in 15% of the THA patients and 25% of the TKA patients, and it correlated with the SF-12 PCS (r2 = - 0.412; p < 0.001), SF-12 MCS (r2 = - 0.473; p < 0.001), HADS-A (r2 = 0.619; p = <0.001), HADS-D (r2 = 0.559; p < 0.001), functionality (r2 = - 0.482; p < 0.001), and WOMAC (r2 = 0.536; p < 0.001) scores at t5. High pre-operative harm avoidance, persistence, and anxiety scores were predictive of residual pain after both THA and TKA (p < 0.001). DISCUSSION: The proportion of patients complaining of residual pain in this study was similar to that in previous findings. Multiple predictors of residual pain after THA and TKA have been previously described, and several studies evaluated the influence of psychological factors on the outcome of joint arthroplasty; however, only four studies investigated the role of personality traits in the outcome of THA and TKA patients, and a unique study out of these investigations demonstrated the effect of personality on persisting pain. CONCLUSION: The current study demonstrated that personality traits and anxiety predict residual pain; thus, pre-operative evaluation of these factors could be helpful in identifying patients at risk for residual pain.

Brain-Behavior-Immune Interaction: Serum Cytokines and Growth Factors in Patients with Eating Disorders at Extremes of the Body Mass Index (BMI) Spectrum.

Alterations of the immune system are known in eating disorders (EDs), however the importance of cytokine balance in this context has not been clarified. We compared cytokines and growth factors at opposite ends of BMI ranges, in 90 patients classified in relation to BMI, depressive and EDs comorbidities. Serum concentrations of interleukin (IL)-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were determined by a biochip analyzer (Randox Labs). Differences were calculated through ANOVA. Possible predictors of higher cytokine levels were evaluated through regression analysis. IL-1α, IL-10, EGF, and IFN-γ were altered individuals with anorexia nervosa (AN) and binge eating disorder (BED). Night-eating was associated with IL-8 and EGF levels, IL-10 concentrations with post-dinner eating and negatively with sweet-eating, long fasting with higher IFN-γ levels. IL-2 increase was not linked to EDs, but to the interaction of depression and BMI. Altogether, for the first time, IL-1α, IL-10, EGF, and IFN-γ were shown to differ between AN and HCs, and between AN and individuals with obesity with or without BED. Only IL-2 was influenced by depression. Dysfunctional eating behaviors predicted abnormal concentrations of IL-10, EGF, IL-8 and IFN-γ.