Task shifting eating disorders prevention: A pilot study of selective interventions adapted for teacher-led universal delivery in secondary schools.

OBJECTIVE: Increasing effectiveness and sustainability of universal school-based eating disorder prevention is needed. This study adapted two existing selective prevention programmes for universal delivery, investigating feasibility, acceptability, and preliminary effects when delivered by trained teachers to classes of mixed-gender adolescents. METHOD: A three-arm controlled pilot study with Year 9 students (N = 288; Mage = 13.61 SDage = .50). Three schools in south Wales and south-west England were allocated to mindfulness-based intervention (MBI), dissonance-based intervention (DBI), or classes-as-usual (CAU) control. Self-reported eating disorder risk factors were collected at baseline, 6-week post-intervention, and 2-month follow-up. Focus groups were conducted post-intervention. RESULTS: Delivery and evaluation were feasible, allowing for flexibility in scheduling, with good retention. Student and teacher ratings indicated moderate acceptability of both interventions, with recommendations for refinement. Mixed model analyses, controlling for baseline, showed significant effects of condition across post-intervention and follow-up for body esteem (DBI > CAU; Cohen's d = .34) and positive affect (MBI > CAU, d = .58). For girls only, both MBI and DBI improved body satisfaction and internalization, and the MBI additionally resulted in improved weight and shape concerns, negative affect, and life disengagement (d's = .39-1.12), across post-intervention and follow-up. DISCUSSION: Selective eating disorder prevention programmes based on cognitive dissonance and mindfulness can be delivered universally in schools, by teachers, allowing for appropriate flexibility necessary for real world implementation. Moderate acceptability indicates areas for improving content and delivery; positive effects on key outcomes are encouraging. These findings provide support for further robust evaluation. PUBLIC SIGNIFICANCE: Existing universal eating disorder prevention is limited by small effects and reliance on highly trained facilitators. This study is the first to adapt mindfulness- and dissonance-based interventions for delivery by teachers, to adolescents of all genders in a classroom setting. Delivery was largely feasible and acceptable, and both interventions showed significant effects across key risk factors for eating disorders, with larger effect sizes than found previously. This underpins further robust evaluation.

Orthorexia nervosa versus healthy orthorexia: Anxiety, perfectionism, and mindfulness as risk and preventative factors of distress.

BACKGROUND: Orthorexia nervosa is a recently conceptualised pathological entity presenting as an obsessive focus on healthy eating with associated psychosocial impairment. AIMS: The present study investigated the differential associations between orthorexia nervosa and healthy orthorexia with distress and impairment. MATERIALS & METHODS: With a community sample (N = 268) multiple measures of orthorexia nervosa and health orthorexia were compared as explanatory variables in mediation structural equation modelling (SEM). Outcome variables assessed and investigated were psychological distress while demographic variables were controlled. The mediating roles of perfectionism and health anxiety on orthorexia nervosa were examined with further preventative mediation role of mindfulness on distress. RESULTS: Distinctive to other eating disorders, gender showed no significant effects on orthorexia nervosa and healthy orthorexia. Signalling measurement issues for this disorder, the different measures of orthorexia nervosa resulted in mixed findings regarding body mass index and age. Findings supported perfectionism and health anxiety as risk factors, as well as mindfulness acceptance as a preventative factor in both orthorexia nervosa and healthy orthorexia. Orthorexia nervosa and healthy orthorexia assessed by most measures, contrary to the expectations, had significant positive associations with psychological distress indicated by stress, anxiety, and depression. DISCUSSION & CONCLUSION: The complexity in differentiating orthorexia nervosa from healthy orthorexia calls for further investigation. This research effort should serve to substantiate the status of orthorexia nervosa as a distinct clinical disorder.

The role of emotion regulation in the relationship between mindfulness and risk factors for disordered eating: A longitudinal mediation analysis.

OBJECTIVE: Evidence suggests mindfulness may reduce risk factors for disordered eating. However, mechanisms of change in this relationship are unclear. This longitudinal study tested whether emotion regulation mediates the prospective associations between mindfulness and two proximal risk factors for disordered eating: weight and shape concerns, and negative affect. METHOD: This study is a secondary analysis of data collected within an eating disorder prevention trial. Adolescent girls (N = 374, Mage  = 15.70, SD = 0.77) completed self-report measures of mindfulness, emotion regulation, weight and shape concerns, and negative affect at baseline, 2 months following baseline, and 7 months following baseline. Path analyses were computed to test hypothesized indirect effects using confidence intervals based on 5000 bootstrap samples. RESULTS: Higher baseline mindfulness predicted lower weight and shape concerns and negative affect at 7 months via a mediator of better emotion regulation at 2 months. This effect remained while controlling for earlier measurements of the mediator and outcome in the model of negative affect but not weight and shape concerns. DISCUSSION: Emotion regulation may be an important mechanism explaining how mindfulness influences negative affect. Efforts should be made to intervene on mindfulness and emotion regulation in prevention and early intervention programmes for eating disorders and other psychiatric conditions. PUBLIC SIGNIFICANCE: Research has shown that mindfulness can help to reduce some of the risk of developing an eating disorder. This study explored whether mindfulness reduces some of this risk by helping people to better manage their emotions. Understanding this process can help us to develop better mindfulness-based strategies to support people who are at risk of developing an eating disorder.

Mindful eating: what we know so far.

Mindful eating is increasingly being used to try to promote healthy eating and weight management. However, the term refers to a diverse set of practices that could have quite different effects on behaviour. This narrative review provides a guide to the concept of mindful eating as well as a comprehensive overview of research in the area. This includes the ways in which mindful eating has been operationalised and measured as well as evidence for effects and potential mechanisms of action. The research reviewed suggests that multi-component mindfulness-based interventions may be beneficial for disordered eating and weight management, but it is unclear whether these benefits exceed those obtained by alternative treatments. Some studies suggest that specific mindful eating strategies may have immediate effects on eating, but more research is needed to reach any definitive conclusions. These studies also suggest that effects may vary depending on the characteristics of the individual and/or the specific eating context. As such, research may ultimately point towards a more personalised approach to the application of mindful eating in order to maximise benefits. Finally, mindful eating interventions for children represent a relatively new area of research and there is currently insufficient evidence to draw any firm conclusions about their value. To advance both our understanding and effective application of mindful eating, more experimental research with high levels of methodological rigour is needed as well as research that explores underpinning mechanisms of action.

[Prevention of eating disorders in obesity]. / Prevención de los trastornos de laconducta alimentaria en la obesidad.

Introduction: Obesity is a public health problem due to its high prevalence, high morbidity, and high mortality. The relationship between eating disorders (ED) and obesity is widely established. A healthcare professional that cares for people with obesity must take into account a series of best practices to minimize the risk of developing an ED in the course of treatment for weight loss. Bariatric surgery (BS) is an effective, long-term treatment in selected patients with severe obesity. During the preoperative period, it is essential to detect any ED due to its high prevalence in this group. After surgery, the presence of a post-op ED and its possible relationship in terms of poorer outcomes make screening during follow-up after surgery essential. From a preventive perspective, cognitive-behavioral therapy before BS could positively influence postoperative results, and its use after BS could improve weight loss efficacy and reduce binge eating and grazing. From a more holistic preventive perspective, many believe in an integrative approach to both obesity and ED. In order to be successful, it is essential to identify any relevant risk and protective factors for both disorders.

Introducción: La obesidad constituye un problema de salud pública por su alta prevalencia y elevada morbimortalidad. La relación entre los trastornos de la conducta alimentaria (TCA) y la obesidad está ampliamente establecida. Es importante que el profesional que atiende a personas con obesidad tenga en cuenta una serie de premisas que minimicen el riesgo de aparición de un trastorno alimentario en el transcurso del tratamiento para perder peso. La cirugía bariátrica (CB) constituye un tratamiento efectivo a largo plazo en los pacientes adecuadamente seleccionados con obesidad grave. Por un lado, la elevada prevalencia de los TCA en este colectivo hace imprescindible la detección de estos trastornos en el preoperatorio. Por otro lado, la presencia de los TCA después de la cirugía y su posible relación en cuanto a peores resultados hace fundamental el cribado durante el seguimiento tras la intervención. Desde el punto de vista preventivo, la realización de una terapia cognitivo-conductual antes de la CB podría influir positivamente en los resultados posoperatorios y su empleo después podría mejorar la eficacia en cuanto a pérdida de peso y disminuir los atracones y el "grazing". Desde una perspectiva más global en relación a la prevención, son muchos quienes apuestan por un enfoque integrador para la obesidad y los TCA. Para ello es fundamental identificar los factores de riesgo y los protectores que tengan relevancia en ambos trastornos.

Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link.

Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health.

Introduction to the special issue on yoga and positive embodiment: a note from the editors on how we got here.

Studying the practice of yoga and its relationship to body image, embodiment, and eating disorders brings together the professional and personal aspects of our lives as yoga practitioners, researchers, and women living in bodies within a society that can be tough on body appreciation. Developing this edition on "Yoga for positive embodiment in eating disorder prevention and treatment" has been a work of love for all of us. As yoga practitioners, we have personally experienced the benefits of yoga in our own bodies and felt that there may be benefits for others. As researchers, we are dedicated to the exploration and utilization of evidence-based practices to enhance well-being, promote a positive body image and sense of embodiment, and both prevent and treat eating disorders. Our experiences as yoga practitioners, in conjunction with our curiosity as researchers, led us to explore the extant evidence for yoga as a tool for leading to improvements in body image, disordered eating behaviors, and eating disorders, and to embark on our own research in this area to fill necessary gaps in our knowledge base. Our long-term dedication to the fields of body image and eating disorders, in conjunction with our emerging interest in yoga as a potential tool, led us to the compilation of this edition on yoga and positive embodiment.

Yoga and eating disorder prevention and treatment: A comprehensive review and meta-analysis.

Yoga is frequently used in conjunction with standard treatment approaches for eating disorders. However, yoga's efficacy and effectiveness in preventing and treating eating disorders has remained unclear. The aim of this comprehensive review and meta-analysis is to review the extant literature and assess the effects of yoga in the prevention and intervention of eating disorder symptoms and correlates in both clinical and non-clinical populations. Studies assessing yoga and its effect on eating disorder symptoms and/or body image as related to disordered eating, were eligible for inclusion. The comprehensive review details correlational, non-controlled, non-randomized controlled, and yoga comparison studies. For the meta-analysis, only randomized controlled trials comparing a yoga-based intervention to a non-yoga control group were included. In total, 43 studies are included in this review, with 11 trials involving 754 participants included in the meta-analysis. Results of the comprehensive review and meta-analyses results indicated yoga interventions demonstrated a small, significant effect on global eating disorder psychopathology, a moderate-to-large effect on binge eating and bulimia, and a small effect on body image concerns, as compared to the control conditions. There was no statistically significant effect on dietary restraint in either direction. Additionally, results indicated a small-to-moderate effect on a composite measure of eating disorder-related constructs. These findings suggest that yoga-based interventions may be an effective approach supporting the prevention and treatment of eating disorders.

Yoga's impact on risk and protective factors for disordered eating: a pilot prevention trial.

Yoga has been proposed as a strategy for improving risk and protective factors for eating disorders, but few prevention trials have been conducted. The purpose of this pilot study was to assess the feasibility and acceptability of a yoga series in female college students (n = 52). Participants were randomized to a yoga intervention (three 50-minute yoga classes/week for 10 weeks conducted by certified yoga teachers who received a 3-day intensive training) or a control group. Risk and protective factors, assessed at baseline, 5 and 10 weeks, included body dissatisfaction, negative affect, loneliness, self-compassion, positive affect, and mindfulness. Mixed models controlling for baseline levels of outcome variables were run. On average, participants attended 20 out of 30 yoga classes, and the majority of participants reported high levels of satisfaction with the yoga series. Appearance orientation decreased and positive affect increased in the yoga group relative to the control group. After controlling for baseline levels, the yoga group had a significantly higher positive affect than the control group. Changes in other outcomes were not statistically significant, as compared to the control condition. Future yoga research directions are discussed including education about body image, measure and sample selection, and use of an implementation science framework.

Future directions for research on yoga and positive embodiment.

This article provides the concluding thoughts on the special issue, Yoga for Positive Embodiment in Eating Disorder Prevention and Treatment, which illustrate the progress being made on the relationship between yoga practice and the different indicators of positive embodiment that is relevant for the prevention and treatment of eating disorders. Based on the current body or work, we offer recommendations for the next steps for researchers for population-based, qualitative, and prevention and intervention research.

Examining the effects of mindfulness-based yoga instruction on positive embodiment and affective responses.

Empirical evidence provides support for the inclusion of yoga as part of eating disorder prevention efforts through its positive impact on positive embodiment and experience of positive core affect. However, there is a need to identify the specific instructional strategies that will more consistently support positive embodiment and positive affect. We examined the effect of teaching a single yoga class using mindfulness-based instruction compared to appearance-based and neutral instruction alternatives on embodiment (i.e., state body surveillance, state body appreciation, pleasure during yoga) and changes in affect from before to after class. Female participants (N = 62; M age = 23.89, SD = 6.86) were randomly assigned to a yoga class that emphasized: being mindfully present in one's body, changing one's appearance, or just getting into yoga poses. ANOVAs revealed significantly higher body surveillance (ηp 2 =.10) and lower forecasted pleasure (ηp 2 =.21) in the appearance class compared to the other two classes. Participants in the mindfulness class experienced greater improvement in affect (ηp 2 =.08) from before to after class and higher remembered pleasure during the yoga class (ηp 2 =.19) compared to those in the appearance class. Emphasizing changes to appearance in yoga instruction may place participants at risk for less positive affect and less positive experiences of embodiment compared to mindfulness-based or even neutral yoga instruction.

Elucidating knowledge and beliefs about obesity and eating disorders among key stakeholders: paving the way for an integrated approach to health promotion.

BACKGROUND: Understanding the knowledge and beliefs of key stakeholders is crucial in developing effective public health interventions. Knowledge and beliefs about obesity and eating disorders (EDs) have rarely been considered, despite increasing awareness of the need for integrated health promotion programs. We investigated key aspects of knowledge and beliefs about obesity and EDs among key stakeholders in Australia. METHODS: Using a semi-structured question guide, eight focus groups and seven individual interviews were conducted with 62 participants including health professionals, personal trainers, teachers and consumer group representatives. An inductive thematic approach was used for data analysis. RESULTS: The findings suggest that, relative to obesity, EDs are poorly understood among teachers, personal trainers, and certain health professionals. Areas of commonality and distinction between the two conditions were identified. Integrated health promotion efforts that focus on shared risk (e.g., low self-esteem, body dissatisfaction) and protective (e.g., healthy eating, regular exercise) factors were supported. Suggested target groups for such efforts included young children, adolescents and parents. CONCLUSIONS: The findings indicate areas where the EDs and obesity fields have common ground and can work together in developing integrated health promotion programs.

Cannabinoids: the lows and the highs of chemotherapy-induced nausea and vomiting.

Despite remaining one of the most widely abused drugs worldwide, Cannabis sativa exhibits remarkable medicinal properties. The phytocannabinoids, cannabidiol and Δ-9-tetrahydrocannabinol, reduce nausea and vomiting, particularly during chemotherapy. This is attributed to their ability to reduce the release of serotonin from enterochromaffin cells in the small intestine, which would otherwise orchestrate the vomiting reflex. Although there are many preclinical and clinical studies on the effects of Δ-9-tetrahydrocannabinol during nausea and vomiting, little is known about the role that cannabidiol plays in this scenario. Since cannabidiol does not induce psychotropic effects, in contrast to other cannabinoids, its use as an anti-emetic is of great interest. This review aims to summarize the available literature on cannabinoid use, with a specific focus on the nonpsychotropic drug cannabidiol, as well as the roles that cannabinoids play in preventing several other adverse side effects of chemotherapy including organ toxicity, pain and loss of appetite.

Promoting positive body image and tackling overweight/obesity in children and adolescents: A combined health psychology and public health approach.

This article draws attention to the dual global problems of disordered eating and overweight/obesity among children and adolescents. It is well recognised that the main risk factor for disordered eating is body dissatisfaction, yet public health messages to tackle overweight/obesity are likely to increase body dissatisfaction. This tension between key public health messages and a health psychology approach is examined, with the goal of seeking a common way forward. We focus on the UK as a case study, where there is currently no statutory education in schools on body image. Since more prescriptive guidance on the curriculum covering personal/social/health issues is soon to be introduced, it is timely to consider the content, and in particular its impact on body image as well as overweight/obesity. Having reviewed current interventions and policy, we argue for a more holistic approach to the obesity problem, using a whole school approach to create a body confident culture.

Psychosocial, Cognitive, and Physical Impact of Elaborate Consultations and Life Review in Female Patients with Non-Metastasized Breast Cancer.

BACKGROUND: Elaborate consultations and life review (ECLR) has been regularly applied in patients of various cancer entities and stages within Anthroposophic-integrative oncology concepts. However, a lack of systematic research in this field has been detected. To close this gap of knowledge, we evaluated the impact of ECLR in patients with non-metastasized breast cancer before, during, and after primary oncological treatment. METHODS: Patient-reported outcome measures were evaluated by analyzing European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30) in patients with non-metastasized breast cancer who had received either oncological standard therapy alone or in combination with ECLR. RESULTS: 95 female patients were eligible for questionnaire analysis (median age 58 years). Adjusted multivariable linear regression analysis revealed that ECLR was associated with significant improvements in medium-term global health/quality of life and emotional, social, and cognitive functioning. Furthermore, ECLR was associated with significant reductions of short-term appetite loss burden, pain, and short- and medium-term financial difficulties. Subgroup analyses revealed significant improvements in pivotal quality-of-life aspects including fatigue (p = 0.002) in chemotherapy-treated patients after ECLR. CONCLUSIONS: 12 months of surveillance of breast cancer patients reveals medium-term recovery of the global health status/quality of life and cognitive and psychosocial well-being associated with ECLR. In addition, our data indicate a possible association between ECLR and reduced short-term fatigue burden, which has to be re-confirmed prospectively in a larger study cohort. As long-term cancer survivors develop psychological symptoms similar to patients with chronic diseases, prospective studies should evaluate the impact of ECLR on the psychosocial well-being in these patients.

The effects of enteral feeding improvement massage on premature infants: A randomised controlled trial.

AIMS AND OBJECTIVES: To prove the effects of an enteral feeding improvement massage for premature infants with regard to their feeding, growing and superior mesentery artery blood flow aspect by a randomised controlled trial. BACKGROUND: Premature infants have feeding-related problems related to eating and absorbing nutrition due to their immature gastrointestinal function. Studies regarding the effectiveness of premature infants' enteral feeding improvement by tactile stimulation massage are rare. DESIGN: The study group was composed of 55 patients. Of the 55 patients, 26 were randomised into an experimental group and 29 were randomised into a control group. METHODS: They were all born <34 weeks of gestational age between 1 July 2011 and 30 March 2012. Premature infants in the experimental group received enteral feeding improvement massage twice a day for 14 days, and infants in the control group received a sham exercise. The collected data were analysed by spss 19.0, through t test, chi-square test (Fisher's exact) and ANCOVA. RESULTS: (i) The experimental group had reached the day of full enteral feeding significantly faster. (ii) The experimental group had a higher superior mesentery artery peak velocity (Vmax ) and lower RI (resistant index). (iii) The experimental group of the feeding-intolerant subgroup had a higher superior mesentery artery Vmax and Vmin . (iv) The experimental group had a heavier weight and larger head circumference after 14 days. CONCLUSIONS: This study demonstrates that enteral feeding improvement massage can be helpful for achieving earlier full enteral feeding, more increased superior mesentery artery, and faster growing. In particular, it can be a therapeutic, independent and evidence-based nursing intervention for feeding-intolerant premature infants. RELEVANCE TO CLINICAL PRACTICE: Neonatal nurses in neonatal intensive care unit can apply enteral feeding improvement massage massage for feeding-intolerant infants.

A controlled trial of a yoga-based prevention program targeting eating disorder risk factors among middle school females.

This study investigates outcomes of a revised version of a yoga-based, eating disorder prevention program, targeting eating disorder risk factors, among fifth grade girls (i.e., Girls Growing in Wellness and Balance: Yoga and Life Skills to Empower [GGWB]). The program is designed to decrease eating disorder risk factors and bolster self-care and includes revisions not yet studied that extend the program to 14 weeks and enhance content addressing self-care. Efficacy was assessed using a controlled, repeated measures design. Results indicate that participation in the GGWB program significantly decreases drive for thinness and body dissatisfaction while significantly increasing self-care when compared to a control group. As expected, the program did not have significant effects on eating disordered behaviour likely due to low baseline rates among participants. Implications of findings as well as directions for future research on prevention are discussed.

From Efficacy to Global Impact: Lessons Learned About What Not to Do in Translating Our Research to Reach.

Although members of the Association for Behavioral and Cognitive Therapies have made significant strides toward the collective goals outlined in our mission statement, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician worldwide administer our best treatments with excellent competency, we still would be unsuccessful in markedly impacting the worldwide burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include increased attention toward prevention; use of lower-cost, simplified interventions; task shifting; train-the-trainer models; community participatory research methodology; and identification of novel funding sources. The Body Project is an empirically supported, cognitive dissonance-based prevention intervention that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project is currently being implemented in 125 countries. The aim of this paper is to share lessons our team has learned in taking a prevention intervention from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.

Evaluation of a Theory-Based Intervention Aimed at Reducing Intention to Use Restrictive Dietary Behaviors Among Adolescent Female Athletes.

OBJECTIVE: To evaluate the effectiveness of a theory-based intervention to reduce the intention to use restrictive dietary behaviors for losing weight among adolescent female athletes involved in aesthetic sports. DESIGN: Cluster-randomized controlled trial. SETTING: Aesthetic sport teams of adolescent female athletes aged 12-17 years. PARTICIPANTS: Two teams (n = 37 athletes) in the intervention group and 3 teams (n = 33) in the comparison group. INTERVENTIONS: The 2 groups received nutrition education during 3 weekly 60-minute sessions. The intervention group was further exposed to a theory-based intervention targeting the specific determinant of intention to use restrictive dietary behaviors for losing weight, namely attitude. MAIN OUTCOME MEASURES: Difference over time between groups in intention to use restrictive dietary behaviors for losing weight and in nutrition knowledge. ANALYSIS: Mixed models for repeated measures. RESULTS: The theory-based intervention contributed to maintaining a low intention of using restrictive dietary behaviors for losing weight over time in the intervention group compared with the comparison group (P < .03). Nutrition knowledge score increased equally in both groups. CONCLUSION AND IMPLICATIONS: Complementing nutrition education with theory-based behavior change intervention may help maintain a low intention of using restrictive dietary behaviors for losing weight among female high school athletes involved in aesthetic sports.