A randomized controlled trial to evaluate the acceptability and effectiveness of two eating disorders prevention interventions: the HEIDI BP-HW project.

BACKGROUND: Eating disorders (ED) are common in Switzerland, as in other Western countries, with a prevalence of any ED of 3.5%. However, no specific prevention intervention has been evaluated in the French-speaking part of the country. In this study, we assessed the acceptability and effectiveness of two well-validated eating disorders prevention interventions: the Body Project intervention (BP), based on cognitive dissonance techniques, and the Healthy Weight intervention (HW), based on the implementation of a healthy lifestyle. METHODS: Forty female students, aged 18-28, with body dissatisfaction, were randomized into three arms: a BP group, an HW group, and a waiting-list control group (WLCG). The primary outcome measure was body dissatisfaction. Secondary outcomes were thin-ideal internalization, dietary restraint, negative affect, and ED psychopathology. Thirty-three participants completed the assessments before and after the one-month interventions or waiting period. A follow-up measurement was conducted one month after the interventions to assess the stability of the results. RESULTS: Both interventions, delivered via a virtual web platform, were considered acceptable. The reduction in body dissatisfaction was greater in the BP group (r = 0.7; p < 0.01) or the HW group (r = 0.6; p < 0.01) than in the WLCG, with large effect sizes. Dietary restraint and shape concern were also significantly reduced in the BP group (r = 0.6 and r = 0.7, respectively; p < 0.01) and HW group (r = 0.5 and r = 0.5, respectively; p < 0.05) compared to the WLCG, with moderate to large effect sizes. The results obtained in each intervention group were stable at the one-month follow-up. CONCLUSIONS: This study showed encouraging results in young women with body dissatisfaction, arguing in favor of the French adaptations of the BP and HW interventions. However, the feasibility of recruitment was difficult, partly due to the pandemic situation at the time of the study, and should be further considered to improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04558073, 22/09/2020 and Swiss National Clinical Trial Portal (SNCTP000003978).

Body image concerns and intuitive eating in older women.

Intuitive eating has been described as representing a positive relationship with food that can support health. However, to date, most of the extant research on intuitive eating has been conducted among young women, limiting our understanding of how intuitive eating can contribute to supporting health in aging women. This study aimed to bridge this gap by exploring body image and eating correlates of intuitive eating in older women. The hypotheses were that among older women, intuitive eating would be significantly associated with lower disordered eating, weight and shape concerns, and fewer depressive symptoms, and that an indirect relationship between BMI and intuitive eating via weight and shape concerns would exist. Community women aged 60-75 (N = 200) completed questionnaires assessing intuitive eating, disordered eating, body concern, depressive symptoms and body mass index (BMI). Higher intuitive eating global scores were associated with lower restraint, lower eating concern, lower body concern, fewer depressive symptoms, and lower BMI. An indirect relationship between BMI and intuitive eating via weight and shape concern emerged, suggesting that being preoccupied by one's appearance hinder the ability to practice intuitive eating. These results suggest that intuitive eating is associated with positive outcomes among older women and might be a useful target for interventions designed to increase healthy aging.

Associations between body dissatisfaction, importance of appearance, and aging anxiety with depression, and appearance-related behaviors in women in mid-life.

The impacts of body dissatisfaction have been widely studied among adolescent girls, but much less in women in mid-life. In this study, we evaluated the associations between body dissatisfaction, psychological health and behaviors used to manage age-related changes, in an online survey of 331 women aged 45-65. Body dissatisfaction, importance of appearance and aging anxiety were associated with higher depression scores. Moreover, importance of appearance and aging anxiety were associated with the probability of using "anti-aging" behaviors. It seems that with age, for a subgroup of women, the pressure to stay young may be added to that of staying thin.

Factors associated with disordered eating behaviors and attitudes in older women.

PURPOSE: The present study explored the potential factors associated with disordered eating behaviors and attitudes in older women. METHODS: Women aged 60-75 years were recruited in the community (n = 203) and completed questionnaires. The Eating Disorder Examination-Questionnaire (EDE-Q) was used to evaluate disordered eating behaviors and attitudes. The independent variables were BMI, age, importance of appearance, importance of body competence, cognitive reappraisal, and fear of age-related appearance changes. Spearman correlation analyses and zero-inflated negative binomial regression models were used to analyze the data. RESULTS: BMI was positively associated with EDE-Q restraint, EDE-Q eating concern, and EDE-Q frequency of objective binge-eating episodes. Importance of appearance was positively related to EDE-Q restraint, and fear of age-related appearance changes to EDE-Q eating concern and objective binge-eating episodes. Cognitive reappraisal was negatively associated with EDE-Q eating concern and excessive exercise in bivariate associations, but the relationships disappeared in the multivariate analyses. CONCLUSIONS: BMI, importance of appearance, and fear of age-related appearance changes turned out to be positively associated with eating disordered behaviors and attitudes, similarly to what can be observed in middle-aged samples. However, the role of cognitive reappraisal was unclear and should be investigated further. LEVEL OF EVIDENCE: Level V: cross-sectional descriptive study.

[Eating disorders and obesity in adolescents†: clinical implications]. / Troubles des conduites ­alimentaires et obésité à l'adolescence†: ­implications cliniques.

Binge eating disorder (BED) is associated with obesity and a quarter of adolescents with weight excess may suffer from the complete or a partial form of this disorder. A systematic screening for BED should be performed in this population as non-identification will complicate the patient's management. A short screening tool, -named ADO-BEDs, was specifically developed for these adolescents. This latter tool appears to be useful to guide the medical consul-tation. As such, the health professional will be able to refer the -patient for further evaluation in case of BED suspicion. Health -professionals should be aware that body dissatisfaction or teasing triggered by the adolescent's body are not an incentive to lose weight and increase the risk of eating disorders. Therefore, negative comments should be avoided in consultation.

Les troubles des conduites alimentaires (TCA) de type accès ­hyperphagiques sont associés à l'obésité et sont présents sous leurs formes complètes ou partielles chez près d'un quart des adolescents en excès de poids. Un dépistage systématique doit être effectué dans cette population lorsqu'elle consulte, afin de permettre une prise en charge optimale. Un outil de dépistage nommé ADO-BEDs a été spécifiquement développé pour ces ­adolescents. Utile pour guider la consultation, il permet au ­soignant d'aborder le trouble et d'adresser le patient pour une évaluation spécialisée en cas de suspicion de TCA. Viser une ­augmentation de l'insatisfaction corporelle ou faire des commentaires négatifs portant sur le physique de l'adolescent ne sont pas une aide à la motivation, mais augmentent le risque de TCA et devraient être évités en consultation.

[Promoting a positive body image in young people.] / La promotion d'une image corporelle positive chez les jeunes.

INTRODUCTION: Positive body image is a recent concept that includes several facets, such as the acceptance of one’s body and the ability to take care of it with safe, nurturing methods. The purpose of this article is to explain this concept and its importance, and to review prevention and health promotion interventions that might be effective for its development. METHOD: We conducted a narrative review, including the latest publications that summarize the concept’s usefulness and the effectiveness of prevention programs that may contribute to the development of positive body image in youth. RESULTS: The development of a positive body image is proposed as a key factor that would allow integrated prevention of the entire spectrum of weight and eating issues in young people, as well as other problems such as depression. Three approaches used for prevention interventions developed primarily to target body dissatisfaction as a risk factor might promote certain aspects of positive body image. It would be advisable to adopt a universal and ecological prevention approach, in order to standardize the messages received throughout the social environment regarding healthy eating, an active lifestyle, and respect for the diversity of weight, shape, and beauty. CONCLUSION: This review highlights the importance of positive body image for public health, as well as the various preventive interventions that have proven effective for youth and young adults, so that future developments can build on what has already been performed.

Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale.

OBJECTIVE: To investigate the performance of a simple and developmentally appropriate 10-item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity. STUDY DESIGN: We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The ?2 or Fisher exact tests were used. RESULTS: There were 94 adolescents aged 12-18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%). CONCLUSIONS: The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.

Qualitative analysis of the role of self-weighing as a strategy of weight control for weight-loss maintainers in comparison with a normal, stable weight group.

Self-weighing seems to have a primary role in weight-loss maintenance. The use of this strategy may help correct even slight weight regain and contribute to long-term weight stability. However, self-weighing has also been associated with negative psychological health consequences in specific subgroups. This study aimed to explore the use and the behavioral and psychological consequences of self-weighing in a group of weight-loss maintainers (WLoMs). We chose a qualitative design to conduct this investigation. Eighteen WLoMs were interviewed and compared to a matched comparison group of 18 participants with a lifelong normal stable weight (NSW). Analyses showed that most WLoMs needed regular self-weighing to be aware of their weight. The weight displayed on the scale helped WLoMs sustain the continuous efforts needed to maintain weight loss and also at times triggered corrective actions that were sometimes drastic. Weight changes generated both negative and positive affect among WLoMs, who could experience anxiety because of self-weighing or have their self-esteem impaired in the case of weight gain. In comparison, the NSW group rarely used self-weighing. They relied on a conscious way of living to control their weight and needed fewer strategies. NSW participants simply went back to their routine when they felt a slight increase in their weight, without experiencing consequences on their mood or self-esteem. Regular self-weighing as a component of weight-loss maintenance should be encouraged to help WLoMs regulate their food and physical activity, provided that potential consequences on psychological well-being, including self-esteem, are screened and addressed when needed.

[A tool for assessing eating behaviors: ESSCA]. / Un outil pour évaluer les comportements alimentaires: ESSCA.

Eating behaviors are key when considering overweight or obesity management. Many issues varying in severity can interfere with the treatment. This article provides a semi-structured interview to address the determinants of food intake--hunger food craving--problematic eating behaviors--snacking, emotional eating--and eating disorders particularly related to overweight. Convenient for healthcare practitioners, this instrument comes with an interview guide to standardize its use. The relatively complete picture of the patient's eating behavior resulting from this assessment contributes to the treatment proposal.

Factor structure of a French version of the Eating Disorder Examination-Questionnaire among women with and without binge eating disorder symptoms.

The Eating Disorder Examination-Questionnaire (EDE-Q) is a self-report questionnaire that is widely used to investigate the core features of eating disorders. The EDE-Q is derived from the Eating Disorder Examination, a semi-structured interview considered as the "gold standard" in the assessment of eating disorders. To verify the factor structure of both instruments, originally composed of four subscales, factor analyses have been conducted with various samples. Heterogeneous results were found. Because no study had investigated the factor structure of the EDE-Q in individuals with binge eating disorder, the goal of our study was to fill this gap. We started with a review of the studies on the EDE and EDE-Q factor structure to decide which models to compare. Among 21 studies that were identified, three models had been replicated several times. We compared these three models-a 22-item, 3-factor model, a brief 7-item, 3-factor model and a brief 8-item, 1-factor model-in two samples of participants, one with threshold and subthreshold criteria for binge eating disorder (N = 116) and one without eating disorders (N = 161). Confirmatory factor analysis revealed a good fit for the brief 7-item, 3-factor model for both populations, whereas other solutions were not acceptable. Cronbach's alpha coefficients of the three factors were acceptable to good, ranging between 0.714 and 0.953. The group with binge eating disorder symptoms had significantly higher scores for each factor. This brief 7-item instrument might be useful for screening or short interventions.

Associations between body weight dissatisfaction and diet quality in women with a body mass index in the healthy weight category: Results from the 2014-2015 Swiss National Nutrition Survey.

BACKGROUND: Few studies have examined whether diet quality is lower in women with body weight dissatisfaction compared to women without body weight dissatisfaction. OBJECTIVES: 1) To examine the association between body weight dissatisfaction and diet quality among women (18-65 years old) in the healthy weight body mass index (BMI) category and 2) to explore dietary and behavioral patterns among women with body weight dissatisfaction. DESIGN: Data were extracted from the cross-sectional 2014-2015 Swiss National Nutrition Survey. PARTICIPANTS/SETTING: Population-based sample of 507 women with BMI ≥ 18.5 and < 25 kg/m2. OUTCOME MEASURES: Dietary intakes assessed by dietitians using two non-consecutive computer-assisted multi-pass 24-hour dietary recalls. Diet quality was measured with a slightly modified version of the Healthy Eating Index (HEI) -2020. STATISTICAL ANALYSES PERFORMED: Multiple linear regressions to test the association between body weight dissatisfaction and total HEI-2020 score. Hierarchical cluster analysis to identify subgroups of women with body weight dissatisfaction. RESULTS: Body weight dissatisfaction was not found to be associated with diet quality (ß = - 1.73 [-4.18 ; 0.71], P =0.16). However, women who were dissatisfied with their body weight had lower scores for the HEI-2020 total fruits (P = 0.050) and whole grains (P = 0.014) components than women who were satisfied with their body weight. Four profiles with different dietary patterns were identified among women with body weight dissatisfaction: "Unhealthy diet with dairy", "Protein and fat", "Vegetables without protein", and "Healthier diet without dairy". CONCLUSIONS: Among women with a BMI in the healthy weight category, overall diet quality was not observed to differ between those with or without body weight dissatisfaction. More research is needed to explore the different profiles of dietary intake in women with body weight dissatisfaction.

Barriers and facilitators of intuitive eating in postmenopausal women: A qualitative study.

This qualitative descriptive research explored barriers and facilitators of the intuitive eating (IE) implementation process, as experienced by six postmenopausal women classified as 'overweight' or 'obese'. The data was analysed using deductive and inductive thematic analysis and six themes were identified. IE implementation included developing scepticism about weight loss diets, dealing with hunger and satiety cues, making nutritious food choices for one's body, struggling with emotional eating, learning to accept one's body and challenging weight stigma and sociocultural norms of beauty and thinness. IE allowed women to develop a more peaceful relationship with their diet, and was accepted as a welcome alternative to dieting.

Comparison of obese and nonobese individuals with binge eating disorder: delicate boundary between binge eating disorder and non-purging bulimia nervosa.

OBJECTIVE: To compare obese and nonobese individuals with binge eating disorder (BED) on demographic data, illness history, eating disorders and psychological health. METHODS: This study used baseline data from a randomized controlled study on the efficacy of an online cognitive behavioural self-help treatment. Seventy-four women aged between 18 and 60 years were recruited in the community. They had to meet full or subthreshold diagnostic criteria for BED according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: Forty per cent of the sample had a body mass index higher than 30 kg/m(2) . Mean age and severity of eating disorders were similar between obese and nonobese individuals. A statistically significant difference emerged regarding dietary restraint, with nonobese BED individuals exhibiting higher scores than obese BED individuals. CONCLUSIONS: Dietary restraint might be one of the factors explaining body mass index differences among BED individuals. This raises the question of the boundary between non-purging bulimia nervosa and BED in nonobese people.

[Psychological preparation for gastric bypass surgery]. / Préparation psychologique a un bypass gastrique.

Bariatric surgery is one of the treatment of choice for morbidly obese patients. However some of them regain weight post-surgery. Psychological factors involved in weight regain have not been clearly identified yet. The Geneva University Hospitals offer patients a psychological preparation for gastric bypass. In order to evaluate this preparation, 22 patients completed questionnaires assessing depressive symptoms (BDI-II), anxiety symptoms (HAD), and the presence of eating disorders (EDI-2) before and after psychological treatment. The results showed a significant improvement of the following EDI-2 subscales: drive for thinness, bulimia, interpersonal distrust, asceticism and interoceptive awareness. These results highlight the importance of a psychological preparation before surgery.

Positive body image, intuitive eating, and psychosocial functioning among older women: Testing an integrated model.

BACKGROUND: Research on the body image and eating behaviors of older women is scarce. Moreover, the scant existing research has lacked a focus on positive dimensions, such as positive reappraisal and acceptance, body appreciation, appearance satisfaction, and intuitive eating among older women. Therefore, the aim of the present study was to examine a model of the relationships among these positive dimensions and psychological functioning in older women. METHODS: A sample of 171 women aged 60-75 years were recruited through social media to respond to a survey assessing body image, eating behaviors, and psychological wellbeing. RESULTS: The final model was a good fit to the data. In this model, positive reappraisal and acceptance of age-related appearance changes was associated with higher body appreciation, in turn associated with higher body image related quality of life, higher levels of intuitive eating, and lower levels of depressive symptoms. CONCLUSION: Positive body image and positive reappraisal of aging-related changes in appearance are associated with psychological wellbeing among older women. Longitudinal data are needed to clarify the direction of these relationships and inform interventions. Body image remains an important dimension among older women and should be accounted for in broader health promotion efforts among this group.

Psychological factors and weight loss in bariatric surgery.

PURPOSE OF REVIEW: Morbid obesity is associated with a high prevalence of psychopathological conditions that might have an impact on postsurgery outcomes. This review summarizes recent data about psychological disorders in obese patients before and after bariatric surgery as well as the assessment and impact of these factors on postsurgery outcomes. RECENT FINDINGS: Psychological health and quality of life were found to improve after bariatric surgery. Weight loss could not be clearly related to any specific psychological condition prior to surgery, but the presence of more than one psychiatric condition might play a role. A multi-intervention treatment, including approaches for lifestyle changes after bariatric surgery showed positive long-term results in term of weight loss and weight loss maintenance. Recent studies focused on eating behavior changes following bariatric surgery providing important information on the topic of eating disorders after bariatric surgery. SUMMARY: Psychological assessment before bariatric surgery and systematic follow-up are necessary to guarantee optimal weight loss and weight loss maintenance. The field of psychological factors in bariatric surgery is still in need of controlled randomized prospective trials to better understand relation between psychological presurgery conditions and surgical outcomes. Self-monitoring and cognitive behavioral programs could prevent weight regain.

Acceptance and efficacy of a guided internet self-help treatment program for obese patients with binge eating disorder.

INTRODUCTION: A significant percentage of obese patients suffer from binge eating disorder (BED), with negative consequences on psychological health, quality of life, weight loss treatment and maintenance. Cognitive behavioral therapy (CBT), delivered in traditional or self-help format, is effective in reducing BED symptoms. To improve dissemination, a self-help treatment program composed of eleven CBT based modules was implemented on the Internet and evaluated in a population of adult obese patients with BED. METHOD: Forty-two obese BED patients wait-listed for a multi-disciplinary obesity treatment took part in the study. Twenty-two patients completing the six-month online guided self-help treatment program were compared to a control group of twenty patients without intervention. Both groups were evaluated before and after six months of Internet self-help treatment or waiting list. A follow-up evaluation was carried out six months later. RESULTS: Participants in the online self-help treatment program showed higher binge eating abstinence rates, lower EDE-Q shape and weight concerns, and improved TFEQ disinhibition of eating and hunger scores compared to the control group. They also scored better on psychological health and quality of life measures after intervention, and gains were maintained at follow-up. No effect was found regarding BMI. The number of modules completed was correlated with a better quality of life improvement at post evaluation. Participants rated the program as useful and easy to use. CONCLUSION: The Internet seems to be a valuable tool for disseminating CBT for BED obese patients. Acceptance of new technology was good in this population. Further research is needed with a larger sample to corroborate these results.

Diet quality in middle-aged and older women with and without body weight dissatisfaction: results from a population-based national nutrition survey in Switzerland.

Body weight dissatisfaction is associated with unhealthy dietary behaviours in young adults, but data are scarce regarding how this relationship evolves with age. The objectives of the present study were to assess the prevalence of body weight dissatisfaction and the association between body weight dissatisfaction, nutrient intake and diet quality in middle-aged and older women. We used data of a population-based sample of 468 middle-aged (50-64 y/o) and older (65-75 y/o) women, extracted from the cross-sectional 2014-15 Swiss National Nutrition Survey. Body weight dissatisfaction was assessed by questionnaire. Dietitians assessed dietary intakes using two non-consecutive computer-assisted multi-pass 24-h dietary recalls and performed anthropometric measurements. Nutrient intakes were calculated and compared with national dietary guidelines, and diet quality scored with the 2010 Alternate Healthy Eating Index (2010-AHEI). 41⋅1 % of women reported body weight dissatisfaction, and 49⋅8 % wanted to lose weight. Body weight dissatisfaction was associated with weight loss desire and a higher body mass index (BMI; P < 0⋅001). Women with body weight dissatisfaction consumed significantly less carbohydrates and dietary fibres, even when BMI was controlled for (P < 0⋅05). They also fell short of national dietary guidelines for magnesium and iron. Body weight dissatisfied women obtained lower 2010-AHEI scores than satisfied women (ß -4⋅36, 95 % CI -6⋅78, -1⋅93). However, this association disappeared when the BMI was introduced in the equation. This highlights the importance of targeting both body dissatisfaction and unhealthy eating in obesity prevention and treatment at all ages.

Healthy Snacks in School: How Do Regulations Work? A Mixed-Design Study.

BACKGROUND: School is an important setting to promote healthy eating habits for children. We compared the effects of 4 conditions on the nutritional quality of snacks brought to school. We also investigated teachers' opinions regarding the process, barriers, and facilitators in regulation implementation. METHODS: We compared the nutritional quality of morning snacks based on 1958 photographs from schools divided into 4 conditions: regulation based on a list of permitted foods and beverages; regulation banning sweets, chips, and sugary drinks; information without regulation; or no intervention. Based on 5 focus groups (N = 18 participants), we investigated factors influencing regulation implementation. RESULTS: In schools with a list of permitted foods and beverages, 76% of the children had a healthy snack, compared to 52% to 54% in the 3 other conditions (p < .01). They also brought less sweet foods compared to those in the other conditions (41% vs. 68% to 71%, p < .01). In focus groups, most teachers supported regulation but also expressed ambivalence about their legitimacy. CONCLUSIONS: In this study, a regulation based on a list of permitted foods and beverages showed the best results. All actors should be involved in a progressive implementation process to increase acceptance of such regulation.

A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project.

Because of the serious consequences of eating disorders on young women's lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18-25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants' satisfaction with the interventions, group discussion at the end of the intervention, and with participants' rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.