Desire to lose weight, dietary intake and psychological correlates among middle-aged and older women. The CoLaus study.

Body dissatisfaction has been regularly associated with negative consequences on health of young women, but less is known regarding middle-aged or older women. However, body dissatisfaction in women has been seen for long as a "normative discontent" (i.e. widespread and chronic dissatisfaction) because of its high prevalence among all age categories. The goal of this study was to explore the relationships between the desire to lose weight, energy intake and psychological health in community-dwelling women issued from the second wave (cross-sectional data) of the cohort study CoLaus (2009-2012, Switzerland), taking age categories (40-59 and 60-80) and body mass index (BMI, normal and overweight/obese) into account. Results showed that the desire to lose weight was common even in women with normal BMI and whatever the age category. Women with normal BMI who wished to lose weight reported lower energy and protein intake per kg of body weight, more signs of depression and less satisfaction with their quality of life than those who did not wish to lose weight in both age groups. The desire to lose weight was similarly associated with psychological health in women with overweight/obesity, in both age categories as well. These results indicate that the desire to lose weight may be associated with an impaired psychological health also in middle-aged and older women, even in those with normal BMI. This should not be considered as normal by health care professionals but as a possible indicator of psychological health and of the capacity to comply with dietary recommendations.

Evaluation of a guided internet self-treatment programme for bulimia nervosa in several European countries.

OBJECTIVE: The purposes of this study were to evaluate the use of an online guided self-treatment programme for bulimia nervosa (BN) and to determine predictors of outcome. Data were collected in four European countries where the programme was simultaneously used. METHOD: One hundred and twenty-seven BN or subthreshold BN female patients (mean age of 24.7 years) participated in a 4-month intervention using a CBT based online-guided self-help programme. Contact during the treatment period included weekly e-mails with a coach. ASSESSMENT: Measures included the Eating Disorders Inventory-2 (EDI-2) and the Symptom Check List-Revised (SCL-90R). RESULTS: Severity of eating disorders symptoms and general psychopathology improved significantly. Twenty-three per cent of patients were symptom free at the end of treatment. The dropout rate was 25.2%. A better score of general psychological health was a predictor of a better outcome. CONCLUSIONS: This study encourages further developments and research on innovative therapy approaches, particularly for those disorders such as BN, with difficult therapy and unclear prognosis.

[Motivational interviewing integrated into cognitive behavioral therapy in obesity treatment]. / L'entretien motivationnel dans la thérapie cognitivo-comportementale des patients obèses.

Cognitive behavioural therapy is a well-known approach which has proved its efficacy in the treatment of eating disorders and obesity. Nevertheless, eating disordered and obese patients are often ambivalent towards treatment and as a consequence, they can't benefit fully from therapy or drop out easily. Nowadays, motivational issues are widely recognized as a critical point. Motivational Interviewing is now considered as valuable to enhance compliance to treatments.

[New technologies for obesity treatment: on-line supported self-treatment program]. / Obésité. Nouvelles technologies pour la prise en charge: autotraitement par Internet.

Obesity treatment effects are difficult to maintain on a long course, especially when patients also suffer from an eating disorder. Confronted with this statement, authors were interested in the use of new technologies to enhance the treatment palette at disposal. A self-treatment for bulimia nervosa on the Internet as well as a system of relapse prevention using Telephone-Linked Care (TLC) technology for obese patients after a weightloss have already been evaluated with success. A new self-treatment program for people suffering from compulsive eating disorders was developed and implemented on the Internet. It contains eleven steps based on cognitive and behavioural therapy and has to be done under a psychologist's supervision.

Cognitive distortions in obese patients with or without eating disorders.

In the normal weight population, cognitive distortions are more often found in people with eating disorders such as anorexia and bulimia than in a control population. With these cognitive distortions, weight and body image become central elements in self-esteem. This exploratory study investigated cognitive distortions in obese patients suffering from binge eating disorder or not. The hypothesis was that the patients suffering from binge eating disorder would have more cognitive distortions. Twenty-nine obese women (11 without and 18 with binge eating disorder) and 13 non-obese female controls were selected. To evaluate the cognitive distortions, subjects completed the Mizes Anorectic Cognitions-Revised (MAC-R) questionnaire. Contrary to our hypothesis, we found no difference in evidence between the two obese groups with or without eating disorders. Possible perspectives for treatment are discussed.

[Self-treament for bulimia on the Internet: first results in Switzerland]. / Autotraitement de la boutimie sur internet: les premiers résultats en Suisse.

Adolescents with bulimia have become a major clinical problem with increasing health concern. A self-help guide, inspired by the cognitive and behavioral therapy, was developed in response to the growing demand for treatment. On the behalf European research fund "SALUT", the guide was implemented on the Internet. The first swiss results are very encouraging; particularly concerning symptoms and the questionnaires (SCL-90 and EDI-2).

[Managing obesity and binge eating disorders]. / Obésité et troubles du comportement alimentaire: comment faire?

Binge eating disorder is frequent in patients suffering from obesity. Such disorders must be detected through the DSM-IV criteria. Binge eating disorder must be taken into account during the treatment in order to diminish the relapse and the "yoyo" phenomenon. The treatment consists in a cognitive-behavioural therapy associated with nutritional approach and favouring physical activity. Even if eating disorders are treated as a priority in psychotherapy, the GP's caring can be done at different levels: examine patients' expectations, weight loss objectives 1-3 kg/month), their motivation to change, encourage them to structure their meals, or help them find binge eating stimuli and their own strategies.

[Validity of a French screening questionnaire for binge eating disorders in adolescents]. / Dépistage de l'hyperphagie boulimique chez les adolescents : validité faciale d'un questionnaire développé en français.

Binge eating disorder is often associated with obesity. It has many psychosocial and somatic consequences and affects obesity treatment outcome. Binge eating has been observed in very young populations. Studies have shown that complications associated with binge eating disorder can appear in children, even when all the criteria included in the definition of the disorder for adults are not met. Therefore, provisional criteria have been proposed to investigate binge eating disorder among children and adolescents. There is an urgent need to enhance the screening of binge eating disorder in the young population, first in order to document the disorder and second to allow for tailored treatment of these populations. Currently, there is no scale in French to detect this type of disorder among children or adolescents. The aim of this study was to develop a self-administered questionnaire in French, which could be used as a screening tool for binge eating disorder among adolescents. We have developed a self-administered questionnaire, based on a previous questionnaire and provisional criteria proposed in the English-speaking world. In the present study, we assessed how the target population understood the expressions used in the questionnaire and refined terminology according to the results. Nineteen adolescents aged 11-18 years (normal weight or with obesity) were interviewed about their understanding of the questionnaire, using a structured individual interview. After completing the questions on their own, because the goal was to end up with a self-administered tool, they were asked to explain their own understanding of each question and to reformulate the terms used. The results highlighted that some words or sentences were misunderstood by adolescents, and we developed more adequate formulations as a consequence. Some terms used in their figurative sense had to be modified. Respondents found it difficult to assess duration and frequency of their behavior and suggested changing the open-ended answers to categories. Over the course of answering the questionnaire, they tended to forget the context and related their answers to their general eating behavior. Therefore, the context (binging) was repeated in each question of the modified version. A self-administered questionnaire can be effective in detecting problematic eating behaviors among adolescents and is a good first step before a diagnosis clarification by a professional. Our results show the importance of development and evaluation with the target population. The discriminant validity of the questionnaire will be evaluated by comparison with an assessment by a professional in a further study.

Randomised controlled trial of a guided self-help treatment on the Internet for binge eating disorder.

Binge eating disorder (BED) is a common and under-treated condition with major health implications. Cognitive behavioural therapy (CBT) self-help manuals have proved to be efficient in BED treatment. Increasing evidence also support the use of new technology to improve treatment access and dissemination. This is the first randomised controlled study to evaluate the efficacy of an Internet guided self-help treatment programme, based on CBT, for adults with threshold and subthreshold BED. Seventy-four women were randomised into two groups. The first group received the six-month online programme with a six-month follow-up. The second group was placed in a six-month waiting list before participating in the six-month intervention. Guidance consisted of a regular e-mail contact with a coach during the whole intervention. Binge eating behaviour, drive for thinness, body dissatisfaction and interoceptive awareness significantly improved after the Internet self-help treatment intervention. The number of objective binge episodes, overall eating disorder symptoms score and perceived hunger also decreased. Improvements were maintained at six-month follow-up. Dropouts exhibited more shape concern and a higher drive for thinness. Overall, a transfer of CBT-based self-help techniques to the Internet was well accepted by patients, and showed positive results for eating disorders psychopathology.

Therapeutic education of diabetic patients.

Therapeutic patient education is a patient-centred approach, focussed on patients' needs, resources, values and strategies. It allows patients to improve their knowledge and skills not only concerning their illness but also their treatment. It brings a better quality of life, a greater therapeutic compliance and a reduction in complications. The most difficult part of therapeutic patient education occurs when patients must change their behaviour. Motivational interviewing and cognitive-behavioural approaches contribute greatly here and allow both the preparation and support of patients during progressive 'step by step' change. The work on resistance to change is fundamental, and ambivalence when faced with the choice of a new way of life must be measured, discussed and negotiated. Patients become partners and we become 'coaches'. The negotiation of objectives must allow patients to choose their own strategies, which normally should cost them the least possible, psychologically, and bring them the maximum benefit. The efficiency of therapeutic patient education no longer needs to be proved: 80% less amputations over 10 years in diabetic patients; 50% maintenance of weight loss over 5 years, etc. In conclusion, therapeutic education is part of a humanistic medical approach centred on patients; it allows them to be active participants in their own treatment with the aim of improving their quality of life and therapeutic compliance, as well as reducing potential complications. Thus, health care professionals teach, inform, train, negotiate with, motivate and accompany patients in the long-term follow-up of their illness.