Food choice by people with intellectual disabilities at day centres: A qualitative study.

People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home.

Effects on obese women of the sugar sucrose added to the diet over 28 d: a quasi-randomised, single-blind, controlled trial.

To investigate whether obese women can compensate for sucrose added to the diet when it is given blind, rather than gaining weight or exhibiting dysfunctional regulation of intake, in the present study, forty-one healthy obese (BMI 30-35 kg/m²) women (age 20-50 years), not currently dieting, were randomly assigned to consume sucrose (n 20) or aspartame (n 21) drinks over 4 weeks in a parallel single-blind design. Over the 4 weeks, one group consumed 4 × 250 ml sucrose drinks (total 1800 kJ/d) and the other group consumed 4 × 250 ml aspartame drinks. During the baseline week and experimental weeks, body weight and other biometric data were measured and steps per day, food intake using 7 d unweighed food diaries, and mood using ten- or seven-point Likert scales four times a day were recorded. At the end of the experiment, the participants weighed 1·72 (SE 0·47) kg less than the value predicted by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) model; the predicted body weight accounted for 94·3% of the variance in the observed body weight and experimental group accounted for a further 1·1% of the variance in the observed body weight, showing that women consuming sucrose drinks gained significantly less weight than predicted. The reported daily energy intake did not increase significantly, and sucrose supplements significantly reduced the reported voluntary sugar, starch and fat intake compared with aspartame. There were no effects on appetite or mood. Over 4 weeks, as part of everyday eating, sucrose given blind in soft drinks was partially compensated for by obese women, as in previous experiments with healthy and overweight participants.

How to measure mood in nutrition research.

Mood is widely assessed in nutrition research, usually with rating scales. A core assumption is that positive mood reinforces ingestion, so it is important to measure mood well. Four relevant theoretical issues are reviewed: (i) the distinction between protracted and transient mood; (ii) the distinction between mood and emotion; (iii) the phenomenology of mood as an unstable tint to consciousness rather than a distinct state of consciousness; (iv) moods can be caused by social and cognitive processes as well as physiological ones. Consequently, mood is difficult to measure and mood rating is easily influenced by non-nutritive aspects of feeding, the psychological, social and physical environment where feeding occurs, and the nature of the rating system employed. Some of the difficulties are illustrated by reviewing experiments looking at the impact of food on mood. The mood-rating systems in common use in nutrition research are then reviewed, the requirements of a better mood-rating system are described, and guidelines are provided for a considered choice of mood-rating system including that assessment should: have two main dimensions; be brief; balance simplicity and comprehensiveness; be easy to use repeatedly. Also mood should be assessed only under conditions where cognitive biases have been considered and controlled.

A mixed methods study of schema modes amongst people living with eating disorders.

BACKGROUND: Schema therapy is promising for people with eating disorders, especially those unresponsive to cognitive behavioural therapy. Complex underlying psychological constructs include dysfunctional schemas and maladaptive modes. This study aimed to explore people living with eating disorders' schema modes and their identification with and understanding of their high scoring modes. METHODS: Sixteen women with enduring eating disorders without prior exposure to schema therapy completed the schema mode inventory for eating disorders short form (SMI-ED-SF), then participated in semi-structured interviews discussing their high scoring modes. Interviews were analysed by thematic analysis. RESULTS: All participants scored above clinical concern on at least one maladaptive mode and many scored high on multiple modes, most commonly Demanding Mode, Vulnerable Child and Detached Self-Soother. Qualitatively, four themes emerged: 1) Adverse family environments related to (a) trauma and the vulnerable and angry child and (b) unrealistically high standards; 2) Mode effects on (a) everyday life and (b) disordered eating; 3) Modes are psychologically protective in (a) avoiding emotion by detachment and soothing, (b) people pleasing by compliance and surrender; 4) Help seeking including (a) barriers to recovery from an eating disorder, (b) dissatisfaction with interventions experienced to date, (c) schema therapy as a promising alternative. DISCUSSION: Participants recognised and identified with their high scoring schema modes. After negative experiences with previous interventions, they considered schema therapy to be a promising alternative that could understand and work on their deeper psychological issues. This suggests that schema modes are a promising way of understanding and working with enduring eating disorders.

Maladaptive modes are important in Schema Therapy for eating disorders. They are momentary patterns of thought, feeling and behaviour, triggered by experiences to which people with eating disorders can be oversensitive. In a child mode the person may be inexplicably childish. A coping mode may involve detachment, surrender to others, or perfectionist overcompensation. A parent mode may involve unrealistic standards and demands. There are also two healthy modes of Healthy Adult and Happy Child, which are often lacking in people with eating disorders. In this study women with enduring eating disorders completed the schema mode inventory and then discussed their high scoring modes. Common maladaptive modes were vulnerable child, demanding parent mode and perfectionistic over-compensator. Participants identified with their high scoring modes and thought them useful for self-understanding, so schema therapy is a promising way of understanding the psychopathology underlying enduring eating disorders.

The Effect of a Very-Low-Calorie Diet (VLCD) vs. a Moderate Energy Deficit Diet in Obese Women with Polycystic Ovary Syndrome (PCOS)-A Randomised Controlled Trial.

We performed an open-label, randomised controlled trial to compare the effects of a very-low-calorie diet (VLCD) vs. moderate energy deficit approach on body weight, body composition, free androgen index (FAI), and metabolic markers in obese women with polycystic ovary syndrome (PCOS). Forty eligible patients were randomly assigned to a VLCD (n = 21) or a conventional energy deficit approach (n = 19) over the same period. After eight weeks, both groups experienced significant weight loss; however, this was greater in the VLCD arm (-10.9% vs. -3.9%, p < 0.0001). There was also a trend towards a reduction in FAI in the VLCD group compared to the energy deficit group (-32.3% vs. -7.7%, p = 0.07). In the VLCD arm, two women (18%) had a biochemical remission of PCOS (FAI < 4); this was not the case for any of the participants in the energy deficit arm. There was a significant within-group increase in the sex-hormone-binding globulin (p = 0.002) and reductions in fasting blood glucose (p = 0.010) and waist to hip ratio (p = 0.04) in the VLCD arm, but not in the energy deficit arm. The VLCD resulted in significantly greater weight reduction and was accompanied by more pronounced improvements in hyperandrogenaemia, body composition, and several metabolic parameters in obese women with PCOS as compared to the energy deficit approach.

Schema Modes, Trauma, and Disordered Eating.

Maladaptive schema modes may mediate between trauma and disordered eating, however there is little relevant evidence. This study aimed to predict disordered eating from modes, trauma, and age and gender. Also, to re-examine the factor structure of the Schema Mode Inventory for Eating Disorders, using an online cross-sectional survey of 612 volunteer participants aged 18 to 65, recruited from online eating disorder support groups, including people with and without diagnosed eating disorders. Measures were sociodemographic variables, the Schema Mode Inventory for Eating Disorders (Short Form; SMI-ED-SF), the Eating Disorder Examination Questionnaire (EDE-Q), and the Trauma History Questionnaire (THQ). Confirmatory factor analysis produced 16 factors similar to the 16 modes. Differences were that Vulnerable Child, Happy Child, and Healthy Adult appeared as a one factor, that all ED items appeared as one factor, and that Bully & Attack and Self-Aggrandizer modes appeared combined. In stepwise linear regression, EDE-Q scores was predicted by Total maladaptive mode score (37.3% of variance), Total adaptive mode score (1.5%) variance, Vulnerable Child (2.8%), Detached Self-Soother (1.5%). Other modes accounted for 1% or less of variance. Schema modes predicted EDE-Q, but the stable existence of discrete persona-like modes was less clear. Further research should refine the structure of SMI-ED-SF and relate modes to interpersonal traumas.

More than signposting: Findings from an evaluation of a social prescribing service.

This paper presents findings from an evaluation of a social prescribing service, undertaken between January 2019 and December 2020. Data was collected through interviews and focus groups with a range of groups including social prescribing managers, link workers (LWs), referrers (GPs and social work practitioners), clients, Voluntary and Community Sector (VCS) agencies and groups. Thematic analysis of data was undertaken, and findings were presented in respect of clients' journeys into social prescribing; the support received from LWs; their onward journeys to VCS support. The findings highlight the challenges for individuals in contacting new agencies/groups and the importance of practitioner referral into and onwards from social prescribing, as well as buddying to support clients on initial agency visits. The depth of the LW role is highlighted, as well as the complexity of client circumstances, highlighting a need for 'more than signposting', and challenging the notion of self-referral as an indicator of motivation. Social prescribing has been positioned as amongst the solutions to the challenges of primary care. However, referrals from GPs were low and significantly outnumbered by those from social workers; this suggests a need to explore in greater depth the use of social prescribing by social workers, who have, to date, been absent from social prescribing research.

The Effect of Free Androgen Index on the Quality of Life of Women With Polycystic Ovary Syndrome: A Cross-Sectional Study.

Purpose: Free androgen index (FAI) and anti-Mullerian hormone (AMH) are independently associated with polycystic ovary syndrome (PCOS). This study aimed to describe the relationship between these two markers and health-related quality of life (HR-QoL) in women with PCOS. Methods: This cross-sectional study consisted of 81 women in the Hull PCOS biobank, who fulfilled the Rotterdam consensus criteria for the diagnosis of PCOS. The primary outcome was to measure the various domains of the QoL in the modified polycystic ovary syndrome questionnaire (MPCOSQ). Results: Mean age of the study participants was 28 ± 6.0 years, mean body mass index (BMI) 33.5 ± 7.8 kg/m2, mean FAI (6 ± 5.5), free testosterone (2.99 ± 0.75) and mean AMH (3.5 ± 0.8 units). In linear regression analysis, the FAI was associated with overall mean MPCOSQ score (Beta = 0.53, P-value = 0.0002), and with depression (Beta = 0.45, P-value = 0.01), hirsutism (Beta = 0.99, P-value = 0.0002) and menstrual irregularity (Beta = 0.31, P-value = 0.04). However, with adjustment for age and BMI, FAI was only associated with the hirsutism domain (Beta = 0.94, P-value = 0.001) of the MPCOSQ. FAI was also associated with the weight domain (Beta = 0.63 P-value = 0.005) of MPCOSQ. However, AMH was not associated with the overall mean MPCOSQ score or with any of its domains. Conclusion: FAI but not AMH was associated with QoL in women with PCOS, and this effect was mediated by BMI.

Effects of sucrose drinks on macronutrient intake, body weight, and mood state in overweight women over 4 weeks.

The long-term effects of sucrose on appetite and mood remain unclear. Normal weight subjects compensate for sucrose added blind to the diet (Reid et al., 2007). Overweight subjects, however, may differ. In a single-blind, between-subjects design, soft drinks (4x25cl per day; 1800kJ sucrose sweetened versus 67kJ aspartame sweetened) were added to the diet of overweight women (n=53, BMI 25-30, age 20-55) for 4 weeks. A 7-day food diary gave measures of total energy, carbohydrate, protein, fat, and micronutrients. Mood and hunger were measured by ten single Likert scales rated daily at 11.00, 14.00, 16.00, and 20.00. Activity levels were measured by diary and pedometer. Baseline energy intake did not differ between groups. During the first week of the intervention energy intake increased slightly in the sucrose group, but not in the aspartame group, then decreased again, so by the final week intake again did not differ from the aspartame group. Compensation was not large enough to produce significant changes in the composition of the voluntary diet. There were no effects on hunger or mood. It is concluded that overweight women do not respond adversely to sucrose added blind to the diet, but compensate for it by reducing voluntary energy intake. Alternative explanations for the correlation between sugary soft drink intake and weight gain are discussed.

Perspectives on eating disorders and service provision: A qualitative study of healthcare professionals.

The study examined healthcare professionals' perspectives of eating disorder patients and services. Qualitative semi-structured interviews were conducted with 18 healthcare professionals resulting in two themes. First, the practical difficulties of meeting the complex service needs of people with eating disorders were illustrated. Second, staff recognised patient diversity and the consequent need for individualised interventions. Services are frustrated in meeting patient needs due to complex resource limitations, which do not amount only to lack of funding. Rather than eating disordered patients being viewed as 'difficult', as reported in previous qualitative research, they are only difficult in a context of limited resources.

Managing eating disorder patients in primary care in the UK: a qualitative study.

It is the general practitioner's (GP's) responsibility to diagnose and manage the care of eating disorder patients but recent surveys suggest that there may be problems. In this qualitative study we have explored the perceptions of 20 GPs. In general they felt that eating disorders had little quantitative impact on their services due to low prevalence, but a high impact when they did occurr due to their complexity. Patients' needs in primary care include improved assessment, constructive holding and monitoring, staff training, referral and continuity of care.

Schizotypy but not Cannabis Use Modestly Predicts Psychotogenic Experiences: A Cross-Sectional Study Using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE).

OBJECTIVE: Cannabis use predicts psychosis in longitudinal studies, but it is difficult to infer causation. Some precursor variables predict both, including childhood trauma and adversity. Additionally, some of the desired effects of cannabis use resemble the symptoms of psychosis. It would be preferable to assess psychotomimetic or "unusual" experiences that include psychotic symptoms but without assuming pathology. Finally, it is possible that similar people are prone to psychosis and drawn to cannabis use, perhaps, because they are sensitive or attracted to unusual experiences. Schizotypy provides a trait measure of proneness to unusual experiences. The study aimed to examine cross-sectionally relationships between cannabis use, schizotypy, and unusual experiences whilst controlling for current trauma symptoms. METHOD: A volunteer online sample (n = 129, 64% women, predominantly students) who had used cannabis at least once was recruited. People who reported active effects of past trauma were excluded with a brief primary care posttraumatic stress disorder screen. Participants completed the Oxford-Liverpool Inventory of Feelings and Experience, the Cognitive Failures Questionnaire, and measures of substance use and sociodemographics. RESULTS: The majority of respondents recounted unusual experiences after cannabis use, and many of these might have been considered symptoms of psychosis if they had received medical attention. In regression analysis, the only predictor of the unusual experiences scale of O-LIFE was schizotypy (measured by the remaining subscales; 4% of variance). There were no correlations between cannabis use frequency and schizotypy or unusual experiences. CONCLUSIONS: These findings suggest that, after controlling for schizotypy and excluding people who are actively experiencing the effects of past trauma, frequency of cannabis use does not predict unusual experiences. However, individuals with schizotypal personality traits may have more unusual experiences when using cannabis.

Testing the Constraint Theory of Addiction: Cannabis Constraints Discriminate Users from Nonusers and Heavy from Light Users.

Constraint theory (Hammersley, 2014) offers a novel way of understanding addiction as a lack of cognitive, behavioural, and social constraints on substance use. Here, cannabis constraints were studied in a large online opportunity sample: N = 302; 205 men, 97 women. Age ranged from 14 to 60 years (mean = 25, SD = 8.0). Most participants were from UK or North America. Participants completed a questionnaire assessing 15 cannabis constraints and standard self-report frequency measures of drug use. Factor analysis of the constraint questionnaire found 15 factors, similar to those proposed theoretically. These factors could discriminate well between past and current users and heavy and light users. The best discriminator was concerns about the possibility of becoming addicted; the less concerned the heavier was use, although those who actually felt addicted were more concerned than others. Past users also constrained due to using legal highs instead, concerns about illegality, and using only when others used. Light users constrained due to availability and cost issues, as well as unpleasant effects. These findings suggest that there is utility in constraint theory and that heavy use occurs due to a relative lack of constraints.

Stuffing down feelings: Bereavement, anxiety and emotional detachment in the life stories of people with eating disorders.

This study aimed to explore the life stories of people with eating disorders (EDs) in order to better understand possible contributing factors to their development. It used a qualitative Life Story method, in order to reduce the tendency to focus on the negative in the lives of people with EDs. Sixteen people in contact with an EDs charity participated. Data were analysed using a thematic analysis. Despite the attempt to elicit both positive and negative information, most themes from the life stories were negative. Here, the focus is on the three most common themes reported, which are less often reported in previous research: (a) substantial bereavement and loss; (b) major issues with anxiety and (c) difficulties coping with emotions. A model is proposed whereby major losses and the resultant anxiety can lead to emotional deadening and 'stuffing down feelings' with food, leading on to an ED. This model implies that interventions need to consider psychological factors in an ED, especially the use of it as a dysfunctional coping strategy, as well as the behavioural and physiological aspects of an ED.

Theorising transient mood after ingestion.

UNLABELLED: Ingesting foods or drugs can alter rated mood. Moods have been theorised as reinforcers that cause ingestion. This assumption may be incompatible with the current two-system models of affect, where 'moods' are less intense yet more protracted than emotions, and affective states are caused by primary rapid affect processing and secondary cognitive appraisal. In ingestion research, moods may be transient rather than protracted and significant changes on mood rating scales are found without reportable changes in mood. CONCLUSIONS: Transient mood is caused cognitively and the temporal dynamics of mood are important. Consequently, when ingestion directly causes changes in affect these may be brief emotions rather than moods. In the absence of emotion, ingestion may provide input to the cognitive processes that cause transient mood, but physiological change cannot easily be inferred backwards from mood ratings. There are a number of unresolved questions about the relationship between rapid affect processing, cognitive appraisal and learning.

Eating disorders patients' views on their disorders and on an outpatient service: a qualitative study.

The objective of the study was to determine sufferers' views of outpatient treatment for eating disorders and provide practical recommendations for treatment practice. Twenty NHS outpatients participated in semi-structured interviews, which were subjected to thematic analysis. Respondents expressed ambivalence about whether their eating disorder is a way of exerting control or a disorder that controls them and this leads to them seeking treatment. Sufferers preferred a practical and sensitive approach and began to rely on treatment for recovery. Treatment needs to facilitate sufferers' need for control by striking a balance between practical and empathetic approaches that both involve patients in treatment decisions and give authoritative guidance.

Pilot Investigation of a Virtual Gastric Band Hypnotherapy Intervention.

This 24-week-long pilot investigation of 30 men and women with a BMI > 27 kg/m(2) aimed to determine whether virtual gastric band (VGB) hypnotherapy has an effect on weight loss in overweight adults, compared to relaxation hypnotherapy and a self-directed diet. Levels of weight loss and gain ranged from -17 kg to +4.7 kg in the VGB hypnotherapy group and -9.3 kg to +7.8 kg in the relaxation group. There was no significant difference between VGB hypnotherapy as a main effect on weight loss, (X(2) = 0.67, p = .41, df = 1) and there was no evidence of differential weight loss over time, (X(2) = 4.2, p = .64, df = 6). Therefore, the authors conclude that there was no significant difference between VGB hypnotherapy and the relaxation hypnotherapy.

Adjustable silicone gastric banding adverse events reported to the Food and Drug Administration.

A silicone adjustable gastric banding system was approved by the Food and Drug Administration (FDA) in June, 2001. The purpose of this report is to review and characterize the reports on silicone adjustable gastric banding systems received by the FDA through August 8, 2002. We also review medical literature on adverse events with silicone adjustable gastric banding systems. Manufacturers of regulated medical devices, such as adjustable silicone gastric bands, are required to report adverse events, including deaths and serious injuries, to the FDA. We reviewed all such reports received by the FDA through August 8, 2002, for adjustable silicone gastric bands and summarize the data by type of adverse event, reported device problems, and reported patient problems. The FDA received 556 reports of adverse events related to the use of adjustable silicone gastric bands. Two of these reports were for deaths, one during surgery and the other as a result of an erosion of the gastric band into the stomach 9 weeks after implantation. Forty-four reports were for injuries including band erosions, slippage, and infection. The most common type of report (499) was for device malfunction, and of these, 485 (97.2%) described a leak at or near the port. Of the 485 leaks reported as malfunctions, 99.4% were treated surgically. The majority of reports were related to disconnection, breakage, and leakage at or near the access port. Physicians and potential patients should be aware of these problems and recognize the possibility that additional surgery(ies) may be required for leaking access port/connections. The loose connection may cause pain and the device no longer performs as intended when there is a leak.

'It's like there are two people in my head': a phenomenological exploration of anorexia nervosa and its relationship to the self.

This study explores the lived experience of anorexia nervosa from the perspective of those who use pro-recovery websites for eating disorders. Fourteen people participated in an online focus group or an e-interview. Data were analysed using interpretative phenomenological analysis. Participants described their disorder as a functional tool for avoiding and coping with negative emotions, changing their identity and obtaining control. A central theme was the experience of an 'anorexic voice' with both demonic and friendly qualities. This voice felt like an external entity that criticised individuals and sometimes dominated their sense of self, particularly as anorexia nervosa got worse. Applying dialogical theory suggests a new model of anorexia nervosa, where the anorexic voice is a self-critical position, which disagrees with and attempts to dominate the more rational self. It is suggested that to move on from anorexia nervosa, the individual needs to address his/her anorexic voice and develop a new dominant position that accepts and values his/her sense of self.

Understanding the experience of ambivalence in anorexia nervosa: the maintainer's perspective.

People with anorexia often feel ambivalent about whether they wish to maintain it or recover from it. One place where individuals can communicate their experiences of wanting to maintain their anorexia is through pro-anorexia websites. This study investigated the experiences and understandings of those who wish to maintain their anorexia and looked at how these understandings may affect their treatment experiences. Data were collected online and analysed using interpretative phenomenological analysis (IPA). Anorexia denoted meanings of a 'tool', an 'entity' and a 'disease'. Participants felt ambivalent about whether their anorexia gave them control or controlled them, whether it played a positive or negative role and whether they wished to maintain their behaviours or recover. Participants also discussed barriers to recovery. Theoretical and treatment implications are discussed.