Factors Influencing Referral for Bariatric Surgery by Primary Care Physicians in Northern Israel.

PURPOSE: Obesity is a chronic metabolic disease with global distribution among adults and children which affects daily functioning and ultimately quality of life. Primary care physicians (PCPs) provide an important role for the treatment of severe obesity. Better understanding of obesity and its treatment options may increase patients' referral rates to the various treatment modalities, including metabolic/bariatric surgery (MBS). MATERIALS AND METHODS: A quantitative cross-sectional study used a self-reported questionnaire among PCPs of Clalit Health Services (CHS) in Northern Israel. The quantitative questionnaire examined the PCP's knowledge, opinions, attitude, and approaches to managing severe obesity. RESULTS: A total of 246 PCPs from Northern Israel filled the questionnaire (42.9%), the majority were Muslim Arabs (54.5%), who gained their medical degree outside of Israel (73.8%) and practicing for over 10 years (58.8%). 64.3% of PCPs had a high workload (over 100 appointments per week), 77.1% did not know the definition of severe obesity, and 69.17% did not attend educational meetings regarding obesity during the previous year. The referral rate for MBS was 50.4% ± 23.3. Two prognostic factors that had a statistically significant effect on the referral rate for bariatric surgery were the total appointments per week, and the number of practice years. Both had a negative association. CONCLUSION: The knowledge and referral rates for bariatric surgery are higher among PCPs with lower workload and relatively fewer practice years. Workshops and annual training courses may fortify knowledge and awareness for the treatment of obesity, which in turn could increase the referral rate for MBS.

Moving between positions: a qualitative study of mentoring relationships in chronic eating disorders.

PURPOSE: Eating disorders (ED) are chronic and challenging-to-treat conditions, often persisting over extended periods. Some patients with EDs require prolonged intensive rehabilitation services, which may include weekly home visits by paraprofessional mentors serving as support persons, providing guidelines, emotional care, and assistance. This study aims to enhance our understanding of the nature of the relationship formed between mentors and patients with EDs. DESIGN & METHODS: Fifteen in-depth qualitative interviews were conducted with patients and paraprofessional mentors. Interviews were analyzed using a descriptive phenomenological approach by two researchers to enhance reliability. FINDINGS: Qualitative analysis highlighted that mentors play a crucial role in patients' rehabilitation. Mentors adapt two positions (investigative and embracing) to address the encountered difficulties, including conflicts, tension, and confusion associated with (in)equality and reciprocity in the mentoring relationship. PRACTICE IMPLICATIONS: Paraprofessional mentors can assist people with ED in their rehabilitation process. To support patients with EDs effectively, it is crucial to train and supervise the mentors in navigating between roles and dealing with boundaries, secrets, lies, and exposure to various aspects of the rehabilitation process. Additionally, we recommend further research using quantitative and empirical tools to complement the qualitative findings presented.

Eating disorders (ED) can be challenging to treat, often requiring long-term intensive support. Paraprofessional mentors are support persons who make weekly home visits to help patients in the rehabilitation process.The study aims to understand the relationship between mentors and patients with ED. Researchers interviewed 15 patients and mentors. They discovered that mentors play a key role in helping patients get better by taking on two important roles. First, mentors act like investigators, trying to understand the challenges and problems that patients face. Second, mentors act as supporters, offering comfort and assistance during difficult times.The study emphasizes the importance of including mentorship in ED treatment and rehabilitation. It also suggests that training and supervision for paraprofessional mentors are crucial to help them handle their roles effectively, especially when dealing with boundaries and complex situations.

A multifaceted training tool to reduce weight bias among healthcare students: A randomized controlled trial.

BACKGROUND: Weight bias toward people with obesity (PwO) is common in healthcare settings. Efforts to address weight bias in healthcare settings should begin during university studies. This study aimed to explore the effect of a multifaceted intervention on weight bias among undergraduate healthcare students. METHODS: An open label randomized controlled trial. The intervention tool consisted of short video lectures on obesity, vignettes simulating interactions between health professionals and PwO, and open discourse with a PwO. The control group received a short-written document on obesity. Online questionnaires on Anti-Fat Attitudes ('AFA'), short form of the Fat-Phobia Scale ('FPS'), Weight Implicit Association Test ('Weight-IAT'), and knowledge about obesity were administered at baseline, 1-week, and 6-week post-intervention. RESULTS: A total of 162, 152, and 146 students participated in the study at baseline, 1-week, and 6-week post-intervention, respectively. Their mean age was 25.8 ± 6.7 years and 88.3% were women. Means of AFA total scores and FPS scores decreased significantly over time only within the intervention group (P Time*Group = 0.002 and 0.014). Both groups showed a similar trend over time in mean scores of Weight-IAT (P Time*Group = 0.868) and knowledge about obesity (P Time*Group = 0.115). CONCLUSIONS: A multifaceted intervention resulted in a significant reduction in explicit weight bias but did not yield any additional advantages over the control group in implicit weight bias and knowledge about obesity. GOV NUMBER: NCT05482802.

Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel.

BACKGROUND: Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). METHODS: A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. RESULTS: About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. CONCLUSIONS: Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.

Disordered Eating Behaviors Among Adolescents and Young Adults with Type 1 Diabetes Treated with Insulin Pumps and Hybrid Closed-Loop Systems.

Background and Aims: Disordered eating behaviors (DEB) are more common among individuals with type 1 diabetes (T1D) compared to those without, and for insulin pump users may be associated with higher hemoglobin A1c (HbA1c). We investigated DEB risk factors among insulin pump-treated individuals with T1D and clinical characteristics of hybrid closed-loop (HCL) systems' users by DEB level. Methods: An observational, cross-sectional study of 167 insulin pump-treated individuals with T1D, 13-21 years of age. Data were obtained from patients' medical charts with additional self-reported questionnaires, including assessment of DEB. Results: DEB were found in 71 (42.5%) individuals, and positively associated with female sex (ß = 2.98 [standard error (SE) = 1.31], P = 0.025), body mass index (BMI)-Z-score (ß = 2.12 [SE = 0.64], P = 0.001), HbA1c (ß = 1.40 [SE = 0.45], P = 0.02), and higher rate of pump discontinuation (ß = 4.48 [SE = 1.99], P = 0.026). The use of HCL systems compared to insulin pumps was associated with higher BMI-Z-score (odds ratio [OR]: 3.46 [95% confidence interval, CI: 1.52-7.87], P = 0.003) and tendency to lower HbA1c level (OR: 0.44 [95% CI: 0.18-1.09], P = 0.078) among individuals without DEB, and with lower HbA1c level (OR: 0.29 [95% CI: 0.10-0.83], P = 0.022) and higher socioeconomic status (OR: 1.73 [95% CI: 1.09-2.74], P = 0.020) among individuals with DEB. Conclusions: DEB are common among individuals with T1D treated with insulin pumps and are associated with higher HbA1c levels. Among T1D individuals with DEB, HCL system use is associated with lower HbA1c compared to insulin pump treatment. Our findings highlight the importance of regular screening for DEB and its risk factors to improve pump treatment and diabetes management. Moreover, individuals with DEB using HCL systems may benefit from reduced HbA1c levels.

Interpersonal Characteristics and Binge Eating among Patients Pursuing Bariatric Surgery.

BACKGROUND: Preoperative binge eating behavior has been associated with difficulties in weight loss maintenance among patients pursuing bariatric surgery. However, limited data exists on the relationship between interpersonal difficulties and binge eating. OBJECTIVES: To identify interpersonal factors linked with binge eating among bariatric surgery candidates. SETTING: One hundred and seventeen adult bariatric surgery candidates (BMI = 42.2 ± 5.2) from three different hospitals completed questionnaires on the day of their bariatric committee meeting for operation approval. METHODS: Binge eating was assessed using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) as a dichotomous variable. Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), and interpersonal characteristics were evaluated using the short version of the Inventory of Interpersonal Problems (IIP-32). Sociodemographic variables (age, gender, income, education) and BMI were considered as confounders. RESULTS: Approximately 25% of bariatric surgery candidates reported experiencing binge eating episodes within the previous three months. Participants with binge eating exhibited significantly lower self-esteem and more interpersonal difficulties, particularly in the domains of aggressiveness and dependence, compared to those without binge eating. Logistic regression analysis revealed that aggressiveness was a significant predictor of binge eating in this sample. CONCLUSIONS: This study is the first, to the best of our knowledge, to investigate the relationship between interpersonal difficulties and binge eating among bariatric surgery candidates. The findings highlight the significant contribution of aggressiveness to binge eating and emphasize the importance of clinicians assessing patients' interpersonal functioning, particularly with regard to aggressiveness, as a factor that may contribute to the maintenance and occurrence of binge eating behaviors.

Health Behaviors during the Early COVID-19 Containment Phase and Their Impact on Psychological Health.

The COVID-19 lockdowns have brought significant changes to individuals' daily lives, including their health behaviors and psychological health. Longitudinal studies exploring changes in health behaviors during the course of the initial containment phase are relatively scarce. Our aim is to understand how health behaviors have evolved during different phases of the early COVID-19 lockdowns and assess the impact of these changes on psychological well-being. By doing so, we hope to provide valuable insights that can enhance the understanding of the relationship between health behaviors and psychological health, with relevance not only to everyday life but to times of crises. A longitudinal study among 313 adults in Israel (44.5 ± 13.4 years old, 80% women) at three timepoints, beginning with the first COVID-19 lockdown (April 2020) and extending through June 2020. In each wave, participants were asked to report about exercising, eating fruits and vegetables, sharing family meals, and screen time. The BSI (Brief Symptom Inventory) was used to assess psychological health. There was an initial increase in the frequency of exercising (3.06 + 2.3 times a week) and shared meals (breakfast, 3.97 + 2.3; lunch, 5.30 + 1.9; dinner, 5.75 + 1.7 times a day) followed by a subsequent significant decrease in these behaviors (exercising, 2.84 + 2.0; breakfast, 2.63 + 2.1; lunch, 3.48 + 2.3; dinner, 4.75 + 2.0). The health behaviors of more exercising (r = -0.145, p = 0.43) and less screen time (r = 0.183, p = 0.010) had a positive impact on psychological health. External events, such as the first COVID-19 lockdown, may influence health behaviors which may, in turn, influence psychological health. While prior studies have mainly highlighted the negative impact of the pandemic on health behaviors, our analyses suggest that the first containment phase may have had an initial beneficial impact on several health behaviors, including exercising and family meals. However, this change was not sustainable.

Disordered eating behaviours in adolescents with type 1 diabetes can be influenced by their weight at diagnosis and rapid weight gain subsequently.

AIMS: To assess the prevalence and disease-related risk factors for disordered eating behaviours among adolescents with type 1 diabetes and also to search for risk factors at disease diagnosis that can predict the development of disordered eating behaviours. METHODS: A retrospective observational study of 291 adolescents aged 15-19 years with type 1 diabetes who completed the Diabetes Eating Problem Survey-Revised (DEPS-R) as is routine in our diabetes clinic. The prevalence of disordered eating behaviours and risk factors for their development was assessed. RESULTS: In 84 (28.9%) adolescents, disordered eating behaviours were found. Disordered eating behaviours were positively associated with female sex (ß = 3.01 [SE = 0.97], p = 0.002), higher BMI-Z score (ß = 2.08 [SE = 0.49], p < 0.001), higher HbA1c (ß = 0.19 [SE = 0.03], p < 0.001) and treatment with multiple daily injections of insulin (ß = 2.19 [SE = 1.02], p = 0.032). At type 1 diabetes diagnosis, higher BMI-Z score (ß = 1.54 [SE = 0.63], p = 0.016) for those diagnosed before age 13 years and increased weight gain at 3 months post-diagnosis (ß = 0.88 [SE = 0.25], p = 0.001) in females diagnosed at age 13 years or older were found to be risk factors for disordered eating behaviours. CONCLUSIONS: Disordered eating behaviours are common among adolescents with type 1 diabetes and are associated with various parameters, including BMI at diagnosis and the rate of weight gain at 3 months post-diagnosis in females. Our findings highlight the need for early preventive efforts for disordered eating behaviours and interventions to avoid late diabetes complications.

The experience of claiming mental health disability benefits: A qualitative analysis of clients' perspectives.

WHAT IS KNOWN ON THE SUBJECT?: The decision to apply for disability benefits may be an important breakthrough in the life of people with severe mental illness. The literature regarding the process of applying for mental health disability benefits is scarce. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is, to the best of our knowledge, the first to fully describe the experience of submitting a claim for mental health disability benefits, as experienced by those diagnosed with severe mental illness. The process of applying for recognition of a mental health disability has three chronological stages-before the claim submission, during the claims process and after recognition. Clients approach the process without any prior knowledge, and therefore they need professional help when submitting their claim. A deterioration in clients' mental health prompts them to apply. A lack of trust in the system affects the application decision/process. The medical committee hearing is described as a complex and multifaceted experience. Clients reported being extensively preoccupied with stigma throughout the process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professional assistance throughout the claims process is a key factor with the potential to change clients' experience of the entire process. It is important to educate mental health nurses about the disability applicating process. Mental health professionals are encouraged to be mindful of the facilitating/hindering mechanisms that are dominant at each stage of the process. There is a need for liaising with relevant agencies that act as advocates for those diagnosed with a mental health illness. ABSTRACT: INTRODUCTION: The decision to apply for disability benefits may be an important breakthrough in the life of those diagnosed with severe mental illness (SMI). Nevertheless, the literature regarding the application process is scarce. AIM: The aim of the study was to explore how people who receive mental health disability benefits retrospectively perceive the process of applying for and receiving these benefits. METHODS: Twenty-four in-depth qualitative interviews were conducted with people whose mental health disability was recognized in the past few years. RESULTS: Analysis revealed three themes describing the process's chronological stages: Before submitting the claim (from deterioration to trust), during the claim process (from bureaucracy to understanding), after receiving recognition (from stigma to gratitude). Each stage includes facilitating factors (e.g. encouragement from professionals) and hindering factors (e.g. stigma, lack of knowledge and trust). DISCUSSION: This is the first study to fully describe the experience of applying for mental health disability benefits, as experienced by clients. The decision to apply is perceived as complex and difficult. Although clients are extensively preoccupied with stigma throughout the process, they are able to express gratitude for the opportunities made available to them. IMPLICATIONS: Professional assistance throughout the claim is a key factor with the potential to change clients' experience of the entire process.

Neighborhood violence and health: the mediating role of loneliness among two ethnic groups in Israel.

Neighborhood violence is associated with poor health, but the mechanisms explaining this association are still unknown. This study seeks to examine the role of loneliness as a mediator of the association between neighborhood violence and health among two ethnic groups (Arabs and Jews) in Israel. A representative survey was conducted among adult residents (1903 Arabs and 2726 Jews) of four Israeli towns: two Arab towns, one Jewish town and one mixed town. A stratified sample of households by residential area, age and sex, was selected in each town. Mediation models were tested using Hayes' PROCESS procedure. Traffic violations, juvenile delinquency and vandalism were reported by more than 50% of Arab residents, relative to about 25-30% of Jewish residents. Loneliness mediated the association between neighborhood violence and health, with a full serial mediation for mental health and a partial serial mediation for physical health. Findings indicate that Arab towns are characterized by severe neighborhood violence. The association between neighborhood violence and physical health was fully dependent on the mediators among both ethnic groups. Future studies should use prospective designs with objective measures of health and violence to validate our cross-sectional findings.

Positive Relationships have Shades of Gray: Age is Associated with More Complex Perceptions of Relationship Quality During the COVID-19 Lockdown.

Drawing on socioemotional selectivity theory, we examined the effect of COVID-19 lockdowns on perceptions of romantic relationships quality among older, compared to younger, adults. During the first lockdown in Israel which involved strict restrictions on movement and association with others, 280 adults aged 25-81 reported positive and negative qualities of their romantic relationship. Of these, 105 participants completed the survey again once lockdown restrictions were lifted. Contrary to our hypotheses, no evidence for age differences in the effect of the lockdown on positive or negative perceptions of relationship quality was detected. In addition, the lockdown did not influence participants' positive and negative perceptions of their romantic partners. However, we did find that, whereas people of all ages represent positive and negative qualities of their romantic partners as separate constructs, the negative association between the two is weaker for older adults compared to younger adults during (but not after) the lockdown. This finding suggests that in stressful times, older adults are better able to avoid negative perceptions clouding positive perceptions and see positive aspects of relationships with romantic partners in the face of negative ones. Findings extend evidence for age associations with complex emotional experiences to emotional aspects of interpersonal relationships. Findings enrich the theoretical understanding of age-related advantages in emotional well-being and may inform potential interventions for improving emotional health and well-being during times of crisis. Supplementary Information: The online version contains supplementary material available at 10.1007/s10804-022-09431-6.

Therapeutic alliance with psychotherapist versus dietician: a pilot study of eating disorder treatment in a multidisciplinary team during the COVID-19 pandemic.

Little is known about the therapeutic alliance (TA) formed with different professionals in multidisciplinary eating disorder (ED) treatment, particularly in the context of online treatment during the COVID-19 pandemic. We aimed to conduct a pilot study during the COVID-19 pandemic examining characteristics of patients' TA with their dieticians and psychotherapists, associations between patients' and therapists' views of the TA, and relationships between psychological characteristics and TAs. Sixty-three patients with EDs and their treating psychotherapists and dieticians were surveyed during the COVID-19 pandemic using the Working Alliance Inventory (WAI-S). Spearman correlation tests were used to examine associations between variables. Positive associations were found between the TAs examined. Concordance was stronger in patient-dietician dyads than in patient-psychotherapist dyads. Severe ED psychopathology was associated with weaker TA (bond subscale). General psychopathology was associated with weaker TA with the dietician (task subscale). Given that several differences were found between the TAs of treatment dyads, further longitudinal studies are needed to validate our pilot findings and to investigate multidisciplinary TAs and their impact on treatment outcomes in online ED treatment settings during the COVID-19 pandemic, as well as in other treatment settings (e.g., in-person settings). This study will contribute to a deeper understanding of the dynamics of TAs in multidisciplinary ED treatment and inform the development of more effective interventions.

Relational uncertainty, interdependence and psychological distress during COVID-19: A longitudinal study.

Drawing on the relational turbulence theory, this study explored the associations of self, partner and relationship uncertainty, and partner interference and facilitation with psychological distress symptoms during the COVID-19 stay-at-home orders. A longitudinal study of 313 individuals was conducted in Israel at three time points, spanning from the first lockdown (April 2020) and through the alleviation of the severe restrictions (June 2020). Multilevel modelling indicated divergent associations between the different sources of relational uncertainty and interdependence and somatization, depression and anxiety. Further analyses pointed to divergent findings regarding how change in self, partner and relationship uncertainty predicted change in somatization, depression and anxiety over the course of the study, depending on whether the three sources of relational uncertainty were analysed separately or simultaneously in the same model. Change in interference from a partner did not predict changes in psychological distress. Theoretical and practical implications of the findings are discussed.

Social Capital as a Mediator and Moderator in the Association between Loneliness and Health, Israel as a Case Study.

Loneliness has been associated with poor health. Social capital (SC) could possibly prevent the ill effects of loneliness. The study aims to assess the association of loneliness with physical and mental health in four different communities in Israel and study the impact of structural and cognitive SC on that association. A cross-sectional face-to-face survey with 4620 adults in four towns was conducted. The questionnaire included self-rated health (SRH), mental health (MH), loneliness, cognitive and structural SC and socioeconomic characteristics. Logistic regression analysis and mediation and moderation effects were calculated. Loneliness was associated with worse SRH (OR = 0.4-0.5) and worse MH (OR = 2.0-10). Both SC variables were associated with health. However, towns differ in these associations. Structural SC serves as a significant mediator between loneliness and SRH in all towns and is a mediator between loneliness and MH in two towns. Cognitive social capital was a moderator between loneliness and MH in two towns. This study suggests that increasing SC could possibly compensate for loneliness and buffer its effect on health. The study reinforces the need for the performance of separate health profiles to assess possible interventions for each community, as not always can we generalize these results to all communities.

Women's perspectives toward their nutritional counseling for eating disorders: a qualitative internet-based study in Israel.

Nutritional counseling is a central part of eating disorder (ED) treatment. However, the nature of this treatment has not yet been described from women's perspectives. We conducted two studies exploring views of women regarding their ED nutritional counseling. In the first study, we used content analysis to reveal practices that registered dietitians (RDs) use in ED treatment. In the second study, we used phenomenological analysis to explore the nature of the client-dietitian collaboration. Data included 1,897 posts and 8,673 responses from 414 distinct female users, retrieved from a moderated ED Internet community website in Israel. Content analysis demonstrated six practices used by RDs: meal planning, weight monitoring, health assessment/consultation, establishing rapports, food logs, joint eating. Phenomenological analysis produced four positions demonstrating client-dietitian collaborations: "Silent dialogue," "Cancelation and deception," "Tough love," "Containment." Findings revealed women's efforts to continue treatment despite their ambivalence about goals and recovery, and RDs' efforts to help women, despite the women's ambivalence, to move forward toward recovery.

Analyses of posts written in online eating disorder and depression/anxiety moderated communities: Emotional and informational communication before and during the COVID-19 outbreak.

INTRODUCTION: Moderated online health communities (OHCs) are digital platforms that provide a means for patients with similar medical conditions to communicate with each other under the supervision of healthcare professionals. AIMS: To examine the impact of the COVID-19 outbreak on content and type of posts published in two moderated OHCs - eating disorders and depression/anxiety - by comparing categorizations of posts written before vs. after the lockdown, and about vs. not about the pandemic. METHODS: Posts were retrieved from Camoni, the first Israeli medical social network (January-June 2017, March-May 2020). A total of 1475 posts were analyzed. Of them, 802 posts were written before and 680 were written during the first lockdown. Posts were divided into two main categories: informational and emotional, and into fourteen subcategories. RESULTS: Before the pandemic, the eating disorders OHC was characterized as primarily emotional (emotional: 66.7%, informational: 45.4%) and the depression/anxiety OHC as primarily informational (emotional: 49.8%, informational: 65.8%) (χ2 = 31.6, p < 0.001). During the lockdown, there was a transition in the eating disorders community, from primarily emotional to primarily informational communication (emotional: 46.1%, informational: 71.7%) (χ2 = 30.3, p < 0.001). In both OHCs, only about one in six posts written during the lockdown was related to the pandemic. There were only minimal differences in subcategorization of posts written before vs. after the outbreak (e.g., searching for medical information was more common during the pandemic: χ2 = 40.9, p < 0.001), as well as about vs. not about the pandemic (e.g., sharing negative emotions was more common when writing about the pandemic: χ2 = 4.1, p = 0.43). CONCLUSION: During the first lockdown, people with eating disorders have increased their use of OHCs as sources of informational (as opposed to emotional) support, but the overall impact of the pandemic on the content of posts written in the examined OHCs was minimal, suggesting that OHCs have not changed their function as a valuable means of providing emotional and informational support for people with mental difficulties.

The implicit association of high-fat foods with shame and its link with eating disorder symptoms: The moderating role of race/ethnicity.

BACKGROUND: An interesting debate in the literature is about the role of race/ethnicity not only as a risk factor for eating disorders (EDs), but also as a moderator of the relations between other risk factors and ED symptoms. The following research question was explored: Does race/ethnicity moderate the relations between the implicit belief that high-fat food is shameful and ED symptoms? METHODS: About 15,000 (N = 14,964) volunteers (67.7% White, 7.7% Asian, 7.4% Hispanic, 6.9% Black) completed the Implicit Association Test (IAT) measuring the implicit associations between high-fat (vs. low-fat) food and shameful (vs. acceptable) on the Project Implicit mental-health website (https://implicit.harvard.edu) between 2011 and 2017. ED symptoms and demographics were measured via self-report. RESULTS: Race/ethnicity moderated (beta = 0.087, p = .002) the relations between IAT and ED symptoms, adjusting for BMI, age, sex, education, such that the IAT was related to ED symptoms among Whites (r = 0.113, p < .001), Hispanics (r = 0.086, p = .004), and Asians (r = 0.097, p = .001), but not Blacks (r = 0.056, p = .071). DISCUSSION: Although the effect size was small, findings imply that some ED risk factors may vary among racial/ethnic groups. Future studies should use prospective designs to examine whether implicit biases actually represent a risk factor for ED symptoms and whether this varies by race/ethnicity.

Emotional Eating in Adults: The Role of Sociodemographics, Lifestyle Behaviors, and Self-Regulation-Findings from a U.S. National Study.

BACKGROUND: Emotional eating, the tendency to overeat in response to negative emotions, has been linked to weight gain. However, scant evidence exists examining the prevalence and correlates of emotional eating among large samples of adults in the United States (U.S.). Hence, we examine the relationship among individual and socioeconomic factors, health behaviors, and self-regulation with emotional eating patterns among U.S. adults. METHODS: Cross-sectional analysis of 5863 Family Health Habits Survey participants. Multivariable, ordered, logistic regression was employed to examine the relationship between the frequency of the desire to eat when emotionally upset (never, rarely, sometimes, often, and very often) and the independent variables. RESULTS: Analysis reveals that 20.5% of the sample tended to emotionally eat often or very often. Being female, non-Hispanic White, and of younger age were all related to a higher likelihood of emotional eating. Additionally, inability to delay gratification (impatience) was related to an 18% increased likelihood (95% confidence interval (CI) 1.05-1.33) for emotional eating. Finally, emotional eating was significantly related to more frequent fast-food consumption. CONCLUSIONS: Program planners might need to develop targeted interventions aimed at enhancing emotional regulation skills while addressing these less healthful behaviors (e.g., fast-food intake) with the goal of obesity and chronic disease prevention.

The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients' perspectives during the COVID-19 lockdown.

BACKGROUND: Studies investigating patients' perspectives towards an abrupt transition from face-to-face to online treatment in eating disorders (EDs) are scarce. The current study aimed to (1) conduct a preliminary assessment of patients' perspectives regarding this transition, and (2) explore potential demographic, clinical, and treatment-related factors associated with these perspectives. METHODS: Sixty-three patients with EDs whose treatment was moved to an online format, were surveyed during the COVID-19 lockdown (April-May 2020). A 6-item measure was developed to examine their perspectives toward this transition. Exploratory factor analyses (EFAs) were conducted to confirm the rational-theoretical structure of the measure (Eigenvalue = 3.745, explaining 62.4% of variance). The Cronbach's alpha value was excellent (α = 0.878). Validated questionnaires were used to measure ED symptoms, general psychopathology, therapeutic alliance, and pandemic anxiety, and their associations with our transition-focused scale and telemedicine satisfaction were examined. RESULTS: Mixed views were found regarding the transition, with the majority (68%) stating that they would not choose to continue online therapy given the option. Longer duration of treatment (r = 0.291, p = 0.022), stronger therapeutic alliance (r = 0.293, p = 0.028), and higher COVID-19 anxiety (r = 0.276, p = 0.029) were linked with more positive views towards the transition. CONCLUSIONS: Analyses suggest that patients' perspectives towards the transition can be measured using a Likert-type 6-item scale. Findings highlight the various responses to online treatment and indicate a need to identify patients who may face difficulties in the transition to this newly ubiquitous treatment mode. Clinicians should be cognizant of these potential difficulties and consider appropriate modes of treatment in the ongoing pandemic situation.

The associations of healthful weight-control behaviors with psychological distress and changes in body mass index among young adults.

The aim of this research is to study young adults who try to lose weight using only healthful weight-control behaviors. Secondary analyses of the US National Longitudinal Study of Adolescent to Adult Health (Add-Health, N = 3,882) were performed. Females who used only healthful weight-control behaviors had lower self-esteem than females who did not try to lose weight, and less depressive symptoms than females who used unhealthful weight-control behaviors. Data suggested that females who used only healthful weight-control behaviors were at higher risk for gains in body mass index than females who did not try to lose weight. This study adds to the extant literature about weight-control behaviors by highlighting that people who try to lose weight using only healthful weight-control behaviors merit special attention from both scientific and practical points of view.