Retraining of automatic action tendencies in individuals with obesity: A randomized controlled trial.

Obesity is a major health concern, characterized by an automatically activated tendency to (over)-eat. Recent research suggests that an effective way to counteract automatic approach tendencies in unhealthy consumption behavior might be approach bias modification. Therefore, we investigated an approach-avoidance training for unhealthy food cues in 189 patients with obesity of a psychosomatic inpatient clinic who were participating in a nutrition advice program. Patients in the active training group were trained to make avoidance movements (pushing a joystick) in response to unhealthy food pictures and approach movements (pulling the joystick) in response to positive pictures, while the control group received sham training (approaching and avoiding both picture types). Approach-avoidance bias, body mass index, eating pathology and food-specific implicit associations were assessed before and after the training. In line with our hypothesis, approach-avoidance bias improved in the active training group after the training, in comparison to the sham training group. Moreover, this effect generalized to new, untrained stimuli. However, no effects of the training were found in a food-specific Single-Target Implicit Association Test, or on eating pathology questionnaires or body mass index. While the training results are promising, the effect of approach-avoidance bias modification on relevant behavior in obesity has yet to be established before it may be implemented as an add-on treatment.

Persistent hyperphagia in acquired brain injury; an observational case study of patients receiving inpatient rehabilitation.

BACKGROUND: Morbid hunger or persistent hyperphagia is a relatively rare but potentially life threatening complication of acquired brain injury (ABI). METHOD: This paper presents findings from an observational case study of patients with hyperphagia receiving inpatient neurobehavioural rehabilitation following their acquired brain injury. The case study has utilized dietetic and medical records of identified patients to confirm the persistent and serious nature of this presentation in order to extract important management principles. RESULTS: The findings confirmed that hyperphagia or morbid hunger posed potentially life-threatening health risks to the patient, primarily around weight control and fluid balance, and risks of aggression towards professional and family carers. Pharmacological or behaviour modification interventions were only partially successful in management of this presentation. The study identified a high need for environmental and cue exposure control in management of this condition.

Obesity and its relationship to addictions: is overeating a form of addictive behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

Rethinking recovery from eating disorders: spiritual and political dimensions.

In this article, we portray women's experiences of long-term recovery from anorexia and compulsive overeating. Semistructured interviewing and an interpretive biographical method were used to coconstruct accounts of each participant's transition to wellness. Thick descriptions of self-identified turning points on the path to recovery are framed in terms of the concept of personal positioning in relation to cultural master narratives. The narratives suggest that long-term recovery involves spiritual or political commitment and purposeful engagement with communities larger than the self.

Case report: treatment of a woman with alcohol and binge eating problems.

The prevalence of eating disorders generally, and bulimia symptomatology in particular, in problem female drinkers has been consistently reported. According to an addictive behaviour model, these two disorders share common features, in particular a compulsion to engage in the behaviour and a sense of loss of control. However, there has been no attempt to treat sufferers of both conditions with a similar treatment approach. The present case study illustrates how a cognitive behavioural and exposure-based approach successfully treated a woman with a history of bulimia and alcohol problems. At 12 months follow up, there was a significant reduction in alcohol consumption and an absence of bingeing and purging episodes.

Poststarvation hyperphagia and body fat overshooting in humans: a role for feedback signals from lean and fat tissues.

An increase in the sensation of hunger and overeating after a period of chronic energy deprivation can be part of an autoregulatory phenomenon attempting to restore body weight. To gain insights into the role of fat and lean tissue depletion as determinants of such a hyperphagic response in humans, we reanalyzed the individual data on food intake and body composition available for the 12 starved and refed men in the classical Minnesota Experiment after a shift from a 12-wk period of restricted refeeding to an ad libitum refeeding period of 8 wk. For each individual, the following were determined: 1) the total hyperphagic response during the ad libitum refeeding period, calculated as the energy intake in excess of that during the prestarvation (control) period; 2) the degree of fat recovery and that of fat-free-mass (FFM) recovery before ad libitum refeeding, calculated as the deviation in fat and FFM from their respective prestarvation values (ie, the amount of fat or FFM before ad libitum refeeding as a percentage of fat or FFM during the control period); and 3) the deficit in energy intake before ad libitum refeeding, calculated as the difference between the energy intake during the period of restricted refeeding and that during the control period. The results indicate that 1) the total hyperphagic response is inversely correlated with the degree of fat recovery (r = -0.6) as well as with that of FFM recovery (r = -0.5), 2) the correlation between hyperphagia and FFM recovery persists after adjustment for fat recovery, and 3) the correlations between hyperphagia and fat recovery or FFM recovery persist after adjustment for the variance in the energy deficit during the preceding period of restricted refeeding. Taken together, these results in humans suggest that poststarvation hyperphagia is determined to a large extent by autoregulatory feedback mechanisms from both fat and lean tissues. These findings, which have implications for both the treatment of obesity and for nutritional rehabilitation after malnutrition and cachexia, have been integrated into a compartmental model of autoregulation of body composition, and can be used to explain the phenomenon of poststarvation overshoot in body fat.

Reducing naltrexone-resistant hyperphagia using laser acupuncture to increase endogenous opiates.

A 28-year-old woman with acquired brain damage suffered subsequent profound mental disability and an intense hyperphagic syndrome complete with life-threatening pica. She was the single subject of two consecutive experiments. In the first, Naltrexone, an orally administered opiate blocker, was given to reduce hyperphagia and distress, but was associated with even greater urgency when eating meals and a manifest increase in distress. While distress reduced to premedication levels on withdrawal of treatment, urgency of eating did not reduce so quickly. In the second experiment a laser acupuncture procedure was used at 2.5 Hz and 10 Hz for 10 days each with an intervening 10-day placebo condition to increase the availability of the subject's endogenous opiates, and thus hopefully produce opposite effects to the first experiment and effect a positive treatment. The 10 Hz condition produced a significant but transient reduction in pica measured by attempts at pica on a supervised walk shortly after each treatment. The subject was also easier to manage on walks, and appeared happier. Further studies using physical exercise or acupressure to achieve similar or better results are discussed.

Modification of severe behaviour problems following herpes simplex encephalitis.

Violent and sexually disinhibited behaviour together with poor self-care developed in a 38-year-old teacher following herpes simplex encephalitis. These behaviours were sufficiently severe to make rehabilitation difficult and return to the community impossible. Initially, only violent behaviour was treated, both by medication and a behaviour programme, and sexual disinhibition subsequently by the latter. In order to implement the programme a special (psychiatric) nurse was required on a 24 h basis. The incidence of violent behaviour was reduced from up to 55 times per day to zero over a period of 2 months. Whether this was affected by medication or behaviour management, or by spontaneous recovery, is discussed. Sexual disinhibition was eliminated in supervised settings, but continued to occur if left unsupervised and this improvement resulted from behaviour management. Poor personal hygiene also improved markedly over the 6-month period. The goal of returning the patient home to live with her family was achieved and she remained there at follow-up. This intervention was carried out in a rehabilitation unit that does not specialize in the treatment of such cases; clearly this has implications for cost and quality of care.

Anorexia nervosa and bulimia: an activity-oriented approach.

In recent years, there has been a growing trend away from a dogmatic adherence to any one approach in the treatment of eating disorders. This paper adds the new element of practice in relation to cognitive change. The activity-oriented approach outlined here stresses that patients with anorexia nervosa or bulimia must maintain responsibility for their own food intake throughout treatment. The key role of the occupational therapist in the treatment team is outlined, and suggestions for assessment and management of this type of patient are given.

Binge eating: a theoretical review.

An eating pattern consisting of gorging, alternating with dieting and purging is identified as a clinical problem in patients of normal weight, in the obese, and in patients with anorexia nervosa. The clinical reports have used a variety of names for this problem, and this has obscured the similarity between the various descriptions. Another perspective on the problem is offered by the experimental research on dietary restraint and counter-regulation. Counter-regulation, found in subjects from all weight groups who are restricting their food intake, is construed as a laboratory version of an eating binge. The clinical and experimental reports are combined to provide suggestions for the aetiology and treatment of the problem of binge eating.