Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

The impact of COVID-19 lockdown on disordered eating behaviors: the mediation role of psychological distress.

PURPOSE: This study aimed to explore the early associations between the experienced psychosocial impact of the COVID-19 pandemic crisis during lockdown, depressive symptomatology, anxiety/stress levels, and disordered eating behaviors in adults during a first COVID-19 lockdown period. METHODS: This was a community-based cross-sectional study assessing 254 Portuguese adults (82.7% women; 35.82 ± 11.82 years) 1 week after the end of the first mandatory COVID-19 lockdown in Portugal. An online survey was conducted to evaluate psychological distress, disordered eating, and psychosocial impact of the COVID-19 pandemic. Pearson correlations and Structural Equation Modeling were performed. RESULTS: Participants reported the presence of meal skipping (52.8%), grazing eating behavior (80.9%), overeating (81.0%), loss of control over eating (47.2%), and binge eating episodes (39.2%) during lockdown. Structural equation modeling analyses, controlling for age and sex, indicated that there was a significant indirect effect of the experienced psychosocial impact of COVID-19 pandemic on disordered eating behaviors mediated through psychological distress. CONCLUSION: The psychosocial impact of the COVID-19 pandemic crisis may lead to disordered eating, and this relation may occur through the elevation of psychological distress. These findings can be used to inform interventions, to enhance mental health and manage disordered eating during similar future situations. Level of evidence V: cross-sectional descriptive study.

Intuitive eating Scale-2: Factor structure and associations with disordered eating, impulsivity and quality of life in adolescents with overweight/obesity.

OBJECTIVE: The Intuitive Eating Scale-2 (IES-2) has been shown to be a valid tool to assess the capability of eating in reaction to natural hunger/satiety cues. However, its factor structure seems to differ in function of cultural/socioeconomic backgrounds, and its psychometric properties among the adolescents with overweight/obesity (BMI-for-age percentile >85th) have not been examined yet. Thus, this study aims to 1) investigating the factorial structure/psychometric properties of IES-2 in adolescents with overweight/obesity; and 2) exploring the associations between impulsivity, quality of life disordered and intuitive eating. METHODS: A total of 202 Portuguese adolescents (124 girls; 78 boys; 12-19 years) under weight-loss treatment with a mean BMI z-score of 2.41 (SD = 0.75) participated in this study. The IES-2 factor structure was explored by confirmatory factor analysis and bifactor models. Test-retest reliability analyses were performed over 6 months (n = 41) and associations between the variables under study were explored. RESULTS: Confirmatory factor analyses with posthoc modifications resulted in a bifactor model with acceptable fit supporting one general factor (intuitive eating) and three specific factors (IES-2 subscales). The "Unconditional Permission to Eat" subscale could not be replicated in this sample. Test-retest reliability analyses suggested good temporal stability. Intuitive eating scores were negatively associated with grazing eating behavior and impulsivity (negative urgency) and positively linked to quality of life. CONCLUSIONS: An adjusted version of IES-2 can be an appropriate measure for assessing intuitive eating levels in adolescents with overweight/obesity. Research on intuitive eating has the potential to enhance pediatric weight-loss interventions.