Quality of Life and Physical Performance in Patients with Obesity: A Network Analysis.

BACKGROUND: The aim of this study was to investigate the interconnections between specific quality-of-life domains in patients with obesity and high or low physical performance using a network approach. METHODS: 716 consecutive female and male patients (aged 18-65 years) with obesity seeking weight-loss treatment were included. The 36-item Short Form Health Survey (SF-36) and the six-minute walking test (6MWT) were used to assess quality of life and physical performance, respectively. The sample was split into two groups according to the distance walked in the 6MWT. Network structures of the SF-36 domains in the two groups were assessed and compared, and the relative importance of individual items in the network structures was determined using centrality analyses. RESULTS: 35.3% (n = 253) of participants covered more distance than expected, and 64.7% (n = 463) did not. Although low-performing patients showed lower quality of life domain scores, the network structures were similar in the two groups, with the SF-36 Vitality representing the central domain in both networks. Mental Health was a node with strong connections in patients who walked less distance. CONCLUSIONS: These findings indicate that psychosocial variables represent the most influential and interconnected features as regards quality of life in both groups.

Residential cognitive-behavioral weight-loss intervention for obesity with and without binge-eating disorder: A prospective case-control study with five-year follow-up.

OBJECTIVE: The aim of this prospective case-control study was to compare the long-term effects of a residential cognitive-behavioral treatment (CBT) for weight loss in severely obese patients with and without binge-eating disorder (BED). METHODS: We assessed weight-loss outcomes and psychological impairment in 54 severely obese female patients with BED and 54 patients matched by age, gender, and body mass index (BMI) without BED admitted to a residential CBT program. Body weight was measured at baseline and at 6-month follow-up and was reported by patients in a telephone interview at 5-year follow-up. Depression, eating disorder psychopathology, general psychopathology, and quality of life were assessed using validated instruments at baseline and at 6-month follow-up. RESULTS: Obese patients with and without BED had similar weight loss at 6-month and 5-year follow-ups. Although both groups showed improved psychosocial variables, at 6 months the BED group maintained higher psychological impairment. Nevertheless, at 5-year follow-up more than half of the BED participants were no longer classifiable as having BED. DISCUSSION: The presence of BED does not affect weight-loss outcome in obese patients treated with the residential CBT for weight loss program considered. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:723-730).

Strong relationship between vitamin D status and bone mineral density in anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is associated with impaired bone health and low bone mineral density (BMD) as a consequence of an inadequate peak bone mass in adolescence and bone loss in young adulthood. The vitamin D status with its implications for bone health in patients affected by AN has only been examined previously in small studies. OBJECTIVE: To evaluate the prevalence of vitamin D deficiency and test the hypothesis that patients with AN and vitamin D deficiency might have worse bone metabolism and lower bone density as compared with AN with adequate vitamin D repletion. DESIGN: We analysed the vitamin D status and bone metabolism in a large cohort (n=89) of untreated patients affected by AN, with amenorrhoea. RESULTS: Vitamin D deficiency is widespread in untreated patients with AN: 16.9% had 25OH vitamin D levels below 12 ng/ml, 36% below 20 ng/ml and 58.4% below 30 ng/ml. PTH values were higher and BMD at both femoral sites were lower in patients with vitamin D<20 ng/ml. Progressively higher values of BMD were observed by 4 ranks of 25 OH vitamin D values (severe deficiency: <12 ng/ml, deficiency: ≥12 ng/ml and <20 ng/ml, insufficiency: ≥20 and <30 ng/ml and normal: ≥30 ng/ml). In patients with severe vitamin D deficiency BMD at the hip were significantly lower than that measured in groups with values over 20 ng/ml (p<0.001 for trend). The level of significance did not change for values adjusted for BMI or body weight. CONCLUSION: We found a strong relationship between vitamin D status and hip BMD values with additional benefits for those with 25OHD levels above 20 ng/ml. Our results support the design of a randomized placebo-controlled clinical trial on the effect of vitamin D on BMD in patients with AN. The second point, whether 25OHD should be above 20 or 30 ng/ml remains a discussion point.

The eating disorder examination: reliability and validity of the Italian version.

OBJECTIVE: To examine the psychometric characteristics of the Italian language version of the latest edition of the eating disorder examination (EDE). METHODS: An Italian version of the EDE (17th edition) was designed and administered to 185 in- and outpatients with eating disorders and 60 age-matched controls. Its internal consistency, inter-rater reliability, short-term (7-23 days) test-retest reliability and criterion validity were evaluated. RESULTS: Internal consistency was high for all four original EDE subscales. Inter-rater reliability was excellent for global EDE scores and original subscales (≥0.93), and for eating disorder behaviours (≥0.89). Test-retest reliability was good for global EDE scores and original subscales (0.57-0.80), objective bulimic episodes and days, vomiting episodes, laxative and diuretic misuse episodes, and excessive exercising (≥0.82), but unsatisfactory for subjective bulimic episodes and days. Patients with eating disorders displayed significantly higher EDE scores than age-matched controls, demonstrating the good criterion validity of the instrument. CONCLUSIONS: The Italian version of the EDE 17.0D has adequate psychometric properties and can therefore be recommended for examining Italian patients with eating disorders in clinical and research settings.

Regional fat distribution in adolescent and adult females with anorexia nervosa: A longitudinal study.

BACKGROUND & AIMS: No study has yet compared body fat distribution before and after weight restoration in adolescent and adult patients with anorexia nervosa (AN) treated according to the same protocol. The study was set up to measure body fat distribution before and after short-term weight restoration in adolescent and adult patients with AN treated according to the same protocol in a specialist inpatient unit. METHODS: We recruited 33 consecutive adolescent female patients with AN, and 33 controls matched by age and post-treatment BMI centile, as well as 33 adult female patients with AN, and 33 controls matched by age and post-treatment BMI. Dual-energy X-ray absorptiometry (DXA) was used to assess body composition before and after short-term weight restoration (BMI ≥ 18.5 kg/m²). RESULTS: Compared with controls, both adolescents and adults with AN showed that a greater amount of fat was lost from the extremities than the trunk before weight restoration, and that there was a central adiposity phenotype after short-term weight restoration. There were no significant differences in body fat distribution between adolescents and adults with AN before or after short-term weight restoration. CONCLUSIONS: Adolescent and adult females with AN have similar body fat distribution both before and after short-term weight restoration, and show a central adiposity phenotype after short-term weight restoration. The clinical implications of this finding are as yet unknown. Clinical Trials Registry- Regional Fat Distribution in Adolescent Girls and Adults with Anorexia Nervosa (ISRCTN73572502).

Night eating syndrome and weight loss outcome in obese patients.

OBJECTIVE: The clinical significance of diagnosing the night eating syndrome (NES) in obese individuals has not been clearly demonstrated. We aimed to test the effect of NES on weight loss outcome in obesity. METHOD: In an observational case-control study, we measured weight loss outcome in obese individuals with NES (32 cases) and 68 non-NES matched participants entering a weight-loss program. The diagnosis of NES was generated by a two-stage assessment, including the Night Eating Questionnaire (screening test) and the Night Eating Syndrome History and Inventory. The program included a 21-day inpatient treatment based on a low-calorie diet, exercise, and psycho-educational groups, followed by a 6-month outpatient follow-up. Body weight, metabolic parameters, and questionnaires of psychopathology were assessed at baseline, at the end of the inpatient period and at the end of follow-up. RESULTS: NES participants were only characterized by significantly higher scores of the Beck Depression Inventory and the Night Eating Questionnaire. The time course of weight loss did not differ between groups throughout the study period. Only eight NES participants were still classified as NES at study end. DISCUSSION: The presence of NES does not affect weight loss outcome of an obesity treatment based on lifestyle modification.