Two sides of weight bias in adolescent binge-eating disorder: Adolescents' perceptions and maternal attitudes.

OBJECTIVE: Adolescents with binge-eating disorder (BED) are suffering from weight teasing and, as found in adult BED, are likely to internalize weight bias. Weight teasing by mothers accounts for psychopathology in overweight (OW), but stigmatization sources are largely unknown in BED. This study sought to address weight bias in adolescents with OW and BED by examining adolescents' perceived parental weight teasing and weight bias internalization in relation to their eating disorder psychopathology and maternal stigmatizing attitudes and beliefs. METHOD: Adolescents with OW and BED (BED; n = 40) were compared to a socio-demographically matched group with OW only and a normal-weight control group (NW; each n = 25). They filled out the Perception of Teasing Scale, with parents as the source of teasing, the Weight Bias Internalization Scale and the Eating Disorder Examination-Questionnaire. Their mothers filled out the Attitudes Toward and Beliefs about Obese Persons Scales. RESULTS: Significantly higher perceived parental weight teasing and weight bias internalization were found in BED compared to OW and NW. Maternal stigmatizing attitudes and beliefs did not differ significantly between groups and were not correlated with adolescents' perceptions of being stigmatized. Perceived parental weight teasing was associated with adolescents' eating disorder psychopathology, however, this association was fully mediated by weight bias internalization. DISCUSSION: Results indicate that adolescents with OW and BED perceive weight teasing in families. As we found no significant association between adolescents' perceptions of being stigmatized and maternal stigmatizing attitudes, future research should examine parent-child interaction or implicit measures of stigmatizing attitudes.

Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients.

OBJECTIVE: Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. METHOD: Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. RESULTS: The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. DISCUSSION: Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

[Evaluation of the One-Year Multimodal Weight Loss Program DOC WEIGHT® 1.0 for Obesity Class II and III]. / Evaluation des einjährigen multimodalen Therapieprogramms DOC WEIGHT® 1.0 zur Gewichtsreduktion bei Patienten mit Adipositas Grad II und III.

According to treatment guidelines, treatment for obesity (body mass index [BMI]≥30.0 kg/m(2)) comprises nutritional, physical, and behavioral interventions. However, evidence-based programs for the treatment of severe obesity are rare. In an uncontrolled study, a total of 190 participants (BMI≥35.0 kg/m(2)) of the one-year multimodal treatment program DOC WEIGHT(®) 1.0 were assessed at pre- (t0) and post-intervention (t1) as well as at 1-year follow-up (t2). Results revealed significant improvements from t0 to t1 in body weight, waist circumference, eating disorder psychopathology, and quality of life that persisted to t2. Long-term multimodal outpatient treatment for severe obesity focusing on behavior modification is promising, however, high rates of loss to follow-up limit explanatory power. To improve evidence, consecutive evaluation is intended.

Cognitive-Behavioral Therapy for Postbariatric Surgery Patients With Mental Disorders: A Pilot Study.

BACKGROUND: Binge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, however, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far. OBJECTIVE: This study examined feasibility of a short-term CBT based on evidence-based manuals for BED and MDD that were adapted to patients following bariatric surgery, and investigated its effectiveness in improving weight loss outcome, psychopathology, and psychosocial functioning. MATERIALS AND METHODS: In an uncontrolled proof-of-concept study, the CBT manual was piloted in N = 7 patients who had undergone roux-en-Y gastric bypass surgery at least 6 months before. Weight loss, eating disorder psychopathology, depressive symptoms, and self-esteem were assessed using clinical interviews and self-report questionnaires at pre-treatment, post-treatment, and in a 3-month follow-up. RESULTS: A significant reduction of body weight was found as well as medium to large effects in the improvement of eating disorder psychopathology, depressive symptoms, and self-esteem from pre-treatment to post-treatment were found. Most of those changes remained stable during the 3-month follow-up period. Study retention was 71.4%. CONCLUSIONS: Feasibility and effectiveness of CBT were documented for patients with BED or MDD following bariatric surgery. Adaptations of the study procedure for proof-of-efficacy in randomized-controlled studies are discussed.

The Effects of Obesity-Related Health Messages on Explicit and Implicit Weight Bias.

The pervasiveness of explicit and implicit weight bias (WB) defined as negative stereotypes and prejudice regarding one's weight has been observed among individuals of all weight categories. As a source of WB, health messages have been discussed due to reinforcing stigmatizing notions. The present study sought to investigate whether health messages (i.e., eat healthy, become physically active) have the potential to increase explicit and implicit WB. Participants (N = 144) from the community were randomized to either an experimental group (EG) or a control group (CG). While the EG was presented with health messages, the CG was presented with neutral information. Before and after manipulation, participants completed measures of explicit and implicit WB. Paired samples t-test revealed no differences in explicit WB after manipulation, however, a small effect decrease of implicit WB in the EG but not in the CG was found. This study provided evidence that health messages might have differential impact to change WB. According to dual-model approaches, explicit and implicit WB tap into two different information processing systems, and thus were differentially affected by health messages. Brief exposure to health messages might have the potential to contribute to health behavior and to mitigate implicit WB.

Nonnormative eating behavior and psychopathology in prebariatric patients with binge-eating disorder and night eating syndrome.

BACKGROUND: Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study sought to investigate the prevalence of BED and NES and associations with various forms of nonnormative eating behavior and psychopathology in prebariatric patients. Within a consecutive multicenter registry study, patients in 6 bariatric surgery centers in Germany were recruited. METHODS: Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures. RESULTS: Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Co-morbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge-eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED. CONCLUSION: BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with nonnormative eating behavior and psychopathology point to their clinical significance and discriminant validity.

Implicit cognitive processes in binge-eating disorder and obesity.

OBJECTIVES: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. METHODS: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. RESULTS: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. CONCLUSIONS: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments.

Psychosocial status and mental health in adolescents before and after bariatric surgery: a systematic literature review.

OBJECTIVE: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. METHODS: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. RESULTS: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. CONCLUSIONS: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Daniel has fallen into a muddy puddle--schadenfreude or sympathy?

The present study investigated the experience of schadenfreude among children. Participants were 4- to 8-year-old children (n = 100) who were told stories of another child experiencing a misfortune while pursuing a morally positive versus morally negative goal. Schadenfreude, sympathy, and helping behaviour towards the suffering child were assessed. Results showed that beginning at the age of 4, emotional and behavioural reactions towards a misfortune of another child were predicted by the moral valence of the other child's goal. Furthermore, morally negative goals decreased helping behaviour and morally positive goals increased helping behaviour. Multilevel mediation analysis revealed that the relation between goal valence and helping behaviour was mediated by both schadenfreude and sympathy. However, those effects were especially pronounced in older children.