De patiënt met een eetprobleem

Voedings- en eetstoornissen komen zowel bij kinderen als bij volwassenen voor. De pica en de ruminatiestoornis komen vooral bij jonge kinderen voor, de andere voedings- en eetstoornissen (anorexia nervosa (AN), boulimia nervosa (BN), binge eating disorder (BED) en de restrictieve voedselinnamestoornis (ARFID)) komen vooral bij adolescenten en volwassenen voor. AN en BN hebben bij respectievelijk 10 % en 5 % van de mensen die eraan lijden, een dodelijke afloop. Eetstoornissen gaan op den duur altijd gepaard met lichamelijke klachten. De huisarts kan twee eenvoudige vragenlijsten (ESP en SCOFF) en de signalenkaart uit de Zorgstandaard Eetstoornissen gebruiken om het vermoeden op een eetstoornis te staven. Zeker bij AN is een verwijzing naar de specialistische GGZ geïndiceerd, waarbij tijdens een eventuele wachttijd de lichamelijke conditie van de patiënt zorgvuldig gemonitord dient te worden. Kinderen en adolescenten met AN dienen tevens naar een kinderarts verwezen te worden als de huisarts AN vermoedt

Reward and punishment related attentional bias in overweight and obesity: The TRAILS study

Overgewicht en obesitas vormen een groeiend probleem voor onze samenleving en gaan samen met een verhoogd risico op medische en psychische aandoeningen. Het is dan ook van groot belang meer zicht te krijgen op de factoren die bijdragen aan het ontstaan/voortbestaan van overgewicht. Mogelijk speelt een verhoogde gevoeligheid voor beloning hierbij een belangrijke rol. In deze studie onderzoeken we voor de eerste keer zowel cross-sectioneel als longitudinaal de relatie tussen overgewicht en beloningsgevoeligheid gemeten met een gedragstaak (i.p.v. vragenlijst). Deelnemers (N = 619) waren een subgroep van de prospectieve cohort studie TRAILS (www.trails.nl). De huidige data maakte deel uit van de derde (T3; Mleeftijd=15.9, SD=0.61) en vierde meting (T4; Mage=18.7, SD=0.56). Adjusted-BMI werd gemeten tijdens beide meetmomenten. Algemene beloningsgevoeligheid werd gemeten tijdens T3 met een gevalideerde cueing task (Derryberry & Reed, 2002). Deze computer taak meet hoe snel mensen hun aandacht richten op, en hoeveel moeite ze hebben om hun aandacht weg te richten van, cues die beloning aanduiden. Zulke cues zullen meer saillant zijn voor personen die gevoelig zijn voor beloning. Resultaten laten zien dat aandacht voor beloning niet samenhangt met BMI op T3, noch met BMI op T4, of de verandering in BMI van T3 naar T4. Gezien de hoge power van de huidige studie kan dit met grote zekerheid geconcludeerd worden. Mogelijk hangen individuele verschillen in gevoeligheid voor beloning wel samenhang met overeten, maar wordt dit niet weerspiegeld in BMI als gevolg van andere factoren die onafhankelijk zijn van gevoeligheid voor beloning. De volgende stap zal zijn om de samenhang tussen gevoeligheid voor beloning en het hebben van binge-eating episodes te onderzoeken

Reward Related Attentional Biases in Overweight, Obesity, and Binge Eating: The TRAILS Study

Individual differences in sensitivity to reward have been linked to several externalizing behavioral problems, and knowledge about the role of this trait in overeating might provide implications to improve the currently available treatment options. Thus far, brain imaging and self-report studies have provided inconclusive evidence about the potential role of reward sensitivity in overeating. However, often these studies use BMI as outcome measure to indicate the degree of overeating. The present study tests the hypothesis that general reward sensitivity is related to overeating (i.e., binge eating episodes) while this may not be reflected in BMI due to other influencing factors that operate independently of reward sensitivity. Participants (N=715) in the current study are a focus cohort of a large prospective population study of Dutch adolescents (www.trails.nl). Data collection was part of the third (T3; Mage=15.9, SD=0.61) and fourth (T4; Mage=18.7, SD=0.56) data wave. During the third wave participants performed a validated spatial cueing task (Derryberry & Reed, 2002) which indexes automatic and voluntary, attentional engagement and disengagement to reward related cues. Cues that signal reward will be more salient for individuals who are sensitive to reward, and this task thus provides a good behavioral measure of reward sensitivity. Additionally, BMI was measured on both T3 and T4 from which adjusted BMI’s were calculated, and a dichotomous score of whether participants had binge eating episodes was available from T4. Results show that attentional biases to cues that signal reward were indeed not related to BMI at baseline, BMI three years later, or the change in BMI over three years. The power of the current study allows us to conclude this with high certainty. Results with regard to the relationship between reward related attentional bias and binge eating episodes have not yet been analyzed but will be discussed during the conference

Attentional Bias for Reward and Punishment in Overweight and Obesity: The TRAILS Study.

More than 80% of obese adolescents will become obese adults, and it is therefore important to enhance insight into characteristics that underlie the development and maintenance of overweight and obesity at a young age. The current study is the first to focus on attentional biases towards rewarding and punishing cues as potentially important factors. Participants were young adolescents (N = 607) who were followed from the age of 13 until the age of 19, and completed a motivational game indexing the attentional bias to general cues of reward and punishment. Additionally, self-reported reward and punishment sensitivity was measured. This study showed that attentional biases to cues that signal reward or punishment and self-reported reward and punishment sensitivity were not related to body mass index or the change in body mass index over six years in adolescents. Thus, attentional bias to cues of reward and cues of punishment, and self-reported reward and punishment sensitivity, do not seem to be crucial factors in the development and maintenance of overweight and obesity in adolescents. Exploratory analyses of the current study suggest that the amount of effort to gain reward and to avoid punishment may play a role in the development and maintenance of overweight and obesity. However, since the effort measure was a construct based on face validity and has not been properly validated, more studies are necessary before firm conclusions can be drawn

Attentional Bias for Reward and Punishment in Overweight and Obesity: The TRAILS Study.

More than 80% of obese adolescents will become obese adults, and it is therefore important to enhance insight into characteristics that underlie the development and maintenance of overweight and obesity at a young age. The current study is the first to focus on attentional biases towards rewarding and punishing cues as potentially important factors. Participants were young adolescents (N = 607) who were followed from the age of 13 until the age of 19, and completed a motivational game indexing the attentional bias to general cues of reward and punishment. Additionally, self-reported reward and punishment sensitivity was measured. This study showed that attentional biases to cues that signal reward or punishment and self-reported reward and punishment sensitivity were not related to body mass index or the change in body mass index over six years in adolescents. Thus, attentional bias to cues of reward and cues of punishment, and self-reported reward and punishment sensitivity, do not seem to be crucial factors in the development and maintenance of overweight and obesity in adolescents. Exploratory analyses of the current study suggest that the amount of effort to gain reward and to avoid punishment may play a role in the development and maintenance of overweight and obesity. However, since the effort measure was a construct based on face validity and has not been properly validated, more studies are necessary before firm conclusions can be drawn

Mean reaction times on positive and negative games, and effort scores of the Spatial Orientation Task, and separately for the first and the second half of the task.

<p>Mean reaction times on positive and negative games, and effort scores of the Spatial Orientation Task, and separately for the first and the second half of the task.</p