¿Los sujetos con obesidad subestiman su tamaño corporal? Una revisión narrativa de los métodos de estimación y teorías explicativas

The widespread of overweight and obesity in the developed countries is a real societal issue, nevertheless a considerable amount of subjects with obesity do not recognize their condition. Researchers used different methods to assess body size perception by obese subjects and the results show that while some subjects with obesity estimate accurately or overestimate their body size, others underestimate their weight and their body size measures. A failure to identify overweight or obesity has serious consequences on the subject's health, as it is widely recognised that self-awareness is the first step to engage in a rehabilitation program. The spread of obesity underestimation and its implications make the case for a new hypothetical body image disorder, which has been called Fatorexia (TM). It consists in the significant underestimation of body size by subjects with obesity, as they are unable or unwilling to acknowledge their condition. Some researchers proposed a social explanation to the underestimation phenomenon, but here an alternative hypothesis, the Allocentric Lock Theory (ALT), is outlined to describe the mechanisms behind the underestimation of body size by subjects with obesity

¿Los sujetos con obesidad subestiman su tamaño corporal? Una revisión narrativa de los métodos de estimación y teorías explicativas

The widespread of overweight and obesity in the developed countries is a real societal issue, nevertheless a considerable amount of subjects with obesity do not recognize their condition. Researchers used different methods to assess body size perception by obese subjects and the results show that while some subjects with obesity estimate accurately or overestimate their body size, others underestimate their weight and their body size measures. A failure to identify overweight or obesity has serious consequences on the subject's health, as it is widely recognised that self-awareness is the first step to engage in a rehabilitation program. The spread of obesity underestimation and its implications make the case for a new hypothetical body image disorder, which has been called Fatorexia (TM). It consists in the significant underestimation of body size by subjects with obesity, as they are unable or unwilling to acknowledge their condition. Some researchers proposed a social explanation to the underestimation phenomenon, but here an alternative hypothesis, the Allocentric Lock Theory (ALT), is outlined to describe the mechanisms behind the underestimation of body size by subjects with obesity

Brief Strategic Therapy vs Cognitive Behavioral Therapy for the Inpatient and Telephone-Based Outpatient Treatment of Binge Eating Disorder: The STRATOB Randomized Controlled Clinical Trial

This paper describes the results of the STRATOB (Systemic and STRATegic psychotherapy for OBesity) study, a two-arm randomized controlled clinical trial (RCT) comparing Brief Strategic Therapy (BST, Nardone or Arezzo model) with the gold standard CBT (Cognitive Behavioral Therapy) for the inpatient and telephone-based outpatient treatment of obese people with Binge Eating Disorder (BED) seeking treatment for weight reduction. Primary outcome measure of the randomized trial was change in the Global Index of the Outcome Questionnaire (OQ 45.2). Secondary outcome measures were BED remission (weekly binge episodes < 2) and weight loss. Data were collected at baseline, at discharge from the hospital (c.a. 1 month after) and after 6 months from discharge.. No significant difference between groups (BST vs CBT) was found in the primary outcome at discharge. However, a greater improvement was seen in the BST vs the CBT group (P<.01) in the primary outcome at 6 months. About secondary outcomes, no significant difference between groups were found in weight change both at discharge and at 6 months. Notably, a significant association emerged between treatment groups and BED remission at 6 months in favor of BST (only 20% of patients in BST group reported a number of weekly binge episodes > 2 vs 63.3% in CBT group)

Internet-Based Behavioral Interventions for Obesity: An Updated Systematic Review

The objective of this systematic review is to update a previous systematic review on the effectiveness of internet-based interventions for weight loss and weight loss maintenance in overweight and obese people with new or additional studies. A literature search from 2008 to March 2010 was conducted. Studies were eligible for inclusion if: participants were adults with a body mass index ≤ 25, at least one study arm involved an internet-based intervention and the primary aims were weight loss or maintenance. Eight additional studies over the eighteen included in the previous review met the inclusion criteria. Data were extracted on sample characteristics, attrition, weight loss, duration of treatment and maintenance of weight loss. Effect sizes (Hedges g) and relative 95% confidence intervals were calculated for all two-way comparisons within each study. No attempt was made to pool the data in a meta-analysis because of the great heterogeneity of designs among studies. An examination of effect sizes show that the higher significant effects pertain studies that found a superiority of behavioral internet-based programs enhanced by features such as tailored feedback on self-monitoring of weight, eating and activity over education only internet-based interventions. However, control groups are very different among studies and this heterogeneity probably accounts for much of the variance in effect sizes. Hence, questions still remain as to the effectiveness of web-based interventions in achieving weight loss or maintenance. Implications for further research include using a “real” control group in order to make meta-analysis possible and developing multi-factorial design in order to separate components of interventions and identify which of them or patterns of them are keys to success

Does resilience mediate the association between mental health symptoms and linguistic markers of trauma processing? Analyzing the narratives of women survivors of intimate partner violence

Intimate partner violence (IPV) is a serious issue for women from all cultures and backgrounds. Studies on the negative consequences of violence suggest that women with a history of abuse are more likely to display depressive and PTSD symptoms. However, recent research has focused on the mechanisms underpinning resilience and the processing of traumatic memories, including linguistic markers and how they may reflect the mental health of traumatized individuals. In this study, we analyzed trauma narratives to investigate whether resilience mediates the impact of PTSD and depression symptoms on five trauma-processing mechanisms (cognitive processing, emotional processing, perceived threat to life, self-perspective, and integration of traumatic memories). Forty-three abused women (mean age = 38.74 years; SD = 9.41) wrote about their traumatic experiences and completed instruments assessing their levels of PTSD, depression, and resilience. We used LIWC software to analyze the women's narratives in terms of linguistic markers of psychological processing. Mediation analysis indicated that resilience fully mediated the impact of mental health symptoms on emotional processing, perceived threat to life, and integration of traumatic memories and partially mediated cognitive processing and self-perspective. We discuss the clinical implications of these findings, emphasizing the need to focus on the resources and strengths of women survivors of abuse in designing targeted psychological interventions

Psychological Well-Being in Obese Inpatients with Ischemic Heart Disease at Entry and at Discharge from a Four-Week Cardiac Rehabilitation Program

The purposes of this observational pre-post study were twofold: 1- to evaluate psychological health in obese patients with ischemic heart disease at admission to cardiac rehabilitation (CR) and 2 – to examine the effectiveness of a 4-week CR residential program in improving obese patients’ psychological well-being at discharge from CR. A sample of 177 obese patients completed the Psychological General Well-Being Inventory (PGWBI) at admission to the CR program and at discharge. The equivalence testing method with normative comparisons was used to determine the clinical significance of improvements after having established that baseline mean scores on the PGWBI scales were significantly lower than normal means. Results show that patients scored equally or better than norms on many PGWBI dimensions at admission to CR but scored significantly worse on Global Score, Vitality and Self-control. At discharge, mean scores that were impaired at baseline returned to normal levels at the more conservative equivalence interval. A 4-week CR program was thus effective in improving obese patients’ psychological well-being. The equivalence testing method allowed to establish the clinical significance of such improvement

TECNOB Study: Ad Interim Results of a Randomized Controlled Trial of a Multidisciplinary Telecare Intervention for Obese Patients with Type-2 Diabetes

Background: Obesity increases the risk of many health complications such as hypertension, coronary heart disease and type 2 diabetes, needs long-lasting treatment for effective results and involves high public and private care-costs. Therefore, it is imperative that enduring and low-cost clinical programs for obesity and related co-morbidities are developed and evaluated. Information and communication technologies (ICT) can help clinicians to deliver treatment in a costeffective and time-saving manner to a large number of obese individuals with co-morbidities. Objective: To examine ad interim effectiveness of a 12-month multidisciplinary telecare intervention for weight loss provided to obese patients with type 2 diabetes. Design, Setting, and Participants: A single-center randomized controlled trial (TECNOB study) started in December 2008. At present, 72 obese patients with type 2 diabetes have been recruited and randomly allocated to the TECNOB program (n=37) or to a control condition (n=39). However, only 34 participants have completed at least the 3-month followup and have been included in this ad interim analysis. 21 out of them have reached also the 6-month follow-up and 13 have achieved the end of the program. Study is still on-going. Intervention: All participants attended 1-month inpatient intensive program that involved individualized medical care, diet therapy, physical training and brief psychological counseling. At discharge, participants allocated to the TECNOB program were instructed to use a weight-loss web-site, a web-based videoconference tool, a dietary software installed into their cellular phones and an electronic armband measuring daily steps and energy expenditure. Main Outcome Measures: Weight and disordered eating-related behaviors and cognitions (EDI-2) at entry to hospital, at discharge from hospital, at 3,6 and 12 months. Results: Ad interim analysis of data from 34 participants showed no statistically significant difference between groups in weight change at any time-point. However, within-group analysis revealed significant reductions of initial weight at discharge from hospital, at 3 months, at 6 months but not at 12 months. Control group had higher scores in Interpersonal distrust at 12 months. Conclusion: This ad interim findings revealed that the effect of the inpatient treatment was high and probably overwhelmed the effect of the TECNOB intervention. Much statistical power and long-term follow-up may enhance the probability to detect the TECNOB effect over and above the great one exerted by the inpatient program

Factor Structure, Validity, and Reliability of the STarT Back Screening Tool in Italian Obese and Non-obese Patients With Low Back Pain

Background: The STarT Back Screening Tool (SBST) is a self-report questionnaire developed for prognostic purposes which evaluates risk factors for disability outcomes in patients with chronic low back pain. Previous studies found that its use enables to provide a cost-effective stratified care. However, its dimensionality has been assessed only using exploratory approaches, and reports on its psychometric properties are conflicting.Objective: The objective of this study was to assess the factorial structure and the psychometric properties of the Italian version of the STarT Back Screening Tool (SBST).Materials and Methods: Patients with medical diagnosis of low back pain were enrolled from a rehabilitation unit of a tertiary care hospital specialized in obesity care (Sample 1) and from a clinical internship center of an osteopathic training institute (Sample 2). At baseline and after 7 days patients were asked to fill a battery of self-report questionnaires. The factorial structure, internal consistency, test-retest reliability, and construct validity of the SBST were assessed.Results: One hundred forty-six patients were enrolled (62 from Sample 1 and 84 from Sample 2). The confirmatory factor analysis showed that the fit of the original two-correlated factors model was adequate (CFI = 0.98, TLI = 0.99, RMSEA = 0.03). Cronbach's alpha of the total scale (alpha = 0.64) and of the subscales (physical subscale alpha = 0.55; psychological subscale alpha = 0.61) was below the cutoffs, partly because of the low correlation of item 2 with the other items. Test-retest reliability was adequate (ICC = 0.84). The SBST had moderate correlations with comparisons questionnaires, except for the Roland-Morris Disability Questionnaire, which had a high correlation (r = 0.65).Discussion: The SBST has adequate psychometric properties and can be used to assess prognostic factors for disability in low back pain patients