Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives

ObjectiveA significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals. MethodThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies. ResultsA total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking. DiscussionPatients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions

Binge eating disorder

Binge eating disorder (BED) is characterized by regular binge-eating episodes during which affected individuals ingest comparably large amounts of food and experience loss of control over their eating behavior. The current worldwide prevalence of BED is estimated to be at least 1.3%. BED is commonly associated with obesity and with somatic and mental health comorbidities. People suffering from BED experience considerable burden and impairments in quality of life, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in the domains of reward processing, inhibitory control and emotion regulation in people affected by BED, and these neurobiological domains are currently targets for emerging treatment approaches. Psychotherapy is currently the first-line treatment for people with BED. Recognition and research on BED has increased since its inclusion into DSM-5, however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification, and implementation of evidence-based interventions in routine clinical practice settings like primary care and mental health outpatient clinics

Compete or rest? Willingness to compete hurt among adolescent elite athletes

Objective Training and competing despite underlying health problems is a common social practice in sport. Adolescent elite athletes are particularly vulnerable to possible health consequences of this risky behavior due to their very sensitive developmental stage. Conceptualizing this phenomenon of playing hurt as sickness presenteeism, and taking the concept of absence/presence legitimacy into account, this paper analyzes the propensity of adolescent elite athletes to compete in the face of health problems. The central aim is to empirically identify characteristics of elite sport subcultures which affect athletes’ willingness to compete hurt (WCH). Materials & methods Based on a comprehensive sample of 1138 German elite adolescent athletes from all Olympic sports (14–18 years), the paper applies classification tree analysis to analyze the social and individual determinants of the WCH. Results Determinants on three hierarchical levels were identified, including type of sport, perceptions of social pressure, coach's leadership style and athletes' age. The group with the highest WCH were athletes from technical sports who have a coach with an autocratic leadership style. Second was athletes from ball games, and those in aesthetic and weight-dependent sports, aged between 17 and 18 years old. The lowest mean WCH-score, by some distance, occurred amongst the group of endurance and power sports athletes who experienced no direct social pressure to play hurt. Conclusions The findings enhance our understanding of absence/presence legitimacy in highly competitive social contexts and contribute to the development of more effective target-group-specific health prevention programs for young athletes

Virtual Reality Exposure to a Healthy Weight Body Is a Promising Adjunct Treatment for Anorexia Nervosa

Introduction/objective: Treatment results of anorexia nervosa (AN) are modest, with fear of weight gain being a strong predictor of treatment outcome and relapse. Here, we present a virtual reality (VR) setup for exposure to healthy weight and evaluate its potential as an adjunct treatment for AN. Methods: In two studies, we investigate VR experience and clinical effects of VR exposure to higher weight in 20 women with high weight concern or shape concern and in 20 women with AN. Results: In study 1, 90% of participants (18/20) reported symptoms of high arousal but verbalized low to medium levels of fear. Study 2 demonstrated that VR exposure to healthy weight induced high arousal in patients with AN and yielded a trend that four sessions of exposure improved fear of weight gain. Explorative analyses revealed three clusters of individual reactions to exposure, which need further exploration. Conclusions: VR exposure is a well-accepted and powerful tool for evoking fear of weight gain in patients with AN. We observed a statistical trend that repeated virtual exposure to healthy weight improved fear of weight gain with large effect sizes. Further studies are needed to determine the mechanisms and differential effects

Video clips for YouTube: Collaborative video creation as an educational concept for knowledge acquisition and attitude change related to obesity stigmatization

Mobile phones and advanced web-based video tools have pushed forward new paradigms for using video in education: Today, students can readily create and broadcast their own digital videos for others and create entirely new patterns of video-based information structures for modern online-communities and multimedia environments. This paradigm shift in video usage can be used for advanced learning about complex topics in higher education, for example, learning about socio-scientific or medical topics. Yet-technology aside-applicable educational concepts using collaborative video creation as a method need to be developed. In the present study, we investigate a specific concept designed to fight obesity stigmatization by developing knowledge using a learning-through-design-approach. We expected that creating videos can actually contribute to a deeper understanding of obesity and to a reduction in stigmatizing attitudes-when compared to a control condition. Dependent measures were based on the students' video products, obesity-related knowledge and attitudes. The course group assessed their own knowledge on causes of obesity and stigmatization because of obesity higher in the post-test than a control group who read a newspaper article on the topic. A corresponding significant reduction in stigmatizing attitudes was found. In sum, results indicate significant differences between students who produced YouTube videos and a control group of students. The results are interpreted as a confirmation of our initial assumptions and evidence indicating that the program is successfully applicable in higher education

Screening instruments for eating disorders in pregnancy: Current evidence, challenges, and future directions

Pregnancy is a vulnerable period for eating disorder (ED) occurrence and maternal EDs are associated with heightened risk of adverse pregnancy and infant outcomes. This highlights the need to identify pregnant women with past or current EDs in order to offer appropriate support. However, there is a knowledge and practice gap on screening pregnant women for EDs. Clinical guidance is lacking in international treatment guidelines, which is unsurprising given that no validated ED screening tool specifically designed for use in antenatal populations exists. Moreover, data on the effectiveness of general population screening tools for identifying EDs in pregnant women are scarce. This article provides a synthesis of current evidence, treatment guidelines, and data on the diagnostic accuracy for screening for EDs in antenatal samples from three studies with different screening approaches. We outline recommendations for future steps to tackle the knowledge and practice gap on screening for EDs in pregnant women, including next steps for the development of a pregnancy-specific ED screener and the use of general mental health screeners to detect EDs during pregnancy. Up-to-date, the jury is still out as how to best identify current or past EDs in pregnancy. More research is needed to assess the efficacy of using general mental health screeners versus ED-specific screening instruments to detect ED in pregnancy. Additionally, clinicians have to be trained on how to assess and manage EDs during pregnancy. Public Significance: Identifying pregnant women with eating disorders (EDs) is a public health concern which can be addressed using multiple approaches, including implementation of general and specific assessments within routine antenatal care, and training of healthcare professionals

Stress and depressive and anxiety symptoms in the general population and in SARS-CoV-2-infected patients : findings from a population-based three-wave study

Objective: Understanding factors that impaired mental health during the COVID-19 pandemic is extremely relevant in order to mitigate long-term consequences of the pandemic and to promote resilience in future crises. Method: Data were collected in southern Germany in a population-based survey study (CoKoS) with three times of measurement in May 2020, November 2020 and July 2021. Predictors of depressive and anxiety symptoms were measured with a short version of the Patient Health Questionnaire (PHQ-4) in the general population (N = 758) and individuals who were infected with SARS-CoV-2 in the beginning of the pandemic (N = 412). We investigated differences between both samples and how stress components (worry, tension, demands and joy) measured with the Perceived Stress Questionnaire (PSQ) varied with depressive and anxiety symptoms over time. Three linear mixed models (GLMMs) were fitted to predict the PHQ-4 stepwise, including sociodemographic variables and stress (PSQ). Results: Depressive and anxiety symptoms increased from May 2020 to November 2020 and remained stable until July 2021. There were no differences between people with SARS-CoV-2 infection and the general population. Those with a pre-existing disease and lower education reported higher levels of depressive and anxiety symptoms. Stress explained a substantial fraction of variance in depressive and anxiety symptoms. The stress component worry emerged as the strongest predictor of depressive and anxiety symptoms, whereas joy seemed to buffer these symptoms. Conclusions: The results suggest that mitigating people’s worry and increasing joy may promote resilience in future crises. Future studies should assess mental health interventions targeted at vulnerable groups, such as those with lower socioeconomic status and poorer health

Depictive and Metric Body Size Estimation in Anorexia Nervosa and Bulimia Nervosa: A Systematic Review and Meta-Analysis.

A distorted representation of one's own body is a diagnostic criterion and core psychopathology of both anorexia nervosa (AN) and bulimia nervosa (BN). Despite recent technical advances in research, it is still unknown whether this body image disturbance is characterized by body dissatisfaction and a low ideal weight and/or includes a distorted perception or processing of body size. In this article, we provide an update and meta-analysis of 42 articles summarizing measures and results for body size estimation (BSE) from 926 individuals with AN, 536 individuals with BN and 1920 controls. We replicate findings that individuals with AN and BN overestimate their body size as compared to controls (ES= 0.63). Our meta-regression shows that metric methods (BSE by direct or indirect spatial measures) yield larger effect sizes than depictive methods (BSE by evaluating distorted pictures), and that effect sizes are larger for patients with BN than for patients with AN. To interpret these results, we suggest a revised theoretical framework for BSE that accounts for differences between depictive and metric BSE methods regarding the underlying body representations (conceptual vs. perceptual, implicit vs. explicit). We also discuss clinical implications and argue for the importance of multimethod approaches to investigate body image disturbance