Towards effective treatment of eating disorders: nothing is as practical as a good theory

There is much room for improvement in the treatment of eating disorders, anorexia nervosa in particular. It is argued that for more effective treatment a radical change in thinking and doing is needed. First, the wide-spread multicausal model of eating disorders must be abandoned and replaced by (a) fundamental strategic research into the most parsimonious explanation of eating disorders and (b) interventions solely directed on the specific maintaining mechanisms. Second, evidence-based working is needed in mental health care. In daily practice, two of three psychotherapists do not treat their eating disordered patients with the best treatment available, i.e. cognitive behaviour therapy. The Dutch Ministry of Health, Welfare and Sport tried to improve the care for eating disorder patients by the nomination of several specialist hospital units. These units are, however, not selected for their treatment quality or the use of evidence-based treatment protocols. It is argued that this ministerial operation will not increase the supply of effective treatment. The Minister obviously should have done two other things to improve the amount and quality of treatment supply for eating disorders: First., she better could invest in a broad array of workshops, training and supervision programs in cognitive behaviour therapy for all psychotherapists working with eating disorders. Second, since nothing is so practical as a good theory, the facilitation of research into parsimonious models of the relevant mechanisms as well as the experimental tests of interventions on these mechanisms would have been a promising move to effective treatment

Cue reactivity and regulation of food intake.

A robust finding in eating research is the so-called counterregulation in restrained eaters. This means that while normal subjects eat less during a taste test, after they consumed a preload, restrained eaters consume more. An explanation is that food exposure causes stronger physiological preparatory reactivity in the restrained eaters. This reactivity is experienced as craving and leads to an increased food intake. To test this theory, 46 high and low restrained eaters were exposed to food or soap, while physiological measurements were made. Afterwards, the subjects performed a taste test, during which food intake was secretly measured. Unrestrained eaters showed an increase in heart rate, gastric activity, and saliva during food exposure; however, restrained eaters did not. Gastric activity significantly correlated with food intake. Group or exposure type did not influence food intake. It can be concluded that unrestrained eaters prepared for food intake, whereas the restrained eaters did not. A possible explanation is that restrained eaters used cognitive suppression to block physiologica

Impulsivity predicts treatment outcome in obese children

Treatment for obesity is still running short, particularly on the long term. However, some people do take advantage of treatments and are able to retain their weight loss. What makes the difference between those who can keep their weight loss and those who cannot? One possible predictor of relapse in obesity treatment is impulsivity. Overall, obese people are found to be more impulsive than lean people, especially obese binge eaters. Intuitively, it would make sense that the most impulsive people are less able to keep control over eating behaviour. Therefore, impulsivity could serve as an obstacle for treatment. In the present study impulsivity was measured with a behavioural task (the stop signal task) in 26 obese children. Overweight of the children was measured before and after treatment and at 6 and 12 months follow ups. The results show that impulsivity was related to overweight at all moments: The most impulsive children were the most overweight ones; even after 12 months. Moreover, impulsivity predicted therapy success: the most impulsive children lost less weight. Impulsivity appears to contribute to the difference between succeeding or failing in attempts to lose weight

One-year follow-up effects of two obesity treatments on psychological well-being and weight.

Objectives. The effectiveness of a cognitive and a behavioural treatment for obese binge eaters and obese non-binge eaters was evaluated at I-year follow-up. Furthermore, we examined the role of weight changes on psychological well-being at I-year follow-up. Design and method. Participants were reassessed 6 months and I year after they had finished a group cognitive treatment or a group behavioural treatment. The outcome measures were; psychological well-being (concerns about shape, weight and eating, self-esteem and depression), binge eating, and weight. Results and conclusions. Analyses on the completers' sample revealed that both treatments had a markedly positive and lasting impact on shape concern, weight concern and eating concern, binge eating, self-esteem, and depression at 1-year followup. Cognitive treatment was not superior to behavioural treatment on most outcome measures. This might be due to selective drop-out, Analyses including non-responders showed that the cognitive treatment was superior on shape, weight and eating concern, and binge eating. The I-year follow-up results for weight-loss were disappointing. Between pre-treatment and 1-year follow-up participants in the behaviour treatment lost 3.0 kg, while participants in the cognitive treatment lost 0.3 kg. However, participants who gained weight were as successful on changes in psychological well-being changes as participants who lost weight

Selective visual attention for ugly and beautiful body parts in eating disorders

Body image disturbance is characteristic of eating disorders, and current treatments use body exposure to reduce bad body feelings. There is however little known about the cognitive effects of body exposure. In the present study, eye movement registration (electroculography) as a direct index of selective visual attention was used while eating symptomatic and normal control participants were exposed to digitalized pictures of their own body and control bodies. The data showed a decreased focus on their own 'beautiful' body parts in the high symptomatic participants, whereas inspection of their own 'ugly' body parts was given priority. In the normal control group a self-serving cognitive bias was found: they focused more on their own 'beautiful' body parts and less on their own 'ugly' body parts. When viewing other bodies the pattern was reversed: high symptom participants allocated their attention to the beautiful parts of other bodies, whereas normal controls concentrated on the ugly parts of the other bodies. From the present findings the hypothesis follows that a change in the processing of information might be needed for body exposure to be successful

Impulsivity in obese women

In our obesogenic environment, self-control might be necessary in order to prevent overeating. Impulsivity is supposed to make it more difficult to resist the temptation to eat too much and can thereby contribute to overweight. In the present study, the hypotheses is tested that obese individuals are more impulsive. Thirty-one obese and 28 lean women, sampled from the normal population, are tested on a behavioural measure and three self-report measures of impulsivity. The obese women appeared more impulsive on the last part of the behavioural task, but not on the self-report measures. Implications of the results are discussed

Food liking, food wanting, and sensory-specific satiety

Sensory-specific satiety refers to a temporary decline in pleasure derived from consuming a certain food in comparison to other unconsumed foods. It has been argued that such a reduction may not be limited to food liking but extends to food wanting as well. Animal research suggests that sensory-specific satiety reflects a reduction in both food liking and food wanting and in the present study it was investigated whether this also holds true for humans. Participants had to consume a certain amount of chocolate milk and afterwards approximately half of the participants played a game to obtain more chocolate milk, whereas the other half played a game to obtain crisps. Participants showed a decline in subjective liking of taste and smell of the chocolate milk in comparison to crisps. Furthermore, they showed less motivation (i.e. wanting) to obtain more chocolate milk. It is concluded that sensory-specific satiety in humans reflects a decrease in both food liking and food wanting