Pharmacological treatment of eating disorders

The treatment of eating disorders (ED) usually involves a multidisciplinary approach and pharmacotherapy is adjunctive to psychological and nutritional interventions. Psychotropic agents are prescribed for most patients with ED to treat both the comorbid conditions and ED core symptoms. Important progresses have occurred in the last years. We present an overview of the current evidences and future directions in the pharmacological treatment of anorexia nervosa, bulimia nervosa and binge eating disorder.O tratamento dos transtornos alimentares (TA) geralmente exige uma abordagem multidisciplinar em que a farmacoterapia é adjuvante de abordagens psicológicas e nutricionais. Psicotrópicos são indicados para a maioria dos pacientes com TA para tratar as comorbidades e também os sintomas chamados nucleares. Progressos importantes estão ocorrendo nos últimos anos. Este artigo apresenta uma revisão das evidências atuais e perspectivas futuras para o tratamento farmacológico da anorexia nervosa, bulimia nervosa e do transtorno da compulsão alimentar periódica.Universidade Federal do Rio de Janeiro Instituto de Psiquiatria Grupo de Obesidade e Transtornos AlimentaresInstituto Estadual de Diabetes e Endocrinologia do Rio de JaneiroUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Grazing prevalence and associations with eating and general psychopathology, body mass index, and quality of life in a middle-income country

Research from high-income countries has shown that grazing is a common but problematic eating pattern, particularly when associated with a sense of loss of control. However, it is unclear whether these patterns hold globally. Thus, the goal of this study was to extend previous research by examining the prevalence and clinical correlates of compulsive grazing (CG) and non-compulsive grazing (NCG) in a middle-income country. Participants (N = 2297) comprised adult residents from Rio de Janeiro, Brazil. Recruitment of this population-based household survey occurred from September 2019 to February 2020. The short inventory of grazing was used to operationalise grazing subtypes. Chi-square analyses, logistic regression, and univariate tests were conducted using the complex samples procedure. The point prevalence of regular CG was 10.2% (n = 239) and was consistent with high-income countries, while NCG was 29.8% (n = 679) and was less frequent than reported in high-income countries. Additionally, similar to high-income countries, CG was associated with a higher body mass index and higher odds of eating disorders, eating disorder symptomatology, depression, anxiety, and a lower physical and mental health-related quality of life, than no grazing and NCG. Overall, this study demonstrated that grazing patterns in high-income countries extend to middle-income countries

Grazing is associated with ADHD symptoms, substance use, and impulsivity in a representative sample of a large metropolitan area in Brazil

Grazing is a clinically relevant eating behaviour, especially when it presents with a sense of loss of control (compulsive grazing). There is evidence that other disordered eating patterns are associated with problematic substance use and impulsivity-related conditions, such as attention-deficit/hyperactivity disorder (ADHD). This overlap contributes to higher psychopathology and treatment complications. Less is known about grazing, and most information originates in high-income countries. Hence, we sought to investigate relationships between grazing, tobacco and alcohol use, ADHD, and impulsivity in a large representative sample from Brazil. Data were collected by trained interviewers from adults (N = 2297) through an in-person household survey based on a stratified and clustered probability sample. We found significant associations between compulsive grazing and problematic alcohol use (OR = 3.02, 95% CI: 1.65, 5.53), ADHD (OR = 8.94, 95% CI: 5.11, 15.63), and smoking (OR = 1.67, 95% CI: 1.12, 2.47), with impulsivity contributing to the first two relationships. The substantial association with ADHD suggests that other executive functions may promote disordered eating, possibly expressed through difficulties in adhering to regular meals. Clinically, these findings highlight the importance of assessing problematic eating patterns, such as compulsive grazing, in those presenting with difficulties with substance use or impulsivity, and vice versa

Physical and mental health outcomes of an integrated cognitive behavioural and weight management therapy for people with an eating disorder characterized by binge eating and a high body mass index : a randomized controlled trial

Background: Bulimia nervosa (BN) and binge eating disorder (BED) are eating disorders (EDs) characterized by recurrent binge eating. They are associated with medical complications, impaired adaptive function and often a high BMI, for which a multidisciplinary treatment approach may be needed. This study explored the efficacy of a novel intervention integrating Cognitive Behavioural Therapy- Enhanced (CBT-E) and weight management for people with recurrent binge eating episodes and high BMI with respect to physical, psychopathological and quality of life outcomes. Methods: Ninety-eight adults diagnosed with BN, BED, or Other Specified/Unspecified Feeding or Eating Disorder (OSFED/UFED) and BMI ≥ 27 to <40 kg/m2 were randomized to a multidisciplinary approach, the Healthy APproach to weIght management and Food in Eating Disorders (HAPIFED) or to CBT-E. Metabolic parameters, health-related quality of life, general psychological and ED symptoms and ED diagnostic status outcomes are reported. Data were analyzed with mixed effects models adopting multiple imputed datasets where data were missing. Results: Both HAPIFED and CBT-E showed statistical significance for the time effect, with reduction in stress (p < 0.001), improvement in mental health-related quality of life (p = 0.032), reduction in binge eating severity (p < 0.001), and also in global ED symptoms scores (p < 0.001), with the significant changes found at end of treatment and sustained at 12-month follow-up. However, no statistical significance was found for differences between the interventions in any of the outcomes measured. Despite a high BMI, most participants (> 75%) had blood test results for glucose, insulin, triglycerides and cholesterol within the normal range, and 52% were within the normal range for the physical component of quality of life at baseline with no change during the trial period. Conclusion: Integrating weight and ED management resulted in comparable outcomes to ED therapy alone. Although adding weight management to an ED intervention had no adverse effects on psychological outcomes, it also had no beneficial effect on metabolic outcomes. Therefore, more intense weight management strategies may be required where indicated to improve metabolic outcomes. Safety will need to be concurrently investigated. Trial registration: US National Institutes of Health clinical trial registration number NCT02464345, date of registration 08/06/2015. Changes to the present paper from the published protocol paper (Trials 18:578, 2015) and as reported in the Trial registration (clinicaltrials.gov) are reported in Supplementary File 1

Patients’ Comprehension of Mindfulness-Based Cognitive Behavioral Therapy in an Outpatient Clinic for Resistant Depression: A Cross-Sectional Study

The current study investigated the comprehension of mindfulness-based cognitive behavioral therapy (MBCT) by patients with resistant depression at the Psychiatry Institute of the Federal University of Rio de Janeiro, Brazil. This was the first time the model was used in the institution to treat these patients. In this study, 45 patients were invited to participate in a baseline session of MBCT that consisted in the explanation of the model and experimental exercises conducted by two experienced therapists. Twenty eight patients accepted to participate. At the end of the intervention, the patients completed a self-administered questionnaire designed by our ambulatory to assess their understanding of the method’s goals. Patients with anxiety disorder was also accessed for group comparison. More than 75% of the patients rated the intervention as comprehensible and workable. Compared to patients with depression, patients with anxiety had a better understanding of the mindfulness framework (6.5%) and the meaning of cognitive behavioral therapy (17.6%). Patients that completed the intervention described the baseline session of MBCT as comprehensive and acceptable. These results may allow possible future developments in the practice of mindfulness as a treatment applicable in many condition and settings even in the Brazilian context

Eating disorder symptoms in Brazilian university students:a systematic review and meta-analysis

Objective: To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED. Methods: The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO). Results: Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively). Conclusion: Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses

Grazing Prevalence and Associations with Eating and General Psychopathology, Body Mass Index, and Quality of Life in a Middle-Income Country

Research from high-income countries has shown that grazing is a common but problematic eating pattern, particularly when associated with a sense of loss of control. However, it is unclear whether these patterns hold globally. Thus, the goal of this study was to extend previous research by examining the prevalence and clinical correlates of compulsive grazing (CG) and non-compulsive grazing (NCG) in a middle-income country. Participants (N = 2297) comprised adult residents from Rio de Janeiro, Brazil. Recruitment of this population-based household survey occurred from September 2019 to February 2020. The short inventory of grazing was used to operationalise grazing subtypes. Chi-square analyses, logistic regression, and univariate tests were conducted using the complex samples procedure. The point prevalence of regular CG was 10.2% (n = 239) and was consistent with high-income countries, while NCG was 29.8% (n = 679) and was less frequent than reported in high-income countries. Additionally, similar to high-income countries, CG was associated with a higher body mass index and higher odds of eating disorders, eating disorder symptomatology, depression, anxiety, and a lower physical and mental health-related quality of life, than no grazing and NCG. Overall, this study demonstrated that grazing patterns in high-income countries extend to middle-income countries

Associations between weight/shape overvaluation, sociodemographic features and BMI : 10-year time trends

Purpose To investigate the prevalence of overvaluation across sociodemographic features and weight status over time. Methods The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n=3047), 2008 (n=3034), 2009 (n=3007), 2015 (n=3005) and 2016 (n=3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed. Results Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04–3.99; 2008/9: OR 1.74, CI 1.50–2.01; 2015/6: OR 1.54, CI 1.34–1.76), had a BMI>30 (2005: OR 3.93, CI 1.49–10.34; 2008/9: OR 2.22, CI 1.31–3.78; 2015/6: OR 2.09, CI 1.19–3.67), had left school (2015/6: OR 1.36, CI 1.14–1.63), and lived in the country (2015/6: OR 1.95, CI 1.69–2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p<0.001). Conclusions Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005–2016. Evidence based medicine Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies