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

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

Time to make a change:A call for more experimental research on key mechanisms in anorexia nervosa

Anorexia nervosa (AN) is a life‐threatening eating disorder, characterised by persistent pathological weight loss behaviours and an intense fear of weight gain and food consumption. Although there is an abundance of scientific theories on the neurobiological, psychological and sociocultural factors thought to be involved in the maintenance of AN, there is little experimental research testing these ideas. The need for theory firmly grounded in empirical evidence becomes strikingly clear when we consider that current treatments for patients with AN are limited in their effectiveness, and relapse after treatment is common

The role of face masks within in-patient psychotherapy: Results of a survey among inpatients and healthcare professionals

IntroductionFace-to-face medical and psychotherapeutic treatments during the Corona pandemic often involve patients and health care providers wearing face masks. We performed a pilot survey assessing the subjective experience of wearing face masks during psychotherapy sessions regarding (i) feasibility, (ii) psychotherapeutic treatment and (iii) communication, emotion and working alliance in patients and healthcare professionals.MethodsA total of n = 62 inpatients (RR = 95.4%) and n = 33 healthcare professionals (RR = 86.8%) at an academic department of Psychosomatic Medicine and Psychotherapy participated in this survey anonymously. The items of the questionnaire were created by the interprofessional expert team and were based on existing instruments: (i) the Therapeutic Relationship Questionnaire and (ii) the German translation of Yalom’s Questionnaire on Experiencing in Group Psychotherapy.ResultsThe majority of patients rate their psychotherapy as highly profitable despite the mask. In individual therapy, face masks seem to have a rather low impact on subjective experience of psychotherapy and the relationship to the psychotherapist. Most patients reported using alternative facial expressions and expressions. In the interactional group therapy, masks were rather hindering. On the healthcare professional side, there were more frequent negative associations of face masks in relation to (i) experiencing connectedness with colleagues, (ii) forming relationships, and (iii) therapeutic treatment.DiscussionInformation should be given to patients about the possible effects of face masks on the recognition of emotions, possible misinterpretations and compensation possibilities through alternative stimuli (e.g., eye area) and they should be encouraged to ask for further information. Especially in group therapy, with patients from other cultural backgrounds and in cases of need for help (e.g., hearing impairment) or complex disorders, appropriate non-verbal gestures and body language should be used to match the intended emotional expression

Association of Leptin Gene DNA Methylation With Diagnosis and Treatment Outcome of Anorexia Nervosa

Epigenetic alterations are increasingly implicated in the pathophysiology of anorexia nervosa (AN) but are as yet poorly understood. We investigated possible associations between the leptin gene (LEP) and the leptin receptor gene (LEPR) DNA promoter methylation and (1) a diagnosis of AN and (2) outcome after a 10 months psychotherapeutic outpatient treatment. 129 (LEPR: n = 135) patients with AN were investigated during the large scale psychotherapeutic Anorexia Nervosa Treatment Outpatient Study (ANTOP) trial, compared to 117 (LEPR: n = 119) age and height matched, normal-weight healthy controls. Blood samples were taken at baseline, the end of therapy (40 weeks) and the 12-months follow-up and compared to controls. Methylation was measured in whole blood via bisulfite sequencing. Within the promoter region 32 (LEP) and 39 CpG sites (LEPR) were analyzed. Two key findings were observed. First, LEP and LEPR methylation at baseline were lower in patients compared to controls (LEP: [%] AN: 30.94 ± 13.2 vs. controls: 34.53 ± 14.6); LEPR ([%] AN: 3.73 ± 5.4 vs. controls: 5.22 ± 8.3, mixed linear models: both P < 0.001). Second, lower DNA methylation of the LEP promoter, with a dynamic upregulation during treatment, was associated with a full recovery in AN patients (% change from baseline to follow-up in full recovery patients: +35.13% (SD: 47.56); mixed linear model: P < 0.0001). To test for potential predictive properties of mean LEP DNA methylation a LEP DNA methylation cut-off (31.25% DNA methylation) was calculated, which significantly discriminated full recovery vs. full syndrome AN patients. This cut-off was then tested in a group of previously unclassified patients (missing follow-up data of the Structured Interview for Anorexic and Bulimic disorders; n = 33). Patients below the cut-off (31.25% LEP DNA methylation) showed an increase in BMI over time, while those above the cut-off had a decrease in BMI (ANOVA at the 12-months follow-up: P = 0.0142). To our knowledge, this is the first study investigating epigenetic alterations in AN over time. Our findings indicate that LEP DNA methylation might be involved in the disease course of AN