State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions

This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone- and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016. The work group agreed that there is strong evidence for efficacy and effectiveness of core behavioral intervention components and processes, but insufficient evidence to determine the comparative effectiveness of multiple clinician delivered weight management modalities, as well as technologies that may or may not supplement clinician delivered treatments. Effective strategies for implementation of weight management services in VHA were identified. The SOTA work group’s foremost policy recommendations are to establish a system-wide culture for weight management and to identify a population-level health metric to measure the impact of weight management interventions that can be tracked and clearly communicated throughout VHA. The work group’s top research recommendation is to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans

The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study

Objective: To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain). Setting: Administrative and electronic health record data from the Veterans Health Administration (VHA). Subjects: A national cohort of US military veterans with MSDs in VHA care during 2001-2012 (N = 1,759,338). Methods: These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics. Results: The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21-1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups. Conclusions: There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis

Racial/ethnic differences in adults in randomized clinical trials of binge eating disorder.

Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in demographic characteristics and eating disorder symptoms in participants enrolled in treatment trials for BED

Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder.

Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and post-treatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome

Gender Differences in Shame in Patients with Binge-Eating Disorder

Abstract JAMBEKAR, SHEILA A., ROBIN M. MASHEB, AND CARLOS M. GRILO. Gender differences in shame in patients with binge-eating disorder. Obes Res. 2003;11: 571-577. Objective: To examine the relationship between shame and the behavioral and attitudinal features of eating disorders in men and women diagnosed with binge-eating disorder (BED). Research Methods and Procedures: Participants were 188 consecutively evaluated adults (38 men and 150 women) who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for BED. Participants were interviewed and completed a battery of measures assessing shame, behavioral and attitudinal features of eating disorders, and general psychological functioning. Results: Shame did not differ significantly by gender and was not associated with BMI or binge-eating frequency. Shame was significantly associated with the attitudinal features of eating disorders, even after controlling for levels of depression and self-esteem. When considered separately by gender and controlling for depression and self-esteem, shame was associated with body dissatisfaction in men and with weight concern in women. Discussion: Men and women with BED, who presented for treatment, reported similar levels of shame. Overall, while shame was related to attitudinal features, the specific associations differed by gender. For men, shame was related to how dissatisfied they felt with their bodies, whereas for women, shame was associated with concerns about weight. Interestingly, shame was not related to BMI or binge-eating frequency in men or women. These results provide preliminary support for self-conscious emotions playing different roles in men and women with BED

Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight

Purpose This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight. Materials and methods Participants were 314 Italian adults (72.6% females, aged 18–76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald’s ω and ordinal α coefficients for internal consistency and Cohen’s weighted Kappa coefficient (Kw) for test–retest reliability. Results Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; Kw= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity. Conclusions EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level. Level of evidence Level V, cross-sectional, descriptive study