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Maston G, Franklin J, Hocking S, Swinbourne J, Gibson A, Manson E, Sainsbury A, Markovic T. Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration. PLoS One 2021; 16:e0253127. [PMID: 34138917 PMCID: PMC8211265 DOI: 10.1371/journal.pone.0253127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 12/27/2022] Open
Abstract
Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.
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Affiliation(s)
- Gabrielle Maston
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Samantha Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Swinbourne
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alice Gibson
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Tania Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Rigas G, Williams K, Sumithran P, Brown WA, Swinbourne J, Purcell K, Caterson ID. Delays in healthcare consultations about obesity - Barriers and implications. Obes Res Clin Pract 2020; 14:487-490. [PMID: 32888856 DOI: 10.1016/j.orcp.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of obesity continues to rise, affecting nearly a third of Australian adults in 2017-18. The stigma and bias people with obesity (PwO) experience is one of the barriers hindering the dialogue between PwO and their Health Care Professionals (HCPs). The results from the ACTION IO Australian cohort are reported here. Identification of local barriers can inform strategies to improve access to quality obesity care within Australia. METHODS The ACTION-IO study was an online cross-sectional survey conducted in 11 countries during June-October 2018. In Australia 1,000 community based adult PwO (body mass index ≥30 kg/m based on self-reported height and weight) and 200 HCPs involved with direct patient care (seeing ≥10 patients with obesity/month) completed the survey. RESULTS There was a mean delay of 8.9 years from when a PwO first started to struggle with their weight, and the initial discussion with an HCP about this. HCPs acknowledged weight loss efforts in only 38.5% of their patients, although 74.6% of PwO had attempted weight loss. Most PwO (82.0%) assumed full responsibility for their weight loss. HCPs identified short appointment times (60.5%) and the cost of obesity medication, programmes and services (58.5%) as barriers to weight management conversations and weight loss, respectively. Most PwO want their HCP to raise the issue of weight with 64 % reporting finding such conversations positive and helpful. CONCLUSION Compared to global results, Australian PwO took 3 years longer to seek medical care about their weight. Better recognition of obesity's impact and targeting barriers to care are needed.
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Affiliation(s)
- Georgia Rigas
- Department of Bariatric Surgery, St. George Private Hospital, Kogarah, Sydney, Australia.
| | - Kathryn Williams
- Department of Bariatric Surgery, St. George Private Hospital, Kogarah, Sydney, Australia; Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Heidelberg, Australia
| | - Wendy A Brown
- Department of Surgery, Monash University, Melbourne, Australia
| | - Jessica Swinbourne
- Boden Collaboration, Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | | | - Ian D Caterson
- Boden Collaboration, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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Redfern J, Hyun K, Singleton A, Hafiz N, Raeside R, Spencer L, Carr B, Caterson I, Cullen J, Ferry C, Santo K, Hayes A, Leung RWM, Raadsma S, Swinbourne J, Cho JG, King M, Roberts M, Kok C, Jenkins C, Chow C. ITM support for patients with chronic respiratory and cardiovascular diseases: a protocol for a randomised controlled trial. BMJ Open 2019; 9:e023863. [PMID: 30826759 PMCID: PMC6430023 DOI: 10.1136/bmjopen-2018-023863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Simple and scalable strategies are needed to improve 'out-of-hospital' support and management for people living with cardiovascular disease (CVD) and respiratory disease. Text messaging via mobile phones has been shown to be effective in helping promote lifestyle change and is supported by quantitative and qualitative evidence. The aim of this study is to test the effectiveness and implementation of a 6-month text messaging support programme for people with CVD and respiratory disease as an addition to cardiac and pulmonary outpatient rehabilitation. METHODS AND ANALYSIS Pragmatic randomised controlled trial (n=310) to test the effectiveness of a 6-month text message support programme on clinical outcomes in people with CVD and chronic respiratory disease who are attending outpatient cardiac and pulmonary rehabilitation. The study includes a nested process evaluation to inform scalability and implementation across settings. The intervention group will receive a text message support programme comprising five messages per week for 26 weeks and the control group will continue with standard care. The primary outcome is exercise capacity (6 min walk distance). Secondary outcomes include clinical measures (proportion of people meeting the Australian guideline-recommended blood pressure and cholesterol targets), lifestyle outcomes (smoking rates, achievement of national guidelines for nutrition and physical activity), quality of life, mood (Hospital Anxiety and Depression Scale), medication adherence and attendance at and completion of rehabilitation. ETHICS AND DISSEMINATION Primary ethics approval was received from the Sydney Local Health District Hospital Human Research Ethics Committee and associated Governance committees at sites. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences. At its conclusion, the study will determine the effectiveness and implementation of a simple programme that aims to improve health outcomes and attendance at rehabilitation for people with CVD and chronic respiratory disease. TRIAL REGISTRATION NUMBER ACTRN12616001167459.
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Affiliation(s)
- Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Karice Hyun
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Singleton
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nashid Hafiz
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Raeside
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lissa Spencer
- Department of Physiotherapy, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Bridie Carr
- NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Ian Caterson
- Boden Institute, University of Sydney, University of Sydney, New South Wales, Australia
| | - John Cullen
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney LHD, Sydney, New South Wales, Australia
| | - Cate Ferry
- NSW Division, Heart Foundation, Sydney, New South Wales, Australia
| | - Karla Santo
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- School of Public Health, University of Sydney, Sydney, Australia
| | - Regina W M Leung
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Raadsma
- Behavioural Insights Unit, NSW Department of Premier and Cabinet, Sydney, New South Wales, Australia
| | - Jessica Swinbourne
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Jin G Cho
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Meredith King
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mary Roberts
- Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Cindy Kok
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Christine Jenkins
- Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Western Sydney Local Health District, Westmead, New South Wales, Australia
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Burton AL, Mitchison D, Hay P, Donnelly B, Thornton C, Russell J, Swinbourne J, Basten C, Goldstein M, Touyz S, Abbott MJ. Beliefs about Binge Eating: Psychometric Properties of the Eating Beliefs Questionnaire (EBQ-18) in Eating Disorder, Obese, and Community Samples. Nutrients 2018; 10:E1306. [PMID: 30223500 PMCID: PMC6165353 DOI: 10.3390/nu10091306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023] Open
Abstract
Binge eating is a core diagnostic feature of bulimia nervosa, binge eating disorder, anorexia nervosa binge/purge type, and is a common feature of "other specified" and "unspecified" feeding and eating disorders. It has been suggested that specific metacognitive beliefs about food, eating, and binge eating may play a key role in the maintenance of binge eating behaviour. The Eating Beliefs Questionnaire (EBQ-18) provides a brief self-report assessment tool measuring three types of metacognitive beliefs: negative, positive, and permissive beliefs about food and eating. This study aimed to build on past research by validating the factor structure and psychometric properties of the EBQ-18 using both a clinical and non-clinical sample. A sample of 688 participants (n = 498 non-clinical participants, n = 161 participants seeking treatment for an eating disorder, and n = 29 participants seeking treatment for obesity) completed a battery of questionnaires, including the EBQ-18 and other measures of eating disorder symptoms and relevant constructs. A subset of 100 non-clinical participants completed the test battery again after an interval of two-weeks, and 38 clinical participants completed the EBQ-18 before and after receiving psychological treatment for their eating disorder. A confirmatory factor analysis (CFA) was conducted and psychometric properties of this measure were assessed. The results of this study provide support for the three-factor model of the EBQ-18. In addition, the EBQ-18 was found to be a valid and reliable measure, with excellent internal consistency, good test-retest reliability in the non-clinical sample, and also demonstrated evidence of sensitivity to treatment in clinical samples with binge eating pathology. Receiver operating characteristic (ROC) curve analyses were used to identify optimal cut-off scores for the EBQ-18. This study provides valuable information about the utility of the EBQ-18 as a measure for use in both clinical and research settings.
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Affiliation(s)
- Amy L Burton
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia.
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
| | - Brooke Donnelly
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
- The Peter Beumont Eating Disorder Service, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia.
| | | | - Janice Russell
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
- The Peter Beumont Eating Disorder Service, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia.
| | - Jessica Swinbourne
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Christopher Basten
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia.
| | - Mandy Goldstein
- Mandy Goldstein Psychology, Bondi Junction, NSW 2022, Australia.
| | - Stephen Touyz
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
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Burton AL, Hay P, Kleitman S, Smith E, Raman J, Swinbourne J, Touyz SW, Abbott MJ. Confirmatory factor analysis and examination of the psychometric properties of the eating beliefs questionnaire. BMC Psychiatry 2017; 17:237. [PMID: 28673268 PMCID: PMC5496235 DOI: 10.1186/s12888-017-1394-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Eating Beliefs Questionnaire (EBQ) is a 27-item self-report measure that assesses positive and negative beliefs about binge eating. It has been validated and its factor structure explored in a non-clinical sample. This study tested the psychometric properties of the EBQ in a clinical and a non-clinical sample. METHOD A sample of 769 participants (573 participants recruited from the university and general community, 76 seeking treatment for an eating disorder and 120 participating in obesity research) completed a battery of questionnaires. A subset of clinical participants with a diagnosis of Bulimia Nervosa or Binge Eating Disorder completed the test-battery before and after receiving a psychological treatment (n = 27) or after allocation to a wait-list period (n = 28), and a subset of 35 community participants completed the test battery again after an interval of two-weeks. Confirmatory Factor Analysis (CFA) was performed. RESULTS CFA found a two-factor structure that provided a good fit to the data, supporting the solution presented in the development paper. Items with poor psychometric properties were removed, resulting in a 16 item measure. EBQ scores were found to correlate with binge eating episode frequency, increases in body mass index (BMI), and measures of eating disorder behaviours and related psychopathology. The EBQ was found to have excellent internal consistency (α = .94), good test-retest reliability (r = .91) and sensitivity to treatment. CONCLUSION These findings indicate that the EBQ is a psychometrically sound and clinically useful measure.
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Affiliation(s)
- Amy L. Burton
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Sydney, NSW Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, NSW, Australia. .,Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Sabina Kleitman
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Sydney, NSW Australia
| | - Evelyn Smith
- 0000 0004 1936 834Xgrid.1013.3School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW Australia
| | - Jayanthi Raman
- 0000 0004 1936 834Xgrid.1013.3School of Medicine, Western Sydney University, Sydney, NSW Australia
| | - Jessica Swinbourne
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney, NSW Australia
| | - Stephen W. Touyz
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Sydney, NSW Australia
| | - Maree J. Abbott
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Sydney, NSW Australia
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da Luz FQ, Sainsbury A, Hay P, Roekenes JA, Swinbourne J, da Silva DC, da S Oliveira M. Early Maladaptive Schemas and Cognitive Distortions in Adults with Morbid Obesity: Relationships with Mental Health Status. Behav Sci (Basel) 2017; 7:E10. [PMID: 28264484 PMCID: PMC5371754 DOI: 10.3390/bs7010010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/13/2017] [Accepted: 02/24/2017] [Indexed: 01/27/2023] Open
Abstract
Dysfunctional cognitions may be associated with unhealthy eating behaviors seen in individuals with obesity. However, dysfunctional cognitions commonly occur in individuals with poor mental health independently of weight. We examined whether individuals with morbid obesity differed with regard to dysfunctional cognitions when compared to individuals of normal weight, when mental health status was controlled for. 111 participants-53 with morbid obesity and 58 of normal weight-were assessed with the Mini-Mental State Examination, Young Schema Questionnaire, Cognitive Distortions Questionnaire, Depression, Anxiety and Stress Scale, and a Demographic and Clinical Questionnaire. Participants with morbid obesity showed higher scores in one (insufficient self-control/self-discipline) of 15 early maladaptive schemas and in one (labeling) of 15 cognitive distortions compared to participants of normal weight. The difference between groups for insufficient self-control/self-discipline was not significant when mental health status was controlled for. Participants with morbid obesity showed more severe anxiety than participants of normal weight. Our findings did not show clinically meaningful differences in dysfunctional cognitions between participants with morbid obesity or of normal weight. Dysfunctional cognitions presented by individuals with morbid obesity are likely related to their individual mental health and not to their weight.
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Affiliation(s)
- Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006, Australia.
- Faculty of Psychology, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6681, Porto Alegre/RS, CEP 90619-900, Brazil.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006, Australia.
| | - Phillipa Hay
- Centre for Health Research and School of Medicine, The University of Western Sydney, Locked Bag 1797, Penrith NSW 2751, Australia.
| | - Jessica A Roekenes
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Jessica Swinbourne
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Dhiordan C da Silva
- Faculty of Psychology, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6681, Porto Alegre/RS, CEP 90619-900, Brazil.
| | - Margareth da S Oliveira
- Faculty of Psychology, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6681, Porto Alegre/RS, CEP 90619-900, Brazil.
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da Luz FQ, Swinbourne J, Sainsbury A, Touyz S, Palavras M, Claudino A, Hay P. HAPIFED: a Healthy APproach to weIght management and Food in Eating Disorders: a case series and manual development. J Eat Disord 2017; 5:29. [PMID: 28824810 PMCID: PMC5558732 DOI: 10.1186/s40337-017-0162-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/14/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a high prevalence of overweight or obesity in people with eating disorders. However, therapies for eating disorders, namely binge eating disorder and bulimia nervosa, do not address weight management. Conversely, weight loss treatments for people with overweight or obesity do not address psychological aspects related to eating disorders. Thus we developed a new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa, entitled HAPIFED (a Healthy APproach to weIght management and Food in Eating Disorders). This paper describes HAPIFED and reports a case series examining its feasibility and acceptability. METHODS Eleven participants with overweight or obesity and binge eating disorder or bulimia nervosa were treated with HAPIFED in two separate groups (with once or twice weekly meetings). Weight, body mass index (BMI) and eating disorder symptoms, as well as depression, anxiety and stress, were assessed at baseline and at the end of the 20-session HAPIFED intervention. RESULTS Eight of the 11 participants completed the intervention, with diverse results. Six of the 8 participants who completed HAPIFED reduced their weight between baseline and the end of the intervention. Median scores on the Eating Disorder Examination Questionnaire for binge eating, restraint, and concerns about eating or weight and shape, were reduced in the group overall between baseline and the end of the intervention. One participant, who at baseline was inducing vomiting and misusing laxatives in an attempt to lose weight, reduced these behaviors by the end of the intervention. Three participants at baseline were undertaking episodes of compulsive exercise, and they reduced or stopped this behavior, but one participant commenced episodes of compulsive exercise by the end of the intervention. All participants who completed the intervention rated the suitability and success of HAPIFED as 7 or more out of 10 (0 = not at all suitable/successful; 10 = extremely suitable/successful). CONCLUSION This case series supports the feasibility and acceptability of HAPIFED as a potential new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa. Clinical trials are necessary to examine the efficacy and effectiveness of HAPIFED. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (Universal Trial Number): U1111-1149-7766. Date of registration: 4th November 2013.
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Affiliation(s)
- Felipe Q da Luz
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia.,CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020 Brazil
| | - Jessica Swinbourne
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia
| | - Amanda Sainsbury
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Stephen Touyz
- The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Marly Palavras
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Angelica Claudino
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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8
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Fuller NR, Sainsbury A, Caterson ID, Enarsson M, Denyer G, Manns C, Swinbourne J, Q da Luz F, Fong M, Markovic TP. Examining mindfulness as a predictor of weight loss - Findings from the DIABEGG study. Obes Res Clin Pract 2016; 11:88-96. [PMID: 27050109 DOI: 10.1016/j.orcp.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/26/2015] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Identifying individuals who are less likely to respond to a weight loss intervention allows better allocation or focus of resources to achieve better weight loss results. The current study investigated whether baseline levels of mindfulness would predict weight loss during a 12-month diet and exercise intervention. METHODS The Five Facet Mindfulness Questionnaire (FFMQ) was administered and body weight measured, at baseline, three, six and 12 months in 140 participants with pre-diabetes or type 2 diabetes mellitus and a body mass index of ≥25kg/m2. 137 of 140 participants completed the FFMQ at baseline and were included in this study. RESULTS There was no correlation between baseline mindfulness scores and weight loss. Mean baseline total FFMQ score was 112.2 [95% confidence interval: 109.4, 115.1] which did not change over the course of the study. Mean baseline body weight was 95.1kg (standard deviation (19.1kg)). There was a significant decrease in weight at month 12 (-3.8kg (±standard deviation 5.8kg)). This is comparable to the weight loss achieved by participants in other interventions of the same duration. CONCLUSIONS The findings suggest that baseline dispositional mindfulness does not predict the amount of weight loss in a lifestyle (diet and exercise) intervention.
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Affiliation(s)
- Nicholas R Fuller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Ian D Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Malin Enarsson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Gareth Denyer
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Clare Manns
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Jessica Swinbourne
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Mackenzie Fong
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Tania P Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
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Zwickert K, Rieger E, Swinbourne J, Manns C, McAulay C, Gibson AA, Sainsbury A, Caterson ID. Technological support to enhance weight loss and weight loss maintenance among obese adults: A pilot randomised controlled trial. Obes Res Clin Pract 2014. [DOI: 10.1016/j.orcp.2014.10.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rieger E, Treasure J, Swinbourne J, Adam B, Manns C, Caterson I. The effectiveness of including support people in a cognitive behavioural weight loss maintenance programme for obese adults: study rationale and design. Clin Obes 2014; 4:77-90. [PMID: 25826731 DOI: 10.1111/cob.12042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
The well-documented finding that obese adults have a high likelihood of weight regain following participation in behavioural weight loss programmes highlights the importance of developing more effective approaches for weight loss maintenance. One promising approach is to improve the quality of social support for effective weight control available to an obese individual by including support people in behavioural weight loss programmes. This paper describes the rationale and design of a randomized controlled trial that evaluates the effectiveness of training support people to assist obese adults in their weight management. The study entails a two-arm randomized controlled trial in which obese participants take part in a 1-year (26-session) cognitive behaviour therapy group weight management programme, including motivational interviewing strategies (CBT-MI). In one arm, participants receive CBT-MI alone, while in the second arm (CBT-MI-SP), participants also have a support person who attends 10 group sessions designed to teach effective skills for supporting an individual in healthy weight control. More specifically, support people will be trained in skills that aim to promote self-motivation for weight management. Assessments of anthropometric, medical, behavioural, motivational, psychological and social functioning take place at pre-treatment, post-treatment and a 1-year follow-up. By helping obese participants to increase and sustain their motivation and skills for weight control both during treatment and in the crucial period after treatment cessation through the ongoing input of support people, the CBT-MI-SP approach of the current study has the potential to effectively help patients to achieve sustained weight loss while minimizing the patient's need for ongoing, intensive weight control treatment with its attendant costs.
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Affiliation(s)
- E Rieger
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S. The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psychiatry 2012; 46:118-31. [PMID: 22311528 DOI: 10.1177/0004867411432071] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the prevalence of comorbid eating and anxiety disorders in women presenting for inpatient and outpatient treatment of an eating disorder and women presenting for outpatient treatment of an anxiety disorder. METHODS The prevalence of comorbidity was investigated from a sample of 152 women, which included 100 women presenting for treatment of an eating disorder and 52 women presenting for treatment of an anxiety disorder. RESULTS Of women presenting for treatment of an eating disorder, 65% also met criteria for at least one comorbid anxiety disorder; 69% of these reported the onset of the anxiety disorder to precede the onset of the eating disorder. Of the anxiety disorders diagnosed, social phobia was most frequently diagnosed (42%) followed by post-traumatic stress disorder (26%), generalised anxiety disorder (23%), obsessive-compulsive disorder (5%), panic/agoraphobia (3%) and specific phobia (2%). We also found that 13.5% of women presenting for anxiety treatment also met criteria for a comorbid eating disorder. Furthermore, 71% (n = 5) reported the onset of the anxiety disorder to precede the onset of the eating disorder. DISCUSSION The results of this study suggest that the prevalence of eating and anxiety disorder comorbidity is high. The present research should improve the clinical understanding of the comorbidity between eating disorders and anxiety disorders. In particular, it is anticipated that this research will have significant aetiological and therapeutic implications especially with regard to improving the clinical effectiveness of psychological treatments for eating disorders and highlighting the importance of screening for eating pathology in the clinical assessment of anxiety disorders.
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Affiliation(s)
- Jessica Swinbourne
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia.
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