Assessment and treatment of compulsive exercise in anorexia nervosa - A combined investigation of Compulsive Exercise Activity Therapy (LEAP) and Compulsive Exercise Test subscales

INTRODUCTION

Compulsive exercise is a transdiagnostic feature of eating disorders which adversely affects aspects of recovery, such as length of hospitalisation, risk of a chronic outcome, and risk of relapse. CompuLsive Exercise Activity TheraPy (LEAP) aims to reduce compulsive exercise through a cognitive behavioural approach. This study aims to investigate the effect of LEAP on compulsive exercise behaviour using subscales of the Compulsive Exercise Test (CET), a measure of exercise in individuals with eating disorders. Predictive validity of the CET's subscales and its ability to predict eating psychopathology are investigated.

METHOD

This study used data from a randomized controlled trial of LEAP (1). Linear mixed modelling was used to investigate the effect of LEAP on compulsive exercise behaviour, and the predictive ability of CET subscales on various outcomes. The CET was compared to other exercise measures to assess its superiority in predicting eating psychopathology.

RESULTS

LEAP was superior in reducing the scores of the CET's Avoidance and Rule Driven Behaviour and Exercise Rigidity subscales. All subscales made a contribution to the respective models. The CET was superior to other measures in predicting eating pathology.

CONCLUSION

The results lend credibility to LEAP's ability to reduce core parts of compulsive exercise. The CET has been found to target important aspects of compulsive exercise behaviour, and has was superior to other exercise measures in predicting eating psychopathology.

Examining sex differences in the association between sedentary behavior and cognitive function in bariatric surgery patients

BACKGROUND

Obesity is associated with cognitive impairment. A potential contributor to these deficits is sedentary behavior (SB), which is linked to poorer cognitive functioning in other populations. Little is known about the association between SB and cognitive function in bariatric surgery populations.

OBJECTIVES

This cross-sectional study examined the association between SB and cognitive function in preoperative bariatric surgery patients, as well as possible sex differences in this relationship.

SETTING

Data were collected at 2 health centers in the United States.

METHODS

A total of 121 participants (43.2 ± 10.3 yr of age) scheduled for Roux-en-Y gastric bypass or sleeve gastrectomy completed the National Institute of Health (NIH) Toolbox for the Assessment of Neurological and Behavioral Function Cognition Domain, a computerized neuropsychological assessment battery. Participants wore a waist-mounted accelerometer for 7 consecutive days to measure SB and light-intensity physical activity (LPA).

RESULTS

Pearson and partial correlations found no significant relationships between cognitive function and SB or LPA in the full sample. However, partial correlations controlling for LPA found that greater SB was associated with poorer performance on List Sorting Working Memory Test in women (r = -.28; P = .006), whereas there was a positive relationship between SB and Dimensional Change Card Sort for men (r = .51; P = .015; 95% CI [.25, .73]).

CONCLUSIONS

These results showed that greater SB, independent of LPA, is associated with poorer working memory in women and better set shifting ability in men. Future studies should examine the possibility of domain-specific cognitive effects associated with SB in bariatric surgery samples and clarify possible sex differences.

Longer-Term Weight Loss Outcomes Are Not Primarily Driven by Diet Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for Class III obesity. Reduced dietary intake is considered a behavioral driver of post-surgical weight loss, but limited data have examined this association. Therefore, this study examined prospective, longitudinal relationships between dietary intake and weight loss over 24 months following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Relationships between weight loss and dietary intake were examined using a validated 24-h dietary recall method. Associations between total energy/macronutrient intake and weight loss outcomes were assessed at 12-, 18-, and 24-months following MBS, defining patients as "responders" and "suboptimal responders". Consistent with previous literature, 12-month responders and suboptimal responders showed significant associations between weight loss and energy (p = 0.018), protein (p = 0.002), and total fat intake (p = 0.005). However, this study also revealed that many of these associations are no longer significant 24 months post-MBS (p > 0.05), despite consistent weight loss trends. This study suggests a short-term signal between these dietary factors and weight loss outcomes 12 months post-MBS; however, this signal does not persist beyond 12 months. These results are essential for interpreting and designing clinical studies measuring long-term post-surgical weight loss outcomes.

Abstract P1-06-03: Differences in Breast Cancers among American-Indians and Whites in the United States

Differences in Breast Cancers among American-Indians and Whites in the United States Background - The United States has made substantial progress in improving breast cancer (BC) outcomes over the years, but unfortunately, this improvement has not impacted all races equally. BC death rates have not improved significantly for American Indian (AI) women, whereas, it significantly decreased for White women. In addition, AI women were more likely to be diagnosed at a younger age with a late-stage disease. We sought to determine the reasons for these disparities. Methods - This is a retrospective cohort study using a hospital registry database (the National Cancer Data Base) (NCDB). We identified female AIs and non-Hispanic Whites in the US diagnosed with BC between the years 2004 and 2016. We compared patient and tumor characteristics between the 2 groups and its effect on age and stage at diagnosis. We also determined hazard ratios (HRs) for overall survival using Cox regression models, both before and after adjustment for covariates. Results – Data on 6,866 AIs and 1,987,324 White women diagnosed with BC were analyzed. The mean (SD) age at diagnosis was significantly younger for AI than for White women (57.72 ± 12.23 vs. 61.87 ± 13.21). AI women traveled double the distance to their treatment facilities, lived in lower median income zip codes, reported a higher percentage of no insurance, and higher comorbidities than Whites. Furthermore, AIs were less likely to be diagnosed with Stage 0 and I BCs, had a larger tumor size, greater number of positive lymph nodes at diagnosis, and higher proportion of triple negative and HER2-positive BCs than Whites. Whites were more likely to have other cancers diagnosed prior to or after their BC diagnosis. All the above tests for comparisons were significant (p-value < 0.001). Correlation between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AIs and Whites. Unadjusted overall survival (OS) was significantly worse for AIs as compared to Whites (HR=1.07; 95% CI: 1.01-1.14, p-value = 0.025). After adjustment of all covariates including age, travel distance, median income of residential zip code, insurance status, cancer sequence, comorbidities, stage, tumor size, number of positive lymph nodes, grade, histology, and hormonal/HER2 status, OS was not significantly different between AIs and Whites (HR=1.04; 95% CI: 0.90-1.20, p-value = 0.601). Conclusion - Our study showed significant differences in patient and tumor characteristics among AI and White BC patients which adversely impacted BC outcomes in AIs. Survival was lower in AIs, but when adjusted for various covariates, the survival difference disappeared. Improvement in BC outcomes in AIs will involve not only improved and early access to screening to identify patients at younger ages and earlier stages at diagnosis, but also long term plans to provide affordable and the full spectrum of cancer care closer to home.

Citation Format: Anu Gaba, Li Cao, Rebecca Renfrew, Janet Wernisch, Abe Sahmoun, Sanjay Goel, Ross Crosby. Differences in Breast Cancers among American-Indians and Whites in the United States [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-06-03.

Antibiotic Prescribing Practices for Upper Respiratory Tract Infections Among Primary Care Providers: A Descriptive Study

Background

Most antibiotics are prescribed in the ambulatory setting with estimates that up to 50% of use is inappropriate. Understanding factors associated with antibiotic misuse is essential to advancing better stewardship in this setting. We sought to assess the frequency of unnecessary antibiotic use for upper respiratory infections (URIs) among primary care providers and identify patient and provider characteristics associated with misuse.

Methods

Unnecessary antibiotic prescribing was assessed in a descriptive study by using adults ≥18 years seen for common URIs in a large, Upper Midwest, integrated health system, electronic medical records from June 2017 through May 2018. Individual provider rates of unnecessary prescribing were compared for primary care providers practicing in the departments of internal medicine, family medicine, or urgent care. Patient and provider characteristics associated with unnecessary prescribing were identified with a logistic regression model.

Results

A total of 49 463 patient encounters were included. Overall, antibiotics were prescribed unnecessarily for 42.2% (95% confidence interval [CI], 41.7–42.6) of the encounters. Patients with acute bronchitis received unnecessary antibiotics most frequently (74.2%; 95% CI, 73.4–75.0). Males and older patients were more likely to have an unnecessary antibiotic prescription. Provider characteristics associated with higher rates of unnecessary prescribing included being in a rural practice, having more years in practice, and being in higher volume practices such as an urgent care setting. Fifteen percent of providers accounted for half of all unnecessary antibiotic prescriptions.

Conclusions

Although higher-volume practices, a rural setting, or longer time in practice were predictors, unnecessary prescribing was common among all providers.

An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa

OBJECTIVE

Cognitive-behavioural therapy (CBT) delivered face-to-face and via the internet reduces bulimia nervosa (BN) symptoms. However, our empirical understanding of factors affecting patient outcomes is limited.

METHOD

Using data from a randomised, controlled trial comparing internet-based (CBT4BN, n = 78) with face-to-face (CBTF2F, n = 71) group CBT (97% female, M = 28 years), we examined general treatment (across conditions) and modality-specific predictors of end-treatment and 1-year outcomes (abstinence, binge-eating frequency, purging frequency).

RESULTS

Improved eating disorder-related quality of life (EDQOL) during treatment and follow-up predicted abstinence at end-treatment and 1-year assessments. Improved EDQOL, disordered eating cognitions, and anxiety symptoms predicted less frequent binge eating and purging. Previous CBT and being employed predicted more frequent binge eating and purging at both assessments. Higher self-transcendence and self-directedness predicted less frequent binge eating. More severe binge eating and purging at baseline and end-treatment predicted more frequent binge eating and purging at subsequent assessments. Improved EDQOL was more strongly associated with positive outcome in CBT4BN; improved depressive symptoms and health-related QOL predicted positive outcome in CBT4BN but not CBTF2F.

DISCUSSION

Symptom improvement and certain character traits predicted positive outcome, whereas more severe presentation and prior CBT experience predicted poorer outcome. Consideration of intreatment symptom improvement may facilitate care recommendations, particularly for internet-based modalities.

Abstract P3-14-10: Breast cancer patterns, behavior and survival among American Indians in the west north central region and the other regions of the U.S

Purpose: American Indians (AIs) constitute the single largest racial minority in North Dakota and South Dakota. There are no studies looking at what sociodemographic or biological factors may play a role in affecting outcomes and mortality of breast cancer (BC) among AIs in the United States. Our study compared the BC patterns, behavior, and survival of AIs living in the West North Central Region (WNCR) of the U.S (which includes ND, SD, MN, NE, IO, KS, MO) to the AI BC patients in the remainder of the country. Methods: We used the records of all AI BC patients diagnosed between the years 2004-2016 from The National Cancer Database participant user files. All analyses were conducted using SPSS software (version 25). Results: Records were available for 6,466 AI BC patients, 798 were in the WNCR. There was no difference between WNCR and other regions in the stage distribution, mean age at diagnosis, morphology, hormonal/HER2 status, tumor size, lymph node status, or second cancers. The WNCR patients had less private insurance, lived in zip codes with lower median income, had more co-morbidities, and traveled longer distances for care (p<0.001 for each). They had higher grade cancers (p<0.001) at diagnosis. The WNCR patients were less likely to have received radiation therapy (p=0.015) but more likely to have received chemotherapy (p<0.001) and hormonal therapy (p=0.009) and had longer inpatient stay days after surgery (p<0.001). Time to first treatment and first treatment within 90 days (88.0% vs. 79.7%, p<0.001) was significantly better in the WNCR than in other regions of the country. Five year mortality rate was higher (16.3% vs. 11.1%, p<0.001) and cumulative survival was lower (p<0.001) in the WNCR as compared to AIs in other regions of the country. Univariate/multivariate analysis failed to identify variables that could explain the differences in 5 year mortality or cumulative survival between WNCR and other regions. Conclusion:AIs with BC in the WNCR had worse 5 year mortality and cumulative survival as compared to AIs in other regions in the US. Our analysis could not identify variables that explained the differences in mortality or cumulative survival between WNCR and other regions.

Citation Format: Anu G Gaba, Li Cao, Rebecca Renfrew, Deann Witte, Janet Wernisch, Denise Lutkemeier, Kristi Egland, Ross Crosby. Breast cancer patterns, behavior and survival among American Indians in the west north central region and the other regions of the U.S. [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-10.

Abstract SS1-08: Did Medicaid expansion under the Affordable Care Act narrow the gap between American Indians and Whites on breast cancer management and prognosis?

Prior studies have shown that over a span of 20 years (1990-2009), breast cancer death rates in the U.S. have not significantly declined for American Indians (AIs) in comparison to the White population. Health insurance coverage contributes independently and positively to the health of individuals through the receipt of adequate preventive services and care for diseases such as breast cancer. To this end, the 2010 Medicaid Expansion as part of the Affordable Care Act (ACA) has extended the health insurance coverage eligibility to adults with incomes up to 133 percent of the federal poverty level. In this study, we examined whether Medicaid expansion resulted in the improvement of breast cancer management and prognosis for AIs relative to the White population. Methods: We abstracted information from the National Cancer Data Base (NCDB) for AI and White breast cancer patients diagnosed between the years 2004-2016 who lived in states that expanded Medicaid in January 2014, and those that did not expand Medicaid. Data on age, race, stage at diagnosis, insurance status, definitive treatment initiation within 30 days of diagnosis, and 3-year mortality was analyzed. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multiple logistic regression to determine the impact of race (White vs. AI), Medicaid expansion status, and pre- vs. post-expansion periods on breast cancer management and prognosis. All p-values are two-sided. Analyses were performed using SPSS software V25. Results: There were 1,465,103 newly diagnosed White and AI breast cancers between the years 2004-2016; 99.7% were Whites and 0.3% were AIs. Of these, 46.9% resided in states that expanded Medicaid in January 2014 and 53.1% in states that did not expand Medicaid; 73.8% were diagnosed in the pre-expansion period (January 2004-December 2013) and 26.2% were diagnosed in the post-expansion period (January 2014-December 2016). There was an increase in the proportion of early stage (0, 1) breast cancer diagnosis in the period 2014-2016 as compared to the period 2004-2013 (OR=1.434, 95% CI:1.159- 1.775; p = 0.001), and this increase was significantly greater for AIs than for Whites (6% vs 3%; p=0.027) in both expansion and non-expansion states. An independent chi-square analysis of AIs found that there was a significant increase of the early stage diagnosis in the expansion states during the post-expansion period (p=0.001). The proportion of uninsured declined in the period 2014-2016 as compared to the period prior (OR=0.331, 95% CI: 0.129- 0.850; p=0.022), more so in the expansion states (decrease from 1.4% to 0.8%), vs. non expansion states (decrease from 2.3% to 2.2%) (p=0.019); no difference in decline was found between Whites and AIs. The probability of getting first definitive treatment within 30 days of diagnosis declined more in states without Medicaid expansion (decrease from 54% to 43%) than in states with Medicaid expansion (decrease from 50% to 43%) (p=0.028) for both AIs and Whites; and the decline was more in Whites (decrease from 55% to 44%) than in AIs (decrease from 49% to 42%) from pre-expansion period to post-expansion period (p=0.018). The 3-year mortality rates did not show any significant relationship to race, expansion status, or the pre- or post-expansion periods. Conclusion: In patients newly diagnosed with breast cancer, the proportion of uninsured declined significantly with Medicaid expansion and the proportion of patients who received first definitive treatment within 30 days of diagnosis decreased significantly less in AIs and in states that expanded Medicaid under the Affordable Care Act. Medicaid expansion increased early breast cancer diagnosis in AIs; this effect was not seen in non-expansion states. Medicaid expansion did not affect 3-year mortality rate.

Citation Format: Anu G Gaba, Li Cao, Rebecca Renfrew, Kristi A Egland, DeAnn L Witte, Janet Wernisch, Ross Crosby. Did Medicaid expansion under the Affordable Care Act narrow the gap between American Indians and Whites on breast cancer management and prognosis? [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS1-08.

Impulsivity and anxiety-related dimensions in adults with bulimic-spectrum disorders differentially relate to eating disordered behaviors

While facets of both anxiety and impulsivity appear central to the development and maintenance of bulimia nervosa (BN), specific BN behaviors may be propagated by differing profiles of risk. The current study examined associations between dimensions of anxiety and impulsivity and BN symptoms (binge eating, vomiting, laxative misuse, driven exercise), both in terms of the presence of such behaviors and their frequency. Two hundred and four women (M_age = 25.7 years) who met DSM-IV criteria for full or subthreshold BN completed self-report measures of perfectionism (Frost Multidimensional Perfectionism Scale), anxiety (Spielberger Trait Anxiety Inventory), impulsivity (Barratt Impulsiveness Scale-11; Impulsive Behavior Scale), eating disordered behaviors (Eating Disorder Examination - Questionnaire), and associated psychiatric symptoms (Michigan Assessment Screening Test/Alcohol-Drug; Maudsley Obsessive-Compulsive Inventory). Factor analysis revealed multidimensional impulsive and anxiety-related traits (5 anxiety-related factors; 7 impulsivity-related factors). In zero-sensitive regression models, different facets of impulsivity evidenced association with the presence of binge eating (risk taking), laxative misuse (impulsive spending), and fasting (difficulty concentrating), along with the frequency of vomiting (long-term planning difficulties). In contrast, anxiety-related dimensions were only associated with driven exercise (high standards) and fasting (concern over mistakes, high standards, parental expectations). Overall, impulsive and anxiety-related factors and symptoms showed distinct associations with specific eating disorder behaviors, even among those with the same diagnosis.

The Course of Eating Disorders Involving Bingeing and Purging Among Adolescent Girls: Prevalence, Stability, and Transitions

PURPOSE

To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States.

METHODS

Using 11 prospective assessments from 9,031 U.S. females ages 9-15 years at baseline of the Growing Up Today Study, we classified cases of the following EDs involving bingeing and purging: bulimia nervosa (BN), binge ED, purging disorder (PD), and subthreshold variants defined by less frequent (monthly vs. weekly) bingeing and purging behaviors. We measured number of years symptomatic and probability of maintaining symptoms, crossing to another diagnosis, or resolving symptoms across consecutive surveys.

RESULTS

Study lifetime disorder prevalence was 2.1% for BN and roughly 6% each for binge ED and PD. Most cases reported symptoms during only one survey year. Twenty-six percent of cases crossed between diagnoses during follow-up. Among participants meeting full threshold diagnostic criteria, transition from BN was most prevalent, crossing most frequently from BN to PD (12.9% of BN cases). Within each disorder phenotype, 20%-40% of cases moved between subthreshold and full threshold criteria across consecutive surveys.

CONCLUSIONS

Diagnostic crossover is not rare among adolescent and young adult females with an ED. Transition patterns from BN to PD add support for considering these classifications in the same diagnostic category of disorders that involve purging. The prevalence of crossover between monthly and weekly symptom frequency suggests that a continuum or staging approach may increase utility of ED classification for prognostic and therapeutic intervention.

Cognitive function and quality of life in bariatric surgery candidates

BACKGROUND

Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates.

OBJECTIVES

We sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates.

SETTING

Three sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York.

METHODS

Sixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline.

RESULTS

Hierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL.

CONCLUSIONS

These preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population.

The Impact of Bariatric Surgery on Sleep Disordered Breathing Parameters From Overnight Polysomnography and Home Sleep Apnea Test

Background Obstructive sleep apnea (OSA) is a common sleep disorder, especially in patients with obesity. Bariatric surgery is an effective tool to reduce weight and treat co-morbid diseases in patients with morbid obesity. One of these disorders is OSA. The most common bariatric procedures currently performed are Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG). Objectives Our study demonstrates that bariatric surgery is a very effective tool to reduce the severity of OSA, if not resolve it. Methods The medical charts of nine patients who had OSA and underwent bariatric surgery (LSG or RYGB) were reviewed and the apnea-hypopnea index (AHI) was compared before and after surgery. The study was conducted at the Sanford sleep center which is affiliated with the University of North Dakota School of Medicine. Results One patient was excluded from the statistical analysis since he was the only male patient, the remaining nine female patients had a significant reduction in AHI after surgery. The mean AHI before surgery was 40 events per hour and seven events per hour after surgery (P 0.004). The mean follow-up with sleep study after surgery was 16 months. The mean reduction in AHI was 80%. There was also an improvement in oxygen saturation (SpO2) before and after surgery (90% and 94% respectively, P 0.008). Conclusion The study confirms the significant reduction in AHI after bariatric surgery in female patients with OSA especially short term (one to two years postoperatively).

Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change

BACKGROUND

Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program.

PURPOSE

In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss.

METHODS

Adults (n = 189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states.

RESULTS

Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses.

CONCLUSIONS

In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.

Measurement invariance of the Eating Disorder Examination in black and white children and adolescents

OBJECTIVE

The Eating Disorder Examination (EDE) was originally developed and validated in primarily white female samples. Since data indicate that eating pathology impacts black youth, elucidating the psychometric appropriateness of the EDE for black youth is crucial.

METHODS

A convenience sample was assembled from seven pediatric obesity studies. The EDE was administered to all youth. Confirmatory factor analyses (CFA) were conducted to examine the original four-factor model fit and two alternative factor structures for black and white youth. With acceptable fit, multiple-group CFAs were conducted. For measurement invariant structures, the interactive effects of race with sex, BMIz, adiposity, and age were explored (all significance levels p < .05).

RESULTS

For both black and white youth (N = 820; 41% black; 37% male; 6-18 years; BMIz -3.11 to 3.40), the original four-factor EDE structure and alternative eight-item one-factor structure had mixed fit via CFA. However, a seven-item, three-factor structure reflecting Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction had good fit and held at the level of strict invariance. Girls reported higher factor scores than boys. BMIz and adiposity were positively associated with each subscale. Age was associated with Dietary Restraint and Body Dissatisfaction. The interactional effects between sex, BMIz, and age with race were not significant; however, the interaction between adiposity and race was significant. At higher adiposity, white youth reported greater pathology than black youth.

CONCLUSION

An abbreviated seven-item, three-factor version of the EDE captures eating pathology equivalently across black and white youth. Full psychometric testing of the modified EDE factor structure in black youth is warranted.

An Investigation of Tic Suppression and the Rebound Effect in Tourette’s Disorder

Many patients, parents of children with Tourette’s disorder, and professionals have suggested that following a period of suppression, tics will rebound to a rate that will exceed the average rate of occurrence. At present, there are no empirical data to support or refute such an effect. This experiment utilized an A-B-A design with replication to test this hypothesized effect. Following baseline observation, participants were instructed to refrain from exhibiting tics while watching videotapes, engaging in conversation, or while alone in a room with no activity. Observation continued following the suppression phase. Results of this experiment showed suppression of tics in almost one half of all sessions, with adults demonstrating suppression more frequently. Furthermore, results of this experiment failed to support a commonly held perception that following a period of voluntary suppression tics will rebound to a rate that will exceed the average rate of occurrence.

Nutritional adequacy of dietary intake in women with anorexia nervosa

Understanding nutrient intake of anorexia nervosa (AN) patients is essential for the treatment. Therefore, estimates of total energy and nutrient consumption were made in a group of young women (19 to 30 years) with restricting and binge purge subtypes of AN participating in an ecological momentary assessment study. Participants completed three nonconsecutive 24-hour diet recalls. Mean nutrient intakes were stratified by subtype and by quartiles of energy intake and compared to the age specific Dietary Reference Intake (DRI) levels, as well as to the reported intakes from the What We Eat In America (WWEIA) dietary survey 2011–2012. Reported intake was determined for energy, macronutrients, and micronutrients. The mean body mass index (BMI) for all participants was 17.2 ± 0.1 kg/m². Reported nutrient intake was insufficient for participants in quartiles 1–3 of both AN subtypes when compared to the DRIs. Intake reported by participants in quartile 4 of both subgroups met requirements for most nutrients and even met or exceeded estimated energy needs. Counseling of AN patients should be directed to total food consumption to improve energy intake and to reduce individual nutritional gaps.

Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial

Background

We describe the theoretical rationale and protocol for Self-Help And Recovery guide for Eating Disorders (SHARED), a trial investigating whether a guided self-care intervention (Recovery MANTRA) is a useful addition to treatment as usual for individuals with anorexia nervosa. Recovery MANTRA, a 6-week self-care intervention supplemented by peer mentorship, is a module extension of the Maudsley Model of Treatment for Adults with Anorexia Nervosa and targets the maintenance factors identified by the cognitive-interpersonal model of the illness.

Methods

Patients accessing outpatient services for anorexia nervosa are randomized to either treatment as usual or treatment as usual plus Recovery MANTRA. Outcome variables include change in body weight at the end of the intervention (primary) and changes in body weight and eating disorder symptoms at immediate and extended follow-up (6-months; secondary). Change is also assessed for the domains identified by the theoretical model, including motivation, hope, confidence to change, positive mood, cognitive flexibility, therapeutic alliance and social adjustment. Feedback from peer mentors is gathered to understand the impact on their own well-being of providing guidance.

Discussion

Results from this exploratory investigation will determine whether a larger clinical trial is justifiable and feasible for this affordable intervention, which has potential for high reach and scalability.

Trial registration

ClinicalTrials.gov NCT02336841.

Improvements in Functional Exercise Capacity after a Residential Behavioural Change, Diet and Fitness Program for Obese Adults

BACKGROUND AND PURPOSE

Obese adults are at an increased risk for mobility-related problems. National guidelines recommend calorie restrictions and exercise for obese adults as a means to improve functional fitness capacity and to increase mobility. Yet, lifestyle weight loss interventions often fail to measure fitness changes. The aim of this study was to assess whether a 1-month, intensive behavioural change, diet and fitness intervention for overweight and obese adults would result in statistically significant and clinically meaningful changes in functional exercise.

METHODS

A pre-post test design was used in this study. Seventy-two participants (40 women, 32 men; mean baseline body mass index (BMI) = 42.6 + 9.0; mean age = 45.8 + 16.8) completed a modified 6-minute walk test (6MWT), performed on a treadmill, at baseline and at end of treatment.

RESULTS

Significant improvements included decreased BMI (2.7 + 1.7 kg m(-2) , p < 0.001) and increased 6MWT distance (66.4 + 73.0 m, p < 0.001). The 6MWT improved by 66 m on average, a reported clinically meaningful difference. Greater improvements in the 6MWT were significantly correlated with greater weight loss and BMI reduction.

DISCUSSION

Our findings suggest that rehabilitation beyond weight loss may be derived from participation in a brief, intensive behavioural change, diet and fitness programme. Physiotherapists are in a prime position to address the physical and motivational challenges participants face while living with severe obesity: targeting functional exercise capacity is one key strategy for addressing immobility associated with obesity. Copyright © 2015 John Wiley & Sons, Ltd.

Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa?

OBJECTIVE

The aim of this study was to examine the relationship between quality of life (QoL), weight, and eating disorder symptoms across treatment in individuals with severe and enduring anorexia nervosa (SE-AN).

METHOD

Participants were 63 adult females with SE-AN presenting to an outpatient, multisite randomized clinical trial. QoL was assessed using three well-validated QoL questionnaire measures, the EDQOL, SF-12, and WSAS. Participants' weight and severity of symptoms was assessed by Eating Disorder Examination (EDE) and weekly BMI change.

RESULTS

Predictors of QoL were evaluated in the context of concurrent, prospective,1 and lagged mixed-effects models. Changes in both BMI and EDE were found to significantly affect current and future QoL ratings.

DISCUSSION

Findings suggest that improvements in QoL may be dependent on symptom change and weight gain. Treatments seeking solely to improve QoL may be unlikely to produce lasting change and clinicians should maintain a focus on weight and behavioral symptoms as much as on improvements in QoL.

The effects of weight loss after bariatric surgery on health-related quality of life and depression

BACKGROUND

In severe obesity, impairments in health-related quality of life (HRQoL) and dysphoric mood are reported. This is a post-surgery analysis of the relationship between HRQoL and depressive symptoms, and weight change after four different types of bariatric procedures.

METHODS

A total of 105 consented patients completed the Short-Form-36 Health Survey (SF-36), the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and the Beck Depression Inventory (BDI) before and 25 months after surgery. Analysis of variance or Kruskal-Wallis test evaluated changes.

RESULTS

Patients with Roux-en Y gastric bypass (46 patients), decreased body mass indexes (BMIs; kg m(-)(2)) 47-31 kg m(-)(2) (P<0.0001); biliopancreatic diversion with duodenal switch (18 patients), decreased BMIs 57-30 kg m(-)(2) (P<0.0001); adjustable gastric banding (18 patients), decreased BMIs 45-38 kg m(-)(2) (P<0.0001); and sleeve gastrectomies (23 patients), decreased BMIs 58 42 kg m(-)(2) (P<0.0001). The excess percentage BMI loss was 69, 89, 36 and 53 kg m(-)(2), respectively (P<0.0001). Before surgery, the SF-36 differences were significant regarding bodily pain (P=0.008) and social functioning (P=0.01). After surgery, physical function (P=0.03), general health (P=0.05) and physical component (P=0.03) were different. IWQOL-Lite recorded no differences until after surgery: physical function (P=0.003), sexual life (P=0.04) and public distress (P=0.003). BDI scores were not different for the four groups at baseline. All improved with surgery, 10.6-4.4 (P=0.0001).

CONCLUSIONS

HRQoL and depressive symptoms significantly improvement after surgery. These improvements do not have a differential effect over the wide range of weight change.Nutrition & Diabetes (2014) 4, e132; doi:10.1038/nutd.2014.29; published online 1 September 2014.

Pathological motivations for exercise and eating disorder specific health-related quality of life

OBJECTIVE

To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL).

METHOD

Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores.

RESULTS

The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL.

DISCUSSION

Our results suggest that pathological motivations for exercise may exacerbate ED's detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL.

Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews

Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. This paper (1) reviews the results of the published studies using the structured interviews to assess psychopathology in bariatric surgery candidates; (2) compares the prevalence rates of psychiatric disorders across these studies with the data from other population samples; and (3) assesses whether sociodemographic variables appear to affect these prevalence rates. We searched online resources, PubMed, PsychINFO and reference lists of all the relevant articles to provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. The prevalence estimates in the non-treatment obese group did not appear to differ substantially from the general population group in the US or the Italian population samples, although they were relatively higher for the German population. However, the rates of psychopathology in the bariatric surgery candidates were considerably higher than the other two population groups in all the samples. Overall, the most common category of lifetime Axis I disorders in all the studies was affective disorders, with anxiety disorders being the most common category of current Axis I disorders. Certain demographic characteristics are also associated with higher rates of psychopathology, such as, female gender, low socioeconomic status, higher BMI. Overall, methodological and sociodemographic differences make these studies difficult to compare and these differences should be taken into account when interpreting the results.

Assessment of quality of life in people with severe and enduring anorexia nervosa: a comparison of generic and specific instruments

BACKGROUND

Criticisms that generic measures of health-related quality of life (HRQoL) are not sensitive to impairment in anorexia nervosa (AN) has spurred the development of disease-specific measures. This study aimed to compare the psychometric properties of a generic to a disease-specific measure of HRQoL.

METHODS

63 participants with AN completed measures of a generic HRQoL (SF-12), disease-specific HRQoL (Eating Disorders Quality of Life Questionnaire; EDQOL), functional impairment (days out of role; DOR; Work and Social Adjustment Scale; WSAS), and eating disorder severity (Eating Disorder Examination; EDE) at baseline, post-treatment, and 6- and 12-months follow-up. Cronbach's α was computed for the SF-12 and EDQOL (internal consistency). Correlations were assessed between SF-12/EDQOL scores and DOR, WSAS, and EDE scores (convergence validity). Three sets of three multiple linear regressions were performed using SF-12 and EDQOL scores as predictors and change in DOR, WSAS, and EDE global scores from baseline to (i) post-treatment, (ii) 6-month follow-up, (iii) and 12-month follow-up as dependent variables (predictive validity and sensitivity).

RESULTS

The EDQOL displayed stronger internal consistency (α = 0.92) than the SF-12 (α = 0.80). The SF-12 converged more strongly with DOR and the WSAS (r(p) = -0.31 to -0.63 vs. 0.06 to 0.70), while the EDQOL converged more strongly with the EDE (r(p) = -0.01 to 0.48 vs. -0.01 to -0.37). The SF-12 demonstrated stronger predictive validity (β = -0.55 to 0.29) and sensitivity to changes in ED severity (β = -0.47 to 0.32).

CONCLUSIONS

The SF-12 is a valid and sensitive measure of HRQoL impairment in patients with AN. While the SF-12 may be preferred in research comparing EDs to other populations, and in research and practice as an indicator of functional impairment; the EDQOL may be preferred by clinicians and researchers interested in HRQoL impairment specifically associated with an ED and as an additional indicator of ED severity.

Negative perceptions about condom use in a clinic population: comparisons by gender, race and age

We sought to elucidate the associations of 13 items assessing negative perceptions about condom use with gender, age and race in a sample of clinic attendees. Patients from four clinics, in three US cities, were recruited (N = 928). Data were collected using audio-computer-assisted self-interviewing. The primary measure was a 13-item adapted version of the Condom Barriers Scale. Logistic regression and chi-square tests were employed to relate the 13 items to gender, age and race. Gender, race and age all had significant associations with negative perceptions of condoms and their use. A primary finding was a large number of significant differences between men and women, with negative perceptions more common among women than among men. For African Americans, especially women, negative perceptions were more common among older participants than among younger participants. In conclusion, important demographic differences regarding negative perceptions may inform the tailoring of intervention efforts that seek to rectify negative perceptions about condoms and thus promote condom use among individuals at risk for sexually transmitted infections (STIs) in the USA. On the other hand, our findings also suggest that the majority of STI clinic attendees may hold positive perceptions about condoms and their use; maintaining and building upon these positive perceptions via education, counselling, and access is also important.

A comparison of condom use perceptions and behaviours between circumcised and intact men attending sexually transmitted disease clinics in the United States

This investigation compared circumcised and intact (uncircumcised) men attending sexually transmitted infection (STI) clinics on condom perceptions and frequencies of use. Men ( N = 316) were recruited from public clinics in two US states. Circumcision status was self-reported through the aid of diagrams. Intact men were less likely to report unprotected vaginal sex ( P < 0.001), infrequent condom use ( P = 0.02) or lack of confidence to use condoms ( P = 0.049). The bivariate association between circumcision status and unprotected sex was moderated by age ( P < 0.001), recent STD acquisition ( P < 0.001) and by confidence level for condom use ( P < 0.001). The bivariate association between circumcision status and infrequent condom use was also moderated by age ( P = 0.002), recent STI acquisition ( P = 0.02) and confidence level ( P = 0.01). Multivariate findings supported the conclusion that intact men may use condoms more frequently and that confidence predicts use, suggesting that intervention programmes should focus on building men's confidence to use condoms, especially for circumcised men.

Possible risk factors for increased suicide following bariatric surgery

OBJECTIVE

There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved.

DESIGN AND METHODS

The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, to delineate future research directions.

RESULTS

First a variety of medical, biological, and genetic factors, including the persistence or recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed.

CONCLUSIONS

A number of possible contributing factors have been identified. Possible theoretical models involved and directions for research are suggested.

Cognitive function predicts weight loss after bariatric surgery

BACKGROUND

Clinically significant cognitive impairment is found in a subset of patients undergoing bariatric surgery. These difficulties could contribute to a reduced adherence to postoperative lifestyle changes and decreased weight loss. The present study is the first to prospectively examine the independent contribution of cognitive function to weight loss after bariatric surgery. Executive function/attention and verbal memory at baseline were expected to negatively predict the percentage of excess weight loss (%EWL) and body mass index (BMI) at follow-up. Three sites of the Longitudinal Assessment of Bariatric Surgery parent project were used: Columbia (New York, NY), Cornell (Princeton, NJ), and the Neuropsychiatric Research Institute (Fargo, ND).

METHODS

A total of 84 individuals enrolled in the Longitudinal Assessment of Bariatric Surgery project undergoing bariatric surgery completed a cognitive evaluation at baseline. The BMI and %EWL were calculated at the 12-week and 12-month postoperative follow-up visits.

RESULTS

Clinical impairment in task performance was most prominent in tasks associated with verbal recall and recognition (14.3-15.5% of the sample) and perseverative errors (15.5%). After accounting for demographic and medical variables, the baseline test results of attention/executive function and memory predicted the BMI and %EWL at 12 months but not at 12 weeks.

CONCLUSIONS

These results have demonstrated that baseline cognition predicts for greater %EWL and lower BMI 12 months after bariatric surgery. Additional work is needed to clarify the degree to which cognition contributes to adherence and the potential mediation of cognition on the relationship between adherence and weight loss in this group.

Rating of Eating Disorder Severity Interview for Children: psychometric properties and comparison with EDI-2 symptom index

OBJECTIVE

This study aimed to evaluate the psychometrics of the Rating of Eating Disorder Severity Interview for Children (REDS-C) and compare it with the Eating Disorder Inventory-2 symptom index.

METHODS

The psychometrics of the REDS-C were analyzed utilizing data from 336 patients, of ages 8 to 18 years. Receiver operator curve analyses were performed to evaluate the ability of the REDS-C and the Eating Disorder Inventory-2 symptom index to discriminate severity of eating disorder symptoms in relationship to an objective standard, defined as hospitalisation for medical stabilisation beyond 1 week.

RESULTS

Three factors were identified using 14 of the 16 original REDS-C items. Resulting subscales demonstrated acceptable reliability and validity. The receiver operator curve results demonstrated the usefulness of the 14-item version of the REDS-C in predicting hospitalisation greater than 7 days as an indicator of symptom severity.

DISCUSSION

The 14-item REDS-C is a reliable tool to assist clinicians in evaluating the severity of eating disorder symptoms in children and adolescents.

Smokers' thoughts and worries: a study using ecological momentary assessment

OBJECTIVE

The purpose of this study was to investigate smokers' thoughts and worries about their smoking behavior. Researchers have sometimes asked smokers to make such self-assessments but typically using retrospective summary judgments.

DESIGN

Using ecological momentary assessment, community and student smokers reported five times daily during two separate 1-week intervals.

MAIN OUTCOME MEASURES

Smokers reported their thoughts about smoking, worries about smoking, and level of contemplation to quit smoking.

RESULTS

Smokers reported thinking negatively about their smoking 26.8% of the time they had a cigarette. The most frequent thoughts reported by smokers related to immediate reinforcement of smoking (e.g., "How I smell like cigarettes"). However, smokers reported more intense worry about thoughts related to health concerns (e.g., "Symptoms I'm having because of smoking"). The occurrence of negative thoughts was significantly and positively related to contemplation about quitting, worry about smoking, and risk perceptions. Finally, self-reported worry intensity was more strongly related to contemplation of quitting than negative thought occurrence.

CONCLUSION

Our results show that thoughts about smoking (i.e., cognitions) and feelings about smoking (i.e., worry) are loosely connected and it is feelings rather than cognitions that are most related to contemplation to quit.

Health care utilization in patients with eating disorders

OBJECTIVE

To examine health care costs among patients with eating disorders (EDs) using the Blue Cross Blue Shield of North Dakota claims database system.

METHOD

Four groups of individuals enrolled between 1999 and 2005 were identified: (1) a group diagnosed with EDs at the beginning of the study period, in 2000 or 2001; (2) a group diagnosed with EDs later in the study period, in 2004 or 2005; (3) a comparison group with depression; and (4) a non-eating disordered comparison group.

RESULTS

Health care costs were high for patients diagnosed with an ED during the period when the diagnosis was made but remained elevated in the years following. Such costs were consistently higher than those for the non-eating disordered comparison group, but similar to the depression comparison group.

DISCUSSION

Health care costs remained elevated after a diagnosis of an ED for an extended period of time.

Predictors of response to cognitive behavioral treatment for bulimia nervosa delivered via telemedicine versus face-to-face

OBJECTIVE

This study presents the results of a receiver operating characteristics (ROC) analysis to evaluate response to cognitive behavioral treatment (CBT) for patients with bulimia nervosa (BN), delivered via telemedicine (TV-CBT) or face-to-face (FTF-CBT).

METHOD

Data were gathered on 116 adults treated with CBT for BN. Response to treatment (i.e., percent reduction in binge eating and purging behavior) were examined at weeks two, four, six, and eight. ROC analysis was completed to predict abstinence at end of treatment (EOT) as well as 3-month and 1-year follow-up for the entire sample and by treatment group (TV-CBT versus FTF-CBT).

RESULTS

ROC analyses revealed that abstinence at EOT and 1-year follow-up was predicted by percent reduction in binge eating behavior whereas abstinence at 3-month follow-up was predicted by percent reduction in purging behavior. Results showed differences in predictors of treatment response when ROC analyses were completed for the entire sample and by treatment group.

DISCUSSION

Results suggest that evaluating percent reduction in binge eating and purging at weeks two, four, six, and eight of treatment is a clinically useful tool for predicting treatment response at EOT, 3-month, and 1-year follow-up.

Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents

BACKGROUND

Anorexia nervosa (AN) is associated with behavioral traits that predate the onset of AN and persist after recovery. We identified patterns of behavioral traits in AN trios (proband plus two biological parents).

METHOD

A total of 433 complete trios were collected in the Price Foundation Genetic Study of AN using standardized instruments for eating disorder (ED) symptoms, anxiety, perfectionism, and temperament. We used latent profile analysis and ANOVA to identify and validate patterns of behavioral traits.

RESULTS

We distinguished three classes with medium to large effect sizes by mothers' and probands' drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance. Fathers did not differ significantly across classes. Classes were distinguished by degree of symptomatology rather than qualitative differences. Class 1 (approximately 33%) comprised low symptom probands and mothers with scores in the healthy range. Class 2 ( approximately 43%) included probands with marked elevations in drive for thinness, body dissatisfaction, neuroticism, trait anxiety, and harm avoidance and mothers with mild anxious/perfectionistic traits. Class 3 (approximately 24%) included probands and mothers with elevations on ED and anxious/perfectionistic traits. Mother-daughter symptom severity was related in classes 1 and 3 only. Trio profiles did not differ significantly by proband clinical status or subtype.

CONCLUSIONS

A key finding is the importance of mother and daughter traits in the identification of temperament and personality patterns in families affected by AN. Mother-daughter pairs with severe ED and anxious/perfectionistic traits may represent a more homogeneous and familial variant of AN that could be of value in genetic studies.

Eating disorder symptoms in pregnancy: a prospective study

OBJECTIVE

Previous work suggests that eating disorder symptoms diminish with pregnancy. However, little prospective study has been conducted, and little is known about pregnancy symptoms in eating disorder not otherwise specified. This research prospectively studies both eating behaviors and disordered eating cognitions in pregnant women with various eating disorder diagnoses.

METHOD

Forty-two participants became pregnant during 4-year follow-up of 385 women with full or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder. Participants completed the Eating Disorders Examination (EDE) at 6-month intervals. Mixed modeling procedures were used to examine change in eating disorder cognitions, binge eating, and purging.

RESULTS

EDE restraint, EDE shape concerns, EDE weight concerns, binge eating, and purging diminished from prepartum to intrapartum, but returned to approximately baseline levels postpartum.

CONCLUSION

In this longitudinal sample of women with diverse eating disorder diagnoses, eating disorder symptoms improved during pregnancy, but worsened postpartum. These results highlight pregnancy as a potential time for eating disorder interventions.

Is multi-impulsive bulimia a distinct type of bulimia nervosa: Psychopathology and EMA findings

OBJECTIVE

To determine if clinically defined multi-impulsive bulimia (MIB) can be validated using an empirical classification approach.

METHOD

One hundred and twenty-five women who met DSM-IV criteria for bulimia nervosa were interviewed and completed a two-week EMA protocol. Participants who reported at least three highly impulsive behaviors were compared to participants who did not report such impulsive behavior. Also, Latent Class Analysis (LCA) was conducted to determine if the MIB classification could be replicated empirically.

RESULTS

LCA produced a two-class solution consistent with the traditional clinical approach to MIB classification. In both approaches, MIB was associated with higher levels of anxiety disorders, child abuse, and daily self-damaging behaviors than the non-MIB class.

CONCLUSION

Clinical classification of MIB was empirically supported through LCA. Although the classes failed to differ in bulimic behavior, MIB appears to represent a group of bulimic individuals with significant trauma histories and associated psychopathology.

Remission from pathological gambling among Hispanics and Native Americans

This community survey studied remission from pathological gambling (PG) among American Indian (AI) and Hispanic American (HA) veterans. Remission was defined as having a lifetime diagnosis of PG, but no gambling symptoms in the last year. Sample consisted of 1624 AI and Hispanic veterans. Instruments included demographic data, the computer-based algorithmic Quick Diagnostic Interview Schedule Symptom, and three symptom checklists, one each for substance related problems (MAST/AD), anxiety and depressive symptoms (BSI-57), and combat-related post-trauma symptoms (PCL/M). Remission was associated with absence of a current Axis 1 diagnosis, especially absence of a current post-traumatic stress disorder.

Eating disorders and personality: A methodological and empirical review

Methodological approaches utilized to evaluate models of the relationship between personality and eating disorders, as well as empirical support for each model, are reviewed. Limited prospective research suggests that negative emotionality, perfectionism, drive for thinness, poor interoceptive awareness, ineffectiveness, and obsessive-compulsive personality traits are likely predisposing factors. Limited family study research suggests that obsessive-compulsive personality disorder (OCPD) and anorexia nervosa share a common familial liability. Potential pathoplastic personality factors include Cluster B personality disorders and OCPD, which predict a poorer course and/or outcome, and histrionic personality traits and self-directedness, which predict a more favorable course and/or outcome. Future research should focus upon sophisticated prospective and family study research in order to best evaluate competing models of the eating disorder-personality relationship.

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders

OBJECTIVE AND METHOD

To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232).

RESULTS

Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment.

CONCLUSION

The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.

Sweet intake, sweet-liking, urges to eat, and weight change: relationship to alcohol dependence and abstinence

INTRODUCTION

Linkages between alcohol dependence (AD) and abstinence and aspects of food ingestion and preference have been described in animals and humans, including (1) eating sweets decreases urges to drink alcohol; (2) preferences for highly sweet tastants is associated with alcohol dependence; and (3) food deprivation leads to increased alcohol intake.

METHODS

We randomly assigned AD subjects in early abstinence to 3 different sets of dietary instructions (eat sweets for alcohol urges; eat a balanced diet; avoid sweets). We compared the groups on urges for alcohol, alcohol consumption, weight, and sweet preference at baseline, one, and six months. We also compared these AD subjects with light-drinking C's and compared AD subjects who remained abstinent for 6 month follow-up with nonabstinent AD subjects.

RESULTS

Recruited AS subjects, 38 of 68, completed 6 month follow-up; 27 of 36 C's completed the follow-up. 21 AD's were abstinent while 17 were non-abstinent. There was no effect of dietary recommendations on urges to drink or alcohol consumption. AD's were more likely than C's to prefer highly sweet tastants. The proportion of AD's preferring the sweetest tastant decreased over time. AD's gained more weight than C's over the 6-month follow-up.

DISCUSSION

While the use of sweets did not affect urges to drink or drinking, important relationships between sweet preference, weight gain, and alcohol dependence or abstinence were identified.

The association between gang involvement and sexual behaviours among detained adolescent males

OBJECTIVE

Data were collected from 270 detained male adolescents (aged 14-18 years) to determine the association between ever having been in a gang and a range of sexual behaviours such as sexual activity, male condom use, sex with multiple partners, and drug use during sex.

METHODS

Participants answered survey questions using audio computer assisted self interviewing (A-CASI) procedures, which assessed demographic, family factors, history of gang membership, and sexual behaviours.

RESULTS

Multiple logistic regression analyses, controlling for demographic, socioeconomic status, and family factors, indicated that adolescents who reported having been in a gang, relative to their peers reporting no gang involvement, were 5.7 times more likely to have had sex, 3.2 times more likely to have got a girl pregnant, and almost four times more likely to have been "high" on alcohol or other drugs during sexual intercourse, have had sex with a partner who was "high" on alcohol or other drugs, or have had sex with multiple partners concurrently.

CONCLUSIONS

Findings suggest that having been in a gang can discriminate between levels of STI associated risk behaviours among an otherwise high risk population-detained adolescent males.

Use of recreational Viagra among men having sex with men

OBJECTIVE

Given the potential for Viagra (sildenafil) use to foster greater friction during sex (owing to enlarged erection size) and prolonged sex, the recreational use of this substance warrants investigation in the context of STI risk. Thus, an exploratory study was conducted to identify bivariate correlates of recreational (non-prescription) Viagra use among men who have sex with men (MSM) attending a popular sex resort for men located in the southern United States.

METHODS

A cross sectional study was conducted. Behavioural measures, including Viagra use, were assessed using a 3 month recall period.

RESULTS

Of 164 men asked to participate, 91% completed a self administered questionnaire. Men resided in 14 states, most of which were located in the southern United States. Their average age was 40 years. Most (93%) men self identified as white. The median annual income interval was $25,000 to $50,000. One sixth (16.7%) reported being HIV positive. 16% reported using non-prescription Viagra. Age (p=0.41), income (p=0.32), and HIV serostatus (p=0.85) were not associated with Viagra use. Of men recently using ecstasy during sex, 35% reported Viagra use compared to 13% among those not using ecstasy (p=0.01). Of men recently using cocaine during sex, 37% reported Viagra use compared to 13% among those not using cocaine (p=0.009). Use of "poppers" approached, but did not achieve, statistical significance as a correlate of Viagra use (p=0.06). Recent frequency of unprotected anal sex (p=0.79), fisting (p=0.10), rimming (p=0.64), and having five or more sex partners (p=0.09) were not associated with Viagra use.

CONCLUSION

Recreational Viagra use was relatively common among men, regardless of age or HIV serostatus. Viagra use was associated with men's substance abuse behaviours rather than their sexual risk behaviours.