Abstracts
Depression (Appetite Disorders)
Depression
Assessed eating behavior of severely depressed patients in order to investigate the behavioral mechanisms underlying the weight gain induced by antidepressants.
Assessments included food intake, appetite and food preferences. Before treatment, there was a decrease in appetite and in food intake with a relative excess of carbohydrates and a preference for sweets.
Maintenance treatment was associated with substantial weight gain. All differences in eating behavior between patients and controls disappeared, with the exception of a decrease in appetite in a subgroup of less-improved patients.
Results suggest that antidepressant treatment induces weight gain by mechanisms that are largely independent of their action on mood.
Kazes M et al., Eating behavior and depression before and after antidepressant treatment: a prospective, naturalistic study. J Affect Disord, 1994 Mar, 30:3, 193-207.
Ethnicity
Ethnicity
Examined ethnic differences in factors associated with disordered eating behaviors.
Data were collected from 17,159 adolescent females who completed a school-based health survey conducted in 1987.
In all ethnic groups, dieting was associated in bivariate analyses with weight dissatisfaction, perceived overweight, and low body pride. Purging was associated with weight dissatisfaction, perceived overweight, low body pride, greater suicide risk, and greater alcohol use. Binge eating was associated with weight dissatisfaction, perceived overweight, low body pride, lower family connectedness, greater peer acceptance concerns, and emotional stress.
Body dissatisfaction and perceived overweight are consistent correlates of dieting and binge eating in adolescent females of diverse ethnic groups. Ethnic subculture does not appear to protect against the broader sociocultural factors that foster body dissatisfaction among adolescent females.
Implications for understanding sociocultural influences on dieting, obesity, and eating disorders are discussed.
French SA et al., Ethnic differences in psychosocial and health behavior correlates of dieting, purging, and binge eating in a population-based sample of adolescent females. Int J Eat Disord, 1997 Nov, 22:3, 315-22.
Gender (1)
Gender (1)
It is crucial to explain the large gender discrepancy in the rates of these disorders, especially anorexia nervosa and bulimia nervosa.
Findings indicated a small, heterogeneous positive relationship between femininity and eating problems and a small, heterogeneous negative relationship between masculinity and eating problems.
Crucial aspects of femininity likely to be related to eating problems need to be operationalized and their link to eating disorders examined.
Murnen SK & Smolak L: Femininity, masculinity, and disordered eating: a meta-analytic review. Int J Eat Disord, 1997 Nov, 22:3, 231-42.
Gender (2) - Stress
Gender (2) - Stress
The relationship between psychological factors and changes in food intake during stress was assessed using questionnaires. Participants completed the State-Trait Anxiety Inventory, the Eating Inventory (which includes scales for disinhibition, cognitive restraint and perceived hunger) the Restraint Scale, the Eating Attitudes Test and the Binge Scale; and reported their height and weight.
Men and women were divided into two groups regarding changes in eating habits during stress: increased intake and no increased intake. There were no significant differences between genders in the proportions of participants in each group. However, correlational analyses revealed different patterns of associations for males and females. For females, high scores on disinhibition were significantly correlated with eating more than usual during a specific stressful experience as well as during stress, in general, while high scores on cognitive restraint were not. For males, neither disinhibition nor cognitive restraint were associated with the relationship between eating and stress. Scores on disinhibition discriminated over 80% of females who reported increased intake during stress from those who reported no increased intake.
In females, the inability to maintain control of self-imposed rules concerning food intake is an important factor in the relationship between stress and eating.
Weinstein SE et al., Changes in food intake in response to stress in men and women: psychological factors. Appetite, 1997 Feb, 28:1, 7-18.
Neuropeptides
Neuropeptides
Neuropeptide Y increases "blood pressure" and appetite, disorders of which have a genetic component. The present study examined the neuropeptide-Y Y1 receptor "gene" (NPYY1R) for involvement in essential "hypertension" (HT) and "obesity".
Conclusion, variant(s) in linkage disequilibrium with the NPYY1R RFLP are not involved in HT or obesity.
Herzog-H: Neuropeptide-Y Y1 receptor gene polymorphism: cross-sectional analyses in essential hypertension and obesity. Biochem-Biophys-Res-Commun. 1993 Oct 29; 196(2): 902-6.
Overview (Appetite Disorders)
Overview
The main forms of eating disorders are anorexia and bulimia nervosa and obesity.
Whilst the body weight of anorexics are by definition low, most bulimics have normal or near normal body weight. Sufferers of anorexia nervosa tend to deny their illness while those with bulimia are often miserable and acutely aware of their eating difficulties.
The aetiological factors in both conditions overlap to a large extent. The outcome of treatment for bulimia is reportedly better than that of anorexia nervosa.
Obese people often become depressed and anxious as a result of low self-esteem causing them to seek psychiatric treatment. The severely obese who are placed on very low calorie diets may develop adverse emotional disturbances whilst weight gain may follow a major depressive illness or develop as a side effect of psychotropic medications.
A subgroup of the obese population engage in frequent binge eating and preliminary criteria are being developed for this condition called "binge eating disorder". Behaviour therapy is the treatment of choice for obesity. Other forms of treatment include individual and group psychotherapy, use of appetite suppressants and in the severely obese, surgical methods.
Low BL Eating disorders. Singapore Med J, 1994 Dec, 35:6, 631-4.
Rumination Syndrome
Rumination Syndrome
To investigate the diagnostic studies necessary to identify rumination syndrome and the long-term therapeutic outcomes of patients with rumination syndrome.
Esophageal and upper gastrointestinal motility, gastric emptying, and electrogastrographic studies were all normal.
Five of 10 patients used biofeedback and relaxation techniques and reported subjective improvement.
Results indicate that rumination syndrome is often confused with a gastric motility disorder and diagnosis is possible if one is aware of this condition. Although there is not a definitive management protocol for this condition, reassurance and education of the patient and the family are crucial first steps followed by behavioral and relaxation programs.
Soykan I et al., The rumination syndrome: clinical and manometric profile, therapy, and long-term outcome. Dig Dis Sci, 1997 Sep, 42:9, 1866-72.
Season (Appetite Disorders)
Season
Patients with bulimia nervosa (BN) often have seasonal patterns of mood and appetite that compare with patterns seen in seasonal affective disorder (SAD). Seasonal patterns in other eating disorder (ED) subgroups have not been adequately described.
AN patients had significantly less seasonal variation overall than either bulimic subgroup, as measured by the global seasonality score (GSS) on the Seasonal Patterns Assessment Questionnaire (SPAQ). AN patients also showed less seasonal change in mood, weight, and energy than BN patients, and less variation in mood and appetite than AN/BN patients.
Fornari VM et al., Seasonal patterns in eating disorder subgroups. Compr Psychiatry, 1994 Nov-Dec, 35:6, 450-6.
Sorority
Sorority
If a subgroup of college women are at increased risk for disordered eating. The sorority members were administered Body Mass Index Silhouettes and the Eating Disorder Inventory.
Findings indicated that these sorority women may have a greater fear of becoming fat, are more dissatisfied with their bodies, and are more weight preoccupied and concerned with dieting than are college women from previous studies.
Also, body size perceptions were distorted among both underweight and overweight women and that thin was the ideal body profile for the majority.
Although bulimia scores were higher for this population than for those reported in all but one of the previous studies, these differences were not significant.
Schulken ED et al., Sorority women's body size perceptions and their weight-related attitudes and behaviors. J Am Coll Health, 1997 Sep, 46:2, 69-74.
Nutritional Intervention
Nutritional Intervention
Abnormal nutritional status and dietary patterns are central features of the eating disorders. Normalization of these features are key components of treatment and recovery because they are powerful perpetuating factors.
Restrictive diets, fat avoidance, and abnormal cognitive and perceptual patterns are typically present, in addition to altered nutritional parameters because of hormonal and metabolic factors.
The primary goal of nutrition intervention in anorexia nervosa is to promote weight gain through increased energy intake, expansion of the diet, and knowledgeable and empathetic dietary counseling. A regular pattern of nutritionally balanced, planned meals and snacks, and the avoidance of restrictive dieting, are essential elements of treatment for the patient with bulimia nervosa.
Rock CL & Curran-Celentano J: Nutritional management of eating disorders. Psychiatr Clin North Am, 1996 Dec, 19:4, 701-13.
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