Therapeutic outcome of adjustable gastric banding in morbid obese patients.

We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

Family study of the aggregation of eating disorders and mood disorders.

BACKGROUND: Family studies have suggested that eating disorders and mood disorders may coaggregate in families. To study further this question, data from a family interview study of probands with and without major depressive disorder was examined. METHOD: A bivariate proband predictive logistic regression model was applied to data from a family interview study, conducted in Innsbruck, Austria, of probands with (N = 64) and without (N = 58) major depressive disorder, together with 330 of their first-degree relatives. RESULTS: The estimated odds ratio (OR) for the familial aggregation of eating disorders (anorexia nervosa, bulimia nervosa and binge-eating disorder) was 7.0 (95 % CI 1.4, 28; P = 0.006); the OR for the familial aggregation of mood disorders (major depression and bipolar disorder) was 2.2 (0.92, 5.4; P = 0.076); and for the familial coaggregation of eating disorders with mood disorders the OR was 2.2 (1.1, 4.6; P = 0.035). CONCLUSIONS: The familial coaggregation of eating disorders with mood disorders was significant and of the same magnitude as the aggregation of mood disorders alone--suggesting that eating disorders and mood disorders have common familial causal factors.

Association of olanzapine-induced weight gain with an increase in body fat.

OBJECTIVE: The goal of this study was to explore the pathophysiology of weight gain during treatment with olanzapine for schizophrenia. METHOD: The authors used a prospective, controlled, open study comparing body weight, body mass index, and related biological measures in mentally and physically healthy volunteers and olanzapine-treated patients with schizophrenia. Weight, eating behavior, leptin serum levels, body mass index, and body composition were assessed over an 8-week observation period. RESULTS: A significant increase in body weight, leptin serum levels, and percentage of body fat was seen in patients treated with olanzapine, but the drug-free comparison group did not show any significant changes. The weight gain during antipsychotic treatment with olanzapine was mainly attributable to an increase in body fat; patients' lean body mass did not change. CONCLUSIONS: In addition to the original finding that an increase in body fat is mainly responsible for olanzapine-induced weight gain, these findings confirm results obtained in other studies showing increases in body weight and serum leptin levels during treatment with second-generation antipsychotics.

Flow-mediated, endothelium-dependent vasodilatation is impaired in male body builders taking anabolic-androgenic steroids.

Self-administration of anabolic-androgenic steroids to increase muscular strength and lean body mass has been used widely among athletes. Flow mediated dilatation (FMD) determined by ultrasound of the brachial artery is accepted as both an in vivo index of endothelial function and an indicator for future atherosclerosis. FMD was calculated in 20 male non-smoking body builders in different phases of their training cycle and in six male non-smoking control athletes. Ultrasound studies of the brachial artery were performed according to the protocol of Celermajer et al. Of the entire training cycle, work-out phase was training phase without actual intake of anabolic-androgenic steroids over 8 weeks; build-up phase included actual intake of anabolic-androgenic steroids; and competition phase consisted of 8 weeks post intake of anabolic-androgenic steroids. Baseline characteristics did not differ between body builder groups except for a higher weight in competition phase body builders. Hormonal analysis revealed suppressed luteinizing hormone and follicle stimulating hormone levels in build-up phase body builders. The lipid profiles showed a marked reduction of HDL-C in build-up phase body builders. FMD was reduced in body builders of all phases when compared to control athletes (work-out phase: 2.5+/-2.7%; build-up phase: 2.1+/-3.0%; competition phase: 0.4+/-2.9% vs. 10.9+/-4.4%, P<0.05 by pairwise comparison using Scheffe's test for work-out phase, build-up phase and competition phase vs. control athletes). The glyceryl trinitrate-induced vasodilatation was diminished, though not statistically significantly, in body builders when compared with control athletes. The differences in FMD persisted after adjustment for vessel size. Our data indicate that intake of anabolic-androgenic steroids is associated with both an atherogenic blood lipid profile and endothelial dysfunction and thus may pose an increased risk of atherosclerosis.

[Quality of life of patients with eating disorders. A catamnestic study]. / Lebensqualität essgestörter Patientinnen. Eine Katamneseerhebung.

OBJECTIVE: To assess the eating behaviour, quality of life and changes in life style in 46 female patients with eating disorders, discharged from our psychosomatic unit at least six month ago. METHODS: Patients meeting the criteria for DSM-IV anorexia nervosa or bulimia nervosa completed the "Lancashire Quality of Life Profile" [16] and a questionnaire covering demographic aspects, eating behaviour and changes in life style. RESULTS: Positive changes in eating behaviour correlated with higher quality of life scores in many of the domains assessed, including leisure, financial situation and perceived mental health. These changes also correlated with positive changes in life style in several domains, in particular family situation and leisure activities. CONCLUSIONS: Results show that various connections between eating behaviour and quality of life as well as life style exist, suggesting a treatment concept that emphasizes both clinical symptoms and psycho-social conflicts.

Body image and psychopathology in male bodybuilders.

BACKGROUND: To compare male bodybuilders to men with eating disorders and control men regarding body image, psychopathology and sexual history. METHOD: We compared 28 male bodybuilders, 30 men with eating disorders (anorexia nervosa, bulimia or binge eating disorder defined by DSM-IV), and 30 controls, using a battery of questionnaires covering weight history, eating behavior, body image, lifetime history of psychiatric disorders, and sexuality. Eating-disordered and control men were recruited from a college student population and studied during the course of an earlier investigation. RESULTS: Bodybuilders exhibited a pattern of eating and exercising as obsessive as that of subjects with eating disorders, but with a 'reverse' focus of gaining muscle as opposed to losing fat. Bodybuilders displayed rates of psychiatric disorders intermediate between men with eating disorders and control men. In measures of body image, the bodybuilders closely resembled the men with eating disorders, but significantly differed from the control men, with the former two groups consistently displaying greater dissatisfaction than the latter. Sexual functioning did not distinguish the three groups except for the item 'lack of sexual desire' which was reported significantly more often by both bodybuilders and men with eating disorders. CONCLUSION: On measures of body image and eating behavior, bodybuilders share many features of individuals with eating disorders.

Body image perception among men in three countries.

OBJECTIVE: The authors tested the hypothesis that men in modern Western societies would desire to have a much leaner and more muscular body than the body they actually had or perceived themselves to have. METHOD: The height, weight, and body fat of college-aged men in Austria (N=54), France (N=65), and the United States (N=81) were measured. Using the somatomorphic matrix, a computerized test devised by the authors, the men chose the body image that they felt represented 1) their own body, 2) the body they ideally would like to have, 3) the body of an average man of their age, and 4) the male body they believed was preferred by women. The men's actual fat and muscularity was compared with that of the four images chosen. RESULTS: Only slight demographic and physical differences were found among the three groups of men. Modest differences were found between the men's measured fat and the fat of the images chosen. However, measures of muscularity produced large and highly significant differences. In all three countries, men chose a ideal body that was a mean of about 28 lb (13 kg) more muscular than themselves and estimated that women preferred a male body about 30 lb (14 kg) more muscular than themselves. In a pilot study, however, the authors found that actual women preferred an ordinary male body without added muscle. CONCLUSIONS: The wide discrepancy between men's actual muscularity and their body ideals may help explain the apparent rise in disorders such as muscle dysmorphia and anabolic steroid abuse.

The weeping behavior in anorexic and bulimic females.

BACKGROUND: The aim of the study was to examine the proneness, the functions and triggering situations of weeping in anorexic and bulimic women. METHODS: Participants were 36 anorexic and 31 bulimic female patients and 56 age-matched female controls. All women completed the Questionnaire on Adult Crying. We limited our study to results on 'crying proneness', 'functions of crying' and 'determining factors of crying'. RESULTS: Bulimic patients reported to have cried significantly more often in the last 4 weeks, to be more likely to cry in situations of distress and to have used weeping significantly more often as a manipulative behavior than control women. Anorexic patients rated their tendency to cry significantly lower and experienced weeping as significantly more negative than controls. CONCLUSIONS: Compared to control women, anorexic patients associated weeping with negative feelings as opposed to bulimic patients who appeared to use weeping on an intentional basis. These deviations from control women seem to mirror the introvert character of anorexic patients and the extrovert impulsive personality of patients with bulimia nervosa, respectively.

Binge eating disorder in females: a population-based investigation.

OBJECTIVE: The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD: A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS: Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION: Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.

Knowledge of calories and its effect on eating behavior in overweight, normal weight, and underweight individuals.

BACKGROUND: To assess changes in the eating behavior of overweight, normal weight, and underweight individuals in response to knowledge about the caloric content of their food. METHODS: Anonymous self-report questionnaires were completed by 1041 staff members attending the Innsbruck University Hospital cafeteria shortly after it started to display the caloric content of all meals. The questions covered the subjects' weight history, body image, eating behavior, and response to knowledge of caloric content. RESULTS: Among the respondents, 141 were classified as overweight, 728 as normal weight, and 118 as underweight. Overweight individuals reported a significantly more frequent change in eating behavior in response to the information, and were also significantly more distressed about weight and eating and dissatisfied with their bodies and their weight than normal and underweight individuals. CONCLUSIONS: Overweight individuals were more likely to report that they had modified their eating in response to information about calories. Whether this reflects an actual change in eating behavior, or merely a wish to give socially desirable responses, remains uncertain.

Binge eating disorder in males: a population-based investigation.

The authors investigated the prevalence of binge eating behavior in a general male Austrian population. A randomly selected sample of 1000 male adults aged 18 to 88 was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. The results showed a total prevalence of eating disorders of 14.9%. Eight subjects (0.8%) met the full diagnostic criteria for binge eating disorder (BED), 42 (4.2%) exhibited a partial binge eating syndrome, 94 (9.4%) an Eating Disorder Not Otherwise Specified, and five subjects (0.5%) a bulimia nervosa. Most subjects with a eating disorder were overweight or obese, particularly those with a full BED syndrome. Our findings indicate that full BED syndromes are very rare in a nonclinical male sample, whereas partial syndromes are fairly common in males.

[Eating disorders in males: a representative survey]. / Essstörungen bei Männern: Eine Repräsentativerhebung.

The present study examined the prevalence of eating disorders in a male representative random sample in Tyrol. The data were collected by telephone. Of the 1000 men, 8 (0.8%) met the DSM-IV diagnostic criteria for binge eating disorder. An additional 42 subjects (4.2%) exhibited a partial binge eating syndrome. These two otherwise widely identical groups of binge eaters were separated only by the DSM-IV frequency criterion. Five subjects (0.5%) met the DSM-IV criteria for the diagnosis of bulimia nervosa, and 94 men (9.4%) reported recurrent overeating. Men with any eating disorder were mostly overweight or obese. The findings show that there is a significant difference in eating disorders between men and women, but certain eating disorders are frequent not only in women but also in men.

Eating-disordered behavior in males: the impact of adverse childhood experiences.

OBJECTIVE: The authors examined the possible relationship of childhood sexual abuse, physical abuse, and dysfunctional family background and the risk for developing an eating disorder in adult males. METHOD: Several anonymous questionnaires were distributed to male university students. RESULTS: Of the 301 men, 12 (4.0%) had experienced childhood sexual abuse, 11 (3.6%) had been victims of physical abuse, 79 (26.2%) reported an adverse family background, and 14 (4.6%) had an increased risk for developing an eating disorder. There were no significant differences in the risk for developing an eating disorder and in total EDI between victims and nonvictims, but a significantly increased risk for eating disorders in men with an adverse family background. DISCUSSION: The findings suggest that long-lasting negative familial relationships, particularly in connection with physically abusive experiences, may increase the risk for eating disorders.

Drug use and lifestyle among college students in Austria and the United States.

Using an anonymous questionnaire, we assessed the prevalence of alcohol use and illicit drug use among 545 college students in Innsbruck, Austria in 1995. The questionnaire also assessed various aspects of students' lifestyles, including academic performance, college activities, career plans, visits to a psychiatrist, and sexual activity. We compared these results with those obtained using the same questionnaire at a similar American college in 1989. We found that the prevalence of virtually all forms of illicit substance use was much higher among the American students. In both Austria and the United States, however, we found few differences between drug users and nonusers on most measures of lifestyle, with the exception of hetero-sexual activity.

[Sexual dysfunctions in men and women: significance of a dysfunctional family climate and sexual abuse]. / Sexuelle Funktionsstörungen bei Männern und Frauen: Bedeutung eines dysfunktionalen Familienklimas und sexuellen Missbrauchs.

The authors examined by questionnaire the prevalence and the possible relationship of childhood sexual abuse and dysfunctional family background to the later sexual dysfunctions in a nonclinical male and female student sample. Of the 202 females, 44 (21.8%) reported a narrowly defined childhood sexual abuse, of the 301 men who completed the questionnaires 29 (9.6%) reported any kind of a sexually abusive experience, and 17 (5.6%) were victims of a marked childhood sexual victimization. 66 (32.6%) females and 79 (26%) males reported an adverse family background. Long-lasting adverse familial relationship to attachment figures were significant to later sexual dysfunctions in both sexes. Women, who reported repeated childhood sexual abuse, reported significantly more frequently sexual desire disorder and orgasm disorder. However, males who experienced-in most cases single-childhood sexual abuse, showed not more frequently sexual dysfunctions than nonvictims.

Eating disorders in Austrian men: an intracultural and crosscultural comparison study.

BACKGROUND: We compared 30 male university students with eating disorders and 30 male comparison subjects without eating disorders recruited by advertisement at Innsbruck University, Austria. METHODS: Subjects were interviewed using instruments that we had previously used in a controlled study of college men with eating disorders in the United States. RESULTS: The Austrian men with eating disorders differed sharply from Austrian comparison subjects, but closely resembled their American counterparts, on prevalence of personal and familial psychopathology, adverse family experiences, and scores on rating scales for eating disorder. Interestingly, dissatisfaction with body image was consistently greater among American subjects regardless of eating disorder status. CONCLUSIONS: Our data suggest a weak association between eating disorders and homosexual or bisexual orientation in men and no consistent association between eating disorders and childhood sexual abuse.

Bulimia nervosa in Austria and the United States: a controlled cross-cultural study.

OBJECTIVE: We sought to compare the features of bulimic subjects in two countries (Austria and the United States). METHOD: To assess how bulimia nervosa presents in different cultural settings, we interviewed 33 women recruited from the University of Innsbruck, Austria, who met DSM-III-R criteria for bulimia nervosa and 33 bulimic women recruited from two universities in Massachusetts. Preliminary results on these bulimic groups have previously been reported. The present study adds a control group of 33 Austrian women and 33 Boston women who were recruited and interviewed by identical methods. RESULTS: Bulimic women in both countries proved significantly distinguishable from controls on eating behavior, attitudes toward body shape and weight, lifetime prevalence of major mood disorder, and a few variables regarding childhood experiences. In addition, we found several marked differences between Austria and the United States which appeared independent of the diagnosis of bulimia nervosa. The most prominent of these were satisfaction with body image and levels of substance abuse. CONCLUSIONS: Bulimia nervosa appears to exhibit stereotypic "core" features which are independent of culture, but it has other features which may influenced by underlying cultural differences.

Sexual dysfunction in males: significance of adverse childhood experiences.

This paper examines the impact of childhood sexual victimization, physical abuse, and dysfunctional family background on sexual dysfunctions in adulthood in a nonclinical male student sample. The current analysis is based on data from a survey by questionnaire from 301 males. Our findings show that (a) occasional sexual dysfunctions, especially premature ejaculation and sexual desire disorder, are frequent in young male adults; and (b) long-lasting adverse familial relationship to attachment figures are more influential to later sexual dysfunction than are childhood sexual abuse experiences.

Eating disorders in college men.

OBJECTIVE: This study was designed to assess the characteristics of men with eating disorders in the community. METHOD: The authors recruited 25 men meeting DSM-IV criteria for eating disorders and 25 comparison men through advertisements in college newspapers. A second comparison group comprised 33 women with bulimia nervosa who were recruited and interviewed with virtually identical methods. RESULTS: The men with eating disorders closely resembled the women with eating disorders but differed sharply from the comparison men in phenomenology of illness, rates of comorbid psychiatric disorders, and dissatisfaction with body image. Homosexuality did not appear to be a common feature of men with eating disorders in the community. Childhood physical and sexual abuse appeared slightly more common among the eating-disordered men than among the comparison men. CONCLUSIONS: Eating disorders, although less common in men than in women, appear to display strikingly similar features in affected individuals of the two genders.

Bulimia nervosa in two cultures: a comparison of Austrian and American college students.

We compared 33 college women meeting DSM-III-R criteria for bulimia nervosa, recruited at Leopold Franzens Universität in Innsbruck, Austria, with 33 bulimic women recruited by identical methods at Northeastern University and Boston University in Boston, Massachusetts. Bulimia nervosa showed striking stereotypy across the two cultures. Austrian and American subjects reported similar demographic features, bulimic symptoms, severity and chronicity of illness, associated personal and familial psychiatric disorders, upbringing and family environment, and frequency of childhood sexual abuse. Only two variables, substance abuse and satisfaction with body image, differed markedly between the two groups. These differences appear to represent ambient differences between American and Austrian culture as a whole, rather than specific features of the bulimic syndrome.