Perspectives and preliminary experiences of psychedelics for the treatment of eating disorders: A systematic scoping review.

OBJECTIVE: Research regarding the therapeutic application of psychedelics and psychedelic-assisted psychotherapy in the treatment of eating disorders (EDs) has begun to emerge. This systematic scoping review aimed to map and synthesise the existing evidence regarding the participant reported efficacy and perspectives concerning psychedelics in the treatment of EDs, and to identify significant research gaps. METHOD: A systematic search was undertaken across several databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS: 1290 publications were identified, 1135 after duplicates removed, with 17 meeting full-eligibility criteria. Overall, findings suggested that most participants reported experiencing a meaningful reduction in their ED symptoms and having positive experiences or an openness to explore psychedelics as a treatment for ED symptoms, although some noted concerns of adverse effects and the importance of having psychological support to increase safety and efficacy. CONCLUSIONS: While preliminary research suggests psychedelics and psychedelic-assisted psychotherapy may be a viable treatment option for ED symptoms, further research with more robust research designs is required to increase confidence in its efficacy, generalisability, and safety as a therapeutic medium.

Loss of control as a transdiagnostic feature in obesity-related eating behaviours: A systematic review.

OBJECTIVE: Emerging evidence suggests that loss of control (LOC) may present as a common feature across disordered eating behaviours. However, there has been limited research on the transdiagnostic nature of LOC in this area. The primary aim of this study was to systematically review disordered eating behaviours and measures of LOC in clinical and non-clinical populations. METHOD: Electronic searches of the relevant databases were conducted. Selected articles were screened for eligibility and assessed for methodological quality. RESULTS: Thirty-four studies met inclusion criteria. Findings demonstrated that LOC was associated with disordered eating behaviours across bariatric populations, eating disorder populations, and community populations. Specifically, LOC was associated with binge eating (subjective and objective episodes), grazing, night eating, and emotional or stress eating. Findings also revealed that LOC was inconsistently operationalised across studies, with varied approaches to measuring the construct. CONCLUSION: Overall, the findings from this review provide support for LOC as a transdiagnostic feature of disordered eating behaviours. Future studies should utilise robust multi-method assessments to measure the severity of LOC, which may provide greater insight into how LOC manifests across different eating disorder presentations.

Depression, anxiety, and psychosocial stressors across BMI classes: A Norwegian population study - The HUNT Study.

Background: Obesity is a global issue with detrimental health impacts. Recent research has highlighted the complexity of obesity due to its psychological correlates. The purpose of the present study was to explore the relationship between body mass index (BMI) and depression, anxiety, and psychosocial stress. Methods: Data, including demographic, height, and weight information from 23 557 adult participants was obtained from the fourth survey of the Norwegian population based Trøndelag Health Study (HUNT4, 2017-2019). The Hospital Anxiety and Depression Scale (HADS) was used to measure self-reported depression and anxiety. We also collected data on 10 domains of psychosocial stress (violence, mental violence, unwanted sex, cyber bullying, school bullying, history of own life-threatening disease, life-threatening disease in family, relationship problems, divorce, and sudden family death), which were aggregated into a cumulative measure of psychosocial stress. Results: Multinomial logistic regression was utilized for statistical analysis. In the full model, the relationship between depression, anxiety, and psychosocial stress were explored controlling for age, sex, income, marital status, and educational attainment. After adjustments, a significant relationship was found between depression and obesity I (OR = 1.05, 95% CI 1.03-1.06, p <.001) and II and III (OR = 1.10, 95% CI 1.06-1.14, p <.001). After the same adjustments, significant relationship between anxiety and overweight and obesity class I was found among elderly participants (≥65 years old). Psychosocial stress significantly and positively related to all levels of BMI, with or without considering anxiety and depression, after controlling for sex, age, educational attainment, marital status, and income in all age groups. Conclusions: Obesity is a multifaceted health problem, significantly related to psychological factors including depression and psychosocial stress, which supports the need for a multifaceted, targeted approach to obesity treatment.

Childhood trauma, posttraumatic stress disorder symptoms, early maladaptive schemas, and schema modes: a comparison of individuals with obesity and normal weight controls.

BACKGROUND: Previous research on the psychological mechanisms of obesity has primarily focused on acute psychopathology. However, there is limited literature on the role of more complex and entrenched psychological processes in weight management. The current study aimed to expand previous research by examining more enduring psychological constructs, including early maladaptive schemas (EMS), schemas modes, and trauma. METHODS: Participants (N = 125) comprised adults with normal weight (n = 40) and obesity (n = 85) from community and clinical settings in Australia. Eligible participants completed a series of self-report questionnaires via Research Electronic Data Capture (REDCap). Two, separate, one-way multivariate analysis of variance (MANOVA) were conducted to examine group differences on the outcome variables. RESULTS: Findings indicated a significant effect of group on EMS and schema modes, V = .51, F(32, 92) = 2.97, p < .001, partial η2 = .51. Follow-up univariate tests revealed that individuals with obesity endorsed significantly more maladaptive schemas and schema modes and significantly less healthy schema modes than individuals with normal weight. In addition, results demonstrated a significant effect of group on childhood trauma and posttraumatic stress disorder (PTSD) symptoms, V = .19, F(6, 118) = 4.70, p < .001, partial η2 = .19. Subsequent univariate tests and chi-square analyses indicated that individuals with obesity reported significantly more childhood trauma as well as significantly more PTSD symptoms within the last month than normal weight individuals. CONCLUSION: This was the first study to compare EMS and schema modes in treatment-seeking individuals with obesity and normal weight controls using the short form version 3 of the Young Schema Questionnaire and revised, 118-item, Schema Mode Inventory. Overall, findings revealed that individuals with obesity experience more complex and enduring psychological difficulties than normal weight individuals. Increased assessment and targeted treatment of these underlying mental health concerns may contribute to a more holistic conceptualisation of obesity and could improve the long-term success of weight management.

The psychometric properties of the grazing questionnaire in an obesity sample with and without binge eating disorder.

BACKGROUND: Despite being the first validated measure of grazing, the Grazing Questionnaire (GQ) has not been investigated among individuals with obesity. Therefore, the current study aimed to examine the psychometric properties of the GQ in an obesity sample. METHODS: Participants (N = 259) were recruited from community and clinical settings in Australia. The sample comprised adults with normal weight (n = 77) and obesity (n = 182). A portion of individuals with obesity (n = 102) had binge eating disorder (BED). Data from the obesity group was examined to establish the factor structure, validity, and reliability of the GQ. A one-way ANOVA with planned contrasts was conducted to compare scores on the GQ across groups. RESULTS: Confirmatory factor analysis revealed that the 2-factor model of the GQ was the best model fit for individuals with obesity. The GQ demonstrated high internal consistency, test-retest reliability over 3 months, and convergent and divergent validity. As hypothesised, the obesity group had significantly higher scores on the GQ than the normal weight group, while the obesity with BED group had significantly higher scores than the obesity without BED group. CONCLUSION: This was the first study to investigate the psychometric properties of the GQ in an obesity sample. Overall, findings indicated that the GQ is a psychometrically sound measure of grazing among individuals with obesity. These findings provide further support for two distinct subtypes of grazing and highlight the importance of increased assessment and management of grazing behaviours for individuals with obesity and eating disorders. Maintaining a healthy weight is one of the greatest challenges for individuals with obesity. Certain eating patterns such as grazing may contribute to difficulties in weight management. Grazing is the repetitive and unplanned eating of small amounts of food that is not related to feeling hungry. Researchers and clinicians often use self-report questionnaires to measure grazing. However, the first validated questionnaire of grazing has not been investigated among individuals with obesity. Therefore, the goal of this study was to examine and validate the Grazing Questionnaire in individuals with obesity. Overall, our results showed that the Grazing Questionnaire is a valid and reliable self-report measure of grazing in individuals with obesity. Similar to previous research, we found that there are two subtypes of grazing. The first subtype involves continuous, unplanned eating. The second subtype is associated with a sense of loss of control over eating. We also found that people with obesity and binge eating disorder graze more than people with obesity that do not have binge eating disorder, while both groups graze more than individuals with normal weight. We recommend that clinicians routinely assess and treat unhelpful grazing patterns when working with individuals with obesity and eating disorders.

Perceived barriers and facilitators to healthy eating and physical activity in endoscopic bariatric patients: a qualitative study.

PURPOSE: To explore the perceived barriers and facilitators to healthy eating and physical activity in individuals opting for endoscopic bariatric procedures. METHODS: A total of 55 participants were recruited from a metropolitan bariatric clinic in Australia. Participants were interviewed at one of two stages of treatment: pre-procedure (n = 34) or 5-6 months post-procedure (n = 18). Interviews were transcribed and analyzed using content analysis. RESULTS: Five themes emerged from analysis of participant responses in both groups including lifestyle, psychological, physiological, social, and eating behaviors. Each theme consisted of subthemes which were either perceived barriers, or facilitators, to healthy eating and physical activity. Perceived barriers consisted of factors such as time constraints, low motivation, unhealthy habits and portion control, low priority of personal health, emotional difficulties, and pain/mobility issues. Facilitators included subthemes such as planning/organization, high motivation, seeing results, improved self-esteem, increased energy, improved mobility, and changing mindset about portions. CONCLUSION: The results highlight the importance of delivering individualized and targeted treatment plans for individuals opting for bariatric procedures. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

A Group Intervention for Individuals With Obesity and Comorbid Binge Eating Disorder: Results From a Feasibility Study.

Purpose: A common challenge among a subgroup of individuals with obesity is binge eating, that exists on a continuum from mild binge eating episodes to severe binge eating disorder (BED). BED is common among bariatric patients and the prevalence of disordered eating and ED in bariatric surgery populations is well known. Conventional treatments and assessment of obesity seldom address the underlying psychological mechanisms of binge eating and subsequent obesity. This study, titled PnP (People need People) is a psychoeducational group pilot intervention for individuals with BED and obesity including patients with previous bariatric surgery. Design, feasibility, and a broad description of the study population is reported. Material and Methods: A total of 42 patients were from an obesity clinic referred to assessment and treatment with PnP in a psychoeducational group setting (3-hour weekly meetings for 10 weeks). Of these, 6 (14.3%) patients had a previous history of bariatric surgery. Feasibility was assessed by tracking attendance, potentially adverse effects and outcome measures including body mass index (BMI), eating disorder pathology, overvaluation of shape and weight, impairment, self-reported childhood difficulties, alexithymia, internalized shame as well as health related quality of life (HRQoL). Results: All 42 patients completed the intervention, with no adverse effects and a high attendance rate with a median attendance of 10 sessions, 95% CI (8.9,9.6) and 0% attrition. Extent of psychosocial impairment due to eating disorder pathology, body dissatisfaction and severity of ED symptoms were high among the patients at baseline. Additionally, self-reported childhood difficulties, alexithymia, and internalized shame were high among the patients and indicate a need to address underlying psychological mechanisms in individuals with BED and comorbid obesity. Improvement of HRQoL and reduction of binge eating between baseline and the end of the intervention was observed with a medium effect. Conclusion: This feasibility study supports PnP as a potential group psychoeducational intervention for patients living with BED and comorbid obesity. Assessments of BED and delivery of this intervention may optimize selection of candidates and bariatric outcomes. These preliminary results warrant further investigation via a randomized control trial (RCT) to examine the efficacy and effectiveness of PnP.

Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series.

PURPOSE: Despite varied treatment effects, weight recidivism is common and typically associated with the abandonment of prescribed weight management strategies. Literature suggests that difficulty with weight management is associated with deficits in executive functioning, in particular cognitive flexibility and response inhibition, the neurocognitive processes that are involved in goal-directed behaviours, such as dietary adherence. These processes are overlooked by mainstream weight loss programmes. The aim of the study was to assess the effectiveness of a cognitive remediation-enabled cognitive behaviour therapy (CR-CBT) in addressing the neurocognitive, psychological and behavioural correlates of weight loss. It was hypothesised that CR-CBT would improve cognitive flexibility and response inhibition, reduce binge eating, aid weight loss and improve metabolic health. METHODS: Four adults with obesity (body mass index > 30 kg/m2) received 7 weeks of manualised CR-CBT and were assessed via a case series analysis at baseline, end of treatment and 3-month follow-up. Treatment included 3 weekly 90-min group-based behaviour weight loss sessions for 3 weeks, followed by twice-weekly 50-min individualised CR-CBT sessions for 4 weeks. RESULTS: Cognitive remediation-enabled cognitive behaviour therapy produced improvements in response inhibition and cognitive flexibility, and reductions in binge eating frequency, weight, and metabolic health readings between baseline and 3-month follow-up. CONCLUSIONS: This is the first study to assess the effectiveness of CR-CBT in the treatment of obesity. Preliminary indications of treatment success are discussed with respect to study limitations. In light of these results, we recommend further investigation via a randomised control trial (RCT). LEVEL OF EVIDENCE: Level IV, case series.

The clinical obesity maintenance model: a structural equation model.

PURPOSE: Theoretical research on the psychological underpinnings of weight management is limited. Recently, the clinical obesity maintenance model (COMM) proposed a theoretical conceptualisation of salient psychological and neuropsychological mechanisms maintaining weight management issues. The current study aimed to empirically test the COMM and elucidate the results in the context of recent empirical findings. METHODS: Participants (N = 165) were recruited from university and community settings in Australia. The sample consisted of adults with normal weight (n = 41), overweight (n = 40), and obesity (n = 84). Participants completed self-report questionnaires and a brief neuropsychological test. Structural equation modelling was used to estimate the associations between the hypothesised variables of the COMM and evaluate the model fit. RESULTS: Findings suggested acceptable to good model fit. Furthermore, several direct effects were found. First, cognitive flexibility directly affected eating habit strength. Second, eating habit strength directly affected eating beliefs. Third, eating beliefs directly affected emotion dysregulation. Fourth, emotion dysregulation directly affected depression and binge eating with depression partially mediating this relationship. Finally, depression directly affected binge eating. CONCLUSION: This was the first study to empirically test the COMM. Overall, findings provide preliminary support for the COMM as a psychological model of weight management and highlight the underlying psychological and neuropsychological mechanisms that may contribute to weight management issues. As this study examined a simplified version of the COMM, future research should continue evaluating this model and consider incorporating these components into more holistic weight management models to improve long-term treatment outcomes. LEVEL OF EVIDENCE: V, cross-sectional descriptive study.

The Clinical Obesity Maintenance Model: A Theoretical Framework for Bariatric Psychology.

Ranked highly in its association with serious medical comorbidities, obesity, a rapidly growing epidemic worldwide, poses a significant socio-economic burden. While bariatric procedures offer the most efficacious treatment for weight loss, a subset of patients risk weight recidivism. Due to the heterogeneity of obesity, it is likely that there are phenotypes or sub-groups of patients that require evidence-based psychological support to produce more sustainable outcomes. So far, however, characteristics of patients have not led to a personalized treatment algorithm for bariatric surgery. Maintenance of weight loss following bariatric surgery requires long-term modification of eating behaviors and physical activity. A recent Clinical Obesity Maintenance Model (COMM) proposed a conceptual framework of salient constructs, including the role of habit, behavioral clusters, emotion dysregulation, mood, health literacy, and executive function as interconnected drivers of obesity maintaining behaviors relevant to the field of bariatric psychology. The primary aim of this concise review is to bring together emerging findings from experimental and epidemiological studies relating to the COMM constructs that may inform the assessment and follow up of bariatric surgery. We also aim to explain the phenotypes that need to be understood and screened prior to bariatric surgery to enable better pre-surgery intervention and optimum post-surgery response.

Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis.

BACKGROUND: Double Burden of Malnutrition (DBM)-the coexistence of undernutrition along with overnutrition-is a significant public health issue in the Asia-Pacific region. The scope of the DBM in this region is largely unknown. This review aims to determine the prevalence of under- and overnutrition as major DBM components and to investigate whether there has been a shift from under- to overnutrition in the Asia-Pacific region. METHODS: Online databases including PubMed and Web of Science were searched for original studies on DBM prevalence in the Asia-Pacific region; particularly, those published from January 2008 to December 2018 were screened for eligibility. We collected data on indicators of under- and overnutrition on the population level and adapted the ratio of prevalence of overweight/obesity versus prevalence of underweight as the main outcome indicator. Pooled prevalence estimates of DBM and the ratio of overnutrition versus undernutrition were generated using R (3.4.0). RESULTS: In total, 33 studies were included in this review. Pooled analysis demonstrated that DBM was generally presented among countries/areas in the Asia-Pacific region except in high-income countries (HICs). Overall, the prevalence of undernutrition was 8.8% (95% CI 7.3-10.6%) while overnutrition among the same population reached 23.0% (95% CI 20.3-26.0%). Countries in the Oceania region or HICs reported low level of undernutrition (less than 3%). All subgroup analysis (geolocation, income level, sex, age) reported pooled prevalence of overweight/obesity as more than 18%. Overall, the whole region and all subgroups were more likely to experience a higher prevalence of overnutrition than undernutrition, except that low- and lower-middle-income countries (L-MICs) had similar prevalence for over- and undernutrition. CONCLUSION: DBM in the Asia-Pacific region is alarmingly high and is titled toward overnutrition. As a result, future interventions/policy targeting to maintain a healthy weight for the population should not just focus on prevention and treatment toward one direction.

Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review.

Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long-term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty-eight studies met inclusion criteria. Findings suggested that most patients experience a short-term reduction in anxiety and depression symptoms from pre-surgery. Over time, however, these symptoms increase and may even return to pre-surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer-term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer-term follow-up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long-term success of patients with obesity.

Patient motivations and expectations prior to bariatric surgery: A qualitative systematic review.

Bariatric surgery is the most effective treatment for weight loss in individuals with severe and complex obesity. While the extant literature has mostly explored clinical outcomes of surgery, recent research has also examined patients' experiences prior to treatment. This systematic review synthesized findings from qualitative studies investigating patients' motives and expectations prior to undergoing bariatric surgery for weight loss. Twenty-eight studies published in English involving 580 participants were identified for inclusion. Data extraction and thematic synthesis yielded four global themes: physiological, emotional, cognitive, and interpersonal/environmental. These represented seven subthemes describing patients' presurgery experiences: relationship with food, physical health, activities of living, personal identity, social relations, presurgery information, and beliefs about surgery. In addition to improving physical and medical comorbidities associated with obesity, participants believed that postsurgery weight loss would produce positive psychosocial impacts by strengthening their personal identities, their relationships, and improving their engagement in public and professional life. The complex and widespread nature of the changes patients expected would result from bariatric surgery highlights the importance of providing pretreatment education focused on psychosocial well-being, as well as concurrent psychological support alongside surgery, to best inform individual treatment selection and clinical practice.

Recent trends in intensive treatments of obesity: Is academic research matching public interest?

BACKGROUND: The demand and the utilization of intensive treatments of obesity have been increased tremendously. OBJECTIVES: This study aimed to investigate trends in interest related to the intensive treatments of obesity in both academic research and the public domain, and assess whether they match each other. SETTING: The BMI Clinic, Double Bay, New South Wales, Australia. METHODS: Intensive treatment of obesity is defined as meal replacement, pharmacologic treatments, and surgical or endoscopic bariatric procedures identified by the national guidelines. To identify the academic research interests, the number of academic research publications for each search topic was identified as converted into relative popularity. To identify the public's interests, Google Trends relative search volume and Twitter message relative intensity for each topic was mined to identify the most recent interests in intensive obesity treatment among the public. RESULTS: There was an increase in academic publications in all treatment domains between 2007 and 2017, but that the research emphasis correlated poorly with public interest. Between 2007 and 2017, the most popular and increasing academic research interest in the intensive treatment of obesity was bariatric surgery, followed by weight loss medication. In 2007, the most popular public-interest treatment was weight loss medication followed by bariatric surgery. In contrast, in 2017, meal replacement and bariatric surgery were equally popular, while the interests in weight loss medication declined. Significant seasonal patterns were also recognized for the public's interests. CONCLUSION: Academic research and public interest are not currently sufficiently aligned in the area of obesity treatment.

Breaking bad habits by improving executive function in individuals with obesity.

BACKGROUND: Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior. These behaviors are particularly difficult to change in the long-term because they are often enacted habitually. Cognitive Remediation Therapy has been modified and applied to the treatment of obesity (CRT-O) with preliminary results of a randomized controlled trial demonstrating significant weight loss and improvements in executive function. The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function. METHOD: Eighty participants with obesity were randomized to CRT-O or control. Measures of executive function (Wisconsin Card Sort Task and Trail Making Task) and unhealthy eating and sedentary behavior habits were administered at baseline, post-intervention and at 3 month follow-up. RESULTS: Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control. Mediation analyses revealed that change in one element of executive function performance (Wisconsin Card Sort Task perseverance errors) mediated the effect of CRT-O on changes in both habit outcomes. CONCLUSION: These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function. In particular, it appears that cognitive flexibility, as measured by the Wisconsin Card Sort task, is a key mechanism in this process. Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice. TRIAL REGISTRATION: The RCT was registered with the Australian New Zealand Registry of Clinical Trials (trial id: ACTRN12613000537752 ).

A randomised controlled trial of manualized cognitive remediation therapy in adult obesity.

OBJECTIVE: Research has indicated that individuals with obesity have neurocognitive deficits, especially in cognitive flexibility that may in turn impact on their weight loss and maintenance. Consequently, we examined the efficacy of a manualised face-to-face cognitive remediation therapy for obesity (CRT-O) within a randomised controlled trial, in terms of improving cognitive flexibility, reducing binge eating behaviour, improving quality of life and helping with weight loss. METHODS: 80 adults with obesity (body mass index >30 kg/m2), 70% binge eaters, received three weekly sessions of group Behavioural Weight Loss (BWL) and then were randomised to 8 sessions of individual CRT-O or to a no-treatment control group. RESULTS: Mixed-effects model analyses revealed that the CRT-O group had a significant improvement in their cognitive flexibility at post-treatment and 3-month follow-up compared to the control group (Cohen's d = 0.96 to 2.1). 68% of those in the CRT-O group achieved a weight loss of 5% or more at follow-up compared to only 15% of the controls (Cohen's d = 1.3). Changes in set-shifting predicted changes in weight (p < .05). Binge eating reduced in the CRT-O group compared to the control (Cohen's d = 0.80). DISCUSSION: This is the first study showing the efficacy of CRT-O for obesity. Future CRT-O studies with longer follow-ups and pairing it with longer BWL programs are needed. TRIALS REGISTRY (ANZCTR): 12613000537752. DATE OF ANZCTR REGISTRATION: 14 May 2013.

Confirmatory factor analysis and examination of the psychometric properties of the eating beliefs questionnaire.

BACKGROUND: The Eating Beliefs Questionnaire (EBQ) is a 27-item self-report measure that assesses positive and negative beliefs about binge eating. It has been validated and its factor structure explored in a non-clinical sample. This study tested the psychometric properties of the EBQ in a clinical and a non-clinical sample. METHOD: A sample of 769 participants (573 participants recruited from the university and general community, 76 seeking treatment for an eating disorder and 120 participating in obesity research) completed a battery of questionnaires. A subset of clinical participants with a diagnosis of Bulimia Nervosa or Binge Eating Disorder completed the test-battery before and after receiving a psychological treatment (n = 27) or after allocation to a wait-list period (n = 28), and a subset of 35 community participants completed the test battery again after an interval of two-weeks. Confirmatory Factor Analysis (CFA) was performed. RESULTS: CFA found a two-factor structure that provided a good fit to the data, supporting the solution presented in the development paper. Items with poor psychometric properties were removed, resulting in a 16 item measure. EBQ scores were found to correlate with binge eating episode frequency, increases in body mass index (BMI), and measures of eating disorder behaviours and related psychopathology. The EBQ was found to have excellent internal consistency (α = .94), good test-retest reliability (r = .91) and sensitivity to treatment. CONCLUSION: These findings indicate that the EBQ is a psychometrically sound and clinically useful measure.

Validation of the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A) in the obese with and without binge eating disorder.

Obesity and binge eating disorder (BED) are both associated with deficiencies in executive function. The Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A) is a self-report measure that assesses executive function. This study aimed to examine the psychometric properties of the BRIEF-A in an obese population, with and without BED, and to explore the differences on the BRIEF-A in the obese, with and without BED, compared to normative sample. 98 obese participants (70 BED) completed the BRIEF-A, DASS-21 and several performance-based measures of executive function. 30 participants completed a repeat assessment two months later. There was evidence of good internal consistency and test-retest reliability, however evidence for construct and convergent validity was mixed. Additionally, it was found that obese individuals report significantly more executive function difficulties on the BRIEF-A than the normative sample. Further, obese with BED report more executive function difficulties than those without. This study shows some evidence of sound psychometric properties of the BRIEF-A in an obese sample, however more research is required to understand the nature of executive function being measured.

Manualised Cognitive Remediation Therapy for adult obesity: study protocol for a randomised controlled trial.

BACKGROUND: Research has shown that obese individuals have cognitive deficiencies in executive function, leading to poor planning and impulse control, and decision-making difficulties. An intervention that could help reduce these deficits and in turn help weight loss maintenance is Cognitive Remediation Therapy for Obesity (CRT-O). We aim to examine the efficacy of manualised CRT-O, which is intended to improve executive function, enhance reflective practice and help weight loss maintenance. METHODS/DESIGN: A randomised controlled trial (registered with the Australian New Zealand Clinical Trials Registry) will be conducted. First, 90 obese adults (body mass index >30 kg/m2) in the community will receive three weekly sessions of a group Behaviour Weight Loss Treatment (BWLT), and then will be randomised either to receive CRT-O or to enter a no-treatment control group. CRT-O training will comprise twice-weekly sessions of 45 minutes over a 4 to 6 week period, for a total of eight sessions. Measurement points will be at baseline, post CRT-O (or 4 to 6 weeks after BWLT for the no-treatment control), 3 months post treatment and 1 year post treatment. The primary outcome will be executive function and secondary outcome measures will include participants' body mass index, hip to waist ratio, eating behaviours and quality of life. DISCUSSION: This is the first study of its kind to examine the efficacy of Cognitive Remediation Therapy for obese adults through a randomised controlled trial. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number: 12613000537752. Date of registration: 14 May 2013.

The clinical obesity maintenance model: an integration of psychological constructs including mood, emotional regulation, disordered overeating, habitual cluster behaviours, health literacy and cognitive function.

Psychological distress and deficits in executive functioning are likely to be important barriers to effective weight loss maintenance. The purpose of this paper is twofold. First, in the light of recent evidence in the fields of neuropsychology and obesity, particularly on the deficits in the executive function in overweight and obese individuals, a conceptual and theoretical framework of obesity maintenance is introduced by way of a clinical obesity maintenance model (COMM). It is argued that psychological variables, that of habitual cluster Behaviors, emotional dysregulation, mood, and health literacy, interact with executive functioning and impact on the overeating/binge eating behaviors of obese individuals. Second, cognizant of this model, it is argued that the focus of obesity management should be extended to include a broader range of maintaining mechanisms, including but not limited to cognitive deficits. Finally, a discussion on potential future directions in research and practice using the COMM is provided.