A Pilot Randomized Controlled Trial of a Technology-Based Approach for Preventing Excess Weight Gain during Pregnancy among Women with Overweight.

OBJECTIVE: Overweight/obesity and excess weight gain during pregnancy are associated with adverse maternal and neonatal outcomes. Few interventions have been effective in limiting gestational weight gain among women with overweight or obesity. This pilot, randomized clinical trial compared treatment as usual (TAU) to a lifestyle modification program delivered via phone for the prevention of excess gestational weight gain in women who had overweight or obesity. METHODS: Participants included 41 pregnant women with a body mass index (BMI) ≥ 25 kg/m2 (mean age = 28.7 ± 5.8 years; mean pre-gravid BMI = 31.2 ± 6.2 kg/m2; 54% black, 39% white). The intervention group (n = 20) received weekly telephone counseling sessions and used WiFi scales to monitor their weight from weeks 16 to 36 of pregnancy. We compared differences in weight and birth outcomes for the intervention vs. the TAU group (n = 21). RESULTS: The intervention and TAU groups did not differ with respect to: gestational weight gain (15.5 ± 5.3 vs. 13.3 ± 6.8 kg, respectively); proportion gaining above the 2009 Institute of Medicine recommended weight range (83 vs. 70%); and weight gain from pre-pregnancy weight to 6 weeks postpartum (4.8 ± 4.6 vs. 3.0 ± 5.5 kg). Other birth and health outcomes also did not differ. CONCLUSION: A telemedicine intervention designed to decrease logistical burden on participants was not more successful in reducing excessive weight gain during pregnancy as compared to TAU. Future studies should examine more intensive forms of remote treatment beginning earlier in pregnancy as well as interventions promoting a healthy weight prior to pregnancy.

"The next mouthful will be the best": influence of prevision of the pleasure on the decision of having a second helping of a just eaten food.

PURPOSE: Firstly, to see if the decision to have a second helping of food is related to the current evaluation of its palatability or to the predicted pleasure of a second helping of the same food. Secondly, to see if there is any relationship between subjects' BMI, their current or predicted evaluation of food palatability and their decision to have a second helping. METHODS: 128 guests attended a village festival with the specific purpose of eating a traditional, local soup made of beans and bacon. Subjects were asked to indicate the pleasure they felt eating the soup and the pleasure they predicted they would feel by having a second helping of the same food. Subjects were then offered a second identical portion of the above described soup. RESULTS: 72 subjects accepted a second helping of the soup. We discovered a significant correlation between predicted pleasure and the decision to have a second helping of the same food. There was also a significant correlation between BMI and the level of predicted pleasure of a second helping. CONCLUSIONS: The decision to have a second helping of food was related to predicted pleasure and not to the pleasure that was experienced during the first helping.

The DSM-5 effect: psychological characteristics of new patients affected by Binge Eating Disorder following the criteria of the DSM-5 in a sample of severe obese patients.

PURPOSE: The current study evaluated whether or not there were significant differences in psychopathological traits between three groups of individuals. The first was a group of patients seeking bariatric surgery diagnosed as being affected by Binge Eating Disorder (BED), according to the new criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This group (NEW BED group) did not meet BED diagnosis following the previous criteria listed in the DSM-IV-TR. The second group of individuals was composed of severely obese patients seeking bariatric surgery not affected by an eating disorder, according to the diagnostic criteria of the DSM-5 (OB group). The third group was composed of individuals within a healthy weight range (Control group). METHODS: 94 severely obese patients (33 in the NEW BED group and 61 in the OB group) were compared to the Control group including 41 participants on depression, anxiety and eating habits. RESULTS: The NEW BED scored significantly higher than the OB group on the Beck Depression Inventory, both the subscales of the State Trait Anxiety Inventory, on disinhibition and hunger subscales of the Three-Factor Eating Questionnaire and on many subscales of the Eating Disorders Inventory. CONCLUSIONS: The new, less restrictive diagnostic criteria for BED of the DSM-5 are useful in identifying obese patients affected by severe psychopathology and dysfunctional eating habits.

Psychopathological characteristics of patients seeking for bariatric surgery, either affected or not by binge eating disorder following the criteria of the DSM IV TR and of the DSM 5.

UNLABELLED: We evaluate whether there are any significant differences in psychopathology between severe obese patients affected by Binge Eating Disorder diagnosed following both the DSM IV TR and the DSM5 criteria, and severe obese patients not having an eating disorder. METHOD: 118 severe obese patients seeking treatment at a center for bariatric surgery in northern Italy were asked to take part in the current study for a period of six months. Average participant age was 44.27 years, SD 12.42. Age ranged from 18 to 67 years. Average patient BMI was 45.03, SD 7.11, ranging from 32.14 to 66.16 kg/m(2). Seventy seven of the patients (65.3%) were females and 41 (34.7%) were males. BED diagnosis was determined following the diagnostic criteria of both the DSM IV TR and the DSM 5. The presence of other eating disorders was excluded through a clinical screening using the Eating Disorder Inventory (EDI). Patient eating habits and the presence of emotional eating were appraised using the Three-Factor Eating Questionnaire. Levels of depression and anxiety were evaluated using the Beck Depression Inventory and the State Trait Anxiety Inventory. RESULTS: 57 out of 118 patients were found to be affected by BED following the DSM 5 criteria; among them 24 followed those of the DSM IV TR. BED patients scored higher on four subscales of the Eating Disorders Inventory: Drive for thinness (DT), Bulimia (B), Body dissatisfaction (BD) and Interoceptive awareness (IA) on the STAI and on the Disinhibition and Hunger subscales of the TFEQ. DISCUSSION: The results confirm the presence of high levels of psychopathology among patients diagnosed with BED, even if they have been diagnosed following the criteria of the DSM 5. There is a great overlap in psychopathology between BED patients diagnosed following the DSM IV TR and the DSM 5 criteria.

Clinical validity of the descriptor. "presence of a belief that one must eat in order to get to sleep" in diagnosing the Night Eating Syndrome.

The diagnostic criteria for the Night Eating Syndrome (NES) published in 2010 require the presence of two core criteria: evening hyperphagia and/or nocturnal awakenings for ingestion of food and three of five diagnostic descriptors. One of the descriptors is as follows: "The belief that one must eat in order to fall asleep". In this study we evaluated whether this conviction is significantly more prominent in obese individuals suffering from insomnia and nocturnal eating, than among obese patients with insomnia who do not eat at night. Ninety-eight obese subjects afflicted by insomnia were included in this study. Eight were affected by NES, 33 by Binge Eating Disorder (BED), and 13 by both BED and NES. Subjects' insomnia and sleep disturbances were assessed using the Insomnia Severity Index and the Sleep Disturbance Questionnaire. The presence of the belief that one must eat at night in order to sleep was evaluated with the question: "Do you need to eat in order to get back to sleep when you wake up at night?" Patients affected by NES and by both BED and NES were convinced that nocturnal food intake was necessary in order to fall back asleep after a night time awakening. The presence of this belief seemed to be a critical factor in identifying the presence of the Night Eating Syndrome among obese subjects suffering from insomnia.

An open-label efficacy trial of escitalopram for night eating syndrome.

OBJECTIVE: Night eating syndrome (NES) has become increasingly recognized as a disorder in need of effective treatments. Selective serotonin reuptake inhibitors have shown efficacy in previous trials, so we sought to expand our understanding of the efficacy of escitalopram in the current trial. METHOD: Thirty-one adults with NES participated in a 12-week open-label trial of escitalopram. Outcome measures included the Night Eating Symptom Scale (NESS), percent of daily intake after the evening meal (% intake) and number of nocturnal ingestions/week (NI), weight, total awakenings/week, mood, and quality of life. Mixed-effects models were used to assess change over time. RESULTS: Significant reductions were observed from week 0 to week 12 for the NESS (30.2 to 15.2), % intake (46% to 17%), NI (5.8 to 1.2), weight (90.2 to 88.6 kg), awakenings (8.1 to 2.7), and BDI-II (12.1 to 7.7). Outcomes did not differ significantly by gender, age, race, or psychiatric co-morbidity status. Eighteen of 31 completed 12 weeks of treatment. DISCUSSION: This open-label trial of escitalopram showed significant reductions in symptoms associated with NES. Randomized controlled trials are warranted to test these findings. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01401595.