Lateral hypothalamic area deep brain stimulation for refractory obesity: a pilot study with preliminary data on safety, body weight, and energy metabolism.

OBJECT: Deep brain stimulation (DBS) of the lateral hypothalamic area (LHA) has been suggested as a potential treatment for intractable obesity. The authors present the 2-year safety results as well as early efficacy and metabolic effects in 3 patients undergoing bilateral LHA DBS in the first study of this approach in humans. METHODS: Three patients meeting strict criteria for intractable obesity, including failed bariatric surgery, underwent bilateral implantation of LHA DBS electrodes as part of an institutional review board- and FDA-approved pilot study. The primary focus of the study was safety; however, the authors also received approval to collect data on early efficacy including weight change and energy metabolism. RESULTS: No serious adverse effects, including detrimental psychological consequences, were observed with continuous LHA DBS after a mean follow-up of 35 months (range 30-39 months). Three-dimensional nonlinear transformation of postoperative imaging superimposed onto brain atlas anatomy was used to confirm and study DBS contact proximity to the LHA. No significant weight loss trends were seen when DBS was programmed using standard settings derived from movement disorder DBS surgery. However, promising weight loss trends have been observed when monopolar DBS stimulation has been applied via specific contacts found to increase the resting metabolic rate measured in a respiratory chamber. CONCLUSIONS: Deep brain stimulation of the LHA may be applied safely to humans with intractable obesity. Early evidence for some weight loss under metabolically optimized settings provides the first "proof of principle" for this novel antiobesity strategy. A larger follow-up study focused on efficacy along with a more rigorous metabolic analysis is planned to further explore the benefits and therapeutic mechanism behind this investigational therapy.

Investigating the use of the Mizes Anorectic Cognitions Questionnaire in a community sample of racially diverse high school males and females.

There are relatively few assessment devices which have been developed to measure the cognitions or cognitive processes of the eating disordered pathology of adolescents. One promising scale is the Mizes Anorectic Cognitions Questionnaire, and its revised version (MAC; MAC-R). The present study examined scores on the MAC and MAC-R in a racially diverse sample consisting of 201 non-clinical adolescents. The goals of this study were (1) to examine the reliability and validity of the MAC and MAC-R in a heretofore unexamined population, adolescents, and (2) to examine scores across sex, race, and weight classification in adolescents in order to determine whether normative data should be further stratified into these groups. Findings of the study suggest that the MAC and MAC-R are internally consistent, reliable, and strongly related to other well-established instruments. The present study also suggests that separate means and standard deviations be used when determining nonclinical male and female adolescent normative scores. There were no significant differences on scores across race and weight classification thus further stratification is not advised.

The impact of caloric preloading on attempts at food and eating-related thought suppression in restrained and unrestrained eaters.

OBJECTIVE: The current study examined the impact of dietary restraint and caloric preload on thought suppression in a sample of 64 college females classified as either restrained or unrestrained eaters. METHOD: Participants engaged in a 60-min laboratory session. One half of the participants were preloaded with a high-calorie milkshake and all participants were randomly assigned to a food and eating-related thought suppression condition or a no suppression control condition. Food-related thoughts were assessed with a digital counter and verbal references to food were tracked with an audio recorder. RESULTS: Restrained participants instructed to suppress food-related thoughts demonstrated significantly more food and eating-related thoughts than unrestrained participants. Preloading was associated with an increase in the frequency of indirect mentions to food and eating. DISCUSSION: Although the hypothesized "rebound" effect did not occur for any study groups, these findings indicate that both restraint status and preloading impact food and eating-related thoughts.

Empirical classification of eating disorders.

Although the eating disorder nosology has become refined over the years, considerable problems remain. The purpose of the present study was to empirically examine eating disorder classification using a sample of treatment-seeking eating-disorder patients. One hundred and fifty-nine patients with diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder, not otherwise specified (EDNOS), were included in a cluster analysis using a variety of eating disorder variables. Findings revealed four clusters, with three clusters resembling AN, restricting type, BN, and binge-eating disorder (BED). The remaining cluster appeared to be a group of patients that were subthresholded in terms of symptom severity. Results also indicated a relatively poor fit between the empirically derived groupings and clinical diagnoses. The implications of these findings for both the current classification system and treatment considerations are discussed.

Efficacy of sertraline for bulimia nervosa.

OBJECTIVE: The current study examined the efficacy of sertraline in the treatment of individuals diagnosed with bulimia nervosa. METHOD: Eighteen women enrolled in an 8-week open trial of sertraline. Eating disorder psychopathology and depressive symptoms were assessed at baseline and at the end of the trial using both semistructured interviews and self-report questionnaires. RESULTS: Findings indicated significant reductions in eating disorder psychopathology, including the number of binges and purges per week, as well as significant reductions in depressive symptoms. In addition, participants did not experience significant weight gain or any other sertraline side effect assessed at the end of the trial compared with baseline. DISCUSSION: Findings from the current study indicate that sertraline is efficacious in the treatment of bulimia nervosa. A double-blind controlled trial of sertraline is recommended for future research.

The validity of subjective measures of body image disturbance.

OBJECTIVE: We examined weight dissatisfaction (actual weight minus self-stated ideal weight) and weight goal (normative weight minus self-stated ideal weight) subjective indices in a large clinical sample to determine how the indices discriminate between diagnostic categories and relate to other measures of body image disturbance. METHOD: Approximately 200 anorexic, bulimic, and eating disorder not otherwise specified (NOS) participants reported their self-stated ideal weight and completed the Mizes Anorectic Cognitions (MAC) Questionnaire, Eating Disorders Inventory (EDI), and Restraint Scale-Revised. RESULTS: Compared with bulimic and NOS participants, anorexics reported less weight dissatisfaction but had an ideal weight that is farthest from normative weight. The weight dissatisfaction measure correlates well with other measures of body image disturbance, and both measures show evidence of discriminant validity. DISCUSSION: These two measures highlight the substantial differences in the nature of body image disturbance between the eating disorder diagnostic groups. Theoretical, clinical, and practical implications are discussed.