Analysis of Portuguese language blogs about bariatric surgery: key doubts of internauts regarding the postoperative period Abstract Background The Internet, particularly blogs have become an important tool for patients to disseminate and exchange information on a variety of health topics, including bariatric surgery. By virtue of its interactivity being free of judgement from health care providers, blogs expose gaps in patients’ knowledge and understanding. Purpose This study analyzes the main doubts expressed in blogs by patients in the postoperative period of bariatric surgery. Method This is a qualitative exploratory study of 11 blogs of patients, who underwent bariatric surgery, that were available on the Internet between October 2013 and May 2017. The data were collected through a structured instrument and analyzed according to Bardin’s suggestions. The sampling method used was intentional. Results Evolution of diet, weight loss, plateau effect, weight regain, physical exercises, physiological changes, complications, use of contraceptive and pregnancy were the main areas of concern. Conclusion More needs to be done to educate and prepare bariatric patients for the postoperative period. The content found in blogs serves towards building better links with patients, helps them make better decisions, and provides them an opportunity to be active participants in their own treatment.

Vulnerable narcissism as a mediator of the relationship between perceived parental invalidation and eating disorder pathology Abstract Purpose Parental invalidation and narcissism have been proposed to play an important role in understanding the etiology of eating disorders. The current research aimed to address two main gaps in the literature. The first aim was to determine the differential associations of grandiose and vulnerable narcissism with eating disorder pathology. The second aim was to find a common mediator between both maternal and paternal invalidation and eating disorder pathology. It was hypothesized that when controlling for vulnerable narcissism, grandiose narcissism would not predict eating disorder pathology. In addition, it was hypothesized that vulnerable narcissism would be a mediator of the relationship between parental invalidation and eating disorder pathology. Methods Participants were 352 women aged 18–30 years who were recruited from the general and tertiary student population, and as such constituted a community sample. Participants completed the Invalidating Childhood Environment Scale, Brief-Pathological Narcissism Inventory, Eating Disorder Examination Questionnaire, the Avoidance of Affect Subscale of the Distress Tolerance Scale, and the Emotional Expression as a Sign of Weakness Subscale of the Attitudes Towards Emotional Expression Scale in an online survey. Results Results showed that, when controlling for vulnerable narcissism, grandiose narcissism was no longer associated with eating disorder pathology. It was also found that parental invalidation had a positive indirect effect upon eating disorder pathology, via vulnerable narcissism. Conclusions The findings indicate that vulnerable narcissism is more strongly associated with eating disorder pathology as opposed to grandiose narcissism and help to further elucidate the mechanisms via which parental invalidation might exert its negative effect on eating disorder pathology. Level of evidence A cross-sectional survey (Level V).

Biases in attention and memory for body shape images in eating disorders Abstract Purpose To investigate attentional and memorial biases towards body shape pictures among female patients with clinical eating disorders and healthy female controls. Methods A visual dot-probe task was used to assess attention towards pictures reflecting either a thin, normal, or obese female body shape. Pictures were presented in pairs; each pair depicted two different body shapes and were presented twice. Participant responses were compared across time and population. Results Overall, the eating disorder patients responded more slowly than controls, F(1,63) = 20.32, p < .001. Both groups showed an attentional bias towards the larger of two body shapes, F(1,63) = 4.30, p = .04, and responded more quickly the second time they viewed the picture pairs, F(1,63) = 33.80, p < .001. Upon second viewing of picture pairs, the eating disorder patients had a larger decrease in reaction time (86 ms) than the control sample (33 ms) only when both pictures included extreme body shapes (thin and obese); the decrease in reaction time when one of the pictures included a normal body shape was the same across groups upon second viewing (eating disorder: 37 ms; control: 32 ms), F(1,63) = 9.32, p = .003. Conclusions These findings suggest that individuals with eating disorders may be biased towards recall of dichotomous and/or extreme body shape images. While it remains unclear whether attentional and/or memorial bias is a risk, maintenance, or causal factor in eating disorders, future studies should employ longitudinal, prospective research designs to address these questions. Level of Evidence Level II, comparative study.

Alcohol consumption after laparoscopic sleeve gastrectomy: 1-year results Abstract Introduction Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption. The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate relationships between different ages and sexes. Materials and methods A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery. Subgroup analyses were performed between male and female and between under and over 40 years old. Results The median AUDIT score decreased from 2.70 (range 1–18) before surgery to 1.38 (range 1–7) after 1 year of SG, indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at baseline 45% of patients consumed alcoholic drinks “from 2 to 4 times per month”, whereas 26 and 39.4% consumed alcohol “never” and “less than once a month,” respectively. After surgery, nobody consumed more then six alcoholic drinks. No differences were found between the subgroups in terms of alcohol consumption and social behavior. Conclusions The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional follow-up and to the hormonal changes. Studies with large samples and long-term follow-up are needed to confirm our data. Level of evidence IV.

Family-based therapy for anorexia nervosa: results from a 7-year longitudinal Singapore study Abstract Purpose To determine the effectiveness of Family-Based Therapy (FBT) as a treatment for Anorexia Nervosa (AN) in adolescents in a Singaporean cohort. FBT has proven effective in studies in the West, but no such study has been done in Asia. Methods This is a retrospective analysis of a hospital-based cohort, which included all paediatric patients (≤ 18-years) with AN treated at a tertiary hospital in Singapore between 2011 and 2017 (n = 119). The patients either received manualised FBT (n = 42) or individualized adolescent focussed therapy (non-FBT) (n = 77). Patient characteristics and time to remission were abstracted from patient records. Survival analysis was used to determine median time to remission and remission-free survival rates. Hazard ratios for remission were obtained by cox regression. Results Patients in the non-FBT group had a significantly longer time to remission compared with the FBT group after adjustment for age, gender, BMI, psychiatric comorbidity, and ethnicity (p = 0.003, HR = 2.523, 95% CI 1.37–4.64). In the FBT group, the median time to remission was 5.0 months (95% CI 3.4–6.6 months); 11 months shorter than the non-FBT group (p < 0.001, 95% CI 7.9–14.1 months). FBT group remission rates were 69% and 90% at 1 and 2 years, respectively. Non-FBT group remission rates were 30% and 57% at 1 and 2 years, respectively. Conclusions This study confirms that FBT is an effective treatment strategy for AN in adolescents in the Asian context. FBT can shorten the illness duration, which reduces disruption to schooling and family life at this critical life stage. Level of evidence Level IV, evidence obtained from retrospective review of data before and after the introduction of new intervention.

Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset Abstract Purpose Understanding how known eating disorder (ED) risk factors change in relating to one another over time may inform efficient intervention targets. We examined short-term (i.e., 1 month) reciprocal longitudinal relations between weight/shape concern and comorbid symptoms (i.e., depressed mood, anxiety) and behaviors (i.e., binge drinking) over the course of 24 months using cross-lagged panel models. Methods Participants were 185 women aged 18–25 years at very high risk for ED onset, randomized to an online ED preventive intervention or waitlist control. We also tested whether relations differed based on intervention receipt. Results Weight/shape concern in 1 month significantly predicted depressed mood the following month; depressed mood in 1 month also predicted weight/shape concern the following month, but the effect size was smaller. Likewise, weight/shape concern in 1 month significantly predicted anxiety the following month, but the reverse was not true. Results showed no temporal relations between weight/shape concern and binge drinking in either direction. Relations between weight/shape concern, and comorbid symptoms and behaviors did not differ based on intervention receipt. Conclusions Results support focusing intervention on reducing weight/shape concern over reducing comorbid constructs for efficient short-term change. Level of evidence Level I, evidence obtained from a properly designed randomized controlled trial.

Food-Cal: development of a controlled database of high and low calorie food matched with non-food pictures Abstract Background Industrialization has led to more varied and attractive high-calorie foods. Health problems such as obesity and diabetes are partially attributed to eating-related self-regulation difficulties that may be caused by increasingly frequent cues for highly palatable foods. Research studies aim at understanding the factors underlying responses to food cues. This has led to the development of food stimuli databases. However, they present some limitations. Objectives This study aimed at providing a controlled set of pictures, including 40 food pictures with high- and low-calorie stimuli, matched with 40 non-food pictures. The second objective was to provide a ready-to-use database with normative data regarding responses and associations between demographic, anthropometric and eating-related characteristics, and picture ratings. Participants A sample of 264 participants rated the total set of pictures. Measures Attractiveness, arousal and palatability were assessed for each picture, as well as participant’s current type of diet, BMI, hunger levels and eating behaviors (uncontrolled and emotional eating). Results Image characteristics (shape, colors, luminance) were comparable between food and matched non-food pictures. Positive correlations were found between hunger levels and attractiveness, arousal and palatability of food. Uncontrolled and emotional eating was positively correlated with high-calorie food palatability, and uncontrolled eating was positively correlated with high-calorie food attractiveness. Participants who did not report any specific diet rated high-calorie foods as more attractive and arousing, whereas vegan and vegetarian participants assessed low-calorie foods as more attractive and palatable. Conclusion The Food-Cal controlled set of picture database can be considered as a useful tool for experimental research. Level of evidence Level V, cross-sectional descriptive study.

Personality traits and dysfunctional construal of online health promotion messages Abstract Purpose With the Internet becoming increasingly popular as a source of information, blogs offering healthy lifestyle techniques and knowledge have become popular and accessible. Despite their focus on health, these blogs portray content that may be negatively construed by viewers, especially those with or at risk for eating disorders. The present study investigated changes in affect and self-esteem after viewing a prototypic health blog. Personality traits, specifically neuroticism and conscientiousness, were also investigated. Methods A prototypic health blog was constructed after extensive review of existing blogs. A parallel format was then followed to create a home décor website for a control condition. Female undergraduate students were randomly assigned to one of two blog sites, and participants completed an earlier personality assessment and post-viewing study questionnaires. Results Contrary to the hypothesis that readers of the health blog will report more negative outcomes, no main effect of blog condition was found. However, individuals high in trait neuroticism experienced greater differences in negative affect, but not self-esteem, when viewing the health blog versus the control blog. Conclusions This study found that viewing health blogs did not have immediate effects on affect and self-esteem, but more neurotic individuals were more inclined to experience negative affect when viewing health promotion messages. Personality traits assessed prior to the experiment were more predictive of negative affect and self-esteem during the experiment than blog viewing conditions. No level of evidence, experimental study.

Disordered eating behaviours and correlates in yoga practitioners: a systematic review Abstract Purpose Yoga has been increasingly used as a complementary therapy for eating disorders. However, it is still not clear whether yoga is effective in the prevention and treatment of eating disorders, as some studies suggest that yoga practitioners show elevated levels of disordered eating behaviours. The goal of this systematic review is, thus, to analyse the occurrence of disordered eating behaviours and correlates in yoga practitioners. Method PRISMA guidelines for systematic reviews were used. Search was conducted in several databases and specific journals. Results Twelve articles, all cross-sectional, were identified, following PRISMA guidelines. Results across studies were inconsistent. Yoga practice was usually associated with healthier eating behaviours, lower disordered eating symptoms, and higher positive body image and body satisfaction, suggesting that yoga practitioners may be at a lower risk of developing eating disorders. However, other studies suggested that a high dosage of yoga practice may be associated with a higher prevalence of disordered eating behaviours. Conclusions As yoga is increasingly used as therapy for eating disorders, understanding the relationship between yoga dosage and disordered eating behaviours is critical to guide treatment recommendations and establish yoga as a valuable complementary therapy. Level of evidence Level I, systematic review.

Effects of a dialectical behavior therapy-based skills group intervention for obese individuals: a Brazilian pilot study Abstract Purpose This pilot study aimed to analyze the effects of an adapted dialectical behavior therapy (DBT) skills training group on problematic and adaptive eating behaviors in Brazilian obese individuals. Methods Thirty-one obese individuals were randomly assigned to 10 sessions of adapted DBT skills training (n = 14) or two months of a waiting list comparison condition (n = 17). Results Attrition rates were similar to what’s been found in comparable studies, with most dropouts happening at the beginning of the treatment. Results showed improvements in binge eating severity (d = 0.80) and depression (d = 0.82) compared to no treatment condition. After the intervention, adaptive eating and distress outcomes showed an improvement trend, reaching nonclinical levels for most participants in the intervention group. Large to moderate between-group effect sizes were observed, but none of those were statistically significant. Large within-group effect sizes were observed in the intervention group in binge eating severity (d = 1.34), intuitive eating (d = 1.33) and depression (d = 1.12). Medium effect sizes were observed in emotional eating (d = 0.73) and in emotion regulation (d = 0.72). Despite positive outcomes in other variables, mindful eating worsened after the intervention (d = 0.66). Conclusions These results are preliminary and require further replications with larger samples, yet they suggest that the intervention may be useful to improve distress outcomes and adaptive eating among obese people. Implications for clinical practice and recommendations for future research are discussed. Level of evidence Level I, randomized controlled trial.