Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls: a randomized controlled trial. Risk Factors That Predict Future Onset of Each DSM–5 Eating Disorder: Predictive Specificity in High-Risk Adolescent Females The natural course of bulimia nervosa and binge eating disorder in young women. Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE).
BACKGROUND The high prevalence and incidence of obesity and eating disorders in US adolescent girls are serious health problems . Because of the shared risk factors for obesity and eating disorders , a targeted prevention of both conditions is a priority . OBJECTIVE We determined whether an adapted interpersonal psychotherapy prevention program is more efficacious for reducing excess weight gain and worsening disordered eating than health education in adolescent girls at high risk of obesity and eating disorders . DESIGN A parallel-group , r and omized controlled trial was conducted between September 2008 and January 2013 in a university-based laboratory and a federal research hospital . The study included 113 adolescent ( 12 - 17-y-old ) girls deemed at high risk of adult obesity and eating disorders because of a body mass index ( BMI ) between the 75th and 97th percentiles and reports of episodes of a loss of control over their eating . Girls were r and omly assigned to participate in an adapted interpersonal psychotherapy or a health-education group program for 12 weekly 90-min group sessions . Follow-up assessment s occurred immediately after group programs and at 6 and 12 mo . RESULTS Participation in both conditions was associated with decreases in expected BMI gain , age-adjusted BMI metrics , the percentage of fat by using dual-energy X-ray absorptiometry , symptoms of depression and anxiety , and the frequency of loss-of-control eating over 12 mo of follow-up ( Ps < 0.001 ) with no group difference . In follow-up analyses , interpersonal psychotherapy was more efficacious than health education at reducing objective binge eating at the 12-mo follow-up ( P < 0.05 ) . CONCLUSIONS The intervention with adolescent girls with loss-of-control eating is associated with lower age-adjusted BMI and percentage of adiposity as well as improved mood symptoms over 1 y. Interpersonal psychotherapy further reduced objective binge eating . Additional research is needed to eluci date the mechanisms by which physical and psychological improvements were observed . This trial was registered at clinical trials.gov as NCT00680979 Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders , we addressed these aims to advance knowledge regarding risk factor specificity . Data from 3 prevention trials that targeted young women with body dissatisfaction ( N = 1,272 ; Mage = 18.5 , SD = 4.2 ) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa ( AN ) , bulimia nervosa ( BN ) , binge eating disorder ( BED ) , and purging disorder ( PD ) . Negative affect and functional impairment predicted onset of all eating disorders . Thin-ideal internalization , body dissatisfaction , dieting , overeating , and mental health care predicted onset of subthreshold/threshold BN , BED , and PD ; positive thinness expectations , denial of cost of pursuing the thin ideal , and fasting predicted onset of 2 of these 3 disorders . Similar risk factors predicted core eating disorder symptom onset . Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI . Only a subset of factors showed unique predictive effects in multivariate models , likely due to moderate correlations between the risk factors ( M r = .14 ) . Results provide support for the theory that pursuit of the thin ideal and the result ing body dissatisfaction , dieting , and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders , but suggest that youth who are inherently lean , rather than purpose ly pursuing the thin ideal , are at risk for AN . Impaired interpersonal functioning and negative affect are transdiagnostic risk factors , suggesting these factors should be targeted in prevention programs BACKGROUND Little is known about the relative course and outcome of bulimia nervosa and binge eating disorder . METHODS Two community-based cohorts were studied prospect ively over a 5-year year period . One comprised 102 participants with bulimia nervosa and the other 48 participants with binge eating disorder ( 21 % [ 9/42 ] of whom had comorbid obesity ) . All participants were female and aged between 16 and 35 years at recruitment . The assessment s were at 15-month intervals and addressed eating disorder features , general psychiatric symptoms , and social functioning . RESULTS Both cohorts showed marked initial improvement followed by gradual improvement thereafter . Between half and two thirds of the bulimia nervosa cohort had some form of eating disorder of clinical severity at each assessment point , although only a minority continued to meet diagnostic criteria for bulimia nervosa . Each year about a third remitted and a third relapsed . The outcome of the binge eating disorder cohort was better , with the proportion with any form of clinical eating disorder declining to 18 % ( 7 of 40 ) by the 5-year follow-up . The relapse rate was low among this cohort . There was little movement of participants across the 2 diagnostic categories and few sought treatment . Both groups gained weight , with 39 % of the binge eating disorder cohort ( 14 of 36 ) meeting criteria for obesity at 5-year follow-up . CONCLUSIONS These findings suggest that , among young women in the community , bulimia nervosa and binge eating disorder have a different course and outcome . Whereas the prognosis of those with bulimia nervosa was relatively poor , the great majority of those with binge eating disorder recovered Objective : People living with psychotic disorders ( schizophrenia spectrum and bipolar disorders ) have high rates of cardiovascular disease risk behaviours , including smoking , physical inactivity and poor diet . We report cardiovascular disease risk , smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm r and omised controlled trial among smokers with psychotic disorders . Methods : Participants ( N = 235 ) drawn from three sites were r and omised to receive nicotine replacement therapy plus ( 1 ) a Healthy Lifestyles intervention  delivered over approximately 9 months or ( 2 ) a largely telephone-delivered intervention ( design ed to control for nicotine replacement therapy provision , session frequency and other monitoring ) . The primary outcome variables were 10-year cardiovascular disease risk and smoking status , while the secondary outcomes included weekly physical activity , unhealthy eating , waist circumference , psychiatric symptomatology , depression and global functioning . Results : Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions , with no significant differences between conditions . One-quarter ( 25.5 % ) of participants reported reducing cigarettes per day by 50 % or more at multiple post-treatment assessment s ; however , few ( 8.9 % ) managed to sustain this across the majority of time points . Changes in other health behaviours or lifestyle factors were modest ; however , significant improvements in depression and global functioning were detected over time in both conditions . Participants experiencing worse ‘ social discomfort ’ at baseline ( e.g. anxiety , mania , poor self-esteem and social disability ) had on average significantly worse global functioning , lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference . Conclusion : Although the telephone-delivered intervention was design ed as a comparison condition , it achieved excellent retention and comparable outcomes . Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders . Discomfort in social situations may also be a useful target for future health interventions , addressing confidence and social skills , and promoting social networks that reduce inactivity OBJECTIVES Individuals with bipolar disorder have high rates of other medical comorbidity , which is associated with higher mortality rates and worse course of illness . The present study examined common predictors of medical comorbidity . METHODS The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study ( Bipolar CHOICE ) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month , r and omized comparative effectiveness trial . Baseline assessment s included current and lifetime DSM-IV-TR diagnoses , demographic information , psychiatric and medical history , severity of psychiatric symptoms , level of functioning , and a fasting blood draw . Medical comorbidities were categorized into two groups : cardiometabolic ( e.g. , diabetes , hyperlipidemia , and metabolic syndrome ) and non-cardiovascular ( e.g. , seizures , asthma , and cancer ) . Additionally , we looked at comorbid substance use ( e.g. , smoking and drug dependence ) . RESULTS We found that 96.3 % of participants had at least one other medical comorbidity . Older age predicted a greater likelihood of having a cardiometabolic condition . Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition , but a greater chance of having other types of medical comorbidity . Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed , less time spent manic/hypomanic , and longer duration of illness . Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides . CONCLUSIONS There appears to be a substantial medical burden associated with bipolar disorder , highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients
These have been of limited long-term effectiveness , though early intervention post-first episode psychosis appears to be more promising [ 6 ] .
Hence , the effectiveness of Cognitive Behaviour Therapy ( CBT ) or
Background Eating disorders are understood to no longer be the remit of lean adolescent girls alone [ 1 ] , whatever pop culture offerings such as Netflix ’s To The Bone might continue to present .
Rather , people with eating disorders are much more diverse , often undiagnosed and often suffering in silence .
One patient population with a unique but poorly understood vulnerability to eating disorders , as well as obesity and poor physical health , is people with bipolar disorder .
Bipolar disorder is a complex , serious mental illness that confers significant functional impairment , primarily due to time spent in manic , depressed , or mixed state episodes , difficulty eliminating subthreshold depressive symptoms , and the financial , social and emotional sequelae of illness episodes .
One significant contributor to disability is physical ill health , with the average life expectancy of someone with bipolar disorder notably reduced due to cardiometabolic illnesses like heart disease and type two diabetes mellitus .
Furthermore , poorer physical health is associated with poorer mental health in this group , such as higher risk of depressive relapse [ 2 , 3 ] .
The past two decades has seen increased focus on preserving and improving the physical health of people with bipolar disorder , who are often prescribed long-term medication known to be conducive to weight gain [ 4 ] .
Trials of a number of interventions have attempted to implement lifestyle interventions to promote healthy eating , physical activity , and social connectedness , in order to prevent or reduce the adverse impact of obesity and improve physical health and psycho-social functioning [ 5 ] .
The role of disordered eating in contributing to physical and mental health outcomes among individuals with bipolar disorder has rarely been considered , despite the fact that approximately one in three people with bipolar disorder also meet criteria for binge eating disorder , bulimia nervosa , or variants of these disorders [ 7 , 8 ] .
Alongside studies question ing the impact of medication on weight gain in bipolar disorder [ 9 ] , identifying the role of weight-cycling in higher cardiovascular risk [ 10 ] , and showing that obesity risk pre- date s medication [ 11 ] , are reports of a link between eating disorders and high Body Mass Index ( BMI , kg/m ) [ 12 ] and evidence that baseline binge eating predicts medication-associated weight gain [ 13 ] .
With these recent developments in mind , the authors were curious about what novel interventions for eating disorders and weight disorder in bipolar disorder exist , and conducted a systematic review about their effectiveness .
In this search no treatments targeting eating disorders specifically were found to exist [ 14 ] , despite the movement of this area into the spotlight over 10 years ago [ 15 ] .