Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls: a randomized controlled trial. Prevention of eating disorders in at-risk college-age women. Effects of a multimodal lifestyle intervention on body mass index in patients with bipolar disorder: a randomized controlled trial. Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. Risk Factors That Predict Future Onset of Each DSM–5 Eating Disorder: Predictive Specificity in High-Risk Adolescent Females Web-Based Cognitive Behavioral Therapy for Female Patients With Eating Disorders: Randomized Controlled Trial Eating Disorder Pathology in Adolescents Participating in a Lifestyle Intervention for Obesity: Associations with Weight Change, General Psychopathology and Health-Related Quality of Life A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program. Efficacy trial of a selective prevention program targeting both eating disorders and obesity among female college students: 1- and 2-year follow-up effects. Orlistat with behavioral weight loss for obesity with versus without binge eating disorder: randomized placebo-controlled trial at a community mental health center serving educationally and economically disadvantaged Latino/as. An exploratory randomized controlled study of a healthy living intervention in early intervention services for psychosis: the INTERvention to encourage ACTivity, improve diet, and reduce weight gain (INTERACT) study. What are the effects of providing evidence-based information on eating disorders and their treatments? A randomized controlled trial in a symptomatic community sample. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. Stigma and treatment of eating disorders in Ireland: healthcare professionals' knowledge and attitudes.
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 CONTEXT Eating disorders , an important health problem among college-age women , may be preventable , given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors . OBJECTIVE To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders ( EDs ) in young women at risk for developing EDs . SETTING San Diego and the San Francisco Bay Area in California . PARTICIPANTS College-age women with high weight and shape concerns were recruited via campus e-mails , posters , and mass media . Six hundred thirty-seven eligible participants were identified , of whom 157 were excluded , for a total sample of 480 . Recruitment occurred between November 13 , 2000 , and October 10 , 2003 . Intervention A r and omized controlled trial of an 8-week , Internet-based cognitive-behavioral intervention ( Student Bodies ) that included a moderated online discussion group . Participants were studied for up to 3 years . MAIN OUTCOME MEASURES The main outcome measure was time to onset of a sub clinical or clinical ED . Secondary measures included change in scores on the Weight Concerns Scale , Global Eating Disorder Examination Question naire , and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood . Moderators of outcome were examined . RESULTS There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention ( P < .001 ) , 1 year ( P < .001 ) , and 2 years ( P < .001 ) . The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group ( P = .02 ) . Over the course of follow-up , 43 participants developed sub clinical or clinical EDs . While there was no overall significant difference in onset of EDs between the intervention and control groups , the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses : ( 1 ) participants with an elevated body mass index ( BMI ) ( > or = 25 , calculated as weight in kilograms divided by height in meters squared ) at baseline and ( 2 ) at 1 site , participants with baseline compensatory behaviors ( eg , self-induced vomiting , laxative use , diuretic use , diet pill use , driven exercise ) . No intervention participant with an elevated baseline BMI developed an ED , while the rates of onset of ED in the comparable BMI control group ( based on survival analysis ) were 4.7 % at 1 year and 11.9 % at 2 years . In the subgroup with a BMI of 25 or higher , the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group ( 95 % confidence interval , 0 % for intervention group ; 2.7 % to 21.1 % for control group ) . For the San Francisco Bay Area site sample with baseline compensatory behaviors , 4 % of participants in the intervention group developed EDs at 1 year and 14.4 % , by 2 years . Rates for the comparable control group were 16 % and 30.4 % , respectively . CONCLUSIONS Among college-age women with high weight and shape concerns , an 8-week , Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs , at least in some high-risk groups . To our knowledge , this is the first study to show that EDs can be prevented in high-risk groups OBJECTIVE Patients with bipolar disorder are at increased risk of weight gain , which in turn increases the risk for somatic disease and nonadherence to maintenance therapy . Therefore , interventions addressing weight gain are expedient for the management of this disorder . We set out to evaluate the effects of a lifestyle intervention on body mass index ( BMI ) and cardiovascular and metabolic parameters in patients with bipolar disorder undergoing mood-stabilizing pharmacologic treatment . METHOD Fifty out patients with bipolar disorder undergoing mood-stabilizing treatment participated in a r and omized controlled trial ( waiting control group : n = 24 and multimodal lifestyle intervention group : n = 26 ) . Groups consisted of 2 cohorts ( cohort 1 : March 2005-February 2006 ; cohort 2 : September 2005-August 2006 ) . The intervention lasted 5 months and consisted of 11 group sessions and weekly fitness training .  BMI and body weight as well as cardiovascular and metabolic parameters were determined at 3 assessment points : at pretreatment baseline , at 5 months ( end of treatment ) , and at 11 months ( 6-month follow-up ) . RESULTS Intention-to-treat analyses showed that the intervention significantly reduced BMI over time ( P = .03 ) , with significant and stable mean differences in BMI change between groups of 0.7 kg/m² ( 95 % CI , 0.2 - 1.3 ) at 5 months and 0.8 kg/m² ( 95 % CI , 0.1 - 1.6 ) at 11 months ' follow-up assessment . The lifestyle intervention had no significant effect on cardiovascular and metabolic parameters ( all nonsignificant ) . The BMI reduction was only seen in female patients ( P = .003 ) . CONCLUSIONS BMI  in patients with bipolar disorder can be reduced with a long-lasting effect by a multimodal lifestyle intervention . However , this effect was only seen in female participants , indicating the need for gender-specific interventions . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00980863 Background The existing literature on weight management interventions targeting physical activity and healthy eating in mental health care appears to provide only limited evidence . The aim of the study was to examine the effectiveness of a 10-week health promotion intervention , followed by a 6-month follow-up period in individuals with mental disorders living in sheltered housing in the Fl and ers region ( Belgium ) . Methods The study had a cluster preference r and omized controlled design . Twenty-five sheltered housing organisations agreed to participate ( 16 in the intervention group , nine in the control group ) . In the intervention group , 225 individuals agreed to participate , while in the control group 99 individuals entered into the study . The main outcomes were changes in body weight , Body Mass Index , waist circumference and fat mass . Secondary outcomes consisted of changes in physical activity levels , eating habits , health-related quality of life and psychiatric symptom severity . Results A significant difference was found between the intervention group and the control group regarding body weight ( −0.35 vs. + 0.22 kg ; p=0.04 ) , Body Mass Index ( −0.12 vs. + 0.08 kg/m2 ; p=0.04 ) , waist circumference ( −0.29 vs. + 0.55 cm ; p<0.01 ) , and fat mass ( −0.99 vs. −0.12 % ; p<0.01 ) . The decrease in these outcomes in the intervention group disappeared during the follow up period , except for fat mass . Within the intervention group , a larger decrease in the primary outcomes was found in the participants who completed the intervention . No significant differences between the two groups in changes in the secondary outcomes were found , except for the pedometer-determined steps/day . In the intervention group , the mean number of daily steps increased , while it decreased in the control group . Conclusions The study demonstrated that small significant improvements in the primary outcomes are possible in individuals with mental disorders .  Integration of health promotion activities targeting physical activity and healthy eating into daily care are , however , necessary to maintain the promising results .Trial registration This study is registered at Clinical Trials.gov 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 OBJECTIVE To examine predictors and moderators of response to cognitive behavioral therapy ( CBT ) and medication treatments for binge-eating disorder ( BED ) . METHOD 108 BED patients in a r and omized double-blind placebo-controlled trial testing CBT and fluoxetine treatments  were assessed prior , throughout , and posttreatment . Demographic factors , psychiatric and personality disorder comorbidity , eating disorder psychopathology , psychological features , and 2 subtyping methods ( negative affect , overvaluation of shape/weight ) were tested as predictors and moderators for the primary outcome of remission from binge eating and 4 secondary dimensional outcomes ( binge-eating frequency , eating disorder psychopathology , depression , and body mass index ) . Mixed-effects models analyzed all available data for each outcome variable . In each model , effects for baseline value and treatment were included with tests of both prediction and moderator effects . RESULTS Several demographic and clinical variables significantly predicted and /or moderated outcomes . One demographic variable signaled a statistical advantage for medication only ( younger participants had greater binge-eating reductions ) , whereas several demographic and clinical variables ( lower self-esteem , negative affect , and overvaluation of shape/weight ) signaled better improvements if receiving CBT .  Overvaluation was the most salient predictor/moderator of outcomes . Overvaluation significantly predicted binge-eating remission ( 29 % of participants with vs. 57 % of participants without overvaluation remitted ) . Overvaluation was especially associated with lower remission rates if receiving medication only ( 10 % vs. 42 % for participants without overvaluation ) . Overvaluation moderated dimensional outcomes : Participants with overvaluation had significantly greater reductions in eating disorder psychopathology and depression levels if receiving CBT . Overvaluation predictor/moderator findings persisted after controlling for negative affect . CONCLUSIONS Our findings have clinical utility for prescription of CBT and medication and implication s for refinement of the BED diagnosis 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 Many patients with eating disorders do not receive help for their symptoms , even though these disorders have severe morbidity . The Internet may offer alternative low-threshold treatment interventions . Objective This study evaluated the effects of a Web-based cognitive behavioral therapy ( CBT ) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology , and to reduce body dissatisfaction and related health problems among patients with eating disorders . Methods A two-arm open r and omized controlled trial comparing a Web-based CBT intervention to a waiting list control condition ( WL ) was carried out among female patients with bulimia nervosa ( BN ) , binge eating disorder ( BED ) , and eating disorders not otherwise specified ( EDNOS ) . The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders , 4th edition , and was established based on participants ’ self-report . Participants were recruited from an open-access website , and the intervention consisted of a structured two-part program within a secure Web-based application . The aim of the first part was to analyze participant ’s eating attitudes and behaviors , while the second part focused on behavioral change . Participants had asynchronous contact with a personal therapist twice a week , solely via the Internet .  Self-report measures of eating disorder psychopathology ( primary outcome ) , body dissatisfaction , physical health , mental health , self-esteem , quality of life , and social functioning were completed at baseline and posttest . Results A total of 214 participants were r and omized to either the  Web-based CBT group ( n=108 ) or to the WL group ( n=106 ) stratified by type of eating disorder ( BN : n=44 ; BED : n=85 ; EDNOS : n=85 ) . Study attrition was low with 94 % of the participants completing the posttest assignment . Overall , Web-based CBT showed a significant improvement over time for eating disorder psychopathology ( F 97=63.07 , P<.001 , d=.82 ) and all secondary outcome measures ( effect sizes between d=.34 to d=.49 ) , except for Body Mass Index . WL participants also improved on most outcomes ; however , effects were smaller in this group with significant between-group effects for eating disorder psychopathology ( F 201=9.42 , P=.002 , d=.44 ) , body dissatisfaction ( F 201=13.16 , P<.001 , d=.42 ) , physical health ( F 200=12.55 , P<.001 , d=.28 ) , mental health ( F 203=4.88 , P=.028 , d=.24 ) , self-esteem ( F 202=5.06 , P=.026 , d=.20 ) , and social functioning ( F 205=7.93 , P=.005 , d=.29 ) . Analyses for the individual subgroups BN , BED , and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups ; however , the between-group effect was significant only for participants with BED ( F 78=4.25 , P=.043 , d=.61 ) . Conclusions Web-based CBT proved to be effective in improving eating disorder psychopathology and related health  among female patients with eating disorders . Trial Registration Nederl and s Trial Register ( NTR ) : NTR2415 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2415 ( Archived by WebCite at http://www.webcitation.org/6T2io3DnJ ) Objective : The aim of this study was to identify the prevalence of eating disorder symptoms in obese adolescents participating in a lifestyle intervention for weight loss and to investigate possible relationships with weight change , general psychopathology , and health-related quality of life ( HRQOL ) . Method : At the beginning and after completion of a 6-month lifestyle intervention , 41 participants ( 20 females ; age : 13.7 ± 1.4 years ) reported on core symptoms of eating disorders ( SCOFF ) , self-esteem ( Rosenberg Self-Esteem Scale , RSES ) , and HRQOL  ( Question naire for Measuring Health-Related Quality of Life in Children and Adolescents , KINDL ) , while parents filled in a question naire assessing their children 's internalizing and externalizing behavioral problems ( Child Behavior Checklist , CBCL ) . Results : Compared to age-matched normative sample s , patients showed increased behavior problems and an impaired HRQOL . 43 % of the patients were screened positive for an eating disorder pathology , and this subgroup showed an increased psychopathological burden compared to patients that were screened negative . The lifestyle intervention result ed in a significant weight loss which was unaffected by the presence of an eating disorder pathology . The screening rate for eating disorders remained stable after the intervention . Conclusion : The large overlap , mutual interaction , and high burden of eating and weight problems in children and adolescents underpin the need for an integrated view in both prevention and treatment approaches in pediatric obesity Research on treatments in anorexia nervosa ( AN ) is scarce . Although most of the therapeutic programs used in ‘ real world practice ’ in AN treatment resort to multidisciplinary approaches , they have rarely been evaluated . Objective To compare two multidimensional post-hospitalization out patients treatment programs for adolescents with severe AN :  Treatment as Usual ( TAU ) versus this treatment plus family therapy ( TAU+FT ) . Method Sixty female AN adolescents , aged 13 to 19 years , were included in a r and omized parallel controlled trial conducted from 1999 to 2002 for the recruitment , and until 2004 for the 18 months follow-up . Allocation to one of the two treatment groups ( 30 in each arm ) was r and omised . The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents . The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics , but not eating disorder symptoms . The main Outcome Measure was the Morgan and Russell outcome category ( Good or Intermediate versus Poor outcome ) . Secondary outcome indicators included AN symptoms or their consequences ( eating symptoms , body mass index , amenorrhea , number of hospitalizations in the course of follow-up , social adjustment ) . The evaluators , but not participants , were blind to r and omization . Results At 18 months follow-up , we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy ( Intention-to-treat : TAU+FT : 12/30 ( 40 % ) ; TAU : 5/29 ( 17.2 % ) p = 0.05 ; Per Protocol analysis : respectively 12/26 ( 46.2 % ) ; 4/27 ( 14.8 % ) , p = 0.01 ) . Similar group effects were observed in terms of achievement of a healthy weight ( i.e. , BMI ≥10th percentile ) and menstrual status . Conclusions Adding family therapy sessions , focusing on intra-familial dynamics rather than eating symptomatology , to a multidimensional program improves treatment effectiveness in girls with severe AN . Trial Registration Controlled-trials.com IS RCT BACKGROUND The purpose of this study was to test prospect ively the feasibility and efficacy of a multimodal weight control program for over-weight and obese severely mentally ill adults who had gained weight while taking atypical antipsychotic medications . METHOD Thirty-one subjects with schizophrenia or schizoaffective disorder ( DSM-IV ) , on treatment with atypical antipsychotics , participated in a 52-week , multimodal weight control program that incorporated nutrition , exercise , and behavioral interventions . The primary outcomes were measures of body mass index ( BMI ) and weight . A variety of secondary outcomes , including hemoglobin A(1c ) level , systolic and diastolic blood pressure , and cholesterol level , were compared from baseline to endpoint . Weight and BMI changes in the intervention group were also compared with changes in 20 nonintervention patients ( " usual care " group ) who were contemporaneously treated in the same clinics . RESULTS Twenty of the 31 subjects in the intervention group completed the program . Statistically significant pre-post improvements in weight ( p < .02 ) , BMI ( p < .02 ) , hemoglobin A(1c ) levels ( p < .001 ) , diastolic ( p < .001 ) and systolic ( p < .05 ) blood pressure , exercise level ( p < .003 ) , nutrition knowledge ( p < .0001 ) , and stage of change ( exercise [ p < .0001 ] and weight [ p < .008 ] ) were seen in the intervention group . Patients attended a mean of 69 % of the sessions during the year of the program . Weight and BMI also decreased significantly ( p = .01 ) in the intervention group compared with the " usual care " group , who gained weight during the observation period . CONCLUSIONS Individuals with schizophrenia and schizoaffective disorder were willing to attend , and benefited from , a weight control program that focused on nutrition , exercise , and motivation . The program result ed in clinical ly significant reductions in weight , BMI , and other risk factors for long-term poor health , including hemoglobin A(1c ) . In contrast , patients who did not receive the weight control intervention continued to gain weight OBJECTIVE Evaluate the effects of a prevention program targeting both eating disorders and obesity at 1- and 2-year follow-ups . METHOD Female college students at risk for these outcomes because of body image concerns ( N = 398 ) were r and omized to the Healthy Weight 2 group-based 4-hr prevention program , which promotes lasting healthy improvements to dietary intake and physical activity and nutrition science health behavior change principles , or an educational brochure control condition . RESULTS Intervention participants showed significantly less body dissatisfaction and eating disorder symptoms and lower eating disorder onset through 2-year follow-up versus controls , but the former 2 effects were small . There were no main effects for body mass index ( BMI ) , depressive symptoms , dieting , caloric intake , physical activity , or obesity onset . Moderator analyses revealed stronger eating disorder symptom effects for youths with initially elevated symptoms and lower pressure to be thin , stronger BMI effects for youths with initially elevated symptoms and BMI scores , and weaker eating disorder symptom effects for youths with initially elevated pressure to be thin . CONCLUSIONS The 60 % reduction in eating disorder onset over the 2-year follow-up was clinical ly significant and a novel effect for a prevention program , but the main effects on continuous outcomes were small , suggesting that adding nutrition science principles weakened the intervention efficacy . Effects on both eating disorder symptoms and BMI were greater for those with elevated eating disorder symptoms and BMI at pretest , implying that it might be useful to target these individuals in future trials OBJECTIVE This study was a r and omized placebo-controlled trial testing the addition of orlistat to behavioral weight loss for obesity in Spanish-speaking-only Latino/as with versus without binge eating disorder ( BED ) performed at a community mental health center serving educationally- and economically-disadvantaged patients . Latino/as have high rates of obesity but are under-represented in obesity treatment studies and despite comparable-to-or-higher rates of BED than Whites , Latino/as are under-represented in BED treatment studies . BED is associated with obesity but whether it predicts/moderates treatment outcomes remains uncertain . Thus , this study also tested whether BED prospect ively predicts/moderates outcomes . METHODS Seventy-nine obese Spanish-speaking-only Latino/as with BED ( N=40 ) versus without BED ( N=39 ) at a community mental health center were r and omly assigned to four-months of orlistat-plus-BWL or placebo-plus-BWL . BWL was culturally-enhanced modification of Diabetes-Prevention-Program delivered in weekly sessions in Spanish . Orlistat ( 120 mg tid ) and matching-placebo delivered with st and ard clinical -management . Participants were assessed independently throughout treatment , post-treatment , and six-month follow-up . RESULTS 78 % completed treatments ; completion rates did not differ significantly by medication or BED . Intent-to-treat mixed-models analyses revealed significant improvements in binge eating , eating-psychopathology , and depression , and significant -- albeit modest -- weight-loss . Overall , the addition of orlistat to BWL was not associated with greater improvements ; however , BED moderated weight-loss :  orlistat-plus-BWL produced significantly greater weight-loss in non-BED group but not in BED . Improvements were maintained through 6-month follow-up ; BED significantly predicted/moderated increases in eating concerns and depression following treatment . Within BED-group , binge-eating remission rates were 65 % ( post-treatment ) and 50 % ( follow-up ) . CONCLUSIONS In this controlled trial performed at community mental health center serving educationally- and economically-disadvantaged Spanish-speaking-only Latino/as with co-morbid psychiatric needs , we observed outcomes for the BWL plus orlistat/placebo medication that approximate or are slightly dampened relative to the literature for efficacy trials with much more restrictive obese and BED sample s. In this complex patient group , adding orlistat to BWL produced greater weight-loss than adding placebo among obese patients without BED but not among those with BED . Although 50 % of BED patients maintained abstinence from binge-eating following these specific obesity treatments ( BWL plus orlistat/placebo ) , BED was a negative prognostic indicator for some outcome variables . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00516919 BACKGROUND People with psychosis often experience weight gain , which places them at risk of cardiovascular disease , diabetes , and early death . OBJECTIVE To determine the uptake , adherence , and clinical effectiveness of a healthy living intervention design ed to reduce weight gain . METHOD An exploratory r and omized controlled trial , comparing the intervention with treatment as usual ( TAU ) in 2 early intervention services for psychosis in Engl and . DSM-IV classification was the diagnostic criteria used to assign the psychiatric diagnoses . The primary outcome was change in body mass index ( BMI ) from baseline to 12-month follow-up . The study was conducted between February 2009 and October 2012 . RESULTS 105 service users , with a BMI of ≥ 25 ( ≥ 24 in South Asians ) , were r and omized to intervention  ( n = 54 ) or  TAU  ( n = 51 ) after stratification by recent commencement of antipsychotic medication . Ninety-three service users ( 89 % ) were followed up at 12 months . Between-group difference in change in BMI was not significant ( effect size = 0.11 ) . The effect of the intervention was larger ( effect size = 0.54 , not significant ) in 15 intervention ( 28 % ) and 10 TAU ( 20 % ) participants who were taking olanzapine or clozapine at r and omization . CONCLUSIONS The healthy living intervention did not show a significant difference in BMI reduction compared to the TAU group . TRIAL REGISTRATION www.is rct n.org identifier : IS RCT N22581937 AIM We hypothesize that a reason for the infrequent uptake of treatments by people with eating disorders is poor knowledge about treatments and outcomes for eating disorders ( ED-Mental Health Literacy ; ED-MHL ) . Our aim was to test putative health benefits of a brief ED-MHL intervention . METHODS In a community-based two-phase survey , 122 young women ( mean age 28.5 SD 6.3 years ) with ED symptoms meeting DSM-IV criteria for clinical severity were r and omized to receive either a brief ED-MHL intervention ( comprising information about efficacious treatments , reputable self-help books and where to go for further information and /or services ) or information about local mental health services only . All were given feedback on their scores on  measures of ED symptoms and quality of life . ED-MHL , ED symptoms and health-related quality of life were assessed prior to the intervention and at 6- and 12-month follow-up . RESULTS One hundred and two participants ( 84 % ) completed follow-up at 12 months . Symptomatic improvement and changes in specific aspects of ED-MHL , namely , less pessimism about how difficult EDs are to treat and improved recognition and knowledge , as well as increased help seeking , were observed in both groups . Differences between groups were uncommon but compared with control participants , those in the intervention group had improved health-related quality of life . CONCLUSIONS A brief community-based intervention aim ed to improve knowledge and beliefs about EDs and their treatments may be a valuable first step in improving health-related outcomes for people with ED , but more research is needed OBJECTIVE The aim of this study was to compare two cognitive-behavioral treatments for out patients with eating disorders , one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance , clinical perfectionism , low self-esteem , or interpersonal difficulties . METHOD A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight ( body mass index over 17.5 ) , were enrolled in a two-site r and omized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up . The control condition was an 8-week waiting list period preceding treatment . Outcomes were measured by independent assessors who were blind to treatment condition . RESULTS Patients in the waiting list control condition exhibited little change in symptom severity , whereas those in the two treatment conditions exhibited substantial and equivalent change , which was well maintained during follow-up . At the 60-week follow-up assessment , 51.3 % of the sample had a level of eating disorder features less than one st and ard deviation above the community mean . Treatment outcome did not depend on eating disorder diagnosis . Patients with marked mood intolerance , clinical perfectionism , low self-esteem , or interpersonal difficulties  appeared to respond better to the more complex treatment , with the reverse pattern evident among the remaining patients . CONCLUSIONS These two transdiagnostic treatments appear to be suitable for the majority of out patients with an eating disorder . The simpler treatment may best be viewed as the default version , with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment OBJECTIVES This study examines aspects of healthcare professionals ' knowledge and attitudes about eating disorders ( EDs ) , which might impede the effective detection or treatment of EDs in Irel and . METHODS A total of 1,916 healthcare professionals were invited to participate in a web-based survey . Participants were r and omly allocated to view one of five vignettes depicting a young person with symptoms consistent with anorexia nervosa , bulimia nervosa , binge-eating disorder , depression or type 1 diabetes . Study -specific questions examined participants ' responses to the vignettes and ED knowledge and experience . RESULTS In total , 171 clinicians responded ( 9 % response rate ) . Participants had an average of 15.8 years of clinical experience ( s.d.=9.2 ) and included psychiatrists , GPs , psychologists and counsellors . Although participants ' knowledge of EDs was moderately good overall , responses showed poor recognition of the symptoms of EDs compared with depression [ χ 2 ( 4 , n=127)=20.17 , p<0.001 ] . Participants viewed EDs as chronic disorders that primarily affected females . Participants believed that clinicians like working with patients with depression and diabetes more than with AN patients [ F (4,101)=5.11 , p=0.001 ] . Among the professionals surveyed , psychiatrists were the most knowledgeable about EDs [ F (4,82)=9.18 , p<0.001 ] , and were more confident in their ability to diagnose and treat EDs than professionals of all other disciplines , except psychologists [ F (4,85)=8.99 , p<0.001 ] . Psychiatrists were also the most pessimistic about ED patients ' long-term life prospect s [ χ 2 ( 4 , n=65)=15.84 , p=0.003 ] . CONCLUSIONS This study recommends that specific attention should be given to EDs in professional educational programmes across healthcare disciplines . This training should not be restricted to improving healthcare professionals ' knowledge of EDs , but should also strive to increase service-providers ' awareness of how their own potentially stigmatising attitudes can undermine engagement with treatment
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 ] .