Eating Disorder Prevention in Schools

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Community Capacity-Building in Schools: Parents’ and Teachers’ Reflections From an Eating Disorder Prevention Program

Community Capacity-Building in Schools: Parents’ and Teachers’ Reflections From an Eating Disorder Prevention Program

One area receiving attention in schools is eating disorder prevention. In a recent study (McVey, Tweed, & Blackmore, 2004) of girls aged 10-14, approxi- mately 30% were dieting and 10% scored at risk for disordered eating. Weight loss behaviors, most common in girls, and muscle gaining behaviors, most common in boys, have been reported in children as young as 10 (McVey, Tweed, & Blackmore, 2005). Despite the mounting evidence creating concern and the amount of academic writing produced over the past decade on the prevention of eating disorders, few empirical research studies have been pub- lished (Austin, 2000). Evaluation of education programs in schools that specifi- cally address eating disorder prevention through didactic teaching of signs and symptoms suggests minimal effectiveness in behavioral change. In fact educa- tion programs that emphasize disease prevention may do more harm than good by causing undue attention to pathology, with limited emphasis on promoting wellness, healthy attitudes, and behavior change (Mann & Burgard, 1998; Rosen & Neumark-Sztainer, 1998). To design effective wellness-based programs and prevent inadvertent escalation of those behaviors and attitudes targeted for prevention, programming must be developmentally appropriate, continually reinforced, and focus on healthy change (Piran, 1998). For example, youth must be consistently exposed to the ideas of self-acceptance and positive body image (Russell & Ryder, 2001a).
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The Effectiveness of Media Literacy and Eating Disorder Prevention in Schools: A Controlled Evaluation with 9th Grade Girls

The Effectiveness of Media Literacy and Eating Disorder Prevention in Schools: A Controlled Evaluation with 9th Grade Girls

Despite an increase in the documentation of eating disorders in the last several decades, eating disturbances were in existence well before current forms of media and during times when cultural ideals promoted hour-glass figures and even corpulence. In the 17 th century, an English physician, Richard Morton, first noted emaciation resulting from emotional instability. Much later, in 1873, two European doctors, Ernest-Charles Lasegue and Sir William Whitney Gull, simultaneously documented separate descriptions of “anorexia hytserica” affecting young women (see Vandereycken, 2002). Throughout and before these periods, though, some people also relished an ascetic superiority in the act of fasting. In fact, in Holy Anorexia, Rudolph Bell (1987) recounts medieval Italian saints who were perfectionistic and starved themselves in the quest for piety and perfect holiness. Plausibly, individuals also felt other types of social pressures or oppression, and eating disorders possibly became expressions of self-loathing and pain, not entirely unlike the contemporary disorders. However, it was not until the 20 th century that the American medical press expressed significant interest in AN. In the 1960s, Hilde Bruch, a German-born American psychiatrist, initiated a conceptualization of AN in the context of distorted body image, poor self-esteem, and a tenacious drive for thinness (see
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Efficacy of a prevention program for eating disorders in schools: a cluster randomized controlled trial

Efficacy of a prevention program for eating disorders in schools: a cluster randomized controlled trial

Prevention programs delivered to whole classes follow a universal prevention approach as female and male ado- lescents participate without prior screening and regard- less of risk status. In the field of eating disorders, the efficacy of universal prevention programs in terms of ef- fect sizes is typically lower than in selective approaches [12] which has been attributed to different baseline scores in unselected samples [13]. Bailey and colleagues summarized the results of 46 trials of universal preven- tion programs for eating disorders as well as six meta- analytic reviews [14]. Satisfactory effect sizes were observed for outcomes related to eating disorder know- ledge while risk factor related outcomes were barely im- proved. The authors concluded that research opportunities for universal eating disorder prevention could be found in following a cognitive dissonance ra- ther than a psychoeducational approach and by offering interactive interventions in a multi-session format. An- other narrative review on effective eating disorder pre- vention programs underlined the need for universal prevention programs that address both genders [15].
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Mapping the evidence for the prevention and treatment of eating disorders in young people

Mapping the evidence for the prevention and treatment of eating disorders in young people

Intervention research is dominated by trials of family based therapy, particularly for AN in the adolescent bracket. Even with the widespread implementation of FBTs due to clin- ical practice guideline recommendations (e.g., [20,80]), fur- ther well-conducted trials are still required, not only to provide a stronger evidence base for clinical recommenda- tions, but to address significant clinical questions that re- main. For example, is FBT the most effective psychological intervention for AN? Head to head trials with other vali- dated psychological interventions adapted for the eating disorders are required. CBT is a potential candidate given its success in BN and the evidence base generated across other adolescent/young adult onset disorders. Interper- sonal therapy also presents an interesting comparison as its relationship framework may have overlapping features with FBT. Important work is also needed to determine the effectiveness of FBT in populations other than adolescents. A recent review described developments of an adapted version of FBT for young adults (18+) [47]. The main adaptation being the definition of family where a prag- matic approach is used to define a ‘family of choice’ which
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Pro-eating disorder search patterns: the possible influence of celebrity eating disorder stories in the media

Pro-eating disorder search patterns: the possible influence of celebrity eating disorder stories in the media

As with any study, the present findings should be interpreted within the context of several limitations. We cannot assume a causal relation between media story coverage of high-profile celebrity ED disclosures and Google search patterns for pro-ED content. Additionally, we do not have access to data about who conducted the Google searches reported and the impact (if any) these searches have on body image or ED behaviour. We also acknowledge that not all news stories of celebrity eating disorder disclosures yielded changes in pro-ED searches; indeed, this was only observed in the case of a higher- profile celebrity. Thus, the trend observed in the current study may only apply to particular celebrity stories ver- sus any celebrity story. Finally, given the nature of data obtained, and because we were looking at individual search terms (versus an aggregate of multiple terms), we were limited in the types of analyses we could perform.
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Binge eating disorder treatment goes online – feasibility, usability, and treatment outcome of an Internet based treatment for binge eating disorder: study protocol for a three arm randomized controlled trial including an immediate treatment, a waitlist,

Binge eating disorder treatment goes online – feasibility, usability, and treatment outcome of an Internet based treatment for binge eating disorder: study protocol for a three arm randomized controlled trial including an immediate treatment, a waitlist, and a placebo control group

from the therapy and show abstinence from binge-eating at the end of the active treatment [11, 16]. Maintenance of the therapy success in follow-up periods from 12 months up to five years has been proven in different studies from our group [13, 15]. The most thoroughly validated moder- ator for treatment success in BED is the reduction of binge-eating episodes by 65 – 70% within the first four treatment sessions ( “ rapid response ” ) (e.g. [13, 16]). A negative predictor of treatment success is over-evaluation of shape and weight. Also, the initial level of psychopath- ology seems to negatively influence treatment effects and it has been shown that therapeutic interventions are gen- erally less successful with increasing duration of the ED [11, 16, 17]. The combination of pharmacotherapy and psychotherapy is not superior to psychotherapy alone and psychopharmacological medication in BED is still at an off-label-use level. Consequently, the spread and improvement of psychological treatments for BED is necessary [1] and Internet-based guided self-help (GSH) treatments are valuable treatment alternatives in BED therapy [1, 11, 18, 19].
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An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status

An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status

Attachment describes an inborn motivation to seek physi- cal and mental proximity to a caregiver in order to find safety and care [8]. It develops between the 6 th and 36 th months of life [2], and it is transmitted cross- generationally [47]. Attachment experiences are inter- nalized to an internal working model (IWM), representing assumptions that the child forms about itself and others [30]. Ainsworth [2] classifies secure, insecure- ambivalent, insecure-avoidant and disorganized attach- ment styles. The first three styles belong to organized behavior, the latter to disorganized behavior. Based on their assumption that each IWM has a positive and a negative level, Bartholomew and Horowitz [4] postulate four attachment styles that combine the two IWMs (self/ other) with the two levels (positive/negative). The four at- tachment styles can be assigned to Ainsworth’s styles [34]. Probably because of the protective effect of secure attach- ment, we find higher rates of this attachment style in non- clinical versus clinical groups [38, 51]. For a secure attach- ment style to develop, the primary caregiver must give lasting and sensitive care [2]: if a child grows up in an en- vironment in which it predominantly experiences anxiety, unresolved loss, rejection and physical or emotional in- stability, it internalizes a self-image that it is not lovable or worthy of support. This is often the case in children who develop an ED [48]. For example, perinatal factors such as obstetric difficulty, prematurity and/or birth trauma, childhood abuse and other traumatic experiences seem to play an important role in the histories of those with an ED, which may result in overprotective and over- controlling behavior in those who try to balance the perceived instability of the child’ s social environment [48, 49]. Parental over-focus on eating and weight may arise as one phenomenon, potentially mediated by socio- cultural stressors such as the ‘thin ideal body size’ [22, 48, 49]. The influence of insecure attachment on mal- adaptive behavior patterns, such as pathological eating to regulate negative emotions, is well demonstrated [19, 21].
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Eating Disorders

Eating Disorders

Stephen W. Touyz, PhD, is Professor of Psychology and Honorary Professor of Psychological Medicine at the University of Sydney and Co-Director of the Peter Beumont Centre for Eating Disorders at Wesley Private Hospital. He has written or edited five books and over 180 research articles and book chapters on eating disorders and related topics. He is a Fellow of the Academy of Eating Disorders and the Australian Psychological Society and is Past President of the Eating Disorders Research Society. He was the inaugural treasurer of the Australian and New Zealand Academy of Eating Disorders and is an executive member of the Eating Disorder Foundation. He is a member of the Editorial Board of the European Eating Disorders Review.
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Internet based interventions for eating disorders in adults: a systematic review

Internet based interventions for eating disorders in adults: a systematic review

All but one intervention [15] were based on CBT, which emphasizes the suitability of cognitive behavioural methods as a basis for the development of internet-based treatments for eating disorders. Of the seven studies based on CBT, six offered patients a guided self-help interven- tion [12-14,16,18,19]. Of these, one delivered the self-help intervention by book, with accompanying tasks and homework [16], while the other studies developed and used a structured treatment program. The remaining CBT-based study used e-mail therapy without following a structured treatment program [17]. All studies that were based on CBT principles and provided relevant informa- tion to calculate effect sizes found significant reductions of eating disordered behaviour within the intervention groups from pre- to post-treatment for primary outcomes (e.g. bingeing and purging) as well as secondary outcomes. These interventions were also found to be beneficial in comparison to being placed on a waiting list. The findings
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HAPIFED: a Healthy APproach to weIght management and Food in Eating Disorders: a case series and manual development

HAPIFED: a Healthy APproach to weIght management and Food in Eating Disorders: a case series and manual development

The results of this pilot study enabled further develop- ment of the therapy in order to potentially optimize it for individuals with BED or BN with comorbid overweight or obesity. Modifications to the therapy im- plemented in this pilot study were made and a new HAPIFED manual (Additional file 1) was developed. Modifications included the addition of a bi-weekly re- view of participants’ progress with eating according to physical hunger and satiety signals, consumption of ad- equate quantities of vegetables and fruits, as well as en- gagement in regular physical activity, in order to promote weight loss. We also recommend in the new HAPIFED manual that in future use of the program, pe- dometers be provided to participants in order to facili- tate monitoring and motivation for physical activity, with a clearer emphasis on healthy versus excessive or driven exercise. Moreover, 20 sessions were considered too few for effective treatment, and 30 sessions are rec- ommended in the revised HAPIFED manual, because extended care in the context of recovery from binge eat- ing disorders was found to predict better outcomes [39]. Participants found it onerous to attend HAPIFED ses- sions twice weekly during work hours. As such, once weekly and/or after work hours would likely have en- abled more people to attend regularly. Additional changes to the revised HAPIFED manual involved in- creases in the number of nutritional education sessions and physical activity educations sessions, development of a formulation of disordered eating and weight gain, in- creased focus on problem solving, training in interper- sonal skills, brainstorming with participants on helpful modifications to the home environment, restructuring of cognitive distortions, and an increased number of ses- sions on relapse prevention.
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Eating disorders in premenstrual dysphoric disorder: a neuroendocrinological pathway to the pathogenesis and treatment of binge eating

Eating disorders in premenstrual dysphoric disorder: a neuroendocrinological pathway to the pathogenesis and treatment of binge eating

Symptom burden was assessed four, eight and 12 weeks, as well as at 6 months-post-surgery. Already at the four-week post-op evaluation, the patient re- ported complete resolution of all previously reported PMDD symptoms. This was also the case eight and 12-weeks after surgery, as well as at the 6-month follow-up. The patient had stopped taking the SSRIs the day after the surgery, and had not felt the need to reintroduce them. Further, the estrogen replacement was well tolerated, with no reports of adverse effects. Paraphrasing the patient, she describing the time after the surgery as “a period of inner peace” that she had not experienced for years. As for the problems related to food, eating and weight, the patient reported a sig- nificant decrease in appetite, a complete absence of the aforementioned cravings, and zero binge eating episodes. She now described feeling full after eating “healthy sized” portions, and had successfully reintro- duced some of the trigger foods that she had previ- ously avoided (e.g. chocolates, bread, nuts and cheese). She also described a sense of relief as she was no lon- ger constantly thinking of food, and reported eating when hungry, without experiencing loss of control. Follow-up EDA-5 and EDDS assessments were per- formed 12-weeks and 6 months post-operatively. None of these interviews yielded a full threshold, or a subclinical eating disorder diagnosis. An EDDS symptom composite score, indicating the patient’ s overall level of eating path- ology, was calculated pre-surgery, and at three and six months follow-up. The retrospective, pre-surgery assess- ment yielded a composite score of 25, whereas the follow-up composite scores had markedly decreased to seven at 3-month follow-up, and to five at 6-month follow-up. An overall symptom cut-off score of 16.5 has shown to accurately distinguish between patients with
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Psychiatric disorders of patients seeking obesity treatment

Psychiatric disorders of patients seeking obesity treatment

Our finding is similar to that of Muhlhans’ study [12], in which women had more prevalent psychiatric disor- ders than men, but inconsistent with that of Kalarchian’s study. In Asia, the criteria for obesity are lower than in Europe and the US, which means that people are gene- rally thinner in Asia. No matter whether physical or socio-cultural factors are involved, women in Asia whose BMI is the same as that of men may have more psycho- logical stress when dealing with obesity. In our study, patients in the surgical group were younger and had higher BMI than those in the non-surgical group. Eating disorders, especially binge eating disorder, is prevalent in bariatric surgery patients [11] and has affected the out- come of weight loss after surgery [27,28]. Postoperative binge eating disorder can predict a poor surgical out- come. However, in our study, there were no differences between the two groups in terms of the prevalence of the other two important psychiatric disorders: mood and anxiety disorders. These two disorders may be affected by many different and complex psychosocial factors, not only BMI. Patients in the surgical group had a higher prevalence of several specific psychiatric disorders (ad- justment disorder, binge eating disorder, and sleep disor- ders) than their non-surgical counterparts, but overall, psychiatric disorders were prevalent in both groups. This implies that people who seek obesity treatment, no ma- tter the treatment they receive, suffer from similar psy- chopathological processes, with some exceptions.
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Comorbid bipolar disorder among patients with conversion disorder

Comorbid bipolar disorder among patients with conversion disorder

There was not a significance difference between age and sexes of the patients. The majority of the patients were graduated from primary school, married and unemployed. Sociodemographic characteristics of patients are shown in Table 1. There were no significant differences in terms of sex, education, marital status, employment, family history, and age between the bipolar disorder group and the unipolar group. Positive previous psychiatric history (p=0.025) was significantly different in conversion patients with comorbid bipolar disorder than the patients with unipolar depression (Table 2).
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REVIEW ARTICLE Treatment of the depressive phase of bipolar affective disorder: a review

REVIEW ARTICLE Treatment of the depressive phase of bipolar affective disorder: a review

Gabapentin, an analogue of the neurotransmitter GABA, was first approved by the FDA in 1994 for use as an adjunctive medication to control partial seizures. However, this drug found its most extensive application as an analgesic for the treatment of neuropathic pain. It is a ligand for the alpha 2 delta sub-unit of voltage-gated calcium channels and decreases glutamate neurotransmission by virtue of this binding. Gabapentin is used in the treatment of a number of neuropsychiatric disorders, but all such applications remain off-label. These include anxiety disorders, refractory major depressive disorder (MDD), bipolar disorder, insomnia, stimulant use disorders, alcohol detoxification, and opioid withdrawal. Neurological conditions for which gabapentin is utilised are migraine with and without aura, neuropathic pain of various aetiologies, complex regional pain syndrome, fibromyalgia, restless legs syndrome, nystagmus, and for the control of menopausal hot flashes . It is a convincing option for bipolar patients with comorbidities such as panic disorder, social phobic disorder, generalized anxiety disorder, post- traumatic stress disorder, and substance use disorders. 26 In
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DSM 5 Table of Contents.pdf

DSM 5 Table of Contents.pdf

Major or Mild Neurocognitive Disorder Due to Prion Disease Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease Major or Mild Neurocognitive Disorder Due to Huntington’s Disease Major or Mild Neurocognitive Disorder Due to Another Medical Condition Major or Mild Neurocognitive Disorder Due to Multiple Etiologies

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Early Improvement in Eating Attitudes during Cognitive Behavioural Therapy for Eating Disorders: The Impact of Personality Disorder Cognitions

Early Improvement in Eating Attitudes during Cognitive Behavioural Therapy for Eating Disorders: The Impact of Personality Disorder Cognitions

understanding the factors that might moderate the effect of evidence-based CBT for the eating disorders. Levels of personality disorder cognitions did not differ between diagnostic subgroups (Connan et al., 2009). As shown by Connan et al. (2009), eating disorder attitudes were most strongly associated with cognitions reflecting the anxiety-based cluster C personality disorders (avoidant, obsessive-compulsive, dependent). This conclusion is in keeping with the comorbidity between eating disorders and anxiety disorders (e.g., Kaye, Bulik, Thornton, Barbarich & Masters, 2004; Swinbourne & Touyz, 2007), and the suggestion that the two share a common core cognitive and behavioural pathology (Waller, 2008). It also supports the work of Sansone et al. (2005, 2006), who demonstrated that avoidant personality disorder is among the most commonly comorbid personality disorders in the eating disorders. The first aim of the current study was to investigate whether personality disorder cognitions at the beginning of treatment are associated with drop-out from the early stages of CBT for eating disorders. Patients who dropped out of treatment prior to session seven had significantly higher levels of dependent personality disorder cognitions than those who remained in treatment (rather than the borderline features that have been suggested to be relevant to drop-out – e.g., Bell, 2001). This finding does not appear to be in keeping with the ‘submissive’ and ‘clinging’ behaviours of those with dependent personality disorder (American Psychiatric Association, 1994). It has been suggested that such individuals’ reliance on others might be expected to make them easy to engage and cooperative at the beginning of therapy (Beck et al., 2004). This unexpected finding might reflect the nature of CBT for the eating disorders, with its emphasis on encouraging the patient to take an active role in therapy from the first session (Waller et al., 2007). Dependent personality disorder cognitions might result in the individual finding this approach challenging. If such individuals look to the therapist to solve their problems (Beck, 2005), then the nature of the CBT approach might result in their disengaging from treatment.
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Treatment effects on compulsive exercise and physical activity in eating disorders

Treatment effects on compulsive exercise and physical activity in eating disorders

High generalizability by recruiting participants with BN or BED from the general population is tempered by excluding mental disorder comorbidity. Combining psychological measures of motives for physical exercise and objective measures of exercise made it possible to study different facets of dysfunctional exercise. Objective measures of PA may reduce the risk of overestimations from self-reports [20], but they may also increase the risk of under-reporting the impact of static movement and weight lifting activities [41], which were practiced during the PED-t treatment con- dition. Another study strength was the RCT design, and that a concealed randomisation procedure prevented biased baseline measures. However, three limitations serve to tem- per the conclusions. The first one is related to the non-randomised control group and the fact that systematic differences between the controls and the other participants could bias the findings. Secondly, the statistical power was restricted due to high drop-out rate notably among the CBT participant, as well as the fact that the controls were not measured at all measure points. As a consequence of the latter, the interpretation of the long-term effect is uncer- tain; still, both treatments appeared to maintain their effects during the follow up period, discarding any assumption about a temporarily fluctuation in CE-behaviour. Despite the use of baseline measures as a covariate, the low power may account for the non-significant between-group differ- ences. Finally, session-by-session data on treatment adher- ence and fidelity were unavailable for the current paper.
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Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial

Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial

The dosing regimen to be used for the outlined study has been derived from both current clinical practice parame- ters and available literature. Low doses of olanzapine (2.5–5.0 mg daily) are typically prescribed for the treat- ment of children and adolescents with severe eating disor- ders. In older or more agitated patients the dose may be increased to 7.5 mg or even 10 mg per day. These doses are typically well tolerated, with sedation as the main noted side effect. In anticipation of this trial, members of the American Academy for Eating Disorders were polled through the online email service ("AED listserv") regard- ing their dosing of olanzapine in clinical practice. The results of this poll revealed a wide range in the dosing of olanzapine, from 1.25–20 mg/day.
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The bidirectional relationship between quality of life and eating disorder symptoms: a 9-year community-based study of Australian women

The bidirectional relationship between quality of life and eating disorder symptoms: a 9-year community-based study of Australian women

Quality of life (QoL) is one such construct, and is defined by the World Health Organisation as “. . . a broad ranging concept affected in a complex way by the person's physical health, psycho- logical state, level of independence, social relationships, personal beliefs and their relationship to salient features of their environment. ” (p153 [3]). The concept of QoL thus generally takes into consideration a number of key life domains, such as mental and physical health, relationships, occupation, education, leisure, spirituality, and community engagement. Health-related QoL (HRQoL) measures, such as the Medical Outcome Studies Short Forms [4,5] assess the extent to which an individual perceives that their health impacts on their level of functioning within domains such as those listed above. However, although they measure aspects of mental HRQoL, these measures do not account for psychological distress in general, which as noted above is another critical component of major mental disorders [1] and QoL definitions [3]. Further, the distinction made by the DSM between psychological distress and functional im- pairment in defining disorder is similarly paralleled by distinctions made in the definition of wellbeing (i.e. the absence of disorder), which has both hedonic (related to a lack of distress and the presence of positive states) and eudaimonic (related to optimal functioning) components [6]. Thus alongside HRQoL in this study, we also consider psychological distress as a separate and key component of QoL.
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Binge eating disorder and night eating syndrome in adults with type 2 diabetes: a systematic review

Binge eating disorder and night eating syndrome in adults with type 2 diabetes: a systematic review

More than half of the included studies were conducted at a single site, reducing the generalisability of the sample. Overall our systematic review showed that there is very limited data available to assess the relationships between BED/NES and diabetes-related outcomes in patients with T2DM. The two studies that measured diabetes-related outcomes and the number of patients with BED and NES included in the analysis were small. Furthermore, all these studies were cross-sectional. Hence causality and direction of relationships could not be ascertained. There is also a lack of data regarding ethnicity, which might play an im- portant role in the relationship between BED/NES and T2DM. Hence, future studies need to take the above-mentioned limitations into account. Moreover, the use of medications known to affect appetite and thus in- fluence eating behaviour was seldom reported.
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