Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / A compulsão alimentar está associada a diversas doenças, entre elas, a obesidade.Com o intuito de pesquisar a diferença hormonal ligada ao controle da fome e da saciedade associada ao episódio de compulsão alimentar (ECA), avaliou-se a concentração sérica dos hormônios que regulam este processo em mulheres adultas. Métodos: O estudo experimental foi composto de 3 grupos (n=23), sendo: grupo Eutrófico (GE;n=8), grupo obeso sem ECA (GO;n=7) e obesas com ECA (ECA;n=8). Todas as mulheres que participaram do estudo freqüentavam os serviços de saúde da Policlínica Piquet Carneiro. Foram dosados os hormônios: Grelina Total, Glucagon, Adiponectina, Amilina, Peptídeo C, GLP-1, Insulina e Leptina séricos nos tempos: jejum, 15 e 60 minutos após a ingestão da refeição fornecida. As refeições ingeridas foram controladas em energia, 55% carboidratos, 15% proteínas, 30% lipídios. Os dados foram analisados como valores médios por grupo em software SAS, considerando p<0,05. Resultados: A idade das mulheres estudadas variou de 32 a 50 anos. A concentração de adiponectina encontrada, que é inversamente proporcional a adiposidade, foi significativamente menor no grupo ECA em relação aos demais grupos (p=0,01). Em relação à leptina, o grupo GO apresentou concentração maior em relação aos demais grupos (p<0,0001). Já, a concentração de grelina encontrada foi significativamente menor no grupo ECA em relação aos demais grupos (p=0,02). Foram encontradas concentrações significativamente maiores de insulina no grupo GO em relação aos demais grupos (p=0,04). A concentração de amilina encontrada foi significativamente maior no grupo GO em relação aos outros grupos (p=0,01). A concentração de GLP-1 encontrada no grupo GO foi maior em média, porém esta diferença não foi estatisticamente significativa entre os grupos (p=0,25). A concentração de Peptídeo C encontrada no grupo GO foi maior em relação aos outros grupos (p=0,003). Apesar da concentração de Glucagon no grupo ECA ser maior em relação aos demais grupos, estes valores não eram diferentes estatisticamente (p=0,13). Nossos achados mostraram que obesas ECA tem perfil hormonal diferente de obesas sem ECA. A baixa concentração de grelina do grupo de obesas ECA e a alta concentração de insulina, peptídeo C e amilina nas obesas com e sem ECA pode estar relacionado com o aumento da ingestão alimentar e com o desequilíbrio energético. / Binge eating is associated to several diseases, including obesity. In order to study the hormonal control of hunger and satiety that is commonly involved in binge-eating process; we evaluated the serum concentration of these hormones in adult women. The experimental study was composed of 3 groups, n= 23: Lean (GE, n = 8), Obese without binge (GO, n = 7) and obese with binge (BEE, n = 8). All women who participated in the study attended the health services of the Polyclinic Piquet Carneiro. Serum hormones were assayed: total ghrelin, glucagon, adiponectin, Amylin, c-Peptide, glucagon like peptide (GLP-1), insulin and Leptin in fasting, 15 and 60 minutes after food intake. Meals were controlled in energy, 55% carbohydrates, 15% protein, 30% lipids. Data were analyzed as average values per group in SAS software, considering p <0.05. Results: Women`s age ranged from 32 to 50 years. The adiponectin concentration, which is inversely proportional to adiposity, was significantly lower in BEE group than the other groups (p=0.01). Leptin of the GO group presented higher concentration than the others (p<0.0001). Ghrelin concentration was significantly lower in BEE group than the other groups (p=0.02). We found a significantly higher concentration of insulin in GO group in comparison to the others (p = 0.04). Amylin concentration was significantly higher in GO group in comparison to the other groups (p=0.01). GLP-1 concentration of GO group was higher on average, but not statistically significant between groups (p=0.25). Cpeptide concentration found in GO group was higher than the others (p=0.003). Despite glucagon concentration in the BEE group was greater than the other groups, these values were not statistically different (p=0.13). Our findings shown that BEE group have different hormonal profile than GO and GE. The lowest concentration of ghrelin found in BEE group and the highest concentration of insulin, C-peptide and amylin found in both obese group with and without binge eating may be related to increased food intake and energy imbalance.

Introduction: Eating disorders are serious psychiatric disorders that often require specialized care. Associated psychiatric comorbidity is frequent, with the most common comorbid conditions being anxiety and mood disorders. Eriksbergsgården in Örebro is one of Sweden’s specialized eating disorder treatment units.Aim: Primary aims were to describe clinical characteristics of the adult patient group at Eriksbergsgården and to evaluate treatment outcome and patient satisfaction at the one-year follow-up. An additional aim was to examine if factors such as psychiatric comorbidity affected treatment outcome.Methods: This study used data from Riksät and Stepwise, two large-scale Swedish registers for eating disorder treatment. Data for this study was registered into Stepwise and Riksät at Eriksbergsgården between August 2010 and December 2017 and 489 adult patients of both genders constituted the study group. Patient characteristics and DSM-IV axis I psychiatric comorbidity were assessed at the initial evaluation. At the one-year follow-up, treatment outcome and patient satisfaction were evaluated.Results: The most common diagnoses in this patient material were eating disorder not otherwise specified, 56.6 %, followed by bulimia nervosa, 26.4 %. At the initial evaluation, 62.0 % of the patients suffered from psychiatric comorbidity. Of the patients with initial comorbidity, 43.3 % were recovered at the one-year follow-up, compared to 62.8 % of the patients with no initial comorbidity, p=0.021.Conclusion: Our results confirm the previously known fact that psychiatric comorbidity among eating disorder patients is common. Also, the results identify psychiatric comorbidity as a possible factor to have negative effect on the treatment outcome.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / A compulsão alimentar está associada a diversas doenças, entre elas, a obesidade.Com o intuito de pesquisar a diferença hormonal ligada ao controle da fome e da saciedade associada ao episódio de compulsão alimentar (ECA), avaliou-se a concentração sérica dos hormônios que regulam este processo em mulheres adultas. Métodos: O estudo experimental foi composto de 3 grupos (n=23), sendo: grupo Eutrófico (GE;n=8), grupo obeso sem ECA (GO;n=7) e obesas com ECA (ECA;n=8). Todas as mulheres que participaram do estudo freqüentavam os serviços de saúde da Policlínica Piquet Carneiro. Foram dosados os hormônios: Grelina Total, Glucagon, Adiponectina, Amilina, Peptídeo C, GLP-1, Insulina e Leptina séricos nos tempos: jejum, 15 e 60 minutos após a ingestão da refeição fornecida. As refeições ingeridas foram controladas em energia, 55% carboidratos, 15% proteínas, 30% lipídios. Os dados foram analisados como valores médios por grupo em software SAS, considerando p<0,05. Resultados: A idade das mulheres estudadas variou de 32 a 50 anos. A concentração de adiponectina encontrada, que é inversamente proporcional a adiposidade, foi significativamente menor no grupo ECA em relação aos demais grupos (p=0,01). Em relação à leptina, o grupo GO apresentou concentração maior em relação aos demais grupos (p<0,0001). Já, a concentração de grelina encontrada foi significativamente menor no grupo ECA em relação aos demais grupos (p=0,02). Foram encontradas concentrações significativamente maiores de insulina no grupo GO em relação aos demais grupos (p=0,04). A concentração de amilina encontrada foi significativamente maior no grupo GO em relação aos outros grupos (p=0,01). A concentração de GLP-1 encontrada no grupo GO foi maior em média, porém esta diferença não foi estatisticamente significativa entre os grupos (p=0,25). A concentração de Peptídeo C encontrada no grupo GO foi maior em relação aos outros grupos (p=0,003). Apesar da concentração de Glucagon no grupo ECA ser maior em relação aos demais grupos, estes valores não eram diferentes estatisticamente (p=0,13). Nossos achados mostraram que obesas ECA tem perfil hormonal diferente de obesas sem ECA. A baixa concentração de grelina do grupo de obesas ECA e a alta concentração de insulina, peptídeo C e amilina nas obesas com e sem ECA pode estar relacionado com o aumento da ingestão alimentar e com o desequilíbrio energético. / Binge eating is associated to several diseases, including obesity. In order to study the hormonal control of hunger and satiety that is commonly involved in binge-eating process; we evaluated the serum concentration of these hormones in adult women. The experimental study was composed of 3 groups, n= 23: Lean (GE, n = 8), Obese without binge (GO, n = 7) and obese with binge (BEE, n = 8). All women who participated in the study attended the health services of the Polyclinic Piquet Carneiro. Serum hormones were assayed: total ghrelin, glucagon, adiponectin, Amylin, c-Peptide, glucagon like peptide (GLP-1), insulin and Leptin in fasting, 15 and 60 minutes after food intake. Meals were controlled in energy, 55% carbohydrates, 15% protein, 30% lipids. Data were analyzed as average values per group in SAS software, considering p <0.05. Results: Women`s age ranged from 32 to 50 years. The adiponectin concentration, which is inversely proportional to adiposity, was significantly lower in BEE group than the other groups (p=0.01). Leptin of the GO group presented higher concentration than the others (p<0.0001). Ghrelin concentration was significantly lower in BEE group than the other groups (p=0.02). We found a significantly higher concentration of insulin in GO group in comparison to the others (p = 0.04). Amylin concentration was significantly higher in GO group in comparison to the other groups (p=0.01). GLP-1 concentration of GO group was higher on average, but not statistically significant between groups (p=0.25). Cpeptide concentration found in GO group was higher than the others (p=0.003). Despite glucagon concentration in the BEE group was greater than the other groups, these values were not statistically different (p=0.13). Our findings shown that BEE group have different hormonal profile than GO and GE. The lowest concentration of ghrelin found in BEE group and the highest concentration of insulin, C-peptide and amylin found in both obese group with and without binge eating may be related to increased food intake and energy imbalance.

Introdução: O aumento da expectativa de vida e da prevalência de doenças crônicas, como o diabetes mellitus (DM), mudou o foco das agências governamentais de saúde. O DM causa complicações crônicas graves comprometendo a qualidade de vida (QV) e a sobrevida; em concomitância com transtornos psiquiátricos como depressão e compulsão alimentar periódica (CAP) piora adesão ao tratamento e deteriora o prognóstico. É possível que abordagem psicoeducativa reverta em melhor controle metabólico e QV por meio de programa de mudanças de hábitos de vida. Objetivo: Avaliar se intervenção no estilo de vida com abordagem intensiva interdisciplinar a indivíduos de risco para DM resulta em melhor QV que a intervenção tradicional (IT). Métodos: 177 indivíduos pré-diabéticos ou portadores de síndrome metabólica, atendidos pelo SUS, foram alocados aleatoriamente para uma IT ou intensiva (II) em hábitos de vida por 9 meses. O grupo de IT foi submetido a consultas médicas trimestrais e o grupo II, além destas, participou de 13 sessões de grupos psicoeducativos para mudanças em hábitos alimentares e atividade física. No momento basal e após 9 meses submeteram-se a exames clínico-laboratoriais e a questionários: versão longa do IPAQ, recordatórios alimentares de 24h, de QV (SF-36), para depressão (IBD e PRIME-MD) e escala de CAP. Fatores preditivos de adesão definida como participação em pelo menos 70 por cento das sessões psicoeducativas foram analisados em modelo de regressão logística. Resultados: Em ambas as intervenções houve melhora significante do IMC, circunferência abdominal e HDL. Após 9 meses, apenas os indivíduos da II reduziram pressão arterial e glicemia. O grupo II obteve melhora significante da QV na maioria dos domínios do SF-36 e nas medidas-resumo do componente físico e mental. Comparando os incrementos na QV induzidos pelas intervenções, foram maiores nos domínios capacidade física (II: 11,1±14,0 vs. IT: 5,3±13,0; p=0,02) e aspecto emocional (II: 20,4±40,2 vs. IT: 16,2±43,8; p=0,05) na II em relação à IT. As frequências de depressão reduziram em ambas as intervenções aos 9 meses, porém as de CAP diminuíram apenas na II (28,0 para 4,0 por cento, p<0,001; IT: 13,7 por cento para 8,6 por cento; p=0,38). As mudanças nos domínios do SF-36 se correlacionaram inversa e significantemente com os deltas do IMC, circunferência abdominal, pressão arterial sistólica e glicemia. Também se detectou correlação inversa dos escores de QV com os de depressão (r= -0,275; p=0,001) e de CAP (r= -0,175; p=0,043). Regressão logística mostrou que o sexo masculino associou-se independentemente à adesão à II (p=0,02), mas não a presença de CAP ou depressão. Conclusão: Intervenção no estilo de vida com abordagem interdisciplinar em indivíduos de risco para DM beneficia mais a QV que IT, em paralelo à melhora metabólica. O controle da CAP e depressão parecem contribuir para melhora da QV, mas não é preditivo de adesão a programa de II. Nossos achados indicam que intervenção interdisciplinar, ainda que não-direcionada à terapia de distúrbios psiquiátricos, pode auxiliar no controle da depressão e CAP e melhorar a QV / Introduction: Longer life expectancy and high prevalence rates of chronic diseases such as diabetes mellitus (DM) have modified the focus of government health agencies. DM causes severe chronic complications deteriorating quality of life (QoL) and survival; concomitance of DM and psychiatric disorders - such as depression and binge eating (BED) - decreases compliance to treatment and deteriorates prognosis. Management of these disorders may revert in better metabolic control and QoL during programs of lifestyle changes. Objective: To assess whether lifestyle intervention with intensive interdisciplinary approach for individuals at risk for DM results in better QoL that traditional intervention (TI). Methods: 177 individuals with pre-diabetes or metabolic syndrome, seen by Brazilian public health system, were randomly allocated to an IT or intensive intervention (II) in life habits for 9 months. Individuals from TI had medical visits each three months and from II additionally attended 13 psychoeducative group sessions focusing on dietary habits and physical activities. At baseline and after 9 months, they were submitted to clinical examination and laboratory procedures and answered questionnaires: long version of IPAQ, 24-h food recalls, QoL (SF-36), for depression (BDI and PRIME-MD) and binge eating scale. Predictors of compliance defined as attendance >70 per cent of group sessions were analysed by logistic regression. Results: In both interventions, significant improvements in body mass index, waist circumference and HDL-cholesterol levels were observed. After 9 months, only the individuals submitted to II had blood pressure and plasma glucose levels reduced. The same individuals had significant increases in almost all domains and summary measures of the SF-36. Comparing the induced increases in QoL, measures were greater in the domains of physical functioning (II: 11.1 ± 14.0 vs. IT: 13.0 ± 5.3; p = 0.02) and role-emotional (II: 20.4 ± 40.2 vs. IT: 16.2 ± 43.8; p = 0.05) in II in relation to IT. Frequencies of depression reduced in both interventions to 9 months, although of BED decreased only in II (28 to 4 per cent, p <0.001; IT: 13.7 per cent to 8.6 per cent, p = 0.38). Changes in SF-36 correlated inversely and significantly with differences of BMI, waist circumference, systolic blood pressure and glucose levels. Also found was as inverse correlation of QoL scores with depression (r = -0.275, p = 0.001) and BED (r = -0.175, p = 0.043). Logistic regression showed that male gender was independently associated with adherence to II (p = 0.02) but not the presence of BED or depression. Conclusion: Intervention in lifestyle with an interdisciplinary approach induced better benefits for QoL of individuals at risk for DM than the IT, as well as for metabolic profile. The decreased frequencies of the BED and depression following the II may contribute to improvement of QoL, but is not predictive of compliance. Our findings indicate that interdisciplinary intervention for prevention of DM, even not directed to psychiatric disorders, has extrametabolic effects, favoring the control depression and BED and improving QoL

Made available in DSpace on 2014-08-20T13:57:56Z (GMT). No. of bitstreams: 1 Dissertacao_Giovanny_Vinicius_Araujo_de_Franca.pdf: 1350290 bytes, checksum: f64656537fb2ed84aef7bef88c09c3df (MD5) Previous issue date: 2010-11-05 / Objective: To estimate the prevalence of episodes of Binge Eating (BE) and to assess potential associations with nutritional status, satisfaction with current body weight, selfrated health status (SRHS) and body weight. Method: A cross-sectional populationbased study was carried out in the city of Pelotas, southern Brazil, with a sample of 2,097 individuals aged 20-59 years. BE was assessed through a questionnaire and defined as binging one or more times over the last three months before the interview. Results: The prevalence of BE and recurrent BE was 7.9% and 2.7%, respectively. In the adjusted analysis, obesity, fair/poor SRHS and body dissatisfaction remained strongly associated with BE. Discussion: This study showed a high prevalence of BE among adults in Pelotas, and its higher among younger women, fat and those who desire to weigh less. The current results are informative, but longitudinal studies would be needed to demonstrate the causal relationship between these events. / Objetivo: estimar a prevalência de episódios de compulsão alimentar (BE) e para avaliar as possíveis associações com estado nutricional, satisfação com o peso corporal atual, o estado de saúde autoavaliados (SRHS) e peso corporal. Método: Estudo transversal populacional realizado na cidade de Pelotas, sul do Brasil, com uma amostra de 2.097 indivíduos com idade entre 20-59 anos. BE foi avaliada através de um questionário e definido como compulsão uma ou mais vezes nos últimos três meses anteriores à entrevista. Resultados: A prevalência da BE e recorrente BE foi de 7,9% e 2,7%, respectivamente. Na análise ajustada, obesidade, SRHS justas / pobres e a insatisfação corporal permaneceu fortemente associada com a BE. Discussão: Este estudo mostrou uma elevada prevalência de CA entre adultos em Pelotas, e sua maior entre as mulheres mais jovens, gordura e aqueles que desejam pesar menos. Os resultados atuais são de caráter informativo, mas estudos longitudinais seriam necessários para demonstrar a relação causal entre esses eventos.

The focus of this treatise is to explore the attitudes and perceptions of university students towards binge drinking at a South African University. Binge drinking among university students is a serious concern, prevalent on many campuses and ingrained on university campuses worldwide. The aims of this study were (a) to describe students’ understanding of binge drinking, (b) to explore and describe university students’ attitudes towards and perceptions of binge drinking, and (c) to explore the contextual factors relating to binge drinking within a university setting. An exploratory, qualitative approach was utilized. The collection of data was initiated using a biographical questionnaire to identify participants relevant to the study. The data collection process continued with semi‐structured focus group interviews. Data was collected by conducting four focus group sessions with two separate groups of students between the ages of 18 and 25 and residing on a university campus. Data analysis was conducted in accordance with the principles and guidelines of Tesch’s (as cited in Creswell, 1994) eight steps in qualitative data analysis. The results of this study indicate the following: there is lack of knowledge and understanding of binge drinking, students have positive perceptions of binge drinking and there is a perception that the university environment promotes binge drinking. In order to address binge drinking, strategies need to be implemented in the student, family, university and community context.

No description available.

Objective: Childhood loss of control (LOC) eating and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid conditions and present with disordered eating behaviors, such as overeating. This study sought to delineate shared and specific abnormalities in physiological, cognitive-motivational, and behavioral components of food-specific impulsivity in children with LOC eating and ADHD. Specifically, children’s reactivity and habituation to food and eating in the absence of hunger were examined. Methods: Within this community-based study, four groups of 8-13 year old children with LOC eating (n=24), ADHD (n=32), comorbid LOC eating/ADHD (n=9), and matched controls (n=34) received a standard laboratory test meal to establish satiety and were then exposed to their favorite snack food in a cue exposure/reactivity trial, while salivation and desire to eat were repeatedly assessed. Subsequently, they were offered a variety of snack foods ad libitum. Results: Children with LOC eating, ADHD, and LOC/ADHD did not differ from controls in salivary reactivity and habituation to food cues. Children with LOC eating and ADHD showed greater cue reactivity of the desire to eat than controls, but groups did not differ in its longer-term increments. At free access, only children with LOC/ADHD consumed significantly more energy than controls. Longer-term increments of desire to eat predicted greater energy intake beyond LOC/ADHD group status. Discussion: Desire to eat among children with comorbid LOC eating and ADHD was associated with overeating in the absence of hunger, which may contribute to excess weight gain. Delineation of the specific features of childhood LOC eating versus ADHD warrants further study.

Objective: Adolescents with binge-eating disorder (BED) are suffering from weight teasing and, as found in adults with BED, are likely to internalize weight bias. Weight teasing by mothers accounts for psychopathology in overweight, but sources of stigmatization are largely unknown in BED. This study sought to address familial weight bias in adolescents with overweight and BED by examining adolescents’ perceived parental weight teasing and weight bias internalization in relation to their eating disorder psychopathology and maternal stigmatizing attitudes and beliefs. Method: Adolescents with overweight and BED (BED; n = 40) were compared to a socio-demographically matched group with overweight only (OW) and a normal-weight control group (NW; each n = 25). They filled out the Perception of Teasing Scale, with parents as the source of teasing, the Weight Bias Internalization Scale and the Eating Disorder Examination-Questionnaire. Their mothers filled out the Attitudes Toward and Beliefs about Obese Persons Scales. Results: Significantly higher perceived parental weight teasing and weight bias internalization were found in BED compared to OW and NW. Maternal stigmatizing attitudes and beliefs did not differ between groups and were not correlated with adolescents’ perceptions of being stigmatized. Perceived parental weight teasing predicted adolescents’ eating disorder psychopathology, however, this association was fully mediated by weight bias internalization. Discussion: These results indicate that adolescents with overweight and BED perceive weight teasing in their own families. As we found no significant association between adolescents’ perceptions of being stigmatized and maternal stigmatizing attitudes, future research should examine weight-related parent-child interaction or implicit measures of stigmatizing attitudes.

Die Binge-Eating-Störung (BES) wird als die häufigste Essstörung bei Erwachsenen und Jugendlichen beschrieben und weist eine hohe Relevanz für die individuelle und öffentliche Gesundheit auf, vor allem basierend auf ihren vielfältigen medizinischen und psychologischen Begleiterscheinungen und dem erheblichen klinischen Leiden der Betroffenen. Die Entwicklung und systematische Evaluierung therapeutischer Ansätze für Betroffene mit BES war und ist somit dringend geboten und liefert heute ein differenziertes Bild der Möglichkeiten und Grenzen psychotherapeutischen Agierens zur Behandlung der BES. Die Behandlungsoption mit der größten Evidenzbasierung bei der BES stellt die Kognitive Verhaltenstherapie (KVT) in ihrem klassischen psychotherapeutischen Modus, also von Angesicht zu Angesicht dar. Um relevante patientenbezogene und organisatorische Barrieren zu umgehen, werden die Prinzipien der KVT außerdem in Form von strukturierter Selbsthilfe (sSH) umgesetzt, deren spezifische Wirksamkeit bei BES ebenfalls meta-analytisch bestätigt wurde. Bei der Konzeption und Weiterentwicklung der Wirksamkeit von psychotherapeutischen Behandlungsansätzen bei BES sind zentrale Prozessaspekte herausgestellt worden, deren Ausprägung und Zustandekommen eine Rolle beim Erwirken erwünschter psychotherapeutischer Ergebnisse spielen. Die in dieser Dissertation betrachteten sogenannten „Prozessfaktoren“ umfassen die therapeutische Allianz, also die emotionale und kooperative Bindung zwischen Therapeut und Patient, einschließlich ihrer Übereinstimmung bezüglich Aufgaben und Zielen der Therapie sowie die therapeutische Adhärenz, also der Grad der Übereinstimmung zwischen Therapiemanual und tatsächlichem therapeutischen Vorgehen. Im Kontext der beschriebenen Vorbefunde konnte Studie 1 erstmalig zeigen, dass die therapeutische Adhärenz und Allianz in der altersangepassten KVT bei Jugendlichen mit BES standardisiert, objektiv, reliabel und mit guten psychometrischen Gütekriterien erfasst werden können sowie dass beide Parameter in der untersuchten Behandlung hohe Ausprägungen aufwiesen. Hypothesenkonform zeigten sich keine Assoziationen beider Parameter mit Therapeuten- oder Behandlungsmerkmalen, während verringerte Adhärenz mit höheren Erwartungen der jugendlichen Patienten an den Erfolg der Therapie und erhöhte Allianz mit einer geringeren Symptomschwere zu Beginn der Therapie verbunden waren. Bezogen auf die Umsetzung kognitiv-verhaltenstherapeutischer Inhalte in Form von sSH, ergibt sich anhand der theoretischen Vorüberlegungen die besondere Relevanz von möglichst vollständiger Partizipation der Patienten in derartigen Therapie-Programmen. Studie 2 liefert, basierend auf Daten einer randomisiert-kontrollierten Studie zur Wirksamkeit von Internetbasierter sSH ein detailliertes Bild der Partizipation innerhalb der Internetbasierten sSH und belegt im Mittel die programmtreue Durchführung der Patienten, aber auch eine mit Vorbefunden vergleichbar hohe Dropout-Rate von knapp 25% der Patienten. Im Vergleich zu Patienten, deren Adhärenzwerte andeuten, dass sie sich an die empfohlenen Durchführungsmodalitäten gehalten haben (z.B. an allen Tagen das Ernährungstagebuch geführt haben), weisen jene Patienten ein höheres Dropout-Risiko auf, die das Ernährungstagebuch an weniger Tagen vollständig ausgefüllt, weniger Nachrichten mit ihrem Therapeuten ausgetauscht und länger für die Bearbeitung einzelner Module benötigt haben. Dabei zeigte sich nicht nur ein großer prädiktiver Effekt von 72% im Gesamtmodell, sondern auch eine besonders hohe Sensitivität und Spezifität für die Prädiktion von Dropout in Bezug auf das unvollständige Ausfüllen des Ernährungstagebuches in Therapiewoche 7, womit dieser Adhärenzparameter zu diesem Zeitpunkt den optimalsten Prädiktor für späteren Dropout in der vorliegenden Studie darstellte. Während nur der BMI einen signifikanten Zusammenhang zur Anzahl der ausgetauschten Nachrichten aufwies, war kein weiteres Patientenmerkmal (zu Beginn der Therapie) mit den beobachteten Adhärenzparametern bzw. Dropout assoziiert. Im Zusammenhang mit dem großen prädiktiven Wert der Adhärenzparameter in der vorliegenden Studie zeigt dieses Ergebnis zudem, dass objektiv erhobene Adhärenzparameter bei der Vorhersage von Dropout gegenüber Patientenmerkmalen zu bevorzugen sind. Vor dem Hintergrund, dass Adhärenz in Internet- oder App-basierten sSH-Programmen automatisch und objektiv erfasst werden kann, könnte deren automatische Überwachung bei der Entwicklung und Durchführung derartiger Programme dabei helfen, Patienten mit abnehmender Adhärenz und einem assoziierten Risiko für späteres Ausscheiden aus der Therapie zu identifizieren. Das klinische Erscheinungsbild der BES ist neben der Essstörungssymptomatik in besonderem Maße von komorbid auftretenden Beeinträchtigungen geprägt, welche in erster Linie Übergewicht (BMI ≥ 25 kg/m²) und Adipositas (BMI ≥ 30 kg/m²) aber auch psychische Störungen wie Angst-, affektive und Substanzkonsumstörungen umfassen. Betroffene der BES berichten neben diesen Komorbiditäten weiterhin psychosoziale und interpersonelle Probleme sowie Einschränkungen der Lebensqualität. Vor allem Betroffene mit komorbid auftretendem Übergewicht bzw. Adipositas leiden zusätzlich unter den medizinischen und psychologischen Korrelaten des Übergewichts sowie unter den verschiedenen Formen gewichtsbezogener Stigmatisierung, mit denen sie in zentralen Lebensbereichen konfrontiert sind (z.B. am Arbeitsplatz, im Gesundheits- und Bildungswesen). Eine stetig wachsende Zahl an wissenschaftlichen Studien belegt wiederum die negativen medizinischen und psychologischen Korrelate von Erfahrungen mit gewichtsbezogener Stigmatisierung, die sich zu den primären Gesundheitseinschränkungen des Übergewichts hinzuaddieren. Basierend auf Daten einer großangelegten, bevölkerungsrepräsentativen Befragung in der deutschen Bevölkerung konnte Studie 3 zeigen, dass Menschen mit Adipositas im Vergleich mit Normalgewichtigen mehr Mobbingerfahrungen berichten. Ein erhöhtes Körpergewicht war nur bei Frauen mit arbeitsplatzbezogenen Gesundheitseinschränkungen (stärkeren Burnout-Symptomen, verringerter Lebensqualität) verbunden. Zusätzlich erwiesen sich Mobbingerfahrungen am Arbeitsplatz, nur bei Frauen und nicht bei Männern, als partieller Mediator für den Zusammenhang von erhöhtem Körpergewicht und arbeitsplatzbezogenen Gesundheitseinschränkungen. Somit legen die Ergebnisse nahe, dass sich, besonders bei Frauen mit Adipositas, verschiedene diskriminierte Merkmale (also weibliches Geschlecht und erhöhtes Körpergewicht) aufsummieren, wodurch sich vor allem in dieser Bevölkerungsgruppe ein entsprechender Handlungsbedarf zur Reduktion der Diskriminierung ergibt, um letztlich die psychosozialen arbeitsbezogenen Belastungen sowie entsprechende medizinische und psychologische Gesundheitsbeeinträchtigungen für Arbeitnehmer und damit verbundene Produktivitätsverluste für Unternehmen abzumildern.:Inhaltsverzeichnis Abbildungs- und Tabellenverzeichnis Abkürzungen 1 Theoretischer Hintergrund 1.1 Die Binge-Eating-Störung 1.1.1 Definition, Epidemiologie und Komorbidität 1.1.2 Therapie der Binge-Eating-Störung 1.1.2.1 Therapeutische Ansätze und Evidenz 1.1.2.2 Psychotherapeutische Prozessfaktoren 1.2 Übergewicht und Adipositas 1.2.1 Definition, Epidemiologie und Komorbidität 1.2.2 Gewichtsbezogene Stigmatisierung am Arbeitsplatz 1.2.2.1 Auftreten gewichtsbezogener Stigmatisierung 1.2.2.2 Korrelate gewichtsbezogener Stigmatisierung 2 Ableitung der Forschungsfragen 2.1 Studie 1 2.2 Studie 2 2.3 Studie 3 3 Publikationsmanuskripte 3.1 Therapist adherence and therapeutic alliance in individual cognitive-behavioral therapy for adolescent binge-eating disorder 3.2 Adherence as a predictor of dropout in Internet-based guided self-help for adults with binge-eating disorder and overweight or obesity 3.3 Sex-specific mediation effects of workplace bullying on associations between employees' weight status and psychological health impairments 4 Zusammenfassung 5 Referenzen Anlagen