Introdução: O estado nutricional da gestante constitui importante fator para o desenvolvimento do feto e da gravidez saudável. Mulheres que apresentam ingestão inadequada de nutrientes têm maior probabilidade de desenvolver gestação de risco. Essa problemática é especialmente intensa quando a mulher apresenta quadro de transtorno alimentar (TA). Este trabalho abordou aspectos históricos, etiologia e epidemiologia dos TA, contemplou os critérios diagnósticos, concebeu os TA no período gravídico puerperal e dissertou sobre TA, sintomatologia ansiosa e depressiva. Os objetivos deste estudo foram determinar a prevalência de TA em gestantes com intercorrências clínicas e verificar a associação com sintomatologia ansiosa, depressiva e atitudes alimentares. Método: Estudo prospectivo transversal foi realizado com 913 gestantes com intercorrências clínicas que estavam no 2° ou 3° trimestre gestacional no ambulatório da Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foi utilizada entrevista dirigida, para avaliação de picacismo; o EAT-26, para avaliar as atitudes alimentares; Structured Clinical Interview for DSM Disorders, para diagnóstico clínico de TA e a escala Hospital Anxiety and Depression, para análise da sintomatologia ansiosa e depressiva. Os dados deste estudo foram submetidos à análise quantitativa e avaliados por meio do programa IBM SPSS for Windows versão 20.0. Resultados: constatou-se prevalência de transtorno alimentar em 7,6% (n=69) (IC 95%: 5,84%-9,28%), sendo 0,1% (n=1), anorexia nervosa; 0,7% (n=6), bulimia nervosa; 1,1% (n=10), transtorno da compulsão alimentar e 5,7% (n=52), picacismo. Encontrou-se significância estatística quando associado TA com as variáveis: religião (p=0,02), abortamento provocado anterior (p < 0,01), tempo de relacionamento (p=0,01), renda per capita (p=0,04), número de gestações (p < 0,01) e número de filhos vivos (p < 0,01). Quanto às atitudes alimentares, observou-se significância estatística com \"sentir-se mal após comer doces\" (p=0,02) e \"passar muito tempo pensando em comida\" (p < 0,01). Constatou-se ainda associação positiva com sintomatologia ansiosa (p < 0,01) e com sintomatologia depressiva (p < 0,01). Conclusão: a prevalência de TA encontrada (7,6%) e sua associação com sintomatologia ansiosa e depressiva, durante a gestação, apontam para a necessidade de cuidados especializados no que diz respeito à prevenção, diagnóstico e tratamento. Dada a importância da alimentação adequada no período gestacional, tanto no que diz respeito à saúde materna, quanto ao desenvolvimento fetal, torna-se necessário implementar, pelos profissionais de saúde, avaliação específica com protocolo predeterminado para diagnóstico de TA no período gestacional / Introduction: The nutritional status of the pregnant woman represents an important factor for the development of the fetus and for a healthy pregnancy. Women who have inadequate nutrient intake are more likely to develop a risky pregnancy. This problem is particularly severe when the woman presents an eating disorder (ED). This paper discusses the historical aspects, etiology and epidemiology of ED, considers the diagnostic criteria, delineates ED in the puerperal pregnancy period and addresses ED, anxiety and depression symptoms. The aims of this study were to estimate the prevalence of ED in pregnant women with clinical complications and to assess the relationship between anxiety and depression symptoms and eating attitudes. Methods: A transversal and prospective study was conducted with 913 women between 2nd and 3rd trimester with high-risk pregnancies in the Obstetrics Clinic Division of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. We conducted structured interviews for the assessment of pica, Structured Clinical Interview for DSM Disorders for diagnostic of ED and Hospital Anxiety and Depression Scale for anxiety and depression symptoms, and applied the EAT-26 questionnaire for eating attitudes. The data analysis was quantitative and conducted with the IBM SPSS for Windows, version 20.0. Results: Lifetime prevalence of ED was 7.6% (n=69) (95% CI: 5.84%-9.28%), 0.1% (n=1) for anorexia nervosa; 0.7% (n=6) for bulimia nervosa; 1.1% (n=10) for binge eating disorder, and 5.7% (n=52) for pica. ED was statistically significant with respect to the following variables: religion (p=0.02), previous induced abortion (p < 0.01), being in a relationship (p=0.01), per capita income (p=0,04), number of previous pregnancies (p<0.01) and number of children (p < 0.01). For the eating attitudes, statistical significance was found with \"feeling ill after eating sweets\" (p < 0.02) and \"spend too much time thinking about food\" (p=0.05), as well as between ED and anxiety (p < 0.01) and depressive symptoms (p < 0.01). Conclusion: The prevalence of ED (7.6%) and its association with anxiety and depression symptoms during pregnancy highlights the need for specialist care for prevention, diagnosis and treatment. Given the importance of proper nutrition during pregnancy, both with regard to maternal health and fetal development, it is necessary to have specific predetermined evaluation protocols implemented by health care professionals for the diagnosis of ED during pregnancy

INTRODUÇÃO: A obesidade na infância e adolescência representa uma epidemia global e figura como um problema de saúde pública proeminente de prevalência crescente. A obesidade frequentemente está associada à compulsão alimentar periódica (CAP) e componentes genéticos participam de sua etiologia multifatorial. Polimorfismos de nucleotídeo único (SNPs) no gene da leptina (LEP) e do receptor da leptina (LEPR) podem modificar a expressão da leptina e de suas vias de sinalização e, consequentemente, alterar a regulação do apetite e da saciedade, contribuindo assim para a etiopatogenia e manutenção da CAP. O objetivo deste trabalho foi investigar a influência dos polimorfismos rs7799039 (G > A) no gene LEP e rs1137100 (A > G), rs1137101 (A > G) e rs8179183 (G > C) no gene LEPR sobre a CAP em crianças e adolescentes obesos, além de caracterizar a população quanto à CAP e verificar a associação dos SNPs com o risco cardiometabólico (RCM) e a obesidade. MÉTODOS: Estudo transversal que incluiu 465 crianças e adolescentes obesos com idade entre 7 e 19 anos avaliados quanto a variáveis antropométricas e metabólicas. Os fatores de RCM consistiram de hipertensão arterial sistêmica, glicemia de jejum alterada, HDL-colesterol baixo e hipertrigliceridemia. A CAP foi avaliada por meio da Escala de Compulsão Alimentar Periódica (ECAP). Para investigar o efeito dos SNPs no risco para a obesidade foi incluído um grupo controle composto por 135 crianças e adolescentes eutróficos. A genotipagem foi realizada por PCR em tempo real e para análise dos SNPs, adotou-se o modelo dominante. Foi calculado o desequilíbrio de ligação entre os SNPs e estimada as frequências dos haplótipos. As comparações entre os grupos foram realizadas estratificadamente por gênero e estádio puberal. Para avaliar a magnitude do risco dos SNPs sobre a CAP e a obesidade foi realizada regressão logística ajustada para variáveis de confusão (idade, Z-IMC e estádio puberal). RESULTADOS: As crianças e adolescentes obesos (12,5 ± 2,9 anos; 52,7% meninas) classificados com CAP apresentaram maior adiposidade e a frequência da CAP foi mais elevada no gênero feminino (OR= 2,146; IC 95% 1,461-3,152; p < 0,001). A frequência do alelo A do rs7799039 foi mais elevada no grupo de obesos (OR= 1,530; IC 95% 1,022-2,292; p= 0,039) e o alelo associou-se ao maior nível de leptina e colesterol total em meninas e à maior glicemia em meninos (p < 0,05). No rs1137100 e o rs1137101, a presença do alelo G em meninas conferiu risco para a hipertrigliceridemia (OR= 1,926; IC 95% 1,010-3,673; p= 0,047 e OR= 2,039; IC 95% 1,057-3,931; p= 0,033, respectivamente). O alelo C do rs8179183 relacionou-se, em meninas, à relação cintura-estatura e glicemia mais elevadas e, em meninos, ao maior percentil de pressão arterial diastólica, glicemia, colesterol total e LDL-colesterol (p <0,05). CONCLUSÃO: Os polimorfismos não foram associados à compulsão alimentar periódica. A CAP foi relacionada ao pior grau de adiposidade e o maior risco foi observado no gênero feminino. O SNP rs7799039 no gene LEP conferiu risco para obesidade, enquanto o rs1137100, rs1137101 e rs8179183 no gene LEPR relacionaram-se ao pior perfil cardiometabólico em crianças e adolescentes obesos / INTRODUCTION: Obesity during childhood and adolescence represents a global epidemic and consists in a prominent public health issue of increasing prevalence. Obesity is frequently associated with binge eating (BE) and genetic factors participate of its multifactorial etiology. Single nucleotide polymorphisms (SNPs) in the leptin (LEP) and leptin receptor (LEPR) genes may modify the leptin expression and its signaling pathways and, consequently, alter appetite and satiety regulation, thus contributing to the etiopathogeny and maintenance of BE. The aim of this study was to investigate the influence of polymorphisms rs7799039 (G > A) in the LEP gene and rs1137100 (A > G), rs1137101 (A > G) and rs8179183 (G > C) in the LEPR gene on BE in obese children and adolescents, besides characterize the population regarding to BE and examine the association of SNPs with cardiometabolic risk (CMR) and obesity. METHODS: Cross-sectional study in which 465 obese children and adolescents aged from 7 to 19 years were enrolled and had anthropometric and metabolic variables assessed. The CMR factors consisted of systemic hypertension, impaired fasting glucose, low HDL-cholesterol levels and hypertriglyceridemia. The BE was evaluated through the Binge Eating Scale (BES). To investigate the effect of SNPs on obesity risk, a control group of 135 eutrophic children and adolescents was enrolled. Genotyping was performed by real-time PCR and for the SNPs analysis, the dominant model was adopted. The linkage disequilibrium between SNPs was calculated and the haplotype frequencies were estimated. Comparisons between groups were performed stratified by gender and pubertal stage. To assess the risk magnitude for the SNPs on BE and obesity, logistic regression adjusted for confounding variables (age, Z-BMI and pubertal stage) was performed. RESULTS: Obese children and adolescents (12.5 ± 2.9 years, 52.7% girls) classified with BE showed greater adiposity and BE frequency was higher among females (OR= 2.146; 95% CI 1.461-3.152; p < 0.001). The observed frequency of A allele of rs7799039 was a higher in the obese group (OR= 1.530; 95% CI 1.022-2.292; p= 0.039) and the allele was associated with higher leptin and total cholesterol levels in girls and higher glucose levels in boys (p < 0.05). For the rs1137100 and rs1137101, the presence of the G allele among girls, conferred risk for hypertriglyceridemia (OR= 1.926; 95% CI 1.010-3.673; p= 0.047 and OR= 2.039; 95% CI 1.057-3.931; p= 0.033, respectively). The C allele of rs8179183 was associated, among girls, with a higher waist-to-height ratio and glucose levels and, among boys, with greater diastolic blood pressure percentile, glucose, total cholesterol and LDL-cholesterol levels (p < 0.05). CONCLUSION: Polymorphisms were not associated with binge eating. BE was related with a more severe adiposity and an increased risk was observed among females. The SNP rs7799039 in the LEP gene contributed to the risk of obesity, whereas the rs1137100, rs1137101 and rs8179183 in LEPR gene were related to a worse cardiometabolic profile in obese children and adolescents

Objective: Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating and is associated with eating disorder and general psychopathology and overweight/obesity. Deficits in cognitive and emotional functioning for eating disorders or obesity have been reported. However, a systematic review on cognitive and emotional functioning for individuals with BED is lacking. Method: A systematic literature search was conducted across three databases (Medline, PubMed, and PsycINFO). Overall, n = 57 studies were included in the present review. Results: Regarding cognitive functioning, individuals with BED consistently demonstrated higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues), whereas cognitive functioning in the context of neutral stimuli appeared to be less affected. Thus, results suggest disorder-related rather than general difficulties in cognitive functioning in BED. With respect to emotional functioning, individuals with BED reported difficulties similar to individuals with other eating disorders, with a tendency to show less severe difficulties in some domains. In addition, individuals with BED reported greater emotional deficits when compared to obese and normal-weight controls. Findings suggest general difficulties in emotional functioning in BED. Thus far, however, investigations of emotional functioning in disorder-relevant situations are lacking. Discussion: Overall, the cross-sectional findings indicate BED to be associated with difficulties in cognitive and emotional functioning. Future research should determine the nature of these difficulties, in regards to general and disorder-related stimuli, and consider interactions of both domains to foster the development and improvement of appropriate interventions in BED.

Objectives: Binge-eating disorder (BED) is characterized by recurrent binge eating episodes, associated eating disorder and general psychopathology, and commonly occurs in obese individuals. Explicit self-esteem and explicit weight bias have been linked to BED, while little is known about implicit cognitive processes such as implicit self-esteem and implicit weight bias. Methods: Obese participants with BED and an individually matched obese only group (OB) and normal weight control group (CG; each N = 26) were recruited from the community to examine group differences and associations in explicit and implicit self-esteem and weight bias, as well as the impact of implicit cognitive processes on global eating disorder psychopathology. Implicit cognitive processes were assessed using the Implicit Association Test. Results: Significantly lower explicit self-esteem, as well as higher exposure to explicit weight bias, compared to CG and OB was found in the BED group. All groups showed positive implicit self-esteem, however, it was significantly lower in BED when compared to CG. BED and CG demonstrated equally high implicit weight bias whereas OB did not. Explicit and implicit measures were not significantly correlated. Global eating disorder psychopathology was predicted by explicit and implicit self-esteem. Conclusions: The results of the present study add to the importance of implicit self-esteem and implicit weight bias beyond explicit measures in BED, while both were previously shown to be associated with onset and maintenance of BED. In conclusion, implicit cognitive processes should be focused on in interventions for BED to investigate their impact on psychological treatments.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

No / This book takes a novel approach to the study of male eating disorders – an area that is often dominated by clinical discourses. The study of eating disorders in men has purportedly suffered from a lack of dedicated attention to personal and socio-cultural aspects. Delderfield tackles this deficiency by spotlighting a set of personal accounts written by a group of men who have experiences of disordered eating. The text presents critical interpretations that aim to situate these experiences in the social and cultural context in which these disorders occur. This discursive work is underpinned by an eclectic scholarly engagement with social psychology and sociology literature around masculinities, embodiment and fatness, belonging, punishment, stigma, and control; leading to understandings about relationships with food, body and self. This is undertaken with a reflexive element, as the personal intersects with the professional. This text will appeal to students, scholars and clinicians in social sciences, humanities, and healthcare studies, including public health.

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This thesis investigates the application of TrueBalance, a conversational agent designed to support young adults vulnerable to eating disorders (EDs). TrueBalance integrates Cognitive Behavioral Therapy (CBT) techniques with biomedical insights, including genetic and neurobiological factors, to provide a more personalized and scientifically grounded support system. It addresses limitations in existing dietary monitoring tools that usually focus on calorie tracking and food intake, often neglecting the nuanced needs of specific groups like young females and elite athletes, who are particularly vulnerable to EDs and disordered eating behaviors.  The study addresses how biomedical determinants can be integrated into a conversational agent, how these agents can utilize CBT principles to support individuals vulnerable to EDs, and what challenges and opportunities arise from the user’s perspective when using such a dialogue model. The research strives to bridge the gap in current dietary self-monitoring tools by offering a more robust and empathetic support system for individuals struggling with EDs. Through iterative development and user testing, TrueBalance has demonstrated its potential as an engaging educational tool. Feedback from both therapists and users has highlighted the tool’s utility in real-world settings. It has led to suggestions for enhancements in personalizing interactions and making response systems more adaptive. The findings suggest conversational agents like TrueBalance have potential in non-clinical support environments for individuals with EDs and function as a potential informative, supportive tool for therapists’ education. / Denna masteruppsats undersöker användningen av TrueBalance, en konversationsagent designad för att stödja unga vuxna som är sårbara för ätstörningar. TrueBalance integrerar tekniker från Kognitiv beteendeterapi (KBT) med biomedicinska insikter, inklusive genetiska och neurobiologiska faktorer, för att tillhandahålla ett mer personligt och vetenskapligt förankrat stödsystem. Den tar itu med begränsningarna i befintliga verktyg för kostövervakning, som vanligtvis fokuserar på kalorispårning och matintag men ofta förbiser de nyanserade behoven hos specifika grupper, såsom unga kvinnor och elitidrottare, som är särskilt sårbara för ätstörningar och ätstörda beteenden. Studien behandlar hur biomedicinska determinanter kan integreras i en konversationsagent, hur dessa agenter kan använda KBT-principer för att stödja individer sårbara för ätstörningar, samt vilka utmaningar och möjligheter som uppstår från användarens perspektiv när de använder en sådan dialogmodell. Forskningen strävar efter att överbrygga klyftan i nuvarande verktyg för kostövervakning genom att erbjuda ett robustare och mer empatiskt stödsystem för individer som kämpar med ätstörningar. Genom iterativ utveckling och användartester har TrueBalance visat sin potential som ett engagerande pedagogiskt verktyg. Återkoppling från både terapeuter och användare har belyst verktygets nytta i verkliga sammanhang. Det har lett till förslag på förbättringar för att personalisera interaktioner och göra responssystemen mer adaptiva. Resultaten tyder på att konversationsagenter som TrueBalance har potential i icke-kliniska stödmiljöer för individer med ätstörningar och kan fungera som ett potentiellt informativt, stödjande verktyg för terapeuters utbildning.