Die Adipositas geht im Erwachsenenalter oft mit psychischer Komorbidität einher, die den Gewichtsreduktionserfolg beeinflussen und eine Behandlung indizieren kann, die von Standardprogrammen der multimodalen Adipositasverhaltenstherapie (AVT) nicht abgedeckt wird. Dieser Artikel diskutiert am Beispiel der häufig komorbiden Binge-Eating-Störung (BES) aktuelle Forschungsergebnisse zu Ätiologie und Intervention bei Komorbidität mit dem Ziel, Implikationen für die weitere Forschung und Behandlung abzuleiten. Weil die Kognitive Verhaltenstherapie (KVT), die am besten belegte Therapieform für Erwachsene mit BES, der AVT bei der Reduktion der Essstörungssymptomatik überlegen war, bei der Gewichtsreduktion nur tendenziell und ausschließlich kurzfristig unterlegen, sollte sich die weitere Interventionsentwicklung auf graduelle Anpassungen der KVT zur Verbesserung der Gewichtsreduktion bei Patienten mit Adipositas und BED konzentrieren. Hierfür kommen mit dem Ziel einer geringfügigen Gewichtsreduktion einzelne adaptierte AVT-Interventionen in Betracht, während sich gleichzeitige oder sequentielle Kombinationen dieser beiden Therapieformen nicht eindeutig bewährt haben. Interventionen, die auf aktuellen Forschungsergebnissen für die Komorbidität beider Störungsbilder fußen, könnten individualisiert einbezogen werden, um die Wirksamkeit für Essstörungssymptomatik und Körpergewicht zu erhöhen. Neue digitale Behandlungsmodalitäten könnten den Transfer in den Lebensalltag und die Nachhaltigkeit der Effekte fördern. Diese Modifikationen hin zu einer adaptiven KVT für Erwachsene mit Adipositas und BES, basierend auf einem patientengerechten Therapierationale, bedürfen der Absicherung durch weitere experimentelle Therapieforschung. / Obesity often co-occurs with mental comorbidity in adults, likely impacting weight loss success and indicating treatment that is not covered by standard behavioral weight loss (BWL) treatment. Using the example of binge-eating disorder (BED) as a frequent comorbid condition, this article discusses current research on etiology and intervention in case of comorbidity, in order to derive implications for research and treatment. Cognitive-behavioral therapy (CBT), the most well-established treatment for adults with BED, was more efficacious than BWL in improving binge-eating symptomatology in patients with obesity and BED, while tending to show lower weight loss effects in the short term only. Therefore, further intervention development should focus on gradual adaptations of CBT for improving weight loss. These interventions could be adapted from BWL and aim at a slight weight loss. Parallel or sequential combinations of these treatments have not consistently demonstrated improved treatment effects. Interventions based on current research could be included on an individual basis, in order to enhance efficacy for eating disorder symptomatology and body weight. New digital treatment modalities could support the transfer into daily life and boost the long-term maintenance of therapeutic gains. These modifications regarding adaptive CBT for adults with obesity and BED should be based on an individual treatment rationale and require further research in an experimental therapeutics framework.

(in English) Nowadays various formerly silenced topics have appeared under the spotlight of public's attention: specifically, mental health awareness has put forward body image concerns as being an incentive for most lethal forms of mental distress such as eating disorders. Despite body image issues are the subject of research for various academic fields, mainly psychology, this thesis attempts to study body image from a different point of view. That is in relation to contemporary diet culture; the thesis focuses on the application of Michel Foucault's theoretical concepts of disciplinary power and "care of the self" practice on the contemporary diet culture. Hence, discovery and review of diet culture controlling mechanisms that might be later internalized by individuals will be in the scope of this work, alongside with the study of diet culture discourse reinforced by influential YouTube content creators. Mainly, the thesis is focused on how dietary practices refer to disciplinary practices, conceptualized by Foucault, while, simultaneously, act as enabling for the subject, mimicking Foucauldian "care of the self" practices. Key words: Michel Foucault, diet, diet culture, care of the self, eating disorder, self- transformation.

Obesity prevalence continues to increase worldwide, yet few safe and effective treatment options are available suggesting there needs to be a greater emphasis on preventing rather than treating obesity. This research investigated the association of obesity predisposing SNPs and a gene score with nutrient consumption patterns including total energy intake and macronutrient distribution in a European ancestry population as well as discussing an evolutionary perspective on eating disorders using current epidemiological evidence to identify genes which may be involved. The association of two of the 14 obesity predisposing SNPs and the gene score with BMI was confirmed in the EpiDREAM population. Novel associations between two SNPs located in or near BDNF (rs6265 and rs1401635) were found with total fat, MUFA, and PUFA intake. Rs1401635 was also associated with total energy and trans fat intake. Novel associations of rs6235 (PCSK1) and the gene score were found with total energy intake. The novel associations found indicate that food related behaviours are one of the mechanisms of action through which obesity predisposing SNPs cause obesity and therefore warrant further investigation. The lack of association among all genes and the modest association of the gene score show that mechanisms other than food consumption are important. The investigation of the evolutionary history of eating disorders revealed that the adapted to flee famine hypothesis is a plausible theory explaining anorexia nervosa while the thrifty genotype hypothesis provides a possible explanation for bulimia nervosa and binge eating disorder. These evolutionary theories can be applied to identify new candidate genes as well as phenotypic traits to investigate to better understand the genetic architecture of eating disorders. Understanding genes associated with disordered eating patterns may highlight future areas for obesity prevention. / Thesis / Master of Science (MSc) / A large percentage of the risk of developing obesity or an eating disorder (anorexia nervosa, bulimia nervosa, and binge eating disorder) is determined by genetics. For obesity, many genes have been identified as influencing risk, but the mechanisms through which the genes work are largely unknown. For eating disorders, gene identification efforts have been mostly unsuccessful and no mechanisms of action have been determined. In the first component of this thesis we found an association between previously identified obesity risk genes and food intake, specifically the total number of calories consumed per day and the percentage of calories from total fat and fat subtypes. These results support that food related behaviours are possible mechanisms of action which need to be further investigated. In the second half of the thesis we viewed eating disorder behaviours from an evolutionary perspective. We concluded that there are theories that possibly explain eating disorder behaviours including being able to live off of small quantities of food as well as binging. These evolutionary theories can be applied to identify new genes to study in the context of eating disorders as well as different definitions of eating disorders.

Studiens syfte är att undersöka hur personer med ätstörning upplever att sjukdomen påverkar sexualiteten samt undersöka vilka erfarenheter de har av samtal om sexuell hälsa och välbefinnande inom ätstörningsvården. Tidigare forskning har visat på sambandet mellan kroppsuppfattning, kroppsmissnöje, kroppsskam och ätstörningar och även sett samband mellan dessa och sexuella dysfunktioner. Forskningen avseende ätstörningar och sexuella svårigheter är något bristfällig, även om det på senare år kommit studier som lyfter ämnet, och i dessa har man sett att individer som har ätstörningar också rapporterar högre vad gäller sexuella svårigheter. Större delen av de studier som gjorts är kvantitativa och i en internationell kontext. Många med ätstörningar kommer i kontakt med hälso- och sjukvården och tidigare forskning har visat att samtal om sexualitet inom en vårdkontext generellt sett är otillräckligt. Studien har en fenomenologisk ansats men även socialkonstruktivistisk och genomförts med en kvalitativ metod bestående av elva halvstrukturerade intervjuer och materialet har analyserats utifrån en reflexiv tematisk analys. Resultaten har analyserats med hjälp av begreppen livsvärld, spegeljag, stigma, skam och skamkompassen för att förstå och visa på samband i kommande analys. Resultatanalysen bygger på de fyra teman: Livsvärlden - en inblick, I-världen-varo med en ätstörning, En hemlös värld samt Vägen mot en tillfredsställande sexualitet - finns den och på vem ligger ansvaret? Resultaten visar att en ätstörning har en biopsykosocial påverkan på sexualiteten och har för många blivit ett hinder vad gäller utlevnad av denna. Resultaten visar även på ett uttryckt behov av sexologiska och relationella samtal inom hälso- och sjukvården för att närma sig en tillfredsställande sexualitet med allt vad det innebär. / The aim of the study is to investigate adults' experiences of how an eating disorder affects their sexuality and to investigate what experiences they have of conversations about sexual health and well-being within eating disorder healthcare services. Previous research has shown the connection between body image, body dissatisfaction, body shame and eating disorders and also seen a correlation between these and sexual dysfunctions. The research regarding eating disorders and sexual difficulties is somewhat lacking, although in recent years there have been studies that highlight the subject, and in these it has been stated that individuals who have an eating disorder also report higher levels of sexual difficulties. Most of existing studies that have been done are quantitative and in an international context. Many people with eating disorders come into contact with healthcare systems and previous research has shown that talking about sexuality within a healthcare context is generally insufficient. This study has a phenomenological but also social constructivist approach. It was conducted with a qualitative method consisting of eleven semi-structured interviews and has been analyzed through a reflexive thematic analysis. The results have been analyzed using the concepts of lifeworld, mirror self, stigma, shame and the compass of shame to understand and show connections in future analysis. The result analysis is based on the four themes: The world of life - an insight, Being-in-the-world with an eating disorder, A homeless world and The road to a satisfying sexuality - does it exist and who is responsible? The results show that an eating disorder has a biopsychosocial impact on sexuality and has for many become an obstacle in terms of experiencing it. The results also show an explicit need for sexological and relational conversations within the healthcare system in order to approach a satisfactory sexuality with all that it entails.

Bakgrund: Relativ energibrist, att gå med energiunderskott över tid, är en realitet inom idrotten och det är också starkt kopplat till ätstörningar och stört ätbeteende. Forskningen pekar på att coacherna, på grund av sin närhet till de aktiva, är i en bra position för att upptäcka och agera på symptom på relativ energibrist, ätstörningar och stört ätbeteende. Man menar vidare att coacherna har för dålig kunskap på området. Syfte: Syftet med denna studie var att identifiera hur elitcoacher ser på sin kunskap, sin roll och sitt ansvar i den elitidrottskontext de tillhör när det gäller relativ energibrist, ätstörningar och stört ätbeteende inom idrotten och vad detta får för konsekvenser.Metod: Studien är genomförd med kvalitativ metod genom semistrukturerade intervjuer med 12 elitcoacher. Urvalet gav en bred representation vad gäller idrotters viktkänslighet. Intervjuerna analyserades med hjälp av Côte och Gilberts kunskapsformer och en modifierad modell av Henriksens ATDE – modell. Resultat: Resultatet visar att coachernas roller ser mycket olika ut i fråga om närheten till de aktiva. Detta påverkar i sin tur coachernas upplevelse av ansvar när det gäller upptäckt och agerande vad gäller relativ energibrist, ätstörningar och stört ätbeteende. Coacherna upplever ämnet relativ energibrist, ätstörningar och stört ätbeteende som laddat och känner sig inte bekväma att ta upp det med de aktiva. Man är rädd att trigga någon till ett stört ätbeteende eller en ätstörning och man menar att det finns ett tabu runt ämnet hos kollegor och specialidrottsförbund. Kunskapsluckor visar sig när det kommer till pedagogiska verktyg och interpersonell kunskap för att applicera sin kunskap i kost och nutrition när det gäller relativ energibrist, ätstörningar och stört ätbeteende. Slutsatser: En bredare kunskapssyn, utanför den teoretiska professionella kunskapen rekommenderas. Förslag på att vända på synen på coachernas kunskap, roll och ansvar föreslås: Börja med att titta på vilket ansvar man vill att coacherna ska ta, vilken roll kräver detta ansvar att coacherna har och till sist vilken kunskap saknas för att i rollen kunna ta det ansvar man önskar att coacherna skall ta. / Background: Relative energy deficiency, to be in an energy defiency over time, is a reality in sport and is conected to eating disorders and disorded eating. According to research, coaches are in a position that could facilitate identification and early interventions on symptoms of relative energy deficiency, eating disorder and disorded eating. Research also notes that the coaches lack in knowledge on the subject. Purpose: The aim of this thesis was to identify how elite coaches perceive their knowledge, role and responsibility when it comes to relative energy deficinecy, eating disorder and disorded eating and the consecvenses that may follow.Method: The research is done with a qualitative approach through 12 semi-structured interviews with swedish elite coaches from a wide range of sports when it comes to weight- sensitivity. The interviews were alanlysed with help of Côte ang Gilberts model of knowledge and a modified version of Henriksens ATDE- model. Result: The result reveals that the role of the coaches differs a lot when it comes to the closeness to the athlete. This affects how the coaches perceive their responsibility when it comes to identification and early intervention in case of relative energy deficiency, eating disorder and disordered eating. The Coaches perceive relative energy deficiency, eating disoder and disordered eating as a loaded subject and they feel uncomfortable to talk about it with the athletes. They are afraid to trigger someone to disorded eating or an eating disorder and they sense a tabu with their colleagues and in the sports federation. There are gaps in coaches knowledge in pedagogy and interpersonal knowledge when it come to the application of knowledge about nutrition linked to relative energy deficiency, eating disorders and disorded eating. Conclusions: A broader view on knowledge, outside the theoretical professional knowledge is recommended. A proposal to change the order in which we think of the problem is formed. Start with figuring out what responsibility you want the coaches to have, then what role they need to have with that responsibility and last, what knowledge do the coaches need for theire role and what responibility you wish they should take.

Syftet med studien var att undersöka synen på kroppsideal i relation till ätstörningsproblematik hos mellanstadieelever utifrån en skolkurators perspektiv. Intervjuer genomfördes med sex skolkuratorer i Gävleborgs län och analyserades sedan utifrån tematisk analys, genom ett salutogent perspektiv och empowerment. Resultatet visade att sociala medier pekades ut som en betydande påverkansfaktor i elevernas syn på kroppsideal och utseende. Kopplingen mellan utvecklandet av ätstörningsproblematik och elevernas syn på kroppsideal var inte tydlig utan andra faktorer pekades ut, kroppsideal kunde dock ses som bidragande faktor. Erfarenheterna av att möta ätstörningsproblematik bland eleverna skilde sig åt mellan skolkuratorerna. Hälsofrämjande arbete i skolan visade sig vara en väsentlig del i skolkuratorernas arbete och något som ansågs bidra till främjandet av god självkänsla samt acceptans av sig själv och andra hos eleverna.

Ätstörningar är en sjukdomsgrupp som blir allt vanligare i samhället. En av orsakerna till att sjukdomen ökar är det orealistiska idealet som presenters i media. Mediatrycket blir även mer påtagligt och lättåtkomligt. Idealet medför en ökad missnöjdhet med den egna kroppen och med utseendet som bidrar till ett driv för förändring. Syftet med denna studie är att undersöka om män påverkats av media i samma utsträckning som kvinnor i insjuknandet av en ätstörning. Samt om könet spelar en central roll för vem som drabbas. Av de som drabbas av en ätstörning och söker vård utgörs enbart 10% av män. Kan idealet ha en påverkan till att färre män drabbas? Eller medför de olika föreställningarna kring könen och sjukdomen att män inte inser att se är sjuka, vågar de inte söka hjälp eftersom det anses vara en kvinnosjukdom? Resultatet tyder på att sjukdomen är komplex till sin natur, där inte enbart en mediafaktorn bidrar till att en person drabbas. / Eating disorders are a disease group that is becoming more common in society. One of the reasons that the disease is increasing is the unrealistic ideal that is presented in media. The media-pressure is substantial and accessible. The beauty ideal involve a dissatisfaction of a persons own body and his or hers appearance that will contribute to the drive of change. The purpose of this study is to investigate if men, as well as women, are influenced by the media-factor in the sicken of an eating disorder. Also if the sex matters and plays a certain role for those who suffer. Only 10 percent of those who are suffering from an eating disorder and that seeks help are men. Can the ideal have an direct affect that less men suffer from this disease? Or can the different expectations of the sexes and of the disease implicate that men don´t realize that they are sick, or that they feel shameful to seek help because eating disorders are known to be a women’s disease? The results implicate that eating disorders is a complex disease and that the media-factor alone does not contribute to sicken or the cause of sickness.

The current study replicated and extended previous research by examining empirically the direct and indirect influence of social pressure (to lose weight and diet), social body comparisons, internalization of the thin ideal, body dissatisfaction, self-esteem, and cardiorespiratory fitness on self-reported dietary restraint in a diverse sample of middle school boys (n = 663); Mage was 12.49 years (SD = .99). With IRB approval, parental consent, and child assent, during annual FITNESSGRAM testing, participants completed questionnaires that measured the study’s constructs. Cardiorespiratory fitness (CRF) was determined by the boys’ performance on the PACER running test. The proposed model was examined using structural equation modeling (SEM). Because measures demonstrated univariate and multivariate normality, the maximum likelihood procedure within EQS to examine the measurement and structural models was used. Fit was determined using a two-index procedure. Participants were randomly split into exploratory (Sample A - 331) and confirmatory (Sample B - 332) samples. For Sample A, the measurement and structural models fit the data well. The structural model was confirmed in Sample B, with the same paths being significant and nonsignficant. For both Sample A and Sample B, 35% of the Dietary Restraint variance was explained. These findings support a multifactorial approach to understanding boys’ self-reported dietary restraint, and illuminate the negative influence of sociocultural weight pressures and salutary effects of CRF on early adolescents’ psychosocial well-being and dietary behaviors.

Contexte : En raison de la pandémie COVID-19, de nombreux programmes pédiatriques spécialisés en troubles des conduites alimentaires (TCA) ont fourni des soins à distance. L'état actuel de la pratique dans les programmes canadiens demeure toutefois inconnu. Ce mémoire vise donc à décrire les adaptations effectuées dans les programmes pédiatriques spécialisés en TCA au Canada et l'impact de ces adaptations sur l'expérience de prestation de soins. Méthodes : Une méthodologie mixte a été utilisée pour interroger des professionnels de la santé travaillant dans des programmes pédiatriques spécialisés en TCA au Canada à l'aide d'un questionnaire transversale et d'entretiens semi-structurés, entre octobre 2021 et mars 2022. Des statistiques descriptives et une analyse de contenu qualitative one été employés. Résultats : Dix-huit professionnels ont répondu au questionnaire. Six d'entre eux ont participé aux entretiens. La majorité des participants ont fourni des services multidisciplinaires à distance durant la pandémie par vidéoconférence (17/18) ou par téléphone (17/18). Souvent, ces services ont été combinés à des soins en personne. La plupart des participants (16/18) s'attendaient à ce que les soins virtuels soient utilisés dans le futur. L'analyse qualitative du contenu a permis de faire ressortir cinq thèmes décrivant l’expérience personnelle des professionnels de la santé qui fournissaient des soins durant la pandémie : (1) répondre à une demande accrue avec des ressources insuffisantes; (2) s'adapter aux changements dans la prestation des soins dus à la pandémie de COVID-19; (3) faire face à l'incertitude et à l'appréhension; (4) les soins virtuels en tant qu'outil clinique acceptable et utile; et (5) les conditions optimales et les attentes pour l'avenir. La plupart des participants aux entretiens avaient une vision globalement positive des soins virtuels. Conclusions : Tous les participants ont été en mesure de fournir des soins multidisciplinaires virtuels et les ont jugés acceptables en tant qu'outil supplémentaire au traitement standard. Ainsi, les soins hybrides, combinant le traitement en personne et virtuel, peuvent être bien adaptés au traitement des TCA chez les jeunes et contribuer à améliorer l’accès aux soins dans le futur. / Background: As a result of the COVID-19 pandemic, many specialized pediatric eating disorder (ED) programs adapted their services and provided care at a distance. The current state of practice in Canadian programs, however, remains unknown. Thus, this thesis aims to describe the adaptations made in specialized pediatric ED programs in Canada and the impact of these adaptations on health professionals’ experience of providing care. Methods: A mixed methods design was used to survey healthcare professionals working in specialized pediatric ED programs in Canada. Data were collected between October 2021 and March 2022 using a cross‐sectional questionnaire and via semi‐structured interviews. Quantitative data were summarized using descriptive statistics and qualitative data were interpreted using qualitative content analysis. Results: Eighteen healthcare professionals completed the questionnaire, of whom six participated in the semi‐structured interviews. The questionnaire showed that, unlike prior to the pandemic, the majority of participants provided multidisciplinary services at a distance, via videoconferencing (17/18) or telephone (17/18). In many cases, this was combined with in-person care. Most participants (16/18) expected that virtual care would continue to be used after the pandemic. Qualitative content analysis generated five themes describing the personal experiences of the health professionals who were providing care during the COVID-19 pandemic: (1) responding to increased demand with insufficient resources; (2) adapting to changes in care due to the COVID‐19 pandemic; (3) dealing with uncertainty and apprehension; (4) virtual care as an acceptable and useful clinical tool, and (5) optimal conditions and future expectations. Most interview participants had globally positive views of virtual care. Conclusions: All participants were able to provide multidisciplinary care virtually and found it to be acceptable as an additional tool to standard treatment. Thus, hybrid care, combining in-person and virtual treatment, may be well-suited to specialized pediatric ED treatment in Canada in the post-pandemic period. It may be a useful tool for increasing access to care in the future.

Bakgrund: Anorexia nervosa (AN) är en ätstörning där den drabbade försöker gå ner i vikt genom självsvält. Förvrängd kroppsuppfattning och ett starkt behov av kontroll över kropp och vikt är förekommande. Många som drabbas av AN avbryter sin behandling i förtid. Att sammanställa personers erfarenheter av att vårdas för AN på ätstörningskliniker kan bidra till viktig kunskap. Denna kunskap kan vara betydande vid utvecklingen av tillvägagångsätt för att stödja personer med AN.   Syfte: Syftet var att beskriva personers erfarenheter av att vårdas för anorexia nervosa på ätstörningskliniker. Metod: Åtta kvalitativa studier har granskats, analyserats och sammanställts i denna litteraturstudie. Databassökning genomfördes i Cinahl, PubMed och PsycInfo. Resultat: Analysen resulterade i två kategorier och sju underkategorier. De två följande kategorierna är ”Att behöva personcentrerad vård” och ”Att dela vardagen med andra personer med ätstörningar och behöva släppa kontrollen”. Konklusion: Litteraturstudien resultat visar att personer med AN upplever ett behov av personcentrerat vård. De beskriver även att vid delaktighet i sin vård ökas motivationen till fortsatt behandling. Med ett gott bemötande från vårdpersonalen kan goda relationer skapas. För att personer med AN ska uppleva att deras behov och önskemål tillgodoses kan det vara av betydelse att vårdpersonalen har kunskap om hur de kan tillämpa personcentrerad vård för personer med AN. / Background: Anorexia nervosa (AN) is an eating disorder in which the individual attempts to lose weight through self-starvation. Distorted body image and a strong need for control over body and weight are common characteristics. Many individuals who suffer from AN discontinue their treatment prematurely. Compiling people's experiences of being treated for AN in eating disorder clinics can contribute to valuable knowledge. This information can be significant in the development of approaches to support individuals with AN.  Aim: The aim of this study was to describe individuals' experiences of being treated for anorexia nervosa at a specialized clinic for eating disorders.  Methods: Eight qualitative studies were reviewed, analyzed, and compiled. A database search was conducted in CINAHL, PubMed, and PsycInfo.  Results: The analysis resulted in two main categories: "Requiring person-centered care" and "Sharing everyday life with others who have eating disorders and learning to let go of control." Conclusion: The results of the literature study indicate that individuals with anorexia nervosa (AN) express a need for person-centered care. They also report that active involvement in their care enhances motivation to sustain treatment. Establishing positive relationships is facilitated by effective treatment from the care staff. To ensure that the needs and preferences of individuals with AN are addressed, it is crucial for the care staff to possess knowledge on the application of person-centered care tailored to this population.