Associations between interoceptive sensitivity,intuitive eating,and body mass index in patients with anorexia nervosa and normal‐weight controls

Reduced perception of bodily signals and low levels of intuitive eating have been reported in patients with anorexia nervosa (AN) compared with normal‐weight individuals. However, findings have been inconsistent and treatment progress might account for some of these inconsistencies. Thirty‐seven inpatients with AN and 39 normal‐weight controls completed a heartbeat perception task and the Intuitive Eating Scale–2. Patients with AN reported lower intuitive eating than controls, whereas interoceptive sensitivity did not differ between groups. Higher interoceptive sensitivity was related to higher intuitive eating across both groups. In patients with AN, both higher interoceptive sensitivity and intuitive eating correlated with the number of days in the hospital and with higher body mass index (BMI), when controlling for BMI at admission. These relationships suggest that interoceptive sensitivity and intuitive eating improve during treatment. Future research should determine whether these improvements promote weight gain or follow it.     

Sex-dependent clinical presentation,body image,and endocrine status in long-term remitted anorexia nervosa

Objective

Although anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex-specific characteristics of long-term remitted AN with respect to residual eating disorder (ED) psychopathology, body image, and endocrinology.

Method

We recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex.

Results

Both patient groups showed residual ED psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity-focused body image ideals, evident in interviews, self-reports, and behavioural data, than both female patients and HCs.

Conclusions

Sex-specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male-specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term.     

Correlations between plasma insulin and body weight in obesity,anorexia nervosa and diabetes mellitus

Summary Determinations of plasma insulin levels (IRI) were performed in 79 patients before and after a quick intravenous glucose load (0.33 g/kg body weight). The patients were divided in normals (N), underweight patients (M), obese (O), latent diabetics (D1) and overt diabetics (D2), obese latent diabetics (OD1) and obese diabetics (OD2). The body weight varied from 59 to 290 per cent of ideal body weight and the age from 14 to 75 years. We were unable to find any significant correlation between basal IRI values and body weight. We found significant correlations between IRI values obtained after glucose administration and body weight. The insulinogenic index rises with increasing body weight in all subjects, in non diabetics (N-M-O) as well as in diabetics (D1-D2-OD1-OD2). In undernutrition due to anorexia nervosa, the basal plasma IRI and the plasma IRI increase after the glucose load are normal in the studied patients. Overt diabetic patients (D2 and OD2) were significantly older than non diabetic patients having the same body weight (N-O). The insulinogenic index fell with increasing age in obese and in diabetic patients. The correlations between plasma IRI and blood sugar are discussed.This study has been performed with the support of the Fondation pour la Recherche Médicale Française at the Clinique endocrinologique (Prof.F. Stephan) and the Laboratoire d'Immunologie générale (Prof. R. Minck), C.H.U. de Strasbourg F 67.     

The importance of body image disturbances for the outcome of outpatient psychotherapy in patients with anorexia nervosa: Results of the ANTOP‐study

This study investigates the role of body image self‐appraisal in predicting the outcomes of outpatient psychotherapy in patients with anorexia nervosa (AN). Multiple linear regression analyses and a path‐analysis model were applied to test the study hypotheses that body image at baseline predicts treatment outcomes of outpatient psychotherapy in patients with AN at follow‐up measurement. The analyses were conducted as secondary analyses in a subgroup (n = 148) of the anorexia nervosa treatment of outpatient‐cohort (ANTOP‐study) (N = 242) of patients with AN. The results show that Negative Evaluation of the Body at baseline predicts perceived stress during psychotherapy, which in turn predicts depressive symptoms at the end of therapy which in turn predicts the outcomes body mass index and EDI‐2 sum score at 12 months follow‐up. The results underline the importance of body image disturbance in the course of AN and call for body image as a central target of psychotherapeutic interventions in patients with AN.     

Linguistic embodiment in typical and atypical anorexia nervosa: Evidence from an image-word matching task

Objective

The integration of sensory, motor, and cognitive systems is embodied cognition, according to which mind and body are not separate and distinct, and our body (and our brain, as part of the body) contributes to determining our mental and cognitive processes. In spite of limited data available, Anorexia nervosa (AN) appears as a condition in which embodied cognition is altered, in particular, if we consider bodily sensations and visuospatial information processing. We aimed to evaluate the ability to correctly identify body parts and actions in both full (AN) and atypical AN (AAN), looking at the role of the underweight status.

Method

A group of 143 females (AN = 45, AAN = 43, unaffected women = 55) was enrolled. All participants performed a linguistic embodied task to evaluate the association between a picture—showing a bodily action—and a written verb. Additionally, a subsample of 24 AN participants performed a retest after stable weight recovery.

Results

Both AN and AAN demonstrated an abnormal ability to evaluate the picture-written verb associations, especially if the involved bodily effectors were the same in both stimuli (i.e., pictorial and verbal) and needed a longer response time.

Conclusions

Specific embodied cognition linked to body schema seems to be impaired in persons with AN. The longitudinal analysis showed a difference between AN and AAN only in the underweight condition, suggesting the presence of an abnormal linguistic embodiment. More attention should be devoted to embodiment during AN treatment to improve bodily cognition, which might, in turn, diminish body misperception.     

A study of bone density change in patients with anorexia nervosa

In patients with anorexia nervosa (AN) several factors combine to cause osteoporosis, and the risk of osteoporosis increases with chronicity of illness. The authors carried out a follow‐up study in patients who attended the Eating Disorders department of the Hospital de Santa Maria. The average follow‐up period was of 7.6 years. Fifteen patients were included. Patients answered clinical history questions and underwent neck of femur and spine densitometry. The most important variable with negative correlations to bone recovery was disease duration. A positive correlation between bone recovery and time since the first menstrual cycle post‐amenorrhea was also found. However, AN is a condition in which once weight improves and menstrual cycles become regular, severe damage to bone structure is still likely to be maintained. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Energy cost of physical activity in patients with anorexia nervosa

To assess the amount of energy cost for a standardized physical activity, activity‐induced thermogenesis (AIT) was measured in eight hyperactive and eight sedentary patients with anorexia nervosa as well as in 14 sport students and 14 sedentary controls. Resting metabolic rate (RMR) and AIT were measured by indirect calorimetry. RMR was measured after an overnight fast and began 20 min after the placement of the hood and lasted for 20 min. For the next 10 min subjects had to ride a recumbent bicycle ergometer (25 W) and AIT was measured. Absolute RMR in both anorectic groups was significantly lower than in both normal weight groups, but after adjusting for lean body mass (LBM) RMR did not differ among the groups. Absolute AIT was significantly lower in hyperactive anorectic patients and in sport students compared to the controls. After adjusting for LBM AIT was still significantly lower in the hyperactive anorectic group and in the group of sport students compared to the control group. These results indicate that despite severe underweight and biological changes in muscles anorectic patients still have an energy sparing metabolism during moderate physical activity. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.