Food‐related impulsivity in obesity and Binge Eating Disorder – a systematic review

Impulsivity towards food has been recognized as a potential factor leading to increased food intake in obesity. Patients suffering from binge eating disorder (BED) form a specific subgroup of obese people that might be characterized by increased impulsivity. These assumptions, although, have yet to be verified. Therefore, this review evaluates evidence for food‐related impulsivity in obese people with and without BED and examines possible differences between both populations. More precisely, evidence for the two components of impulsivity is analyzed separately: evidence for reward sensitivity, specifically, the urge for appetitive stimuli and evidence for rash‐spontaneous behaviour such as acting disinhibited with no regard for the consequences. Our search resulted in 51 articles demonstrating generally increased food‐related impulsivity. We found particular emphasis on increased reward sensitivity in obese people, which appeared to be more pronounced in people with BED. There was little and conflicting evidence, however, concerning increased rash‐spontaneous behaviour in obese people without BED, but consistent evidence of an increase in obese people with BED. All in all, the evidence supports the view that BED represents a specific phenotype of obesity with increased food‐related impulsivity. Taking these specific deficits into account can enhance the effectiveness of weight reduction programmes and psychotherapy.     

Efficacy of psychiatric day treatment. Course and outcome of psychiatric disorders in a randomised trial

The course of the psychopathology and social functioning in an experimental day-treatment group referred for inpatient psychiatric treatment is compared with that of a control group receiving standard inpatient care. During a follow-up period of 2 years subjects were interviewed three times. The interview comprised information about psychiatric symptoms, psychological functions, psychiatric diagnosis and social-role functioning. Apart from these discrete assessments an effort was made to map episodes of illness throughout the follow-up period. Upon entry the groups did not differ in terms of psychopathology or social functioning. At follow-up both groups had improved significantly with respect to symptomatology, psychological and social functioning. The extent to which the groups improved did not differ significantly regarding pathology, but self-care improved more in the experimental group. The average duration of episodes of illness was similar for the experimental and control group. During the 2-year follow-up patients suffered from a well-defined disorder during an average of 11 months. The fact that approximately 40% of them were still a psychiatric case after 2 years further underscores the severity of their pathology.     

Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial.

OBJECTIVE: Because previous studies of day treatment as an alternative to inpatient treatment had major disadvantages or methodological shortcomings, the authors conducted a randomized controlled trial to estimate and predict the extent to which day treatment is feasible for unselected patients referred for inpatient treatment. METHOD: Of 160 patients, 57 were randomly assigned to the control condition and 103 were assigned to the experimental condition. Control patients received standard clinical care. In the experimental condition, day treatment was attempted as soon as the patient's condition permitted. The average number of nights per week that experimental patients spent away from the hospital was compared to the average number of nights away for patients under standard care. RESULTS: Day treatment was satisfactory for 40% of the experimental patients but was completely infeasible for another 40%. The level of surveillance needed in the first week, physical illness, number of previous admissions, depressive symptoms, and treatment by qualified psychiatrists versus registrars were variables predictive of these differences. CONCLUSIONS: In this unselected group of patients, no absolute contraindications against day treatment were found. This suggests that the selection criteria applied in nearly all other controlled studies on the subject were unwarranted. The approach used in this study facilitated treatment in the least restrictive environment possible.     

Noninvasive time-dependent cytometry monitoring by digital holography

Using a digital holographic microscope setup, it is possible to measure dynamic volume changes in living cells. The cells were investigated time-dependently in transmission mode for different kinds of stimuli affecting their morphology. The measured phase shift was correlated to the cellular optical thickness, and then of the cell volume as well as the refractive index were calculated and interpreted. For the characterization of the digital holographic microscope setup, we have developed a transparent three-dimensional (3-D) reference chart that can be used as a lateral resolution chart and step-height resolution chart included in one substrate. For the monitoring of living cells, a biocompatible and autoclavable flow chamber was designed, which allows us to add, exchange, or dilute the fluid within the flow chamber. An integrated changeable coverslip enables inverse microscopic applications. Trypsinization, cell swelling and shrinking induced by osmolarity changes, and apoptosis served as model processes to elucidate the potential of the digital holographic microscopy (DHM).     

Is higher dairy consumption associated with lower body weight and fewer metabolic disturbances? The Hoorn Study

BACKGROUND: Dairy consumption has been postulated to reduce the risk of obesity and metabolic disturbances. OBJECTIVE: The aim of this study was to evaluate the associations of dairy consumption with body weight and other components of the metabolic syndrome. DESIGN: We used cross-sectional data for 2064 men and women aged 50-75 y who participated in the Hoorn Study. The metabolic syndrome was defined according to the National Cholesterol Education Program Expert Panel. Dairy consumption was assessed by using a semiquantitative food-frequency questionnaire. RESULTS: The median consumption of total dairy products was 4.1 servings/d. After adjustment for potential confounders (ie, dietary factors, physical activity, smoking, income, educational level, and antihypertensive medication), total dairy consumption was significantly associated with lower diastolic blood pressure (beta +/- SE: -0.31 +/- 0.12 mm Hg/serving) and higher fasting glucose concentrations (0.04 +/- 0.02 mmol/L per serving), but not with body weight or other metabolic variables (ie, lipids, postload glucose, or insulin). When different dairy products were distinguished, borderline significant (P < 0.10) inverse associations were observed for dairy desserts, milk, and yogurt with systolic (-1.26 +/- 0.58, -0.57 +/- 0.34, and -1.28 +/- 0.74 mm Hg/serving, respectively) and diastolic (-0.58 +/- 0.31, -0.57 +/- 0.18, and -0.35 +/- 0.40 mm Hg/serving, respectively) blood pressure, whereas cheese consumption was positively associated with body mass index (0.15 +/- 0.08/serving). CONCLUSION: In an elderly Dutch population, higher dairy consumption was not associated with lower weight or more favorable levels of components of the metabolic syndrome, except for a modest association with lower blood pressure.     

Stigmatization of obese individuals by human resource professionals: an experimental study

ABSTRACT: BACKGROUND: Weight-related stigmatization is as a public health problem. It impairs the psychological well-being of obese individuals and hinders them from adopting weight-loss behaviors. We conducted an experimental study to investigate weight stigmatization in work settings using a sample of experienced human resource (HR) professionals from a real-life employment setting. METHODS: In a cross-sectional, computer-based experimental study, a volunteer sample of 127 HR professionals (age: 41.1 +/- 10.9 yrs., 56% female), who regularly make career decisions about other people, evaluated individuals shown in standardized photographs regarding work-related prestige and achievements. The photographed individuals differed with respect to gender, ethnicity, and Body Mass Index (BMI). RESULTS: Participants underestimated the occupational prestige of obese individuals and overestimated it for normal-weight individuals. Obese people were more often disqualified from being hired and less often nominated for a supervisory position, while non-ethnic normal-weight individuals were favored. Stigmatization was most pronounced in obese females. CONCLUSIONS: The data suggest that HR professionals are prone to pronounced weight stigmatization, especially in women. This highlights the need for interventions targeting this stigmatization as well as stigma-management strategies for obese individuals. Weight stigmatization and its consequences needs to be a topic that is more strongly addressed in clinical obesity care.     

Risk of a Recurrent Cardiovascular Event in Individuals With Type 2 Diabetes or Intermediate Hyperglycemia: The Hoorn Study

OBJECTIVE

To investigate risk of a recurrent cardiovascular event and its predictors in a population-based cohort.

RESEARCH DESIGN AND METHODS

Participants of the Hoorn Study who had experienced a first cardiovascular event after baseline (n = 336) were followed with respect to a recurrent event. Absolute risk of a recurrent event was calculated for individuals with normal glucose metabolism, intermediate hyperglycemia, and type 2 diabetes. Cox regression models were used to investigate which variables, measured before the first vascular event, predicted a recurrent event using the stepwise backward procedure.

RESULTS

During a median follow-up of 4.1 years, 44% (n = 148) of the population developed a recurrent vascular event. The rate of recurrent events per 100 person-years was 7.2 (95% CI 5.8–8.7) in individuals with normal glucose metabolism, compared with 9.8 (6.6–14.0) in individuals with intermediate hyperglycemia and 12.5 (8.5–17.6) in individuals with type 2 diabetes. Higher age (hazard ratio 1.02 [95% CI 1.00–1.04]), male sex (1.56 [1.08–2.25]), waist circumference (1.02 [1.02–1.03]), higher systolic blood pressure (1.01 [1.01–1.02]), higher HbA_1c (%, 1.13 [0.97–1.31]/ mmol/mol, 1.01 [1.00–1.03]), and family history of myocardial infarction (1.38 [0.96–2.00]) predicted a recurrent cardiovascular event.

CONCLUSIONS

Individuals with type 2 diabetes, but not individuals with intermediate hyperglycemia, are at increased risk for a recurrent vascular event compared with individuals with normal glucose metabolism. In people with a history of cardiovascular disease, people at increased risk of a recurrent event can be identified based on the patient’s risk profile before the first event.Due to aging, the increasing prevalence of obesity and diabetes worldwide, and improved care after a first cardiovascular event, the number of people at risk for a recurrent cardiovascular event is increasing (1).High blood pressure levels, dyslipidemia, smoking, and type 2 diabetes are known risk factors for a first cardiovascular event in the general population, with addition of glycemic level (HbA_1c) in individuals with diabetes (2–4). Also, individuals in a prediabetic state (elevated glucose levels) are at increased risk for a first cardiovascular event compared with individuals with normal glucose metabolism (5).In 1998, the cumulative incidence of recurrent events in patients with and without type 2 diabetes was described (5). Since then, care after a first cardiovascular event has improved, which might have affected absolute risk of a recurrent event. Less is known about predictors of a recurrent cardiovascular event in the general population. In general, established risk factors for a first event have not been found to be predictive for a recurrent event regarding various outcomes (6–8).In the current study, we investigated whether people in a prediabetic state as well as people with type 2 diabetes are at increased risk of a recurrent cardiovascular event compared with people with normal glucose metabolism. To enable identification of individuals at high risk for a recurrent event and consequently effectively target screening, predictors of a recurrent cardiovascular event were determined, based on the patient’s risk profile before the first event.