Search

Introduction: The Australian‐led 2023 International evidence‐based guideline for the assessment and management of polycystic ovary syndrome was based on best available evidence, clinical expertise and consumer preference. It followed best practice, involved extensive evidence synthesis and applied relevant frameworks across evidence quality, feasibility, acceptability, cost and implementation. Thirty‐nine societies and organisations covering 71 countries were engaged. The evidence in the assessment and management of polycystic ovary syndrome (PCOS) has generally improved in the past five years, but remains of low to moderate quality. The technical evidence report, 52 systematic reviews and analyses (approximately 6000 pages) underpin 77 evidence‐based and 54 consensus recommendations, with 123 practice points. Main recommendations: Changes include: refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti‐Müllerian hormone levels as an alternative to ultrasound in adults only, and differentiation of adolescent and adult criteria;strengthening the recognition of broad features of PCOS including metabolic effects, cardiovascular disease, dermatological symptoms, sleep apnoea, a high prevalence of psychological features and a high risk of adverse pregnancy outcomes;emphasising the poorly recognised, diverse burden of disease, the vital need for greater health professional education, evidence‐based patient information, improved models of care, shared decision making and research efforts to improve patient experience;maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma; andemphasising evidence‐based medical therapy and cheaper and safer fertility management. Changes in management as a result of this guideline: The 2023 guideline is approved by the National Health and Medical Research Council and provides clinicians and patients with clear advice on best practice in a common and neglected condition, based on the best available evidence, expert multidisciplinary input and consumer preferences. It provides vital, extensive patient and provider resources to enhance evidence‐based care. The full guideline is available at www.monash.edu/medicine/mchri/pcos/guideline. [ABSTRACT FROM AUTHOR]

Summary: Background: Weight stigma is associated with poor mental health correlates in cross‐sectional research. Researchers are increasingly using Ecological Momentary Assessment (EMA) methods, collecting comprehensive within‐person data to understand the temporal nature of weight stigma and its biopsychosocial correlates. Aim: To systematically review EMA studies on the effect of weight stigma on biopsychosocial correlates and integrate the findings. Method: PsycINFO, CINAHL, Embase, Medline Complete, and Web of Science were searched and studies were doubled screened (H.B. and X.P.G.). Results: Twelve studies (N = 615) met our inclusion criteria. For both between‐ and within‐subject effects, experienced and internalized weight stigmas were associated with negative correlates/outcomes (e.g., higher disordered eating and lower positive mood). However, studies differed in the correlate measures assessed, EMA methods used, and participant instructions provided. Given these inconsistencies, comparison across studies was difficult, and findings could not be reliably integrated. Conclusions: Consistent with previous research, studies from this review suggest weight stigma leads to adverse outcomes. EMA has the potential to overcome many of the limitations present in cross‐sectional research on weight stigma and provide more ecologically valid and reliable results. We argue for a collaborative data‐sharing consortium with standardized EMA methodologies, so researchers worldwide can contribute to and make use of a large, collective dataset on weight stigma and health correlates (see osf.io/s5ru6/). [ABSTRACT FROM AUTHOR]

Summary: Objective: Conceptualisation and measurement of weight stigma varies across available studies assessing those affected. This paper aims to systematically review the psychometric properties of available self‐reported measures of weight stigma. Method: Studies exploring the development and/or validation of weight stigma measures were identified through systematically searching Medline, CINAHL, PsycINFO, Embase, Web of Science, and Scopus databases. The Consensus‐based Standards of Health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties of measures. Results: Thirty‐six articles, reporting 18 different weight stigma measures, were included. For most included measures, measure development and content validity have not been assessed/reported. Structural validity, internal consistency, and hypothesis testing were the most commonly assessed/reported psychometric properties. High‐quality ratings were given only for these properties. Most measures were rated as "indeterminate" and received an overall quality rating of "Very Low" as results were based on limited evidence. Conclusions: Psychometric properties for published weight stigma measures have rarely been assessed/reported. The observed poor methodological quality for measure development, and limited content validity evidence, negatively impact the quality of evidence for the measures. There is a need for studies assessing the psychometric properties of existing weight stigma measures using COSMIN guidelines, and for a well‐designed weight stigma measure informed by both theory and research. [ABSTRACT FROM AUTHOR]

Summary: Lifestyle is fundamental in chronic disease prevention and management, and it has been recommended as a first‐line treatment in the Australian polycystic ovary syndrome (PCOS) guideline 2011. The first international evidence‐based guideline on PCOS was developed in 2018, which expanded the scope and evidence in the Australian guideline. This paper summarizes the lifestyle recommendations and evidence summaries from the guideline. International multidisciplinary guideline development groups delivered the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. The process followed the Appraisal of Guidelines for Research and Evaluation II and The Grading of Recommendations, Assessment, Development and Evaluation framework. Extensive communication and meetings addressed six prioritized clinical questions through five reviews. Evidence‐based recommendations were formulated before consensus voting within the panel. Evidence shows the benefits of multicomponent lifestyle intervention, efficacy of exercise and weight gain prevention with no specific diet recommended. Lifestyle management is the first‐line management in the intervention hierarchy in PCOS. Multicomponent lifestyle intervention including diet, exercise and behavioural strategies is central to PCOS management with a focus on weight and healthy lifestyle behaviours. The translation programme optimizes reach and dissemination for health professionals and consumers. [ABSTRACT FROM AUTHOR]

Summary: The primary objective of the study was to identify the effect of intervention strategies on attrition within a weight loss programme among adults aged 18 to 65 years. The secondary objective of the study was to assess the impact of such intervention strategies among female‐only weight loss programmes. The literature search was performed in Ovid (CINAHL Plus, MEDLINE, EMBASE, Cochrane [Cochrane Database of Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register], and PsycINFO). Studies must have identified weight loss as the main aim and compared the primary weight loss programme alone (control) with the primary weight loss programme coupled with an additional intervention strategy (intervention). Papers must have had a mean participant age between 18 and 65 years and available in English. Fifty‐seven trials met the inclusion criteria and were included in the meta‐analysis. Strategies that successfully reduced attrition included the incorporation of financial incentives (n = 8), a multicomponent approach (n = 13), and use of self‐monitoring technology (n = 4). The majority of studies were of low to moderate methodological quality because of insufficient reporting. A limited number of female‐only trials were found (n = 13). Implementation of financial incentives, multicomponent interventions, and self‐monitoring technology help reduce attrition among adult weight loss programmes. Further studies are required to identify the impact of intervention strategies on attrition in women. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective Meta-analyses have documented the efficacy of cognitive-behavioral therapy (CBT) for reducing symptoms of eating disorders. However, it is not known whether CBT for eating disorders can also improve quality of life (QoL). This meta-analysis therefore examined the effects of CBT for eating disorders on subjective QoL and health-related quality of life (QoL). Method Studies that assessed QoL before and after CBT for eating disorders were searched in the PsycInfo and Medline database. Thirty-four articles met inclusion criteria. Pooled within and between-groups Hedge's g were calculated at post-treatment and follow-up for treatment changes on both subjective and HRQoL using a random effects model. Results CBT led to significant and modest improvements in subjective QoL and HRQoL from pre to post-treatment and follow-up. CBT led to greater subjective QoL improvements than inactive (i.e., wait-list) and active (i.e., a combination of bona fide therapies, psychoeducation) comparisons. CBT also led to greater HRQoL improvements than inactive, but not active, comparisons. Prepost QoL improvements were larger in studies that delivered CBT individually and by a therapist or according to the cognitive maintenance model of eating disorders (CBT-BN or CBT-E); though this was not replicated at follow-up Conclusions Findings provide preliminary evidence that CBT for eating disorders is associated with modest improvements in QOL, and that CBT may be associated with greater improvements in QOL relative to comparison conditions. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the impact of mindfulness-based interventions on psychological and physical health outcomes in adults who are overweight or obese. Methods We searched 14 electronic databases for randomized controlled trials and prospective cohort studies that met eligibility criteria. Comprehensive Meta-analysis software was used to compute the effect size estimate Hedge's g. Results Fifteen studies measuring post-treatment outcomes of mindfulness-based interventions in 560 individuals were identified. The average weight loss was 4.2 kg. Overall effects were large for improving eating behaviours ( g = 1.08), medium for depression ( g = 0.64), anxiety ( g = 0.62) and eating attitudes ( g = 0.57) and s mall for body mass index (BMI; g = 0.47) and metacognition ( g = 0.38) outcomes. Therapeutic effects for BMI ( g = 0.43), anxiety ( g = 0.53), eating attitudes ( g = 0.48) and eating behaviours ( g = 0.53) remained significant when examining results from higher quality randomized control trials alone. There was no efficacy advantage for studies exceeding the median dose of 12 h of face-to-face intervention. Studies utilizing an Acceptance and Commitment Therapy approach provided the only significant effect for improving BMI (g = 0.66), while mindfulness approaches produced great variation from small to large ( g = 0.30-1.68) effects across a range of psychological health and eating-related constructs. Finally, the limited longitudinal data suggested maintenance of BMI ( g = 0.85) and eating attitudes ( g = 0.75) gains at follow-up were only detectable in lower quality prospective cohort studies. Conclusions Mindfulness-based interventions may be both physically and psychologically beneficial for adults who are overweight or obese, but further high-quality research examining the mechanisms of action are encouraged. [ABSTRACT FROM AUTHOR]

This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty-five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive-behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This review aimed to (a) examine the effects of rapid response on behavioral, cognitive, and weight-gain outcomes across the eating disorders, (b) determine whether diagnosis, treatment modality, the type of rapid response (changes in disordered eating cognitions or behaviors), or the type of behavioral outcome moderated this effect, and (c) identify factors that predict a rapid response. Method Thirty-four articles met inclusion criteria from six databases. End of treatment and follow-up outcomes were divided into three categories: Behavioral (binge eating/purging), cognitive (EDE global scores), and weight gain. Average weighted effect sizes(r) were calculated. Results Rapid response strongly predicted better end of treatment and follow-up cognitive and behavioral outcomes. Moderator analyses showed that the effect size for rapid response on behavioral outcomes was larger when studies included both binge eating and purging (as opposed to just binge eating) as a behavioral outcome. Diagnosis, treatment modality, and the type of rapid response experienced did not moderate the relationship between early response and outcome. The evidence for weight gain was mixed. None of the baseline variables analyzed (eating disorder psychopathology, demographics, BMI, and depression scores) predicted a rapid response. Discussion As there is a solid evidence base supporting the prognostic importance of rapid response, the focus should shift toward identifying the within-treatment mechanisms that predict a rapid response so that the effectiveness of eating disorder treatment can be improved. There is a need for future research to use theories of eating disorders as a guide to assess within-treatment predictors of rapid response. © 2016 Wiley Periodicals, Inc. Int J Eat Disord 2016; 49:905-919 [ABSTRACT FROM AUTHOR]

Objective While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity. Methods Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study. Results Twenty-three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index ≥25 kg m−2; 18-65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment-seeking individuals. Available research shows that weight stigma is consistently associated with medication non-adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized. Conclusions While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter-relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered. [ABSTRACT FROM AUTHOR]

Aim: This paper explored the relationship between maternal controlling feeding behaviours and child eating and weight in preschool-aged children. Methods: Ninety mothers of 2- to 5-year-old children (M = 3.48, SD = 0.84, 54.4% males) completed self-report measures assessing maternal controlling feeding behaviours, child eating patterns and weight. Results: Univariate analyses indicated that child food neophobia was associated with authoritarian feeding ( r= 0.29), pressure to eat ( r= 0.28) and restriction ( r= 0.34). Child food pickiness was associated with authoritarian feeding ( r= 0.35). No association was found between maternal feeding strategies and child weight. Multivariate regression analyses indicated that authoritarian feeding, restriction and pressure to eat were significantly associated with the variance in child food neophobia (adjusted R2= 12.6%) and pickiness (adjusted R2= 12.0%). Conclusions: The findings suggest that maternal control in feeding is associated with undesirable eating patterns in preschool-aged children. Interventions targeting reduction in maternal controlling feeding may promote desirable eating patterns in preschool-aged children. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether (1) initial and/or (2) changes in psychosocial functioning predict body mass index (BMI) z-score change over 4 years in overweight/mildly obese 5- to 9-year old children presenting to primary care. Design and Methods: Eligible participants ( n = 258) were overweight/mildly obese children (IOTF criteria) recruited into the LEAP2 trial (ISRCTN52511065) from 3,958 children visiting general practitioners in Melbourne, Australia from May 2005 to July 2006. Predictors were change scores calculated from repeated measures of parent- and child-reported child health-related quality of life (PedsQL) and self-esteem; child-reported desire to be thinner; and parent-reported child weight concern. Outcome was measured BMI z-score change from baseline to 4 years. Results: The 189 respondents (61% female; 73% retention) showed little mean change in BMI z-score (−0.08) but wide variation (standard deviation 0.50, range −1.32 to 1.20). Only one baseline measure (better parent-reported PedsQL School Functioning) predicted improving BMI z-score. However, parents and children consistently reported that changes in psychosocial functioning (i.e., PedsQL Social and Global Self-esteem) were inversely related to BMI z-score change scores. The strongest predictors of decreases in BMI z-scores were changes in child-reported body-image variables, i.e., improvements in Physical Appearance Self-esteem (β =0.40, 95% CI −0.98 to −0.15, P < 0.01) and declines in Desire to be Thinner (β = 0.33, 95% CI 0.04 to 0.23, P < 0.01). Conclusions: At presentation to primary care, it seems unlikely that targeting the psychosocial factors measured in this study would influence BMI z-score change in overweight/mildly obese children. Subsequent change in psychosocial well-being covaries with BMI z-score change and may have important adolescent ramifications; the causal directions for these associations require further research. [ABSTRACT FROM AUTHOR]

Abstract: This study examined the efficacy of a program for parents of young adolescents combining behavioral family intervention with acceptance-based strategies. 180 parents were randomly allocated to a 6-session group ABCD Parenting Young Adolescent Program or wait-list condition. Completer analysis indicated parents in the intervention reported significantly higher adolescent prosocial behaviors (p = 0.020), lower conduct problems (p = 0.048) and total difficulties (p = 0.041). These parents also reported lower stress associated with adolescent moodiness (p = 0.032), parent life-restriction (p < 0.001), adult-relations (p < 0.001), social isolation (p = 0.012), incompetence/guilt (p < 0.001), lower stress in the parenting domain (p < 0.001) and lower overall stress (p = 0.003) relative to the control condition following the intervention period. No other statistically significant differences were evident (p < 0.05). Results of intention-to-treat analyses were similar. Greater reliable clinically significant change was also achieved for the intervention condition. Participants reported high satisfaction with all elements of the ABCD program. Results suggest the program may assist parents of young adolescents to promote or maintain protective factors in their families. Australian and New Zealand Clinical Trials Registry: ANZCTRN12609000194268. [Copyright &y& Elsevier]

This study explored reported barriers to treatment completion in a sample of adolescents and their parents who either completed or did not complete family-based cognitive behavioral lifestyle intervention for overweight and obese adolescents. The sample comprises 56 overweight or obese adolescents (52% female) aged 11.5-18.9 years (mean = 14.5, s.d. = 1.8) and a parent. 57% of families did not complete treatment and maintenance phases of the intervention. A telephone-administered questionnaire assessing barriers to participation was completed by 96% of adolescents and 91% of parent completers and 100% of adolescents and 94% of parent noncompleters. Adolescents and parents most commonly reported barriers to participation related to research demands, treatment approach, program components/strategies, practical barriers, and other individual/family demands. Parents also noted adolescent effort, parent-adolescent conflict, and adolescent unhappiness as barriers to participation. While both completers and noncompleters experienced barriers to participation, families who discontinued treatment reported experiencing more treatment barriers. Findings of the current study suggest that adolescents and parents may find it easier to participate in adolescent overweight and obesity interventions if research and out-of-session program demands are minimized, efforts are made to enhance adolescent motivation, and treatment is offered in a convenient location and scheduled around school holidays and other family demands. Results also suggest that targeting adolescent unhappiness, family stressors, and parent-adolescent conflict in treatment may improve retention. Future research should explore the impact of these modifications on treatment completion and outcomes. [ABSTRACT FROM AUTHOR]

Little is known about factors associated with treatment initiation in overweight and obese adolescents. This study investigated parent-reported adolescent demographic, adolescent health, and parent motivation factors associated with initiation of a family-based adolescent overweight and obesity intervention. A telephone survey was completed by 349 parents calling to register their interest in participating in a cognitive behavioral lifestyle intervention for adolescent overweight and obesity. A total of 172 families (49.3%) returned their consent form to initiate treatment. A binomial logistic regression, with predictors entered in three blocks: (i) adolescent demographic (adolescent age, gender, adolescent BMI-for-age z-score, parent BMI); (ii) adolescent health (perceived adolescent physical and mental health, presence of an adolescent physical health problem or mental health problem, medication intake); and (iii) parent motivation (perceived adolescent weight category, concern about adolescent weight, importance of adolescent weight, confidence in adolescent capacity to change weight, priority of adolescent weight loss, discrepancy between adolescent current and ideal weight, previous weight loss attempts), was significant (χ2 (16) = 35.19, P = 0.004) accounting for 12.4-16.5% (95% confidence interval) of treatment initiation variance. Parent-reported adolescent physical health problem, parent perception of adolescent weight category, parent priority of adolescent weight loss, and parent perception of discrepancy between adolescent current and ideal weight were significant in the model. These findings indicate that data collected at intake are associated with treatment initiation and highlight the role of assessing and enhancing treatment motivation from initial contact. [ABSTRACT FROM AUTHOR]

Issue addressed: The school setting is an important context for the development of children's eating behaviours. As most Australian children (86%) bring their lunch from home, knowledge of what parents provide in home-prepared school lunches can inform efforts to improve their nutritional quality. This study investigated the content of children's home-prepared school lunches, considered variation across the school week, and explored gender and grade level differences. Methods: This observational analysis of children's home-prepared school lunches was conducted in children attending the first three years of school at one of five northern Melbourne metropolitan schools. One hundred and seventy parents (response rate 12%) gave consent for their child's lunch to be audited up to five times (minimum of three) across a one-month period. The food and beverage items of students' school lunches were audited using the School Food Checklist. Results: The average home-prepared school lunch contained a sandwich, a piece of fruit and one and a half servings of extras (low nutritional value and/or high in added fat, salt or sugar). Servings of bread declined (Wilks' Λ=0.82, p=0.01) from Monday to Friday and there were more servings of extras (Wilks' Λ=0.79, p<0.01) on Monday than Wednesday. Younger children's lunches contained fewer servings of fruit (F(2,71.93)=4.84, p=0.03), vegetables (F(2,78.97)=3.86, p<0.05) and bread (F(2,140)=4.36, p=0.02) than those of older children. Girls' lunches contained significantly more vegetables than boys' lunches, (t(154.51)=-2.21, p=0.03). Conclusions: Lunches were high in extras and low in servings of vegetables and other healthy snacks with minor variations in the quantity of bread and extras across the school week. [ABSTRACT FROM AUTHOR]