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Background: The majority of women who quit smoking as a result of pregnancy will resume smoking during the first 6 months postpartum. Evidence suggests that changes in depressive symptoms, perceived stress, and concerns about weight may relate to postpartum smoking relapse., Purpose: This study was designed to prospectively evaluate the relationship of mood and weight concerns to postpartum smoking among women who quit smoking during pregnancy., Methods: Pregnant women who had quit smoking (N=183) were recruited between February 2003 and November 2006. Women completed assessments of mood (depressive symptoms, perceived stress, positive and negative affect) and weight concerns during the third trimester of pregnancy and at 6, 12, and 24 weeks postpartum. Self-reported smoking status was verified by expired-air carbon monoxide and salivary cotinine at each assessment. Cox regression analyses in which mood and weight concerns were treated as time-dependent covariates were conducted in 2007 and 2009., Results: By 24 weeks postpartum, 65% of women had resumed smoking. Smoking-related weight concerns increased risk of relapse, and positive affect and self-efficacy for weight management without smoking decreased risk of relapse postpartum. Moreover, after controlling for variables previously related to postpartum relapse, weight concerns remained significantly related to smoking relapse., Conclusions: Smoking-related weight concerns and positive affect increase the likelihood that a woman will resume smoking postpartum. Moreover, weight concerns appear to be salient even in the context of other factors shown to affect postpartum smoking. This study suggests that interventions may need to address women's weight concerns and mood to help sustain smoking abstinence after childbirth., (Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes., Methods: Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels., Results: There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools., Conclusions: Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.)

Objective: This study aimed to evaluate emotion avoidance in patients with anorexia nervosa (AN) and to examine whether emotion avoidance helps to explain (i.e., mediates) the relation between depressive and anxiety symptoms and eating disorder (ED) psychopathology in this group., Method: Seventy-five patients with AN completed questionnaires to assess study variables. Rates of emotion avoidance were compared to published data, and regression models were used to test the hypothesis that emotion avoidance mediates the relation between depressive and anxiety symptoms and ED psychopathology in AN., Results: Patients with AN endorsed levels of emotion avoidance that were comparable to or higher than other psychiatric populations and exceeded community controls. As predicted, emotion avoidance significantly explained the relations of depressive and anxiety symptoms to ED psychopathology., Discussion: Findings confirm that emotion avoidance is present in patients with AN and provide initial support for the idea that anorexic symptoms function, in part, to help individuals avoid aversive emotional states., (2009 by Wiley Periodicals, Inc.)

Objective: This study sought to document self-reported binge eating in a large sample of severely obese children and to examine the impact of binge eating on changes in percent overweight among children randomized to family-based behavioral treatment (intervention) versus control (usual care)., Participants and Methods: As part of a larger randomized controlled trial, 192 children aged 8-12 years (M=10.2, s.d.=1.2) with a mean body mass index (BMI) percentile of 99.2 (s.d.=0.7) completed assessments at baseline and 6-, 12-, and 18 months post-randomization. A parent or guardian also participated. Child psychological symptoms, including binge eating, were measured before randomization using self-report questionnaires. Child height and weight were measured at baseline, 6-, 12-, and 18 months. The primary study outcome was percent overweight (that is, percent over median BMI for age and sex)., Results: Twenty-two children (11.5%) endorsed binge eating at baseline (Binge Eating Group). Children in the Binge Eating Group were younger and had more depressive, anxiety, and eating disorder symptoms, and lower self-esteem than children in the rest of the sample (No Binge Eating Group). There also were differences between the Binge Eating and No Binge Eating groups with respect to the short-term effects of treatment group assignment on change in percent overweight during the study. Specifically, improvements in percent overweight in the intervention condition relative to usual care were documented in the No Binge Eating Group only. Among children in the Binge Eating Group, those assigned to intervention showed a 2.6% increase in percent overweight, on average, at the completion of acute treatment as compared to an 8.5% decrease among children without binge eating. However, these effects were not maintained during follow-up., Conclusion: Results of this study suggest the importance of considering binge eating in the development of weight management programs for severely obese youth.

Both endothelial nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF) are important vasodilators in pulmonary circulation. Sepsis is known to impair endothelium-dependent dilation in the pulmonary vasculature, but the mechanisms are incompletely understood. We have examined the relative contribution of EDHF/NO to the attenuated endothelium-dependent relaxation of pulmonary artery in sepsis, and the role of inducible nitric oxide synthase (iNOS)-derived NO in this mechanism. Sepsis was induced in male adult Wistar rats by caecal ligation and puncture. At 18h after surgery, left and right branches of pulmonary arteries were isolated for tension recording, NO/cyclic guanosine monophosphate (cGMP) measurements, mRNA and protein expressions. Despite a marked decrease in the arterial endothelial nitric oxide synthase (eNOS) mRNA and phosphorylated-eNOS (p-eNOS) protein expressions in sepsis, endothelium-dependent relaxation to acetylcholine (ACh) mediated by NO, acetylcholine-stimulated NO release and tissue cGMP levels were moderately inhibited. Sepsis however abolished the N(G)-Nitro-l-arginine methyl ester (L-NAME)/indomethacin-resistant arterial relaxation (EDHF response) to acetylcholine in this vessel. In vitro treatment of the arterial rings from septic rats with 1400W, a selective inhibitor of iNOS restored the EDHF response, but had no effect on the acetylcholine-induced relaxation mediated by endothelial NO. The functional role of iNOS-derived NO in impairing EDHF-mediated relaxation was coincident with an increased basal NO production, iNOS mRNA and protein expressions in the rat pulmonary artery. In conclusion, the loss of the EDHF response may be primarily responsible for the endothelial dysfunction in sepsis, and its restoration by a selective iNOS inhibitor may improve pulmonary vasodilation.

Background: We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bupropion therapy would enhance abstinence for weight-concerned women smokers., Methods: In a randomized, double-blind, placebo-controlled trial, weight-concerned women (n = 349; 86% white) received smoking cessation counseling and were randomized to 1 of 2 adjunctive counseling components: CONCERNS or STANDARD (standard cessation treatment with added discussion of smoking topics but no specific weight focus), and 1 of 2 medication conditions: bupropion hydrochloride sustained release (B) or placebo (P) for 6 months. Rates and duration of biochemically verified prolonged abstinence were the primary outcomes. Point-prevalent abstinence, postcessation weight gain, and changes in nicotine withdrawal, depressive symptoms, and weight concerns were evaluated., Results: Women in the CONCERNS + B group had higher rates of abstinence (34.0%) and longer time to relapse than did those in the STANDARD + B (21%; P = .05) or CONCERNS + P (11.5%; P = .005) groups at 6 months, although rates of prolonged abstinence in the CONCERNS + B and STANDARD + B groups did not differ significantly at 12 months. Abstinence rates and duration did not differ in the STANDARD + B group (21% and 19%) compared with the STANDARD + P group (10% and 7%) at 6 and 12 months, respectively. There were no differences among abstinent women in postcessation weight gain or weight concerns, although STANDARD + B produced greater decreases in nicotine withdrawal and depressive symptoms than did STANDARD + P., Conclusions: Weight-concerned women smokers receiving the combination of CONCERNS + B were most likely to sustain abstinence. This effect was not related to differences in postcessation weight gain or changes in weight concerns. Trial Registration clinicaltrials.gov Identifier: NCT00006170.

Objective: This study examined the clinical significance of loss of control (LOC) over eating in bariatric surgery patients over 24 months of prospective, multiwave follow-ups., Method: Three hundred sixty-one gastric bypass surgery patients completed a battery of assessments before surgery and at 6, 12, and 24 months following surgery. In addition to weight loss and LOC over eating, the assessments targeted eating disorder psychopathology, depression levels, and quality of life. The study was conducted between January 2002 and February 2008., Results: Prior to surgery, 61% of patients reported general LOC; postsurgery, 31% reported LOC at 6-month follow-up, 36% reported LOC at 12-month follow-up, and 39% reported LOC at 24-month follow-up. Preoperative LOC did not predict postoperative outcomes. In contrast, mixed models analyses revealed that postsurgery LOC was predictive of weight loss outcomes: patients with LOC postsurgery lost significantly less weight at 12-month (34.6% vs 37.2% BMI loss) and 24-month (35.8% vs 39.1% BMI loss) postsurgery follow-ups. Postsurgery LOC also significantly predicted eating disorder psychopathology, depression, and quality of life at 12- and 24-month postsurgery follow-ups., Conclusions: Preoperative LOC does not appear to be a negative prognostic indicator for postsurgical outcomes. Postoperative LOC, however, significantly predicts poorer postsurgical weight loss and psychosocial outcomes at 12 and 24 months following surgery. Since LOC following bariatric surgery significantly predicts attenuated postsurgical improvements, it may signal a need for clinical attention., (Copyright 2010 Physicians Postgraduate Press, Inc.)

Sepsis has been reported to impair endothelium-dependent vasodilations mediated by nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF). Although some studies demonstrate that statins can improve NO-mediated response in septic animals, little is known about its effect on the EDHF response. The present study examined the effects of atorvastatin pretreatment on sepsis-induced endothelial dysfunctions and hypotension in rats. Eighteen hours after the induction of sepsis by cecal ligation and puncture, thoracic aorta and second generation pulmonary arteries were isolated to examine acetylcholine-induced endothelium-dependent dilations mediated by NO and EDHF, respectively. The messenger RNA (mRNA) expression for endothelial NO synthase (eNOS) and inducible NO synthase (iNOS) was done by real-time polymerase chain reaction. NO was measured as nitrate/nitrite release using Griess method. Mean arterial pressure was measured by the invasive method. Sepsis significantly decreased (26%) the relaxation response to acetylcholine in the rat aorta. It also markedly inhibited the eNOS mRNA expression and acetylcholine-stimulated NO release in this vessel. Pretreatment of the rats with atorvastatin (10 mg/kg, orally) 48, 24, and 2 hours before induction of sepsis preserved acetylcholine-induced relaxation, eNOS mRNA expression, acetylcholine-stimulated NO release, and attenuated increase in the inducible NO synthase mRNA expression and basal NO production in the aorta. The maximal EDHF response mediated by acetylcholine was 25.30% +/- 3.00% in the pulmonary artery. Sepsis abolished this response but atorvastatin restored it (22.55% +/- 2.50%). Atorvastatin, however, failed to prevent sepsis-induced hypotension. These results suggest that atorvastatin can restore impaired endothelium-dependent vasodilations mediated by NO and EDHF but not hypotension in sepsis.

Objective: Using Wakefield's conceptualization of mental disorder as "harmful mental dysfunction" (Wakefield, Am Psychol, 47, 373-388, 1992), we examined the evidence for including obesity as a mental disorder in DSM-V., Method: We searched computer databases and examined reference lists from review articles published in the last 10 years to identify empirical papers relevant to the present review., Results: Obesity is a condition of heterogeneous etiology that is harmful for most individuals. However, there is scant evidence that obesity, in general, is caused by mental dysfunction. Although recent work examining the neurocircuitry of energy balance has suggested that mental dysfunction may be involved in the etiology of specific obesity phenotypes, findings are too preliminary to support classification of obesity as a mental disorder. Nevertheless, there is evidence that obesity is related to mental disorder and many of the medications used to treat psychiatric illness., Discussion: There is little evidence for including obesity as a mental disorder in DSM-V. However, results confirm the importance of monitoring adiposity routinely among patients with psychiatric illness.

Objective: We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity., Methods: Participants were 192 children 8.0 to 12.0 years of age (mean +/- SD: 10.2 +/- 1.2 years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance., Results: Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-to-treat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended > or =75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants., Conclusions: Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended > or =75% of sessions.

HEALTHY was a multi-center primary prevention trial designed to reduce risk factors for type 2 diabetes in adolescents. Seven centers each recruited six middle schools that were randomized to either intervention or control. The HEALTHY intervention integrated multiple components in nutrition, physical education, behavior change and communications and promotion. The conceptual rationale as well as the design and development of the behavior intervention component are described. Pilot study data informed the development of the behavior intervention component. Principles of social learning and health-related behavior change were incorporated. One element of the behavior intervention component was a sequence of peer-led, teacher-facilitated learning activities known as FLASH (Fun Learning Activities for Student Health). Five FLASH modules were implemented over five semesters of the HEALTHY study, with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade. Each module contained sessions that were designed to be delivered on a weekly basis to foster self-awareness, knowledge, decision-making skills and peer involvement for health behavior change. FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity. Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the student's lifestyle change choices. Family outreach strategies included the delivery of newsletters and supplemental packages with materials to promote healthy behavior in the home environment during school summer and winter holiday breaks. In conclusion, the HEALTHY behavior intervention component, when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns, is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States.

The current study examined the hypothesis that acetylcholine-induced N(omega)-Nitro-L-arginine methyl ester (L-NAME)-resistant endothelium-dependent relaxations in the chicken carotid artery are mediated by nitric oxide and carbon monoxide. Acetylcholine (1 nM-3 microM) caused a concentration-dependent relaxation (pD(2) 6.81+/-0.05, R(max) 115+/-3%) of the artery segments precontracted with phenylephrine (3 microM). L-NAME (1 mM) decreased the sensitivity (pD(2) 6.44+/-0.06), but not the efficacy (R(max) 108+/-3%) of acetylcholine. It also partially decreased the acetylcholine (3 microM)-stimulated nitrite release. While treatment with N(omega)-Nitro-L-arginine (l-NNA; 1 mM) plus L-NAME (1 mM) decreased the acetylcholine-stimulated nitrite release to the basal level, it moderately inhibited (R(max) 77+/-3%) the maximal relaxation elicited with the muscarinic agonist. 2-Phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (PTIO; 100 microM) a specific scavenger of nitric oxide (NO) plus the two NOS inhibitors further decreased the acetylcholine-evoked relaxation (R(max) 34+/-2%). Although soluble guanylyl cyclase (sGC) inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; 10 microM) markedly inhibited the acetylcholine-stimulated increase in tissue cGMP to less than the basal levels, it only decreased the sensitivity, but not the efficacy of the agonist either in the presence or absence of L-NAME (1 mM). Zinc Protoporphyrin-IX (ZnPP; 10 microM), a hemeoxygenase (HO) inhibitor, partially inhibited (R(max) 72+/-3%) the L-NAME-resistant acetylcholine-induced relaxations. A combined treatment of the arterial rings with L-NAME, l-NNA, PTIO and ZnPP nearly abolished (R(max) 7+/-0.9%) the vasodilator responses to acetylcholine. Endothelium removal abolished the relaxation response to acetylcholine. In conclusion, it is suggested that the acetylcholine-induced L-NAME-resistant relaxation is primarily, mediated by NO with a small but significant contribution from endothelium-derived carbon monoxide in the chicken carotid artery.

This study was designed to document eating disorder symptoms in a well-defined sample of patients with bipolar disorder and to evaluate the relationship of current loss of control over eating (LOC) to demographic and clinical features hypothesized to characterize bipolar patients at risk for disordered eating. Eighty-one patients enrolled in the Bipolar Disorder Center for Pennsylvanians provided demographic information and completed the Structured Clinical Interview for DSM-IV Axis I Disorders. The Eating Disorder Examination was administered by independent clinicians to evaluate current and lifetime eating disorder symptomatology. Twenty-one percent of participants met DSM-IV criteria for a lifetime eating disorder, and 44% reported a history of LOC. Patients who endorsed weekly LOC during the past six months (n=18) were heavier, had more atypical depressive symptoms, and were more likely to have a lifetime substance use disorder compared to patients in the rest of the sample (n=63). These findings indicate that eating disorder symptoms are prevalent in patients with bipolar disorder and are associated with obesity and other psychiatric morbidity. Screening for eating disorders in bipolar patients is warranted, as intervention may minimize distress and improve treatment outcome.

Mood and weight concerns may relate to postpartum smoking, and racial differences in these concerns may be important in developing interventions to prevent postpartum relapse. We compared differences in the smoking patterns, mood, and weight concerns of Black and White women who quit smoking during pregnancy (N = 174). In univariate comparisons, there were no consistent differences in nicotine dependence, smoking history, or motivation to remain abstinent postpartum. Moreover, although there were univariate differences in negative affect, smoking for weight control, and eating disinhibition, after controlling for differences in income and educational background between Black and White women, these differences in mood and weight concerns were no longer significant. In our sample of pregnant women who had quit smoking, Black and White women did not differ in mood and weight concerns, two potentially modifiable variables that may affect smoking postpartum relapse.

The present study examined the role of voltage-gated potassium (K(v)) channels and myo-endothelial gap junctions in 4-aminopyridine-induced inhibition of acetylcholine-evoked endothelium-dependent relaxation and NO release in the rat carotid artery. The acetylcholine-induced relaxation was drastically inhibited by 94% and 82%, respectively in the presence of either 100 microM N(G)-nitro-l-arginine methyl ester (L-NAME) or 10 microM 1H-[1,2,4]oxadiazolo[4,3,a]quinoxalin-1-one (ODQ), while it was abolished following endothelium removal. 4-aminopyridine (1 mM), a preferential blocker of the K(v) channels significantly decreased the vasodilator potency, as well as efficacy of acetylcholine (pD(2) 5.7+/-0.09, R(max) 86.1+/-3.5% versus control 6.7+/-0.10 R(max) 106+/-3.5%, n=6), but had no effect on the relaxations elicited by either sodium nitroprusside (SNP) or 8-bromo-cyclic guanosine monophosphate (8-Br-cGMP). 4-AP (1 mM) also inhibited acetylcholine (3 microM)-stimulated nitrite release in the carotid artery segments (99.4+/-4.93 pmol/mg tissue weight wt; n=6 versus control 123.8+/-7.43 pmol/mg tissue weight wt, n=6). 18alpha-glycyrrhetinic acid (18alpha-GA, 5 microM), a gap junction blocker, completely prevented the inhibition of acetylcholine-induced relaxation, as well as nitrite release by 4-AP. In the pulmonary artery, however antagonism of acetylcholine-evoked relaxation by 4-AP was not reversed by 18alpha-GA. These results suggest that 4-AP-induced inhibition of endothelium-dependent relaxation and NO release involves electrical coupling between vascular smooth muscle and endothelial cells via myo-endothelial gap junctions in the rat carotid artery, but not in the pulmonary artery. Further, direct activation of 4-AP-sensitive vascular K(v) channels by endothelium-derived NO is not evident in the carotid blood vessel, while this appears to be an important mechanism of acetylcholine-induced relaxation in the pulmonary artery.

Objective: Inpatient hospitalization has been a mainstay of treatment for anorexia nervosa (AN), but decreasing lengths of inpatient stay have prompted the development of alternative care-continuum models. This study characterizes the 6-month outcomes of 71 patients with AN who completed an inpatient-treatment protocol (approximately 5 weeks), followed by a day-hospital program (DHP) (approximately 3 weeks)., Method: Data were derived from chart reviews and questionnaire data were collected during routine clinical care., Results: On discharge from DHP, 35.2% of patients showed excellent outcomes, whereas 23.9% exhibited poor outcomes. At 6 months after DHP discharge, 47.9% of the patients were successful in maintaining outpatient treatment status. Patients with successful 6-month outcomes were admitted to inpatient at a higher weight, had fewer previous hospitalizations, were younger, were rated by inpatient staff as more committed to treatment, endorsed less AN psychopathology during inpatient admission, and showed greater weight gain during DHP. Number of previous hospitalizations and weight gain immediately after inpatient discharge predicted 89.2% of outcome classifications 6 months after DHP discharge., Conclusion: These findings highlight both the potential benefits of this care-continuum model for patients who previously have not been hospitalized and the pressing need to develop alternative treatment strategies for patients with more chronic AN., ((c) 2008 by Wiley Periodicals, Inc.)

Binge eating is common in middle childhood (6-12 years) and often presents in concert with disordered eating attitudes, emotional distress, overweight and adiposity. Binge eating is also predictive of excessive weight gain and is associated with energy intake. However, few children meet DSM-IV-TR criteria for binge eating disorder, thereby making treatment recommendations a challenge. We propose criteria for a new diagnosis, Loss of Control Eating Disorder in Children age 12 years and younger, for further study. The criteria put forward are a revision of Marcus and Kalarchian's [Marcus, M.D., & Kalarchian, M.A. (2003). Binge eating in children and adolescents. International Journal of Eating Disorders, 34 Suppl, S47-S57.] provisional binge eating disorder research criteria for children 14 years and younger, and are based upon the evolving literature in children with binge and loss of control eating episodes. A rationale for the new criteria set is provided, and future research directions are proposed.

Objective: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions., Method: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems., Results: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05)., Conclusion: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.

Background: Although most bariatric surgery patients undergo a preoperative psychological evaluation, the potential effect of psychiatric disorders on weight loss is not well understood. We sought to document the relationship of preoperative psychiatric disorders to the 6-month outcomes after gastric bypass., Methods: The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to assess current and lifetime Axis I clinical disorders, as well as Axis II personality disorders, before surgery. We used linear regression models to examine the relationship of psychiatric disorders to postoperative weight-related outcomes., Results: The sample (n = 207) was 83.1% female and 92.7% white. The preoperative body mass index (BMI) was 51.4 +/- 9.6 kg/m(2) and age was 45.8 +/- 9.5 years. After adjusting for the initial BMI, gender, race, and age, a lifetime Axis I disorder was associated with a smaller decrease in BMI (t = -3.7, df = 205, P <.001) at 6 months after surgery. The results of separate models for each class of disorder indicated that lifetime mood disorder was associated with a smaller decrease in BMI (t = -3.7, df = 205, P <.001), as was lifetime anxiety disorder (t = -2.6, df = 205, P = 0.009), but substance and eating disorders were not. In this sample, current Axis I clinical disorders and Axis II personality disorders were unrelated to outcomes at 6 months. Similar overall results were found when the percentage of weight loss and excess weight loss were predicted., Conclusion: The results of our study have shown that patients who have ever had an Axis I clinical disorder, especially mood or anxiety, exhibit poorer weight outcomes 6 months after gastric bypass than those who have never had an Axis I disorder. Additional research with larger samples is needed to replicate these findings and examine more fully the effect of current clinical disorders and personality disorders on weight loss. Nevertheless, our results suggest that patients with current or past disorders might benefit from close monitoring or psychosocial intervention to improve their short-term outcomes. However, a greater duration of follow-up is needed to identify predictors of longer-term weight control.

The aim of the present study was to examine the role of protein kinase G (G-kinase) in the mechanism of endogenous nitric oxide (NO) deficiency-induced supersensitivity to the nitrovasodilator sodium nitroprusside (SNP) in isolated rat pulmonary artery. Tension experiments and cGMP measurements were carried out on isolated rat pulmonary artery to assess the influence of NO deficiency, caused by either N-nitro-L-arginine methyl ester (L-NAME) treatment or endothelium removal on the vasodilator potency of SNP. Sodium nitroprusside was more potent (pD2; 8.21 +/- 0.04) in relaxing arterial rings treated with 100microM L-NAME or denuded of the endothelium (pD2; 8.44 +/- 0.11) compared with the endothelium-intact controls (pD2; 7.61 +/- 0.05). Similarly, the tissue sensitivity to 8-Br-cGMP, a G-kinase activator, was significantly (P < 0.05) greater after L-NAME treatment (pD2; 5.04 +/- 0.09) or endothelium removal (pD2; 5.28 +/- 0.11) in comparison with the controls (pD2; 4.22 +/- 0.17). On the other hand, dibutyryl cAMP, an activator of protein kinase A, was equipotent in dilating control (pD2; 4.14 +/- 0.04) and L-NAME-treated (pD2 4.21 +/- 0.05) vessels. Further, L-NAME treatment significantly (P < 0.05) decreased the basal cGMP but enhanced SNP (1 microM)-stimulated increase in the tissue cyclic nucleotide levels (271.8 +/- 39.93 pmol/mg protein versus control: 66.19 +/- 7.18 pmol/mg protein), indicating sensitization of soluble guanylyl cyclase to NO. The increased sensitivity of G-kinase to cGMP observed in the present study suggests a novel mechanism of supersensitivity in vascular smooth muscle to nitrovasodilators in acute NO deficiency. Further, it explains the influence of ambient cGMP in determining the sensitivity of G-kinase in vascular smooth muscle.

Family studies of anorexia nervosa and bulimia nervosa have yielded important information about the etiologies of these eating disorders. By contrast, little is known about familial factors of etiologic importance for binge-eating disorder (BED). The purpose of the current family history study was to assess the prevalence of comorbid psychopathology in a non-treatment seeking female sample of 31 probands with BED, 32 control probands without BED, and their 283 first-degree relatives. In-person semistructured clinical interviews were conducted with the probands, who also served as informants for all of their first-degree relatives. Significantly higher lifetime rates of major depressive disorder, dysthymic disorder, and social phobia were found among women with BED compared with control women. Significantly higher lifetime rates of bipolar (I or II) disorder, any depressive disorder, nearly all anxiety disorders, anorexia nervosa, and BED were reported among the first-degree relatives of women with BED compared with the first-degree relatives of control women. Furthermore, female relatives of women with BED were reported to have higher rates of substance use disorders and dysthymic disorder compared with female relatives of control women without BED. Nearly all disorders that were elevated in relatives of women with BED followed a pattern of independent transmission from BED. The primary exception was substance use disorder among female relatives, whose transmission pattern was consistent with that of a shared etiology with BED. Thus, BED and substance use disorder may share a common mechanism of familial transmission among women.

Background: This study used standardized assessments to evaluate the association between childhood maltreatment (i.e., emotional, physical, and sexual abuse and emotional and physical neglect) and Axis I and II psychiatric disorders in patients presenting for bariatric surgery., Methods: Participants (N = 230) provided demographic information and completed the Childhood Trauma Questionnaire, short form. The Structured Clinical Interview for the DSM-IV was used to assess Axis I clinical disorders and Axis II personality disorders., Results: Approximately 66% of participants had a history of childhood maltreatment. Individuals reporting childhood maltreatment had a greater number of lifetime Axis I diagnoses than did those without, although the effect for physical neglect was no longer significant after controlling for multiple comparisons. With respect to specific Axis I diagnoses, a history of emotional or sexual abuse was associated with increased rates of lifetime mood and anxiety disorder diagnoses. Emotional neglect also was associated with increased rates of mood disorder diagnoses, and physical abuse was associated with increased rates of substance use disorders. There was no significant association between childhood maltreatment and personality psychopathology., Conclusion: This study confirms high rates of childhood maltreatment in patients presenting for bariatric surgery that are associated with increased prevalence of lifetime mood, anxiety, and substance use disorders. Future prospective studies should include evaluation of a broad range of mental health and childhood experiences to tease apart the nature of the relationships between these factors and their potential impact on post-surgical outcomes.

The phenomenology of childhood and adolescent loss of control (LOC) eating is unknown. The authors interviewed 445 youths to assess aspects of aberrant eating. LOC was associated with eating forbidden food before the episode; eating when not hungry; eating alone; and experiencing secrecy, negative emotions, and a sense of "numbing" while eating (ps<.01). Hierarchical cluster analysis revealed a subgroup, most of whom reported LOC eating. Cluster members reported having a trigger initiate episodes, eating while watching television, and having decreased awareness regarding the amount consumed. The authors conclude that aspects of LOC eating during youth are similar to aspects of adult episodes, but a youth-specific presentation may exist. Findings may provide an intervening point to prevent excessive weight gain and eating disorders., ((Copyright) 2007 APA.)

Cerebral ischaemia is considered to be an important cause of central nervous system dysfunction in heat stress. We hypothesized that heat stress would alter the reactivity of isolated carotid artery to vasoactive agents. Carotid arteries were isolated from broiler chickens maintained either at 23-24 degrees C with 55-65% humidity (control conditions) or exposed to 40 +/- 1 degrees C with 35% humidity for 4 h (heat stress). Contractions were elicited with vasoconstrictors such as 5-HT, phenylephrine, guanfacine and CaCl(2) (K(+)-depolarized) in endothelium-denuded arterial rings. Heat stress significantly increased the potency of 5-HT, but had no effect on the sensitivity of the vessel to phenylephrine or guanfacine. In contrast, it markedly decreased the potency and efficacy of CaCl(2). Vasodilator responses to ACh (endothelium-intact) and sodium nitroprusside (endothelium-denuded), however, were unaffected. Although cyclopiazonic acid (10 microm) significantly decreased 5-HT responses in both the conditions, the agonist was still more potent in heat stress. Extracellular Ca(2)(+) removal had no effect on contractions caused by 5-HT in control conditions, but it significantly decreased the agonist potency in heat stress. Interestingly, nifedipine (1 microm) markedly inhibited 5-HT-induced contractions both in control conditions and in heat stress, implying an inhibitory effect on both Ca(2)(+) influx and release. Thus, nifedipine had a markedly greater inhibitory effect on 5-HT-induced contractions in heat stress compared with control conditions. The results suggest that heat stress increased the vasoconstrictor responses to 5-HT by a mechanism that involved extracellular Ca(2)(+) influx through nifedipine-sensitive L-type calcium channels.

Objectives: The objectives of the study were to evaluate the clinical significance of lifetime eating disorder comorbidity in a well-defined sample of patients with bipolar spectrum disorders and to describe cognitive correlates of disordered eating in this group., Method: Twenty-six bipolar patients with a lifetime history of a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined eating disorder (n = 17) or a clinically significant subthreshold eating disorder (n = 9) (ED group) were compared with 46 bipolar patients with no history of an eating disorder (no-ED group) on demographic and clinical characteristics at study presentation, history of bipolar illness, and other psychiatric comorbidity. Measures included the Structured Clinical Interview for the DSM-IV Axis I Disorders, the Clinical Global Impression-Severity Scale-Bipolar Version (CGI-S-BP), and the Eating Disorder Examination. Height and weight were recorded to calculate body mass index., Results: Patients in the ED group were heavier and were rated as more symptomatic on the CGI-S-BP than were patients in the no-ED group. The ED group also had a higher number of lifetime depressive episodes and greater psychiatric comorbidity, excluding eating and mood disorders. Finally, after controlling for body mass index and CGI-S-BP rating, patients in the ED group had significantly higher Eating Disorder Examination Restraint, Eating Concern, Shape Concern, Weight Concern, and Global scores than did patients in the no-ED group., Conclusions: These findings highlight the need for a renewed emphasis on the evaluation and management of weight and eating in the mood disorders. In particular, this research suggests that eating disorder comorbidity may be a marker for increased symptom load and illness burden in bipolar disorder.

Smoking cessation often results in weight gain. Although smoking cessation frequently is recommended to patients presenting for weight loss surgery (WLS), the relationship between smoking cessation and weight gain among WLS candidates is poorly understood. Thus, we sought to document the history and prevalence of smoking and smoking-related weight gain among WLS candidates. Subjects (N=67) presenting for bariatric surgery provided demographic information, were interviewed about smoking, and were weighed and measured prior to operation. Sixty-seven percent of patients reported a lifetime history of smoking, and 26.9% were current smokers. Among lifetime smokers who had attempted to quit, the average maximum amount of weight gained following smoking cessation was 28.1 lb, but there was wide variability in postcessation weight gain. These data suggest that smoking among candidates for bariatric surgery is prevalent and that previous cessation attempts were associated with considerable weight gain. Because patients often receive recommendations to quit smoking and lose weight prior to surgery, additional information on the impact of presurgical smoking cessation on long-tem weight control in this population is needed.

Objective: We used a dimensional measure of mood psychopathology to document lifetime depressive and manic-hypomanic spectrum symptoms in 50 patients with anorexia nervosa (AN)., Method: Participants provided demographic information and completed the Self-Report Questionnaire for Mood Spectrum, a 161-item instrument that documents lifetime symptoms, traits, and behaviors characteristic of threshold and subthreshold mood episodes. Analyses focused on the association of depressive and manic-hypomanic component scores with indicators of clinical severity in AN., Results: Lifetime severity of depressive (M[SD] = 39.1[13.9]) and manic-hypomanic (M[SD] = 23.8[12.1]) spectrum symptoms exceeded the established thresholds for clinical significance on these scales (ie, score > or =22). There was a positive correlation between the number of manic-hypomanic items endorsed and the number of depressive items endorsed. After controlling for lifetime history of mood disorder, severity of depressive and manic-hypomanic spectrum symptomatology also was associated with a history of self-induced vomiting and suicidality in patients with AN., Conclusion: These data provide initial evidence for the clinical significance of depressive and manic-hypomanic spectrum symptoms in patients with AN. Future work is needed to determine how mood spectrum psychopathology might impact the course and treatment of AN.

We hypothesized that among overweight women smokers, those with Childhood Onset weight problems may be more likely to engage in unhealthy eating and dieting behaviors, including smoking to control weight. Data were collapsed from 89 currently overweight (BMI> or =25) women smokers who were recruited to participate in smoking research projects that focused on weight, body image, and food intake. We compared those who reported first becoming overweight before Junior High School (n=22) with those who recalled first experiencing weight problems during Junior High School or later (n=67). Women with Childhood Onset weight problems reported first trying cigarettes at a significantly younger age than those with Later Onset (13 vs. 15 years of age, respectively), and they reported more nicotine withdrawal symptoms during smoking abstinence, with a significantly greater likelihood of endorsing anger/irritability and trouble concentrating. No group differences were evident for cigarettes per day or other indicators of nicotine dependence (e.g., FTND). Although it is unclear whether having weight problems during childhood contributes directly to smoking initiation, our results provide evidence that Childhood Onset weight problems may serve as a marker for earlier smoking experimentation and may also complicate cessation efforts due to their association with elevated withdrawal symptomatology. Future longitudinal studies with prospective measures of weight, dieting, and smoking initiation may be helpful in establishing causal pathways in different subgroups of smokers.

Background: There is little information about the symptoms of disordered eating or their association with psychological and physical parameters in midlife women., Purpose: The aim is to examine (a) the prevalence of binge eating, inappropriate weight control behaviors, and weight and body image concerns among middle-aged community women; (b) whether rates of eating disorder symptoms vary among ethnic groups and are associated with socioeconomic status, weight-related variables, current depressive symptoms or history of major depression, substance abuse or dependence, or childhood abuse; and (c) whether the association between ethnicity and eating disorder symptoms persists after adjustment for covariates., Methods: The sample of 589 pre- and early perimenopausal African American, Hispanic, and White women were participants in the Study of Women's Health Across the Nation (SWAN), a U.S. multisite longitudinal study of menopause and aging. Women reported information on sociodemographic, symptom, health, psychosocial and lifestyle variables. DSM-IV disorders were determined, physical measures were obtained, and a questionnaire to assess symptoms of eating disorders was completed., Results: Rates of regular binge eating, dissatisfaction with eating patterns, and marked fear of weight gain were 11, 29.3, and 9.2%, respectively. African Americans were more likely than were Whites to report fasting. In multivariable analyses, high body mass index (or waist circumference), depressive symptoms, past depression, and history of childhood/adolescence abuse were significantly associated with the Binge Eating and Preoccupation with Eating, Shape and Weight subscale scores., Conclusions: These data suggest that further examination of the relationship between eating problems and well being in older women is warranted.

Objective: Women 25 to 45 years old are at risk for weight gain and future obesity. This trial was designed to evaluate the efficacy of two interventions relative to a control group in preventing weight gain among normal or overweight women and to identify demographic, behavioral, and psychosocial factors related to weight gain prevention., Research Methods and Procedures: Healthy women (N = 284), ages 25 to 44, with BMI < 30 were randomized to one of three intervention conditions: a clinic-based group, a correspondence course, or an information-only control. Intervention was provided over 2 years, with a follow-up at Year 3. BMI and factors related to eating and weight were assessed yearly., Results: Over the 3-year study period, 40% (n = 114) of the women remained at or below baseline body weight (+/-2 lbs), and 60% gained weight (>2 lbs). Intervention had no effect on weight over time. Independently of intervention, women who were older, not actively dieting to lose weight, and who reported less perceived hunger at baseline were more likely to be successful at weight maintenance. Weight maintenance also was associated with increasing dietary restraint (conscious thoughts and purposeful behaviors to control calorie intake) and decreasing dietary disinhibition (the tendency to lose control over eating) over time., Discussion: This study raises concern about the feasibility and efficacy of weight gain prevention interventions because most women were interested in weight loss, rather than weight gain prevention, and the interventions had no effect on weight stability. Novel approaches to the prevention of weight gain are needed.

Objective: The present study was designed to document psychiatric disorders among candidates for weight loss surgery and to examine the relationship of psychopathology to degree of obesity and functional health status., Method: The authors collected demographic and clinical information from 288 individuals seeking surgery. Assessments were administered independently of the preoperative screening and approval process. The study group was mostly female (83.3%) and white (88.2%). Mean body mass index (BMI) of the group was 52.2 kg/m(2) (SD=9.7), and the mean age was 46.2 years (SD=9.4)., Results: Approximately 66% of the participants had a lifetime history of at least one axis I disorder, and 38% met diagnostic criteria at the time of preoperative evaluation. In addition, 29% met criteria for one or more axis II disorders. Axis I psychopathology, but not axis II, was positively related to BMI, and both axis I and axis II psychopathology were associated with lower scores on the Medical Outcomes Study 36-item Short-Form Health Survey., Conclusions: Current and past DSM-IV psychiatric disorders are prevalent among bariatric surgery candidates and are associated with greater obesity and lower functional health status, highlighting the need to understand potential implications for surgery preparation and outcome. Future work also will focus on the course of psychiatric disorder during the post-surgery period and its relationship to weight loss and maintenance.

Conventional wisdom teaches that chronic headaches typically improve and often abate during pregnancy, leading many clinicians to take a wait-and-see approach of delaying treatment in hopes of seeing spontaneous improvement. Although headaches do improve in later pregnancy for up to 50% of chronic headache sufferers, headaches persist and may even worsen for the remainder. Clinicians must recognize that treating headache during pregnancy is important in order to limit excessive use of over-the-counter pain remedies, dehydration, and pain- related disability. Safe and effective medication and nonmedication treatment options are available for the pregnant headache sufferer, including both acute care and preventive therapies. Care of the pregnant headache patient should begin before she is known to be pregnant, when the fertile female is initially established as a patient. Preconception planning should include modification of medication regimes to include medications safe for use during early pregnancy, when the woman may not yet realize she is pregnant, and effective nonmedication therapies, such as relaxation, biofeedback, and lifestyle modification.

Background: Although many women quit smoking during pregnancy, most resume smoking postpartum. One factor that may be important in postpartum relapse is a pregnant woman's motivation to remain abstinent after delivery., Purpose: We assessed motivation for postpartum abstinence among pregnant women who had quit smoking and examined the relationship of weight concerns and mood to abstinence motivation., Methods: Pregnant former smokers, recruited between February 2000 and November 2004, completed assessments of smoking, weight concerns, depressive symptoms, and perceived stress., Results: Sixty-five percent were highly motivated to remain abstinent postpartum. Women who were and were not motivated were similar in age, race, and nicotine dependence. However, motivated women reported more stress, greater self-efficacy for weight management, less hunger, and less smoking for weight control than did less motivated women. After controlling for intention to breast-feed, nicotine dependence, years of smoking, partner smoking, and race, self-efficacy for weight control was related to motivation to maintain postpartum abstinence., Conclusions: These data suggest that weight concerns are associated with motivation for postpartum smoking abstinence, and interventions designed to prevent postpartum smoking relapse may need to target eating, weight, and shape concerns.

Objective: We provide a model to explicate how factors representing different levels of analysis (i.e., biology, psychology, sociodemographics, and behavior) interact to influence the onset and maintenance of obesity in bipolar disorder., Data Sources: We conducted MEDLINE (1966-2005) and PsycInfo (1872-2005) searches of all English-language articles using the keywords obesity, body weight, weight gain, and metabolic syndrome combined with bipolar disorder, depression, atypical depression, binge eating, and pharmacotherapy., Study Selection: Studies were selected if they provided data regarding (1) the prevalence of obesity in patients with bipolar disorder, (2) correlates of obesity in patients with bipolar disorder, or (3) evidence that a clinical feature(s) or correlate(s) of bipolar disorder is associated with obesity. Ninety-two studies were reviewed., Data Synthesis: Obesity is prevalent in patients with bipolar disorder and is associated with increased medical morbidity and poorer psychiatric outcome. Variables that may interact to influence the onset and maintenance of obesity in bipolar disorder include genetic factors, neurotransmitter abnormalities, atypical depression, eating behaviors, pharmacotherapy, age, gender, socioeconomic status, and physical inactivity., Conclusions: Although the exact causes of obesity in bipolar disorder undoubtedly vary across patients, the etiologic cascade, which includes biological, psychological, and sociodemographic variables, ultimately directly or indirectly affects levels of physical activity and eating behavior, leading to obesity in this population. Behavioral interventions aimed at targeting physical inactivity and overeating in bipolar disorder patients are needed, as are better screening and treatment for binge eating. Finally, there is a clear need for ongoing research to explicate the causes and consequences of obesity across levels of analysis.

Objective: We sought to examine rates of eating disorder symptoms among seriously overweight children seeking treatment using the Eating Disorder Examination for Children (ChEDE) and to provide initial data about their association with treatment outcome., Method: Overweight children (N = 27) 8-13 years old were interviewed using the ChEDE before participating in a family-based behavioral treatment program. Height and weight were measured pretreatment, posttreatment, and approximately 8 months posttreatment., Results: Fifteen percent of children reported subjective bulimic episodes (SBE). Weight loss did not differ for children with and without SBEs, but concerns about body shape were related to larger weight losses during treatment., Conclusion: A considerable minority of treatment-seeking overweight children report an episodic sense of loss of control over eating. Loss of control is related to other disordered eating attitudes and behaviors, but does not appear to affect treatment outcome. Future studies are needed to replicate these initial findings.

Objective: The current study describes the short-term outcome of 61 inpatients with anorexia nervosa (AN), utilizing a standardized protocol that could be completed by most patients within the typical length of stay (LOS) in an academic medical center in our geographic area., Method: Patients were placed on disorder-specific and medication clinical pathways and completed questionnaires at admission and discharge. Diagnostic, historical, demographic, and treatment-related information was obtained., Results: Treatment was sufficient to resolve acute medical problems, initiate refeeding, and interrupt compensatory behaviors, but continued intensive treatment will be critical to full recovery. Patients were discharged at an average of 85% of ideal body weight (IBW). Twenty patients were discharged against medical advice (AMA). Clinical and demographic variables poorly predicted AMA status., Discussion: Attainable inpatient treatment goals in our care environment appear to be > or = 80% IBW at discharge, resolution of acute medical problems, and interruption of compensatory behaviors. Future research should examine whether shorter LOS increases readmission rates or long-term costs., (2005 by Wiley Periodicals, Inc.)

Objective: Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little is known about the management of obesity among individuals with severe and persistent mental illness. Thus we sought to evaluate the potential utility of a behavioral weight control program for this population., Method: Outpatients receiving psychiatric care at a university medical center who had a body mass index (BMI; weight in kg/[height in m](2)) >or= 30 and were currently taking antipsychotic medication participated in a 12-week group behavioral weight control program. A medical chart review was conducted for each participant's body weight over the 10 months prior to beginning the program. A multiple baseline design was used to determine the impact of the intervention on BMI through 12-month posttreatment follow-up. We also assessed self-reported eating behavior, physical activity, and health-related quality of life. Data were collected from October 2000 to July 2003., Results: Among 35 patients who began the program, 29 (83%) completed treatment, with mean (+/- SD) weight loss of 5.04 (+/- 7.52) pounds (p = .001) and improvements in eating, activity, and quality of life. At 3-month posttreatment follow-up (N = 27; 77%), total mean weight loss was 7.14 (+/- 11.47) pounds (p = .003). Results of a longitudinal model based on general estimating equations indicated that, relative to the pretreatment period, BMI decreased significantly during treatment and remained stable through 12-month posttreatment follow-up., Conclusion: Behavioral weight control is a promising approach to the treatment of obesity among outpatients taking antipsychotic medications, but longer and more robust interventions are needed.

Research has demonstrated that a lapse in cigarette abstinence often leads smokers to fully relapse (i.e., return to daily smoking). However, patterns of smoking resumption beyond the point at which relapse occurs have not been examined in systematic follow-up studies. Daily cigarette intake data for 108 female adult smokers who participated in a smoking cessation trial were recorded at several points during the 365 days following the participants' quit date. SAS Proc Traj, a group-based mixture modeling procedure, was used to determine cigarette-use trajectories over time (i.e., patterns of smoking resumption). Over the 365 days, 27% of the sample maintained abstinence. Among the 73% who relapsed, four distinct trajectories emerged: low-level users (8% of the overall sample), moderate users (17%), slow-returners (15%), and quick-returners (33%). A few individual characteristics differentiated these groups. Overall, the findings illustrate that, after relapsing, smokers do not follow a unitary course of smoking resumption; rather, they exhibit more variable resumption patterns than previously assumed.

Objective: The goals of this study were to assess eating disorder symptoms in depressed women with no history of eating disturbance and to evaluate the clinical significance of these symptoms relative to those reported by women with bulimia spectrum disorder., Method: Participants were 63 women with major depressive disorder (MDD) (n = 19), bulimia spectrum disorder (n = 20), or no history of MDD or eating disorder (n = 24). Measures included diagnostic interviews and self-report questionnaires designed to assess diagnostic criteria for bulimia nervosa, subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction., Results: There were no significant differences between depressed and bulimic women on shape concerns, appearance overvaluation, or body dissatisfaction. Depressed women endorsed significantly more subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction than did control subjects., Discussion: Eating disorder symptoms may be associated with depression in women in the absence of comorbid eating disorder diagnoses., (Copyright 2005 by Wiley Periodicals, Inc)

Training of new investigators is critical to promoting research in anorexia nervosa. Obstacles to training are noted, examples of current research training and early career funding opportunities are discussed, and suggestions to support training are offered., (2005 by Wiley Periodicals, Inc.)

Eating disorders (ED) patients are at high risk for developing suicidal behavior. The aim of the present study was to investigate factors associated with suicidal behavior in ED patients. One hundred fifty patients at an outpatient ED clinic were included in the study. Data were gathered by retrospective chart analysis. We found that 48 patients (32%) had a history of parasuicide (i.e., suicide attempts, self-injury, or both). A significantly greater percentage of parasuicidal patients than nonparasuicidal patients had EDs with bingeing/pursing symptomatology, used more than one type of purging method, and had a lifetime history of a drug use disorder, impulse control problems, and bipolar disorder, as well as a more extensive outpatient and inpatient treatment history. The findings of this study support an increased tendency toward impulsivity among parasuicidal ED outpatients.

The majority of women who quit smoking during pregnancy will resume smoking during the postpartum period. Little is known, however, about the predictors of postpartum relapses to smoking. Changes in mood and increases in concerns about weight are common during the postpartum period, and these factors may affect women's postpartum smoking behavior. In this paper, we present a model of the relationship among mood, weight concerns and postpartum smoking. Data from previous postpartum relapse prevention trials are reviewed and evidence of a connection between changes in mood and weight concerns to postpartum relapse is presented. Directions for future research on the prevention of smoking relapses during the postpartum period, and the roles of mood and weight concerns in smoking relapse are presented.

Objective: We examined differences in the onset pattern of comorbid disorders in eating-disordered women with and without a history of parasuicide to elucidate potential etiologic differences between the two groups., Methods: Fifty-four women with a current or past eating disorder partcipated. Of these women, 27 had a history of suicide attempts and self-injury and 27 had no history of suicide attempts or self-injury. The age and pattern of onset for the eating disorder relative to comorbid major depression, anxiety disorder, and substance use disorder were compared between the groups., Results: The onset of major depression and anxiety disorders occurred at a younger age in the parasuicidal group. In addition, the onset of major depression in the parasuicidal group occurred significantly more often before the onset of the eating disorder., Discussion: The eating disorder may be secondary to a mood disturbance in women with parasuicidal histories., (Copyright 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 190-197, 2004.)

Objective: To determine whether cognitive behavior therapy (CBT) targeted to problematic attitudes common among women with functional hypothalamic amenorrhea would restore ovarian function., Design: Randomized, prospective, controlled intervention., Setting: Clinical research center in an academic medical institution., Patient(s): Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise., Intervention(s): Subjects were randomized to CBT or observation for 20 weeks., Main Outcome Measure(s): Serum levels of E(2) and P and vaginal bleeding were monitored., Result(s): Of eight women treated with CBT, six resumed ovulating, one had partial recovery of ovarian function without evidence of ovulation, and one did not display return of ovarian function. Of those randomized to observation, one resumed ovulating, one had partial return of ovarian function, and six did not recover. Thus, CBT resulted in a higher rate of ovarian activity (87.5%) than did observation (25.0%), chi(2) = 7.14., Conclusion(s): A cognitive behavioral intervention designed to minimize problematic attitudes linked to hypothalamic allostasis was more likely to result in resumption of ovarian activity than observation. The prompt ovarian response to CBT suggests that a tailored behavioral intervention offers an efficacious treatment option that also avoids the pitfalls of pharmacological modalities.

Because a history of depression has been hypothesized to affect cessation efforts and may be particularly problematic for women concerned about weight gain, we sought to document the prevalence of depression history among weight-concerned women smokers and evaluate its effect on treatment outcome. We also evaluated the impact of baseline depressive symptoms and cessation-related changes in symptoms. Women (N = 219) were classified as depression history positive (Major Depressive Disorder [MDD]) (MDD+) or negative (MDD-) according to responses on the Inventory to Diagnose Depression-Lifetime Version. All women received a group-based smoking cessation treatment. Women provided expired-air carbon monoxide samples, completed measures of depressive symptoms, and were weighed at pretreatment and 1, 3, 6, and 12 months after quitting. Fifty-two per cent (n = 115) reported a lifetime history of major depressive disorder. Although MDD+ women were significantly more nicotine dependent, rates of continuous abstinence did not differ between MDD+ and MDD- women. However, MDD+ women were more likely to drop out of treatment prior to quitting. Additionally, depressive symptoms were associated with abstinence irrespective of depression history. Women who reported an increase in depressive symptoms from pre- to post-treatment were significantly less likely to be abstinent post-treatment, suggesting that depressive symptoms are more predictive of outcome than is previous disorder. Moreover, because of the prevalence of depression history among this subgroup of women smokers and its impact on early attrition, additional engagement and retention strategies may be useful.

Objective: To establish what is known about binge eating in children and adolescents and to identify unresolved questions., Method: We reviewed relevant studies to highlight and synthesize salient research findings., Discussion: Available research has suggested that loss of control over eating may be more important than consumption of an objectively large amount of food in the assessment of binge eating in children. In addition, dieting may not be associated consistently with binge eating in children. Behavioral correlates of binges may include eating in the absence of hunger, eating in response to strong emotions or external cues, and eating in secret. On the basis of available research, provisional research criteria for binge eating disorder (BED) in children are suggested to stimulate further study of pediatric samples. We emphasize the need for prospective studies on the relationships among aberrant eating, weight and mood, and the inclusion of boys and girls of different ethnicities., (Copyright 2003 by Wiley Periodicals, Inc.)

Background: A better understanding of the relationship of eating behavior and attitudes to weight loss following gastric bypass (GBP) will enable the development of interventions to improve outcome. Thus, the present study sought to characterize the postoperative weight, eating behavior, and attitudes toward body shape and weight in a cross-section of GBP patients. A second objective was to examine the relationship of postoperative binge eating to surgery outcome., Methods: 99 patients who underwent GBP > 2 and < 7 years before the study start date completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Three-Factor Eating Questionnaire (TFEQ). Subjects self-reported their current body weight, weight change over the past 3 months, and lowest weight since surgery., Results: BMI remained significantly below the preoperative level, but significant weight regain was reported at long-term follow-up. 46% of participants reported recurrent loss of control over eating (objective or subjective bulimic episodes) on the EDE-Q. These patients constituted a distinctive subgroup with a less favorable outcome, including greater weight regain., Conclusion: Self-reported loss of control over eating was related to weight regain after GBP and may be an important target for clinical intervention. The relationship of binge eating and related psychopathology to outcome following GBP warrants further investigation.