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Introduction. The glucagon-like peptide-1 analogue liraglutide 3.0 mg is an out-of-pocket medication approved for weight management in obesity. We aimed to investigate the relationship between psychiatric symptoms (i.e., depression, anxiety, binge eating) and adherence to therapy. Methods. A clinical audit was carried out on 54 adults with obesity treated with liraglutide 3.0 mg. We retrospectively analyzed the relation between (1) psychiatric symptoms evaluated through the State-Trait Anxiety Inventory (STAI-Y1), the Beck Depression Inventory (BDI), the Binge Eating Scale (BES); and (2) adherence to therapy by assessing the maximum dosage (MD) and treatment duration (TD). Results. In the whole cohort, the average weight loss was 4.43% (± SD = 5.5). We found a negative correlation between anxiety symptoms (STAI-Y1 score) and MD (r=-,276), between depression symptoms (BDI score) and TD (r=-,276), and between a high probability of binge eating (BES score > 17) and TD (r=-,275). Linear regression analysis demonstrated that STAI-Y1 score predicted MD [R2 = .076, p = .044], BDI score predicted TD [R2 = .076, p = .044], and significant binge eating predicted TD [R2 = .076, p = .044]. Despite the lower adherence, the presence of psychiatric symptoms did not lead to a reduction in drug effectiveness on weight loss. Conclusion. Psychiatric symptoms can predict reduced adherence to liraglutide 3.0 mg therapy in real life. However, this does not appear to jeopardize its effect on weight loss. These findings suggest that persons with obesity and impaired mental health can also benefit from treatment. Level of evidence. Level V, descriptive studies.

Behavioural lifestyle interventions focused on diet and physical activity are a cornerstone for the treatment of obesity. However, their effects vary substantially across individuals in terms of magnitude and durability. Personalized approaches that target psychological well-being may be promising to facilitate healthy behaviours and sustained weight loss. This preliminary study aimed to explore whether the sequential combination of behavioural lifestyle intervention (BLI) and well-being therapy (WBT) may result in more favourable outcomes than BLI alone in promoting weight loss (primary outcome) and improving psychological well-being, distress, dietary behaviours and physical activity (secondary outcomes). A total of 83 patients with obesity were randomly assigned to BLI/WBT (N = 38) or BLI group (N = 45). The BLI group received a 12-week behavioural weight loss programme, whereas the BLI/WBT group received the same programme followed by an additional 4-week WBT, adapted for group interventions. Data were collected at pretreatment (baseline, T1), at the end of BLI/WBT (T2), at 6-month (T3) and 12-month (T4) follow-ups. There was a significant weight loss in both treatment groups at T2, T3 and T4. The BLI/WBT group showed greater improvements in depressive symptoms at T3 and T4, in autonomy at T2, in personal growth at T4 and in global well-being at T4 compared with BLI group. WBT yielded no additional effect on weight loss. However, the secondary outcomes indicate that WBT may have enduring effects that reduce vulnerability to psychological distress in patients with obesity. In order to confirm these preliminary findings and explore whether a more intensive and individualized WBT can foster sustained weight loss, future studies are needed.

Although the literature suggested that impaired psychological well-being (PWB) is associated with obesity, evidence on the role of PWB in weight outcomes is limited and inconclusive. This research aimed to investigate the joint role of PWB in achieving clinically significant weight loss (CWL; loss of 5% of the initial weight) through a comprehensive lifestyle intervention for obesity using a broad-based evaluation.This study is a prospective cohort of 96 patients with obesity attending a comprehensive lifestyle intervention for weight loss. Data on weight, lifestyle, PWB, and distress, were collected before and after the intervention.30.5% of the participants achieved CWL at the end of treatment. A more pronounced increase in autonomy (odds ratio = 0.80 [95%Unbalanced dimensions of PWB, in particular exceedingly high autonomy, may contribute to a poor weight loss outcome. This study paves the way for the addition of psychotherapeutic strategies geared to euthymia in comprehensive lifestyle intervention.Aunque la literatura sugiere que el deterioro del bienestar psicológico (BP) está asociado con obesidad, la evidencia sobre el papel del BP en el peso es limitada. Se investiga el papel del BP en el logro de pérdida de peso clínicamente significativa (PPCS; pérdida del 5% del peso inicial) a través de una intervención integral sobre el estilo de vida con respecto a la obesidad.Cohorte prospectiva de 96 pacientes con obesidad que asisten a una intervención integral sobre el estilo de vida para la pérdida de peso. Se recolectaron datos sobre peso, estilo de vida, BP y angustia, antes y después de la intervención.El 30,5% de los participantes lograron pérdida de peso al final del tratamiento. Mayor aumento de autonomía (razón de momios = 0,80 [Las dimensiones desequilibradas del BP, en particular la autonomía excesivamente alta, pueden contribuir a una pérdida de peso insuficiente. Se allana el camino para añadir estrategias psicoterapéuticas orientadas a la eutimia en la intervención integral en el estilo de vida.

Obesity has become an increasingly widespread endemic with social implications; however, the relationship between higher body mass index (BMI) and psychological functioning is still not fully understood. This study examined the differences in affect-related psychological variables among BMI classes. A total of 134 adults seeking treatment for obesity and 124 controls completed a set of questionnaires to assess: trait emotional intelligence, emotion regulation strategies, anxiety, depression, binge eating behaviors and happiness. Correlations and multivariate analysis of variance were run per each study variable controlling for BMI class (normal weight, overweight, or obesity class I, II, III). Individuals with obesity class III were characterized by reduced trait emotional intelligence and happiness, and a higher tendency to use emotion suppression compared to normal weight individuals. All individuals with obesity also showed higher levels of depression and binge eating behaviors compared to both normal weight and overweight adults. Depression and emotion suppression were the most relevant discriminant factors across BMI classes, while trait emotional intelligence resulted as an important psychological factor clustering individual differences between obese and non-obese individuals. These results suggest that more attention to the affective domain of psychological functioning is needed for proper and comprehensive treatment of obesity.

Background: Despite intensive training, a few individuals with Type 1 diabetes mellitus (T1DM) fail to reach the desired metabolic targets. Aim: To evaluate the association between disease-related emotional and cognitive aspects and metabolic control in subjects with T1DM. Subjects and methods: Health locus of control (HLOC), sense of coherence (SOC), and self-esteem were assessed in T1DM subjects using validated questionnaires. Sixty-seven consecutive subjects who did not attain the desired HbA1c target (mean HbA1c, 8.3% [67 mmol/mol]) were compared with 30 cases in satisfactory metabolic control (HbA1c levels

AIM: To determine the clinical effectiveness of intense psychological support to physical activity (PA) in nonalcoholic fatty liver disease (NAFLD), compared with cognitive-behavioral treatment (CBT). METHODS: Twenty-two NAFLD cases received support to exercise, tailored to their motivational needs (PA group). The effects on body weight, physical fitness [6-min walk test, VO2max and the PA-rating (PA-R) questionnaire] and body fat (fatty liver indices and visceral adiposity index) were compared with data obtained in 44 NAFLD subjects enrolled in a CBT program for weight loss, after adjustment for propensity score, calculated on baseline data. Measurements were performed at baseline, at 4-mo and one-year follow-up. Changes in anthropometric, biochemical and PA parameters were tested by repeated measurement ANOVA. Outcome results were tested by logistic regression analysis. RESULTS: At the end of the intensive program, BMI was less significantly reduced in the PA group (-1.09 ± 1.68 kg/m(2) vs -2.04 ± 1.42 kg/m(2) in the CBT group, P = 0.019) and the difference was maintained at 1-year follow-up (-0.73 ± 1.63 vs -1.95 ± 1.88, P = 0.012) (ANOVA, P = 0.005). PA-R was similar at baseline, when only 14% of cases in PA and 36% in CBT (P = 0.120) recorded values ≥ 3. At 4 mo, a PA-R ≥ 3 was registered in 91% of PA and 46% of CBT, respectively (P < 0.001) and PA-R ≥ 5 (up to 3 h/wk of moderate-to-heavy intensity physical activity) was registered in 41% of PA and only 9% of CBT group (P < 0.007). The 6-min walk test increased by 139 ± 26 m in PA and by only 43 ± 38 m in CBT (P < 0.001) and VO2max by 8.2 ± 3.8 mL/kg per minute and 3.3 ± 2.7 mL/kg per minute, respectively (P < 0.002). After adjustment for propensity, weight loss > 7% was significantly associated with CBT group at one year (OR = 6.21; 95%CI: 1.23-31.30), whereas PA-R > 3 was associated with PA group (10.31; 2.02-52.63). Liver enzymes decreased to values within normal limits in 36% of PA cases and 61% of CBT (P < 0.070). Estimated liver fat (Kotronen index) fell below the fatty liver threshold in 36% of PA and 34% and CBT cases at one-year (not different). Also the fatty liver index and the visceral adiposity index improved to a similar extent. CONCLUSION: Intensive psychological counseling for PA produces hepatic effects not different from standard CBT, improving physical fitness and liver fat independent of weight loss. Strategies promoting exercise are worth and effective in motivated patients, particularly in lean NAFLD patients where large weight loss cannot be systematically pursued. KEYWORDS: Behavior treatment; Liver enzymes; Nonalcoholic fatty liver disease; Physical activity; Physical fitness; Weight loss liver fat

Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized clinical condition associated with features of metabolic syndrome and having insulin resistance as the underlying metabolic defect. Reduced insulin sensitivity favors the accumulation of free fatty acids and triglycerides within the hepatocytes, resulting in hepatocellular damage that may be self-maintaining and progressive. As the disease stems from excess calorie intake and/or low levels of physical activity, the correction of unhealthy lifestyles is the first line of approach to any prevention and treatment strategy. Patients are invited to modify their habits starting a restricted calorie dietary program associated with regular physical exercise, which should be maintained lifelong. Prescriptive diets are effective for short-term weight loss, but making patients increase and maintain their daily physical activity is hard to achieve. Only behavioral treatment can give patients the practical instruments to reach their eating and activity targets, incorporate them into their lifestyle, and maintain the results for long periods and possibly indefinitely. Very few studies have tested the effects of a behavioral approach in NAFLD patients, and adequate long-term trials having histology as an outcome measure have not been carried out so far. Future studies should test the potential of behavior treatment to restrict NAFLD progression to fibrosis, cirrhosis, and eventually hepatocellular carcinoma. Given the difficulties of implementing lifestyle modifications in adults, healthy lifestyle habits should be promoted in children as part of prevention programs to reduce the future burden of liver disease of metabolic origin.

We aimed to test the effects of a psychological support program on the psychological distress, mood, and quality of life of well-educated individuals with type 1 diabetes. A newly developed support program was offered to 60 patients with type 1 diabetes on intensive insulin treatment, previously enrolled in group-care educational programs. Thirty-three subjects participated (experimental group, in groups of 8–12 subjects); 22, who postponed their entry, were used as controls. The program consisted of 7 weekly work sessions of 2 hours chaired by a psychologist and covered aspects of daily living with diabetes using role-playing, metaplan, and problem solving. At baseline and approximately 6 months later, all participants completed a battery of questionnaires, and the differences between the experimental and the control group were analyzed by repeated-measurements ANOVA. In response to the psychological support program, subjects in the experimental group reduced their depressive mood (Beck Depression Inventory and depression scales of the Psychological Well-Being Index) and anxiety (Self-rating Anxiety Scale), improved disease-specific quality of life (Symptom and Well-Being scales of the Well-Being Enquiry for Diabetes), increased their internal and decreased their external locus of control. These changes were accompanied by a 0.3% decrease in glycosylated hemoglobin, whereas no significant changes were observed in the control group (ANOVA, P = 0.032). These results underline the importance of psychological aspects in individuals with type 1 diabetes; treating the psychological aspects related to the disease may be as important as medical control in order to improve living with diabetes.

Cognitive behavioural therapy (CBT) is the most comprehensive means of medically treating obesity, but only few data have so far been published concerning its long-term effectiveness. We here report our experience of 1068 consecutive patients (868 females) treated with CBT at a university-based obesity centre. The patients were enrolled into three different programmes: a 14-week LEARN programme (672 patients), a 16-week MOB programme for the morbidly obese (259 patients), or a 20-week BINGE programme for subjects affected by binge eating (137 patients). Eighty-five percent of the subjects completed the weekly programmes. The percentage of patients attending the scheduled control visits during the 1-year follow-up gradually decreased, being very low in the BINGE group (10%). The percentage weight loss was an average of 6% during the weekly courses, being higher in the MOB programme; by the end of the weekly sessions, it exceeded 10% of initial body weight in 22% of cases and increased to 36% during the follow-up. The cumulative probability of follow-up was higher among the patients undergoing the MOB and LEARN programmes than among the BINGE patients (p0.0001), and decreased with the increasing severity of obesity. Female gender and a weight loss of10% i.b.w. increased compliance to follow-up. The study further demonstrates the difficulty of achieving compliance to chronic management of obesity and the critical role of binge eating disorder in the medium-term treatment of obesity. Strategies are needed to improve adherence to a follow-up protocol.

The construct of trait Emotional Intelligence (trait EI) takes into account the subjective aspects of human’s emotional experience, as it conceptualizes EI as a set of self-perceived emotional abilities. Although several studies have shown the importance of trait EI over individual’s health and wellbeing, there’s currently no literature studying its role in the context of eating disorders. Given the well-known association between obesity and emotional difficulties, this study attempts to provide new insights into the potential application of trait EI. A sample of 164 obese patients was recruited between May 2014 and June 2016. Each patient completed a set of self-report questionnaires including the Trait Emotional Intelligence Questionnaire, the Emotion Regulation Questionnaire, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Binge Eating Scale. Independent assessments were performed at three time points (baseline, after three months, and after six months) at the S. Orsola Malpighi Hospital (Bologna). At each time point body weight and other medical were measured. A sample of normally-weighted adults was also recruited through an online software. Correlations, ANOVAs and mediation analysis were used as analytic strategies. Our results show differences in trait EI between case and control. Additionally, data show that trait EI has different functions over BMI depending on the predictor being considered. More detailed results will be presented at the conference. These results suggest once more the importance of emotional difficulties in obese patients and underline that trait EI may play an important role both as risk and as protective factor in the development of overweight and obesity.