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Ignacio Jáuregui-Lobera,1 Patricia Bolaños-Ríos,2 Inmaculada Ruiz-Prieto21Department of Nutrition and Bromatology, Pablo de Olavide University, Seville, Spain; 2Behavioral Sciences Institute, Seville, SpainPurpose: The aim of this study was to analyze the relationships among thought–shape fusion (TSF), specific instruments to assess body image disturbances, and body image quality of life in eating disorder patients in order to improve the understanding of the links between body image concerns and a specific bias consisting of beliefs about the consequences of thinking about forbidden foods.Patients and methods: The final sample included 76 eating disorder patients (mean age 20.13 ± 2.28 years; 59 women and seven men). After having obtained informed consent, the following questionnaires were administered: Body Appreciation Scale (BAS), Body Image Quality of Life Inventory (BIQLI-SP), Body Shape Questionnaire (BSQ), Eating Disorders Inventory-2 (EDI-2), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90-Revised (SCL-90-R) and Thought-Shape Fusion Questionnaire (TSF-Q).Results: Significant correlations were found between TSF-Q and body image-related variables. Those with higher scores in TSF showed higher scores in the BSQ (P < 0.0001), Eating Disorder Inventory – Drive for Thinness (EDI-DT) (P < 0.0001), and Eating Disorder Inventory – Body Dissatisfaction (EDI-BD) (P < 0.0001). The same patients showed lower scores in the BAS (P < 0.0001). With respect to the psychopathological variables, patients with high TSF obtained higher scores in all SCL-90-R subscales as well as in the STAI.Conclusion: The current study shows the interrelations among different body image-related variables, TSF, and body image quality of life.Keywords: cognitive distortions, quality of life, body appreciation, psychopathology, anorexia nervosa, bulimia nervosa

OBJECTIVE: Recently, it has been reported that food choices of relatives of eating disorder (ED) patients are not adequate having in mind a healthy model of eating habits. The aim of this study was to analyse how work conditions relate to parents' food choice coping strategies in both families with a member suffering from an ED and families with no sick members. In addition, the differences in those strategies between the two types of working parents were studied. METHODS: A total of 80 employed fathers (n = 27) and mothers (n = 53) of patients with an ED (n =50) and healthy offsprings (n = 30) were interviewed. The mean age was 43.57 ± 5.69 and they had moderate incomes. Food choice coping strategies, used by working parents to integrate work and family demands, were measured by means of 22 items included in five categories. RESULTS: Considering the food choice coping strategies, ED patients' relatives show better skills than relatives of healthy offsprings do. The fact of preparing more meals at home and less fast food as main meal are good examples of those better strategies as well as to miss less number of breakfasts and lunches because of work-family conflict, grabbing less frequently and overeat less after missing a meal. DISCUSSION: The therapeutic effort to improve the food choices of ED patients' relatives, especially when both father and mother work, are a key point to improve the eating habits of ED patients, thus contributing to a better outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To analyse the stress level at different academic times, by measuring salivary cortisol and assessing the influence of the stress level on the effectiveness of a nutrition education program for adolescents. METHODS: Salivary cortisol of 42 compulsory secondary education students was determined (morning and evening) at the beginning of the course and in the time prior to final exams. A nutrition education program was developed during the course and food consumption data were collected by means of a food frequency questionnaire in both initial and final moments. In addition, the body mass index was determined. RESULTS: The initial morning cortisol level was lower with respect to the final morning level (P < 0.05), with higher levels in females (P < 0.05). In the final determination, the morning cortisol was also higher in girls (P < 0.01). There were no significant changes in body mass index. 23.8% of students referred fewer consumption of carbonated beverages after the intervention program, while 28.57% reported having breakfast before leaving home. A reduction in the consumption of fruit at the end of the study was observed. DISCUSSION: To properly assess whether the observed changes are related to the nutrition education program or with the stressful situation due to the proximity of the exams, which would imply an increase in the intake, more studies would be necessary at the different stages of the course. [ABSTRACT FROM AUTHOR]

Introduction: Food craving consists of a strong motivational state whereby a person is driven to seek and ingest a specifically desired food. Objectives: To explore the influence of mental imagery on the food craving experience as well as to analyse the role of different psychological variables. Methods: Participants consisted of 65 normal weight undergraduate students. An experimental induction of food craving was analysed considering the actual previous craving and the induced one as a state food craving. Measures of trait food craving, imaging ability, dietary restraint, anxiety, depression, and coping strategies were considered. Results: Sweet foods in general and chocolate in particular were the most craved foods. During the induction thoughts and images were the most highly rated triggers, and all the different sensory modalities were involved. Anxiety, depression, and negative coping strategies influenced the results with regards to the food craving. Discussion: This study confirms the role of mental imagery, the correlation between state and trait food craving, and the influence of different psychological variables on the food craving. [ABSTRACT FROM AUTHOR]

Objective: The aim was to induce the thought-shape fusion (TSF) distortion experimentally, testing: a) Whether the TSF distortion could be induced by anxiety in general or if it had a specific relationship with thoughts related to the intake of fattening foods; b) Whether the TSF could be induced in non-clinical participants as well as in the eating disorder patients; c) Whether participants with more appropriate coping strategies would experience less TSF than those who showed inadequate coping strategies; and d) That TSF could have behavioural effects (e.g., neutralization of TSF and food intake) related to emotions. Methods: The sample comprised two groups (eating disorder patients and students), with 45 participants each, aged between 18 and 25 years, 92.50% and 86.7% of women in the eating disorders group and the students group respectively. The two groups underwent three experimental conditions (TSF, anxiety, and control), measuring the results with regards to the emotional and behavioural responses. Results: Participants in the TSF induction condition reported more guilt, more feelings of fatness, more likelihood of weight gain, and higher degree of moral wrongdoing compared with participants in both the anxiety and control induction conditions. The effect of the adequate coping strategies in decreasing the strength of the TSF bias was confirmed in both eating disorder patients and non-clinical participants. Discussion: The study of the TSF distortion may have relevant implications in terms of treatment and prognostic of eating disorders. This distortion may be involved in the development and maintenance of eating disorder psychopathology. [ABSTRACT FROM AUTHOR]

Obesity may be considered a social stigma. In addition, people with obesity are frequently aware of stigma directed at others who have a similar weight and come to think stigmatized thoughts about themselves. Our study focused specifically on how blatant and subtle discrimination and weight self-stigma are related to depression and anxiety in people with obesity. The sample comprised 170 participants from the Clinical Nutrition Unit of the "Hospital de Valme" (Seville, Spain). The Weight Self-Stigma Questionnaire, the Multidimensional Perceived Discrimination Scale, and the Hospital Anxiety and Depression Scale were used. It was found that blatant and subtle discrimination and weight self-stigma were positively related to depression (.31, .38, and .45 respectively) and anxiety (.30, .36, and .49 respectively; all ps < .01). The path analysis conducted showed that there was a mediational effect of weight self-stigma between blatant (β = .36) and subtle discrimination (β = .40) and depression (β = .24) and anxiety (β = .49; all ps < .01). According to these results, it can be said that weight self-stigma was a full mediator in the model found because the relationships between the independent and the dependent variables were non-significant. Finally, results are discussed in the frame of the obesity stigma literature, and some clinical implications of the results of the study are suggested.

Purpose: Perceived vulnerability to disease (beliefs about personal susceptibility to contracting an infectious disease) is usually related to the expression of prejudice towards different stigmatized groups. In this study, the relationship between this variable and the expression of the prejudice towards obese people was analyzed., Method: The sample comprised a total of 137 children and teenagers, aged between 12 and 17 years, from a Spanish high school who fulfilled several scales which measure perceived vulnerability to disease, antifat attitudes and perceived controllability of weight. Additionally, body mass index (BMI) was calculated by means of the participants' height and weight., Results: Perceived infectability (one of the factors of the perceived vulnerability to disease scale) was negatively related to controllability of weight, and germ aversion (the second factor of the vulnerability scale), showed a positive relationship with the antipathy towards obese people. Finally, perceived controllability of weight was positively correlated with BMI., Conclusions: The implications of these results in the field of the study of the prejudice toward obese people are discussed. To our knowledge, no other studies have investigated the relationship between perceived vulnerability to disease and antifat attitudes in minors. Additionally, this is the first time that the measured BMI has been used instead of the self-reported one.

Introduction: bearing in mind the influence of the environment on the individuals and their choices and behaviours in general and particularly with respect to food, it might be interesting to explore whether eating habits are better or healthier in rural areas than in urban ones., Objective: to analyse the perception of the level in which eating habits could be considered better or worse, more or less healthy, in rural and urban areas., Method: 281 students (18.37 ± 6.28 years) volunteered participated in the study completing an ad hoc questionnaire designed to measure the characteristics attributed by the participants to the rural and urban eating habits., Results: 49.50% of the participants considered that food is better in rural areas, 8.50% in urban contexts and 42% equally in both rural and urban areas; 80.42% responded that food is healthier in rural areas and 19.57% in urban areas. In addition, 85.10% of the participants coming from rural families considered that food is healthier in the country and the same applies to 75.80% coming from urban families., Discussion and Conclusions: the perception about what is healthy is not uniform. From a general point of view it seems that eating better is not the same than eating healthier. The idea of eating better not always is synonymous of eating healthy from a medical-nutritional point of view. This difference could make it difficult to spread the idea of a healthy way of eating to the general population., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: factors related to food, shape, weight and exercise, transmitted from parents to children, and media sociocultural factors, such as social networks, also influence the development of Eating Disorders (ED)., Objectives: to analyse the influence of family eating habits and the parents perception about the influence of social networks on the development and maintenance of ED., Method: 30 parents of ED patients participated voluntarily in this study fulfilling a series of questionnaires, as well as reporting their weight and height., Results: it is observed an underestimation of weight in the case of overweight (33.33%) and obesity (35%) without considering the fact of going on diet in the future (χ2 = 11.31; p < 0.01). It must be noted that it exists an excessive consumption of meats, snacks and sweets. During weekends it is observed an increased intake of calories and sugar (p < 0.01) and cholesterol (p < 0.05), while the intake of fibre, iron, zinc and magnesium is reduced (p < 0.01). In addition, the consumption of water and bread decreases and other habits seem to be more relevant (e.g. snacking, intake of a single dish) (p < 0.05)., Discussion and Conclusions: eating habits of ED patients' families improve by means of the nutrition education included in the treatment. Relatives do not perceive adequately the risk of the social networks in their children, which might contribute to the maintenance and future relapses of ED., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: in the last years the rates of overweight and obesity in adolescents have been increasing simultaneously with a progressive abandon of the Mediterranean dietary patterns. In addition many adolescents misperceive their weight., Objectives: to analyse the prevalence of overweight/ obesity, to assess the self-perception of weight and to explore the eating habits in a child and adolescent sample. The relationship among these variables and the influence on the psychosocial wellbeing are also analysed., Method: a total of 87 secondary school students participated in this project. Weight and height were obtained, the self-perceived weight was assessed and a series of questionnaires were applied in order to explore the participants´ wellbeing., Results: 28.73% of the sample had overweight and 9.19% obesity, 27.48% of the students misperceived their weight and only a quarter of the sample had a proper Mediterranean dietary pattern. The frequency of weight control was related positively with a higher weight perception., Discussion and Conclusions: many participants underestimated their weight and a possible association between overweight/obesity and skipping breakfast was observed. A progressive increase in the prevalence of overweight and obesity in adolescents is confirmed and the need to implement nutrition education programs after analyzing the eating habits is proposed., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Few studies are focused on the antioxidant status and its changes in anorexia nervosa (AN). Based on the hypothesis that renutrition improves that status, the aim was to determine the plasma antioxidant status and the antioxidant enzymes activity at the beginning of a personalized nutritional program (T0) and after recovering normal body mass index (BMI) (T1). The relationship between changes in BMI and biochemical parameters was determined. Nutritional intake, body composition, anthropometric, hematological and biochemical parameters were studied in 25 women with AN (19.20 ± 6.07 years). Plasma antioxidant capacity and antioxidant enzymes activity were measured. Mean time to recover normal weight was 4.1 ± 2.44 months. Energy, macronutrients and micronutrients intake improved. Catalase activity was significantly modified after dietary intake improvement and weight recovery (T0 = 25.04 ± 1.97 vs. T1 = 35.54 ± 2.60 μmol/min/mL; p < 0.01). Total antioxidant capacity increased significantly after gaining weight (T0 = 1033.03 ± 34.38 vs. T1 = 1504.61 ± 99.73 μmol/L; p < 0.01). Superoxide dismutase activity decreased (p < 0.05) and glutathione peroxidase did not change. Our results support an association between nutrition improvement and weight gain in patients with AN, followed by an enhancement of antioxidant capacity and catalase antioxidant system.

The aims of this study were to analyze the psychometric properties of the Spanish version of the Three-Factor Eating Questionnaire-R18 (TFEQ-SP), as well as determine its validity by evaluating the relationship of the TFEQ-SP with different parameters related to body mass index, weight perception, perception of physical fitness, self-esteem, and food intake, as well as with weight control-related variables. A total of 281 participants (aged 18.38 ± 6.31) were studied. The factor analysis yielded three factors: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). The internal consistency of the TFEQ-SP was determined by means of Cronbach's α coefficient, with values ranging between 0.75 and 0.87. Higher scores on CR were found in women (p < 0.5), overweight/obese participants (p < 0.001), participants with lower self-esteem (p < 0.05), participants who overestimated their weight (p < 0.001), participants who weighed themselves frequently (p < 0.001) and those who were about to go on a diet (p < 0.001). Higher EE scores were found in participants with lower self-esteem scores (p < 0.05), among participants with a poorer perception of their physical fitness (p < 0.01) and when participants were about to diet (p < 0.05). Higher scores on UE were observed in case of poorer perception of physical fitness (p < 0.05). The validation study of the TFEQ-SP meets the requirements for measuring the three different facets of eating behavior: CR, UE, and EE.

Introduction: Most of the studies on weight misperception have been carried out in the US where it has been estimated that 20-40% of overweight or obese people underestimate their weight status. The perception of the physical fitness is a little studied variable but suggested as relevant in the adoption of healthy behaviours., Objectives: The aims were to analyze weight misperception and physical fitness perception in adolescents, evaluating the relationship between weight misperception and physical fitness perception and body weight management behaviours (diet and exercise) as well as to analyze the relationship between weight misperception and psychosocial well-being., Methods: A total of 655 students participated voluntarily in the study during which they completed a series of questionnaires. Weight and height of all participants were collected., Results: Many young people misperceived their weight and its physical fitness. The majority of participants who were overweight or obese did not go on diet to manage their body weight. Those who overestimated their weight had the worst psycho-emotional state., Discussion: The work is novel in Spain, it follows the methodology carried out in international studies on the same topic and the results are similar to those obtained in other populations., Conclusion: Weight misperception and physical fitness perception influence the adoption of healthy body weight management behaviors and is related to psychosocial well- being of young people., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: It has been found that the olfactorygustatory function is altered in patients with eating disorders, with an impairment affecting the perception of olfactory and gustatory stimuli., Objective: The aim was to explore the subjective reactivity after the exposure and tasting of foods with different gradient of sweetness and different fats textures. In addition, changes in the thought-shape fusion (TSF) cognitive distortion were assessed after tasting those different presentations as well as the correlations between the initial scores on TSF-Questionnaire (TSF-Q) and the different responses after that tasting., Method: A total of 15 healthy controls and 23 outpatients with anorexia nervosa underwent two sessions of tasting (sweets with different gradient of sweetness and fats with different textures) and they filled several questionnaires (pre- and post-tasting) to measure their responses after tasting., Results: Participants showed less "self-control" after tasting sweets. The score on TSF-Q increased significantly after the sweets tasting in the patients group. Patients had the worst response after tasting presentations with more quantity of glucose (less gradient of sweetness) than after tasting those with more amount of sucrose (much more sweetness). With respect to the fats, patients showed the worst reaction after tasting the most unfamiliar texture. Pre fats tasting TSF-Q scores correlated significantly with all responses in the patients group., Discussion: Both psychological and biological (e.g. genetic) factors could be involved in the reactions of patients with anorexia nervosa after tasting sweets and fats., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

The aims of the current study were to explore possible gender differences in weight misperception, self-reported physical fitness, and dieting, and to analyze the relationship between these variables and others, such as self-esteem, body appreciation, general mental health, and eating- and body image-related variables among adolescents. In addition, the specific risk for eating disorders was examined, as well as the possible clusters with respect to the risk status. The sample comprised 655 students, 313 females and 342 males, aged 16.22 ± 4.58. Different scales of perceived overweight, self-reported physical fitness and dieting together with the Body Mass Index (BMI) were considered along with instruments such as the International Physical Activity Questionnaire (IPAQ), General Health Questionnaire (GHQ-28), Self-Esteem Scale (SES), Body Appreciation Scale (BAS) and Eating Disorders Inventory-2 (EDI-2). Since some gender differences were found with respect to these adolescent groups, it is necessary to design prevention programs that not only focus on traditional factors such as BMI or body image, but also on elements like weight perception, self-reported fitness and nutritional education.

Introduction: Human eating behaviour is regulated by multiple factors. Anorexia nervosa patients show a restrictive eating pattern while bulimia nervosa patients present bingeing-purging episodes. Although treatments are specially successful in the normalization of body composition, maladaptive eating behaviours tend to persist being a risk factor for relapse and recurrence., Objectives: The aim of this work was to assess the quality of the nutritional choice of eating disorders patients after a year of nutritional education and to assess improvements in choice capacity., Methods: Thirty-one outpatients of an eating disorders unit planned a menu after body composition normalization and repeated this plan each three months during a one-year programme of nutritional education., Results: Patients improved the time spent on the assignment (p < 0.01), Body Mass Index (p < 0.01), their body fat mass (p < 0.01) and the content of energy (p < 0.05), carbohydrates (p < 0.01) and polyunsaturated fatty acids (p < 0.05) in their chosen menus. No differences were found on proteins, total fat or fat profile, vitamins or minerals. 12.9% and 3.2% of the patients chose their menu according to the recommendations of caloric and lipid profile, respectively, after a year of nutritional education., Discussion: Although patients improved energy and carbohydrates content of the menus they tended to reduce caloric and fat food choices, which could lead to relapse and recurrence. Specific nutritional education programmes along with the mandatory psychological and psychiatric treatment may be effective., Conclusions: One year of nutritional education combined with psychological and psychiatric treatment improved those factors usually involved in relapse and recurrence, thus contributing to a proper outcome., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: Is there a group of psychometric variables, which correlates with the criteria of an interdisciplinary team about the course of ED?, Objectives: The aim of this study was to analyse the correlation between the clinic criteria of an interdisciplinary team with respect to the course of eating disorders (ED) and different psychometric criteria., Methods: The course was analysed in a final sample of 30 ED outpatients during their six first months of treatment. A scale of clinical criteria of the course of ED (therapeutic team's opinion) and different questionnaires on psychological, psychopathological and eating-related variables were used. The statistical analysis comprised of a discriminant analysis in order to find the variables with a discriminant function to distinguish between a fair-bad course and a good course., Results: Perceived stress, self-esteem, the variables of the SCL-90-R, depression, thought-shape fusion, anxiety, food craving and the score on body shape questionnaire were found to have discriminant function. Comparing the therapeutic team's criteria and the results of the questionnaires a 10% of patients were misclassified., Discussion: The results highlight the necessary and permanent checking of the relationship among the clinical criteria regarding the course of ED (members' team opinion) and different psychological, psychopathological and eating-related variables., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: One of the main problems of patients with eating disorders is their body dissatisfaction. Although these individuals usually are not satisfied with their bodies there are not many investigations that focus on how these patients see people with real weight problems. For this reason, in this study it is analyzed how women with eating disorders see obese people., Methods: A total of 104 participants (35 with anorexia nervosa, 28 with bulimia nervosa, 16 with eating disorder not otherwise specified and 25 controls) were selected to conduct the study. To measure anti-fat attitudes the Spanish version of the Antifat Attitudes Questionnaire was used. To measure if participants had body dissatisfaction it was used the Spanish versions of the Body Shape Questionnaire. Finally, anthropometric measures (height and weight) were taken in order to calculate the BMI (kg/m(2)), as well as some socio-demographic information., Results: It was found that participants with bulimia nervosa showed scores higher on antifat attitudes than the rest of the participants. Additionally, it was found that this result was influenced by the body dissatisfaction of the participants., Discussion: These results suggest that negative attitudes toward obese people may influence an individual's body image. One way of maintaining a positive body image (especially, the subjective dimension, body satisfaction) is to compare oneself with those perceived as physically inferior (people with weight problems), a strategy that is especially relevant when the mass media insists in depict extreme thin women., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)