Abstract Purpose Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change. Methods Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU (n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms. Results Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group. Discussion In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image–focused interventions may be beneficial. Level of evidence Level I, randomized controlled trial. Trial registration The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).
Accurate perception of food portion sizes is implicated in healthy eating, yet little is known about psychological correlates of portion estimation in non-clinical, normal-weight adults. This exploratory study examined whether consumption intent (self vs other) and markers of psychological processes associated with eating (dietary restraint, shape/weight overvaluation, body dissatisfaction) are associated with portion size estimation errors, and whether these errors relate to body mass index (BMI). Seventy-one adults (BMI 18.5–24.9 kg/m2) without current or past psychiatric disorders were included. Eating psychopathology was assessed using the brief 7-item, 3-factor version of the Eating Disorder Examination Questionnaire (Dietary Restraint, Shape/Weight Overvaluation, Body Dissatisfaction). Portion estimation was measured with the Portion Estimation Task, with images rated on a visual analog scale (0–100) under two conditions: general intent (for others) and intent-to-eat (for self). A proportional estimation error index was calculated across all non-full portion sizes relative to each participant’s full-portion reference. A linear mixed model tested the effect of intent and Pearson correlations examined the association with psychological variables and BMI. Consumption intent did not influence portion size estimation (p = 0.989), so conditions were combined. Estimation Error Indices were positively correlated with Dietary Restraint (r(69) = 0.27, p = 0.021), but not with Shape/Weight Overvaluation or Body Dissatisfaction. BMI correlated with Shape/Weight Overvaluation and Body Dissatisfaction, but not with Dietary Restraint or the Estimation Error Index. In normal-weight adults without eating disorders, greater dietary restraint is associated with larger biases in portion size estimation, whereas BMI and body-related evaluative concerns primarily track weight status rather than perceptual errors in portion size estimations. Findings are exploratory and warrant replication in larger, more diverse samples. Level of evidence: III. Evidence obtained from well-designed cohort or case–control analytic studies.
Obesity is a chronic, relapsing disease associated with substantial metabolic morbidity. While bariatric surgery and pharmacotherapy can be effective, their use may be limited by invasiveness, adverse effects, cost, or long-term accessibility. There remains a need for sustainable, non-invasive lifestyle-based strategies applicable in routine outpatient care. This study evaluated 10-year outcomes of a structured lifestyle-based nutritional intervention (metabolic endolipolysis) in adults with obesity. This retrospective observational cohort study evaluated long-term outcomes of a structured outpatient nutritional intervention in a real-world clinical setting. A total of 100 adults with obesity (BMI ≥ 30 kg/m2) were included. The intervention was based on a defined macronutrient composition with strict dietary fat limitation (approximately 30 g/day), adequate protein intake (≥ 110 g/day), and normoglycemic carbohydrate intake, combined with behavioral support and recommended daily moderate physical activity. Body composition was assessed annually using bioelectrical impedance analysis. Metabolic outcomes included HbA1c, fasting glucose, lipid profile, and liver enzymes. A mean fat mass reduction of 9.6 kg was observed during the first year, with sustained reductions over the 10-year follow-up. Total fat mass decreased by 23.1
PURPOSE:The transition to fatherhood constitutes a substantial life event that can profoundly impact individuals and their relationships. This influence may be amplified when an anorexia nervosa (AN) is present within the family. This study aimed to examine paternal experiences during the pre- and postpartum period and assess how maternal AN influences these experiences. METHODS:Six semi-structured qualitative interviews were conducted with three male partners of women with and without AN, to explore their prepartum perspectives on the paternal role, their postpartum eating behaviors, overall well-being, and the impact of the AN on their relationship. The data was analyzed in accordance with the principles of qualitative content analysis as proposed by Mayring. RESULTS:The analysis yielded six main categories that were deductively identified from the interview guide, with several sub-categories generated from the interview data. Many topics were raised by both groups and are in support of previous research. Group-specific aspects also emerged, such as a lower level of reflection on fatherhood among partners of women with AN. All partners of women with AN noted that the disorder affected the relationship, for example by causing conflicts. CONCLUSION:The partly distinct experiences reported by the two groups highlight the impact of maternal AN on family dynamics and emphasize the need to incorporate paternal perspectives in eating disorder research during the transition to parenthood. Integrating fathers' experiences can enhance understanding of familial dynamics and inform the development of targeted interventions to support all family members during this critical period. LEVEL OF EVIDENCE III:Evidence obtained from well-designed cohort or case-control analytic studies.
Abstract Purpose This study aimed at investigating whether taste sensitivity is reduced in patients with anorexia nervosa (AN) and at examining the relationship between sweet taste perception, anthropometric and psychopathological parameters. Methods In this case–control study, 15 female patients aged 12–24 years with eating disorders—comprising 13 with AN and 2 with atypical anorexia nervosa (aAN)—and 9 age-matched healthy controls underwent the assessment of taste sensitivity using 5 mL of a 17% sucrose solution on a visual analog scale (VAS) ranging from 0 to 100. Anthropometric parameters, bioimpedance measures and questionnaires were collected. Results Patients with AN exhibited significantly lower VAS scores than controls (p < 0.05). VAS scores were inversely correlated with BSCL test scores for both the anxiety and depression subscales and the total score (anxiety rs = − 0.489, p < 0.05; depression rs = − 0.658, p < 0.01; GSI rs = − 0.590, p < 0.01), and with the SCL-90 for the same domains (anxiety rs = − 0.529, p < 0.05; depression rs = − 0.602, p < 0.01; GSI rs = − 0.614, p < 0.01). Negative correlations were identified for the EDE-Q subscales of restraint (rs = − 0.429, p < 0.05), weight concern (rs = − 0.473, p < 0.05), and body shape concern (rs = − 0.501, p < 0.05), as well as starvation symptoms on the SSI (rs = − 0.435, p = 0.030). Conclusion Our findings suggest a blunted hedonic response to sweet taste in patients with AN, particularly among those with poorer nutritional status and higher anxiety and depression traits. Longitudinal studies with larger sample sizes are necessary to evaluate prognostic relevance of assessments of taste sensitivity. Level of evidence Level III (evidence obtained from well-designed cohort or case–control analytic studies).
Abstract Purpose To identify person-centered psychological profiles of eating-related risk based on early maladaptive schemas (EMS), emotion regulation difficulties, and eating behaviors, and to examine their external validation using anthropometric indices (BMI, waist circumference, WC) and the FTO rs9939609 genotype. Methods Fifty women aged 18–35 years (approximately balanced between normal weight and overweight/obese groups) completed the YSQ-S3, DERS-36, and QERB. Standardized variables were clustered with k-means (k = 2–4); the optimal solution was selected via silhouette and BIC with stability checks. BMI and WC were used for external validation; FTO rs9939609 (AA/AT/TT) was examined using χ2/Fisher’s tests. Results A two-cluster solution best fit the data. Cluster 1 (n = 23) showed higher EMS, greater emotion dysregulation, and higher emotional/habitual overeating, alongside higher restraint, whereas Cluster 2 (n = 27) showed a consistently lower-risk profile. Cluster 1 presented higher WC (M = 92.74 cm, SD = 12.86) and BMI (M = 30.44, SD = 5.18) than Cluster 2 (WC: M = 75.19 cm, SD = 18.60; BMI: M = 22.65, SD = 4.15); differences were significant in parametric and nonparametric tests (all p < 0.001; Hedges’ g = 1.07–1.65). The FTO genotype distribution did not differ between clusters (χ 2(2) = 0.33, p = 0.848). Conclusions Distinct schema–emotion regulation profiles may be observable in young women and appear to align with central adiposity and BMI. While FTO rs9939609 did not differentiate clusters, person-centered profiling may help inform hypothesis generation regarding schema- and regulation-focused strategies in weight-related risk, with potential relevance for both clinical and educational contexts. Level of evidence Level III, observational analytic (cross-sectional) study.
Abstract Over the past four decades, global childhood obesity rates have risen significantly. Modifiable factors such as diet, physical activity, family dynamics, and screen time play an important role in childhood obesity and are often targeted in interventions. However, no comprehensive review of instruments assessing these factors has been published, prompting this study. A systematic review following PRISMA guidelines was conducted to identify validated multidimensional lifestyle assessment instruments (defined as those assessing at least two constructs) for children aged 2–12 years living with overweight or obesity. Four databases (Pubmed, PsychINFO, CINAHL, and Embase) were searched for studies from 1980 to 2024. First, 7844 studies were screened by title and abstract by two independent reviewers. The resultant 141 full-text studies were also independently reviewed by 2 reviewers. Study quality was assessed and data on psychometric properties were extracted. Thirteen papers covering eight instruments were included: Healthy Kids (Niños Sanos), Family Health Behaviour Scale, Lifestyle Behaviour Checklist, Family Nutrition Physical Activity screening tool, Family Eating and Activity Habits Questionnaire, Home Environment Survey, Child Obesity Risk Questionnaire 2–5, and Energy Retention Behaviour Scale for Children. These instruments assessed various factors, including diet, mealtime routines, physical activity, sedentary behaviour, sleep, parental beliefs and the home environment. The instruments showed significant heterogeneity, with no single instrument covering the entire 2–12 years age range or measuring the same constructs comprehensively. The quality of the reviewed studies varied, particularly in the range of psychometric properties examined. Based on the results of this review, there is no one measure shown to be validated specifically for children living with overweight/obesity that addresses a broad range of domains that respond to change over time. Level II: Evidence obtained from well-designed controlled trials without randomisation.
Interest in obesity has grown exponentially over the last years, with the availability of highly effective new pharmacological treatment options. The increasing use of pharmacological treatment options has stimulated debates on several fundamental issues, including (1) full recognition of obesity as a disease, and (2) optimization of the diagnostic criteria of obesity and the timing for offering different treatment options. We aim at critically discussing here the similarities, discrepancies, and potential misunderstandings suggested by the European Association for the Study of Obesity (EASO) and Lancet Diabetes Endocrinology Commission statements. In particular, two aspects are discussed: (1) the BMI limitations and the necessity to include visceral fat and, more in general, body composition assessment in the diagnosis of obesity; (2) the opportunity to consider obesity always as a clinically relevant chronic disease due to its biological, psychological, and social characteristics.
Despite the introduction of new eating disorder diagnoses in 2013 with the DSM-5, the characterization of population-level trends and sociodemographic patterns of these expanded eating disorder definitions remain limited. This study examined temporal changes in eating disorder diagnoses and sociodemographic characteristics among adolescents and young adults between the years 2015 and 2023 using the Epic Cosmos database, an aggregate of electronic health records across various healthcare systems. This is a retrospective cohort study using Epic Cosmos data, identifying individuals aged 9 years–25 years with an ICD-10 code consistent with an eating disorder diagnosis. Adjusted multivariable regression models assessed temporal changes and associations between sociodemographic characteristics and specific eating disorder diagnoses. Among 195,015 individuals, the most common eating disorder diagnoses during the study period were unspecified eating disorder (31
PURPOSE:Eating disorders are frequently associated with fragmented self-experiences, including harsh self-criticism, shame, and withdrawal, which may be difficult to articulate using standard clinical interviews. Structured elicitation tools may support the exploration of these internal self-states in a clinically meaningful way. METHODS:A total of 14 women receiving treatment for eating disorders at a specialised Italian centre participated in a structured elicitation interview using nine visual-symbolic self-part cards developed for clinical use. For each card, participants provided a numeric endorsement rating (0-10) and open-ended explanations following fixed prompts. Data were analysed using an inductive thematic approach with cross-case comparison. RESULTS:Higher endorsement was observed for cards reflecting self-rejection, internal criticism, and concealment. Across participants' accounts, four cross-cutting themes emerged: (1) persecutory self-criticism linked to internalised relational judgement; (2) shame-based body rejection as a core self-reference; (3) protective withdrawal associated with emotional invisibility and (4) developmental discontinuity characterised by forced maturity and unmet childhood needs. CONCLUSIONS:This brief report suggests that structured elicitation using visual-symbolic prompts can facilitate the exploration of clinically relevant self-states in people with eating disorders. Findings are preliminary but highlight the potential value of this approach for assessment and psychotherapy formulation. LEVEL OF EVIDENCE:Level V, qualitative descriptive study based on clinical interviews.
Online self-assessments in mental health are becoming increasingly common, and the COVID-19 pandemic has further accelerated the need for reliable digital tools. However, the degree of equivalence between online self-assessments and in-person interviews in the context of eating disorders remains under-researched. This study investigated the equivalence of adolescent patient responses on the Eating Disorder Examination (EDE) collected across these two modalities. The EDE was administered in a cross-over test–retest design, both as an online self-assessment questionnaire and as an in-person interview, to 49 adolescents (47 females, 15.9 ± 1.9 years) attending specialized outpatient clinic services. The Eating Disorder Inventory-2 (EDI-2) served as a reference measure. Equivalence of EDE scores was tested with a two one-sided t test procedure (TOST) for paired data with bootstrapping using a non-inferiority margin of ± 0.5 raw points. Cramer's V assessed agreement between the two EDE-derived diagnoses. The analyses confirmed equivalence between the two EDE versions. However, when comparing diagnoses based solely on EDE responses with clinician-derived diagnoses, a non-negligible effect of assessment modality emerged (Cramer’s V = 0.56; proportion of shared variability = 0.31), with the online self-assessment version being more accurate. When objective weight data were included, diagnostic accuracy increased to nearly 90
To investigate the association between the C-reactive protein-Albumin-lymphocyte (CALLY) index and obesity in adolescents, and evaluate its predictive performance compared to traditional inflammatory markers. Data from NHANES 2015–2018 were analyzed, including 2188 adolescents aged 12–20 years. The CALLY index was calculated as (albumin × lymphocytes)/CRP. Multivariate weighted logistic regression was used to assess associations with obesity. Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) were computed to evaluate the predictive performance of the CALLY index compared to traditional inflammatory markers (NLR, PLR, SII, SIRI). Survey-weighted logistic regression assessed associations of CALLY with obesity; model fit (Nagelkerke R2) and discrimination were evaluated, with sensitivity analyses for model specifications. The CALLY index was inversely associated with obesity (OR = 0.968, 95
Whether common sleep phenotypes causally influence anorexia nervosa (AN) or obsessive–compulsive disorder (OCD) is unclear; we used Mendelian randomization (MR) to test effects of daytime sleepiness (DS), insomnia, and sleep apnea (SA) on AN and OCD, and the reverse direction. We conducted bidirectional two-sample MR using genome-wide association studies (GWAS) of DS (N = 452,071), insomnia (N = 453,379), SA (N = 523,366), AN (N = 72,517), and OCD (N = 33,943), predominantly of European ancestry. Instruments were single-nucleotide polymorphisms meeting genome-wide significance (p < 5 × 10⁻8), clumped for linkage disequilibrium (r2 < 0.001) with mean F > 10; harmonization aligned effect alleles. The primary estimator was inverse-variance weighted (IVW), with weighted median and MR-Egger as sensitivity analyses. Heterogeneity and pleiotropy were evaluated with Cochran’s Q, MR-Egger intercepts, and MR-PRESSO. Genetic liability to SA was associated with higher risks of AN (IVW OR = 1.47, 95
Abstract Purpose Approximately 27% of patients with an eating disorder (ED) present with comorbid non-suicidal self-injurious behaviors (NSSI). EDs comorbid with NSSI display worse eating psychopathology and overall psychological distress. This follow-up study aims to compare the clinical and psychopathological characteristics at the time of hospital admission and the long-term outcome of patients with and without comorbid NSSI. Methods 73 adolescents affected with an ED were included in the study and divided into two groups depending on the comorbidity with NSSI. Clinical and anamnestic data, personality traits, social, emotional and behavioral functioning, and eating psychopathology were collected. A comparison was made between the NSSI group and the non-NSSI group on clinical and psychopathological characteristics. After a 5-year follow-up, participants were interviewed with a structured interview to investigate the history of AN and NSSI, and they completed questionnaires for the self-assessment. Results Specific personality traits like low Cooperativeness and low levels of Reward Dependence, greater impairment of behavioral and emotional functioning, and worse eating psychopathology characterized AN participants with NSSI. The 5-year outcome was less favorable in participants with a history of NSSI with a remission rate 77.7% in participants with AN alone and of 21% in participants with NSSI. Conclusions The differences between subgroups highlight the need to investigate NSSI at the initial clinical evaluation of adolescents who come to observation for an ED. Clinical and psychopathological characteristics of AN with comorbid NSSI require more intensive care and tailored therapeutic approaches to improve the long-term outcome, promoting recovery and improving quality of life. Level of Evidence III: Evidence obtained from well-designed cohort or case–control analytic studies
Abstract Purpose To examine the association between childhood traumatic events and weight restoration during specialized inpatient treatment for anorexia nervosa (AN). Methods Within this naturalistic prospective exploratory single-center study, patients with AN were recruited between 2014 and 2019 from a specialized eating disorder inpatient unit. Childhood traumatic events were assessed using the Childhood Trauma Questionnaire Short Form (CTQ-SF) and the Adverse Childhood Experiences Questionnaire (ACE). Posttraumatic stress disorder (PTSD) was diagnosed via a clinical interview. A mixed linear model was used to analyze associations between childhood traumatic events and weight restoration, while adjusting for the confounders AN subtype, medication, psychological comorbidities, gender and age. Results Sixty patients with AN (mean age 24.60 years, SD = 7.60; 95% female; 77% restricting subtype) participated. The mean body mass index (BMI) increase after 12 weeks was 2.48 kg/m2 (SD = 0.88). Six patients (10%) were diagnosed with PTSD. The mean CTQ-SF sum score was 43.78 (SD = 18.00), and 17 patients (28.33%) indicated a relevant exposure to adverse childhood experiences (ACE). There were no relevant associations between childhood traumatic events and weight restoration during inpatient treatment (CTQ-SF b = 0.00, 95% CI [−0.02, 0.02]; ACE b = −0.04, 95% CI [−0.16, 0.07]). Conclusion In our sample childhood traumatic events were not associated with weight restoration during inpatient treatment for AN. Given the low prevalence of childhood traumatic events in the present sample, further studies are recommended to explore the potential impact of childhood traumatic events on weight restoration in AN to optimize clinical outcomes. Level of evidence Level III: evidence obtained from well-designed cohort or case–control analytic studies.
Orthorexia nervosa (ON) is characterized by an excessive preoccupation with healthy eating that may lead to rigidity, distress, and functional impairment. Validated instruments for assessing orthorexic tendencies in adolescent psychiatric settings remain limited. This study aimed to examine the psychometric properties of the Turkish version of the Düsseldorf Orthorexia Scale (TR-DOS) in a clinically referred adolescent sample. Adolescents aged 12–18 years presenting to a child and adolescent psychiatry outpatient clinic completed the TR-DOS, Orthorexia Nervosa Inventory (ONI), Eating Attitudes Test-26 (EAT-26), and Revised Child Anxiety and Depression Scale–Child Version (RCADS-CV). Psychiatric diagnoses were established through clinician-administered DSM-5 interviews. Construct validity was examined using exploratory and confirmatory factor analyses, internal consistency using Cronbach’s alpha and McDonald’s omega, and convergent validity through correlations with related measures. The sample comprised 209 adolescents (61.2
Mindfulness is increasingly being investigated as a relevant factor for weight management. It is currently unclear how and which underlying dispositional mindfulness and eating behavior-specific mindfulness processes are related to body weight. The purpose of this study was to investigate how dispositional mindfulness and mindful eating facets differ between adults with lower weight, overweight, and obesity. Dutch adults (N = 1118; Mage = 52.1) completed a cross-sectional assessment of dispositional mindfulness, mindful eating, and body mass index (BMI). Multivariate analyses were used to examine differences between BMI groups (i.e., participants with lower weight, overweight, and obesity) on dispositional mindfulness and mindful eating facets, controlling for demographics and meditation experience. There were no differences between the BMI groups in dispositional mindfulness facets. In terms of mindful eating, participants with obesity showed a heightened awareness of the effects of environmental cues on their eating behavior, and a lower capacity to refrain from reactive responses and judgment toward their eating, in comparison to participants with a lower weight. Results suggest that behavior-specific mindful eating may be a relevant factor to address to promote healthy weight management in the general, non-treatment-seeking population. These explorative findings need to be replicated and explored further through studies utilizing more robust, longitudinal research designs.
Abstract Background The prevalence of obesity in India has reached epidemic levels with 40.3% living with overweight or obesity. Problematic eating behaviours have been implicated in the development and maintenance of overweight and obesity. Conventional cognitive-behavioural intervention for eating disorders has not shown favourable long-term outcomes in weight management. Recent research has indicated early evidence for using cognitive remediation therapy (CRT-O) for eating disorders including disordered eating behaviours in those living with overweight and obesity. We conducted a feasibility study through a randomized controlled trial (RCT) with 70 young Indian adults with obesity or overweight. We also obtained participant feedback post-intervention, to identify putative contributing factors to the study outcomes. Methodology Fifteen young adult participants completed 28 sessions of CRT-O intervention program for their weight management. On trial completion, participants were randomly selected to provide their feedback and experience of their participation. A semi-structured qualitative interview was conducted. Transcripts were semantically coded and thematic analysis was done. Results Thematic analysis yielded six themes: 1. gaining new insights into their eating habits; 2. self-reported changes in eating behaviours; 3. self-reported behavioural changes; 4. perceived physical benefits; 5. perceived psychological benefits; 6. perceptions about the CRT-program. The sub-themes that emerged indicated general acceptance of the CRT-O intervention and its potential translation in real life. Conclusions This study showed improved metacognitive awareness on participants’ eating behaviours. Additionally, the findings indicated that participants developed an improved ability to resist several highly palatable but unhealthy foods. Participants also reported experiencing more self-control in their food grazing habits and reported that this led to a better ability to manage their weight.
Abstract Background Pregnancy and the postpartum period are vulnerable phases, particularly for women with eating disorder (ED) history. While prior nutritional research has mainly focused on pregnancy, little is known about long-term dietary patterns in this population. This study examined dietary intake in women with and without ED history from pregnancy to 3 years postpartum. Methods A validated food frequency questionnaire (FFQ) assessed dietary intake in women with ED history (ED group, T1: active ED: n = 12, past ED: n = 12) and healthy controls (HC group, T1: n = 33). Dietary patterns, food groups, as well as macro- und micronutrient intakes were analysed during pregnancy (T1), 1 year postpartum (T2), and 3 years postpartum (T3). Results Omnivorous diets predominated (T1: 75.4%, T2: 73.2% T3: 74.4%), with no significant differences between groups or over time. However, women with ED history consumed fewer animal-based, energy-dense, sugar- and fat-rich foods. Nutrient intake during pregnancy was comparable between groups. Postpartum, the ED group showed lower fat intake (p = 0.027, T2) higher fiber intake (p = 0.037, T3) and lower vitamin B12 intake (p = 0.031, T3). Conclusion Nutrient supply during pregnancy was comparable between groups, which is encouraging. Differences in food group consumption may reflect a greater health consciousness or residual restrictive behaviors in women with ED history. Given the known increase in ED symptoms after childbirth, these findings emphasize the need to further examine this nutritionally and psychosocially vulnerable period. Level of evidence: Level 3.
Abstract Background Binge-eating disorder (BED) is common and often persistent despite evidence-based psychotherapy, highlighting the need for scalable adjunctive interventions. Objective To evaluate feasibility, acceptability, and preliminary efficacy of a dietitian-supported ketogenic diet (KD) in adults with BED. Methods In this 12-week, single-arm pilot study conducted at Charité – Universitätsmedizin Berlin, adults (18–65 years) with DSM-5 BED and BMI 25–45 kg/m2 received a structured KD (< 20 g net carbohydrates/day; 15–20% energy from protein; 70–80% from fat) with dietitian counseling. Capillary β-hydroxybutyrate (BHB) was self-monitored twice weekly to index nutritional ketosis (BHB ≥ 0.5 mmol/L). Outcomes were assessed at baseline and week 12, including binge-eating days/week (EDE), BED severity (Y-BOCS-BE), eating-disorder psychopathology (EDE-Q), depressive symptoms (PHQ-9), and body weight. Results Of 39 individuals screened, 20 enrolled and 85% completed the 12-week assessment. Mean adherence (percent BHB readings ≥ 0.5 mmol/L) was 76% (SD 14), with mean BHB 1.3 mmol/L (SD 0.4). Binge-eating days/week decreased from 4.2 (SD 1.3) to 1.1 (SD 1.5) (p < 0.001). Y-BOCS-BE improved from 28.9 (SD 3.1) to 11.8 (SD 7.2) (p < 0.001). EDE-Q decreased from 4.3 (SD 0.9) to 2.4 (SD 1.3) (p = 0.002), PHQ-9 from 16.5 (SD 3.8) to 8.2 (SD 4.5) (p = 0.005), and body weight from 102.4 (SD 16.1) kg to 95.8 (SD 16.9) kg (p < 0.001). Conclusions In this single-arm pilot study, a dietitian-supported ketogenic diet was feasible and acceptable in adults with BED, and improvements in binge-eating behaviors and related psychopathology were observed during the 12-week intervention period. These findings are preliminary and do not establish therapeutic efficacy. Controlled trials with active comparators and longer follow-up are required to evaluate safety, sustainability, and clinical utility.
