OBJECTIVE:This systematic review evaluated the feasibility, efficacy, adherence, and methodological quality of ecological momentary intervention (EMI)-based treatments for individuals with diagnosed eating disorders (EDs) and/or obesity. METHOD:Eight electronic databases were systematically searched from inception to January 2026. Randomized, non-randomized, and uncontrolled studies evaluating EMI-based treatments for individuals with diagnosed EDs and/or obesity were included. Data on intervention characteristics, clinical and behavioral outcomes, feasibility, acceptability, and adherence were extracted. Risk of bias was assessed using RoB 2 and ROBINS-I, and findings were synthesized narratively. RESULTS:Fourteen studies met inclusion criteria (eight obesity-focused, six ED-focused), including nine randomized controlled trials. In ED studies, EMI-augmented interventions were associated with significant within-group reductions in binge-eating frequency and ED psychopathology. However, superiority over active cognitive-behavioral therapy-based controls was inconsistent and primarily observed during maintenance phases. Obesity-focused trials demonstrated small to moderate within-group improvements in weight-related outcomes, with generally small and non-sustained between-group effects. Feasibility and acceptability were generally high, although retention and engagement varied across studies. Risk of bias was low in most randomized trials but higher in non-randomized studies. DISCUSSION:EMIs appear to be a feasible and acceptable approach for extending evidence-based treatments for EDs and obesity into daily life. Current evidence suggests that EMIs may exert a beneficial adjunctive effect by enhancing engagement and improving short-term behavioral outcomes. However, their impact on long-term clinical outcomes remains limited and inconsistent, underscoring the necessity for conducting rigorously designed clinical trials with extended follow-up periods.

BACKGROUND:Previous studies that have focused primarily on binge eating in young adults have suggested an association between the personality trait sensation seeking and disordered eating. Far less is known about this relationship in adolescents, particularly concerning sensation seeking and eating disorder psychopathology. Thus, the present study investigated the association between sensation seeking and disordered eating, including eating disorder psychopathology and relevant diagnostic symptoms of eating disorders (i.e., binge eating) in healthy adolescents, while also considering relevant sociodemographic variables. Additionally, moderating effects of weight status and behavioral difficulties were explored. METHODS:Four hundred 13- to 15-year-old participants from the LIFE Child study (Leipzig, Germany) provided information on sensation seeking (encompassing novelty- and intensity-seeking), disordered eating, behavioral difficulties, and sociodemographic data. Objective anthropometric measurements (body mass index, BMI) were also taken. Multiple linear regression models were applied to assess associations between sensation seeking and sociodemographic variables, as well as between sensation seeking and disordered eating. BMI and behavioral difficulties were included as moderators for analyses on interactions. RESULTS:Boys displayed higher levels of sensation seeking than girls, and novelty seeking was positively associated with socioeconomic status. Sensation seeking was positively associated with restraint and overeating. Associations with eating concern, loss of control eating, and binge eating did not remain significant after correction for multiple testing. The association between sensation seeking and disordered eating was stronger in adolescents with a higher BMI, more symptoms of hyperactivity/inattention, more emotional symptoms, and more peer problems. CONCLUSION:The results indicate that higher sensation seeking is associated with restraint and overeating in adolescence. Hyperactivity/inattention and internalizing symptoms were shown to moderate associations between sensation seeking and disordered eating, suggesting that they may be promising targets for prevention strategies and interventions.

OBJECTIVE:Pioneer studies suggested the effectiveness of food-specific electroencephalography (EEG) and real-time functional near-infrared spectroscopy (rtfNIRS) neurofeedback (NF) trainings in the treatment of binge-eating disorder (BED). These trainings aim to improve participants' neurophysiological self-regulation. However, pretreatment neurophysiological activity, a supposed key predictor of NF outcomes, remains unexplored. METHOD:This preregistered analysis (https://osf.io/xsrj3) used data from a randomized-controlled trial (DRKS00014752) on 47 adults (47 ± 13 years, 81% women) with interview-assessed BED having undergone food-specific EEG- or rtfNIRS-NF (12 sessions, over 8 weeks). Bayesian linear models explored pretreatment fronto-central high beta power (23-28 Hz; indicating increased attention) in EEG, pretreatment prefrontal oxygenation in fNIRS (indicating increased cognitive control), and rapid response (RR; early reductions in binge eating) as predictors of treatment outcomes reflecting mental and physical health at posttreatment and 6-month follow-up. RESULTS:Higher high beta power during passive viewing of food pictures, lower high beta power, and less oxygenation during regulatory NF tasks, as well as RR predicted more favorable primary outcomes, including reduced objective binge-eating episodes and increased abstinence from binge eating. Overall, neurophysiological predictors-especially EEG activity-showed greater predictive value than RR. CONCLUSION:The preliminary findings suggest the relevance of neurophysiological activity in the prediction of NF treatment outcomes in BED. While patients with increased involuntary attention in response to food stimuli profited most from EEG-NF, those with greater difficulties in voluntary recruitment of food-related cognitive control profited most from rtfNIRS-NF. The predictors identified could guide future treatment allocation and represent a first step toward more individualized therapy approaches.

BACKGROUND:The Child Eating Behaviour Questionnaire (CEBQ) is an internationally applied, parent-report questionnaire on children's eating behaviors, but has mainly been validated in population-based samples or children with obesity. This study presents a first comprehensive validation of the German version of the CEBQ in a treatment-seeking and community-based sample including anorexia nervosa (AN), avoidant-restrictive food intake disorder (ARFID), loss of control (LOC) eating, attention-deficit/hyperactivity disorder (ADHD), and a healthy control group. METHODS:The German version of the CEBQ was completed by 226 parents of children and adolescents (9 months to 17 years) in Germany and Switzerland. Factorial, convergent, and discriminant validity, internal consistency, as well as sociodemographic correlates were assessed, using objectively measured anthropometrics and well-established clinical interviews and questionnaires on eating disorders and associated psychopathology in parent- and self-report. RESULTS:The original 8-factor structure showed acceptable model fit and acceptable to excellent internal consistency. Convergent validity was mostly supported by weight status and interview- and questionnaire-measured eating behaviors. The CEBQ subscales differentiated between groups associated with overeating (ADHD, LOC eating) versus restrictive eating (ARFID and AN). CONCLUSION:The results support the German version of the CEBQ as a valid and reliable tool for assessing eating behavior in youth with eating disorders and ADHD. Future research using larger and age-specific samples should examine psychometric comparability across developmental stages and may provide norms for the CEBQ to enhance its utility as a screening tool.

A single nucleotide polymorphism in the brain derived neurotrophic factor (BDNF)-encoding gene leads to diminished BDNF signaling resulting from Val66Met and has been linked to obesity. Previous imaging studies regarding the impact of BDNF Val66Met on the central serotonin system, which is involved in behavior, cognition and control of satiety, have not focused on body weight or food-intake related behavior. We revisited a cohort of thirty non-depressed individuals with obesity and 15 normal-weight controls. 29 obese and 13 controls underwent [11C]DASB positron emission tomography imaging of the serotonin transporter (5-HTT), Val66Met genotyping and behavioral assessment with the Three-Factor Eating Questionnaire (TFEQ), which measures cognitive restraint, disinhibition and hunger. Volume-of-interest analyses were used to examine the influence of BDNF Val66Met on 5-HTT binding potential (BPND), BMI, and questionnaire scores. Compared to the homozygous Val/Val genotype, Met-carriers showed a significant increase of 5-HTT BPND in the medial prefrontal cortex. The data did not support a BDNF Val66Met effect on TFEQ measures, especially not on cognitive restraint. However, the construct of disinhibition and hunger correlated positively with BMI in homozygous Val-carriers while cognitive restraint did not. This study, despite its small sample size, indicates a possible dampening effect of BDNF Val66Met on prefrontal cortical serotonergic tone.

OBJECTIVES:There is an increasing trend towards embedding consumer and community involvement in all health and medical research. The Executive Committee of the International Journal of Eating Disorders (IJED) disseminated a survey for eating disorder researchers investigating their practices and perspectives regarding Patient and Public Involvement (PPI) in research, with the goal of informing our procedures in future. METHOD:A survey was distributed globally via eating disorder organizations, professional networks, and individual researchers. Researchers (N = 119) of various career stages completed the survey. RESULTS:Three quarters of the researchers had consulted people with lived experience to inform their research; 45% said that they employed lived experience and/or peer researchers across all stages of their research, and 75% viewed PPI as improving the quality, relevance, feasibility, adoption, or implementation of research. Concerns were expressed about the challenges associated with PPI, including cost, time, expertise, disclosure of lived experience status, the need to maintain robust scientific principles, concern about the validity of results, and potential harm to the person with lived experience. Most did not want disclosure of PPI to be mandatory or to impact the review process. CONCLUSION:These insights informed the development of an approach to recognizing the involvement of PPI in our publishing. Rather than an obligatory statement, IJED encourages use of PPI and disclosures, with inclusion of a description and implications for the interpretation of the research detailed in manuscripts.

Children and adolescents with rare diseases represent a population that may be at risk for an avoidant/restrictive food intake disorder (ARFID). This study aimed to quantitatively examine the symptoms of ARFID in a sample of children and adolescents with rare diseases and their association with sociodemographic characteristics, eating disorder psychopathology, health-related quality of life (HRQoL), and mental health. In this observational study, data from 309 families of children with rare diseases drawn from a multicenter clinical study were used to estimate the prevalence of ARFID symptoms in children and adolescents aged 8–21 years in Germany was estimated via self-report (n = 169) and parent report (n = 502). Differences between the sample of individuals with rare diseases and normative population data, between those with and without ARFID symptoms, and between subgroups of rare diseases were investigated. Additionally, correlations between eating disorder psychopathology, sociodemographic, and psychosocial variables were investigated. The prevalence of symptoms of ARFID was relatively high, with a relevant difference between self-report (3.6

OBJECTIVE:Eating disorders (EDs) often emerge in adolescence, but developmental trajectories across different core features remain largely unclear. METHOD:The prospective, community-based study included N = 898 participants aged 9.5-17.5 years (47.6% female, age 11.8 ± 1.4 years) with annual follow-up over 2-6 (3.4 ± 1.2) years. Multivariate trajectories of binge eating, restraint, weight-compensatory behaviors (Eating Disorder Examination-Questionnaire for Children), and body mass index-standard deviation score (BMI-SDS) derived from objective anthropometrics were analyzed using group-based multi-trajectory modeling (GBMTM) separately for girls and boys. ED and general psychopathology were used for validation and outcome comparisons. RESULTS:GBMTM identified five distinct trajectories of ED symptoms and BMI-SDS in girls and six in boys. Low-symptom trajectories at lower, normal, and higher BMI-SDS were most common and showed only mild, transient ED symptoms. In boys, trajectories were largely characterized by stable ED symptoms at different BMI-SDS levels, whereas in girls, ED symptoms showed more pronounced change over time. In both sexes, two high-risk subgroups reflected bulimic and binge-eating patterns and followed trajectories with elevated or increasing ED symptoms across ages, which in girls were particularly associated with increased ED and general psychopathology at last assessment. DISCUSSION:GBMTM results support the developmental specificity of bulimic/binge-eating syndromes and noneating-disordered overweight across adolescence. High-risk subgroups in both sexes-and their particularly unfavorable outcomes in girls-underscore the need for sex-specific early identification strategies that consider longitudinal constellations of multiple ED symptoms and weight status rather than single indicators.

Our four-year interdisciplinary behavioral weight loss program is fully covered by public health insurance for patients with a body mass index of ≥35 kg/m2. We evaluated the real-world outcomes of anthropometric, metabolic and psychologic parameters collected prior to the start (t0, n = 381, 71% women) and after each segment of the program (t1–4, n = 243, 126, 94, and 77). It is a prospective evaluation of clinical real-world data including all patients who started the first segment of behavioral treatment until they quit/finished the program. The mean dropout rates per treatment segment were 23%. Body weight after one year decreased from 127.3 kg to 122.2 (p < 0.001). Average hemoglobin A1c value decreased from 5.8% to 5.6% in all patients (p < 0.001) and from 6.6% to 6.2% in patients with type 2 diabetes (p < 0.001). Further metabolic and psychological parameters improved significantly as well. The average weight nadir was reached after two segments, co-occurring with the most beneficial changes in laboratory parameters. Afterwards, mean weight slightly increased accompanied by a discrete loss of benefits in laboratory parameters. Our real-world data with significant health improvements adds important value to discussions about the funding of obesity therapy and thus has the chance to improve therapy availability for obesity patients worldwide.

OBJECTIVE:Obesity surgery (OS) results in substantial, albeit heterogeneous, long-term improvements in weight and mental health, with unclear trajectories and their associations. This study examined multivariate trajectories of weight, psychopathology, and health-related quality of life (HRQOL) after OS, and their prospective association with long-term health outcomes. METHOD:In the prospective multicenter Psychosocial Registry of Obesity Surgery, N = 856 patients were classified into multivariate trajectory classes using latent class linear mixed models, based on assessments of weight, depression, eating disorder psychopathology, and HRQOL at baseline and annually 1-5 years following OS. The prognostic significance of trajectory classes for 6-year follow-up was examined. Multivariate trajectory modeling was compared with univariate weight trajectory modeling for concordance and prognostic significance. RESULTS:We identified three trajectory classes of low (I, 2.8%), medium (II, 89.1%), and high (III, 8.1%) sustainability 1-5 years after OS, indicating high (I) or gradual deterioration (II) or further improvement (III) after initial improvement of indicators. The low sustainability class (I) reached nadir improvements earliest. Consistently, trajectory classes were prospectively associated with differential clinically significant improvement in weight and mental health at the 6-year follow-up. Multivariate trajectory modeling was discordant with univariate weight trajectory modeling and showed greater predictive value for health outcomes at the 6-year follow-up. DISCUSSION:Patients who achieve nadir improvements in weight and mental health early may require clinical attention to prevent long-term relapse. Monitoring changes in the first years after OS appears essential to identify patients in need of additional intervention, ideally using indicators beyond weight, such as mental health.

BACKGROUND:This study validated a parent-report version of the Eating Disorder Examination-Questionnaire adapted for Children (ChEDE-Q), referred to as the ChEDE-QP, within a population-based sample of parent-child dyads, including both children with and without loss of control (LOC) eating. METHOD:The ChEDE-QP was completed by 115 parent-child dyads. Item characteristics, reliability, factor structure, discriminant, convergent, and criterion validity were evaluated. The child version of the Eating Disorder Examination (ChEDE) interview and the ChEDE-Q were used for validation. RESULTS:Missing item responses occurred in 0-4% of items. Corrected item-subscale correlations were mostly sufficient. Internal consistency ranged from acceptable to excellent. Medium-sized correlations between ChEDE-QP, ChEDE-Q and ChEDE global and subscale scores indicated satisfying convergent validity. Nonsignificant differences between children with and without LOC indicated low discriminant validity. Regarding the presence of LOC eating, parental and child reports were poorly associated. DISCUSSION:The ChEDE-QP was found to be a reliable questionnaire for assessing children's eating disorder psychopathology, indicating that parents are helpful for gaining a general understanding of eating disorder psychopathology. However, the agreement on the presence of LOC eating between parents and children was low indicating that the ChEDE-QP should not be used for assessing LOC eating episodes in the absence of child report.

Executive function deficits, particularly in cognitive flexibility, are often implicated in people with Higher Body Weight (HBW). The current study aimed to explore the association between specific executive functions (attentional capacities, sequencing, and flexibility) with self-reported physical and mental health outcomes over 12 months in individuals with HBW (Class 3 obesity, BMI≥40 kg/m2). Participants (n = 244, 70.5 % female) enrolled in an outpatient weight management program, mean age 48.1 ± 13.7 years, weight 150.3 ± 32.7 kg, and BMI 53.3 ± 9.1 kg/m2. They completed the Trail Making Test (TMT) assessing cognitive state (attentional capacities, sequencing, and flexibility), Eating Disorder Examination Questionnaire-Short (EDE-QS) assessing eating disorder symptoms, Kessler-10 Scale (K10) assessing psychological distress, and 12-Item Short-Form Survey (SF-12) measuring self-reported physical health. Results showed that at baseline the participants demonstrated cognitive impairment, and had moderate to high levels of psychological distress, and eating disorder symptoms. Significant (p < 0.05) correlations were found between age and slower cognitive processing and cognitive flexibility at baseline. At 12 months follow-up, cognitive function, psychological distress, and binge eating frequency improved significantly compared to baseline (p < 0.001). Self-reported physical health measures of the SF-12 including self-reported energy levels and moderate physical activity, correlated with better cognitive performance at both time points. Conversely, weight, BMI, and psychological distress showed weak associations with cognitive function. These findings indicate that Self-reported physical health measures, rather than anthropometry or psychological distress, may be key predictors of cognitive function in individuals with HBW. Addressing both physical and emotional health may be crucial for improving cognitive and overall treatment outcomes in this population.

OBJECTIVE:Research on social support, attachment insecurity, and negative affect in night eating syndrome (NES) is sparse, although these factors have been proposed as key components of etiological models in other eating disorders. This study investigated whether individuals with night eating (NE) symptoms reported lower social support, greater attachment insecurity, and increased negative affect compared to those without, and examined if negative affect mediated the relationship between interpersonal problems (lack of social support, attachment insecurity) and NE symptoms. METHOD:A representative German population sample of 2423 participants (1297 women, 53.5%) aged between 18 and 92 years completed the Night Eating Questionnaire. Multivariate analysis of variance (MANOVA) analyzed differences between individuals with vs. without NE symptoms in social support, attachment insecurity, and negative affect. Mediation analyses examined cross-sectionally negative affect as a mediator on the relationship between interpersonal problems (lacking social support and attachment insecurity) and NE symptoms. RESULTS:Individuals with NE symptoms reported lower social support (less than small effect), more insecure attachment (small effect), and greater negative affect (small effect) than those without NE symptoms. Negative affect mediated the associations between social support or attachment insecurity and NE symptoms (small effect). All results remained significant after controlling for BMI. DISCUSSION:Given elevated interpersonal problems and negative affect in individuals with vs. without NE symptoms, and the evidence of cross-sectional applicability of the interpersonal model to NES, longitudinal research should examine this mediational effect and investigate interpersonal problems and negative affect as potential risk or maintaining factors of NES.

The bibliometric study by Lee and Chi presents the most comprehensive analysis of eating disorder (ED) research publications to date, tracing publication trends, thematic developments, and the interplay between academic and public attention over the past five decades. The findings reveal a marked and sustained growth in ED-related publications since the early 2000s, reflecting the field's consolidation while also underscoring persistent imbalances. Notably, the analysis highlights the dominance of English-speaking countries in research output, the underrepresentation of lower-income regions, and the limited visibility of certain EDs and demographic groups. Network analyses of Medical Subject Headings' terms indicate thematic stability over time but also point to neglected areas of clinical relevance. Furthermore, the weak correlation between academic citations and public attention raises important questions about science communication and the alignment of scholarly impact with societal salience. To enhance global inclusivity and scientific relevance, it is proposed that publication barriers be removed, thematic scope broadened, and cross-disciplinary collaboration strengthened. Such strategies are essential to enable ED research to remain responsive to evolving clinical needs within culturally and demographically diverse populations amid an increasingly complex global landscape.

Introduction: The Weight Control/Blame (WCB) subscale of the Antifat Attitudes Test (AFAT) measures weight stigma, particularly beliefs linking obesity to personal responsibility, which contributes to discrimination and negative psychological, often reinforced by political ideologies and authoritarian attitudes. This study sought to (1) develop and validate an economic version of the WCB subscale and (2) evaluate associations between weight stigmatizing attitudes, authoritarian beliefs, sexist attitudes, and conspiracy mentality. METHODS:A four-item short form of the WCB subscale (WCB-4) was developed using a representative sample of the German population (N = 1,000) and validated on a second sample (N = 2,524). We assessed psychometric properties, convergent, and divergent validity. RESULTS:The four-item solution demonstrated good internal consistency (ω = 0.807) and favorable confirmatory factor analysis results. Weight stigma positively correlated with authoritarian and sexist beliefs, and negatively with depression, anxiety, and body mass index. CONCLUSION:The WCB-4 is a reliable and valid tool for assessing weight stigma in epidemiological research. It highlighted positive associations with authoritarian beliefs and sexist attitudes, reflecting an interconnected system of biases against marginalized groups. Though a minor correlation was found between conspiracy mentality and authoritarian beliefs, no significant link emerged between conspiracy mentality and weight stigma. .

Family factors like parental psychopathology and parental expressed emotion, referring to the emotional atmosphere within a family, play a significant role in the maintenance and treatment outcome of anorexia nervosa. However, nothing is known about these parental characteristics in avoidant/restrictive food intake disorder (ARFID). This study aimed to determine the proportion of parents exceeding clinical cutoffs for depression, eating disorder psychopathology, and expressed emotion, specifically criticism and emotional overinvolvement, in ARFID, anorexia nervosa (AN), and healthy controls (HC), and to evaluate group differences. Associations between parental characteristics and child illness characteristics were analyzed. Treatment-seeking children and adolescents (0–17 years) with ARFID (n = 42) were compared to those with AN (n = 25) and HC (n = 42) in parental eating disorder psychopathology (Eating Disorder Examination-Questionnaire 8), parental depression (Patient Health Questionnaire-9), and parental expressed emotion (Family Questionnaire). When comparing ARFID with AN and HC, the proportions of parents exceeding clinical cutoffs for depression (26

Abstract Background Obesity is a multifactorial disease reaching pandemic proportions with increasing healthcare costs, advocating the development of better prevention and treatment strategies. Previous research indicates that the gut microbiome plays an important role in metabolic, hormonal, and neuronal cross-talk underlying eating behavior. We therefore aim to examine the effects of prebiotic and neurocognitive behavioral interventions on food decision-making and to assay the underlying mechanisms in a Randomized Controlled Trial (RCT). Method This study uses a parallel arm RCT design with a 26-week intervention period. We plan to enroll 90 participants (male/diverse/female) living with overweight or obesity, defined as either a Waist-to-Hip Ratio (WHR) ≥ 0.9 (male)/0.85 (diverse, female) or a Body Mass Index (BMI) ≥ 25 kg/m2. Key inclusion criteria are 18–60 years of age and exclusion criteria are type 2 diabetes, psychiatric disease, and Magnetic Resonance Imaging (MRI) contraindications. The interventions comprise either a daily supplementary intake of 30 g soluble fiber (inulin), or weekly neurocognitive behavioral group sessions, compared to placebo (equicaloric maltodextrin). At baseline and follow-up, food decision-making is assessed utilizing task-based MRI. Secondary outcome measures include structural MRI, eating habits, lifestyle factors, personality traits, and mood. Further, we obtain fecal and blood samples to investigate gut microbiome composition and related metabolites. Discussion This study relies on expanding research suggesting that dietary prebiotics could improve gut microbiome composition, leading to beneficial effects on gut-brain signaling and higher-order cognitive functions. In parallel, neurocognitive behavioral interventions have been proposed to improve unhealthy eating habits and metabolic status. However, causal evidence on how these “bottom-up” and “top-down” processes affect food decision-making and neuronal correlates in humans is still scarce. In addition, microbiome, and gut-brain-axis-related mediating mechanisms remain unclear. The present study proposes a comprehensive approach to assess the effects of these gut-brain-related processes influencing food decision-making in overweight and obesity. Trial registration ClinicalTrials.gov NCT05353504. Retrospectively registered on 29 April 2022.