Handbook of Eating Disorders and Obesity

An eating disorder refers to a type of mental disorder, which occurs due to abnormal eating behaviors affecting mental or physical health negatively. There are various types of eating disorders such as bulimia nervosa, avoidant/restrictive food intake disorder (ARFID), anorexia nervosa, pica, binge eating disorder, rumination syndrome and a group of other feeding or eating disorders. The treatment of eating disorders differs from disorder to disorder, and includes reducing excessive exercise, counseling, reduction of efforts to eliminate food, and dietary advice. Obesity is the state where excess body fat gets accumulated in the body, which results in negative impacts on human health. It is measured through body mass index (BMI) in which a person's weight is divided by the square of the person's height. It is a major cause of disability and also leads to various diseases and conditions like obstructive sleep apnea, osteoarthritis, cardiovascular diseases, certain types of cancer and type 2 diabetes. The readers would gain knowledge that would broaden their perspective about eating disorders and obesity through this book. It unravels the recent studies on these disorders. This book will prove to be immensely beneficial to students and researchers in this field of study. Preface to the 3rd Edition of the Handbook Contents Part I Diagnosis of Eating Disorders 1 Classification and Diagnosis: A Historical Perspective 1.1 A Truly Biopsychosocial Phenomenon 1.2 History of Obesity Diagnosis 1.3 History of Anorexia Nervosa and its Diagnosis 1.4 History of the Diagnosis of Binge Eating and Overeating 1.5 History of Bulimia Nervosa and its Diagnosis 1.6 Influences of Medical Disease Concepts on Eating Disorders 1.7 Developments in Classification and Diagnosis References 2 Dieting Behavior and Body Image in Societal Change 2.1 How Common are Body Image Problems and Dieting Behavior? And How are They Related? 2.2 Do Body-Related Attitudes and Eating Behavior Change in the Transition from Adolescence to Young Adulthood? Conclusion References 3 Eating Disorders in the ICD-11 and DSM-5 3.1 Introduction 3.2 Anorexia Nervosa 3.3 Bulimia Nervosa 3.4 Binge Eating Disorder 3.5 Avoidant/Restrictive Food Intake Disorder (ARFID) 3.6 Pica 3.7 Rumination and Regurgitation 3.8 “Other Specified Feeding or Eating Disorder” and “Unspecified Feeding or Eating Disorder” References 4 Clinical Aspects of Anorexia Nervosa, Bulimia Nervosa, and Avoidant-Restrictive Food Intake Disorder in Adulthood 4.1 Classification of Anorexia Nervosa 4.1.1 Subtypes of Anorexia Nervosa 4.2 Classification of Bulimia Nervosa 4.2.1 Subtypes of Bulimia Nervosa 4.3 Avoidant-Restrictive Food Intake Disorder 4.4 Compensatory Behaviors 4.4.1 Fasting 4.4.2 Vomiting 4.4.3 Abuse of Medications 4.4.4 Excessive Exercise 4.4.5 Additional Compensatory Behaviors References 5 Clinical Aspects of Binge-Eating Disorder 5.1 Diagnostic Criteria 5.2 Further Psychopathological Features 5.3 Epidemiology and Course 5.4 Comorbidities 5.4.1 Mental Comorbidity 5.4.2 Obesity References 6 Atypical Eating Disorders and Eating Disorders Not Otherwise Specified 6.1 Atypical, Subsyndromal Eating Disorders 6.2 Purging Disorder 6.3 Night Eating Syndrome 6.4 Pica 6.5 Rumination Disorder 6.6 Avoidant/Restrictive Food Intake Disorder (ARFID) References 7 Orthorexia Nervosa 7.1 Concept and Definition 7.2 Symptomatology 7.3 Nosological Classification 7.4 Diagnosis and Epidemiology 7.5 Etiology 7.6 Relation to Other Eating Disorders 7.7 Treatment References 8 Body Image Disturbances 8.1 Body Image Issues in Eating Disorders 8.2 Body Image Disturbance: Theoretical Conceptions and Definition Attempts 8.2.1 Perceptual Component 8.2.2 Cognitive-Affective or Cognitive-Evaluative Component 8.2.3 Behavioral Component 8.3 Body Image Disturbances as Core Symptoms of Eating Disorders: Research Approaches and Empirical Findings 8.4 Evaluation of Existing Findings References 9 Diagnosis of Eating Disorders 9.1 Screening for Eating Disorders 9.2 Detailed Psychological Assessment for a Suspected Eating Disorder 9.2.1 Search for Physical, Psychological, or Behavioral Characteristics of an Eating Disorder 9.2.1.1 Underweight or Overweight 9.2.1.2 Psychological and Behavioral Characteristics 9.2.1.3 Restriction of Calorie Intake 9.2.1.4 Binge Eating 9.2.1.5 Compensatory Behavior 9.2.2 Assessment of Impairment due to Disturbed Eating Behavior 9.2.3 Operationalized Diagnostics 9.3 Medical Diagnostics for Eating Disorders 9.4 Differential Diagnostic Considerations References Part II Epidemiology, Etiology, and Course of Eating Disorders 10 Prevalence and Incidence of Anorectic and Bulimic Eating Disorders 10.1 Prevalence 10.2 Incidence References 11 Course and Prognosis of Anorexia Nervosa 11.1 Results of the Research on the Course of AN 11.2 Mortality 11.3 Prognostic Indicators for a Poor Course References 12 Course of Bulimia Nervosa and Binge-Eating Disorder 12.1 Diagnosis 12.2 Course of Eating Disorder Symptoms 12.2.1 Remission and Recovery 12.2.2 Relapse and Chronicity 12.2.3 Mortality 12.3 Comorbidity 12.4 Social Factors 12.5 Prognosis 12.5.1 Age and Duration of Illness 12.5.2 Severity of Eating Disorder and Treatment 12.5.3 Comorbidity 12.5.4 Personality Traits 12.5.5 Family of Origin Characteristics Further References 13 Course and Prognosis of Binge Eating Disorder 13.1 Introduction 13.2 Onset 13.3 Distribution 13.4 Comorbidity—Quality of Life—Level of Functioning 13.5 Disorder Duration 13.6 Course of Treatment 13.7 Change of Eating Disorder Diagnosis 13.8 Mortality 13.9 Prognosis: What Promotes and What Hinders a Positive Course? References 14 Anorexia Nervosa in Childhood and Adolescence 14.1 Definition and Classification 14.2 Epidemiology 14.3 Symptomatology 14.4 Comorbidity and Differential Diagnosis 14.4.1 Psychological Comorbidity 14.4.2 Somatic Comorbidity 14.5 Differential Diagnosis 14.6 Course References 15 Eating Disorders in Men 15.1 General Information on Anorexia Nervosa and Bulimia Nervosa in Men 15.1.1 “Muscularity-Oriented Disordered Eating” 15.2 Onset of the Disorder 15.2.1 Risk Factor: Body Dissatisfaction 15.2.2 Additional Risk Factors 15.3 Disease Course 15.4 Treatment and Outcome 15.5 Atypical Eating Disorders and Binge Eating Disorder (BED) References 16 Eating Disorders and Competitive Sports 16.1 Body Weight and Body Composition in Competitive Sports 16.2 Energy Balance in Competitive Sports 16.3 Epidemiology 16.4 Risk Factors 16.5 Pathophysiological Mechanisms 16.5.1 Eating Disorders 16.5.2 Menstrual Cycle Disorders and Reduction of Testosterone Levels 16.5.3 Low Bone Density 16.6 Health Consequences 16.6.1 Medical Consequences 16.6.2 Psychological and Social Consequences 16.7 Screening and Diagnosis 16.7.1 Screening 16.7.2 Diagnostic Procedure 16.7.2.1 Anamnesis 16.7.2.2 Bone Density Measurement 16.8 Prevention and Therapy 16.8.1 Prevention 16.8.2 Therapy 16.9 Performance-Optimized Weight Management for Athletes 16.9.1 Guidelines for Appropriate Weight Loss 16.9.2 Guidelines for Performance-Enhancing Weight Gain Further Reading 17 Cognitive Behavioral Therapy Models 17.1 Predisposing Factors 17.1.1 Biological Factors 17.1.2 Sociocultural Factors 17.1.3 Family Factors 17.1.4 Individual Factors 17.2 Triggering Factors 17.3 Maintaining Factors 17.4 The Transdiagnostic Model References 18 Psychodynamic Model Concepts 18.1 Operationalized Psychodynamic Diagnosis (OPD) 18.2 Effectiveness of Psychodynamic Psychotherapy Methods References 19 Epidemiology, Etiology, and Course of Eating Disorders 19.1 Systemic and Family Perspective 19.1.1 Historical Development 19.1.2 The Family as a “Risk Factor” 19.1.3 The Family as a Resilience-Promoting Institution 19.2 Does the Family Influence the Eating Disorder or Vice Versa? 19.3 Conclusions for Practice References 20 Genetic Aspects of Eating Disorders 20.1 Anorexia Nervosa 20.1.1 Family and Twin Studies 20.1.2 Rare Variants 20.1.3 Genome-wide Association Studies (GWAS) 20.2 Bulimia Nervosa and Binge Eating Disorder 20.2.1 Family and Twin Studies 20.2.2 Association Studies 20.2.3 Genome-wide Association Studies 20.3 Outlook—Gene-Environment Interactions and Epigenetics References 21 Psychosocial Risk Factors 21.1 Anorexia nervosa 21.1.1 Gender 21.1.2 Ethnicity and Age 21.1.3 Factors Related to Pregnancy and Birth 21.1.4 Eating and Feeding Problems 21.1.5 Mother’s Educational Level 21.1.6 Preoccupation with Shape and Weight/Dieting/Body Weight, Body Dissatisfaction 21.1.7 Acculturation 21.1.8 Sexual Abuse 21.1.9 Attachment Style and Family Climate 21.1.10 Family Psychopathology 21.1.11 Own Psychopathology 21.1.12 Self-esteem 21.1.13 Perfectionism and Neuroticism 21.1.14 Occupational Groups and Risk Sports 21.2 Bulimia nervosa 21.2.1 Gender, Ethnicity, Time of Birth, and Age 21.2.2 Eating and Feeding Problems 21.2.3 Preoccupation with Shape and Weight/Dieting/Body Weight 21.2.4 Acculturation 21.2.5 Own Psychopathology 21.2.6 Family Psychopathology 21.2.7 Sexual Abuse 21.2.8 Attachment Style and Family Climate, Negative Comments about Food, Weight, and Body Shape 21.2.9 Problems with Self-Esteem 21.2.10 Perfectionism and Neuroticism 21.2.11 Professional Groups and Risk Sports 21.2.12 Additional factors 21.3 Binge Eating Disorder (BED) 21.3.1 Findings from Longitudinal Studies 21.3.2 Findings from Cross-sectional Studies 21.4 Interaction of Risk Factors in the Development of Eating Disorders 21.5 Conclusion and Outlook References 22 Sociocultural Aspects of Eating Disorders 22.1 Anorexia nervosa 22.1.1 Cultural-historical perspective 22.1.2 Prevalence in Different Cultures 22.1.3 Influences of the Thin Body Ideal 22.1.4 Other Sociocultural Influencing Factors 22.2 Bulimia nervosa 22.2.1 Cultural-Historical Perspective 22.2.2 Prevalence in Cultures with and without Connection to Western Media Content 22.2.3 Influences of the Thin Body Ideal 22.2.4 Further sociocultural influencing factors 22.3 Cultural Factors in Weight Gain, Obesity, and Binge Eating Disorder 22.3.1 The Role of Norms and Ideals in Media and Public Morality 22.4 Common Factors: Upheaval and Migration, Religious Orientation, and Role Expectations for Women 22.5 Conclusion and Limitations References 23 The Influence of Media on Body Image 23.1 The Media Image of the Female Body 23.2 Television Shows and Eating Disorders 23.3 Social Media and BodyDissatisfaction 23.4 Social Media and Eating Disorders 23.5 What Might Help? References Part III Psychological Comorbidity 24 Affective Disorders and Anxiety Disorders 24.1 Comorbidity in Mental Disorders 24.2 Anorexia nervosa 24.3 Bulimia nervosa 24.4 Binge Eating Disorder 24.5 Obesity 24.6 Summary and Conclusions References 25 Psychological Comorbidity and Personality Disorders 25.1 Prevalence of comorbidity between eating disorders and other mental disorders 25.1.1 Eating Disorders and Depressive Disorders 25.1.2 Eating Disorders and Anxiety Disorders 25.1.3 Eating Disorders and Obsessive-Compulsive Disorders 25.1.4 Eating Disorders and Posttraumatic Stress Disorder 25.1.5 Eating Disorders and Disorders with Psychotropic Substances 25.1.6 Eating Disorders and Sexual Disorders 25.1.7 Eating Disorders and Personality Disorders 25.1.8 Cluster Analyses of Comorbid Disorders in Eating Disorders 25.2 Delineation of Differential Diagnosis vs. Comorbidity 25.3 Mechanisms of Interaction between Eating Disorders and Other Mental Disorders 25.3.1 Comorbid Disorders as a Specific Risk Factor for Eating Disorders 25.3.2 Comorbid Disorders as a Complication of Eating Disorders 25.3.3 Common Risk Factors for Eating Disorders and Comorbid Disorders 25.4 Therapy for Comorbid Disorders Including Eating Disorders 25.4.1 Treatment for Eating Disorders and Depressive Disorder 25.4.2 Treatment for Eating Disorders and Cluster-C Personality Disorder 25.4.3 Treatment for Eating Disorders and Cluster-B Personality Disorder 25.4.4 Treatment for Eating Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder, and PTSD 25.4.5 Eating Disorders and Disorders with Psychotropic Substances 25.4.6 Eating Disorders and Sexual Disorders References 26 Non-Suicidal Self-Injury and Eating Disorders 26.1 NSSI: An Overview 26.2 Associations Between NSSI and Eating Disorders 26.3 Therapy for NSSI and Eating Disorders References 27 Mechanisms of Addiction in Eating and Weight Disorders 27.1 Introduction 27.2 Models of the Development and Maintenance of Dependent Behavior 27.3 Mechanisms of Dependent Behaviorin Eating and Weight Disorders 27.4 The Concept of “Food Addiction” 27.5 Therapy 27.6 Summary References Part IV Biological and Medical Aspects of Eating Disorders 28 Hunger and Satiety 28.1 The Process of Food Intake 28.1.1 Cephalic Phase 28.1.2 Gastric Phase 28.1.3 Intestinal Phase 28.2 Biological, Sensory, and Psychological Factors of Hunger and Satiation 28.2.1 Biological Factors 28.2.1.1 Peripheral Hormonal Regulatory Processes 28.2.1.2 Central Nervous Hunger and Satiety Regulation 28.2.1.3 Genetic Factors 28.2.2 Sensory Factors 28.2.3 Psychological Factors 28.2.3.1 Cognitive Factors 28.2.3.2 Emotional Factors 28.2.3.3 Social Factors 28.3 Hunger and Satiety and the Regulation of Body Weight References 29 Peripheral Peptide Hormones, Neuropeptides, and Neurotransmitters 29.1 Peripheral Peptide Hormones and Neuropeptides 29.1.1 Basics 29.1.2 Findings in Eating Disorders 29.1.2.1 Leptin 29.1.2.2 Ghrelin 29.1.2.3 PYY 29.1.2.4 CCK 29.1.2.5 Centrally Secreted Neuropeptides of Weight Regulation 29.2 Neurotransmitters 29.2.1 Basics 29.2.2 Findings in Eating Disorders 29.2.2.1 Serotonin 29.2.2.2 Dopamine 29.2.2.3 Norepinephrine References 30 Reward System in Eating Disorders and Obesity 30.1 General Neural Reward Processing 30.2 Relationship between Neural Reward Processing and EatingBehavior 30.3 Anorexia nervosa 30.4 Bulimia nervosa 30.5 Binge Eating Disorder 30.6 Obesity References 31 Neuropsychological Findings in Eating Disorders 31.1 Research Questions 31.2 Attentional Bias 31.3 Learning and Memory 31.4 Executive Functions, Reward Processing, and Decision-Making 31.5 Central Coherence and Theory of Mind 31.6 Factors Influencing Neurocognitive Deficits 31.7 Neuropsychological Findings in the Course of Therapy 31.7.1 Can Neuropsychological Performance Predict the Course of the Eating Disorder? 31.8 Conclusion and Outlook References 32 Imaging Techniques in Eating Disorders 32.1 Overview 32.2 Anorexia nervosa 32.2.1 Computed Tomography and Magnetic Resonance Imaging 32.2.2 Magnetic Resonance Spectroscopy 32.2.3 Positron Emission Tomography (Single-Photon Emission Computed Tomography) 32.2.3.1 Without Activation 32.2.3.2 With Activation 32.2.4 Functional Magnetic Resonance Imaging 32.2.5 Neurotransmitter Studies using SPECT and PET 32.3 Bulimia nervosa 32.3.1 Computed Tomography and Magnetic Resonance Imaging 32.3.2 Magnetic Resonance Spectroscopy 32.3.3 Positron Emission Tomography (Single-Photon Emission Computed Tomography) 32.3.3.1 Without Activation 32.3.3.2 With Activation 32.3.4 Functional Magnetic Resonance Imaging 32.3.5 Neurotransmitter Studies using SPECT and PET References 33 The Gut Microbiome in Anorexia Nervosa 33.1 Weight development 33.2 Immunology and Inflammation 33.3 Gut-Brain Axis References Part V Medical Complications and Somatic Comorbidity 34 Medical Complications in Anorexia Nervosa and Bulimia Nervosa 34.1 Physical Complaints and Laboratory Chemical Changes 34.2 Organ Manifestations 34.2.1 Cardiovascular System 34.2.2 Skeletal System 34.2.3 Gastrointestinal Tract 34.2.4 Skin and Teeth 34.2.5 Endocrine System 34.2.6 Kidney, Water, and Electrolyte Balance 34.2.7 The Refeeding Syndrome References 35 Gynecological Aspects in Anorexia Nervosa and Bulimia Nervosa 35.1 Hormonal Disorders 35.1.1 Occurrence of Menstrual Cycle Disorders 35.1.2 Primary Amenorrhea 35.1.3 Secondary Amenorrhea 35.1.4 Endocrine Pathomechanism 35.1.5 Oral Hormonal Contraceptives and Bone Metabolism 35.2 Fertility and Reproduction 35.3 Pregnancy and Birth 35.3.1 Anorexia nervosa 35.3.2 Bulimia nervosa 35.4 Conclusion and Recommendations References 36 Eating Disorders and Diabetes Mellitus 36.1 Eating disorders and type 1 diabetes 36.2 Diabetes Mellitus and Eating Disorders, a Coincidental Coincidence? 36.3 Insulin Dose and Weight Regulation (“Insulin Purging”) 36.4 Course of Eating Disorders in People with Diabetes Mellitus 36.5 Diagnosis and Treatment of Patients with Diabetes Mellitus and Eating Disorders References Part VI Treatment of Eating Disorders 37 Prevention of Eating Disorders 37.1 Types of Prevention 37.2 The “Diet Culture” 37.3 Target Areas for Primary Prevention of Eating Disorders 37.4 Efficacy of Prevention 37.4.1 Efficacy of Primary Prevention 37.4.2 Efficacy of Secondary Prevention 37.4.3 The Use of New Technologies in Primary, Secondary, and Tertiary Prevention 37.4.4 Joint Prevention Programs for Eating Disorders and Obesity References 38 Treatment of Eating Disorders in Childhood and Adolescence 38.1 Somatic rehabilitation and nutritional therapy 38.2 Individual Psychotherapeutic Treatment 38.3 Involvement of the Family 38.3.1 Group Psychoeducation for Parents 38.3.2 Family-Based Intervention 38.3.2.1 Conclusion 38.4 Treatment of Comorbidity and Medication 38.4.1 Anxiety Disorders 38.4.2 Social Phobia 38.4.3 Obsessive-Compulsive Disorder and Depression 38.4.4 Pharmacological Treatment 38.4.4.1 Anorexia Nervosa 38.4.4.2 Bulimia Nervosa References 39 Alternatives to Inpatient Treatment of Anorexia Nervosa in Childhood and Adolescence—Day Patient Treatment and Home Treatment 39.1 Disadvantages of inpatient treatment for children and adolescents 39.2 Day Patient Treatment 39.2.1 Practical Implementation 39.2.2 Efficacy of Day Patient Treatment 39.2.3 Multi-Family Therapy 39.3 Home Treatment 39.3.1 Advantages of Home Treatment (HoT) 39.3.2 Framework and Funding of HoT 39.3.3 Practical Implementation of HoT 39.3.4 Initial Results of HoT References 40 Family-Based Therapy 40.1 Introduction 40.2 Description of Family-Based Treatment 40.3 Efficacy of Family-Based Therapy 40.3.1 FBT in the German Guidelines for Diagnosis and Treatment of Eating Disorders 40.3.2 Who benefits most from FBT? 40.4 Current Developments 40.5 Limitations of the Application of Family-Based Therapy 40.6 Conclusion for Practice References 41 Psychodynamic Therapy 41.1 Foundations 41.2 Focal Psychodynamic Psychotherapy 41.3 Disorder-Specific Modifications of Psychodynamic Therapy 41.3.1 Anorexia Nervosa 41.3.2 Bulimia Nervosa 41.4 Binge Eating Disorder References 42 Cognitive Behavioral Therapy 42.1 General Approach and Standard Elements in the Treatment of Eating Disorders 42.2 Normalization of Eating Behavior 42.2.1 Cognitive Treatment Elements 42.2.2 Specific Aspects in the Treatment of Anorexia Nervosa 42.2.2.1 Weight Restoration 42.2.2.2 Motivation 42.2.3 SpecificAspects in the Treatment of Binge Eating-Related Eating Disorders 42.2.3.1 Emotion Regulation and Impulsivity 42.2.4 Third-Wave Cognitive Behavioral Therapy Methods in the Treatment of Eating Disorders 42.2.4.1 DBT 42.2.4.2 ACT 42.2.4.3 Schema Therapy 42.2.4.4 Mindfulness-Based Therapy 42.2.4.5 CFT 42.2.5 Effectiveness of Cognitive Behavioral Therapy in the Treatment of Eating Disorders 42.3 Conclusions References 43 Interpersonal Psychotherapy 43.1 Basics of Interpersonal Psychotherapy for Eating Disorders 43.1.1 Theoretical and Empirical Foundations of IPT 43.2 Eating Disorder Treatment through IPT 43.2.1 Initial Phase 43.2.2 Middle Phase 43.2.3 Final Phase 43.3 Scientific Foundation of IPT 43.3.1 IPT for Bulimia nervosa 43.3.2 IPT for Binge-Eating Disorder 43.3.3 IPT for Anorexia nervosa 43.4 Summary and Outlook References 44 Cognitive Remediation Therapy 44.1 Cognitive Inflexibility and Anorexia Nervosa 44.2 Set-shifting and Central Coherence 44.3 Translating Research Findings into a Targeted Intervention 44.4 Overview of the Intervention 44.5 Modules of the Intervention 44.6 Metacognitive Level 44.7 Example Presentation of the Exercises 44.8 Evidence 44.9 Conclusion for Practice References 45 Treatment of Body Image Disorders 45.1 Development of a Disturbance Model 45.2 Modification of Dysfunctional Body-Related Cognitions 45.3 Body Exposure via Mirror and Video 45.3.1 Goals 45.3.2 Procedure 45.4 Exposure Exercises for Reducing Body-Related Avoidance and Checking Behavior 45.5 Building Positive Body-Related Activities 45.6 Findings on the Effectiveness of Cognitive-Behavioral Interventions for Improving Body Image References 46 Pharmacotherapy of Eating Disorders 46.1 Anorexia Nervosa 46.1.1 Weight Restoration 46.1.2 Relapse Prevention 46.2 Bulimia Nervosa 46.2.1 Acute Therapy 46.2.2 Maintenance Therapy 46.2.3 Combination of Psychotherapy and Medication 46.2.4 Sequential Therapy 46.3 Binge Eating Disorder 46.3.1 Reduction of Binge Eating Episodes 46.3.2 Combination of Psychotherapy and Medication References 47 Neuromodulation in Eating Disorders 47.1 Introduction 47.2 Assumed Mechanisms of Action in the Treatment of Eating Disorders 47.3 Introduction to Neuromodulation Methods 47.3.1 Evidence regarding the effectivity of Non-invasive Neuromodulation in Eating Disorders 47.3.1.1 Treatment Goal Enhancement of Self-Control 47.3.1.2 Treatment Goal Reduction of Self-Control 47.3.1.3 Treatment Goal Reduction of Eating Disorder-Related Cognitions 47.4 Conclusion and Outlook References 48 Inpatient and Day Hospital Treatment for Eating Disorders 48.1 Significance of Inpatient and Day Hospital Treatment 48.1.1 Overall Treatment Planning 48.1.2 Differences Between Inpatient and Day Hospital Programs 48.1.3 Goals 48.1.4 Elements of Inpatient and Day Hospital Treatment 48.2 Anorexia Nervosa 48.2.1 Indication 48.2.2 Treatment Agreements 48.2.3 Characteristic Difficulties 48.3 Bulimia Nervosa 48.3.1 Indication 48.3.2 Treatment Agreements 48.4 Binge Eating Disorder 48.4.1 Indication 48.4.2 Goals 48.5 Conclusion References 49 Self-Help in Eating Disorders 49.1 Why Self-Help? 49.2 What is Self-Help? 49.3 Self-Help Guide 49.4 For Whom Is Self-Help Suitable? 49.5 Anorexia Nervosa 49.6 Bulimia Nervosa 49.7 Binge Eating Disorder 49.8 Conclusion and Outlook References 50 Use of Modern Media in Prevention and Treatment 50.1 Forms of Digital Interventions 50.2 Areas of Application for Digital Interventions 50.2.1 Prevention and Early Intervention 50.2.2 Self-help and Treatment 50.2.3 Aftercare and Relapse Prevention 50.3 Conclusion References 51 Involuntary Treatment in Anorexia Nervosa 51.1 Forced Treatment Under Guardianship Law 51.2 Coercive psychotherapy 51.3 Procedure for Coercive Measures 51.4 Treatment With Respect References 52 Treatment of Chronically Ill Patients 52.1 Definition of Terms 52.2 Initial Situation 52.3 Helpful Basic Principles in the Treatment of Chronically Ill Patients 52.3.1 Timing of Therapy Initiation 52.3.2 Transparency of Framework Conditions 52.3.3 Establishing Joint Therapy Goals 52.3.4 The Therapist as an Ally 52.3.5 Appeal to Personal Responsibility 52.3.6 Acceptance of the Protracted Length of Treatment 52.3.7 Voluntariness of Treatment 52.3.8 Integration into the Care Chain 52.3.9 “Right to Involuntary Admission” 52.3.10 Don't Give Up Hope References 53 Working with Family Members 53.1 Definitions and Context 53.2 Why Work with Family Members? 53.3 Burden on Family Members 53.4 Needs of Family Members 53.5 Goals and Contents of Working with Family Members 53.6 Interventions for Family Members 53.7 Summary and Outlook References 54 Relapse Prevention in Anorexia Nervosa 54.1 Relapses in Anorexia Nervosa 54.1.1 Protective and Risk Factors regarding Relapse 54.1.2 Care Situation and Risk of Relapse 54.2 Specifics of Relapse Prevention in AnorexiaNervosa 54.2.1 Importance 54.2.2 Treatment Goals 54.2.3 Treatment Elements 54.3 Therapy and Care Concepts 54.3.1 Guided Self-Help 54.3.2 Pharmacotherapy 54.3.3 Psychotherapy 54.3.4 Therapeutic residential groups References Part VII Definition, Classification, and Epidemiology of Obesity 55 Diagnosis and Etiology of Obesity 55.1 Diagnosis of Obesity 55.1.1 Anthropometry and Definition of Obesity 55.1.2 Methods for Measuring Body Composition 55.2 Causes of Obesity 55.2.1 Genetic Predisposition 55.2.2 Disturbance of Energy Intake 55.2.3 Regulation of Hunger and Satiety 55.2.4 Malnutrition 55.2.5 Significance of Macronutrients 55.2.6 Alcohol 55.2.7 Portion Sizes 55.2.8 Physical Inactivity, Immobility 55.3 Recording of Physical Activity 55.4 Low Socioeconomic Status 55.5 Sleep Deprivation—Disturbed Sleep 55.6 Diseases Associated With Obesity 55.7 Drugs and Weight Gain References 56 Epidemiology of Obesity 56.1 Introduction 56.2 Definition of Obesity in Epidemiological Studies 56.3 Global and Temporal Trends in Obesity Prevalence 56.4 Development of Individual BMI Over the Life Course 56.5 Determinants of the Rising Prevalence of Obesity References 57 Psychosocial Factors of Obesity in Childhood and Adolescence 57.1 Definition and Prevalence of Obesity 57.2 Social Stigmatization, Teasing, and Obesity 57.2.1 Negative Social Evaluation 57.2.2 Teasing 57.3 Psychological Disorders and Behavioral Problems 57.3.1 Affective Disorders 57.3.2 Anxiety Disorders 57.3.3 Externalizing Disorders 57.3.4 Loss of Control Eating and Binge Eating 57.3.5 Self-Esteem and Body Image 57.4 Quality of Life 57.5 Conclusion: Importance of Psychological Factors References 58 Socioeconomic Aspects of Obesity 58.1 Background 58.2 Model Proposal 58.2.1 Obesogenic Environment 58.2.2 Material Deprivation 58.2.3 Health Literacy 58.2.4 Psychosocial Stressors and Resources 58.2.5 Pre- and Perinatal Factors 58.2.6 Nutrition, Exercise Behavior, and Resting Metabolism 58.3 Modern Explanatory Approaches—The Life Course Perspective 58.4 Selection Thesis References 59 Genetic Aspects of Obesity 59.1 Twin and Adoption Studies 59.2 Monogenic Disorders 59.3 Association Studies 59.3.1 Candidate Gene Approach 59.3.1.1 Melanocortin Receptor 4 59.4 Polygenic Forms of Obesity 59.4.1 Polygenic Risk Scores 59.5 Conclusion References 60 Microbiome and Inflammation in Obesity 60.1 Gastrointestinal (GI) Microbiota 60.2 GI Microbiota in Obesity 60.3 GI Microbiota and Inflammation in Obesity 60.4 Influence of Diet and Lifestyle on the GI Microbiota in Obesity 60.5 Influence of Pro- and Prebiotics on GI Microbiota in Obesity References 61 Risk Factors of Obesity in Childhood and Adolescence 61.1 Background 61.2 Risk Factors and Causes 61.2.1 Social Inheritance 61.2.2 Genetics 61.2.3 Availability of Food and Portion Sizes 61.2.4 Sedentary and Resting Lifestyle 61.2.5 Industrialization and Globalization 61.2.6 Health Risks of Obesity 61.2.7 Risk Factors and Barriers References Part VIII Comorbidity of Obesity 62 Social and Psychosocial Consequences of Obesity: Weight-Related Stigmatization and Discrimination 62.1 Weight-related Stigmatization and Discrimination in Obesity 62.1.1 Professional Life 62.1.2 Healthcare 62.1.3 Childhood 62.1.4 Public Social Sphere 62.1.5 Media 62.1.6 State of Research 62.2 Psychosocial Consequences of Weight-Related Stigmatization and Discrimination 62.3 Conclusion and Outlook References 63 Obesity and Comorbid Mental Disorders 63.1 Mental Stress and Illnesses in Obesity 63.2 Psychosocial Stress 63.3 Psychosomatic Aspects of Obesity 63.4 Obesity and Depression 63.5 Pathological Hypercaloric Eating Behavior and Binge Eating Disorder 63.6 Obesity, Personality Traits, and Personality Disorders 63.7 Obesity and Addiction Disorders References 64 Metabolic Syndrome and Depression 64.1 Background 64.1.1 Prevalence 64.1.2 Definitions 64.1.3 Criticism of the Concept of Metabolic Syndrome 64.2 Epidemiology 64.2.1 Metabolic Syndrome 64.2.2 Depression 64.2.3 Metabolic Syndrome and Mental Disorders 64.3 Relationship Between Metabolic Syndrome and Depression 64.4 Therapy 64.4.1 General Aspects 64.4.2 Treatment Principles 64.4.3 Efficacy References 65 Tobacco Dependence in Eating Disorders and Obesity 65.1 Foundations of Tobacco Dependence 65.1.1 Neurobiological Aspects of Tobacco Dependence 65.1.2 Psychosocial Aspects of Tobacco Addiction 65.2 Diagnosis of Tobacco Addiction 65.3 Tobacco Addiction and Eating Disorders 65.4 Factors Associated with Increased Smoking Prevalence in Eating Disorders 65.4.1 Weight Control and Weight Concerns 65.4.2 Emotion Regulation 65.4.3 Genetic Factors 65.5 Smoking and Obesity 65.6 Weight Gain Due to Tobacco Abstinence 65.7 Treatment of Tobacco Dependence 65.7.1 Medicinal Treatment Options 65.7.2 Motivational Interviewing and Psychotherapy 65.8 Tobacco Cessation in Patients with Eating Disorders References 66 Impulsivity and Obesity 66.1 Impulsivity 66.1.1 Food-Associated Impulsivity in Obesity 66.1.2 Food-Independent Impulsivity in Obesity 66.2 Impulsive Disorders and Obesity 66.2.1 Obesity and Binge Eating Disorder 66.2.2 Obesity and Attention Deficit/Hyperactivity Disorder(ADHD) 66.2.3 Obesity and Self-Harming Behaviors 66.3 Conclusion References 67 Obesity and Binge Eating Disorder 67.1 Obesity with Binge Eating Disorder 67.2 Etiology of Binge Eating Disorder 67.3 Specifics of Obesity with Binge Eating Disorder 67.4 Psychotherapeutic Treatment Approaches for Obesity with Binge Eating Disorder 67.5 Psychotherapeutic Treatment Approaches for Binge Eating Disorder References Part IX The Treatment of Obesity 68 Prevention of Obesity 68.1 Background 68.2 Concepts and Efficacy of Measures for Primary Prevention of Obesity Relating to Lifestyle and Living Environment 68.2.1 Strategies for Behavioral and Contextual Prevention 68.2.2 How Effective are Measures of Behavioral and Structural Prevention of Obesity? 68.2.3 What are Suitable Times for Prevention of Obesity in Children and Adolescents? 68.2.4 What are Suitable Settings for Obesity Prevention? 68.3 Prevention of Obesity—What’s Next? References 69 Treatment of Obesity in Childhood and Adolescence 69.1 Indication 69.2 Treatment Goals 69.3 Approach and Treatment Components 69.3.1 Education Programs 69.3.1.1 Nutritional Therapy 69.3.1.2 Exercise Therapy 69.3.1.3 Behavioral Therapy Methods 69.3.1.4 Involvement of Parents or Caregivers 69.3.1.5 Long-Term Care 69.3.1.6 Group vs. Individual Therapy 69.3.1.7 Prognostic Factors for Successful Treatment 69.3.2 Other Therapies 69.3.3 Possible Side Effects of Treatment References 70 Family-Based Approaches to Treatment 70.1 Introduction 70.1.1 Family Contribution to the Development of Obesity 70.1.1.1 Genetic Contribution vs. Lifestyle 70.1.1.2 Influence of Social Status and Migration Background 70.1.2 Basic Principles of Family Therapy for Chronic Diseases 70.2 Family-Based Treatment Approaches 70.2.1 Family Imprinting in Infancy and Preschool Age 70.2.1.1 Nutritional Behavior 70.2.1.2 Physical Activity Behavior 70.2.1.3 Media Consumption 70.2.2 Importance of Parenting Skills for Treatment 70.2.2.1 Inconsistent parenting style 70.2.2.2 Limited Parenting Ability Due to Mental Illness 70.2.3 Effects of Everyday Structure 70.3 Problem Areas of Family-Based Approaches 70.3.1 Psychosocial Stress Situations 70.3.2 Specifics in Families with Migration Background 70.3.3 Resource-Oriented Treatment Strategies 70.4 Conclusion and Implications References 71 Fad Diets and Commercial Programs 71.1 Requirements for a Diet 71.2 Classification of Diets for Weight Loss 71.3 Evaluation of Diet Programs 7