Category: Eating Disorders

— Overwhelmed by tons of daily diet advice? If only we knew which diet tips to follow.

According to a new finding by a team of Cornell University researchers, dieters who focus on changing their surroundings find it easier to adhere to their diet. Understandably, they also report losing the most weight.

The researchers, led by Brian Wansink, Director of the Cornell Food and Brand Lab, presented their findings at the Experimental Biology conference in Anaheim, Calif.

For the study, 200 participants from the National Mindless Eating Challenge (predecessor of the MindlessMethod.com) were given diet tips from three distinct categories: 1) change your environment, 2) change your eating behavior, and 3) change your food choices.

"We found that dieters who were given stylized environmental tips — such as use a 10-inch plate, move the candy dish, or rearrange their cupboards — stuck to their diets an average of two more days per month," said Wansink, author of the book, Mindless Eating: Why We Eat More Than We Think.

In this three-month study, people reported losing 1 to 2 pounds per month per tip. What made the biggest difference? "Consistency," Wansink said, "If a person was able to follow a tip for at least 20 days each month, changes really started to happen."

What are some examples of environmental changes? Wansink advises using smaller dinner plates, keeping high calorie foods out of sight, and turning off the television, computer and cell phones during mealtime.

"These types of changes are much easier to follow than saying you will eat smaller meals, substitute fruit for sweets, or give up chocolate and French fries," he added.

The National Mindless Eating Challenge was the predecessor of the Mindless Method (MindlessMethod.com). It focused on helping people eliminate or reverse the hidden cues that determine what, when and how much they eat.

Psychological acupuncture has been shown to be successful in reducing food cravings for up to six months in people who are overweight or obese.

The technique combines gentle tapping on pressure points while focussing on particular emotions and thoughts.

Psychologist Dr Peta Stapleton, an academic title holder in Griffith University's School of Medicine, said the technique was painless and easy to learn.

Her research also showed the impact on food cravings was almost immediate and long lasting. Food cravings significantly reduced after just four, two-hour sessions and were maintained at a six-month follow-up.

"Participants in the trial were surprised by how quickly the technique works — that it doesn't take a lot of time to eliminate food cravings they may have had for many years," Dr Stapleton said.

She said common cravings were for sweet carbohydrates such as cakes and chocolate or salty foods such as chips and savoury biscuits.

"Food cravings play a big role in people's food consumption and ultimately their body weight. If we can beat the cravings without the need for willpower or conscious control of behaviour, then weight loss is also possible."

While the study did not show any significant impact on body weight or body mass index (BMI) after six months, the results of a 12-month follow-up are still being analysed.

Dr Stapleton, who specialises in the management of eating disorders, said some participants had actually forgotten they had a previous problem with food cravings until they were reminded at the six-month follow-up.

She said because the technique helps over-ride emotional eating at a sub-conscious level, it was more likely to be effective in the long-term.

Psychological acupuncture, also known as the emotional freedom technique (EFT), has also been used to manage clinical issues such as post traumatic stress disorder, phobias and addictions.

The results of the study will be presented at the International Congress of Applied Psychology in Melbourne in July.

 A group of women in a new study seemed unlikely to have body image issues — at least their responses on a tried-and-true psychological screening presented no red flags.

That assessment changed when Brigham Young University researchers used MRI technology to observe what happened in the brain when people viewed images of complete strangers.

If the stranger happened to be overweight and female, it surprisingly activated in women's brains an area that processes identity and self-reflection. Men did not show signs of any self-reflection in similar situations.

"These women have no history of eating disorders and project an attitude that they don't care about body image," said Mark Allen, a BYU neuroscientist. "Yet under the surface is an anxiety about getting fat and the centrality of body image to self."

Allen makes his report with grad student Tyler Owens and BYU psychology professor Diane Spangler in the May issue of the psychological journal Personality and Individual Differences.

Spangler and Allen collaborate on a long-term project to improve treatment of eating disorders by tracking progress with brain imaging. When anorexic and bulimic women view an overweight stranger, the brain's self-reflection center — known as the medial prefrontal cortex — lights up in ways that suggest extreme unhappiness and in some cases, self-loathing.

The motivation for this new study was to establish a point of reference among a control group of women who scored in the healthy range on eating disorder diagnostic tests. Surprisingly, even this control group exhibited what Allen calls "sub-clinical" issues with body image.

Seeing that, Allen and Owens ran the experiments with a group of men for comparison.

"Although these women's brain activity doesn't look like full-blown eating disorders, they are much closer to it than men are," Allen said.

Spangler says women are bombarded with messages that perpetuate the thin ideal, and the barrage changes how they view themselves.

"Many women learn that bodily appearance and thinness constitute what is important about them, and their brain responding reflects that," Spangler said. "I think it is an unfortunate and false idea to learn about oneself and does put one at greater risk for eating and mood disorders."

"It's like the plant in my office," she continued."It has the potential to grow in any direction, but actually only grows in the direction of the window — the direction that receives the most reinforcement."

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Journal Reference:

1. Owens, T.E., Allen, M.D., Spangler, D.L. An fMRI study of self-reflection about body image: Sex differences. Personality and Individual Differences, 2010; 48 (7): 849 DOI: 10.1016/j.paid.2010.02.012

 Diagnostic cutoffs for anorexia nervosa and bulimia nervosa may be too strict, a study from the Stanford University School of Medicine and Lucile Packard Children's Hospital has found. Many patients who do not meet full criteria for these diseases are nevertheless quite ill, and the diagnosis they now receive, "Eating Disorder Not Otherwise Specified," may delay their ability to get treatment.

"There's mounting evidence that we should reconsider the EDNOS categorization for young people," said Rebecka Peebles, MD, the study's primary author.

The EDNOS diagnosis has become a "mosh pit," lumping dissimilar patients into a single category that gets poor recognition from clinicians and health insurers, she said. "It is a bit misleading to patients — it can make them feel like they don't have a real eating disorder," said Peebles, an instructor in pediatrics at Stanford and an adolescent medicine specialist with the Comprehensive Eating Disorders Program at Packard Children's Hospital.

Anorexia and bulimia affect about 1 percent and between 2 and 5 percent of teen girls, respectively, and both diseases are more common among females than males. Their diagnostic criteria were developed by expert consensus, without the benefit of studies to track patients' health. An anorexia diagnosis is now based on being at less than 85 percent of the expected body weight, loss of menstrual periods for at least three months and fear of weight gain despite being dangerously thin. Bulimia patients repeatedly binge on large quantities of food, then "purge" calories by vomiting, abusing laxatives or diuretics, or overexercising. Both diseases can cause serious long-term health problems, and severe cases may lead to death.

Peebles' team conducted the first-ever large study to ask whether adolescents with EDNOS are less ill than those who meet the full diagnostic criteria for anorexia or bulimia. The research, which will be published online April 12 in Pediatrics, examined records from all 1,310 female patients treated for eating disorders at Packard Children's between January 1997 and April 2008. They verified patients' diagnoses of anorexia, bulimia or EDNOS, and created categories of "partial anorexia nervosa" and "partial bulimia nervosa" to analyze patients who barely missed cutoffs for these diseases.

"Our purpose was to ask if the diagnostic criteria now in use are really separating out the sickest of the sick," Peebles said. Patients' conditions were assessed by noting signs of malnutrition — such as low heart rate, low blood pressure, low body temperature, low blood levels of potassium and phosphorus — and long QT interval (an electrocardiogram measurement linked to risk of sudden cardiac death).

Nearly two-thirds of the patients studied had EDNOS. As the researchers suspected, the EDNOS category acted as a catchall; patients with partial anorexia were more similar to those with full-blown anorexia than to other EDNOS patients with partial bulimia, for instance. In addition, 60 percent of EDNOS patients met medical criteria for hospitalization and this group was, on average, sicker than patients diagnosed with full-blown bulimia.

The sickest EDNOS patients were those who had dropped more than 25 percent of their body weight before diagnosis. These patients had been overweight and had lost weight too quickly and dangerously in order to end up at what is typically considered a normal weight.

"People were initially just patting them on the back for their weight loss," Peebles said. "It often took months or years for others to realize that what they were doing didn't seem healthy." Despite their normal body weights, this group was in some ways worse off than underweight patients diagnosed with anorexia, she added. "They manifested criteria of severe malnutrition."

In sum, Peebles said, the study suggests that medical criteria for eating disorders should be re-evaluated. Though the current diagnostics cover the right general areas, "we erroneously treat these criteria in a very black-and-white way," she said. "Many practitioners interpret these to believe that menses has to be lost to get an anorexia diagnosis; bulimics have to binge and purge at least two times a week for three months. These findings illustrate the arbitrary nature of those cutoffs."

The issue is particularly urgent because many health insurers offer less coverage for EDNOS treatment than for treatment of anorexia or bulimia. And doctors and parents may be falsely reassured if a child is labeled with EDNOS.

"I think that when parents walk out of a doctor's office having heard their kid doesn't meet criteria for anorexia, they're relieved," Peebles said. But they shouldn't let their guard down: in many cases, the child's disturbed eating patterns still need treatment.

The Stanford collaborators on Peebles' team were Jenny Wilson, MD, a resident in pediatrics, and James Lock, MD, PhD, professor of psychiatry and behavioral sciences and of pediatrics. The study was funded by the Stanford Pediatric Research Fund and the American Heart Association, with additional support from the Stanford Medical Scholars Research Program and the National Institutes of Health.

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Journal Reference:

1. Rebecka Peebles, Kristina K. Hardy, Jenny L. Wilson, and James D. Lock. Are Diagnostic Criteria for Eating Disorders Markers of Medical Severity?Pediatrics, 2010 DOI: 10.1542/peds.2008-1777

A new study finds that a self-guided, 12-week program helps binge eaters stop binging for up to a year and the program can also save money for those who participate. Recurrent binge eating is the most common eating disorder in the country, affecting more than three percent of the population, or nine million people, yet few treatment options are available.

But a first-of-a-kind study conducted by researchers at the Kaiser Permanente Center for Health Research, Wesleyan University and Rutgers University found that more than 63 percent of participants had stopped binging at the end of the program — compared to just over 28 percent of those who did not participate. The program lasted only 12 weeks, but most of the participants were still binge free a year later. A second study, also published in the April issue of the Journal of Consulting and Clinical Psychology, found that program participants saved money because they spent less on things like dietary supplements and weight loss programs.

"It is unusual to find a program like this that works well, and also saves the patient money. It's a win-win for everyone," said study author Frances Lynch, PhD, MSPH, a health economist at the Kaiser Permanente Center for Health Research. "This type of program is something that all health care systems should consider implementing."

"People who binge eat more than other people do during a short period of time and they lose control of their eating during these episodes. Binge eating is often accompanied by depression, shame, weight gain, loss of self-esteem and it costs the healthcare system millions of extra dollars," said the study's principal investigator Ruth H. Striegel-Moore, PhD, a professor of psychology at Wesleyan University. "Our studies show that recurrent binge eating can be successfully treated with a brief, easily administered program, and that's great news for patients and their providers."

Binge eating has received a lot of media attention recently because the American Psychiatric Association is recommending that it be considered a separate, distinct eating disorder like bulimia and anorexia. This new diagnosis can be expected to focus more attention on binge eating and how best to treat it, according to the researchers. It also could influence the number of people diagnosed and how insurers will cover treatment.

This randomized controlled trial, conducted in 2004-2005, involved 123 members of the Kaiser Permanente health plan in Oregon and southwest Washington. More than 90 percent of them were women, and the average age was 37. To be included in the study, participants had to have at least one binge eating episode a week during the previous three months with no gaps of two or more weeks between episodes.

Half of the participants were enrolled in the intervention and asked to read the book "Overcoming Binge Eating" by Dr. Christopher Fairburn, a professor of psychiatry and expert on eating disorders. The book details scientific information about binge eating and then outlines a six-step self-help program using self-monitoring, self-control and problem-solving strategies. Participants in the study attended eight therapy sessions over the course of12 weeks in which counselors explained the rationale for cognitive behavioral therapy and helped participants apply the strategies in the book. The first session lasted one hour, and subsequent sessions were 20-25 minutes. The average cost of the intervention was $167 per patient.

All participants were mailed fliers detailing the health plan's offerings for healthy living and eating and encouraged to contact their primary care physician to learn about more services.

By the end of the 12-week program 63.5 percent of participants had stopped binging, compared to 28.3 percent of those who did not participate. Six months later, 74.5 percent of program participants abstained from binging, compared to 44.1 percent in usual care. At one year, 64.2 percent of participants were binge free, compared to 44.6 percent of those in usual care.

Everyone in the trial was asked to provide extensive information about their binge eating episodes, how often they missed work or were less productive at work, and the amount they spent on health care, weight-loss programs and weight loss supplements. Researchers also examined expenditures on medications, doctor visits, and other health-related services.

The researchers then compared these costs between the two groups and found that average total costs were $447 less in the intervention group. This included an average savings of $149 for the participants, who spent less on weight loss programs, over-the-counter medications and supplements. Total costs for the intervention group were $3,670 per person per year, and costs for the control group were $4,098.

As expected, participants in the intervention group spent less on weight loss programs and over-the-counter medications and supplements.

"While program results are promising, we highly encourage anyone who has problems with binge eating to consult with their doctors to make sure this program is right for them," said study co-author Lynn DeBar, PhD, clinical psychologist at the Kaiser Permanente Center for Health Research.

Study authors include: Lynn DeBar, John F. Dickerson, Frances Lynch and Nancy Perrin from the Kaiser Permanente Center for Health Research in Portland, Oregon; Ruth H. Striegel-Moore and Francine Rosselli from Wesleyan University; G. Terence Wilson from Rutgers, The State University of New Jersey; and Helena C. Kraemer from the Stanford University School of Medicine.

Undergraduate women who join a sorority are more likely to judge their own bodies from an outsider's perspective (known as self-objectification) and display higher levels of bulimic attitudes and behaviors than those who do not take part in the sorority's recruitment process. Over time, those women who join the group also show higher levels of body shame.

These findings, part of Ashley Marie Rolnik's senior honors thesis at Northwestern University in the US, are published online in Springer's journal Sex Roles.

On college campuses across the US, thousands of women join sororities every year through a structured recruitment process — the sorority rush. Although these sisterhoods provide college women with opportunities for personal growth and enrichment, they have been criticized for their potential to lead their members to focus excessively and unhealthily on their appearance.

Rolnik's study is the first to test objectification theory (which links self-objectification to body dissatisfaction and shame, eating disorders and associated behaviors) outside the laboratory in a real-life context. They surveyed 127 first-year college women aged 17-20 years at a US Midwestern University to investigate the relationship between participation in a sorority rush, self-objectification, and eating disorder behaviors. The students were split into two groups: those who went through the recruitment process and joined the sorority, and those who did not take part in any aspect of the rush. At four different time points (before the rush; a few days into the rush; on the day the bids to join are received; and one month after the rush), participants completed online questionnaires.

Levels of self-objectification and disordered eating behaviors were higher among rush participants than among women who did not take part, throughout the study period. A month after the rush, new members also displayed higher levels of body shame. Those women with higher body weights were more likely to drop out of the rush process and feel dissatisfied with it, even though those who dropped out were not overweight but simply less thin than those who joined the sorority. These findings suggest that sorority membership may exacerbate pre-existing, problematic attitudes and behaviors.

The authors conclude: "Interventions aimed at reducing sorority women's focus on physical appearance may hold promise as one of the many routes to addressing body image disturbance and eating disorders among sorority members. As sororities are very powerful at influencing the norms and ideals of their members, a move away from a focus on appearance and towards a set of norms that encourages healthy eating habits and more positive approaches to body image has real potential."

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Journal Reference:

1. Rolnik AM, Engeln-Maddox R, Miller SA. Here's Looking at You: Self-Objectification, Body Image Disturbance, and Sorority Rush. Sex Roles, 2010; DOI: 10.1007/s11199-010-9745-y

 Eating chocolate may lower your risk of having a stroke, according to an analysis of available research that was released February 11 and will be presented at the American Academy of Neurology's 62nd Annual Meeting in Toronto April 10 to April 17, 2010. Another study found that eating chocolate may lower the risk of death after suffering a stroke.

The analysis involved reviewing three studies on chocolate and stroke.

"More research is needed to determine whether chocolate truly lowers stroke risk, or whether healthier people are simply more likely to eat chocolate than others," said study author Sarah Sahib, BScCA, with McMaster University in Hamilton, Ontario, Canada. Sahib worked alongside Gustavo Saposnik, MD, MSc, where the study was completed at St. Michael's Hospital and the University of Toronto.

Chocolate is rich in antioxidants called flavonoids, which may have a protective effect against stroke, but more research is needed.

The first study found that 44,489 people who ate one serving of chocolate per week were 22 percent less likely to have a stroke than people who ate no chocolate. The second study found that 1,169 people who ate 50 grams of chocolate once a week were 46 percent less likely to die following a stroke than people who did not eat chocolate.

The researchers found only one additional relevant study in their search of all the available research. That study found no link between eating chocolate and risk of stroke or death.

The American Psychiatric Association has released the proposed draft diagnostic criteria for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM). The draft criteria represent content changes under consideration for DSM, which is the standard classification of mental disorders used by mental health and other health professionals, and is used for diagnostic and research purposes.

"These draft criteria represent a decade of work by the APA in reviewing and revising DSM," said APA President Alan Schatzberg, M.D. "But it is important to note that DSM-5 is still very much a work in progress — and these proposed revisions are by no means final." The proposed diagnostic criteria will be available for public comment until April 20, and will be reviewed and refined over the next two years. During this time, the APA will conduct three phases of field trials to test some of the proposed diagnostic criteria in real-world clinical settings.

Proposed revisions

Members of 13 work groups, representing different categories of psychiatric diagnoses, have reviewed a wide body of scientific research in the field and consulted with a number of expert advisors to arrive at their proposed revisions to DSM. Among the draft revisions are the following:

• The recommendation of new categories for learning disorders and a single diagnostic category, "autism spectrum disorders" that will incorporate the current diagnoses of autistic disorder, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified). Work group members have also recommended that the diagnostic term "mental retardation" be changed to "intellectual disability," bringing the DSM criteria into alignment with terminology used by other disciplines.
• Eliminating the current categories substance abuse and dependence, replacing them with the new category "addiction and related disorders." This will include substance use disorders, with each drug identified in its own category.
• Eliminating the category of dependence will better differentiate between the compulsive drug-seeking behavior of addiction and normal responses of tolerance and withdrawal that some patients experience when using prescribed medications that affect the central nervous system.
• Creating a new category of "behavioral addictions," in which gambling will be the sole disorder. Internet addiction was considered for this category, but work group members decided there was insufficient research data to do so, so they recommended it be included in the manual's appendix instead, with a goal of encouraging additional study.
• New suicide scales for adults and adolescents to help clinicians identify those individuals most at risk, with a goal of enhancing interventions across a broad range of mental disorders; the scales include research-based criteria such as impulsive behavior and heavy drinking in teens.
• Consideration of a new "risk syndromes" category, with information to help clinicians identify earlier stages of some serious mental disorders, such as neurocognitive disorder (dementia) and psychosis.
• A proposed new diagnostic category, temper dysregulation with dysphoria (TDD), within the Mood Disorders section of the manual. The new criteria are based on a decade of research on severe mood dysregulation, and may help clinicians better differentiate children with these symptoms from those with bipolar disorder or oppositional defiant disorder.
• New recognition of binge eating disorder and improved criteria for anorexia nervosa and bulimia nervosa, as well as recommended changes in the definitions of some eating disorders now described as beginning in infancy and childhood to emphasize that they may also develop in older individuals.

The APA has prepared detailed press releases on each of these topics, which are available on the DSM-5 Web site.

Dimensional Assessments

In addition to proposed changes to specific diagnostic criteria, the APA is proposing that "dimensional assessments" be added to diagnostic evaluations of mental disorders. These would permit clinicians to evaluate the severity of symptoms, as well as take into account "cross-cutting" symptoms that exist across a number of different diagnoses (such as insomnia or anxiety).

"We know that anxiety is often associated with depression, for example, but the current DSM doesn't have a good system for capturing symptoms that don't fit neatly into a single diagnosis, said David Kupfer, M.D., chair of the DSM-5 Task Force. "Dimensional assessments represent an important benefit for clinicians evaluating and treating patients with mental illness. It may help them better evaluate how a patient is improving with treatment, help them address symptoms that affect a patient's quality of life and better assess patients whose symptoms may not yet be severe — leading to earlier effective treatment."

Careful Consideration of Gender, Race and Ethnicity

The process for developing the proposed diagnostic criteria for DSM-5 has included careful consideration of how gender, race and ethnicity may affect the diagnosis of mental illness. The team has sought significant involvement of women, members of diverse racial and ethnic groups, and international researchers and clinicians. The APA also designated a specific study group to review and research these issues, and ensure they were taken into account in the development of diagnostic criteria.

The Gender and Cross-Cultural Study Group reviewed epidemiological data sets from the United States and other countries to determine if there were significant differences in incidence of mental illness among different subgroups (e.g., gender, race and ethnicity) that might indicate a bias in currently-used diagnostic criteria, including conducting meta-analyses (additional analyses combining data from different studies). Group members reviewed the literature from a broad range of international researchers who have explored issues of gender, ethnic and racial differences for specific diagnostic categories of mental illness. The study group also considered whether there was widespread cultural bias in criteria for specific diagnoses.

As a result of this process, the study group has tried to determine whether the diagnostic categories of mental illness in DSM need changes in order to be sensitive to the various ways in which gender, race and culture affect the expression of symptoms.

Public Review of Proposed Revisions

The resulting recommendations for revisions to the current DSM are being posted on the APA's Web site for the manual, www.DSM5.org, for public review and written comment. These comments will be reviewed and considered by the relevant DSM-5 Work Groups.

"The process for developing DSM-5 continues to be deliberative, thoughtful and inclusive," explained Dr. Kupfer. "It is our job to review and consider the significant advances that have been made in neuroscience and behavioral science over the past two decades. The APA is committed to developing a manual that is both based on the best science available and useful to clinicians and researchers."

Overview of DSM-5 Development Process

The last edition of DSM was published in 1994. Beginning in 2000, during the initial phase of revising DSM, the APA engaged almost 400 international research investigators in 13 NIH supported conferences. In order to invite comments from the wider research, clinical and consumer communities, the APA launched a DSM-5 Prelude Web site in 2004 to garner questions, comments, and research findings during the revision process.

Starting in 2007, the DSM-5 Task Force and Work Groups, made up of over 160 world-renowned clinicians and researchers, were tasked with building on the previous seven years of scientific reviews, conducting additional focused reviews, and garnering input from a wide range of advisors as the basis for proposing draft criteria. In addition to the work groups in diagnostic categories, there were study groups assigned to review gender, age and cross-cultural issues.

Based on the upcoming comments to the draft criteria and findings of the field trials, the work groups will propose final revisions to the diagnostic criteria in 2012. The final draft of DSM-5 will be submitted to the APA's Assembly and Board of Trustees for their review and approval. A release of the final, approved DSM-5 is expected in May 2013.

Ever get a buzz from eating chocolate? A study published in the open access journal BMC Neuroscience has shown that chocolate-craving mice are ready to tolerate electric shocks to get their fix.

Rossella Ventura worked with a team of researchers from the Santa Lucia Foundation, Rome, Italy, to study the links between stress and compulsive food-seeking. She said, “We used a new model of compulsive behavior to test whether a previous stressful experience of hunger might override a conditioned response to avoid a certain kind of food – in this case, chocolate”.

Ventura and her colleagues first trained well-fed mice and starved mice to seek chocolate in one chamber rather than going into an empty chamber. Then, they added a mild electric shock to the chamber containing the chocolate. Unsurprisingly, the well-fed animals avoided the sweet treat.  However, mice that had previously been starved, before being allowed to eat their way back up their normal weight, resisted this conditioning – continuing to seek out chocolate despite the painful consequences.

This is an index of compulsive behavior and the researchers claim that this matches compulsive food seeking in the face of negative consequences in humans.

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Journal Reference:

1. Emanuele Claudio Latagliata, Enrico Patrono, Stefano Puglisi-Allegra and Rossella Ventura. Food seeking in spite of harmful consequences is under prefrontal cortical noradrenergic control. BMC Neuroscience, 2010 11:15 DOI: 10.1186/1471-2202-11-15

A pioneering international study involving academics from the University of Sheffield has shown for the first time that it is possible to improve the eating skills and nutritional status of older people with dementia.

The study, which was published in the International Journal of Geriatric Psychiatry and funded by the National Health Research Institutes of Taiwan, tested two separate intervention methods to assess the eating patterns of dementia patients in Taiwan.

Loss of memory and problems with judgement in dementia patients can cause difficulties in relation to eating and nutrition. Poor eating habits in patients have been associated with poor quality of life and can lead to pressure ulcers and infections.

The study used two different step-by-step training programmes to help older people with dementia regain eating skills which are commonly lost. The methods were then compared with no intervention. Patients were tested using a range of measures including their feeding difficulty score and nutritional assessment. Results showed that both methods of intervention reduced their difficulty feeding score and improved their nutritional assessment when compared with no intervention.

The study was led by Professor Li-Chan Lin, a former Leverhulme Visiting Professor at the University of Sheffield, from the National Yang-Min University in Taipei, Taiwan. Professor Roger Watson, from the University of Sheffield´s School of Nursing and Midwifery, developed the primary measure for feeding difficulty and also consulted with the author on the design of the study and interpretation of the results.

Professor Watson said: "Nutritional problems of older people with dementia are dangerous for the person with dementia, distressing for friends and relatives and very hard to treat. This is just a start, but the study demonstrates that something can be done and it lays the foundation for a promising line of enquiry."

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Journal Reference:

1. Lin et al. Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia. International Journal of Geriatric Psychiatry, 2010; DOI: 10.1002/gps.2433