• Are Trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction

      Treasure, Janet; Leslie, Monica; Chami, Rayane; Fernández-Aranda, Fernando; King's College London; University Hospital of Bellvitge and CIBERobn (ISCIII)
      Explanatory models for eating disorders have changed over time to account for changing clinical presentations. The transdiagnostic model evolved from the maintenance model, which provided the framework for cognitive behavioural therapy for bulimia nervosa. However, for many individuals (especially those at the extreme ends of the weight spectrum), this account does not fully fit. New evidence generated from research framed within the food addiction hypothesis is synthesised here into a model that can explain recurrent binge eating behaviour. New interventions that target core maintenance elements identified within the model may be useful additions to a complex model of treatment for eating disorders.
    • The Neural Correlates of a Central Coherence Task in Young Women with Anorexia Nervosa

      Leslie, Monica; Halls, Daniel; Leppanen, Jenni; Sedgewick, Felicity; Lang, Katie; Fonville, Leon; Simic, Mima; Mandy, William; Nicholls, Dasha; Williams, Steven; et al. (Wiley, 2021-07-18)
      Objective: Heightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples. Methods: We recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan. Results: There were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task. Conclusions: These findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.
    • A Novel Approach for Autism Spectrum Condition patients with Eating Disorders: Analysis of Treatment Cost-savings

      Tchanturia, Kate; Dandil, Yasemin; Li, Zhuo; Smith, Katherine; Leslie, Monica; Byford, Sarah; King's College London; South London and Maudsley NHS Foundation Trust; Illia University (Wiley, 2020-07-10)
      Objective: In the current economic context, it is critical to ensure that eating disorder (ED) treatments are both effective and cost-effective. We describe the impact of a novel clinical pathway developed to better meet the needs of autistic patients with EDs on the length and cost of hospital admissions. Method: The pathway was based on the Institute for Healthcare’s Model of Improvement methodology, using an iterative Plan, Do, Study, Act format to introduce change and to co-produce the work with people with lived experience and with healthcare professionals. We explored the change in length and cost of admissions before and after the pathway was introduced. Results: Preliminary results suggest that the treatment innovations associated with this pathway have led to reduced lengths of admission for patients with the comorbidity, which were not seen for patients without the comorbidity. Estimated cost-savings were approximately £22,837 per patient and approximately £275,000 per year for the service as a whole. Conclusion: Going forward, our aim is to continue to evaluate the effectiveness and cost-effectiveness of investment in the pathway to determine whether the pathway improves the quality of care for patients with a comorbid ED and autism and is good value for money.
    • Testing the addictive appetite model of binge eating: The importance of craving, coping, and reward enhancement

      Leslie, Monica; Turton, Robert; Burgess, Emilee; Nazar, Bruno; Treasure, Janet; King's College London; University of Alabama at Birmingham; Federal University of Rio de Janeiro
      In the current study, we examine components of the “addictive appetite” model of recurrent binge eating. Specifically, we tested the influence of addictive processes and the influence of emotional regulation processes on recurrent binge eating behaviour. We recruited 79 women in total for the current study; 22 with bulimia nervosa, 26 weight-matched lean comparison women, 15 women with binge eating disorder, and 16 weight-matched overweight/obese comparison women. Participants completed questionnaire assessments of food craving and motivations for eating. Compared to weight-matched comparison women, women with binge-type eating disorders endorse significantly greater levels of food craving, eating for purposes of coping, and eating for purposes of reward enhancement. A cluster analysis revealed that these three traits distinguish women with binge-type eating disorders from weight-matched comparison women. These findings provide support for the addictive appetite model of binge eating behaviour, and highlight addictive and emotional regulation processes as potential targets for treatment.