Lucero Munguía

Obesity is a major contributor to chronic disease and multimorbidity, leading to progressively increasing clinical complexity across the life course. However, the relationship between obesity and overall clinical complexity remains insufficiently characterized, particularly at the population level, where territorial and socioeconomic inequalities should also be considered. In this review, we summarize the current evidence and complement it with an in-depth characterization of the demographic, socioeconomic, clinical, and healthcare utilization burden associated with obesity in a population of 8 million people in Catalonia, Spain. Beyond individual comorbidities, we examine multimorbidity using a comprehensive risk stratification measure and evaluate the impact of obesity on healthcare resource utilization and expenditure. Obesity was more prevalent among women and socioeconomically disadvantaged populations and followed a marked geographic deprivation gradient. Compared with a reference population standardized by age, sex, and socioeconomic status, individuals with obesity had a substantially greater multimorbidity burden, with 13% classified as high risk according to the AMG index versus 5% of the reference population. They also had greater healthcare utilization, including 4.5 additional primary care visits and 2.4 more prescribed medications per person annually. Mean annual healthcare expenditure reached €2,633 per person, representing a 108% increase compared with the reference population, while the total healthcare expenditure attributable to obesity was estimated at €2.1 billion in 2023. These findings underscore the substantial impact of obesity on multimorbidity, healthcare utilization, and healthcare expenditure, reinforcing the need for policies that address both obesity and its underlying socioeconomic determinants.

Background/Objectives: Sociocultural factors, including migration and acculturation, may influence the clinical profile and course of eating disorders (EDs). This study examined differences between immigrant and native-born Spanish patients with EDs in (1) clinical presentation and (2) treatment response. Methods: Consecutive outpatients from the Eating Disorders Unit at Bellvitge University Hospital (Barcelona, Spain) were assessed using the Eating Disorder Inventory-2 (EDI-2), Symptom Checklist-90-R (SCL-90-R), and Temperament and Character Inventory-Revised (TCI-R). Statistical analyses included chi-square tests, ANOVA, Cox regression for dropout, and logistic regression for predictors of poor outcome, adjusted for ED subtype. Results: The sample included 1104 patients (947 native-born; 157 immigrants). Immigrant patients showed a distinct clinical profile, with lower drive for thinness and body dissatisfaction but higher interpersonal distrust, maturity fears, perfectionism, anxiety-related symptoms, and self-transcendence. They also presented a worse treatment response, including higher dropout rates, poorer outcomes, and lower remission rates. Predictive models identified different risk factors for poor treatment response in each group: among native-born patients, younger age of ED onset, higher novelty seeking, and lower self-directedness were associated with worse outcomes, whereas among immigrant patients, greater ED severity, lower harm avoidance, and lower self-transcendence predicted poorer results. Conclusions: Immigrant patients with EDs exhibit a differentiated clinical presentation and less favorable treatment response compared to native-born patients. The differential predictors of poor outcome highlight the need for culturally informed and individually tailored interventions that consider both sociocultural context and personality-related vulnerabilities.

Background: Difficulties in emotion regulation (ER) are commonly described in eating disorders (ED), but few studies report its impact on ED treatment outcome. The main goal of this study was to investigate the patterns of change in difficulties in ER among ED-diagnosed female patients who received a Cognitive Behavioral Therapy (CBT) treatment. Methods: Participants (N = 74; Mage = 29.2; SD = 11.5) completed pre- and post-treatment questionnaires to assess difficulties in ER, disordered eating symptoms, general psychopathology, and personality traits. Results: Considering ED treatment outcome status, 24.3% of patients displayed a poor outcome, while 28.4% achieved partial remission, and 47.3% achieved full remission. Most of the patients who achieved full remission (80%) reported decreases in difficulties in ER, while only 55.6% of the participants displaying poor outcomes reported improvements in ER. The results from the structural equation modeling (SEM) suggest that the risk of poor outcome was directly related to increased post-treatment difficulties in ER, while improvements in the severity index of global psychopathology was related to increased pre-treatment difficulties in ER. Conclusions: Better ED treatment outcomes are associated with higher levels of ER improvements. Future prospective studies are warranted to establish which ER components may positively influence the recovery of ED-diagnosed patients.

Background: Food addiction (FA) is prevalent among individuals with severe obesity and has been associated with poorer weight loss (WL) outcomes after dietary interventions. However, its long-term impact after bariatric surgery (BS) remains unclear. Objective: This study aimed to evaluate the effect of preoperative FA on WL and weight regain (WR) three years after different BS techniques. Methods: An ambispective study was conducted in 165 patients undergoing BS (41.1% sleeve gastrectomy [SG], 13.3% Roux-en-Y gastric bypass [RYGB], and 45.6% hypoabsorptive procedures [HA]). FA was assessed preoperatively using the Yale Food Addiction Scale 2.0. WL outcomes were evaluated at 1 and 3 years postoperatively. Mixed-effects models were used to assess longitudinal changes, adjusted for baseline weight, sex, type 2 diabetes (T2D), and height. Results: FA was present in 17.6% of patients. At 3 years, total WL was lower in FA patients compared to those without FA (−27.1% vs. −31.0%; p = 0.023), driven by greater WR from nadir (+8.3% vs. +1.7%; p = 0.03). The effect was particularly pronounced after RYGB and HA, but not after SG. Nevertheless, a substantial proportion of FA patients (58%) were no longer classified as having obesity at 3 years. The presence of FA was not associated with insufficient WL or lower T2D remission rates. Mixed models confirmed a significant interaction between FA and time, indicating a trend toward reduced WL over time in FA patients. Conclusions: Preoperative FA was not associated with a reduced likelihood of achieving satisfactory WL following BS. Our data does not support the use of preoperative FA as a decisive factor in guiding the choice of BS type. Although FA was associated with increased WR over time, clinically meaningful WL was achieved in most patients. Long-term multidisciplinary follow-up remains essential in this subgroup.

Purpose of Review: Food addiction (FA) has been found to be associated with impulsivity, mainly urgency (negative and positive) and lack of perseverance. The present systematic review aimed to identify differences in impulsivity by gender and current implications of treatment regarding FA and impulsivity in clinical populations. The search was conducted in PubMed, Scopus, and Web of Science (WOS) databases, using the following search terms: “food addiction” and “impuls*.” Studies were included if they were written in English, had an observational design (e.g., cross-sectional, longitudinal, case-control), and used a quantitative methodology, without a limited search period to avoid selection bias. Recent Findings: We included twenty-nine articles that aimed to examine whether there is a relationship between FA and impulsivity in clinical populations. Looking at gender differences, attentional and motor impulsivity were found to be related to FA in samples of women with obesity, whereas in the only study in a sample of men with obesity, cognitive and non-planning impulsivity appeared to be more associated with FA. Moreover, we identified three studies on the effects of interventions which included motivational, psychosocial, nutritional, and mindfulness components to address impulsivity and FA in cohorts with overweight/obesity and with substance use disorder (SUD). While some studies reported decreased levels of impulsivity, in other studies only FA decreased, and only one study showed significant changes in both FA and impulsivity after treatment. Summary: Further research is needed to better understand the association between impulsivity and FA. Specifically, more studies with male populations could provide further evidence on how to better tailor treatment designs.

Background and aims: Self-exclusion in gambling disorder (GD) is considered a measure to decrease the negative consequences of gambling behavior. Under a formal self-exclusion program, gamblers request to be banned from accessing to the gambling venues or online gambling.The aims of the present study are: 1) to determine sociodemographic characteristics of a clinical sample of seeking-treatment patients with GD who are self-excluded before arriving at the care unit; 2) to identify personality traits and general psychopathology of this clinical population; 3) to analyze the response to treatment, in terms of relapses and dropouts.Methods: 1,416 adults seeking treatment for GD, who are self-excluded completed screening tools to identify GD symptomatology, general psychopathology, and personality traits. The treatment outcome was measured by dropout and relapses.Results: Self-exclusion was significantly related to female sex and a high sociodemographic status. Also, it was associated with a preference for strategic and mixed gambling, longest duration and severity of the disorder, high rates of general psychopathology, more presence of illegal acts and high sensation seeking rates. In relation to treatment, self-exclusion was associated with low relapse rates.Conclusions: The patients who self-exclude before seeking treatment have a specific clinical profile, including high sociodemographic status, highest severity of GD, more years of evolution of the disorder and high emotional distress rates; however, these patients' presents better response to treatment. Clinically, it could be expected that this strategy could be used as a facilitating variable in the therapeutic process.

Sports betting is becoming increasingly widespread, and a growing number of individuals, both adolescents and adults, participate in this type of gambling. The main aim of this systematic review was to assess correlates of sports betting (sociodemographic features, gambling-related variables, co-occurring psychopathologies, and personality tendencies) through a systematic review conducted following the PRISMA guidelines. Relevant studies were identified via searches of NCBI/PubMed and APA PsycInfo databases. Individuals from the general population and/or with a clinical diagnosis of gambling disorder (GD) were included, irrespective of gender and age. In addition, the studies needed to have administered at least one clinical interview/psychometric instrument to assess the presence of problematic gambling/GD, contain at least one group of participants with sports betting, and directly analyze the association between sports betting and any of the following features: sociodemographics, gambling-related variables, co-occurring psychopathologies, and/or personality tendencies. Fifty-four articles were included. Multiple sociodemographic variables have been studied in relation to sports betting. In general, males with high impulsivity have greater tendencies for sports betting. The co-occurrence of certain pathologies, especially substance use or other addictive disorders, was also suggested. Most studies were cross-sectional, assessed participants using self-administered instruments, recruited samples using non-probability online panels, included small samples, had unbalanced samples, and included samples from only one country. Impulsive males may be particularly prone to sports gambling and related problems. Future research should examine prevention strategies that may help prevent the development of sport-betting-related GD and other addictive behaviors in vulnerable individuals.

Gambling disorder (GD) is associated with deficits in emotion regulation and impulsivity-related personality traits. In recent years there has been an increase in the use of serious games (SG) to address these factors with positive results. The aim of this study was to analyze the efficacy of the intervention with a new SG (e-Estesia), as an adjunct to a CBT intervention for GD. The sample comprised two groups (experimental group (n = 40) and control group (n = 64)) of patients with GD diagnosis. Both groups received 16 weekly CBT sessions and, concurrently, only the experimental group received 15 additional sessions with e-Estesia. Pre-post treatment with e-Estesia administered in both groups were: DSM-5 Criteria, South Oaks Gambling Screen, Symptom Checklist-Revised and measure of relapses, dropout and compliance of treatment. As regards the experimental group were also administered: Difficulties in Emotion Regulation Scale, Emotion Regulation Questionnaire, and Impulsive Behavior Scale. No statistically significant differences in the general psychopathological state, emotion regulation or impulsivity were found when comparing the groups. However, patients enrolled in the e-Estesia intervention had significantly less relapses and better indicators of treatment compliance than the control group. Considering these results, the use of complementary tools such as SG are useful for addressing GD.

Background: Impulse control disorders (ICDs) are commonly developed among patients who take dopamine agonist drugs as a treatment for Parkinson disease (PD). Gambling disorder and hypersexuality are more frequent in male patients with PD, with a prevalence over 4% in dopamine agonists users. Although impulsive-compulsive behaviors are related to antiparkinsonian medication, and even though ICD symptomatology, such as hypersexuality, often subsides when the dopaminergic dose is reduced, sometimes ICD persists in spite of drug adjustment. Consequently, a multidisciplinary approach should be considered to address these comorbidities and to explore new forms of complementary interventions, such as serious games or therapies adapted to PD. Objective: The aim of this study is to present the case of a patient with ICD (ie, hypersexuality) triggered by dopaminergic medication for PD. A combined intervention was carried out using cognitive behavioral therapy (CBT) for ICD adapted to PD, plus an intervention using a serious game—e-Estesia—whose objective is to improve emotion regulation and impulsivity. The aim of the combination of these interventions was to reduce the harm of the disease. Methods: After 20 CBT sessions, the patient received the e-Estesia intervention over 15 sessions. Repeated measures, before and after the combined intervention, were administered to assess emotion regulation, general psychopathology, and emotional distress and impulsivity. Results: After the intervention with CBT techniques and e-Estesia, the patient presented fewer difficulties to regulate emotion, less emotional distress, and lower levels of impulsivity in comparison to before the treatment. Moreover, the frequency and severity of the relapses also decreased. Conclusions: The combined intervention—CBT and a serious game—showed positive results in terms of treatment outcomes.