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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: 5 July 2025 | Viewed by 14953

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Prof. Dr. Hubertus Himmerich

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Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
Interests: eating disorders; obesity; nutrition and mental disorders; weight regulation; psychopharmacology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues

A change in eating behaviour, which might be accompanied by altered eating-related emotions and cognitions, may be a symptom of a mental health disorder, a consequence of psychopharmacological treatment, or an indication of a specific eating disorder.

Examples of mental health disorders that are associated with changes in eating behaviour, food choice, appetite, and weight regulation are anxiety and mood disorders, neurodevelopmental disorders, post-traumatic stress disorder, schizophrenia, and sleep disorders.

Psychopharmacological agents can either increase appetite and body weight, such as in the case of second-generation antipsychotics and antihistaminergic antidepressants, or lead to a loss of appetite, such as in the case of the antidepressant bupropion and the stimulant lisdexamfetamine. Furthermore, there have been reports that weight-loss medications such as glucagon-like peptide-1 (GLP-1) receptor agonists improve mood in people with both obesity and depression. There is also hope that GLP-1 receptor agonists might provide future treatments for binge-eating disorder.

Thus, this Special Issue will cover various eating-related aspects of mental health disorders.

Prof. Dr. Hubertus Himmerich
Guest Editor

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Keywords

anorexia nervosa
bulimia nervosa
binge-eating disorder
avoidant restrictive food intake disorder
pica
rumination disorder
anxiety disorders
mood disorders
depression
autism
antipsychotics
antidepressants
stimulants
GLP-1 receptor agonists

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Published Papers (9 papers)

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Research

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20 pages, 938 KiB

Open AccessArticle

Overweight, Obesity, and Depression in Multimorbid Older Adults: Prevalence, Diagnostic Agreement, and Associated Factors in Primary Care—Results from a Multicenter Observational Study

by Daniel Christopher Bludau, Alexander Pabst, Franziska Bleck, Siegfried Weyerer, Wolfgang Maier, Jochen Gensichen, Karola Mergenthal, Horst Bickel, Angela Fuchs, Ingmar Schäfer, Hans-Helmut König, Birgitt Wiese, Gerhard Schön, Karl Wegscheider, Martin Scherer, Steffi G. Riedel-Heller and Margrit Löbner

Nutrients 2025, 17(8), 1394; https://doi.org/10.3390/nu17081394 - 21 Apr 2025

Viewed by 243

Abstract

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen’s kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

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15 pages, 258 KiB

Open AccessArticle

#BodyPositivity: The Role of Body Appreciation and Body Mass Index for Muscle Dysmorphia, Body Attitudes and Exercise Motives Among Men

by Kamila Czepczor-Bernat, Adriana Modrzejewska and Justyna Modrzejewska

Nutrients 2025, 17(7), 1177; https://doi.org/10.3390/nu17071177 - 28 Mar 2025

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Abstract

Objectives: The main aim of this study was to investigate the hypothesis that men with high body appreciation and healthy (normal) weight would have significantly lower levels of muscle dysmorphia and the non-adaptive (negative) multiple dimensions of body attitudes, as well as higher levels of the selected pro-health and adaptive exercise motives, than those men with low body appreciation and excess body weight. Methods: A total of 374 Polish men (M_age = 28.96 ± 8.52) completed the following questionnaires: (a) the Body Appreciation Scale-2, (b) the Muscle Dysmorphic Disorder Inventory, (c) the Male Body Attitude Scale, and (d) the Exercise Motivations Inventory-2. Results: By analyzing the most important findings, it was discovered, as hypothesized, that significant differences (in terms of most of the assessed scale/subscales) were found between men who had high body appreciation and healthy weight (Cluster 4), and men with low body appreciation and excess body weight (Cluster 3). Cluster 4 (vs. Cluster 3) was characterized as follows: (a) considering muscle dysmorphia, these participants had lower levels in terms of the total score and subscale of appearance intolerance; (b) they had fewer non-adaptive (negative) body attitudes, with lower total scores and lower scores on two subscales (body fat and height); (c) for the selected pro-health and adaptive exercise motives, Cluster 4 had higher levels on all subscales. Conclusions: Our results show that holding views in line with positive body image is also beneficial for the functioning of adult men. However, further research needs to be conducted in this area to determine whether the content in the interventions and prevention activities for both sexes should be the same and what factors should be taken into account in order to influence excessive fixation on a muscularity. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

12 pages, 253 KiB

Open AccessArticle

Parents of Adolescents with Anorexia Nervosa and Parents of Adult Women with Anorexia Nervosa

by Federico Amianto, Giulia Dell’Oca, Daniele Marcotulli, Chiara Davico and Andrea Martinuzzi

Nutrients 2025, 17(7), 1115; https://doi.org/10.3390/nu17071115 - 24 Mar 2025

Viewed by 391

Abstract

Background: Anorexia nervosa (AN) remains a severe psychiatric disorder with multifactorial pathogenesis and an uncertain prognosis. It is essential to identify any factors that may contribute to its onset in order to improve the targeting of preventive and therapeutic interventions. The present study explores the characteristics of parents of daughters with AN, comparing those with different ages of onset and ages at intake, in order to identify potential contributing factors from the parental side. Methods: The study recruited 69 adolescents and 56 adults diagnosed with AN, along with 73 healthy controls (HC). The 80 mothers and 69 fathers of the participants were compared to controls in terms of the age of onset and age at intake of their daughters. Self-administered instruments were used to assess personality (TCI), eating behaviors (EDI-2), general psychopathology (BDI), and family functioning (FAD). Results: The analysis revealed that several personality and psychopathological traits distinguished the parents of AN participants from the HC group in both conditions. Both mothers of adolescent- and adult-onset AN participants with any age at intake displayed greater harm avoidance and lower self-directedness facets, as well as greater inadequacy and social insecurity than controls. Fathers were less disordered and more self-indulgent and compassionate, but lower in role definition. Specifically, mothers of daughters with adolescent-onset AN and younger age at intake were more prone to depression. In contrast, mothers of daughters with an adult age at intake showed lower resourcefulness and higher levels of perceived inadequacy. Conclusions: Higher resourcefulness and a lower sense of ineffectiveness may help mothers facilitate earlier therapeutic intervention for their daughters. On the other hand, maternal depressive symptoms may play a significant role in the earlier onset of and intake for AN in their daughters. Supporting assertive qualities in mothers through preventive interventions is recommended, while maternal depression should be appropriately treated to prevent an early psychopathological onset in daughters. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

14 pages, 243 KiB

Open AccessArticle

The Additive Psychosocial Effects of Binge Eating and Food Insecurity Among Midlife and Older Women

by Lisa Smith Kilpela, Taylur Loera, Salomé Adelia Wilfred, Jessica Salinas, Sabrina E. Cuauro and Carolyn Black Becker

Nutrients 2025, 17(4), 730; https://doi.org/10.3390/nu17040730 - 19 Feb 2025

Viewed by 557

Abstract

Background/Objectives: Evidence suggests that food insecurity (FI) is a risk factor for eating disorder (ED) symptoms, especially binge eating (BE), yet research focusing on the psychosocial effects among midlife/older women is lacking. Midlife/older women living with FI experience intersectional disadvantage, thus highlighting the need for an independent investigation of the cultural and contextual factors of this population. The current study examined the difference in psychological health and quality of life (QOL) among women living with BE and FI (BE + FI) versus FI without BE. Method: Female clients of a food bank, aged 50+ (N = 295; M age = 62.1 years, SD = 8.2) living with FI completed measures of BE and psychosocial comorbidities. The measures were provided in English and Spanish. Results: A multivariate analysis of covariance compared women living with BE and FI (BE + FI) versus FI without BE on outcomes related to mental health and wellbeing. Covarying for age, FI severity, and ethnicity, the results indicated that women living with BE + FI reported worsened anxiety, depression, ED-related psychosocial impairment, internalized weight stigma, and QOL versus women living with FI without BE (all ps < 0.001). Effect sizes ranged from small to medium to large. Conclusions: Midlife/older women living with BE + FI report poorer psychological health and QOL than those living with FI without BE, demonstrating a critical need for mental healthcare in this population. Innovative solutions—and likely a portfolio of interventional approaches with various entry points and delivery modalities—are warranted, if we are to make significant strides in addressing ED symptoms in this population. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

16 pages, 243 KiB

Open AccessArticle

Parental Perspectives on Eating Disorders of Their School-Age Children with ADHD in Hong Kong: A Qualitative Study

by Shu-Cheng Chen, To Ming Stanley Wu, Han Li, Jia-Wen Shou, Jing Qin, Guo-Tao Wu, Wai-Yin Cheng and Wing-Fai Yeung

Nutrients 2025, 17(3), 513; https://doi.org/10.3390/nu17030513 - 30 Jan 2025

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Abstract

Background: Children with attention deficit hyperactivity disorder (ADHD) frequently encounter eating problems. However, qualitative research on the eating problems of these children and the strategies employed by their parents to manage these issues remains limited. This study aimed to explore the eating problems of school-age children with ADHD and the coping strategies used by parents in urban settings like Hong Kong. Methods: A descriptive qualitative design was utilized, employing semi-structured focus group interviews. Purposive sampling was used to recruit 12 parents who voluntarily participated in five focus group sessions. The interviews were conducted in Cantonese, audio-recorded, and transcribed verbatim. Data were analyzed using template thematic analysis to identify key themes and subthemes. Results: Two major themes emerged: challenges affecting ADHD children’s eating behaviors and parental coping strategies in Hong Kong. Children’s eating difficulties stemmed from ADHD-specific behaviors, compounded by Hong Kong’s demanding educational system and urban environmental constraints. In response, parents developed multifaceted coping approaches, ranging from dietary modifications and behavioral management strategies to healthcare resource utilization, while adapting their urban lifestyle to accommodate their children’s needs. Conclusions: Children with ADHD face eating challenges that intersect with Hong Kong’s sociocultural environment, where educational pressure, limited living spaces, and parents’ work schedules influence their eating patterns. Parents adopt integrated Eastern–Western approaches, supported by Hong Kong’s comprehensive healthcare resources spanning professional networks and community programs. Evidence-based dietary guidelines are essential to address ADHD-related nutritional misconceptions. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

16 pages, 460 KiB

Open AccessEditor’s ChoiceArticle

Cognitive Functions in Adolescent Girls with Anorexia Nervosa during Nutritional Rehabilitation

by Katarzyna Jowik-Krzemińska, Dagmara Dylewska, Aleksandra Pawlińska-Maćkowiak, Agnieszka Słopień and Marta Tyszkiewicz-Nwafor

Nutrients 2024, 16(20), 3435; https://doi.org/10.3390/nu16203435 - 10 Oct 2024

Cited by 1 | Viewed by 7748

Abstract

Background: The present study aimed to evaluate cognitive function and laboratory parameters in adolescent girls with anorexia nervosa (AN) before and after nutritional rehabilitation (NR) compared to healthy female peers (CG). Methods: We evaluated 36 girls with AN at two-time points, during acute malnutrition (AN1) and after NR, in a partially normalized weight status (AN2). We compared their cognitive functions and laboratory parameters to 48 healthy CG subjects. Cognitive function was assessed using a Cognitive Assessment Battery (CAB) assessment, depressive symptom levels were assessed using a Beck Depression Inventory (BDI) assessment, and eating disorders were assessed using an Eating Attitude Test (EAT-26). Results: The AN1 group scored better in total cognition, attention, estimation, and spatial perception than the CG group (p < 0.05), with scores increasing in the AN2 group. Shifting and visual perception values did not differ between the study groups (p = 0.677, p = 0.506, respectively). Laboratory tests showed no significant abnormalities and did not differ significantly between groups (p > 0.05). There was a negative correlation for EAT-26 and CAB in the AN1 group (rho = −0.43, p = 0.01), but not for BDI. Conclusions: Cognitive function in adolescent girls with AN was better than CG and correlated with EAT-26 score. These results highlight the high compensatory capacity of the adolescent body to maintain cognitive function despite severe malnutrition. Our results suggest that although normalization of body weight is crucial, other factors can significantly influence improvements in cognitive function. Cognitive deficits and laboratory tests may not be biomarkers of early forms of AN. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

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Review

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14 pages, 1103 KiB

Open AccessReview

Association Between Orthorexia and Plant-Based Diets—Is There a Vicious Cycle?

by Patrycja Szulc, Kaja Willich and Patrycja Gogga

Nutrients 2025, 17(8), 1337; https://doi.org/10.3390/nu17081337 - 13 Apr 2025

Viewed by 502

Abstract

Nowadays, social media and rapidly changing dietary trends encourage people to constantly—often excessively—control their diet, which leads to an increased risk of developing eating disorders, including orthorexia nervosa (ON). At the same time, more and more people reduce or give up consumption of meat and other animal products, adopting different types of plant-based (vegetarian) diets. The following paper aimed to demonstrate the significant similarities between orthorexia and plant-based diets and to highlight the necessity of developing new or adapting existing diagnostic tools for orthorexia considering the lifestyle characteristics of vegetarians, especially vegans. It remains unclear whether vegetarianism increases the risk of developing ON or whether the development of ON increases the chances of switching to a plant-based diet. However, based on the available literature, a positive association can be shown between the two. On the one hand, a vegetarian diet may be a cover for ON, but on the other, vegetarians, as a group avoiding specific food products, may be wrongly perceived as disordered. Thus, it is important to distinguish ON from the so-called healthy orthorexia (HO), which is a non-pathological interest in healthy eating, to avoid overdiagnosis and stigmatization of people using healthy alternative diets, including plant-based diets, since the mere fact of following them does not constitute evidence of orthorexia. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

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31 pages, 869 KiB

Open AccessReview

Autism, ADHD, and Their Traits in Adults with Obesity: A Scoping Review

by Lauren Makin, Adia Meyer, Elisa Zesch, Valeria Mondelli and Kate Tchanturia

Nutrients 2025, 17(5), 787; https://doi.org/10.3390/nu17050787 - 24 Feb 2025

Viewed by 1059

Abstract

Introduction: Autism and ADHD shape behaviours related to food, exercise, and body image, potentially influencing obesity treatment outcomes, as seen in eating disorder research. Resultantly, autistic and ADHD patients with obesity may have distinct experiences and differences compared to non-autistic and non-ADHD patients. This review maps existing literature on autism and ADHD in adults with obesity. Methods: Following PRISMA guidelines, six databases (Embase, MEDLINE, PsycINFO, Web of Science, CENTRAL, and Scopus) were searched for studies on autism and/or ADHD (diagnosed, probable, or traits) in adults with obesity. Screening and data extraction were conducted twice independently for each record. Results: Thirty-one studies were included, with 1,027,773 participants. Two case reports described successful use of weight loss drugs in autistic people with obesity. Eight prevalence studies suggested ADHD is overrepresented in obesity, regardless of binge eating status. Nineteen studies examined clinical profiles: ADHD patients had lower socioeconomic status, poorer health-related quality of life, increased impulsivity, cognitive inflexibility, and neuroticism, alongside lower agreeableness, conscientiousness, self-directedness, and cooperativeness. ADHD patients also exhibited higher psychopathology, problematic alcohol use, and disordered eating. Eight studies assessed treatment responses, noting poorer outcomes from behavioural programs and obesity pharmacotherapy, but similar post-surgical weight outcomes, despite increased complications. Two studies considered ADHD-specific treatment adaptions, one reporting a successful trial of ADHD medication for weight loss and the other reporting on switching to transdermal ADHD medications after bariatric surgery. Conclusions: This review underscores the need for more research on autism and obesity. For ADHD, findings suggest frequent co-occurrence with obesity, but lived experiences and tailored interventions remain underexplored. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

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39 pages, 1812 KiB

Open AccessReview

Enteral Tube Nutrition in Anorexia Nervosa and Atypical Anorexia Nervosa and Outcomes: A Systematic Scoping Review

by Namrata Dhopatkar, Johanna L. Keeler, Davide Gravina, Jacinda Gower, Hiba Mutwalli, Sevgi Bektas, Sarah J. Fuller, Hubertus Himmerich and Janet Treasure

Nutrients 2025, 17(3), 425; https://doi.org/10.3390/nu17030425 - 24 Jan 2025

Viewed by 1596

Abstract

Background: Anorexia nervosa and atypical anorexia nervosa require refeeding as a core part of their treatment, and enteral tube nutrition (ETN) may be needed in some individuals either to supplement or replace oral nutrition. This scoping review aimed to explore outcomes associated with phases of ETN, including initial nutrition, transition from enteral nutrition to oral intake, and to overall nutrition; Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist was used. A systematic search was performed using the Ovid and the Web of Science databases, using relevant search terms identifying 37 studies to be included in the review. Quantitative and qualitative data were synthesised and presented; Results: ETN resulted in similar or higher weight gain than oral nutrition. Refeeding syndrome parameters were comparable between ETN and oral nutrition with some indication that prophylactic phosphate supported mitigation of hypophosphataemia. Global psychological parameters related to the eating disorder improved with nutrition; however, there was an indication that weight and shape concerns did not improve during this period. There was a lack of evidence related to transition from ETN to oral intake. Qualitative data indicated meanings attached to the tube, suggesting that additional support may be needed for the transition away from the tube. Furthermore, consideration may be required to support individuals in mitigating trauma related to ETN under restraint; Conclusions: ETN, when required, is a viable alternative to oral intake. Results indicated the need for further research, especially in the transition from ETN to oral intake with regard to strategies of transition and support, and outcomes related to these strategies. Full article

(This article belongs to the Special Issue Eating and Mental Health Disorders)

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