Epidemiology and risk factors of eating disorders: a two-stage epidemiologic study in a Spanish population aged 12-18 years

A Scoping Review of the Prevalence of Eating Disorders in Spain

INTRODUCTION

Eating disorders (EDs) are mental health illnesses with a multifactorial origin. At present, no review of indexed publications studying their prevalence in Spain is available.

MATERIAL AND METHODS

A scoping review (PROSPERO -CRD42019140884-) was carried out through systematic searches (MEDLINE, EMBASE and PsycINFO) until January 2022. Papers published in Spanish/English analysing the prevalence of EDs in Spain (population < 65 years) were selected.

RESULTS

A total of 766 articles were identified (186 eliminated as duplicates). A total of 580 articles were analysed on the basis of title and abstract, and 67 articles were selected for full-text analysis. A total of 37 studies analysed the prevalence of EDs in Spain.

CONCLUSIONS

This is the first scoping review to analyse the prevalence of EDs in Spain. Puberty and adolescence are the most extensively studied stages. There is a high heterogeneity in the use of ED screening tools and a paucity of information on diagnostic tools.

Going deeper into eating and body image pathology in males: Prevalence of muscle dysmorphia and eating disorders in a university representative sample

Disorders associated with body dissatisfaction such eating disorders (ED) and muscle dysmorphia (MD) in males are understudied and surrounded by controversy regarding their nosological aspects. The current study examined the prevalence rates of clinical cases of ED and MD through a two-phase study with gold standard clinical interview in a representative sample of 850 Spanish undergraduate men, of whom 141 were interviewed. Levels of body dissatisfaction, compulsive exercise, anxious-depressive symptoms and the amount of physical activity were also explored. A prevalence rate for ED of 1.4% and 1.3% for MD was found. No differences were observed between the clinical groups on scales related to body image, supporting the current perspective that MD as well as ED and Body Dysmorphic Disorder could be clustered in a new spectrum of body image disorders, where the behaviours performed to achieve body change could range from restriction or muscularity-oriented eating alterations to pathological exercise or cosmetic surgery. The usefulness of the cut-off points of the screening questionnaires in MD and ED in males are discussed.

Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg’s self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables ‘number of meals’ (p < 0.01), ‘dieting’ (p < 0.01), and ‘drug consumption to lose weight’ (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.

Does physical appearance perfectionism predict disordered dieting?

Despite that disordered eating has been repeatedly associated with perfectionism, the results are inconsistent as to which exact dimensions of perfectionism it is related to. Moreover, the increasing evidence that perfectionism is best conceptualized as a domain-specific, as opposed to a global, trait contribute to the lack of clarity. Therefore, the aim of this study was to examine which dimensions of global and physical appearance perfectionism statistically predict disordered dieting in a non-clinical adult female sample. In total 437 participants completed the Short Almost Perfect Scale, which distinguishes between adaptive and maladaptive perfectionism, the Physical Appearance Perfectionism Scale, which distinguishes between hope for perfection and worry about imperfection, and the Dieting subscale of the Eating Attitudes Test-26. A hierarchical regression analysis revealed that only maladaptive, as opposed to adaptive, global perfectionism statistically predicted disordered dieting. Furthermore, both dimensions of physical appearance perfectionism statistically predicted disordered dieting, although worry about imperfection, its maladaptive dimension, was the strongest statistical predictor. The present results demonstrate that worry about imperfection is an effective statistical predictor of disordered dieting among women, possibly serving as a starting point for further research investigating the utility of its incorporation in prevention and treatment protocols for disordered eating.

Psychiatric comorbidity and maternal distress among adolescent eating disorder patients: A comparison with substance use disorder patients

High rates of comorbidity are found among eating disorder (ED) patients, which may negatively affect treatment outcome and prognosis. However, there is a shortage of studies in Spain using clinician administered interviews to assess rates of comorbidity among these patients, particularly in adolescents. This study aimed to evaluate Axis I psychiatric diagnoses in adolescent patients with an ED and to compare them with patients with a distinct disorder with adolescent onset, substance use disorder (SUD) patients. Considering that maternal psychological distress is another factor involved in ED prognosis, a secondary aim was to examine the relationship between patient's psychological variables and maternal distress (depression and anxiety). The cross-sectional study included 50 ED patients, 48 SUD patients, and their mothers. More than half of the patients received a diagnosis for a comorbid disorder. Internalizing problems were more common among EDs and externalizing disorders were the most common comorbidities among SUDs, similar to findings from other countries. Maternal distress was associated with higher levels of depression and symptom severity in patients. No differences in distress were found between mothers of patients with a comorbid diagnosis and those without. Elevated anxiety or depression in mothers did not increase the likelihood of patients having a particular primary diagnosis. In short, while both ED and SUD patients presented high rates of comorbidity, the types of comorbid diagnoses were specific to each group. Assessing for the presence of comorbid disorders and targeting maternal psychological distress may guide treatment interventions and improve patient prognosis.

Children's Eating Attitudes Test: Reliability and validation in Japanese adolescents

Eating disorders (ED) are serious psychosomatic disorders that commonly occur in girls during adolescence. An increase in earlier onset ED has recently been suggested. Therefore, accurate assessment of eating attitudes in children is a necessary part of school mental health. The 26-item Children's Eating Attitudes Test (ChEAT-26) is widely used internationally to assess abnormal eating attitudes. The present study aimed to validate the Japanese version of the ChEAT-26. Participants were 7076 school children (aged 10-15years) from large, medium-sized, and small cities, and 44 children with anorexia nervosa. We examined the average ChEAT-26 score by participant attributes, including sex, age, geographical region, and school style. Factor analysis of the ChEAT-26 content was performed with varimax rotation. The optimal cut-off point was evaluated using receiver operating characteristic (ROC) analysis. The mean ChEAT-26 score was 7.94 for girls and 5.86 for boys. The mean score was significantly higher in children from larger cities than small cities, and was higher with increasing age, and private schools. Five factors explained 31.4% of the variance. The Cronbach's alpha was 0.81 for the scale. The area under the ROC curve was 0.83; sensitivity was 0.69 and specificity was 0.93 for a cut-off score of 18. The Japanese version of the ChEAT-26 is a reliable and valid psychometric tool that may be useful in the triage and assessment of children with anorexia nervosa.

Transitioning from DSM-IV to DSM-5: A systematic review of eating disorder prevalence assessment

OBJECTIVE

The objective of this study was to systematically review the literature on assessment of eating disorder prevalence during the DSM-IV era (1994-2015).

METHOD

A PubMed search was conducted targeting articles on prevalence, incidence and epidemiology of eating disorders. The review was performed in accordance with PRISMA guidelines, and was limited to DSM-IV based eating disorder diagnoses published between 1994 and 2015.

RESULTS

A total of 74 studies fulfilled inclusion criteria and were included in the study. Results yielded evidence of over 40 different assessment instruments used to assess eating disorder prevalence, with the EAT-40 being the most commonly used screening instrument, and the SCID being the most frequently used interview. The vast majority of studies employed two-stage designs, closely followed by clinical interviews. Observations of higher prevalence rates were found in studies employing self-reports compared to two-stage designs and interviews.

DISCUSSION

Eating disorder prevalence rates have varied significantly during the DSM-IV era, and are dependent on assessment methods used and samples investigated. Following the transition to the DSM-5, eating disorder prevalence will change, warranting novel approaches to assessment and treatment planning. © 2016 Wiley Periodicals, Inc.

A two-stage epidemiological study of eating disorders and muscle dysmorphia in male university students in Buenos Aires

OBJECTIVE

Studies using traditional screening instruments tend to report a lower prevalence of eating disorders (EDs) in men than is observed in women. It is therefore unclear whether such instruments are valid for the assessment of ED in males. Lack of a formal diagnostic definition of muscle dysmorphia syndrome (MD) makes it difficult to identify men at risk. The study aimed to assess the prevalence of ED and MD in male university students of Buenos Aires.

METHOD

A cross-sectional, two-stage, representative survey was of 472 male students from six different schools in Buenos Aires, mostly aged between 18 and 28 years. The first stage involved administration of self-report questionnaires (Eating Attitude Test-26; scores ≥15 indicate "at risk" status). In Stage 2 students at risk of developing EDs were evaluated with a clinical interview, the Eating Disorder Examination (EDE; 12th edition). Two control students were interviewed for every at risk student.

RESULTS

The prevalence of EDs among university male students was 1.9% (n = 9). All participants with an ED presented with illness classified as eating disorder not otherwise specified (EDNOS). Using the Drive for Muscularity Scale (DMS) with a 52-point threshold we identified possible MD in 6.99% (n = 33) of the sample.

DISCUSSION

The prevalence of ED detected in this study is comparable with previous findings in male populations, and below that observed in female populations. However, the prevalence of possible cases of MD resembles the total rate of EDs in women. Characteristics associated with EDs and MD in men are also discussed.

Prevalence and comorbidity of eating disorders among a community sample of adolescents: 2-year follow-up

The previous literature about comorbidity between eating disorders (ED) and other DSM-IV psychiatric disorders in adolescence has employed cross-sectional studies with clinical samples, where the comorbid disorders were diagnosed retrospectively. The present study aims to overcome these limitations by the analysis of comorbidity in a community population during 2-year follow-up. A semi-structured interview was applied to a teenager sample. Firstly, a cross-sectional and non-randomized study on psychiatric morbidity was conducted with 993 teenagers between the ages of 12 and 16 from five schools. Secondly, 326 students between 14 and 17 years old of one school were reassessed 2 years later in order to detect ED new cases and find associations with previous psychiatric disorders. The ED prevalence was 3.6%. Cross-sectional analysis revealed that 62.9% of individuals with an ED had comorbid disorders: anxiety disorders (51.4%), Attention Deficit Hyperactivity Disorder (31.4%), oppositional defiant disorder (11.4%), and obsessive compulsive disorder (8.6%). Prospective longitudinal analysis showed an ED incidence rate of 2.76% over the course of 2 years. 22.2% of new cases had received previous psychiatric diagnoses, of which all were anxiety disorders. Thus, ED exhibited a high comorbidity rate among adolescent populations and anxiety disorders were the most common comorbid diagnosis.

Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review

Challenges to epidemiological studies of eating and related body image disturbance disorders in males include, in addition to low base rates and the predominance of residual diagnostic categories, the female-centric nature of current classification schemes and the consequent lack of appropriate assessment instruments. In this narrative review, we summarise epidemiological data regarding the prevalence and correlates of eating disorders, related body image disturbance disorders, and eating disorder features in males. Attention is focused on disorders most likely to be observed among males, such as muscle dysmorphia and muscularity-oriented excessive exercise. It is argued that, given the multiple challenges involved in research of this kind, a focus on features is more likely to advance the field than a focus on diagnoses. In terms of correlates, we focus on impairment and help-seeking, since these issues are most relevant in informing public health burden, service provision, and related issues. We end with some thoughts about current gaps in the knowledge base and directions for future research that we consider to be most promising.

[Role of Serotonin Transporter Gene in Eating Disorders]

BACKGROUND

The serotoninergic system has been implicated in mood and appetite regulation, and the serotonin transporter gene (SLC6A4) is a commonly studied candidate gene for eating disorders. However, most studies have focused on a single polymorphism (5-HTTLPR) in SLC6A4.

OBJECTIVE

We present the studies published on the association between eating disorders (ED) and 5-HTTLPR polymorphism in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS).

METHOD

Search of databases: MEDLINE, ISI, and PubMed for SLC6A4 and ED.

CONCLUSIONS

From a review of 37 original articles, it was suggested that carriers of S allele is a risk factor for eating disorders, especially for AN. However, BN did not show any association. Also, BMI, impulsivity, anxiety, depression, and age of onset have been associated with S allele in ED patients.

Altered mitochondrial function and oxidative stress in leukocytes of anorexia nervosa patients

Context

Anorexia nervosa is a common illness among adolescents and is characterised by oxidative stress.

Objective

The effects of anorexia on mitochondrial function and redox state in leukocytes from anorexic subjects were evaluated.

Design and setting

A multi-centre, cross-sectional case-control study was performed.

Patients

Our study population consisted of 20 anorexic patients and 20 age-matched controls, all of which were Caucasian women.

Main outcome measures

Anthropometric and metabolic parameters were evaluated in the study population. To assess whether anorexia nervosa affects mitochondrial function and redox state in leukocytes of anorexic patients, we measured mitochondrial oxygen consumption, membrane potential, reactive oxygen species production, glutathione levels, mitochondrial mass, and complex I and III activity in polymorphonuclear cells.

Results

Mitochondrial function was impaired in the leukocytes of the anorexic patients. This was evident in a decrease in mitochondrial O₂ consumption (P<0.05), mitochondrial membrane potential (P<0.01) and GSH levels (P<0.05), and an increase in ROS production (P<0.05) with respect to control subjects. Furthermore, a reduction of mitochondrial mass was detected in leukocytes of the anorexic patients (P<0.05), while the activity of mitochondrial complex I (P<0.001), but not that of complex III, was found to be inhibited in the same population.

Conclusions

Oxidative stress is produced in the leukocytes of anorexic patients and is closely related to mitochondrial dysfunction. Our results lead us to propose that the oxidative stress that occurs in anorexia takes place at mitochondrial complex I. Future research concerning mitochondrial dysfunction and oxidative stress should aim to determine the physiological mechanism involved in this effect and the physiological impact of anorexia.

Comparison of Single- and Double-Stage Designs in the Prevalence Estimation of Eating Disorders in Community Samples

The aim of this research was to compare two different case-identification designs: (a) a one-stage anonymous design using the Eating Disorders Examination-Questionnaire (EDE-Q; Fairburn & Beglin, 1994) as diagnostic instrument and (b) a two-stage-non-anonymous design using the Eating Attitudes Test (EAT; Garner & Garfinkel, 1979) and the EDE-Q as screening instruments and the clinical interview Eating Disorders Examination (EDE; Fairburn & Cooper, 1993) as diagnostic instrument, in the estimation of eating disorders prevalence in community samples. Both epidemiological designs were compared in: eating disorders prevalence, population at risk, and weekly frequency of associated symptomatology (binge eating episodes, self-vomiting) within a sample of 559 scholars (14 to 18 year-old males and females) studying in the region of Madrid. Eating disorders prevalence estimation using single-stage design was 6.2%, and 3% using the two-stage design; however, these differences were not significant (p = .067). No significant differences between the two procedures were found either in population at risk or in weekly frequency of reported self-vomiting. Reported binge eating episodes were higher in the one-stage design. The use of a two-stage procedure with clinical interview (vs. questionnaire) leads to a better understanding of the items (specially the most ambiguous ones) and thus, to a more accurate prevalence estimation.

Psychometric Evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian Young Adults

The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ–3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ–3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = –.35, respectively. Cronbach’s alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ–3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.

A Meta-Analysis of the Diagnostic Accuracy of the SCOFF

A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF. The 15 selected studies represented a total of 882 cases and 4350 controls. The main criterion for inclusion was that the primary study had provided diagnostic classification with both a diagnostic reference and with the SCOFF (with five items and a cut-off point of two). The pooled estimates were .80 (sensitivity) and .93 (specificity). The moderator variables gender and type of measure for the diagnostic reference (interview versus psychometric tests) account for part of the observed variability. For diagnostic references based on interviews the estimate of the efficacy improves significantly. For the studies that match this criterion the sensitivity is .882 and the specificity .925 (diagnostic odds ratio, 92.19). The main conclusion was that the five questions of the SCOFF constitute a very useful screening tool, in several languages; it is highly recommended for screening purposes.

A school-based program implemented by community providers previously trained for the prevention of eating and weight-related problems in secondary-school adolescents: the MABIC study protocol

Background

The prevention of eating disorders and disordered eating are increasingly recognized as public health priorities. Challenges in this field included moving from efficacy to effectiveness and developing an integrated approach to the prevention of a broad spectrum of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. The main aim of this effectiveness trial protocol is to test whether this program has effects when incorporating an integrated approach to prevention and when previously-trained community providers implement the intervention.

Methods/design

The research design involved a multi-center non-randomized controlled trial with baseline, post and 1-year follow-up measures. Six schools from the city of Sabadell (close to Barcelona) participated in the intervention group, and eleven schools from four towns neighboring Sabadell participated in the control group. A total of 174 girls and 180 boys in the intervention group, and 484 girls and 490 boys in the control group were registered in class lists prior to baseline. A total of 18 community providers, secondary-school class tutors, nurses from the Catalan Government’s Health and School Program, and health promotion technicians from Sabadell City Council were trained and delivered the program. Shared risk factors of eating and weight-related problems were assessed as main measures.

Discussion

It will be vital for progress in disordered eating prevention to conduct effectiveness trials, which test whether interventions are effective when delivered by community providers under ecologically valid conditions, as opposed to tightly controlled research trials. The MABIC project will provide new contributions in this transition from efficacy to effectiveness and new data about progress in the integrated approach to prevention. Pending the results, the effectiveness trial meets the effectiveness standards set down by the Society for Prevention Research. This study will provide new evidence to improve and enhance disordered eating prevention programs.

Trial registration

Current Controlled Trials ISRCTN47682626

[Factors of the drive for thinness and dieting: from the viewpoint of impression management]

Thinness is considered as one type of adornment; as such, it has a psychological function for others. Thus the drive for thinness and dieting were investigated from the viewpoint of impression management. Study 1 investigated a model that the need for approval affects dieting through the outcome expectancies of others' evaluations and the drive for thinness. The results of structural equation modeling indicated high validity for this model. Study 2 investigated the moderating role of self-esteem in the relationship between positive/negative outcome expectancies of others' evaluations and the drive for thinness. The results showed that self-esteem did not act as a moderator between the two components and the drive for thinness.

Impact of a School-Based Disordered Eating Prevention Program in Adolescent Girls: General and Specific Effects Depending on Adherence to the Interactive Activities

This study assessed the impact of a school-based program aimed at preventing disordered eating. The program was based on the media-literacy approach and has interactive format. The program was assessed under strong methodological conditions. Seven schools with 263 Spanish adolescent girls in the area of Barcelona, were randomly assigned to either the complete prevention program condition, the partial program condition or the non-treatment control condition, and assessed at pre, post and 6-month follow-up. The program was effective in generating positive changes at follow-up. The effects sizes (ESd= 0.29 to ESd= 0.38) were greater, on average, than that obtained up to now in selective-universal programs, and similar or greater than that achieved by targeted prevention programs. The results indicate a greater and relevant effect size of the intervention in those participants who completed the inter-session interactive activities (ESd= 0.29 to ESd= 0.45) although the differences were not significant. These results suggest the importance of monitoring adherence to the activities in all programs defined as “interactive”. The implications and limitations of this study are discussed.

Integrated prevention of obesity and eating disorders: barriers, developments and opportunities

OBJECTIVE

The serious consequences of obesity and eating disorders (ED), difficulties encountered in treatment and the high prevalence of these conditions are important reasons to develop efforts aimed at their prevention. The implementation of integrated interventions aimed at preventing risk factors for both obesity and ED constitutes a very exciting development. In the present paper we discuss and review the main reasons for an integrated approach to the spectrum of eating- and weight-related problems, which include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviours, unhealthy dieting practices, body dissatisfaction, binge-eating disorder, overweight and obesity. Given differences between the fields with regard to current perspectives and objectives, key barriers to an integrated approach to prevention are discussed. In order to show the possibilities of development of this approach, we review the main contributions made to date in the fields of both obesity and ED prevention. In particular, environmental approaches in the prevention of obesity and ED are reviewed, given their potential for preventing a broad spectrum of eating- and weight-related problems. Furthermore, several examples of initiatives that have utilized an integrated approach to prevention are discussed.

DESIGN

Narrative review.

CONCLUSIONS

We recommend a scenario in which the two fields share knowledge to enhance the difficult work of preventing and treating both ED and obesity.

[Eating disorders: Considerations on nosology, etiology and treatment in the XXI century]

Amazing advances have been made in medical sciences since the first international conference on eating disorders (ED) was held in the 1970s, and there have been remarkable changes in the field of ED itself. Back then, virtually all that was talked about was anorexia nervosa; clinicians and researchers were mainly concerned about the possible hypothalamic and endocrine factors that seemed to be involved and there had been no epidemiological studies or controlled trials with psychiatric drugs or psychotherapy. Although the picture today is quite different, there are still significant gaps which even affect the classification of these disorders, as well as their neurobiological bases and both the pharmacological and psychological treatments which should be used. This paper gives a brief summary of these gaps and discusses the need to find endophenotypes which may help in categorising and directing research into these disorders. Mention is made of possible contributions from other fields for the benefit of greater progress in understanding eating disorders. Specific reference is made to the addictive model, out of which neuropsychology and animal models may provide data transferable to our area of expertise. Lastly, the current state of ED treatment is discussed with pointers as to from what perspective it would be most useful to seek improvements.

Transtornos alimentares e imagem corporal em acadêmicos de Educação Física

O objetivo deste estudo foi identificar as associações entre excesso de peso corporal, provável transtorno alimentar e distorção da imagem corporal em acadêmicos de educação física. A amostra foi formada por 229 universitários (45,6% rapazes). A imagem corporal foi analisada pelo questionário Body Shape Questionnaire (BSQ) e os indicadores de transtorno alimentar pelo Eating Attitudes Test (EAT-26). A presença de transtorno alimentar esteve associada às distorções da imagem corporal (p<0,001) e não ao estado nutricional (p=0,448). Já a distorção com a imagem corporal esteve associada tanto com o provável distúrbio alimentar (p<0,001) e com o estado nutricional (p=0,016). Os universitários com distorção da imagem corporal apresentaram uma prevalência 5,29 vezes maior (IC 95%: 2,15-13,09) de transtorno alimentar em relação ao grupo sem distorção. Os indicadores de transtorno alimentar e distorção da imagem corporal foram superiores no grupo feminino e a maior prevalência de excesso de peso no sexo masculino.

Eating habits, physical activity, consumption of substances and eating disorders in adolescents

The aim of this study was to evaluate the differences between adolescents with a high or low risk of developing an eating disorder (ED) in different health behaviors (eating habits, physical activity and the consumption of substances) per gender. The EAT-40 and the Inventory of Behavioral Health in Scholars were applied to 2142 middle school students from Alicante (Spain), of whom 52.8% were girls and 47.2% were boys, with an average age of 13.92 years old (Sd = 1.34). Results indicated that girls with a high risk of developing an ED consumed fewer meals, ate fewer unhealthy foods, followed more diets and paid more attention to nutritional components. Furthermore, they also performed more physical activity with the objective of losing weight, and consumed more tobacco, alcohol and medicines. Boys at high risk of developing an ED followed more diets and paid more attention to nutritional components. For boys, no more differences were found. These results suggest that any program directed at the prevention of ED should not only include nutritional education, but should also seek to promote regular physical activity with objectives other than weight loss or the burning of calories.

Children's eating attitudes test: validation in a sample of Spanish schoolchildren

OBJECTIVE

To validate the Spanish version of the Children's Eating Attitudes Test (ChEAT).

METHOD

The factor structure and other psychometric characteristics of the questionnaire were examined using the answers of 38,554 schoolchildren. Diagnostic efficiency was based on a standardized clinical interview of 968 schoolchildren who had previously completed the questionnaire.

RESULTS

Five factors ("preoccupation with thinness," "dieting," "social pressure to eat," "purging," and "preoccupation with food and oral control") explained 46% of the variance. Cronbach's α was .858 for the total scale. The area under the receiver operating characteristic curve was .851. Sensitivity (SE) was 27% and specificity (SP) 96% for a cut-off of 20. A more appropriate cut-off was 15, where SE and SP were 62% and 90% respectively, and the positive and negative predictive values 27 and 98%.

DISCUSSION

The ChEAT psychometric characteristics are adequate. The questionnaire is valid. A cut-off point of 15 is recommended for adolescents.

The prevalence of eating disorders in a Hungarian secondary school population over a period of 10 years

Az evészavarok sokféle, időnként irreverzíbilis és veszélyes szövődményekkel és jelentős pszichiátriai komorbiditással járó betegségek, amelyek elsősorban a fiatal nőket érintik. Ellentmondásos eredményeket közölnek azzal kapcsolatban, időben hogyan változik az evészavarok gyakorisága. Célkitűzés: annak meghatározása, hogyan változott az evészavarok és tüneteinek gyakorisága 10 év alatt. Módszerek: Az 1989-ben végzett vizsgálatot (Túry és mtsai, 1991; Szabó és Túry, 1991) ismételtük meg az 1998/1999-es tanévben. Mindkét vizsgálatban ugyanazokat a kérdőíveket alkalmaztuk az evészavarok vizsgálatára: az Evési attitűdök tesztjét, a Bulimia kognitív disztorziós skálát és az Evészavar-súlyossági skálát. A kérdőívet 6 város 9 középiskolájának tanulói töltötték ki. Eredmények: Összesen 2731 tanuló vett részt a vizsgálatban (2138 lány és 593 fiú, az 1. vizsgálatban 932, a másodikban 1799). A testsúly csökkentésére használt módszerek és az evészavar-patológiát jelző kérdőíves pontszám szerint a kóros jelenségek lényegesen gyakoribbak a lányok körében, emellett 10 év távlatában gyakoribbá is váltak. A klinikai és szubklinikai anorexia és bulimia gyakorisága is lényegesen nőtt a lányoknál a vizsgált időszakban (összesen 0,12%-ról 0,68%-ra). Következtetések: Eredményeink alapján az evészavarok tünetei és az evészavar-szindrómák gyakorisága lényegesen nőtt 10 év alatt a hazai középiskolás lányok csoportjában. Ebben nagy jelentőséget tulajdonítunk a külső megjelenés fontosságának és a karcsúságideál térnyerésének.

Effect of gender and school level on disordered eating behaviours and attitudes in Mexican adolescents

The aim of this study was to assess eating behaviours and attitudes in a community sample of 615 adolescent Mexican students recruited at a middle school (192 boys and 226 girls; mean age +/- standard deviation 13.56+/-0.09) and high school (90 boys and 107 girls; mean age 16.04+/-0.12 years), who completed the Eating Attitudes Test (EAT), the Bulimia Test (BULIT) and the Body Shape Questionnaire (BSQ). Multiple analysis of variance revealed the significant effect of gender on the negative feelings, body dissatisfaction, drive of thinness and perceived social pressure subscales, and school level on the body dissatisfaction and food preoccupation subscales. Among the high school girls, the gender x school level interaction had a significant effect on negative feelings, body dissatisfaction, drive of thinness, food preoccupation and perceived social pressure subscales. These data support previous findings concerning gender, and also suggest that perceived social pressure in the case of girls and food preoccupation in the case of boys could be important factors in the natural development of eating disorders.

A controlled assessment of school-based preventive programs for reducing eating disorder risk factors in adolescent Spanish girls

This study assesses the impact of an eating disorders universal preventive program on a representative sample of Spanish adolescents in the area of Barcelona, Spain. 323 adolescent girls were assigned to three experimental conditions: complete intervention, partial intervention, and non-treatment. The program obtained a significant change in reducing the influences of the aesthetic body ideal and in improving the knowledge of nutrition. Nevertheless, attained post-treatment changes dissipate at the 6 month follow-up. In our opinion, the lack of lasting effects should be attributed to a series of considerations such as format, tests not validated for this age, or insufficient research.

Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study

BACKGROUND

The aim of this study was to assess the magnitude of the university population at high-risk of developing an eating disorder and the prevalence of unhealthy eating attitudes and behaviours amongst groups at risk; gender, school or academic year differences were also explored.

METHODS

A cross-sectional study based on self-report was used to screen university students at high-risk for an eating disorder. The sample size was of 2551 university students enrolled in 13 schools between the ages of 18 and 26 years. The instruments included: a social-demographic questionnaire, the Eating Disorders Inventory (EDI), the Body Shape Questionnaire (BSQ), the Symptom Check List 90-R (SCL-90-R), and the Self-Esteem Scale (RSE). The sample design is a non-proportional stratified sample by academic year and school. The prevalence rate was estimated controlling academic year and school. Logistic regression analysis was used to investigate adjusted associations between gender, school and academic year.

RESULTS

Female students presented unhealthy weight-control behaviours as dieting, laxatives use or self-induced vomiting to lose weight than males. A total of 6% of the females had a BMI of 17.5 or less or 2.5% had amenorrhea for 3 or more months. In contrast, a higher proportion of males (11.6%) reported binge eating behaviour. The prevalence rate of students at high-risk for an eating disorder was 14.9% (11.6-18) for males and 20.8% (18.7-22.8) for females, according to an overall cut-off point on the EDI questionnaire. Prevalence rates presented statistically significant differences by gender (p < 0.001) but not by school or academic year.

CONCLUSION

The prevalence of eating disorder risk in university students is high and is associated with unhealthy weight-control practices, similar results have been found in previous studies using cut-off points in questionnaires. These results may be taken into account to encourage early detection and a greater awareness for seeking treatment in order to improve the diagnosis, among students on university campuses.

Low socioeconomic status predicts abnormal eating attitudes in Latin American female adolescents

The objective of this study was to study the proportion of Ecuadorian students fulfilling criteria on the Eating Attitudes Test (EAT) in relation to socioeconomic status. Seven hundred and twenty three female adolescent participants recruited from Quito, Ecuador were administered a brief questionnaire consisting of the EAT-40 as well as lifestyle questions. Mean EAT-40 score was 17.12, with 14% fulfilling criteria. Lower socioeconomic status and watching more television predicted higher scores; however BMI, age, and positive smoking status failed to correlate. The presently unvalidated Spanish version of the EAT-26 highly correlated with the validated EAT-40 (R=0.94). A higher than expected proportion of Ecuadorians are at risk for eating disorders, especially among lower socioeconomic groups. The EAT-26 should be considered for validation as a primary screening tool in Latin America.

Erhebung von Essverhalten und Verhaltensauffälligkeiten bei Kindern und Jugendlichen

Zusammenfassung: Fragestellung: Gibt es bei Kindern und Jugendlichen Zusammenhänge zwischen Body Mass Index und psychosozialen Problemen einschließlich essstörungstypischer Symptome? Methodik: 1057 Schüler im Alter von 10 bis 17 Jahren füllten den Youth Self-Report (YSR) und das Eating Disorder Inventory für Kinder (EDI-C) aus. Soziodemographische Daten, sowie Information über Körperlänge und Gewicht wurden ebenfalls erhoben. Ergebnisse: Untergewichtige Mädchen berichteten weniger Probleme als normalgewichtige. Mädchen mit Übergewicht erreichten höhere Werte als normalgewichtige auf sechs von elf EDI-C-Skalen (Schlankheitsstreben, Bulimie, Unzufriedenheit mit der Figur, Minderwertigkeitsgefühle, Misstrauen gegenüber anderen und Unsicherheit in der Wahrnehmung von Gefühlen) sowie auf den YSR-Skalen Ängstlich/Depressiv und Soziale Probleme. Ähnlich zeigten übergewichtige Jungen mehr soziale Probleme als normalgewichtige und höhere Werte auf denselben EDI-C-Skalen wie übergewichtige Mädchen mit Ausnahme von Misstrauen gegenüber anderen. Untergewichtige Jungen unterscheiden sich von normalgewichtigen im YSR durch vermehrte körperliche Beschwerden, im EDI-C dagegen auf keiner der Skalen signifikant. Schlussfolgerungen: Übergewichtige Kinder und Jugendliche leiden offenbar unter psychosozialen Problemen, einschließlich solcher, die für Essgestörte typisch sind. Daher bedürfen sie der Intervention nicht nur zur Vermeidung körperlicher Folgen von Übergewicht und Adipositas. Dabei sollte ihre Essstörungssymptomatik Berücksichtigung finden.

The SCOFF-c: psychometric properties of the Catalan version in a Spanish adolescent sample

OBJECTIVE

The objective of this study is to validate the Catalan version of the SCOFF questionnaire with a community sample of adolescents.

METHOD

This study used a community sample of 954 participants (475 girls and 479 boys; aged between 10.9 and 17.3 years and from the city of Barcelona) and a risk group of 78 participants (35 men and 43 women; derived from the community sample) that have exceeded > or =95 percentile in at least two of the three scales of the Eating Disorders Inventory-2 (EDI-2): Drive for Thinness, Bulimia, and Body Dissatisfaction.

RESULTS

There were significant differences in total SCOFF scores across gender and school grades. The SCOFF best cutoff point was 2 (sensitivity=73.08%; specificity=77.74%). Concurrent validity with the EDI-2 varied between low and moderate. The reliability of the SCOFF questionnaire was moderate. Exploratory factor analysis of the SCOFF questionnaire showed a two-factor structure for the total sample and for girls, and one factor for boys.

CONCLUSION

The best cutoff point for this community sample is 2. The data suggest that the SCOFF questionnaire could be a useful screening questionnaire to enable the detection of groups possibly at risk for eating disorders among adolescent Spanish community samples.

Eating problems and personality traits. An Italian pilot study among 992 high school students

OBJECTIVE

To evaluate the prevalence of eating problems and to investigate personality traits associated with disturbed eating behaviours among Italian high school students.

METHOD

Cross-sectional study involving 992 students from six high schools in Turin, Italy. Students completed the Eating Attitudes Test-40 (EAT-40), the Temperament and Character Inventory (TCI) and a Food Frequency Questionnaire (FFQ); their weight and height were measured.

RESULTS

5.5% of the whole sample and 7.4% of girls scored above the EAT-40 cutoff value. A higher Body Mass Index (BMI) correlates with higher EAT scores. Low scores on Self-Directedness and Reward Dependence together with high Persistence emerged in subjects with eating problems.

DISCUSSION

Dieting and higher BMI are confirmed as correlates of eating problems. Personality traits measured with the TCI emerge for the first time as correlates of eating problems. Longitudinal studies should clear whether these are risk factors or not.

Partial syndromes in eating disorders: a prevalence study on a sample of Italian adolescents

OBJECTIVE

Exploring the spectrum of eating disorders (ED) and its sociodemographic correlates in a population of adolescents.

METHOD

The sample included 788 adolescent students (384 females and 404 males, 12-14 years old) from Verona, Northern Italy. A two-stage sampling procedure was adopted. Eating Disorder Inventory-2 (EDI-2), Body Image Satisfaction Questionnaire (BISQ) and a socio-demographic questionnaire were applied to the sample in the first stage. The sample was then partitioned in two strata, "below-cutoff" and "above-cutoff", using the threshold DT > or = 14 for the Drive for Thinness (DT) subscale. A second sample of 59+58 subjects was selected from the two strata. The structural interview of the second stage consisted of the Structured Clinical Interview for DSM-IV Axis I Disorders and the Symptom Checklist of EDI-2.

RESULTS

Partial syndromes of ED were diagnosed in 9.4% of the interviewed sample with a sex ratio F/M=6. The following factors resulted to be related to partial syndrome of ED: dieting to be thin, body mass index, mother's occupation and being a menstruating girl.

CONCLUSION

This study represents one of the few prevalence and association studies about ED in young Italian adolescents. It evidences that partial syndromes of ED, in particular the partial syndrome of binge eating disorder, are the most frequent syndromes in early adolescence. Some social and parental factors resulted to be significantly related to these syndromes.

The influence of restrained and external eating patterns on overeating

Eating in response to an increasingly obesogenic environment has been strongly implicated as a salient aspect of eating behaviour, arguably influenced by learning and experience. Interindividual differences in susceptibility to weight gain may be due, in part, to variability in response to environmental triggers. The phenomenon of food craving may also be an important factor influencing appetite control. The present study tested a model, in which food craving was hypothesised to be an intervening causal variable, on a causal pathway between responsivity to environmental cues and the development of obesity. One hundred and twenty four participants (aged 21-71 years, 83 females and 41 males) completed the study. Participants completed the Dutch eating behaviour questionnaire (DEBQ), measuring external eating (externality), emotional eating (emotionality) and restrained eating behaviour (restraint), and an adapted form of the food craving inventory (FCI), assessing cravings for carbohydrate, fats, sweets and fast food fats, in addition to total food cravings. Initial analysis showed positive correlations between FCI-tot and body mass index (BMI), FCI-fats and BMI and FCI-fast food fats and BMI in both men and women, and between FCI-carbohydrates and BMI in men only. Multiple regression analyses showed externality as the principal predictor of food craving, which was greater in males compared to females, but differential for different food groups between genders. Restrained eating and cravings for fats and fast food fats were negatively associated in women only. As predicted, total cravings, and cravings for fats and fast food foods mediated the positive association between external eating and BMI. It is concluded that appetitive response to external cues as an important risk factor in appetite control is mediated through cravings for particular food groups and is gender-dependent.

Prevalence of eating disorders among adolescent and young adult scholastic population in the region of Madrid (Spain)

OBJECTIVE

The prevalence of eating disorders (EDs) in a representative scholastic sample was evaluated, and the demographic factors associated with ED were assessed.

METHOD

The study used a two-stage epidemiological design. The study population was a randomly selected sample of 1545 students (12- to 21-year-old males and females) in the region of Madrid (Spain).

RESULTS

ED prevalence was 3.43%. Prevalence estimations were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death.

DISCUSSION

Despite the methodological improvements over previous epidemiological studies developed in Spain, there were no significant differences in the prevalence estimations.

Prevalence of eating disorders in a Spanish community adolescent sample

OBJECTIVE

To describe the prevalence of eating disorders (ED) among Spanish adolescents and to present the reliability of the Catalan version of the EDE-12.

METHOD

A community sample of 1155 participants, and a risk sample of 93 participants, aged between 10.9 and 17.3 years old, from the city of Barcelona participated in the study. The study involved two stages: first, an initial screening with the Eating Disorder Inventory-2 (EDI-2), and second, a structured clinical interview (EDE-12). Three scales of the EDI-2 (Drive for thinness, Body dissatisfaction and Bulimia) were used to select the at risk sample; the Eating Disorders Examination-12 (EDE-12) was only administered to the at-risk sample.

RESULTS

A 1.28% of the total sample was detected as ED (2.31% of girls and 0.17% of boys). Reliability coefficients of EDE-12 ranged from medium to high.

DISCUSSION

Symptoms of anorexia and bulimia nervosa were higher among girls than boys. Preoccupation with maintained low weight, with body image and shape, and taking excessive exercise in order to loose weight, are increasing among Spanish adolescents. Prevalence rate of ED is lower than other studies with Spanish' adolescents sample, and could be related to the sample age (13.16% of the sample is smaller than 12 years old), and to the non response bias to the interview because the assessment was carried out in the school setting.

Comorbidity between obesity and attention deficit/hyperactivity disorder: population study with 13-15-year-olds

OBJECTIVE

This study analyzes whether obese children have a higher risk of attention deficit/hyperactivity "characteristics" (AD/HD) than do children with other nutritional states.

METHOD

This study included 35,403 participants from 486 community schools. They completed the AD/HD scale of the Strengths and Difficulties Questionnaire (SDQ) and were weighed and measured. 2879 of the participants were obese and 78 were morbidly obese (BMI>40).

RESULTS

A discrete, nonsignificant, increment was found in the AD/HD characteristics of male participants with morbid obesity, as compared with the other nutritional states. Among morbidly obese females, the prevalence of AD/HD characteristics was slightly superior, although not significantly, to that found in participants with normal weight, overweight or obese (BMI<40).

CONCLUSION

Among nonclinical populations with a communitarian origin, previous findings reporting high rates of AD/HD in obese children are not replicated. This increment in the prevalence of AD/HD among hospitalized obese children could be the result of selection bias.

Eating disorders and body image in Spanish and Mexican female adolescents

OBJECTIVE

To compare the prevalence of eating disorders (ED), socio-cultural risk factors, and body image characteristics in two populations of female adolescents, one Mexican and one Spanish, from similar socio-economic backgrounds.

METHOD

A total of 467 Spanish and 329 Mexican girls aged from 11-12 to 17-18 years were assessed using the Eating Attitude Test-26 (EAT-26), the CETCA (Eating Disorders Assessment Questionnaire), the CIMEC (Questionnaire on Influences on Body Shape Model), and a survey of socio-demographic and risk factors produced for this study.

RESULTS

One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase.

CONCLUSIONS

Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society.

Time trends in eating disturbances in young Greek migrants

OBJECTIVE

The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established.

METHOD

Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX).

RESULTS

At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria.

CONCLUSION

Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.

The Eating Disorders Section of the Development and Well-Being Assessment (DAWBA): development and validation

OBJECTIVE: Development and validation of the Eating Disorders Section of the Development and Well-Being Assessment (DAWBA). It is a package of questionnaires, interviews and evaluation techniques, designed to generate DSM-IV and ICD-10 based diagnoses of anorexia, bulimia nervosa and the respective partial syndromes in epidemiological studies, in subjects who are 7 to 17 years old. The parents are interviewed in all cases, as are young people aged 11 or more. METHODS: 174 girls, divided into three groups, were assessed with the Eating Disorders Section of the Development and Well-Being Assessment: 48 with eating disorders, 55 clinical controls (with depression, obsessive-compulsive disorder or gastrointestinal disease) and 71 community controls. The sensitivity, specificity and predictive values of the assessment were investigated by comparing the Development and Well-Being Assessment diagnoses with independent psychiatric diagnoses. The test-retest reliability was investigated by reapplying the measure on 55 subjects after 2 or 3 weeks. RESULTS: For the detection of any DSM-IV and ICD-10 eating disorder, the final Development and Well-Being Assessment diagnosis had a sensitivity of 100%, specificity of 94%, positive predictive value of 88%, and a negative predictive value of 100%; there was 95% agreement between the initial and repeat diagnoses (a kappa of 0.81). CONCLUSION: The Eating Disorders Section of the Development and Well-Being Assessment has suitable psychometric properties for use in clinical and epidemiological studies.