The changing profile of eating disorders and related sociocultural factors in Japan between 1700 and 2020: A systematic scoping review

Onset patterns and clinical features of binge-eating disorder in a Japanese clinical sample

OBJECTIVE

This study aimed to investigate the clinical presentation of binge-eating disorder (BED) in a Japanese sample and to examine the relationship between subtypes of BED differing in onset patterns and those differing in prior history of another eating disorder (ED).

METHODS

The study participants were 137 adults who met the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for BED. We subtyped participants based on prior history of another ED: 55 (40.1%) participants with a history of another ED (BED ED+) and 82 participants without such a history (BED ED-).

RESULTS

Unlike in some Western studies, approximately three quarters of participants had a body mass index of <25 kg/m2 . None of the participants reported a history of another ED with purging or excessive exercise. All BED ED+ participants transitioned to BED from anorexia nervosa restricting type (AN-R) or from atypical AN-R. BED ED+ participants reported more severe psychopathology than BED ED-participants. Only 20% had a treatment history for BED. Dieting preceded their first binge eating in 55 participants (DIET-first BED), and binge eating preceded their first dieting in 82 participants (BINGE-first BED). Regarding the relationship between the two different subtypes, all DIET-first BED participants were in the BED ED+ group, whereas all BINGE-first BED participants were in the BED ED-group.

DISCUSSION

Present findings revealed the clinical presentation of BED in a Japan-based study and suggested that subtypes of BED differing in the prior history of another ED yielded an accurate prediction of onset patterns (dieting first vs. binge eating first).

PUBLIC SIGNIFICANCE

This study highlights the need for clinicians to consider subtype differences in onset patterns and clinical features of BED to treat and prevent this disorder. This study revealed that, although individuals with BED in Japan have severe symptoms and a long duration of illness, only 20% have received BED treatment. The results indicate a need to disseminate knowledge about BED to the Japanese public and healthcare providers.

The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review

OBJECTIVE

There has been no review on eating disorder-focused psychological interventions in East Asia. The aims of this systematic scoping review were to summarize existing and forthcoming studies and to synthesize the cultural adaptations and effectiveness of the interventions identified.

METHOD

Five databases (PubMed, Embase, Global Health, Medline, PsychInfo) and seven trial registries were searched. Studies examining eating disorder (ED)-focused psychological interventions in East Asia were included. Narrative synthesis was used for the analysis.

RESULTS

Eighteen published studies and 14 ongoing/completed but unpublished studies were included. Most published studies were uncontrolled and five were feasibility studies. Among the ongoing studies, 71% are randomized controlled trials. Cognitive therapies were the main approach used, including individual cognitive behavioral therapy (CBT), internet CBT, group CBT, guided self-help, and cognitive remediation therapy. Cultural adaptations were mostly related to language, communication style and tailoring the dietary requirements to local diets. Interventions were shortened to increase acceptability and reduce financial and time burden to patients. Overall, studies showed good acceptability, completion rates and positive effects on ED symptoms (indicated by moderate to large effect sizes or statistical significance).

DISCUSSION

Studies were underpowered and uncontrolled, thus precluding meaningful interpretations of effectiveness to be made. However, the psychological interventions were acceptable and showed promise in delivery. Digital and group interventions seemed to be the most feasible given barriers in the local health systems. More controlled studies, as well as studies on children and adolescents, are needed in future.

PUBLIC SIGNIFICANCE

This is the first systematic scoping review examining psychological interventions for eating disorders in East Asia. Research in eating disorders has largely focused on White people and in Western countries. This review will be helpful for clinicians and researchers to understand the current state of the field through a non-Eurocentric lens, to identify gaps and plan future research.

Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire

PURPOSE

Weight bias internalization (WBI) is significantly associated with negative physiological and psychological consequences. Given its negative effects, appropriate measurement of WBI is required for weight management and mental and physical health in people with weight problems. One of the most reliable and frequently used questionnaires to assess WBI is the Weight Self-Stigma Questionnaire (WSSQ). However, a Japanese version of the WSSQ has not yet been developed. Thus, the current study aimed to develop a Japanese version of the WSSQ (WSSQ-J) and validate its psychometric properties in the Japanese context.

METHODS

A total of 1454 Japanese participants (age 34.44 ± 6.92; male = 498) with diverse weight statuses (Body mass index: 21.44 ± 3.52, 13.79-41.40 kg/m²) completed an online survey for the WSSQ-J. The internal consistency of the WSSQ-J was estimated by calculating Cronbach's α. Confirmatory factor analysis (CFA) was then carried out to confirm that the factor structure of the WSSQ-J was the same as that of the subscales of the original WSSQ.

RESULTS

The WSSQ-J had a Cronbach's α of 0.917, indicating good internal consistency. In CFA, the comparative fit index was 0.945, the root mean square error of approximation was 0.085, and the standardized root mean square residual was 0.040, indicating that the two-factor model showed satisfactory goodness-of-fit.

CONCLUSION

This study replicated the original findings related to the WSSQ, showing that the WSSQ-J is a reliable WBI questionnaire consisting of two factors. Therefore, the WSSQ-J would be a reliable tool for assessing WBI among Japanese.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Risk of eating disorders and the relationship with interest in modern culture among young female students in a university in Bangladesh: a cross-sectional study

BACKGROUND

Eating disorders (EDs) emerge most often in adolescent girls. While the basic neural and psychiatric mechanisms of ED development remain unknown, their incidence has increased with sociocultural modernization. To determine what aspects of modern culture are related to EDs, we examined the relationship between predisposition to EDs and interest in several modern cultural factors among young female university students in Bangladesh.

METHODS

A cross-sectional study was conducted in a population of 196 female students aged 18-29 years in a university in Bangladesh. Their predisposition to EDs was examined using the Eating Attitudes Test-26 (EAT-26), and their interest in modern culture was evaluated by grading interest in fashionable clothes, Indian TV shows/serials, luxury food and social network activities, and by examining involvement in cultural activities such as playing, dancing, parties and singing. The relationship between predisposition to EDs and interest in modern culture was then examined. The relation between EAT-26 score and body mass index (BMI) was also examined.

RESULTS

The EAT-26 revealed that 37% of the participants were at risk of developing an ED. Correlation analyses showed that a high EAT-26 score was correlated with a high interest in fashionable clothes and Indian TV shows/serials, but not with a high interest in luxury food or social network activities, or involvement in cultural activities, such as playing, dancing, parties and singing. Further, EAT-26 questions in the dieting category and oral control category, but not the bulimia and food preoccupation category, were correlated with interest in cultural factors. EAT-26 score showed no significant correlation with BMI.

CONCLUSIONS

The results of this study indicate that the risk of EDs is related to an interest in several facets of modern culture. Monitoring the cultural interests of adolescent females, who are continually exposed to modern culture and highly susceptible to EDs, will contribute to the prevention of EDs.

The light and the dark side of social media use: Depression, anxiety, and eating attitudes among adolescents

In the current study, we explored the links between social networking activity, eating attitudes (EA), anxiety, and depression among adolescents. We used a cross-sectional design. Our sample consisted of 532 males and females, aged 12 to 15 (M = 13.55, SD = 0.90), from the Eastern side of Romania. We analyzed our data using three different pathways to explore these relationships on the overall sample, as well as the at-risk for eating disorders (ED) group (n = 134), and the non-ED-risk (n = 398) samples. The results suggested that depressive and anxiety symptoms partially mediated the relationship between social networking and eating attitudes in the overall group and in the not-at-risk for ED group, but not in the at-risk for ED sample. When controlling for gender, social networking use partially mediated the relationship between anxiety and depressive symptoms and eating attitudes in the overall group and the not-at-risk for ED group, and a total mediating effect within this relationship in the at-risk ED sample was also found. In adolescents with symptoms of potential ED, social networking use seemed to have a protective role compared to the not-at-risk sample. The present study suggested that social networking use might increase the chances of developing unhealthy eating attitudes in adolescents who are not-at risk to develop an eating disorder, but, at the same time, it might play a protective role (instead of a harmful one) for adolescents who already developed such symptoms. Results are discussed concerning their clinical and practical implication for adolescents? physical and mental health, especially during the COVID?19 pandemic, and the potential protective role of social media use for adolescents with ED symptoms.

Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

PURPOSE OF REVIEW

To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality.

RECENT FINDINGS

Although the overall incidence rate of anorexia nervosa is considerably stable over the past decades, the incidence among younger persons (aged <15 years) has increased. It is unclear whether this reflects earlier detection or earlier age of onset. Nevertheless, it has implications for future research into risk factors and for prevention programs. For bulimia nervosa, there has been a decline in overall incidence rate over time. The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3% among males. Regarding bulimia nervosa, up to 3% of females and more than 1% of males suffer from this disorder during their lifetime. While epidemiological studies in the past mainly focused on young females from Western countries, anorexia nervosa and bulimia nervosa are reported worldwide among males and females from all ages. Both eating disorders may carry a five or more times increased mortality risk.

SUMMARY

Anorexia nervosa and bulimia nervosa occur worldwide among females and males of all age groups and are associated with an increased mortality risk.

Body Image and Eating Disorders Among South Asian American Women: What Are We Missing?

This study used focus group methodology to examine South Asian (SA) American women's conceptualizations of eating disorders (EDs) and body dissatisfaction, and their perspectives regarding cultural influences on these conditions. Using a qualitative descriptive approach, seven focus groups were conducted (N = 54, mean age = 20.11 years, SD = 2.52). Themes (n = 15) were organized according to the amended objectification theory framework. Women described experiences of cultural stressors specifically related to living in the United States, and weight stigma from multiple sources, especially older women (e.g., mothers, relatives, and aunties). Participants also experienced pressures to achieve competing body and appearance ideals ("thin" and "healthy"). In addition, they reported pressures to possess light skin, dark black hair, minimal body hair, and marry young, and noted these pressures negatively impacted their body esteem. Findings indicate that a combination of "traditional" and culturally-influenced factors are important to consider when conceptualizing eating pathology and body image in young SA American women.

Introduction to a special issue on eating disorders in Asia

OBJECTIVE

It is our pleasure to introduce a special issue of the International Journal of Eating Disorders on eating disorders (EDs) in Asia.

METHOD

We received such a robust response to the special edition that we were able to fill two issues. Contributions focused on seven main themes: (1) prevalence, (2) time trends, (3) healthcare systems, (4) treatment, (5) risk factors, (6) assessment, and (7) orthorexia.

RESULTS

New prevalence and time trend data from China, Iran, Singapore, Japan, and Taiwan suggest that EDs are increasingly common in Asia but are not always detected in healthcare settings. Only a minority of individuals with EDs in Singapore receive treatment, and psychosocial treatment and prevention interventions that are evidence-based in the West may require cultural adaptation before they can be fully implemented in Japan, Singapore, China, and South Korea. Psychological risk factors for EDs are more similar than different in Iran, India, Japan, and China, but biological risk factors are understudied across the continent. Psychometrically sound assessment tools are available in many Asian languages.

DISCUSSION

We hope this special issue provides a catalyst and blueprint for global collaboration to relieve the burden of suffering of EDs in Asia and beyond.