Accountability in promoting representation of historically marginalized racial and ethnic populations in the eating disorders field: A call to action

Partnering With Food Pantries to Disseminate and Implement Eating Disorder Interventions

OBJECTIVE

Food insecurity is associated with eating disorder psychopathology. This Spotlight describes why food pantries could be promising partners for disseminating and implementing eating disorder interventions.

METHOD

Researchers are increasingly collaborating with community-based organizations to improve access to health interventions, because community-based organizations overcome structural barriers to traditional healthcare by being embedded physically in the communities they serve, convenient to visit, regularly frequented, and led by trusted community members.

RESULTS

We describe strategies we have identified with our partner to disseminate and implement our digital intervention for binge eating; we also discuss ways we support the pantry's needs to improve the mutuality of the partnership.

DISCUSSION

The potential benefits of partnerships with food pantries make this an area to explore further. Future research directions include deeply engaging with food pantries to determine how pantries benefit from disseminating and implementing eating disorder interventions and how to intervene in non-stigmatizing ways, what resources they need to sustainably support these efforts, what eating disorder intervention modalities guests are willing and able to engage with, what intervention adaptations are needed so individuals with food insecurity can meaningfully engage in eating disorder intervention, and what implementation strategies facilitate uptake to intervention sustainably over time.

Experiences of intensive treatment for people with eating disorders: a systematic review and thematic synthesis

BACKGROUND

Eating disorders are complex difficulties that impact the individual, their supporters and society. Increasing numbers are being admitted to intensive treatment settings (e.g., for inpatient treatment, day-patient treatment or acute medical treatment). The lived experience perspectives of what helps and hinders eating disorder recovery during intensive treatment is an emerging area of interest. This review aims to explore patients' perspectives of what helps and hinders recovery in these contexts.

METHODS

A systematic review was conducted to identify studies using qualitative methods to explore patients' experiences of intensive treatment for an eating disorder. Article quality was assessed using the Critical Appraisal Skill Programme (CASP) checklist and thematic synthesis was used to analyse the primary research and develop overarching analytical themes.

RESULTS

Thirty articles met inclusion criteria and were included in this review. The methodological quality was mostly good. Thematic synthesis generated six main themes; collaborative care supports recovery; a safe and terrifying environment; negotiating identity; supporting mind and body; the need for specialist support; and the value of close others. The included articles focused predominantly on specialist inpatient care and were from eight different countries. One clear limitation was that ethnicity data were not reported in 22 out of the 30 studies. When ethnicity data were reported, participants predominantly identified as white.

CONCLUSIONS

This review identifies that a person-centred, biopsychosocial approach is necessary throughout all stages of eating disorder treatment, with support from a sufficiently resourced and adequately trained multidisciplinary team. Improving physical health remains fundamental to eating disorder recovery, though psychological support is also essential to understand what causes and maintains the eating disorder and to facilitate a shift away from an eating disorder dominated identity. Carers and peers who instil hope and offer empathy and validation are valuable additional sources of support. Future research should explore what works best for whom and why, evaluating patient and carer focused psychological interventions and dietetic support during intensive treatment. Future research should also explore the long-term effects of, at times, coercive and distressing treatment practices and determine how to mitigate against potential iatrogenic harm.

Avoidant/Restrictive Food Intake Disorder: Review and Recent Advances

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder recently codified in DSM-5 that affects individuals of all ages. A proliferation of ARFID research has emerged over the years, and this review provides a brief overview of the current understanding of ARFID epidemiology, symptoms, comorbid conditions, assessment, and treatment. The review highlights recent research updates regarding ARFID among adults, putative neurobiological mechanisms underlying ARFID, and new treatment trials. Findings from this review demonstrate that ARFID is as prevalent as other eating disorders, even among adults, and is associated with significant medical and psychiatric comorbid conditions. New, promising treatments for children, adolescents, and adults are in the early stages of development. Several assessments are now available to aid in the screening and diagnosis of ARFID and have demonstrated cross-cultural validity. Areas for future research and clinical guidance, including unresolved questions regarding ARFID categorization and differential diagnosis, are discussed.

Bulimia Nervosa and Binge-Eating Disorder Across the Lifespan

This article aims to review the current evidence-based psychotherapy and psychopharmacological treatments for adults and youths with bulimia nervosa (BN) and binge-eating disorder (BED). Treatments for adults and for children and adolescents are discussed separately, including developmental considerations in the management of these disorders among youths. Although several evidence-based psychotherapy and psychopharmacological treatment options have been established for adults with BN or BED, there is much less empirical support for the management of these eating disorders among children and adolescents. This review concludes by discussing promising modalities and innovations, highlighting the potential utility of integrating technology into treatment approaches. Despite decades of treatment development and testing, a sizable proportion of individuals with BN or BED do not respond to the current evidence-based treatments, highlighting the need for continued research in these domains. Future research should focus on testing psychotherapy treatments among diverse samples in large, randomized controlled trials, as well as on treatments that can be easily scaled and implemented in community settings.

Examining eating disorder pathology and self-stigma of help-seeking behaviors in a community sample of sexual minority adults: an intersectional investigation of race and gender

BACKGROUND

Self-stigma of seeking psychological help is a critical factor prohibiting individuals from seeking eating disorder (ED) treatment, but has been widely unexplored in racial/ethnic and sexual minority (SM) samples. The current study examined differences in ED pathology and self-stigma of help-seeking at the intersection of race and gender within a cisgender SM sample.

METHODS

Cisgender SM participants (n = 354) identifying as Black, Indigenous, or People of Color (BIPOC; 52%), Asian American and Pacific Islander (AAPI; 24%), or White (24%) were recruited through Prolific Academic. One-way analyses of variance were used to examine differences in the Self-Stigma of Seeking Help Scale (SSOSH) and Eating Pathology Symptom Inventory (EPSI) subscales among men and women in each group. Pearson's correlations explored associations between SSOSH and EPSI subscales within each subgroup.

RESULTS

Findings indicated significant between-group differences on the SSOSH and the EPSI subscales of Body Dissatisfaction, Purging, and Excessive Exercise. SSOSH was significantly positively correlated with Body Dissatisfaction in the White SM cis-women group and Binge Eating in the BIPOC SM cis-men group.

CONCLUSIONS

Results demonstrate unique, intersectional between-group differences in ED pathology and self-stigma among SM individuals. Further research on the impact of intersectionality on these constructs within larger samples is warranted.

The natural course of binge-eating disorder: findings from a prospective, community-based study of adults

BACKGROUND

Epidemiological data offer conflicting views of the natural course of binge-eating disorder (BED), with large retrospective studies suggesting a protracted course and small prospective studies suggesting a briefer duration. We thus examined changes in BED diagnostic status in a prospective, community-based study that was larger and more representative with respect to sex, age of onset, and body mass index (BMI) than prior multi-year prospective studies.

METHODS

Probands and relatives with current DSM-IV BED (n = 156) from a family study of BED ('baseline') were selected for follow-up at 2.5 and 5 years. Probands were required to have BMI > 25 (women) or >27 (men). Diagnostic interviews and questionnaires were administered at all timepoints.

RESULTS

Of participants with follow-up data (n = 137), 78.1% were female, and 11.7% and 88.3% reported identifying as Black and White, respectively. At baseline, their mean age was 47.2 years, and mean BMI was 36.1. At 2.5 (and 5) years, 61.3% (45.7%), 23.4% (32.6%), and 15.3% (21.7%) of assessed participants exhibited full, sub-threshold, and no BED, respectively. No participants displayed anorexia or bulimia nervosa at follow-up timepoints. Median time to remission (i.e. no BED) exceeded 60 months, and median time to relapse (i.e. sub-threshold or full BED) after remission was 30 months. Two classes of machine learning methods did not consistently outperform random guessing at predicting time to remission from baseline demographic and clinical variables.

CONCLUSIONS

Among community-based adults with higher BMI, BED improves with time, but full remission often takes many years, and relapse is common.

Prospective 2-Year Course and Predictors of Outcome in Avoidant/Restrictive Food Intake Disorder

OBJECTIVE

To evaluate the 2-year course and outcomes of full and subthreshold avoidant/restrictive food intake disorder (ARFID) in youth aged 9 to 23 years at baseline using a prospective longitudinal design to characterize the remission and persistence of ARFID, evaluate diagnostic crossover, and identify predictors of outcome. Greater severity in each ARFID profile-sensory sensitivity, fear of aversive consequences, and lack of interest-was hypothesized to predict greater likelihood of illness persistence, controlling for age, sex, body mass index percentile, ARFID treatment status, and baseline diagnosis.

METHOD

Participants (N = 100; age range, 9-23 years; 49% female; 91% White) were followed over 2 years. The Pica, ARFID, and Rumination Disorder Interview was used across 3 time points (baseline, year 1, year 2) to measure the severity of each ARFID profile and evaluate illness persistence or remission, and the Eating Disorder Assessment for DSM-5 was used to evaluate diagnostic crossover.

RESULTS

Across the 2-year follow-up period, half the participants persisted with their original diagnosis, and 3% of participants experienced a diagnostic shift to anorexia nervosa. Greater severity in the sensory sensitivity and lack of interest profiles was associated with higher likelihood of ARFID persistence at year 1 only; greater severity in the fear of aversive consequences profile was associated with higher likelihood of ARFID remission at year 2 only.

CONCLUSION

Findings underscore the distinctiveness of ARFID from other eating disorders and emphasize its persistence over 2 years. Results also highlight the predictive validity and prognostic value of the ARFID profiles (ie, sensory sensitivity, fear of aversive consequences, lack of interest).

Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight

BACKGROUND

Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. The emergence of shape/weight-related eating disorder symptoms in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. We aimed to characterize the emergence of eating disorder symptoms among adults with an initial diagnosis of ARFID who ultimately developed other eating disorders.

METHOD

Thirty-five participants (94% female; Mage = 23.17 ± 5.84 years) with a history of ARFID and a later, separate eating disorder completed clinical interviews (i.e., Structured Clinical Interview for DSM-5 - Research Version and Longitudinal Interval Follow-Up Evaluation) assessing the period between ARFID and the later eating disorder. Participants used calendars to aid in recall of symptoms over time. Descriptive statistics characterized the presence, order of, and time to each symptom. Paired samples t-tests compared weeks to emergence between symptoms.

RESULTS

Most participants (71%) developed restricting eating disorders; the remainder (29%) developed binge-spectrum eating disorders. Cognitive symptoms (e.g., shape/weight concerns) tended to onset initially and were followed by behavioral symptoms. Shape/weight-related food avoidance presented first, objective binge eating, fasting, and excessive exercise occurred next, followed by subjective binge eating and purging.

CONCLUSIONS

Diagnostic crossover from ARFID to another (typically restricting) eating disorder following the development of shape/weight concerns may represent the natural progression of a singular clinical phenomenon. Findings identify potential pathways from ARFID to the development of another eating disorder, highlighting possible clinical targets for preventing this outcome.

Effects of Covid-19-related anxiety on overeating and weight gain in a diverse college sample

The outbreak of the Covid-19 pandemic has been linked with caloric overeating and weight gain. We employed a mediation analysis to determine whether pandemic-associated overeating was a direct effect of Covid-19-related anxiety (affect regulation theory) or mediated by a coping mechanism of escape eating (escape theory). A diverse pool of college students participated in a repeated cross-sectional study during three separate waves: May 2021 (wave 1, n = 349), December 2021 (wave 2, n = 253), and March 2022 (wave 3, n = 132). The results revealed a significant indirect effect of Covid-19-related anxiety on high-caloric overeating mediated by escape eating, but no direct path between Covid-19-related anxiety and caloric overeating. Analysis of racial/ethnic status uncovered significantly greater Covid-weight gain in Hispanic participants compared with White, Black, and Asian participants. Our results suggest that Covid-19 weight gain is a byproduct of a mediated escape mechanism differentially affecting racial/ethnic groups.

Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies

OBJECTIVES

To enhance equity in clinical and epidemiological research, it is crucial to understand researcher motivations for conducting equity-relevant studies. Therefore, we evaluated author motivations in a randomly selected sample of equity-relevant observational studies published during the COVID-19 pandemic.

STUDY DESIGN AND SETTING

We searched MEDLINE for studies from 2020 to 2022, resulting in 16,828 references. We randomly selected 320 studies purposefully sampled across income setting (high vs low-middle-income), COVID-19 topic (vs non-COVID-19), and focus on populations experiencing inequities. Of those, 206 explicitly mentioned motivations which we analyzed thematically. We used discourse analysis to investigate the reasons behind emerging motivations.

RESULTS

We identified the following motivations: (1) examining health disparities, (2) tackling social determinants to improve access, and (3) addressing knowledge gaps in health equity. Discourse analysis showed motivations stem from commitments to social justice and recognizing the importance of highlighting it in research. Other discourses included aspiring to improve health-care efficiency, wanting to understand cause-effect relationships, and seeking to contribute to an equitable evidence base.

CONCLUSION

Understanding researchers' motivations for assessing health equity can aid in developing guidance that tailors to their needs. We will consider these motivations in developing and sharing equity guidance to better meet researchers' needs.

From disparities to equity: striving for more in our treatments for feeding and eating disorders

Adopting a framework of equity is urgently needed to reduce disparities persistent in feeding and eating disorder (FED) treatment models. This framework must emphasize the exchange of knowledge between relevant stakeholders and implementation strategies to impact practice and embrace a systemic change in the FED field.

Avoidant/restrictive food intake disorder differs from anorexia nervosa in delay discounting

BACKGROUND

Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are the two primary restrictive eating disorders; however, they are driven by differing motives for inadequate dietary intake. Despite overlap in restrictive eating behaviors and subsequent malnutrition, it remains unknown if ARFID and AN also share commonalities in their cognitive profiles, with cognitive alterations being a key identifier of AN. Discounting the present value of future outcomes with increasing delay to their expected receipt represents a core cognitive process guiding human decision-making. A hallmark cognitive characteristic of individuals with AN (vs. healthy controls [HC]) is reduced discounting of future outcomes, resulting in reduced impulsivity and higher likelihood of favoring delayed gratification. Whether individuals with ARFID display a similar reduction in delay discounting as those with AN (vs. an opposing bias towards increased delay discounting or no bias) is important in informing transdiagnostic versus disorder-specific cognitive characteristics and optimizing future intervention strategies.

METHOD

To address this research question, 104 participants (ARFID: n = 57, AN: n = 28, HC: n = 19) completed a computerized Delay Discounting Task. Groups were compared by their delay discounting parameter (ln)k.

RESULTS

Individuals with ARFID displayed a larger delay discounting parameter than those with AN, indicating steeper delay discounting (M ± SD = -6.10 ± 2.00 vs. -7.26 ± 1.73, p = 0.026 [age-adjusted], Hedges' g = 0.59), with no difference from HC (p = 0.514, Hedges' g = -0.35).

CONCLUSION

Our findings provide a first indication of distinct cognitive profiles among the two primary restrictive eating disorders. The present results, together with future research spanning additional cognitive domains and including larger and more diverse samples of individuals with ARFID (vs. AN), will contribute to identifying maintenance mechanisms that are unique to each disorder as well as contribute to the optimization and tailoring of treatment strategies across the spectrum of restrictive eating disorders.

Clinical staging across eating disorders: a scoping review protocol

INTRODUCTION

Clinical staging models in psychiatry assert that there are earlier, less severe or more malleable forms of illness that are distinguishable from later, more chronic forms of illness, and that these stages may have different prognostic and treatment implications. Previous reviews on clinical staging in eating disorders (EDs) suggest a staging heuristic could be useful for anorexia nervosa, but less research is available on how this applies to other EDs. An up-to-date review is required to synthesise new and heterogenous avenues of research. This scoping review aims to explore the extent and types of evidence in relation to illness staging for EDs and how these concepts are associated with treatment response and outcomes.

METHODS AND ANALYSIS

This protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. We will consider any documents providing evidence for clinical staging such as those which describe full or partial staging models, for all EDs, across various domains of assessment and functioning. Participants will include clinical or non-clinical population samples with full-syndrome EDs or disordered eating behaviour. PubMed, PsycINFO, MEDLINE and Web of Science databases will be systematically searched for relevant literature. Two authors will export documents and screen titles, abstracts and full texts. Data will be extracted into a charting form drafted by the authors. A narrative summary of the documents will be conducted in line with the study aims. Finally, clinical and research recommendations will be outlined.

ETHICS AND DISSEMINATION

Ethical approval will not be required to synthesise published and unpublished literature. The study will be published in a peer-reviewed journal and shared at conferences, via social media, and in other communications.

Using PROGRESS-plus to identify current approaches to the collection and reporting of equity-relevant data: a scoping review

OBJECTIVES

Our objectives were to identify what and how data relating to the social determinants of health are collected and reported in equity-relevant studies and map these data to the PROGRESS-Plus framework.

STUDY DESIGN AND SETTING

We performed a scoping review. We ran two systematic searches of MEDLINE and Embase for equity-relevant studies published during 2021. We included studies in any language without limitations to participant characteristics. Included studies were required to have collected and reported at least two participant variables relevant to evaluating individual-level social determinants of health. We applied the PROGRESS-Plus framework to identify and organize these data.

RESULTS

We extracted data from 200 equity-relevant studies, providing 962 items defined by PROGRESS-Plus. A median of 4 (interquartile range = 2) PROGRESS-Plus items were reported in the included studies. 92% of studies reported age; 78% reported sex/gender; 65% reported educational attainment; 49% reported socioeconomic status; 45% reported race; 44% reported social capital; 33% reported occupation; 14% reported place and 9% reported religion.

CONCLUSION

Our synthesis demonstrated that researchers currently collect a limited range of equity-relevant data, but usefully provides a range of examples spanning PROGRESS-Plus to inform the development of improved, standardized practices.

The need for epidemiological research on eating disorders in Africa and the Caribbean

The eating disorders field acknowledges the need to include diverse populations in research. Although global diversity has increased in epidemiologic research, there is still a significant lack of research in Africa and the Caribbean. The objectives of this article are to highlight knowledge gaps in these regions and make recommendations to improve future research. We searched the literature about the epidemiology of eating disorders in Africa and the Caribbean and provided a brief summary of research findings and measures used to identify cases. There is a large knowledge gap about the epidemiology of eating disorders across African and Caribbean nations. Knowledge about the cultural appropriateness of measurement instruments and screening tools is also lacking. Inadequate information about the epidemiology of eating disorders in Africa and the Caribbean inhibits the eating disorders research field from identifying who is affected. Further, measures and screening instruments with uncertain cultural validity inhibit the ability to understand case presentations and treatment targets. We recommend that the field advocate for the inclusion of eating disorders in larger population health research and that future research should evaluate the appropriateness of measurement instruments to capture eating disorder cases in African and Caribbean countries. PUBLIC SIGNIFICANCE: There is a lack of eating disorder research in African and Caribbean countries. The limited studies that do exist show evidence of eating disorders in African and Caribbean countries. Research is needed to develop culturally relevant measures for screening and case identification, and to calculate incidence and prevalence.

Recruitment strategies to increase racial and ethnic diversity in anorexia nervosa clinical research

OBJECTIVE

Inclusion of underrepresented racial and ethnic groups in eating disorder (ED) research is a critical unmet need, but evidence-based recruitment strategies are lacking. We sought to determine whether methods we had implemented to increase recruitment of underrepresented racial and ethnic groups were successful in improving racial and ethnic diversity in a clinical trial in women with anorexia nervosa.

METHOD

We implemented new strategies for recruitment of underrepresented racial and ethnic groups in a clinical trial on bone health in women with anorexia nervosa, including leveraging social media, liberalizing language on advertisements to be more inclusive of women who are as yet undiagnosed with the disorder or feel stigmatized by its name, translating advertisements to Spanish, and engaging community health centers. We compared participants' race and ethnicity in this clinical trial versus two similar prior clinical trials.

RESULTS

The percent of non-White and Hispanic participants who have signed a consent form in our ongoing clinical trial (2021-2023) is higher versus two previous clinical trials on bone health in women with anorexia nervosa (2011-2019) with similar inclusion/exclusion criteria and endpoints [non-White: 11/38 (28.9%) vs. 11/188 (5.9%), Hispanic: 6/38 (15.8%) vs. 5/188 (2.7%), p ≤ 0.006]. There was no change in the percent of Black participants [0/38 (0%) vs. 1/188 (0.5%), p = 1.0].

DISCUSSION

Viewing clinical research recruitment through a diversity, equity, and inclusion lens can improve racial and ethnic diversity in ED research. Further research recruitment strategies are needed to be more inclusive of Black populations.

Intersectional approaches to risk, resilience, and mental health in marginalized populations: Introduction to the special section

Although persistent health disparities affecting marginalized communities have long been recognized, marginalized populations (i.e., oppressed groups with stigmatized social identities) have remained significantly understudied in clinical science and allied disciplines. To reduce mental health disparities, it is critical to examine the experiences of Black, Indigenous, and people of color and sexual and gender minority populations within an intersectional framework (i.e., intersection of multiple marginalized identities) and to identify processes through which these experiences relate to risk and resilience for negative mental health outcomes. The goal of this special section is to highlight recent efforts to address this critical need by examining mental health among marginalized individuals impacted by multiple systems of oppression. These studies demonstrate the generative potential of intersectional approaches in clinical science. Our hope is that these studies will encourage future work in this field, with the ultimate aim of addressing disparities in underserved and understudied populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of Treatment Outcome in Eating Disorders: A Roadmap to Inform Future Research Efforts

PURPOSE OF REVIEW

With the current review, we provide a brief summary of recent literature that tests clinically observable characteristics at baseline that may impact treatment response, across eating disorder diagnoses. We then provide a critical discussion regarding how researchers may shift their approach to this research to improve treatment implications and generalizability of these findings.

RECENT FINDINGS

Recent work has broadly replicated prior findings suggesting a negative impact of lower weight status, poor emotion regulation, and early-life trauma on eating disorder treatment outcomes. Findings are more mixed for the relative contributions of illness duration, psychiatric comorbidity, and baseline symptom severity. Recent studies have begun to explore more specific domains of previously tested predictors (e.g., specific comorbidities) as well as previously neglected identity-related and systemic factors. However, recent research continues to use similar sampling techniques and approaches to analysis used in prior work. We propose that resolving remaining questions and illuminating predictors of treatment outcome in eating disorders requires a new approach to research sampling and study design. Suggested changes that can be applied within a traditional clinical trial framework may yield new insights with relevance across transdiagnostic eating disorder presentations.

Negative affect and loss-of-control eating in relation to adiposity among non-Hispanic youth identifying as black or white

Negative affect and loss-of-control (LOC)-eating are consistently linked and prevalent among youth identifying as non-Hispanic Black (NHB) and non-Hispanic White (NHW), particularly those with high weight. Given health disparities in high weight and associated cardiometabolic health concerns among NHB youth, elucidating how the association of negative affect with adiposity may vary by racial/ethnic group, and whether that relationship is impacted by LOC-eating, is warranted. Social inequities and related stressors are associated with negative affect among NHB youth, which may place this group at increased risk for excess weight gain. Across multiple aggregated protocols, 651 youth (13.0 ± 2.7 y; 65.9 % girls, 40.7 % NHB; 1.0 ± 1.1 BMIz; 37.6 % LOC-eating) self-reported trait anxiety and depressive symptoms as facets of negative affect. LOC-eating was assessed by interview and adiposity was measured objectively. Cross-sectional moderated mediation models predicted adiposity from ethno-racial identification (NHB, NHW) through the pathway of anxiety or depressive symptoms and examined whether LOC-eating influenced the strength of the pathway, adjusting for SES, age, height, and sex. The association between ethno-racial identity and adiposity was partially mediated by both anxiety (95 % CI = [0.01, 0.05]) and depressive symptoms (95 % CI = [0.02, 0.08]), but the mediation was not moderated by LOC-eating for either anxiety (95 % CI = [-0.04, 0.003]) or depressive symptoms (95 % CI = [-0.07, 0.03]). Mechanisms underlying the link between negative affect and adiposity among NHB youth, such as stress from discrimination and stress-related inflammation, should be explored. These data highlight the need to study impacts of social inequities on psychosocial and health outcomes.

Disordered eating during pregnancy among individuals participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

BACKGROUND

Food insecurity is associated with adverse psychosocial and health consequences in pregnancy. In non-pregnant populations, evidence suggests that food insecurity is linked to eating pathology, independent of depression or anxiety. Food assistance programs intended to reduce food insecurity, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), may unintentionally contribute to eating pathology through a "feast-or-famine" cycle (i.e., cyclical periods of food deprivation and food access over the benefit month). Thus, the present study examined associations between WIC participation and disordered eating in pregnancy, covarying for depressive symptoms.

METHODS

The present study is a secondary analysis of the Pittsburgh Girls Study (PGS), a 21-year prospective longitudinal study that over-sampled households in low resourced neighborhoods. The present analysis included a subset of pregnant PGS participants (N = 210; 13-25 years of age) who reported on WIC participation, and disordered eating and depressive symptoms on validated measures.

RESULTS

Negative binomial regression models covarying for participant's age at conception and gestational age at assessment found that WIC participation was associated with higher scores on overall eating pathology as well as dieting and oral control subscales, but not bulimic or food preoccupation subscales, or a binge-eating item. Patterns of findings did not change when depressive symptom severity was included in models.

DISCUSSION

WIC participation was associated with eating pathology during pregnancy. Future research should clarify directional relationships among food insecurity, food assistance, and eating behavior in pregnancy to promote health equity.

More than an outcome: a person-centered, ecological framework for eating disorder recovery

BACKGROUND

Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. BODY: In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual's level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.

Evidence Based Update on Psychosocial Treatments for Eating Disorders in Children and Adolescents

Eating disorders (EDs) are life-threatening psychiatric illnesses that occur in adolescents. Unfortunately, limited randomized controlled trials exist to address EDs in this vulnerable population. The current review updates a prior Journal of Clinical Child and Adolescent Psychology review from 2015. The recommendations in this review build upon those that were previously published. This update was completed through a systematic search of three major scientific databases (PsychInfo, Pubmed, and Cochrane) from 2015 to 2022 (inclusively) from three databases, employing relevant medial subject headings. Additionally, expert colleagues were asked for additional literature to include. Thirty-one new studies were added to this review. Psychosocial treatments included family therapies, individual therapy, cognitive-behavioral therapy, interpersonal psychotherapy, cognitive training, dialectical behavioral therapy, and more recently, virtual or telehealth-based practices and guided self-help modalities for carers of youth with EDs. Using the Journal of Clinical Child and Adolescent Psychology's methodological review criteria, this update found behavioral family-based treatment modalities (FBT) for both adolescent anorexia nervosa and bulimia nervosa met well-established treatment criteria. To date, there were no well-established treatments found for child and adolescent avoidant-restrictive food intake disorder, or binge eating disorder. Internet facilitated cognitive-behavioral therapy and family-based therapy were found to be possibly efficacious for binge eating disorder. Family-based treatment was found to be possibly efficacious for avoidant restrictive food intake disorder, with other clinical trials for cognitive treatment modalities under way. Ongoing research examining treatments for eating disorders in children and adolescents broadly is needed.

Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample

OBJECTIVE

There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782).

METHOD

We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option.

RESULTS

Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections.

DISCUSSION

This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.

PUBLIC SIGNIFICANCE

We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.

Disordered eating symptoms as a function of perceived weight status and race: An intersectional examination

Disordered eating (DE) exhibited by individuals with intersecting marginalized identities may be less likely to be perceived as pathological compared to DE exhibited by individuals with non-marginalized identities. The present experiment tested the intersectional impact of weight status and race stimuli on responses to DE in a college sample. Undergraduate students (N = 193, M_age = 18.57, SD = 1.88, 71 % female) read a fictional account from a female target with DE who was described as "underweight," "average weight," or "overweight," and "White" or "Black." Participants completed an in-lab survey assessing detection of and responses to DE. Three 2 (race: Black, White) x 3 (weight status: underweight, average weight, overweight) ANCOVAs revealed a main effect of weight status. DE was more likely to be detected in "underweight" than "average" and "overweight" targets (p < .001). Participants encouraged weight loss for "average" and "overweight" targets compared to "underweight" targets (p < .001) and encouraged weight restoration for "underweight" targets compared to "average weight" and "overweight" targets (p < .001). No significant effects for target race or interaction between weight status and race emerged. These findings underscore the salience of weight status in shaping perceptions of DE.

Preliminary validation of the pica, ARFID and rumination disorder interview ARFID questionnaire (PARDI-AR-Q)

BACKGROUND

The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a structured interview that can be used to determine diagnosis, presenting characteristics, and severity across three disorders, including avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the psychometric properties of a questionnaire focused specifically on ARFID (PARDI-AR-Q), which has the potential to provide related information with less participant burden.

METHODS

Adolescents and adults (n = 71, ages 14-40 years) with ARFID (n = 42) and healthy control participants (HC, n = 29) completed the PARDI-AR-Q and other measures. A subset of the ARFID group (n = 27) also completed the PARDI interview.

RESULTS

An exploratory factor analysis of proposed subscale items identified three factors corresponding to the ARFID phenotypes of avoidance based on the sensory characteristics of food, lack of interest in eating or food, and concern about aversive consequences of eating. Further analyses supported the internal consistency and convergent validity of the PARDI-AR-Q subscales, and subscale ratings on the questionnaire showed large and significant correlations (all p-values < 0.001; r's ranging from 0.48 to 0.77) with the corresponding subscales on the interview. The ARFID group scored significantly higher than HC on all subscales. Furthermore, 90% of the ARFID group scored positive on the PARDI-AR-Q diagnostic algorithm while 93% of the HC scored negative.

CONCLUSIONS

Though replication in larger and more diverse samples is needed, findings provide early support for the validity of the PARDI-AR-Q as a self-report measure for possible ARFID in clinical or research settings.

Update on the epidemiology and treatment of eating disorders among Hispanic/Latinx Americans in the United States

PURPOSE OF REVIEW

This review provides a 6-year update on the prevalence and treatment of eating disorders among Hispanic/Latinx Americans in the United States.

RECENT FINDINGS

Prevalence of eating disorders tends to be lower in Hispanic/Latinx American adolescents and adults relative to non-Hispanic White peers. Numerous risk factors for disordered eating symptoms have been identified, including negative body image, depression, sexual assault and culturally specific risk factors, including ethnic discrimination and acculturative stress. Hispanic/Latinx individuals seek treatment less often with the most influential barriers being cost of treatment, eating disorder stigma, eating disorder shame and mental health shame in general. Limited research on the treatment for eating disorders continue to persist. Culturally adapted cognitive behavioural therapy yielded similar outcomes to traditional cognitive behaviour therapy and had better treatment adherence and retention rates.

SUMMARY

The medical and sociopolitical climate of the United States has changed significantly since our previous review. The need for research on the effectiveness of eating disorder treatments for Hispanic/Latinx Americans remains important for one of the fastest growing populations in the U.S.

The COVID-19 pandemic and youth with anorexia nervosa: A retrospective comparative cohort design

OBJECTIVE

There is a growing body of literature suggesting the novel coronavirus pandemic (COVID-19) negatively impacts mental health in individuals self-reporting an eating disorder (ED); however, limited pediatric data is available about the impact COVID-19 has had on youth with EDs, specifically Anorexia Nervosa (AN). Our study uses a cross-sectional design to explore differences in ED symptoms between adolescents diagnosed with AN during the COVID-19 pandemic compared to a retrospective cohort of adolescents for whom these measures were previously collected, prior to the pandemic.

METHOD

We report cross-sectional data assessing differences between AN behaviors and cognitions during the COVID-19 pandemic compared to a retrospective cohort (n = 25 per cohort) assessed before the pandemic.

RESULTS

Results suggest that individuals with a first-time diagnosis of AN during the pandemic had lower percent expected body weight, and more compulsive exercise behaviors.

CONCLUSIONS

These data support existing pediatric findings in exercise and body weight differences in adolescents with AN before and during the pandemic. Findings may be helpful in informing considerations for providers treating ED patients amidst and after the pandemic.

PUBLIC SIGNIFICANCE

This manuscript compares a retrospective cohort of adolescents diagnosed with AN prior to the pandemic to a cohort of adolescents diagnosed with AN during the pandemic. Results report that adolescents diagnosed with AN during the pandemic have lower weights and increased compensatory exercise behavior compared to adolescents diagnosed with AN before the pandemic despite no difference in length of illness. Findings may be helpful in informing considerations for providers treating ED patients amidst and after the pandemic.

Predictors of treatment seeking and uptake among respondents to a widely disseminated online eating disorders screen in the United States

OBJECTIVE

To explore predictors of treatment seeking and uptake among individuals following an online eating disorders (EDs) screen in the U.S. disseminated by the National Eating Disorders Association.

METHOD

Respondents who screened at risk or positive for a probable ED from 04/2019 to 05/2021 (N = 263,530) were eligible to complete a 2-month follow-up survey that assessed treatment seeking and uptake after being offered referral options following screening. Analyses were conducted using chi-square tests or logistic regressions.

RESULTS

Sixty thousand thirty-four respondents (22.8%) opted-in to the follow-up survey, of whom 2276 (3.8%) completed it. Of the final analytic sample (n = 1922), 35.7% of respondents reported seeking and 22.4% reported receiving treatment. Treatment seeking and uptake were more common among respondents who were female, White, or >24 years of age; uptake was more common among respondents who were non-Hispanic or higher income. Elevated shape/weight concerns were significantly, albeit modestly, associated with reduced likelihood to receive treatment.

DISCUSSION

Demographic differences in treatment seeking and uptake highlight the need to optimize ED screening tools/feedback to meet the needs of underserved groups and to address stereotypes and structural barriers that may interfere. Research is also needed to identify barriers to uptake among those with elevated shape/weight concerns.

PUBLIC SIGNIFICANCE

Relatively low rates of treatment seeking and uptake were observed, particularly among underserved groups, 2 months following a widely disseminated online eating disorders screen. Optimization of online eating disorder screening tools and delivery of feedback and referral information may be needed to increase health care utilization.

Structural validity of the Eating Disorder Examination-Questionnaire: A systematic review

OBJECTIVE

The main aim was to perform a systematic literature review of studies investigating the factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q), a widely used measure of eating pathology. Secondary aims were to summarize the quality of reporting of latent variable (factor) analyses in these studies and review support for different factor solutions.

METHOD

Literature was identified through Scopus, Medline, PsycInfo, and ProQuest databases published up to February 23, 2022 and outreach via an international listserv. All studies published in English reporting factor analysis of the EDE-Q were included with few restrictions. Sixty studies including 63,389 participants met inclusion criteria.

RESULTS

The originally proposed four-factor solution received little empirical support, although few alternative models have been robustly evaluated. Items assessing shape and weight concerns frequently coalesce in factor solutions, suggesting that these constructs are closely related. Investigations of brief versions of the EDE-Q have produced more consistent findings, suggesting that these measures, particularly a seven-item version, might be useful alternatives to the full version. Quality of studies was reasonable, with important methodological elements of factor analysis often reported.

DISCUSSION

The findings are of relevance to practitioners and researchers, suggesting that the "original" factor structure of the EDE-Q should be reconsidered and that use of a seven-item version is to be encouraged.

PUBLIC SIGNIFICANCE

Self-report questionnaires are widely used in the assessment of disordered eating. The current study found that there is little consensus about the structure of a common measure of eating psychopathology. There is more consistent support for a brief, seven-item, version assessing dietary restraint, body dissatisfaction, and overvaluation of weight and shape.

Measuring Ostracism-Induced Changes in Consumption of Palatable Food: Feasibility of a Novel Behavioral Task

Purpose

Ostracism is a highly aversive interpersonal experience. Previous research suggests that it can increase consumption of highly palatable food in some individuals, but decrease it in others. Thus, we developed the Cyberball-Milkshake Task (CMT), to facilitate research investigating individual differences in ostracism's effects on consumption of highly palatable food. We present data on feasibility for the CMT in a sample of young adult women.

Materials and Methods

Participants were 22 women, 18-30 years old, reporting very low or very high levels of emotional eating at screening. Participants performed the CMT, which consisted of 12 trials. Each trial included: playing a round of Cyberball (a computerized game of catch with fictitious "other participants" programmed to either include or exclude the participant); viewing a chocolate image; and then consuming a participant-determined amount of milkshake. Participants subsequently played an additional inclusion and exclusion round of Cyberball, each immediately followed by questionnaires assessing current mood and recent Cyberball experience.

Results

Cyberball exclusion (vs. inclusion) was associated with large, significant increases in reported ostracism and threats to self-esteem; exclusion's effects on affect were in the expected direction (e.g., increased negative affect), but generally small and non-significant. Milkshake intake was measurable for 95% of participants, on 96% of trials. Intake decreased quadratically across trials, with a steep negative slope for low trial numbers that decreased to the point of being flat for the highest trial numbers.

Discussion

The CMT is a generally feasible approach to investigating ostracism's effects on consumption of highly palatable food. The feasibility (and validity) of the CMT may benefit from modification (e.g., fewer trials and longer rounds of Cyberball). Future research should examine whether performance on a modified version of the CMT predicts real-world behavior in a larger sample.

Eating Disorder Examination-Questionnaire: Evaluating factor structures and establishing measurement invariance with Asian/Hawaiian/Pacific Islander, Black, and White American college men

OBJECTIVE

This study evaluated the factor structure and invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a sample of Asian/Hawaiian/Pacific Islander (n = 163), Black (n = 155), and White (n = 367) American university men.

METHOD

Twelve different EDE-Q factor structures reported in the literature were evaluated using multi-group confirmatory factor analyses, and measurement invariance assessed.

RESULTS

A respecified four-factor structure proposed by Parker et al. (2016) showed superior fit and was invariant across groups. Significant differences emerged across all latent factors, with small to medium effects. Asian/Hawaiian/Pacific Islander men reported significantly higher scores on factors assessing Appearance Concern, Overvaluation of Shape/Weight, and Eating Concerns, and were more likely to endorse regular objective binge eating (OBE) and fasting episodes than their Black and White peers. Both White and Asian/Hawaiian/Pacific Islander men reported greater dietary restraint than Black men. Among this sample, frequencies of regular compensatory exercise ranged from 10% to 16%, fasting 6% to 14%, and OBEs 1% to 10%.

DISCUSSION

Results provide further support for the use of alternate EDE-Q factor structures, especially among non-White men. In this study, Asian/Hawaiian/Pacific Islander men reported the highest levels of ED psychopathology relative to White and Black men, indicating they might be particularly vulnerable to EDs.

PUBLIC SIGNIFICANCE

This study failed to find support for using the original Eating Disorder Examination-Questionnaire four-factor structure to detect disordered eating in Asian, Black, and White American college men. An alternate model proposed by Parker et al. in 2016 may be more appropriate. Asian men also reported the highest levels of eating psychopathology relative to their peers, suggesting they may be at high risk for developing eating disorders.