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Vincent C, Bodnaruc AM, Prud'homme D, Guenette J, Giroux I. Disordered eating behaviours during the menopausal transition: a systematic review. Appl Physiol Nutr Metab 2024; 49:1286-1308. [PMID: 39229895 DOI: 10.1139/apnm-2023-0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Disordered eating refers to a range of eating behaviours and attitudes towards weight and food that can negatively influence physical and psychosocial well-being. The menopausal transition could be a vulnerable period for disordered eating due to major hormonal fluctuations, menopausal symptoms, common body composition shifts, and an increased risk of psychological challenges. This systematic review aimed to summarize evidence on the associations between the menopausal transition and disordered eating. Records published before October 2023 were identified through MEDLINE, PsycINFO, Scopus, Embase, and CINAHL. Studies investigating associations between menopausal status, menopausal symptoms, or reproductive hormone levels, and disordered eating during the menopausal transition were sought. A total of 1301 non-duplicate records were screened, with 10 studies deemed eligible for inclusion. Most included studies used a cross-sectional design (n = 9). Findings include potentially higher levels of binge eating during the perimenopausal stage, whereas restrictive eating behaviours appeared more common during postmenopause compared to premenopause. Both studies investigating menopausal symptoms found strong positive associations with disordered eating. Nonetheless, findings are equivocal with contrasting results and limited methodological quality across studies. Further research is needed to verify these findings and better assist health professionals in supporting healthy eating behaviours in menopausal women during this complex transition. (PROSPERO ID: CRD42021290736).
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Affiliation(s)
- Coralie Vincent
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Alexandra M Bodnaruc
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Université de Moncton, Moncton, NB, Canada
| | - Jacob Guenette
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Anaya C, Culbert KM, Klump KL. Binge Eating Risk During Midlife and the Menopausal Transition: Sensitivity to Ovarian Hormones as Potential Mechanisms of Risk. Curr Psychiatry Rep 2023; 25:45-52. [PMID: 36565385 PMCID: PMC9974637 DOI: 10.1007/s11920-022-01405-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Recent research suggests that binge eating may be more prevalent among women in midlife than previously believed. The menopausal transition, an important developmental stage during midlife, is characterized by substantial fluctuations and eventual decreases in ovarian hormones that may contribute to increased risk. This narrative review summarizes findings from studies of binge eating during midlife and menopause and discusses the potential role of ovarian hormones in binge eating risk. RECENT FINDINGS Studies are few in number and findings are mixed, with only some studies showing increased binge eating during midlife and the menopausal transition. Sensitivity to ovarian hormones, potentially through gene x hormone interactions, may influence who experiences increased binge eating risk and could help explain mixed findings in the field. Future studies of hormone sensitivity and gene x hormone interactions are needed to further elucidate midlife and menopausal risk for binge eating in women.
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Affiliation(s)
- Carolina Anaya
- Department of Psychology, Michigan State University, MI, 48824-1116, East Lansing, USA
| | - Kristen M Culbert
- Department of Psychology, Michigan State University, MI, 48824-1116, East Lansing, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, MI, 48824-1116, East Lansing, USA.
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Vincent C, Bodnaruc AM, Prud’homme D, Olson V, Giroux I. Associations between menopause and body image: A systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231209536. [PMID: 37994043 PMCID: PMC10666711 DOI: 10.1177/17455057231209536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/28/2023] [Accepted: 09/28/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The menopausal transition involves multiple biological and psychosocial challenges that may render middle-aged women vulnerable to body image concerns. OBJECTIVE The aim of this study was to summarize evidence on the associations between menopause and body image perception in healthy middle-aged women. DESIGN This study is a systematic review of observational studies. DATA SOURCES AND METHODS Menopause-related exposure measures included menopausal stages, menopausal symptoms, and reproductive hormone levels during the menopausal transition. Studies investigating body image as an outcome, including through a positive (e.g. body self-esteem) or negative (e.g. body dissatisfaction) lens, were considered eligible. Articles published before March 2023 were identified through MEDLINE, PsycINFO, and Embase and underwent double screening, extraction, and quality assessment by two independent investigators. Characteristics and results were summarized using narrative synthesis. RESULTS A total of 820 non-duplicate records were identified, with 18 observational studies deemed eligible for inclusion after full-text screening. All studies investigating menopausal symptoms and body image (n = 6) found some significant association between them, with a higher frequency, intensity, or number of symptoms being associated with greater body image concern. Differences in body image perception between menopausal stages were inconsistent across studies (n = 12), while evidence of potential associations between reproductive hormones and body image was minimal (n = 2). Findings should be interpreted with caution as 17 of the included studies used a cross-sectional design, and not all studies adjusted their analyses for relevant confounders. CONCLUSION Overall, menopausal symptoms showed relatively consistent associations with a more negative body image perception. Additional research is required to understand the potential role of menopausal stages and reproductive hormone levels in the body image perception of middle-aged women and to confirm the direction of reported associations. REGISTRATION PROSPERO-CRD42021241637.
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Affiliation(s)
- Coralie Vincent
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Alexandra M Bodnaruc
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Denis Prud’homme
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Université de Moncton, Moncton, NB, Canada
| | - Viviane Olson
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Presseller EK, Clark KE, Fojtu C, Juarascio AS. An empirical examination of appetite hormones and cognitive and behavioral bulimic symptomatology. Eat Weight Disord 2021; 26:1129-1137. [PMID: 32951131 PMCID: PMC8095371 DOI: 10.1007/s40519-020-01009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Existing literature has demonstrated that appetite hormones are frequently dysregulated in individuals with bulimic-spectrum eating disorders (BN-EDs). Although dysregulations in appetite hormones may maintain BN-EDs, very limited research has examined the association between dysregulated appetite hormones and cognitive and behavioral bulimic symptoms. We hypothesized that greater frequency of behavioral symptoms and severity of cognitive symptoms of BN-EDs would correlate with greater dysregulation in appetite hormones. METHODS The association between ghrelin, cortisol, leptin, GLP-1, and amylin levels and eating pathology was examined in treatment-seeking adults with BN-EDs (N = 33). Participants completed bloodwork to assess fasting blood hormone levels and bulimic symptoms were measured by the Eating Disorder Examination. Pearson partial correlations were run to examine the association between hormone levels and eating pathology, controlling for BMI. RESULTS Contrary to hypotheses, none of the appetite hormones tested were significantly associated with frequency of behavioral ED symptoms (p range = 0.13-0.97, negligible to small effect sizes). Global eating pathology was positively associated with leptin (p = 0.03) and negatively associated with GLP-1 (p = 0.03) and amylin (p = 0.04), with medium effect sizes. Post hoc analyses indicated significantly stronger associations between appetite hormones and cognitive eating pathology than between appetite hormones and frequency of binge eating [GLP-1 (p = 0.02) and amylin (p = 0.02)] or compensatory behaviors [leptin (p = 0.03), GLP-1 (p = 0.02), and amylin (p = 0.04)]. CONCLUSION In individuals with BN-EDs, appetite hormones may be more strongly associated with cognitive symptoms than behavioral symptoms. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Emily K Presseller
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, 19104, USA. .,Department of Psychology, Drexel University, Philadelphia, PA, USA.
| | - Kelsey E Clark
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Caroline Fojtu
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
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Culbert KM, Sisk CL, Klump KL. A Narrative Review of Sex Differences in Eating Disorders: Is There a Biological Basis? Clin Ther 2021; 43:95-111. [PMID: 33375999 PMCID: PMC7902379 DOI: 10.1016/j.clinthera.2020.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Eating disorders and their core symptoms (eg, binge eating, body weight/shape concerns) disproportionately affect females, and these sex-differentiated effects become prominent during and after puberty. Although psychosocial influences such as heightened sociocultural pressures for thinness in girls and women contribute to this sex imbalance, biological factors could also play an important role. METHODS This narrative review summarizes evidence of biological factors underlying the sex-differentiated prevalence of eating pathology as well as within-sex variability in risk. FINDINGS There are sex differences in the pubertal emergence of genetic effects on eating pathology (adrenarche in males; gonadarche in females), and at least some genetic contributions to eating pathology seem to vary between the sexes. Furthermore, sex steroid hormones (eg, testosterone, estradiol, progesterone) are leading contributors to differential risk for eating pathology in males and females across the life span. Emerging data suggest that between-sex and within-sex variability in risk might occur via hormone-driven modulation (activation/deactivation) of genetic influences and neural responsiveness to food-related cues. IMPLICATIONS There is a biological basis to heightened risk for eating pathology in females, relative to males, as well as unique biological influences within each sex. Findings from this review highlight the importance of studying both sexes and considering sex-specific biological mechanisms that may underlie differential risk for eating pathology.
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Affiliation(s)
- Kristen M Culbert
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Cheryl L Sisk
- Neuroscience Program, Michigan State University, East Lansing, MI, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Thompson KA, Bardone-Cone AM. Menopausal status and disordered eating and body image concerns among middle-aged women. Int J Eat Disord 2019; 52:314-318. [PMID: 30702172 DOI: 10.1002/eat.23030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/01/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Eating disorders are present among middle-aged women, yet most eating disorder knowledge comes from adolescents and young adults. There is arguably a need for research specific to middle-aged women and eating pathology. One biological factor that may contribute to eating disorder symptoms and is unique to middle-aged women is menopause, given the changes in body shape and weight that direct women's bodies away from the young, thin beauty standard. METHOD This study explored group differences in disordered eating and body image by menopausal status. Participants were 310 middle-aged women between the ages of 40 and 68. They completed an online survey about their menopausal status, disordered eating, and body image concerns. We compared disordered eating behaviors and attitudes across three groups: premenopausal women, perimenopausal women, and postmenopausal women. RESULTS Results indicated no group differences on either disordered eating or body image concerns by menopausal status. DISCUSSION These findings suggest the perimenopausal period may not be a window of vulnerability for women in general. Given these mixed findings, future research should examine moderators to determine when there are menopausal status group differences on eating pathology.
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Affiliation(s)
- Katherine A Thompson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Fowler N, Vo PT, Sisk CL, Klump KL. Stress as a potential moderator of ovarian hormone influences on binge eating in women. F1000Res 2019; 8. [PMID: 30854192 PMCID: PMC6396839 DOI: 10.12688/f1000research.16895.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Abstract
Previous research has demonstrated significant associations between increased levels of ovarian hormones and increased rates of binge eating (BE) in women. However, whereas all women experience fluctuations in ovarian hormones across the menstrual cycle, not all women binge eat in response to these fluctuations, suggesting that other factors must contribute. Stress is one potential contributing factor. Specifically, it may be that hormone-BE associations are stronger in women who experience high levels of stress, particularly as stress has been shown to be a precipitant to BE episodes in women. To date, no studies have directly examined stress as a moderator of hormone-BE associations, but indirect data (that is, associations between BE and stress and between ovarian hormones and stress) could provide initial clues about moderating effects. Given the above, the purpose of this narrative review was to evaluate these indirect data and their promise for understanding the role of stress in hormone-BE associations. Studies examining associations between all three phenotypes (that is, ovarian hormones, stress, and BE) in animals and humans were reviewed to provide the most thorough and up-to-date review of the literature on the potential moderating effects of stress on ovarian hormone-BE associations. Overall, current evidence suggests that associations between hormones and BE may be stronger in women with high stress levels, possibly via altered hypothalamic-pituitary-adrenal axis response to stress and increased sensitivity to and altered effects of ovarian hormones during stress. Additional studies are necessary to directly examine stress as a moderator of ovarian hormone-BE associations and identify the mechanisms underlying these effects.
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Affiliation(s)
- Natasha Fowler
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
| | - Phuong T Vo
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
| | - Cheryl L Sisk
- Neuroscience Program, Michigan State University, 293 Farm Lane, East Lansing, MI, 48824-1116, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824-1116, USA
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8
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Sex steroid hormones and differential risk for eating pathology: a review of genetic and phenotypic effects across development. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW We summarized recent literature on the epidemiology and treatment of eating disorders in middle-aged and older women and men. RECENT FINDINGS The prevalence of eating disorders according to DSM-5 criteria is around 3.5% in older (>40 years) women and around 1-2% in older men. The majority of those eating disordered persons are not in treatment. There are new terms like 'perimenopausal eating disorders' and 'muscularity-oriented eating disorders' indicating the impact of the aging process and sex-specific differences. SUMMARY Disordered eating and eating disorders occur in both women and men of all ages. Medical complications because of age, the stigma of eating disorders in a still 'untypical' age, and the glorification of sports activity often hinder the recognition of eating disorders in midlife and older persons. Treatment approaches should consider treatment strategies tailored for older women and men, addressing the context of midlife and aging.
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Schaumberg K, Welch E, Breithaupt L, Hübel C, Baker JH, Munn-Chernoff MA, Yilmaz Z, Ehrlich S, Mustelin L, Ghaderi A, Hardaway AJ, Bulik-Sullivan EC, Hedman AM, Jangmo A, Nilsson IAK, Wiklund C, Yao S, Seidel M, Bulik CM. The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:432-450. [PMID: 28967161 PMCID: PMC5711426 DOI: 10.1002/erv.2553] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In 2015, the Academy for Eating Disorders collaborated with international patient, advocacy, and parent organizations to craft the 'Nine Truths About Eating Disorders'. This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the 'Nine Truths'. METHODS The literature supporting each of the 'Nine Truths' was reviewed, summarized and richly annotated. RESULTS Most of the 'Nine Truths' arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes and their treatments. CONCLUSIONS The 'Nine Truths About Eating Disorders' is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Katherine Schaumberg
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elisabeth Welch
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lauren Breithaupt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Linda Mustelin
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Public Health and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andrew J Hardaway
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily C Bulik-Sullivan
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Camilla Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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