Patterns and prevalence of disordered eating and weight control behaviors in women ages 25-45

Is there a basis for a weight cut-off point? A large-scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre

OBJECTIVE

There is debate surrounding how to differentiate between anorexia nervosa (AN) and atypical AN (atypAN) as diagnostic entities, and whether a distinction based on BMI is warranted. Better understanding eating disorder (ED) and emotional symptoms across atypAN and AN subtypes [AN-restricting (AN-R), AN-binge/purge (AN-BP)], with and without controlling for BMI, can elucidate how atypAN differs from AN subtypes and whether there is a basis for a BMI cut-off.

METHODS

1810 female patients at an ED treatment centre completed intake surveys. ANCOVAs assessed differences across AN-R (n = 853), AN-BP (n = 726), and atypAN (n = 231) groups on ED, depressive, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness, with and without controlling for BMI.

RESULTS

Relative to AN-R, atypAN and AN-BP groups endorsed significantly higher ED and depressive symptoms, anxiety sensitivity, experiential avoidance, and significantly lower mindfulness (all p < 0.001), but atypAN and AN-BP groups did not differ from one another. When controlling for BMI, all previously significant differences between atypAN and AN-R did not remain significant.

CONCLUSION

Individuals with atypAN who have a higher BMI experience more pronounced ED and emotional symptoms, suggesting that relying solely on BMI as a marker of illness severity may be problematic.

Prevalence and Etiology of Eating Disorders in Polycystic Ovary Syndrome: A Scoping Review

Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disorder affecting females across the lifespan. Eating disorders (EDs) are psychiatric conditions that may impact the development of PCOS and comorbidities including obesity, metabolic syndrome, and type 2 diabetes. The aim of this scoping review was to determine the prevalence of EDs and disordered eating, and to review the etiology of EDs in PCOS. The review was conducted using search terms addressing PCOS, EDs, and disordered eating in databases, including PubMed, Scopus, PsycINFO, and CINAHL. Structured interviews, self-administered questionnaires, chart review, or self-reported diagnosis were used to identify EDs in 38 studies included in the review. The prevalence of any ED in those with PCOS ranged from 0% to 62%. Those with PCOS were 3-6-fold more likely to have an ED and higher odds ratios (ORs) of an elevated ED score compared with controls. In those with PCOS, 30% had a higher OR of bulimia nervosa and binge ED was 3-fold higher compared with controls. Studies were limited on anorexia nervosa and other specified feeding or ED (such as night eating syndrome) and these were not reported to be higher in PCOS. To our knowledge, no studies reported on avoidant/restrictive food intake disorder, rumination disorder, or pica in PCOS. Studies showed strong associations between overweight, body dissatisfaction, and disordered eating in PCOS. The etiologic development of EDs in PCOS remains unclear; however, psychological, metabolic, hypothalamic, and genetic factors are implicated. The prevalence of any ED in PCOS varied because of the use of different diagnostic and screening tools. Screening of all individuals with PCOS for EDs is recommended and high-quality studies on the prevalence, pathogenesis of specific EDs, relationship to comorbidities, and effective interventions to treat ED in those with PCOS are needed.

Ayahuasca ceremony leaders' perspectives on special considerations for eating disorders

Eating disorders (EDs) are difficult conditions to resolve, necessitating novel treatments. Ayahuasca, a psychedelic plant medicine originating in Indigenous Amazonian communities, is being investigated. Aspects of ceremonial ayahuasca use (purging, dietary restrictions) appear similar to ED behaviors, raising questions about ayahuasca's suitability as an intervention for individuals with EDs. This study explored the perspectives of ayahuasca ceremony leaders on these and other considerations for ceremonial ayahuasca drinking among individuals with EDs. A qualitative content analysis of interviews was undertaken with 15 ayahuasca ceremony leaders, the majority of whom were from the West/Global North. Screening for EDs, purging and dietary restrictions, potential risks and dangers, and complementarity with conventional ED treatment emerged as categories. The findings offer ideas, including careful screening and extra support, to promote safe and beneficial ceremony experiences for ceremony participants with EDs. More research is needed to clarify the impacts of ceremony-related purging and preparatory diets. To evolve conventional models of treatment, the ED field could consider Indigenous approaches to mental health whereby ayahuasca ceremony leaders and ED researchers and clinicians collaborate in a decolonizing, bidirectional bridging process between Western and Indigenous paradigms of healing.

Psychometric evaluation of the Chinese version of the Scale of Effects of Social Media on Eating Behaviour and research of its influencing factors

BACKGROUND

Social media has become an indispensable part of contemporary young people's lives, and the influence of social media on college students' eating and other health-related behaviors has become increasingly prominent. However, there is no assessment tool to determine the effects of social media on Chinese college students' eating behavior. This study aims to translate the Scale of Effects of Social Media on Eating Behaviour (SESMEB) into Chinese. Its applicability to Chinese college students was examined through reliability and validity indexes, and the influencing factors of SESMEB were explored.

METHODS

The questionnaire survey included 2374 Chinese college students. The Brislin translation model was used to translate the original scale into Chinese. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the construct validity of the scale, and the content validity of the scale was assessed through the content validity index. The internal consistency of the scale was assessed by calculating Cronbach's alpha coefficient, McDonald's Omega coefficient, split-half reliability, and test-retest reliability. Multiple stepwise linear regression analysis was performed to identify potential influences on the effects of social media on eating behavior.

RESULTS

EFA supported the one-factor structure, and the factor loadings of each item on this dimension were higher than 0.40. CFA showed good model fitness indexes. The content validity index of the scale was 0.94. The Cronbach's alpha coefficient and McDonald's Omega coefficient for the scale were 0.964, the split-half reliability coefficient was 0.953, and the test-retest reliability was 0.849. Gender, education, major, frequency of social media use, online sexual objectification experiences, fear of negative evaluations, and physical appearance perfectionism explained 73.8% of the variance in the effects of social media on eating behavior.

CONCLUSIONS

The Chinese version of the SESMEB has good psychometric properties and is a valid measurement tool for assessing the effects of social media on college students' eating behavior. Subjects who were female, highly educated, non-medical, had frequent social media use, online sexual objectification experiences, fear of negative evaluations, and physical appearance perfectionism used social media to have a higher impact on eating behavior.

Mothers with Dysregulated Eating and Their Offspring's Emotional/Behavioral Functioning during the COVID-19 Pandemic: A Descriptive Study

OBJECTIVE

Research on the psychopathological effects of the COVID-19 pandemic has not specifically focused on mothers with dysregulated eating and their children.

METHODS

This study aimed to observe whether the symptoms of mothers with binge eating episodes (assessed through the SCL-90/R and the TFEQ-R18) worsened from the pre-pandemic period (T1) to the pandemic period (T2). In addition, we sought to assess whether the levels of internalizing/externalizing and dysregulation symptoms in children (assessed through the CBCL 6-18) worsened from T1 to T2.

RESULTS

Our results showed that the values obtained for mothers in the SCL-90/R were significantly higher at T2 (during the pandemic), particularly for Depression, Phobic Anxiety, Interpersonal Sensitivity, and Obsessive-Compulsive subscales. Moreover, in both the Emotional Eating and Uncontrolled Eating subscales of the TFEQ-R18, mothers at T2 scored substantially higher than mothers at T1. The emotional/behavioral functioning of children was more maladaptive at T2, according to mothers, especially for the subscales of Withdrawn, Anxious/Depressed, and Aggressive Behavior. Children also had significantly higher scores on the Internalizing and Externalizing subscales, as well as greater symptoms of dysregulation.

CONCLUSIONS

This study contributes to demonstrating that the COVID-19 pandemic may have had increased maladaptive emotional/behavioral functioning in children and their mothers with dysregulated eating.

Functions of disordered eating behaviors: a qualitative analysis of the lived experience and clinician perspectives

BACKGROUND

One method to improve treatment outcomes for individuals with eating disorders (EDs) may be understanding and targeting individuals' motives for engaging in DE behaviors-or the functions of DE behaviors. The goal of this study was to investigate and categorize the various functions of DE behaviors from the perspectives of adults who engage in DE behaviors and clinicians who treat EDs.

METHODS

Individuals who engage in DE behaviors (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of DE behaviors.

RESULTS

Four main functions of DE behaviors were identified by the authors: (1) alleviating shape, weight, and eating concerns; (2) regulating emotions; (3) regulating one's self-concept; and (4) regulating interpersonal relationships/communicating with others.

CONCLUSIONS

Differences in participant responses, particularly regarding the relevance of alleviating shape and weight concerns as an DE behavior function, highlight the importance of individualized conceptualizations of DE behavior functions for any given client.

Attentional vigilance of food information in disordered eating behaviors

INTRODUCTION

Disordered eating behaviors (DEBs) are very common among female college students, which seriously endanger their health and well-being. Therefore, the study of the mechanism of DEBs can provide effective evidence for early detection and intervention.

METHODS

In total of 54 female college students were recruited and assigned to DEB group (n = 29) and healthy control (HC) group (n = 25) according to their scores in the Eating Attitudes Test-26 (EAT-26). Then, the Exogenous Cueing Task (ECT) was used to evaluate their reaction time (RT) to the location of a target dot preceded by a food or neutral cue.

RESULTS

The study found that compared with HC group, DEB group showed more attentional engagement to food stimuli, indicating that attentional vigilance to food information could be considered as a specific attentional bias of DEBs.

DISCUSSION

Our findings not only provide evidence of the potential mechanism of DEBs from the perspective of attentional bias, but also can be considered as an effective and objective indicator for early screening of subclinical eating disorders (EDs).

Orthorexia symptoms and disordered eating behaviors in young women with cancer

OBJECTIVE

A cancer diagnosis can motivate people to modify behaviors believed to influence prognosis or recurrence risk, including their eating habits. Orthorexia is a type of disordered eating that involves an extreme fixation on healthy eating. The current study examined: 1) the presence of orthorexia symptoms and disordered eating behavior in young adult women with cancer; 2) factors associated with orthorexia and disordered eating behaviors; and 3) the type and frequency of eating behavior changes made following cancer diagnosis.

METHODS

Young adult women with cancer participated in an online survey. The Düsseldorf Orthorexia Scale measured orthorexia symptoms and the Eating Habits Questionnaire assessed disordered eating behaviors. Fear of cancer recurrence, body image satisfaction, intolerance of uncertainty, internet use, and eating habit changes were also assessed.

RESULTS

Of participants (N = 93), 36.7 % scored in the clinical range for orthorexia symptoms. A greater perceived knowledge of nutrition was related to higher cancer-related body image dissatisfaction (p = .03) and more years of education (p = .001). Approaching statistical significance (p = .05) were a positive correlation between intolerance of uncertainty and orthorexia symptom severity, a positive correlation between fear of cancer recurrence and problems associated with eating habits, and a negative correlation between internet use and positive emotions associated with healthy eating habits. Overall, 44.1 % of young adult women changed their eating habits since their cancer diagnosis and 69.9 % intended to in the next year.

CONCLUSIONS

Young adult women with cancer show elevated orthorexia symptoms and disordered eating behaviors, which are associated with potentially modifiable psychosocial factors.

Nutritional behavior during the COVID-19 pandemic: the association of fear and sleep quality with emotional eating

PURPOSE

Even though it is known that fear and poor sleep quality trigger emotional eating, whether fear and poor sleep quality are associated with emotional eating during the COVID-19 pandemic is not clear. This study aimed to evaluate the association of fear of COVID-19, sleep quality, and some sociodemographic characteristics with emotional eating during the COVID-19 pandemic.

METHOD

This cross-sectional descriptive study was completed with 495 participants in Turkey. The participants filled out a questionnaire that asked about sociodemographic characteristics, fear of COVID-19, nutritional behaviors, sleep quality, and self-reported weight and height through email or social media.

RESULTS

The fear of COVID-19 score (β: 0.090, p < 0.05) and sleep quality score (β: 0.289, p < 0.001) were associated with the emotional eating score at the rate of 0.8% and 8.3%, respectively. The association of fear of COVID-19 with emotional eating disappeared when combined with various factors. The collective association of all factors, fear of COVID-19 (β: 0.042, p > 0.05), sleep quality (β: 0.246, p < 0.001), BMI (β: 0.275, p < 0.001), age (β:  - 0.259, p < 0.001) and gender (β:  - 0.169, p < 0.001) were associated with the emotional eating score at the rate of 18.3%.

CONCLUSIONS

These findings suggest that fear of COVID-19, sleep quality, BMI, age, and gender were associated with emotional eating during the pandemic. We hope that this study will help in the development of guidelines and strategies through understanding the factors associated with nutritional behavior during the pandemic period.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The impacts of COVID-19 on eating disorders and disordered eating: A mixed studies systematic review and implications

Purpose

The unique constraints to everyday life brought about by the COVID-19 pandemic have been suggested to negatively impact those with pre-existing mental health issues such as eating disorders. While individuals with eating disorders or disordered eating behaviors likely represent a vulnerable group to the COVID-19 pandemic, the impact of the pandemic is yet to be fully established.

Methods

We systematically examined the impact of the COVID-19 pandemic on eating disorders and disordered eating behaviors. We searched electronic databases MEDLINE, PsycINFO, CINAHL, and EMBASE for literature published until October 2021. Eligible studies were required to report on individuals with or without a diagnosed eating disorder or disordered eating behaviors who were exposed to the COVID-19 pandemic.

Findings

Seventy-two studies met eligibility criteria with the majority reporting an increase in eating disorder or disordered eating behaviors associated with the COVID-19 pandemic. Specifically, it appears children and adolescents and individuals with a diagnosed eating disorder may present vulnerable groups to the impacts of the COVID-19 pandemic.

Discussion

This mixed systematic review provides a timely insight into COVID-19 eating disorder literature and will assist in understanding possible future long-term impacts of the pandemic on eating disorder behaviors. It appears that the role of stress in the development and maintenance of eating disorders may have been intensified to cope with the uncertainty of the COVID-19 pandemic. Future research is needed among understudied and minority groups and to examine the long-term implications of the COVID-19 pandemic on eating disorders and disordered eating behaviors.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284749, PROSPERO [CRD42021284749].

Substance Use Disorder and Anxiety, Depression, Eating Disorder, PTSD, and Phobia Comorbidities Among Individuals Attending Residential Substance Use Treatment Settings

Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.

Behavior Change Around an Online Health Awareness Campaign: A Causal Impact Study

National Eating Disorders Association conducts a NEDAwareness week every year, during which it publishes content on social media and news aimed to raise awareness of eating disorders. Measuring the impact of these actions is vital for maximizing the effectiveness of such interventions. This study is an effort to empirically measure the change in behavior of users who engage with NEDAwareness content, and compare the detected changes between campaigns in two different years. We analyze a total of 35,895 tweets generated during two campaigns of NEDAwareness campaigns in 2019 and 2020. In order to assess the reach of each campaign, we consider the users participating in the campaigns and their number of followers, as well as retweeting engagement. We use the Linguistic Inquiry and Word Count (LIWC) text modeling and causal impact analysis in order to gauge the change in self-expression of users who have interacted with the NEDAwareness content, compared to a baseline group of users. We further enrich our understanding of the users by extracting gender information from their display names. We find that, despite large media corporations (such as MTV and Teen Vogue) participating in the campaign, it is governmental and nonprofit accounts who are among the accounts that attract the most retweets. Whereas the most influential accounts were well-connected in 2019, the 2020 campaign saw little retweeting between such accounts, negatively impacting the reach of the material. Both campaigns engaged women at around 40% and men 17%, supporting previous research showing women to be more likely to share their experiences with eating disorders. Further, women were more likely to mention other health topics within the 15 days of the intervention, including pregnancy and abortion, as well as depression and anxiety, and to discuss the developing COVID pandemic in 2020. Despite the positive message of the campaign, we find that the users who have engaged with this content were more likely to mention the linguistic categories concerning anxiety and risk. Thus, we illustrate the complex, gender-specific effects of NEDAwareness online health intervention campaign on the continued self-expression of its audience and provide actionable insights for potential improvement of such public health efforts.

Exploring eating and exercise-related indicators during COVID-19 quarantine in Portugal: concerns and routine changes in women with different BMI

PURPOSE

The present study aimed to understand how quarantine associated with COVID-19 was experienced by women from different BMI groups (underweight, normal weight, pre-obesity, and obesity), by exploring the changes introduced in eating and exercise routines and the differences between BMI groups regarding shape concern, weight concern, and binge eating behaviours reported during this time.

METHODS

This study comprised 580 women aged between 18 and 65 years old, who completed self-report measures, during the mandatory confinement in Portugal due to COVID-19. The total sample was divided into four groups, according to their BMI.

RESULTS

Results revealed that overall, there were no significant differences between the groups regarding the eating and exercise routine changes introduced during quarantine. However, significant differences between the four groups were found in the reported body and eating-related difficulties (shape concern, weight concern, and binge eating behaviours), with the pre-obesity and obesity groups presenting significant higher levels.

CONCLUSIONS

Our study suggests that, even though the changes introduced to the eating and exercise routine are independent of BMI, the pre-obesity and obesity group represent a major vulnerability group for the development of eating disorders. We hope this study allows professionals to understand the need to develop different guidelines and strategies for the pre-obesity and obesity female population during the deconfinement period.

LEVEL OF EVIDENCE

Level V-Descriptive study.

Disordered eating in college women: associations with the mother-daughter relationship and family weight-related conversations

PURPOSE

Extensive work in the field has found multiple risk factors of disordered eating among women; however, there is limited research regarding the associations of maternal influence and family weight-related conversations during childhood with eating disorder psychopathology later in adulthood. Thus, the purpose of this study was to explore how the mother-daughter relationship and family weight-related conversations may influence the development of disordered eating in college-aged women.

METHODS

A diverse sample of 551 college-aged women completed an online survey with instruments that assessed disordered eating risk (dependent variable) with the following independent variables: aspects of the mother-daughter relationship (maternal regard and responsibility) and family weight-related conversations (emphasis on maternal weight, appearance weight control, and parent weight talk). Mediation analysis was performed using hierarchical regression analyses to examine the influence of maternal factors in combination with family weight-related conversations with disordered eating risk.

RESULTS

Using hierarchical regression analyses, aspects of the mother-daughter relationship were significantly associated with risk of disordered eating. However, this significant relationship was diminished in the presence of family weight-related conversations. Furthermore, a test of the mediation suggests that family weight-related conversations may act as a pathway for influencing perceived maternal factors in the development of disordered eating.

CONCLUSIONS

Findings illustrate the important role mothers may have in shaping their daughters eating attitudes and behaviors. Future disordered eating prevention programs and interventions may consider developing strategies in educating parents on conversations regarding weight.

LEVEL OF EVIDENCE

Descriptive cross-sectional study, Level V.

Disordered eating and eating disorders among women seeking fertility treatment: A systematic review

The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.

Differential Effects of Intuitive and Disordered Eating on Physical and Psychological Outcomes for Women with Young Children

OBJECTIVES

Pressure to lose weight can increase the risk of developing disordered eating behaviours, negative body image and depressive symptomatology. Eating intuitively may counteract these negative outcomes. This research examined the unique relationship between intuitive eating and disordered eating on body mass index (BMI), body image and depressive symptoms for women of young children.

METHODS

A survey of women with a child aged between six and 48 months, included the Intuitive Eating Scale, Eating Attitudes Test-26, Body Shape Questionnaire and Edinburgh Postnatal Depression Scale. Multivariate analysis of variance (MANOVA) was conducted as an omnibus test to estimate the effect of intuitive and disordered eating on BMI, negative body image and depressive symptoms.

RESULTS

Of the 419 sample (M age = 32.06), 32% were classified with disordered and 32% with intuitive eating. MANOVA and regression analysis found disordered eating positively associated with depressive symptoms, (β = 0.303) and negative body image (β = 0.318). Intuitive eating was associated with lower depressive symptoms (β =  - 0.183) and negative body image (β =  - 0.615). Disordered eating (β =  - 0.194) and intuitive eating (β =  - 0.586) both contributed to lower BMI, with the association stronger for intuitive eating.

CONCLUSION

The early parenting period involves a high risk for developing disordered eating behaviours. Eating patterns are modifiable factors, illustrating the potential for positive and preventive health outcomes through adopting intuitive eating behaviours. There is an opportunity for healthcare professionals to promote physical and psychological health including for women in the early parenting period.

Functional assessment of restrictive eating: A three-study clinically heterogeneous and transdiagnostic investigation

Restrictive eating is common and associated with negative psychological outcomes across the life span and eating disorder (ED) severity levels. Little is known about functional processes that maintain restriction, especially outside of narrow diagnostic categories (e.g., anorexia nervosa). Here, we extend research on operant four-function models (identifying automatic negative, automatic positive, social negative, and social positive reinforcement functions) that have previously been applied to nonsuicidal self-injury (NSSI), binge eating, and purging to restricting. We assessed restrictive eating functions in three samples: clinically heterogeneous adolescents (Study 1: N = 457), transdiagnostic adults (Study 2: N = 145), and adults with acute or recently weight-restored anorexia nervosa (Study 3: N = 45). Study 1 indicated the four-function model was a good fit for restricting (root mean square error of approximation [RMSEA] = .06, Tucker-Lewis index [TLI] = .88). This factor structure replicated in Study 2 (comparative fit index [CFI] = .97, RMSEA = .07, TLI = .97, standardized root mean square residual [SRMR] = .09). Unlike NSSI, binge eating, and purging, which have been found to primarily serve automatic negative reinforcement functions, all three present studies found automatic positive reinforcement was most highly endorsed (by up to 85% of participants). In Studies 1 and 3, automatic functions were associated with poorer emotion regulation (ps < .05). In Study 1, social functions were associated with less social support (ps < .001). Across studies, automatic functions were associated with greater restriction ps < .05). Functions varied slightly by ED diagnosis. Across ED presentation, severity, and developmental stage, restrictive eating may be largely maintained by automatic positive reinforcement, with some variability across presentations. Continued examination of restrictive eating functions will establish processes that maintain restriction, allowing more precise treatment targeting for these problematic behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Three Mediating Pathways of Anxiety and Security in the Relationship between Coping Style and Disordered Eating Behaviors among Chinese Female College Students

Background

According to previous studies, eating disorders and disordered eating behaviors are associated with coping style, anxiety, and sense of security. However, the specific mechanism between them has not been elucidated. The purpose of this study was to explore whether anxiety and sense of security play mediating roles in coping style and disordered eating behaviors among Chinese female college students.

Method

Six hundred and ninety-one female college students (mean age = 19.36; SD = 1.06) completed the Simple Coping Style Questionnaire, the Eating Disorder Inventory, the Security Questionnaire, the Hospital Anxiety and Depression Scale, and a brief demographic survey. The percentage bootstrap method of deviation correction was conducted to determine the mediating effect of anxiety and sense of security on coping style and disordered eating behaviors.

Results

Coping style had direct and indirect effects on disordered eating behaviors. Anxiety and sense of security were not only independent mediators in the relationship between coping style and disordered eating behaviors but also chain mediators.

Conclusions

The results of the current study provide preliminary evidence that preventive interventions targeting anxiety and sense of security may be feasible for young women who develop disordered eating behaviors due to stress in their lives.

Chew and spit (CHSP) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating features

A recent general population study of Chew and Spit (CHSP) behavior in adults found a 0.4% prevalence, predominantly in females. The current study explores this further by examining the same phenomenon in secondary-school aged adolescents. This study also explores the relationship between CHSP and other demographic and eating disorder (ED) features in 5111 adolescents (11-to-19 years of age) from 13 schools in New South Wales, Australia. Participants completed measures of ED symptoms and behaviors and change to impairment with two components: psychological distress (K-10) and health related quality of life (HRQoL; PedsQL). CHSP was found to have a 12.2% (95% CI 0.114, 0.132]) point-prevalence rate. Participants who indicated engaging in CHSP reported significantly higher levels of psychological distress (K-10) and lower HRQoL scores (PedsQL) compared to those that did not report CHSP. There was a dose-response relationship between CHSP frequency, psychological distress and HRQoL physical scores but not for HRQoL emotional and HRQoL social scores. Participants who reported regular CHSP were more likely to be female, younger, and to engage in compensatory behaviors such as purging. The high frequency of CHSP behavior in adolescents with disordered eating could suggest that CHSP should be considered in routine ED screening practices. Future studies may examine how to treat CHSP or investigate more focused treatment approaches, in order to target the behavior of CHSP more directly.

Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics

Irritable bowel syndrome affects 10% to 15% of the population, and up to 90% of patients with irritable bowel syndrome exclude certain foods to improve their gastrointestinal symptoms. Although focused dietary restrictions are a normal, adaptive response, restrictions can spiral out of control and result in maladaptive restriction. Dietary therapies are rapidly becoming first-line treatment of irritable bowel syndrome, and gastroenterologists need to be aware of red flag symptoms of maladaptive eating patterns and the negative effects of prescribing restrictive diets. There is also growing awareness of the association between eating disorders and gastrointestinal symptoms, including irritable bowel syndrome symptoms.

A qualitative exploration of motivations for fasting and the impact of Ramadan on eating behaviors and body image among young adult Muslim women in the United Kingdom

Research exploring the impact of fasting in Ramadan on eating behaviors has focused on Muslim-majority countries and has neglected to examine impacts beyond the month when "normal" eating patterns resume. This study aimed to explore the experiences of United Kingdom-residing young adult Muslim women who were fasting in Ramadan to understand its impact on their body image and eating behaviors both during and 1-month following Ramadan. In-depth, semi-structured interviews were conducted with 14 Muslim women aged between 18 and 35 (Mage = 27.3) at two distinct time-points: during the last week of Ramadan and 1-2 months later. The interviews explored questions related to motivations for fasting, experience of fasting in Ramadan, and eating behaviors and thoughts related to body image and appearance. Thematic Analysis revealed three themes: (1) family and community expectations to fast (2) exertion of control of on eating behaviors and (3) preoccupation with weight and appearance. The results suggest that family and community play a strong role in motivating women to fast during Ramadan, alongside the need to feel a sense of belonging to their community. This can conflict with the pressure and desire to assimilate with Western culture and associated appearance ideals, thus putting women at greater risk of disordered eating and body image concerns. These findings suggest important implications for increased support in the Muslim community, and the need for further research to explore this topic across longer time-points and in different cultural groups.

The Association Between Autistic Traits and Disordered Eating is Moderated by Sex/Gender and Independent of Anxiety and Depression

Previous studies have reported positive correlations between autistic traits and disordered eating, though it is unclear whether the association is moderated by sex/gender or whether it is independent of anxiety or depression. We present the findings of an online survey of 691 participants who completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), and Eating Attitudes Test-26 (EAT-26). Following a pre-registered analysis plan, we observed positive correlations between AQ and EAT-26 in males and females, with the association being significantly stronger in females. AQ also remained a significant predictor of EAT-26 when anxiety and depression were controlled for statistically. These findings may be relevant when considering therapeutic interventions in disordered eating populations that exhibit autistic traits.

Relationships between patterns of weight-related self-monitoring and eating disorder symptomology among undergraduate and graduate students

OBJECTIVE

To characterize patterns of weight-related self-monitoring (WRSM) among US undergraduate and graduate students and examine associations between identified patterns of WRSM and eating disorder symptomology.

METHOD

Undergraduate and graduate students from 12 US colleges and universities (N = 10,010) reported the frequency with which they use WRSM, including self-weighing and dietary self-monitoring. Eating disorder symptomology was assessed using the Eating Disorder Examination Questionnaire. Gender-specific patterns of WRSM were identified using latent class analysis, and logistic regressions were used to identify differences in the odds of eating disorder symptomology across patterns of WRSM.

RESULTS

Among this sample, 32.7% weighed themselves regularly; 44.1% reported knowing the nutrition facts of the foods they ate; 33.6% reported knowing the caloric content of the foods they ate; and 12.8% counted the calories they ate. Among women, four patterns of WRSM were identified: "no WRSM," "all forms of WRSM," "knowing nutrition/calorie facts," and "self-weigh only." Compared with the "no WRSM" pattern, women in all other patterns experienced increased eating disorder symptomology. Among men, three patterns were identified: "no WRSM," "all forms of WRSM," and "knowing nutrition/calorie facts." Only men in the "all forms WRSM" pattern had increased eating disorder symptomatology compared with those in the "no WRSM" pattern.

DISCUSSION

In a large sample of undergraduate and graduate students, engaging in any WRSM was associated with increased eating disorder symptomology among women, particularly for those who engaged in all forms. Among men, engaging in all forms of WRSM was the only pattern associated with higher eating disorder symptomology.

Childhood maltreatment and disordered eating attitudes and behaviors in adult men and women:Findings from project EAT

This study examined gender differences in the association between childhood maltreatment and disordered eating attitudes and behaviors in adulthood. Data were derived from 1647 adults (ages 27-33) participating in a population-based, longitudinal study (Project EAT-IV: Eating Among Teens and Young Adults, 1998-2016). Childhood maltreatment (sexual abuse, physical abuse, emotional abuse, emotional neglect) and disordered eating attitudes and behaviors (overeating, binge eating, extreme weight control behaviors, unhealthy weight control behaviors, chronic dieting, weight and shape concerns) were assessed. Relative risk regression models were used to examine whether childhood maltreatment was related to individual disordered eating attitudes and behaviors. Gender differences in these associations were explored. A history of any childhood maltreatment was associated with more than 60% greater risk for chronic dieting and overeating, with additional associations found for binge eating, weight and shape concerns, and unhealthy weight control behaviors. All types of abuse and neglect were associated with at least one type of disordered eating outcome. Examination of the point estimates indicated that emotional neglect was most consistently related to higher risk for disordered eating attitudes and behaviors. Although there were no statistically significant gender differences in the association between childhood maltreatment and disordered eating attitudes and behaviors, the patterning of these effects highlighted unique qualitative similarities and differences in these relationships between men and women. Taken together, these findings implicate childhood maltreatment, particularly emotional neglect, as a meaningful risk factor for problematic eating outcomes in both men and women during adulthood.

Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders

Eating disorders (ED) are complex mental illnesses and are not a result of personal choice. Full recovery from an ED is possible. The severity and inherent lethality of an ED is undisputed, and the role of the registered dietitian nutritionist (RDN) is essential. Clinical symptomology presents at varying developmental milestones and is perpetuated through a sociocultural evaluation of beauty and drive for ascetic idealism. ED are globally prevalent in 4.4% of the population aged 5 to 17 years, yet affect individuals across the entire lifespan, including all cultures and genders. The Behavioral Health Nutrition Dietetic Practice Group, along with the Academy of Nutrition and Dietetics Quality Management Committee, revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Eating Disorders. Including the RDN in ED treatment is vital for all levels of care. The RDN must be perceptive to negative symptoms indicative of psychological triggers when exploring food belief systems, patterns of disinhibition, and nutrition misinformation with clients. Through a conscious awareness of medical, psychological, and behavioral strategies, the implementation of the SOP and SOPP supports a dynamic and holistic view of ED treatment by the RDN. The SOP and SOPP are complementary resources for RDNs and are intended to be used as self-evaluation tools for assuring competent practice in ED and for determining potential education, training, supervision, and mentorship needs for advancement to a higher practice level in a variety of settings.

Internal states and interoception along a spectrum of eating disorder symptomology

OBJECTIVE

Recent studies on atypical interoceptive capabilities have focused on clinical populations, including anorexia nervosa[1,2]. The present exploratory study aims to characterize the influence of disordered eating symptomology on interoceptive capabilities in college students, a population for which dangerous dieting behaviors may emerge.

METHOD

Ninety-nine participants were randomized to consume a blinded high calorie or low calorie midday shake. Participants reported frequency of eating disorder cognitions and behaviors; indicated changes in satiety, happiness, and energy pre- and post-consumption; and guessed the calories in their shake. Outcomes (perceived satiety, changes in mood, and caloric guess) were regressed on eating disorder symptoms scores, the high/low calorie shake condition, and the interaction between these predictors.

RESULTS

Those randomized to receive the high calorie shake reported feeling fuller, but only when endorsing lower levels of eating concern. Those randomized to the high calorie shake reported greater post-meal happiness, but only at greater levels of eating concerns. Lastly, those with lower levels of eating restraint reported an expected positive association between level of fullness and calorie guess, but those with higher levels of eating restraint did not exhibit any relationship between perceived fullness and calorie guess.

DISCUSSION

Results of this exploratory suggest that irregular eating habits (e.g., not eating a sufficient amount for lunch) may have direct consequences on interoceptive capabilities. Further, these capacities may be impacted by individual differences in eating concern and restraint. Preliminary findings suggest that impairment in deciphering visceral signals may be associated with the degree of eating disorder symptomology; such impairment may occur at lower levels of symptomatology than normative data would indicate.

Meeting of Minds around Food Addiction: Insights from Addiction Medicine, Nutrition, Psychology, and Neurosciences

This review, focused on food addiction (FA), considers opinions from specialists with different expertise in addiction medicine, nutrition, health psychology, and behavioral neurosciences. The concept of FA is a recurring issue in the clinical description of abnormal eating. Even though some tools have been developed to diagnose FA, such as the Yale Food Addiction Scale (YFAS) questionnaire, the FA concept is not recognized as an eating disorder (ED) so far and is even not mentioned in the Diagnostic and Statistical Manuel of Mental Disorders version 5 (DSM-5) or the International Classification of Disease (ICD-11). Its triggering mechanisms and relationships with other substance use disorders (SUD) need to be further explored. Food addiction (FA) is frequent in the overweight or obese population, but it remains unclear whether it could articulate with obesity-related comorbidities. As there is currently no validated therapy against FA in obese patients, FA is often underdiagnosed and untreated, so that FA may partly explain failure of obesity treatment, addiction transfer, and weight regain after obesity surgery. Future studies should assess whether a dedicated management of FA is associated with better outcomes, especially after obesity surgery. For prevention and treatment purposes, it is necessary to promote a comprehensive psychological approach to FA. Understanding the developmental process of FA and identifying precociously some high-risk profiles can be achieved via the exploration of the environmental, emotional, and cognitive components of eating, as well as their relationships with emotion management, some personality traits, and internalized weight stigma. Under the light of behavioral neurosciences and neuroimaging, FA reveals a specific brain phenotype that is characterized by anomalies in the reward and inhibitory control processes. These anomalies are likely to disrupt the emotional, cognitive, and attentional spheres, but further research is needed to disentangle their complex relationship and overlap with obesity and other forms of SUD. Prevention, diagnosis, and treatment must rely on a multidisciplinary coherence to adapt existing strategies to FA management and to provide social and emotional support to these patients suffering from highly stigmatized medical conditions, namely overweight and addiction. Multi-level interventions could combine motivational interviews, cognitive behavioral therapies, and self-help groups, while benefiting from modern exploratory and interventional tools to target specific neurocognitive processes.

Women's Experiences with a Mindful Eating Program for Binge and Emotional Eating: A Qualitative Investigation into the Process of Change

Objectives: Mindfulness-based interventions (MBIs) have been shown to reduce engagement in disordered eating behaviors, although how these interventions engender change remains unclear. The objective of this exploratory qualitative study was to describe the experiences and perceived attitudinal and behavioral changes of women participating in a mindful eating program. Design: Focus group discussions were held with women participating in a community-based mindful eating program for binge and emotional eating. A semistructured interview guide was used to explore participants' conceptualizations of mindfulness-based attitudinal and behavior change, as related to food, eating, and body image. The focus group discussions were audio-recorded, transcribed, and analyzed using thematic analysis to identify salient concepts. Settings/Location: Focus group discussions were held at the Center for Mindfulness at the University of Massachusetts Medical School (UMMS) (United States). Participants: A sample of nine women who were enrolled in the mindful eating program at UMMS for problems with self-reported binge and/or emotional eating participated in this study. Results: Four themes were constructed that described a process of mindfulness-based behavior change, including (1) Learning Through Self-Awareness, (2) Self-Empowerment, (3) Mindful Choice-Making, and (4) Resilient Self-Care. An overarching description of the participants' perceived attitudinal and behavior changes was developed: "unforced freedom of choice, emerging from embodied awareness." Conclusions: These findings suggest that MBIs reduce may disordered eating behaviors through empowering women to make positive choices about food, eating, and coping, without focusing on weight control. Future research is needed to examine whether these findings replicate in larger and more diverse samples, and how they can be used to optimize and implement eating-specific MBIs in community-based settings.

Associations between weight loss difficulty, disordered eating behaviors and poor weight loss outcomes in Arab female university students

Little is known about the impact of eating behaviors on weight management efforts among college students in non-Western settings. This study aimed to explore the relationship between eating behaviors, weight loss outcomes, and perceived weight loss difficulties (PWLD) among young Arab women trying to lose weight. A cross-sectional probability sample was used to recruit female university students aged 18 years and older in the state of Qatar. Participants (N = 937) completed an online survey measuring their attitudes and behaviors towards healthy eating, body image, and weight loss. More than two third (67.2%) reported facing difficulties when trying to lose weight and around one-third (31.2%) screened positive for disordered eating. Chi-squared and logistic regression analyses showed a strong and independent association between unsuccessful weight loss including lack of weight loss or maintenance after weight loss attempts, and PWLD (OR 8.6, p = .002). In addition, eating meals a few hours before sleeping (OR 1.98; p = .02) and having disordered eating (OR 2.28; p = .02) were positively associated with PWLD. BMI, weight loss goal and skipping breakfast were not associated with PWLD after adjustment for all covariates. Future studies are needed to develop better tools to comprehensively assess PWLD and validate against short- and long-term measured weight loss outcomes.

Social Media, Thin-Ideal, Body Dissatisfaction and Disordered Eating Attitudes: An Exploratory Analysis

Disordered eating attitudes are rapidly increasing, especially among young women in their twenties. These disordered behaviours result from the interaction of several factors, including beauty ideals. A significant factor is social media, by which the unrealistic beauty ideals are popularized and may lead to these behaviours. The objectives of this study were, first, to determine the relationship between disordered eating behaviours among female university students and sociocultural factors, such as the use of social network sites, beauty ideals, body satisfaction, body image and the body image desired to achieve and, second, to determine whether there is a sensitive relationship between disordered eating attitudes, addiction to social networks, and testosterone levels as a biological factor. The data (N = 168) was obtained using validated surveys (EAT-26, BSQ, CIPE-a, SNSA) and indirect measures of prenatal testosterone. The data was analysed using chi-square, Student’s t-test, correlation tests and logistic regression tests. The results showed that disordered eating attitudes were linked to self-esteem (p < 0.001), body image (p < 0.001), body desired to achieve (p < 0.001), the use of social media (p < 0.001) and prenatal testosterone (p < 0.01). The findings presented in this study suggest a relationship between body image, body concerns, body dissatisfaction, and disordered eating attitudes among college women.

Fifteen-Year Prevalence, Trajectories, and Predictors of Body Dissatisfaction From Adolescence to Middle Adulthood

Body dissatisfaction is common in adolescence and associated with negative outcomes (e.g., eating disorders). We identified common individual trajectories of body dissatisfaction from mid-adolescence to adulthood, and predictors of divergent patterns. Participants were 1,455 individuals from four waves of Project EAT (Eating and Activity in Teens and Young Adults), a population-based, 15-year longitudinal study. Aggregate body dissatisfaction increased over 15 years, which was largely attributable to increases in weight. Growth mixture modeling identified four common patterns of body dissatisfaction, revealing nearly 95% of individuals experienced relatively stable body dissatisfaction from adolescence through adulthood. Baseline depression, self-esteem, parent communication/caring, peer dieting, and weight-based teasing predicted differing trajectories. Body dissatisfaction appears largely stable from mid-adolescence onward. There may be a critical period for body image development during childhood/early adolescence. Clinicians should intervene upon body dissatisfaction before it becomes chronic, and target depression, self-esteem, parent/child connectedness, and responses to teasing and peer dieting.

Feeding Practices and Parenting: A Pathway to Child Health and Family Happiness

Feeding and parenting are inextricably linked. The complex bidirectional interactions between parent feeding practices and child eating behaviour shape the early feeding environment which in turn interacts with genetic predispositions to lay the foundation for life-long eating habits and health outcomes. Parent feeding and child (and parent) eating are central to the fabric of family life and are strongly rooted in culture and tradition. Yet, many parents experience stress and anxiety related to this ubiquitous parenting task and perceive their child as a “fussy eater” or a “difficult feeder.” Parents commonly misinterpret heritable and developmentally “normal” child eating behaviour, such as food refusal, as cause for concern. In an effort to get their child to “eat well” they respond with coercive feeding practices, such as pressure, reward and restriction. Emotional feeding that uses food to comfort, distract, calm or shape behaviour is also common. Although well intentioned, these non-responsive, parent- rather than child-centred feeding practices are ineffective, even counterproductive. They teach children to eat for reasons unrelated to appetite and, hence, more than they need and fail to support development of healthy food preferences and appetite regulation. Early feeding interventions are needed that assist parents to understand normal child eating behaviour and promote responsive feeding practices and effective food parenting. The aim of this chapter is to review (1) “normal” eating behaviour of young children, (2) the range of feeding practices and strategies that parents use to respond to and try to shape these behaviours, (3) evidence for approaches to feeding young children that have potential to reduce conflict related to child feeding and promote life-long healthy eating patterns that are a key determinant of long-term health and well-being and (4) to provide an overview of an early feeding intervention, NOURISH, which demonstrated a positive impact on maternal feeding practices and potentially reduced parent anxiety and stress related to feeding.

Prevalence of eating disorders over the 2000-2018 period: a systematic literature review

BACKGROUND

Eating disorders (EDs) lead to multiple psychiatric and somatic complications and thus constitute a major public health concern.

OBJECTIVES

The aim of this study was to give an exhaustive view of the studies reporting the prevalence of the different EDs or total EDs and to study their evolution.

METHODS

A literature search following PRISMA Guidelines and limited to studies in English or French published between 2000 and 2018 was performed and relevant studies were included in this systematic review on the prevalence of EDs. The literature search revealed 94 studies with accurate ED diagnosis and 27 with broad ED diagnosis.

RESULTS

In 94 studies with accurate ED diagnosis, the weighted means (ranges) of lifetime ED were 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. The weighted means (ranges) of 12-month ED prevalence were 2.2% (0.8-13.1%) for women and 0.7% (0.3-0.9%) for men. The weighted means (ranges) of point prevalence were 5.7% (0.9-13.5%) for women and 2.2% (0.2-7.3%) for men. According to continents, the weighted means (ranges) of point prevalence were 4.6% (2.0-13.5%) in America, 2.2% (0.2-13.1%) in Europe, and 3.5% (0.6-7.8%) in Asia.In addition to the former, 27 other studies reported the prevalence of EDs as broad categories resulting in weighted means (ranges) of total point prevalence of any EDs of 19.4% (6.5-36.0%) for women and 13.8% (3.6-27.1%) for men.

CONCLUSIONS

Despite the complexity of integrating all ED prevalence data, the most recent studies confirm that EDs are highly prevalent worldwide, especially in women. Moreover, the weighted means of point ED prevalence increased over the study period from 3.5% for the 2000-2006 period to 7.8% for the 2013-2018 period. This highlights a real challenge for public health and healthcare providers.

Compensatory behaviors among racial and ethnic minority undergraduate women

Limited research has examined prevalence rates of disordered eating across racial and ethnic groups. The current study aimed to assess the prevalence of compensatory behaviors across minority undergraduate women. Self-report responses (N = 3,430) on the Eating Disorder Examination Questionnaire were analyzed from 2,094 White (55.9%), 684 Hispanic/Latina (18.3%), 508 Asian (13.6%), 235 Black (6.3%), and 65 Native American/Alaskan Native (1.7%) women attending college within the United States. Racial and ethnic differences were significant across all compensatory behaviors. Most notably, Asian and Native American women engage in compensatory behaviors comparable to or more than their White peers, and Black women consistently reported the lowest prevalence rate of any behavior. Findings were compared to the existing literature, noting general trends across studies that may help inform screening, assessment, and treatment of eating pathology as well as suggest future directions for intervention science.

Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis

OBJECTIVE

Although prior meta-analyses have significantly enriched the available literature on the comorbidity of substance use disorders (SUD) among individuals with eating disorders (ED), there have been few, recent, comprehensive reviews, and limited meta-analyses that include a range of SUDs.

METHOD

In accordance with the PRISMA guidelines, six electronic databases were searched, and a total of 1013 articles were identified using a combination of search terms to identify relevant prevalence studies: eating disorder, substance-related disorder, drug dependence, drug abuse, drug addiction, substance abuse, and prevalence. After two authors screened articles and extracted data independently, 43 articles met inclusion criteria. Data was coded, and a risk of bias assessment was conducted for each included study. Meta-analysis and moderator-analysis was carried out using random-effects modelling.

RESULTS

The pooled lifetime and current prevalence of any comorbid SUD was 21.9% (95% CI 16.7-28.0) and 7.7% (95% CI 2.0-25.8), respectively. Tobacco (36.1 ± 23.1%), caffeine (23.8 ± 12.5%), and alcohol (20.6 ± 16.0%) were the most prevalent SUD comorbidities. Higher prevalence was observed in all-female samples, primarily Caucasian samples, and binge-purge presentations. Neither lifetime nor current prevalence were associated with age.

DISCUSSION

These results suggest that individuals with eating disorders should be regularly screened and offered treatment for substance use disorders concurrently during treatment for ED.

The Use of General Health Apps Among Users with Specific Conditions: Why College Women with Disordered Eating Adopt Food Diary Apps

There is a myriad of mobile health applications designed to address a variety of health conditions. While these apps hold significant promise for the management of these conditions, users sometimes turn to general health apps, rather than those designed with their specific condition in mind, which can lead to unmet needs and worsened conditions. We outline one example by focusing on college women with disordered eating behaviors and their use of general food diary apps, rather than eating disorder-specific apps. We investigate the types of health apps they use and how they choose them, focusing on the role of motivations and search behavior. We found their initial motivation informs their search process, which results in their selection of general food diary apps. Researchers should consider app adoption as influenced by user motivations and navigation behavior, particularly when determining how and why general apps are used and how clinicians can help.

"Toxic pleasures": A study of eating out behavior in Arab female university students and its associations with psychological distress and disordered eating

University years are a critical period in which young people establish independence and adopt lasting health behaviors. The aim of this study was to estimate the associations between eating out, psychological distress, and disordered eating behaviors among young Arab females in Qatar a rapidly developing small nation. A cross-sectional probability-based survey of 1615 Qatar University's female students assessed the frequency of eating out (main independent variable) and other eating behaviors in relation to two main dependent variables, disordered eating and psychological distress, which were measured using the Eating Attitudes Test and the Kessler Psychological Distress Scale, respectively. Multivariable logistic-regression analyses were used to estimate these two main associations with and without adjustment for other potential confounding variables, including the main effects of psychological distress and disordered eating on each other. Of the students, 45% reported eating out 3 times or more a week. Furthermore, approximately 18% screened positive for disordered eating and 33% reported high levels of psychological distress in the past 30 days. After adjustment for other variables, eating out 5 times or more a week was not significantly associated with the odds of disordered eating (OR 1.21, p = 0.32). However, eating out 5 times or more per week was significantly associated with odds of having psychological distress (OR 1.46, p = 0.03). Both psychological distress and disordered eating were strongly associated with each other (OR 2.58, p < 0.001).

Patterns of weight control behavior persisting beyond young adulthood: Results from a 15-year longitudinal study

OBJECTIVE

Dieting and unhealthy weight control behaviors have been associated with negative outcomes. Most research has examined the prevalence of these behaviors in adolescence and young adulthood. Less is known about whether they persist further into adulthood. We examined patterns of weight control behaviors beyond young adulthood using data from 1,455 males and females participating in Project EAT (Eating and Activity in Teens and Young Adults), a 15-year population-based, longitudinal study.

METHOD

Participants completed surveys assessing dieting, high-frequency dieting (i.e., 5+ times/year), unhealthy weight control (e.g., fasting), and extreme weight control (e.g., vomiting) at each 5-year assessment (Waves 1-4). Longitudinal logistic regression models tested trends in weight control behaviors across the waves. Likelihood of persisting or discontinuing each behavior from Wave 3 to Wave 4 was examined through cross tabulations.

RESULTS

Between Waves 3 and 4 in adulthood, dieting increased for both genders (Women: p < .001; Men: p = .004) and high-frequency dieting (p < .001) and unhealthy weight control behaviors (p = .011) increased for men. For both genders, dieting and unhealthy weight control patterns initiated in prior to young adulthood were more likely to persist than cease in adulthood (ps < .001).

DISCUSSION

Weight control behaviors continue to be prevalent in adulthood, and to especially increase among men. Research is needed to understand the consequences of weight control behaviors in different life stages; however, the results suggest that interventions to decrease unhealthy weight management practices may be needed well into adulthood.

Associations between complementary medicine, satisfaction with body weight and shape, and the use of methods to lose or control weight: Results of a national survey of 8009 Australian women

OBJECTIVE

This study aimed to determine whether the use of complementary medicine (CM) is associated with body satisfaction and weight management methods in Australian women.

METHODS

Women aged 34-39 years from the Australian Longitudinal Study on Women's Health were surveyed regarding satisfaction with their body weight and shape, and the use of weight management methods. Associations with CM use were analysed using logistic regression modelling.

RESULTS

Women using CM less likely wanted to lose weight; and were more likely to cut down on fats and/or sugars, use low glycaemic diets, diet books and 'other' methods (OR: 1.33-2.83) compared to CM non-users. Women using herbal medicine products 'sometimes' were more likely to use meal replacements/slimming products (OR: 1.50-1.67) compared to non-users.

DISCUSSION

Australian women using CM are more likely to be satisfied with their body weight and shape, and to use a range of weight management approaches compared to CM non-users.

Do Disordered Eating Behaviours Have Long-term Health-related Consequences?

OBJECTIVE

Long-term health-related consequences of disordered eating behaviours of young adults remain poorly understood. We examined whether disordered eating behaviours in mid-20s are associated with physical and mental health 10 years later.

METHODS

Women (n = 2631) and men (n = 2394) from a population-based FinnTwin16 cohort were assessed using three subscales of the Eating Disorder Inventory-2 at age 24. Self-rated health, body mass index (BMI), waist circumference and psychological distress were assessed at age 24 and reassessed 10 years later.

RESULTS

In crude models, disordered eating behaviours at age 24 were associated cross-sectionally and prospectively with poor self-rated health, higher BMI, larger waist circumference and psychological distress in both sexes. In models adjusted for baseline BMI and potential confounders, disordered eating behaviours predicted increased psychological distress in both sexes and poor self-rated health in men.

CONCLUSIONS

Among young adults, disordered eating behaviours are associated with long-term health-related consequences, particularly psychological distress. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Desire to Be Underweight: Exploratory Study on a Weight Loss App Community and User Perceptions of the Impact on Disordered Eating Behaviors

Background

Mobile health (mHealth) apps for weight loss (weight loss apps) can be useful diet and exercise tools for individuals in need of losing weight. Most studies view weight loss app users as these types of individuals, but not all users have the same needs. In fact, users with disordered eating behaviors who desire to be underweight are also utilizing weight loss apps; however, few studies give a sense of the prevalence of these users in weight loss app communities and their perceptions of weight loss apps in relation to disordered eating behaviors.

Objective

The aim of this study was to provide an analysis of users’ body mass indices (BMIs) in a weight loss app community and examples of how users with underweight BMI goals perceive the impact of the app on disordered eating behaviors.

Methods

We focused on two aspects of a weight loss app (DropPounds): profile data and forum posts, and we moved from a broader picture of the community to a narrower focus on users’ perceptions. We analyzed profile data to better understand the goal BMIs of all users, highlighting the prevalence of users with underweight BMI goals. Then we explored how users with a desire to be underweight discussed the weight loss app’s impact on disordered eating behaviors.

Results

We found three main results: (1) no user (regardless of start BMI) starts with a weight gain goal, and most users want to lose weight; (2) 6.78% (1261/18,601) of the community want to be underweight, and most identify as female; (3) users with underweight BMI goals tend to view the app as positive, especially for reducing bingeing; however, some acknowledge its role in exacerbating disordered eating behaviors.

Conclusions

These findings are important for our understanding of the different types of users who utilize weight loss apps, the perceptions of weight loss apps related to disordered eating, and how weight loss apps may impact users with a desire to be underweight. Whereas these users had underweight goals, they often view the app as helpful in reducing disordered eating behaviors, which led to additional questions. Therefore, future research is needed.

Connecting Eating Pathology with Risk for Engaging in Suicidal Behavior: The Mediating Role of Experiential Avoidance

Individuals with eating pathology, particularly those with diagnosed eating disorders, are at high risk for suicide. It is less clear whether undiagnosed eating pathology and subsyndromal eating disorders carry the same risk and, if so, what mechanisms may explain why higher levels of eating pathology yield greater risk for engaging in suicidal behaviors. The indirect relationship between disordered eating and risk for suicidal behaviors via facets of experiential avoidance was tested using a multiple-mediator model. The model was tested using bootstrapping estimates of indirect effects in a sample of 218 noncollege student adults (Mage = 32.33, 66.1% women) with a history of suicidal attempt and/or history of nonsuicidal self-injury (NSSI). Results revealed that disordered eating indirectly predicted risk for suicidal behaviors, distress aversion (i.e., negative attitudes or dislike of distress), and procrastination (i.e., delaying engagement with distressing activities). Results suggest that targeting experiential avoidance and helping those who have a history of engaging in suicidal behaviors and/or NSSI develop regulation strategies to use during times of distress may be of utmost importance for treatment and prevention of eating pathology.

Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis

The purpose of this systematic review and meta-analysis was to estimate the prevalence of personal weight control attempts (weight loss and/or maintenance) worldwide and to identify correlates, personal strategies used and the underlying motives. We included epidemiological/observational studies of adults (≥18 years) reporting prevalence of weight control attempts in the past-year. Seventy-two studies (n = 1,184,942) met eligibility criteria. Results from high quality studies showed that 42% of adults from general populations and 44% of adults from ethnic-minority populations reported trying to lose weight, and 23% of adults from general populations reported trying to maintain weight annually. In general population studies, higher prevalence of weight loss attempts was observed in the decade of 2000-2009 (48.2%), in Europe/Central Asia (61.3%) and in overweight/obese individuals and in women (p < 0.01). Of the 37 strategies (grouped in 10 domains of the Oxford Food and Activity Behaviours Taxonomy) and 12 motives reported for trying to control weight, exercising and dieting (within the energy compensation and restraint domains, respectively) and wellbeing and long-term health were the most prevalent. To our knowledge, this is the first systematic review to investigate weight control attempts worldwide. Key strategies and motives were identified which have implications for future public health initiatives on weight control.

The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample

Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.

Associations between yoga/meditation use, body satisfaction, and weight management methods: Results of a national cross-sectional survey of 8009 Australian women

OBJECTIVES

To analyze whether yoga or meditation use is associated with body (dis)satisfaction and weight control methods in Australian women.

METHODS

Women ages 34 to 39 y from the Australian Longitudinal Study on Women's Health were surveyed regarding body satisfaction, weight control behaviors, and yoga and meditation practice. Associations of body satisfaction and weight control methods with yoga/meditation practice were analyzed using chi-squared tests and multiple logistic regression modelling.

RESULTS

Of the 8009 women, 49% were overweight or obese. Sixty-five percent of women with normal body mass index (BMI) and approximately 95% of women with overweight/obesity wanted to lose weight. At least one in four women with normal BMI was dissatisfied with body weight and shape, as were more than two in three women with overweight/obesity. The most common weight control methods included exercising (82.7%), cutting down meal sizes (76.8%), and cutting down sugars or fats (71.9%). Yoga/meditation was practiced frequently by 688 women (8.6%) and occasionally by 1176 women (14.7%). Yoga/meditation users with normal BMI were less likely dissatisfied with body weight and shape. All yoga/meditation users more likely exercised and followed a low glycemic diet or diet books; and women with obesity occasionally using yoga/meditation also more likely used fasting or smoking to lose weight.

CONCLUSION

Yoga/meditation users with normal BMI appear to be more satisfied with their body weight and shape than non-yoga/meditation users. While women with normal BMI or overweight tend to rely on healthy weight control methods, women with obesity occasional using yoga/meditation may more likely utilize unhealthy weight control methods.