Exercise and eating disorder symptoms among young females

Weight status and weight-control exercise in adolescents: A longitudinal population-based study

OBJECTIVE

Exercise is a transdiagnostic clinical feature of eating disorders, but consensus is lacking as to what constitutes, and gives rise to, excessive exercise motivated by weight control. Using a longitudinal cohort study, we aimed to describe population-level prevalence rates of varying levels of weight-control exercise and examine gender and weight status (overweight or obesity; OVOB) as cross-sectional determinants of weight-control exercise in 14-15-year-old adolescents. We then evaluated the association of OVOB at 10-11 years with weight-control exercise at 14-15 years.

METHODS

The sample comprised 6329 adolescents from the Longitudinal Study of Australian Children (LSAC). Weight and height were measured in early adolescence (aged 10-11) and in mid-adolescence (aged 14-15). Participants reported weight-control exercise using the Branched Eating Disorders Test at 14-15 years.

RESULTS

In mid-adolescence, the estimated population prevalence for any weight-control exercise was 49 % (55 % in females). For girls, moderate levels of exercise were most prevalent, and low levels for boys. For all levels except for the very lowest, boys with (vs. without) OVOB history (10-11 years) had about twice the odds of endorsing every level of weight-control exercise. Patterns among girls were similar, though lower in magnitude (∼1.5 times).

CONCLUSIONS

For both girls and boys, across most exercise levels, rates of weight-control exercise were greatest for those with OVOB; for the highest exercise level, effects were strongest for boys with OVOB. To accurately identify at-risk adolescents, our results provide preliminary support for a fluid definition of excessive weight-control exercise, dependent on gender and weight status.

Exercise behaviour and body esteem of gym-goers in india

Exercise dependence is described as exercise which is harmful if engaged compulsively and excessively. The present study aims to investigate differences in categories of exercise behaviours and areas of body esteem in gym-goers in India across genders. The study used a cross-sectional design, and the sample consisted of 291 gym-goers (females = 146; males = 145) The Exercise Dependence Scale- 21 (EDS-21) and Body Esteem Scale-Revised (BES-R) was administered to the gym-goers in India after seeking informed consent. The obtained data were statistically analysed using descriptive statistics and multivariate analysis of variance. The results of the study indicated that there was a significant difference in the three categories of exercise behaviours and three areas of body esteem in male gym-goers. However, such similar differences were not found in female gym-goers. The differences found in body esteem for the male gym-goers in certain areas suggest how exercise has an impact on body image. For female gym-goers, we can see that irrespective of the category they belong to, there is no difference in the areas of body esteem. We can understand such findings with the sociocultural model of excessive exercise given by White and Halliwell (DOI: 10.1016/j.bodyim.2010.02.002) where perceived sociocultural pressure predicts excessive exercise, which is mediated by body image. Strengths and limitations of the study are discussed. Future research in India based on qualitative and longitudinal designs are warranted.

Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review

OBJECTIVE

Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association.

METHOD

We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME.

RESULTS

Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME.

DISCUSSION

Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.

Psychometric properties of instruments assessing exercise in patients with eating disorders: a systematic review

BACKGROUND

Research has identified factors specific to exercise in eating disorder patients such as affect regulation and compulsivity. Existing measures of exercise behaviour which were not originally designed for eating disorder patients may not adequately assess these factors. The aim of this systematic review is to identify and assess the psychometric properties of all self-report measures of exercise designed to be used with eating disorder patients.

METHOD

A systematic review was conducted following the PRISMA guidelines. MedLine, Scopus and PsycINFO were systematically searched. A total of 12 studies examining two measures, the Exercise and Eating Disorders and the Compulsive Exercise Test, met inclusion criteria.

RESULTS

Validation studies showed promising results for both tests and established internal consistency, concurrent and convergent validity, and construct validity. The factor structure of the Compulsive Exercise Test was not confirmed in the majority of the studies included in this review, while there are only two studies conducting factor analysis on the Exercise and Eating Disorders.

CONCLUSION

The two measures identified by this systematic review represent the current research on measures of compulsive exercise for eating disorder patients. Further research is needed to confirm a factor structure and validate both the Compulsive Exercise Test and the Exercise and Eating Disorders in more diverse clinical samples.

Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology

OBJECTIVE

Maladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology.

DESIGN

This study examined cross-sectional data.

METHOD

Undergraduate participants (N =235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores.

RESULTS

Results suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence.

CONCLUSIONS

Clinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs.

Prevalence and correlates of self-reported disordered eating: A cross-sectional study among 90 592 middle-aged Norwegian women

Disordered eating (DE) is extensively studied among adolescents and young women. However, there is growing evidence that DE as well as the clinical eating disorders may occur at any age from childhood to advanced years. This study aimed to determine the prevalence and correlates of DE in a representative sample of middle-aged women from Norway. The study included 90 592 women (median age: 55 years) from the Norwegian Women and Cancer study who responded to a questionnaire between the years 2002–2005. Correlates of self-reported DE were assessed by logistic regression analyses. The overall period prevalence of DE between 2002–2005 was 0.28 (95% confidence interval 0.25–0.31) %, and was highest among women ≥ 66 years: 0.65 (0.60–0.70) %. DE was strongly associated with depression (Odds ratio [OR] 3.34 [95% confidence interval 2.53–4.41]), being unemployed (OR 1.78 [1.32–2.40]) and single (OR 1.66 [1.25–2.20]). Women with DE were more likely to report low energy intake (OR 1.41 [1.08–1.86]) and were less likely to be moderately physically active (OR 0.67 [0.47–0.95]). Using the largest study sample in the literature, the present findings confirm smaller studies showing that DE do occur in women in mid-life and older age as well. Our results contribute to address a somewhat under-communicated community health problem that needs attention in terms of age-specific treatment and prevention.

The connection between exercise addiction and orthorexia nervosa in German fitness sports

PURPOSE

The combination of physical activity and healthy eating habits has potentially positive effects on health. However, both practices can also lead to pathological behaviors such as exercise addiction (EA) and orthorexia nervosa (ON), thus generating negative effects. So far, studies analyzing the connection between these two phenomena cannot be found. The current paper is aiming to close this gap.

METHODS

The sample (n = 1.008) consisted of 559 male and 449 female active members of three fitness studios, and was analyzed in a cross-sectional study design. The Exercise Addiction Inventory (EAI) was used to establish exercise addiction and the Düsseldorfer Orthorexie Skala (DOS) was used to evaluate orthorectic eating behavior.

RESULTS

Out of the whole sample, 10.2% exhibit EA, while ON is prevalent in 3.4%. Twenty-three (2.3%) individuals suffer from both. There is a significant positive correlation between DOS and EAI (p < .001, r = .421). Female participants (p < .001, r = .452) show a higher correlation compared to male participants (p < .001, r = .418).

CONCLUSION

The results suggest a positive correlation between ON and EA in the context of German fitness sports. Both seem to be serious phenomena and require further investigation.

LEVEL OF EVIDENCE

Level V (cross-sectional descriptive study).

The Athletes' Relationships with Training scale (ART): A self-report measure of unhealthy training behaviors associated with eating disorders

OBJECTIVE

Several studies indicate that eating-disorder (ED) psychopathology is elevated in athletes compared to non-athletes. The assessment of excessive exercise among athletes is a challenge because, compared to non-athletes, athletes are required to train at higher intensities and for longer periods of time. However, individuals participating in competitive sports are still susceptible to unhealthy physical-activity patterns. Most ED assessments were developed and normed in non-athlete samples and, therefore, do not capture the nuances of athletes' training experiences. The purpose of the current study was to develop and validate a clinically useful, self-report measure of unhealthy training behaviors and beliefs in athletes, the Athletes' Relationships with Training Scale (ART).

METHOD

The initial item pool was administered to N = 267 women collegiate athletes who were participating in an ED prevention program study and N = 65 women athletes who were in ED treatment.

RESULTS

Factor analyses indicated the ART had a four-factor structure. Factorial and construct validity of the ART were demonstrated. ART scores significantly predicted health care utilization and differed between athletes with an ED versus athletes without an ED. For athletes in ED treatment, ART scores significantly decreased from treatment admission to discharge.

DISCUSSION

The ART showed evidence of strong psychometric properties and clinical utility. The ART could be helpful for clinicians and athletic trainers to help gauge whether athletes are engaging in unhealthy training practices that may warrant clinical attention and for tracking clinical outcomes in athletes with EDs who are receiving treatment.

Disordered Eating, Compulsive Exercise, and Sport Participation in a UK Adolescent Sample

The sport literature has produced equivocal results as to whether sport participation is a protective or risk factor for disordered eating. One mechanism by which it could be a risk factor is the increased drive or compulsion to exercise. This study compared the levels of disordered eating and compulsive exercise between adolescent sport and non-sport participants. A sample of 417 male and female adolescents, aged 14-16 years old, was recruited from UK secondary schools. Participants completed questionnaire packs that included: the Eating Disorder Inventory; a measure of exercise behaviour; and the Compulsive Exercise Test (CET). Non-sport participants reported significantly greater body dissatisfaction than sport participants, and this was true for boys and girls. Significant group differences were also reported for many of the CET scales, with sport participants generally reporting greater levels of compulsive exercise than non-sport participants. Implications of these results are discussed. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Perfecting Weight Restriction: The Moderating Influence of Body Dissatisfaction on the Relationship Between Perfectionism and Weight Control Practices

This study explored the moderating effect of body dissatisfaction (BD) on the relationship between perfectionism and weight restricting and control behaviours (WRCBs). A sample of 167 female undergraduates completed self-report measures of perfectionism, BD and WRCBs. BD was not found to moderate the relationship between either perfectionism and dieting, or perfectionism and exercise. Instead, BD uniquely predicted both dieting and exercise, as did the perfectionism dimensions of self-oriented perfectionism, concern over mistakes, parental standards, and organisation. BD moderated the relationship between perfectionism and purging for analyses involving self-oriented perfectionism, concern over mistakes, and doubts about actions, such that there was a significant positive association between perfectionism and purging when BD was high but not low. Perfectionism and BD are important in different ways to WRCBs. The importance of measuring multiple dimensions of perfectionism and differentiating between the various types of WRCBs is highlighted.

Defining Features of Unhealthy Exercise Associated with Disordered Eating and Eating Disorder Diagnoses

OBJECTIVES

The current study sought to compare different features of unhealthy exercise on associations with disordered eating and their ability to identify individuals with eating disorders. A secondary aim of the study was to compare prevalence and overlap of different aspects of unhealthy exercise and potential differences in their gender distribution.

DESIGN

Cross-sectional epidemiological study.

METHODS

A community-based sample of men (n=592) and women (n=1468) completed surveys of health and eating patterns, including questions regarding exercise habits and eating disorder symptoms.

RESULTS

Compulsive and compensatory features of exercise were the best predictors of disordered eating and eating disorder diagnoses compared to exercise that was excessive in quantity. Further, compulsive and compensatory aspects of unhealthy exercise represented overlapping, yet distinct qualities in both men and women.

CONCLUSIONS

Including the compulsive quality among the defining features of unhealthy exercise may improve identification of eating disorders, particularly in men. Results suggest that the compensatory aspect of unhealthy exercise is not adequately captured by the compulsive aspect of unhealthy exercise. Thus, interventions that target unhealthy exercise behaviors among high-risk individuals, such as athletes, may benefit from addressing both the compulsive and compensatory aspects of unhealthy exercise. Future prospective longitudinal studies will aid in determining the direction of the association between these features of unhealthy exercise and the onset of eating pathology.

Hard exercise, affect lability, and personality among individuals with bulimia nervosa

The current study explores the personality traits of compulsivity (e.g., sense of orderliness and duty to perform tasks completely) and restricted expression (e.g., emotion expression difficulties) as potential moderators of the relation between affect lability and frequency of hard exercise episodes in a sample of individuals with bulimic pathology. Participants were 204 adult females recruited in five Midwestern cities who met criteria for threshold or subthreshold bulimia nervosa (BN). Compulsivity was found to significantly moderate the relation between affect lability and number of hard exercise episodes over the past 28 days, such that among those with high compulsivity, level of affect lability was associated with the number of hard exercise episodes; whereas, among those with low compulsivity, affect lability was not associated with the number of hard exercise episodes. The same pattern of findings emerged for restricted expression; however, this finding approached, but did not reach statistical significance. As such, it appears that affect lability is differentially related to hard exercise among individuals with BN depending upon the level of compulsivity and, to a more limited extent, restricted expression. These results suggest that, for individuals with BN with either compulsivity or restricted expression, focusing treatment on increasing flexibility and/or verbal expression of emotions may help in the context of intense, fluctuating affect.

A pilot study of a new assessment of physical activity in eating disorder patients

BACKGROUND/AIM

In order to get more detailed information about exercise regimes and disturbances among patients with eating disorders, a new self report questionnaire was developed. The Exercise and Eating Disorders (EED) was developed to capture aspects not included in existing questionnaires. The aim of this study was to test the internal consistency and concurrent validity of the EED, and to investigate to what extent the questionnaire discriminates between inpatients and controls.

METHOD

Fifty female eating disorder patients (anorexia nervosa n=25, bulimia nervosa n=10, EDNOS n=15) in a specialized inpatient unit and 51 female age-matched student controls were assessed with the EED and the Body Attitude Test (BAT).

RESULTS

The results indicate satisfactory internal consistency (Cronbach's Alpha 0.92) of the sum score of the whole sample. The validity of the EED was supported by the correlation analysis between EED and Body Attitude Test (BAT) (Spearman's rho=0.84, p<0.01). There was a significant statistical difference between patients and controls in total score and subscales of the EED (p<0.001).

CONCLUSION

The preliminary test of the EED questionnaire was promising. It is a short instrument, and seems to distinguish well between patients and controls. EED captures other dimensions of physical activity and exercise disturbances not captured in other questionnaires related to exercise. Further research is needed to test the psychometric properties of EED in bigger samples.

Compulsive exercise and eating disorders

The aim of this review was to develop an empirically supported cognitive behavioural model of compulsive exercise within the context of the eating disorders. A systematic review of the correlates and predictors of compulsive exercise among eating disordered patients identified four key correlates. These were subsequently validated by a second review, incorporating both the clinical and non-clinical as well as the exercise science literatures. A proposed model is presented which is both evidence-based and testable.

Beliefs about excessive exercise in eating disorders: the role of obsessions and compulsions

OBJECTIVE

This study aimed to develop an understanding of excessive exercise in eating disorders by exploring the role of exercise beliefs, obsessive beliefs and obsessive-compulsive behaviours.

METHOD

Sixty-four women were recruited from eating disorder services and 75 non-clinical women were recruited from a university. Exercise beliefs and behaviours, obsessive beliefs and behaviours and eating disorder psychopathology were assessed using self-report questionnaires.

RESULTS

There was an association between exercise beliefs, obsessive beliefs and obsessive-compulsive behaviours in the eating-disordered group, but not in the non-eating-disordered group. In the eating-disordered group obsessive beliefs and obsessive-compulsive behaviours were associated with a significant proportion of variance in exercise beliefs after controlling for eating disorder psychopathology and BMI. In the non-eating-disordered group obsessive beliefs and behaviours were associated with beliefs about exercise as a method of affect regulation after controlling for BMI.

CONCLUSION

The results are compatible with a model in which obsessive beliefs and exercise beliefs could maintain exercise in eating disorders. This has implications for the assessment and treatment of excessive exercise. Further research is necessary to determine the causality of these relationships.

Sociocultural correlates of compulsive exercise: is the environment important in fostering a compulsivity towards exercise among adolescents?

Sociocultural factors hypothesised to be influential in eating disorders were assessed for their relationship with compulsive exercise. A sample of 828 adolescent boys and girls completed measures assessing sociocultural messages to change body shape as well as pressure to be thin, and also measures of compulsive exercise and disordered eating. Results showed that the sociocultural influences differed slightly between boys and girls. Hierarchical regressions showed that, after controlling for disordered eating and BMI, messages to become more muscular and media pressure to be thin significantly predicted compulsive exercise in boys, while the same regression in girls reported only media pressure to be thin as a significant predictor of compulsive exercise. These findings demonstrate the influence of the media in boys' and girls' compulsive exercising, as well as highlight the influence of body shape messages to become more muscular on boys' compulsive exercise.

Associations between specific components of compulsive exercise and eating-disordered cognitions and behaviors among young women

OBJECTIVE

To explore the associations between specific elements of compulsive exercise and both eating-disordered cognitions and eating-disordered behaviors in a nonclinical sample of young women.

METHOD

A sample of young women (n = 498) completed self-report measures of eating pathology (The Eating Disorders Examination Questionnaire) and a relatively new measure of Compulsive Exercise Test.

RESULTS

Specific elements of compulsive exercise were associated with elevated levels of eating-disordered cognitions and increased frequency of eating-disordered behaviors.

DISCUSSION

These results support a multifunctional conceptualization of compulsive exercise, suggesting that some of the functionality of compulsive exercise may be akin to other forms of purging, and further supporting the notion of a possible functional equivalence between compulsive exercise and specific eating-disordered behaviors in terms of affect regulation.

Examination of a sociocultural model of excessive exercise among male and female adolescents

There is substantial evidence that sociocultural pressures and body image disturbances can lead to disordered eating, yet few studies have examined their impact on excessive exercise. The study adapted a sociocultural model for disordered eating to predict excessive exercise using data from boys and girls in early adolescence (N=421). Perceived sociocultural pressures to lose weight and build muscle, body image disturbance and appearance investment were associated with a compulsive need to exercise. Adolescents' investment in appearance and body image disturbance fully mediated the relationship between sociocultural pressures and a compulsive need for exercise. There was no support for the meditational model in predicting adolescents' frequency or duration of exercise. Results support the sociocultural model as an explanatory model for excessive exercise, but suggest appearance investment and body image disturbance are important mediators of sociocultural pressures.

Similarities and differences between excessive exercising anorexia nervosa patients compared with DSM-IV defined anorexia nervosa subtypes

This study describes anorexia nervosa (AN) patients who use excessive exercise for weight management and how this behaviour relates to the classical Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) sub-grouping of AN. The study compared 428 clinical AN patients with 119 age and gender-matched controls. The AN cases were initially dichotomised according to DSM-IV subtype criteria into restricting (RAN; N=198) and binge-purge (BPAN; N=230) anorexia. The psychometric instruments were chosen to reflect key features concerning the diagnosis of eating disorders and characteristics of eating and food behaviour and included the 26-item Eating Attitude Test (EAT-26), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behaviour Questionnaire (DEBQ), Eysenck Personality Inventory (EPI) and Rosenberg Self-Esteem scale (RSE). Structured clinical interviews (1) were carried out in order to identify the subgroup of patients who use excessive exercise in order to facilitate weight control (EAN). The three groups (RAN, BPAN, EAN) did not differ in measures of current age, current body mass index, age of onset of AN and measures of restrained eating. However, significant differences were observed on EAT-26, DEBQ emotional and external factors, TFEQ disinhibition and hunger factors, EPI extraversion and neuroticism, and self-esteem. The EAN were similar to the RAN on the majority of variables but showed significant differences on extraversion, neuroticism, self-esteem and disease pathology (EAT-26). Compared with BPAN, EAN had lower disease pathology (EAT-26 scores), scored higher on the EPI extraversion scale, lower on the neuroticism scale and had greater self-esteem. The EAN also displayed significantly lower emotional and external eating (DEBQ) than BPAN and significantly lower disinhibition and hunger scores (TFEQ). These data suggest that EAN group display a mixed profile of characteristics resembling both BPAN and RAN. When EAN are defined as a separate group they appear to be phenotypically more similar to RAN than BPAN on this particular profile of variables. However when DSM-IV criteria are applied they are almost exclusively classified as BPAN. This outcome suggests that EAN do constitute an identifiable group that can be distinguished from RAN and BPAN. Consequently it is likely that the behaviour of excessive exercising should be considered as clinically relevant on the outcome of treatment.

The Role of Exercise Dependence for the Relationship between Exercise Behavior and Eating Pathology

Our study examined the potential mediating or moderating effect of exercise dependence on the exercise—eating pathology relationship. Female university students ( N = 330) completed Internet-based self-report measures of exercise behavior, exercise dependence, and eating pathology. Exercise dependence served as a mediator for the relationship between exercise and eating pathology. This unidirectional causal model suggests that an individual's pathological motivation or compulsion to exercise is the critical mediating component in the exercise—eating pathology relationship. The best target for removing the link between exercise behavior and eating pathology may be reformulating exercise dependence symptoms.

Factors associated with abnormal eating attitudes among female college students in Japan

OBJECTIVES

To determine the prevalence rates of abnormal eating attitudes and associated risk factors among female Japanese college students.

SUBJECTS AND METHODS

The study population was 7812 female college students in Tokyo. They were asked to fill out the Japanese version of EAT-26 and lifestyle questionnaires.

RESULTS

5.1% of the subjects had a total EAT-26 score above the cutoff point (>20). Multiple regression analysis found the most important factors associated with abnormal eating attitudes were distorted body image, fewer sleeping hours, irregular meal habits, cigarette smoking and more exercise.

DISCUSSION

The prevalence of abnormal eating attitudes among female college students in this study was lower than that of Japanese female high school students and lower than that reported for college students of both western and non-western countries. Our results suggest that body image dissatisfaction may be the most important factor associated with abnormal eating behavior.

Does "excessive" or "compulsive" best describe exercise as a symptom of bulimia nervosa?

OBJECTIVE

The criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Washington, DC: American Psychiatric Association) for bulimia nervosa include "excessive exercise" as an inappropriate compensatory behavior, suggesting that it is the quantity of the physical activity that is symptomatic, rather than its quality. The current study evaluated the hypothesis that psychological commitment to exercise (compulsive quality) will be more predictive of disordered eating attitudes and behaviors than the amount of time devoted to exercise (excessive quantity).

METHOD

Female (n = 162) and male (n = 103) undergraduates completed the Eating Disorder Inventory (EDI) subscales, the Obligatory Exercise Questionnaire (OEQ), and questions to assess the duration and frequency of exercise.

RESULTS

Using multivariate analysis, the OEQ score was a positive predictor of disordered eating attitudes and behaviors, and exercise time was a negative predictor.

DISCUSSION

"Compulsive" may be a better description than "excessive" in characterizing exercise as a symptom of bulimia nervosa.

Gender, eating behavior, and personality characteristics in physically active students

The aim of this paper was to examine associations between personality traits, eating disorder (ED) behavior, exercise, and gender. The participants (n=1482: 905 women and 577 men) were students from four universities in Norway. The subjects filled out a compound questionnaire including demographics, weekly hours of exercise, type of sport, Karolinska Scales of Personality (KSP), and the Eating Disorder Inventory (EDI). Because of the data collection procedure, it is difficult to provide a clear-cut response rate in this study. The results showed that the risk ratio for women who scored 40 or higher on the EDI was three times higher compared with men. ED behavior did not seem to be associated with high weekly hours of physical activity in general. There were significant gender differences in personality traits. However, women and men with high scores on the EDI showed no differences on the KSP scales, except on "detachment" and "indirect aggression". The most important predictors for weekly hours of physical activity were the EDI scales "drive for thinness" and "body dissatisfaction", and the personality variables "extraversion" and "neuroticism". The factors that contributed most to the differences between students who scored 40 or higher on the EDI and those who scored below 40 on the EDI were neuroticism, BMI, gender, and age.

Population at risk for eating disorders in a Spanish region

OBJECTIVE

To estimate the prevalence of adolescent population at risk for eating disorders (EDs), to examine gender differences and their association with non-psychotic mental disorders.

METHODS

Cross-sectional study using an anonymous, self-reported questionnaire in the classroom and measurement of weight and height in a representative sample of 4334 teenagers of both sexes. A definition of population at risk for EDs has been established, that differentiates those with dieting criteria and those with binge-purge eating behaviour criteria. This definition includes a combination of weight, behaviour, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, and Eating Disorder Inventory (EDI) results. The General Health Questionnaire-28 (GHQ-28) was used to assess non-psychotic mental disorders.

RESULTS

The prevalence of population at risk for EDs was 2.2% (95% CI: 1.6-2.8) for men and 15.3% (95% CI: 13.8-16.9) for women. The prevalence rate of combining both ED risk and mental disorder was 0.8% (95% CI: 0.4-1.2) for men and 9.9% (95% CI: 8.6-11.2) for women. Non-psychotic mental disorders were more prevalent in the population at risk for EDs than in the rest of the population.

CONCLUSIONS

A considerable proportion of adolescent females have eating problems and non-psychotic mental disorders. Their male counterparts also suffer from these disorders, however, a different pattern is followed.

Athletics, perfectionism, and disordered eating

OBJECTIVES

To determine the effects of sex, perfectionism, level of athletic participation (varsity vs. recreational), and type of sport (swimming, running, or soccer) on disordered eating.

METHOD

Male and female swimmers, runners, and soccer players at Stanford University were recruited at both the recreational and varsity level. Athletes were given the Multidimensional Perfectionism Scale (MPS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorders Examination Questionnaire (EDE-Q), and a survey on demographics and level of athletic competition. Of 257 athletes identified, 250 (97.3%) returned the questionnaires.

RESULTS

A Multivariate Analysis of Variance (MANOVA) was used to assess the variables' effects on disordered eating attitudes. Significant main effects were found for Sex (F5,199=25.7, p<0.001), Level (F5,199=2.5, p<0.05), and Perfectionism (F10,400=3.0, p<0.001). Only two of the ten interaction terms were significant: Sex by Level of athletic participation (F5,199=3.2, p<0.01) and Sex by Perfectionism (F10,400=2.1, p<0.05). Females displayed higher disordered eating than males. Disordered eating attitudes increased with perfectionism and were greater for recreational athletes than varsity, but this trend was significant for females only. Type of sport showed no significant effects. When examining physiological data a higher percentage of varsity females had irregular periods (42.9%) or amenorrhea (14.3%) than recreational females (13.4% and 2.9%, respectively).

DISCUSSION

Males showed little variability in their data due to low disordered eating scores overall, thus demonstrated few significant results. The greatest risk factor for disordered eating attitudes for females was perfectionism, which crossed all athletic divisions. Although recreational athletes seemed more at risk psychologically, the varsity athletes had more physiological risk.

Medical complications of bulimia nervosa

Bulimia nervosa (BN) is a prevalent illness. There are multiple different medical complications that impact the overall treatment plan and prognosis of these patients. Practitioners should be alert for medical complications that are a direct result of the mode of purging behavior utilized by the bulimic patient. The treatment will proceed most smoothly if the primary care physician and the mental health professional work collaboratively and have clear and frequent communication.

Hyperactivity in patients with anorexia nervosa and in semistarved rats: evidence for a pivotal role of hypoleptinemia

Patients with anorexia nervosa (AN) often show normal to elevated physical activity levels despite severe weight loss and emaciation. This is seemingly in contrast to the loss of energy and fatigue characteristic of other starvation states associated with weight loss. Despite the fact that historical accounts and clinical case studies of AN have regularly commented on the elevated activity levels, the behavior has become only recently the subject of systematic study. Because rodents and other species increase their activity upon food restriction leading to weight loss when given access to an activity wheel--a phenomenon referred to as activity-based anorexia or semi-starvation-induced hyperactivity (SIH)-it has been proposed that the hyperactivity in AN patients may reflect the mobilization of phylogenetically old pathways in individuals predisposed to AN. Exogeneous application of leptin in this animal model of AN has recently been shown to suppress completely the development of SIH. Hypoleptinemia, as a result of the food restriction, may represent the initial trigger for the increased activity levels in AN patients and in food-restricted rats. In the first and second parts of our review, we will summarize the relevant findings pertaining to hyperactivity in AN patients and in the rat model, respectively. We conclude with a synopsis and implications for future research.