Eating disorders

COVID-19 and changes in young adults' weight concerns

The COVID-19 pandemic introduced fundamental challenges to nearly all aspects of college students' lives, yet changes in key domains of their health, including weight concerns, remain untested. The current study utilized a longitudinal project comprised of 355 young-adult college students (Mage=19.5, 66.8% female, 33.2% male) oversampled for recent substance use behavior. Participants completed multiple assessments (mode = 5) from September 2017 to September 2021. Piecewise growth-curve models tested whether COVID-19 onset was associated with changes in the trajectories of young adults' weight concerns. Analyses also examined participants' sex as a moderator of these trajectories. On average, participants reported a significant increase in weight concern levels around the start of COVID-19, although weight concern slopes were not significantly different before and after COVID-19. Additionally, moderation analyses showed that females (but not males) had a significant increase in weight concern levels after COVID-19 onset.

Eating disorders and the risk of esophageal and stomach cancers-A nationwide, population-based cohort study in Taiwan

BACKGROUND

Previous studies have shown elevated cancer risk in anorexia nervosa but the literature on other eating disorders (EDs) is scarce. This study aimed to investigate the association between all EDs and esophageal, stomach, and other cancers.

METHODS

We used a retrospective cohort design, based on a two-million randomized longitudinal health insurance dataset, a sub-dataset of Taiwan's National Health Insurance Research Database. From all the potential participants aged 20 years or more, a total of 6,628 participants were enrolled, including 1,657 patients with EDs, with sex-, age-, and indexed date-matched (1:3) 4,971 controls. Each participant was individually tracked from 2000 to 2015 to identify incident cases of cancers, including esophageal cancer (EC), stomach cancer (SC), and all other cancers (AOC). The multivariate Cox proportional hazards model was employed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDs and cancer.

RESULTS

Of the total 6,628 enrollees, 222 in 1,657 individuals with EDs and 810 in the 4,971 non-ED control individuals developed cancer (1,262.40 vs. 1,472.15 per 100,000 person-years), and the Kaplan-Meier survival analysis was not statistically significant (log-rank, p = .324). However, after adjusting for covariates, the risk of EC and SC among the individuals with an ED was significantly higher, with adjusted HRs of 5.32 (95% CI: 1.07-26.49, p < .001) and 4.61 (95% CI: 1.91-11.14, p < .001), respectively. EDs were not associated with other cancers.

CONCLUSIONS

This study provides evidence for the association between EDs and the risk for EC and SC. Further research on mechanisms and prevention is therefore needed.

Heart and anorexia nervosa

Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe-potentially life-threatening-somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.

Prevention of Eating Disorders among Adolescents

Since eating disorders frequently begin during adolescence, high school students represent a high risk population for the development of these disorders. For this reason, a pilot project for the prevention of eating disorders was instituted at the high school level. The primary goal of this pilot project was to educate students, faculty, and staff at the school about the incidence, symptoms, and consequences of eating disorders. Consultation and referral services were also provided. An evaluation component of the project assessed the informational impact of the prevention program on the students. On a questionnaire designed for the project, a significantly greater number of questions about eating disorders were answered correctly by students who were recipients of the prevention program than by those who were not. The results of this project demonstrate the feasibility of using the high school setting to promote increased awareness of eating disorders and their consequences among high school students.

Body Image Perception among Women of African Descent: A Normative Context?

The purpose of this article is to integrate research from across the social sciences in order to understand Black women's body image perceptions. To accomplish this goal, the effects of race, ethnicity, class and culture are examined. Cultural differences between African Canadians/Americans and Blacks living in Africa and the Caribbean are outlined and their effects on Black women's experiences of weight and eating are also discussed. Some of the historical underpinnings, and several aspects of the current social context within which Black women live are explored in order to explain body image perceptions.

What Triggers Abnormal Eating in Bulimic and Nonbulimic Women?; The Role of Dissociative Experiences, Negative Affect, and Psychopathology

Dissociative experiences and abnormal eating were examined in 92 non-eating-disordered women and 61 age-matched bulimic women. In the nonclinical sample of women, dissociative experiences were associated with abnormal eating attitudes and behavior, even after controlling for other forms of psychopathology; furthermore, dissociation mediated the relationships between abnormal eating and sexual abuse, abnormal eating and emotional distress, and abnormal eating and impulsivity Analyses using both bulimic women and occasional binge eaters among the controls showed that a combination of reported negative affect and dissociative experiences preceding a binge was associated with the highest levels of abnormal eating. Finally, in both bulimic women and occasional binge eaters, feelings of panic appeared to decrease as a binge episode progressed, whereas, in bulimic women only, dissociative experiences appeared to increase during binge eating. The implications for the role of dissociation in combination with emotional distress in triggering and reinforcing abnormal eating in women are discussed.

Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review

Eating disorders have multiple medical sequelae, including potentially life-threatening cardiovascular complications. This article describes our cardiology practice experience of treating adults with eating disorders in the outpatient setting and documents baseline cardiac findings in this complex patient population. We describe our findings in patients across the spectrum of eating disorders; past studies have generally focused on anorexia only. This article also includes a review of the current literature on cardiovascular complications associated with disordered eating.

Personality Assessment Inventory profiles of university students with eating disorders

BACKGROUND

Eating disorders are complex disorders that involve medical and psychological symptoms. Understanding the psychological factors associated with different eating disorders is important for assessment, diagnosis, and treatment.

METHODS

This study sought to determine on which of the 22 Personality Assessment Inventory (PAI) scales patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) differed, and whether the PAI can be used to classify eating disorder subtypes. Because we were interested in both whether the PAI could be used to differentiate eating disorder subtypes from each other, as well as from other disorders, we also included a group of patients with major depression.

RESULTS

The three eating disorder groups did differ significantly from each other, and from the patients with depression, on a number of the PAI scales. Only two PAI scales (Anxiety and Depression), however, exceeded a T-score of 70 for the patients with anorexia nervosa, no scales exceeded a T-score of 70 for the patients with bulimia nervosa or EDNOS, and only two exceeded a T-score of 70 for the patients with depression (Depression and Suicide). A discriminant function analysis revealed an overall correct classification between the groups of 81.6%.

CONCLUSIONS

The PAI helps to understand the psychological factors associated with eating disorders and can be used to assist with assessment. Continued investigation using the PAI in an eating disordered population is supported.

Identifying high-school dance students who will develop an eating disorder: a 1-year prospective study

This study examined the changes in eating disorder (ED) status over 1 year and identified risk factors for EDs among female dance students. In 2003, all students enrolled in each of the nation's 12 high schools with gifted dance programs participated in a two-phase survey. The same participants were invited to take part in a follow-up survey 1 year later. In all, 583 persons completed the phase 1 questionnaire survey, and 245 persons completed interviews twice at baseline and follow-up. Thirty-five females had a newly developed ED, and less than half of the ED cases found at baseline had recovered at follow-up. Being a grade 12 student carried a reduced risk of EDs, whereas higher baseline scores on the Bulimic Investigatory Test Edinburgh (BITE) increased risks of developing an ED after 1 year. A 10-item BITE questionnaire validly identified girl dance students who would develop EDs later in high school. EDs were more commonly developed during middle adolescence, and we suggest that prevention work against EDs begin in this period among the dance student population. The brief screening questionnaire might help detect intervention targets of a prevention program among adolescent dance students.

Eructophilia in bulimia nervosa: a clinical feature

This report offers the first detailed description of repetitive eructation (belching) in a patient with bulimia nervosa. The case was a man in his 30's with bulimia nervosa characterized by daily bingeing and purging behavior. Detailed assessment revealed repetitive eructation which was construed as a learned behavior precipitated and maintained by aerophagia (air swallowing) secondary to regular binge-eating. Eructation was associated with a strong sense of "relief" that shared a common phenomenology with other purging behaviors. Repetitive eructation was addressed as part of outpatient treatment using a cognitive-therapy approach. Eructation became less frequent during outpatient treatment but the patient disengaged after six sessions. We define a new term "eructophilia" where repetitive eructation takes on an ego-syntonic, self-contained, and autonomous quality which serves as a reinforcing stimulus in itself. Issues of phenomenology and motivating factors are further discussed.

Body weight perception among high school students and its influence on weight management behaviors in normal weight students: a cross-sectional study

AIM

This study investigates body weight perception and its influence on weight management behaviors in normal weight adolescents in Timis County, Romania. We hypothesized that misperception of overweight in normal weight adolescents would be positively associated with unhealthy weight control behaviors.

METHODS

From 2908 respondents participating in the survey we selected a total of 2093 normal weight high school students for the analysis. Outcome measures included self-reported height and weight measurements, overweight misperceptions and weight control behaviors. Weighted prevalence estimates and odds ratios were computed.

RESULTS

There were 22.64% of normal weight students who perceived themselves as overweight. Females (36.48%) were more likely to perceive themselves as overweight than males (8.15%) (P < 0.0001). After adjusting for age and gender, students who perceived themselves as overweight were more likely to exercise (OR = 2.85; 95% CI: 2.25-3.61), eat less food, fewer calories or low fat foods (OR = 3.54; 95% CI: 2.78-4.51), fast for 24 hours or more (OR = 1.79; 95% CI: 1.28-2.49), take diet pills, powders or tea (OR = 3.93; 95% CI: 2.62-5.89), vomit or take laxatives (OR = 1.96; 95% CI: 1.15-3.34) to lose weight or to keep from gaining weight, compared to students who did not perceive themselves as overweight.

CONCLUSION

A significant proportion of normal weight high school students misperceive themselves as overweight and are engaging in unhealthy weight management behaviors. These results should be considered when establishing prevention programs and educational components that address weight misperceptions and the harmful effects of unhealthy weight control methods should be performed even among normal weight adolescents.

Laboratory parameters and appetite regulators in patients with anorexia nervosa

Anorexia nervosa (AN) has serious negative effects on multiple organs and systems of the human body. As patients often do not make their eating disorder the subject of discussion, the physician is forced to rely on the physical examination and laboratory parameters as diagnostic hints. Obvious signs of AN are a body mass index (BMI) below 17.5 kg/m, dry and scaly skin, lanugo, edema, acrocyanosis, petechias, dental problems, and low blood pressure. However, because the often complex laboratory alterations can be difficult for the general psychiatrist to interpret, this article presents some useful guidelines. The plasma of patients with AN often shows alterations in laboratory parameters and appetite regulators, including electrolytes, liver enzymes, leukocyte count, hemoglobin (Hb), leptin, neuropeptide Y (NPY), triiodothyronine (T3), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, ghrelin, pancreatic polypeptide (PP), tumor necrosis factor-alpha (TNF-alpha), and cortisol. Medical problems secondary to AN or due to the treatment itself may lead to further laboratory abnormalities. To date, despite these associated laboratory alterations, the diagnosis of anorexia is a clinical one, based on weight and specific psychopathology.

Modified activity-stress paradigm in an animal model of the female athlete triad

The exercising woman with nutritional deficits and related menstrual irregularities is at risk of compromising long-term bone health, i.e., the female athlete triad. There is no animal model of the female athlete triad. The purpose of this study was to examine long-term energy restriction in voluntary wheel-running female rats on estrous cycling, bone mineral content, and leptin levels. Twelve female Sprague-Dawley rats (age 34 days) were fed ad libitum and given access to running wheels during an initial 14-wk period, providing baseline and age-related data. Daily collection included dietary intake, body weight, estrous cycling, and voluntary running distance. At 4 mo, rats were randomized into two groups, six restrict-fed rats (70% of ad libitum intake) and six rats continuing as ad libitum-fed controls. Energy intake, energy expenditure, and energy availability (energy intake - energy expenditure) were calculated for each animal. Serum estradiol and leptin concentrations were measured by RIA. Femoral and tibial bone mineral density and bone mineral content (BMC) were determined by dual-energy X-ray absorptiometry. Restrict-fed rats exhibited a decrease in energy availability during Weight Loss and Anestrous phases (P = 0.002). Compared with controls after 12 wk, restrict-fed rats showed reduced concentrations of serum estradiol (P = 0.002) and leptin (P = 0.002), lower ovarian weight (P = 0.002), and decreased femoral (P = 0.041) and tibial (P = 0.05) BMC. Decreased energy availability resulted in anestrus and significant decreases in BMC, estrogen and leptin levels, and body weight. Finally, there is a critical level of energy availability to maintain estrous cycling.

Parent-adolescent relationships and the development of weight concerns from early to late adolescence

OBJECTIVE

This work describes the developmental course of adolescents' weight concerns and examines links with changes in parent-adolescent relationships for girls and boys.

METHOD

Adolescents and parents in 191 families participated in 3 annual home interviews; adolescents rated their weight concerns and their intimacy and conflict with parents. Parental knowledge was measured based on the match between adolescents' and parents' reports of youth's experiences each day during 7 evening telephone calls.

RESULTS

Girls' weight concerns increased from age 11 to 16 and then declined, whereas boys' concerns declined beginning at age 11. Increases in girls' weight concerns were linked to increases in conflict with mothers and fathers and decreases in maternal intimacy and knowledge. At a trend level, declines in boys' weight concerns were associated with declines in father conflict.

CONCLUSION

Mothers and fathers may have unique influences on adolescent weight concerns. Intervention programming should target parent-adolescent relationships.

Application criteria of enteral nutrition in patients with anorexia nervosa: correlation between clinical and psychological data in a "lifesaving" treatment

BACKGROUND

Data and research increasingly point to multiple factors in the genesis of eating-behavior disorders, but the lack of a clear etiological definition prevents a unique therapeutic or prognostic approach from being defined. Therapeutic approaches, as well as scientific research, have separately analyzed the psychological aspects and the clinical-nutrition aspects without integrating the variables or correlating clinical and psychological data. This work has several goals because it aims at considering the problem from the 2 different perspectives. Psychological and clinical variables are analyzed both separately and together in order to assess (a) the minimal criteria to define a cure as "lifesaving" and submit a patient to artificial nutrition; (b) the kind of implementation artificial nutrition should follow; (c) which indicators of the efficacy of artificial nutrition must be taken into account; (d) the results in nutrition terms that may be obtained during the follow-up; (e) if artificial nutrition may be used as a therapeutic tool; (f) if there are any psychological effects after artificial nutrition; (g) if there are any effects due to the patients' age; and (h) the correlation between the psychological profile of a patient and the acceptance of the nutrition treatment.

METHODS

Several psychological and pharmacologic variables, together with clinical and anthropometric data and blood chemical values, were all considered.

CONCLUSIONS

Besides defining minimal criteria for a "lifesaving" cure and proposing 2 ad hoc scales for the assessment of patients' subjective willingness toward feeding and for the objective measurement of feeding itself, clinical data and correlations with psychological data evidenced the importance of artificial nutrition and specifically of enteral nutrition as a therapeutic tool, allowing us to define the modalities of implementation of enteral nutrition. Results show that, because enteral nutrition did not deteriorate the psychological state of the patients, and was found to be accepted more positively than feeding orally in the most critical initial phase, it should be included in the therapy.

Self-reported weight perceptions, dieting behavior, and breakfast eating among high school adolescents

This study explored the relationships among weight perceptions, dieting behavior, and breakfast eating in 4597 public high school adolescents using the Centers for Disease Control and Prevention Youth Risk Behavior Survey. Adjusted multiple logistic regression models were constructed separately for race and gender groups via SUDAAN (Survey Data Analysis). Adjusted odds ratios [ORs] and 95% confidence intervals were calculated to determine the strength of relationships. Approximately 42% of the sample reported not eating breakfast within the past 5 days, while 41% were trying to lose weight, and 37% were dieting to lose weight. Excessive dietary practices (eg, fasting, taking diet pills or laxatives, and vomiting to lose weight) were reported by approximately 25% of the sample. When compared to those eating breakfast within the past 5 days, all race and gender groups that did not report eating breakfast were significantly more likely to report fasting to lose weight (ORs = 1.70-2.97). In addition, all race/gender groups, with the exception of black females, were significantly more likely to perceive themselves as overweight (ORs = 1.44-1.61) and trying to lose weight (ORs = 1.40-1.72). Among males, not eating breakfast was significantly associated with taking diet pills to lose weight (ORs = 2.31-2.40), eating fewer calories to lose weight (ORs = 1.38-1.49), and inversely associated with trying to gain weight (ORs = 0.71-0.74). Results suggest that these adolescents may be skipping breakfast as part of a patterned lifestyle of unhealthy weight management and that efforts to encourage youth to eat breakfast will likely not ameliorate all dietary challenges that appear beyond the scope of increased breakfast offerings.

The effects of bone therapy on tibial bone loss in young women with anorexia nervosa

OBJECTIVE

Osteoporosis is recognized as a common medical complication of anorexia nervosa (AN). The purpose of the current study was to investigate the recovery mechanism of osteoporosis in AN and the effect of medical treatment on the skeletal system.

METHOD

We conducted a randomized placebo-controlled study of the effects of etidronate and calcium and vitamin D on bone loss in 41 outpatients with the restricting type of AN (AN-R). We measured the tibial speed of sound (SOS) before and after 3 months of treatment.

RESULTS

The bone mineral density (BMD) of the tibial SOS change in both the etidronate group and the calcium and vitamin D Group was significantly greater (p < .001) than in the control group. Urine-N-telopeptide cross-links of type I collagen (NTx) before and after treatment decreased significantly (p < .01) in the etidronate group.

CONCLUSION

These findings suggest that both etidronate and calcium and vitamin D are equally efficacious for reversing the degree of osteoporosis in patients with AN.

Anorexia nervosa in a child with tuberous sclerosis complex

Psychiatric disorders pose a significant burden to the quality of life of individuals with tuberous sclerosis complex and their caregivers. The relationship between the location and distribution of brain abnormalities in tuberous sclerosis complex and specific neuropsychiatric disorders is largely unknown. We present the first case in the literature of a child with tuberous sclerosis complex and anorexia nervosa and discuss the relevance of electroencephalography, magnetic resonance imaging, and neuropsychologic testing. To understand psychiatric disturbances in tuberous sclerosis complex, we must consider each of the following factors: cerebral pathology, seizure history, cognitive impairment, psychosocial stressors, and medications.

The role of social norms and friends’ influences on unhealthy weight-control behaviors among adolescent girls

Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends' dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends' involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends' dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR = 1.47, CI = 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR = 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI = .97-1.50), even after controlling for friends' dieting behaviors. The social influences examined here were not associated with UWCBs among underweight ( < 15th percentile) or overweight ( > 95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed.

Diagnosing bulimia nervosa with parotid gland swelling

BACKGROUND

The authors describe bulimia nervosa, or BN, and its effect on the parotid gland. The associated asymptomatic bilaterally enlarged parotid glands often present a diagnostic dilemma.

CASE DESCRIPTION

The authors present a case of a 22-year-old woman with BN who had bilateral parotid gland swelling, serum electrolyte alteration and no dental stigmata. Her principal concern was the associated cosmetic deformity.

CLINICAL IMPLICATIONS

Because patients with BN who have parotid gland swelling usually are secretive about their purging, the diagnosis may be confirmed by conducting a clinical examination and a serum electrolyte study. Prompt diagnosis can avoid serious medical complications.

Antecedents and consequences of binge eating episodes in women with an eating disorder

The aim of this study was to explore antecedents and sequelae of binge eating episodes. A sample of eating disorders (n = 154 women) was selected from a total of 1849 female respondents (out of 2500) recruited as part of a general population-based survey. Included participants met DSM-III-R criteria for anorexia nervosa (AN), bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) based on the Survey for Eating Disorders (SEDs). Preliminary criteria for binge eating disorder (BED) were added. Results indicated that the most frequently reported antecedents and consequences of binge eating were emotional and physiological factors. There were significant differences between the different ED subgroups in their frequency of binge eating episodes. Regarding antecedents of a binge eating episode, the SEDs-defined ED subgroups had overall differences in frequency on "stomach feeling". In particular, the BN-group reported "euphoria" more frequently than the BED and EDNOS-groups. Concerning consequences of a binge eating episode, there were overall differences between the ED subgroups on "fall asleep", and in addition a borderline significance was found for "disturbed by others" (p = 0.059). None of the eight women in the AN group reported "euphoria" as a factor that terminated a binge eating episode. The findings may have important implications with regard to prevention and treatment of ED.

A characteristic reactive hypoglycemia induced by rapid change of eating behavior in anorexia nervosa: a case report

The relationship among reactive hypoglycemia, corresponding insulin metabolism, and eating behavior in anorexia nervosa (AN) has not been well documented.

METHOD

A 22-year-old woman with AN was admitted to Kagoshima University Hospital. An oral glucose tolerance test was performed with additional sampling at 15 minutes on the seventh hospital day when her daily caloric intake rapidly increased, reaching 2,000kcal perday.

RESULTS

An elevated level of insulin secretion (1,190pmol/L) was observed during the very early phase (15 minutes) after glucose load, whereas corresponding blood glucose elevations were not as high (1.2mmol/L). The patient experienced asymptomatic hypoglycemia (2.1mmol/L).

CONCLUSIONS

Our findings suggested that a rapid increase of energy intake might cause reactive hypoglycemia with characteristic insulin metabolism, that is, an elevated level of insulin secretion during the very early phase.

Eating disorders

Anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified remain a significant cause of morbidity and mortality in girls and young women. Management of eating disorders typically requires a multidisciplinary team approach, often spear-headed by the clinician initially detecting the illness. This article addresses the definitions and prevalence of eating disorders, tips on recognition and management of medical complications, and reproductive health concerns for these young women. Issues surrounding care of the patient with the female athlete triad, or amenorrhea, osteopenia, and eating disorders, are also discussed.

Insulinogenic index at 15 min as a marker of nutritional rehabilitation in anorexia nervosa

BACKGROUND

Insulin responses to the oral-glucose-tolerance test (OGTT) in anorexia nervosa (AN) are related to body weight and show various patterns. Although weight gain is a key indicator of a successful nutritional program, it is not a sufficiently accurate index for assessing nutritional status, especially in the periods of marked fear of obesity, because patients often manipulate body weight measurements.

OBJECTIVE

The aim of this study was to determine the relation between insulin metabolism during the early phase of the OGTT and progress (weekly weight gain) during nutritional rehabilitation.

DESIGN

Forty-eight inpatients with AN (25 AN restricting type and 23 AN bulimic type) underwent the OGTT, with additional blood sampling at 15 min, when energy intake reached 6694 kJ/d (1600 kcal/d). Thirteen healthy volunteers were also studied. To evaluate early-phase insulin metabolism, we calculated the insulinogenic index after 15 (II(15 min)) and 30 min. On the basis of weekly changes in body weight, the AN participants were divided into good (> or =0.5 kg) and poor (<0.5 kg) responders.

RESULTS

Among the AN patients, 48% were poor responders. Analysis of variance showed significant differences in the II(15 min) values (P = 0.0005) and showed that II(15 min) values for good responders were significantly higher than those for the other groups.

CONCLUSIONS

These findings suggest that a lack of progress in weight gain is frequently observed in AN and that II(15 min) values may be a useful marker with which to assess the weekly progress during nutritional rehabilitation.

Spectral analysis of R-R interval variability by short-term recording in anorexia nervosa

Subjects with anorexia nervosa (AN) present a number of changes in autonomic system functions, such as thermoregulation, vascular motility, heart rate and rhythm, and blood pressure. We evaluated the changes in the autonomic control of heart rate and blood pressure after postural variation by means of the spectral analysis of R-R interval variability (HRV in 13 female subjects with AN diagnosed on the basis of diagnostic statistical manual (DSM-IV) criteria, a mean age of 25 +/- 5.8 years and a mean body mass index (BMI) of 16.9 +/- 2.6. The controls were 16 healthy female subjects with a mean age of 25 +/- 2.3 years and a normal BMI. The data were statistically evaluated by means of one-way analysis of variance or Student's t test. The high frequency (HF) components of the spectral analysis did not significantly change when passing from clino- to orthostatism in the AN subjects, but there were significant changes in the controls. The changes in the low frequency (LF) components were similar in both groups, but smaller in the AN subjects. However, the difference between the two series was not statistically significant. The variance in the orthostatic R-R intervals recorded in the AN subjects was significantly less than the clinostatic intervals, the intervals recorded in the controls. These results indicate that AN subjects show signs of autonomic dysfunction. The increase in the HF component of the spectral analysis suggests that parasympathetic modulation is abnormally persistent during orthostatism, furthermore, the variability of the R-R intervals indicates that orthosympathetic regulation is also altered in AN.

Serum cholesterol in bulimia nervosa

OBJECTIVE

The purpose of this retrospective study was to replicate and to extend previous work indicating that bulimia nervosa is associated with elevated serum levels of cholesterol and to examine the association between cholesterol and other clinical and serum measures.

METHODS

Clinical characteristics and laboratory data including nonfasting cholesterol and thyroid indices were collected from charts of 119 women with bulimia nervosa and 42 female controls.

RESULTS

There was no significant difference between the two groups in mean age or body mass index. The mean serum cholesterol level of the patient group was statistically significantly greater than that of the control group (patients: 194 +/- 36 mg/dl; controls: 176 +/- 34 mg/dl; t = 2.77; df = 159; p =.006). The mean calculated free T4 of the bulimia nervosa patient group was statistically lower than that of the control group (patients: 1.89 +/- 0.32; controls: 2.09 +/- 0.26; t = 2.86; df = 141; p =.005). There was no correlation between calculated free T4 and serum cholesterol within the combined group (r =.04, p >.5, N = 143) or within the patient group (r =.08, p >.3, N = 118).

CONCLUSIONS

The average serum level of cholesterol is elevated in the patients with bulimia nervosa. The mechanism for and the consequences of this abnormality are uncertain.

Population-based prevention of eating disorders: an application of the Rose prevention model

BACKGROUND

Several decades of concerted research on eating disorders have generated a broad range of proposed causal influences, but much of this etiologic research does not elucidate practical avenues for preventive interventions. Translating etiologic theory into community health interventions depends on the identification of key leverage points, factors that are amenable to public health intervention and provide an opportunity to maximize impact on the outcome of interest. Population-based preventive strategies, elaborated by epidemiologist Geoffrey Rose, can maximize the impact of public health interventions. In the case of eating disorders, Rose's model is instructive: Dieting stands out as risk behavior that may both fit Rose's model well and be a key leverage point for preventive intervention.

METHODS

Grounded in Rose's work, this article lodges a theoretical argument for the population-based prevention of eating disorders. In the introductory section, existing research on the epidemiology of dieting is reviewed, showing that it is extremely common among adolescent girls and women and that the behavior has been implicated as a causal factor for disordered eating. Next, new evidence is offered to build a case for how a population-wide reduction in dieting may be an effective strategy for prevention of eating pathology. Finally Rose's prevention framework is used to introduce a unique and provocative perspective on the prevention of eating disorders.

RESULTS

Dieting is a normative behavior in our culture with psychological and physiological effects in the causal chain leading to eating pathology. This behavior may represent an ideal target for population-based prevention.

CONCLUSIONS

Theoretical and empirical evidence suggests that a population-wide reduction in dieting may be a justifiable and effective strategy for prevention of eating pathology.

Overweight concerns and body dissatisfaction among third-grade children: the impacts of ethnicity and socioeconomic status

OBJECTIVE

To examine the prevalence of overweight concerns and body dissatisfaction among third-grade girls and boys and the influences of ethnicity and socioeconomic status (SES).

STUDY DESIGN

Nine hundred sixty-nine children (mean age, 8.5 years) attending 13 northern California public elementary schools completed assessments of overweight concerns, body dissatisfaction, and desired shape, height, and weight.

RESULTS

The sample was 44% white, 21% Latino, 19% non-Filipino Asian American, 8% Filipino, and 5% African American. Twenty-six percent of boys and 35% of girls reported wanting to lose weight, and 17% of boys and 24% of girls reported dieting to lose weight. Among girls, Latinas and African Americans reported significantly more overweight concerns than Asian Americans and Filipinas, and Latinas reported significantly more overweight concerns than whites. White and Latina girls also reported greater body dissatisfaction than Asian American girls. Some differences persisted even after controlling for actual body fatness. Higher SES African American girls reported significantly more overweight concerns than lower SES African American girls, but higher SES white girls reported less overweight concerns than lower SES white girls.

CONCLUSION

Overweight concerns and body dissatisfaction are highly prevalent among third-grade girls and boys, across ethnicity and SES. Young Latina and African American girls manifest equivalent or higher levels of disordered eating attitudes and behaviors as white and Asian American girls.

Anorectal dysfunction in constipated women with anorexia nervosa

OBJECTIVE

To evaluate anorectal and colonic function in a group of patients with anorexia nervosa complaining of chronic constipation.

PATIENTS AND METHODS

Twelve women (age range, 19-29 years) meeting the criteria for anorexia nervosa and complaining of chronic constipation were recruited for the study. A group of 12 healthy women served as controls. Colonic transit time was measured by a radiopaque marker technique. Anorectal manometry and a test of rectal sensation were carried out with use of standard techniques to measure pelvic floor dysfunction. A subgroup of 8 patients was retested after an adequate refeeding program was completed.

RESULTS

Eight (66.7%) of 12 patients with anorexia nervosa had slow colonic transit times, while 5 (41.7%) had pelvic floor dysfunction. Colonic transit time normalized in the 8 patients who completed the 4-week refeeding program. However, pelvic floor dysfunction did not normalize in these patients.

CONCLUSIONS

Patients with anorexia nervosa who complain of constipation have anorectal motor abnormalities. Delayed colonic transit time is probably due to abnormal eating behavior.

The relationship of pubertal status to body image, social physique anxiety, preoccupation with weight and nutritional status in young females

The relationship of puberty to body image, social physique anxiety, preoccupation with weight and nutritional status was examined in 77 non-obese females (7-16 years). Results showed that 34% of the pre-pubescent girls, 36% of the early pubescent girls and 76% of the post-pubescent girls were dissatisfied with their body shape. Social physique anxiety, determined by the SPAS scale, and preoccupation with weight, measured by the Eating Disorder Inventory were observed in all pubertal groups but were more evident in the early and post-pubescent groups. No significant difference existed among the maturation groups in mean caloric and nutrient intake. The results showed that antecedents for developing an eating disorder existed in all maturational groups studied, although no health risk behaviours regarding nutritional status were observed.

Menstrual and premenstrual issues in female military cadets: a unique population with significant concerns

CONTEXT

There is a strong need to determine what effect, if any, menstruation has on the performance of duty as a Cadet at the United States Military Academy (USMA) at West Point, and to determine what impact, if any, the USMA environment has on the menstrual cycle.

STUDY OBJECTIVES

To study menstrual function and premenstrual symptoms in a structured, rigorous military environment; determine the perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and evaluate the difficulties inherent to menstruation in a military setting.

DESIGN, SETTING, AND PARTICIPANTS

A survey about high school menstrual and premenstrual function, and the Premenstrual Assessment Form (PAF), were completed by all 158 freshman female Cadets in July 1991. In May 1992, 83 participants completed a survey assessing menstrual and premenstrual symptoms, including interference with activities during the year.

MAIN OUTCOME MEASURES

Menstrual regularity, premenstrual symptoms, interference with activities.

RESULTS

Participants reported menstrual patterns and premenstrual symptoms in high school similar to other females their age. Most (62%) predicted a change in menstruation at the USMA, half were worried that physical symptoms would interfere with activities, one-fourth were worried that premenstrual symptoms would interfere with activities, and one-fourth were worried that obtaining and changing menstrual materials would interfere with activities. Almost all respondents (91%) reported changes in menstruation during the year, most commonly less regular, less frequent, shorter, lighter, and less crampy periods. Menstrual and premenstrual symptoms interfered with physical activities (66.2%, 61.4% respectively) more so than academic (50.6%, 45.7% respectively) or military activities (39.8%, 47.0% respectively). Female Cadets described significant difficulties with changing (62.6%), obtaining (51.8%), and disposing of (38.5%) menstrual materials.

CONCLUSIONS

The data demonstrate major changes in menstrual function in over 90% of female Cadets; a significant perceived impact of menstrual and premenstrual symptoms on academic, physical, and military activities; and difficulties in obtaining, changing, and disposing of menstrual materials in a military setting. These findings have implications for females in the military, as well as for young women generally.

Binge eating and substance use among male and female adolescents

OBJECTIVE

This study examines the relationship between binge eating and substance use behaviors and attitudes in adolescents and explores gender differences and mental health correlates.

METHOD

The data are derived from the 1997 Ontario Student Drug Use Survey of public and Catholic school students. A weighted sample of 1,031 girls and 888 boys was categorized as nonbingers, past bingers, and noncompensating or compensating binge eaters.

RESULTS

Binge eaters, particularly those who compensated, were more likely to use all types of substances, particularly cannabis and drugs other than tobacco and alcohol. Binge eating was associated with more problematic and heavier substance use and with lowered self-esteem and more depression. Female bingers were more likely to report compensatory behaviors than male students but gender differences in the relationship between binge eating and substance use were few.

DISCUSSION

Adolescent binge eaters who engage in compensatory behaviors may be an appropriate target group for preventive programs in high schools.

Long-term fracture risk among women with anorexia nervosa: a population-based cohort study

OBJECTIVE

To determine if fractures represent an important problem for women with anorexia nervosa who may fail to achieve peak bone mass and may experience premature bone loss from decreased estrogen levels.

PATIENTS AND METHODS

In this population-based retrospective cohort study, we identified 208 Rochester, Minn, residents that were first diagnosed as having anorexia nervosa between 1935 and 1989, whose subsequent fractures were documented in contemporary medical records and compared with expected numbers of fractures (standardized incidence ratios [SIRs]).

RESULTS

Subjects were followed up for 2689 person-years during which time 45 patients suffered 88 fractures. Fracture risk was increased among the 193 women (SIR, 2.9; 95% confidence interval, 2.0-3.9) as well as the 15 men (SIR, 3.4; 95% confidence interval, 1.1-7.9). The cumulative incidence of any fracture at 40 years after the diagnosis of anorexia nervosa was 57%. Fractures of the hip, spine, and forearm were late complications, occurring on average 38, 25, and 24 years, respectively, after diagnosis.

CONCLUSION

Young women with anorexia nervosa are at increased risk of fractures later in life. Greater attention should be paid to the skeletal health of these individuals.

Exposure to the mass media and weight concerns among girls

OBJECTIVE

To assess the influence of the media on girls' weight concerns, weight control/loss behaviors, and perceptions of body weight and shape.

DESIGN

Cross-sectional survey completed in school. The questionnaire assessed body weight, dissatisfaction with body weight and shape, exposure to fashion magazines, the impact of media on feelings about weight and shape, attributes of and preferences for body types, and whether subjects had gone on a diet to lose weight or initiated exercise because of an article in a magazine.

SETTING

Mandatory physical education class in public elementary, junior high, and high schools.

PARTICIPANTS

Subjects included 548 5th- through 12th-grade girls in a working-class suburb in the northeastern United States.

OUTCOME MEASURES

Perceived influence of fashion magazines on body dissatisfaction, idea of the perfect body shape, dieting to lose weight, and initiating an exercise program.

RESULTS

Pictures in magazines had a strong impact on girls' perceptions of their weight and shape. Of the girls, 69% reported that magazine pictures influence their idea of the perfect body shape, and 47% reported wanting to lose weight because of magazine pictures. There was a positive linear association between the frequency of reading women's magazines and the prevalence of having dieted to lose weight because of a magazine article, initiating an exercise program because of a magazine article, wanting to lose weight because of pictures in magazines, and feeling that pictures in magazines influence their idea of the perfect body shape. In multivariate logistic regression models controlling for weight status (overweight vs not overweight), school level (elementary vs junior high school, elementary vs high school), and race/ethnic group, girls who were frequent readers of fashion magazines were two to three times more likely than infrequent readers to diet to lose weight because of a magazine article (odds ratio [OR] = 2.11, 95% confidence interval [CI]: 1.19-3.75); to exercise to lose weight because of a magazine article (OR = 3.02, 95% CI: 1.77-5.17); and to feel that magazines influence what they believe is the ideal body shape (OR = 2.81; 95% CI: 1.72-4.58). In addition, moderate-frequency readers were more likely than infrequent readers of fashion magazines to report exercising because of a magazine article (OR = 1.94; 95% CI: 1.14-3.30) and feeling that magazines influence what they believe is the ideal body shape (OR = 2.03; 95% CI: 1.30-3.15).

DISCUSSION

The majority of the preadolescent and adolescent girls in this school-based study were unhappy with their body weight and shape. This discontentment was strongly related to the frequency of reading fashion magazines. Although previous studies have concluded that the print media promotes an unrealistically thin body ideal, which in turn is at least partially responsible for promoting eating disorders, the present study is the first that we are aware of to assess directly the impact of the print media on the weight and body shape beliefs of young girls. We observed that the frequency of reading fashion magazines was positively associated with the prevalence of having dieted to lose weight, having gone on a diet because of a magazine article, exercising to lose weight or improve body shape, and deciding to exercise because of a magazine article. Given the substantial health risk associated with overweight and the fact that during the past 2 decades the prevalence of overweight has increased sharply among children and adolescents, it is not prudent to suggest that overweight girls should accept their body shape and not be encouraged to lose weight. However, aspiring to look like underweight models may have deleterious psychological consequences. The results suggest that the print media aimed at young girls could serve a public health role by refraining from relying on models who are severely underweight and printing more articles on the benefits of physical

Exercise and reproductive dysfunction

OBJECTIVE

To provide an overview of our current understanding of exercise-induced reproductive dysfunction and an approach to its evaluation and management.

DESIGN

A MEDLINE search was performed to review all articles with title words related to menstrual dysfunction, amenorrhea, oligomenorrhea, exercise, and athletic activities from 1966 to 1998. The pathophysiology, proposed mechanisms, clinical manifestations, evaluation, and management of exercise-associated reproductive dysfunction were compiled.

CONCLUSION(S)

Exercise-induced menstrual irregularity appears to be multifactorial in origin and remains a diagnosis of exclusion. The underlying mechanisms are mainly speculative. Clinical manifestations range from luteal phase deficiency to anovulation, amenorrhea, and even delayed menarche. Evaluation should include a thorough history and a complete physical plus pelvic examination. Most cases are reversible with dietary and exercise modifications. Hormonal replacement in cases of a prolonged hypoestrogenic state with evidence of increased bone loss is recommended, although the long-term consequences of prolonged hormonal deficiency are ill-defined.