Epidemiology of eating disorders part II: an update with a special reference to the DSM-5

The Relationship between Body Dissatisfaction and Eating Disorder Symptoms in Young Women Aspiring Fashion Models: The Mediating Role of Stress

It is widely recognized that body dissatisfaction is an important public health concern. In the past, being a fashion model was almost synonymous with anorexia/bulimia, and even today, there are cases of eating disorders in young women whose ambition is to become a top model. Moreover, stress can play a substantial role within ill health via related behaviors such as smoking, substance abuse, and inappropriate eating. In our study, we examined 112 aspiring fashion models aged between 15 and 24 years (M = 19.5, SD = 2.08) from 32 different countries of the world during an international contest, and 100 students (control group), aged between 16 and 22 years (M = 18.6, SD = 1.39). The purpose of this cross-sectional study was to examine whether stress mediated the relationship between body dissatisfaction and eating disorders. The study included the administration of stress and self-efficacy and the locus of control dimensions, body (image) dissatisfaction, and eating attitude disorder. Results indicated higher scores on body dissatisfaction, stress level, and eating attitudes disorder among the group of fashion models compared to the control. Mediational analyses showed that body dissatisfaction was partially mediated by stress level on eating disorders. Especially in the aspiring fashion models, there are often many possibilities that competitive stress causes candidates to exacerbate attempts to maintain their body weight below normal weight/height parameters. These results indicated that appropriate intervention for the management of stress level could possibly defend against the negative impact of body dissatisfaction on eating disorder symptoms. The presence of skilled health workers in the field of nutrition and psychology can be extremely important in the field of fashion to maintain an adequate quality of life.

The Influence of Self-Efficacy and Locus of Control on Body Image: A Path-Analysis in Aspiring Fashion Models, Athletes and Students

It is widely documented that negative body image is a significant public health concern due to its association with symptoms of disordered eating and worse psychological well-being. The purpose of the study was to develop a path model of intrapersonal dimensions (self-efficacy and internal locus of control) as antecedents of perceived stress toward females’ body dissatisfaction and eating attitude disorders. A total of 300 females, including 100 aspiring fashion models, 100 athletes and 100 students (controls), between 15 and 24 years of age (M = 19.6, SD = 1.85) participated in the study. Measures included level of psychological stress, self-efficacy and locus of control dimensions, body dissatisfaction and eating attitude disorder indices. A path analysis confirmed our research hypothesis. Comparing the three subsamples, we found better fit indexes in the two subgroups with elevated investment on their body image with respect the control group. More specifically, the model in the group of aspiring fashion models showed the best fit index. These results indicated that aspiring fashion models have a strong desire to maintain their low body mass or to become thinner. For this reason, a suitable involvement of expert health workers in the nutritional and psychological field could be extremely essential in the fashion world to maintain a healthier well-being.

Meaning in Life Mediates Between Emotional Deregulation and Eating Disorders Psychopathology: A Research From the Meaning-Making Model of Eating Disorders

Emotional dysregulation, age, gender, and obesity are transdiagnostic risk factors for the development and maintenance of eating disorders (EDs). Previous studies found that patients with ED had less meaning in life than the non-clinical population, and that meaning in life acted as a buffer in the course of ED; however, to the data, there are no studies about the mediator role of meaning in life in association between the emotional dysregulation and the ED psychopathology.

Objective: To analyze the mediating role of meaning in life in the relationship between emotional dysregulation and the ED psychopathology in three samples with diverse risk factors for ED.

Method: Sample 1, n = 153 undergraduate young women; sample 2, n = 122 participants with obesity; and sample 3, n = 292 participants with ED. Multiple mediation analysis was performed.

Results: Sample 1: meaning in life showed a mediation effect between emotional dysregulation and the ED psychopathology (direct effect β = 0.390, p < 0.05) (indirect effect β = 0.227, p < 0.05), body satisfaction (direct effect β = −0.017, p < 0.05) (indirect effect β = −0.013, p < 0.01), and depression symptoms (direct effect β = 1.112, p < 0.001) (indirect effect β = 0.414, p < 0.001); sample 2: meaning in life showed a mediation effect between emotional dysregulation and binge eating and purging behaviors (direct effect β = 0.194, p < 0.01) (indirect effect β = 0.054, p < 0.05) and depression symptoms (direct effect β = 0.357, p < 0.001) (indirect effect β = 0.063, p < 0.05); sample 3: meaning in life showed a mediation effect between emotional dysregulation and the ED psychopathology (direct effect β = 0.884, p < 0.001) (indirect effect β = 0.252, p < 0.007), body satisfaction (direct effect β = −0.033, p < 0.05) (indirect effect β = −0.021, p < 0.001), borderline symptoms (direct effect β = 0.040, p < 0.001) (indirect effect β = 0.025, p < 0.001), and hopelessness (direct effect β = 0.211, p < 0.001) (indirect effect β = 0.087, p < 0.001).

Conclusions: These studies suggest the importance of considering meaning in life as a variable in the onset and maintenance of ED.

The Re-shaping of Bodies: A Discourse Analysis of Feminine Athleticism

Slender and skinny body ideals have been associated with psychological disorders such as eating disorders. However, the tendency to promote a “healthier” and more athletic female body ideal has received minimal critical attention. This study aims at exploring the underlying conditions for such an athletic ideal through asking: How is the female athletic body constructed in the pseudonymous contemporary women’s fitness magazine, “Xrzise”? We investigated the object of inquiry through a modified version of Parker’s Foucauldian discourse analysis. We analyzed the interviews of four athletic role models in “Xrzise” and identified four discourses: “Neo-liberal discourse,” “Health expertise discourse,” “Discourse of surveillance and control” and “Discourse of emancipation.” The “Neoliberal discourse” constructs the female athletic body as something that the individual woman should strive for by appropriately managing her own resources, abilities and skills. The “Health expertise discourse” constructs the female athletic body through a homeostatic logic where the individual is responsible and healthcare experts have the mandate to intervene in order to maintain good health. The “Discourse of surveillance and control” constructs the female athletic body as an internalized panoptic stance, disciplining women to accept hegemonic beauty ideals. The “Discourse of emancipation” accentuates that the female athletic body is alleviated from a culturally rigid body image and instead improved physical performance and functionality are considered good ends. The results and discussion indicate that the female athletic body is a result of a complex nexus of different discourses associated with the powers of economy, sex differences, institutions, and ideological forces. We have advocated that magazines like “Xrzise” can have covert disciplinary effects hidden by seemingly well-intentioned motives, which can contribute to women’s objectification of their bodies.

A new treatment for eating disorders combining physical exercise and dietary therapy (the PED-t): experiences from patients who dropped out

Purpose: Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining physical exercise and dietary therapy (PED-t).Methods: We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach.Results: Three themes emerged: "standing on the outside", "unmet expectations" and "participation not a waste of time". Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced.Conclusion: A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.

Patients' views on a new treatment for Bulimia nervosa and binge eating disorder combining physical exercise and dietary therapy (the PED-t). A qualitative study

A new group based treatment for patients with bulimia nervosa (BN) and binge eating disorder (BED), combining guided Physical Exercise and Dietary therapy (PED-t), has shown the capacity to alleviate BN and BED symptoms. The PED-t is run by therapists with a professional background in sport sciences and nutrition, which in many clinical settings is an uncommon group of professionals. The symptom reduction effects using the PED-t need validation from patients who have been given this kind of treatment, as negative experiences may impinge further clinical implementation. To explore such experiences, semistructural interviews were conducted with 15 participants. The interviews were transcribed and analyzed using a systematic text condensation approach. Overall, patients experienced the format and content of the PED-t as beneficial and as providing tools to manage BN- and BED symptoms. The patients' experiences of therapist credibility was enhanced by their appreciation of the therapists' professional background. Finally, some treatment modifications were suggested. Overall, the PED-t may thus be offered to patients with BN and BED, by a new set of professionals, and in uncommon settings. This possibility calls for future effectiveness studies integrating both parametric and experiential data.

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.

Eating disorders among fashion models: a systematic review of the literature

PURPOSE

In the light of recent concerns regarding the eating disorders among fashion models and professional regulations of fashion model occupation, an examination of the scientific evidence on this issue is necessary. The article reviews findings on the prevalence of eating disorders and body image concerns among professional fashion models.

METHOD

A systematic literature search was conducted using ProQUEST, EBSCO, PsycINFO, SCOPUS, and Gale Canage electronic databases.

RESULTS

A very low number of studies conducted on fashion models and eating disorders resulted between 1980 and 2015, with seven articles included in this review. Overall, results of these studies do not indicate a higher prevalence of eating disorders among fashion models compared to non-models. Fashion models have a positive body image and generally do not report more dysfunctional eating behaviors than controls. However, fashion models are on average slightly underweight with significantly lower BMI than controls, and give higher importance to appearance and thin body shape, and thus have a higher prevalence of partial-syndrome eating disorders than controls.

CONCLUSION

Despite public concerns, research on eating disorders among professional fashion models is extremely scarce and results cannot be generalized to all models. The existing research fails to clarify the matter of eating disorders among fashion models and given the small number of studies, further research is needed.

The PED-t trial protocol: The effect of physical exercise -and dietary therapy compared with cognitive behavior therapy in treatment of bulimia nervosa and binge eating disorder

BACKGROUND

Sufferers from bulimia nervosa (BN) and binge eating disorder (BED) underestimate the severity risk of their illness and, therefore, postpone seeking professional help for years. Moreover, less than one in five actually seek professional help and only 50% respond to current treatments, such as cognitive behavioral therapy (CBT). The impetus for the present trial is to explore a novel combination treatment approach adapted from physical exercise- and dietary therapy (PED-t). The therapeutic underpinnings of these separate treatment components are well-known, but their combination to treat BN and BED have never been previously tested. The purpose of this paper is to provide the rationale for this new treatment approach and to outline the specific methods and procedures.

METHODS

The PED-t trial uses a prospective randomized controlled design. It allocates women between 18 and 40 years (BMI range 17.5-35.0) to groups consisting of 5-8 members who receive either CBT or PED-t for 16 weeks. Excess participants are allocated to a waiting list control group condition. All participants are assessed at baseline, post-treatment, 6, 12 and 24 months' post-follow-up, respectively, and monitored for changes in biological, psychological and therapy process variables. The primary outcome relates to the ED symptom severity, while secondary outcomes relates to treatment effects on physical health, treatment satisfaction, therapeutic alliance, and cost-effectiveness. We aim to disseminate the results in high-impact journals, preferable open access, and at international conferences.

DISCUSSION

We expect that the new treatment will perform equal to CBT in terms of behavioral and psychological symptoms, but better in terms of reducing somatic symptoms and complications. We also expect that the new treatment will improve physical fitness and thereby, quality of life. Hence, the new treatment will add to the portfolio of evidence-based therapies and thereby provide a good treatment alternative for females with BN and BED.

TRIAL REGISTRATION

Prospectively registered in REC the 16th of December 2013 with the identifier number 2013/1871 , and in Clinical Trials the 17th of February 2014 with the identifier number NCT02079935 .