A Network Analysis Investigation of Disordered Eating Across Demographic and Developmental Subpopulations Using a National Epidemiological Sample of High School Students

Disordered eating (DE) poses a large societal burden, yet limited research has examined DE from a developmental epidemiological perspective. It is important to consider how demographics influence DE symptoms to inform prevention and early intervention programs across diverse subpopulations. Therefore, we conducted network analyses using a large nationally representative epidemiological sample of high school students (Youth Risk Behavior Survey, United States; n = 59,582) to identify the most important symptoms and symptom relationships among six DE behaviors. We compared networks by sex, grade, and race to identify differences in symptom networks. Dieting for weight loss was highly central across networks. Networks significantly differed across sex, grade, and race. Our results suggest that dieting for weight loss may be an early intervention target for eating disorders, regardless of demographic and developmental factors. In addition, sex, race, and age should be accounted for when researching and developing prevention programs for DE and eating disorders. Public health officials, as well as mental health professionals, should present a more balanced message about dieting and weight loss to high school students to prevent the detrimental impact of DE on physical and mental health. Notably, this study is the first large, nationwide epidemiological sample using DE symptoms in network analysis.

Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders

The stereotype that eating disorders (ED) primarily present among individuals of higher socioeconomic status (SES) has long persisted in popular and professional perception. This belief has likely contributed to disparities in ED identification and treatment, particularly among those of lower SES backgrounds. The objective of this article was to systematically review the literature investigating socioeconomic diversity in distinct ED diagnoses. A PRISMA search was conducted to identify studies that empirically assessed the association between ED pathology and indicators of SES via PubMed and PsycINFO. This search generated 13,538 articles, of which 62 articles published between 1973 and August 2020 met criteria for inclusion in the review. Included studies were primarily cross-sectional and covered diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), with quality ratings of poor, fair, and good. Results are examined in the context of studies' sampling methods, operationalization of SES, and statistical analyses. There is no consistent pattern of evidence to suggest a relationship between high SES and ED. Instead, all ED present across a wide range of socioeconomic backgrounds. Limitations included the predominance of cross-sectional study designs and poor to fair quality ratings. Future research should include adequately powered, community-based longitudinal studies that examine how sociocultural factors, including SES, intersect to influence ED risk and treatment outcome. The existing data suggest an urgent need to prioritize affordable and accessible ED treatment.

Binge eating, orthorexia nervosa, restrained eating, and quality of life: a population study in Lebanon

OBJECTIVES

To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL.

METHODS

This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment.

RESULTS

Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors.

CONCLUSION

When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Endorsement of Binge Eating Symptoms in a Sample of Predominantly Non-Hispanic Black Adolescents

Binge eating disorder (BED) as well as individual subthreshold binge eating symptoms are related to deleterious physical and socioemotional outcomes among adolescents. The present study examined the prevalence of specific binge eating behaviors among a sample of primarily non-Hispanic Black outpatients presenting to weight management and endocrinology clinics. Analyses are based on 103 adolescents (69.9% female, 66.9% non-Hispanic Black) who endorsed one or more binge eating symptoms on a nonstandardized clinical assessment patterned after Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The most commonly endorsed symptom was eating in excess of what is considered normal (71.8%), while least commonly endorsed symptoms included guilt, distress, and embarrassment due to overeating (17.5% to 26.2%). More than half of the participants endorsed multiple specific binge eating symptoms. The level of subthreshold symptomatology reported underscores the importance of developmental and cultural tailoring of prevention and intervention efforts to address these behaviors as a means of curbing clinical-level onset of BED.

Patient and Provider Perspectives on Communication About Body Image With Adolescents and Young Adults With Cystic Fibrosis

Objective

This mixed-methods study examined perspectives of adolescents and young adults (AYAs) with cystic fibrosis (CF) and health care providers on body image communication.

Methods

Interviews and questionnaires were completed by 20 AYAs and 28 providers.

Results

Although 85% of patients reported they had never had a body image conversation with a health care provider, 74% of providers reported discussing this topic with patients. Patients and providers described body image as an important issue, which should be discussed comfortably and supportively. However, patients often preferred to discuss body image as a distinct topic, separate from physical health, whereas providers preferred integrating body image conversations within weight- and health-based discussions.

Conclusions

Body image is an important topic for AYAs with CF that often goes unaddressed or addressed in ways that are less preferred by patients. Providers should reduce barriers to effective communication about this important topic, particularly through increased awareness of AYA preferences.

Parental characteristics in association with disordered eating in 11- to 12-year-olds: A study within the Danish National Birth Cohort

We examined the association between parental characteristics and disordered eating among 11- to 12-year-olds within the Danish National Birth Cohort. Frequency of fasting, purging, and binge eating was obtained by self-report from 37,592 children and combined into a measure of disordered eating (no, monthly, and weekly). Information on parental characteristics was obtained during pregnancy, from the 7-year follow-up, and by linkage to population registers. Data were analysed using multinomial logistic regression models with robust standard errors. In total, 3.1% reported weekly and 4.1% reported monthly disordered eating. Parental young age, low educational level, and overweight/obesity were associated with disordered eating. The relative risk ratios for, respectively, weekly and monthly disordered eating according to maternal eating disorder were 1.01 [0.75, 1.37] and 1.09 [0.84, 1.42]. Disordered eating is common among children and is associated with several parental characteristics. We found social inequality in disordered eating, but our data did not support an association with maternal eating disorder.

Do Hispanic Girls Develop Eating Disorders? A Critical Review of the Literature

INTRODUCTION

Eating disorders have become increasingly prevalent in North America. Anorexia nervosa, bulimia nervosa, and binge eating disorder were previously thought to solely affect Caucasian women. However, contemporary research has studied the occurrence of this phenomenon in ethnic minority women, such as Latinas.

METHODS

This article presents a critical review of 12 quantitative, prospective psychological research studies from the past 17 years.

RESULTS

The authors in the reviewed literature identified bodily dissatisfaction, environmental influences, and acculturation as significant risk factors in the development of eating disorders in Hispanic girls and women.

CONCLUSION

The methodology and empirical findings from these studies are discussed, and suggestions for future research and culturally sensitive clinical treatment are considered.

Eating Disorders in Lebanon: Directions for Public Health Action

Research in the field of eating disorders (ED) is limited in the Middle East. The aim of the present study was to profile Lebanese ED outpatients. A mixed-method design was used. Clinicians across Lebanon filled individual questionnaires about their 2013 ED outpatients (n = 104) and participated in focus groups. Results showed that bulimia nervosa was the most prevalent ED (46.1 %) followed by anorexia nervosa (39.4 %) and binge eating (14.4 %). The emerging socio-demographic profile of the Lebanese ED patient was that of a single female young adult of middle to high socio-economic status with severe ED symptoms (amenorrhea, multiple purging behaviors) and depression. Also, there was a general delay in seeking help which made patient recovery more difficult. The present study emphasizes the critical need for a public health approach to ED awareness and could help in developing preventive and remedial educational programs targeting youth in Lebanon and the Middle East.

Impact of short-term refeeding on appetite and meal experiences in new onset adolescent eating disorders

Restrictive eating disorders (ED) are increasing and represent a serious risk to the health of adolescent females. Restrictive ED in youth are often treated through aggressive short-term refeeding. Although evidence supports that this intervention is the "gold standard" for improving ED outcomes in youth, little research has specifically probed appetite and meal-related responses to this type of intensive, short-term refeeding in newly diagnosed individuals. Information about appetite and meal-related dysfunction could provide valuable insights regarding treatment-interfering features of ED in both acute inpatient and longer-term outpatient treatment. The purpose of this study was to evaluate the hunger, fullness, olfactory, and gustatory responses of adolescents with newly-diagnosed restrictive ED and to probe how and when these responses are altered by refeeding. Using a quasi-experimental ecologically valid methodology, this study described and compared profiles of hunger, fullness, olfactory, and gustatory responses in adolescent females (n = 15) with newly diagnosed restrictive ED at hospital admission (i.e., severe malnutrition) and after medical refeeding, in comparison to healthy controls (n = 15). Results showed that newly diagnosed (i.e., malnourished) adolescents with ED showed significantly different meal-related experiences than controls. Refeeding improved some of these differences, but not all. Following refeeding, females with ED continued to show lower hunger, greater fullness, and lower pleasantness of smell ratings compared to controls. Unpleasantness of taste ratings maladaptively increased, such that females who were re-fed reported more aversive scents than pre-treatment. Profiles of meal-related responses were also identified and compared between groups. The applicability of these findings are discussed within the context of critical periods of change during refeeding treatment and potentially promising intervention targets that might enhance treatment outcomes for adolescents with newly onset, restrictive ED.

Anorexia nervosa: A fresh perspective

Anorexia nervosa is currently presented as a pathologised, psycho-medical feminine phenomenon through aetiological rationalisations and theories. Research results indicate that there have been no improvements in treatment outcomes for anorexia for over 50 years, except, possibly, with forms of family therapy for adolescents. This situation can be seen as critical and calls for alternative ways of understanding anorexia, and consequent different approaches to psychotherapy for persons in relationship with anorexia. This article critically explores these issues, and suggests that such circumstances offer opportunities for alternative post-structuralist approaches for informing different understandings of and working with anorexia in collaborative relational arrangements where the voices of persons in relationship with anorexia are honoured and heard.

Risco para transtornos alimentares em escolares de Salvador, Bahia, e a dimensão raça/cor

OBJETIVO: Estimar a existência de fatores de risco associados aos transtornos alimentares em escolares da cidade de Salvador, Bahia, por meio da dimensão étnico-racial como fator de heterogeneidade. MÉTODOS: Os participantes da pesquisa são escolares do sexo feminino, na faixa etária entre 15 e 30 anos, residentes na cidade de Salvador, no Estado da Bahia. Foram investigadas 626 estudantes, selecionadas em instituições públicas e privadas de ensino médio e universitário. Utilizaram-se o Eating Atittude Test-26, o Body Shape Questionnaire e o Beck Depression Inventory como instrumentos de identificação de risco para os transtornos alimentares. A classificação étnico-racial se deu por autodeclaração, de acordo com as categorias do Instituto Brasileiro de Geografia e Estatística. Foram realizadas análises descritivas, bivariadas (χ2 de Pearson) e regressão logística multivariada para análise dos dados. RESULTADOS: As estudantes que se identificaram como amarelas ou indígenas têm 3,6 vezes mais chances de desenvolverem comportamentos alimentares desordenados e 4,8 vezes mais possibilidade de estarem insatisfeitas com sua imagem corporal. As pardas apresentam 2,5 vezes mais risco para essa insatisfação. A depressão é uma comorbidade que deve ser considerada, apesar de não estar associada significativamente à raça/cor. CONCLUSÃO: As mulheres não brancas em Salvador apresentam risco de desenvolver transtornos alimentares. Outros estudos que combinam métodos quantitativos e qualitativos podem permitir uma análise mais robusta quanto à relação entre transtornos alimentares e raça/cor e etnia.

Race, ethnicity, and eating disorder recognition by peers

We investigated racial/ethnic stereotyping in the recognition and referral of eating disorders with 663 university students. We explored responses to problem and eating disorder recognition and health care referrals after subjects read a vignette concerning a patient of a different race/ethnic background presenting with eating disorders. A series of three 4 × 3 ANOVAs revealed significant main effects for eating disorders across all three outcome variables. There were no significant main effects across the four different race/ethnicity conditions and no significant race by condition interactions. Lack of general eating disorder recognition and health care referrals by student participants were found. [Supplemental files are available for this article. Go to the publishers's online edition of Eating Disorders for the following free supplemental resource: online appendix containing vignettes 1-3, as described in the "Methods" section].

Internalization of the thin ideal among low-income ethnic minority adolescent girls

Internalization of the thin ideal has been thought to occur disproportionately among Caucasian, upper-class girls and women. The current research challenges this view by assessing thin-ideal internalization among low-income ethnic minority girls (N=48). This research identifies differences between low-income ethnic minority adolescent girls who highly internalize the thin ideal (HI) and those who have lower internalization of thinness (LI). Results indicate that HI and LI groups do not differ based on ethnicity or weight categorization. Body satisfaction, competence, and perceived sociocultural pressure were analyzed as individual differences between HI versus LI participants. Those in the LI group have higher athletic competence and body satisfaction ratings for weight compared to the HI group. By identifying differences in thin-ideal internalization in this understudied population, factors that may protect someone from endorsing the thin ideal may be discovered.

PREVALENCE OF EATING DISTURBANCE AND BODY IMAGE DISSATISFACTION IN YOUNG GIRLS: AN EXAMINATION OF THE VARIANCE ACROSS RACIAL AND SOCIOECONOMIC GROUPS

Eating disorder research has predominantly focused on White adolescent females. More recent research suggests that eating disorders occur in various racial and age groups. The current study examines prevalence and stability of body image dissatisfaction and eating disturbance in 9- and 10-year-old girls and whether there is variability by racial group or socioeconomic status (SES). Five hundred eighty-one girls completed the Children's Eating Attitude Test (ChEAT) and the Body Image Measure (BIM). Results showed that 11% of the sample scored in the Anorexic range at age 9 and about 7% at age 10. When examining body image, 35% of the sample at age 9 and 38% at age 10 selected Ideal Figures that were smaller than their Real Figures on the BIM. There was a significant difference between the racial groups in their reports of eating disturbance, but not body image dissatisfaction. Specifically, the Minority group had higher eating disturbance scores on average at ages 9 and 10 when compared to the White group. SES did not account for eating disturbance or body image dissatisfaction. These results challenge the maxim that eating disturbance and body image dissatisfaction occur primarily in White females from middle and upper SES populations.

Body image and eating disorders in older adults: a review

Researchers have shown body image to be an important part of a person's self-concept and have linked body dissatisfaction to various psychopathologies, most frequently eating disorders. However, the majority of the literature to date has focused on adolescents and college-aged samples, with little attention paid to the course of body image and eating disorders throughout the life span. The present article reviews the available literature on body image and eating disorders in older adults to understand more fully the unique presentation of body concerns and disordered eating across the life span. The authors address unique factors affecting body dissatisfaction and the development of eating disorders among older adults and offer directions for future research.

Beyond "healthy eating" and "healthy weights": harassment and the health curriculum in middle schools

In this paper we use data from interviews conducted with grades 7 and 8 girls to explore connections between body-based harassment and girls' body modification practices. We discuss how the elementary health curricula fail to consider harassment and other cultural factors that influence the body modification practices and eating patterns of diverse girls. More specifically, we argue that the "healthy eating, healthy weights" approach of the grades 7 and 8 Ontario health curriculum has five limitations: (1) it sends contradictory messages; (2) it increases anxieties about body weight; (3) it ignores the multiple causes of eating problems; (4) it marginalizes issues most relevant to racialized girls; and (5) it ignores dilemmas associated with physical development. We conclude with suggestions for developing a curriculum on body dissatisfaction and eating disorders prevention that considers the various socio-cultural factors influencing the range of body monitoring and modifying practices taken up by girls.

Eating disorders in college

Anorexia nervosa and bulimia nervosa are serious chronic psychiatric disorders that can result in significant medical and psychologic outcomes. These multifaceted disorders affect the emotions, thinking, behavior, and physical health of afflicted individuals. Symptoms often peak during the years many youth are attending college. The intersection of issues of emancipation, individuation, intimacy, and eating disorders may be part of the reason that researchers report a high incidence of eating disorders in this specialized population. This article presents an overview of eating disorders in the college population and covers psychologic and psychopharmacologic treatment.