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Aouad P, Hay P, Soh N, Touyz S, Mannan H, Mitchison D. Chew and spit (CHSP) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating features. Eat Disord 2021; 29:509-522. [PMID: 31770086 DOI: 10.1080/10640266.2019.1695449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A recent general population study of Chew and Spit (CHSP) behavior in adults found a 0.4% prevalence, predominantly in females. The current study explores this further by examining the same phenomenon in secondary-school aged adolescents. This study also explores the relationship between CHSP and other demographic and eating disorder (ED) features in 5111 adolescents (11-to-19 years of age) from 13 schools in New South Wales, Australia. Participants completed measures of ED symptoms and behaviors and change to impairment with two components: psychological distress (K-10) and health related quality of life (HRQoL; PedsQL). CHSP was found to have a 12.2% (95% CI 0.114, 0.132]) point-prevalence rate. Participants who indicated engaging in CHSP reported significantly higher levels of psychological distress (K-10) and lower HRQoL scores (PedsQL) compared to those that did not report CHSP. There was a dose-response relationship between CHSP frequency, psychological distress and HRQoL physical scores but not for HRQoL emotional and HRQoL social scores. Participants who reported regular CHSP were more likely to be female, younger, and to engage in compensatory behaviors such as purging. The high frequency of CHSP behavior in adolescents with disordered eating could suggest that CHSP should be considered in routine ED screening practices. Future studies may examine how to treat CHSP or investigate more focused treatment approaches, in order to target the behavior of CHSP more directly.
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Affiliation(s)
- Phillip Aouad
- School of Psychology, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Nerissa Soh
- Honorary Associate, University of Sydney Northern Clinical School, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
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Aouad P, Stedal K, Walø-Syversen G, Hay P, Lindvall Dahlgren C. Chew and spit (CHSP) in bariatric patients: a case series. J Eat Disord 2021; 9:89. [PMID: 34289898 PMCID: PMC8296715 DOI: 10.1186/s40337-021-00441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Studies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature. CASE PRESENTATION The current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology-including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit. CONCLUSIONS The current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery.
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Affiliation(s)
- Phillip Aouad
- InsideOut Institute, University of Sydney, Sydney, Australia. .,School of Medicine, Western Sydney University, Penrith, NSW, Australia.
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Gro Walø-Syversen
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Bjørknes University College, Oslo, Norway
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Schmalbach I, Herhaus B, Pässler S, Schmalbach B, Berth H, Petrowski K. Effects of stress on chewing and food intake in patients with anorexia nervosa. Int J Eat Disord 2021; 54:1160-1170. [PMID: 33751639 DOI: 10.1002/eat.23500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study investigates the impact of psychosocial stress on chewing and eating behavior in patients with anorexia nervosa (PAN ). METHOD The eating and chewing behavior of PAN were examined in a standardized setting by means of a chewing sensor. These procedures encompassed n = 19 PAN , age, and gender matched to n = 19 healthy controls (HC). Food intake and chewing frequency were assessed in two experimental conditions: rest versus stress (via Trier Social Stress Test). To verify stress induction, two appraisal scales were employed. In addition, chronic stress, psychological distress and eating disorder symptoms were assessed. RESULTS In terms of food intake and chewing frequency, the results of the 2x2 ANOVA demonstrated a significant effect of condition and group. During stress, all participants demonstrated a higher chewing frequency and a decreased ingestion. In general, patients ate less at a lower chewing frequency (vs. HC). However, sample specific analyses demonstrated that the eating and chewing behavior of PAN remained unchanged regardless of the condition, except for their drinking. Food choices were comparable between the groups, but appetite values significantly differed. DISCUSSION The increase in chewing frequency in all participants during stress suggests that chewing might impact affect regulation, however, not specifically in PAN . Future research should clarify to what extent the normalization of chewing behavior could ameliorate ED-symptoms (incl. food intake) in PAN . The application of a chewing sensor could support this aim and future interventions.
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Affiliation(s)
- Ileana Schmalbach
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neurosciences, Research Group Applied Medical Psychology and Medical Sociology, Dresden, Germany
| | - Benedict Herhaus
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sebastian Pässler
- Abteilung für Innere Medizin III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Bjarne Schmalbach
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Hendrik Berth
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neurosciences, Research Group Applied Medical Psychology and Medical Sociology, Dresden, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Abteilung für Innere Medizin III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
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Ivezaj V, Carr MM, Brode C, Devlin M, Heinberg LJ, Kalarchian MA, Sysko R, Williams-Kerver G, Mitchell JE. Disordered eating following bariatric surgery: a review of measurement and conceptual considerations. Surg Obes Relat Dis 2021; 17:1510-1520. [PMID: 34083136 DOI: 10.1016/j.soard.2021.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 02/24/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.
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Affiliation(s)
| | - Meagan M Carr
- Yale University School of Medicine, New Haven, Connecticut
| | - Cassie Brode
- West Virginia University School of Medicine, West Virginia
| | - Michael Devlin
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | | | - Robyn Sysko
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - James E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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Aouad P, Morad A, Hay P, Soh N, Touyz S, Rhodes P. Chew and Spit (CHSP): An interpretative phenomenological analysis (IPA). Eat Behav 2020; 37:101388. [PMID: 32413733 DOI: 10.1016/j.eatbeh.2020.101388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Abstract
Chew and Spit (CHSP) is a prevalent disordered eating symptom and has been thought to be associated with a number of adverse effects. In the current study, 18 participants (>90% female, aged between 18 and 51) took part in answering questions about their experiences, struggles, concerns, methods of coping, and personal meaning of CHSP and how it has impacted their lives. Data collection and analysis were conducted in accordance with Interpretative Phenomenological Analysis (IPA) methodology. Findings revealed 7 primary themes of CHSP, which highlighted that CHSP may be: (1) associated with negative emotions - primarily shame; (2) exacerbated by stress and may be a mechanism to help regain control; (3) temporarily provides pleasure; (4) a distraction or form of escapism; (5) a self-soothing or coping mechanism; (6) addictive, ritualistic, and similar to other eating disorders in that it can become part of an individual's self-identity; and (7) adversely impacting psychological, physiological, and social health. Some of the identified superordinate themes were in line with previous studies hypotheses. However, overall the findings indicated that individuals who CHSP are often embroiled in what they may perceive as a struggle, with no specific, efficacious, approach to helping them control the behavior. Future studies should focus on the treatment of CHSP, including treatment of CHSP as a potential primary symptom of pathological eating. Moreover, the perceived implications of engaging in CHSP should be examined more closely, with clinicians screening for the behavior and carefully considering their approach when attempting to treat patients for CHSP.
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Affiliation(s)
- Phillip Aouad
- School of Psychology, University of Sydney, Sydney, Australia; InsideOut Institute, Faculty of Medicine, University of Sydney, Sydney, Australia; School of Medicine, Western Sydney University, Penrith, Australia.
| | - Arshia Morad
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia.
| | - Nerissa Soh
- Honorary Associate, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia.
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Williams-Kerver GA, Steffen KJ, Mitchell JE. Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature. Curr Psychiatry Rep 2019; 21:86. [PMID: 31410596 PMCID: PMC7953688 DOI: 10.1007/s11920-019-1071-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to extend the prior literature on eating pathology following bariatric surgery by highlighting themes in data published over the past 3 years and identifying limitations and future directions for research. RECENT FINDINGS Changes in eating pathology after bariatric surgery remain consistent with previous research. Specifically, diagnostic prevalence rates and incidence of related behaviors generally decrease following surgery. However, some research supports that these factors increase and/or remit over time following surgery, and that they subsequently have a negative impact on weight loss outcomes. While recent findings have extended knowledge on eating pathology following bariatric surgery, the overall body of literature is still relatively limited. Additional research is needed, including work focusing on the standardization of eating pathology definitions, development/validation of standardized eating pathology instruments for bariatric surgery patients, and predictors of risk for continued or new onset eating pathology following surgery.
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Affiliation(s)
- Gail A Williams-Kerver
- Center for Biobehavioral Research, Sanford Research, 120 South 8th St., P.O. Box 2010, Fargo, ND, 58122, USA.
| | - Kristine J Steffen
- Center for Biobehavioral Research, Sanford Research, 120 South 8th St., P.O. Box 2010, Fargo, ND, 58122, USA
- Department of Pharmaceutical Science, College of Pharmacy, Nursing, and Alliances, North Dakota State University, Fargo, ND, USA
| | - James E Mitchell
- Center for Biobehavioral Research, Sanford Research, 120 South 8th St., P.O. Box 2010, Fargo, ND, 58122, USA
- University of North Dakota School of Medicine, Grand Forks, ND, USA
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Aouad P, Hay P, Soh N, Touyz S. Prevalence of chew and spit and its relation to other features of disordered eating in a community sample. Int J Eat Disord 2018; 51:968-972. [PMID: 29722040 DOI: 10.1002/eat.22873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Until recently, research into Chew and Spit (CHSP) behavior has predominantly focused on clinical samples, and little is known of its prevalence in the community. The current study aimed to bridge this gap by exploring CHSP features in a representative sample of the general population. We hypothesized that the point-prevalence of CHSP would be less than 1%; concurrent with other eating disorder symptomology, and associated with poorer health related quality of life (HRQoL). METHODOLOGY Using the 2016, respondent-based, South Australian Health Omnibus Survey (HOS), data were collected on 3047 participants aged ≥15 years old. HRQoL was assessed with the Short-Form health-questionnaire-v1 (SF-12). RESULTS CHSP point prevalence was 0.4% (95% CI .23 to .69%; n = 13), and was more prevalent in people with compensatory disordered eating behaviors. The median age of those with CHSP was 39, and both mental and physical HRQoL were reduced compared with the general population (Mdn: MHQoL = 49; HRQoL = 50), with MHQoL being significantly lower in those with symptoms of a clinically diagnosable ED and concurrently engaged in CHSP (z = -2.33, p = .020). CONCLUSIONS Due to the low prevalence of CHSP, the reliability of inferential statistics may increase the chance of Type II errors, therefore, future studies should use larger samples. Although CHSP is not "common" in a wider community sample, its prevalence appears to be similar to other ED associated symptoms.
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Affiliation(s)
- Phillip Aouad
- School of Psychology, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Nerissa Soh
- Sydney Medical School - Northern Clinical School, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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Heriseanu AI, Hay P, Corbit L, Touyz S. Grazing in adults with obesity and eating disorders: A systematic review of associated clinical features and meta-analysis of prevalence. Clin Psychol Rev 2017; 58:16-32. [DOI: 10.1016/j.cpr.2017.09.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/18/2017] [Accepted: 09/12/2017] [Indexed: 02/06/2023]
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