A Review of Eating Disorders and Disordered Eating amongst Nutrition Students and Dietetic Professionals

Cocreating eating disorder education solutions: A design thinking approach to dietetics curricula in Australia

BACKGROUND

As the prevalence of eating disorders continues to increase, there is an urgent need to equip the emerging dietetics workforce to provide care to this growing population. The present study aimed to describe a five-step design thinking process that was applied to brainstorm ideas and develop and test solutions for consideration in the future.

METHODS

A pragmatic, five-step design thinking approach was used during a 1-day, in-person design thinking retreat. Purposive sampling was used to identify key stakeholders, including subject matter, learning and teaching, as well as lived experience experts, dietetics students and recent graduates. Reflexive thematic analysis was used to analyse brainstormed and design solution ideas.

RESULTS

Seventeen participants attended the design thinking retreat in April 2023. Four education prototypes were developed and tested by stakeholders including: (1) a change to accreditation requirements for dietetics curricula; (2) a multimodal learning package for penultimate year students; (3) embedding disordered eating and eating disorder content into existing curriculum and upskilling educators; and (4) codesigning an eating disorder module.

CONCLUSIONS

The design thinking retreat engaged a variety of stakeholders in curriculum design resulting in an array of prototype approaches that aimed to embed eating disorder content into university curricula. Further research is needed to test the prototypes and understand what impact this has on dietetics students' feelings of preparedness to provide care to people seeking this support.

Exploring the Associations between Media and Instagram Interaction Patterns with Weight Bias among Undergraduate Nutrition Students in the Brazilian Nutritionists' Health Study

This study examined the association between media and Instagram interaction patterns with weight bias among undergraduate nutrition students in the Brazilian Nutritionists' Health Study. We also explored the potential mediating role of students' own body image perception in these relationships. A total of 406 students (78% women) participated in this cross-sectional analysis. Sociodemographic data, media influence, Instagram interaction patterns, body image perception, and weight bias were assessed using semi-structured questionnaires. Findings indicated that exposure to fitness content on Instagram (β = 0.17, p < 0.001) and the pursuit of an ideal athletic body (β = 0.12, p = 0.034) were associated with increased weight bias. In contrast, engagement with body diversity content (β = -0.23, p < 0.001) and perceived pressure from media to conform to appearance ideals (β = -0.24, p < 0.001) had a mitigating effect on weight bias. Notably, body image perception did not mediate these relationships (p > 0.05). In conclusion, this study revealed a link between media exposure and weight bias among undergraduate nutrition students, independent of their body image perception. Developing social media literacy programs that encourage students to critically evaluate media content is imperative to reduce weight bias. Additionally, a deeper examination of the media content that contributes to weight bias and the potential need for targeted regulatory measures is warranted.

Supporting nutrition and dietetics students' relationships with food and body image: Adopting a co-created curricula approach

AIMS

The aims of this study were to: (1) explore perspectives of university students' and academics' regarding disordered eating, eating disorders and body image in relation to pedagogy and curricula and (2) to evaluate a co-designed student seminar and an academic workshop on these topics.

METHODS

A participatory action research approach was employed whereby an educational intervention was co-created by academics and students. An online seminar was presented to students and a 1-h workshop was presented to academic staff. Evaluation was conducted via a post-seminar anonymous survey for students and a pre- and post-anonymous workshop survey for academics with a mix of Likert-scale questions and open text boxes. Qualitative data were open coded, both deductively and inductively, and quantitative data were analysed descriptively.

RESULTS

One hundred and seventeen students attended the voluntary education seminar. Six themes were identified from student qualitative data which included feeling safe, empowered, inspired, connected, emotional and reflective. Problematic aspects of pedagogy and curricula were identified by students and included: using personal data for teaching, demonising language to describe food/bodies and not always feeling safe or supported to discuss disordered eating. Twenty academics shared divergent perspectives-some reported feeling concerned and challenged by the content (exploring disordered eating with students), others noted the complexity of the area, and others reported low/moderate confidence or indifference in the space and felt this content outside of their scope as educators.

CONCLUSION

Curricula interventions that reduce triggering and shaming and increase space and support for strengthening students' relationships with food and their bodies are valued by nutrition and dietetics students. We encourage academics to consider pedagogical approaches and expand discourse in this space.

'Through education, we can make change': A design thinking approach to entry-level dietetics education regarding eating disorders

AIMS

To co-create strategies and identify opportunities to integrate eating disorder content within dietetics curricula at one Australian university with stakeholders using a design thinking approach.

METHODS

A pragmatic mixed-methods, participatory design approach was used. An online survey explored the learning needs of dietetic students and recent graduates regarding eating disorders. Following the survey, a one-day design thinking retreat was held with stakeholders who were identified from the research team's professional networks. Eating disorder dietitians, learning experts, dietetic students, graduates, and those with lived experience were asked to identify strategies to enhance students' confidence and competence to provide care for people living with eating disorders. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using inductive coding and reflexive thematic analysis.

RESULTS

Sixty-four students (n = 55, 86%) and recent graduates (n = 9, 14%) completed the online survey (26% response). Seventeen stakeholders attended the retreat. Four themes were identified: (1) changing perceptions of eating disorder care from specialist to 'core business'; (2) desiring and advocating for a national change to dietetics curricula; (3) importance of lived experience at the centre of curriculum design and delivery; and (4) collaborating to co-design and deliver eating disorder content at university.

CONCLUSION

Raising awareness, upskilling students and educators, enhanced collaboration between universities and stakeholders, and the inclusion of lived experience were key to preparing students to provide care to people seeking support for eating disorders. Further research is needed to assess the impact these strategies have on dietetic students' confidence and competence.

What Is Considered Healthy Eating? An Exploratory Study among College Students of Nutrition and Food Science

In modern industrialized societies, the focus on healthy eating has increased significantly across multiple sectors, including the media, public policy, expert opinion, and public awareness. The aim of this research was to explore the perceptions of healthy eating and the barriers to adopting a healthy diet among undergraduate students in Human Nutrition and Dietetics (HND) and Food Science and Technology (FST) degrees in Spain. An exploratory and descriptive cross-sectional study was conducted using a qualitative and quantitative methodology and convenience sampling. Two focus groups and a questionnaire were utilized (300 participants from all academic years completed the survey). Differences in definitions of healthy eating and perceived barriers were found between genders and students at different stages of training (p < 0.05). In their understanding of healthy eating, the students placed importance on balance, variety, moderation, and individual factors. Although students considered it easy to follow a healthy diet, family's eating habits, time availability, and emotional states were found to be the main barriers to the implementation of healthy practices. The obtained data supports the need to critically address perceptions of healthy eating throughout the training of nutrition and food science professionals. The insights obtained on the perceived barriers highlight the importance of considering both individual and environmental factors.

Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach

CONTEXT

Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies.

OBJECTIVE

The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study.

DATA SOURCES

MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022.

DATA EXTRACTION

Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions.

DATA ANALYSIS

A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared.

CONCLUSIONS

Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.

Exploring the perceived influence of social media use on disordered eating in nutrition and dietetics students

BACKGROUND

Social media use (SMU) is increasingly widespread. More recently, SMU has been associated with increases in disordered eating; however, few qualitative studies have explored this issue in nutrition and dietetics students specifically, where susceptibility to disordered eating may be particularly high. The present study therefore aimed to investigate the perceived impact of SMU on disordered eating in nutrition and dietetics students.

METHODS

One-to-one, in-depth, semi-structured interviews were conducted with nutrition and dietetics students from universities across the UK. Interviews explored students' views on the potential influence of SMU on their eating-related thoughts, feelings and behaviours. Data were thematically analysed to identify key themes.

RESULTS

The findings suggested that SMU may provide students with a useful tool for the exploration of new recipes, ingredients and health-related information, thus enabling them to improve their eating behaviour and diet quality. However, students also showed high levels of objective awareness regarding the problems associated with SMU, including the presence of misinformation, body image dissatisfaction, social pressures and disordered eating. Interestingly, despite enabling them to detect sources of misinformation, students also discussed the negative impact that their course had on their eating habits, suggesting course content may be an additional risk factor for the development of disordered eating for this particular group.

CONCLUSIONS

Future research should investigate ways to mitigate the negative impact of SMU and course content on disordered eating in nutrition and dietetics students.

Maternal Bonding as a Protective Factor for Orthorexia Nervosa Risk in Dietetics Students

This study aimed to determine the prevalence of the risk of orthorexia nervosa (ON) in dietetics students in Greece, and its relationship with diet, risk of eating disorder (ED), body mass index (BMI), body image flexibility, and parental attachment. The participants were 132 dietetics students, with a mean age of 22.94 ± 3.5 years, who completed a series of questionnaires that recorded sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); ON indicators as determined by the ORTO-15 questionnaire; body image flexibility, with the Body Image-Acceptance and Action Questionnaire (BI-AAQ-5); the risk for ED as assessed using the EAT-26; anxiety level according to the STAIT 6 instrument; and recollection of their parents' attitudes towards them during the first 16 years of life, with the Parental Bonding Instrument (PBI). ON risk appeared to be significantly associated with BMI (p = 0.002), exercise frequency (p = 0.023), anxiety level (p = 0.002), risk of ED (p < 0.001), body image inflexibility (p < 0.001), and inversely with the affectionate constraint of maternal bonding (p = 0.036). In conclusion, disordered eating behaviors and body shape concerns are prevalent among dietetics students, with parental attachment to the mother influencing their occurrence. Identification of potential ON and development of prevention mechanisms during childhood could help eliminate these concerns and improve the lives of dietetics students.

Global Prevalence of Eating Disorders in Nutrition and Dietetic University Students: A Systematic Scoping Review

BACKGROUND

Nutrition and dietetics (ND) training encourages behaviors that can be considered risk factors for eating disorders or disordered eating. This paper aims to explore the prevalence of eating disorders (EDs) and predictors of eating disorders (/P-EDs) in ND students.

METHODS

A systematic scoping review of the literature was performed on PubMed, ERIC, PsychINFO, OVID Medline, and Scopus in October 2022.

RESULTS

A total of 2097 papers were retrieved from the search, of which 19 studies met the inclusion criteria. The resultant literature reported that 4-32% of ND students were at high risk of EDs (n = 6 studies), and 23-89% could be classified as having orthorexia nervosa (n = 7 studies). Further, 37-86% reported body image/fat dissatisfaction (n = 10 studies), and 100% of students reported weight dissatisfaction (n = 1 study).

CONCLUSIONS

This paper highlights the prevalence of EDs and P-EDs across ND students. Further research is warranted to explore the cause, context, and impact on ND students' wellbeing and professional identity and supporting diversity within the profession. Future studies should also consider curriculum approaches to address this occupational hazard.

Study the Effect of an Innovative Educational Program Promoting Healthy Food Habits on Eating Disorders, Mediterranean Diet Adherence and Body Composition in University Students

The university stage is a good time to promote healthy eating strategies. The sociological and cultural changes experienced by students lead them to skip meals, increase their intake of fast food and energy-dense foods, decreasing adherence to the Mediterranean diet (MD). Professionals related to food such as nutritionists and dietitians are also considered a population at risk of developing eating disorders due to the extensive knowledge they possess, which can be used for both good and bad practice. The objective was to analyze the impact of a 4-month educational program promoting the Mediterranean diet on risky eating behaviors, adherence to the Mediterranean diet, and body composition in nutrition and dietetics students, studying the differences according to the group investigated (control group and educated group). The context of the research was 196 students (49 males and 147 females) from two consecutive years. The control group did not receive any type of intervention, while with the control group (educated) an educational program was carried out. Results showed that women with greater control over energy intake, carbohydrates, and sugar had a lower percentage of fat mass, while in men, the relationship was established with weight. Regarding adherence to the Mediterranean diet, at post, it is adequate in both men (8.25 ± 2.87) and women (7.90 ± 2.89), with no significant differences between the intervention groups.

Food addiction, orthorexia nervosa and dietary diversity among Bangladeshi university students: a large online survey during the COVID-19 pandemic

PURPOSE

Maladaptive eating behaviors like food addiction (FA) are common among students, and orthorexia nervosa (ON) is being evaluated as a new condition among eating disorders (EDs). Moreover, dietary diversity (DD) is recognized as an important component of a healthy diet. Thus, the current study sought to examine the prevalence of ON and FA as well as the factors associated with ON, FA, and DD among university students in Bangladesh during the COVID-19 pandemic.

METHODS

Four-thousand-and-seventy-six students were recruited and completed an online survey consisting of the Bratman Orthorexia test, the modified Yale Food Addiction Scale, and a questionnaire based on the Food and Agriculture Organizations' guidelines. Inferential statistics, bivariate and multivariable linear regression were used for analyzing data.

RESULTS

ON and FA were observed in 1.7% and 7.5% of participants, respectively, with 43.8% exhibiting Health Fanatic eating attitude. The mean DD score was 5.96 (SD = 1.56). Students with ON consumed more legumes, nuts, seeds, and vegetables including dark green leafy vegetables whereas students with FA consumed more organ meats and eggs. Students who were older-aged, married, formerly smoked, had fitness goals, and had guilty feelings about violating food rules were more likely to have ON, whereas those who were female, were married, actively smoked, and were overweight and obese were more likely to have FA.

CONCLUSIONS

The findings suggest that students from Bangladesh are at risk of FA, and less so for ON. These entities and low DD deserve more research attention in Bangladesh to increase awareness and ensure appropriate interventions.

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant’s survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages—most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.

Öğrencilerin Antropometrik Ölçümleri ile Akdeniz Diyeti ve Beslenme Alışkanlıkları Arasındaki İlişkinin Değerlendirilmesi

Aim: In the study, the aim was to assess the possible correlation between the Mediterranean diet quality index with anthropometric measurements by identifying the ability of students attending Tekirdağ Namık Kemal University Department of Nutrition and Dietetics to apply academic knowledge related to healthy lifestyles to their own lives and their healthy eating obsessions.Method: The sample for the study comprised a total of 174 students who volunteered to participate, aged between 18-24 years abiding by the study participation criteria, including 54 in the fourth year, 65 in the third year, and 59 in the second year of university. The survey form was applied to students participating in the research with the face-to-face interview method. Additionally, the anthropometric measurements and body composition of students completing the survey form were determined.Results: As a result of these assessments, students had a mean Mediterranean Diet Quality Index of 5.3±2.95 and mean ORTO-11 scale point of 24.75±6.48. The mean body weight of students was 59.7±11.1 kg and mean BMI was 21.72±3.1. In our study, it was determined that as the level of class increased, compliance with the Mediterranean diet increased. It was found that as the Mediterranean diet quality index scores of the students increased, BMI values and the ORTO-11 scale scores decreased (p&lt;0.05).Conclusion: It has been determined that compliance with the Mediterranean diet positively affects the body weight, BMI and body composition of individuals. Moreover, there was a determined positive correlation between the orthorexic behaviors and compliance with the Mediterranean diet.

Prevalence, correlates, and gender disparities related to eating disordered behaviors among health science students and healthcare practitioners in Lebanon: Findings of a national cross sectional study

Background

The raised prevalence of eating disorders (ED) amongst health science students and health professionals is of mounting concern. This study aims to determine the prevalence and correlates of eating disorders risk amongst a sample of Lebanese health science students and healthcare practitioners of both genders.

Methods

This cross-sectional study enrolled a convenient sample of 1,000 participants (mean age: 23 ± 5.4; females: 74.9%) from faculties of health sciences, clinics, pharmacies, and hospitals. The validated Eating Attitudes Test (EAT-26) was used to screen for eating disorders. Anthropometric data were self-reported by respondents to assess their nutritional status.

Results

The risk of eating disorders was prevalent in 22.5% of participants. Females were at higher risk of ED compared to males p = 0.03. Eating disorders risk did not differ between students and practitioners (p = 0.3). The highest proportion of high-risk participants were students studying nutrition and practitioners (40.9%), outracing their counterparts in nursing (18.7%), medicine (17.8%), pharmacy (17.7%), and midwifery (4.9%) sciences (p = 0.02). Most high-risk participants had normal body weight (60.4%), and 28.9% were overweight (p = 0.001). Female gender, nutrition profession, and dieting were associated with increasing the odd of ED. Particularly, dieting increased the risk around five times. Further, each 3 participants over 10 were facing binge eating behavior.

Conclusion

This study uncovers an undervalued profession-related-health-disorder in Lebanese health science students and healthcare practitioners. Specific attention should be given to EDs in professional educational programmes across healthcare disciplines.

Exploring the relevance of intersectionality in Australian dietetics: Issues of diversity and representation

Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the lens of intersectionality. Dietetics in Australia continues to be dominated by Australian-born women, and ideologies about dietitians perpetuate narratives of white, young, slim, women. Intersectional approaches to critiquing diversity in dietetics provides a useful framework to extend critical studies of health disparities into disparities in the dietetics professional workforce, which is advanced through structural, political and representational intersectionality guided critique. Through the analysis, a dialog is prompted in order to chart paths forward to find 'how differences will find expression' within the professional group. To do this, dietetics as a profession must reckon with its historical roots and step forward, out of a perceived position of objective neutrality regarding people and diversity, and into a position that can recognise that professional institutions have the power to exclude and marginalise, along with the power to include and transform.

Interaction patterns on body size and health on Instagram and associated factors in nutrition students: an exploratory study

ABSTRACT Objective To identify interaction patterns on body size and health on Instagram and associated factors in nutrition students. Methods A total of 406 students (78% female) were included in this cross-sectional study. Instagram sociodemographic, academic and interaction data (Instagram time of use, exposure frequency to contents on body size and health, Instagram as a source of information and number of followers) were collected using a self-administered virtual questionnaire. A factor analysis by main component was used to derive the interaction patterns of Instagram as well as regression analyses to test the association of the patterns with the sociodemographic and academic factors. Results Three interaction patterns were observed on body size and health, named: “Fitness Pattern”; “Body Positivity Pattern” and “High Engagement Pattern”. Private Institutions’ Students who are on or have been on a diet and studying in the first semesters were associated with the “Fitness Pattern” (p<0.05). Female students, from public institutions, who changed their weight during the course and whose family’s head had higher education, were associated with the “Body Positivity Pattern” (p<0.05). Female students, younger and on a diet, were associated with the “High engagement Pattern” (p<0.05). Conclusion Gender, type of educational institution and diet practice of nutrition students are the factors that are most associated with different patterns of interaction on body size and health on Instagram.

"It was Like Magic": Relationships Supporting Compassion, Creativity, and Sense of Coherence in Nutrition Students

The purpose of this exploratory research was to understand the experiences and learnings of dietetic and nutrition students following a 3-week intensive summer course designed to enhance students' understandings of compassion, creativity, and sense of coherence as they apply to personal growth and socially just professional practice. Seven of 15 students participated in one-on-one, semi-structured interviews. Data analysis was conducted using inductive thematic analysis, resulting in 3 meta-themes: (i) personal meaning and sense making, (ii) relational and power dynamics, and (iii) disruption; participants contextualized these themes via a dynamic interplay within and among the domains of self, pedagogy, and practice. As a result of taking this course, participants developed an enhanced sense of coherence, self-compassion, well-being, and a more equity-focused understanding of health. Student development may have been achieved through attending to student experience and a relational pedagogical epistemology that allowed students to make personal, interpersonal, and systemic connections among their own subjective experiences, the experiences of peers, and broader social impacts on health. Given nutrition classrooms are largely positivist, it is important to consider how these environments as relational contexts may support or undermine compassion, sense of coherence, and ultimately the health and well-being of students.

Uso da mídia social e sua associação com comportamentos alimentares disfuncionais em estudantes de Nutrição

RESUMO Objetivos: Avaliar a associação entre o uso da mídia social e comportamentos alimentares disfuncionais e identificar preditores desses comportamentos. Métodos: Estudo realizado com 207 estudantes de Nutrição. Foram aplicadas três medidas para obter dados sociodemográficos, uso da mídia social e comportamentos alimentares disfuncionais (Eating Attitudes Test-26). A associação entre o uso da mídia social e os comportamentos alimentares disfuncionais foi verificada pelo teste qui-quadrado de Pearson (p < 0,05). Regressão logística binária foi conduzida para avaliar preditores dos comportamentos alimentares disfuncionais, considerando as razões de chance. Resultados: Comportamentos alimentares disfuncionais foram verificados em 27,9% dos estudantes de Nutrição. As variáveis de uso da mídia social associadas aos comportamentos alimentares disfuncionais incluem o hábito de acompanhar dicas alimentares e de consumir alimentos sugeridos pela mídia, o tempo de uso, seguir dieta e/ou orientação nutricional, motivação para seguir uma dieta sem um acompanhamento nutricional e consumo de alimentos e fármacos para a perda de peso. Os preditores dos comportamentos alimentares disfuncionais foram: “Já consumi alimentos propostos pela mídia com o intuito de perda de peso” e “Ao observar corpos disseminados como ‘belos’ pela mídia, me sinto motivado a seguir uma dieta sem um acompanhamento nutricional adequado por um nutricionista”. Conclusões: Diversas crenças e comportamentos orientados ao uso da mídia social estão associados aos comportamentos alimentares disfuncionais em estudantes de Nutrição, em que se destacam maiores razões de chances para o desenvolvimento de comportamentos de risco quando há consumo de alimentos para perda de peso e motivação para seguir dieta sem acompanhamento nutricional, mesmo por esse grupo.

The relationship between orthorexia nervosa and body composition in female students of the nutrition and dietetics department

This study was carried out to determine the relationship between orthorexia nervosa (ON) and eating disorder and body composition, class level, and place of residence in university students from the Department of Nutrition and Dietetics. The participants (n = 136; 20.9 ± 2.0 years) were all female students, whose scores on the Orthorexia Nervosa Questionnaire (ORTO-11) and the Eating Attitudes Test (EAT-40) indicated a prevalence of ON and eating disorder. Assessment of body composition indices (Tanita bioelectrical impedance; SC-330) of the participants showed there to be no significant difference in the EAT-40 and ORTO-11 scores in terms of body composition, class level, and place of residence. A large majority of the participants (70.6%) had high ORTO-11 scores, and a significant negative correlation (p < 0.05) was identified between the EAT-40 and ORTO-11 scores. Final results from analysis of the data showed that although abnormal orthorexic tendencies were common among the students from the Department of Nutrition and Dietetics, they were nonetheless able to maintain body composition within normal values. LEVEL OF EVIDENCE: V, cross-sectional descriptive study.

Food addiction, orthorexia, and food-related stress among dietetics students

PURPOSE

Health sciences, and in particular Nutrition and Dietetics students, have been shown to exhibit an increased prevalence of disordered eating. The aim of the present cross-sectional study was to evaluate other specified feeding and eating disorders (OSFEDs), including stress-related eating, food addiction, and orthorexia, in relation to the dietary intake, among nutrition/dietetics students.

METHODS

A total of 176 undergraduate students from a Department of Nutrition and Dietetics, in Greece, participated in the study. Dietary intake was recorded, and the prevalence of Eating and Appraisal Due to Emotion and Stress (EADES), food addiction (with the modified Yale Food Addition scale mYFAS), and orthorexia were assessed. Chi-square and t tests were performed between sexes, orthorexic and non-orthorexic students, as well as between food-addicted and non-addicted participants. Multiple linear regression analysis assessed relationships between energy intake, BMI or waist circumference, and the food-related psychometric scales.

RESULTS

Among participating students, 4.5% had food addiction and 68.2% demonstrated orthorexia. No differences were observed between men and women, concerning the prevalence of food addiction and orthorexia, the sum of mYFAS symptoms, or individual EADES factors. Orthorexic students exhibited increased BMI, reduced energy, and saturated fat intake. In addition, orthorexic men consumed more vegetables. Multiple linear regression analysis revealed that orthorexic behavior was associated with increased BMI, waist circumference and energy intake. Lower BMI was associated with increasing ability to cope with emotion-and-stress-related eating and increasing appraisal of ability and resources to cope with emotions and stress. Emotion-and-stress-related eating was negatively associated with BMI. Appraisal of ability and resources to cope with emotions and stress was associated with the energy intake. Finally, age was positively correlated with the appraisal of outside stressors/influences, indicating increased ability to cope with outside stressors among older students.

CONCLUSIONS

The study shows that despite the suggested interventions, the problem of OSFEDs among nutrition and dietetics students is still valid. Regular screening, counseling, and education is needed to reduce its prevalence.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Prevalence of Exercise Addiction Symptomology and Disordered Eating in Australian Students Studying Nutrition and Dietetics

BACKGROUND

Previous research has reported the existence of disordered eating in students studying nutrition and dietetics. However, the occurrence of exercise addiction, previously linked to disordered eating, is poorly understood in this group.

OBJECTIVE

The main objective of this study was to explore the prevalence of self-reported symptoms of exercise addiction and the association with disordered eating in a sample of students studying nutrition and dietetics. A secondary objective was to compare the prevalence of exercise addiction to students enrolled in another health-related degree.

DESIGN

We conducted a cross-sectional study in 165 undergraduate students.

PARTICIPANTS/SETTING

Participants were students of both sexes enrolled in nutrition and dietetics and occupational therapy degree programs at an Australian university in August 2013.

MAIN OUTCOME MEASURES

Participants completed four validated questionnaires for assessment of exercise- and eating-related attitudes and behaviors measuring scores for exercise addiction, weekly volume of physical activity (PA), eating disorder symptoms, and cognitive restraint. Stretch stature and body mass were measured and body composition was assessed using dual energy x-ray absorptiometry.

STATISTICAL ANALYSES PERFORMED

Independent t test, Mann-Whitney U test, and χ² test were completed to compare groups of students based on sex, degree, or eating attitudes. Spearman's correlation was performed to explore associations between continuous variables (exercise addiction scores, PA volume, and scores for eating attitudes and cognitive restraint).

RESULTS

Approximately 23% of nutrition and dietetics students were found to be at risk of exercise addiction (20% females and 35% males; P=0.205), while the majority demonstrated some symptoms of exercise addiction. A similar proportion of at risk individuals was found in the female occupational therapy group (19%; P=1.000). In females (nutrition and dietetics and occupational therapy combined), the exercise addiction scores were associated with three other outcome measures: PA volume (r_s=0.41; P<0.001), eating attitudes scores (r_s=0.24; P=0.008), and cognitive restraint (r_s=0.32; P<0.001). Comparative analysis indicated that female students with high cognitive restraint had greater exercise addiction scores than those with low cognitive restraint (20.3 [4.8] compared to 17.8 [4.2]; P=0.003).

CONCLUSIONS

Results suggest high prevalence of exercise addiction in this sample of undergraduate health-related degree students and its link to amount of PA and disordered eating in females. Future research should include larger samples of both sexes to build the existing understanding on these maladaptive behaviors.

Eating behaviour among nutrition students and social desirability as a confounder

INTRODUCTION

The study of eating behaviour should consider the presence of potential sources of bias, including social desirability. This is particularly relevant among students of Nutrition Sciences, since they have a higher risk of eating disorders.

OBJECTIVE

To analyse the effect of social desirability in the assessment of eating behaviour dimensions among nutrition students.

METHODS

In this cross-sectional study, we analysed data from 149 students of Nutrition Sciences. Participants completed a questionnaire assessing social desirability and eating behaviour dimensions (emotional, external and binge eating, flexible and rigid control, and eating self-efficacy).

RESULTS

Among males, social desirability had a negative association with binge eating, while among women it had a negative association with emotional, external and binge eating and a positive association with eating self-efficacy. In both subsamples, social desirability showed no significant association with any of the two types of dietary restraint (rigid and flexible control).

DISCUSSION

Overall, the association between social desirability and eating behaviour dimensions among students of Nutrition Sciences occurs in the same direction as found in students from other areas. However, alongside these similarities, there is a stronger association between social desirability and binge eating among male students of Nutrition Sciences. We hypothesize that this may be related with the different knowledge of students from different areas, and the way they perceive and face the treatment of eating disorders.

CONCLUSION

Our study shows that social desirability should be considered while assessing eating behaviour among nutrition students, particularly when studying external eating, binge eating and eating self-efficacy. Moreover, when tailoring interventions to reduce the possible effects of eating behaviour on nutritionists and dieticians' practice, we should consider the influence of social desirability.

The relationship between dietary intake and energy availability, eating attitudes and cognitive restraint in students enrolled in undergraduate nutrition degrees

The aim of this research was to explore the relationship of total energy and macronutrient intake, energy balance and energy availability to eating attitudes and cognitive restraint in students enrolled in undergraduate nutrition degrees. Energy and micronutrient intake was assessed in 63 students (n = 50 nutrition, and n = 13 occupation therapy degrees; n = 51 females, n = 12 males) using three 24-h dietary recalls. Energy requirements were calculated based on measured resting metabolic rate, estimated exercise energy expenditure, and dietary induced thermogenesis. Body composition was assessed using dual energy x-ray absorptiometry. Eating attitudes and cognitive restraint were measured using previously validated tools. Eighteen percent of nutrition students were classified as having low energy availability (<30 kcal kgFFM^-1d^-1) and 38% were in negative energy balance. Eating attitudes and cognitive restraint were not associated with total energy or macronutrient intake. However, female nutrition students with high cognitive restraint had greater exercise energy expenditure and thus lower energy availability than those with low cognitive restraint (371 (302) kcal d^-1 compared to 145 (206) kcal d^-1, P < 0.01, and 35 (7) kcal d^-1 compared to 41 (10) kcal d^-1 of fat free mass, P = 0.005). Additionally, in females, disordered eating attitudes and cognitive restraint negatively correlated with energy availability (r_s = -0.37, P = 0.02 and r_s = -0.51, P < 0.01 respectively). There were no differences in outcomes between nutrition and non-nutrition students. The current study suggests that those students with disordered eating attitudes and cognitive restraint may be controlling their energy balance through exercise, as opposed to restricting food intake.