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Rupani N, Miller J, Renteria JA, Kaliebe KE. The impact of yoga on body image in adults: A systematic review of quantitative studies. Body Image 2024; 51:101772. [PMID: 39047524 DOI: 10.1016/j.bodyim.2024.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Abstract
Evidence suggests that yoga can be used as an intervention to improve body image. This systematic review evaluates the evidence of the efficacy of yoga in improving body image among adults. Authors followed PRISMA guidelines, searching Pubmed, Ovid MEDLINE, Embase, Cochrane, CINHAL, PsycInfo, and grey literature up to December 2, 2023 and identifying 446 unique records. Eligibility criteria included English-language, peer-reviewed studies with quantitative data on adult populations. Twenty-nine studies were eligible for inclusion and were evaluated for methodological quality using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Interventions focused solely on yoga varied in length, frequency, and style. Our synthesis revealed that yoga is associated with improved body satisfaction and appreciation, as well as reduced body dissatisfaction, across diverse adult populations, including those with clinical or subclinical levels of body dissatisfaction. Most low- and moderate-quality studies reported significant improvements, and some suggested a dose-response relationship. However, the evidence is limited by methodological weaknesses, such as a lack of blinding and inadequate reporting. Despite these limitations, findings support yoga as a promising intervention for improving body image in adults. Future research should aim for methodologically rigorous studies that use validated outcome measures and more inclusive populations.
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Affiliation(s)
- Neil Rupani
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States.
| | - Justin Miller
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Julyssa A Renteria
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Kristopher E Kaliebe
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Health, Tampa, FL, United States
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Masheb RM, Snow JL, Siegel SE, Munro LF, Huggins J, Hamilton AB, Maguen S. US Military Veteran Perspectives on Eating Disorder Screening, Diagnosis, and Treatment: A Qualitative Study. Int J Eat Disord 2024. [PMID: 38989608 DOI: 10.1002/eat.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE We aimed to explore US veteran perspectives on eating disorder screening, diagnosis, patient-provider conversations, and care in the Veterans Health Administration (VHA). METHOD Rapid qualitative analysis of 30-45 min phone interviews with 16 (N = 16) veterans with an electronic health record ICD-10 eating disorder diagnosis, who received care at one of two VHA healthcare systems in Connecticut or California. Topics covered included: conversations with providers about eating disorder symptoms, diagnosis, and referral to treatment; feedback about an eating disorder screener, and; reflections on eating disorders among veterans and VHA's effort to address them. RESULTS Most veterans reported difficulty understanding and defining the problems they were experiencing and self-diagnosed their eating disorder before discussing it with a provider. Treatment referrals were almost universally for being overweight rather than for an eating disorder, often leading veterans to feel misunderstood or marginalized. Overall, veterans were enthusiastic about the screener, preferred screening to be conducted by primary care providers, and noted that conversations needed to be non-stigmatizing. There was consensus that VHA is not doing enough to address this issue, that group support and therapy could be beneficial, and that resources needed to be centralized and accessible. DISCUSSION For the most part, veterans felt that, at best, eating disorders and disordered eating are overlooked, and at worst, conflated with overweight. The majority of veterans got referred for weight loss or weight management services but would welcome the opportunity to be screened for, and referred to, eating disorder treatment.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer L Snow
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sarah E Siegel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Lindsay F Munro
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Joy Huggins
- San Francisco VA Health Care System, Mental Health Service, San Francisco, California, USA
| | - Alison B Hamilton
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California, USA
| | - Shira Maguen
- San Francisco VA Health Care System, Mental Health Service, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, California, USA
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Mason TB. Loneliness as a moderator of the association of affective symptoms and binge eating among college women. Eat Behav 2024; 54:101903. [PMID: 39002467 DOI: 10.1016/j.eatbeh.2024.101903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/11/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
Affective symptoms (e.g., depression, anxiety, shame) are a potent risk factor for binge eating. However, less is known on the role of loneliness as a moderator of affective symptoms and binge eating. This objective of the current study was to investigate main effects and interactions of affective symptoms and loneliness in relation to binge eating in college women. A sample of 556 undergraduate women completed self-report questionnaires of affective symptoms, loneliness, and binge eating. Results revealed significant interactions between each affective symptom variable and loneliness in relation to binge eating, such that loneliness strengthened the positive association of affective symptoms and greater binge eating. The findings of this study demonstrate an important role of loneliness to binge eating among college women, especially those with underlying affective vulnerabilities. More theoretical and treatment-oriented work on the role of loneliness in binge eating is needed to understand mechanisms and interventions/preventions.
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Affiliation(s)
- Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
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Duvall A, Hanson O. Peer Support and Beyond: The Role of Lived Experience in a New Era of Eating Disorder Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:333-338. [PMID: 38988465 PMCID: PMC11231480 DOI: 10.1176/appi.focus.20240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
When valued and recognized for the insights gained through direct lived experience, people in eating disorder recovery and their caregivers can improve treatment outcomes. From direct care delivery-in the form of peer support-to roles in leadership, program development, and research, individuals with lived experience can positively impact patient well-being, treatment outcomes, and the field as a whole. Peer supporters can inspire hope, build connections, share diverse experiences, and disseminate clinical insight and skills through a lived experience lens. These tools and the value of expertise by experience can lead to further clinical innovation when integrated into program development, research, and leadership roles in the eating disorder field. As rates of eating disorders continue to rise, it is more important than ever to integrate the voices of lived experience to enhance and strengthen existing treatment-and help create new approaches that could transform the healing process for countless individuals.
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Affiliation(s)
- Ally Duvall
- Equip Health, San Diego, California (Duvall); private practice, Los Angeles, California (Hanson)
| | - Oona Hanson
- Equip Health, San Diego, California (Duvall); private practice, Los Angeles, California (Hanson)
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Brieva-Toloza AV, Hovmand OR, Micali N, Christensen AB. Let's get aligned! Developing a core outcome set for clinical trials in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2024; 32:652-661. [PMID: 38389169 DOI: 10.1002/erv.3079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Our study aimed to review the outcome measures/assessment instruments used and to assess their heterogeneity/homogeneity in eating disorders (EDs) randomised controlled trials. METHODS APA PsycInfo, PubMed, and Embase were searched in December 2022 to identify studies published between and inclusive of January 2012 and December 2022. Inclusion/exclusion criteria were: (1) complete articles published in peer-reviewed scientific journals, which were: (2) randomised trials, (3) in a clinical setting (4) with human subjects, (5) with an ICD or DSM diagnosis of Anorexia Nervosa, Binge Eating Disorder, or Bulimia Nervosa. The selected papers also: (6) used one or more standardised instruments designed to measure one or more psychometric characteristics associated with ED as a primary or secondary outcome, as judged by the authors of this systematic review, and (7) were published in English or Danish. RESULTS Ninety one articles were included, and a total of 196 outcome measures were collected. DISCUSSION The diversity of outcome measures in ED trials hampers result comparability and data integration. We suggest creating a core outcome measure set using the Delphi method, including clinician and patient-reported ED assessments, along with relevant comorbidity scales.
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Affiliation(s)
- Anna Victoria Brieva-Toloza
- Eating Disorders Research Unit, Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Oliver Rumle Hovmand
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Nadia Micali
- Eating Disorders Research Unit, Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anne Bryde Christensen
- Eating Disorders Research Unit, Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Riddle M, Blalock DV, Robertson L, Duffy A, Le Grange D, Mehler PS, Rienecke RD, Joiner T. Comparing eating disorder treatment outcomes of transgender and gender diverse adolescents with those of cisgender adolescents. Int J Eat Disord 2024; 57:1555-1565. [PMID: 38483005 DOI: 10.1002/eat.24195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/11/2024] [Accepted: 03/01/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Eating disorder (ED), depression, and anxiety symptoms at admission and discharge were compared, as were admission-to-discharge changes, for transgender and gender diverse (TGD), and cisgender adolescents receiving intensive treatment for EDs. METHOD Participants were 44 TGD and 573 cisgender adolescents admitted to a treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) at admission and discharge. RESULTS Both groups had elevated EDE-Q scores at admission (TGD: M = 3.78, standard deviation [SD] = 1.70; cisgender: M = 3.33, SD = 1.74) that improved by discharge (TGD: M = 2.27, SD = 1.83, Cohen's d = .98; cisgender: M = 2.10, SD = 1.54, Cohen's d = .79); there were no differences in EDE-Q between groups at admission (p = .09; odds ratio [OR] = 1.18, 95% confidence interval [CI] [.98, 1.44]) or discharge (p = .48; OR = 1.07, 95% CI [.88, 1.30]). On admission, TGD adolescents had higher suicidality, measured by PHQ-9, item 9 (p < .001; OR = 1.94, 95% CI [1.51, 2.52]), and depression (p < .001; OR = 1.10, 95% CI [1.05, 1.16]) than cisgender participants. Severity decreased over treatment for all measures. Both groups showed similar improvement on suicidality (p = .93; OR = .98, 95% CI [.70,1.36]), depression (p = .42; OR = 1.02, 95% CI [.97, 1.07]), and anxiety (p = .14; OR = 1.05, 95% CI [.99, 1.12]). However, at discharge, suicidality (p = .02; OR = 1.40, 95% CI [1.04, 1.85]), depression (p < .01; OR = 1.06, 95% CI [1.02, 1.11]), and anxiety (p = .02; OR = 1.06, 95% CI [1.01, 1.12]) were higher for TGD adolescents than their cisgender peers. DISCUSSION All participants had similar ED symptom severity and improvement. Depression, anxiety, and suicidality remained elevated for TGD adolescents compared to their cisgender peers at discharge, suggesting the need for targeted treatment. PUBLIC SIGNIFICANCE Transgender and gender diverse (TGD) adolescents have increased risk of eating disorders (EDs); few studies examine how they respond to ED treatment. We examine treatment outcomes of TGD adolescents receiving ED treatment compared to their cisgender peers. We measured ED symptoms along with depression, anxiety, and suicidality at the beginning and end of treatment. While TGD adolescents showed similar improvement in ED symptoms, measures of depression, anxiety, and suicidality remained elevated at the time of discharge.
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Affiliation(s)
- Megan Riddle
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Bellevue, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- Emeritus, Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
- ACUTE at Denver Health, Denver, Colorado, USA
- Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Halbeisen G, Braks K, Huber TJ, Paslakis G. Exploring Gender Differences in Early Weight Change and Variability in Adolescents with Anorexia Nervosa during Inpatient Treatment. J Clin Med 2024; 13:3255. [PMID: 38892966 PMCID: PMC11172843 DOI: 10.3390/jcm13113255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Adolescents' early responses and overall outcomes during anorexia nervosa (AN) treatment may differ by patient gender, raising the question of whether evaluating clinical data during AN treatment may require different criteria. Methods: We investigated, using patient records, whether young men and young women with AN differed in terms of early treatment response (defined as weight change and variability within the first 14 days) and whether early treatment responses predicted treatment outcomes similarly across genders. Results: Weight changes predicted patient discharge weight across all gender groups. Weight variability predicted higher disordered eating psychopathology and higher body image insecurities at discharge. Gender differences emerged only for weight gain, which was more pronounced for young men, and gender modulated the effects of weight gain and variability on general psychopathology outcomes. Conclusions: The present findings suggest that early weight changes and weight variability are similarly important predictors of AN treatment outcomes in adolescents but also hint at possible gender differences in terms of the link between weight change and, respectively, variability on general psychopathology.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, 32123 Luebbecke, Germany;
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, 32545 Bad Oeynhausen, Germany
| | - Thomas J. Huber
- Centre for Eating Disorders, Klinik am Korso, 32545 Bad Oeynhausen, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, 32123 Luebbecke, Germany;
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Kuehne C, Phillips MD, Moody S, Bryson C, Campbell IC, Conde P, Cummins N, Desrivières S, Dineley J, Dobson R, Douglas D, Folarin A, Gallop L, Hemmings A, İnce B, Mason L, Rashid Z, Bromell A, Sims C, Allen K, Bailie C, Bains P, Basher M, Battisti F, Baudinet J, Bristow K, Dawson N, Dodd L, Frater V, Freudenthal R, Gripton B, Kan C, Khor JWT, Kotze N, Laverack S, Martin L, Maxwell S, McDonald S, McKnight D, McKay R, Merrin J, Nash M, Nicholls D, Palmer S, Pearce S, Roberts C, Serpell L, Severs E, Simic M, Staton A, Westaway S, Sharpe H, Schmidt U, Bartel H, French T, Kelly J, Micali N, Raman S, Treasure J, Malik U, Rabelo-da-Ponte D, Stephens F, Opitz T, Trompeter N, Wilkins J, Parnell T, Abbas R, Bromell A, Davis G, Eadie C, Gracie L, Heslop B, McKenzie K, Odubanjo E, Sims C, Street T, Tavares-Semedo A, Wilkinson E, Zocek L. Characterising illness stages and recovery trajectories of eating disorders in young people via remote measurement technology (STORY): a multi-centre prospective cohort study protocol. BMC Psychiatry 2024; 24:409. [PMID: 38816707 PMCID: PMC11137943 DOI: 10.1186/s12888-024-05841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious, often chronic, conditions associated with pronounced morbidity, mortality, and dysfunction increasingly affecting young people worldwide. Illness progression, stages and recovery trajectories of EDs are still poorly characterised. The STORY study dynamically and longitudinally assesses young people with different EDs (restricting; bingeing/bulimic presentations) and illness durations (earlier; later stages) compared to healthy controls. Remote measurement technology (RMT) with active and passive sensing is used to advance understanding of the heterogeneity of earlier and more progressed clinical presentations and predictors of recovery or relapse. METHODS STORY follows 720 young people aged 16-25 with EDs and 120 healthy controls for 12 months. Online self-report questionnaires regularly assess ED symptoms, psychiatric comorbidities, quality of life, and socioeconomic environment. Additional ongoing monitoring using multi-parametric RMT via smartphones and wearable smart rings ('Ōura ring') unobtrusively measures individuals' daily behaviour and physiology (e.g., Bluetooth connections, sleep, autonomic arousal). A subgroup of participants completes additional in-person cognitive and neuroimaging assessments at study-baseline and after 12 months. DISCUSSION By leveraging these large-scale longitudinal data from participants across ED diagnoses and illness durations, the STORY study seeks to elucidate potential biopsychosocial predictors of outcome, their interplay with developmental and socioemotional changes, and barriers and facilitators of recovery. STORY holds the promise of providing actionable findings that can be translated into clinical practice by informing the development of both early intervention and personalised treatment that is tailored to illness stage and individual circumstances, ultimately disrupting the long-term burden of EDs on individuals and their families.
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Affiliation(s)
- Carina Kuehne
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Matthew D Phillips
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Sarah Moody
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Callum Bryson
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Iain C Campbell
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Pauline Conde
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | - Nicholas Cummins
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | - Sylvane Desrivières
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Judith Dineley
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | - Richard Dobson
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, London, UK
- University College London, Institute of Health Informatics, London, UK
| | - Daire Douglas
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Amos Folarin
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, London, UK
- University College London, Institute of Health Informatics, London, UK
| | - Lucy Gallop
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Amelia Hemmings
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Başak İnce
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Luke Mason
- Department of Forensic and Neurodevelopmental Science, IoPPN, King's College London, London, UK
| | - Zulqarnain Rashid
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | | | | | - Karina Allen
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chantal Bailie
- Cornwall Partnership NHS Foundation Trus, Bodmin, Cornwall, UK
| | - Parveen Bains
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Mike Basher
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | | | - Julian Baudinet
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine Bristow
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Nicola Dawson
- Bradford District Care NHS Foundation Trust, West Yorkshire, UK
| | - Lizzie Dodd
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Victoria Frater
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert Freudenthal
- Barnet, Enfield and Haringey Mental Health NHS Foundation Trust, London, UK
| | - Beth Gripton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Carol Kan
- Central and North West London NHS Foundation Trust, London, UK
| | - Joel W T Khor
- South West London & St. George's Mental Health NHS Trust, St George's Eating Disorders Service, London, UK
| | - Nicus Kotze
- Dorset Healthcare University NHS Foundation Trust, Poole, Dorset, UK
| | - Stuart Laverack
- Derbyshire Healthcare NHS Foundation Trust, Derby, Derbyshire, UK
| | - Lee Martin
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Sarah Maxwell
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Sarah McDonald
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Delysia McKnight
- North Staffordshire Combined Healthcare NHS Trust; Trentham, Staffordshire, UK
| | | | - Jessica Merrin
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Mel Nash
- Devon Partnership NHS Foundation Trust, Exeter, Devon, UK
| | - Dasha Nicholls
- Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Samantha Pearce
- Cornwall Partnership NHS Foundation Trus, Bodmin, Cornwall, UK
| | | | - Lucy Serpell
- North East London NHS Foundation Trust, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Amelia Staton
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sian Westaway
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Helen Sharpe
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
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Bazo Perez M, Frazier LD. Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors. J Eat Disord 2024; 12:62. [PMID: 38773646 PMCID: PMC11110273 DOI: 10.1186/s40337-024-01023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/15/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs. METHODS Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors. RESULTS The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies. DISCUSSION Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.
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Affiliation(s)
- Maria Bazo Perez
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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Halbeisen G, Laskowski N, Brandt G, Waschescio U, Paslakis G. Eating Disorders in Men. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:86-91. [PMID: 38019152 PMCID: PMC11002438 DOI: 10.3238/arztebl.m2023.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Eating disorders are seen mainly as a problem affecting women, not just by the public at large, but also in specialized circles. Although it is true that more women than men suffer from all types of eating disorder, pertinent reviews have clearly shown that they do indeed occur in men, and that the available evidence on the matter is limited. The stigmatization of men with eating disorders makes it harder for these men, and for the relevant professionals, to recognize the symptoms and to seek or provide help. METHODS This review is based on publications retrieved by a selective search in PubMed on the epidemiological, diagnostic, clinical, and therapeutic aspects of eating disorders in men. RESULTS Current estimated lifetime prevalences in men are 0.2% for anorexia nervosa, 0.6% for bulimia nervosa, and 1% for bingeeating disorder; the corresponding figures for women are 1.4%, 1.9%, and 2.8%. Men and women may display different manifestations. Women are thought to be mainly seeking a slim figure and weight reduction; men, a muscular build. The established Germanlanguage screening and diagnostic tools, however, do not cover the types of symptoms that are more common in men. Little is known about whether treatment yields comparable results in men and women. CONCLUSION It is important to combat the stigmati - zation of men with eating disorders and to remove the obstacles to their appropriate diagnosis and treatment. The current methods of screening and diagnosis need to be adapted to take account of the special aspects of abnormal eating behavior in men. It remains unclear whether and how the disorderspecific treatment of these conditions in men should differ from their treatment in women.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | - Nora Laskowski
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | - Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | | | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
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11
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Dumstorf K, Halbeisen G, Paslakis G. How evaluative pairings improve body dissatisfaction in adult women: evidence from a randomized-controlled online study. J Eat Disord 2024; 12:18. [PMID: 38268007 PMCID: PMC10809437 DOI: 10.1186/s40337-024-00975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Many young women are dissatisfied with their bodies. This study investigated the effect on current body dissatisfaction levels of a newly developed evaluative conditioning procedure that paired self-similar and self-dissimilar images of bodies with positive and neutral affective images, respectively. We hypothesized that learning the contingency that self-similar bodies predict positive affectivity is one process that could aid in explaining how these procedures function. METHODS Adult women without disordered eating pathology participated in an online experiment with random assignment to an intervention or a control condition. All participants initially rated body images in self-similarity and were subsequently asked to categorize positive and neutral images by valence as quickly and accurately as possible. In the intervention condition, self-similar bodies systematically preceded positive images, and self-dissimilar images preceded neutral images, creating a similar body → positive contingency. Pairings in the control condition were unsystematic such that no contingency was present. We measured categorization latencies and accuracies to infer contingency learning as well as current body dissatisfaction immediately before and after exposure to the pairings. All participants further completed measures of trait body image concerns and disordered eating psychopathology at baseline, which we examined as moderators of an expected relation between condition assignment, contingency learning, and body dissatisfaction improvements. RESULTS We analyzed data from N = 173 women fulfilling the inclusion criteria. Moderated mediation analyses showed that assignment to the intervention (vs. control) condition predicted increased similar body → positive contingency learning, which in turn predicted improved body dissatisfaction post-intervention, but only among women with higher pre-existing trait body image concerns or disordered eating levels. CONCLUSIONS The findings point toward the relevancy of further exploring the utility of pairing procedures. Similar body → positive contingency learning predicted improved body dissatisfaction in individuals with normatively high body image concerns, which suggests pairing procedures could help inform future research on reducing body dissatisfaction.
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Affiliation(s)
- Katharina Dumstorf
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312, Luebbecke, Germany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312, Luebbecke, Germany.
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312, Luebbecke, Germany
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12
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Meneguzzo P, Baron E, Marchesin S, Andretta AM, Nalesso L, Stella S, Todisco P. Tuning in to recovery: influence of music on emotional well-being during mealtime in inpatient facilities for eating disorders. J Eat Disord 2024; 12:7. [PMID: 38225626 PMCID: PMC10789025 DOI: 10.1186/s40337-024-00970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND In rehabilitating eating disorders (ED), mealtimes are critical but often induce stress, both for restrictive and binge-purge disorders. Although preliminary data indicate a positive effect of music during mealtime, few studies employ an experimental approach. This study examines the influence of background music during mealtime in an inpatient ward setting, offering a real-world perspective. METHODS Fifty-one women diagnosed with ED participated in this within-subjects study. Over two weeks, during lunch and dinner, they were exposed to three randomized music conditions: no music, focus piano music, and pop music. The self-report questionnaires captured affective states, noise levels, and hunger, while trained dietitians recorded food consumption and eating rituals. RESULTS The absence of music led to an increase in uneaten food (p = 0.001) and the presence of eating rituals (p = 0.012) during mealtimes. Significantly, only silence during mealtime reduced positive emotional states, while background music maintained positive emotions (p < 0.001). No specific differences emerged between the two types of music (focus piano and pop). CONCLUSIONS These findings affirm the positive impact of background music during mealtime in real-world settings, enhancing the potential of inpatient eating rehabilitation programs for individuals with ED. More studies are needed to validate and extend these results, particularly in outpatient settings.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35128, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Elisa Baron
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Silvia Marchesin
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Anna Maria Andretta
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Lisa Nalesso
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Sonia Stella
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
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13
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Foyster M, Sultan N, Tonkovic M, Govus A, Burton-Murray H, Tuck CJ, Biesiekierski JR. Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study. Eat Weight Disord 2023; 28:101. [PMID: 38070009 PMCID: PMC10710386 DOI: 10.1007/s40519-023-01631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. METHODS Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). RESULTS ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). CONCLUSION Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. LEVEL OF EVIDENCE III: Evidence obtained from cohort studies.
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Affiliation(s)
- Mandy Foyster
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Nessmah Sultan
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Matilda Tonkovic
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Andrew Govus
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Helen Burton-Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Caroline J Tuck
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, VIC, Australia
| | - Jessica R Biesiekierski
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia.
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
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Nicula M, Grennan L, Loewen T, Crews E, Giuliani K, Webb C, Gouveia MR, Couturier J. Virtual parent-led peer support groups for parents of children with eating disorders: A mixed methods feasibility study. Int J Eat Disord 2023; 56:2107-2119. [PMID: 37578287 DOI: 10.1002/eat.24042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To examine the feasibility of a virtual parent-led peer support group (vPLPSG) intervention for parents of children with eating disorders (EDs). METHODS Forty-four parents were invited to attend 2-h-long vPLPSG sessions every other week for 6 months. A convergent mixed methods design was used to integrate quantitative survey data (collected at three timepoints and analyzed using repeated measures ANOVA) and qualitative interview data (collected at 6 months and analyzed using content analysis) to assess intervention feasibility. Feasibility was comprised of acceptability (e.g., recruitment and retention rates, desire to continue attending the groups) and preliminary effectiveness (e.g., change in parents' self-reported burden). RESULTS The recruitment rate (67%), retention rate (77%), and attendance rate (60%) demonstrated adequate acceptability. All parents expressed their recommendation of this group to other parents, and most wanted to continue attending vPLPSG sessions. Participants qualitatively reported less isolation and burden as well as improvements in skills and confidence to manage their child's symptoms. These preliminary effectiveness findings were corroborated by quantitative data, with participants reporting a significant decrease in burden [mean difference (MD) = 6.61; p < .004], increase in confidence (MD = 11.17; p < .001), and decrease in unmet needs (MD = 5.03; p < .001) from baseline to 6-months. DISCUSSION The vPLPSG intervention demonstrated feasibility with respect to acceptability and improvements in preliminary parental outcomes. Future research should evaluate the effectiveness of this intervention using a larger, more diverse sample. PUBLIC SIGNIFICANCE Dedicated efforts to support caregivers, such as through virtual parent-led peer support groups, have the potential to increase confidence and decrease burden for parents managing their child's eating disorder.
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Affiliation(s)
| | | | - Techiya Loewen
- Phoenix Wings Eating Disorder Recovery Initiative, Woodstock, Ontario, Canada
| | - Erica Crews
- Reach Out Centre for Kids, Burlington, Ontario, Canada
| | | | - Cheryl Webb
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Jennifer Couturier
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
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15
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Scutt K, Ali K, Rieger E, Monaghan C, Ford R, Fabry E, Fassnacht D. An investigation of the dual continua model of mental health in the context of eating disorder symptomatology using latent profile analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:782-799. [PMID: 37667829 DOI: 10.1111/bjc.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The dual continua model of mental health suggests that mental well-being and mental illness are two distinct continua that are interrelated in their contributions to overall mental health. This study investigated the dual continua model in individuals with eating disorder symptoms. METHOD Female university students (N = 346) completed measures of mental well-being, eating disorder symptomatology, clinical impairment and psychological distress. Confirmatory factor and latent profile analyses were used to derive underlying mental health profiles. RESULTS Results revealed two oblique factors representing the mental well-being and eating disorder symptomatology constructs and four unique mental health profiles that were partially consistent with the dual continua model emerged: 'flourishing', 'vulnerable', 'partially symptomatic and content', and 'languishing'. The derived mental health profiles had unique characteristics described by psychological distress and clinical impairment. CONCLUSIONS The results did not provide conclusive evidence for the dual continua model as they could also be interpreted in a manner consistent with the unidimensional approach. While the dual continua model is a promising avenue to understand mental health in a way that looks beyond symptoms, these results caution against its rapid adoption and encourage future research to understand how eating disorder symptomatology and positive mental health assets contribute to overall mental health.
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Affiliation(s)
- Katharine Scutt
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kathina Ali
- University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Elizabeth Rieger
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Conal Monaghan
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rachael Ford
- Flinders University, Adelaide, South Australia, Australia
| | - Esme Fabry
- Flinders University, Adelaide, South Australia, Australia
| | - Daniel Fassnacht
- University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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16
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Duffy F, Peebles I, Maloney E, Robertson MDA, Sharpe H. Individuals with restrictive eating disorders' experience of the introduction of calories on menus in England: An interpretative phenomenological analysis study. EUROPEAN EATING DISORDERS REVIEW 2023; 31:802-812. [PMID: 37406031 DOI: 10.1002/erv.3007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE In April 2022 the Calorie Labelling (Out of Home) Regulations came into effect in England where cafés, restaurants, and takeaways with over 250 employees were required to provide calorie labelling on menus. Concerns have been raised regarding the potential negative impact this could have on individuals with eating disorders (EDs), yet this has not been explored using qualitative methodology. METHOD Eleven participants with a current or previously diagnosed restrictive ED were interviewed in September 2022. Interpretative Phenomenological Analysis (IPA) was used to explore their experience of the introduction of calories on menus. RESULTS Using IPA we established six themes and seven subordinate themes. These included the introduction of calories on menus as an 'attack' on individuals with EDs; the prominent visual display of calories as an attentional pull; normalising of calories counting; the impact on behaviour; and associated strategies for managing. CONCLUSION This contributes to research surrounding the implications for public health policies on individuals with EDs, especially their ability to reinforce and amplify disordered thoughts and behaviours, and the need for greater consideration of how to minimise impact and potential harm of large public health campaigns.
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Affiliation(s)
- Fiona Duffy
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Imogen Peebles
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Ellen Maloney
- School of Philosophy, Psychology and Language, University of Edinburgh, Edinburgh, Scotland
| | | | - Helen Sharpe
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
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17
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Parker JE, Levinson JA, Hunger JM, Enders CK, Laraia BA, Epel ES, Tomiyama AJ. Longitudinal Stability of Disordered-Eating Symptoms From Age 12 to 40 in Black and White Women. Clin Psychol Sci 2023; 11:879-893. [PMID: 37694231 PMCID: PMC10488908 DOI: 10.1177/21677026221144253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The purpose of the current study was to test the longitudinal association between disordered eating symptoms (body dissatisfaction, drive for thinness and bulimia) in adolescence (ages 12, 14, 16, 18, 19) and adulthood (age 40) in a sample of 883 white and Black women. We also investigated moderation by race. Adolescent symptoms at each time point significantly predicted adulthood symptoms for the body dissatisfaction and drive for thinness subscales, for both Black and white women. Bulimia symptoms in adolescence predicted symptoms in adulthood; however, the effect was largely driven by white women. Although moderation was non-significant, among white women, bulimia symptoms at all adolescent time points predicted adulthood bulimia, but among Black women, only symptoms at ages 18 and 19 were predictive of adulthood bulimia. Results suggest that both Black and white women are susceptible to disordered eating and that symptoms emerging in adolescence can potentially follow women into midlife.
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Affiliation(s)
- Jordan E Parker
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Jordan A Levinson
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Jeffrey M Hunger
- Miami University, Department of Psychology, 321 Psychology Building, Oxford, Ohio 45056, USA
| | - Craig K Enders
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Barbara A Laraia
- University of California, Berkeley School of Public Health, Division of Public Health Nutrition, 207B University Hall, Berkeley, CA 94720, United States
| | - Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, & Center for Health and Community, University of California, 3333 California St, Ste 465, San Francisco, CA, 94122
| | - A Janet Tomiyama
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA, 90095, USA
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18
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Mason TB, Crosby RD, Engel SG, Morales JC, Wonderlich SA. Ecological momentary assessment of mood regulation eating expectancies in eating disorders: Convergent and predictive validity. EUROPEAN EATING DISORDERS REVIEW 2023; 31:717-723. [PMID: 37337314 PMCID: PMC10465104 DOI: 10.1002/erv.2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/15/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Eating expectancies (EE) are the anticipation of various benefits or detriments from eating, with mood regulation being a salient type of EE associated with eating disorders. This study examined the convergent and predictive validity of ecological momentary assessment (EMA) mood regulation EE items, including mood improvement and mood worsening EE. METHODS Thirty women with binge-eating pathology completed a 14-day EMA protocol, which included measures of mood regulation EE, affect, appetite, appearance- and body-related factors and disordered-eating behaviours. RESULTS Greater within-subjects hunger and lower within-subjects positive affect and fullness were related to elevated mood improvement EE. Higher within-subjects appearance concerns, fullness, body social comparisons and thinness pressure were associated with higher mood worsening EE. Greater within-subjects mood worsening EE predicted greater likelihood of vomiting at the subsequent time point, but there were no within-subjects associations between mood improvement EE and behaviours. Yet, greater between-subjects mood worsening EE were associated with more restraint/restriction and binge eating, and greater between-subjects mood improvement EE were associated with more binge eating. CONCLUSIONS Findings support the convergent validity of EMA mood regulation EE items. There was limited predictive validity evidence, suggesting complexities in how mood regulation EE predict behaviour in daily life.
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Affiliation(s)
- Tyler B. Mason
- Department of Public Health and Population Health Sciences, University of Southern California, Los Angeles, CA
| | - Ross D. Crosby
- Sanford Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Scott G. Engel
- Sanford Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Jeremy C. Morales
- Department of Public Health and Population Health Sciences, University of Southern California, Los Angeles, CA
| | - Stephen A. Wonderlich
- Sanford Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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Paslakis G, Dimitropoulos G, Halbeisen G. Editorial: A global perspective on diversity in eating disorders. Front Psychiatry 2023; 14:1276078. [PMID: 37711418 PMCID: PMC10497862 DOI: 10.3389/fpsyt.2023.1276078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Lübbecke, Germany
| | | | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Lübbecke, Germany
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20
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Peebles I, Cronje JL, Clark L, Sharpe H, Duffy F. Experiences of inpatient eating disorder admissions: A systematic review and meta-synthesis. Eat Behav 2023; 50:101753. [PMID: 37329771 DOI: 10.1016/j.eatbeh.2023.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/22/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE There has been a significant increase in the number of inpatient admissions for individuals with eating disorders and, with the most critical cases requiring inpatient treatment, it is essential that we continue to improve associated outcomes. The aim of the study was to synthesise the available qualitative literature on the experiences of inpatient admissions for eating disorders to understand individuals' experiences and identify areas that may require further research and/or service development. METHOD Searches were performed on the following online databases: PsycINFO, PsycArticles, PsycTherapy MEDLINE, Embase, CINAHL, ASSIA, Scopus and Proquest Open Access Theses. Only papers with qualitative data regarding individuals' experiences of inpatient eating disorder treatment were considered. The CASP qualitative checklist was used to assess studies and relevant data items were extracted. Thematic synthesis was used to integrate the findings in the identified studies. GRADE-CERQual was used to rate the confidence in the findings. RESULTS Twenty-eight studies were identified which the CASP assessment considered to be adequate. The synthesis produced 5 main themes; 'Care and control', 'Inpatient bubble', 'Being supported and understood', 'Challenges of living with others' eating disorders' and finally 'Relationship to eating disorder'. The GRADE CERQual framework rated findings with high or moderate confidence. CONCLUSIONS Findings reaffirmed the importance of patient-centred care and the significant impact of being separated from normal life with others also experiencing an eating disorder.
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Affiliation(s)
- Imogen Peebles
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland; CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
| | - Jamie-Lee Cronje
- CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
| | - Lilli Clark
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland.
| | - Helen Sharpe
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland.
| | - Fiona Duffy
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland; CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
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21
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Strauch J, Agnew A, Meenaghan E, Miller KK, Haines MS. Recruitment strategies to increase racial and ethnic diversity in anorexia nervosa clinical research. J Eat Disord 2023; 11:118. [PMID: 37454157 PMCID: PMC10349455 DOI: 10.1186/s40337-023-00844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Inclusion of underrepresented racial and ethnic groups in eating disorder (ED) research is a critical unmet need, but evidence-based recruitment strategies are lacking. We sought to determine whether methods we had implemented to increase recruitment of underrepresented racial and ethnic groups were successful in improving racial and ethnic diversity in a clinical trial in women with anorexia nervosa. METHOD We implemented new strategies for recruitment of underrepresented racial and ethnic groups in a clinical trial on bone health in women with anorexia nervosa, including leveraging social media, liberalizing language on advertisements to be more inclusive of women who are as yet undiagnosed with the disorder or feel stigmatized by its name, translating advertisements to Spanish, and engaging community health centers. We compared participants' race and ethnicity in this clinical trial versus two similar prior clinical trials. RESULTS The percent of non-White and Hispanic participants who have signed a consent form in our ongoing clinical trial (2021-2023) is higher versus two previous clinical trials on bone health in women with anorexia nervosa (2011-2019) with similar inclusion/exclusion criteria and endpoints [non-White: 11/38 (28.9%) vs. 11/188 (5.9%), Hispanic: 6/38 (15.8%) vs. 5/188 (2.7%), p ≤ 0.006]. There was no change in the percent of Black participants [0/38 (0%) vs. 1/188 (0.5%), p = 1.0]. DISCUSSION Viewing clinical research recruitment through a diversity, equity, and inclusion lens can improve racial and ethnic diversity in ED research. Further research recruitment strategies are needed to be more inclusive of Black populations.
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Affiliation(s)
- Julianne Strauch
- Neuroendocrine Unit, Massachusetts General Hospital, 50 Staniford Street, Suite 750B, Boston, MA, 02114, USA
| | - Alexandra Agnew
- Neuroendocrine Unit, Massachusetts General Hospital, 50 Staniford Street, Suite 750B, Boston, MA, 02114, USA
| | - Erinne Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital, 50 Staniford Street, Suite 750B, Boston, MA, 02114, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, 50 Staniford Street, Suite 750B, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Melanie S Haines
- Neuroendocrine Unit, Massachusetts General Hospital, 50 Staniford Street, Suite 750B, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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22
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Traut P, Halbeisen G, Braks K, Huber TJ, Paslakis G. Sociodemographic and clinical features of men and women with eating disorders: a diagnosis-matched, retrospective comparison among inpatients. Front Psychiatry 2023; 14:1192693. [PMID: 37484681 PMCID: PMC10359980 DOI: 10.3389/fpsyt.2023.1192693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Eating disorders (EDs) are among the most severe mental disorders in women and men, often associated with high symptom burden and significant limitations in daily functioning, frequent comorbidities, chronic course of illness, and even high mortality rates. At the same time, differences between men and women with EDs remain poorly explored. Methods In this study, we compared 104 men to 104 diagnosis-matched women with EDs regarding sociodemographic and clinical features. Using latent class mixture modelling, we identified four distinct patient subgroups based on their sociodemographic features. Results Men with EDs had significantly higher odds than women to belong to a "single-childfree-working" class. Moreover, while there were few overall differences in ED-related symptoms and general psychopathology between men and women, single-childfree-working men with EDs presented with higher general psychopathology symptoms than men in the other classes. Discussion We discuss how considering sex and gender along with further sociodemographic differences in EDs may help to improve ED diagnosis and treatment.
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Affiliation(s)
- Philipp Traut
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, Bad Oeynhausen, Germany
| | - Thomas J. Huber
- Centre for Eating Disorders, Klinik am Korso, Bad Oeynhausen, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
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23
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Mensinger JL, Shepherd BF, Schapiro S, Aware Y, Brochu PM, Calogero RM, Tylka TL. Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index. Eat Behav 2023; 49:101730. [PMID: 37121132 DOI: 10.1016/j.eatbeh.2023.101730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Stevie Schapiro
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Yashvi Aware
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Rachel M Calogero
- Department of Psychology, Western University, Westminster Hall, Office 321, London, ON N6K 5C2, Canada.
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, 170F Morrill Hall, 1465 Mt. Vernon Avenue, Marion, OH 43302, United States of America.
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24
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Laskowski NM, Halbeisen G, Braks K, Huber TJ, Paslakis G. Factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q) in adult men with eating disorders. J Eat Disord 2023; 11:34. [PMID: 36879335 PMCID: PMC9987121 DOI: 10.1186/s40337-023-00757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Previous investigations on the Eating Disorder Examination-Questionnaire (EDE-Q) factor structures in men have been restricted to non-clinical settings, limiting conclusions about the factorial validity in men with eating disorders (ED). This study aimed to examine the factor structure of the German EDE-Q in a clinical group of adult men with diagnosed ED. METHODS ED symptoms were assessed using the validated German version of the EDE-Q. Exploratory factor analysis (EFA) using principal-axis factoring based on polychoric correlations was conducted for the full sample (N = 188) using Varimax-Rotation with Kaiser-Normalization. RESULTS Horn's parallel analysis suggested a five-factor solution with an explained variance of 68%. The EFA factors were labeled "Restraint" (items 1, 3-6), "Body Dissatisfaction" (items 25-28), "Weight Concern" (items 10-12, 20), "Preoccupation" (items 7 and 8), and "Importance" (items 22 and 23). Items 2, 9, 19, 21, and 24 were excluded due to low communalities. CONCLUSIONS Factors associated with body concerns and body dissatisfaction in adult men with ED are not fully represented in the EDE-Q. This could be due to differences in body ideals in men, e.g., the underestimation of the role of concerns about musculature. Consequently, it may be useful to apply the 17-item five-factor structure of the EDE-Q presented here to adult men with diagnosed ED.
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Affiliation(s)
- Nora M Laskowski
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312, Luebbecke, Germany.
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312, Luebbecke, Germany
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, 32545, Bad Oeynhausen, Germany
| | - Thomas J Huber
- Centre for Eating Disorders, Klinik am Korso, 32545, Bad Oeynhausen, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312, Luebbecke, Germany
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25
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Brandt G, Halbeisen G, Braks K, Huber TJ, Paslakis G. Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes. EUROPEAN EATING DISORDERS REVIEW 2023; 31:413-424. [PMID: 36802088 DOI: 10.1002/erv.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Phenotypical comparisons between individuals with obesity without binge eating disorder (OB) and individuals with obesity and comorbid binge eating disorder (OB + BED) are subject to ongoing investigations. At the same time, gender-related differences have rarely been explored, raising the question whether men and women with OB and OB + BED may require differently tailored treatments. METHOD We retrospectively compared pre- versus post-treatment data in a matched sample of n = 180 men and n = 180 women with OB or OB + BED who received inpatient treatment. RESULTS We found that men displayed higher weight loss than women independent of diagnostic group. In addition, men with OB + BED showed higher weight loss than men with OB after 7 weeks of treatment. CONCLUSIONS The present findings add to an emerging yet overall still sparse body of studies comparing phenotypical features and treatment outcomes in men and women with OB and OB + BED; implications for further research are discussed. CLINICAL TRIAL REGISTRATION The study was prospectively registered with the German Clinical Trial Register as part of application DRKS00028441.
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Affiliation(s)
- Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, Bad Oeynhausen, Germany
| | - Thomas J Huber
- Centre for Eating Disorders, Klinik am Korso, Bad Oeynhausen, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
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26
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Clark MTR, Manuel J, Lacey C, Pitama S, Cunningham R, Jordan J. Reimagining eating disorder spaces: a qualitative study exploring Māori experiences of accessing treatment for eating disorders in Aotearoa New Zealand. J Eat Disord 2023; 11:22. [PMID: 36793068 PMCID: PMC9930305 DOI: 10.1186/s40337-023-00748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Health, illness, and the body are conceptualized within the cultural context of a society. The values and belief systems of a society, including media portrayals, shape how health and illness present. Traditionally, Western portrayals of eating disorders have been prioritized over and above Indigenous realities. This paper explores the lived experiences of Māori with eating disorders and their whānau (family/support system) to identify the enablers and barriers to accessing specialist services for eating disorders in New Zealand. METHOD Kaupapa Māori research methodology was used to ensure the research supported Māori health advancement. Fifteen semi-structured interviews were completed with Māori participants including; those with an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, and binge eating disorder), and/or their whānau. Structural, descriptive, and pattern coding was undertaken within the thematic analysis. Low's spatializing culture framework was used to interpret the findings. RESULTS Two overarching themes identified systemic and social barriers to accessing treatment for Māori with eating disorders. The first theme, was space, that described the material culture within eating disorder settings. This theme critiqued eating disorder services, including idiosyncratic use of assessment methods, inaccessible service locations, and the limited number of beds available in specialist mental health services. The second theme, place, referred to the meaning given to social interactions created within space. Participants critiqued the privileging of non-Māori experiences, and how this makes a place and space of exclusion for Māori and their whānau in eating disorder services in New Zealand. Other barriers included shame and stigma, while enablers included family support and self-advocacy. CONCLUSION More education is needed for those working in the space of primary health settings about the diversity of those with eating disorders to enable them to look beyond the stereotype of what an eating disorder looks like, and to take seriously the concerns of whaiora and whānau who present with disordered eating concerns. There is also a need for thorough assessment and early referral for eating disorder treatment to ensure the benefits of early intervention are enabled for Māori. Attention given to these findings will ensure a place for Māori in specialist eating disorder services in New Zealand.
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Affiliation(s)
- Mau Te Rangimarie Clark
- Department of Māori Indigenous Health Innovation, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Jenni Manuel
- Department of Māori Indigenous Health Innovation, University of Otago, PO Box 4345, Christchurch, New Zealand.,Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Māori Indigenous Health Innovation, University of Otago, PO Box 4345, Christchurch, New Zealand.,Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori Indigenous Health Innovation, University of Otago, PO Box 4345, Christchurch, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Te Whatu Ora, Waitaha - Canterbury, Canterbury, New Zealand
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27
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Labarta AC, Bendit A. Culturally Responsive and Compassionate Eating Disorder Treatment: Serving Marginalized Communities with a Relational-Cultural and Self-Compassion Approach. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2023. [DOI: 10.1080/15401383.2023.2174629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Adriana C. Labarta
- College of Professional Advancement, Department of Counseling, Mercer University, Atlanta, GA, USA
| | - Arielle Bendit
- College of Education, Counseling & Psychological Services (CAPS), Florida Atlantic University, Boca Raton, FL, USA
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28
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McGowan A, Barry MR, Sonneville KR, Leung CW. Greater social adversity is associated with more disordered eating attitudes and behaviors among children from Southeast Michigan. Int J Eat Disord 2022; 55:1670-1677. [PMID: 35833678 PMCID: PMC10084038 DOI: 10.1002/eat.23775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study is to examine the association between indicators of social adversity, including socioeconomic status and race/ethnicity, and children's disordered eating behaviors and attitudes. METHODS Children ages 8-10 years old (n = 183) were recruited from Michigan. Data were collected through in-home surveys. The Children's Eating Attitudes Test (ChEAT-24) measured disordered eating attitudes and behaviors in the sample. Cumulative social adversity was considered the sum of four binary variables: caregiver race/ethnicity, caregiver education, household income, and child-reported food security status. Linear mixed models examined the association between social adversity indicators and ChEAT-24 scores. RESULTS Children of primary caregivers of color had significantly higher ChEAT-24 scores than children of white caregivers (p = .03). Children who reported food insecurity had significantly higher ChEAT-24 scores compared to children who reported food security (p = .01). Compared to children with the lowest social adversity score, children with the highest score had a 4.8-unit higher ChEAT-24 score (95% CI .3-9.4), after adjusting for covariates. A significant trend was observed for greater social adversity and higher ChEAT-24 score (p-trend = .02). CONCLUSION A linear association was observed between greater social adversity and more disordered eating behaviors and attitudes among children in this sample. These findings emphasize the need for eating disorder research in children from racial/ethnic minorities and socioeconomically disadvantaged populations to support future prevention efforts. PUBLIC SIGNIFICANCE Greater exposure to social adversity was associated with more disordered eating behaviors among preadolescent children. Given that eating disorders are understudied in lower-income and minority racial/ethnic populations, this study highlights the need for additional research to better support prevention and treatment efforts among children from socioeconomically diverse backgrounds.
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Affiliation(s)
- Andrea McGowan
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Mikayla R Barry
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Cindy W Leung
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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29
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Riddle MC, Robertson L, Blalock DV, Duffy A, Le Grange D, Mehler PS, Rienecke RD, Joiner T. Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals. Int J Eat Disord 2022; 55:1532-1540. [PMID: 36151729 DOI: 10.1002/eat.23812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to compare symptom severity of eating disorders (EDs), depression and anxiety at admission and discharge for transgender and nonbinary (TNB) individuals and cisgender adult individuals receiving treatment for EDs at higher levels of care (HLOC), adding to the limited research in this area. METHOD Participants were 25 TNB individuals and 376 cisgender individuals admitted to a HLOC ED treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9, and Beck Anxiety Inventory at admission and discharge. RESULTS TNB individuals showed significant improvements on EDE-Q global scores between admission and discharge (Cohen's d = 1.27), and showed similar improvements on the EDE-Q over the course of treatment (Cohen's d = 0.06) when compared to cisgender individuals. TNB individuals had more severe depression at admission (Cohen's d = 0.61). Although depression improved over the course of treatment for both groups, TNB individuals showed less improvement (Cohen's d = 0.59). Suicidality was higher for TNB individuals on admission and discharge and did not improve significantly over the course of treatment (Cohen's d = 0.38). DISCUSSION This study provides preliminary evidence that TNB and cisgender individuals show similar improvement in ED symptoms during HLOC treatment. However, TNB individuals have more severe depression and less improvement in depression compared to cisgender individuals, without improvement in suicidality. TNB individuals may benefit from care targeting depression and suicidality during ED treatment. PUBLIC SIGNIFICANCE STATEMENT TNB individuals have increased risk of EDs. Little research addresses how TNB individuals respond to ED treatment, which was traditionally created for cisgender individuals. We present one of the first studies examining ED treatment outcomes for TNB adults. TNB individuals showed improved ED symptoms with treatment, but less improvement in depression and their suicidality remained elevated. This suggests the need for targeted treatment.
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Affiliation(s)
- Megan C Riddle
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Bellevue, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA.,ACUTE at Denver Health, Denver, Colorado, USA.,Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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30
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Brandt G, Stobrawe J, Korte S, Prüll L, Laskowski NM, Halbeisen G, Paslakis G. Medical Students' Perspectives on LGBTQI+ Healthcare and Education in Germany: Results of a Nationwide Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10010. [PMID: 36011644 PMCID: PMC9408586 DOI: 10.3390/ijerph191610010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/30/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
The healthcare needs of lesbian, gay, bisexual, trans*, queer, and intersex (LGBTQI+) persons are often overlooked, prompting national and international calls to include diversity-related competencies into medical students' training. However, LGBTQI+-focused healthcare education targets remain elusive, as surveys reveal considerable variability across national student populations. To generate empirical data and vocalize recommendations for medical education, we conducted the first nationwide online survey among 670 German medical students from 33 universities. Overall, most respondents reported low confidence regarding their medical training preparing them for LGBTQI+ patients, stated that LGBTQI+ themes were not covered during training, and agreed that the inclusion of such themes is urgently needed. In addition, we found gender and LGBTQI+ community member status to be key variables. Men scored lower in knowledge than women, while community members scored higher than non-community members. Similarly, community members reported higher comfort levels. Non-community men showed the highest levels of prejudice and efficacy beliefs, while at the same time had the lowest scores in contacts and the perceived importance of LGBTQI+-related teaching. Keeping subgroup differences in mind, we recommend that educational training should include LGBTQI+ healthcare aspects and address self-efficacy beliefs in future medical professionals to overcome LGBTQI+ healthcare disparities.
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Affiliation(s)
- Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
| | - Jule Stobrawe
- German Medical Students’ Association (BVMD e.V.), Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS (SCORA), 10115 Berlin, Germany
| | - Sophia Korte
- German Medical Students’ Association (BVMD e.V.), Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS (SCORA), 10115 Berlin, Germany
| | - Livia Prüll
- Institute of Functional and Clinical Anatomy, University Medical Center Mainz, 55131 Mainz, Germany
| | - Nora M. Laskowski
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Virchowstr. 65, 32312 Luebbecke, Germany
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31
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Halbeisen G, Braks K, Huber TJ, Paslakis G. Gender Differences in Treatment Outcomes for Eating Disorders: A Case-Matched, Retrospective Pre–Post Comparison. Nutrients 2022; 14:nu14112240. [PMID: 35684040 PMCID: PMC9183188 DOI: 10.3390/nu14112240] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Eating disorders (EDs) are increasingly emerging as a health risk in men, yet men remain underrepresented in ED research, including interventional trials. This underrepresentation of men may have facilitated the development of women-centered ED treatments that result in suboptimal outcomes for men. The present study retrospectively compared pre- vs. post-treatment outcomes between age-, diagnosis-, and length-of-treatment-matched samples of n = 200 men and n = 200 women with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), or Eating Disorder Not Otherwise Specified (EDNOS), treated in the same setting during the same period, and using the same measurements. Compared to women, men with AN showed marked improvements in weight gains during treatment as well as in ED-specific cognitions and general psychopathology. Likewise, men with BED showed marked weight loss during treatment compared to women with BED; ED-specific cognitions and general psychopathology outcomes were comparable in this case. For BN and EDNOS, weight, ED-specific cognitions, and general psychopathology outcomes remained largely comparable between men and women. Implications for treatments are discussed.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, 32312 Luebbecke, Germany;
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, 32545 Bad Oeynhausen, Germany; (K.B.); (T.J.H.)
| | - Thomas J. Huber
- Centre for Eating Disorders, Klinik am Korso, 32545 Bad Oeynhausen, Germany; (K.B.); (T.J.H.)
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, 32312 Luebbecke, Germany;
- Correspondence:
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