Gender Differences in Treatment Outcomes for Eating Disorders: A Case-Matched, Retrospective Pre–Post Comparison

The collateral effects of the COVID-19 pandemic: A gender-specific systematic review of disordered eating behaviour in the general population

OBJECTIVE

The COVID-19 pandemic initiated public health measures, impacting mental health and exacerbating disordered eating behaviours (DEB). This study aims to fill gaps in understanding DEB in the general population during the pandemic, emphasising gender dynamics and the experiences of gender and/or sexual minority (SGM) individuals.

METHOD

A systematic literature review followed PRISMA guidelines to investigate DEB during the pandemic, focusing on gender-sensitive analyses and SGM populations. Outcomes from the included studies were synthesised to identify patterns and associations related to DEB, particularly considering gender dynamics and SGM experiences.

RESULTS

Significant gender associations with DEB were observed, with women consistently exhibiting higher scores. SGM populations also showed elevated DEB symptoms. Longitudinal studies indicated changes in DEB over time, with some decreases observed among men.

CONCLUSIONS

The review underscores significant gender differences in DEB during the pandemic, with women exhibiting higher symptom levels. Lockdown measures had nuanced impacts on DEB, varying across studies. Various factors including pandemic-related stressors influenced DEB. Consideration of these factors can inform tailored interventions for DEB in the general population. Overall, the review enhances our understanding of how gender intersects with the pandemic's impact on DEB, emphasising the need for diverse approaches to address these behaviours.

Eating disorders in medical students: prevalence, risk factors, comparison with the general population

Objectives

The main objectives were to investigate the prevalence of ED and associated risk factors among medical students in Romania, as well as to determine which variables may predict ED and to explore the differences between medical students and the general population.

Methods

The Eating Disorders Inventory questionnaire (EDI-3) was applied. Also, the body mass index of the students was calculated, socio-demographic information regarding personal and family medical history was collected (mental and chronic diseases, self-reported sleep difficulties in the past 6 months, family history of obesity) and potentially risky events (history of ridicule, major negative events, social pressure to be thin from family, friends, media).

Results

37.1% students are at risk of eating disorders, 41% females and 23% males, according to the EDI-3. 14.42% were underweight, 65.05% normal weight, 16.99% overweight and 3.53% obese. Compared to the nationally representative sample in Romania, medical students had significantly higher scores for ED risk and for all other psychological factors.

Conclusion

Medical students have a high risk of developing ED, even higher than the general population. Several factors were associated with the ED risk, including female gender, experiencing sleeping difficulties, feelings of ridicule, family pressure and media pressure, prior ED history, high BMI, negative events and family history of mental illness. The regression analysis showed that family pressure is a strong predictor for ED risk.

Investigating the structure of disordered eating symptoms in adult men: A network analysis

OBJECTIVE

Eating disorders (EDs) increasingly emerge as a health risk in men, but there is concern that men's symptoms go unnoticed due to stereotypical perceptions and gender-related differences in symptom presentation. Novel assessments focused particularly on attitudes and behaviours towards increasing muscle size and definition. Using network analysis, this study aimed to corroborate and extend previous findings on disordered eating presentation in men by examining the role of muscularity concerns among an extended range of disordered eating symptoms.

METHOD

N = 294 adult men (18 years or older) completed muscularity-related and disordered eating assessments, among which we included assessments for orthorexic eating and Avoidant/Restrictive Food Intake Disorder for the first time. We selected symptoms empirically, estimated a regularised network, identified symptom communities, evaluated network loadings and bridge centrality estimates, and compared network structures between different groups of participants.

RESULTS

We identified five symptom communities related to muscularity-related concerns, features of core ED psychopathology, and selective eating. Symptoms regarding ruminating about healthy eating, guilt for unhealthy eating, weight overvaluation, concerns about muscularity, and selective eating emerged as highly central.

DISCUSSION

The results largely corroborate previous observations but suggest that muscle-building behaviours are part of a broader cluster of male body shaping and rule-based dieting behaviours.

Differential exposure to palatable food and its effects on binge-like eating behavior in adolescent rats

Introduction

Consumption of palatable food (PF) can lead to chronic overconsumption and obesity. Furthermore, adolescents may be vulnerable to excessively reinforcing foods, which increases the probability of developing overweight and obesity in adulthood. The role of PF availability in binge-like intake among adolescents without caloric needs remains unclear. The present study aimed to evaluate which PF access protocol is the most sensitive to induce increased caloric intake and binge-like eating during adolescence.

Methods

We used 24 male Wistar rats [30 postnatal days (PND)]; standard food and water were provided ad libitum. Rats were randomly assigned to one of three groups: (a) continuous, daily access to PF; (b) intermittent, 1-day access/1-day no-access; or (c) weekend, 3 days-access/4 days no-access. All groups had 1 h access to PF (chocolate sandwich cookies). Access protocols were maintained for 6 weeks; afterward, rats underwent a 7-day withdrawal period, and were then evaluated on a binge-eating test.

Results

Chronic restricted PF access induces binge-like intake, with intermittent access resulting in the highest binge index. Additionally, caloric intake of PF increases over time during adolescence, with differential effects of intermittent and weekend access.

Conclusion

Chronic restricted access to PF during adolescence induces binge-like intake, with differences depending on PF availability. This can lead to chronic overconsumption under non-homeostatic conditions.

Gender differences in body composition, dietary patterns, and physical activity: insights from a cross-sectional study

Introduction

This study investigates the interplay between body composition, dietary patterns, and physical activity across genders, focusing on gender-specific differences in food preferences and eating behaviors. Understanding these interactions is crucial for developing targeted nutritional and lifestyle interventions.

Methods

A cross-sectional study was conducted with 1,333 participants (58.7% female, 41.3% male), aged 18-65 years. Participants were categorized into tertiles based on their fat mass to fat-free mass (FM-to-FFM) ratio. Data on dietary choices, eating behaviors, and physical activity were collected and analyzed to identify gender-specific trends.

Results

Significant gender-specific differences were observed in food preferences and eating behaviors. Males experienced greater hunger in the late afternoon, while females felt more hunger in the morning. Males showed a preference for processed and red meats, whereas females preferred cooked vegetables. Eating behaviors such as meal skipping, uncontrolled eating, nocturnal eating, and taste preferences (sweet or salty) varied distinctly between FM-to-FFM tertiles and genders. Higher FM-to-FFM ratios correlated with lower physical activity levels, particularly in strength training and general sports engagement.

Discussion

These findings highlight the complex interactions between body composition, dietary habits, and lifestyle factors, emphasizing gender-specific differences. The results suggest that body composition and BMI significantly impact health-related behaviors, necessitating tailored interventions to address these differences and promote healthier lifestyles.

Exploring Gender Differences in Early Weight Change and Variability in Adolescents with Anorexia Nervosa during Inpatient Treatment

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.

A new network analysis model in anorexia nervosa patients based on self-reported eating disorder symptoms, psychological distress, and cognitive flexibility

OBJECTIVES

Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample.

METHODS

One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence.

RESULTS

The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress.

CONCLUSIONS

The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence.

Eating Disorders in Men

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.

Factors associated with lifetime history of eating disorder in non-psychotic patients with suicidal ideation

BACKGROUND

Data on the sociodemographic, biographical, and clinical factors associated with a lifetime diagnosis of eating disorders (ED) in patients with non-psychotic mental disorders (NPMD) and suicidal ideation (SI) are scarce.

METHODS

A cohort study was conducted at the Moscow Research and Clinical Center for Neuropsychiatry. The sample consisted of consecutive patients with non-psychotic mental disorders and SI, aged 1845 years. Participants with a lifetime diagnosis of anorexia and/or bulimia (then in remission or recovery) were compared with those without ED in terms of their sociodemographic profile, clinical characteristics, lifetime traumatic events, and some behavioral patterns. All participants underwent the Russian version of the Self-Injurious Thoughts and Behaviors Interview and completed the Brief Reasons for Living Inventory, the State and Trait Anxiety Inventory, and the Beck Depression Inventory.

RESULTS

A total of 892 patients with non-psychotic mental disorders and SI were included in the study. The mean age was 25.7 years, and 84% were assigned female at birth. Same-sex experience was more common in the ED group. Patients with an ED were more likely to have a history of physical and sexual abuse and to have witnessed domestic violence. The proportion of participants with piercings, tattoos, or severe body modifications was significantly higher in the ED group. Patients with a lifetime ED were more likely to engage in nonsuicidal self-injurious behaviors and to have a history of suicide attempts.

CONCLUSION

Lifetime ED in NPMD patients with SI is associated with younger age, being assigned female at birth, having an alternative gender identity, having same-sex experience, having more than one psychiatric diagnosis, having been diagnosed with bipolar disorder, experiencing severe depression and anxiety, being exposed to multiple traumatic experiences, having various body modifications, practicing NSSI, and having a lifetime story of suicide attempts.

Sociodemographic and clinical features of men and women with eating disorders: a diagnosis-matched, retrospective comparison among inpatients

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.

Exploratory graph analysis (EGA) of the dimensional structure of the eating disorder examination-questionnaire (EDE-Q) in women with eating disorders

This study examined the dimensional structure of the German Eating Disorder Examination-Questionnaire (EDE-Q) in clinical groups of women with Anorexia Nervosa (AN; N = 821), Bulimia Nervosa (BN; N = 573), and Binge-Eating Disorder (BED; N = 359) using Exploratory Graph Analyses (EGA). The EGA yielded a 12-item-four-dimension structure for the AN group (subscales "Restraint", "Body Dissatisfaction", "Preoccupation", "Importance"), a 20-item-five-dimension structure for the BN group (subscales "Restraint", "Body Dissatisfaction", "Eating Concern", "Preoccupation", "Importance"), and a 17-item-four-dimension structure for the BED group (subscales "Restraint", "Body Dissatisfaction", "Concern", "Importance"). This first investigation of the EDE-Q's dimensional structure using EGA suggests that the original factor model may be suboptimal for specific clinical ED samples and that alternative scoring should be considered when screening specific cohorts or evaluating the effects of interventions.

Eating Disorders and Nutritional Beliefs, Trends or Practices

This Special Issue of Nutrients on "Eating disorders and nutritional beliefs, trends or practices" contains ten empirical papers that cover various aspects of the topic [...].

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes

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.