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Kons K, Essayli J, Shook J. Comparing the knowledge, attitudes, and practices of pediatric and family medicine clinicians toward atypical anorexia nervosa versus anorexia nervosa. Int J Eat Disord 2024; 57:993-1001. [PMID: 38082458 PMCID: PMC11018502 DOI: 10.1002/eat.24095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To investigate the knowledge, attitudes, and current practices of adolescent primary care providers regarding the epidemiology, clinical features, and diagnosis of atypical anorexia nervosa (AN) compared to AN. METHODS An online survey was sent to the Pediatric and Family Medicine clinicians who provide medical care to adolescents. Statistical analyses compared differences in responses to questions about atypical AN versus AN. RESULTS Relative to AN, participants (n = 67) were significantly less familiar with atypical AN, less likely to consider a diagnosis of atypical AN, less comfortable identifying atypical AN, less likely to counsel patients with atypical AN on health risks, less likely to refer patients with atypical AN to a specialist, and less likely to correctly identify atypical AN. Clinicians with more years in medical practice reported a significantly larger gap in familiarity between AN and atypical AN than clinicians with less than 5 years of practice. CONCLUSIONS Providers who care for adolescents appear to be less familiar with and less likely to identify atypical AN compared to AN. This knowledge gap may be more pronounced among clinicians with more years practicing medicine due to the novelty of atypical AN as a diagnosis. Lack of knowledge surrounding atypical AN risk factors may result in delayed diagnosis and associated poor health outcomes. Future research should investigate strategies that improve knowledge and screening of atypical AN in medical and other settings. PUBLIC SIGNIFICANCE Pediatric and Family Medicine clinicians are less familiar with atypical anorexia nervosa (AN) and less likely to diagnose a patient with atypical AN relative to AN. Insufficient knowledge about atypical AN may place these individuals at increased risk for worsening restrictive eating and the physical and psychological consequences of malnutrition.
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Affiliation(s)
- Kelly Kons
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jamal Essayli
- Department of Pediatrics, Division of Adolescent Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer Shook
- Department of Pediatrics, Division of Adolescent Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Sayed Ahmed HA, Abo El-Ela SG, Joudeh AI, Moawd SM, El Hayek S, Shah J, Eldahshan NA. Prevalence and Correlates of Night Eating Syndrome, Insomnia, and Psychological Distress in Primary Care Patients with Obesity: A Cross-Sectional Study. Obes Facts 2024; 17:274-285. [PMID: 38484714 PMCID: PMC11149973 DOI: 10.1159/000538341] [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: 06/11/2023] [Accepted: 03/05/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Management of obesity is challenging for both patients and healthcare workers. Considering the low success rate of current interventions, this study aimed to explore the prevalence and associated factors of night eating syndrome (NES), insomnia, and psychological distress among individuals with obesity in order to plan comprehensive obesity management interventions. METHODS A cross-sectional study on a convenient sample from five primary healthcare centers in Port Said, Egypt, was conducted from November 2020 to March 2021. Sociodemographic and clinical characteristics were collected in addition to the assessment of NES, insomnia, and psychological distress using the Arabic versions of the Night Eating Diagnostic Questionnaire (NEQ), the Insomnia Severity Index (ISI), and the Patient Health Questionnaire-4 (PHQ-4) scales, respectively. Associations of NES, insomnia, and psychological distress were assessed by multiple regression analysis. We performed Bonferroni adjustments for multiple comparisons. RESULTS We included 425 participants with obesity with a mean age of 45.52 ± 6.96 years. In all, 54.4% were females and the mean body mass index (BMI) was 35.20 ± 4.41 kg/m2. The prevalence rates of NES, insomnia, and psychological distress were 21.6% (95% CI: 17.7-25.6%), 15.3% (95% CI: 11.9-18.7%), and 18.8% (95% CI: 15.1-22.6%), respectively. NES was significantly associated with younger age (OR 0.974, p = 0.016), physical inactivity (OR 0.485, p = 0.010), insomnia (OR 2.227, p = 0.014), and psychological distress (OR 2.503, p = 0.002). Insomnia showed strong associations with NES (OR 2.255, p = 0.015) and psychological distress (OR 5.990, p < 0.001). Associated factors of psychological distress symptoms included insomnia (OR 6.098, p < 0.001) and NES (OR 2.463, p = 0.003). CONCLUSION The prevalence rates of NES, insomnia, and psychological distress were high among primary care patients with obesity, and these conditions were interrelated. Optimal obesity management necessitates individualized and targeted multidisciplinary care plans that take into consideration individual patients' mental, behavioral, and dietary habits needs.
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Affiliation(s)
- Hazem A Sayed Ahmed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sohila G Abo El-Ela
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anwar I Joudeh
- Internal Medicine Department, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
- Internal Medicine Department, College of Medicine, University of Qatar, Doha, Qatar
| | - Sally M Moawd
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Samer El Hayek
- Medical Department, Erada Center for Treatment and Rehabilitation in Dubai, Dubai, United Arab Emirates
| | - Jaffer Shah
- Weill Cornell Medicine, New York, New York, USA
| | - Nahed Amen Eldahshan
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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3
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Huffman LG, Lawrence-Sidebottom D, Beam AB, Parikh A, Guerra R, Roots M, Huberty J. Improvements in Adolescents' Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study. JMIR Form Res 2024; 8:e54253. [PMID: 38294855 PMCID: PMC10867747 DOI: 10.2196/54253] [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: 11/02/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. OBJECTIVE This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents' disordered eating behaviors. METHODS Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. RESULTS Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). CONCLUSIONS Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer Huberty
- Bend Health Inc, Madison, WI, United States
- FitMinded Inc LLC, Phoenix, AZ, United States
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4
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Banna MHA, Akter S, Kabir H, Brazendale K, Sultana MS, Alshahrani NZ, Ahinkorah BO, Salihu T, Azhar BS, Hassan MN. Internet addiction, depressive symptoms, and anxiety symptoms are associated with the risk of eating disorders among university students in Bangladesh. Sci Rep 2023; 13:20527. [PMID: 37993471 PMCID: PMC10665554 DOI: 10.1038/s41598-023-47101-z] [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: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
The risk of developing an eating disorder among university students is higher than the general population in Bangladesh. Since psychiatric disorders (such as depression and anxiety) and addictive behaviors (e.g., internet addiction) predominantly exist among university students in the country, these may increase their vulnerability to developing an eating disorder. The association of internet addiction, depression, and anxiety with the risk of eating disorders among Bangladeshi university students is relatively unknown; therefore, this study investigates the association. This study was a cross-sectional design. Students (N = 700) from two public universities in Bangladesh completed the Patient Health Questionnaire (PHQ-9) scale, the Generalized Anxiety Disorder (GAD-7) tool, and Orman's Internet Addiction Survey (OIAS) to measure exposure variables. Eating Attitudes Test-26 (EAT-26) assessed the outcome variable. Multivariable logistic regression analysis showed that internet addiction [adjusted odds ratio (aOR) for moderate addiction = 2.15 and severe addiction = 3.95], depressive (aOR 3.04), and anxiety (aOR 2.06) symptoms were associated with an increased risk of eating disorder among study participants. Future longitudinal studies on university students are recommended to gain a better understanding about the causal factors of eating disorder to support intervention initiatives and strategies by public health practitioners and policy experts.
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Affiliation(s)
- Md Hasan Al Banna
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
- Nutrition Initiative, Kushtia, Bangladesh.
| | - Shammy Akter
- Department of Applied Nutrition and Food Technology, Faculty of Biological Sciences, Islamic University, Kushtia, Bangladesh
| | - Humayun Kabir
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Keith Brazendale
- Department of Health Sciences, University of Central Florida, Orlando, USA
| | - Mst Sadia Sultana
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Tarif Salihu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bably Sabina Azhar
- Department of Applied Nutrition and Food Technology, Faculty of Biological Sciences, Islamic University, Kushtia, Bangladesh
| | - Md Nazmul Hassan
- Department of Environmental Sanitation, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
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Tokatly Latzer I, Richmond TK, Zhang B, Pearl PL. Eating disorders occur at high rates in adolescents with epilepsy and are associated with psychiatric comorbidities and suicidality. Epilepsia 2023; 64:2982-2992. [PMID: 37611929 DOI: 10.1111/epi.17759] [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: 04/25/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES To assess the occurrence rate, characteristics, and impact of eating disorders (EDs) in adolescents with epilepsy. METHODS In this observational study, adolescents with epilepsy seen in a single center between 2013 and 2022 who had comorbid EDs were compared to two control groups of adolescents with only epilepsy and only EDs. Patients with intellectual disability or autism spectrum disorder were excluded. Data retrieved included demographic and anthropometric details and clinical variables relating to seizure types, EDs, and psychiatric disorders and behaviors. RESULTS A total of 376 subjects were included in the study: 84 adolescents with both epilepsy and eating disorders, 135 with only epilepsy, and 157 with only EDs. The rate of EDs in adolescents with epilepsy was 7.0% (95% confidence interval [CI] 5.6%-8.5%) overall, 11.3% (95% CI 8.8%-14.3%) in females, and 3.1% (95% CI 1.9%-4.8%) in males. The median (interquartile range [IQR]) time difference between the onset of epilepsy to an ED was 1.6 (.5-3.6) years. Among adolescents with epilepsy, those with an ED were more likely to be female (p = .001) and have a lower body mass index z-score (zBMI) percentile (p < .001). Epilepsy type, seizure frequency, or seizure duration were not specific for having or not having EDs. Among adolescents with EDs, those with epilepsy had a younger onset of their EDs (p < .001), included relatively more males (p = .007), and consisted of more cases of anorexia-nervosa-restrictive type (p < .001), and fewer cases of bulimia nervosa (p = .04) and binge eating disorder (p = .003). Adolescents with epilepsy and a comorbid ED were more likely to have psychiatric comorbidities such as depression, anxiety, and suicidality than adolescents with only epilepsy or EDs. SIGNIFICANCE EDs should be suspected and screened for in intellectually intact female and male adolescents with epilepsy, irrespective of their epilepsy type. If disturbed eating behaviors or EDs are identified, further evaluation should be directed at detecting other psychopathologies, including suicidality.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Beckmann EA, Aarnio-Peterson CM, Jastrowski Mano KE. Advancing the Assessment and Treatment of Comorbid Pediatric Chronic Functional Abdominal Pain (CFAP) and Restrictive Eating Disorders. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1539. [PMID: 37761500 PMCID: PMC10527586 DOI: 10.3390/children10091539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
The aim of this review is to heighten awareness of the association between chronic functional abdominal pain (CFAP) and restrictive eating disorders (ED) in adolescents. We describe current diagnostic practices and propose future research efforts to improve the assessment and treatment of comorbid CFAP and restrictive EDs. A narrative review of the literature on CFAP and EDs was performed using PubMed, JSTOR, ScienceDirect, and PsycINFO and the following search terms: 'restrictive eating disorders', 'chronic functional abdominal pain', 'chronic pain' 'treatment' 'diagnosis' and 'adolescents'. Published studies on restrictive EDs and CFAP from May 2008 to March 2023 were included. Ascribable to the overlap in etiology and symptom presentation, adolescents with chronic pain are significantly less likely to have their ED pathology promptly identified by providers compared to adolescents without comorbid chronic pain. This highlights the importance of the time sensitive and accurate identification of EDs in adolescents with CFAP. Overall, assessment methods are limited and EDs take longer to be identified in adolescents with comorbid CFAP. Future efforts should address diagnostic practices in pediatric settings and improve the communication among medical and mental health providers in order to promote the rapid and effective diagnosis and treatment of comorbid CFAP and EDs.
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Affiliation(s)
- Emily A. Beckmann
- Department of Psychology, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Claire M. Aarnio-Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
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Ali SA, Mahfouz MS, Hakami RA, Altubayqi TH, Alhazmi NH, Adawi NA, Khormi RM, Yaqoub W, Maghfori G, Mujarribi MH, Dighriri IM. Prevalence and Associated Factors of Eating Disorders Among Female Students at Jazan University, Kingdom of Saudi Arabia: A Survey Study. Cureus 2023; 15:e43291. [PMID: 37692630 PMCID: PMC10492635 DOI: 10.7759/cureus.43291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Concerns about the incidence of eating disorders (EDs) among university students are spreading throughout the world. In Saudi Arabia, little is known about the prevalence and associated factors of EDs among female university students. Thus, this study investigated the prevalence, common types, and potential associated factors of EDs among female students of Jazan University. Methods: A cross-sectional survey was conducted between August 31, 2020, and November 2, 2020. The snowball technique was used to recruit female students via an electronic survey distributed in Arabic. The survey collected information about demographic characteristics, and SCOFF (Sick, Control, One, Fat, Food) and Eating Attitudes Test (EAT-26) scales. Cronbach's alpha for the SCOFF and EAT-26 scales was calculated to be 0.78 and 0.58, respectively, in this study. RESULTS A total of 566 female students participated in the survey, with a mean age of 22.12 ± 2.93 years. The results showed that 47.9% of participants were at risk for EDs based on SCOFF scores, while 26.5% were at risk based on EAT-26 scores. The most common types of EDs were bulimia nervosa and binge eating disorder. Furthermore, the study identified several sociodemographic characteristics, including year of study (p = 0.042), college type (p = 0.004), body weight (p = 0.001), and BMI (p = 0.001), that are significantly associated with EDs. However, no significant relationships were observed between marital status (p = 0.103), age (p = 0.147), and height (p = 0.509) with SCOFF scores. Some students reported frequent binge eating, purging, or laxative/diet pill misuse. CONCLUSIONS The study revealed a moderate to high prevalence of risk for EDs among female university students in Jazan, Saudi Arabia, associated with higher study years, college majors, and body weight and BMI. Dangerous ED behaviors reported by some students signal an urgent need for resources to identify and support those suffering from these disorders. Targeted interventions and services may help address this critical issue on campuses and support vulnerable students in need. Continued research and public health action are needed to curb the spread of these disorders.
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Affiliation(s)
- Suhaila A Ali
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | - Mohammed S Mahfouz
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
| | | | | | | | | | | | - Weam Yaqoub
- Faculty of Medicine, Jazan University, Jazan, SAU
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Martínez-Rodríguez A, Vidal-Martínez L, Martínez-Olcina M, Miralles-Amorós L, Sánchez-Sáez JA, Ramos-Campo DJ, Sánchez-Sánchez J, Martínez-Amorós N, Cheikh-Moussa K, Asencio-Mas N, Andreu-Caravaca L, Rubio-Arias JÁ. Study the Effect of an Innovative Educational Program Promoting Healthy Food Habits on Eating Disorders, Mediterranean Diet Adherence and Body Composition in University Students. Healthcare (Basel) 2023; 11:healthcare11070965. [PMID: 37046892 PMCID: PMC10094267 DOI: 10.3390/healthcare11070965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
The university stage is a good time to promote healthy eating strategies. The sociological and cultural changes experienced by students lead them to skip meals, increase their intake of fast food and energy-dense foods, decreasing adherence to the Mediterranean diet (MD). Professionals related to food such as nutritionists and dietitians are also considered a population at risk of developing eating disorders due to the extensive knowledge they possess, which can be used for both good and bad practice. The objective was to analyze the impact of a 4-month educational program promoting the Mediterranean diet on risky eating behaviors, adherence to the Mediterranean diet, and body composition in nutrition and dietetics students, studying the differences according to the group investigated (control group and educated group). The context of the research was 196 students (49 males and 147 females) from two consecutive years. The control group did not receive any type of intervention, while with the control group (educated) an educational program was carried out. Results showed that women with greater control over energy intake, carbohydrates, and sugar had a lower percentage of fat mass, while in men, the relationship was established with weight. Regarding adherence to the Mediterranean diet, at post, it is adequate in both men (8.25 ± 2.87) and women (7.90 ± 2.89), with no significant differences between the intervention groups.
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McEntee ML, Philip SR, Phelan SM. Dismantling weight stigma in eating disorder treatment: Next steps for the field. Front Psychiatry 2023; 14:1157594. [PMID: 37113547 PMCID: PMC10126256 DOI: 10.3389/fpsyt.2023.1157594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
The authors posit current guidelines and treatment for eating disorders (EDs) fail to adequately address, and often perpetuate, weight stigma. The social devaluation and denigration of higher-weight individuals cuts across nearly every life domain and is associated with negative physiological and psychosocial outcomes, mirroring the harms attributed to weight itself. Maintaining focus on weight in ED treatment can intensify weight stigma among patients and providers, leading to increased internalization, shame, and poorer health outcomes. Stigma has been recognized as a fundamental cause of health inequities. With no clear evidence that the proposed mechanisms of ED treatment effectively address internalized weight bias and its association with disordered eating behavior, it is not hard to imagine that providers' perpetuation of weight bias, however unintentional, may be a key contributor to the suboptimal response to ED treatment. Several reported examples of weight stigma in ED treatment are discussed to illustrate the pervasiveness and insidiousness of this problem. The authors contend weight management inherently perpetuates weight stigma and outline steps for researchers and providers to promote weight-inclusive care (targeting health behavior change rather than weight itself) as an alternative approach capable of addressing some of the many social injustices in the history of this field.
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Affiliation(s)
- Mindy L. McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
- *Correspondence: Mindy L. McEntee,
| | - Samantha R. Philip
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Sean M. Phelan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Giacomini G, Elhadidy HSMA, Paladini G, Onorati R, Sciurpa E, Gianino MM, Borraccino A. Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192012988. [PMID: 36293569 PMCID: PMC9602016 DOI: 10.3390/ijerph192012988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 05/08/2023]
Abstract
Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual's well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people's mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs' hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ to 22.2‱). Significant hospitalization rate increases were observed both in 15-19 and in 10-14 females' age groups in 2021. Non-significant increases were observed in all males' age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.
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Affiliation(s)
- Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | | | - Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Piedmont Region, 10195 Grugliasco, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
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Bryant E, Spielman K, Le A, Marks P, Touyz S, Maguire S, Brennan L, Bryant E, Byrne S, Caldwell B, Calvert S, Carroll B, Castle D, Caterson I, Chelius B, Chiem L, Clarke S, Conti J, Crouch L, Dammery G, Dzajkovski N, Fardouly J, Feneley J, Foroughi N, Fuller-Tyszkiewicz M, Fursland A, Gonzalez-Arce V, Gouldthorp B, Griffin K, Griffiths S, Hambleton A, Hannigan A, Hart M, Hart S, Hay P, Hickie I, Kay-Lambkin F, King R, Kohn M, Koreshe E, Krug I, Le A, Linardon J, Long R, Long A, Madden S, Maguire S, Maloney D, Marks P, McLean S, Meddick T, Miskovic-Wheatley J, Mitchison D, O’Kearney R, Paterson R, Paxton S, Pehlivan M, Pepin G, Phillipou A, Piccone J, Pinkus R, Raykos B, Rhodes P, Rieger E, Rodan S, Rockett K, Russell J, Russell H, Salter F, Sawyer S, Shelton B, Singh U, Smith S, Smith E, Spielman K, Squire S, Thomson J, Tiggemann M, Touyz S, Utpala R, Vartanian L, Wallis A, Ward W, Wells S, Wertheim E, Wilksch S, Williams M, Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord 2022; 10:78. [PMID: 35672777 PMCID: PMC9175461 DOI: 10.1186/s40337-022-00597-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. METHODS This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. RESULTS Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. CONCLUSIONS A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karen Spielman
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, New South Wales Health, Sydney, Australia
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12
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Rangel Paniz G, Lebow J, Sim L, Lacy BE, Farraye FA, Werlang ME. Eating Disorders: Diagnosis and Management Considerations for the IBD Practice. Inflamm Bowel Dis 2022; 28:936-946. [PMID: 34096582 DOI: 10.1093/ibd/izab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Graziella Rangel Paniz
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Monia E Werlang
- Division of Gastroenterology and Liver Center, Prisma-Health-Upstate, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, United States
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13
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Convertino AD, Blashill AJ. Psychiatric comorbidity of eating disorders in children between the ages of 9 and 10. J Child Psychol Psychiatry 2022; 63:519-526. [PMID: 34225382 DOI: 10.1111/jcpp.13484] [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] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study. METHODS The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression. RESULTS Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research. CONCLUSIONS This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.
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Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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14
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Li S, Cui G, Yin Y, Tang K, Chen L, Liu X. Prospective Association Between Problematic Mobile Phone Use and Eating Disorder Symptoms and the Mediating Effect of Resilience in Chinese College Students: A 1-Year Longitudinal Study. Front Public Health 2022; 10:857246. [PMID: 35570941 PMCID: PMC9092370 DOI: 10.3389/fpubh.2022.857246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 12/19/2022] Open
Abstract
A previous cross-sectional study found that problematic mobile phone use (PMPU) was associated with students' eating disorder symptoms. However, since the cross-sectional study cannot infer the causality and the direction of effect, the longitudinal relationship between the two and the mechanism behind this relationship are unclear. Therefore, the present study explores the prospective association between PMPU and eating disorder symptoms and related mediation mechanisms using a 1-year longitudinal study of 1,181 college students (from December 2019 [T1] to December 2020 [T2]). Survey tools used include the Mobile Phone Addiction Tendency Scale, the 10-item Connor-Davidson resilience scale, and the 12 item Short Form of the Eating Disorder Examination Questionnaire. The longitudinal relationship between PMPU and eating disorder symptoms and the mediating effect of resilience was analyzed using a cross-lagged model. The results showed that PMPU (β = 0.086, P < 0.01) and resilience (β = -0.145, P < 0.01) at T1 predicted eating disorder symptoms at T2, but not vice versa. PMPU was bidirectionally associated with resilience, and the prediction effect of PMPU at T1 to resilience at T2 (β = -0.151, P < 0.001) was higher than the prediction effect of resilience at T1 to PMPU at T2 (β = -0.134, P < 0.001). The standardized indirect effect of PMPU at T1 on eating disorder symptoms at T2 via resilience was significant (β = 0.022, 95% CI = 0.010~0.040, P < 0.001). Therefore, PMPU and resilience were predictive for eating disorder symptoms in college students, and resilience may play a mediating role in the prospective association between PMPU and eating disorder symptoms. This study provides new ideas and higher-level evidence for the development of prevention and intervention measures for college students' eating disorder symptoms.
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Affiliation(s)
- Shaojie Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghui Cui
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongtian Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kaixuan Tang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lei Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xinyao Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
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15
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Morie KP, Crowley MJ, Mayes LC, Potenza MN. The process of emotion identification: Considerations for psychiatric disorders. J Psychiatr Res 2022; 148:264-274. [PMID: 35151218 PMCID: PMC8969204 DOI: 10.1016/j.jpsychires.2022.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts.
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Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA.
| | - Michael J Crowley
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Linda C Mayes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; Connecticut Mental Health Center, New Haven, CT, 06519, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, 06510, USA
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16
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Kabakuş Aykut M, Bilici S. The relationship between the risk of eating disorder and meal patterns in University students. Eat Weight Disord 2022; 27:579-587. [PMID: 33881762 DOI: 10.1007/s40519-021-01179-4] [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: 12/02/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study was carried out to evaluate the relation between meal patterns and the risk of eating disorders in university students. METHODS The study was conducted on a total of 331 volunteer students with a mean age of 22.08 ± 1.80 years, 56.5% female. Participants' sociodemographic characteristics, health information and eating habits like meal skipping and dieting were questioned. Sick, Control, One stone, Fat, Food (SCOFF) Eating Disorders Scale and Eating Disorder Examination Questionnaire (EDE-Q) were used to determine eating behavior disorders, with face to face interviews by the researches. RESULTS A significant correlation was found between dieting and skipping meals and the risk of eating disorders in both genders (p < 0.05). In addition, when the reasons for skipping meals were questioned, a significant relationship was detected between skipping meals and eating behaviour disorders by 3.285 times (p = 0.000). Also, every unit of increase in body mass index (BMI) values of individuals who participated to the study led to an increase in eating disorders by a factor of 1.262 (p = 0.000). CONCLUSIONS Our findings support concerns about the negative health effects of increasing overweight among university students in accordance with the data that the increase in BMI values led to an increase in eating disorders. Notably a significant correlation was found between dieting, skipping meals and the risk of eating disorders in both genders it is highlighting the need for monitoring and early diagnosis of eating disorders in youth with simple scales like SCOFF. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Memnune Kabakuş Aykut
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gümüşhane University, Gümüşhane, Turkey
| | - Saniye Bilici
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Çankaya, Ankara, Turkey.
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17
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Koposov RA, Stickley A, Ruchkin V. Bulimia Symptoms in Russian Youth: Prevalence and Association With Internalizing Problems. Front Psychiatry 2022; 12:797388. [PMID: 35126206 PMCID: PMC8811208 DOI: 10.3389/fpsyt.2021.797388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There has been limited research on bulimia symptoms in adolescents from the general population outside the United States. This study aimed to evaluate the prevalence of bulimia symptoms in Russian youth and explore the associations between a clinical level of self-reported probable bulimia nervosa (BN) and internalizing problems, binge drinking and functional impairment by gender. METHODS Data were collected from a representative sample of school students (N = 2,515, 59.5% female) from Northern Russia [age M (SD) = 14.89 ± 1.13 years]. Probable BN and internalizing psychopathology were assessed using self-report scales. Chi-square and independent sample t-tests were used to compare respondents' demographic characteristics and disordered eating behaviors. GLM multivariate analysis of covariance was used to assess the associations between probable BN, functional impairment and mental health problems (MHP) by gender. RESULTS Analyses showed that the 3-month prevalence of probable BN was higher in girls (3.9%) than in boys (1.2%). Probable BN was associated with depressive and anxiety symptoms, somatic anxiety, somatic complaints, binge drinking and functional impairment. Boys reported a higher level of problem scores in relation to probable BN. CONCLUSIONS Our findings suggest that bulimia symptoms are prevalent in Russian adolescents and are associated with MHP and functional impairment. Timely recognition of bulimia symptoms and associated MHP is important for early prevention and intervention strategies.
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Affiliation(s)
- Roman A. Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Stockholm Center for Health and Social Change, Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Child Study Center, Yale University Medical School, New Haven, CT, United States
- Säter Forensic Psychiatric Clinic, Säter, Sweden
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18
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Tokatly Latzer I, Senderowich N, Fattal-Valevski A, Mitelpunkt A, Uliel-Sibony S, Hausman-Kedem M. Disordered Eating Behaviors in Young Individuals With Idiopathic Intracranial Hypertension. Pediatr Neurol 2021; 125:1-8. [PMID: 34563874 DOI: 10.1016/j.pediatrneurol.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to assess the prevalence of disordered eating behaviors (DEBs) in young individuals with idiopathic intracranial hypertension (IIH) and to identify predictors of DEBs in this population. METHODS Individuals with IIH aged eight to 25 years and their matched controls responded to a self-rating survey comprised of the Eating Attitude Test-26 for assessing the presence of DEBs and the Depression, Anxiety and Stress Scale. RESULTS Fifty-three subjects with IIH and 106 healthy controls were included. DEBs were significantly more prevalent in individuals with IIH (P < 0.001). Individuals with IIH and DEBs were more likely to have longer periods of treatment [odds ratio: 1.07, 95% CI: 1.02-1.41), P = 0.008] and to have lost a significant amount of weight during the course of treatment [odds ratio: 9.06 (95% CI: 1.30-62.9), P = 0.026]. Depression, anxiety, and stress were more prevalent in the IIH group than in the controls (P = 0.004) and were associated with DEBs in these individuals (P = 0.01). CONCLUSIONS There is an increased prevalence of DEBs among young individuals with IIH, which persists even after disease resolution, and is associated with higher reported rates of depression, anxiety, and stress. Medical caregivers should have heightened awareness to DEBs in individuals with IIH with the aim of early identification and intervention.
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Affiliation(s)
- Itay Tokatly Latzer
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noam Senderowich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexis Mitelpunkt
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimrit Uliel-Sibony
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Ivancic L, Maguire S, Miskovic-Wheatley J, Harrison C, Nassar N. Prevalence and management of people with eating disorders presenting to primary care: A national study. Aust N Z J Psychiatry 2021; 55:1089-1100. [PMID: 33722071 DOI: 10.1177/0004867421998752] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Primary care practitioners are well placed to support diagnosis and appropriate treatment of eating disorders as they are often the first point of contact with the health care system. However, little is known about management of eating disorders in primary care. We aimed to estimate the prevalence of management of eating disorders in primary care and identify how these disorders are managed. METHODS This study used data from the Bettering the Evaluation of Care of Health programme, which annually surveys 1000 randomly sampled general practitioners in Australia who each record details of 100 successive patient encounters. In total, data were utilised from 1,568,100 primary care encounters between 2000/2001 and 2015/2016. RESULTS Eating disorders were managed in less than 1% of primary care encounters between 2000/2001 and 2015/2016. When extrapolated to the Australian population, up to 0.32% of the population were managed in primary care for a primary or probable eating disorder. In the majority of encounters where an eating disorder was managed (58.5%), the encounter was initiated for reasons other than the eating disorder itself. Of a group of patients identified with a clinically significant low body mass index (N = 5917), a small number (n = 118) had either no other diagnosis or a related condition that may be indicative of an eating disorder. In encounters where an eating disorder was managed, referrals to a mental health specialist/service, medical specialist and nutritionist/dietician were provided in 20%, 8% and 6% of encounters, respectively. Mental health treatment plans, which provide subsidised access to mental health services, were ascribed in approximately 7.7% of encounters where an eating disorder was managed. CONCLUSION Primary care provides an opportunity to improve detection and management of eating disorders, particularly when patients present for 'other' issues or with unexplained low body mass index and one or more symptoms related to an eating disorder.
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Affiliation(s)
- Lorraine Ivancic
- InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, NSW, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, NSW, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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20
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Reas DL, Isomaa R, Solhaug Gulliksen K, Levallius J. Clinicians as a critical link: Understanding health professionals' beliefs and attitudes toward anorexia nervosa, bulimia nervosa, and binge eating disorder. Scand J Psychol 2021; 62:775-779. [PMID: 34569633 DOI: 10.1111/sjop.12777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
Understanding the perspectives of health professionals remains an understudied issue, yet may help bridge research-practice gaps and pinpoint important areas for education, training, and research. This study investigated attitudes toward anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) among Nordic health professionals specialized within the eating disorder (ED) field. Participants (n = 144) completed a modified ED-version of the Illness Perception Questionnaire which assessed attitudes and beliefs toward perceived symptom controllability, severity, treatment effectiveness, and views on the prognosis of AN, BN, and BED. Personal enjoyment and level of comfort working with AN, BN, and BED were also assessed. The majority agreed or strongly agreed that patients with AN, BN, and BED were not responsible for their illness, and viewed the illnesses as psychological rather than medical in etiology. AN was viewed as the most severe and enduring, followed by BN, then BED. Treatment for BN was viewed as being more highly effective than treatments for either AN or BED. Professionals rated significantly less enjoyment and less confidence working with BED. To conclude, both commonalities and differences in attitudes toward AN, BN and BED were found in terms of perceived symptom controllability, views on severity, treatment effectiveness, and anticipated prognosis. In particular, findings emphasized the need for additional training in the management of BED among Nordic healthcare professionals.
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Affiliation(s)
- Deborah Lynn Reas
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Rasmus Isomaa
- Department of Social Services and Health Care, Fredrikakliniken, Jakobstad, Finland.,Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Kjersti Solhaug Gulliksen
- The Norwegian Psychological Association, Oslo, Norway.,The Institute of Eating Disorders, Hunger House, Oslo, Norway
| | - Johanna Levallius
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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21
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Bryant E, Miskovic-Wheatley J, Touyz SW, Crosby RD, Koreshe E, Maguire S. Identification of high risk and early stage eating disorders: first validation of a digital screening tool. J Eat Disord 2021; 9:109. [PMID: 34488899 PMCID: PMC8419810 DOI: 10.1186/s40337-021-00464-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/20/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Eating disorders are amongst the deadliest of all mental disorders, however detection and early intervention rates remain extremely low. Current standardised screening questionnaires can be arduous or confronting and are ill-validated for online use, despite a universal shift to digital healthcare. The present study describes the development and pilot validation of a novel digital screening tool (the InsideOut Institute-Screener) for high risk and early stage eating disorders to drive early intervention and reduced morbidity. METHODS We utilised a mixed cross-sectional and repeated measures longitudinal survey research design to assess symptom severity and recognised parameters of statistical validity. Participants were recruited through social media and traditional advertising, and through MTurk. An Eating Disorders Examination Questionnaire (EDE-Q) global score of 2.3 and assessment of eating disorder behaviours was used to determine probable ED. 1346 participants aged 14-74 (mean [SE] age 26.60 [11.14] years; 73.8% female, 22.6% male) completed the survey battery. 19% were randomised to two-week follow-up for reliability analysis. RESULTS Strong positive correlations between the IOI-S and both the EDE-Q global (rs = .88) and SCOFF (rs = .75) total score were found, providing support for the concurrent validity of the scale. Inter-item correlations were moderate to strong (rs = .46-.73). Correlations between the IOI-S and two measures of social desirability diverged, providing support for the discriminant validity of the scale. The IOI-S demonstrated high internal consistency (α = .908, ω = .910) and excellent two-week test-retest reliability (.968, 95% CI 0.959-0.975; p ≤ 0.1). The IOI-S accurately distinguished probable eating disorders (sensitivity = 82.8%, specificity = 89.7% [AUC = .944], LR+ = 8.04, LR- = 0.19) and two stepped levels of risk. CONCLUSIONS AND RELEVANCE The present study provides excellent initial support for the psychometric validity of the InsideOut Institute digital screening tool, which has the potential to streamline early intervention in the hopes of reducing current high morbidity and mortality. Further validation should be undertaken in known clinical populations. Eating disorders are amongst the deadliest of all mental disorders, however detection and early intervention rates remain extremely low. The present study describes the initial psychometric validation of a novel digital screening tool (the InsideOut Institute Screener) for high risk and early stage eating disorders, for self-referral and/or use in primary care. 1346 participants aged 14-74 of all genders completed a survey battery designed to assess common parameters of statistical validity. Strong support was found for the screener's ability to accurately measure eating disorder risk and symptomatology. The screener was highly positively correlated with a well known and extensively validated long form self-report questionnaire for eating disorder symptomatology. This study is a pilot validation and the genesis of a project that aims ultimately to drive early intervention leading to reduced morbidity and mortality rates in this illness group.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia.
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Stephen W Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Eyza Koreshe
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
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Individuals Diagnosed with Binge-Eating Disorder Have DNA Hypomethylated Sites in Genes of the Metabolic System: A Pilot Study. Nutrients 2021; 13:nu13051413. [PMID: 33922358 PMCID: PMC8145109 DOI: 10.3390/nu13051413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
Binge-eating disorder, recently accepted as a diagnostic category, is differentiated from bulimia nervosa in that the former shows the presence of binge-eating episodes and the absence of compensatory behavior. Epigenetics is a conjunct of mechanisms (like DNA methylation) that regulate gene expression, which are dependent on environmental changes. Analysis of DNA methylation in eating disorders shows that it is reduced. The present study aimed to analyze the genome-wide DNA methylation differences between individuals diagnosed with BED and BN. A total of 46 individuals were analyzed using the Infinium Methylation EPIC array. We found 11 differentially methylated sites between BED- and BN-diagnosed individuals, with genome-wide significance. Most of the associations were found in genes related to metabolic processes (ST3GAL4, PRKAG2, and FRK), which are hypomethylated genes in BED. Cg04781532, located in the body of the PRKAG2 gene (protein kinase AMP-activated non-catalytic subunit gamma 2), was hypomethylated in individuals with BED. Agonists of PRKAG2, which is the subunit of AMPK (AMP-activated protein kinase), are proposed to treat obesity, BED, and BN. The present study contributes important insights into the effect that BED could have on PRKAG2 activation.
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Khoshkerdar P, Raeisi Z. The effect of mindfulness‐based stress reduction on body image concerns of adolescent girls with dysfunctional eating attitudes. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Parya Khoshkerdar
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran,
| | - Zohreh Raeisi
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran,
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Bryant E, Miskovic-Wheatley J, Touyz S, Crosby RD, Koreshe E, Cao L, Maguire S. Transitioning to digital first line intervention - validation of a brief online screener for early identification of a suspected eating disorder: study protocol. J Eat Disord 2020; 8:60. [PMID: 33292579 PMCID: PMC7657667 DOI: 10.1186/s40337-020-00339-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Only one in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Early intervention has been associated with better prognosis, with those seeking specialised intervention in the early stages of their illness more than twice as likely to achieve remission. Current screening measures typically require expert administration and are rarely validated across a spectrum of DSM-5 eating disorder presentations or for online use. In light of COVID-19 and increasing reliance on telehealth technologies in the intervention and delivery of mental health services, online assessments suitable for self-referral are likely to be the first step to seeking care. InsideOut Institute has developed a 6-item online screening tool for the purposes of identifying eating disorder risk and symptomatology, aimed specifically at increasing help-seeking behaviour in subsyndromal and early presentations. METHODS This study investigates the reliability and validity of the InsideOut Institute Screener (IOI-S), using a cross-sectional survey research design. Participants aged 14 and over will complete an extensive baseline survey battery for evaluation. 50% of participants will be randomly selected for one follow-up re-test of the IOI-S only, 2 weeks post initial testing. The IOI-S will be analysed for statistical reliability on two parameters: internal consistency and test re-test reliability, and for statistical validity on four parameters: concurrent validity, sensitivity and specificity, convergent and discriminant validity. DISCUSSION The rapid and ongoing shift to digital intervention has highlighted gaps and opportunities in our pathways to care. Adequate screening for eating disorders is a major gap. This study aims to validate an online screening tool for use in telehealth early intervention, designed for users seeking information for a suspected eating disorder. The screener meets those at risk 'where they are' (i.e. online) and may improve timely referrals to relevant services. This is of particular salience as face-to-face healthcare and traditional frontline interventions are disrupted, and we are challenged to re-design our practices to deliver diagnostic and treatment services in highly adaptive digital contexts.
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Affiliation(s)
- Emma Bryant
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Eyza Koreshe
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Li Cao
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
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Genis-Mendoza AD, Martínez-Magaña JJ, Ruiz-Ramos D, Gonzalez-Covarrubias V, Tovilla-Zarate CA, Narvaez MLL, Castro TBG, Juárez-Rojop IE, Nicolini H. Interaction of FTO rs9939609 and the native American-origin ABCA1 p.Arg230Cys with circulating leptin levels in Mexican adolescents diagnosed with eating disorders: Preliminary results. Psychiatry Res 2020; 291:113270. [PMID: 32763537 DOI: 10.1016/j.psychres.2020.113270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023]
Abstract
Eating disorders (ED) are characterized by disruption of eating behaviour and alteration of food intake. Leptin, is one of the main hormones that modulate food intake and are altered in individuals diagnosed with ED. Genetic risk variants for obesity, like those reported inFTO and ABCA1, have also been associated to ED disorders. The present study aimed to analysed leptin circulating levels and the interaction between obesity-risk variants in FTO and ABCA1, in adolescents diagnosed with ED. A total of 99 individuals diagnosed with ED were genotype using Taqman probes for FTO (rs9939609) and ABCA1 (p.Arg230Cys, rs9282541). Commercial enzyme-linked immunosorbent assays were utilized to determined circulating leptin. Differences in leptin concentration were analysed by t-Student or ANOVA test. Gene-gene interaction were analysed using general estimation equations. Circulating leptin levels differed between the three diagnostic groups, lead by individuals diagnosed with binge eating-disorder. In individuals with more than 3 of episodes of binge-eating per week having the highest leptin levels. Also, we found that carriers of both risk alleles had the highest leptin levels. Our observations found an interaction between FTO rs9969609 and the native American-origin ABCA1 p.Arg230Cys to modulate circulating leptin levels in Mexican adolescents diagnosed with eating-disorders.
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Affiliation(s)
- Alma Delia Genis-Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, CDMX, México; Hospital Psiquiátrico Infantil "Juan N. Navarro" Servicios de Administración Psiquiátrica, CDMX, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México.
| | - José Jaime Martínez-Magaña
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, CDMX, México; División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - David Ruiz-Ramos
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, CDMX, México; División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Vanessa Gonzalez-Covarrubias
- Laboratorio de Farmacogenómica, Instituto Nacional de Medicina Genómica, CDMX, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Carlos Alfonso Tovilla-Zarate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Mari Lilia López Narvaez
- Hospital General de Yajalón Dr. Manuel Velasco Siles. Secretaria de Salud de Chiapas. Yajalón, Chiapas, Mexico; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Thelma Beatriz Gonzalez Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Isela Esther Juárez-Rojop
- Hospital General de Yajalón Dr. Manuel Velasco Siles. Secretaria de Salud de Chiapas. Yajalón, Chiapas, Mexico; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | - Humberto Nicolini
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, CDMX, México; División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México; Grupo de Estudios Médicos y Familiares Carracci, CDMX, México.
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Himmerich H, Kan C, Au K, Treasure J. Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences. Pharmacol Ther 2020; 217:107667. [PMID: 32858054 DOI: 10.1016/j.pharmthera.2020.107667] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
| | - Carol Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
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Harrer M, Adam SH, Messner EM, Baumeister H, Cuijpers P, Bruffaerts R, Auerbach RP, Kessler RC, Jacobi C, Taylor CB, Ebert DD. Prevention of eating disorders at universities: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:813-833. [PMID: 31943298 DOI: 10.1002/eat.23224] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Eating problems are highly prevalent among young adults. Universities could be an optimal setting to prevent the onset of eating disorders through psychological intervention. As part of the World Mental Health-International College Student initiative, this systematic review and meta-analysis synthesizes data on the efficacy of eating disorder prevention programs targeting university students. METHOD A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, PsycINFO) for randomized trials comparing psychological preventive interventions for eating disorders targeting university students with psychoeducation or inactive controls was performed on October 22, 2019. RESULTS Twenty-seven studies were included. Thirteen (48.1%) were rated to have a low risk of bias. The relative risk of developing a subthreshold or full-blown eating disorder was incidence rate ratio = 0.62 (95% CI [0.44, 0.87], n c = 8, numbers-needed-to-treat [NNT] = 26.08; standardized clinical interviews only), indicating a 38% decrease in incidence in the intervention groups compared to controls. Small to moderate between-group effects at posttest were found on eating disorder symptoms (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, n c = 26), dieting (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, n c = 21), body dissatisfaction (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, n c = 25), drive for thinness (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, n c = 12), weight concerns (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, n c = 13), and affective symptoms (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, n c = 18). The effects on bulimia nervosa symptoms were not significant. Heterogeneity was moderate across comparisons. DISCUSSION Eating disorder prevention on campus can have significant, small-to-moderate effects on eating disorder symptoms and risk factors. Results also suggest that the prevention of subthreshold and full-syndrome eating disorders is feasible using such interventions. More research is needed to identify ways to motivate students to use preventive eating disorder interventions. ANTECEDENTES Los trastornos de la conducta alimentaria son altamente prevalentes entre los adultos jóvenes. Las universidades podrían ser un entorno óptimo para prevenir la aparición de trastornos alimentarios a través de la intervención psicológica. Como parte de la iniciativa World Mental Health-International College Student, esta revisión sistemática y meta-análisis sintetiza datos sobre la eficacia de los programas de prevención de trastornos alimentarios dirigidos a estudiantes universitarios. MÉTODO: Una búsqueda bibliográfica sistemática de datos bibliográficas (CENTRAL, MEDLINE, PsycINFO) para ensayos aleatorios que comparaban intervenciones preventivas psicológicas para trastornos alimentarios dirigidos a estudiantes universitarios con psicoeducación o controles inactivos fue realizada hasta el 22 de octubre de 2019. RESULTADOS Se incluyeron 27 estudios. Trece (48,1%) fueron calificados como de bajo riesgo de sesgo. El riesgo relativo de desarrollar un trastorno de la conducta alimentaria subclínico (parcial) o completo fue IRR = 0.62 (95% CI [0.44, 0.87], nc = 8, NNT = 26.08; sólo entrevistas clínicas estandarizadas), lo que indica una disminución del 38% en la incidencia en los grupos de intervención en comparación con los controles. Se encontraron efectos pequeños a moderados entre los grupos en la post-prueba en los síntomas del trastorno alimentario (g = 0.35, 95% CI [0.24, 0.46], NNT = 5.10, nc = 26), dieta (g = 0.43, 95% CI [0.29, 0.57], NNT = 4.17, nc = 21), insatisfacción corporal (g = 0.40, 95% CI [0.27, 0.53], NNT = 4.48, nc = 25), impulso por delgadez (g = 0.43, 95% CI [0.27, 0.59], NNT = 4.23, nc = 12), problemas de peso (g = 0.33, 95% CI [0.10, 0.57], NNT = 5.35, nc = 13) y síntomas afectivos (g = 0.27, 95% CI [0.15, 0.38], NNT = 6.70, nc = 18). Los efectos sobre los síntomas de la bulimia nervosa no fueron significativos. La heterogeneidad fue moderada en las comparaciones. DISCUSIÓN: La prevención de los trastornos de la conducta alimentaria en el campus universitario puede tener efectos significativos, de pequeños a moderados, sobre los síntomas del trastorno alimentario y los factores de riesgo. Los resultados también sugieren que la prevención de los trastornos alimentarios subclínicos o parciales y síndromes completos es factible utilizando tales intervenciones. Se necesita más investigación para identificar formas de motivar a los estudiantes a usar intervenciones preventivas para los trastornos de la conducta alimentaria.
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Affiliation(s)
- Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sophia H Adam
- Psychotherapeutische Praxengemeinschaft Handschuhsheim, Heidelberg, Germany
| | - Eva-Maria Messner
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, New York
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Craig Barr Taylor
- Department of Psychiatry, Stanford University Medical Center, Stanford, California
| | - David D Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Pertuz-Cortes C, Navarro-Jiménez E, Laborde-Cárdenas C, Gómez-Méndez P, Lasprilla-Fawcett S. Implementation of clinical practice guidelines for the timely detection and diagnosis of eating disorders in adolescents and adults in the outpatient and priority department of a public psychiatric hospital in Colombia. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:102-108. [PMID: 32446416 DOI: 10.1016/j.rcp.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/18/2018] [Accepted: 05/28/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To implement clinical practice guidelines (CPGs) for the timely detection and diagnosis of eating disorders in adolescents and adults in the priority outpatient department of a public psychiatric hospital in Barranquilla, Colombia. Barriers to access to the implemented guidelines were identified. METHODS For the identification of evidence-based CPGs to be implemented, systematic searches were carried out in international databases of development agencies or compilers of clinical practice guidelines, and in databases that contained scientific literature on issues related to eating disorders. CONCLUSIONS The two guidelines shortlisted for the final selection by consensus of a multidisciplinary team at the hospital were the "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders" and the "Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya", the latter being finally chosen by consensus. There are not yet CPGs implemented for health professionals in the priority outpatient department of Colombian hospitals for eating disorders.
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Affiliation(s)
| | | | | | - Pedro Gómez-Méndez
- Facultad de Ciencias de la Salud, Universidad del Norte, Barranquilla, Colombia
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Disordered eating behaviors in adolescents with celiac disease. Eat Weight Disord 2020; 25:365-371. [PMID: 30368766 DOI: 10.1007/s40519-018-0605-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 10/21/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Celiac disease (CD) is a chronic immune-mediated systemic disease characterized by inflammation and villous atrophy of the small intestine. A strict, lifelong gluten-free diet (GFD) is the only treatment for CD. Disordered eating behaviors (DEBs) prevail in adolescence and young adulthood, and confer a risk of developing into full-blown eating disorders. The aims of the current study were to assess the incidence and risk factors for DEBs among individuals with CD, and to examine an association between adherence to GFD and DEBs. METHODS A cohort of 136 individuals with CD responded to a web-mediated survey that assessed DEBs and adherence to a GFD. The survey included demographic data (gender, age, weight, disease duration) and two self-rating questionnaires: the Eating Attitudes Test-26 and the gluten-free diet questionnaire. RESULTS DEBs were found in 19% of female and 7% of male responders. These individuals were characterized by being overweight (p = 0.02), of an older age (p = 0.04) and female sex (p = 0.06). Strict adherence to a GFD was reported by 32% of the responders and was not correlated with age, disease duration, age at diagnosis of CD and with being overweight. CONCLUSIONS Caregivers should be aware of the increased occurrence of DEBs in adolescents with CD, especially those who are overweight, older and of a female gender. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Dunbar EMP, Tortolani C, Donaldson A, DerMarderosian D, Rickerby M, Goldschmidt AB. Disseminating Education and Treatment for Children and Adolescents with Eating Disorders Across Levels of Care. RHODE ISLAND MEDICAL JOURNAL (2013) 2020; 103:36-39. [PMID: 32122099 PMCID: PMC7081153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Eating disorders (EDs) are psychiatric illnesses with high rates of morbidity and mortality. Healthcare providers often receive inadequate training in evidence-based ED assessment and treatment. DESIGN Project CORE (Creating Opportunities for Rhode Island Eating Disorders Professionals) was developed to disseminate ED training/education and treatment approaches to the healthcare workforce. An interdisciplinary research team partners with pediatric healthcare professionals/trainees and supports them to better understand how to diagnose, manage, and collaborate across disciplines in the care of patients with EDs. METHODS Phase I involves a needs assessment of pediatric healthcare professionals' knowledge, attitudes and needs in treating EDs. Phase II involves the development of training/education approaches, and therapeutic interventions for patients with EDs. In Phase III approaches/interventions are further developed and disseminated across RI. PRINCIPAL CONCLUSIONS Project CORE's goals will address barriers to effective ED treatment in RI and broaden the workforce of interdisciplinary providers trained to recognize and treat patients with EDs across multiple healthcare settings.
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Affiliation(s)
| | - Christina Tortolani
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island College, Providence, RI, USA
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Bizri M, Geagea L, Kobeissy F, Talih F. Prevalence of Eating Disorders Among Medical Students in a Lebanese Medical School: A Cross-Sectional Study. Neuropsychiatr Dis Treat 2020; 16:1879-1887. [PMID: 32801721 PMCID: PMC7414930 DOI: 10.2147/ndt.s266241] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Eating disorders are among the most severe psychiatric disorders. Medical students are subjected to high levels of stress and have a high risk of developing burnout and mental health problems, including eating disorders. Due to societal stigma and lack of awareness, it is plausible that disordered eating behaviors among students may go unrecognized and under-reported. The current study aimed to evaluate the prevalence and possible factors associated with eating disorders among medical students at the American University of Beirut in Lebanon (AUB). METHODS This cross-sectional descriptive study was conducted in 2017 at AUB. Electronic anonymous surveys were sent to all 412 medical students, with a mean age of 23, enrolled in our four-year medical school. In addition to demographic data, students were asked to complete two validated questionnaires, the SCOFF and EAT-26, to assess eating disorders risk. RESULTS Total responses were 156, out of which 124 completed the whole survey. A total of 131 participants completed the Eat-26 questionnaire and 124 participants completed the SCOFF questionnaire. Out of those, 17% on EAT-26 and 19% on SCOFF were found to be at high risk of developing eating disorders. CONCLUSION There seems to be a high level of underrecognized and under-treated disordered eating behaviors among female medical students at AUB. Raising awareness among medical students is important, as well as developing better prevention and treatment strategies.
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Affiliation(s)
- Maya Bizri
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Luna Geagea
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Kobeissy
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farid Talih
- American University of Beirut Medical Center, Beirut, Lebanon
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Colledge F, Cody R, Pühse U, Gerber M. Responses of fitness center employees to cases of suspected eating disorders or excessive exercise. J Eat Disord 2020; 8:8. [PMID: 32140227 PMCID: PMC7050120 DOI: 10.1186/s40337-020-0284-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While exercise and physical activity are important parts of a healthy life, there is evidence that some individuals exercise to a degree which may jeopardize their health. These individuals may in some cases be exercising to lose weight or compensate binge eating episodes as part of an eating disorder. Others may experience an addiction-like relationship with exercise. Fitness center employees are ideally placed to observe these forms of unhealthy behavior, and are responsible for ensuring that clients do not put themselves at undue risk; however, to date, no study has addressed both eating disorders and excessive exercise. Therefore, the aim of our study is to determine whether these employees report incidences of these issues, and if they believe they can differentiate between them. METHODS One-hundred-and-forty fitness centers in the German-speaking regions of Switzerland were contacted. Of these, 99 employees (60 men, 39 women, Mage = 33.33 years, SD = 12.02) responded to an online questionnaire. The questionnaire briefly described the two issues of interest (eating disorders and excessive exercise), and then invited respondents to complete a number of questions detailing whether they had experience with these issues, and how they dealt with them. RESULTS Approximately 75% of the employees had suspected a client of having an eating disorder or exercising excessively, and 65% of these respondents confronted the client at least once. Interestingly, respondents reported clearly that they felt able to differentiate between the two types of disorder. Older respondents were significantly more likely to have suspicions and act on them. However, less than half of the respondents were aware of guidelines addressing this issue, and the majority desired more information about how to identify and address both disorders. CONCLUSIONS Swiss fitness center employees frequently encounter individuals who they suspect of exercising excessively, or suffering from an eating disorder. While they often confront these individuals, they would like more detailed information about how to manage this process. Given that both disorders can potentially lead to severe health consequences, a detailed description of symptoms, management techniques and resources should be a feature in all Swiss fitness center guidelines.
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Affiliation(s)
- Flora Colledge
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320b, 4052 Basel, Switzerland
| | - Robyn Cody
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320b, 4052 Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320b, 4052 Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320b, 4052 Basel, Switzerland
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Tavolacci MP, Gillibert A, Zhu Soubise A, Grigioni S, Déchelotte P. Screening four broad categories of eating disorders: suitability of a clinical algorithm adapted from the SCOFF questionnaire. BMC Psychiatry 2019; 19:366. [PMID: 31752796 PMCID: PMC6868823 DOI: 10.1186/s12888-019-2338-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We evaluated the performance of a clinical algorithm (Expali™), combining two or more positive answers to SCOFF questionnaire with Body Mass Index (BMI), to identify four Broad Categories of eating disorders (ED) derived from DSM-5. METHODS The clinical algorithm (Expali™) was developed from 104 combinations of BMI levels and answers to five SCOFF questions with at least two positive answers. Two senior ED physicians allocated each combination to one of the four Broad Categories of ED derived from DSM-5: restrictive disorder, bulimic disorder, hyperphagic disorder and other unspecified ED diagnosed by ED clinicians. The performance of Expali™ was evaluated on data from 206 patients with ED. Sensitivity, specificity values and Youden index were calculated for each category. RESULTS The 206 patients were diagnosed as follows: 31.5% restrictive disorder, 18.9% bulimic disorder, 40.8% hyperphagic disorder and 8.8% other ED. The sensitivity of Expali™ for restrictive, bulimic, hyperphagic and other unspecified ED were respectively: 76.9, 69.2, 79.7 and 16.7%. The Youden index was respectively 0.73, 0.57, 0.67 and 0.07. CONCLUSIONS In a SCOFF-positive ED population (at least two positive answers), the clinical algorithm Expali™ demonstrated good suitability by correctly classifying three of the four Broad Categories of eating disorders (restrictive, bulimic and hyperphagic disorder). It could be useful both to healthcare professionals and the general population to enable earlier detection and treatment of ED and to improve patient outcomes.
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Affiliation(s)
- Marie-Pierre Tavolacci
- Normandie Univ, UNIROUEN, U1073, Rouen University Hospital, Clinical Investigation Center 1404, F-76000, Rouen, France.
| | - André Gillibert
- grid.41724.34Rouen University Hospital, Clinical Investigation Center 1404, F-76000 Rouen, France
| | - Aurélien Zhu Soubise
- grid.41724.34Rouen University Hospital, Clinical Investigation Center 1404, F-76000 Rouen, France
| | - Sébastien Grigioni
- grid.41724.34Department of Nutrition, Normandie Univ, UNIROUEN, U1073, Rouen University Hospital, F-76000 Rouen, France
| | - Pierre Déchelotte
- grid.41724.34Department of Nutrition, Normandie Univ, UNIROUEN, U1073, Rouen University Hospital, F-76000 Rouen, France
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Russon J, Mensinger J, Herres J, Shearer A, Vaughan K, Wang SB, Diamond GS. Identifying Risk Factors for Disordered Eating among Female Youth in Primary Care. Child Psychiatry Hum Dev 2019; 50:727-737. [PMID: 30847634 DOI: 10.1007/s10578-019-00875-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14-24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.
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Affiliation(s)
- Jody Russon
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, USA.
| | - Janell Mensinger
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Joanna Herres
- Psychology Department, The College of New Jersey, Jersey City, NJ, USA
| | - Annie Shearer
- School of Medicine, University of Pittsburgh, Pittsburg, PA, USA
| | - Katherine Vaughan
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Shirley B Wang
- Psychology Department, The College of New Jersey, Jersey City, NJ, USA
| | - Guy S Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
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Miri N, Noroozi M, Zavoshy R, Ezzeddin N. The Association of Body Image With Anthropometric Measures and Eating Disorders Among Students From University Sports Teams. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2019. [DOI: 10.15171/ijer.2019.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and aims: Body image is defined as a complex concept involving a person’s thoughts, feelings, and attitudes about his/her body. The body image dissatisfaction may expose the individuals, specifically athletes, to eating disorders (EDs). The aim of this study is to assess the association of body image score with EDs and anthropometric measures in students from university sports teams. Methods: This cross-sectional study was carried out on 225 students from sports teams of Qazvin University in 2014. The samples were selected by the census method. The Multidimensional BodySelf Relations Questionnaire (MBSRQ), eating attitudes test (EAT-26) questionnaire, and demographic information questionnaire were used for collecting data. Anthropometric characteristics were also measured. The data were analyzed in SPSS software version 22.0. Results: The result of the study showed that the association of body image score with age (P=0.012, OR=0.80, CI=0.179, 1.437) and waist-to-height ratio (WHtR) (P=0.013, OR=-52.14, CI=-93.20, -11.08) was positively significant. Although the mean body image score was lower in students with EDs, it was not statistically significant. In addition, there was not a significant association between body image score and other variables such as marital status, gender, educational level, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and hip circumference (HC) (P>0.05). Conclusion: In this study, the body image had a positive significant association with age, and a negative significant one with WHtR. This may indicate that abdominal obesity plays an important role in body image satisfaction among students from the university sports teams.
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Affiliation(s)
- Nastaran Miri
- Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mostafa Noroozi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rosa Zavoshy
- Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Neda Ezzeddin
- Department of Community Nutrition, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Eating disorders risk among medical students: a global systematic review and meta-analysis. Eat Weight Disord 2019; 24:397-410. [PMID: 29785631 DOI: 10.1007/s40519-018-0516-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/10/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Medical students appear to be a high-risk group to develop psychological problems including eating disorders (ED). The prevalence estimates of ED risk vary greatly between studies. This systematic review and meta-analysis was done to estimate the prevalence of ED risk among medical students. METHODS An electronic search of EMBASE, MEDLINE, ProQuest and Google Scholar was conducted. Studies that reported the prevalence of ED risk among medical students and were published in English peer-reviewed journals between 1982 and 2017 were included. Information about study characteristics and the prevalence of ED risk were extracted by four investigators. Each article was reviewed independently by at least two investigators. Estimates were pooled using random-effects meta-analysis using the DerSimonian-Laird method. The main outcome of interest was the prevalence of ED risk in medical students. RESULTS The prevalence of ED risk among medical students was extracted from nineteen cross-sectional studies across nine countries (total participants n = 5722). The overall pooled prevalence rate of ED risk was 10.4% (497/5722 students, 95% CI 7.8-13.0%), with statistically significant evidence between-study heterogeneity (Q = 295, τ2 = 0.003, I2 = 94.0%, P < 0.001). Prevalence estimates between studies ranged from 2.2 to 29.1%. CONCLUSION In this systematic review and meta-analysis, the summary prevalence of ED risk among medical students was 10.4%. Further research is needed to identify and prevent ED in this population. Studies are also needed to investigate concurrent pathologies associated with ED risk. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Stopyra MA, Simon JJ, Skunde M, Walther S, Bendszus M, Herzog W, Friederich HC. Altered functional connectivity in binge eating disorder and bulimia nervosa: A resting-state fMRI study. Brain Behav 2019; 9:e01207. [PMID: 30644179 PMCID: PMC6379643 DOI: 10.1002/brb3.1207] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The etiology of bulimic-type eating (BTE) disorders such as binge eating disorder (BED) and bulimia nervosa (BN) is still largely unknown. Brain networks subserving the processing of rewards, emotions, and cognitive control seem to play a crucial role in the development and maintenance of eating disorders. Therefore, further investigations into the neurobiological underpinnings are needed to discern abnormal connectivity patterns in BTE disorders. METHODS The present study aimed to investigate functional as well as seed-based connectivity within well-defined brain networks. Twenty-seven individuals with BED, 29 individuals with BN, 28 overweight, and 30 normal-weight control participants matched by age, gender, and education underwent resting-state functional magnetic resonance imaging. Functional connectivity was assessed by spatial group independent component analysis and a seed-based correlation approach by examining the default mode network (DMN), salience network (SN), and executive network (EN). RESULTS Group comparisons revealed that BTE disorder patients exhibit aberrant functional connectivity in the dorsal anterior cingulate cortex (dACC) within the SN, as well as in the medial prefrontal cortex within the DMN. Furthermore, BED and BN groups differed from each other in functional connectivity within each network. Seed-based correlational analysis revealed stronger synchronous dACC-retrosplenial cortex activity in the BN group. CONCLUSION Our findings demonstrate abnormalities in brain networks involved in salience attribution, self-referential processing, and cognitive control in bulimic-type eating disorders. Together with our observation of functional connectivity differences between BED and BN, this study offers a differentiated account of both similarities and differences regarding brain connectivity in BED and BN.
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Affiliation(s)
- Marion A Stopyra
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Psychological Institute, Heidelberg University, Heidelberg, Germany
| | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Mandy Skunde
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Walther
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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The Role of Ghrelin in Anorexia Nervosa. Int J Mol Sci 2018; 19:ijms19072117. [PMID: 30037011 PMCID: PMC6073411 DOI: 10.3390/ijms19072117] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022] Open
Abstract
Ghrelin, a 28-amino acid peptide hormone expressed in X/A-like endocrine cells of the stomach, is the only known peripherally produced and centrally acting peptide that stimulates food intake and therefore attracted a lot of attention with one major focus on the treatment of conditions where an increased energy intake or body weight gain is desired. Anorexia nervosa is an eating disorder characterized by a pronounced reduction of body weight, a disturbed body image and hormonal alterations. Ghrelin signaling has been thoroughly investigated under conditions of anorexia nervosa. The present review will highlight these alterations of ghrelin in anorexia and discuss possible treatment strategies targeting ghrelin signaling. Lastly, gaps in knowledge will be mentioned to foster future research.
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Choi JW, Kwon SK, Kim SM, Cho H, Lee HC, Kim HY. Interstitial Nephritis Caused by Anorexia Nervosa in Young Male; A Case Report and Literature Review. Electrolyte Blood Press 2018; 16:15-17. [PMID: 30046330 PMCID: PMC6051943 DOI: 10.5049/ebp.2018.16.1.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022] Open
Abstract
Severe eating disorders characterized by repetitive episodes of purging and vomiting can occasionally trigger acute kidney injury. However, interstitial nephritis induced by episodes of repeated vomiting has rarely been reported, and the pathophysiology of this entity remains unknown. A 26-year-old man was admitted to our hospital because of known hypokalemia. His serum electrolyte profile showed: sodium 133 mEq/L, potassium 2.6 mEq/L, chloride 72 mEq/L, total carbon dioxide 50 mEq/L, blood urea nitrogen/creatinine ratio (BUN/Cr) 21.9/1.98 mg/dL, and magnesium 2.0 mg/dL. Arterial blood gas analysis showed: pH 7.557, partial pressure of carbon dioxide 65.8 mmHg, and bicarbonate 58.5 mEq/L. His urinary potassium concentration was 73.2 mEq/L, and Cr was 111 mg/dL. Renal biopsy revealed acute tubular necrosis and tubulointerstitial nephritis with a few shrunken glomeruli. Repeated psychogenic vomiting may precipitate acute kidney injury and interstitial nephritis secondary to volume depletion and hypokalemia. Serum electrolyte levels and renal function should be carefully monitored in patients diagnosed with eating disorders to prevent tubular ischemia and interstitial nephritis.
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Affiliation(s)
- Ji Wook Choi
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Soon Kil Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sun Moon Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyunjeong Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ho-Chang Lee
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hye-Young Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Stevenson BL, Kwan MY, Dvorak RD, Gordon KH. Empirically derived classes of eating pathology in male and female college students. Eat Disord 2018; 26:200-211. [PMID: 29035152 DOI: 10.1080/10640266.2017.1378525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The empirical structure of eating disorder (ED) pathology has often been studied in female, clinical samples, leaving questions about the structure of ED pathology in males and nonclinical samples. METHOD A latent class analysis was performed on data combined from two different studies (N = 1,751) using the behavioral items in the Eating Disorder Examination Questionnaire (EDE-Q; binge eating, self-induced vomiting, laxative use, and excessive exercise), with the addition of an item representing restraint. Validation analyses examined weight, shape, and eating concern among the classes. RESULTS Three similar classes emerged for both the men and women's models: very low ED behaviors, binge eating, and high ED behaviors. DISCUSSION These results suggest that binge eating occurs within the context of lower symptom and higher symptom presentations, and that the empirical structure of ED symptoms does not differ in men and women in the nonclinical population. Further research is needed to clarify whether ED phenotypes differ in men and women.
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Affiliation(s)
| | - Mun Yee Kwan
- b Department of Psychology, North Dakota State University , Fargo , ND , USA
| | - Robert D Dvorak
- a Department of Psychology, University of Central Florida , Orlando , FL , USA
| | - Kathryn H Gordon
- b Department of Psychology, North Dakota State University , Fargo , ND , USA
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Lee ES, Ohk TG, Lee WW, Park SM, Ahn JY, Sohn YD, Ahn HC. A Death Case of Bulimia Nervosa Presented with Abdominal Distention. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bulimia nervosa is one of the eating disorders. Psychological manifestations of this disease, such as guilt or denial, may interfere with patient communication. The patients with bulimia nervosa are most commonly between ages of 17 and 25 years old, and often maintain normal body weight. It is not easy to screen out and diagnose bulimia nervosa patients at the emergency department. We reported two bulimia nervosa patients who visited our emergency department with abdominal distension, and one of them died of abdominal compartment syndrome. We confirmed collapse of the abdominal aorta and key arteries in enhanced abdominal computed tomography. Promptly, we performed gastrostomy for reduction of abdominal pressure, but she finally succumbed due to multiple organ failure 12 hours after the surgery.
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Patterns of medical utilization before the first hospitalization for women with anorexia nervosa in Taiwan. J Psychosom Res 2017; 102:1-7. [PMID: 28992891 DOI: 10.1016/j.jpsychores.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan. METHOD We selected female anorexia nervosa patients (n=239) and control participants hospitalized for peptic ulcers (n=478) or appendectomy (n=478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed. RESULTS Compared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6±45.0 visits; peptic ulcers, 45.3±37.3 visits; appendectomy, 32.5±26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency. CONCLUSIONS We posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted.
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Barron LJ, Barron RF, Johnson JCS, Wagner I, Ward CJB, Ward SRB, Barron FM, Ward WK. A retrospective analysis of biochemical and haematological parameters in patients with eating disorders. J Eat Disord 2017; 5:32. [PMID: 29026589 PMCID: PMC5623971 DOI: 10.1186/s40337-017-0158-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/08/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The objective of the study was to determine whether levels of biochemical and haematological parameters in patients with eating disorders (EDs) varied from the general population. Whilst dietary restrictions can lead to nutritional deficiencies, specific abnormalities may be relevant to the diagnosis, pathogenesis and treatment of EDs. METHODS With ethics approval and informed consent, a retrospective chart audit was conducted of 113 patients with EDs at a general practice in Brisbane, Australia. This was analysed first as a total group (TG) and then in 4 ED subgroups: Anorexia nervosa (AN), Bulimia nervosa (BN), ED Not Otherwise Specified (EDNOS), and AN/BN. Eighteen parameters were assessed at or near first presentation: cholesterol, folate, vitamin B12, magnesium, manganese, zinc, calcium, potassium, urate, sodium, albumin, phosphate, ferritin, vitamin D, white cell count, neutrophils, red cell count and platelets. Results were analysed using IBM SPSS 21 and Microsoft Excel 2013 by two-tailed, one-sample t-tests (TG and 4 subgroups) and chi-square tests (TG only) and compared to the population mean standards. Results for the TG and each subgroup individually were then compared with the known reference interval (RI). RESULTS For the total sample, t-tests showed significant differences for all parameters (p < 0.05) except cholesterol. Most parameters gave results below population levels, but folate, phosphate, albumin, calcium and vitamin B12 were above. More patients than expected were below the RI for most parameters in the TG and subgroups. CONCLUSIONS At diagnosis, in patients with EDs, there are often significant differences in multiple haematological and biochemical parameters. Early identification of these abnormalities may provide additional avenues of ED treatment through supplementation and dietary guidance, and may be used to reinforce negative impacts on health caused by the ED to the patient, their family and their treatment team (general practitioner, dietitian and mental health professionals). Study data would support routine measurement of a full blood count and electrolytes, phosphate, magnesium, liver function tests, ferritin, vitamin B12, red cell folate, vitamin D, manganese and zinc for all patients at first presentation with an ED.
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Affiliation(s)
- Leanne J. Barron
- Brisbane City Doctors Medical Practice, Brisbane, QLD Australia
- Eating Disorders Multidisciplinary Clinic, Queensland University of Technology, Brisbane, QLD Australia
| | - Robert F. Barron
- Riverina-Murray Institute of Higher Education, Wagga Wagga, NSW Australia
| | | | - Ingrid Wagner
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD Australia
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
| | - Cameron J. B. Ward
- Lady Cilento Children’s Hospital, Brisbane, QLD Australia
- University of Queensland, Brisbane, QLD Australia
- Mater Medical Research Institute, Brisbane, Australia
- Queensland Paediatric Cardiac Research Group, Queensland, Australia
| | | | | | - Warren K. Ward
- Eating Disorders Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
- School of Medicine, University of Queensland, Brisbane, QLD Australia
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Identification and Management of Eating Disorders in Integrated Primary Care: Recommendations for Psychologists in Integrated Care Settings. J Clin Psychol Med Settings 2017; 24:163-177. [DOI: 10.1007/s10880-017-9497-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Knowledge, Attitudes and Challenges of Healthcare Professionals Managing People With Eating Disorders: A Literature Review. Arch Psychiatr Nurs 2017; 31:125-136. [PMID: 28104050 DOI: 10.1016/j.apnu.2016.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/04/2016] [Accepted: 09/04/2016] [Indexed: 11/23/2022]
Abstract
This review consolidates findings regarding knowledge and attitudes of healthcare professionals, together with challenges faced while caring for patients with eating disorders. A rigorous and systematic approach was taken to identify 21 articles, which include 12 quantitative, 7 qualitative, and 2 mixed-method papers. Healthcare professionals' knowledge and attitudes toward patients with eating disorders will be discussed, while identifying if factors like age, gender, work experience or profession have an impact on these two variables. Challenges faced during care provision will also be examined. Methodological limitations and knowledge gaps from these articles will be discussed, together with implications of this review.
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Solmi F, Hotopf M, Hatch SL, Treasure J, Micali N. Eating disorders in a multi-ethnic inner-city UK sample: prevalence, comorbidity and service use. Soc Psychiatry Psychiatr Epidemiol 2016; 51:369-81. [PMID: 26631229 DOI: 10.1007/s00127-015-1146-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE No studies have investigated the prevalence of eating disorders (ED) according to DSM-5 criteria and few have explored their comorbidity and service use in the general population in the UK. We aimed to estimate the prevalence, comorbidity, and service use in individuals with ED in a multi-ethnic inner city sample. METHODS A total of 1698 individuals (age 16/90) were screened for ED in the first phase of the South East London Community Health Study and 145 were followed up with a diagnostic interview. Data was weighed for survey design and Chi Square tests were used to investigate socio-demographic distribution, comorbidity and service use in participants with ED. RESULTS The point prevalence of ED was 4.4 % (Binge Eating Disorder (BED) 3.6 %; Bulimia Nervosa (BN) 0.8 %) and 7.4 % when including sub-threshold diagnoses (Purging Disorder (PD) 0.6 %; Other Specified Feeding and Eating Disorders (OSFED) 2.4 %). No cases of AN were identified. Purging Disorder was the ED with the highest proportion of comorbid disorders. A minority of participants with ED had accessed specialist care services. CONCLUSIONS ED are common, the comorbidity of ED was in line with previous studies and no ethnic differences were identified. Although PD is not a full diagnosis in DSM-5, we found some evidence of high comorbidity with other disorders, that needs to be replicated using larger samples. Service use was low across ED diagnoses, despite high levels of comorbidity.
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Affiliation(s)
- F Solmi
- Behavioural and Brain Science Unit, Institute of Child Health, University College London, London, UK.
- Division of Psychiatry, University College London, Gower Street, London, UK.
| | - M Hotopf
- Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - S L Hatch
- Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - J Treasure
- Eating Disorders Department, Institute of Psychiatry, King's College London, London, UK
| | - N Micali
- Behavioural and Brain Science Unit, Institute of Child Health, University College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
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Savuskoski M, Uusiautti S, Määttä K. From fear of eating to appetite for life: food and eating in an anorectic mind. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2016. [DOI: 10.1080/02673843.2012.709175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Brownlow RS, Maguire S, O'Dell A, Dias-da-Costa C, Touyz S, Russell J. Evaluation of an online training program in eating disorders for health professionals in Australia. J Eat Disord 2015; 3:37. [PMID: 26550477 PMCID: PMC4636783 DOI: 10.1186/s40337-015-0078-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early detection and treatment of eating disorders is instrumental in positive health outcomes for this serious public health concern. As such, workforce development in screening, diagnosis and early treatment of eating disorders is needed. Research has demonstrated both high rates of failure to accurately diagnose and treat cases early and low levels of perceived access to training in eating disorders by health professionals-representing an urgent need for clinician training in this area. However, significant barriers to the access of evidence-based training programs exist, including availability, cost and time, particularly when large geographic distances are involved. Online learning presents a solution to workforce challenges, as it can be delivered anywhere, at a fraction of the cost of traditional training, timing is user controlled, and a growing body of research is demonstrating it as effective as face-to-face training. The Centre for Eating and Dieting Disorders in Australia has developed an Online Training Program In Eating Disorders, to educate health professionals in the nature, identification, assessment and management of eating disorders. The aim of the current study was to evaluate the ability of this online learning course to improve clinician levels of knowledge, skill and confidence to treat eating disorders. As well as its effect on stigmatised beliefs about eating disorders known to effect treatment delivery. METHODS One-hundred-eighty-seven health professionals participated in the program. A pre training questionnaire and a post training evaluation examined participants' levels of knowledge, skill and confidence to treat eating disorders, as well attitudes and beliefs about people with eating disorders. RESULTS Significant improvements in knowledge, skill, and confidence to treat eating disorders was found between pre and post program assessment in health professionals who completed the course, along with a significant decrease in stigmatised beliefs about eating disorders. DISCUSSION The results of this study demonstrated that the online training program was an effective tool in increasing health professionals' level of knowledge, skill and confidence to treat people with eating disorders. The results also demonstrated that online training reduced health professionals' personal bias towards people with eating disorders. Limitations of this study include the use of self-report measures rather than observation of the health professional in clinical practice. As a result, it is not possible to make determinations regarding the translation of these results to clinical settings. CONCLUSIONS The findings of this study suggest that online training programs may present an innovative solution to the considerable workforce development challenges faced by clinicians needing training in eating disorders.
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Affiliation(s)
| | | | - Adrienne O'Dell
- The Centre for Eating and Dieting Disorders, Sydney, NSW Australia
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Abstract
Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.
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Affiliation(s)
- Kenisha Campbell
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecka Peebles
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Experience of an eating disorders out-patient program in an internal medicine hospital. Eat Weight Disord 2013; 18:429-35. [PMID: 24097344 DOI: 10.1007/s40519-013-0073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. METHODS A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. RESULTS After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. CONCLUSIONS The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.
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