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Comorbidity of diabetes and eating disorders. Does diabetes control reflect disturbed eating behavior?

OBJECTIVE: This multicenter study was designed to explore the prevalence of clinical and subclinical eating disorders (EDs), the extent of intentional omission of insulin and oral antidiabetic agents, and its relationship to glycemic control in an inpatient and outpatient population of men and women with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Data have been collected from 12 diabetes medical centers in two German cities. In a questionnaire and interview-based study, a sample of male and female patients (n = 341 type 1, n = 322 type 2) was assessed for the following eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. For lack of interview data of several patients meeting the screening criteria, prevalence ranges were calculated. RESULTS: The overall prevalence range of current EDs was 5.9-8.0% (lifetime prevalence 10.3-14.0%). When patients were stratified according to type 1 and type 2 diabetes, there was no difference in prevalence of EDs. However, the distribution of the EDs was different in both types of diabetes, with a predominance of binge eating disorder in the type 2 diabetes sample. Type 1 (5.9%) and type 2 (2.2%) diabetic patients reported deliberate omission of hyperglycemic drugs (insulin or oral agents) in order to lose weight. Compared with control subjects, neither the presence of EDs nor insulin omission influenced diabetic control. CONCLUSIONS: There seems to be no difference in prevalence rates of EDs in both types of diabetes; however, distribution of EDs is different. The findings suggest that neither EDs nor insulin omission are necessarily associated with poor control of glycemia. Binge eating disorder seems to precede type 2 diabetes in most patients and could be one of the causes of obesity that often precedes type 2 diabetes.

Adolescent↗

[Risk assessment for eating disorders in a high school: a study based on the Eating Attitudes Test 26].

AIM: Disordered eating behaviours can lead to clinically evident and serious eating disorders (ED). Aim of this paper is to determine their extent among adolescents and to evaluate the associated characteristics. METHODS: All students of a high school (age 14-18) have been asked to fill up the Eating Attitudes Test (EAT-26) anonymously. EAT-26 is a self-reported questionnaire identifying subjects at risk for ED. This questionnaire included also an integrative section, aimed at investigating some ED-related variables (family composition, diet among relatives, social relationships, spare time activities, self-esteem). Collected data have been analyzed using EpiInfo6. RESULTS: The study involved all the 902 students of the school; 833 questionnaires have been distributed and 701 were collected (89.4% from girls, 10.3% from boys). The percentage of EAT-26 positive boys (i.e. scoring = or > 20) is 3%, while for girls is 13.7%. A positive test significantly correlates with low self-esteem (OR = 46.67, CI = 13.16-182.04), contentious relationships with the mother (OR = 2.20, CI = 1.12-4.29) and the father (OR=2.45, CI=1.24-4.80). No significant correlation has been found for being an only child, living in a single-parent family having limited/not having social relationships, having unsatisfactory social relationships, spending spare time mostly alone, watching TV more than 2 h per day. CONCLUSION: Our data suggest an increasing diffusion in the risk for ED among adolescents. Personal characteristics and behaviours related to this risk are good start points to program projects focusing on primary and secondary prevention of ED in high schools.

Adolescent↗

The relationship between binge eating severity and body fat in nonpurge binge eating women.

The relationship between binge eating severity, measured by caloric intake, and amount of body fat, measured by percent of body fat and body mass index (BMI) was examined in nonpurge binge eating women. Although there was a low, but significant, relationship between binge eating severity and BMI, the relationship was not significant between binge eating severity and percent of body fat. Age and weight cycling were the best predictors for percent of body fat, while weight cycling alone was the best predictor for BMI. It cannot be assumed that caloric intake during binge eating is the central cause of obesity in nonpurge binge eating women.

Adult↗

The impact of sexual and physical abuse on eating disordered and psychiatric symptoms: a comparison of eating disordered and psychiatric inpatients.

The authors compared rates of physical and sexual abuse in women with eating disorders (N = 102) and general psychiatric disorders (N = 49). Relationships between sexual abuse and severity of eating disordered and psychiatric symptoms were also examined. While high rates of sexual abuse were found in the eating disordered sample, these rates were not significantly higher than those found in the general psychiatric population. No relationship between a history of sexual abuse and severity of eating disordered symptoms was found. However, within the eating disordered group, sexually abuse subjects reported more severe psychiatric disturbances of an obsessive and phobic nature than nonabused subjects. These findings suggest that while sexually abusive experiences may be related to increased psychological distress, they do not serve to increase eating disordered symptomatology.

Adolescent↗

Onset of binge eating, dieting, obesity, and mood disorders among subjects seeking treatment for binge eating disorder.

Binge eating disorder (BED) identified in adulthood is often clinically associated with obesity and a lifetime history of affective disorders. Several authors have suggested that dieting may predispose individuals to binge eating which then may lead to obesity. However, few BED studies have examined the chronology of the onset of binge eating, dieting, obesity, and mood disorders. This study evaluated retrospective reports from 30 women participating in a BED treatment study. Although the majority of subjects in this adult sample were obese, initiation of binge eating behavior usually occurred during adolescence at a time when most subjects reported being of normal weight. Obesity developed several years after the age of onset of meeting BED criteria. Onset of binge eating usually predated that of dieting or major depressive disorder in the majority of subjects. The results support the importance of early intervention for binge eating.

Adolescent↗

Binge eating disorder and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic?

OBJECTIVE: The purpose of this paper is to explore the relationship between binge eating disorder (BED) and obesity. METHODS: Recent literature relating to the etiology, risk factors, pathophysiology, and treatment of binge eating disorder was reviewed. RESULTS: The data suggest that binge eating may be a contributor to the development of obesity in susceptible individuals. Although eating disorders treatment in the absence of obesity treatment does not result in large weight losses, amelioration of binge eating does result in small weight losses and decreased weight regain over time. DISCUSSION: Our challenge in the future is to understand better the ways in which BED and obesity co-exist, and to find treatment strategies that will relieve the distress and dysfunction due to this disordered eating while enhancing appropriate weight loss or preventing further weight gain.

Bulimia↗

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders.

OBJECTIVE AND METHOD: To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232). RESULTS: Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment. CONCLUSION: The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.

Adolescent↗

The effects of a monoclonal antibody to interferon-gamma on experimental autoimmune thyroiditis (EAT): prevention of disease and decrease of EAT-specific T cells.

CBA/J mice immunized with thyroglobulin (Tg) develop an experimental autoimmune thyroiditis (EAT) with lymphocytic infiltration of the thyroid glands, autoantibodies to Tg and occurrence of EAT-specific T cells. When these mice were treated for 4 weeks after immunization with 1 mg/week of a monoclonal antibody (mAb) that neutralizes the activity of interferon-gamma (IFN) a beneficial effect on the onset of EAT was observed. Characteristic features of EAT were significantly reduced, including the lymphocytic infiltrations of the thyroid glands and the serum levels of autoantibodies to Tg. Moreover, in lymphoid organs, mAb to IFN-gamma significantly reduced the percentages of Tg-specific CD8+ cells, labeled by the anti-clonotypic mAb AG7. These Tg-specific T cells seem responsible for thyroid damages and disease development, since EAT was simultaneously abrogated. These results show that IFN-gamma plays an essential role in the pathophysiology of EAT and suggest the possibility to treat autoimmune thyroid diseases with mAb to IFN-gamma or drugs able to antagonize the production and/or the action of this cytokine.

Animals↗

Eating attitudes and prevalence of eating disorders: a survey in secondary schools in Lecce, southern Italy.

Epidemiological studies on eating disorders in southern Italy are practically non-existent. This study evaluated the eating attitudes and the prevalence of eating disorders in a sample of 795 students (588 females and 207 males) among 6 secondary schools from Lecce. A two-stage study was conducted: a first screening stage followed by a clinical interview. 58.4% of girls and 19.7% of boys displayed dissatisfaction with regard to their own body. Current dieting was more prevalent in girls (18.7%) than in boys (4.8%); 17.9% of normal weight girls and 11.7% of underweight girls were on a restrictive diet; while only 2.5% of normal weight boys were on a diet. Point prevalence rates of eating disorders found in our sample were: 0.2% anorexia nervosa, 1.7% bulimia nervosa, and 4% eating disorders not otherwise specified category. Although southern Italians are stereotypically different from the northern Italians in terms of physical traits, historical, cultural and social backgrounds, the prevalence of eating disorders in southern Italian adolescent sample is surprisingly similar to those reported by the areas of both northern and central Italy as well as other western countries.

Adolescent↗

Factor structure of the Eating Attitudes Test (EAT) in a Turkish university sample.

OBJECTIVE: The primary purpose of this study was to compare the factor structure of the Eating Attitudes Test (EAT) in a sample of Turkish university students with both that of the original Canadian study and that of a Turkish study conducted ten years earlier. METHOD: The EAT 40 was administered to a sample of 270 female undergraduates at the Bogazici and Marmara universities in Istanbul, Turkey. RESULTS: The factor structure produced more closely resembled the original than did that of the study conducted ten years ago. Of particular note was the presence of a bulimia factor which had not emerged in the previous Turkish study, together with a new factor labelled "Ambivalence about Eating". DISCUSSION: Comparison of the two Turkish studies highlights the emergence of a bulimia factor not present ten years ago. This reflects clinical experience. Moreover the new Ambivalence about Eating factor is discussed in terms of the transitional nature of Turkish society and the role of a culture clash between traditional and westernized attitudes towards food. It is therefore predicted that the prevalence of eating disorders in Turkish culture will dramatically increase in the foreseeable future.

Adult↗

Eating attitudes and behaviors of pre- and postpubertal females: clues to the etiology of eating disorders.

Eating disorders are most likely to occur in females in early adolescence. In the hope of identifying the nature of the changes occurring across puberty which may predispose adolescents to eating disorders three groups, 30 prepubertal girls, 28 postpubertal girls, and 28 adult women matched on height and weight to the postpubertal group were compared for meal pattern characteristics and food intake regulation, as well as changes in eating attitudes and behaviors. They completed a set of psychometrics measuring their eating attitudes, body image, and disposition and also maintained 7-day diaries of everything they ingested, time of ingestion, and subjective and social conditions. Neither the overall intakes nor the meal sizes significantly differed between age groups. The prepubertal females ate the most relative to body weight, ate with more other people present and earlier in the day. They were relatively happy, calm, slightly hungry, unrestrained, satisfied with their bodies and depression was associated with lower intake. The postpubertal group, on the other hand, were relatively restrained, ate faster, and ate only 76.5% of the recommended amount. They had a more negative body image, greater dissatisfaction with their bodies, and greater restraint of eating than the prepubertal group, and depression was associated with higher intake. These changes may leave the young woman extremely vulnerable and under the appropriate conditions or with the appropriate personality type may lead to the development of an eating disorder.

Adolescent↗

Reliability of the Eating Disorder Examination-Questionnaire in patients with binge eating disorder.

This study examined the test-retest reliability of the Eating Disorder Examination-Questionnaire (EDE-Q) in patients with binge eating disorder (BED). Short-term (mean days = 4.8; SD = 3.6) test-retest reliability of the EDE was examined in a sample of 86 patients with BED. Test-retest reliability was excellent for objective bulimic episodes (correlation = .84), but poor to unacceptable for subjective bulimic episodes and objective overeating episodes (correlations = .51 and .39, respectively). Test-retest reliabilities were good for the EDE-Q scales (correlations = .66 to .77), albeit somewhat variable for the individual EDE-Q items (.54 to .78). These findings support the reliability of the EDE-Q for patients with BED. The EDE-Q has utility for assessing the number of binge eating episodes (objective bulimic episodes) and associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies in suggesting that these eating behaviors may not be reliable indicators of eating disorders for patients with BED.

Adult↗

Psychosocial variables, eating behavior, depression, and binge eating in morbidly obese subjects.

OBJECTIVES: Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among patients seeking treatment for obesity. The purpose of this study was to determine whether morbidly obese subjects with BED differ from those without BED (NBED) in terms of eating behavior, social/environmental variables, and depression. RESEARCH METHODS AND PROCEDURES: Out of 110 morbidly obese (BMI > or = 40 kg/m2) subjects, 88 could be reliably classified as BED (19) or NBED (69). These subjects (age 42.0+/-13.4 years, BMI 47.0+/-5.7 kg/m2) were examined by a semi-structured interview and by validated questionnaires to assess depression and eating behavior. RESULTS: Subjects with BED showed higher scores of disinhibited eating (12.3+/-2.7 vs. 9.1+/-3.6, p<0.05), were more likely to attribute obesity to their eating habits (chi2=8.4, p<0.05), and rated their social environment regarding relationships as less supportive and cohesive (chi2=10.6, p=0.001). In addition, patients with BED experienced an earlier onset of obesity (chi2=6.3, p<0.05). No relationship, however, was found between binge eating disorder and depression. DISCUSSION: Morbidly obese patients with BED exhibit typical psychological features when compared to those without BED. Their recognition by a structured psychological evaluation in conjunction with questionnaires might be necessary to develop appropriate therapeutic strategies to facilitate weight loss.

Adult↗

A comparison of different methods for assessing the features of eating disorders in patients with binge eating disorder.

The authors compared 3 methods for assessing the features of eating disorders in patients with binge eating disorder (BED). Participants were administered the Eating Disorder Examination (EDE) interview and completed the EDE Questionnaire (EDE-Q) at baseline. Participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. The EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating) and on the Dietary Restraint, Eating Concern, Weight Concern, and Shape Concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes were not significant, but scores on the 4 subscales differed significantly, with the EDE-Q yielding higher scores. At 4 weeks, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes, and the mean difference between methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. Thus, in patients with BED, the 3 assessment methods showed some acceptable convergence, most notably for objective bulimic episodes.

Adult↗

Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication.

OBJECTIVE: To compare different methods for assessing the features of eating disorders in patients with binge eating disorder (BED). RESEARCH METHODS AND PROCEDURES: A total of 47 participants with BED were administered the Eating Disorder Examination (EDE) Interview and completed the EDE-Questionnaire (EDE-Q) at baseline. A total of 37 participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. RESULTS: At baseline, the EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating), overeating episodes, and on the dietary restraint, eating concern, weight concern, and shape concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes and overeating were not significant but scores on the four subscales differed significantly, with the EDE-Q yielding higher scores. At the 4-week point, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes and the mean difference between the methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. DISCUSSION: In patients with BED, the three assessment methods showed some areas of acceptable convergence.

Adult↗

Eating in public places: a review of reports of the direct observation of eating behavior.

A review of 13 studies of the direct observation of eating was undertaken in an effort to learn what these studies tell us about the causes and control of obesity. The studies assessed several measures of eating behavior but few of them assessed the same measures. There was no agreement about a distinctive 'obese eating style', but two measures showed promise in discriminating obese from non-obese persons. The first was food choice: obese persons chose more food than non-obese persons (and men chose more than women and tall persons more than short ones). The second measure was rate of eating: obese persons consumed more food per minute than non-obese persons. The studies point up the remarkable plasticity of human eating behavior and the wide range of factors which influence it. This plasticity has profound implications for both research and therapy. It means that only unusual care in the identification and control of extraneous variables will permit adequate assessment of the variables under investigation. Its second implication is as important: if eating is so dependent upon environment, it may be easier to modify than previously thought.

Feeding Behavior↗

Adoptive transfer of experimental autoimmune thyroiditis (EAT) with in vitro activated lymph node cells from thyroglobulin-sensitized guinea pigs: characterization of the cell that transfers EAT.

Relatively low numbers of lymph node cells (LNC) from Strain 2 or Strain 13 guinea pigs sensitized with guinea pig thyroglobulin (GPTG) could transfer experimental autoimmune thyroiditis (EAT) to normal syngeneic recipients after in vitro culture with GPTG. The EAT induced in recipients of cultured LNC was similar in incidence and severity to EAT induced by active immunization with GPTG in complete Freund's adjuvant. The cells that were effective in transferring EAT were shown to be immunoglobulin-negative, nylon wool nonadherent, and Ia-negative. The effector cells were sensitive to irradiation after in vitro activation, indicating that cell proliferation in the recipient is required for development of EAT. Recipient animals often developed moderate to severe lesions of EAT yet none had detectable delayed hypersensitivity to GPTG and the majority also had no detectable anti-GPTG antibody.

Animals↗