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PubMed1995

Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992.

OBJECTIVE: The authors sought to examine changes in prevalence of dieting behavior and eating disorder symptoms from 1982 to 1992. METHOD: In 1982, 625 women and 276 men participated in a study examining body weight, eating habits, dieting tendencies, and eating disorder symptoms. Ten years later 564 women and 235 men at the same college completed a nearly identical survey. Similar random sampling methods were used for both studies. All respondents were classified into one of five groups (nondieter, dieter, problem dieter, subclinical eating disorder, or eating disorder according to DSM-III-R criteria). RESULTS: On almost all measures there were significant reductions of problematic eating behaviors and disordered attitudes about body, weight, and shape from 1982 to 1992. The estimated prevalence of bulimia nervosa dropped from 7.2% to 5.1% for women and from 1.1% to 0.4% for men. Binge eating, vomiting, diuretic use, and diet pill use also declined for women during this period. Significantly fewer women and men reported chronic dieting in 1992 than in 1982, and there was evidence of improved body image for both sexes. Subjects in 1992 also reported healthier eating habits in terms of dietary intake and meal regularity. Finally, women in 1992 were more likely to be overweight and were, on average, five pounds heavier than their 1982 counterparts. CONCLUSIONS: The prevalence of problematic eating behaviors and eating disorder symptoms appears to be abating. However, they remain a significant problem that affects a substantial segment of this population.

Adult↗

PubMed2002

An exploration of eating disorders in a Georgian sample.

BACKGROUND: There is debate as to whether eating disorders may be culture-bound. However, accumulating evidence suggests that eating disorders may be found outside of the West, although the precise form of the eating disorder may differ. AIMS: There were two aims of this study: (1) to translate and establish the psychometric properties of standard questionnaires to measure eating pathology in a Georgian sample; (2) to use these measures to determine whether cases of eating disorders exist in Georgia. METHODS: We held focus groups of various health professionals to establish how eating disorders present in Georgia and to identify groups perceived to be at high risk of having an eating disorder. We obtained translated versions of a number of standardized questionnaires (measuring eating and general psychopathology) from 245 women from these identified high risk groups and a subsample were given a structured clinical interview. RESULTS: We estimated from the responses to the questionnaires, that as many as 5% may have clinically significant bulimia nervosa, 7% fell in the weight range for anorexia nervosa with a further 7% in the weight range for obesity. We interviewed a sample of the high scoring group which confirmed the presence of clinically significant eating pathology in the majority of those identified as possible cases. CONCLUSIONS: The results of this study suggest there may be women in Georgia with significant eating problems.

Adult↗

PubMed1997

Disordered eating behaviors and bone-mineral density in women who misuse alcohol.

Because lower bone-mineral density is one potential physiological consequence of eating disorders and chronic alcohol misuse, the risk for osteoporosis may be compounded in women who have both conditions. This study investigated the frequency of eating disorders in 25 women who misuse alcohol and compared bone-mineral density between those with and without multiple disordered eating behaviors. Disordered eating behaviors were assessed through the EAT-26 (Eating Attitudes Test) and a structured interview addressing binge eating, purging, and other weight-control behaviors. Bone-mineral density was measured using dual energy x-ray densitometry. Although only one woman met the DSM-III-R criteria for a current eating disorder, 12% had past histories suggestive of anorexia nervosa and 40% had multiple disordered eating behaviors with bulimic features. Bone-mineral density of the femoral neck was 9.3% greater in women with multiple disordered eating behaviors (p < or = .05).

Absorptiometry, Photon↗

PubMed1994

Eating disorders in female athletes.

Eating disorders can lead to death. The prevalence of subclinical and eating disorders is high among female athletes, and the prevalence of eating disorders is higher among female athletes than nonathletes. Athletes competing in sports where leanness or a specific bodyweight is considered important are more prone to develop eating disorders than athletes competing in sports where these factors are considered less important. It appears necessary to examine true eating disorders, the subclinical disorders and the range of behaviours and attitudes associated with eating disturbances in athletes, to learn how these clinical and subclinical disorders are related. Because of methodological weaknesses in the existing studies, including deficient description of the populations studied and the methods of data collection, the best instrument or interview method is not known. Therefore, more research on athletes and eating disorders is needed. Suggestions of the possible sport specific risk factors associated with the development of eating disorders in athletes exist, but large scale longitudinal studies are needed to learn more about risk factors and the aetiology of eating disorders in athletes at different competitive levels and within different sports. Further studies are required on the short and long term effects of eating disorders on athletes' health and athletic performance.

Feeding and Eating Disorders↗

PubMed1992

Eating disorders in adolescents with IDDM. A controlled study.

OBJECTIVE: To determine the prevalence of clinical eating disorders and lesser degrees of disturbed eating in adolescents with IDDM and a matched sample of nondiabetic control subjects. RESEARCH DESIGN AND METHODS: A cross-sectional survey of eating habits and attitudes conducted in 76 adolescents with IDDM, and age- and sex-matched nondiabetic control subjects. Eating disorder features were assessed by standardized research interview adapted for use with patients with diabetes (EDE). Glycemic control was assessed by GHb assay. RESULTS: Adolescent girls with IDDM were heavier than nondiabetic female control subjects and were dieting more intensively to control their shape and weight. However, clinical eating disorders were no more common among adolescent girls with IDDM than among nondiabetic control subjects. Nine percent of the IDDM girls met diagnostic criteria for an operational version of "Eating disorder not otherwise specified." Fifteen percent had omitted or reduced their dose of insulin to influence their shape and weight. Eating disorder features and insulin misuse for shape and weight control were not found in IDDM or nondiabetic boys, and these two groups did not differ in their body weight. CONCLUSIONS: Adolescent girls with IDDM are heavier than their nondiabetic counterparts and diet more intensively to control their shape and weight. Disordered eating habits and weight control behavior are common, but no more so in IDDM than in nondiabetic subjects. Insulin misuse for the purpose of shape and weight control is not restricted to subjects with a clinical eating disorder. Disordered eating is associated with impaired glycemic control.

Adolescent↗

PubMed1992

Eating disorders: antecedents, evolution and course.

Concepts of eating disorders have altered so that anorexia nervosa is now recognized as an important but uncommon syndrome within a spectrum of disordered eating. Behaviours used by dieters constitute the mild end of the eating disorder spectrum. Dieting in young women is for the most part a transient and benign activity without longer-term consequences. However, a group of dieters do progress to develop the symptoms and behaviour of eating disorders, so that dieting has been associated with an eight-fold rise in the risk of later eating disorder. Dieting or factors closely associated may account for most eating disorders in young women. Many antecedents of eating disorder appear to operate through increasing the risk of dieting rather than determining eating disorders specifically. Only the development of further neurotic and depressive symptoms characterizes dieters progressing to eating disorders. As the evidence implicating dieting in the origin of eating disorders becomes stronger so strategies for primary prevention become clearer.

Adolescent↗

PubMed2000

Treatment of binge-eating disorder with topiramate: a clinical case series.

BACKGROUND: Reduced appetite and weight loss were found in clinical trials of topiramate for epilepsy. Binge-eating disorder is characterized by recurrent episodes of binge eating that are not associated with regular use of inappropriate compensatory behaviors. Overweight and obesity may be common complications. To explore the effectiveness and tolerability of topiramate in binge-eating disorder, we describe the response of 13 consecutive outpatients with binge-eating disorder to naturalistic, open-label treatment with topiramate. METHOD: The response of 13 female outpatients with binge-eating disorder by DSM-IV criteria to naturalistic, open-label treatment with topiramate (100-1400 mg/day) was reviewed. Response of binge-eating disorder symptoms was clinically assessed as none, mild, moderate, marked, or remission. Weight and side effects were also evaluated. RESULTS: All 13 patients had comorbid Axis I psychiatric disorders along with binge-eating disorder and were receiving psychotropic medications at the time of topiramate administration. After beginning topiramate treatment, 9 patients displayed a moderate or better response of binge-eating disorder symptoms that was maintained for periods ranging from 3 to 30 months (mean +/- SD = 18.7+/-8.0 months). Two other patients displayed moderate or marked responses that subsequently diminished. The remaining 2 patients had a mild or no response. The mean +/- SD weight of the 13 patients decreased from 99.3+/-26.4 kg to 87.5+/-20.4 kg (z = -2.4, df = 1, p = .02), but only 7 patients lost > or = 5 kg of weight. The mean topiramate treatment dose was 492.3+/-467.8 mg/day for all 13 patients. The mean topiramate dose was higher in patients who lost > or = 5 kg than in patients who lost < 5 kg. Also, topiramate dose correlated significantly with weight loss (p < .01). In general, topiramate was well tolerated, with neurologic side effects the most common. Of 3 patients who discontinued topiramate because of side effects, 2 resumed the drug at a later date without significant recurrence of these effects. CONCLUSION: Topiramate may be an effective treatment for binge-eating disorder. Controlled studies of topiramate in binge-eating disorder appear warranted.

Ambulatory Care↗

PubMed2002

Traits of irrational beliefs related to eating problems in Japanese college women.

This study focused on the relation of irrational beliefs and Body Mass Index (BMI) to inappropriate eating attitudes in Japanese college women. A total of 110 nonclinical subjects completed the Japanese Irrational Belief Test (JIBT) and the Japanese version of the Eating Attitudes Test (EAT). The JIBT subscale of 'self expectation' had significant positive correlations with the EAT total score and the subscales of 'obsession with eating', 'dieting' and 'obese-phobia'. The JIBT subscale of 'dependence' had a significant positive correlation with the EAT subscale of 'obsession with eating'. BMI score showed significant positive correlations with the EAT total score and the subscales of 'dieting' and 'obesephobia'. The present results suggest that characteristic irrational beliefs are associated with inappropriate eating attitudes, suggesting that clarifying and then modifying the irrationality may be a useful method of preventive intervention in nonclinical young women with eating problems.

Adult↗

PubMed2002

A comparison of purging and non-purging eating disorder patients in comorbid personality disorders and psychopathology.

OBJECTIVE: We evaluated the significance of purging behavior in the diagnosis of eating disorders through an objective assessment of eating disorder psychopathology including personality disorders. METHODS: Subjects were 42 consecutive outpatients with eating disorders who visited the Outpatient Psychiatric Clinic at Tokai University Hospital (Kanagawa, Japan). Diagnosis of eating and personality disorders was established using the modified Structured Clinical Interviews for DSM-III-R and DSM-III-R-Axis II. Eating disorder symptoms and psychopathology were assessed with the Eating Disorder Examination, Eating Disorder Inventory 2, Beck Depression Inventory, and Leyton Obsessional Inventory Results were compared between purgers and non-purgers. RESULTS: Purgers had severe borderline or avoidant personality disorder, mixed personality disorder, eating attitude, depressive symptoms, and obsessive symptoms. CONCLUSION: Purging behavior in eating disorder patients is associated with personality disorders, depression, and obsessive symptoms. Assessment of this behavior is critical in the diagnosis and treatment of eating disorders.

Adult↗

PubMedDate not supplied

[Schizophrenia and eating disorders].

The comorbidity of schizophrenia and eating disorders is understudied. In the early nineteenth century, Eugen Bleuler has reported cases of schizophrenia with eating disorders that were related to delusional ideas. Potomania, merycism and pica have often been described in schizophrenic patients. Schizophrenic patients with eating disorders usually do not meet all criteria for typical eating disorders and are therefore classified as "eating disorders not otherwise specified" (EDNOS). It may even be difficult to recognize schizophrenia in patients with eating disorders associated to delusional ideas and distorted cognitions related to food or body perception. In any case, the diagnosis of schizophrenia should preferably be made and is only valid after renutrition is achieved. The prevalence of schizophrenia in samples of patients with eating disorders is generally below 10% but reaches 35% in males, the most frequent form being hebephrenia. Cognitive behavioural therapies for eating disorders need to be adapted in cases of comorbid schizophrenia. The new antipsychotic medications seem helpful in patients with eating disorders with or without schizophrenia. They reduce anxiety towards eating and bring in better adherence to treatments.

Antipsychotic Agents↗

PubMedDate not supplied

Determinants of healthy eating in children and youth.

This review outlines the state of knowledge and research gaps in the area of determinants of healthy eating among children and youth. The article is structured around individual and collective determinants that affect healthy eating in children and youth. We defined healthy eating as "eating practices and behaviours that are consistent with improving, maintaining and/or enhancing health." Relevant databases were searched for papers published between January 1992 and March 2003 that focussed on children or youth and reported at least one factor relevant to healthy eating. Among collective factors, familial factors and the nature of foods available in the physical environment, including at home, schools and in fast-food establishments, stand out as significant influences on healthy eating in children and youth. The media, particularly television, also have an enormous potential influence and can overshadow familial influences. Individual factors identified include knowledge, attitudes and food preferences; only the latter have been identified as a strong determinant of healthy eating in both children and adolescents. The results of the review identified a significant body of literature in the area of determinants of healthy eating in children and youth; however, very little of this research has taken place in Canada. Only a few determinants, such as economic factors and food security, the content of media nutritional messages, and the issue of flavours, neophobia and food preferences, have undergone some examination by Canadian researchers. Research priorities for Canada in the area of determinants of healthy eating and surveillance of eating behaviours are identified.

Adolescent↗

PubMed2006

[Eating disorders: symptomatology, course and prognosis, epidemiology, and psychiatric comorbidity. Review article].

OBJECTIVE: Eating disorders are a group of serious psychiatric disorders that affect primarily young women and can have serious consequences on their lives and their families. Eating disorders are characterized by disordered eating behaviour with desire for thinness that can result in serious physical and psychological symptoms and death. Eating disorders tend to run a chronic course. Psychiatric comorbidity and physical complications are common among eating disordered patients and these issues need to be taken into consideration during treatment. Prevalence and incidence of eating disorders appears to be increasing in Western societies and follow increased prosperity and obesity problems. There is no reason to believe that the situation is different in Iceland but research is lacking. In this review article we address the main symptoms and diagnostic criteria of three types of eating disorders, that is anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified. The course and prognosis, epidemiology, and psychiatric comorbidity of eating disorders will also be presented. Finally, we discuss the services available to eating disordered patients here in Iceland and the need for further development of the services.

Anorexia Nervosa↗

PubMed1986

Childhood eating disorders.

Eating is a sensitive barometer of emotional state and parent-child interaction. Psychosocial distortions often appear first to the health worker and are referred to the dietitian as distortions in eating. At times, the distortion is severe enough to be called an eating disorder. An eating disorder of childhood is the misuse of feeding in an attempt to solve or camouflage family problems of living that seem otherwise insoluble. The childhood eating disorder might take the form of failure to thrive, obesity, excessive finickiness, or, most commonly, vehement and protracted struggles between parent and child about eating. An eating disorder is a biopsychosocial problem. It is based on characteristics and distortions in physical, physiological, psychological, and social factors. The dietitian who is to be helpful with families referred to her for correction of eating difficulties must be able to detect the disordered situation and differentiate it from one that is simply problematic. If an eating disorder exists, it is unlikely that the situation will change without psychotherapeutic intervention into family functioning. An appropriately conducted symptom management approach to correct the eating distortion is a helpful and potentially successful adjunct to psychotherapy. Such a component should be constructed around the restoration of a positive feeding relationship.

Affective Symptoms↗

PubMed1996

Clinical characteristics associated with binge eating in obese females: a descriptive study.

OBJECTIVE: To investigate differences in clinical characteristics of obese female participants based on presence and degree of binge eating behavior. DESIGN: Descriptive comparison of various clinical characteristics of obese women diagnosed with binge eating disorder (BED) assessed by semi-structured interview to those for similar weight participants reporting subthreshold BED and those who do not binge eat. SUBJECTS. 185 healthy women seeking obesity treatment (age: 20-55 y, BMI: 28.4-51.5 kg/m2). MEASUREMENTS: Baseline self-report questionnaires included the Weight and Eating Patterns (QEWP), Eating Disorders Questionnaire (EDQ), Beck Depression Inventory (BDI); clinical interviews included the Hamilton Depression Rating Scale (HDRS) and Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). RESULTS: In comparison to other obese women, obese participants meeting full BED criteria report an earlier onset of binge eating, increased food cravings, increased diet pill use, decreased fasting, greater fear of gaining weight, increased body perception disturbance, and increased depressive symptomatology and general psychopathology. CONCLUSIONS: Obese women with BED report greater eating-related and general psychopathology than non-binge eating disordered women of comparable weight. Although endorsement of food cravings unrelated to hunger was associated with binge eating diagnosis, the role of dietary restriction among this population remains unclear and requires further investigation. Theoretical and clinical implications that binge eating episodes for individuals with BED may be related to negative affect states and increased dietary disinhibition are discussed.

Adult↗

PubMed1998

[Eating before of an unselected student population of the 7th to 10th grade in a Berlin school].

In 1990 a study of 32 girls and 44 boys in Grades 7 to 10 in a former "East Berlin" school in the borough of Prenzlauer Berg was carried out in continuation of an "East-West Berlin Study on Eating Disorders in Adolescents" which we had initiated in the mid-eighties. The Eating Attitudes Test (EAT), Eating Disorder Inventory (EDI), State of Comfort Scale (SCS) were used in a one-step study design together with complementary clinical and sociodemographic data, including body weight, height and BMI. On the whole, all students were well aware of their own body measurements and had definite ideas about their ideal body weight. Boys were less sure about their real weight, while girls showed some insecurity in defining their ideal weight. Regardless of weight parameters, girls were more strongly preoccupied with issues specific to eating disorders, such as dissatisfaction with their own body, the quest for a slim figure and diet. They were more severely affected by perceptions of insufficiency. 44% of all girls and 4% of the boys said they had problems with their body weight. These students' intensive preoccupation with issues specific to eating disorders was dependent on their actual body weight. They exhibited more clearly pronounced psychological characteristics of eating disorders. Eating-related and psychological characteristics of eating disorders were significantly more pronounced in girls with irregular menstruation. The correlation between irregular menstruation and individually perceived weight problems was significant. These results are discussed in greater detail with due consideration of the need for understanding the specific dynamics of eating attitudes in the general population.

Adolescent↗

PubMed1999

Family climates: family factors specific to disturbed eating and bulimia nervosa.

More than a decade of research has characterized the families of individuals with bulimia and bulimia anorexia (Anorexia Nervosa, Binge/Purging Type) as less expressive, less cohesive, and experiencing more conflicts than normal control families. This two-part study investigated variables believed more directly related to disturbed eating and bulimia as contributing to a "family climate for eating disorders." In Study 1. a nonclinical sample of 324 women who had just left home for college and a sample of 121 mothers evaluated their families. Principal-components analyses revealed the same factor structure for both students and mothers, with Family Body Satisfaction, Family Social Appearance Orientation, and Family Achievement Emphasis loading together, representing the hypothesized family climate for eating disorders: the remaining variables loaded with the more traditional family process variables (conflict, cohesion, expressiveness), representing a more general family dysfunction. As predicted, the family climate for eating disorders factor score was a more powerful predictor of disturbed eating. Study 2 extended these findings into a clin ical population, examining whether the family climate for eating disorders variables would distinguish individuals with bulimia from both depressed and healthy controls. Groups of eating-disordered patients (n = 40) and depressed (n = 17) and healthy (n = 27) controls completed family measures. The eating-disordered group scored significantly higher on family climate variables than control groups. Family process variables distinguished clinical groups (depressed and eating disordered) from healthy controls, but not from one another. Controlling for depression removed group differences on family process variables, but family climate variables continued to distinguish the eating-disordered group from both control groups. Indications for further research are discussed.

Adolescent↗

PubMed1999

Role of leptin in women with eating disorders.

OBJECTIVE: This study investigated the role of leptin on eating behavior and reproductive function in eating disorders. METHOD: The subjects included 80 eating-disordered women, having different fat mass, eating behavior, and endocrine abnormalities, and 26 control women. Plasma leptin, insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), cortisol, insulin growth factor-1 (IGF-1), free T4 levels, percent body fat, eating behavior score, and menstrual status score were evaluated for each subject. RESULTS: In eating-disordered patients, log of leptin levels were significantly correlated with body fat mass, eating behavior score, menstrual status score, and insulin, LH, and FSH levels. Stepwise regression analysis showed that fat mass and eating behavior score were significant determinants of leptin levels. Furthermore, in patients undergoing recovery, leptin levels were determined by fat mass and/or eating behavior. DISCUSSION: These results suggest that leptin may play some role in counteracting the abnormal eating behavior, reproductive function, and fat mass in these disorders.

Adipose Tissue↗

PubMed2006

Self-help and guided self-help for eating disorders.

BACKGROUND: Anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) are common and disabling disorders. Many patients experience difficulties accessing specialist psychological treatments. Pure self-help (PSH: self-help material only) or guided self-help (GSH: self-help material with therapist guidance), may bridge this gap. OBJECTIVES MAIN OBJECTIVE: Evaluate evidence from randomised controlled trials (RCTs) / controlled clinical trials (CCTs) for the efficacy of PSH/GSH with respect to eating disorder symptoms, compared with waiting list or placebo/attention control, other psychological or pharmacological treatments (or combinations/augmentations) in people with eating disorders. SECONDARY OBJECTIVE: Evaluate evidence for the efficacy of PSH/GSH regarding comorbid symptomatology and costs. SEARCH STRATEGY: CCDANCTR-Studies and CCDANCTR-References were searched in November 2005, other electronic databases were searched, relevant journals and grey literature were checked, and personal approaches were made to authors. SELECTION CRITERIA: Published/unpublished RCTs/CCTs evaluating PSH/GSH for any eating disorder. DATA COLLECTION AND ANALYSIS: Data was extracted using a customized spreadsheet. Relative Risks (RR) were calculated from dichotomous data and weighted/standardized mean differences (WMD/SMD) from continuous data, using a random effects model. MAIN RESULTS: Twelve RCTs and three CCTs were identified, all focusing on BN, BED, EDNOS or combinations of these, in adults, using manual-based PSH/GSH across various settings. Primary comparisons:At end of treatment, PSH/GSH did not significantly differ from waiting list in abstinence from bingeing (RR 0.72, 95% CI 0.47 to 1.09), or purging (RR 0.86, 95% CI 0.68 to 1.08), although these treatments produced greater improvement on other eating disorder symptoms, psychiatric symptomatology and interpersonal functioning but not depression. Compared to other formal psychological therapies, PSH/GSH did not differ significantly at end of treatment or follow-up in improvement on bingeing and purging (RR 0.99, 95% CI 0.75 to 1.31), other eating disorder symptoms, level of interpersonal functioning or depression. There were no significant differences in treatment dropout. Secondary comparisons:One small study in BED found that cognitive-behavioural GSH compared to a non-specific control treatment produced significantly greater improvements in abstinence from bingeing and other eating disorder symptoms. Studies comparing PSH with GSH found no significant differences between treatment groups at end of treatment or follow-up. Comparison between different types of PSH/GSH found significant differences on eating disorder symptoms but not on bingeing/purging abstinence rates. AUTHORS' CONCLUSIONS: PSH/GSH may have some utility as a first step in treatment and may have potential as an alternative to formal therapist-delivered psychological therapy. Future research should focus on producing large well-conducted studies of self-help treatments in eating disorders including health economic evaluations, different types and modes of delivering self-help (e.g. computerised versus manual-based) and different populations and settings.

Anorexia Nervosa↗