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The EAT-26 as screening instrument for clinical nutrition unit attenders.

OBJECTIVE: The aim of this study was to use the Eating Attitudes Test-26 (EAT-26) as a screening instrument on a specific population with a marked prevalence of binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). The EAT-26 questionnaire was used in order to identify the high-risk subjects for referral to clinical evaluation. METHOD: EAT-26 was administered to 845 subjects who, for the first time, came to the Nutritional Medicine Service looking for a diet between January 1999 and December 2002. From this initial sample, subsequently, 250 subjects were randomly selected and administered a semistructured clinical interview for DSM-IV (SCID I, version 2.0). RESULTS: Discriminant analysis provided a cutoff value of EAT-26=11. Logistic regression analysis indicated high Dieting (D) or Bulimia (B) subscale scores as a risk factor of EDNOS or bulimia nervosa (BN) cases, respectively; on the other hand, a high Oral Control (O) subscale score represented a protecting factor for BED cases. CONCLUSION: Our study tried to assess the usefulness of EAT-26 as a screening instrument for obese patients attending a Medical Nutritional Service. Results from this study suggest that a cutoff score of 11, lower than that indicated in the literature, improves the diagnostic accuracy of the EAT-26 in a high-risk setting regarding sensibility level (68.1%) and leading to a reduction of the false negative rate (31.9%).

Adolescent↗

Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status.

OBJECTIVE: To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status. DESIGN: General population cross-sectional survey. SUBJECTS: A total of 4891 young women from the community aged 18-42 years, of which 630 were in the obese weight range. MEASUREMENTS: Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10). RESULTS: Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, 'hard' exercise and subjective bulimic episodes also contributed to the model predicting psychological distress. CONCLUSION: As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.

Adolescent↗

Stroke patients in nursing homes: eating, feeding, nutrition and related care.

The purpose of this study was to explore eating, feeding and nutrition among stroke patients in nursing homes as described by their nurses and by assessments. Registered Nurses were interviewed about an individual stroke patient's state of health, care needs and nursing care received and nursing records were reviewed. Information on eating, feeding and nutrition was extracted from the interviews and nursing records. A comprehensive instrument, the Resident Assessment Instrument, was also used to assess these patients' state of health. The domains of eating, feeding and nutrition were focused on in this study. Manifest content analysis was used. The results showed that more than 80% of the stroke patients in nursing homes were assessed as having some sort of dependence in eating. According to the Registered Nurses, 22 out of 40 patients demonstrated different eating disabilities. The number of eating disabilities in individual patients ranged from 1 to 7, which emphasized the complexity of eating disabilities in stroke patients. Dysphagia was reported in almost one-fourth of the patients and 30% were described and/or assessed as having a poor food intake or poor appetite. The Registered Nurses' descriptions of the eating disabilities, nutritional problems and their care were often vague and unspecific. Only six weights were documented in the nursing records and there were no nutritional records. The findings highlight the importance of making careful observations and assessments, and of maintaining documentation about eating and nutrition early after a patient's arrival in the nursing home to enable appropriate care and promotion of health.

Activities of Daily Living↗

Eating disorders in Spanish female athletes.

The objective of the study was to determine the prevalence of eating disorders and risk factors for their development in female athletes. Two hundred and eighty-three elite sportswomen, competing in 20 different sports, were administered the EAT, the CETCA (the Eating Disorders Assessment Questionnaire, based on DSM-III-R diagnostic criteria), and two other inventories which evaluated 1) the possible influence on eating disorders of exposure of the body in public and 2) pressure from coaches regarding eating habits, weight, physical appearance and performance. More than 11% of subjects had scores above the cut-off point (>30) on the EAT questionnaire, a proportion similar to that found in a general female population in Spain. On the basis of the CETCA score, AN was putatively diagnosed in 2.5% of the sample, and BN in 20.1%. Though some of these cases may have been EDNOS (eating disorders not otherwise specified), the proportion of athletes suffering from some kind of eating disorder was five times higher than in the general population (22.6% vs. 4.1%). No differences were found between the sportswomen and the general population in terms of specific risk behaviours and attitudes, but a substantial subgroup of athletes presented two or more of these risk behaviours. Exposure of the body in public seems to be a risk factor for eating disorders in general, and pressure from coaches seems to be a risk factor for bulimia.

Attitude↗

A review of family and social determinants of children's eating patterns and diet quality.

With the growing problem of childhood obesity, recent research has begun to focus on family and social influences on children's eating patterns. Research has demonstrated that children's eating patterns are strongly influenced by characteristics of both the physical and social environment. With regard to the physical environment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater quantities when larger portions are provided. Additionally, characteristics of the social environment, including various socioeconomic and sociocultural factors such as parents' education, time constraints, and ethnicity influence the types of foods children eat. Mealtime structure is also an important factor related to children's eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also play a direct role in children's eating patterns through their behaviors, attitudes, and feeding styles. Interventions aimed at improving children's nutrition need to address the variety of social and physical factors that influence children's eating patterns.

Child↗

Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students.

OBJECTIVE: To examine eating disorder attitudes and psychopathology among female university students in Australia and Thailand. METHOD: Participants were 110 Caucasian Australians, 130 Asian Australians and 101 Thais in Thailand. The instruments included the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI). RESULTS: Eating disorder attitudes and psychopathology scores in the Thai group were found to be highest. The Asian Australian group did not have significantly higher scores on the EAT-26 than the Caucasian Australian group, but had higher scores in some subscales of the EDI-2. That the Thai group had the highest scores in susceptibility to developing an eating disorder and eating disorder psychopathology may be partially explained in sociocultural terms, with pressure to be thin more extreme in Thailand than in Australia. The evidence suggested that unhealthy eating disorder psychopathology is not limited to Western societies but is already present in Thai and other Asian societies.

Adolescent↗

Nocturnal eating: prevalence and features in 120 insomniac referrals.

Pathologic nocturnal eating can be associated with a heterogeneous group of medical and psychiatric disorders. The current study was designed to evaluate the prevalence and clinical features of nocturnal eating syndrome (NES), a major subtype of pathological nocturnal eating. Conducted prospectively over an 18-month period (January 1994-June 1995), the study consisted of clinical, psychological, and polysomnographic assessments of 120 adult subjects (51 males, 69 females; mean age 42.6 years, range 18-86 years) who were either self-referrals (58%) or physician referrals (42%) to our Sleep Disorders Center for insomnia complaints. Nocturnal eating with features that are typical of NES, namely compulsive feeding shortly after a mid-non-rapid eye movement (NREM) sleep awakening, in the absence of daytime eating disorders, occurred in seven subjects (five females, two males; mean age 50.8 +/- 9.5 years; mean age at onset of NES 42 years, range 18-61 years), or 5.8% of the sample. NES accounted for 44.4% of all the nocturnal eating cases observed. The data suggest that an adult, late-onset variety of NES is not infrequent. Several of the clinical features of our NES patient series correspond closely to most of those observed in other descriptions of NES in the literature. Overall, the data reinforce the idea that NES is a distinct syndrome, even though some of its features overlap with sleep-related eating disorders (e.g. associated with sleepwalking, restless legs syndrome, obstructive sleep apnea, etc.) and with eating disorders such as daytime binge eating.

Adolescent↗

Eating habits and attitudes in the postpartum period.

The object of this study was to examine the changes in women's eating habits and attitudes in the 6 months after childbirth, focusing particularly on eating-disorder psychopathology. A general population sample of 97 primigravid women originally studied during pregnancy were followed for 6 months postpartum to describe their changes in eating and weight after childbirth with particular reference to the behaviors and attitudes characteristic of clinical eating disorders. Assessment was by standardized interview. It was found that eating disorder symptoms increased markedly in the 3 months postpartum and then plateaued over the next 6 months. This overall plateauing masked substantial variation in different domains; in particular, weight concern continued to increase to the 6-month assessment, although shape concern decreased. Concern about residual weight gain after the birth of a child was described by many mothers as particularly distressing and seemed to precipitate a clinical eating disorder in a few cases. Many women would have welcomed educational advice about how to deal with changes in eating, weight, and shape after pregnancy. It was concluded, therefore, that overall, there is evidence of an increase in eating-disorder psychopathology in the 6 months after childbirth. It is argued that education about how to deal with the changes in weight and shape after pregnancy might decrease the risk of developing frank eating disorder psychopathology.

Adult↗

The effect of social cues on the eating behavior of obese and normal subjects.

Schachter's externality hypothesis suggests that overweight individuals are more likely to be induced to eat by salient external cues than normal weight individuals. While a range of studies have demonstrated the plausibility of this hypothesis in the case of sensory stimuli (e.g., taste cues), there is little evidence that the hypothesis applies to social stimuli. The current study examines this latter proposition by exposing male and female, overweight and normal weight subjects to a same-sex or opposite-sex peer model. Under the guise of engaging in a taste experiment, the subjects were either exposed to a model who tasted no crackers (no eat), one cracker (low eat), or twenty crackers (high eat). In addition, control model-absent conditions were also run for purposes of establishing baseline eating rates. If the externality hypotheses were to prevail in social domains, one would expect overweight subjects to be more prone to model the cracker-eating behavior of the peer than normal weight individuals. However, the findings indicate that all subject groups regardless of weight evidence a rather clear modeling effect and all subjects evidence social inhibition effects on their eating behavior as well. Several intriguing interactions among subject sex, model sex, subject weight, and social condition were also found. The discussion explores the relevance of an externality model of overweight eating in social domains, and focuses upon the interesting and somewhat distinct pattern of socially mediated eating exhibited by overweight females.

Cues↗

A preliminary survey of dieting, body dissatisfaction, and eating problems among high school cheerleaders.

Cheerleading, a staple of American schools, has received little attention in scholarly research. This sport is considered "high risk" for development of eating disorders; therefore, female, high school cheerleaders (n = 156, mean age = 15.43 years) from the southeastern region were surveyed in this preliminary study to determine rates of dieting, body dissatisfaction, and eating problems. Almost one-half of the girls (46%) indicated they were currently trying to lose weight. Body dissatisfaction was significant by race [chi 2 (2, n = 153) = 9.270, p = .010] and was reported by 50% and 73.5% of Black and White girls, respectively. About 13% of girls had EAT-26 scores of 20 or higher (possible eating problems). On the Orientation to Exercise Questionnaire, a measure of subclinical eating disorders, those with eating problems (EAT-26 score of > or = 20) had significantly higher scores (M = 87.65, p = .0002) than those without problems (M = 76.05). Furthermore, scores increased by 69% for each unit increase in BMI (p = .0481, slope = +.6902). The cheerleaders did not appear at higher risk for eating problems than adolescent girls in general, but this age group is considered at "high risk" for eating disorders, so those who work with cheerleaders should be aware of warning signs.

Adolescent↗

Women with eating problems: a community survey.

A survey was conducted of the eating habits and attitudes of a sample of young adult women. Each woman was asked whether she considered herself to have an eating problem. The sample comprised 369 attenders at a family planning clinic. Self-report assessment procedures were used, including the Eating Attitudes Test (EAT) and the General Health Questionnaire (GHQ). Eating problems were reported by 20.6 per cent of the sample. Factors which strongly discriminated between those with an eating problem and the remainder were binge eating and a high score on the EAT. Other important factors were laxative use and high levels of psychological morbidity. Self-induced vomiting was only weakly associated with reporting an eating problem, and past and present weight were unrelated to such reports.

Adolescent↗

Behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders.

The purpose of this study was to delineate and further define the behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders. Subjects consisted of 24 athletes with subclinical eating disorders (SCED) and 24 control athletes. Group classification was determined by scores on the Eating Disorder Inventory (EDI), the Body Shape Questionnaire (BSQ), and a symptom checklist for eating disorders (EDI-SC). Characteristics representative of the female athletes with subclinical eating disorders were derived from an extensive health and dieting history questionnaire and an in-depth interview (the Eating Disorder Examination). Energy intake and expenditure (kcal/d) were estimated using 7-day weighed food records and activity logs. The characteristics most common in the female athletes with subclinical eating disorders included: (a) preoccupation with food, energy intake, and body weight; (b) distorted body image and body weight dissatisfaction; (c) undue influence of body weight on self-evaluation; (d) intense fear of gaining weight even though at or slightly below ( approximately 5%) normal weight; (e) attempts to lose weight using one or more pathogenic weight control methods; (g) food intake governed by self-hatred upon breaking a rule; (h) absence of medical disorder to explain energy restriction, weight loss, or maintenance of low body weight; and (i) menstrual dysfunction. Awareness of these characteristics may aid in more timely identification and treatment of female athletes with disordered eating patterns and, perhaps, prevent the development of more serious, clinical eating disorders.

Adult↗

Symptoms of eating disorders in patients with obsessive-compulsive disorder.

OBJECTIVE: This study was designed to explore potential overlap of the symptoms of obsessive-compulsive disorder and eating disorders. METHOD: The authors administered a structured, self-rating scale, the Eating Disorder Inventory, to 59 outpatients at an obsessive-compulsive disorder clinic and to 60 sex-matched normal volunteers. The Eating Disorder Inventory has been previously validated as a reliable measure of the specific cognitive and behavioral dimensions of the psychopathology typical of patients with eating disorders. The scores of the patients with obsessive-compulsive disorder and of the healthy comparison subjects were compared with those of 32 female inpatients with anorexia nervosa (N = 10) or bulimia nervosa (N = 22) who had also been given the inventory. RESULTS: The patients with obsessive-compulsive disorder scored significantly higher than the healthy comparison subjects on all eight subscales of the Eating Disorder Inventory: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears. Relative to the healthy subjects, male patients with obsessive-compulsive disorder had more symptoms than female patients with obsessive-compulsive disorder. The scores of the female patients with obsessive-compulsive disorder were midway between those of the 32 female patients with eating disorders and those of the 35 female normal subjects. CONCLUSIONS: These results suggest that patients with obsessive-compulsive disorder display significantly more disturbed eating attitudes and behavior than healthy comparison subjects and that they share some of the psychopathological eating attitudes and behavior that are common to patients with eating disorders.

Adult↗

Young female alcoholics with and without eating disorders: a comparative study in Japan.

OBJECTIVE: The authors sought to delineate the characteristics of female alcoholics with eating disorders. METHOD: The study subjects were 29 female Japanese outpatients and inpatients, 30 years of age or younger, with DSM-III-R diagnoses of either alcohol dependence or alcohol abuse and eating disorders. Twenty-one female alcoholics within the same age range who did not have eating disorders served as the comparison group. The social and familial backgrounds, clinical course, and clinical symptoms of the two groups were compared with the use of a structured interview form developed for the study. RESULTS: Ninety-three percent of the subjects with eating disorders had bulimia nervosa; 52% had anorexia nervosa. In all cases, both disorders continued after the onset of problem drinking. The age distributions of the two groups of alcoholic subjects clearly differed: no one in the comparison group was under the age of 24, and the number of comparison subjects increased with age after age 24, whereas the subjects with eating disorders ranged in age from 19 to 30 years, with the greatest number at age 26. More of the alcoholic subjects with eating disorders had never been married, they had had an earlier onset of alcoholism, and they had lower body weights than those without eating disorders. Also, more of them had depression and borderline personality disorder. CONCLUSIONS: The findings suggest that young female alcoholics with eating disorders constitute a clinical subgroup of alcoholics with distinct sociodemographic characteristics and a clinical course and symptoms that differ from those of both younger and older female alcoholics without eating disorders.

Adult↗

Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study.

OBJECTIVE: This study examined the importance of potential risk factors for eating disorder onset in a large multiethnic sample followed for up to 3 years, with assessment instruments validated for the target population and a structured clinical interview used to make diagnoses. METHOD: Participants were 1,103 girls initially assessed in grades 6-9 in school districts in Arizona and California. Each year, students completed the McKnight Risk Factor Survey, had body height and weight measured, and underwent a structured clinical interview. The McKnight Risk Factor Survey, a self-report instrument developed for this age group, includes questions related to risk factors for eating disorders. RESULTS: During follow-up, 32 girls (2.9%) developed a partial- or full-syndrome eating disorder. At the Arizona site, there was a significant interaction between Hispanics and higher scores on a factor measuring thin body preoccupation and social pressure in predicting onset of eating disorders. An increase in negative life events also predicted onset of eating disorders in this sample. At the California site, only thin body preoccupation and social pressure predicted onset of eating disorders. A four-item screen derived from thin body preoccupation and social pressure had a sensitivity of 0.72, a specificity of 0.80, and an efficiency of 0.79. CONCLUSIONS: Thin body preoccupation and social pressure are important risk factors for the development of eating disorders in adolescents. Some Hispanic groups are at risk of developing eating disorders. Efforts to reduce peer, cultural, and other sources of thin body preoccupation may be necessary to prevent eating disorders.

Adolescent↗

Morbidity risk for obsessive-compulsive spectrum disorders in first-degree relatives of patients with eating disorders.

OBJECTIVE: A hypothesis that eating disorders are a phenomenological variant of obsessive-compulsive disorder (OCD) has been proposed. This study was conducted to determine whether anorexia nervosa and bulimia, the two main eating disorders, are familial and whether the risk for obsessive-compulsive spectrum disorders (OCD and tic disorders) is higher in families of patients with eating disorders. METHOD: The morbidity risk for obsessive-compulsive spectrum disorders in first-degree relatives of 136 female probands with eating disorders (84 with anorexia nervosa, 52 with bulimia) was compared to that for first-degree relatives of 72 female comparison subjects. RESULTS: The morbidity risk for obsessive-compulsive spectrum disorders was significantly higher among the 436 relatives of the eating disorder probands than among the 358 relatives of the comparison subjects (9.69% versus 0%). This finding was independent of any comorbid diagnosis of an obsessive-compulsive spectrum disorder in the eating disorder probands. The eating disorder group and the comparison group did not differ in familial risk for eating disorders and tic disorders. CONCLUSIONS: To better understand the genetic components of eating disorders, these disorders should be considered as part of the obsessive-compulsive spectrum of disorders.

Adolescent↗

Eating disorders in schizophrenia.

An investigation of eating disorders in a population of chronic schizophrenic patients confirmed that there is a distinction between eating disorders of psychotics and eating disorders of the young. All the DSM-III criteria of eating disorders, except one, were observed among the psychotics although no patient fulfilled the necessary criteria for an eating disorder diagnosis except for one anorexic woman. All varieties of schizophrenic eating disorder were reported: in two-fifths of the patients eating disorders were associated with delusions and in one sixth with hallucinations; more than half of the patients had deviant eating behaviour which was not associated with any thought or perceptual disorders. Schizophrenic eating disorders were common, yet not disturbing to the social life of the open mental hospital or to that of the community surrounding it.

Adult↗

Attachment research in eating disorders.

AIM: In a recent review, disturbances in attachment have been linked with eating disorder symptomatology. However, because of the limitations of study design, few inferences could be drawn about these processes in the aetiology and maintenance of eating disorder. Since that review, there has been further development in the instruments used and the publication of several further studies of attachment processes in eating disorders. We reviewed the field, expecting that greater clarity may have emerged in the 3 years since the previous review. METHOD: A review of the literature was carried out, using the computer search PsychLIT, Medline, Embase and The Cochrane Library. RESULTS: There have been more studies published in this area in the last 3 years than in the entire period up until then. These can broadly be divided into those carried out in clinical and non-clinical populations, with greater weight ascribed to the former. The vast majority of studies found that attachment processes, by whatever method measured, are abnormal in eating disordered populations. Attachment style (dismissing versus preoccupied) may be linked with eating disorder diagnostic subgroup. CONCLUSIONS: Insecure attachment is common in eating disordered populations, with implications for therapy. Further work with refined instruments may clarify whether or not there is a specific association between attachment style and eating disorder subgroup. However, such an association is likely to be complicated and it may be more fruitful to study specific aspects of attachment, rather than global attachment style, in relation to eating disorder behaviour. The transgenerational transmission of attachment is a fruitful area for further investigation in eating disordered populations.

Feeding and Eating Disorders↗