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PubMed2005

Eating disorders and emotional and physical well-being: associations between student self-reports of eating disorders and quality of life as measured by the SF-36.

OBJECTIVE: To assess health-related quality of life (HRQoL) in subjects with eating disorders in terms of eating disorder type and in relation to self-reports of longstanding illness, depression and self-harming behaviours. METHOD: Data on eating disorder history, SF-36 health status, longstanding illness, and self-reported frequencies of depression, self-harming behaviour, and suicidal thoughts or acts were collected during 1996 as part of a UK postal survey of students' health. Completed questionnaires were returned by 1439 of 3750 students (response rate 42%). RESULTS: Eighty-three respondents (5.8%; 8.9% of females) reported a probable eating disorder history: 54 (3.8%) bulimia nervosa, 22 (1.6%) binge eating disorder, and 7 (0.5%) anorexia nervosa. Eating disorder subjects reported more impairment in SF-36 emotional than physical well-being, with significantly lower mental (p < 0.001) but not physical (p = 0.21) component summary scores. This was most evident in bulimia nervosa and binge eating disorder subjects. Anorexia nervosa subjects reported fewer SF-36 emotional limitations although they were significantly more likely to report depression, self-harming behaviour, and suicidal ideation. DISCUSSION: An eating disorder history is accompanied by HRQoL impairment primarily in emotional well-being. Anorexia nervosa subjects perceive fewer limitations than subjects with other eating disorders. While this is consistent with previous reports of better SF-36 emotional well-being in those with restrictive eating behaviours, it may also suggest that the SF-36 is insensitive to emotional distress in anorexia nervosa.

Adult↗

PubMedDate not supplied

Screening disordered eating attitudes and eating disorders in a sample of Turkish female college students.

It has been hypothesized that college women are particularly susceptible to the development and maintenance of disturbed eating behaviors. The purpose of this study was to determine the frequency of disordered eating attitudes and eating disorders in a sample of Turkish female college students. The Eating Attitudes Test was administered to a sample of 414 female college students. The subjects who had a score of 30 or higher were accepted as having disordered eating attitudes, and all of them have been examined using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for eating disorders. Of the overall sample, 17.1% of subjects were classified as having disordered eating attitudes. This subgroup of subjects was then compared with the remainder on all the other measures. The differences between students with disordered eating attitudes and those without on sociodemographic variables (except for age) were not statistically significant. The rate was 1% for eating disorders including anorexia nervosa (0.5%) and bulimia nervosa (0.5%). This study suggested that the prevalences of disordered eating attitudes and anorexia nervosa among female college students in Turkey were similar to those found in Western societies, but the rate for bulimia nervosa was lower compared with Western societies.

Adolescent↗

PubMed2006

Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?

OBJECTIVE: To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. DESIGN: Population-based 5-year longitudinal study. PARTICIPANTS: Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). MAIN OUTCOME MEASURES: Weight status, binge eating, extreme weight control, and self-reported eating disorder. STATISTICAL ANALYSIS: Multiple linear and logistic regressions. RESULTS: Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. CONCLUSIONS: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Adolescent↗

PubMedDate not supplied

What is binge eating? A comparison of binge eater, peer, and professional judgments of eating episodes.

Binge eating is a central diagnostic feature of bulimia nervosa (BN) and binge-eating disorder (BED), yet the phenomenon of bingeing has not been adequately defined, and there is considerable variability in how individuals label eating episodes as binges. We examined the agreement among binge-eating individuals, non-eating-disordered peers, and professional dietitians over whether particular eating episodes were binges. Twenty-nine females with BED, fifteen nonclinical binge eaters (NCB), three peer judges, and three dietitians rated a sample of eating episodes of the binge-eating individuals as either binges or nonbinges based on the types and amounts of food eaten as well as the duration of each eating episode. BED participants labeled a significantly higher proportion of their intakes as binges relative to NCB participants. Peer judges were more likely than were dietitians to label participants' eating episodes as binges. Agreement within dietitian and peer groups was poor to fair, whereas agreement between these groups was fair. Finally, agreement between participants and the external judges (i.e., peers, dietitians) was poor. Possible explanations for these findings as well as implications for the diagnosis of BN and BED are discussed.

Adult↗

PubMedDate not supplied

[Construction and validation of a new screnning questionnaires for eating disorders: the inventory for the screening of eating disorders/(ISED)].

OBJECTIVE: The study aims to construct and validate a new screening questionnaire for the identification of cases at risk for eating disorders. SETTING AND SAMPLE: We assessed 218 female adolescent students recruited in a vocational school in Mestre (VE) and 88 patients consecutively referred to the Eating Disorders Unit of the University of Padova. PROCEDURE AND MAIN OUTCOME MEASURES: All subjects completed the new questionnaire, the Inventory for the Screening of Eating Disorders (ISED), and the Eating Attitudes Test (EAT). Sixty-two percent of female students and all the patients underwent a structured diagnostic interview (SCID for DSM-IV) for the diagnosis of eating disorders. The reliability, validity and screening ability of the questionnaire have been assessed. RESULTS: The reliability of the ISED, measured by Cronbach's alpha, is good (alpha = 0.87), as is the convergent validity (correlations with EAT). In order to improve the screening ability, the questionnaire has been further divided in two subscales: one for the identification of cases at risk for anorexia nervosa (ISED-AN) and the other for cases at risk for bulimia nervosa (ISED-BN). The screening ability of the two subscales is greater than that of EAT, although the difference is not statistically significant. The ISED cutoff points have greater positive predictive values than those of EAT in the screening of both anorexia nervosa and bulimia nervosa. CONCLUSIONS: The ISED appears to be a valid and reliable questionnaire among female adolescents. Its use might improve the identification of cases at risk for eating disorders and in particular those at risk for anorexia nervosa. Other studies are needed to confirm the validity and performance of the questionnaire among samples of different ages and socio-economic status.

Adult↗

PubMed2000

Onset of dieting vs binge eating in outpatients with binge eating disorder.

OBJECTIVE: To examine the potential significance of the sequence of the onset of dieting and binge eating in binge eating disorder (BED). DESIGN: BED patients were interviewed and completed a battery of psychometrically well-established measures of current eating behaviors, eating disorder psychopathology, and associated psychological functioning. SUBJECTS: Participants were 98 consecutive outpatients with BED evaluated for a clinical trial. MEASURES: Interview data, self-report measures and measured body weight were examined. RESULTS: Participants who reported that dieting preceded binge eating (DIETfirst, 65%) were compared to those who reported that binge eating preceded their first diet (BINGEfirst, 35%). The study groups did not differ in demography, current or highest body mass index, current eating behaviors or psychopathology, or psychological functioning. The two groups did not differ in age of first diet; however, the BINGEfirst group was significantly younger when first overweight, at onset of binge eating, and at onset of BED diagnosis. The BINGEfirst group reported a higher frequency of being teased about their weight. CONCLUSIONS: A substantial subgroup of BED patients report that binge eating preceded their first diet. This finding, which replicates previous reports for BED and appears higher than that generally reported for bulimia nervosa, may have implication for etiologic models of binge eating.

Adolescent↗

PubMed2001

Connections between parental eating attitudes and children's meagre eating: questionnaire findings.

UNLABELLED: This study investigated whether young children's problematic, meagre eating is associated with the eating habits and attitudes of the parents. The subjects, 397 children, their mothers (n = 397) and fathers (n = 375) participated in a prospective atherosclerosis risk-factor intervention trial. The parents evaluated their own eating behaviour in questionnaires when their child was 13 mo old. The children's eating problems were recorded by the mothers when the child was 13 mo old, and by both parents when the child was 5 y old. At both ages, the weight and height of the children were measured. Problematic or maladaptive eating habits of the children were found to be connected to those of their parents. The mother's poor ability to enjoy eating, high tendency to snack and low tendency to eat only when hungry, as well as the father's difficulty in maintaining ideal weight significantly predicted persistent problems of meagre eating in their children. CONCLUSION: The study suggests that the eating habits and attitudes of parents may be reflected in the eating behaviour of young children.

Adult↗

PubMed2004

Eating disorders with binge-eating behaviour are associated with the s allele of the 3'-UTR VNTR polymorphism of the dopamine transporter gene.

OBJECTIVE: The dopaminergic system is associated with feelings of pleasure and reward and with positive hedonic processes related to food, sexual activity and certain substances. Because it is recognized that patients who have eating disorders with binge-eating behaviour have a high comorbidity of substance dependence, we examined the association between the variable number of tandem repeats (VNTR) polymorphism in the 3; untranslated region of the dopamine transporter gene (DAT1) and eating disorders with binge-eating behaviour. METHODS: The subjects were 90 female Japanese patients with eating disorders diagnosed using DSM-IV; they were compared with 115 healthy female controls. Genomic DNA was extracted from whole blood, and standard polymerase chain reaction testing was performed. We compared the frequencies of a short allele (7 or 9 repeats) and a long allele (10 or 11 repeats) in both groups. RESULTS: In the group who had an eating disorder with binge-eating behaviour, the frequency of a short allele was significantly higher compared with the control group. CONCLUSION: It seems plausible that the association between the DAT1 VNTR and binge-eating behaviour indicates that dysregulation of dopamine reuptake may act as a common pathophysiologic mechanism in eating disorders with binge-eating behaviour and in disorders related to substance use.

Adolescent↗

PubMed2002

On the relation of flexible and rigid control of eating to body mass index and overeating in patients with binge eating disorder.

OBJECTIVE: To examine the relationship of flexible and rigid dimensions of restrained eating to body mass index (BMI) and overeating in outpatients with binge eating disorder (BED). METHOD: Participants were 148 consecutive outpatients who met criteria for BED. The Three-Factor Eating Questionnaire (TFEQ) was administered to assess Cognitive Restraint, Hunger, and Disinhibition. The TFEQ also contains two Cognitive Restraint subscales--Flexible Control and Rigid Control. The Eating Disorder Examination-Questionnaire version (EDE-Q) was administered to assess frequency of different forms of overeating during the past 28 days and the attitudinal features of eating disorders. RESULTS: Flexible Control and Rigid Control were significantly correlated with each other. They were both negatively correlated with BMI, but neither was significantly correlated with the frequency of binge eating or other forms of overeating. In addition, Flexible Control and Rigid Control predicted almost the same amount of variance in BMI. DISCUSSION: BED patients exhibit flexible and rigid control of eating that is related to BMI, but not to the frequency of binge eating or other forms of overeating. Results of the present study provide preliminary evidence that flexible and rigid control of eating may not be a useful distinction in BED patients. However, increased restraint, regardless of type, may prove to be of benefit with regard to weight control and may not have adverse effects on binge eating in obese BED patients.

Adult↗

PubMed2004

Antecedents and consequences of binge eating episodes in women with an eating disorder.

The aim of this study was to explore antecedents and sequelae of binge eating episodes. A sample of eating disorders (n = 154 women) was selected from a total of 1849 female respondents (out of 2500) recruited as part of a general population-based survey. Included participants met DSM-III-R criteria for anorexia nervosa (AN), bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) based on the Survey for Eating Disorders (SEDs). Preliminary criteria for binge eating disorder (BED) were added. Results indicated that the most frequently reported antecedents and consequences of binge eating were emotional and physiological factors. There were significant differences between the different ED subgroups in their frequency of binge eating episodes. Regarding antecedents of a binge eating episode, the SEDs-defined ED subgroups had overall differences in frequency on "stomach feeling". In particular, the BN-group reported "euphoria" more frequently than the BED and EDNOS-groups. Concerning consequences of a binge eating episode, there were overall differences between the ED subgroups on "fall asleep", and in addition a borderline significance was found for "disturbed by others" (p = 0.059). None of the eight women in the AN group reported "euphoria" as a factor that terminated a binge eating episode. The findings may have important implications with regard to prevention and treatment of ED.

Adult↗

PubMed2006

Adolescents' views of food and eating: identifying barriers to healthy eating.

Contemporary Western society has encouraged an obesogenic culture of eating amongst youth. Multiple factors may influence an adolescent's susceptibility to this eating culture, and thus act as a barrier to healthy eating. Given the increasing prevalence of obesity amongst adolescents, the need to reduce these barriers has become a necessity. Twelve focus group discussions of single-sex groups of boys or girls ranging from early to-mid adolescence (N=73) were employed to identify key perceptions of, and influences upon, healthy eating behaviour. Thematic analysis identified four key factors as barriers to healthy eating. These factors were: physical and psychological reinforcement of eating behaviour; perceptions of food and eating behaviour; perceptions of contradictory food-related social pressures; and perceptions of the concept of healthy eating itself. Overall, healthy eating as a goal in its own right is notably absent from the data and would appear to be elided by competing pressures to eat unhealthily and to lose weight. This insight should inform the development of future food-related communications to adolescents.

Adolescent↗

PubMed2003

Characteristics of binge eating among women in the community seeking treatment for binge eating or weight loss.

This study examined characteristics of binge eating among overweight women in the community seeking treatment for binge eating or weight loss. Five hundred and ninety-two women completed a telephone interview in which binge eating was thoroughly assessed. A large percentage of the sample (84.4%) reported features of binge eating consistent with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) definition of a binge. A significantly higher rate of DSM-IV BED (33.6%) was found compared to previous studies. Eleven percent of the sample denied bingeing/purging (nonbinge eating disorder, NBED) and 55.4% of the sample reported other eating problems such as bingeing or purging. Women with binge eating disorder (BED) had a higher BMI, became overweight earlier, and reported more unhealthy weight control methods than NBED women. BED women also reported more current and past depression and suicidal ideation than NBED women. BED reported more maternal overweight than NBED, but BED and NBED participants did not differ in paternal overweight or parental eating disorders. Future studies should investigate the relationship between binge eating and suicidal ideation to better understand whether depression precedes or follows binge eating.

Journal Article↗

PubMedDate not supplied

Exploring alexithymia, depression, and binge eating in self-reported eating disorders in women.

TOPIC: Binge eating is often a way of life for many women even if the diagnostic criteria for the tentative DSM-IV-TR diagnosis of binge eating disorder is not met. METHODS: Binge eating was conceptualized as a problem in affect regulation. Affective indices of alexithymia and depression were measure with the Toronto Alexithymia Scale (TAS), the Alexithymia-Provoked Response Questionnaire (APQR), and the Beck Depression Inventory (BDI), respectively. This study was an exploratory study of 65 subjects, 35 of whom self-reported as eating disordered and 30 as non-eating disordered. FINDINGS: Of the eating-disordered subjects, 95% scored significantly on the Eating Habits Checklist as binge eaters, 18% as anorexic, and 23% as bulimic. Significant relationships were found between alexithymia and binge eating and depression. A stepwise logistic regression found that both alexithymia and depression discriminated between women with and without binge eating at .001 and .002, respectively. CONCLUSIONS: This study found that alexithymia was more highly correlated with binge eating than with either anorexia or bulimia. In addition, a significant history of trauma and health problems for those who reported as binge eaters was reported. Implications for practice are discussed.

Adult↗

PubMed1993

Eating attitudes test in boys and girls aged 6-18 years: decrease in concerns with eating in boys and the increase in girls with their ages.

Concerns with eating were studied in 130 Japanese boys and 125 girls aged 6-18 years using the Simplified Eating Attitudes Test (s-EAT). The s-EAT scores in girls slightly increased with age. The mean scores in girls at age 10 years or older were significantly higher than in boys of the same age, suggesting that pubertal girls have more concerns with eating. On the other hand, s-EAT scores in boys that were not overweight decreased as they grew older, contributing, at least partly, to the sexual difference in eating behavior. The mean scores in overweight boys were higher than in boys that were not overweight. The score in boys correlated significantly with weight though there was no significant correlation in girls. These results suggest that, in addition to increased concerns with eating in girls, decreased concerns with age in boys is one of the causes of the sexual difference in eating behavior, especially during puberty. Eating behaviors in girls seem to be less influenced by changes in body weight than in boys.

Adolescent↗

PubMed2000

Evaluation of a screening test for female college athletes with eating disorders and disordered eating.

OBJECTIVE: To develop a screening test to detect female college athletes with eating disorders/disordered eating (ED/ DE). No validated eating disorder screening tests specifically for athletes have been available. DESIGN AND SETTING: In this cross-sectional study, subjects from a large midwestern university completed 3 objective tests and a structured diagnostic interview. MEASUREMENTS: A new test, developed and pilot tested by the researchers (Athletic Milieu Direct Questionnaire, AMDQ), and 2 tests normed for the general population (Eating Disorder Inventory-2, Bulimia Test-Revised) were used to identify ED/DE athletes. A structured, validated, diagnostic interview (Eating Disorder Examination, version 12.OD) was used to determine which test was most effective in screening female college athletes. SUBJECTS: Subjects included 149 female athletes, ages 18 to 25 years, from 11 Division I and select club sports. RESULTS: ED/DE subjects (35%) were found in almost every sport. Of the ED/DE subjects, 65% exhibited disordered eating, 25% were bulimic, 8% were classified as eating disordered not otherwise specified (NOS), and 2% were anorexic. The AMDQ more accurately identified ED/DE than any test or combination of items. The AMDQ produced superior results on 7 of 9 epidemiologic analyses; sensitivity was 80% and specificity was 77%, meaning that it correctly classified approximately 4 of every 5 persons who were truly exhibiting an eating disorder or disordered eating. CONCLUSIONS: We recommend that the AMDQ subsets, which met statistical criteria, be used to screen for ED/DE to enable early identification of athletes at the disordered eating or NOS stage and to initiate interventions before the disorder progresses.

Journal Article↗

PubMed1994

Binge eating behavior in patients with eating disorders.

The purpose of this study was to determine whether the objectively observed binge eating behavior of obese subjects meeting the proposed DSM-IV criteria for binge eating disorder would be similar to that observed in patients with bulimia nervosa. Non-obese patients with bulimia nervosa (BN), obese subjects with binge eating disorder (BED), obese and non-obese women without eating disorders were each instructed to binge eat single- and multiple-item meals. In the multiple-item meal, the obese subjects with BED ate significantly more (1515 kcal) than obese subjects without BED (1115 kcal), but they ate less than the normal-weight bulimic patients (2680 kcal). The non-obese controls ate amounts similar to the obese non-binge-eating-disordered group (1093 and 1115.2 kcal, respectively). In the single-item meal, consisting of ice cream, patients with BN ate significantly more than any other group (1307 kcal), while obese subjects with or without binge-eating disorder ate significantly more (762 kcal) than non-obese controls (308 kcal). This study has demonstrated that although both BN and BED are characterized by recurrent episodes of binge eating, quantitatively there appear to be differences between the eating disturbances in the two disorders. Because single- and multiple-item meals differ in external cues, these results also suggest that the obese subjects with BED may be disinhibited by external cues, while obese subjects without BED may be inhibited by external cues.

Adolescent↗

PubMed2004

Association between a vasopressin receptor AVPR1A promoter region microsatellite and eating behavior measured by a self-report questionnaire (Eating Attitudes Test) in a family-based study of a nonclinical population.

OBJECTIVES: Considerable evidence including twin and family studies suggests that biologic determinants interact with cultural cues in the etiology of anorexia and bulimia nervosa. A gene that makes "biologic sense" in contributing susceptibility to these disorders, and to our knowledge not previously investigated for this phenotype, is the vasopressin receptor (AVPR1A), which we have tested for association with eating pathology. METHODS: We genotyped 280 families with same-sex siblings for two microsatellites in the promoter region of the AVPR1A gene. Siblings completed the 26-item Eating Attitudes Test (EAT) and the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorders Inventory (EDI). The Quantitative Transmission Disequilibrium Test program (QTDT), which employs flexible and powerful variance-components procedures, was used to test for an association between EAT scores and the two AVPR1A promoter region microsatellites, RS1 and RS3. RESULTS: A significant association (p = .036) was detected between the RS3 microsatellite and EAT scores. The strongest association was between RS3 and the Dieting subscale of the EAT (p = .011). A significant association was also observed between the EDI-DT and the RS3 microsatellit (p = .0450). CONCLUSIONS: We demonstrate for the first time an association between a microsatellite polymorphism in the AVPR1A promoter region and scores on the EAT as well as with the EDI-DT. The strongest association was observed between the RS3 microsatellite and the Dieting subscale of the EAT. The relevant phenotype appears to tap severe dietary restriction for weight loss purposes.

Adolescent↗

PubMed1999

A generalizability study of the Eating Attitudes Test (EAT-12) in non-clinical adolescents.

One of the most frequently used measures of eating and weight problems is the Eating Attitudes Test (EAT). The paper discusses conceptual heterogeneity in the EAT in the light of eating disorder continuum theory. Psychometric qualities of the Norwegian 12-item version of the EAT was based on a sample of 224 female and 261 male adolescents aged 14-15 years. Generalizability theory enabled us to study the impact of multiple sources of measurement errors of the EAT-12. The analyses suggest that acceptable generalizability is achieved by the present design on applying 4 items within 3 categories of the EAT. Alternative designs are suggested, and the utility of G-theory is discussed. The results also provide evidence of a gender difference in the structure of the universe score variance. Non-clinical adolescents' ways of organizing information about food and eating are discussed in the light of gender differences.

Adolescent↗