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PubMedDate not supplied

Diabetes mellitus and eating disorders: a multicenter study on the comorbidity of the two diseases.

Because diet is a key issue in the treatment of diabetes mellitus, it is assumed that these patients are prone to eating disorders. In a multicenter study, we have therefore assessed the prevalence of eating disorders in 662 patients with insulin dependent diabetes mellitus (IDDM) (n = 340) and non-insulin-dependent diabetes mellitus (NIDDM) (n = 322). A two-stage study combining self-rating questionnaires and a standardized interview was carried out. We found a prevalence of eating disorders of 5.9% (lifetime prevalence of 10%), irrespective of gender and type of diabetes; 4.1% of the whole sample reported intentional insulin undertreatment or omission. When patients were stratified according to IDDM and NIDDM, there was no difference in the prevalence of all eating disorders (point prevalence 5.5% vs. 6.5%, lifetime prevalence 10.0% vs. 9.9%). Prevalence of bulimia nervosa (BN) was more frequent in IDDM patients (point prevalence 1.5% vs. 0.3%, lifetime prevalence 3.2% vs. 1.9%) and binge eating (BED) was more frequent in NIDDM patients (point prevalence 1.8% vs. 3.7%, lifetime prevalence 2.6% vs. 5.9%). We conclude that eating disorders seem to be equally frequent in IDDM and NIDDM patients. However, there might be different features of eating disorders in both types of diabetes.

Adolescent↗

PubMedDate not supplied

Eating disorders guidelines from NICE.

CONTEXT: January, 2004, marked the publication of NICE guidelines for the treatment of eating disorders, a series of recommendations from a multidisciplinary, comprehensive, and rigorous process. The recommendations are assigned a grade from A (strong empirical support from well-conducted randomised trials) to C (expert opinion without strong empirical data). Over 100 recommendations were made, most of which were given a C grade. No specific recommendations were made for anorexia nervosa. Cognitive behavioural therapy for bulimia nervosa was assigned grade A because of the evidence showing that it is superior to other psychological and drug treatments. Antidepressants for bulimia nervosa were given grade B. No specific recommendations were made for atypical eating disorders except for binge-eating disorder (cognitive behavioural therapy was recommended [A]). STARTING POINT: The methodological rigour of the NICE guidelines is in contrast with the current Practice Guideline for Eating Disorders (PGED) of the American Psychiatric Association. PGED does not detail criteria for evaluating supporting research. Instead of making clear recommendations, PGED is uncritically inclusive and emphasises subjective judgment of individual clinicians. The NICE guidelines balance recommending specific treatments against the importance of clinical judgment when guideline recommendations are not readily applicable. WHERE NEXT: Evidence-based guidelines are limited by the quality of the available research and its clinical relevance. The NICE guidelines underscore the absence of sufficient evidence for guidance in several important areas, such as atypical eating disorders (eating disorders not otherwise specified) which are the most common. Research on the treatment of these atypical eating disorders is needed. Evidence-based psychological treatments are not routinely implemented in general practice. Dissemination of these demonstrably effective treatments poses a challenge, and learning how to implement evidence-based psychological treatments and monitor their use is a research priority.

Evidence-Based Medicine↗

PubMedDate not supplied

Self-control in relation to problem drinking and symptoms of disordered eating.

The present study investigated problem drinking and symptoms of disordered eating in relation to (a) restrained drinking and eating, and (b) cognitive self-control. One hundred and ninety-eight high school students (97 males and 101 females; mean age = 16.45 years) completed questionnaires that assessed problem drinking, symptoms of disordered eating, restrained eating and drinking, and cognitive self-control. Using principal components analysis, three factors with eigenvalues greater than 1 were found to summarize the interrelationships among the examined measures. For both sexes, the first two factors primarily reflected problem drinking and restrained drinking, and problem eating and restrained eating, respectively. The third factor reflected a more general problem with control underlying aspects of both problem drinking and problem eating.

Adolescent↗

PubMedDate not supplied

Self-control in relation to problem drinking and symptoms of disordered eating.

The present study investigated problem drinking and symptoms of disordered eating in relation to (a) restrained drinking and eating and (b) cognitive self-control. One hundred ninety-eight high school students (97 males and 101 females: mean age = 16.45 years) completed questionnaires which assessed problem drinking, symptoms of disordered eating, restrained eating and drinking, and cognitive self-control. Using principal components analysis, three factors with eigenvalues greater than one were found to summarise the interrelationships among the examined measures. For both sexes, the first two factors primarily reflected problem drinking and restrained drinking, and problem eating and restrained eating, respectively. The third factor reflected a more general problem with control underlying aspects of both problem drinking and problem eating.

Adolescent↗

PubMed1999

What are the eating cognitions of children whose chronic diseases do and do not require attention to diet?

Nutrition therapy is essential to the management of several chronic diseases affecting adolescents. Unfortunately, dietary impositions may evoke pathological eating-related cognitions. This pilot study examined eating- and weight-related cognitions of 55 adolescents attending a summer camp for youngsters with a heterogeneous variety of chronic diseases. Campers completed the Eating Cognitions Questionnaire and the Situational Obstacles to Dietary Adherence questionnaire. Campers whose medical regimens included special dietary recommendations (n = 24) were expected to have more cognitions associated with eating disorders than those without dietary restrictions (n = 31). Girls were significantly more concerned than boys about weight and restrictive dietary rules. Cognitions of youngsters with special dietary recommendations showed greater flexibility, less eating pathology and less weight concern than campers without recommended diets. Contrary to previous reports, dietary restrictions were associated with more appropriate eating cognitions, suggesting that adolescents with chronic illnesses requiring nutrition therapy may not necessarily bear greater risk of eating disorders.

Adaptation, Psychological↗

PubMed2000

Regional cerebral blood flow during exposure to food in obese binge eating women.

Cerebral responses elicited by the sight of food were evaluated in eight obese binge eating, 11 obese and 12 normal-weight non-binge eating women. Regional cerebral blood flow (rCBF) was mapped while the subjects were looking at a picture of a landscape (control) or at a portion of food (food exposure), and was measured by [99mTc]ethyl-cysteine-dimer and single photon emission computed tomography. Exposure to food was associated with different changes in the cerebral blood flow (normalized to mean cerebellar counts) of the right and left hemispheres in the obese binge eating than in the obese or normal-weight non-binge eating women. As compared with the non-binge eating groups, the obese binge eating women had, due to food exposure, a greater increase in the cerebral blood flow in the left than right hemisphere, especially in the frontal and pre-frontal regions. In addition, strong linear correlations were observed in this group between the rCBF of the left frontal and pre-frontal regions and the increase in the feeling of hunger during the exposure to food. Left hemisphere and its frontal and pre-frontal regions could thus play a role in binge eating behavior in humans.

Adult↗

PubMed2001

Differences between adolescents and young adults at presentation to an eating disorders program.

OBJECTIVE: To describe differences between adolescents and adults in clinical presentation of eating disorders. METHODS: Data from the charts of 622 female patients treated for an eating disorder in a division of adolescent medicine between 1980 and 1994 were coded and computerized. General categories included demographic and family factors, weight loss and weight changes, eating-related behaviors, diagnosis and severity, and treatment issues. Differences between the 438 patients who were aged 9-19 years (adolescents) and 184 patients who were aged 20-46 years (adults) were analyzed. RESULTS: Adolescents were more likely than adults (p <.05) to have a diagnosis of "eating disorder not otherwise specified," lower global severity score, greater denial and less desire for help, weight loss > or = 3 lb/month, lower original and maximum weights, and history of fasting and elimination of junk food from their diets. Adults were more likely than adolescents (p <.05) to have >1 year of weight loss, greater total weight loss, history of binge eating and laxative use, history of diuretic and ipecac use, diagnosis of bulimia nervosa, and prior use of psychiatric medications. Adolescents and adults did not differ (p >.05) in parents' occupational level; height, weight, and percent ideal body weight at presentation; original percent ideal body weight; use of diet pills, elimination of meat and use of a low-fat diet; daily calorie intake; prior eating disorder hospitalizations; and hospitalization during the course of treatment. CONCLUSIONS: The findings in this study document and confirm that there are important differences between adolescents and adults that must be taken into account in the evaluation and treatment of patients with eating disorders.

Adolescent↗

PubMed2002

Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity.

PURPOSE: To examine the current prevalence of disordered eating behaviors in a large sample of adolescents, by gender and ethnicity, and to identify gender and ethnic-specific risk and protective factors. METHODS: The study population included 81,247 9th- and 12th-graders who completed the 1998 Minnesota Student Survey, a self-report, school-based survey which included questions about disordered eating behaviors and a variety of psychosocial characteristics. RESULTS: Fifty-six percent of 9th-grade females and 28% of 9th-grade males report disordered eating behaviors (i.e. one or more of the following to lose or control weight: fasting or skipping meals, diet pills, vomiting, laxatives or smoking cigarettes; and binge-eating), with slightly higher rates among 12th-grade females and males, 57% and 31%, respectively. Among both genders, Hispanic and American Indian youth reported the highest prevalence of disordered eating. Risk factors for disordered eating among both males and females included cigarette smoking, appearance concerns, and alcohol use. Protective factors for both males and females were positive self-esteem, emotional well-being, school achievement, and family connectedness. While risk and protective factors were similar across gender, they differed across ethnicity particularly among females. CONCLUSIONS: Health professionals working with youth need to be aware of the high prevalence of these subclinical disordered eating behaviors, ask appropriate screening questions, and provide resources and referral, if necessary, for youth reporting these behaviors. Knowledge of risk and protective factors can serve to guide intervention and prevention efforts, particularly as they apply across ethnicity.

Adolescent↗

PubMed2000

Bone mineral status in adolescent girls: effects of eating disorders and exercise.

PURPOSE: To compare whole-body, lumbar, total spine, and pelvis bone mineral density (BMD), body mass index (BMI), body composition, energy expenditure for physical activity, and dietary intake of adolescents, aged 16-22 years. METHODS: Three study groups included 25 girls with histories of eating disorderd, 25 girls with no histories of eating diso rders who exercised < or = 7 hours/week, and 15 girls with no history of eating disorders who exercised > 7 hours/week. Bone mineral density was measured by dual-energy x-ray absorptiometry (DEXA), body composition by bioelectric impedance and DEXA, energy expenditure by Personal Activity Computer, nutrient intake by 4-day dietary recalls/records, and BMI by measures of height/weight. General linear models, LSM +/- SEM, Student's t-tests, and correlation analyses were used to determine group differences. RESULTS: No significant differences in whole-body, spinal, and pelvis BMD were found among the three groups. Mean body fat (percent) was significantly higher (p =.0001) for the group with histories of eating disorders than other groups. Dietary intakes of adolescents with histories of eating disorders were significantly lower for energy (p =.0001), fat (p =.0001), calcium (p =.0007), vitamin D (p =.0180), and zinc (p =.0057) than those without eating disorder histories who exercised </= 7 hours/week. CONCLUSION: Except for body fat (percent), measures of BMD, energy expenditure, and BMI were not significantly different among groups. Our data suggest that with full recovery from eating disorders, teenage girls can achieve normal bone mass and body composition.

Absorptiometry, Photon↗

PubMedDate not supplied

Eating disorders: current concepts.

OBJECTIVE: To review for the community pharmacist common eating disorders and suggest strategies for pharmacist-directed patient education. DATA SOURCES: Current literature. DATA SYNTHESIS: Women are much more likely than men to develop eating disorders, and Western culture's emphasis on thinness contributes to the prevalence of eating disorders in the United States. Regardless of the type, all eating disorders are rooted in emotions, often traced to problems during adolescence. Anorexia nervosa patients continually set and strive to obtain lower goal weights to the point that their general well-being is compromised. Bulimia nervosa is characterized by excessive eating followed by purging that is an apparent attempt to relieve the tension and guilt associated with the initial overeating. Rather than directly dealing with tension and anger, a patient suffering from binge eating overindulges in food. Most overeaters are aware that excess weight is detrimental to their health, but they cannot control their overeating behavior. CONCLUSION: In treating eating disorders, it is important to address patients' emotional and psychological needs as well as physical symptoms. Patients often need encouragement to seek and continue treatment, and pharmacists are in an ideal position to provide that support.

Feeding and Eating Disorders↗

PubMedDate not supplied

Knowledge, beliefs, attitudes, and behaviors related to weight control, eating disorders, and body image in Australian trainee home economics and physical education teachers.

OBJECTIVE: To examine the knowledge, beliefs, and attitudes about weight control and eating disorders among trainee home economics and physical education teachers and to assess their body image and weight control practices. The association between actual body weight and body image was also examined. DESIGN: Survey research was undertaken using a self-report questionnaire. Height and weight were measured. SUBJECTS/SETTINGS: Trainee home economics and physical education teachers (N = 216, 96% participation rate) in their last month of training at three major state teacher training universities completed a questionnaire during their regular class times. MAIN OUTCOME MEASURES: Advice teachers give to overweight adolescents knowledge and beliefs about eating disorders, body image, desired weight, food habits, dieting, body appearance ratings, weight control practices, and diagnosed and self-reported eating disorders. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics, chi square, and analyses of variance compare gender and Body Mass Index differences. RESULTS: Males (85%) and females (87%) advised young overweight adolescents to diet to lose weight. Twenty percent of females and 13% of males regularly skipped breakfast. The advise given showed a lack of specific nutrition education about weight control, adolescent nutritional needs, and fad diets. Participants held misconceptions about eating disorders, and a range of 14% to 72% answered these questions incorrectly. Fourteen percent of females self-reported that they currently had an eating disorder, but only 6% had received treatment. Some females used potentially dangerous methods of weight loss, including 19% who abused laxatives and 10% who induced vomiting. IMPLICATIONS: Trainee home economics and physical education teachers need specific nutrition information and training about eating disorders, weight control, and suitable advice for overweight students. The female trainee teachers in our study had a poor body image and disordered eating similar to other young women in Western countries, and this should be taken into account by teacher training institutions.

Adult↗

PubMed2000

Role of dietary carbohydrate and frequent eating in body-weight control.

Despite widespread interest in body-weight control, the prevalence of obesity continues to rise worldwide. Current public health advice for obesity prevention is clearly failing. The present paper examines the appropriateness of current public health advice for body-weight control, i.e. to reduce consumption of fatty foods, to reduce consumption of sugar and to avoid snacking between meals. An increase in carbohydrate: fat ratio should improve body-weight control, as high-carbohydrate low-fat diets are less likely to lead to overeating, and if overeating does occur, less of the excess energy is likely to be stored as fat. However, it is suggested that for the long-term prevention of weight gain, advice to increase consumption of carbohydrate-rich foods may be more effective than advice which focuses on reducing consumption of fatty food. Moreover, in view of the inverse relationship between fat and sugar intakes, sugar may have a positive role to play in body-weight control in facilitating an increase in carbohydrate: fat ratio. Snacking for most individuals appears not to adversely affect body-weight control, and for some it may improve control. This situation may exist because frequent eating helps appetite control, thus preventing overeating at meals, and as snacks overall tend to be higher in carbohydrate and lower in fat than meals, frequent eating may be a strategy for increasing carbohydrate: fat ratio. It is also suggested that eating 'little and often' may be a more compatible pattern of eating for a physically-active lifestyle than eating large meals. Perhaps the most appropriate advice on food intake that would work synergistically with concurrent advice to increase physical activity is to eat more carbohydrate, and to eat frequently.

Appetite↗

PubMed1996

A two-stage epidemiological study of abnormal eating attitudes and their prospective risk factors in Polish schoolgirls.

In this longitudinal two-stage screening study of abnormal eating attitudes and behaviours in Polish schoolgirls self-report questionnaires (EAT-26) were completed by 747 schoolgirls aged between 14 and 16 years. On the basis of their EAT-26 scores 167 girls were selected for a clinical interview conducted blind to questionnaire scores. No clinical cases of DSM-III-R anorexia or bulimia nervosa were identified, however, there was a point prevalence of 2.34% for subclinical eating disorder and of 28.6% for dieting. Natural history was investigated, repeating the screening and interviews after 10 months. Both the group mean EAT-26 score and the proportion of subclinical cases remained the same at follow-up however, individual girls showed substantial fluctuations over time. On re-screening 11.5% of the sample had moved EAT category (based on scoring below or above the clinical cut-off point). Follow-up interviews showed that 58% (7) of the original subclinical cases were no longer cases while seven girls were "new' subclinical cases. This second stage of the study also aimed to investigate the risk factors for the development of eating disorders. Several family factors distinguished the dieters from non-dieters at the initial stage. Subjects who began dieting between the initial and follow-up interviews had higher Body Mass Index, felt more overweight and had greater discrepancy between their current and ideal weights than the non-dieters. However, analysis of regression revealed no specific risk factors for development of a subclinical syndrome.

Adolescent↗

PubMed1999

The structure of genetic and environmental risk factors for three measures of disordered eating.

BACKGROUND: The study explored the genetic and environmental risk factors for both the behaviours and attitudes characteristic of disordered eating. METHODS: In three waves of data collection, information was collected from female twins regarding their eating and attitudes towards eating, weight and shape. The first assessment consisted of a self-report questionnaire (1988-9) with 1682 women. The second assessment consisted of a semi-structured psychiatric interview schedule (1992-3), completed by 1852 women, many of whom had completed Wave 1 assessment. The third assessment, with 325 women chosen from Waves 1 and 2 (1995-6), consisted of a semi-structured interview (the Eating Disorder Examination). RESULTS: As only one twin pair was concordant for lifetime bulimia nervosa at Wave 3 assessment, ordinal measures of all assessments were used in a multivariate genetic analysis. Results indicated that additive genetic and non-shared environmental influences best explained variance in liability to disordered eating, with about 60% (95% CI 50-68) of the variance explained by genetic factors. Comparison with a model allowing for the effects of shared environment indicated genetic factors accounted for a similar degree of variance (59%, 95% CI 36-68). CONCLUSION: Liability to the development of the behaviours and attitudes characteristic of eating disorders is best explained by both environmental and genetic factors, with covariation between the three measures best explained by a single latent phenotype of disordered eating which has a heritability of 60%.

Adult↗

PubMed2002

Changes in health related quality of life among patients treated for eating disorders.

OBJECTIVE: To prospectively investigate changes in the perception of health-related quality of life (HRQoL) among eating disorder patients after 2 years of treatment and follow-up and clinical predictors of change. METHOD: One hundred and thirty-one consecutive subjects were recruited from an eating disorder outpatient clinic. Subjects completed a generic HRQoL questionnaire, the Short Form-36 (SF-36), as well as the Eating Attitudes Test (EAT-40) to measure symptom severity and the Hospital Anxiety and Depression scale (HAD), at the first visit and after 24 months. RESULTS: Perception of HRQoL, measured by the SF-36, showed significant improvement in all but the role emotional domain after 2 years. The greatest improvements were observed in the physical function and social function domains, followed by mental health and vitality. Despite significant improvement in the summary mental health scale, scores after 2 years of treatment and follow-up were still below normative population values of women aged 18-34. Severity of eating disorder symptoms and presence of anxiety or depression at baseline significantly affected improvement in various SF-36 domains. CONCLUSIONS: Despite improvements in perception of HRQoL, eating disorder patients were more dysfunctional in all domains of the SF-36 even after 2 years of treatment and follow-up compared with women in the general population, and the severity of eating disorder symptoms was correlated with degree of dysfunction.

Adolescent↗

PubMed2001

Associated health risks of adolescents with disordered eating: how different are they from their peers? Results from a high school survey.

In this study, we compare health risks of adolescents with disordered eating to those of their peers without disordered eating. A self-report health survey from a community sample of 1769 high school students was used to compare emotional, medical, and social behaviors of these two groups. Risk data for disordered eating students was compared within and across genders. Adolescents with disordered eating are at increased risk for emotional and physical health problems compared to their peers. Overall health risks for boys and girls with disordered eating are quite similar. However, boys with disordered eating develop associated health risk profiles that differentiate them from male peers by having increased mental health, sexual and physical abuse, and general health problems. Girls with disordered eating have associated health risks for substance use and sexual risk-taking that distinguished them from their female peers.

Adolescent↗

PubMed2004

Body image and eating disturbances across ethnic groups: more similarities than differences.

Sociocultural models of eating pathology posit that ethnic minority groups should show fewer eating disturbances than Whites. Thus, the authors tested whether there were ethnic differences in eating disorder symptoms and risk factors for eating pathology and whether the relations between risk factors and eating pathology differed across ethnic groups, with data from adolescent and adult females (N = 785). Only 1 of the 14 tests of main effect differences between ethnic groups was significant and none of the 49 tests of whether ethnicity moderated the relations of risk factors to eating pathology were significant. Findings provide little support for the hypothesized ethnic differences in eating disturbances and suggest that ethnic minority groups have reached parity with Whites in this domain.

Adolescent↗

PubMed2004

Gastric bypass in a low-income, inner-city population: eating disturbances and weight loss.

OBJECTIVE: To examine the prevalence of eating disturbances and psychiatric disorders among extremely obese patients before and after gastric bypass surgery and to examine the relationship between these disturbances and weight outcomes. RESEARCH METHODS AND PROCEDURES: Sixty-five women patients (ages 19 to 67) with a mean BMI of 54.1 were assessed by semistructured psychiatric interview before surgery and by telephone interview after surgery (mean follow-up: 16.4 months) to determine psychiatric status, eating disturbances, and weight and health-related variables. RESULTS: Patients lost a mean of 71% of their excess BMI, with significantly poorer weight loss outcomes among African Americans. Psychiatric disorders remained prevalent before (37%) and after (41%) surgery. In contrast, binge eating disorder dropped from 48% to 0%. Psychiatric diagnosis did not affect weight outcomes. Instead, more frequent preoperative binge eating, along with greater initial BMI, follow-up length, and postoperative exercise, predicted greater BMI loss. Postsurgical health behaviors (exercise and smoking) and nocturnal eating episodes were also linked to weight loss. Exercise frequency increased and smoking frequency tended to decrease after surgery. DISCUSSION: These findings indicated that eating and psychiatric disturbances did not inhibit weight loss after gastric bypass and should not contraindicate surgery. Prior binge eating, eliminated after surgery, predicted BMI loss and, thus, may have previously been a maintaining factor in the obesity of these patients. The association between health behaviors and outcome suggests possible targets for intervention to improve surgical results. Poorer outcomes among African Americans indicate that these patients should be closely monitored and supported after surgery.

Adult↗