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PubMed2006

Associations between disordered eating behaviors and licit and illicit substance use and abuse in a university sample.

OBJECTIVES: To examine associations between discrete eating disordered behaviors as well as clusters of eating disordered behaviors in relation to the use and abuse of a wide spectrum of substance classes, both licit and illicit, in a female university sample. METHODS: Women with particular types of eating disordered behaviors were selected from a pool of 526 students who completed the Women's Health Survey. Analyses compared the frequencies of lifetime engagement in a wide range of licit and illicit substances between each of the eating disorder groups and the normal control group. RESULTS: Associations were found between severe levels of alcohol consumption and binge eating, dieting with purging and the use of central nervous stimulants, and bingeing with dieting and tobacco use and the abuse of prescription medications. CONCLUSION: Examining a broad range of substance classes, with differing physiological properties and effects, in relation to specific disordered eating behaviors, could contribute to theory development regarding the functions of the specific co-occurring behaviors.

Adolescent↗
PubMed2005

The night eating syndrome: a progress report.

The night eating syndrome (NES) is an eating disorder marked by a delay in the circadian pattern of eating that disrupts sleep. Studies have shown that those with NES eat a significant proportion of their calories after their evening meal and wake up during the night to eat. However, the timing of the sleep cycles are phase appropriate, with similar bedtimes and morning wake up times as control subjects, suggesting that the delayed eating rhythm may secondarily disrupt sleep. A case study and an open-label trial with SSRIs suggest that they may treat NES effectively. Randomized controlled trials are needed.

Adult↗
PubMed2006

Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representative sample of Irish adults.

Attitudes towards healthy eating were explored according to dietary, lifestyle and socio-demographic correlates in a random sample of 1256 Irish adults. Data were obtained from an Irish cross-sectional survey (1997-1999). A self-administered questionnaire was used to obtain attitudinal information. Food consumption was estimated using a 7-d food diary. A majority of the sample had a positive attitude or motivation towards their healthy eating behaviour. Those who perceived their own eating habits to be healthy were more likely to comply with current dietary guidelines than those who did not. Females, increasing age, higher social class, tertiary education, non-smokers, lower body-weights and increased recreational activity were associated with a lower odds ratio (OR) for having a negative attitude towards their healthy eating behaviour. An increased intake (g/d) of breakfast cereals, vegetables, fruit and poultry dishes were associated with decreased OR for negative attitudes towards their healthy eating behaviour, while an increased intake of high-calorie beverages (g/d) was associated with an increased OR. It can be concluded that attitudes or motivation towards eating healthily was related to measured dietary and lifestyle behaviour in this sample. Future research is warranted to devise appropriate methods of instituting attitude change towards dietary behaviour in certain subgroups of the population.

Adolescent↗
PubMed2005

Functional neuroanatomy of body shape perception in healthy and eating-disordered women.

BACKGROUND: Abnormalities in perception and evaluation of body shape are a hallmark of eating disorders. METHODS: Brain responses to line drawings of underweight, normal weight, and overweight female bodies were measured with functional magnetic resonance imaging in 9 women with bulimia nervosa, 13 with anorexia nervosa, and 18 healthy women. Participants rated the stimuli for fear and disgust. RESULTS: In the three groups, the lateral fusiform gyrus, inferior parietal cortex, and lateral prefrontal cortex were activated in response to body shapes compared with the control condition (drawings of houses). The responses in the lateral fusiform gyrus and in the parietal cortex were less strong in patients with eating disorders compared with healthy control subjects. Patients with eating disorders rated the body shapes in all weight categories as more aversive than did healthy women. In the group with eating disorders, the aversion ratings correlated positively with activity in the right medial apical prefrontal cortex. CONCLUSIONS: Processing of female body shapes engages a distributed neural network, parts of which are underactive in women with eating disorders. The considerable variability in subjective emotional reaction to body shapes in patients with eating disorders is associated with differential activity in the prefrontal cortex.

Adult↗
PubMed2005

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery.

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.

Adult↗
PubMed2005

Eating disorders in athletes: managing the risks.

Athletes risk injuries and make personal sacrifices in their education, careers, and personal relationships in pursuit of excellence. Well-prepared athletes and their support teams take steps to minimize these risks. Since the 1980s, it has been apparent that development of an eating disorder is a risk associated with considerable morbidity and significant mortality, and with shorter careers characterized by inconsistency and recurrent injury. How likely is it that an athlete will develop an eating disorder? Who is at risk? Can eating disorders be prevented? How can eating disorders be identified? What are the consequences of developing an eating disorder? What can be done to help an athlete who has an eating disorder? This article attempts to answer these questions.

Comorbidity↗
PubMed2004

Effects of disordered eating and obesity on weight, craving, and food intake during ad libitum smoking and abstinence.

Although there is empirical support for the association between smoking, disordered eating, and subsequent weight gain upon smoking cessation, there have been no prospective studies to track changes in eating patterns during smoking abstinence and explore underlying biobehavioral processes. To help fill these gaps, we recruited four groups of women (N=48, 12/group) based on presence vs. absence of obesity and on low vs. high risk of severe dieting and/or binge-eating to participate in a laboratory study of eating in the context of ad libitum smoking and smoking abstinence. Participants [mean age 31.3 years; Fagerstrom Test of Nicotine Dependence (FTND) 4.3; smoking rate 18.7 cigarettes/day] completed two sessions: one after ad libitum smoking, the other after 2 days' smoking abstinence, in counterbalanced order. After a half-day's restricted eating, participants watched a video, with measured amounts of preselected preferred food available throughout. Cigarettes were available during the ad libitum smoking session. High-risk women weighed more after 2 days' abstinence than during the ad libitum smoking condition, whereas low-risk women did not differ across conditions. Nicotine craving changed significantly more in anticipation of nicotine deprivation for high-BMI women than their low-BMI counterparts. Caloric intake was marginally attenuated during abstinence for low-BMI compared with high-BMI participants (P<.10), an effect primarily accounted for by differences in protein intake (P<.10). These findings suggest that low-BMI women may be less prone to weight gain during early abstinence, possibly because they compensate for metabolic changes induced by nicotine washout by eating less. Craving increases experienced by high-BMI women during abstinence under conditions of food deprivation may contribute to difficulty quitting in these women.

Adolescent↗
PubMed2005

Empirical classification of eating disorders.

Although the eating disorder nosology has become refined over the years, considerable problems remain. The purpose of the present study was to empirically examine eating disorder classification using a sample of treatment-seeking eating-disorder patients. One hundred and fifty-nine patients with diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder, not otherwise specified (EDNOS), were included in a cluster analysis using a variety of eating disorder variables. Findings revealed four clusters, with three clusters resembling AN, restricting type, BN, and binge-eating disorder (BED). The remaining cluster appeared to be a group of patients that were subthresholded in terms of symptom severity. Results also indicated a relatively poor fit between the empirically derived groupings and clinical diagnoses. The implications of these findings for both the current classification system and treatment considerations are discussed.

Adult↗
PubMed2005

An attachment insecurity model of negative affect among women seeking treatment for an eating disorder.

The purpose of this study was to propose and test a model of attachment insecurity in a clinical sample of 268 eating disordered women. Structural relationships among attachment insecurity, BMI, perceived pressure to diet, body dissatisfaction, restrained eating, and negative affect were assessed. A heterogeneous sample of treatment seeking women with a diagnosed eating disorder completed psychometric tests prior to receiving treatment. The data were analysed using structural equation modeling. Fit indices indicated that the hypothesized model fit adequately to the data. Although cross-sectional in nature, the data suggested that attachment insecurity may lead to negative affect. As well, attachment insecurity may lead to body dissatisfaction, which in turn may lead to restrained eating among women with eating disorders. Attachment insecurity could be a possible vulnerability factor for the development of eating disorder symptoms among women.

Adolescent↗
PubMed2006

Does the avoidance of body and shape concerns reinforce eating disordered attitudes? Evidence from a manipulation study.

It is theoretically plausible to assume that attention plays a role in eating disordered attitudes. Indeed, studies examining relations between eating disorders and attention to body and/or shape related stimuli have found such associations. Although this research is invaluable in characterizing relations between attentional processes and eating disordered attitudes, such work remains correlational in nature. In the present investigation, 73 undergraduate women were randomly assigned to one of two attentional training conditions. One condition trained attention away from body/shape words, whereas the other trained attention toward body/shape words. Following this training participants reported on their eating-related attitudes. Women trained to avoid body/shape words subsequently reported more concerns about eating and body shape. These results suggest that attentional avoidance of body/shape concerns increases such concerns. The results point to the potential causal effects of attention on eating disordered attitudes, in turn suggesting a basis for possible treatment.

Adult↗
PubMed2006

The eating disorder belief questionnaire: psychometric properties in an adolescent sample.

The current study aimed to investigate the psychometric properties of the Eating Disorder Belief Questionnaire in older adolescent females. Three hundred and sixty-seven girls aged 17 or 18 who were in secondary school education completed the Eating Disorder Belief Questionnaire, the Beck Depression Inventory and the Eating Attitudes Test. They also provided information on height and weight. The Eating Disorder Belief Questionnaire had an almost identical factor structure to that previously found in adult women, although the factors were not quite as discrete as those in the original validation study. Internal consistency for each factor was high and construct validity (including convergent and criterion related validity) was very good. The almost identical factor structure, and other good psychometric properties, found for the Eating Disorder Belief Questionnaire in the current study suggests that it is an appropriate measure for use in clinical settings and in research studies involving 17-18 year old girls. This includes older adolescents with eating disorders. The possibility that adolescents show a developmental tendency for less separation between the constructs assessed, when compared with adults, is of particular interest, and requires further exploration.

Adolescent↗
PubMed2006

Functional hypothalamic amenorrhea is associated with elevated ghrelin and disordered eating.

OBJECTIVE: To determine whether ghrelin, an orexigen released by the stomach, is elevated in women with hypothalamic amenorrhea who are of normal weight and whether this is associated with abnormal eating behaviors. DESIGN: Controlled clinical study. SETTING: Healthy volunteers in an academic research environment. PATIENT(S): Twenty-seven women with functional hypothalamic amenorrhea (FHA) and 42 normally menstruating women. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ghrelin and eating behavior. RESULT(S): Ghrelin was significantly elevated in FHA (648.4 +/- 92.0 pg/mL vs. controls 596.7 +/- 79.0 pg/mL), while leptin, although lower, was not significantly so (FHA 5.4 +/- 2.8 ng/mL vs. controls 6.4 +/- 3 ng/mL). Eating Attitudes Test (EAT) scores were also significantly elevated in FHA (15.3 +/- 10.6 vs. controls 10.3 +/- 8.4), particularly on the subscale that measured bulimic behaviors. However, FHA patients consumed significantly more kilocalories (1,930 kcal/day vs. 1,588 kcal/day). CONCLUSION(S): High ghrelin in women with FHA may be linked to abnormal dietary behaviors, as reflected in high EAT scores yet characterized by normal caloric intake. Ghrelin may act as a restraining metabolic signal preventing a return to cyclicity in women with both disordered eating and FHA, prolonging amenorrhea when leptin has returned to normal.

Adult↗
PubMed2006

Self-weighing in adolescents: helpful or harmful? Longitudinal associations with body weight changes and disordered eating.

PURPOSE: This study addresses the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviors over a 5-year period among adolescent females and males? METHODS: Project EAT is a 5-year population-based longitudinal study. Participants completed surveys exploring factors associated with eating and weight concerns. Participants included 2516 adolescents who were transitioning from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort). RESULTS: In the older cohort of females and in both cohorts of males, frequent self-weighing at Time 1 was not associated with weight changes at Time 2 (5 years later), after adjusting for Time 1 weight status and sociodemographic characteristics. In the younger cohort of females, Time 1 frequent self-weighing predicted weight increases at Time 2. In both cohorts of females, but not in males, Time 1 frequent self-weighing predicted higher prevalences of Time 2 disordered eating behaviors, including unhealthy weight control behaviors and binge eating, after adjusting for Time 1 behavioral outcomes, weight status, and sociodemographic characteristics. CONCLUSIONS: Frequent self-weighing was not associated with weight change, with the exception of predicting weight increases in younger females. In females, but not males, self-weighing predicted a higher frequency of binge eating and unhealthy weight control behaviors. Although further research is needed to explore the potential merits and problems associated with regular self-weighing, the findings suggest that population-based obesity prevention strategies targeting adolescents should avoid messages likely to lead to frequent self-weighing.

Adolescent↗
PubMed2006

Hospitalization of children and adolescents for eating disorders in the State of New York.

PURPOSE: To examine hospitalization patterns, length of stay, cost and insurance status for children and adolescents with Eating Disorders. METHODS: A cross-sectional study was conducted of patients with eating disorders aged 9 to 17 years, discharged from hospitals in the State of New York in 1995. All patients discharged in the state were registered by the State Planning and Research Collaborative System (SPARCS). A subset was identified based on coding by the International Classification of Diseases (ICD) for Anorexia Nervosa, Bulimia and Eating Disturbance Not Otherwise Specified. The Statistical Analysis System (SAS) was used for data analysis. The variables selected were gender, ethnicity, insurance status and length of stay. RESULTS: In one year there were 352 hospitalizations, 312 females (88.6%) and 40 males (11.4%); 279 Caucasians (79.3%), 35 African Americans (9.9%), and 38 Other (10.8%); commercial insurance 246 (69.9%), Medicaid 68 (19.3%), other 38 (10.8%). The diagnostic categories were Anorexia Nervosa 242, Bulimia 59, and Eating Disturbance Not Otherwise Specified 63 (reflecting dual diagnosis in 13). Mean length of stay was 18.43 days, the median was 7 days. The cost per stay ranged between 341.78 dollars and 148,471 dollars; with a median of 3817 dollars and a mean of 10,019 dollars. Length of stay was not influenced by gender, age, or ethnicity; only payor status, availability of insurance, was dominant. CONCLUSIONS: This is the first statewide report on hospitalization of children and adolescents for eating disorders. The mean cost in 1995 exceeded 10,000 dollars. A correlation was found between length of stay and insurance status. Hospitalizations for eating disorder have a significant public health impact, calling for the formulation of fair and rational strategies to optimize care.

Adolescent↗
PubMedDate not supplied

Eating disorders and women's health: an update.

Anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified have a significant impact on the health care and childbearing outcomes of the female population. Primary care contact for gynecologic care, childbearing, or infertility can serve as a critical entry point for the initial recognition of potentially devastating disorders that may result in permanent impairment and/or chronic debilitation. This review addresses the nature and prevalence of eating disorders and the management of pregnancy complicated by an active eating disorder or a history of an eating disorder. Genetic influences and intergenerational transmission of eating disorders are discussed. Finally, the increased risk for postpartum depression among women with a current or past eating disorder is examined. Factors critical to improving pregnancy outcome and reducing the risk for exacerbation or relapse in the postpartum period are identified.

Adolescent↗
PubMed2005

Repetitive transcranial magnetic stimulation: a possible novel therapeutic approach to eating disorders.

The two most common eating disorders, anorexia nervosa and bulimia nervosa, are characterized by aberrant eating patterns and disturbances in body image. Treatment involves combining individual, behavioural, group, and family therapies, possibly with medications. Studies have found that medication, chiefly antidepressants, could be of help in bulimia nervosa but the evidence is weaker for use in anorexia nervosa. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that briefly stimulates or depresses cortical areas within the brain. It has been used in the treatment of various psychiatric disorders, especially major depression, which is a condition that patients with eating disorders often experience as a significant comorbidity. Given that both disorders may share a common pathogenesis, this report proposes that rTMS may represent an alternative strategy for the treatment of eating disorders. Other evidence that supports this notion comes from animal studies that show that rTMS can change feeding behaviours and central neurotransmitters related to the regulation of eating behaviours. Further investigation into the dose, duration and type of rTMS stimulus is needed to verify the efficacy of this intervention in eating disorders.

Animals↗
PubMed2004

Eating disorders: clinical features and pathophysiology.

Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders of eating and weight-related behavior that together afflict some 1-3% of women in the United States. One of the remarkable features about each of the eating disorders is how persistent the disordered eating behavior becomes once it has begun. Substantial psychological, social, and physiological disturbances are associated with eating disorders, and it has been very difficult to disentangle those factors that may result from the disturbed behavior from the factors that may have predisposed individuals to, or precipitated the development of, the disorder. This article will briefly review the definitions, phenomenology, and identified risk factors for development of each of the major eating disorders. Pathophysiology will be discussed, with a particular focus on candidate factors that might sustain disordered eating behavior, as informed by clinical and basic science research. Future research directions will be suggested.

Anorexia Nervosa↗
PubMed2006

Survey on dysfunctional eating behavior in adult persons with intellectual disability living in the community.

Prevalence of dysfunctional eating behavior was investigated in 311 adult persons with mental retardation living in the West Coast of Norway. Reports from a questionnaire filled out by health workers were used as observational data. The main finding was that 64.3% of the clients showed indices of dysfunctional eating behavior. The five most frequent dysfunctional behaviors was eating to fast (27.7%) followed by bolting one's food (25.1%), refusal of food (19.9%), excessive eating (18.3%) and non co-operative during mealtime (17.0%). In 50% of the cases, one or more eating dysfunction was present every day and the intensity of the behavior was regarded as high or very high in 26.2% of the cases. It is suggested that more studies are needed to single out treatment approaches to eating dysfunction's in adult persons as has been done on food refusal in children.

Adult↗